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Home My WebLink About042-1005-30-400 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479492 .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: Linder, Lee I Warren, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: co .0 1cv -0 + = CST-8 M 03.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark + 2.1o0 �.2 �,zS a), 4D Dosing Alt. BM Z p 04. Aeration Bldg. Sewer 9"y ' 0.11 ' I Holding St/Ht Inlet q. I 9 �•.s TANK SETBACK INFORMATION St/HtOutlet 1 33 V -39 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > �5 / CD ( (O:t + _� Dt Bottom Dosing Header /Man. Aeration \ Dist. Pipe (0. p, 1 b 1 Holding Bot, System 1 `• `� ' `,' D . I b Final Grade / - PUMP /SIPHON INFORMATION ( Manufacturer Demand St Cover /I GPM Model Number TDH Lift rich Loss System Head TD Ft Forcemain Length Dist. to well SOIL ABSORPTION SYSTEM 2 ben WBtfRtNCHJ Width Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME 3 � R4• SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufactur r: INFORMATION CHAMBER OR Type Of System: + _ _ UNIT Model Number DISTRIBUTION SYSTEM Header/ ani Id Distribution x Hole Size x Hole Spacing Vent to Air Intake 1 ^ P e(s) + Length Dia Len Dia Spacing SOIL ER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of j 7reeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes [� No 1 1 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: f\j,,9/jL__y .S Inspection #2: Location: 1207 113th Avenue Roberts, WI 54023 (NW 1/4 SW 1/4 3 T29N RI 8W) NA Lot 4 ) Parcel No: 03.29.18. 1.) Alt BM Description = `^^ % 6J-'�j °"#.- � ( �7" 2.) Bldg sewer length = 1 Hs._ � gth,i , - amount of cover = y.Z, 4-- 3) P-- PL szs Plan revision Required? -1 Yes No A J am• ?� -{-4- z Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) Safety and Buiidi ivisi County 201 W. Washington Ave., x 71 c ' I COI ��II � M adison, WI 7-7 Sanitary Permit Number (to be filled in by CO (608) 266 -3 1 7 1 Department of Commerce - State plan I,D. Number Sanitary Permit Application ,� f In uccord with Comet 83.21, Wis. Adm. Code, porson int'on ED may be utwd for secondary purlx>sos Privacy 1w, s 190M��1 li G ``' I'n�ucl Ad�1aw (itdi�ntMien mailing addtrosf) 1. Application information- Please Print All Information F 1 ? ?00 Parcel # t # Block Property O ier's Nam ST. CROIX COUNTY ZONING OFFICE Property Owner' Mailing Address r perty Location V., = �14LV" Section City, S e Zip Code Phone Number T � N R (Circl ) IL Type of Building (check all that apply) 3 Sabd+visitnrl<fiHtto CSI Number_ �1 or 2 Family Dwelling - Number of Bedrooms _ t �'� ❑ Public /Commercial - Describe Use ❑City ❑yillage,E!To ip of ❑ State Owned Describe Use Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ij New System ❑ ( Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System --- ---. -- List !'rovious I'tmttit Number and Dah: Issual i li. U Permit Kcncwui U of I'ennit it U Change I] I'crmit "Transfer to New Before Expiration Plumber Owner IV, T e of POWTS System; Check all that app Nor - preac�rizd Ln -Groun ❑ Mound >- 24 in, of suitable soil [I Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank C3 Peat Filter ❑ Aerobic Treatment Unit 11 Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber rip ravel -less ❑ explain) V. Dis ersaUTreatment Area Information: Dispersal Area Pro osed s � S stem Elevation Design Flow Dis (gpd) Design Soil Application Rate(gpdsf) ispersal Area Req (sf) P P Y capacity in Total Number n Manufacturer Prefab Site $ 1 Fiber Plastic I. T Vank laic aP tY Concrete .Constructed Glass Gallons Gallons of Units Now Existing Tanks Tanks Septic or Holding Tank G ' Aerobic Treatment Unit Dosing Chamber I L � o ibili Statement- 1, the uodenigncd, aas a res osibility for instal tion of the POWTS shown on the atiscbed Plans VII. Res I'!uPlum Sig MP/MPR$ Number Busitta s Wlorle Number Ili Statc, Zip ode) Z' n VI oun /De artment Use Onl Sanitary Permit Feo mcludrs Groundwater Date slued las ' g Signature Pa) Approved ❑ Disapproved Sure arge Fee) ❑ Ow ner Given Reason for Denial IX Conditions of Approval/Reasons for Jisapproval TEM OWNER: 1 Ic ank, effluent filter and S Qom- e,0 dispersal cell must all be serviced / maintained �y�� 7 C� as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. r S) $ "1 Attach complete plans (to the County o nly) for t he system �apewtot Wan S112:1 in a in SBD -6398 (R. 01/03) w -3 09,7 , kNI-w VIP hL A W at o w , c E N f R IT .t. Il k L f • p.7►. t 309.7.E o co 0 1 i c Z R. C 1J 1f RECEIVE Wisconsin Department of CoLerc�e IL EVALUA TION REPORT Page L of Division of Safety and BuildinNO V 3 20 in accordancmm 85, Wis. Adm. Code T I Attach complete site plan o County hes in size. Plan must s include, but not limited to: v F nt (BM), direction and Parcel I.D. /� %" - yI ZC�✓ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Re ie wed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 114 1/4 S _2 T N R E (or) Property Owner's Mailing Add ess Lot # Block # Subd. Name or CSM# t� - - I� . City State Zip Code Phone Number ❑ City ❑ Village Town N #rest Road ILA L (� New Construction User Residential / Number of bedrooms _� Code derived design flow rate 1� GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Q Z Flood Plain elevation if applicable General comments and recommendations: ��n•�c'� -,e��, Js �� _ — Slo1� F 71 Boring # [] Boring Tull Pit Ground surface elev. 1_5' ft. Depth to limiting factor Z ; & in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -R -,f& 4114 91 96 �6V 6 o" 7�F ❑ Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor 2 K in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 f 7 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Oluent #2 = BOP, < 30 mg /L and TSS < 30 mg /L CST Name (Pleas rint) Signature /y CST Number Address Date Evaluation , a nd - - a ed Telephone Number SBD -8330 (P,07/00) Property Owner � Parcel ID # Page of 51 ❑ B oring Boring # �, Pit Ground surface elev. ft. Depth to limiting factor 9� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 J _> , 1 44 S 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F1 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 * 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 \ �,- I'd rp r ! t a � AL N w p. y n rr 0 a .� o co . 14 i� f y y i 1 a w J • t O Q 09/20/2005 09:08 FAX 1 715 247 3038 BELISLE EXCAVATING x001 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing; Address _ _ , 07. , / T , "I�j Property Address 11 3 411 ( Verification required from Planning & 'Zoning Department for new t;wlstruction.) City /Slate - /� l Parcel Identification Number LEGAL DESCRIPTION Property Location _ :4 ,Sec. , T _N R W, Town ul' Subdivision _� , Lot #. Certified Survey Map #s Volume hake # Warranty Deed # ��/� � n._. Voluntc. Spec house sus no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and uzaitiummtcc of your septic system could result in its premature failure tv handle wastes. Proper maintenance consists of JAIMping out the septic tank every three years or sooner, if needed, by a liL;ennsed 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 subtrur to St, Croix County Planting & Zoning Dep arttnt;nt a certification form, signed by the owner and by a master plumber, jomneyntan, plumber, restricted plumber or a licensed pumper vorifyirtg that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and purnping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fortt4 herein, as set by the Departmwnt of Commerce and the Department of Natural Ausources, State of Wisconsin. Cer6ficatwn stating that yuur Septic system ltas been Maintained must be completed and relurned to the tit. (,ruix County Planning & Zonirtg DvI a lmu nt wilhnt W days ul'the tlurc year exhirauuu date. 1 /we certify that all statrrrients on this form are true. to the best of my /our knowledge, lint'!.• widure tliu owner(s) of the property described above., by virtue ofa warranty deed recorded in Register of Deeds Office. Number f beds nis < rf LgfCYN ATURE 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 applicatibn a recorded warranty deed frorn the Register of Deeds Office and a copy of the certified stuvey map if reference is made in the warranty deed. (REV, 08/05) 09/20/2005 TUE 9:01 FAX 2 001 /001 09/20 /2005 09:08 FAX 1 715 247 3038 BELISLE EXCAVATING 11001 ST. CROIX COUN SEPTIC TANK M,A,JNTENA.NCE AGREEMENT' AND OWNERSHIP CERTIFICATION .FORM: Owner /Buyer Mailing Address Property Address � ( Verification requtrcd front Plt aaLMinb Zoning Department for new construction.) City /State �� Parcel Identification Number LEGAL DESCRIPTION Property Loe�tion,/ _ �� , ;q , Sec. 3 , TN R�_W, '1'orvn ul' Subdivision _�5�, Lbt #, Certilietl Survey Mop , Volume / l ago # Warranty Deed # Volume 1 1':lbc: Spec house yos ( n)lp Lot limes idutitiflablu yes Ito SYSTEM MAIMMN <VQC AND ONM t CLPRTIFICATIQN linproper use and UvAint.uru icc O f yUllr sopdt: system could result i its prenunture thilure it) lutndte wastes. Proper maintenunce consists of pumping out the vcptic lack every three years or sooner, if heeded, by a licuttsed pumper. What you put into the system can affect the Function of the, septic tank as a tr s taga 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 subrytit to St, Croix County Pla,rra iag & &W ag Departinsanl a certification form, signed by the owner and by a master plumber, jowmeymatt plumber, restricted plumber or a licensed pumper voril'yiug that (1) the on -site wastewater disposal system is in proper operisutg condition and/or (2) after inspection and purnping (ifucccsz.try), the septic tank is les than 113 full of sludge. Uwe, the undersigned have read the above requirCmcnt% and agree to maintain the private sewagu disposal gygtam with the standards set fortis, hereut, as set by the llepariment of Commerce and the Department of Natural Itusourcus, State of Wisconsin. Certification statilig tllal yuut',eptic syslum bas been maititaintA must be completed and returned tt) ilia tit. ( ;wix County Planning & Y.onnib Dvpar tntcett witltui io days or div tltt•ro your uAlliniltuu klate. liwe certify t till sluloments an this 1'cum are true: to Lhu bust of my /our knowludl,e, l /w: um /are Wo owner(s) ofthe property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ;Z LOGN ATURE l' bedr rrts 9 /i9 /Os OF APPLIC'ANT(S) DATE * * *Atty inrr rmation that is rtiisrcpresented u a.y result in the sanitary permit being revoked by the J'lwiniug & Zoning bepattment. include with this applicatibn a recorded warranty deed from the Register of Deeds Office and a copy of the Certified Pavey nup if reference is made in the warranty decd. (REV, 08/05) Parcel #: 042 - 1005 -30 -000 09/22/2005 03:20 PM PAGE 1 OF 1 Alt. Parcel #: 03.29.18.42A 042 - TOWN OF WARREN Current ,X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - MIDWEST EQUITIES LLC MIDWEST EQUITIES LLC 990 HILLCREST STE 110 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 36.000 Plat: N/A -NOT AVAILABLE SEC 3 T29N R18W NW SW EXC PT TO GOVMT & Block/Condo Bldg: INC N 50FT SW SW EZ -U- 1510/095 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 03- 29N -18W NW SW Notes: Parcel History: Date Doc # Vol /Page Type 03/22/2005 790139 2768/580 QC 01/15/2004 751756 2492/462 LC 07/23/1997 1215/511 PR 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/28/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 34.000 4,700 0 4,700 NO UNDEVELOPED G5 1.000 100 0 100 NO PRODUCTIVE FORST LANC G6 1.000 3,000 0 3,000 NO Totals for 2005: General Property 36.000 7,800 0 7,800 Woodland 0.000 0 0 Totals for 2004: General Property 36.000 7,800 0 7,800 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _Z_ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ Ni- Per mit # v Septic Tank Manufacturer _❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA. Number of Bedrooms ❑ NA Effluent Filter Mod � ❑ NA Number of Public Facility Units NA Pump Tank Capacity al N/ Estimated flow (average) g al/day Pump Tank Manufacturer �'NA Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer -M Pump Soil Application Rate oal /day /W Pump Model 1 A Standard Influent /Effluent Quality Monthly average' Pretreatment Unit ANA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gr.vul Filtor (J I'oat Filter Biochemical Oxygen Demand (BOD,) 6220 mg /L U NA ❑ Mechanical Amatiun 0 Wutland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) T - -- 0 NA Biochemical Oxygen Demand (BOD 530 mg /L -Olin- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L 5 NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <_10' cfu /100ml ❑ Drip -Line Cl 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: 13 monthlsl ears) (Maximum i3 years)' ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volTe ❑ NA Inspect dispersal cell(s) At least onto every: ❑ month(,') (Maximum 3 years) ❑ NA ,5 ji f yuar(s) - Clean effluent filter l f t leastorice.every: ❑ monthlsl ❑ NA S /V "_' Ste' `&V � �� ,,, • ❑ monthlsl � NA d;t ,:.:� ` Inspect pump, pump controls & alarm i At least once every: 1:1 ream ) Flush laterals and pressure test At least once every: 13 month(s) ,Q NA _ ❑ year(s) Other. ❑ month(s) ' =p NA At least once every: ❑ 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 'sny 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 trre 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. 'rt' When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank the entire contents of the tank shall be removed by a Septage Servicing Operator, and disposed of In accordance with ohepter NR - 113, Wisconsin Administrative Code. Ali other services inciucing out not limited to the servicing or a fluent filters, mechanical ur pressurized components, pretreatment unitk, ano any servicing Ott iwtervais of !0 ;e onuntns, snarl ce ai;;qotnied by a certified POVV'rS Maintainer, A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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 high" ater levels. When power is restored the excess wastewater will h discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge u effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorir,,; power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t , 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 an 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 th POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fa-,: foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; o painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of sixvice 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 complian . replacement system: IXl 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 wil 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 area: pon failure of the POWTS a soil and sit, evaluati available a holding tam may be installed as a last resor a failed POWTS. • Mound and at -grade absorption systems may be reconstructed in place following removal of the biomat at th, 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 NO "i ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF t . PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL 9R,/ POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LUCAL REGULATORY AUTHORITY Name Name ' Phone Phone s This document was drafted in compliance with chapter Comm 83,22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. 8120 S-e+�4 " 8 8 1 P 5 1 3 KATHLEEN H. WALSH STATE BAR O I W CONSIN FORM 1 – 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO.. MI RECEIVED FOR RECORD Document Number 09/06/2005 08:06AN This Deed, made between Midwest E uities LLC. a Wisconsin LLC., WARRANTY DEED Grantor, and Lee A. Linder t1� and Jami L. EXEMPT # Brown )O I S Grantee. Grantor, fdr a valuab a consideration conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix County State of TRANS FEE: 269.70 COPY FEE: Wisconsin (the "Property "): CC FEE: PAGES: I Recording Area Na and Return Address � s � ® arcel Identification Number (PIN) This is not homestead property. (Is) (is not) Lot 4 of Certified Survey Map filed January 26, 2005 in Volume 19, Page 4918 as Document No. 785901. Located in part of the NW % of the SW '/A and part of the SW ` /A of the SW I /. of Section 3, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 2nd day of September 2005 (SEAL) (SEAL) l<k E l �a w k, tv5 , � Ares lay -,�" Midwest Equities, LLC., a Wisconsin LLC. (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, - Wr=f in( SWATZ ) ss. authenticat�Ts gaYPLIC St.CroixCounty STATE OF t.". P S _' C Personally came before me this 2nd day of Sep ember, 2005 the above named of Midwest Eauities. LLC.. a * Wisconsin LLC. to me known to be the person who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoi instru a and acknowledge the (If not, same. 'E` fls Yr�`� authorized by §706.06, Wis. Stats) THIS INSTRUMENT'WAS DRAFTED BY W e W O` -L fx — Coldwell Banker BurneVRobert Nicholson Notary Public, Stath of Wisconsin 1301 Coulee Road Hudson, WI 54016 My commission is permanent. (If not, state expiration date: 5 -45760 (Signatures may be authenticated or acknowledged. 1 Both are not necessary.) Names of persons signing in any ca2acity must be typed or printed below their si nature. - 76S9Q11 VOL - 19EL�PAGE 4918 REGISTER OF DEEDS ST. CROIK CO. MI RECEIVED FOR RECORD 61/26/2005 04:00PN CERTIFIED SURVEY MAP COPY FEE" PAGES: 3 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST 1/4 OF THE SOUTHWEST 1/4 AND PART OF THE SOUTHWEST 1/4 OF THE SOUTHWEST 1/4 OF SECTION 3, TOWNSHIP 29 NORTH. RANGE 18 WEST. TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. -- N 89'15'10" E 5282.28' -- / W 1/4 COR. SEC. 3 EAST -WEST 1(4 LINE / - - -- 1318.84 - -- - - -- — 5;P963.44' C 1/4 i I UNPLATTED LANDS COR. 3 — — — — — / N 89'31'44" E I w i N 89'04'31" E 247.90' , ^� 242.84' : 1 xh 4Y - a0 I I • �" S s9y oso `1M a NQ I 1419.83' W cat ,`�, LOT 2 �. crj .n C) 400515 S.F. - p LOT 1 a co 80' TEMPORARY 919 Ac ,- w 322253 S.F. CUL -DE -SAC 'i N Z EA TO BE I 7.40 Ac. REMOVED UPON - i"" uj O I i �� EASTERLY EXTENSION ,, �' t` ^� w OF ROADWAY. 0 4 E ' i ai �o Z_ i W � nZ 1�58O9 J4 uj L 8 I I / / ' T O� ' " S '1 32'- 0 L '' ! _ - _ 1 . L6 v' uj * 363659 S.F. a ^p a _L1 0 ��® �� 8.35 Ac w 4 I I L2 i' ® N .59'08'07 E Z l m R ••••• 94 t'�� • " LYNN I I — — � H rAPHREY - LOT 4 Ali ¢ j I ! 233843 S.F. NJO s /Oy 5.37 Ac. 't YV1 ND SlJ RJR v 1 '5 .86' i 738.38' 529.94' I - 1268.32' - UIPLATTED LANDS LEGEND: w ` l S 89'27'23" W 1321.18' ■ SET BY 18" IRON o o PIN WT. 1 1.50 LBS./FT. �o OWNER: 0 SET 1 1/4" BY 18" IRON S c SW COR. SURVEY CONDUCTED AT THE PIN WT. 4.172 LBS./FT. SEC. 3 REQUEST OF THE OWNER: FOUND 3" ALUMINUM Z MIDWEST EQUITIES, LLC COUNTY SECTION MONUMENT 990 HILLCREST STREET NOTE: SUITE 110 ----- - - - - -- 100' BUILDING SETBACK BEARINGS ARE REFERENCED TO THE WEST BALDWIN, WI 54002 LINE LINE OF THE SW 1/4 OF SECTION 3. PROPOSED DRIVEWAY LOCATIONS ASSUMED TO BEAR N 00'49'01" E. R. A. - RECORDED AS NOTE: — ' -- 12' UTILITY EASEMENT SCAtE: i" - 200' DEDICATION EAST OF TEMPORARY 30' MIDWEST NATURAL GAS CUL -DE -SAC TO BE CONSTRUCTED BY _ _ _ 0 5 � PROPERTY OWNER TO THE EAST. J EASEMENT (VOL. 1510. PG. 95) THIS INSTRUMENT DRAFTED BY KEVIN SAMUEL SHEET 1 OF 3 HUMPHREY ENGINEERING Vol 19 Page 4918