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HomeMy WebLinkAbout042-1043-70-100 Wisconsin Depart`nent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safdty and Building Division INSPECTION REPORT Sanitary Permit No: 506198 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: McKenna, Erin I Warren, Town of 042- 1043 -70 -100 CST BM Elev: nsp. BM Elev BM Description: n �1 Section /Town /Range /Map No: JQ� e m G 16.29.18.248A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic F �0 /Z sa Benchmark Y • Q` 160 Alt. BM All ,e Aeration Bldg. Sewer •7� g3 z Z Holding SUHt Inlet 1 . 7 q1 • 35 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom /- Z4 Dosing Header /Man. 75 Aeration Dist. Pipe /a 'j , 7 J D • 7Z S Holding Bot. System //. / 3 cr SK 4'Z. 7 Final Grade 7 a5�f PUMP /SIPHON INFORMATION Manufacturer Demand St Cover� \ 3 i6 I / 6.f * G P `I l � Model Num TDH Lift Friction Loss Syste TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length e No. Of Tre PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth DIMENSIONS 4 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: 9" 1 V INFORMATION CHAMBER OR Ty Of System / / e / A UNIT Model Number: YP Y I � 1/� /'v Y 6w�GWCiB 3 �0 11y e J DISTRIBUTION SYSTEM Z6 I Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake i •� 11�t Pipe(s) Length �Z Dia T Length Dia Spacing ` SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of 1 xx Seeded /Sodded 1 xx Mulched Yes No Bed Trench Center Bed /Trench Edges Topsoil Yes 7,�No \ COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / ! Inspection #2: Location: 953 100th Street o erts, WI 54023 (SW 1/4 NW 1/4 16 T29N R1 8W) NA Lot 1 Parcel No: 16.29.18.248A10 � &% 1.) Alt BM Description = r �.�, ye s a 2.) Bldg sewer length = z7 / - amount of cover = 1 !^ Plan revision Required? Yes ' ;o, / , No I I llp 3 7 Use other side for additional information. No. Date �Insepctor"s Si ature SBD -6710 (R.3/97) r - Safety and Buildings Division County W 201 W. Washington Ave., P.O. Box 716 FVIs Madison, W 1 53707 - 7162 itary rmit Number (to be filled in CO/fS�/f (608) 266 -3151 �/� / / a ) Department of Commerce _so Sanitary Permit Application fate Plan . . ber In accord with Comm 83.21, Wis. Adm. Code, personal informat' may be used for secondary purposes Privacy Law, s15. (1)(m) ECEIVED Proj ct Address (if differen than mailing address) I. Application Information - Please Print Ail Information 3 / �Q�h J MAY 2 1 2007 Property O Part k Lot Block C ST. CROIX cOUNYY d t9 Y3 �'Z 0. "e PropeRy Owner's Mailing Address �1� Pro Location / 7 �' © /1L/� ✓�'Y - S !!� ' /., '1A Section 9 CA , State f - Zip Code c, Phone Number 0 "' ,i (,•(/ / .' J 7� Zd B Q3 T N R Ecle) 1 T of Building (check all that apply) idIor2 Family Dwelling - Number ofBedrooms Q 4 Subdivision Name CSM Number ❑ Public/Commercial - Describe Use / G' J' �l9 ❑ State Owned - Describe Use ❑City_ ❑Village lkro;nship of tVpL IIL Type of ermit: (Check only one box on line A. Complete line B if applicable) A. New System Y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / Q IV. T ype of POWTS S stem: Check all that apply) — Y49 q - ❑ Non - Pressurized In- Ground ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -G and ❑ Holding Tank ❑ Peat Filter 11 Aerobic Treatment Unit Cl Recirculating Sand Filter C3 Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Clravel-lqsp Pipe ❑ Other (explain) V. Dis ersalfrreatment Area Information: I 3 Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Requi sf) Dispers � � Proposed (sf) Syttem Elevation ; 710 0 A nk Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber P astir Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank e / � t Aerobic Troannent Unit V Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum is Signature MP /MPRS Number Business Phone Number ;?,;� -*�? 791 Plumber's 44dress (Street, i , State, Zip Code) V1ll. C unt /Department Use nl proved ❑ Disapproved Sanitary Permit Fee (includes Ground%yter Da te Issued Issuing Age Signat (No hips) Surcharge Fee) ,�f 1 �� d S/� �� ❑ Owner Given Reason for Denial�7J 7` G� IX. Conditions of Approval/Reasons for Disapproval S YSTEM OWNER: %D - � ��i' ' G� ,`y t-k sWv s Septic tank, effluent filter and n� dispersal cell must all be serviced / maintained �n as per management plan provided by plumber. �;, 2. All setback requirements must be maintained as per applicable co a of trit K i ahWiete plans (to tee c unty only) for the system dii paper not teas than /2 11 inches in size SBD -6398 (R. 01/03) �(i2 L' ;,Q,a, ; �5 i0 4L VA itm e •� Rl �a O 4 6- C- w o �Jm, ` Cb y • ' -� LA ' n "' �A 0 Tyi t ot Eh � '� tJ ac 4 Q � � 1 2065 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan St. Croix include, but not limited to: vertical and horizontal reference point (BM), directi percent slope, scale or dimensions, north arrow, and location and distance to nearest road. pending from 04 - 1043 70 - A86•f reel I.D. Please print all information, eviewed Date Personal information you provide may used for REC EDy L" s 15.04 (1) (m)). � d Property Owner le P Property Location David & Dianne McKenna A 0 5 2007 Govt. Lot SW 1 NW 19 16 T 2 9 NR 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2- 9 . 1156 Hwy 12 1 I � PFepcced,CSM city State Zip Code Phone Number _j City J Village t/ Town Nearest Road Roberts Wt 1 54023 1 (715) 749 - 3598 Warren 110Th Street sol New Construction Use: V1 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement I Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.5 gpd loading rate. Recommended system elev. _ 96.00'. Boring # I Boring Pit Ground Surface elev. 101.35 ft. Depth to limiting factor >1 14" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - E 1 *Eff#2 1 0-19 10yr3/2 none sit 2fsbk mvfr as 2f, 1 m 0.6 0.8 2 19-28 10yr4/4 none gr sl 2msbk mvfr cw 1fm 0.6 1.0 3 28 -39 10yr4/4 none Is & gr 0 sg dl gs If 0.7 1.6 4 1 39 -58 10yr4/6 none s 0 sg dl gs - 0.7 1.6 5 58- 4 10yr6/4 none / strat. s 0 sg di - - 0.5 1.0 C l 01 le 4 f (., 9 �._ 5 , contains approx. 50% coarse fragments. H#5 consists l6 f stratified f s & ms - loading rate adjusted to reflect permiatiility restrictions associated with stratification. 2] Boring # I Boring 01 Pit Ground Surface elev. 100.47 ft. Depth to limiting factor > 106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 *Eft#2 1 0 -24 10yr3/2 none sit 2fsbk mvfr as 2f, 1m 0.6 0.8 2 2446 10yr4/4 none gr $l 2msbk mvfr cw 1 fm 0.6 1.0 3 36-46 10yr414 none gr Is 0 sg dl gs 1fm 0.7 1.6 4 46 -65 10yr4/6 none strat, s 0 sg dl gs - 0,5 1.0 5 65-106 10yr6/4 none f strat. s 0 sg dl - - 0.5 1.0 6 H#4 & 5 consist of stratified Is m loading rbtes adjusted to reflect permiability restrictions associated with stratification. * Effluent #1 = BOD 5 > 30 < 220 mg/ and TSS >30 150 mg/L * Effluent #2 = BOD S30 mg/L and TSS S30 mg /L CST Name (Please Print) Sign re: CST Number James K. Thompson p_ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Os ois, WI 54020 3/15/2007 715- 248 -7767 Property Owner David & Dianne McKenna Parcel ID # pending from 042- 1043 -70 -000 Page 2 of 3 3 ] F Boring # I Boring 61 Pit Ground Surface elev. 99.92 ft. Depth to limiting factor >102" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -19 10yr3/2 none sil 2fsbk mvfr as 2f, 1m 0.6 0.8 2 19 -28 10yr4 /4 none gr sl 2msbk mvfr Cw 1fm 0.6 1.0 3 28 -39 10yr4/4 none Is & gr 0 sg dl gs 1fm 0.7 1.6 4 39 -58 10yr4/6 none s 0 sg dl gs - 0.7 1.6 5 58 -102 10yr6/4 none + strat. s 0 sg dl - - 0.5 1.0 �3 H #3 contains approx. 50% coarse fragments. H#5 consists of stratified fs & ms - loading rate adjusted to reflect permiability restrictions associated with stratification. F-1 Boring # I Boring Pit J Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots 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 , L30 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) A.C.E. SOU & Site EvaW bons . Sa f �R � u0.�ion A pr : c 6 91i4.cle elf C-. 3 /y "xl8 °�t6arSCEa� /af G.rn�� I�`7lcrlriG/O�o�O. b oa. #o'f /o�3- �o -ct 997 37' 6 60 al o� o elegy = iaO. 6D' , 1 s , t 0 1 ' o � 1 o ` \ ` H I n � ` 1 Preposccf i � \\ iQes%c 1 \ ' c � 1 t '7oe oj' �aa+►a(a�'or� �o6e = /o6.9s'as - 164 kled re- E/e0. _ /oi es'' i S2. 4-9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM (� c K Owner /Buyer rrrn -mm\ Mailing Address 91 _7 7 1.2 00 6rz WT SV,923 Property Address D qA S � a 4�) - n (Verification required from Planning & Zoning Department for new construction.) r_1 041 City /State p/�,E�- S Parcel Identification Number ©Y 2 — 16 4f - 70 —000 LEGAL DESCRIPTION Property Location $ W 1 /4 , 1� W '/a , Sec. �, T N R_ W, Town of t Subdivision , Lot # � . Certified Survey Map # g , Volume _ , Page # z Warranty Deed # Volume , Page # < . Spec house yes Lot lines identifiable yes no 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 §Comm. 83.52(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 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms .� 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. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner '�y(/y�rl� Septic Tank Capacity Z 2SZ gal ❑ NA Permit # Septic Tank Manufacturer waaih ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2 "6 2 - (i2 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer NA Soil Application Rate Q gal/day/ft' Pump Model ❑ A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODd <_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dis ersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD <_30 mg /L n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 53 L �NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) ^- 10 c u/ 0 ❑ Drip -Line ❑Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: �a��/ ar>� , 84A 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: _ 2 � ❑ ear( )(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2 ❑ m h(s) (Maximum 3 ears) ❑ NA ear ► y Clean effluent filter At least once every: / onth(s) ❑ NA l ❑ years) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) ❑ NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank, volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ? "of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 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 fa' and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement tem: 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. l" � T aluat 71t IOU leptem 44821 is a o mg tank be ' e ai a ?9t)441 13 mz,, fb P_ A16W CbojSM C - ❑ 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 Name Phone 7/ 5-�- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 15t G Phone Phone — 7/ _— This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d) &(fl and 83.5411). (2) & (3), Wisconsin Administrative Code. CERTIFIE[� SVRVEY MAP LOCATED IN PART OF THE SW1 /4 OF THE NW1 /4 OF SECTION 16, T29N, R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. OWNER SURVEYOR DAVID AND DIANE MCKENNA EDWIN C FLANUM 1156 HWY 12 NORTHLAND SURVEYING, INC. ROBERTS. WI 54023 P.O. BOX 14 ROBERTS, WI 54023 SURVEYOR'S CERTIFICATE I, Edwin C. Flanum, Registered Wisconsin Land Surveyor, hereby certify that by the direction of David and Diane McKenna, I have surveyed, mapped and described the parcel of land which is represented by this Certified Survey Map; that the exterior boundary of the parcel of land surveyed and mapped is described as follows: A parcel of land located in part of the SWt /4 of the NWi /4 of Section 16, T29N, R1 8W, Town of Warren, St. Croix County, Wisconsin; described as follows: Beginning at the W1/4 Corner of said Section 16; thence S89 °22 "E, along the east -west quarter line of said section, 1052.59 feet; thence N00 °37'1 5 "E 336.33 feet; thence N89 °22'45W 997.37 feet to the centerline of a town road (110th Street) being . a point on a 880.00 foot radius curve, concave southeasterly, whose central angle measures 21 °11'39 ", whose chord bears S10 °29'01.5 "W and measures 323.67 feet; thence southerly, along said centerline and the arc of said curve, 325.52 feet to the west line of the NW1/4 of said section; thence S00 °06'48 "E, along said west line, 17.44 feet to the point of beginning. Described parcel contains 8.00 acres (348,493 Sq. Ft.). Parcel is subject to town road (110th Street) right -of -way and all other easements, restrictions, and covenants of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes, the Land Subdivision Ordinance of the County of St. Croix, and the Subdivision Ordinance of the Town of Warren, in surveying and C��V►GC ���tr,tt ST. 6"611 ocxJ MAY 4 4 2001 � Eowlt+ • � c. g -24t) If rapt recordod within 30 days of = ^MERY, 1 " COUNTY TREASURER'S CERTIFICATE val date apProvalshall be WISCONSIN. null and void ' STATE OF WISCONSIN)SS y COUNTY OF ST. CROIX) I, Cheryl Slind, being the duly elected, qualified and acting Treasurer of St. Croix County, do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of affecting the land Included in this Certified Survey Map. Cheryl Slind, Date County Treasurer Each parcel shown on this map (plat) is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croy County Zoning Office and the Town of Warren. PCN - 042 - 1043 -70 -0000 P1,012- 16.29.18.247B SHEET 2 OF 2 SHEETS V01- 22 Pave SRQ9 Il I IlIIII VIII Illll llill VIII !11111111 lNlil IIII Iii! State Bar of Wisconsin Form 1 -2003 * 8 5 0 6 5 7 1 WARRANTY DEED 850657 KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between David McKenna a /k/a David M. McKenna and Diane 05/16/2007 10 :40AM McKenna a /k/a Diane L. McKenna, husband and wife holding as WARRANTY DEED survivorship marital property, EXEMPT 1 8 ( "Grantor," whether one or more), and Erin D. McKenna and Abbie L. McKenna, REC FEE 11.00 husband and wife, as survivorship marital property PAGES 1 ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area f estate, together with the rents, profits, fixtures and other appurtenant interests, in Name and Return Address St. Croix County, State of Wisconsin ('Property") (if more space is Leo A. Beskar needed, please attach addendum): Rodli Beskar Boles Krueger & Pletcher, SC A parcel of land located in part of the Southwest Quarter of the Northwest 219 N. Main Street, PO Box 138 Quarter (SW' /4 of NWl /4) of Section Sixteen (16), Township Twenty -Nine (29) River Falls, WI 54022 North, Range Eighteen (18) West, Town of Warren, St. Croix County, Wisconsin; described as follows: 042 1043 - 70 - 000 Lot One (1) of Certified Survey Map, as recorded in the St. Croix County Register Parcel Identification Number (PIN) of Deeds Office in Volume 22, Page 5392 as Document No. 849899. This is not homestead ro e P P ttY• Parcel is subject to town road (110th Street) right -of -way and all other easements, ox) (is not) restrictions, and covenants of record. Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except: any restrictions, easements or rights of way of record. Dated 7— "` (SEAL) �� �� (SEAL) * * David M. McKenna (SEAL) l (SEAL) * Diane I McKenna AUTHENTICATION ACKNOWLEDGMENT Signature(s) David M. McKenna and Diane L. McKenna STATE OF Wisconsin ) ) ss. authenticated on Pierce COUNTY) Personally came before me on t CJ .. "'••'•'•• ti *the above -named David M. McKenna and Diane L. McKenna, TITLE: MEMBER STATE BAR OF 9�ONS�1 (If not, d O • , me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706. G Z strument d acknowled 6�•\ : O ft THIS INSTRUMENT DRAFTED BY: s' P� �j * 5 D Leo A. Beskar 4i, qvve V ? p� Notary Public, State of Wisconsin Rodli Beskar Boles Krueger & My commission (expires: g —1Z -I D ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED STATE BAR OF WISCONSIN FORM NO. 1-2003 *Type name below signatures. 0 State Bar of Wisconsin 2003 INFO-PRO- Legal Fortes • (800)655 -2021 • infoprotom,s.com f I {111l1IIIII[Il III [IlIIlINIIISlIlilfllllillllll I I * 8 4 9 8 9 9 2 849899 VOL 5392 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., WI o RECEIVED FOR RECORD BEARINGS ARE REFERENCED TO THE ST. 05/04/2007 11: 25AM N m CROIX COUNTY COORDINATE SYSTEM CERTIFIED SURVEY MAP ? REC FEE: 13.00 o •�1������ii�i COPY FEE: 3.00 ti `d1........ "� .� PAGES: 2 ' m tf> -Col c c ._0 i o 96TH AVENUE ice' 3 M "M m i ♦O'T•.• ........•.•'�•`��,% ` -a O ° cn nn r y I A A p I� Ill I� t� r oo 41. 4;a / 61 / I !� � z� - W �C () O> M / �� j 0 D w '48 "E w 33.00 C y \� Y 2613.75' N Z C �' mZ Z 7 7.8T I' o `�— w r �Q Z Z O Y In T M cn O o o a n O r ac m m �D W n O z c m 0 rn �� �n �� o cP n0 m < 3J ! 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