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HomeMy WebLinkAbout026-1137-21-000 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety wind Building Division INSPECTION REPORT Sanitary Permit No: 420736 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. Richmond Township 026- 1137 -21 -000 CST BM Elev: Insp. BM Elev: BM Description Section/Town/Range /Map No: 01. d ' O� eR a � ti•.t� 20.30.18.977 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark F 166 - 7. 57z /0-7 z /06 . v Dosing Alt. BM L ' L —r� �p 3, 'Z Aeration 7 Bldg. Sewer - Holding St/Ht Inlet / o , 3 9 z . TANK SETBACK INFORMATION St/HtOutlet TANK TO P /L. WELL BLDG. Vent to Air Intake ROAD Dt Inlet dr Septic (p I � Dt Bottom Dosing Header /Man. , "T T Aeration Di . pe + 3 T7 Holding Bbt. Syst �y. n Cr PUMP /SIPHON INFORMATION Final Grade / V 0 � 7• Manufactur r _ Demand St Cover G / O 3 . z— Model Number _ TDH Lift rictio ss System Head TDH Ft F main Length Dia. to Well SOIL ABSORPTION SYSTEM r BED/TRENCH Width / Length 10 No. Of Tran es PIT DIMENSIONS No. Of Pits Inside Dia. UL:iqu�id ep th DIMENSIONS SETBACK SYSTEM TO P/L B G WELL LAKE /BYRE LEACHING anufa INFORMATION CHAMBER OR _ / Tyr Of System: UNIT 4 AX / `� odel Number: DISTRIBUTION SYSTEM t HeadedManifojd Distribution x Hole Size x Hole Spacing Ven o Air Intake f�lL Pipe(s) j.,2� �� 1 �` > / Length Dia Length l(� Dia Spacing u (J SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over L Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 7 /- Bed/Trench Edges Topsoil Yes E No FMI Yes [Feg� No COW M (Include code discrepencies, persons present, etc.) Inspection #1:�// 6 Inspection #2: Location: 1087 148th Ave New Richmond, WI 54017 (SE 1/4 NE 1/4 20 T30N R1 8W) Golf View Acres Lo 21 — Parcel No: 20.30.18.977 1.) Alt BM Description = ST' �>v�L ev— 2.) Bldg sewer length = 3(p - amount of cover = �. q / Plan revision Required? Vie. Yes No Use other side for additional information 4S' SBD -6710 (R.3/97) Date Insepctoenature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 - N* 6 ST aonsin Madison, WI 53707 - 7082 Site Address v D artment of Commerce f08 vp Sanitary Permit plumber " Sanitary Permit Application In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide ❑ .Check if Revision Z 7 ( d- 0 77- 3 _ fors purposes Privac Law may be used secondary I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name M R p 0 e Parcel Number 0 Z ( 1! Z( p 0 i 1 ao 44 ! t gT Property Owner's Mailing Address OUNTY ,1rperty Location ZONING OFFIC <' �t1 U 7 J� 'k►Ve '-A; S�© T30 N, R�t R City, State Zip Code Phone Number Lot Number Block Number Subdivision Name CSM Number & L111j Svof 71 Y dvL_� II. Type of Building (Check all that apply.) / — 0 City AK 1 or 2 Family Dwelling - Number of Bedrooms t� Village ❑ Public /Commercial - Describe Use ❑Towns ' ❑ State Owned `� �`�" (D 2' )c 3' Nearest Road 71 III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. New 2 ❑Relacement S 3 ❑ Replacement of 6 ❑ Addition to System Replacement Tank Ord Existing System For County use B ' ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) - 44X Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Construct Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 13 Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other V. Dispersal/Treatment Area I C X 34/7 S 3 . Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation ,So {p /� r / a..� ��s0' 17.Y/ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing /�t�- Tanks Tanks pac r Holding Tank X000 0t Dosing Chamber VII. Responsibility Statement- 1, the under signed, assume responsibility for inst allation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP " P umber Business Phone Number 2Z/y - 7 1 '71 r- .2 6Y6637 Plumber's Address (Street, City, State, Zip Code) 3 /yo ST Am-t Gv.k s - ( (o o / VIII. County /De artment Use Onl Disapproved Sanitary Permit Fee (inclu es Groundwater Da Issued suing A nt Signature Stamps) Approved C Owner Given Initial Adverse 2 S d d 3 3 G�2%ir Determination Surcharge Fee) ` IX. Conditions of Approval/Reasons for Disapproval F3, V3 , Attach co m I teMans (to the Count only) or the system on paper not less than 8112 x 11 inches in size 8 � / ..tee a� Se4o r , Sys > s' i -6398 (R. 05101) SE'Nr S 2 oT 3o Ne !f tv Z z > 41'7 1 ZO 2 I , l ": L11-./ i S -- "we / 9s 87 - 21 4 1co �- / I I ,te yin W i t r i 1 I I ! , I I K _ - - an-- I I � I _ I , - l I i I t I f i dl I I I , a furl oL I I , i , I I I i l I i _ Q i - i -_ i - - - - -�- - - - -�- 1 - -_� - - - } - - I -- -- _.i I ; I yy , ! I r `< ,00 z �'�� z s 87,373 sq.ft. W \ s� 2.01 acres igi , \ ASSUMED BEAR r N , / �• zI sr ;' J OF SECTION 2 aFL 1b `.0 �9J, • \ F \ �� W.E. / �, 945.5-,25YR 945.3 100,YR 21 _ \ ! J► /o \ 87,263 sq.ft. 4 200 acres �' �\ /o�" . • ` �. '. 'y \ (�? '\ / ��, -. � \u -•��� \\ mo � �h'` ryh ti H.W.E. \ \\ \ \ 948.9 25YR I y \ 2 0 949.5 100YR I (0 87,744 sq.ft. .00%k ,�' 15 \ \ \ \ 2.01 acres g� / / A, 87,126 sq.ft. • 00' /C • > 2.00 acres A \ S \ Monument o \ \ \ Mess noted) s \. e Set � l \ \ \ s 87,126 sq.ft. \ \ \ d •S� 2.00 acres \ \ \ \ \ easement 0 ' •'� �� \ - g? \ \ NOTED) y �d1���h• \ \ \ Line \ \ / \ \ ements 88,760 sq.ft. ces and angles BENCHMARK: 12 "ASH 2.04 acres -\ RR SPIKE IN NE SIDE djustment ELEVATION= 963.24 ted Mth Ib sorest 1 e it 0.01' FND. 3 /4'REBAR y 11 T i N / r y Ai �l Tip �L YYYYYY vc rc 7S j 2 /Co _ I 9C. ' ; S I , ; i j , j i I I � r � I ', �.. �, I, '. _. _. i i I L. � i ___ i I ',., -.. _ Ii _. ..' � i '., ', i i _ - _ � _ _ . �, ', I ' I i I i � i I I � i ' � � ` � i I I i � I I � i j I i i � � ! � � � � I i i i __ _ _._ - � �� � - - I '� i i � I �i i I i ��' I ! �, I i I I � I I i` I - - , i I i � I i I I � i '� ', � � I '�,, � I. I - - _. i i � �� - - i i � � � j � i � I �- i i __ _ _ i i ! ', I i � � __ �. _ - - - - -- I� � � I � � j � I I _' � � i I i � � � I � � � � � � I r I 1 i I ,' 'I ,I _. !� i ' i � il ._ - � i I � i � �� j i � i i ! � i � i ,_ I I � � i � 1 ;., � , � i I I I I i � I i i � i I , I �� ' ! i I i - I ' � L i t � �_ _ I �' '` i _ i � i � � I PAGE 3 OF NAME c( LOW ZI LEGAL DESCRIPTIONS E a S T N R /8E or SCALE: 1 "= yd I BM 1 ELEVATION /00 d BM 1 DESCRIPTION BM 2 ELEVATION '7 S $ 7 Si c., 7 v BM 2 DESCRIPTION o -� SYSTEM ELEVATION jo p gY oa Goer sr 93.00 ALTERNATE ELEVATION hp p 9 o o Goy, CONTQUR ELEVATION 9G. od , 7. oo. 9�.od gG.Od b � � t t7 oc) ■ h � � 0 yo+ a ' Q — Q SIGNATURE DATE 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page -- of .Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S� . C r Ul include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ,� 2 �� _ ..... ;.._ .. Re y Date P /ease pdnt all Personal information you rxovide may be used for seconds rdeses�fF�ttliBCyt alw §• 3 QA (1) (m)). (,(�iyvy�� / 43 Property Owner Props , Location R t d E SOn -i ��_ 'Vi«,r_ Govt.lpt 1/4�1F 1/4 Se () T 3Q N R (g E(or 11 Property Owners Matii Address Lot # ° " ock # Subd. Name or CSMI/ ng Got���eW Acres ► .o . Cox Ibto2 s city State Zap Code Phone umber 1 . ❑ village [Town Nearest Road f 11 (Cost > ?�lg:abF A &h ® New Construction Use: ® Residential / Number of bedrooms . ;4 `ti a derived design flow rate 4 56 (ono GPD Replacement ❑ Re _w . Public or commercial - Describe: - - -` ❑ P Parent material U4L So __ Flood Plain elevation if applicable n uc General comments U C.o w t r 4 3. O y a 7- 'r� -- and recommendations: 4 2(e o • Q:. 0 6 GO e f 4Z a $i A dx )14 11 I Boring # Boring ® Pit Ground surface elev. ft Depth to limiting factor in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cart Color Gr. Sz. Sh. *Eff#1 I *Eff#2 I o _ t 1 2 I s Z C lv� Z / -3G I 10 41 S i C - Z m c X2. 9d. Boring # ❑ Boring _ ® Pit Ground surface elev. ft Depth to limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'- in. Munsell Qu. Sz. Cont. Cola' Gr. Sz. Sh. *Eff#1 *EfW 1 0 - SL I m It ryn,>" r I v `'( 2 8 -I IO m5 m J. Z i * Etfluemt #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mg1L * Effluent #2 = BOD < 30 mg1L and TSS < 30 ntgJl CST Name (Please Print) mature (ST Number Aaom Sehu ker � "- - � 253309 Address Date Evaluation Conducted Telephone Number 2.It3 8b'' -` ^� . Som�rse� w I 5' _- � �/ C� IS) Z�! �- '-I�o$ r Property Owner N e 15or, Parcel ID# Page 2 of 3 F3] Boring # E] Boring 6 Z 0 0 Pit Ground surface elev. — ft Depth to limiting factor 11 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. r *Eff#1 - Eff#2 I Q – IO �p r3l 2 5ii 2r7—CA mfr C- 5 2 io 16 L 1 S i d -C r c _ 3 Z& -1 ID L co m5 O rn 1 _ — - / . Z F-1 Boring # E] 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 Cola Gr, Sz. Sh. - Ef1#1 "Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting facer in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent 42 = 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- 264 -8777. sBD -8330 (R07/00) PAGE 3 OF 7 j NAME 1 a( Sc n LOT# Z( LEGAL DESCRIPTIONS E' / <,UQI< SZo Tao N R rgE (or)(0 SCALE: 1 "= yd BM 1 ELEVATION /00 • d I BM I DESCRIPTION by o-C _ P• {fie + x BM 2 ELEVATION gs 7 .SPA. c1 ` BM 2 DESCRIPTION &e o � we P• �J e SYSTEM ELEVATION P 9h!od GowQr- 93Oo ALTERNATE ELEVATION &e 93ov 6 . 91. s� CONTOUR ELEVATION 9G. od 97. ad, 9b� gG.od �o f7 ou �.od � Z y +�� / �, Dr , Sty (� e ♦ rr+ t 0 o i� SIGNATURE '�' DATE /d - o/ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIHP CERTIFICATION FORM Owner/Buyer Mailing Address //4 Property Address (Verification required from Planning Department for new construction) City /State IUt K W J D, W Parcel Identification Number C) Z ' /0 / z - Z-o //37- �l -av0 LEGAL DESCRIPTION Property Location SF %, ' /., Sec. 2 , T Q N -R t W, Town of "nj Subdivision �Ct Lot # 7- 1 Certified Survey Map # Volume _ . Page # /! Warranty Deed # C� O o� y , Volume / 1 L : Page # 7' _ Spec house ❑ yes (moo Lot lines identifiable E 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 mastorplumber, journeyman plumber, restricted plumber 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. I/we, 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 been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year a piration date. 4 ,2 6,W / /O /U3 NATURE F 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 owner(s) of th perty describeWa�ove, Ab,)v,*,rtu e of a warranty deed recorded in Register of Deeds Office. r o/ o,3 ATURE 40 APPLICANT DATE « « « « «« A Formation 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 POWTS OWNER'S MANUAL 8& MANAGEMENT PLAN Pa / of FILE INFORMATION SYSTEM SPECIFICATIONS Owner & 9 1ve. Septic Tank Capacity 106 a l ❑ NA Permit # , IQ 19 3� Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model koo ❑ NA Number of Public Facility Units W NA Pump Tank Capacity a l ❑ NA Estimated flow (average) 300 al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) $"D al /day Pump Manufacturer ❑ NA Soil Application Rate , 7 al /da /ftz Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) S30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD x220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TS S) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD _ :30 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal C oliform (geome mean) :510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: eB ear('(s) (Maximum 3 years) 13 NA Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) 13 NA P ® year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA ,3 IN year(s) Inspect pump, pump controls & alarm At least once every: ❑ earth(s) [3 NA Y Flush laterals and pressure test At least once every: ❑ mont ❑ NA P ❑ year(s) ) ❑ month(s) Other: At least once every: ❑ year(s) ❑ NA 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 cell(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 S12 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. GMW (4/01) ,Pag H of START UP AND OPERATION For new construction, 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 cell(s). 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 pumpl 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 'ils and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacemen ystem: 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. / V si has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and -site *ealu do us performed o locate a ' able re I t area. I ce a olding tank may ns ed as las ort t ce the 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 Name Phone ' ? Is - - 0(t' 6 6 3 ? Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 1-21 ST. Orrin Phone Phone 3 74 _ 4 $'0 This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. J 1 9 1 5 P tj 8 3 6H2534 STATE BAR OF WISCONSIN FORM 2 - t999 KATHLEEN H. WALSH Docume Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Hillvale Development Limited, a RECEIVED FOR RECORD Minnesota Limited Liability Partnership, 06 -25 -2002 8:30 AH WARRANTY DEED EX Grantor, and Halle Builders, Inc. REC FEE: # 17 : 11.00 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, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lots 16, 19,2 0 & 21, olfview Acres, Town of Richmond, St. Croix g aC BANK County, Wisco sin. sew va507 This deed is given in fulfillment of that certain Land Contract between the parties hereto dated July 30,200 1, 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. Ot) (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 AUTHENTICATION ACKNOWLED E Aj, �,•. STATE OF WISCONSIN Signatures) . C: r• v County authenticated this day of Personally came before me. November 1 2 ' XX�rn3pled Hillvale ' Limited, a Minn` to LdY, liBity + 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 blic, S e isconsin Hudson, WI 54016 M 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. 1niam U n Prae. nsls Cmp-y. F-3 a+rac. wt 800455-2021 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2.1999 82 Q' J� t-, It LA s4 8� o. 8 � S78°29' 5 "E 196.00' ti t� � sr X28 1 "E `o p 2S 2 Pk a �°� 39 3 i � ss� o RA!�A 6,S ' N ��'1� � 0 2 / cC F,q T 90 o 2S 8 7 2 l r SEMI oo . qi \ c; w • O N C, / Cv p - ��,, p o 1� Q ) / w ARAo `O CV J ; o �� o N � J ° D / '"