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HomeMy WebLinkAbout032-1054-10-075 s Wisconsin Department of Comme:c$ PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453026 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: Deal, David & Jennifer --I— Somerset Township CST BM Elev: Insp. BM Elev: BM I Description: Section/Town /Range /Map No: ti 0 (S N Ct4Z tit., T ^e,2- 21.31.19. Z TANK INFORMATION ELEVATION DATA _5c� TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer 5:60 Holding SUHt Inlet 9 q 3l TANK SETBACK INFORMATION �GL f� ( pp F14W St/Ht Outlet Z , 0-3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet , Septic / vl / / 1 j Dt Bottom Dosing k— -A U, Header /Man. Aeration Dist. Pipe ec- q. 2s 14 V7 '! 9215 Holding Bot. Syste O S /, 7 c Final Grade ,7 ) PUMP /SIPHON INFORMATION FbZ_ 9 3 Manufacturer Demand St Cover GPM Model Numbe TDH Lift Frictio System Head TDH F Forcemain L Dia. o well SOIL ABSORPTION SYSTEM BED/TRENCH Width / � Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS j 2 a 3 fop-2- L n 4 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: y INFORMATION Type Of System: CHAMBER OR J_kLoy, Al �� / � V UNIT Model Number. DISTRIBUTION SYSTEM � T Header /Manifold Distribution x Hole Size x Hole S Vent to Air Intake Q' y Pipe Length V Dia Length Dia Spacing, SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over t I Depth Over / xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 3 D B ' ed /Trench Edges 2 D� Topso es No Yes o tj C '' OMMENTS: (Include code Iscre encies, persons present, etc. Inspection #1: 07 / _/ Ycl_Ins P__ Locat on So a et, WI" 5445 (NE 1/4 NE1 4 21 T,�1 R1 Lot 3 Parcel No: 21.31.19. 2_(0 j 'z 1.) Alt BM Description =�AG c'4 O/' ``�'� - 4- L6 &. 2.) Bldg sewer length e 3 Y - amount of cover = 5/ t✓� �r f�Lc,. (,vtvf14 Plan revision Required? Yes ;No Use other side for additional information. _ SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. A Safety and B ' n Co ty 201 W. Washin t Ave., . 0. Box N visconsin Madison, 53707 - 71621 1 Sani� Permit Number (to be filled in by Co.) (608) 6 -315 Q� y Department of Commerce 'M �� OZG ( �20 O FF to Plan I.D. Number Sanitary Permit Applicatio In accord with. Comm 83.21, Wis. Adm. Code, personal information y provid may be used for secondary purposes Privacy Law, s15.04(1)(m Project Address (if different than mailing address) I. Application Information - Please Print All Information \' q-7 t /Os"'t 1 Property Owner's Na ']7e arcel # Lot # Block # 7 S Property Owner's M ailing Address Property Location S �I City , 6'/a, lVi ' /a,Section f , State / Zip Code / Phone Number V /V � 6 6 f X? (circle e) I11. Type of Building (check all that apply) T J� - N; R or& uU 1 or. 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM N bet ❑ Public /Conimercial - Describe L 3 g7 4J OI- 1 7 A 2 ❑ State Owned - Describe Use 'J �u C� � Rl� - ❑City_ ❑Village %Township of J;'a •'.✓!Z III. Type of Permit: (Check only one box on line A. Complete line B if apph abl ) {� New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration P Plumber Owner IV. Ty e of POWTS System: (Check all that apply) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -I 5e ❑ Odie (explain) ti V. Dispersal/Treatment Area Information: — �� { Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (so A � o ( -f System levation 1 1,6 VI. Tank It Capacity in Total Number ntfacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing 2ftee-(_ Tanks Tanks _— Septic or Holding TatUc I Aerobic Treatniant Uni[ /` —�._. Dosing Chamber X ` D[ � -- VII. Responsibility Statement- I, the undersigned, assume esponsibility for htstallat of the PO WTS shown oil the att ached plans. PI w ber's Na me (Print) Plum n's Si gn MP11C S Number -- � Business Phone Number Plumber's Addre ss (Street, City, State, Zip de) VII I. Con nt ille artment Use Onl Approvzd ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is win Agent Sign tur No Stamps) ❑ Owner Given Reason for Denial Surcharge Pee) 2SU I� IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be served /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County ( for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) I P6AL Ifo ,/�'r'�Zz6��17 �L w � tu- FGi �v ®�+e-e =x 3 E.�. /ply gt.Sb cep i I I I A-f)(4 J, k6AL I\j w� �r R J ` c nil ® L �A10 - l Oak +&,e ;,D.� pa CIA C ' 1. ' 1147 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8% County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print a ::R iewed 8y Date l Personal information you provide maybe used 5. (1) (m)). C/ Property Owner Pro rty Location IT Goodman, David Go Lot NE 1/4 NE 1/4 S 21 T 31 N R 19 W Property Owner's Mailing Address Lot Block # Subd. Name or CSM# 485 210th Ave. Proposed CSM City State Zip City Village ✓ Town Nearest Road Somerset WI 1 54025 1 715 - 247 - 4250 Somerset 1 210Th Ave ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd /sgft rating. Possible system elevation for Area I is (Upper) 91.8" (Lower) 89.8 ". Slope is 16 %. Boring # Boring ✓ Pit Ground Surface elev. 94.80 ft. Depth to limiting factor >110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft- in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 1 Oyr3 /1 none Is 1 msbk mvfr cw 2m,2f .7 1.2 2 7 -39 1Oyr4/4 none Is Osg ml gw 2f .7 1.2 3 39-110 1Oyr5/6 none s Osg ml -- ---- .7 1.2 �. z Z Boring # Boring ✓ Pit Ground Surface elev. 94.80 ft. Depth to limiting factor >1 09 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 1 0-3 1 Oyr3 /1 none Is 1 msbk mvfr cs 3m,2f .7 1.2 2 3 -11 1 Oyr4 13 none Is 1 csbk mvfr gw 2m,2f .7 1.2 3 11 -29 10yr4/4 none Is 1csbk mvfr gw 2f .7 1.2 II I 4 29-109 10yr5/6 none s Osg ml - - -- - - - - -- .7 1.2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD S30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature: CST !Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 12/9/02 715 - 247 -2941 l Property Owner Goodman, David Parcel ID # Page 2 of 3 3 ] Boring # Boring ✓ Pit Ground Surface elev. 89.67 ft. Depth to limiting factor >111 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDR in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -5 1Oyr3/2 none Is 2msbk mvfr cs 3co,2f .7 1.2 2 5 -26 1Oyr4/3 none Is Icsbk mvfr gw 2m,2f .7 1.2 3 26-44 1 Oyr4 /4 none Is 1 csbk mvfr gw 1 f .7 1.2 4 44 -111 1Oyr5/6 none s Osg ml - - -- - - - -- .7 1.2 F-1 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 QP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg /L 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 „POA matarial :n o...�ltAm�tP f—f -1 ... ^ —f—t tha Avn ,4—t of AAR_7f4 -11 Cl — TTV fnR_')4A_2777 / it 6D' All f 2Idfd" l 32 f3 r 1 iLI J o q A 133 _ 13 3 4R i a Rt� Jl y2 ra" yes' a/o / G S T.l f 1 / - t z 40(p 7 Cambinatio.n Sep.*;ic* Tank and PUMP CHAMBER CROS5 SECTIOIJ PiD SPECIFICATIONS VCIJT CAP WEATHER POF R JUNCTIOIJ 50X C. I. VEIJT PIPC fPPROVED LOCKIQG y OOOIC. MA�Jk�OLE COVER M IsJ4 LA6E� FR0 w A ►.� —.T 0 � .ilNOOw OR FRC pu,r �1J sP �e11a1J P lP qLK I u TA, K j w ! rYtC= -T1 s tm O-rr' 'Ib "MIN. ' r �\ _ - - - - -! -- i- PROVIDE 11J( -E T „'�' � AIRTIGHT SEAL zkFT -L� A I I I APPROYED JONT, APPROVED JOINT z�c8tle i4 I I I W /C. T. ?IPE �P'c W /C.T- PIFZOR Tank Const .ruction I II ALARM shall comply with I II TLHR ('13.15 and 83.20 c I I I oN C I 1 I PUP\P OFF f� D COUCRETE pLL OCK 3" APFS� RISER EXIT PLF,(AIITED OIJLy IF TAWK MAUUFACTLIRER HAS SUCH APPROVAL. gFppING SEPTIC f SPECIFICATIC)QS DOSE W 1izs rl-7-1 Co�jCCX � IJUIhfaER OF DOSES: PER DAB TnrJK5 MAN UFACTURCR.: TAI.JK SIZE; Z� GAI -L0QS DOSE VOLUME IIJCL- U01A7G OACKFLOW: Z�� GALLON5 ALARM MAI.IU FACT UR.EA: �? � MODEL IJUMbER: IQL N CAPACITIES: A IIJCHESOK GALLOU5 SWITCH T.jF`Z: � !� = z IuCHES'OR �4- LLOU5 PUMP MAIJUFACTUKCR: k�� CF IWCHE5 OR e�- " EkLL4US MODEL fJUMtSER: � L y 0- INL HES OR ( Z 3 r 4(a ALLOMS 5W17CH TYPE: W� u`EJ� UOTE: PUMP AND ALARM ARE TO 6L MINIMUM D15CKARGE RATE GPM INSTALLED ON 5EP+LRATE CIRCUITS VERTICAL DIFFEKEIUCF DETWCEIJ PUMP OFF Au0,.OI5TRIBUTIOQ PIPE �Q FEET + MIIJIMUM 1JETWORK SUPPLY PRESSURE , ; , , C) FEET + FEET OF FORCE MjI X y FEET T loarL ��7 FKLCTIOU FACTOR_. TOTAL CyWMIC HEAD = FEET As per.manu£acturer G 0 ,t� gal /in. y M E40 Series 410 HP Effluent and Drain Water Pumps p Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 U) 30 L Z 25 8 Z Q N I 20 6 J < 15 Q 0 4 0 10 ~ 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F. E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.,$.A. ff ck4nw Q STANDARD CHAMBER 52" Ouick4 Standard Chamber 48 " (EFFECTIVE LENGTH) i .......... _._._._.............. 12 „ 8" __ B 34" SIDE VIEW SECTION VIEW ultiP rt End a M o Cap R 16" 12" i 34" SIDE VIEW TOP VIEW FRONT VIEW R n .f 1 ��`�� �� � .�"� r a q _ ' ,�a � *G �s�c� �,a rv �w•f „���T� �' u" »i v � ��. d s�+ INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, and plate, wedge and other accessory manufactured by Infiltrator ( "Unitsi, when installed and operated in a leachfield of an onsite septic system in accordance with Infltratw's instructions, is warranted to the original purchaser ("Holder") against defective materials and workmanship for one year from the date that the septic permit is Issued for the septic System containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) • days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrators liability specifically excludes the cost of removal and/or installation of the Units. O (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT R TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. SYSTEMS INC (c) This Limited Warranty, shall be void it any part of the chamber system is manufactured by anyone other than Infiltrator. The Umited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including ms of Environmental Onsite Wastewater Solutions•"' production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically excluded from Limtted Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or Old Saybrook, CT 06475 myy event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited 860- 577 -7000 •FAX 860 - 577 -7001 Further, in no event shall Infiltrator be responsible for any kiss or damage to the Holler, the Units, or any third party resulting from Installation or ship- 8OO -ZZ 1 - 4436 ment, or from any product liability claims of Holder w any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the origi- nal Holder, The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty require- ments. Any purchaser of Units should contact Infi trator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. it Infiltrator, Equalizer and SideWinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark in Mexico, Contour, Contour Swivel Connection, MicroLeaching, PolyTuff, SnapLock, Chamber PosiLock, QuickCut, QuickPlay RECYCLEOPAPER and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 In traitor Systems Inc. Printed in U.S.A. 0011203HP -0 c, Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number S 02t Number of Bedrooms Design Flow - Peak (gpd)`j Estimated Flow - Average (gpd) W Septic Tank Capacity (gal) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspe once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to servi s under s, 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. PLAf_ '71� '2- 7 3 ►� - 2 i n 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Dom - t c k - D e Mailing Address Property Address J X ( (Verification required 1A 1 nning Department for new construction) City /State 032 I Or; Ll - I c - ccx--, Parcel Identification Number I.F.C.Al. DF.SCRIPTION Property Location ALL /4, 0 E '/4, Sec. 21 , T 31 N -R! L A_W, Town of Subdivision , Lot # 7 ZZ 7 2Jri lr>t Certified Survey Map # Y>ot ��uG.t l 6 cA , Volume � � Page # Z/ 3 z. Z c 1/ Warranty Deed # - ,Volume LM ,Page # Spec house ❑ 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 treaUnent 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 master Plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) 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 S herein, as , t by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification t y septic ystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 t re e' e piration date. SIGNATURE OF APPLICANT DATE I we) rtify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty d scri o e, y virtue of a warranty deed recorded in Register of Deeds Office. -' - -o SIGNATURE OF APPLICANT DATE * * * * ** 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 U. 2408P 155 :>.a . STATF 13AIZ OF WISCONSIN DORM 2 - 1999 ItATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO. , WI This Deed made between David A. Goodman and Itita B. RECEIVED FOR RECORD Goodman, f /k /a Rita B. Bailey, husband and wife, 6~9/]2/200=+ 09:--AM Granter, and Uavicl I'. Ural and J ennifer K. Deal, husb:uul and wife, WARRANTY UEEV Grantee. LYEMl�i 11 Grantor, for a valuable consideration, conveys and warrants to Grantee II EG FL E: : 1 1 00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: (if more space is needed, please attach addendum): COPY F'EF;: That part of NLl /4 NLl /4 and SEAM NLIl4 Sec. 21 13tN -R U1 CC FEE• PAGES: 1 described as follows: Lot 3 of Certified Survey Map recorded in Volume 17 of Certified Survey Maps, page 4522, as Document No. 722387. Together with a lib foot casement for ingress and egress as shown on the subject Certified Survey Map, St. Croix County, IVisconsin. Reuuding Arca Nance and Rctum Addre's — David J. Estreen 304 Locust Street Hudson, WI 54016 032 - 1054 -10 -000 Parcel Identification Number (PIN) This is not homestead property (is not) Exceptions to warranties: h;asements, resti and rights - of - way of record, if any. Dated this Jay of August 2003 Ili * *41 al l & cocl Davvidd A. Goodman * Rita B. Gocx1ran, f /K/a Kita 13. Dailey AUTHENTICATION ACKNOWLEDGMENT Signatwe(s) STATE 01; WISCONSIN ) ) ss. ST. CROIX County ) authenticated this day of , Personally came before me this �' l dad (•., August r d3,.lhc'aliove'tkilji'� David A. Goodman and Rita B. Goofti, pll, &k /a A;lt' I ' * Bailey, husband and wife, i 'fl MEM13EIZ STATE 13AIZ OI• WISCONSIN i �' # w. (If not, to me known to be the 1) rson(s) wil 30 list �iriyi}, r authorized by $ 706.06, Wis. Stats.) instrument and acknowledged the saniC, •'•r.... ' �� c f ri THIS INSTRUMENT WAS DRAP'I'L?D 13Y L � Attorney Kristina Ogland * /!'1t:Clt -CAA t. &'A Hudson, WI 54016 Notary Public, St. to of /Ln & 6U My ('on)lnissiotrT'rPLTif'Tm". (II' not, state expiration date: (Signatures may he authenticated or acknowick1ged. Both arc not necessary.) 42 * Names of persons signing in any capacity ,,list be 11 lied or printed below their signature. [fill it I'rnlessionals co- Fond du Lac. wl STATE, BAR OF 11'ISCONSIN M0655 -2021 WARRANTY DEP"D FO101 No. 2 - 1997 r — 722367 VOL 17 PAGE 4522 KATIREM H. MU3N —" REGISTER OF DEEDS RECEIVED FOR WORD CERTIFIED SURVEY MAP 9 02 s50PM LOCATED IN PART OF THE NEI /4 OF THE NEI /4 AND IN PART OF CERTIFIED SURVEY MAP THE SE 1/4 OF THE NE 1/4 OF SECTION 21, T3 IN, R19W, TOWN OF REP FEE s 13.00 COPY FEE: 3.00 SOMERSET, ST. CROIX COUNTY, WISCONSIN. PAGES: 2 1 Q04 9 C�o3o0 �a ' d �_�o�3ofilo Ofn_] N89 °37'58 "W 2604.58' V �LSa lYl:.lu 9 _2 Q T H yl w(m- ORTH UN OFF THE THE NE 1/4 Q N89 °37'58 "W 651.18' — - - �s51_i r� W $ N. 114 COR _ 2�P , _ _ SEC. 21 b —� b NE CO1 w $ S89 °3758 "E 0 %, 0 aj 651.22' a1 tzs —$ 9 co SE C. 21 Q O W w I wzz W ui l�, BSI � QQ Q N s LOT 2 z 4.020 ACRES SURVEYOR: W 175,132 S0. FT:1NC. SHED WELL �° i DOUGLAS J. ZAHLER RIGHT OF WAY r. � ct ® °; S & N LAND SURVEYING, INC. w p o @ 2920 ENLOE STREET HOUSE (? (V 3;839 ACRES r I O ip i0 9 i HUDSON, WI 54018 r M 187,229 SO, FT. EX. _ RIGHT OF WAY CR ��77 j O re (0 r SEPTIC �° PREPARED FOR: q LOT 1 g i DAVID GOODMAN 1 O 6.494 ACRES ° 485 210TH AVE. CONTIGUOUS I 282,874 SO. FT. INC. SOMERSET, WI. i BUILDABLE AREA -.� RIGHT OF WAY AND . 3.3t ACRES I INC. EASEMENT P v' 5.187 ACRES L4) (� 225,076 80. FT. EX. �' Op RIGHT OF WAY AND N M yi EX. EASEMENT ^ w r S89 °21'21 "E aril 652.08' ©i W D 260.04' �) 392.02' a $ v 3 -- I.17 13 1 32600 _� 1 w 9 i Q 3.43 0) ' 192.57' IQ N 7. 93 293. 5' �I I� 359.01' ' �"� x: � 0 d L7 L8 r 9 g i Q CONT 9 BUILDABLEAR CONTIGUOUS Z 0.9t ACRES , w b e BUILDABLE AREA N �+ z 2.7t ACRES 1 o � Ip �; (D APPROVED o CONTAINS 1 + ACRES ST. CROIX COUNTY o Z z z ' cc NET BUILDABLE Pk1rlrlinp Zonlnra and Parks Cantu I I g 1 � w g T MAY 2 1 2M3 W ' J Z to r c0 If recorded within X) ' fl i Q5 0 0 cp ,� X11 app ai date approval shat Qo t0 LOT 3 nuN and void 9, 1 0 5.001 ACRES 217,833 So. FT. o LOT 4 ° 4.950 ACRES 5.000 ACRES I NOTE: ALL LOTS HAVE ACCESS 215,640 SO. FT. EX. 217,815 SO. FT. i AVAILABLE WITH OUT EASEMENT DISTURBING 20% SLOPES. 4.950 ACRES 215,852 S0. FT. EX. �I EASEMENT ' SOUTH LINE OF THE NE 114 o OF THE NE 1/4 -- – 6.4.54' – 288.3i _ -- NORTH LINE N89 r 21 652.89' — OF THE SE I/4 aO4 6 °� °moo Ob SCALE IN FEET 1" = 150' OF THE NE I/4 _________________. d�do -- _� �� 150 0 150 THIS INSTRUMENT DRAFTED BY: WES ANDERSON JOB NO. 6221 DATE: 11/20/2002 REVISED: 1/27/03 SHEET 1 OF 2 SHEETS Vol. 17 Page 4522 . \ ° \ C; 9 ~ 0 � . k � k � \ 0 \ ƒ z . LL, \ 0 < . # � » \ \ CD E � # t ) � z » t 2 § § z CL ca . q / z } \ § ) co a / ! ƒ a 0 z $ ® k # �_ # \ \ C ` ) w g = ) rg k § m (L 0. m / 2 ¥ o k 2 0 S ) r } ƒ ) } j t k .. �\ a a a { ' Pkil # $ k « « ƒ ■ Q< o c _ © _ 04 M N § 2 = E \ � z m c ) e e p@ « 2 3 2 E � �k0 j / k�C� / / $j = \ f \ / ; _ & . co 2 ' k \ \ 'k \ 0 z / i ) / d .. $ i k CL ° - ° ■ § & § \ 2 ; Q U a ■§ o� Q