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040-1284-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572849 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: Conway, Scott&Anjanette I Troy, Town of 040-1284-10-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 09.28.19.1605 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �Bench ark i e i2 5a o� � g,7 /43.4 C7, 3.F�3 Dosing - ` t /� Alt.BM r ! 5 /Qf'•9 Aeration J Bldg.Sewe Holding St/Ht Inlet L rytQi , St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet Septic b Z� %/ Dt Bottom 7� Dosing Header/Man. ��• S G1Z• y Aeration Dist. Pipe 1l•4 1?. 4 9L //•$ q1. 9/ Holding Bot. System /2. 1 q1,37 2. . $7 Final Grade PUMP/SIPHON INFORMATION e LJ S;r,Q Q 1-7- 7 2-52 7 Manufacturer Demand St Cove / .P,,AA GPM 17IV\ —�! Q?J•�7 �.5 /6�, q`f Model Number TDH L' Friction Loss System Head T Ft Forcemain nth Dia. o Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No.Of Trenches PIT DIMENSIONS No.Of its Inside Dia Liqu' Depth DIMENSIONS 3 ?6 Z �E__ _, �- SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEACHING Manufactuf@r: / INFORMATION Type Of System: i CHAMBER OR i4 r�t �� -7160/ / UNIT ModellSNuFm-ber: /I e /J/v S DISTRIBUTION SYSTEM 11 1Z�-ZZ �� Header/Manifold / 11 Distribution x Hole Size x Hole Spacing V Air In ke ,Z i— i 1 Pipe(s) �� �++� �- �►+� �� Length-711 Dia `'/ Length Dia Spacing ✓� d� 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 Yes 0 No Yes � No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 523 Orchard Drive Hudson,WI 54016(NW 1/4 NW 1/4 9 T28N R1 9W) Orchard,The Lot 11 Parcel No: 09.28.19.1605 1.)Alt BM Description= 5c0H C' CO`1t..— 4— eJc- Oh. 2.)Bldg sewer length -amount of cover= ' 1 - Plan revision Required? Yes 'I` r 54j ( '{ Use other side for additional information. SBD-6710(R.3/97) ep s Date Ins Sign re Cert.No. 411 J rh W(7 r H c o N y �l Q 4L la UO I'n 0 � y Dl may. O rz— i t V V) � 1 nl Q oc- cS m J i i XR - ° County Safety and Buildings Division C O 1 , 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) a My c!1 VVT 57, 7-7162 °p4s�oxeti _. J State Transaction Number c, ermit Application In accordance with S��JJ2,Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior t6,1� g a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary v Law,s.15.04 1 m Stats. purposes in accordance with the Privacy 2! ?-) o e� .A- o .P R( I. Application Information—Please Print All Inform Parcel# � a^ Property Owner's Name � „ Q, / OV bl Z g 4- o-a v o Property Location Property Owner's Mailing Address L5Z V£ Govt.Lot t0 7 City,State Zip Code Phone Number AJ W y, -AM�/,, Section / �� 1 � ^� (circle one) /V 1/� 1 l T C- a N; R _E or() II.Type of Building(check all that apply) Lot# r Subdivision Name J�,1 or 2 Family Dwelling—Number of Bedrooms r / Block# ---- Ql2 C /! f/ZD �aeR.�M� ❑Public/Commercial—Describe Use ❑ City of CSM Number ❑ Village of ❑State Owned—Describe Use = ,..F Pe O T•own of 2- .-s- CeAt W 1 2 Z 4,- Z Z-- ci% r5 III.Type of Permit: (Check only olne box on line A. Complete line B if applicable) A. ❑New System Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. ❑ Permit,Renewal ❑Permit Revision ❑ Change of Plumber ❑Permit Transfer to Ne nn Before Expiration - Owner �� 1—n A I YLIAI�elt- IV.T pe of POWTS System/Component/Device: Check all that apply) a~ kf XNon-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in,of suitable soil ❑Mound<24 in.of suitable soil P/rl> ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.DisDersaL/Treatniefit Area Information: Design Flow(gpd) Design Soil Application Rate Dispersal Area Required(sf) Dispersal �posed(s System Elevation L IoOC� (® / wj VI.Tank Info Capacity m C aci Total #of Manufacturer Gallons Gallons Units a ;? j New Tanks Existing Tanks 2 r 2 2 2 � � 2� l✓ ��3�;/t /a0 w U vs y rn w C7 a Septic or Holding Tank ��, Z �.1��1✓s�2 k Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MPA40ft Wumber Business Phone Number Z26` 7 71s -Z73 D &a NE&S I Plumber's dress(Street,City,State,Zip Code) &C Le4 Ay VIII.Coun /De artment Use Only Approved ❑� Permit Fee Date sue Issuing t Signature ❑ O eason for Denial $ J47 DL Conditjpp ieasons for Disapproval �\ ^�J I C t� r"— Y1 tank,affluient frtterand` J �/ G3 i l �icl>crsal cell must all be services/maintained aG V&p6r management plan provided by plumber. 2 ; k fegtlirements must be>maiMafned + tics bhoode'/ordinances. Attach to complete plans for the system and submit to the County only on pa er not less than 8 in z 11 inches in size SBD-6398(R. 11/11) i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: 5(f 0 C p nl WA Owner's Address: Z 3 CO 2 C(4 A V2-D PIR I(rE U-ID So.^/ W 1 SC/ C) Legal Description: Ali U) 9 9 w Township: +K 0 County: Subdivision Name: 6 0 Z-CJ+A p Lot Number: Parcel ID Number: (_)L�D ( Z a 4l Q 000 Page f Index and title Page 2. Plot Plan Page 3' S stem Sizing & Cross-Section Page 4,. OVACIC if INFiL-tAN+-0 _J' Page 5; Maintenance Information Pages 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test& House Plans Designer/Plumber: 69 N�Cf-v'J License Number: nil p z-Z b 7 Date: Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 r M + � 11a Q N H At co c•l � N v � o � rn 7 sa V i . S i ?—or 2— Family Dwelling In-ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow(DWF) _ #of bedrooms x 150 gal/day/bedroom = gal/day Design Loading Rate(DLR)or Soil Application Rate= 0-7_-gpd/ft2 (per SPS Table 383.44-1, 2,or 3) Required Distribution cell area=DWF 0 0 gal/day _DLR r Z gpd/ft2 = ft' #Chambers=Required Distribution cell area ft2 = o ft2/unit EISA = �Chambers Chamber Manufacturer and Model: N r—I L+(Z A-- d/Z 6?kL(c,(c S-+��`1 ^�d'`r"o PLti(S Actual Distribution cell area= Required cell area ft2 + ft2/unit EISA End Cap Pair ft 9 A Cross-Section In-ground Soil Absorption System (2-cell): 4"Schedule 40 PVC f�vent pipe with vent cap 12 inches minimum 12 inches minimum inches Soil Cover Trench 1 Sys- - tern Elevation Z inch Chamber Height I—ft __Ll_ft Trench 2 System l4 „� Elevation —LLft ft Trench Separation Leaching Chamber Width ---73 ft to limiting factor Plan View In-ground Soil Absorption System (2-cell): Trench 1 Modify 3 ft header/ design as ft Leaching Chambers �� needed. Trench 2 4 inch Header Sch. 3,03 IV ft with end camps Draw O for a Vent and for Observation Pipe above. They will be located _�ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. Page of x Quick4 Plus Standard Chamber Side and End Views �. 0 48" (EFFECTIVE LENGTH) 12„ e Quick4 Plus All-in-One 12 Encap Front, Side and End Views 11.2" F 13" • 8"INVERT � 8"INVER T 5.3"INVERT , 18.2" f Quick4 Plus All-in-One Periscope OUICK4 PLUS ti ALL-tN-0NE SWIVEL ERISCOP� i '. 12.7"INVERT ENDC-0NEiz � ENOCAP 5" 9" t Quick4 Plus Standard,Chamber Specifications — Size (W x L x H) ,.,,,,.,,..,. 34" x 53" x 12" (86 cm x 135 cm x 31 cm) Invert Height`..,.....,. „,,.. 0.6", 5,3", 8.0", 12,7" § Effective Length ................... ..................... .. 48" (122 cm) (1.5 cm, 8.4 cm, 18,5 cm, 22.6 cm) INFILTRATOR SYSTEMS,INC.STANDARD LIMITED WARRANTY (a)The structural integrity of each chamber,end plate,wedge and other accessory manufactured by Infiltrator("Units"),when installed and E operated in a leachfield of an onsite septic system in accordance with Infiltrator'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, ya z 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. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT k TO THE UNITS;INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c)This Limited Warranty shall be void if any part of the chamber system Is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR does not extend to incidental,consequential,special or indirect damages. InfiltrStpr shall not be liable for penalties or liquidated damages, systems inc. including loss of production and profits,labor and materials,overhead costs,or other losses or expenses incurred by the Holder or any third party. y Specifically excluded from Limited 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 minimum ground covers set forth in the Installation instructions;the placement of improper materials into the system Containing 6 Business Park Road • P.O. Box 768 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 any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475 terms set forth in this Limited Warranty.Further,in no event shall Infiltrator be responsible for any loss or damage to the Holder,the Units,or any 860.577.7000• FAX 860.577.7001 # third party resulting from installation or shipment,or from any product liability claims of Holder or any third party, For this Limited Warranty to apply,the Units must be installed in accordance with all site conditions required by stale and local codes;all other applicable laws;and Infiltrator's installation instructions. 800.221,4436 1 (d)No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the www.infiltratorsystems.com original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator'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. ". mcmmw U.S.Patents:4,759.661;5,017,041;5,156,468:5,336,017;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. infiltrator,Equalizer,Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc.Infiltrator is a registered trademark in France.Infiltrator Systems Inc. is a registered trademark in Mexico.Contour Swivel Connection is a trademark of Infiltrator Systems Inc.©2009 Infiltrator Systems Inc.Printed in U.S.A. PLUS0510101SI-2 POWTS OWNER'S MANUAL &'MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS , Owner Gp LUA Septic Tank Capacity 400-&— 1 z6v al ❑ NA Permit # Septic Tank Manufacturer W I'arSCr-t2 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units J*NA Pump Tank Capacity r a..— E2ftj_'— al K NA Estimated flow (average) 416`0 V40 gal/day Pump Tank Manufacturer LL),.c —12 ANA Design flow (peak), (Estimated x 1.5) �,pd gal/day Pump Manufacturer W ,®-NA Soil Application Rate al/da /ft2 Pump Model ,R 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 (BOD6) 6220 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 (BODE) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510`cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ys in dia. ❑NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: 13 NA i MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ month(s) every: (Maximum 3 years) 0 NA e ir(s) Pump out contents of tank(s) When combined sludge and scum equals one-third W3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) ❑ NA 3 ®❑year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: ® year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 3 IN year(s) Flush laterals and pressure test At least once eve ry: ❑ month(s) ❑ NA 3 11 year(s) ❑ month(s) Other: At least once every: ❑ ear(s) ❑ NA 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 c'pll(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 (Y3) 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) Al START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or of er chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents a 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. ABANDONMENT 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 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. 13 . 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 Name © CL SON' Name Phone S — Z 7 3 7`T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name :ro µ.vg acv' 5%4 Ari*A v -✓ Name P/07 C_ E Cc et 01?041 C&/X Zd14l fc Phone 7/5 Z 73 5-- (( Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1), (2) &(3), Wisconsin Administrative Code. Al. l.l(Vk&%_VUl14 1 1 SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer JYCO& C�. Mailing Addres !� Property Addres (Verification required from Planning&Zoning Blepartme rf` ew construction.) r City/State ��� Parcel Identification Number LEGAL DESCRIPTION Property Location Il)W '/4 , nl�n1 '/4 , Sec. ') , T z g N R I CI_W, Town of 4 jZ T Subdivision Plat: 414 ts O R L►iA A, zr , Lot#�. Certified Survey Map# ,Volume ,Page# Warranty Deed# qLoo :z (before 2007)Volume , Page# Spec house QyesMo Lot lines identifiable Plyes0no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 NU of sl*. 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating the your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form rue to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty d rd!recorded in Register of Deeds Office. Nu ber bed ms \ F . SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04112) ` State Bar of Wisconsin Form 6-2003 1111111111111111111 1 11111111 111111111111 IN SPECIAL WARRANTY DEED 111 11 914009 Document Number Document Name BETH PABST This Deed,made between Aurora Loan Services.LLC, REGISTER OF DEEDS ("Grantor,"whether one or more),and Scott Conway and Anianette ST. CROIX CO., WI Conway,*("Grantee,"whether one or more). RECEIVED FOR RECORD Grantor,for a valuable consideration,conveys to Grantee the following 03/31/2010 04:1 OPM described real estate,together with the rents,profits,fixtures and other appurtenant SPECIAL WARRANTY DEED interests,in Saint Croix County,State of Wisconsin(the"Property")(if more space EXEMPT • is needed,please attach addendum): REC FEE: 11.00 TRANS FEE: 759.00 Lot Eleven(11)PLAT OF THE ORCHARD SUBDIVISION,in the Town of PAGES: 1 Troy,St.Croix County,Wisconsin. ,J *Husband and Wife„ As Survivorship Marital A"% Property j Ptecarding Area S, Edina Realty Title t 400 South Second Street,#115 Hudson,WI 54016-1974 File# 0 Oa. 040-1284-10-000 Parcel Identification Number(?IN) This fs not homestead property Iv Grantor warrants that the title to the Property is good,indefeasible,in fee simple and free and clear of encumbrances arising by, through or under Grantor,except c Dated this y da of �y i arora 1�aa4 Services. LLC -&C, by (SEAL) by G (SEAL) f + AVIVA Sfi,VICE PRESIDENT (SEAL) Green River Capital, LC as Attorney in Fact (SEAL) AUTE ENTICATION CKNOWLEDGAIENT STATE OF U1.1 Ol�tn ) Signature(s� authenticated this day of, ��+,,�' ll )ss. n�X COUNTY) Personally came before ale this day �1 0 the above named�i i VA r�,-tAS" , yV to me Imown to be the persons)who executed the foregoing instrument TITLE:MEMBER STATE BAR OF WISCONSIN and acknowledged the same. (If not, authorized by§706.06,Wis.Stats.) I 7T11S INSTRUMENT WAS DRAFTED BY Rjian H Wolter,Esq �Q Notary Public,State of w a 1A Q S\G L O My commission isl pelmane�(If not state expiration� d t •) '3•i3 Notary Public AMY NUTTALL 1 .'.:. .� ' Q Commission(570058 09OST0237 g MY Camnuasiar Expires �cess June 3,2013 (Signatures may be authenticated or acknowledged.Both are not a11C LZ1S74RlSY�E 7 �,,tah ? NOTE:THIS IS A STANDARD FORM.ANY MODIFICATIONS TO THIS FORM SHOULD u, JJ SPECIAL WARRANTY DEED m 2003 STATE BAR OF WISCONSIN FORM NO.6-2003 Type name below signatures of 1 . ._ n cn o ■ 2 0 = ( } ID / { ) § \ 7 \ # \ J® && /^ m 9 ® co 2 « m = / e ' »> L\ i} 7\ $ 9 m a a 0 $ (\ \ c o } m m o g m 2 . \ \ / / ID L \ \ Q w� /° , \ § \ E o o E ID c = \ % C 0 \ 7 I ID m Ln « - \ § a 0 r (A m / E / § o c Z . _ M "a "a - �, 0 0 o a � I - t o , & a . § \ � C) C _ / o o 0 0 $ ƒ i [ d e Z ■ A w m % / \ / (? c ce Z / /{ ;. CD 2 } - \_ ` )® ¥» / > $ \ CL *§% Z / m / § ) k 1 / \ c 0) § 2L . EC <2\ / % E }CD . ~_(° . /_0 f =r ƒ ( \{/ t a = & CL '{ ) \ CD ° \ NJ _2 *\ / < % f / . S a \ \ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399665 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: Miller, Sam I Troy Township 040 - 1284 -10 -000 CST BM Elev: Insp. BM Elev: BM Descri0on: ,1 OD . a < M - D " 3 /ls t � = CST % .4 4 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELE7 Septic Benchmark 1 p l.v G_.S� t2S'a ( CO Dosing Alt. BM 5'r Aeration Bldg. Sewer ,5 g J Holding St/Ht Inlet St/Ht Outlet • 1. r TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I � 2 S � ! Dt Bottom Dosing Header /Man. Q.sy r 9'f qv Aeration Dist. Pipe (o. (� Holding Bot. System ��, (os , Final Grade PUMP /SIPHON INFORMATION ''� •�� 9�.2 Manufa t Demand St Cover ' 4 � Q I• f Model Num t TDH Lift F ' n Loss System Head TDH Ft rcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTE BEDITRENCH Width Len No. Of Trench e PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 / '� Z SETBACK SYSTEM TO — IP/L JBLDG IWELL LAKE /STREAM LEACHING Man aiturer INFORMATION CHAMBER OR b4l S�•r Type Of System: 4 `S I UNIT Model Number ( t ow DISTRIBUTION SYSTEM { lc.y. ✓» Header/ anifold Lk Distribution x Hole Size x Hole Spacing Vent to Air Intake /fin Pipes) . Lengt Dia Len Dia Spacing 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 Yes No Yes No COMMENTS: (Include co a discrepencies, persons present, etc.) Inspection #1� '� �� Inspection #2: �- --:- -; ocation: 523 Orchard Dr Hudson, WI 54016 (NW 1/4 NW 1/4 9 T28N R1 9W) The Orchard Lot 11 Parcel No: 09.28.19.133A 1.) Alt BM Description = Vu tbogr 2.) Bldg sewer length - amount of cover = Z`f• Plan revision Required? Yes )C No Use other side for additional information.. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Sl C R•o f Madison, Wl 53707 - 7162 Site Address iseonsin Department of Commerce Sanitary Permit A li tion - Sanitary Perms Number PP �`�` ' In accord wqh CA= 83.21, Wis. Adm. Code, pe n > °✓ ❑ Check if Revision taw be used for Pnv 5. L App Iafamndon - P 14111111 Print AB C4 w a State Pla I.D. Nu mber Property Owner's Name ` Parcel Number CS 0 - 2 $q -(o —ante Propetty �,a Address Property L.octtion e� p BDV�� N,R� E Ci4', Sty Zip Code - Lot Number / ' Block N umbe r Subdivision Name CSM Number 14 o 1 5 1 4 -3 8�, - Z 7 � 2 TO I Q W4 K Y :93 5oa IL Type of Building (sharp all that 9pp1Y) Ocity 19 or 2 Family Dwellia8 - Number or Bedrooms " / [)Village 0 Public/ - Dube Use ownshi 't rZd 0 O /1 3E - 114 - IQ<'` p .1��a p' f�stds NeanatRad T12Et�lC- rl C'S 93, 3 / "A- - �fZ11J III, Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) or Cou-ty use A 1 New 2 ❑ Beplaeement System 3 ❑ Replacement of �60 �t w spent Tank Onl B. 0 Check if Sanitary Permit PreviaWy lswed Permit Number Date Issued IV. Type of Permit: (Check all that apply)(nolnbering ache me is for internal use) 3 o - 1 O � ,b 45/g 44 Non - Ptesaurirad ID-Ground 210 Mound 47 ❑ Sam Filter 50 ❑ Constructed Wetland 22 0 Pressurind C � L 410 Holding Tank 48 ❑ Single Pass 510 Drip Line 45 ❑ At-Grade 46 0 Aerobic Treatment Unit 49 ❑ Recirculating 30 0 Other V. t Area Information: DesiSz (�) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Regired Proposed Rau( Gals. /Days/Sq.Ft.) (Min. /Inch) Elevation r .SOD S S� -qT / - //, z, — 9 2 , 0° q 7, rev 0 0 L Prefab s VI. Tank Info Capacity in Total Number Maatficturer Concrete Co tntructed Steel Giter Plastic Gallons Gallons of Tanks New Eslstina Tanks Taots r Septic Or Holding Tank I Lod 4? • TE f} VII. R bility Statement - 1, the undo � assume rapoasibility ort installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumper': Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 0 70 fir✓ tlti,�� v.OS tr1 t �. VIII. county V me partment use Onl Approved C1 Disapproved Sanitaty Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Foe) . ❑ Owner Given Initial Adverse ZzS• S Determination (• Qr of Approval/Reasons for Disapproval proval � n `✓J tt�i rJu..s7t� .---- /��7't(.�n - � .�-f 61M.t- '�t.�J/•(M�F -L AvAch eaaplete piam (to the couaty Only) for the system an roper •« lm than slR s 11 inches in du SAD -6398 (R. 05/01) -,I J r � ti Z 4 ;J w OL W c � � ,ell a� a o AM. �I N Ok � a a M I t - lop VA M � cT- O � uE- IL o Qj fn _ \ \'\ iLk m Lu i t :J r -� +� NA N y - Z6� C Q0 + J 4 QL co \ � M a � ra — (� r N ' Q I, FN, IW � Q ", 0- Q d 40 d t u►- I. V C 0 1 4 � o ry of z- m ® '-u VA 1389 Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code AC.E. Sal & Site Evaluations Attach complete site plan on paper not less, than OU 11 "es in size. Plan must County St. CfoiX include, but not limited to: vertical snd h4ontal reference point ($M), direction and Parcel I.D. percent slope, scale a dimemsions;fiortlr arrow, and locatim od dhonce to nearest road. 040 - 1039 -70, 1D#9.28.19.133A P/ease all iqftO tlon BY Date Personal imormation you pro may me used er1 (dW jL* s. 15.04 (1) (m)). I 2� Property Owner Property Location Miller, Sam `� r �� ;Govt. Lot NW 1/4 NW 1/4 S 9 T 28 N R 19 W Property Owner's Mailing Address ��`�� ��, �� �� -� l Lot # Block # Subd. Name or CSM0 P.O. Box 151 , 11 Plat Of Miller's Orchard City State 'zp.Code Nun$lser eJ City J Udlage Y Town Nearest Road Hudson WI " 54b16 ; (7 "G5� 769 Troy I Orchard Drive New Construction Use: a Residential / Number of bedrooms 4 Code derived design flaw rate 600 GPD J Replacement - J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Recommend installing 2 trenches at 3' x 90.625', using 29 high capacity BioDiffuser infiltrator chambers at system elev. = 92.00'. 1 Baring # Boring om Pit Ground Surface elev. 98.01 ft. Depth to limiting factor — > 131 in. Sod Appicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe *Eff#1 *E 1 0 -9 1Oyr3/2 no sl 2f sbk mvfr as 2f 0.5 0.9 2 9 -19 1 Oyr4/3 none sil 2fsb mfr cs 1 f,vf 0.5 0.8 3 19 -26 1Oyr4/4 none sl 2msbk mfr as 1vf 0.5 0.9 4 26 -31 7.5yr4/6 none Is O s g ml cs - 0.7 1.2 5 31 -59 10yr5/6 none s Osg ml gs - 0.7 1.2 6 59 -131 1Oyr5/4 none s Osg M l - - 0.7 1.2 Boring # I Boring Im Pit Gnwnd Surface elev. 98.14 ft. Depth to limiting factor >135" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G *Eff#1 1 0 -7 1 Oyr312 none gr. sl 2fsbk mvfr as 2f 0.5 0.9 2 7 -14 1 Oyr4/3 none I 1 ms bk mvfr cs 1 f 0.7 1.2 3 14 -20 1Oyr4/4 none s Osg ml gs - 0.7 1.2 4 20 -52 1Oyr5 /6 none s Osg mi gs - 0.7 1.2 I 5 52 -95 10yr5/4 - -_- none - -- -- s - -- - -_Osg T_ ml gs - 0.7 1.2 - k l 6 95 -135 1 /4 none s Osg — ml - 0.7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 4160 mg/L BOD <30 mg/L and TSS <-0 mg/L CST Name Please Print Signstu CST Number James K. Thompson s 3602 Address AC.E. Sal & Site Evaluations Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 4/23/01 715- 248 -7767 1 1389 Phoperty ownsr Miller, Sam Parcel ID # 040- 1 -70, YD #9.28.19.133A Page 2 of 3 D factor > 127 Boom 96.23 , # � Boring n in. R Bori Pit Ground Surface elev. ft. Depth to limfing Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'EH#1 'Eff#2 1 0 - 18 1Oyr3/2 none sil 2 f s bk mvfr as 2f 0.5 0.8 2 18 -30 1 Oyr3/3 none sil 2fsbk mfr Cs 1 f,vf 0.5 0.8 3 30 -37 1Oyr4/6 none sl 2msbk mfr as 1vf 0.5 0.9 4 3747 7.5yr4/6 none Is Osg ml Cs - 0.7 1.2 5 47 -74 1Oyr5/6 none s Osg ml gs - 0.7 1.2 / 6 74 -127 1Oyr5 /4 none s Osg M - - 0.7 1.2 50 *46 - - 4] Boring # - j Borin _ n Pit Ground Surface elev. 96.40 R. Depth to limiting factor > 120 in. Sal Appian Rate Horizon Depth Dominant Cola Redox Desdiption Texture Structure Consistence Boundary Roots *Eff#1 'Eff#2 1 0-8 1Oyr3/2 none gr. sl 2fsbk mvfr as 2f 0.5 0.9 2 8 -16 1Oyr413 none Is lmsbk mvfr Cs 1f 0.7 1.2 3 16 -27 1Oyr4 /4 none s Osg ml gs - 0.7 1.2 4 27-62 1Oyr5 /6 none s O ml gs - 0.7 1.2 5 62 -90 1Oyr5 /4 none s Osg ml gs - 0.7 1.2 TA 6 90 -120 1Oyr6 /4 none s _ Osg ml - - 0.7 1.2 F61 Boring # Baring !M Pit Ground Surface slap. 96.25 ft. Depth to limiting factor > 124" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIr 'Eff#1 *Eff#2 1 0 -10 1Oyr3/2 none sil 2fsbk mvfr as 2f 0.5 0.8 2 10 -18 1Oyr4/4 none sil 2fsbk mfr as 1f,vf 0.5 0.8 3 18 -24 7.5yr4/6 none gr.Is 2msbk mfr cw - 0.5 0.9 4 24 -55 1Oyr5 /6 none s O ml Cs - 0.7 1.2 5 55 -73 1Oyr5 /4 none s Osg ml gs - 0.7 1.2 6 73 -124 1 Oyr6 /4 none s Osg M 1 - - 0.7 1.2 Horizon #3 contains 10% cxbbles. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mglL 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. /o z �� /Yf,� /c r :S Q�claa�; ■ ,�,�� �1,se r ✓a�or� sec, 9, T, aF •GoiX cv /. � �$ 63 Bq ■ ■ • L IZ %.0 14 Jg. o o f 8 • r2bar. E /ee = 97.73. 980` �d0.0 K Be n6) rytare To o f 3 /8 " /r.ba�l AsrctmQd eIev = .10o.cn: 502. & ,/ ' Co. Hwy FF 1�er /389 I 5 e c An Bi m o D i fff user S 76" 00 00 00 00 00 00 00 00 00 DO 00 OD OO Oa Chamber �� DO OD DO DD o0 00 00 0o Height OO OO OD O( OD DO 4 � OO CJ � DD DO O oo Ol DO C;QI OO � l � O DO Ol OO Ol 00 !=]O OO l�O AN three l3ioWuser sizes can withstand H - 10.loadS when in4WW with Rr+4Wy W*ded Chamber and soils. A. MW- Height d vovor is A l p1es: The End View 14 IN001itfuNr is for H -2A loads. of 18' of cover is 34" req*ed ;f9r, K -20 loads. 4" Knockout i Universal End Cap Available Sizes Dimens ; ions ' Length 76" 76" 76" Width 34" 34" 34 Height 11" 14" 16" `/ Invert 6.S 9 11.3 10 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 6 Number of Bedrooms Design Flow - Peak (gpd) Cpo 0 Estimated Flow - Average (gpd) o Septic Tank Capacity (gal) z. S0 Soil Absorption Component Size (ft') . z Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) (" ( <7) Maximum Influent Particle Size (in) Sorb 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 Inspect 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 service septic tanks 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 se and outlet filter shall be assessed at least K � once every 3 years by inspection. TIO outlet filte shall be cleaned as nec essary 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 r Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inchesJn diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 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. 7ti Z, 2_ his — 3 VG, g (c,'f Z G/� X Ca Lt. �y ZO fl 7 i 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION 0ORM Owner/Buyer S rY1 �� I L G IF7 rt_,._ Mailing Address �� �" —z-. Address � /) �n b Property y _ _ (Verification required from Planning Department for new construction) j`� " Ct �,� O Parcel Identification Number ty/st� �-� s =fit wL D SCRI ON pro Location ' /4..L�_ '/•, Sec.L, T N_It r W - own of PAY Subdivision - ©lZ- ' . Lot # (L_. Cerdtied Survey Map # �n 3 �� . Volume Page # 5 Warranty Deed # 3 Volume / : E - s" � . Page # 2 - ' Spec house A yes ❑ no Lot lines identifiable Yyes ❑ no By= M&MMANCE Impooper use and maintenanceof your septic system could result is its prema failure to handl at you Pu P consists of pumping out the septic tank every three Yew's or sooner, if needed by a licensed Pumpe can affect the function of the septic tank as a treatment stage in the waste disposal system. The PmperiY mner aim m. to submit to St. Croix Zoning Department a certification for signed by the owner and by • p that ( 1 ) the on -site wsstearaterdispoml tysteSystem ranterplumber, journeyman plumber, restricted plumber or a licensed pumper the tic tank is less than 1/3 !1111 of sludge. is in proper operating condition and/or (2) after inspection and pumping (if necessary), sep Lwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standatds set forth, herein, as set by *e Department of Commerce and the Department of Natural Resources, State of Wisconsin• iCenift� ou stating that your septic system has been maintained must be completed and returned to* the St. Croix County Zoning ; da the date. a DATE A APPLICANT ATION i; i we cer* that all statements on this form are true to the beat of my (our) knowledge. I (we) am (are) the l dwner(s) of .de bove b virtue of a warranty deed recorded in Register of Deeds Office. i • DATE A F CANT 00.000 Amy information,that is mia-represented may result in the sanitary permit being revoked by the Zoning Department. 0000•. •• Iaelude with this application: a copy o warranty deed from f certified survey map Re r i ference is made in the warranty deed r ` STATE BAR OF WISCONSIN FORM 7 - 1998 632796 TRUSTEE'S DEED KATHLEEN H. WALSH Doc~ Nurnow V 1555 PAGE 323 ST. CROIXOCO., WI DANIEL S. SOLBERG AND KARLA J. SOLBERG RECEIVED FOR RECORD 11 -01 -12000 11:30 AM TRUSTEES DEED as Trustee of EXEMPT 1 DANIEL S. SOLBERG AND KARLA J. SOLBERG REVOCABLE CERT COPY FEE: TR UST - DATED APRIL 26, 2000 - COPY FEE: TRANSFER FEE: 28!0.30 RECORDING FEE: 10.00 for a valuable consideration conveys without warrant to PAGES: 1 SAM E. MILLER, A SINGLE PERSON ntK(X" Area Grantee. _ .._. the following described foal estate In ST . County. 'Nwm and Rie"'n Add'e" State of Wisconsin: SAM MILLER j PART OF -THE NWk OF THE NWk AND THE Salk OF THE NWk AND THE HUDSON, WI NEk OF THE Ntibt; AND THE NWk OF THE NEIL AND THE NA OF THE SWIG OF SECTION 9, TOWNSHIP 28 NORTH, RANGE 19 WEST, TOWN OF TROY, ST. CROIR COUNTY WISCONSIN AND MORE PARTICULARLY .- - :._:- ___..:--- DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF 040 - 1038 -60 040- 1039 -60 -000 SAID SECTION 9, THENCE S00'5O'54 4 'E ALONG THE WEST LINE OF 040 - 1039 -7n -non SAIDNWk 2626.30 FEET TO THE WEST QUARTER CORNER OF SAID Poem Identdcal" Nwrow Ip" SECTION 9; THENCE S00'45'32 "E ALONG THE WEST LINE Salk OF SAID SECTION 9 150.31 FEET: THENCE S56'24 "E 70.00 FEET: THENCE N59 ° 15 1 17 "E 850.85 FEET THENfj ON AN ARC OF A CURVE TO THE RIGHT 102.10 FEET AND WHOSE RADIUS IS 403.00 FEET AND CHOEARS N07'32 "W 101.78'FEET; THENCE N00'21'49 "E 569.05 FEET; THENCE S88 0 45'38 "W 250. k FEET; THENCE N00'50'54 "W 350.92FEET; THENCE S88 ° 57'07 "W 512.29 FEET; THENCE N00 100.00 FEET; THENCE N88 "E 250.31 FEET; THENCE NO3 ° 10'51 "E 202.31 FEET; THENCE N32'19'49 "W 95.25 FEET; THENCE NO2 ° 24'54 "E 136.96 FEET; THENCE S87 °34'25 "E 198.63 FEET; THENCE SO1 ° 54'33 "W 149.41 FEET; THENCE N89 ° 46'50 "E 148.76 FEET; THENCE S2 °27 11 W 256.95 FEET; THENCE N88 ° 57'07 "E 1065.55 FEET; THENCE N89 ° 12'30 "E 325.61 FEET; THENCE S00 ° 47'30 "E 10.00 FEET; THENCE N89 "E 554.46 FEET; THENCE NO1 ° 23'32 "t 587.22 FEET; THENCE N55 "E 651.90 FEET; THENCE N38 ° 09'35 "W 413.25 FEET; THENCE S89p31'02 "W 142.03 FEET TO THE NORTH QUARTER CORNER OF SAID SECTION 9; THENCE S89 ° 12'35 "W ALONG THE NORTH LINE OF THE NWk OF SAID SECTION 9, 2666.45 FEET TO THE POINT OF BEGINNING, SAID PARCEL CONTAINS 96.52 ACRES AND IS SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. Dated this day of OCTOBER 200 (SEAL) yi+ X low ,�ln (SEAL) DANIEL S. SOLDER KARLA J. SOLBERG Trion Tmstee AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, V ss. Count. P Ily came before me this day of authenticated this day of �+ the above named TITLE MEMBER STATE BAR OF WISCONSIN V U to (If not, me known to be the person L who executed the foregoing authorized by 5706.06, Wis. Stets.) I strument and acknowledge the e THIS INSTRUMENT WAS DRAFTED BY j C� orary H EYWOOD6 CARI. S.C. 204 LOCUST STR . T Strafe f Wisconsi HUDSON, WI 54016 Notary Public. State of Wisconsin My commission Is permanent. (If not. state expiration date. (Signatures may be authenticated or acknowledged. Both are not necessary) • r:,m., of ponoro stptmB to ,n C q-.ty mW W typal or PMtW Wt Uur vs-tun ........ STATE BAR OF WISCONSIN WVCW% - 1.0981 Sant. Co. brat TRU:TEE'S GEED FORM No 7 - 1998 M"Sam Wn NIQNWAY SETBACK THE ORCHARD, AS PER WISCONSIN ADMINISTRATIVE CODE TRANS 233 NO IMPROVEMENTS OR STRUCTURES ARE ALLOWED BETWEEN THE RIGHT -OF -WAY AND THE SETBACK LOCATED tN PART OF THE NORTHWEST 1/4 OF UNE IMPROVEMENTS INCLUDE BUT ARE NOT LIMITED TO SIGNS, PARKING LOTS, PART THE SURVEY 1/4 MAP REC EC THE NOR C 5 ERTIFIED D S SURVEY PARALLEL DRIVEWAYS. WELLS, SEPTIC SYSTEMS, DRAINAGE FACILITIES, ETC.. R ORDED IN PART C OF THE NORTHWEST 1/4 OF THE SOU BEING EXPRESSLY INTENDED THAT THESE RESTRICTIONS SHALL CONSTITUTE A 5 OF CERTIFIED SURVEY MAP RECORDED IN RESTRICTION FOR THE BENEFIT OF THE PUBLIC ACCORDING TO SECTION 236.293, PART OF THE NORTHEAST 1/4 OF THE NOR - WISCONSIN STATUTES AND SHALL BE ENFORCEABLE BY THE DEPARTMENT OF THE NORTHWEST 1/4 OF THE NORTHEAST 1 TRANSPORTATION. CONTACT THE WISCONSIN DEPARTMENT OF TRANSPORTATION NORTH, RANGE 19 WEST, TOWN OF TROY, S DISTRICT OFFICE FOR INFORMATION. THE PHONE NUMBER MAYBE OBTAINED BY CONTACTING YOUR COUNTY HIGHWAY DEPARTMENT. i I I I I SR GZS I FOUND 3' ALIMINUM ' MONUMENT NORTHWEST CORNER SECTION 9 I SMP I NORTH LINE NW 11/4 SECTION 9 2666.{15' 589'12'35 "W 252.60 287.60 as 316.45 x,.i ,s,.ts A .aa' E PIXIO NNE 054.20' N '41 E N 017!'11• E / a M — N - LOT 28 LOT 0 1 9 516-24 1 42: 1 " l LOT 32 OT 31 3 N artotr E 14513 Sq. Ft. CSM_LOT 3 I /'N VOL_ 9 PAGE 2603 , / 109052 Sq. Ft. ' 'L^ 2.63 Ac. 2.50 Ac. 1= N.B. 1.98 AC. N.B. 2.06 AC. 1 l N.B. 86124 sq. , N.B. 89629 sq. f \ / N 119902 Sq. Ft. + / / y c I 2.75 Ac. / g 109 -- - - -- N.B. 2.41 AC. 2.51 AC. t t,i I/ N.B. 105181 sq. ft. N.B. 2.33 AC. o �r w N.B. 101345 sq, fl. / \ / 170_12'- - — _86.71' _ LOT ,9O / tnN oFUT RO A I 895953'W ®� �\` �\ , ® OED"M pukc M� 066' EASEMENT 893953' /' Z e•as' _ a 109035 Sq. Ft. S 7e 2 ' t�O N — — 169.14 292.02' — / / \ \ \ 2.50 AC. 42 E N.B. 2.50 AC. / LOT 26 -, N �� *\ B� N.B. 109035 sq. ft. ryry j. TEMPORARY CUL -DE -SAC 117229 S q Ft. EASEMENT (REMOVE UPON LOT 9 2.69 Ac. s �\ ' `� / y s t / .� I WESTERLY EXTENSION OF o 10968 Sq. Ft. o , ROAD) i., N.B. 2.57 AC. • ,�' / �• 4r• n• Z a � I N.B. 111750 sq. ft. ��.!*,� � 'b /� � �52 AC. c to ` / a� i \ Qi. `� 4 N.B. 2.36 AC. �I.OT 10 �• N.B. 102923 sq. 1t. yam. � z �i 22 - z ? N — —112 7 Sq. Ft. F �c - - - - -- – - -- – 4 7P". 2. 9 Ac. ® ., s8 , - -- 0 r J W \ \� ��� �--- -- - - -M — W \ 19$.63' N.B. X 1��59 AC. Z w S87'34'25 "E B. 1127`47 sq. ft. rn' DEEDED BY 1 149.41 S01 '$4'33 N (6N AFFIDAVIT L / N� LOT 11 LOT 81 "' IV c� ^ z 160 u \ 171954 Sq. Ft. 0 1C u 11626 Sq. Fit. --- 3.95 Ac. a ^! I 2.56 Ac. 148.76' N89'46'50 "E — 3.9 — CSM VOL_5 3 N.B. 5 AC. Z c_o N.B. 171954 sq. fl. - J ° NJ PAG 1300 [95.25 N32'19'4 "W N.B. 2.56 AC. O N.B. 111626 s ft. z H z M � p to 502.64' _ _ - - _- (V - - -- — _ — — -- – – – – – – - - -- — — — — — — 1066 250.31' N88'57'07 "E _ 100.00' N00'50'54 "W – – – —� R.A. 512.30' N88'45'38'E _ COUNTY HIGHWAY FF - 7 512.29' 588'57'07 "W — - - — — — — _� — — — — — I F — — — — — — — — — — — — ------- - - - - -- ------- - - - - - 235.64' 276.65' + UATrw I INF T