HomeMy WebLinkAbout032-1061-60-000 Wisconsin Department of Commglce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building DivSsion
INSPECTION REPORT Sanitary Permit No:
405087 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:
Van Genderen, Rhonda Somerset Towns 032 - 1061 -60 -000
CST BM Elev: Insp. BM Elev: BM Description:
TANK FORMATION f ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
<Z
Dosing Alt. BM
1W z . zz
Aeration Bldg. Sewer (Z J
" v -
Holdi t Inlet
TANK SETBACK INFORMATION Ht Outlet 5_3( 1 6 0 , 3 ?
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic )(Q �� z t D Bottom
G -z
Dosing Header /Man. , �•�S '7 3. 32-
i T
Aeration Dist. Pipe �r d
Q3 -Zy
Holding Bot. System L
PUMP /SIPHON INFORMATION Final Grade (j, v0 4% 2
Ma turer Demand St Cover x
GPM
Model Number
lam 3 /06
TDH Lift Friction s em Head TDH Ft# �. O
1 1
Forcemain Le Dia. Dist. to
SOIL ABI§ORPTION SYSTEM e
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS S I Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM IN Ma fact rer
INFORMATION Type Of System: , Z S� HAM NIT OR Mo el m
uber. a
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
11 lr Pipe(s) '
t �{' !� f 7 2
Length Dia Length Dia Spacing N S U
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
5] Yes Fm] X, Yes [kl No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:q /.jj / O Inspection #2: / /
Location: 639 205th Ave Somerset, WI 54025 (NE 1/4 SW 1/4 23 T31 R19W) NA Lot 2 [ 5 Parcel No: 23.31.19.311C
t
1.) Alt BM Description = ' � 0 1 5 ` d f af�00V� �Sl' 1 y C*,V11 � eojacf ly 1(6 ta)
2.) Bldg sewer length = Z `� f' It S� . / O r etv"
= r � T�+
�d � ��� �¢
- amount of cover
3 �o�3r�rva {yin )0 pe S L- 2" I �Cp.I0jle� fh of
PlXf67Y' o**u rte� (Ye x' No
Use other side for additional information. * .. Insepctor's - na ure Cert. No.
SBD -6710 (R.3/97)
i
i
1
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1
Safety and Buildings Division County
` 201 W. Washington Ave.. P.O. Box 7162
i seonsin _ Madison. WI 53707 - 7162 Site Address )
De artment of Commerce S 'I -D`z- d /�S 3 4d -
Sanitary Permit Application Sanitar Permit umber
In accord with Comm 83.21. Wis. Adm. Code, personal info Ep ❑ Check if Revision
may be used for secondary purposes Privacy La a 5.
I. Application Information - Please Print All Information State Plan I.
D. Number 61
property is Name 1 1 Number 'goo
OIX
5.
CO UNTY _
Property Owner's Mailing ddress 1 ZONING roperty Location
N. R J-9 le
City, State Zip Code Phone Number Lot Num r Bloc Numb ,3I'
H. Type of Building (check all that apply) ❑City
X I or 2 Family Dwelling - Number of Bedrooms []Village
❑ Public/Commercial - Describe Use ownship l
❑ State Owned Nearest Road
1
M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line if applicable)
A For County use
1 New 2 ❑Replacement System 3 ❑ Replacemem of 6 ❑Addition to
stem Tank Onl Eris ' stem
B. ❑Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) �1 a
44,d Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 05AIga ; ^' 31
22 ❑ prey I Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. Dispe rsal/Treatment Area Information: 7i C W
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed te(Gals./Days/Sq.Ft.) (Min. h) Elevation
S _
7 / q.
. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks A Concrete Constructed Glass
New Existing
Tanks Talcs
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement - I, the undersigned, assy& responsibility for installation of the POWTS shown on the attached plans.
Plumber's ame (Print) Plumber' Si MP/MPRS Number Business Phone Number
P1 is Address ( treet, City, State, Zip Code
L
VIII. C t /De artment Use onl
pproved Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee) 4 Owner Given Initial Adverse Determination
IX. C�yvtA pr��Q„� for Disapproval
...e/1-�,� l��p,�(�,d�•t�t�'r' f3'�.>�"1�•
7a 0
Attach complete plans (to the C04 0 01Y) for the system on paper not less thaw Sin : 1 Inches m
SBD -6398 (R. 05101)
4 6 � 40
25
0
L of- �1
jat �.Jr.s' A �ifo �s,Fx, G;�it6i2
,� get �}e►�s<
.!8 .:.Jien�'s,//l�/.� �.� •i+ 1 •,1.�/,lza - ,G��l�?0 ��
ti�
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Sys
bw r`S �7ec �i�anv P
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SUPPLY ING.
_ i,J e)✓�
ly
MUSTEE
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3�
r . — Wisconsin -
Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and,Buildings Page _� of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
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. #
i 7
APPLICANT INFORMATION - Please print all information. R iew O by Date
Personal information you provide may be used for secondary purposes (fAiy aw, s. 15.04 (11,(m)).
t
Property Owner r Property Location
Govt. Lot 1/4 1/4,S T N,R X(or&
Property Owner's Mailing Address t • Lot # Block# Subd. Name or CSM#
�ZZ'7R9
City State Zip Code Phone Nun*de' N N Nearest ❑ City El Village Town Road
( : —)
X New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow _ _ gpd Recommended design loading rate �_ bed, gpd /f? _X trench, gpd /ft
Absorption area required 5 Zrg _ bed, ft 7_ trench, ft Maximum design loading rate bed, gpd /ft trench, gpd /ft
i
Recommended infiltration surface elevation(s) �� ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material Flood plain elevation, if applicable It
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holdinn
U = Unsuitable for system S U 2 S El � S ❑ U PIS ❑ U ❑ S RU ❑ S
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
c
Ground
elev.
Depth to
limiting 8 ��
factor
in.
Remarks:
Boring #
�?
Ground
elev.
ft.
h
Depth to
limiting
factor
?min. Remarks:
CST Name le a Print) Signature Telephone No.
Address Date CST Number
SOIL DESCRIPTION REPORT
PROPERTY OWNER ` � Page of 3
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
Ground
elev.
<ff.
Depth to
limiting
factor
Remarks:
Boring #
,
-
S n
Ground r
elev.
Si ft• y = 36
d
Depth to
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring #
Ground
f
elev.
5ya: ft-
Depth to
limiting
factor
?�,' in. Remarks:
Boring #
..........................
,
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
S � � �l1
L
CERTIFIED SURVEY MAP
LOT I CERTIFIED SURVEY MAP VOLUME 8 PAGE 2215 AND P
THE NEI /4 OF THE SWI /4 SECTION 23. T31N. R19W. TOWN 01
ST. CROIX COUNTY. WISCONSIN
UNPLA TTED LANDS NORTH L I N E SWI /4 SEC . 23
N 90 °00'00'E 2679.97'
.................................. ...............................
33' 419.98
33' 853 98 :33'x'' 417.51 ' M
"
354.00' �a+ '
S89 °51'39 "E 420.00 `
oM v 37'47 o Co C/L 205th AVE I w
v 66' WIDE R -O -W
Z'U CO 0
set back d ing so 0
—w °
3 w to O I v
Q garage ro v
CO N
M :
Lr
' � O hou se p � w NI;I ,,
NI I U ,,0//��,,,
M O O w W >� V`\SC NS/
O '� 1
Go
LYL L. ELLIOTT
8.1300
Ln LOT 1 a 0 I ; HUDSON, WI
6.00 AC,
N 261.329 SF INC. R/W 6.67' GI 10 1%< 1 d 1 "••.....••'� ��►��
M 5.69 AC. <
247.915 SF. EXC. R/W
S 89 °51'40'E 417.15'
3 �
00 W
7 tree occupies E -
ro corner E"
N 90 °00'00 "W 353.98'
O - CL
O z
z
z N
...� _� (
L . i0 U
oI _. 0
W O N v7
F- 13.51 N v
588.631 INC, R/W
Go
3
W
a 13.45 AC.
z 586.096 SF. EXC. R/W z
e
0
O
N w
N 89 °56'41'W 836.70'
SOUTH LINE NEI /4 OF THE SWI /4
UNPLA TTED LANDS FOUND 2" IRON PI SCALE 1' _ 200'
PE
$I /4 COR. SEC. 23 0 100 200
OWNER REQUESTED SURVEY LEGEND
DAVID AND DEBRA HELGET
637 205th STREET 9 FOUND ALUM. CO. MON.
SOMERSET. WIS. 54025
PHONE 715 -247 -5707 SET 3/4" X 24" IRON PIN
WT. 1.50 LBS /FT.
o FOUND 11/4" IRON PIPE
BEARINGS REFERENCED `0 THE
THIS INSTRUMENT DRAFTED BY L. ELLIOTT NORTH LINE SWI /4 SEC. 23
SHEET 1 OF 2. PAGE I OF 2 (ASSUMED N90 °00 '' E)
i
CERTIFIED SURVEY MAP
LOT 1 CERTIFIED SURVEY MAP VOLUME 8, PAGE 2215 AND
PART OF THE NE1 /4 OF THE SW1 /4, SECTION 23, T31N,
R19W, TOWN OF SOMERSET, ST. CROIX COUNTY
WISCONSIN
I, LYLE L. ELLIOTT, REGISTERED LAND SURVEYOR S -1300 DO HEREBY
CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS PLAT
IS A TRUE AND CORRECT REPRESENTATION OF LOT 1, CERTIFIED
SURVEY MAP VOLUME 6, PAGE 2215, AND PART OF THE NE1 /4 OF THE
SW1 /4, SECTION 23, T31N, R19W, TOWN OF SOMERSET, ST. CROIX
COUNTY, WISCONSIN, AND MORE PARTICULARLY DESCRIBED AS FOLLOWS;
COMMENCING AT THE WEST QUARTER CORNER SAID SECTION 31, THENCE
N90 0 00'00 "E ALONG THE NORTH LINE SW1 /4 SECTION 23 1842.48 FEET
TO THE POINT OF BEGINNING; THENCE N90 "E ALONG SAID NORTH
LINE 419.96 FEET; THENCE S00 0 53'48 "E 526.03 FEET; THENCE
S89 0 51'40 "E 417.15 FEET TO THE EAST LINE SW1 /4; THENCE
S00 0 51'43 "E ALONG SAID EAST LINE 701.21 FEET; THENCE
N89 0 56'41 "W ALONG THE SOUTH LINE OF THE NE1 /4 OF THE SW1 /4
636.70 FEET; THENCE N00 "W 1347.45 FEET" TO THE POINT OF
BEGINNING.
SAID PARCEL CONTAINS 19.51 ACRES MORE OR LESS, AND IS SUBJECT
TO ANY EASEMENTS OR RESTRICTIONS OF RECORD.
I HEREBY CERTIFY THAT I HAVE FULLY COMPLIED WITH THE
PROVISIONS OF SECTION 236.34 OF THE WISCONSIN REVISED STATUTES
AND THE ORDINANCE OF ST. CROIX COUNTY AND THE TOWN OF
SOMERSET IN SURVEYING AND DIVIDING SAME.
EACH PARCEL SHOWN ON THIS PLAT IS SUBJECT TO STATE, COUNTY AND
TOWNSHIP LAWS, REGULATIONS AND RULES (i . we'Lldr , rrdLur
.... ....
car ca.11rc+.ye ways 01' si nk 1 -- i c) 1 e5
of clu5eu d epress ions, all slopes of 20% of rirOrle d rru 12% or
riror e c>ir hiyrI erodible soils &Lc.) BEFORE PURCHASING OR
DEVELOPING ANY PARCEL CONTACT" THE ST. CROIX COUNTY ZONING
BOARD AND THE TOWN OF SOMERSET FOR ADVICE.
PLANNING COMMISSION APPROVED
DATE:
LY L. ELLIOTT, RLS 1300
NS1N���i�,
DATE: MARCH 27, 2000 ` ���5,.•• '• ���,
SHEET 2 OF 2 PAGE 2 OF 2
:. � ���E S•� X11
e and 'Sv`'e�
ptrr
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ���u>✓ °" Un.� C�'' o'er' =^'
Mailing Address
S `yl �) (.jo,/-v0 J•T #���' fH.IR ✓iF_ cJ ✓f'^� SS /Z�o
Property Address b,3 y 1 /a ✓F
��Trn. ✓�= r ctl� Syv;�s
(Verification required from Planning Department for new construction) .
J� m: ✓'� r L 1 Parcel Identification Number
03-Z - /off/ - 6 , ) - /io
City /State
LEGAL DESCRIPTION
Property Location AJ r'- '/4, f j 'ix Sec• .2 3, T -R_
W, Town of
Lot # —
Subdivision
Certified Survey Map # 6 L?:- ' f
Volume Page #
2 � Volume , Page
Warranty Dced # �— ,
Spec house [I yes �Q no
Lot lines identifiable ( yes D 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 e aror o oner, if ne b l icen ed pumper, What you put into the system
can a ffect the function of the septic tank as ate sta
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 (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. pfivate
hue, the undersigned have read the above requirements and agree eo m ainta in t of N Resources, S ate of Wisconsin. sin. disposal the
ation
set forth, herein, as set by the Department of Commerce and the D p g
Zonin Office within 30
stating that your septic system has been maintained trust be completed and returned to the St. Croix County
days f the three ar expiration date.
DATE
SIGNATURE OF A PLICANT
OWNER CERTIFICATION
I (we) certify that all statements on this form are tnte to the best of my (our) knowledge, I (we) am (are) the owmer(s) of
the pr My dese 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
"�u � DATE
SIGNATURE OF PLICANT
«. «. :. 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
POWTS 0WN1;R'S MANUAL & 1\IANAGEWNT PLAN raev.l r
FILE INFORMATION j SYSTEM SPECIFICATION
Owner � - Septic Tank Ca acit al o NA
Permit # Septic Tank Manufacturer = o NA
Effluent Filter Manufacturer ° ❑ NA
DESIGN PARAMETERS Effluent Filter Model ❑ NA
Number of bedrooms ❑ NA Pump Tank Cap acity al A NA
Number of Commercial Unit A NA Pump Tank Manufacturer %NA
Estimated flow (average) Z5 gal/day Pump Manufacturer rz4. NA
Design flow (peak), (Estimated x 1.5) <. gal/day Pump Model jxNA
Soil Application Rate gallday1ft" Pretreated Unit
Influent /Effluent Quality Monthly ilvcragc* u Sind /Gravel F'ilter ct Peat Diller
Flits, Oils do Grease (I;OG) <30 ntg /L
n Mcchanical Aeration t Wetland
Biochemical Oxygen Demand (BODs) <220 mg /L ❑Disinfection o Other:
Total Suspended Solids (TSS) < 150 m L Manufacturer
Pretreated Effluent Quality O NA Monthly Average ** Dispersal Cell(s)
;X111-ground (gravity) ❑ In- ground (pressurized) ,
Biuchcmical Oxygen Demand (BODs) <30 ntg /L U At - grade o Mound
Total Suspended Solids (TSS) : �30 ntg /L ❑ Drip -line o Other:
Fecal Coliform (geometric mean) <10' cfu /100mL
Maximum Effluent Particle Size '/8 inch diameter Values typical for domestic (non - commercial)
wastewater and septic tank effluent.
** Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequenc
Inspect condition of tank(s) At least once ever o months ear(s ) (Maximum 3 rs)
Pump out contents of tanks When combined sludge and scum equals one third '' /a) of tank volume
Inspect dis ersal cell(s) At least once every ❑ months ears Maximum 3 rs)
Clean effluent filter At least once every ❑ months ear(s
Inspect punip, p ump controls &alarm At least once every ❑ months o ears _0NA
Flush laterals and pressure test At least once every ❑ months ❑ ear(s) _P4,NA
Other: At least once every ❑ months ❑ ear(s) 5KNA
Other: At least once every o months ❑ ears cK 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 ('/3) 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 ch. NR 113,
Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other
maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regukitory authority within 10 days of completion of any service event.
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 my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have
the contents of the tanks(s) removed by a septage servicing operator prior to use.
Owner: 1, ,y Cad '' Paga-20e
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater
will be discharged to the dispersal 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 soft absorption are.
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.
ABANDONEMENT
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 ch. 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
replacement 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 the time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INSTA 1 1 , 2 POWTS MAINTAINER
Name
Name
Phone
Phone
SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY
Name Name G
Phone Phone
1796pia t52
vn! 665888
STATE BAR OF WISCONSIN FORM 2 -1999 :Sriiti� -':A H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
i:. CROIX CO., WI
This Deed, made between Clint J. Parnell and Shontel M. Parnell, ;IECEiVED FOR RECORD
husband and wife 12-2: - 001 8:30 AM
4ARP•ANTY DEED
Grantor, and Rhonda Van Genderen, a single person :)TEMPT li
8 P EKT COPY FEE:
?is�kFEF'FEE: 330.00
i ORDIti� FEE: 11.00
PAGES. 1
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
Part of the NE' /. of SW '/4 of Section 23, Township 31 North, Range 19
West, St. Croix County, Wisconsin described as follows: Lot 2 of Certified g LQbS IM •uospnH
Survey Map filed May 10, 2000 in Vol. 14, Page 3846, Doc, No. 622799. Z i1un pd 88Inoo LOS L
YN NNV9 A31 A 3TDV3
032 - 1061 -60 -110
Parcel Identification Number (PIN)
This is not homestead property.
OI) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this :� Ll 'v day of October 2001
Clint J. Parnell
+ • Shontel M. Parnell
' R
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF WISCONSIN )
) ss.
County )
authenticated this day of Personally came before me this C L (IZ day of
October 2001 the above named
Clint J. Parnell and Shontel M. Parnell, husband and wife
+ ti1 tytll lllllly/
K i
TITLE: MEMBER STATE BAR OF WISCONSt�+f
t 1 . ` . to me gown to be
(If not, the person(s) who executed the foregoing
authorized by 0 706.06, Wis. Stats.) ✓ )nspumeAt and ac now e same.
ed th
THIS INSTRUMENT WAS DRAFTED 13Y;( , r^ r / n-e
Attorney Kristin Ogland .G d . '61; : -) " Nol Public, State of Wisconsin
Hudson, WI 54016 l % .*mission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not'^ sty$ a`��
• Names ofpersons signing in any capacity must be typed or printed below their signature. Inamauon professional. company, Fond du Lao, w1
STATE BAR OF WISCONSIN 800.655 - 2021
WARRANTY DEED FORM No. 2 -1999
622799
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CERTIFIED SURVEY MAP
LOT I CERTIFIED SURVEY MAP VOLUME 8 PAGE 2215 INCLUDED AND BEING PART OF
THE NEI /4 OF THE SWI /4 SECTION 23. T31N. R19W. TOWN OF SOMERSET
ST. CROIX COUNTY. WISCONSIN o
UNPLA TTED LANDS NORTH LINE SWI /4 SEC.23
N 90 2679.97' F ILED
33 :.............. 419 .98
33: 3 3.98'38.33 :, � 417.51' � X14 � �
S 354.00 . ... S89 ' 40' E N 2000
S89 ► I
I . 51 ' 39' E 420.00 / A +4LSH
eGislerolp
uN 37.47' $ M C/L 205th AVE H SL Croix 6,m
r 100' building p 66' WIDE R -O -W 2
^_U OD set back
W rq
garage
m N
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n ^ ^ a —3101 061 r'
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^ rl� in ' L Y L. ELLIOTT--
;n LOT 1 0 o I HUD IN ,
6.00 AC. N .S/ Loin;
N
n 5.69 AC. z 261.329 SF INC. R/W N 6.67' ��'��' '' -"•'� J am`
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247.915 SF. EXC. R/W
S 89 417.15' "
OD Lil
tree occupies F
rri corner F
N 90 353.98'
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o LOT 2 o N y
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t go 58 .631 INC. R/W w ^
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APPROVED 1 8640 AC F. R/W M z
ST. CROIX COUNTY ,� J
Pia mina 7mmInq and Parks Committee c
O H
WAY 10 2000 y w
89' 6'41'W 836.70'
If o bh L I NEI /4 OF THE SWI /4 r7
approval date apptova N
nugandvaid m SCALE I' - 200'
UNPLA TTED ANDS FOUND 2' IRON PIPE M
SI /4 COR. SEC. 23 — 0 100 200
OWNER REOUESTED VEY LEGEND
DAVID AND DEBRA HEL
637 205th STREET !9 FOUND ALUM. CO. MON.
SOMERSET. WIS. 54025
PHONE 715- 247 -5707 SET 3/4' X 24 IRON PIN
WT. 1.50 LBS /FT.
0 FOUND II /4' IRON PIPE
BEARINGS REFERENCED TO THE
THIS INSTRUMENT DRAFTED BY L. ELLIOTT NORTH LINE SWI /4 SEC. 23
SHEET I OF 2. PAGE I OF 2 (ASSUMED N90'00 " E)
Vol. ] 4 Page 3846
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