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HomeMy WebLinkAbout022-1060-50-100 (3)Department of Safety County 0 & Professional Services, SCROIX er (to be filled in by Co.) Sanitary Permit Number S Pa Industry Services Division Sanitary Permit Application State Transaction Number in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit NA Project Address (if different than mailing is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. SAME 1. Application Information — Please Print All Information Property Owner's Name Parcel # GREEN PASTURES FAMILY FARM & RENTALS LLC 022 -1060 - 50- 000 Property Owner's Mailing Address Property Location 263 LIBERTY ROAD Govt. Lot NA City, State Zip Code Phone Number RIVER FALLS, WI 54022 218 - 371 - 0700 SW Y4, NW '/4, Section 21 .1.28 N R 18 lW II. Type of Building (check all that apply) Lot # ❑{1 or 2 Family Dwelling — Number of Bedrooms 3 NA Subdivision Name NA Block # Public/Commercial — Describe Use NA ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number Wown of KINNICKINNIC NA III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a licable. New System Replacement System Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) CONNECTING BATHROOM FOR SHED Holding tank X IN Ground ❑ At -Grade Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/s Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation s 450 0.7 642.86 650 97.00; 95.50; 9*.wA FT. Capacity in Total # of Manufacturer "tank Information Gallons Gallons Units � °o v New Tanks Existing Tanks a U 0.. , in n i C7 Septic or Holding Tank 1000 1000 1 WIESER X Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for in allation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' i i tur, MP/MPRS Number Business Phone Number MICHAEL RODEWALD 931384 715 - 425 - 6200 Plumber's Address (Street, City, State, Zip Code) 285 C.T.H. SS, RIVER FALLS, WI 54022 VI. County/Department Use Only El Approved El Disapproved Permit Pee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial . Conditions of Approval/Reasons for Disapproval Attach to complete plans for the system and submit to the County only on paper not less than A 1/2 x I I inches in size S13D-6398 (R. 03/22) PREVIOUS PAPERWORK (SOIL TEST & ASBUILT W-B2 W-B3 Effluent Filter Model #: xxxx 95.50 PAGE40F4 In-ground Gravity Management Plan IMPORTANT: The owner of this in1Jround gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, 'Msc. Admin. Code. Pursuant to SPS 383.52 (2), 'Msc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthennore. all inspection and maintenance activities shafl be performed by a �istered POWTS Maintainer in accordance with SPS 383.52 (3), 'Msc. Admin. Code. Maximum Dispersal Area Operating LimitS: Design Flow= Lf 50 gpd; B005 S 220 mgl·1; TSS S 150 mgL·1; FOGS 30 mgL·1 Inspection Checklist INSPECT EVERY 3 YEARS o typeduse 0 age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., punps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids vohme in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution/ drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent d ponding in distribution celf prior to dosing a dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components -if applicable (i.e., wiring, connections, switches, controls, timerS, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure -compare to design specification)o surface discharge cl effluent or sewage back-up into structure served Maintenance checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septie and dos e tank(s) shall be punped by a certified septage servicing operator licenSed under s. 281.48 Was. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shaH be pursuant to NR 113, Wisc. Admin. Code. o Effluent fllta[(s) shall be inspected every 3 years and $hall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenanee reports shall be submitted to the proper local government unit in accordan� will, SPS 383.55 Wisc. Admin. Code. Rt8PCl� any component failure or malfunction to: Name cl individual or company: M.1 t:.E �B�,T£N DD&. · · £-°&. · -·Phone: · 7J.5::-!fz,t:;--{i;.20V Local government unit address: tl·t.J.J).50A.J, w;f _,..ZIP: 54fJtl& Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), 'Msc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wsc. Admin. Code. No product for chemical or physical restoration of the POwts may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and reploeed by a �lying dispersal comoonent in a pre-determined area of suitable soils. System Abfndonment If use of this POWTS is discontinued, it shall be ·abandoned in accoroance with SPS 383.33, Wisc. Admin. Code. 2BD m(tlo3 EWPWIkJ=BOD>30z 330 udrB1p 122a 30z120 ud1f .EWnWl k3: BOD'x3o uJAf sup 122z30ud�f [rA rvNE mEezi[!i MI 2aem VWwx 3 5 l .T, 3 p;a En3w A 1J2-VSB-1112 lRNPus wrk WtltlA 10 Hf1l bE HopMa aN IGIVA Y C21 NsuK lbw++e bpal 2. - AVB33 C21 Nw9sJ soup a 2 1S9Q loAtl2\ - ore a - - 01 1e 2 10AN2W - O0 a m - 01 1e \ W21 1'2AMW - pad a 1NY Q 32'IV 12AMW - _ 0 3 1eAN31V - zq 31<usPY uy !NJ OV OQ ! tr3V 1eAtl32�! - ay SYIusPZVM ua oa p'2 0'B Hoto:W W DMWI WM1roap DUJzuvul CaPi dl' K' Cow NIPi tleppx Osaa!dfau lexWe CJ2x-2u 2Jwgms CPpxalsW BPrupsa NOPR .EWI .EWtS C604k m w Hs{e CBouuBk Obg� ClodW bVlscc Fsn d181 Y Dsdpro WWud {sRa pp wlelu �.dyy EYM Hcl®ua xwup 2 a 21-22 3r21 1pAtl2e 1 MW - - _ o*d 005 a - _ 01 01 1 e 42 3 S I lFSB trle 1MM I 12AIf3'N !eAlSS-P.1 - - - r z:1 HI SfsPN 3{"PWPM 31-wsgzpy uJW uJ2. wµ - !N SN OB OV 02 10 oe 0e H w ly DaNV WnWI DoususW Daa dxK Cow COKK Mpox DsmlMxw lexpXe CJ 2s a: 2Jlnlas DWZIgsuPc BotimlA tlaop .EWk{ .EWS CbD1bL 20l bbbePeillou tlaN C Boaudp Bouud CJOIW zmWec ele^'81'03Y Dcau Jp NUWud lsga�lu lFen Bd peyurnLv Cwewl cauueuN sup iewuurxpslollz. 201f 1E21 CONDDCIED bOtl Ybb{fOAVf Ct C2W - CONlIEN110MVf INCMNJMD 1tlENCHE2-OB bVLlIWI Jcual DA Y H 'IDWd{"Y fI r Yr! H D 8!-Ma;c� CCV,C!!ClEC .LC FJc1NpD VblY EI' ent0vc-1llF•.g1C []y «uleu! pbngca mluwei�al-paPppc: bIPW bIW xIL.xP:U V9balospe NY u pNP•nCPPnurra, nee: �tleawawlalNWpoe.aoeoPppa \ cPp\aW�pauP.,wle 200 CbD tlIAEtl bVff2 MI 2VO33 144b ) KFI&I"INNIC CpA' 21a1a' SJb bPPw Nnwpw p Co p AVnlae plow Nesipl tl tlOVD 323 fIBEtl1A tlOVD 2Vwvc btl0602ED fOlV bENdNC blobWA C^ML 2 Wallud Vp & 2K was*aa C2W sW fqk CNEEN bV210tlE2 [VWIfA bVtlW Y tlEN1Yf2 ffC DON fa 2M $1 2 S! 1 38 mg !B p(dp M blobs A k bob WAR Pou M�2ouel llxPWelM.V Aon hopW pnxp yw 2xupea Cnwaee l6wscA (se'z l2 ONJNwI)' ❑ bikkak buw NI W W 6Icw' tlenlliwp uopy suow sup M+n0ou sup O�zryutt to wsesJ lose. I DSW PnlwJ«IsuVep w�pjc%spp POPxPUJsl Welauw WWI IBWl psxsou suq bucWlfiabe' OA-lOBO-20-030 V1 nwblele ne blsu cub sllglsazWw 9 J'3 x lJ wcl:sz w a¢a yW wmlxglp6 lm FI D' lu 9a 19w Mo 2b2 322' M12 Vpw Cope CyWA 21' CNDIX to 2O1f EnVfflVliON kSEbOk51 wna�J a I IN�nA zelAlpea M=ourtu DcysWuewq 2gWAp buyczzRl2culccs GREEN PASTURES FAMILY FARM & RENTALS LLC ❑ Boring ❑3 Boring # Q Pit Ground surface elev. 97.37 ft. Page 2 0f- 4 Depth to limiting factor 90 in. / elev. 89.87 ft. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 "Eff#1 "Eff#2 1 0-24 7.5YR2.5/2 — sil 2f-ma&sbk mfr cs 2vf-co 0.6 0.8 2 24-36 7.5YR4/4 sicl 2f-msbk mfr cs 1 vf-co 0.4 0.6 3 36-49 7.5YR4/6 — sl 2fsbk mvfr cs 1 vf-m 0.6 1.0 4 49-90 7.5YR5/4 s Osg dl — _ 0.7 1.6 some gr F;�] Boring # Boring o Pit Ground surface elev. i (, h. Depth to limiting factor Oi� in. / elev.gAX ft. 4. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 "Eff#1 'Eff#2 .� Z fL-Zz- 7. 55M 34 - n ?-III- zz-�I� z4� K Ash 0. 5 - 73 v 1! - W 5 .1't' — -- 0.7 1, � 73--qt I v V 10*6 0,7 Ma Acvi :3 e v2— - 1-7Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 "Eff#1 -Eff#2 " Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 <_ 150 mg/L " Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L I P _ HaznwEa ioo•� r,Q Ve At cc rr Wes. LB! L I I__D.�0 (VIDh1N blr 3��% f i � f !II NouN s't l &1861 1 rGS91 pezcungou: 2 �1 (Gw i� brl,IR9• �M,Y1 t 1Ne M zEc• C•l=pscKtXwo!t )6XCGW MN6LG wo sq) bHObEH1A OMNElS �"WM �unkfa Lvw!r TAV� , t Kl t a 7, _= dO FJ' blof blsu b9ae-1 of 1. . rjj ft %lAnm".1 I i►fl 000 G/-Ir-19' 926 Ale. - Su ME ' Proposed Lot 5 97% A Proposed Lot 4 I RAF, !.I ScOv I11 I n coldour JOI(OV141W.,1 (Ca11(jotS tihtwlrr*11 1#1%# Sr. Cluix Couffl y I IIIAN 11 Corn ----gap �y 1J�X-zn� ---� Existitlg LO( l Cerli ted $utvey 10,11)' Volume , r 71d435 it�•.n� . r!S Pagc 4480 DoC10ri)(,ri1 Number l / T OGOEN + Ml -WI � �. 0v l A6 � w{ ai f yy��yrrll l � M11 r 11 i ,i Hate: 4-1� 1 �. i,, K i n . Wisconsin Department of Commerce Division of Safety and Buildings. SOIL EVALUATION REPORT Page of in accordance with Comm 8�, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal infon"nation you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). ❑ New Construction [ -Replacement Parent material Lv General comments and recommendations. �i7-GLO \X Use: Residential 1 Number of bedrooms LJ Code derived design flow rate C,�O GPD Public or commercial • Describe: 6 Lam- fit- 4 11 Flood Plain elevation if applicable n. Boring Boring # � ® Pit Ground surface elev. ,� 03 ft. Depth to limiting factor � � in. . on Rate Soil Applipti Bonin r] Boring Ground surface elev. � � � � � � ® Pit 0 ' fL Depth to limiting factor in. Soli Anaicatinn Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD ftz 'Eff#1 -Eff#2 ? OAS c,,%j -- • S • 4�. Sfl 1- ` Eiliuont #1 = BODs > 30 < 220 mgtL and TSS >30.`. 150 mq& • Effluent #2 = 8003130 rnq& and TSS < 30 nV& CST Name (Please Print) atum CST Number Arbhur L. td �3— 1 �a e�erer 220254 Address W e g e r e r Soil T e s .t i n g & Design Service Date EvaWfion Conducted Telephone Number 421 N. Main S t . River falls 9 1-11 54022 715-425-0165 eq Property Omer �JLL—l_l f',KI Parcel IDa ozz-IDbO-SD-oo0 pave Z of 3 I '�] Boning a ❑ Borina 1 �� .. 1 n R ...,,,.. �..ew o.o.. ...._ - .. ...,v...........ro .o..... - Shc Application Rate Herren Depth In Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fp 'EHat 'ERa2 0-i8 tuti,t3(z — S i l L Fsbk cw 1� S 3 37-108 toY2si6 S 0 S9 M — .�7 Z yf9JSo ❑ Borfag # ❑ Boring - pit Ground surface elev. ft Depth fa Ilm org factor in. Soil Applipetion Rate Hodzod:. Depth In. Dominant Cdor Munsell Retlox Description Ou. 5z. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPOAF 'EDat 'Eff#2 ❑ Boring AL❑ Bodno ❑ pit Ground surface elev. 0. Depth to OMtlng factor Shc AppNrafbn Rate Horizon Depth In. Dominant Color Munsell Roderic Deseziptiun Du. Sz. Cent Color Texture Structure Gr. Sz. Sh. Consistence Boundary Root; GPD/fp •Elf#1 'EM 'Effluent #1= BOOS >30<220 mall and TSS>W <150 milli. 'Effluent #2=BODx<30 mWL and TSS<30 mWL The Department of Commence is auequal opportunity ttrycc provider and employer. If you need assistance to access services or need material m an alternate format, please eonfact the department al 608-2663 ] 51 or TI'Y 608-264-8777. Property (Nner wtLLt tiMS - Parcel ID U2-2-IAf)0 S�Dp D�Op \1 Paw Z- or 3 I � I Bodnu # El Boring t� l(!�" IV I� ch,✓ O.w F(I Lull lft� oil I —I Pit xaruunu sunew e� - r.sUl — Saw Hppm;cnfon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GPDIhr In. MUnsell Cu. Sz. Cont. Cow Gr. Sz. Sh. 'EI#t1 •Eft#2 1 0-Is MIIR-30- — S i I Z F5 h cw L%p -S Z -S 123 6r1s \csDk of 3 �_lo my2sl6 S 0S9 N 4 ❑ Boring # ❑Baring ❑ pit Ground surface elev. It. Depm 1p Ilmltlng factor ❑ Boring # �dng Ground surYam elev. n. Depm to Ilmitinp factor N. ❑ Pit Shc Applimdon Rate Horizon Death Dominant Color Redox Desmi Texture Structure Conslslenm Boundary Roots GPD/11r Munseil On. Sz. Cont. Color Gr. Sz. Sh. •ERl11 'Eff1t2 'EBluenl#i=BODs>30 <220 n�Latb TSS >30<150 mgrL •E#luent #2=BODs<30 rng2 aM TSS <30 myL 'ILe Department of Commerce is ao equal opportunity service provider and employer. If you need assistantt fo access cervitts or need material N an alternate lama; please contact the depemnent at GOS-266-J I S I or'ITl 608-264-87]7. ❑ Boring # ❑Baring ❑ pit Ground surface elev. It. Depm 1p Ilmltlng factor ❑ Boring # �dng Ground surYam elev. n. Depm to Ilmitinp factor N. ❑ Pit Shc Applimdon Rate Horizon Death Dominant Color Redox Desmi Texture Structure Conslslenm Boundary Roots GPD/11r Munseil On. Sz. Cont. Color Gr. Sz. Sh. •ERl11 'Eff1t2 'EBluenl#i=BODs>30 <220 n�Latb TSS >30<150 mgrL •E#luent #2=BODs<30 rng2 aM TSS <30 myL 'ILe Department of Commerce is ao equal opportunity service provider and employer. If you need assistantt fo access cervitts or need material N an alternate lama; please contact the depemnent at GOS-266-J I S I or'ITl 608-264-87]7. Scale 1'•3D ' /I PrDOSigSS= /(�t,hi�k�nn �C f,3x9AP. 7-� UB"'$wiro � IMF j J S ¢f4j Lasma Q ReR I --#uu. 15 aUy C4v 1. er,w stiwt �- ,Sito 14AM ty. aa7y69 / 9�a3�e� l " dAt"A.f ZDde � Df P,ZI'LH\y ) }lewl�)DD9a� Cq LJ/ 0 t l� /OD , Sa>� s ';o tea- 9�• a 3 ireµ�leS W/lb Q 5! ClA, Ltk A9$tot 6w� »I - tR , J m-:0' O'J 3UlZOw1- D� S 1 D)u6_ly' �eS1E�L9�9 _,-�- C;DpY 715-425-0165 � b % s�3' JOO\vJ�yR O P 220254 �.3-1SO CST Signa[vre Date IelepDooe No. CSi No. Job H0: � �v _ 60 13D '!GP' Community Development Department – Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov SANITARY SYSTEM OWNERSHIP/ADDRESS FORM Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources.Once approved, this completed form and educational information will be sent to you by email. Owner/Buyer Mailing Address City/State/Zip Phone Number (required) Email Address (required) Parcel Identification Number (found on the property tax bill) Property Location _____ ¼ , _____ ¼ , Sec. _____, T _____N R_____W, Town of . Subdivision Plat: , Lot # _____. Certified Survey Map # , Volume , Page # . Warranty Deed # (before 2006)Volume , Page # . Number of bedrooms Spec house ‡yes ‡no Lot lines identifiable ‡yes ‡no New Property Address (Verification of new address required from Community Development Department for new construction.) / / (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System:Include with this form 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. NEW SYSTEM: LEGAL DESCRIPTION File #: ______________ Office Use Only Created 2/2021 OFFICE USE ONLY OWNER/BUYER INFORMATION GREEN PASTURES FAMILY FARM & RENTALS LLC 263 LIBERTY ROAD RIVER FALLS, WI 54022 218 - 371 - 0700 scotteickschen@gmail.com 022 - 1060 - 50 - 000 SW NW 21 28 18 KINNICKINNIC NA NA NA NA 3 STATE BAR OF WISCONSIN FORM 2 - 2003 WARRANTY DEED Document Number This Deed, made between Jon Scott Williams and Susan Elaine Williams, husband and wife (Grantor), and Green Pastures Family Farm & Rentals LLC, a Wisconsin Limited Liability Company (Grantee). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate together with the rents, profits, fixtures and other appurtenant interests in ST. CROIX County, State of Wisconsin. SEE ATTACHED EXHIBIT A 1159936 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/14/2022 10:38 AM EXEMPT#: REC FEE 30.00 TRANS FEE 3,075.00 PAGES: 3 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Name & Return Address Burnet Title 7550 France Ave A, Suite 300 Edina, MN 55435 Burnet Title 2167022-09717 022-1060-50-100 Parcel Identification Number (PIN) This is homestead property. Exceptions to warranties: municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, present uses of the Property that violate the foregoing where such violations were disclosed by Grantor in its Real Estate Condition Report and in Grantee's purchase contract, and general taxes levied in the year of closing and thereafter. Dated this 7th day of October, 2022. Signature(s) 4on Scott W' liams and Susan Elaine Williams (SEAL) *BY: Jon Scott Williams a5 �,u l�u`IU (SEAL) *BY: Susan Elaine Williams AUTHENTICATION ACKNOWLEDGEMENT State of Minnesota } SS. Authenticated this day of County of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY: Burnet Title -Andrea Noble, 7550 France Ave. S., #300, Edina, MN 5543512167022-09717 Personally came before me this day of , 20 , the above named Jon Scott Williams and Susan Elaine Williamsm husband and wife to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. SEE ATTACHED ACKNOWLEDGMENT Notary Public, State of Wisconsin My Commission (is permanent) (expires: (Signatures maybe authenticated or acknowledged. Both are not necessary) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 St. Croix CouhTyrV1,69qjp&lp2866nVt6fE3• CERTIFICATE OF ACKNOWLEDGMENT NAN STATE OF WSI MA Florida County of Osceola This instrument was acknowledged by use of communication technology on 10/07/2022 by Jon Scott Williams and Susan Elaine Williams married to each other (date) (name with marital status) who produced driver license/passport as identification. who declared that _they are located in Osceola Florida (he/she/they) (is/are) (county) (state) Nia A Hamilton Notary Signature NIA A HAMILTON Notary Public - State of Florida Commission#HH27454 \�' F Expires on August 3. 2024 j'IIIIF \\\\\\\\\\ My commission expires: 08/03/2024 My notary commission number is: HH27454 Notarized online using audio -video communication Rev. 7.19 St. Croix County 1159936 Page 2 of 3 EXHIBIT A Lot 1 and Outlot 1 of Certified Survey Map recorded in Volume 17 of Certified Survey Maps, Page 4480, as Document No. 714135, located in the Southwest Quarter of the Northwest Quarter and the Northwest Quarter of the Southwest Quarter of Section 21, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. St. Croix County 1159936 Page 3 of 3 • • CERTIFIED SURVEY MAP Located in the SW 1/4 of the NW 1/4 and the NW 1/4 of the SW 1/4 of Section 21, T28N, R18W, Town of Vinnickinnic, St. Croix County, Wisconsin, being Lot 1 and Outlot 1 of the Certified Survey Map recorded in Volume 17, Page 4480, Document Number 714135. See Page 3 for Animal Structure NW Corner Note and Shoreland and c(o Section 21 Floodplain Zoning Note T28N, R18W 1170488 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/28/2023 03:14 PM CERTIFIED SURVEY MAP VOLUME: 33 PAGE: 7286 REC FEE: 30.00 PAGES: 3 LO �l� 6 N_ i'aI o 6' (Aluminum Cap) S 89°27'50" E 596.09' Unplatted Land 33.01' ® 563.08' 1/4 7 zi of Bldg A�NW ® SW 1t til z 01 4, Driv Soil Boring, typical Lot 4 �I p o I 00 &_ eway I M �V l v Garage S 18°48'52"' W ci N N �" 76.00' q° I �I Nl I 33' IWell N 89°27'50" W 341.46' 33' House j N _I to Silo Q I Corn N 89°27'50" W 229.41I I <r 1 ca Cribs M of 196.40' Manhol��.rn a 1 UI N I z O A B C e Bldg. L. E tion Lot 5 �1 J I O Bldg, pipe, typical Shed I l3Septic Easement on " o separate document Approximate boundary I^ U I + --rN of FEMA Flood Zone AE y ��- \ v= l N I 00 O l p ri _ ° t\183°43' ll" E 289 13— :— :� _- - I v �A r xim t - G - M _ � ---- •� pp a e Edge of to I v zo Wetland 1 o I l 0 \ Z 3 33 pcC'al U �° I l 1il 'tl • Me I L6 i l ;Q� � - 3 �etland, per � ��• �I J r_�� WIDNR Suurface\� �\ood l i Areas Lot 4 2.735 Acres 119,141 S.F. Including Road Right -Of -Way 2.551 Acres 111,129 S.F. Excluding Road Right -Of -Way Lot 5 7.370 +/- Acres 321,030 +/- S.F. Including Road Right -Of -Way 7.000 +/- Acres 304,925 +/- S.F. Excluding Road Right -Of -Way m u0c=� = d o to N i U)4- p 0 d 03: m R C ,C Z d �a co .c 01 i Water Data Vlewer \ \ m 4. o Z F o u l 33' 33' I o Out— lot 1 C.S.M., V. 17 _ — I z ` — —P. — 4480,_Doc_No_714135 \ Kinnickinnic fl — — — \ River fast -West 114 Section Linek \ —� — W 1/4 Corner, Section 21 659 — — . — — — — — — as 33.01' 128N, R18W 582.05' r — _ 77'+/- \ N 89°27'50" W 692'+/- (678'+/J (N 00°5352" WJ N 1 cv (N 89°4706" W) l� 616' l N 00°53'57" W Of 0 46.87 Lot 1_C.S.M., V. 11, P. 3132, Doc. No. 547232 Lo m West line of — — — — — — — — — ---------- ZI to N t/teSW1�4 Legend NW 114-SW,1/4 o 1 LO SW Corner County Section Corner p I c Section 21 monument, found T28N, R18W (9 (Steel "Survey Mark Nail", Ni unless otherwise noted). C ' N Scale In Feet .. � a • 1 1/4 (o.d.) Iron Pipe, found. ail v b N 1 1/4" (o.d.) x 18" Iron 1 3 0 60 120 240 O Pipe weighing 1.68 lbs./ vlinear foot, set. I l o (2oo.00J Previously recorded dimension. o' Z Note J I S I T bl Proposed Driveway Location. ne e .UluIa on Page 2 for "letter" dimensions. This instrument drafted by Daniel .P. Kugel 75' Shoreland Zoning Setback. Daniel P. Kugel S-2684 Professional Land Surveyor Ogden Engineering Company 1234 South Wasson Lane River Falls, WI 54022 Job No. 23-3695 Date: April 26, 2023 Revised: August 18, 2023 Revised: August 28, 2023 Owner & Subdivider Green Pastures Family Farm & Rentals LLC 263 Liberty Road Page 1 of 3 River Falls, WI 54022 g ANN DANIEL P. KUGEL S-2684 RIVER FALLS, LIA St. Croix County 1170488 Page 1 of 3 33 — %2, y`P 0 CERTIFIED SURVEY MAP Located in the SW 1/4 of the NW 1/4 and the NW 1/4 of the SW 1/4 of Section 21, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin, being Lot 1 and Outlot 1 of the Certified Survey Map recorded in Volume 17, Page 4480, Document Number 714135. Surveyor's Certificate I, Daniel P. Kugel, Professional Land Surveyor, hereby certify that I have surveyed, divided, and mapped this Certified Survey Map located in the SW 1/4 of the NW 1/4 and the NW 1/4 of the SW 114, all in Section 21, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin, and is described as follows: Lot 1 and Outlot 1 of the Certified Survey Map recorded in Volume 17, Page 4480, Document Number 714135. This parcel contains 10.105 acres, more or less, being 440,171 square feet, more or less, including road right-of-way, and 9.551 acres, more or less, being 416,054 square feet, more or less, excluding road right-of-way. Subject to all easements, restrictions, covenants and conditions of record. I certify that I have made such survey, land division and Certified Survey Map by the direction of the owner of said land, that such map is a correct representation of all the exterior boundaries of the land surveyed and the subdivision thereof made, and that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the subdivision rules and regulations of the Town of Kinnickinnic and St. Croix County in surveying, dividing and mapping the same. Date: April 26, 2023 Revised: August 18, 2023 Revised: August 28, 2023 Daniel P. Kugel S-2684 Job No. 23-3695 NS Professional Land Surveyor ```````,,��''''. Ogden Engineering Company , 1234 South Wasson Lane i DANIEL P. = River Falls, Wisconsin 54022 KUGEL S-2684 = Owner & Subdivider RIVER FALLS, = Green Pastures Family Farm & Rentals LLC < vVI per: 263 Liberty Road River Falls, Wl 54022 SU Line Table Line Bearing and Distance Line Bearing and Distance A N 89027'50" W 33.01' H N 83043'11" E 255.97' B N 89027'50" W 118.69' 1 N 79046'30" W 185.36' C N 89027'50" W 77.71' J N 22042'24" W 137.78' D S 18048'52" W 44.02' K N 56028'08" W 162.81' E N 77040'35" W 65.28' L N 55029'56" W 88.67' F N 00032'10" E 28.46' M N 55029'56" W 48.33' G N 83043'11" E 33.16' N N 55029'56" W 40.34' Page 2 of 3 St. Croix County 1170488 Page 2 of 3 33^ ?a8� CERTIFIED SURVEY MAP Located in the SW 1/4 of the NW 1/4 and the NW 1/4 of the SW 1/4 of Section 21, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin, being Lot 1 and Outlot 1 of the Certified Survey Map recorded in Volume 17, Page 4480, Document Number 714135. Animal Structure Note A violation of the St. Croix County Code of Ordinances, Chapter 15 Zoning, will be created if a structure is used to house animal units at a setback distance less than allowed by the Ordinance, or, if the amount of animal units exceeds the maximum allowed by the Ordinance. Shoreland and Floodplain Zoning Note This map contains areas that are subject to the Shoreland and Floodplain Overlay Zoning Districts;. additional restrictions apply. Contact the Community Development Department for further information. County Treasurer's Certificate Approved State of Wisconsin ) AUG 2 P 2023 SS St Croix County St. Croix County ) Community Development I, Denise Anderson, being the duly elected, qualified and acting treasurer of the County of St. Croix, do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of AuQL.st a8, , 20a3 , affecting the lands included on this Certified Survey Map. Auqust' a0., &0&3 a- W- CGIZaA Date Denise Anderson County Treasurer St. Croix County Note Each parcel shown on this map 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. Croix County Community Development Department and the Town of Kinnickinnic. Date: April 26, 2023 Revised: August 18, 2023 c C Ns�ti��'''' DAN I EL P. KUGEL S-2684 RIVER FALLS, WI Daniel P. Kugel S-2684 Job No. 23-3695 Professional Land Surveyor Ogden Engineering Company 1234 South Wasson Lane River Falls, Wisconsin 54022 Owner & Subdivider Green Pastures Family Farm & Rentals LLC 263 Liberty Road River Falls, WI 54022 St. Croix County 1170488 Page 3 of 3 Page 3 of 3 33-7A3� Document Number 0; (SM ,?ego rd�) Document Title J I''fl I it I III 1�III1III Do cI :8997710 Ix:5179352 JL170489 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/2S/2023 03:14_PM EXEMPT #: REC FEE 30.00 PAGES: 5 Recording Area Name and Return Address /4; vef Ae lJ� S"yo Z Z W6-10 66) --S-o-lod Parcel Identification Number (PIN) THIS PAGE IS PART OF THIS LEGAL DOCUMENT— DO NOT REMOVE. This information must be completed by submitter: _document title, name & return address. and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/22/2010 St. Croix County 1170489 Page 1 of 5 Name and Return Address Parcel Identification Number (PIN) REAL ESTATE, SANITARY EASEMENT AGREEMENT Green Pastures Family Farm, LLC and Scott and Alexa Eickschen St. Croix County 1170489 Page 2 of 5 REAL ESTATE, SANITARY EASEMENT AGREEMENT THIS AGREEMENT is made on August 23, 2023, by and between Green Pastures Family Farm LLC of Z61 Liberty Road, River Falls, Wisconsin 54022, hereinafter ("Grantor"), and Scott and Alexa Eickschen of U5 Liberty Road, River Falls, Wisconsin, 54022 hereinafter ("Grantee"). Recitals A. The Grantor is the owner of certain real property commonly known as Z� Liberty Road, River Falls, Wisconsin, 54022. B. The Grantee is the owner of certain real property commonly known as 1,6 Liberty Road, River Falls, Wisconsin. C. The Grantee desires to acquire certain rights in the Servient Estate. 1. Grant of Easement For valuable consideration, Grantor hereby grants to Grantee an easement on and across the following - described portion of the Servient Estate. 2. Character of Easement It is the intention of the parties that the easement granted appurtenant to the Dominant Estate, in that the easement benefits the use and enjoyment of the Dominant Estate by The sanitary system easement is to encompass the dimensions and location of the sanitary easement as laid out on page of CSM Volume created and filed in the year 2023. As such, grantee is granted rights to operate and use the property's existing sanitary system servicing the existing dwelling. At such a time the existing system fails, lot 4 shall install a new system located entirely on lot 4. Grantor grants access rights to grantee for regular maintenance, repairs and inspection of the existing system.. 3. Duration and Binding Effect The easement shall endure through the life of the existing sanitary system. This Agreement is made expressly for the benefit of, and shall be binding on, the heirs, personal representatives, successors in interest, and assigns of the respective parties. 4. Purpose of Easement The easement will benefit the Grantee by The sanitary system easement is to encompass the dimensions and location of the sanitary easement laid out on page of the new CSM, created and filed in 2023. As such, grantee is granted rights to operate and use the property's existing sanitary system servicing the existing dwelling. At such a time the existing system fails, lot 4 shall install a new system located entirely on lot 4. Grantor grants access rights to grantee for regular maintenance, repairs and inspection of the existing system.. 6. Exclusiveness of Easement The easement, rights, and privileges granted by this easement are exclusive, and Grantor covenants not to convey any other easement or conflicting rights within the area covered by this grant, or nonexclusive, and Grantor reserves and retains the right to convey similar easement and rights to such other persons as Grantor may deem proper. 7. Grantor's Rights Grantor also retains, reserves, and shall continue to enjoy the use of the surface of the land subject to this easement for any and all purposes that do not interfere with or prevent the use by Grantee of the easement. Grantor's retained rights include, but are not limited to, the right to build and use the surface of the easement St. Croix County 1170489 Page 3 of 5 for drainage ditches and private streets, roads, driveways, alleys, walks, gardens, lawns, planting or parking areas, and other like uses. The Grantor further reserves the right to dedicate all or any part of the property affected by this easement to any city for use as a public street, road, or alley, if the dedication can be accomplished without extinguishing or otherwise interfering with the rights of Grantee in the easement. If the Grantor or any of Grantor's successors or assigns dedicates all or any part of the property affected by this easement, the Grantee and its successors and assigns shall execute all instruments that may be necessary or appropriate to effectuate the dedications. 8. Grantee's Rights and Duties Grantee shall have the duty to repair and maintain the property subject to the easement and shall at all times keep the easement property free and open for the benefit of Grantor and any other concurrent user. Grantee shall at all times act so as to safeguard Grantor's property. Grantee shall have the right to keep access to the easement open by removing vegetation and by cutting or trimming trees or vegetation that may encroach on the easement property. Grantee shall have the right to cut and trim trees or shrubbery that may encroach on the easement property. Grantee shall dispose of all cuttings and trimmings by hauling them away from the premises. 9. Termination This easement may be terminated by written agreement signed by all owners of record and other successors to the respective interests of Grantor and Grantee in the Dominant and Servient Estates. Grantee, his/her heirs, successors, and assigns may execute and record a release of this easement at any time. This easement shall also terminate if the purposes of the easement cease to exist, are abandoned by Grantee, or become impossible to perform. 10. Failure to Perform Should Grantee fail to perform any covenant, undertaking, or obligation arising under this easement, all rights and privileges granted shall terminate and the provisions of this Agreement creating the easement shall be of no further effect. In such a case, within thirty days of receipt of a written demand from Grantor, Grantee shall execute and record all documents necessary to terminate the easement of record. Should Grantee fail or refuse to record the necessary documents, Grantor shall be entitled to bring an action for the purpose of declaring the easement to be terminated. 11. Entire Agreement This instrument contains the entire agreement between the parties relating to the rights granted and the obligations assumed. Any oral representations or modifications concerning this instrument shall be of no force and effect. Any modification of this Agreement must be in writing and must be signed by both parties. 12. Attorney's Fees If legal action is initiated by either party for the purpose of enforcing or interpreting this Agreement, or to compel the recording of a release, the prevailing party shall be entitled to recover from the losing party reasonable expenses, attorney's fees, and costs. St. Croix County 1170489 Page 4 of 5 The parties have executed this agreement on the above mentioned date. By: l Green Pastures Family Farm CCC GRANTEE: By: Scott and ACKNOWLEDGMENT 70 Date: Date STATE OF WISCONSIN - St. Croix Coujity. Personally came before me this day of a , d 3 the above named u�L� n to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. �.0f ... ISM' .'4 Notary Public, State of Wisconsin y?1 JULIE A. My Commission is permanent. If not, state expiration date: PETERSON Date: 0.2(0 (Q-3aaS- S,ff E,Alm St. Croix County 1170489 Page 5 of 5 je tr B ling # Pit Ground surface elev. � 0�' oo ft. Depth to limiting factor l 8 in. on Depth in. 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II 'a Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'EfY"1 'Efi#2 In. Munsell Qu. Az. Cont, Color �, i:rr �, ✓ ��+1 'l r1 '"� ail. :�� �J, __ .. r: j t, w � ,t ...-• ❑[� Poring Boring # � Pit Ground surface elev. ft. Depth to limiting factor in. I elev. ft. r��+—