HomeMy WebLinkAbout026-1137-19-000 r consin Department of commerce PRIVATE SEWAGE SYSTEM County: St. Croix
safety and Building DivisicF#
A INSPECTION REPORT Sanitar Permit No:
4207 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Halle Builders Inc. I Richmond Township 026 -1137- 1 -000
CST BM Elev: Insp. BM Elev: IBM Description: 9 Section/Town /Range /Map No:
00' D /D U. A vd 6 ' d -ol 20.30.18.977
TANK INFORMATION IV ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic DO O Benchmark 101 1
!/ " /o/ 9 loo a
Dosing F �/ � � Alt. M
Aeration Bldg. Sewer �
Holding
IS *Ht Inlet
S`ha>c�d �,e X14. zL / -r1 -6
TANK SETBACK INFORMATION S Ht Outlet ✓
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
f i-
Septic > ' 2 U - 0 �i Dt Bottom
Dosing y � N � Header n. X 1
Aeration \ Dist. Pipe p a 3
Holding Tot. System
Final Grade "
PUMP /SIPHON INFORMATION JJ 0-F
Manufacturer Demand St Cover
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length
SOIL ABSORPTION SYSTEM J C�irh Pay j 2 ���
BEDITRENCH Width J Length No. Of Trench PIT DIMENSIONS No. f Pits Inside Dia. Liquid Depth
DIMENSIONS t
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM 711EACHIN Ma u r:
INFORMATION (_ _� / _
M OR - � TT Ta
Typ CHA
e f System:
S Yam- NIT Model Number. z i,
DISTRIBUTION SYSTEM
Header /Manifold Distributioon�� � Cr x Hole Size x Hole Spacing Vent to Air Intake
/ // Pipe(s) to / d �le
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only V B and CkAm b?
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
Yes No :Ye:j No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / r7 3 Inspection #2: — rQ Location:,WrLth Ave New Richmond, WI 54017 (SE 1//►4 NE
1/4 20 T30N R18W)I eG�,, ollf View Acres L&21_ t 9 Parcel No: 20.30.18.977
1.) Alt BM Description 5 T CO
= V 2— liVl � .. 4e " j 2 � 6 3 J
2.) Bldg sewer length = a -V .Ckt/ (�/� S •N
- amount of cover = ,],,,, �-s� ��
Plan revision Required? es o /
Use other side for additional information.
CO
Dat 11 II '' __ ^ dd Insepctor's Sign ture I _ ,,r Cart.. No.. / ,
6 V,0,,r-rX-0(/(6
6D 5710 (R.3/97) � jet f � — �14* be. 4 4v V-CA. !
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
420561 0
GENERAL 44 FORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal i*,formation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village X Township Parcel Tax No:
Halle Builders Inc. I Richmond Township 026- 1137 -19 -000
CST BM Elev: Insp. BM Elev: 7 escription:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
uid Depth
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System:
UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
Yes [] No 0 Yes % No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1079 148th Avenue New Richmond, WI 54017 (SE 1/4 NE 1/4 20 T30N R18W) Golf View Acres Lot 19 Parcel No: 20.30.18.975
1.) Alt BM Description = S_ ) o �n /�
p
2.) Bldg sewer length
= ""`-�
- amount of cover
Plan revision Required? (r] Yes ® No
Use other side for additional information.
SBD - 6710 (R.3/97) Date Insepctor's Signature Cert. No.
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Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7082 ced4 l
N v%iconsin Madison, WI 53707 - 7082 Site Address
Departm: nt of Commerce dj 2T /077
` Sanitary Permit Application Sanitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision [�
may be used for secondary purposes Privacy Law, s15.04(1)(m)
I. Application Information - Please Print All Information State Plan I.D. Number J n
I Pm
perty Owner's Name d . Parcel Number /�/ i �
N&C � , RE(,Ei�.�E C•6- 1 137-19 -6Z)0
Property Owner's Mailing Address Property Location y 5
20QZ , e� -, ,4 ,! 14; S 2Z T,36 N, R E
C ty, State Zip Code Lot Number Block Number
Subdivision Name CSM Number
II Type of Building (Check all that apply.) 3 f���� El city
1 or 2 Family Dwelling - Number of Bedrooms T ❑Villa e
❑ Public /Commercial - Describe Use g
❑ State Owned T 3 / 9 lTownshi
t0 �� Nearest Road
I
III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.)
A. ew 3 ❑ Replacement of 6 ❑ Addition to
System 2 ❑ Replacement System Tank Ong Existing System For County use
B ' ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV.Jype of POWT System: (Check all that apply. Numbering is for internal use.) 1 �'
q Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ nstrttcted Wetland
22 11 Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip L' �/ /� �B✓
45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 r 2 z
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation teal GrAfe
Required Proposed Rate(Gals. /Days/Sq. Ft.) (Min. /Inch) ay 7, •7 CS Elevation
VI. Tank Info Capacity in Total Number Manufacturer / Prefab Site Steel " r
Gallons Gallons of Tanks /�! Concrete Constructed Glass
New I Existing
Tanks Tanks
pti or Holding Tank
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume re sponsibility for ins tallation of the POWTS shown on the'attached plans.
Plumber's Name (Print) Plumbe , Signature MP/ ber Business Phone Number
zz e-!`7 / 21.r- - 7G CC 7
Plumber's Address (Street, Citty, State, Zip Code)
l
VIII. County !De artment Use Onl
Disapproved D IIssuing Stamps)
Sanitar Permit Fee (includes Groundwater 'Approved ❑Owner Given Initial Adverse Surcharge Fee) Z��, 6l
Determination f
IX. Conditions of Approval/Reasons f P�ro�v�
< • �7g� /�� Z
s - A f I &A , .
A h complete plans (to a County onl ) fo • the s tem an of less than 1/2 7,41 inch / �s in size
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3
Ditision of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
C r oi x
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S-� •
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 1 I 1
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Z 6v- /137 1q
9 -�.0
_ -- - Date
Please pdtlt all i by
Personal information you provide may be used for seconds pulgto$es (Privacy Law: §. 15, 1) (m)). Gi� L I
Property Owner f Property ; ocation
/ I1E671VE 1 1, E o 7'
RtcJ�ard e SO►'7 -V God• Lot ��SF 1/4��1/4 SZC5 T 3Q N R (j0
Property Owner's Mailing Address ' } �+ Lot # '_ , # S". Name or CSM#
10 i�.C�. C'aOx IOto2 -- �I'9'.' r Gg(Cview AcreS
State Zip Code P ►umber ❑ , ❑ Village [Town Nearest Road
- C4UNTY
11 ( cow �; ?yF ,j ; ►ch m y
® New Construction Use: ® Residential / Number of b a derived design flow rate 4 5 O C080 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material /S V +W 4 5 In Flood Plain elevation if applicable ft.
General comments $ 5 4-e wi e (-e C -o w o/ 9 4 - • o d)
and recommendation: y e- \r qy. o0 Low e
�"� s�i4.1 �r ,731 aitP�.,
F-1 Boring # F1 Boring
® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description FTexture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
I O -l2 U 312 -- 2 k r E cS I v� . 5 2 1 -_ 2 ) Z � C-
k r S -
3 m5 C� mI — Z Z
F
Boring # ❑ Boring
® Pit Ground surface elev. q9 ft Depth to limiting facto in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/lf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0- 1a 2 5; Zmsb cs Ivy 5
2 $-12 10 : IA S i d 2 c — ` ( P
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD 5 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
A�do�rv, Sc ke 2533cA
Address Date Evaluation Concluded Telephone Number
2%k3 SOT' -' SourerseA w 1 24022
Properly Owner N e Icon Parcel ID # Page 2 ' of 3
3] F Boring # ❑ Boring
0 pit Ground surface elev. DO• 76 ft Depth to Igniting factor �C1Q_ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
bk
Co --lb i S • c
3�
a Boring ❑ # ❑ Boring
Pit Ground surface elev. ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
F—I Boring # Boring
El Pit Ground surface elev. ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777.
SBD 330 (8.07/00)
PAGE 3 OF 3
NAME LOT# t LEGAL DESCRIPTION SE is E
SCALE: F'=
BM I ELEVATION
BM 1 DESCRIPTION fo p
BM 2 ELEVATION 9 (D. cJ Z- -e z C) ( X
BM 2 DESCRIPTION 4n a I z" 1 qvc.
SYSTEM ELEVATION -(off Q7 o Gowsr Qw ac
ALTERNATE ELEVATION top Qyoo L•ac,,sr Q3 cc
CONTOUR ELEVATION 651 '?-f 0 y'?, O v
O ]
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$4,
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SIGNATURE s DATE
I
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner A (,f l✓ 8o) L D S Septic Tank Capacity 600 g a l O NA
Permit /a D r�-� Septic Tank Manufacturer U��C� ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 4'e ❑ NA
Number of Bedrooms - 0 NA Effluent Filter Model A ❑ NA
Number of Public Facility Units '"A Pump Tank Capacity al [4-n>A
Estimated flow (average) 3 g al/day Pump Tank Manufacturer O-NA
Design flow (peak), (Estimated x 1.5) L f S g al/day Pump Manufacturer M
Soil Appl' U al /da /W Pump Model O NA
andard Influent/Effluent Quality Monthly average` Pretreatment Unit NA
e (FOG) 530 mg /L O Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (SOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average =n-Ground al Cell(s) 13 NA
Biochemical Oxygen Demand (BOD 530 mg /L (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L A ❑ At -Grade - ❑ Mound
Fecal Coliform (geometric mean) 51 W cfu /100m1 ❑ Drip -Line '. ❑ Other:
Maximum Effluent Particle Size s in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other' O NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ rt}onth(s) (Maximum 3 yea ) ❑ NA
Inspect condition of tank(s) At least once every: Z pearls)
Pump out contents of tank(s) When combined sludge and scum equals one -third IY of tank volume ❑ NA
❑r� nth(s) axlmum 3 years) NA
Inspect dispersal cell(s) At least once every: �i C�1'year(s)
❑ month(s) ❑ NA
Clean effluent filter At least once every: (— Z pLya*ds)
❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
'0 month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: O month(s) ❑ NA
At least once every: ❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page « of
sTART UP AND OPERATION
For new constriction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal celllsl. If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
Within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts, condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant
replacem t system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name -bOjV I ,J 'S U4, Name
Phone " I S 1 (0 ( ( �j�- Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name 5"T < C 6 1 X Iv <N lr
Phone Phone 'j l '� - l0 ' f 6
This document was drafted in compliance with chapter Comm 83.22(2)(b)(11(d) &(f) and 83.5411. (21 & (3), Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
LU owner/Buyer
Mailing Address
Property Address 1 O 1
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number
LEGAL DESCRIPTION
Property Location I /�, N f- ' /4, Sec. TN -RW, Town of
Subdivision Lot # �.�.
Certified Survey Map # , Volume , Page #
Warranty Deed # S 2- 5 2A , Volume L 5 Page #
Spec house ❑ yes ❑ no Lot lines identifiable yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
mastcrplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has n maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the y
e qt
e �
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property describKd above, by vi of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
« «*s *« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
(t
I J 1 9 1 5 tl 6 3 66253<+
STATE BAR OF WISCONSIN FORM 2 - 1499 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO.. WI
This deed, made between Hillvale Develo Limited, a RECEIVED FOR RECORD
Minnesota L imited Liability Partnership, 06 -25 -2002 8:30 AM
- - - -- — WARRANTY DEED
EXEMPT f 17
Grantor, and Halle Builders, Inc.
REC FEE: 11.80
-- TRANS FEE:
COPY FEE:
CERT COPY FEE:
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
Slate of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Name and Return Address
Lots 16 19, 0 & 21, Golfview Acres, Town of Richmond, St. Croix S &C BMX
County, tsconsin. PO Boot 475
yew Richrmnd, WI M017
This deed is given in fulfillment of that certain Land Contract between the -
parties hereto dated July 30, 2001, recorded August 7, 2001, in Vol. 1694,
Page 565, as Doc. No. 653153. Pt 026 - 1012 -50 _
Parcel ldcntifte tuber (PIN)
This is not homestead property.
CK) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any,
Dated this day of November 2001
Hillvale Development Limited
+ By: Richard Nelson
r
AUTHENTICATION ACKNOWLED E ',A
STATE OF WISCONSIN
Signatures} Vss.
Count
authenticated this day of
Personally carne before me cc ax 4f
20x1
November ed
'' f c ' ; " " - "?�((� �FTt
Hillvale Development Limited, a Minne3gta L►4h Cj t Isvility
Partnership, by Richard Nelson -
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, — instrument and acknowledged the same.
authorized by 0 706.06, Wis. Stars.)
Y — - -- - a y
Hudson WIt5401 land - -__ — _ -__ �
My Stlr e,gf Wisccrnsln
THIS INSTRUMENT WAS DRAFTED BY
c o m mission is permanent. (If not, state expiration date:
(Signatures may he authenticated or acknowledged. Both are not necessary.) G U )
r Narnes of persons signing in any capacity must be typed or printed below their signature . mro rt aaon araessiaoei: company, F-' au a00800 5-2 0 21 -
STATE BAR OF WISCONSIN
WARRANTY DEED FORNI No. 2.1999
STATE BAR OF WISCONSIN FORM 2 - 1999
Document Number WARRANTY DEED
This Deed, made between Hillvale Development Limited, a
Minnesota Limited Liability Partnership,
Grantor, and Halle Builders, Inc.
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Name and Return Address
Lots 16, 19, 20 & 21, Golfview Acres, Town of Richmond, St. Croix
County, Wisconsin.
This deed is given in fulfillment of that certain Land Contract between the
parties hereto dated July 30, 2001, recorded August 7, 2001, in Vol. 1694,
Page 565, as Doc. No. 653153. Pt 026 - 1012 -50
Parcel Identification Number (PIN)
This is not homestead property.
(K) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of November 2001
Hill Development Limited
* * By: Richard Nelson
* *
AUTHENTICATION ACKNOWLEDG.M� ISA ,1
STATE OF WISCONSIN � ' ''
Signature(s)
f
County l) ,� 11
authenticated this day of Personally came before
November 2001x. abtS�{e,4ia�
Hillvale Development Limited.. Minnesota Lrinited Laal�ility
* Partnership, by Richard Nelson
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Filblic, Stale isconsin
Hudson, WI 54016 My_ Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
* Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company, Fond du Lee, vin
STATE BAR OF WISCONSIN 800 -655-2021
WARRANTY DEED FORM No. 2 - 1999
ASSUMED BEARINGS REFERENCED TO THE NORTH LINE OF IHL NW 1/ , (+
OF SECTION 21, T 30. N., R Ig jSSUMED TO BEAR N 9 °50'17 "E.
Tood
suwj
� Q
1 NIII1N
63 sq.ft.
acres t
0 ac Hendershot
t, Todd M. Hender , RLS 2362
+� 3s
Registered Esc si or
n Land S ry y
�^ Dated this day of � 2001.
20 , S/4 1y (re
20 80 00, 6 30, 0,9
\ 87,744 sq.ft.
\ 2.01 acres 34 8 3p
ti 18
87,443 sq.ft.
\�0 \ ` �h �j� 1 n 2.01 acres
J Z
$9, sq.ft. v 80' RADIUS EASEMENT
\ , O TEMPORARY CUL —DE —SAC TC
2.05 acres cA �p AUTOMATICALLY VACATED WI
\ \ \ \ —P* ROAD EXTENSION TO THE SC
\ \ \ to
�
r
ti ?ms \ \ \ ��25g•415
\
,
103- M 2 g2.
32• — W
108, "E
88,760 sq.ft. -
2.04 acres
37' OUTLOT 1
65,361 sq.ft. TOP C
4
512 1.50acres ELEV
FOUND 314" -11
IRON REBAR N00 °31'31 ' W 737.24 South line of t
West line of the SE 1/4 ,
NE 1/4 of Sec.
of the NE 1/4 of Sec. 20 SW corner of NE 1/4
UNPLATTED _LANDS_ D c 3 , R1 8W. Per
05017 V01-13,
3665.( Iron Poe)
..,_.. 7 /4 line of Sec.
April 14 2 April 2003 May 2003
� S M T W T i= S S M T W T F S
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Monday 6 7 8 9101112 4 5 6 7 8 910
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TaskPad
7 am d 0 TaskPad
�1✓ ❑ Tom Fisher - Holding Tank
❑ Ordinance update
❑ CST Training Worksho
8 00
900 Updated: Zoning Department Bi- weekly'Staff Meeting (Conference room -' 1216)
— L
1 000
11 00
12 pm lunch
L 00
Notes
2 00 Gillie /Golfview Acres Lot 20/ 420323 / (/Richmond)
3 00 Goltview Lot 21- 420736 (Richmond)
4 00
S oo
6 00
Pam Quinn 1 5/30/2003
05/30/2003 08:35 7152687080 GILLE TRUCKING PAGE 01
Gillf Twcl w� I NC
352 140 T ' STREET
AMERY, W1 54001
PRONE (715) 268 -6637
F AX: (715) 268 -7080
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Phone: Pages (includes cover):
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