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HomeMy WebLinkAbout038-1121-40-120 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 463032 0 GENERAL INFORMATION , State Plan ID No: Personal information you provide may be used' air secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Dalton, Donald Star Prairie Township 038 - 1121 -40 -120 CST BM Elev: Insp. BM Elev: BM Description: , 7 n/Town /Range /Map No: 96 30.31.18.502A20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY t STATION BS HI FS ELEV. Septic , - ` e /Z J � Benchmark Dosing Alt. BM ? Aeration Bldg. Sewer i e, `ZS Holding St/Ht Inlet 87.5''3 TANK SETBACK INFORMATION St/Ht Outlet 70 87.3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 3 _ Dt Bottom Dosing Header /Man. C' ).5'a Aeration Dist. Pipe Holding Bot. System l0_ $4.. /d. 2 m d r. 8 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM l� 1(3 1 Model Num <.�.7 Lift FrI Loss System Head TDH Ft Forcemain Length Dia. ell SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS . 1 8-7 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: —r+ UNIT Model Number: c {I- .. '7 + cs s. DISTRIBUTION SYSTEM 1 14 e �,,.� Vcn 1- 0}6 ' � c � Header/Mani'old Distribution x Hole Size x Hole Spacing IV..t to Air I take I Pipe(s) � Length � Dia i Length Dia Spacing SOIL COVER x Pressure SyptemsiDnly xx Mound Or At - Grade Systems Only Depth Over -------- - th Over xx;Depth of xx Seeded /Sodded xx Mulched Bed/Trench Ce Be rench Ed es soil 9 P L ] Yes [ No L Yes J No OMME S: (Include code dis encies, persons present, etc.) Inspection #1: / .29 4CH Inspection #2: / tion: 1956 County Road C Star Prairie, WI 54026 (SE 1/4 NE 1/4 30 T31 R1 8W) NA Lot 2 Parcel No: 30.V r M Description =7p P 4!rb 4 � � - wer length = ' of cover = Y 1 Zequired? I Yes No 7 ell for additional informatio • Date Insepctors Signature J 1 95 - 6, d:r - c Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce Submit completed form to coup if not ' [Privacy Law, s. 15.04(1)(m)] ( p �' state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County t State S itary Permit Number ❑ Check if revision to previous application State Plan I. D. Number =�' °t 3032- _a.. I. Application Information - Please Print all Informa ' Location: Property Owner>4me Property Location !✓ f j d fLLMNumber 4 /4, y�C) Property Owner's Mailing Address Block Number Ida /'D fr 7 Ci , State Zip Code Phone Number o CSM Numbe II. Type of Building: (check one) Cl - Nt ❑ City 1 or 2 Family Dwelling -No. of Bedrooms: 1 L Village 0 6 Public/Cominercial describe use):_ C� f-�� Town of ,e P - 0 State-Owned I'S L . 5/� P 4 4-9-r e Nearest Road rr - n �� c.� l// ` r Parcel Tax Number(s) II . ype of Permit: (Ch only one Bo on line A. Check box on line B if applicable) A) 1. .l[;ZNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Exist System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Are Inform 1. Design Flow (gpd) 2. Dispersal Area 3. Dispers 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Propo Rate (Gals. /day /sq. ft.) (Min. /inch) _ Elevation VII. Tank Capacity in Tbfal # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum e Name (print) Plumbe ' Signature (no stamps): MP/MPRS No. Business Phone Number t lu er's Address (Street, City, State, Zip Cod IX. County/Department Use Only + ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issum Agent Signature (No stamps) ?90kpproved ❑ Owner Given Initial Adverse Surcharge Fee) Determination X. Conditions of Approval /Reasons for Disapproval: L S 3) SYSTEM OWNER: 1 Septic tank, effluent filter and n�� dispersal cell must all be serviced t maintained S� .� �,e,n n2 t,>2llaC nt plan provided b -- as per manageme p p Y lumber. P 2. All setback requirements must be maintained �,, Q 'gv� ?&W73 s vS k"y as per applicable code /ordinances. " 3D -6398 (R. 07/00) PLOT PLAN PROJECT Don Dalton ADDRESS 1643 100th st. NewRichmon w. 54017 SE 114 NE 1/4S 30 - /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MFRS Byron Bird Jr. 220527 zz DATE 8 -23 -04 BEDROOM 4 CONVENTIONAL XXX Grade ONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE O LOAD RATE .7 ABSORPTION AREA 858 # of chambers 28 BENCHMARK V.R.P Top of steel fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL .H.R.P. Same as BM Vent SYSTEM ELEVATION T 1=86.8 T -2 =86.8 > 12" Of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber 6" „ • PL 238' Drive Garage 182.'. 7 / Pro PL 4 bed house �) Co Rd C �, a4 -' 20' Ye �n�•� .'t,. i St 182' B'0' O ob pipe or B. 3 B1 91 91' BM PL 238 45, 10' , al i PLOT PLAN PROJECT Don Dalton ADDRESS 1643 100th st. NewRichmon Wi. 54017 SE 114 NE 1 /4s 30 - /T 3 1 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 8 -23 -04 BEDROOM 4 sisa CONVENTIONAL XXXX -Grade LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a LOAD RATE .7 ABSORPTION AREA 858 # of chambers 28 BENCHMARK V.R.P Top of steel fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL IH.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =86.8 T -2 =86.8 >12" Of Bio Diffuser with Cove 3 1. 1 ft A2 per chamber 6" L PL 238' Drive Garage 182' Pro PL 4 bed house Co Rd C 20' st 182' B _J Wo O ob pipe 8 9 BI 4' B._, 91 BM I� PL 238 > 45, 10' aitB Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. a C 1 A Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan mu t a ty include, but not limited to: vertical and horizontal reference point (BM), direction an parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest —f�,, Zl— O ^jv�D Please print all information. Rev' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 6fj 0 9 Property Owner Property Location l a h Govt. Lot 1/4 /4 S T3 N R -CCE (o Property Owne ailing Address Lot # Block # I Subd. Name or CSM# &44MOI S Zip Code Phone Number ❑City [3 Village ,® -Town Nearest Road t l �' l .a , I Go '-'� New Construction UselTResidential /Number of bedrooms Code derived design flow rate 4g re, 4:5) GPD ❑ Replacement ❑ Public or commercial - Describe;. Parent material !r Flood Plain elevation if applicable ft. General comments and recommendations: 5 Boring # a Boring ❑ pit Ground surface elev. ft. Depth to limiting factor 2, W in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 •Eff#2 6 _ $Z_ ® Boring # ❑pit Ground surface elev. ft. Depth to limiting facto D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell g 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 CST Name (Please Print) f Signature CST N A e Date Evaluation Conducted Telephone Number �i Property Owner �� Parcel ID # Page of LY] Boring # "t Boring pJ ❑ Pit Ground surface elev. /� ft . Depth to limiting factor /7 /O n. Soil Appl ication 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 I 'Eff#2 1y1 r li . J S° ss. 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # Boring Ground surface elev. ft. Depth to limiting factor ❑ pit in. Soil Aj3plication 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& and TSS 1 30 nxyL 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- 2648777. SBD -8330 (R.07 /00) Soil Test Plot Plan Project Name Don Dalton Byron ird Jr. Address 1643 100th st. NewRichmond Wi. 54017 CS #220527 Lot Subdivision Date 7 / 2 9 12 003 Count ST. CROIX S E 1/4 1/48 T 3 1 N /R W Townshi Sta rPr a irie M Boring Q Well PL Property Line# Alt. BM base of steel post 96.3 ,BM or VRP Assume Elevation 100 ft top of steel post Systern Ely. T- 1 =87.8T-2=87.7 H.R.P. Same as BM PL 238' "Drive Garage 182' Pro PL 4 bed house CoRdC 90' 182' 91' 44J)' 3 B PL 10' 10' �� 238' 45' 45 �' POWTS OWNER'S MANUAL & MANAGEMENT PLAN i age of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank. Capacity ga l ❑ NA Permit # 3 O3 Z Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer f O NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity ga l O NA Estimated flow (average) O gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) ©0 al /day 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 - Ground (gravity) ❑ In- Ground i, ssurized) Total Suspended Solids (TSS) <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ ea�� (Maximum y ar ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -thir 3 -Qf +ank v __r ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum years) ❑ NA years) Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) Ins Inspect pump, um controls & alarm At least once ever ❑ month(s) C3 NA P P. P P y� ❑year(s) pressure test At least once ever ❑ month(s) ❑ NA Flush laterals and P y� ❑ year(s) Other: At least once ever ❑ month(s) C3 NA Y: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following license certification: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicin aerator. Tar inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify a racks or leaky measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on ti round surfacf The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to che( )r any pondin of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing conditic d requires tl immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y3) or more of the tank ime, the entif contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with jpter NR 11" Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized compor pretreatme units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintains +. A service r -port shall be provided to the local regulatory authority within 10 days of completion of anv service GMW (4/0' Wage of _ START UP AND OPERATION 4 .For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other aIs that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the ents 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 exbess wastevv I he discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface , e of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to rinc power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump s rc 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,ie 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 It(e.Of th, POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfeetayl'Its; fat foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; mods -ad"Als; oil painting products; pesticides; sanitary napkins; tampons; and water softener brine. r ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system 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 wi . , 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 eomplia' replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorpti( 1 system. The replacement area should be protected from disturbance and compaction and should not be infringed;�on I y required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement '986 wil result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systefris mus! 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 ,POW i 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'SW si *F evaluation must be performed to locate a suitable replacement area. If no replacement area is available a hold" tar• 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 tt 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. 00 NC, 'T ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS — - POWTS INSTALLER POWTS MAINTAINER Name 7 Name a c� Phone Phone SEPTAGE SERVICING OPERATOR (PU PER) LOCAL REGULATORY AUTHORITY Name Name Phone L Phone ,6 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. r ''l ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L'n oia ff c..! _ Mailing Address Property Address (Verification required from Planning Department for new construction.) i City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 5z--' /4 , /'� '/4 , Sec., T ,N R /� W, Town of �r�i�uii►� L Subdivision , Lot # 2 — Certified Survey Map # Volume Page # v2 0, Warranty Deed # 3 7 Volume z (o E{9 , Page # 30 Spec house no Lot lines identifiabltg�e) 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. 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 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 Zoning Department within 30 days of the three year expiration date. ,d,_ , A�L SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property d c bed abo of a warranty deed recorded in Register of Deeds Office dc SIGNAIURE OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. U 2 6 4 9 P 3 0 9 - 7734iaM ly STATE BAR OF WISCONSIN FORM 2 - 1999 KKATHLEER H. WALSH WA RRAN D D EaIS"1 OF DEEDS Document Number ��' ST. CROIX CO., WI This Deed, made between Robert R. Maitrejean and Doris A. RECEIVED FOR RECORD 09!0312804 18:10AM Maitrejean, husband and wife Grantor, and Donald Dalton WARRANTY DEED Grantee, l %ElPT i 3 Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.80 the following des. - rih. xt ,cai -state in St. Croix County, State of TRANS FEE: Wisconsin (i , 00n ;race is needed, please attach addendum): COPY FEE: That part of SE 11 K'/4 Sec. 30- 731N -R19W described as follows: Lot I CC FEE: PAGES: 1 of Certified Survey Map recorded in V:d. 8 of Certified Survey Maps, RECEI page 2260 as Doc. No. 461603. St. Croix county, Wisconsin. Lot 1 of Certified Survey Map x.-corded in Volume 8, Page 2260, located in part of the SE 1/4 of the NE 5 E P 8 2004 1 14 of Section 30, Township' 31 N, Ranee 18W, Town Recording Area of Star Prairie. St: Croix Wisconsin. Name and Return L . ,LO NAG OFFICE �� This deed is being given to correct the legal 21 �N! description in Warranty Deed dated November 13, 2003, r T j G A' I LAP/ P/ recorded November 13, 2003 in Vol. 2456,Pacje 230, P. O. 1✓0'/ 3,55 9 as Doc. No. 746602. HUDSOMA, WI 54016 03&112140 -120 ;038- 1121 -40 -110 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this —t--- day of August r 1 2004 _ ........ - --------------------------------------------- - - • - --- -- -- .... ................... Robert R Mait relean �! -- ? - * Doris A. Maitrejean AUTHENTICATION ACKNOWLEDGMENT Signature(s) Robert R. Maitrejean and Doris A. Maitrejean, STATE OF ) husba and wif ) ss. .......... - ..... County ) authenticated thisda of August, 2 004 Personally came before me this day of ----- - - - - -- - - - - -- the above named K ristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorne Kristina Ogland Hud WI . 54016 Notary Public, State of ....... .... .. ........ – - — My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, W 1 STATE BAR OF WISCONSIN 800 - 655.2021 WARRANTY DEED FORM No. 2 -1999 U. 2456P 230 74660,E STATE BAR OF WISCONSIN FORM 2 - 1999 .�' I KATHLEEN H. WALSH m Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX Co., WI This Deed, made between _Robert R Maitreiean and Doris A RECEIVED FOR RECORD Mai ean• h band d an wife Grantor, 1 trei us d 1/13/2003 02.15P02:15P?( and Donald Dalton Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEM1p1 8 the following described real estate In St. Croix County, State of Wisconsin REC FEE: 11.00 ace is needed, please attach addendum): TRANS FEE: 210.00 Lertified Survey Map recorded in V COPY FEE: Page Page 2260, located C FE i : the SE 1/4 of the NE 114 of Section 30, Township 31N, Range 18W, Town of Star Prairie, St. Croix County, Wisconsin. Recording Area Navie and Retyq 0. (0" �1 i0 l bq,3 c 038 - 1121 -40- 110:038- 1121 40-120 Parcel Identification Number (PIN) This is not homestead property - ©(1 �D (is) (is not) Exceptions to warra tights -of- -way of record, if any. Dated this day of November ­ 2003 - - - - -- .. — - -- -- - -- - -- ' Robert R. M _.. Doris A. Maitrejean AUTHENTICATION ACKNOWLEDGMENT Signature(s) Robert R. Mai trciean and Doris A. Mait rgfean, STATE OF ) hus and -- - - - -- -- -- - - --- ......._ ) ss. County ) authenticated this day of Nov ember , 2003 - - - - -- -- - -- k � _ Personally came before me this day of - -- -- -- -- the above named " Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN - - -- - -- (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 Attorne Kristine ptla nd Huds on, WI 54016 _ ­­_-1-1 _ .. ------ - - -. -- .- •._ Notary Public, State of (Signatures may be authenticated or acknowledged. Both are not necessary.) My Commission is permanent. (If not, state expiration date - - -- - - - -- _ ---- -- - - -- . _ -- -- ') " Names of persons signing in any capacity must be typed or printed below their signature. Informuion Professionals Co., Fond du Lac. W WARRANTY DEED STATE BAR OF WISCONSIN 800 -05 -2021 FORM No. 2 -1999 Il ( - AUG2 LFp 119gp,. Ca m 461603 CERTIFIED SURVEY MAP Located in part of the SE4 of the NE4 of Section 30, T31N, R18W, Town of Star Prairie, St. Croix County,, Wisconsin. LEGEND OWNER 6 County Section Monument Robert R. Maitrejean Computed Position of Section Corner Route 1 Somerset, WI 54025 0 1 x 24 Iron Pipe Set, weighing 1.68 lbs. per linear foot APPROVED AUG 21 1990 ST. CROIX COUNTY S55 043'09 "E COMPyk PARKS ' PLANNING 71.14 '' `Y' f isc,Krn.,, F �' AN D ZONING COMMITTEE ".> ;tea ,�� � �• - 0 D 9 S / o 4�1 9 b 4J • Z Note Temporary Cul —De —Sac to be 1 / v N removed upon extension of �� ; 'w 0 0 9 0 S9 N Private: Road Easement as Q; °n F c o 0 cool shown on this map. 4P� 00 4b o` tp 0 �.a .�ti �0 j O ' S ` fo ' /�j ,Q ,i `° ao a a $ - h 9 S9 a ti A�; y y N OO ° 37'35" E � ` 4 0�0 c^,° F t / , c s 66.00a SS S° �i a J °�' o y h q , W ,o u, S89 022'25 "E % °j�Ir 238 309 -, / �^7 m �., iv 16.00' 4 1 g G� `� s 0 j � 4S ® 0 9c^ S / }Q (D © �`SSo �/ NE CORNER OF Q R- . , g3� SECTION 30 5 � / 00, S 34 2 1 i&d 44.78 / \ —� N89 0 22'25 "W 'c , M b 16.00' 1 ��a.%? 5G SCALE IN FEET a - a c i d i ti 411 M N Q O 100 200 300 . 'CI gN vOj�/ N I JI Z N 89 ° 22' 25" W 1105.19' 4374.47 East- West`1 /4 line of Section 30 W W I/4 CORNER OF E 1/4 CORNER OF O SECTION 30 SECTION 30 V' o 8 U) This instrument drafted by Fran Bleskacek Pro j. No. 88 -29 SE CORNER OF VWIE 8 PAGE 2260 SECTION 30 Jessie Nye Subject: Byron, Dalton, 463032 Location: Star Prairie Start: Thu 10/28/2004 11:30 AM End: Thu 10/28/2004 12:30 PM Recurrence: (none) 038-1121-40-120 30.31.18.502A20 1956 County Road C i 1