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HomeMy WebLinkAbout038-1078-10-100 o - :t ■ 0) 0 c � ° , \ ; a i C) C/) e z /§ e§ E 2 n , § e o co # $ < 0.\ 0 n� §\ 2 0 to 4` Z 9D - we 9D �C \ ` ■ § % ° E ƒ 2 E § t a « / e 0 CD ¢ § \ 0 \ Col J � » 7 \ § CD % e // S S g E CO) c a ° � ■ � 0' � z CL o a o D 2 2 3 § 2 < — z } \ { T a o > \� % OIQ � { ® , 0) � � • E � & z .. > 7 0 \ 2 9 \ �- � ` S N L , / 3 E_ � e / $ / k / § q 0 .. T [ f » 3 k ® 2 B F q » � � c cEEmI> �§kE; 0 ;0226[ §f /)k \2)z k +kCL C CL _ 0) M.o MQ= —e,E 22 %CD 2 � ® 'L @E ƒ ° §\\ §t k C/) CL « a CD v §aa( 0) E —$ /; Q. §t� ® 2 R \ I § ®o § °® a E CD * Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463281 0 (ATTACH TO PERMIT) GENERAL INFORM 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 r N , o'. Melvin, John P. Star Prairie, Town of (, Y - I I;/ b - /& CST BM Elev: Insp. BM Elev: BM Description: Q Section/Town /Range /Map No: . 0 a � � a, - 3 ✓L� 1�� � � � 4 18.31.18. TANK INFORMATION e_ df /", DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se p tic Benchmark c� pp / oa Dosing 1 4- �Jv B Aeration V r l Bldg. Sewer �f VLd X90 Holding St/Ht Inlet St/Ht Outlet �. TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. >Lto Intake ROAD Dt Inlet Septic J > / Z / Dt Bottom Dosing Header /Man. ! l� Aeration Dist. Pip r, f Holding Bot. System S-e� - (1 ` Final Grade _ PUMP /SIPHON INFORMATION `-- 3 �� �' /0-) (O Manufacturer Demand StCover �'/��'� /• 3 GPM Model Number i a . / 7-S 0 -2 TDH Lift Friction Loss Syst TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width ' L No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Li uid Depth DIMENSIONS 3 v/3 SETBACK SYSTEM TO P/L BLD WELL LAKE /STREAM LEACHING Manu urer: INFORMATION / CHAMBER O U G SUS Type System: r I UNIT Model Number: © S � DISTRIBUTION SYSTEM r11 �jYd n�ra✓►� eu. Had e anifolyl Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) ngth Dia Length Dia Spacing SOIL COVER Pressure Systems Only xx Mound Or At -Grade Systems Only �� Z £ / h Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: � / � 7/ L Inspection #2: / / ✓ Location: 2140 90th Street Star Prairie, WI 54026 (NE 1/4 SE 1/4 18 T31 IN R1 8W) NA Lot 1 No: 18.31.18. 1.) Alt BM Description= M tm (61 2.) Bldg sewer length = ? / ��h -I vt� - amoun o cover = Plan revision Required? Yes 1 NA �' �/ OS ` S Use other side for additional information / -' SBD -6710 (R.3/97) 1 � �G�� nD,ate� �/� Inse cto Si na Cert . No Safety and Buildings Division County 201 W. Washington Ave.. P.O. Box 7162 isc�nsin Mad6' WI 53707 - 7162 Sanitary Pam' Number (to be filled in by Co.) (608) 266 -3151 De artment of Commerc State Plan I.D. Numbs Sanita p ice * - - �- - In accord with Comm 8321, Wis. m. in Projec �? t Address (if different than mailing address) may be used for secondary purposes w. is. / qQ 1. Application Information - Please Print All Information DEC Property owner's Name ST, CROIX COUN I "Y arcel !I Loth k t! oc /rt ING OFFICE P r operty t oration _rn 117- e2 Property Owner's Mailing Address V G S Lion City, State _ Zip Code Phone Number d /7Yt �r �- 7 /�I C '�� T,-Z4 N; RL=Qt aC �/ Type of Building (check all that apply) �� / Subdivision N e CSM Number } or2 Family Dwelling - Number ofBedrooms V: �� (�P7 7 79 p ,31 1 ❑ PubliciCommercial - Describe Use ❑Cmr ❑village ❑T wnshiq of�_ ❑ State Owned - Describe Use / / �r�q //V Iii. Type of Permit: (Check only one box u � Irme A. Complete line B pplicable) A. O New System ❑ Replaoernart System ❑ TmatmentMolding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of PO WTS System: Check all that a pply) Non - pressurized In und ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade [I Single Pass Sand Filter ❑ -Gro Constructed Wetland ❑ Pressurized M Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ' Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dis rsalfFrcst eat Area In ortrtatiou: I Area P ed (sf) Syscan Elevation G Design Raw (gpd) Design Soil Application Rate(yp+s Dispersal Area Requirod (sf) Disperse 1) / = 9o2 _ dJ r = / 7 T- _qi VI, Tan Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass _ New l.xisting - Tanks Tanks or (ding Tank L G Treatment Unk Dosing Chamber VII. Responsibility Statement - i. the aadersigned, assume respond tiny for (astallatiom of We POWTS shown oa the attached plans Plum 'Name (Print) Plumber' r lure MP/MPRS Number Business Phone Number Plu 's Address (Street, City, S e, 7ip Come), ` .� Z � -e S �O VIII. cunt , e artmen( Use Onl Sanitary Permit F includes Ground �� /e Issued sluing Ag Sigma re to Ps) 6 4 pproved ❑ Disapproved Surcharge Fee) T7t 3 i( ❑ Owner Given Reason for Denial J Ica.. Conditions of Approval/Reasons for Disapproval - SYSTE U3 _ �`Qn p�pa -- A 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per manaqQmQot plan provided by plum er. L syj�Piy„ 114 2. All setback requirements must be main Q as per applicable code /ordinances, CLffs� Mach eo plains (to Cw co mty wry) or Sys y paper not them ilrz : t heyld si arpkte BD- 639(8.01/03) ,.ti.. 601-h n � PLOT PLAN PROJECT John Melvin ADDRESS 2527 61st St - Somerset Wi. 54025 NE1 1/4 SE 1/4S 18 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr . 220527 DATE 12-28-05 BEDROOM 5 CONVENTIONAL XXXX At ade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1600 gal combo LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 1875 # of chambe 61 ,BENCHMARK V.R.P. nail in 0 elm tree ��'']] ASSUME ELEVATION 100 , t__► BOREHOLE (DWELL *H.R.P Same as BM Vent SYSTEM ELEVATION T -1 =92.0 T -2 =91.9 T -3 =91. T -4 =91.7 > 12" Of Bio Diffuser with (c, .; - 4 - 1 o Cove 31.1 ft per 1 ' 6'1 ` chamber U 6" 6' e at system tong 94 Elevation ffi PL v > 550' to Pl > l B5 100' V ' s 100' l � tai r:'' B2 9 6 7 ' 5 alt B 95' 4' 3 B1 �-r, 10 I „ 0 va���' PL st 9d Gu �U Bed , Driveway se \ Garage Uo i� I G VV rt'�) PLOT PLAN PROJECT John Melvin ADDRESS 2327 61st st. Somerset Wi. 54025 NE1 1/4 SE 1 /4S 18 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 12 -28 -05 BEDROOM 5 CONVENTIONAL XXXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1600 gal combo LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE C3 LOAD RATE •5 ABSORPTION AREA 1875 # of chambers 61 kk BENCHMARK V.R.P. nail in 10 " elm tree ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =92.0 T -2 =91.9 T -3 =91.8 T -4 =91.7 >12 99 of Bio Diffuser with Cove 31.1 ft ^2 per mbe char 6" tong 3W, Md Elevation PL > 550' to Pl > 5 B3 100' 100' B2 ' 5 A Br 1 95' 4 ' 30' B1 94' 10' 96' PL st O ob pipe 20' 4 Bed Driveway Hopuse Garage REC�� Wisconsin SOIL E�TALU ION REPORT Page U � of Division of L f i accordance w ArrxV" Wis. dm. Code County S G Attach complete site plan on paper not I s than k' in size. P n must ^ include, but not limited to: vertical and ho MY dire ion and parcel I.D. kp T C21;` percent slope, scale or dimensions, north arrow, an i istance o nearest road. /—' Please print all information. I Revii5way Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m )). � � 3 b Property Owner / Property Location ovt. Lot 1/4,��— 1/4 S/ T N R f E (o Property Owners Mailing Addre Lot # Block # Subd. Name or �F, o - To ST � C �?C' P7-N e-r-.; . Z t State � } ip Code ' Phone Number ❑ City C1 Village Town Nearest Road 5a New Construction Use: EY Residential / Number of bedrooms Code derived design flow rate 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G / , 'r _ 047ccc., a'_ Flood Plain elevation if applicable General comments and recommendations: F/I ® Boring Boring # q UO El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 © Sl 15 A44 2 � 2 Boring # � Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 /,o mAI , �..�, -� A0,/Y 0 -7 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Plea Print) -r-- ignature CST Number — Address Date Evaluation Conducted Telephone Number l t Property Owner �1 l5 � 1AI -1 Parcel ID# Page 2 of 3-- 1 Boring # Boring E:] pit Ground surface elev. �Y O ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ,q 2- 2-V r F Boring # El E] ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - Eff#2 Borin # 9 E] Boring F1 11 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 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 need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) I T , 3 �3 a ' Sail Test Plot Plan PlAect name John Melvin Byron Bir T. Address `" 2327St St. Somerset Wi. 54025 CSTM 20527 Lot._ Subdly�ision CSm I9 "7 Date 9 /22/2004 County CROIX N E. 1 /48E 1AS 18 T 31 N /R W Township Pr airie Boring Q Well PL Property Line# Alt. BM Base of Elm Tree 95.3 ( Z( 1 - 7' d e /AJ Qrn ,BM or VRP Assume Elevation 100 ft. in 10' Elm Ribbon System Fj v T- 1= 9ZgT -2 =91.9 T -3 =91.8 H.R.P Same as BM SCALE 1" 40 ` Unless other wise Noted — J"v6t " a/2 - �aA (-A PL > 550' to P1 > > �> 3 100' r B2 50 V 5 B 50 alt B 15' 95 94' B1 96' PL �. 4 lam tiv Ho use Garage Driveway v i Y' ,� t f j' a �►[ i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer y Zag /L" 1 .11 Mailing Address 3 / /5f 5�`G�>' 1 Property Address �? J (Verification required from Planning Department for new construction)_ City /State U117 Parcel Identification Number l LEGAL DESCRIPTION /2 1 Property Location _� /., ' /�, Sec. � , T N -R ` W, Town of � A ^ v Subdivision . Lot # Certified Survey Map # 7 1 /* j , Volume Page # 7 •� J Warranty Deed # :2 !4 5 , Volume Page # Spec house ❑ yes p� no Lot lines identifiable)X yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrplumber, joumeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of year expiration date. G� i �GNA"TURE OF LICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the pro pe described above, by v' a of a warranty deed recorded in Register of Deeds Office. SIGN 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 I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of ?� FILE INFORMATION SYSTEM SPECIFICATIONS Owner 2 <J -7 Septic Tank Capacity a l ❑ NA Permit # Septic Tank Manufacturer Lu ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms E3 NA Effluent Filter Model j ❑ NA Number of Public Facility Units NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer [3 NA Design flow (peak), (Estimated x 1.5) e:�o al /da Pump Manufacturer ❑ NA Soil Application Rate , gal/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L)n- Ground (ravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L )<NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :51 0 00ml ❑ 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 ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 2i ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ year('(s) (Maximum 3 years) ❑ NA Clean effluent filter least once every: month(s) ❑ NA year(s) ❑ month (s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) pressure test At least once eve ❑ month(s) ❑ NA Flush laterals and P every: ❑year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) 1 Page 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 pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. A13ANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be take to prov - de a code compliant replacement system: �J/] ?� Sy I A suitable replacement (Are been evaluated and may be utilized for the loca on of a replacement it a orption 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 i alled as a last resort to replace the failed POWTS. j Th site of been evalu d to ide J1 a suit a repla ment a Upon fa of the i e ev, uat' n mus a perfo ed to locate a e replacement a a. If no replacement area is available a holding tank ma a installed a st resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER � r Name , Name Phone / . — 6 7� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name - _ (, I Phone �""j fb Phone This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d) &If) and 83.5411►, (2) & (3), Wisconsin Administrative Code. V, Z 7 1 6 P 1 3 0 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 2000 REGISTER OF DEEDS ST. CROIIG CO.. MI Document Number WARPLA34TY DEED RECEIVED FOR RECORD This Deed, made between .Tames . Melvin and Sharon A. Melvin, 12/16/2004 10:00AN husband and wife (M�p WARRANTY DEED - -- EXEMPT ii 8 Grantor, and John P. Melvin T FEE. 11.06 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Lot 1 of Certified Survey Map dated November 4, 2004, filed November 4, 2004, in Vol. 19, Page 4874 as document number 779036. Recording Area Name and Return Address Dwight P. Cummins CUMMINS LAW OF1*CE, P.A. 353 5th Avenue North Bayport, MN 55003 _0 - 10 78 -40 -000 Farcel Identification Numbed(PIN) This Is not homestead property. (is) (is not) Exceptions to warranties: Dated this S 1 day of �� 2004 * * aMej Melvin a k a JaR1eS P, Me lvin * *Sharon Melvin . ,6/k /a Sharon A. Melvin AUTHENTICATION " ACKNOWLEDGMENT Si natures STATE OF Minn ) Washington County ) authenticated this _ day of Personally came before me this _ day of 2004 — the above named -- i— T - James and Sharon Melvin, husband and wife a /k /a * — Jame P. Melvin and SrLaron v nr TITLE: MEMBER STATE BAR OF WISCONSIN husband a rtd e (If not, to me lcno the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) illstrtlll c edged th e same. THIS INSTRUMENT WAS DRAFTED BY * G✓,s k F' �... __ -~ Dwight P. Cummins _ Notary uP blic, State of Minnesota 363 5th Avenue North, Bayport, M.N 55003 My Commissi (Signatures tney be authenticated or acknowledged. Both are not necessary.) M ( ) * Names of persons signing in any capacity must be typed or printed below their signature. - MINNESOTA My Commission Expires Jan. 31, 2005 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 2000 s.com 05 04:09 PM 01/03/20 Parcel #: 038-1078-10-000 PAGE 1 OF 1 Alt. Parcel #: 18.31.18.321A 038 - TOWN OF STAR PRAIRIE Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner MELVIN, JAMES & SHARON JAMES & SHARON MELVIN 2142 90TH ST SOMERSET WI 54025 Districts: SC = School SP = Special operty Address ): " = Primary Type Dist # Description 22142 90TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 10.000 Plat: N/A -NOT AVAILABLE SEC 18 T31 N R18W S 1/4 NE SE 10 AC Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 499/629 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 30188 200,700 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.000 69,100 140,500 209,600 NO Totals for 2004: General Property 10.000 69,100 140,500 209,600 Woodland 0.000 0 0 Totals for 2003: General Property 10.000 44,000 105,200 149,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 142 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ;I 2233`; 262 7izt2,s �1 AFFIDAVIT OF C09UCTION KATHLEEN H. WALSH Docurnent number REGISTER OF DEEDS ST. CROIX CO., WI TYPE OR PRINT CLEARLY IN BLACK OR RED M RECEIVED FOR RECORD AFFIANT, Maril K. Voeltz , hereby swears or 05/13/2003 09:30AH affirms that a certain document which was titled as follows: CORRECTIVE AFFIDAVIT Mortgage (type of document), recorded on EXEMPT # the 2nd day of April . 200 (year) in volume REC FEE: 47.00 2191 , page 114 — , as document number 715,517 TRANS FEE: aqd was recorded in _ St. Croix County. State of Wisconsin. COPY FEE: contalned the following error (if more space is needed, please attach addendum): CC FEE: PAGES: 19 Incorrect legal description Recordins area Name and return address F irst National Bank of New Richmond 0 Box 89 N ew Richmond, WI 54017 AFFIANT snakes this Affidavit for the purpose of correcting thg above document 038-1078-10 as follows (if more space is needed, please attach addendum); p (PINt South Half of South Half of Northeast Quarter of Southeast Quarter, Section 18- 31 -18, St. Croix County, Wisconsin I ' The original document (in part or whole) lfl s N*nM ffitaMed to this Affidavit (if original document is not attached. please attach legal description and names of grantors and grantees). Dated: May 12, 2003 Signed: , • Mar yn . Voeltz Affiant State of Wisconsin ) AFFIANT is the (check one): )3S. County of OL- C ro i x . ) Drafter of the document being corrected. C3 Owner of the property described In the document being Subscribed and sworn to (or affirmed) before t0� corrected. 12th day of May /7 O Other - explain: RPt ±j na . w .nson Notary Public. State of Wisconsin My Compassion (expires) (is): _ 04 - 02 - o6 This Instrument is drafted by: Marilyn Y. Voeltz THIS FORM IS NOT INTENDED FOR INSTRUMENTS OF CONVEYANCE SUCH AS DEEDS AND LAND CONTRACTS. VOL 1380 Pacf :?91. 22. Release. Upon payment of all sums secured by this Security Instrument, Lender shall release this Security Instrument without charge to Borrower. Borrower shall pay any recordation costs. 23. Accelerated Redemption Periods. if (a) the Property is 20 acres or less in size, (b) Lender in an action to foreclose this Security Instrument waives all right to a judgment for deficiency and (c) Lender consents to Borrower's remaining in possession of the Property, then the sale of the property may be 6 months from the date the judgment is entered if the Property is owner - occupied at the time of the commencement of the foreclosure action. If conditions (b) and (c) above are met and the Property is not owner- occupied at the time of the commencement of the foreclosure action, then the sale of the Property may be 3 months from the date the judgment is entered. In any event, if the Property has been abandoned, then the sale of the Property may be 2 months from the date the judgment is entered. 24. Attorneys' Fees, If this Security Instrument is subject to Chapter 428 of the Wisconsin Statutes, "reasonable attorneys' fees" shall mean only those attorneys' fees allowed by that chapter. 25. Riders to this Security Instrument. If one or more riders are executed by Borrower and recorded together with this Security Instrument, the covenants and agreements of each such rider shall be incorporated into and shall amend and supplement the covenants and agreements of this Security Instrument as if the rider(s) were a part of this Security Instrument. [Check applicable box(es)] ❑ Adjustable Rate Rider ❑ Condominium Rider ❑ 1-4 Family Rider ❑ Graduated Payment Rider ❑ Planned Unit Development Rider ❑ Biweekly Payment Rider ❑ Balloon Rider ❑ Rate Improvement Rider ❑ Second Home Rider ❑ Other(s) [specify] BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Security Instrument and in any rider(s) executed by Borrower and recorded with it. } Signed, sealed and delivered in the presence of. .................................. ............................... fro... �.. ..... .... ( ) MELVIN - Borrower ........ (Seal) ......A. MEI,�IIN - Borrower [Space Below This Line For Acknowledgment] STATE OF WISCONSIN, .S..T.. SIX ......................... ............................... County ss: The foregoing instrument was acknowledged before me thi NCI71MPER, 16,,E „1998,,,, ................. ..................... ....... (date) b S.?..?. A.?MEvN�..xvsaiorm - AI 3 D wig ................. ..... ............................... (person acknowledgi ) My Commission expires: 10149 -0 ublic, State of Wisconsin PAUL A PAULSCN, JR PAUL This .instrtxmettt_was - prepared by -. J. ��ri s..(' jYIS$). .. ..................iVa of W J bwrw Bankers Syatama, Inc., St. Cloud, MN 11- 800. 397.2341) Form MO -1 -WI 8/4/98 Form 3050 9190 (pose 6 a pages) VOL 1380 PA C E 3, 86 • KATHLEEN H. WALSH REGISTER OF DEEDS Return Address: NORTHWEST SAVINGS BANK ST. CROIX CO., WI 234 KEL AVE S RECEIVED FOR RECORD AMERY, WI 54001 11 -25 -1999 9:15 AN MORTGAGE EXEMPT D CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 20.00 Parcel Number: �3� ,1 -10 PAGES: 6 . ...................... MORTGAGE [Space Above This Line For Recording Data] THIS MORTGAGE ( "Security Instrument ") is given on ........ ER„�6,,••199p.......• ]he mortgagor is 5Yu?.Arlo, A.��,YPb.. PPAW.� ?�............ ................. ............................... ..................... rrower w ......:......................................................................................... .......... g N�'I MST..$� .. BANK BANK, ). This Security Instrument is g to ......... . ................. . which is organized and existing under the laws of 2M..S (?F Ste ......................... and whose address is 234. RAVE. q,.. Yom. WI....�40 ................. ... C Lender "). Borrower owes Lender the principal sum of S N_ THOUSAND NO 100* +k ••••••••••••••• ....... ........ Dollars (U.S. $.. .. r . 000 00 ..... ....................). This debt is evidenced by Borrower's note dated the same date as this Security Instrument ( "Note "), which provides for monthly payments, with the full debt, if not paid earlier, due and payable on D� 1 1 . E i.l,._ 2QU .............. , This Security Instrument secures to Lender: (a) the repayment of the debt evidenced by the Note, with interest, and all renewals, extensions and modifications of the Note; (b) the payment of all other sutra, with interest, advanced under paragraph 7 to protect the security of this Security Instrument; and (c) the performance of Borrower's covenants and agreements under this Security Instrument and the Note. For this purpose, Borrower does hereby mortgage, grant and convey to Lender, with power of sale, the following described property located in ST. jr�P4XX ............................... ............................... County, Wisconsin: OF I 4 OFSE 1 4) HALF F N AT QUARTER S O U EAST Q (S 1/2 OF S 1/2 THIS IS THE HOMESTEAD PROPERTY OF THE MRTGAGORS SUBJECT TO EASEMENTS, RESTRICTIONS AND RESERVATIONS OF RECORD which has the address o 24?, BOTH ST Spy' ................ IStroet] 1('Ity] Wisconsin ....54029 ........................... ( "property Address "); [zip Code] WISCONSIN— Single Family— Fannie Mae/Freddie Mac UNIFORM INSTRUMENT Form 3050 8100 (png, I of pages) 13 nken Sv*t -, Inc.• St. Cloud, MN (1- 600-997.23411 Form PAD•1 -WI 6/4/96 Parcel #: 038 - 1078 -40 -000 01/03/2005 04:50 PM PAGE 1 OF 1 Alt. Parcel #: 18.31.18.321 D 038 - TOWN OF STAR PRAIRIE Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner JAMES & SHARON MELVIN * MELVIN, JAMES & SHARON 2142 90TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 W ITC Legal Description: Acres: 10.000 Plat: N/A -NOT AVAILABLE SEC 18 T31 N R1 8W N 1/2 OF S 1/2 OF NE SE Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 08/13/1997 1257/582 QC 07/23/1997 499/628 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 30191 23,900 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 10.000 25,000 0 25,000 NO Totals for 2004: General Property 10.000 25,000 0 25,000 Woodland 0.000 0 0 Totals for 2003: General Property 10.000 12,000 0 12,000 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 VL9 92 ed 61 TOA z io L ME" z�-- ' r UNPLAMD LANDS Cr, q R WEST LINE OF THE NE1 14 OF THE SEI /4 N00° 13 - 29"W 552.21' ( c y G) gag 75 Ila ru C? Q M N w m 6i AN En NE Ev is r,., � . � ~ -� L � S LS�Q (C7 _ c N m gi ?g oo O N N0r2�°35'3011 32151' Nte46 _ -d y 'y0 en rn LE e�to I�» Z ='� I A i lAQ ��1 T a R ����ryry yj N Q ro f-. tit I cT O W — 31, —� U3 ;L 281.98' ta �� SOO °2657"£ - - -- 500 °1650" 6 36' -- S00°26'S7"E 7324.90j -- — _ — FAR - -- - -` - -- - -- S62 AO' a 662.40' v EAST LINE OF THE SEI /4 tLNPLATTED LANDS cn y �a �! •�o � x rn m °' LM 01— ru r -' iGUT2 X Z = 53�JVd dVK A3Auns KdeO a ve aNO334 Has a3Alaoau o IM 'DO KIoso .LS J SQ38Q 3D lY3tSI'J3tf � � Frs -rvr H �(33�HdVH VL8h 3JYd 6Z 'IOA 9!E�iQ76,L 4' N STAR PRAIRIE PLAT T -31 -N • R -18 -W (Landowners) POLK CO. See Page 112 For Additional Names. 800 900 POLK/ST CROIX RD 1000 1100 CARDINAL DR 1200 1300 1400 K G C w r a Randall e t Dou8las x CEDAR STAR G 3 33�qqpp Muy o Rtvard r tr CEDAR X 40 ��� 261 c $ z LAKE B 2 as p l P PRAIRIE tt.er CEDAR ,ow DR Chart- G A 200 $ ' 9F 3 OR A y gl seed w NllfOn Rpdney ° ...RRRSSS / 5 ,... 3i S a §� � � VIM 1 �g f 128 qqd �$ Te r gg is $} 8 JJII mn 95th aW7BsTO *nTg80 h M UN � 99 — j g5 g ,.►.• r tr . { a S usan a 20 TO 1 tr i Y � & 1- ssdeay A 8 a 60 MeedS9 R 4f $I 38 H a Nelson S o 13 h o Normal Lannn io N A6 240i DL a A . N & i iu� tzt cn so DB Re D•L R/ E sea.` aS20 Fan sa■ W1 0 0 OLD n u• • .. ranee M - sr— e RD Daniel I °saws C71Hord lan •c u ra . c s w E7 is s 10 �e 0 Gal W AhMess s 40 tog.x �. 40 40 Kam >as a. lessen U, H C 24 W asssa •s;.m tr vad a c ww� ss tr ` tl o3 og 40 C g °¢ s tr Elfin 50 .o "era ames dt 8 R r s a: 7 a i tr Z ^; n 2 s•o 117 _ _40 j_' w is A < N m a AVE t Richard s g it t CC r A ) odor g E B y ®p® ? 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Cae9 „ 176 1VI 59 tr a : Sy Fz RALEIGH RD WINDING TRAIL RD 54 180th AVE K SOMERSET'S' PAGE 62 RICHMOND PAGE 48 °`�••, FARMINGTON MUTUAL INSURANCE CO COUNTRYSIDE VETERINARY CLINIC, S.C. DR. )OHN SWINGLE, DVM DR. LORI VON RUDEN, DVM DR. BRIAN KELLER, DVM DR. KRISHAWN KAIBEL, DVM DR. MEREDITH SMITH, DVM FLOService Vete *wry Ciro * 14 Hoar Emergency Service Professional Pet aoomhg * 8"dng 715- 246 -5606 1231 N. KHDwiES AvE 71 5 - I*W RIC1WOOND yV�� 54017 Fax 715 - 246 - 9256 E -Mal: cvcC *40ressenter.com 66