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HomeMy WebLinkAbout042-1077-40-000 r Dnsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix —arety and Building Division - INSPECTION REPORT sanitary Permit No: 399456 0 GENERAL I'NF'ORMATION (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: Warren Township Warren Township 042 - 1077 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: ' 1 100' 121 hu, TANK INFORMATION V I ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. AA \ ff) / Septic Benchmark 2 5� 3. zs 603.2 Dosing - Alt. BM /07 0 Aeration Bldg. Sew p c/ 10 4 1. 2- o G 1 Holding S t Inlet , q / O - h G l TANK SETBACK INFORMATION S t Outlet r 7 . / 63 S TANK TO P/L WELL RBLDG. it intake ROAD Dt Inlet r? r Septic Dt Bottom Dosing Header/Man. i /_ s Dis ]pe Aeration l� 41D 9y- 2 Holding Bot. System t) 7 PUMP /SIPHON INFORMATION Final Grade q-7, Manufacturer GPM nd St Cover Z . 2 / D -7 Model Nu er a j g7, 3-7 TDH Lift rictio ss System Head TDH Ft J � Forcemaifr ength Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width t Len / L , No. Of Trenchers PIT DIMENSIONS No. Of Inside Dia. Liquid Depth DIMENSIONS ? j SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREA LEACHING Many ct re INFORMATION CHAMBER O Ty Of System: SAA/ f UNIT Model Number: > ob ,r�, r DISTRIBUTION SYSTEM / Header /Manifold Distributio r / x Hole Size x Hole Sp ing Vent to A IntaKO Pipe(s) i Length Dia Length Dia pacing X v�„o( SOIL COVER x Pressure Systems Only ound r Systems Only Depth Over l Depth Over 1 xx Depth of xx Seeded /Sodded Mulched BedlTrench Center �'� Bedrrrench Edges Topsoil ❑ Yes E] xx No ❑ Yes ❑ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:/1—/ Inspection #2: Location: 720 112th St r barts, WI 54023 (SW 1/4 SW 1/4 28 T29N R18W) NA Lot NA Parcel No: 28.29.18.441A 1.) Alt BM Description = � ' S 2.) Bldg sewer length / � L ►ti1�oU� -d SdLC � �1 � t �2 IA'4' �.Ou.c{ tvti� rrttA.�� - amount of cover = 2' W/ 2 "�hi I osk hf1A+► 4'n W6c4& k- 1 (el� Plan revision Required? ❑ Yes o `j S � $ 0 Use other side for additional information. G' Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) i 0 Sanitary Permit Application N Safety & Buildings Division In accord with Comm 83.21, Wis. Adm Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 14se6nsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Departrfient of Commerce p (Submit completed form to county if not [Privacy Law, s. 15.0 state owned.) Attach complete plans (to the county copy only) fo s ,'on pdpdr polkss pap than 8 -I/2 x 1 I inches in size. County / S"* Permit Number revisioo pre vio ation State Plan I. D. Number 3 I. Application Information - Please Print all Information Location: Property Owner Name ` Property Location e—(r fir` e N GU 2001 W ` �j1 1/4$ !J� 1/4, T' N, RI E (or) �# Property Owner's Mailing Address �V l 1 ,2 jr y pa Lot Number Block Number 100 5 +, R '7� G, 't 0 a c rt t Ci , State Zip Code er Subdivision Name or CSM Number :5- II. Type of Building: (check one) ❑ cit W or 2 Family Dwelling - No. of Bedrooms 13 gage own of lic /Commercial (describe use):_ qn / / � J ❑ State-Owned Al L X x/ f, ('Z ct I 1 �� W0. Nearest Road v' Parcel Tax Number(s)o y, . jo 7 — 4o - v a o III. Type of P it: (Check only one box on line A. Check box on line B if applicable) L Z A) 1. U New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV ype of POWT System: (Check all that apply) on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation Final Grade .r Required Proposed Rate (Gals. /day sq. ft.) (Min. /inch) t{ QS: & 7 levatpn Z / S - ;2, . '71 , «F >r- 4 3 .o L�''.'z 0 VII. Tank Capacity in Total # of Mahufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ks 12,50 ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) IX. County/Depa went Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin ent�ture (No stamps) K Approved 13 Owner Given Initial Adverse Surcharge Fee) o D ` Determination X. Conditions of Approval /Reasons for Disapproval: 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. All setbacks to system and residential structure must meet applicable code requirements. 3. This system was designed in accordance with the in- ground soil absorption component manual (version 2.0). 4. The erosion control practices must be maintained by the town until the site has been established with vegetation. 5. Well setbacks to be maintained per NR 811 & 812. 6. All conditions ot the special exception approval snall Be met. SBD -6398 (R. 07/00) Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 I�c0ns n www.commerce.state.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 22, 2000 CUST ID No.226375 ATTN: POWTS INSPECTOR ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL �, / \ L PLAN APPROVAL EXPIRES: 11/22/2 �" y Identification Numbers Transaction ID No. 447433 Site ID No. 201723 SITE: /o Please refer to both identification numbers, _. , above in all correspondence with the'a agency WARREN TOWN HALL p g y ST CROIX County, Town of WA N 1 .;;�` `° 720 112TH ST, ROBERTS 5402 SW1 /4, SW1 /4, 528, T29N, R18W ` %�.� r. FOR: \ Description: NEW NON- PRESSURIZ��1(�RQUN4 &STEM / 542 GPD Object Type: POWT System Regulated ObjecflDW .: 770148 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerel , ) DATE RECEIVED 11/16/2000 / FEE REQUIRED $ 175.00 1 FEE RECEIVED $ 175.00 ETER E PAGEL , P TS P N REVIEWER II BALANCE DUE $ 0.00 Integrated Services (608)266-2889, M - F, 0745 - 1630 HRS PEPAGEL @COMMERCE. STATE. WI.US WiSMA'RT code: 7633 cc: RICHARD MEYER ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Q r 4- i= fV .. o w iv - Mailing Address 7 ;Z 0 // 2 - rA Property Address RD /�ti l,(,7 / (Verification required from Planning Department for new construction)_ City /State D YI (r�S .Q Parcel Identification Number © A l 2 ' 1 d9 7 7 ' //0- CCO LEGAL DESCRIPTION Property Location 50J '/4, -5 W '/4, Sec. 2 $ , T_g LN -R W, Town of WfL H H ,FT N Subdivision . Lot # Certified Survey Map # r , Volume , Page # Warranty Deed # 3 --� , Volume - . Page # 3 3 d Spec house ❑ yes g -no Lot lines identifiable 2 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. ent a certification form, signed b the owner and by a owner agrees to submit to St. Croix Zoning D r� Sn Y The property owner II e! artm masterplumber, joumeymanplumber , restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe the undersigned have read the above requirements and to maintain the private sewage disposal system with the standards qu agree set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification statin g tha t septic has been maintained must be c and returned to the St. Croix County Zoning Office within 30 your Y eP tic s days of the three year expiration date. 11 / 30/ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * *** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1 0�, J� 099 1 mI `A N� N NI NI SzZ VI — 9£'OZ5 II v� \ c d � � I I Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 *6consin www.commerce.state.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 22, 2000 CUST ID No.226375 ATTN: POWTS INSPECTOR ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/22/2002 Identification Numbers Transaction ID No. 447433 Site ID No. 201723 SITE: Please refer to both identification numbers,_ WARREN TOWN HALL above, in all correspondence with the agency. ST CROIX County, Town of WARREN 720 112TH ST, ROBERTS 54023 SW1 /4, SW1 /4, S28, T29N, R18W FOR: Description: NEW NON - PRESSURIZED IN- GROUND SYSTEM / 542 GPD Object Type: POWT System Regulated Object ID No.: 770148 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes,. is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address 1'9PAGEL, DATE RECEIVED 11/16/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 PO S PLA REVIEWER II BALANCE DUE $ 0.00 Integrated Services (608)266-2889, M - F, 0745 - 1630 HRS PEPAGEL @COMMERCE.STATE.WI.US W MA code, X33. cc: RICHARD MEYER 1 ULBRICHT & ASSOCIATES CO. 655 it Road • Hudson, WI 54016 neg- Designers of F.ngineer1rrg Syslems ��Ef�I 86 -8185 Private Sewage Consullanls S� NOV 16 2000 SAFETY & BLpGS 1D'V. PROJECT INDEX PLAN ID # 447433 DATE Nov.12,2000 OWNER Warren Township PHONE 715 - 749 -3994 c/o Richard Meyer, Town Chairman ADDRESS 667 100th St. Roberts, Wis. 54023 LEGAL DESCRIPTION Approx. 20 acres. PIN 042 - 1077 -40 -000 SW1 /4, SW1 /4, Sec.28, T29N, R18W TOWN OF Warren COUNTY St. Croix CSTM Robert Ulbricht 226375 LOCAL AUTHORITY/ SUPERVISION Si :aax Call Zening Dept. PROJECT DESCRIPTION: New construction. For a proposed new Town Hall. chairman: Meeting hall seating for 190 people (247 gpd), 2 -3 occasional clerk "employees" (39 gpd); 3 floor drains (75gpd). There will be a "coffee" single compartment sink, but no meals shall be prepared or cleaned up, nor shall the meeting hall be rented for banquests, parties. No dishwasher therefore is planned /proposed. Total estimated daily wasteflow per Comm-83.43-1 (TABLE N) 361 gals. DESIGN WASTELOAD CAPAC 361 x 1.5 factor = 542 gp NOTE: as per the townchairman, since no meals or cooking is proposed, a private grease interceptor is not required. SoiA are very permiable (.7gpd /ft2). A conventional inground vYQ�tem is proposed: high capacity Infiltator trenches. nd lflohal � y AP of DEPq \` ```�������`�rrnuiurnn►rniigr� Ill s, TO F CF .. l E CDI/y ` ROBERT W. ' CORR = ULinici T 7�/ 3 SP OND N D1160 T �j� 3 C HUDSON, Wl Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN VIEWS Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg . 4 it ft it it ff rr Pg.5 ZABEL FILTER & MANAGEMENT PLANS. '11ris dpst.gn rot installation t.s based entirely on measurements, elevations, ar- curacy 11iP 11ndeoaPo ry his or his Si o (s1.c� pee et:r..) and soil Suitnbi.lity provided by CS'IM_�_, r.s, as reported, shall remain the sole responsibility or i.lre any tine cr this POWTS design ty an related unlicensed Parties Y licaneed plumber, or any shall not be or P ersons (excavaters, laborers) conettuad as an assumption or responsibility by the designer for the xorkmanabip, const substitution or Selection or any ruction, placement, components not placement, or any assumptions by the plumt-e that are an un state approved or Y of loo components proper, or the effects of poor judgement � if aorking under adverse damaging waahe Soils) by any such parties or pereone, t r conditions (wet /frozen Il . i J I lk fil a o to m Q � b N ►. D tr � kA- -, N . o 7 �y Goo N'G I O 'v z o 7� rn t vl ^ rr fi GN m R � —� f I x y ��� a UN d o M 112- T • � c - a IT Pg. 6 Continued. POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors: `� V G 5-7 l• A) * Licensed installer, responsible for providing an operation/ maintenance "Users" mafn�u,/a-l: / N * Licensed service / inspection agent other than installer: x{005 w l. 3P - 2�3 0 l�illl� 7'0 �E �U•�r S vi c U)/ yG /�'l�;v,.c�U -c * Electrician, for pump, electric controls, wiring units IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shove>>ting, etc.) across the mound area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakkge). It is 1 recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone t0 maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated ^J G into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly quali6ied person should be performing this work which involves health D & severe safety risks. Evidence of effluent ponding in system's treatment cell shall also be regularly inspected. r � . i I Wisconsin D e merce SOIL EVALUATION REPORT Page of Division f of in accordance with Comm 85, Wis. Adm. Code _ County S7. ceoc x- A a m I n �P� ►' t less than 8 1/2 x 11 inches in size. Plan must i but vertic4sn horizontal reference point (BM), direction and Parcel I.D. 10 Z,/2 -/D 7 7 - yQ • 4 ' 1 � nt slope, scale or dimension, - p h arrow, and location and distance to nearest road. G s ri t all information. RevX by Date CR rep r , Pegg nal inform vide m sed for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prop n 41M ING0F iClt4 Nay &R Property Location 20 S Q Q OWAD C}f/�r PM A) Govt. Lot sA) 1/4 SW1 14 S 2 8 T 29 N R /�/ E (or Property Ow it n Lot # I Block # Subd. Name or CSM# City State Zip Code Phone Number El City F] lage Village own Nearest Road. M C RT S w I. 5 vo Z3 ( 7 /5 7y - 3ff 4 ,� mgRE // 9- sr: New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement K Public or commercial - Describe: SEE 8EI4010 . Parent material - sf}A>DY dtrTk>>} P4--- Flood Plain elevation if applicable 04 ft. General comments ©��S% - ���' ��- �✓`' / ?Ie��•D� and recommendations: �►✓�� Sl�� L o z. , "le4,P T � 1p — EXcesS J-i& I;� GAS f Wk -FOR APo Ee-?'ie ❑ Boring IfS'14 % -- / SST ,BUSS - • Boring # Qg. �• Pit Ground surface elev. 1 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 D � y/ I©yQ 311( S L 21n AX SLi, e S 2 - F - s . 2. I] Boring # I❑ Boring 1i pit Ground surface elev. ft. Depth to limiting factor 7 �1 D 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 / 0 1 loge s� atiir s ,� s�. w L f • s • 9 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L ' CST Name (Please Print) Signature ��• � � C tuber � Z s 3 7 Address Date Evaluation Conducted Telephone Number Privat sewage Consultants 57Z 1'0&- e f• IVE PpO fOSSO ?- 655 O'Neil Rd. H nD� Hudson, Wis. 54016 //'J �G� . o ceAPPO AL Y 70WO c t & CS U -2- �6� f l�,ee S - 3r 3 �/60A Ae s /,ems. 4u y �,�:�, � - 7 ' • o ,r- t�- -i,�G- �P,e ; sya.� Slue _ oe s44&s No N �� ��rf�s O P, % � FOR ' I9� TS, n y a pl - kw l ts #tee . �l i �,OA) F k) d � Property Owner Parcel ID # Page Z of 3 [3 Baring # ❑ Boring Pit' > (((� �( 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 /W in. Munsell Qu. 8z. Cont. Color I Gr. Sz. Sh I 'Eff#1 'Eff#2 I 2 - 7.11 7•s YR Yl vt /� Gs • 3 .'►So Boring #' ❑ Boring q5• Its 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 0- io y-e lVel s Z,w shy ds4, w Z --f- , s . 9 2 - • L 7.5 V k — ag,F1� LS /, . ? t • Z s yiP ZQ /o Cv S �, ? 1 • Z x 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 z 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.6/00) 1 N u s � � Qs `?<1 kx\ C3 o N, G rl- \ X_- c w All T ° N -o oo i0 0 �n I 1e I I �r� .�; G L y � � W o v o ) "oo 11 2- State of Wisconsin VOl .1145PAGE 336 QUIT -CLAIM DEED Department of Natural Resources Form 2200 -3 Rev. 2/90 BY ZHIS DEED, the State of Wisconsin ( Department of Natural Resources). formerly ati on Commission. Grantor. e eb conveys d quit-claims t MR. grw5r.2. for a valuable consideration of ur Thousand and 40) Dollars and Other Good and Valuable Consideration the followine d escribed real estate in St. Croix County. State of Wisconsin. Township 29 North. Rangg_18 West Section 28: All that part of Gov't Lot 6, lying westerly of the existing town road running northerly across said Lot 6. Section 33: Also all that part of the NW 1/4 of the NW 1/4, lying northwesterly of the centerline of the town road (now vacated) running northeasterly across said NW 1/4 of the NW 1/4. (SEE REVERSE SIDE FOR RESTRICTIONS) THIS CONVEYANCE IS EXEMPT FROM A REAL ESTATE TRANSFER FEE PURSUANT TO SUBSECTION 77.25(2) OF THE WISCONSIN STATUTES. Executed at Madison, Wisconsin this 19th day of June 1995. State of Wisconsin Signed and Sealed in the Presence of: Department. of tural Resources B A ea ) ( Wald L. S Deputy Secretary) (Department Seal) State of Wisconsin ) ss. Dane County ) Personally came before me this LQt1L day of _ T,, A.D. , 1921, Ronald L. Sesmann Deputy Secretary of the Department of Natural Resources to me known t the person who executed the foregoing instrument, and to me known to be sucb two etary of the Department of Natural Resources, and acknowledged that h ;rQ, a foregoing instrument as such officer as the deed of the �if��stural Resources by its authorit . �eai) Karl E. Hansen �b rrr •rP� This instrument was drafted by the Notary Public, State of Wisconsin Department of Natural Resources My Commission (expires)(is) /24/96 r VCL 1145PA,Z 337 This conveyance is made subject to the condition that the above described land shall be used for public outdoor recreational purposes, and if at any time said land ceases to be so used the estate hereby conveyed shall immediately become vested in the State of Wisconsin (Department of Natural Resources) or its assigns. This conveyance is " subject to the following reservations carried forward from the original deed from the State of Wisconsin (State Highway Commission) to the State of Wisconsin (State Conservation Commission) recorded in Book 373 on Page 290 as Document No. 263877 in the office of the Register of Deeds for St. Croix County: No direct access will be permitted between the above tracts and Interstate Highway 94. No junkyard of any nature will be permitted on the tracts of any portion thereof. No buildings or structures shall be erected, placed or moved within 60 feet of the nearest boundary of Interstate Highway 94 or shall conform to the St. Croix County Setback Ordinance. whichever is more restrictive. No advertising signs or billboards shall be permitted except as authorized by pertinent state and local regulations. All the above tenets are subject to any existing utility or town road easements. w $ a, a cn c' p, i .. .. .. N Ln Ln W 9 04 'v o c x o \ ; O w V C ° w N \ IF cn f 6 o, N. J N w I I I I I II li li R)L ,, I I II'�II h o lb e °a� / /Z--