HomeMy WebLinkAbout002-1009-75-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name:
City Village Township
Nik & Kelsey Newgard
TOWN OF BALDWIN
CST BM Elev:
Insp. BM Elev:
BM Description:
;X?
M ASL IM 5PFT MAPLE- , DVM DF MDUND
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
$00
er �
•
►S�s, C�q���a 10�
I
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
�1Dol
►�,-D
))OD
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION 34.
„ 13
Manufacturer
L'A�_�1�r"Vl�
Demand
GPM
'0
52 9P"` jj.
Model Number
TDH
Lift
Friction Loss
System Head
TDH Ft
q. 0
5.5yb
3 3
l l ss
Forcemain
Length
31.
Dia.
Dist. to Well
t,l�
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
648402
State Plan ID No:
Parcel Tax No:
002-1009-75-000
Section/Town/Range/Map No:
05.29.16.69B
STATION
BS
HI
FS
ELEV.
Benchmark
S.�
IDS.s
Alt. BM
oP of WILL 14SWu (Mor Ttf)
10S . S
Bldg. Sewer
0 W ovk)k C6,A04 QvY5,�
St/Ht Inlet
t5s
Q�.qS
t e
Dt Bottom
Header/Man.
Dist. Pipe
2 I
103��1
Bot. System
Final Grade
St Cover
I•o3.j
CMJTDVV,
❑ ❑,
I OD. 3
/�k � ., �ST Co�,,f
`� • �(p
I D0 S�
1 Do. 5
OeAADO�
q 5- 53
BED/TRENCH
DIMENSIONS
Width \
Length
�
No. Of Trenches
I
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liqu' epth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL LAKE/STRE
LEACHING
CHAMBER OR
UNIT
Manufacturer:
Type Of System:
i
4 'Zo b
I
Model Number-
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
I Pipe(s) 3`�u
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only RK FLOMFEK
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 2221 CTY RD DD
1.) Alt BM Description = 11 Oi a � San P'�'r I� 2'�eyd Dk
2.) Bldg sewer length = IDd, h C e 111A 61' 4 j4J<_ . I s'H 4141
- amount of cover =
Plan revision Required? El Yes [_XNo
Use other side for additional information. ID I $ 13
SBD-6710 (R.3/97) Date Insepctor's Sign t
re Cert. No.
s,4,i/- w z j -- 60 -7
I
4= Mm&m Yw& Way
P.O. Brno 7162
Madim. VA 53707-7162
Sanit" K' Application
In ce Frith' 3021(4 VrVL AdEL Owk QMS %woon it. "Ieffirip
LS rNuind prioria obukft a swiMmy pmmk Nw a ftw hr e Sawkwed to
deg Dqammt of Sdq wd hohokM ftm Pftosd i - wlA� aWbe aced breng—liag
w c a rdmPdvny LM's ULO*&% WAL L
E!9!2n M i wM So IL
1. AnnUesflm qmk-- Amm'� PHS&AMS-M11- WIN I
Proporty Owmes Nmw
PnVeM Chrmes Main A4&=
UWJI Sam, zip CO&
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211 or 2 Funft Dwdft - Notdm aBWkwm
. cjc��� .
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Pw NW" Q* be MW
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of III% i *M
fie. _"��___
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AT
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9 "w
WT enhumt Am =d Tw& !'I S111 ill I"—
f
Am RApind (d) AmPnVaiw(d Bkmdm
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CA UZ BE.
rwrp g PM F�m�oi�o��uur��:�
���O���ro
I�IL�11�1.�
. * I _m_ ��_ 'w- __M0'_=L_AM -- .0
ve ar a Are
_-K&w r 715- 9VZ� Visir
C
it
S OWNER:
tank, effluent filter and dis,persal cell
ffW be serviced / maintained as pw
jj�lk -+tS-. 39rp L�4
,W"w*nt plan provided by plumlxr. -in
on 1%
#wf"16 V
!se tback requirements must be maintairwd
.2 i* IL7
'xNPY
v -f " Vol or
7 ?.P:P
gh 'If7ilf 70
SEEM
& ofir
f*Lb sw8b
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ork fe jr
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n
Wisconsin legit cif Safety and Professional Services "y N it T 81,1 Phone: 608-266-2112
Divksion cif industry Services Web: h1t12L-4WN�A'-V.Q%'
4822 Madison Yards Way
Emil:
PO Box 7302
Madison, WI 53707 Tony Ever Covernor
Dan Hereth, Secretary
January 12.,2023
CONDMONAL APPROVAL
PLAN APPROVAL EXPIRES: 2025-1-12
Plan Review: PWT5-012300067-C
Kent Hoke
200 Bremer Ave, Ste D
Colfax, Wl
SITE:
Newgard
County Road D
Town of Baldwin
St Croix County
NW X NW Y-a S5-T29N-R16W
FOR:
Description:4 bedroom-600 GPD mound-20►"
to limiting factor- Effluent Filter -
Maintenance required.
Conditionally
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
SEE CORRESPONDENCE
Mound Component Manual - Ver. 2.1, 5BD-
10691-P (5/22-5/27)
Pressure Distribution Component Manual - Ver.
2.1 (May 2022-2027)
Verify proper dose is achieved and system is not being over dosed.
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101-01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per
s.145.06, stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and
removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees
and shrubs flush to the ground and leave stumps. Avoid operating equipment on the
Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid
compaction.
Components and soil removed from an existing drain field shall be properly disposed of so that there is no
risk to public or environmental health.
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 14S.19,, Wis. Mats.
Inspection of the private sewage system installation is required. Arrangements for inspection shall be made
Stith the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis.
State.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
• Specifications and this letter shall be on -sited en to
A coRY of the aporoved plans, g construction and op
ins pecbon by authorized representatives of the Department, wb&h may include local inspectors.
Owner Res onsibillities
The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a
copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is
operated and maintained in accordance with this chapter and the approved management plan under s. SPS
383.54(l).
in the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
,utilized in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building,, structure,, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the
address on this letterhead.
The above left addressee shall provide a copy of this letter and the POVVTS management plan to the owner and
any others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerelyt
4,o,TaJh"4q
Joshua Rowley
POWTS Plan Reviewer,, Division of Industry Services
(715) 634-5124
Joshua. rowley@w1sconsin-.RoV
Private Onsite WasteWater Treatment System
Ind= andTide Page
Lkue w�
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t
Owne`"s ,+ ddrew:
M.. I 1 6tI
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NIX /Y 44)tA.tO • Y- ,tic /'fa...,a 1;7a� rs .JEw1
IL
16, APPROVED
---�C�r.-vt9/rf AL
SERVICES
X14e040e0%)� � .syd�2 DIVISION OF INDUSTRY SERVICES
Opp
_A4
?V �!4J g? N !f � 4)
SEE CORRESPONDENCE
Lo!M Y4eF1, Q1y of i✓ R t a w fd
sr C,ca,x
Lot Number. Ar $kx* Numbw, SMNum r. 1- �e
Subdivisim Name;
Parcel LD. Numb= 4 - - 6-do
Page 1
Page 2
Page 3
Pale 4
Pale 5
Page 6
Page 7
Page 8
It1daC and 11t1E Pap
Plat Plan
Crowr-+on
4'a 1 Vicw
Lateral
Septic :il ■ mlfChamber,:Md1 & Si rM+1i
Pump +wi •M:11xr'. Ire*r f : 1.iF1
POWTS
OwneesAftwW ''Management
AK f4 Ucem #-. - Aelz : 9� 12 Y1 Y ?
is 4 am : ••i t; l "r � •,`� r c .' # �f�►iT,f WRIKi iT' -_ T it Z, • � P; : I IF: i 9 P -1;f%_ Of C61.
rMd i•rs aaimr W. t4' ralr:i,1!
gTrewr ,11 Ndw ! i• ! /.ei# ffi iar Version o11'2022-2027)
tMwhrmP_rw SMI Ihm1ustion
N
/vi /vc4j4; 44J- .�
W41, Ivid, 5; ON? N,
q7PI
7.J
PC 140.6 jrd/ doe SO. 1,,14C ("/OX/,frjrd# 4CA
a .i at
D : f
Z=loft
ft
Q = 9 5 ft
8 1 ft
57 ft
3Y ft
ft
ft
■ ft
L B f t
r ft
4' ach. 40 PVC
observation pipe
f.5 ft
0.5 ft
OE07EXTII.E FABRIC COVERING
` AaTiA C-33 SAND FILL
--- �L TOP 8011
CR-09119CTION OF MOUND Page of
UPMRNED LATERAL & ACCESS BOX
TOP SOIL ON PIPE & WATER11GHT CAP
►:I INBUTM LATERAL # ;,
�YMAIN\1 .1-yWe
�f►.5�.
or a WSURFACE
.1P %SLOPE DISTRJ13UTM* cELL V. 5 FORCE WM (T *A 40 PVC Ej6)
# # ', 1.
Min.
RequkW .4A0.— + le
U1 M I --TV A 0 e
2" Fcrm Mein
7.3
Observation pipe 'e r
i.fPL
,.� .. � rr4 ■4Fi � rw . r
0
+ s*
'
. , r F w ' w $sue C « S* * * r �� ;,� • + y Fi * ��� ! f �� s ••. . ; R-1 s[ E r e+` -
1
�C tin.
pdke)028Wj
0" PVC
D2055)
Upturned Lawal voth Accen Box
Prohibit disturbance arvd vehicle traffic vAthin 15 tt of downs!downslope too.
BasW Area ft x 3 a 3 7. .1'(t2 Min. Required�.
PIPE LATERAL LAYOUT OF MOUND
(Center Manifdd with Aggregate) T
ROLZ D = 31,14 in. �—
LhTZRJLL ILIA . w YY in •
NA=70LD DM a in . (�. 40 PVC
am- - I?pipe D
07,2jr ft.
3 fto I
ft . S,
-* 3
f
1000
'�.
3
HOLES LOCATED EVENLY
ON BOTTOM OF PIPE.
p #�
513
P L[•2S
f
Minimum Number of Holes = dd 7. Y ft2 + 12 = 51 Holes
1 Holes/Lateral x Laterals = 16") Boles x 0.66 gpm / ( 16" Hole = '.32 GPM = SYSTEM FLOW
PIPE 1 OLUME = . Laterals (total) x g . = 14. 9 4 x 5 = et'g GAL = MINIMUM DOSE VOLUME
PIPE INVERT ELEVATION = l r45- 1L
0
Pape S of 4 ..
CWL4%FVC Tm* Vad
d� �4war
0
_ .rs . i& I�
r �
rA~& JF
W"
awachTyp4c "&
ERM
JI Pump IA@mli� i 1 err �r
Mbw
q. 32 A
Itnom xj�*S
FFMr ..,.N.... ......... .mow..
ft
Mob VdLwm ftx 1 , ' w gat
+do as voksm -
f
Aimm Scot Wbove an 0 a - 1 in a "gid CC)
OrdOffIomtmmurwmit_,(,,,d_ in= _117.1 gW (B)
ff a ink bum 8 in= ' gM
dp
qop
Alolk
�iiiiii�
4-IJ
'Dille
M,
PIN
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or
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e
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dr
traft' over
MOP& I's wasIhing t1roughout the week Avoid vehicle inking water supply. Maintain a replard flaw by, fm
all system oomponenm Compaction o r'snow over *je deal unit may cmm it to c ze
11P.
IN&ECI]ONS & KAINTENANCE: Inspection shall be made by W indMdual carrying one cal® the following licenses or
certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or septage Servicing Operator (per the attached
Maintenance Schedule). Tank inspections must include a visual intpeWon of the tank to idenlify any missing, or broken hardware,
identify any cracks or leeks- meamm the volumc of combined slufte and =um and chwA for any backup or pondkS of effluent to the
ground surface and tea all elact**1 equipment such as pumps and akms. Any &&mu sWI be pmnraptly corrected. Exposed openings
gemer than 8 inches in diamcwr "I be Wired with effccdve locking devices to PMTCUt ArStal or unauthorizcd entry the tanks,
Whm the combination of sludge and scxn in my tmk exceeds one-third 0 8) or more of the tank volurne.., the entirc cOnWnLS Of the
tank algal be rcmovcd by ji SeptSayleing Opamir and disposW or ina=Tdancr. witb Ch. NR 113, Wisconsin Admin. Code.
Specific seryicing mcchwiic3must be provided 'Irver6cal is >1 5 feet or if hofimmal is > 150 fCct and instructiom tO bc provided below.
The outlet ffitcr(s) sha I I be meted andckaned to mmoveany acc=ubded 301idsm=rdingto manufacturcel specifications. Solids
washed fi-om the filter shall be retained in the tank- Filter c3caning may be nccem.y at more firquent intcivaI3 tban stated in the
m aintenance schedul e to keep the system operating.
Alarms sbould be tested on a regular basis by the home owner. if an alarm sounds, contact an hWlMdual lk=ncd to servi= P OWTS.
Thcre is normally a 'I day reserve under mgular operafing condidons, however water should be until vW problems with the
system are carrectcd, to present back-up of sewage into the dwelling or surfacing.
ABAli DONA]II INT: When the POWTS hits andlor is pennsnently taken out orsmicc the following steps shall be taken to cnsurc that
the system is propeffy and safily abandoned in compliance with Ch. SPS 393.33, Wisconsin Admire. Code:
• All piping to tanks and pits duM be disconneMd wd the abandoned pipe openings seded
• The contcnt5 of all la and pigs &WI be r egn mmd sad pimperly disposed of by a SqftV Servicing Opelvor.
• After pumVtin& all tanks md pits slash be axnavaW and rctnoved ordieir co vem i revved and the void space filled with 300,
gravel, or otNw irk sWild mnerW.
CONTINGENCY PLAN: If the POWTS fails and cm otbe rgpaftW the rollowingmenures have bream, or must betaken, to provide a
cADde compliant Mplaccment system: beutilized for the location of a rePhument Soil absOrPt ion system. The
A suitable replacement area has been evaluated and maw '0. - r. - -_ upon by mqu 1 re d s etbacks
replacement ama should be Pr ftom diswrbamc and compar-60n and should not be w
Mtn existing and proposed SucwM lot lines and wells. Failure 10 protest the replacement mu Flindff S it unusable. Replacement
systems must comply with the rules in effect at the: time of replacernenL a
0 A suitable reptwement area is not avaHabic duc to setback and/or soil limitations. Ong advances in POWTS techno,logy a
holding twk may be installed as a last rewft to replace the W led POWTS . rS luation must
�I The she has not been evaluated to idcndf� a sultaNc replant area.. Upon ft pow
Upon lure a holding a soil and sac ova
tank may be installed as a last
be performed to locate a suitable mplacernentreplacementreplacementeiL If'no replacement am is available
resort to replan the Ekiled POWTS. following removal of the biornat at the infiltrative
53 Mound and at -grade so H absorption systems may be ctA ir
e n place
sur face. RecoriMuctkm 0 FsUch SY9Cm!5 M ust ply witb Lhe rubes in eff= at dW UNIC.
j&AMO!"I SFYDCv PUMPAIND OTHER TREATMIOT TANKS MAY CONTLkN MTHAL GASSES ANMR MUFFIM, NT
XL & DEATH
OXVGTK DO NOT ENTER A SVMX� PIJMLP,, OR OTHn FATMrENT TANK UNDER AJNY CUtCUNWANCY
MAY RZSJLJLT_RESCIMOFA WON FROM THIC INTERIOR OFA TANK MAY RE DI LT OR MMSSMM
ADDMONAL COMMENTS:
po%VTS INSTALLER
Name: r
Phone:
SEPTAGE SERVICING 0 tATOR
Nature:
Phone.
Na A&MV544"
P hone:
LOCA4 RZGU&!LTO AUTIBOIUTY
NameW•o, r Y
..
FPlhh on er: 7/J- 3& - WOO
Maintenance Instmcbons,
rNE SEN
rEM-
To anwe rm %prom 1w It www ho
C r '�► �� � ,� � � � � ���, your
Cl� emuPh to r � ors `a d he an d � it becarnes
ig Pw �` At a t r shmid be ciftnW wAmnever the tank
WPOC IN� In � �, �. case end a
r * - * CNcounty heafth
Ifs WW tD
hOpect
and/orlis iV MWVGWmt10Sm#vim
and' er *wwL Tbw *Ow own Phi. fir% Perna and shirt,
weft MWIci�hwhW
�
* If b��i bewWw
end. If * at
2 Remove the fiNer carbidpsbypnpiao ft ei. hndla
NW oft aaurofb nmdnQ hm 11
ftft3. S�r�yltte cx�ia�efi�swih a baato reniors.uy
'MftW (AWP1+�bAt61oMtfrtl�
odlor tithe optiord modpllmi"ft
ftrm owr ofsny da6riR Wbauroft 11 wwedr
an back inlofto* ktdo not�lawsaidsawwitl
bfil io11nw-TApinbowng,
4 P90=ft cM'I�idgs bads irAotlr hmia
'S 5ome Bl1lt�titirNi �Ome w�h aR *If1A'd�aC�l�li
IA�IN11�1a {�f 118BE�6 C�Elfl�, I Y(m SIN ill ohm
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Yft it dW An aWft *" =mail*
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The DcpL of Safety. and Pi affivelskmd SWASM is 20 OqUW OP P 'der quad employer. If you need assismnoe to
a -vices yr '2b=sftWit= the at 609-2+1 - 3151 or TIN through Relay.
Y'r -1 .* 99
IV SLO14 641,
k;
SANITARY SYSTEM File
Sr CR JJ INN T Y office Use Only
OWNERSHIP/ADDRESS FORM crww2m"
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. If you would like to view your issued sanitary permit online, you can
do so by using the Prpqg-rly Files Scanned weblink.
OWNER/BUYER INFORMATION
Owner/Buyer � \�- Pc,.�f� C�-r�
Mailing Address _ � U 1' ll �x i � �1
City/State/Zip
0
Phone Number (required) J��a " ���-O U���
-
Email Address (required) onPr.,�ar�r�+��q
Parcel Identification Number - � i� � - � J v��(found on the property tax bill)
-N I
,1 A P1 IJ I Le I k,'l
Property Location N'4 1/4 1/4 , Sec. tJ"' T N Rj CC W, Town of dl l�lY"1 �
Subdivision Plat: Lot #
Volume -3-1 -,--------,Page#
Certified Survey Map #
� � 3 1$' 2� b �� g _.
Warranty Deed *. (before 2006)Volume Page
Number of bedrooms Spec house 0 yes 0 no Lot lines identifiable 0 yes 0 no
OFFICE USE (MLY
New, Property Address CT) d
(Vedcat ion of new address required from Community Development Department for new construction.)
FJOAP
(Staff initials)
Z , 6 , Z o z3
(Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
Now 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.
Community Development Department — Land Use Division 715-245-4250 Fax
71 S-386-4680 St. Croix County Government Center
cddi. V 1101 Carmichael Road, Hudson, WI 54016 V
or im�
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INTERIOR ROOM L A YOU T PLAN .XL..E Imm &S ,ffi. m.
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ar -ftm.e 4D rl, it
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State Bar Of Wisconsin Form 7-2003
TRUSTEE'S DEED
Document Number Document Name
THIS DEED, made between
Thomas M. Kanten, as Trustee of the Thomas M. Kanten and Melody A.
Kanten Revocable Living Trust dated October 22, 2019 and any
amendments thereto
'Grantor," whether one or more), and
Kelsey M. Newgard and Nikolas K. Newgard, married to each other as
suvtvorship marital property
("Grantee," whether one or more}.
Granter conveys to Grantee, without warranty,, the following described real
estate, together with the rents, profits, fixtures and other appurtenant
interests, in St. Croix County, State of Wisconsin ("Property ) (If more space
is needed, please attach addendum):
SEE EXHIBIT "A" A77ACHED HERETO AND MADE A PART HERE -OF
1159779
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
10/10/2022 02:28 PM
EXCEPT:
REC FEE 30.00
TRANS FEE 810.00
PAGES: 3
"The above recording information
verifies that this document has
ReCobjeefreelectronically recorded
Nam e%n6%W)C4Aq: the sub-rWitter
TitleSmart, Inc.
4810 White Bear Parkway, Suite 100
White Bear Lake, MN 55110
002-1009-75-000
Parcel Identification Number (PIN)
(Signatures may be aulhenticatW or acJuvv&dged, Both are not necessary.)
TRUSTEE'S DEED NOTE: THIS IS A STANDARD FORM. ANYOD MIFICATIONS TO THIS FORM SHOULD BE CLEARLY 1[)ENnFIED.
*Type We("g%t!" ty 11 �91
@ 2003 STATE BAROF WISCONSIN FO�
Manc, YgA65
Dated-- August 19, 2022
Thomas M. Kanten, as Trustee of the Thomas M. Kanten and Melody A. Kanten Revocable Living Trust dated October 22, 2019
BY:
Thomas M. Kanteh
Trustee
AUTHENTICATION
Signature(s): Thomas M, Kanten, as Trustee of the Thomas
M. Kanten and MeWy A. Kanten Revocable Living Trust
dated October 22, 2019 and any amendments thereto
authenticated on
TITLE: MEMBER STATE BAR OF WISCONSIN-
(If not,
authorized by Wis. Stat. § 70f3.06)
THIS INSTRUMENT DRAFTED BY:
TiCeSmart, Inc.
4810 White Bear Parkway, Suite 100
White Bear Lake, IVIN 55110
ACKNOWLEDGMENT
STATE OF MINNESOTA
)SS.
WASHINGTON COUNTY
Personally carve before me on this the 19th day of August, 2022'
the above named Thomas M. Kanten as Trustee of the Thomas
M. Kanten and Melody A. Kanten Revocable Living Trust dated
October 22, 2019 to me known to be the person(s) who executed
the for nstrurnent and acknoWedged the same.
akk
Notary Public, cf Minnesota
My Commission (is permanent) (expires.- 0113112025)
AM BAKKE
NOTARY PUWC
�L*. MtNNF907A
kly C WIV-ni or F's -,VU JVL 31
(Signatures may be authenticated or acknoWedged. Both aria not necessary,)
TRUSTEFS DEED NOTE: THIS IS A STANDARD FORM. ANY MODWICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
@ 2003 STATE BAR OF WISCONSIN
TFORM NO. 7-2003
yw 9V- "et*ke&Mty 1159779 Page 2 of 3
EXHIBIT "'All
Lot Fifteen (15) of Certified Survey Map recorded in Volume 31 of Certifed Survey Maps on page 6968 as Document No. 1131828 '
located in the North Half of the Northwest Quarter (N/2 NWI/,4) of Secti
ixtn 1
on Five (5), Township Twenty-nine (29) North, Range
See(6) West, Town of Baldwin, St. Croix County, Wisconsin.
(SignJftres may be authenbdated or acknowledged. Both are not nwa"ary.)
TRUSTEE"S DEED NOTE: TWIS LS, A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
T�pe!Sj,,5(� 0 2003 STATE BAR OF WISCONSItj
1159779 Page 3 of 3 FORM NO. 7-2003
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SCALE: 1 INCH = 400 FEET
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CERTIFIED SURVEY MAP
LOCATED IN PART OF THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER AND PART OF THE NORTHEAST QUARTER OF
THE NORTHWEST OF SECTION S. TOWNSHIP 29 NORTH, RANGE 16 WEST, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN.
LEGEND
7-nrAt LOT 16 AREA & FOUND ALUMINUM COUNTY SECTION CORNER MONUMENT
EA"110ING Riven w WAY
'qr vv. 1`91� S
FT. ES
w
98-L 487 SQ. M 941,9&8 SQ. FT
'L t2 10. 236 ACRES 5 1'9.32-9 A SQ.
FIELDWORK COMPLETED. 2/26/21
0
UNPLATTED
LAND
NCWTH WEST CORNER-\
SECT ON 5
SURVEY MARK NAIL
--A
PREPARED FOR: SURVEYOR:
TOM KANTEN DOUG ZAHLER
118T 220TH STREET S & N LAND SURVEYING
SALDNMN, W1 54002 2920 ENLOE ST. SUITE 101
HUDSON, WI 54016
The prupedy depIctod by this map contains arvas that errs
subject to the Shorsiand Ovwfay District Additional
rostrktions apply: COfiftct Came vnffy Development for
further Informntion.
Lots 14, 25 and 16 are zoned R-1, Residential District, which
allows 1 principal dwelling per 10 acres. Two additional
residentlal anks are avollabk for Lot 14 and 2 residential
units are avagalbe for Lot J 5 while zoned as R- 1. This notr
is intended to assign residential units and does not account
for required lot destgn standards, such as suftable sails for
private ort-site wastewater trewment sy3ftms, access
standards, etr- PICUSE contact the COMMWnity
DevElopment Departmentfor more Information.
()IF WISL-1
co DOUGLA.S J.
ZAHUR
S-2 I f5
LIDS
61112021
83,17'-
S00*38'58"E
FOUND I INCH OUTSIDE DIAMETER IRON PIPE
SET 1 INCH OUTSIDE DIAMETER BY is INCH LONG
IRON PIPE, WEIGHING I-13 LESS. PER LINEAR FOOT
LOT I UNPLATTED LAND APPROXIMATE WETLAND LIMITS DERIVED
FROM AERIAL AND UDAR DATA.
C.S. M. COUNTY
94
ROAD "DD#r UNPLATTED LAND -ziF' UNPLATTED
PG. 2669
Uff LAND UNPLATTED
ILD OVWJ/4 r—NORMERNSTAT -SOUTH R. 0. W
I _____—ES1 I SMALL cc :3 t LAND
:_21 POWER COMPAI ;V) COUNTY RD. "t I
TRACT -NORM QUARTER
CORNER SEC'"ON 5
S86'PSfi'0Z-E 2628.9s,_
S 8 6'0 5 L0_1 " E7 2 6 2 13 —W- LL
n _Y MARK AWL SURVIE
33 vAnor- 33-� Iwo- - -WEST LINE .401 _J
NWZ14 - NW 114 0. To T.15
Ir 59
EXIS-TING DRIVE
is 111 Q. FT.
J_
ka P% 25-871 ACRES
LU 11 LOT.16
CA 1.6
*-4 om OUMIJILDIRGS
FENCE� LOT 14
:t Zzjqous� SETBACK 1, 119,433 SQ. F7
- 10 _ . 11S0.0 AL
0 1 -EXISTING ORAT
LOW BUILDMG OPENING - J
C418 Z 011 AL
Z QED ID
LOT``J 41
C.S. fail . 6 N87VFJL4"W Z A,
VOL. 23 3,76'
�_-11 U,
M69'
PG. 5573 �;� - 527.03' 938.28,
-EAST - -
220TH ST. 220M Sr. 14876w'14"W 2619.9s,
UNPLATTED LAND SOUTH LINE N 112 - N W 114 -
UNPLATTED LAND
Each ParcW shown on this map is subject to State, County and Township laws, rules ant! regulations
(Le-, wtftnds, minimum lot size, access to parcel, air-) Before purchasing or developing any parcel contact
ON St Croix County Community Development Department and the Town of Baldwin for advice.
ti 83.14'
SW*15'50"r
00 1
Ln CM -
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VOL. 31 tZ
P 6918
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AIN
My and Pr fessionWidtA)
wig• Copt,of Safety
D"AsiOn Of Safety and Buildl gs S IL EVALUA1QUZZP.0R4 L:-Lqr age --L of .3
St -V%w mf� vv 6 J00, s. A
Attach complete so plan o pa ewqmen Mm. Code
County
i . ncJude, but not limited to. v ' x 11 inches in size. Plan must L4e
nzoft(x
ntal reference point (8M). direction and •
Percent slo.pe, scale or dimensions, north arrow. and location and distance to nearest road,. Parcel L D. f4w
PlSaSe print all information. R wed 7�.-4
b
Personal information you provide may be uuW for sec - ondary n"Tnr%*&& fb--- I - Y- /L
Replacement I NUMDer catbedr()OMS Code derived design ftow rate GPD
Parent material Public or Commercial - Describe:
.,,�
General COMments Flood Plain elevation If applicable
and recommendations
Should -itxkc +i&t mo(t- reS+Y-iL(,-Hvr-- hc>rizz)n
Boang # F Boring
19 pit
Bo6ng # Boring
pit
Ground surface elev. 9�.�f ft
Ground surface elev. .97-75 ft.
" Effluent #1 = BOD > 30 < 2�n rnrifl nnA '174C!
DePth to limiting factor 2..0
Depth to lunifina factor - ?0
Effluent #4- = BOD 30 Mg/L and TSS <- 30 riglL
Property Owner--F6 vs%- Parce; ID # Page
of
'c"ing
Bonng #
pi+ Ground surface etev.
- 97-0 -7 t
Boring # Boring
Pit
[]Burin Boring
g # F7 Pit
Ground surface elev fL
Ground surface elev. f t
Depth to i'mitint
1 .1 factor
Depth to i1mitinq factor
Depth to limiting factor
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < ISO mg/L Effluent #2 = BOD < 30 Mg/L and TES < 30 MgIL
The Dept. of Safery. and Professional Services is an equal opportunity service provider
accand employer. If you need assistance to
c--ss scrvices or need material in an altemate fonnat. contact the department at 608-266-3'151 1 or I-rY through Relay
5DD-83.1", (P, I I/ I j)
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P 11 MA R1 11301
No* 648402
DID
APTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanituy permit is to allow installation
of the private sewage stem described in the permit.
(b) The approval of the unitary permit is based on
regulations -in force on the date of approval.
(c) The unitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought; and that
changed regulations may impede renewal.
( The sanitary permit Is transferable.
History: 1977 c. 16; 1979 c, 34,221; 1981 c. 314
Note: if you wish to renew the perm14 or transfer ownership of
the permit, please contact the county authority.
RIZED ISSUING OFFICER - DATE
UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIENM
BD-0 499 111 0)