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HomeMy WebLinkAbout032-1041-80-125 Wisconsin DdpartmentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 514990 0 GENERAL INFORMATION 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: Germain, Walter & Debra Somerset, Town of 032 - 1041 -80 -125 CST BM Elev: Insp. BM Eleva M Description: Sectionrrown /Range /Map No: � (, ` ti 14.31.19.207A20 TANK INFORMATION "E ELEVATION DATA TYPE MANUFACTURER F ` CAPACITY STATION BS HI FS ELEV. r Septic �. Benchmark Dosing - ,,.». ? Alt. BM 4 +. VIII. 4 55 �' «� Accat+on- r J Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO WELL BLDG. �( t to Int ROt4D Dt Inlet Septic � - Dt Bottom - 30 �s 7 1 1 l3 5 Dosing / 1 r j Header /Man. Aeration Dist. Pipe 45-.7Z- . q ' . 9G Holding ( C - " Bot. System PUMP /SIPHON inal Grade ON INFORMATION CJ , Manufacturer _ /1 r 1 Demand St CoyAr 7 GPM . 1 4<. e.J 4. (Q � � • J f` Model Number TDH Lift Friction Loss System Head T Ft r x < t 5 h Forcemain Lengt ! I Dia. t/ Dist. to Well Z/1' SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length 11 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS — SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type of System: Iu UNIT Model Number: / h 5 DISTRIBUTION SYSTEM - �( 26 = (evo Header /Manifold y Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) ' �.. Lengt Dia Length Dia Spacing (' tt:n:1 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 f1 Bed/ Trench Edges 1 Topsoil 0 Yes 0 No Q Yes Q No r COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2122 Hwy 35 Som rt, WI 54025 �§E 1/4 SE 1/4 14 T31N R19W) NA Lot 1 -, Parcel ][�o: 14.31.1 - 07A20 1.) Alt BM Description 2.) Bldg sewer length - amount of cover =� `�:� ^cf,.,�t.a....l�Q Plan revision Required? 0 Yes No Use other side for additional information. Date Insepctor Signatur ! Cart. No. SBD -6710 (R.3/97) I i Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ' Madison, WI 53707 - 7162 sanitary Permit Number (to be filled in by Co.) State Transaction Nutpber Sanitary Permit Application N r [ J L„ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the nate gove unit is required prior to obtaining a sanitary permit. Note: Application fonts for state-own are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal info foT secondary purpo in accordance with the Privacy Law, s. 15.040)(m). S I. A li.-ation Information — Please Print All Info ` n O� 1 Property Owner's Name Parcel # `>✓ = �-�,�� SEP i l 2008 p 'moo Property Location Property Owner's Mailing 3�"' ST. CROIX COUNTY Ci Nir F I CE G ovt. Lot City, State Zip Code r d Y., %., Section �Family � ' T � L — N; R/ H. ding (check su Subdivision Name that apply) Lot # welling - Number of Bedrooms J �J Block 11,19 Z A 4�1 ❑ Public /Commercial - Describe Use ._ ❑ City of CSM Number ❑ Village of 13 State Owned _Describe Use Town of Sa - 3 w 4- r III. Type of Permit: (Check only 'one box on line A. Complete line B if applicable) A ' ❑ New System Replacement System ❑ Tmatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumb Permit Transfe Plumber El to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of ;POWTS S stem/Com onent/Device: Check all that a I on- Pressd In Ground ❑Pressurized In- Ground [] At -Grade [] Mound > 24 in. of suitable soil ❑Mound < 24 in. of suitable soil ❑ Holding Tank 11 Other Dispersal Component (explain) ❑Pretreatment Device (explain) V. Dis rsal/Trea ent Area Information• Flow (gpd) Design Soil Application te(gpdsf) I Dispersal Area Required Dispersal Area Proposed (at) Syatsm Elev on 1"?-A& ,3/ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units qq New Tanks Existing Tanks V m Sti o r Eoldii,g rack Dosing Chamber 7605 i/ VII. Responsibility Statement - I, the undersigned, n esponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's * ature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, Stat Zip Code) e!�// fI VIII. County/Department Use Oil Pe lntit Fee Date 1 ued Issuing t Signature t�v5 )Wp proved ❑ -7 11 en Reason for Dena 1 65 9 I / IX. Condit easons for Disapproval 6 111 G 6 +e , b Q b 1. Septic tank, eftltidnt finer and `�V (n� dispersal cell must all be servlces-/ maintained as per management plan provided by plumber. f IT — 2. All setback requirements must be maintaihed P 1 J At - 5 1 D / ( l GS 6 "%ft ia co ple a o he system and submit the County only on paper not less than 8 112 111 inches I Kim ` 8" ,�.,,r�s, SBD -6398 (R. 01/07) Valid thru 01/09 P�,•�. ltn��-a,�.Ca,� PROJECT WallvGermain ANIR OT PLAN ADD ESS 2122 Hwv 35 Somerset Wi 54025 SE 1/4 SE 1/4S 14 9 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 9/17/08 DATE BEDROOM 4 CONVENTIONAL XXX IN-G1 RE SU CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1211 IL - --- # of chambers 60 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEST Filter ❑BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 89.7/89.5/89.3 3.5' below qrade Well is to meet all setbacks required by Vents 100' WDNR time 4% Slope ` B -1 Plans Designed Using Please note: additional borin Conventional n 2.0 32' will done CC me of testing as Manual Version 2.0 per conversation with Ryan and to possibly lower system elevation and be able to install 3 -3' x 82' cells with >3' spacing B -3 21 4' system in the .7 soils! B -2 10' ST 100' mho B.M.* ' 8 42 96' Existing 31D bedroom house 18' 4 To be pumped and buried Vent >6" Quick4 Standard -W Of Cover Leaching Chamber with 20.0 ft2 of Area C C ® P 4' Lon 12 " 5.8ft ^2 /pair of end caps Long 34" Grade at System Elevation OT PLAN Pik(, ECT WallvGermain ADDR S 2122 Hwv 35 Somerset Wi 54025 SE 1/4 SE 1 /4S 14 /A3fl /R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 BEDROOM 4 CONVENTIONAL IN -G ND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1211 # of chambers 60 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100° Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89.7/89.5/89.3 3.5' below qrade Well is to meet all setbacks required by WDNR 4% Slope B -1 Plans Designed Using Conventional Powts 32' Manual Version 2.0 B -3 21 3 -3' x 82' cells with >3' spacing 4' 10' B -2 Vents Huffcutt Combo TankO 75' 90' 8' B M * 42 96' Existing 36' bedroom T Well 18' house To be pumped and buried Vent j 11 Quick4 Standard -W over Leaching Chamber with 20.0 ft2 of Area 5.8ft ^2 /pair of end caps Long 12" Grade at System Elevation 34" L/R LAN PROJECT WallvGermain ESS 2122 Hwv 35 Somerset Wi 54025 SE 1/4 SE 1/4S 14 /T W TOWN Somers et COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE BEDROOM 4 CONVENTIONAL )00( IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1211 # of chambers 60 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEST Filter ❑BOREHOLE O WELL H. R. P. Same as Benchmark SYSTEM ELEVATION 89.7/89.5/89.3 3.5' below grade Well is to meet all setbacks required by Vents 100' WDNR 4% Slope B -1 Plans Designed Using Please note: additional boring Conventional Powts 32 , will done C time of testing as Manual Version 2.0 per conversation with Ryan and to possibly lower system elevation and be able to install B -3 21 system in the .7 soils! 3 -3' x 82' cells with >3' spacing 41 B -2 10' ST O 75' 100' 8 , B.M.* 42' 96' Existing 4 36' bedroom T Well 8' house 1 To be pumped and buried Vent >6„ Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12„ 5.8ft ^2 /pair of end caps 3 4" Grade at System Elevation } Departrnent of Industry, HmanRelations SOIL AND SITE EVALUATION REPORT Page of of Safety & Buildings In accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #/Q — dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REV BY _DATE PROPERTY OWNER: 1 PROPERTY LOCATION GOVT. LOT 1/4 _ 1/4,S f T , N,R PROPERTY OWNER': MAILING ADD RESS LOT BLO K # I SUBD. NAIYE OR CSM # CITY ST I ODE PHONE NUMBER ❑CITY VILLAGE Of WN NEAR ROAD �- [ ] New Construction Use p(] Residential / Number of bedrooms [ ] Addition to existing building (� Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design 1 ding rate �� bed, gpd /ft2 � trench, gpd /ft Absorption area required bed, ft S 1 trench, ft Maximum design loading rate : ,gy bed, gpd /ft f trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / si a co iderations Parent material J - Flood plain elevation, if applicable ft S = Suitable for system NVENTIONAL MOUND CO IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system 2 S❑ U S❑ U [R S❑ U ® S ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground _' elev. Depth to _ _ — limiting factor Remarks: Boring # s' Ground elev. — ft. - Depth to limiting factor Remarks: i 4 ry CST Name: — Please Print Phone: O/k NT Address: _ OA F /CE i Signature: i Date: U A� ✓� - I t PROPERTY OWNER SOIL DESCRIPTION REPORT Pqge PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon Y in. Munsell Ou. Sz. Color Gr. Sz. Sh. Bed Trench Ground 1 lej elev. s yr s ft. — Depth to limiting r factor I �Tjl Remarks: Boring # \i Ground elev. ft. Depth to limiting factor I Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: 'I SBD- 8330(8.05/92) PROPERTY OWNER ' Page- SOIL DESCRIPTION REPORT PARCEL I.D. # ' Consistence Boixxia Texture ry Roots Boring Horizon Depth Dominant Color Mottles Structure GPD /ft # in. Munsell Qu. Sz. Pont. Color Gr. Sz. Sh. Bed Trench •n :w.v..v J Ground elev. ' — Depth to / limiting factor r Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # � Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) .. a I , I I I � ' i 1 i I I - . Y . 1 1 r I - - - -- - -- - - T- - -- T _ i , i r I I 1 I a I � I I i r - r i I 1 I I . I i - � LA Lt -� -- __._ - - - - -- ., - __ � - - .__ � � i � ; - -- '� , - -- _ _ _ -__ _ ._ _- ._ i I� i -. i i ! � i i _ �_- - -- � . _. I _ -- I _.. , __ _. I i - -- � i L _ -..__. _ .___ _ _ _ - -- - - -- - -- -._�._ i - � _ ., � �- i __ _ _ . - -- _ __ i __ ' ' i i � j i � i '. ___ _- -- i h I - -� - ' � _ � _ � -- i _ � i - - - � � - r -- - I � I i j i i i r _. _. .. __ i I i I �, �, � I - _ 1 i 1 I i i i ' I i i ___ __- _.._ _ _ ____ �. r l_ 1 __ � , i I i i Maintenance and Contingency Plan for a Septic SYstm Maintenance Plan 1 . Septic Tank is to be pumped once every 3 years. 2. Effluentfitter is to be cleaned once a year Please note: a larger fitter Is being installed In order to extend the maintenance interval of the fitter. 3. Once every 3 years, cells are to be inspected via the Inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditlorm d into the system • 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted erted away syste m. 8. Discharge into system is not exceed those required as per Comm. 83 y Plan O "on #1. system faits, determine cause of failure, use alternate area and U�statt new Pb in tested replacement area. txomat. Option #2. Install sys at a lower elevation, by removing chambers, removing and install new system. elevation for rep lacement area, and system ppt<onfKi. No adequate area is suitable o p cannont be towered. install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246-4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / I OWNERSHIP CERTIFICATION FORM Owner/Buyer l•� Q- (l 6 f �'" Mailing Address �- Property Address (Verification required from Planning & Zoning Department for new construction.) � � l City /State Parcel Identification Number ` LEGAL DESCRIPTION rll � 1 /a S.G- - '/a , Serb, T �/ N /�W, Town of �� Property Locatio , Subdivision , Lot # L Certified Survey Map # l/� 5 C� �j , Volume a/ , Page # � b ° Warranty Deed # , Volume (2� y ` , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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 Planning & Zoning Department within 30 days of the three year expiration date. 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 the property crib above, ;OF e of a warranty deed recorded in Register of Deeds Office. IG TURF APPLICANT(S) DATE *** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ,c C { #AMS£R CROSS SECTIa;� ADD SPECIr ICATIOKS S EP"IIC TAN% UMP t�£k P;tOOF .. „gDv E G BOX APPRtJV ER Y: V £WT PIPE 12 MI1 . - *� Wl PAD ; w G �dlgga€� ORITK C4N�UIT Wr �_ k” HIM- FIl4 �! .D . QPUADE i ter" = a z a INLET GAS- WATER TIGHT s�?� -S A SEAL WATER a A ppRojo FIFE _. _ . • �3L.t�R �'- � s � 3` I0 AIL APP WM C. PIPE i3 W SLID. OFF ELEY - SOIL ; is �*. A FFROV ED B=D NG U IWER TAN COI;Cp I:TE PAD 3 SPyCI'f'ICfi.TZ4i�5 - I2#3SE5 PER Ol,Y - �t4BER . S EP'T'IC / DOSE v��ME zNCiJ�i7 =� TANV. HANUE -1yC J.F -ER' E�{35E FIAWB• S GAL. - SEPTI 4 GAI.. _ a , �ncurs - �- ---- -- -fAt1X SIZES HOSE -r� �'`: �: � _ % _ GAL CAPACITIES: 2 - INCIKES AI+�ti MAFACWXERs' , 8 '` L m 0f)rL AMBER -- WN J C = S ImcliES E ' -�t�A SWITCH TYP pump HA JFAC IR£R = Z i-RR 1.6.23 Wu N � ;;C�im� _--F -- Aif�� irTIRI�G AS P t , H FEET RATE G ' -��,ON PIP£ - - Z . "" FEET REQLiIR� DISCHARGE z F AND �?ISTRI - - - � FEET CE $ ;tEEN ptT3�P O - - - FACT0 - fEET ,VERTICAL D;FFEREN PRESSUR FRICYI Ji� J ININ` NETWORK F#?RCE!'IA�H X �� 0 f �� MET - DIAMLTER ._.. -- D1t4El4SIONS OF NhP LIQU INT£RNA3. . SIGgE'Di I I — TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENT AND DEWATERiNG 25 _ Model 1 53/55/57/59 0 2 6 Ft. Meters Go!. L trs. w - 5 1.5 43 '.63 15 10 3.1 34 129 z 4 15 4.6 19 72 r 0 10 Shut –off Hecd 19.25 ft. (5.9m) 0 2 5 �3 15/166 5/32 �I 4 5/8 1 1:/2 -11 /? NPT 0 I` U.S. GALLONS 10 20 30 40 50 ! I 3 15/16 LITERS O gp 160 FLOW PER MINUTE 009997 4 1/16 aP ?^�3, C" �1 �'' - � ,r" L�uF l Variable level float switches available. Variable level long cycle systems available. Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. l � to 1/10 - Duplex systems available. � I 3 3/32 SKM � Y Single Seal Control Selection ustings �� LEO T {31 i "xi a E Model volts Phase Mode Amps simplex Duplex CSA UL 1. Integral float operated mechanical switch, no external control required. M53/55 & M57/59 115 1 Auto 9.7 1 -- Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53/55 & N57/59 i 115' '- 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FM0477. BN53 115 1 Auto 9.7 Y Y 3. Mechanical alternator °M -Pak" 10 -0072 or 10 -0075. BN57 115 1 Auto 9.7 -- Y 4. See FM0712 for correct model of Electrical Altemator. BE53157 230 1 Auto 4.6 I - Y 653155 & D57159 1 230 1 Auto 4.8 1 - -Y Y 5. Variable level control switch 10 -0225 used as a control activator, with Electrical E53155 & E57/59 1 230 1 Non 4.8 2 3 or 4 & 5 Y Y Attemator (3) or (4) float system. Single piggyback switch included. 6 CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches, FM0477 - 5 ��, 5 �� Electrical Altemator, FM0486; Mechanical Altemator, FM0495; Sump /Sewage Basins, FM0487; and Single Phase Simplex Pump ControliAlarm Systems, FM0732. Y r, ' For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. __ - -- — MAIL TO: P.O. BOX "E�" Louisville, KY 40266 � Manufacturers of. . - O SHIP TO. 3649 Cane Run Road ��rr O ® Louisville, KY 40211.1961 AWL/TY9Ud/P6 ,SAYE I,YJ p ® (502) 778 - 2731.1(800) 928 -PUMP httpJ/www.zoe11er.c0m PL/MP 40 FAX (502) 774 -3624 © Copyright 2002 Zoeller Co. All rights reserved. U 2698P 398 T4SOaa6 t STATE BAR OF WISCONSIN FORM 3 - 1999 KATHLEEN H. N ALSH REGISTER OF DEEDS Document Number QUIT CLAIM DEED ST. CROIX CO., MI RECEIVED FOR RECORD This Deed, made between Walter Germain, a/k/a Walter E. 11/1$/2004 01:SOP![ Germain and Debra C. Germain, a/k/a Debra Germain Grantor, QUIT CLAIN DEED and Walter Germain. a /k /a Walter E. Germain and Debra C. Germain, EXEMPT # 13 a /k/a Debra Germain REC FEE: 13.90 Grantee. TRANS FEE: Grantor quit claims to Grantee the following described real estate in COPY FEE: CC FEE: St. Croix County, State of Wisconsin (if more space is needed, please attach PAGES 2 addendum): See Attached Exhibit "A ". Recording Area Name and Return Addres WAt-`ra'r' ,p bo Hw� 3s *� Sow -e,v st w , - f00 Together with all appurtenant rights, title and interests. Parcel identification Number (PIN) This is not homestead property. Dated this _� day of September 1 2004 (is) (is not) * * Walter G ermain, aWa Walter E. Ger - -- _-- - - - -_~ - - - -- * Debra C. Germain, aAU Debra Germa . Y P — - -- -- - AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF - Wts_dnStn AMY J. - - - - -- ) ss. McCUNE County ) Jj authenticated this - day of wiSC4� Personally came before me this � September , 2004 the above named W alter Germain, a/k/a Walter E. Germain, and D ebra C. * -_ -- - - -- - - -- Ger a/k/a Debra Germain, - _ - -- TITLE: MEMBER STATE BAR OF WISCONSIN T _ (If not, _ _ _ _ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY _ A ttorney Kristina Ogland * _ t fr � � _ -- Hudson, W 5 40 16 -_- —_ _ _ Notary li ,State of [,(Ji�e{jYYj,�j►�j — My ommission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) fi ) Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac. WI STATE BAR OF WISCONSIN 800 -655 -2021 QUIT CLAIM DEED FORM No. 3 -1999 • U 2698P 399 EXHIBIT "A" Lot 1 of a Certified Survey Map recorded in Volume 9 Page 2665 as Document No. 503354 in the St. Croix County Register of Deeds, EXCEPT: Commencing at the East Quarter Corner of said Section 14; thence, on an assumed bearing along the cast line of the Southeast Quarter of said Section 14, South 02 degrees 17 minutes 24 seconds East a distance of 1331.30 feet to the northeast corner of said Lot 1 and the point of beginning; thence, continuing along last said east line, South 02 degrees 17 minutes 24 seconds East a distance of 611.15 feet; thence South 88 degrees 57 minutes 36 seconds West a distance of 493.44 feet; thence North 03 degrees 46 minutes 19 seconds West a distance of 611.70 feet to the north line of said Lot 1; thence, along last said north line, North 88 degrees 57 minutes 36 seconds East a distance of 509.26 feet to the point of beginning. The parcel shown on this document is being added to the parcels described in Vol. 708, Page 253 as Doc. No. 400622, in Vol. 1114, Page 373 as Doc. No. 526802 and in Vol. 1952, Page 588 as Doc. No. 687539, with the Register of Deeds for St. Croix County, more particularly described as follows: The South % of the Southeast Quarter of Section 14, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin, EXCEPT Lot I of a Certified Survey Map recorded in Volume 9 Page 2665 as Document Number 503354. The intention of the Grantors is to create one parcel (combining the above described parcels) and therefore, this conveyance is exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Sec. 18.05 (A) (3). i !� FILM0 p : ^ .,�. 4 JAPES 7'Cn!'NFLL %ols ?cr Ct 5 03354 St Croix Co., Wl S CERTIFIED SURVEY MAP Located in part of the SE'h of the SEh of Section 14, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin. .� LEGEND N F E} Corner of - Aluminum County Section Monument Section 14 O -1" x 24" Iron Pipe Set, weighing 1.68 lbs. per H O linear foot. ••.. .• • ........ -100' Roadway Setback Line s d w w - Existing Fenceline y s -Well +' A Pond 3 W r m y O L _- d O1 N L W � O O N O � C W m n to N L 8 8 UNPLATTC'I) `A N North line of the SE} of the SE} of Section 14 ( 70' 100' N87o17 "W 980.22' 920.20' 60.02' — 160' 100' so I � I.f•) I Cr) 11 rn o I In I V71 J I CSI I o _JI 00 !' ( _J1 S88o32'00 "E m o CSI 20.001 CO W Z 1 d F- 1 (=> W v = j UJI �_' - LOT 1 I m Q I N o JI o -. ;' m �_ I o 20.00 Acres Including R/W �' N •^ � J I I = I_1 871,247 247 S q Ft. + LLI ro �I 18.56 Acres Excluding R/N o z W Z:) I 808,527 Sq. Ft. a. o z 80' 100' d 80.02' -�- 900.16' S87 "E 980.18' _ L LANDS r OWNER - o Michael J. Germain VQLUF1E 9 PAGE 2665 c o m 2122 Hwy. 11 N. s Somerset, WI 54025 ° ab " ea • SCALE IN FEET T� $ J. c 49 SE Corner of Section 14 0 100 200 400 A Pamel #: 032 - 1041 -80 -125 07/20/2007 09:04 AM PA 1 O F 1 Alt. Parcel #: 14.31.19.207A -20 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/18/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - GERMAIN, WALTER & DEBRA WALTER & DEBRA GERMAIN 2100 HWY 35 N SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 2122 HWY 35 N SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 7.000 Plat: N/A -NOT AVAILABLE SEC 14 T31 N R1 9W PT SE SE BEING PT OF Block/Condo Bldg: LOT 1 OF CSM 9/2665 (20 AC) DESC AS COM E 1/4 COR SEC 14; TH S02' E 1331.30 FT Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) TO POB; TH S 02'E 611.15 FT; TH S88' W 14-31N-19W SE SE 493.44 FT; TH NO3' W 611.70 FT; TH N88' E 509.26 FT TO POB Notes: Parcel History: Date Doc # Vol /Page Type 11/18/2004 780326 2698/398 QC 12/10/2001 664723 1786/395 WD 03/27/2001 641390 1608/226 SD 01/10/2000 616739 1483/236 J more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.000 68,000 109,500 177,500 NO Totals for 2007: General Property 7.000 68,000 109,500 177,500 Woodland 0.000 0 0 Totals for 2006: General Property 7.000 68,000 109,500 177,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I