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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 569523 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal inforri at,on 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:
Paulson, Donald & Jane Somerset, Town of 032-1034-50-025
CST BM Elev: Insp. BM Elev: IBM Descriptn: J Section/Town/Range/Map No:
(
Uwe wk~'e 12.31.19.1580
ad ~ q -
TANK INFORMATION ELEVATION DATA
TYPE t MANU i TURER CAPACITY STATION BS HI FS ELEV.
Septic V \t Benchmark ~/I I ~/~1 YT
D 1 L Alt. BM
};p 0-0- 3.5 ~ D
Bldg. Sewer 60 12 /
St/Ht Inlet j 7. S
TANK SETBACK INFO21ifiAT St/Ht Outlet 7 10 -7
1 ~ 'CC / V J
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ✓
Deeing- / Header/Man. pg
AOFSSOM Dist. Pipe 1 (O `J
H _ . Bot. System lo,q 3,
12.0
PUMP/SIPHON INFORMATION Final Grade 71
Man Demand St Co e , S r
GPM 15 v
del Number
D Lift System Head Ft
FDia. Dist. to Well
SOIL ABSORPTION SYSTEM S~
BED/TRENCH Width f Lengtl ) No. Of Trenches /t nsi a ia. Liqu~
DIMENSIONS !~✓1 I"'
SETBACK SYSTEM TO P/L BLDG WELL LA REAM LEACHING rManufa INFORMATION CHAMBER OR
Ty a Of System: ~ UNIT del Ny~eq
`O f
NU~10
DISTRIBUTION SYST
Header ir- Distribution ole Spacin Vent to Air Intak
Pipe(s)
Length is
S' i _ 7::::
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over I Depth Over xx D f xx Seeded/Sodded xx M hedd
Bed/Trench Cent l/I Bed /Trench Edge soil Yes ~ No / Yes No
COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: / `Z. / Inspection #2:
Location: 711 224th Ave SOMERSET, WI 54025 (NW 11/4 SW 1/4 12 T31N R19 Wild Turkey Retreat II Lot 33 Parcel No: 12.31.19.158
= Zrt 2 1 ( d SySkw_ to reptc~w~a2,G~
1. Alt BM Description ~ am
2.) Bldg sewer length = 1f?i ~I
amount of cover = 3~
Sv*~-~`-~- ~D pan
- -
Plan revision Reqnir? Yes No 8 Tn Iq~ Use other side for additional inform Ion. -
Date 54 Insepctor' ignature Cert. No.
SBD-6710 (R.3/97)
990
Ivey
'PoaG, 99 00
99/0
1. 1 O nJ
~00001*
990 10-00 Q,
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County
Safety and Buildings Division
r B 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
S P ' rl Madison. WI 53707-7162
:ta, S j
State Transaction Number
Sanitary Perm' ion
In accordance with SPS 383.21(2), Wis. Adm. Code, s form to the app cute governmental unit
is required prior to obtaining a sanitary permit. Note: A ottns for state-own are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Pers formation you provide for secondary
Z"
purposes in accordance with the Privacy Law, s. 15.040 in , Stats. y ' 411
1. Application Information -Please Print Information A .4
Parcel #
Property Owner's Name T 7
l ~,yGO/ ~~Q O
O
Property Owner's Mailing Address Property Location /
~`~~p ' Y GovL Lot
Zip Code Phone Number /t9ft AA~ ,
City, S •l`/•, Section
cucle one
lz__ T~/N, RE
II. Type of Building (check all that apply) Lot #
Su ivision Name
Ily I or 2 Family Dwelling - Number of Bedrooms /
OL Block #
❑ Public/Commercial - Describe Use I 1:1 City of
o~ n c,
CSMNum r ❑ Villageof
❑ State Owned -Describe Use ,Town ofy
z Q's zz~-zZ r
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. , .New System ❑ Replacement System ❑ TreatmendHolding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
t'7
Before Expiration Owner J I/
IU S stem/Com onent/Device: Check all that a 1
rIV. Type of POWTS
kon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. ofsuitable soil ❑ Mound <24 in. ofsuitable soil
❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersai/Trea ent Area Information:
Design Flow (gpd) Design Soil Application Rate(gpd Dispersal Area Required (s0 Dispersal Area Proposed( System Elevation
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o j u
.V. V Q
New Tanks Exrshng Tanks 45 w ci
v o 2 ~ D -
Ad
Septic or Holding Tank - T
Dosing (umber
VII. Res sibility Statement- I, the undersi ued, assume respoas' ty for installation of the POWTS shown on the attached plans.
Plum r' arse ( t Plumbe s Si t MP/MPRS Number Business Phone Number
227
-2 7
lumber's ddress ( treet City, S te, Zip Co
b 1
VII oun /De artment Use Onl
Permit Fee Date Issued issuing t Signatu
Approved $ ~ 75. ~
ven Reason for De 'al
IX. Condit 441mWeasons for Disapproval
1. Septic tank, effluent filter and
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2. -A11 Ck requirements must be 'maintained
Attach to complete plans for the system and submit to the County only on paper not less than 8 iR x 11 inches in size
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: I A
Owner's Address:
Legal Description: 'g~
Township: -.5 4;7
County:
Subdivision Name: u)J Y F L✓~
Lot Number:
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing
Page 4 System Cross-Section
Page 5 Fitter Specs
Page 6 Maintenance & Management Plan
Page 7 Se-tic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CS//M or Plat
S I V9/~N®;J GjO0~7
Designer/Plumber: - License Number.
Date: - Phone Number yr9z 7
Signature ,
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101).
Page 1
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Lisa 7 so: / elw- - Js7
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42,
Soil bso anon Siestem Cross §Rg#on
ft
Final Grade
4' Sdtedule 40
PVC Vent Fipe o7 ,E ft
VmVent Cap
Leaching wft
Chamber on
Soirydon ~ Plan View
g~ ft
ft
} Leaching Tren h 1
ft Vent Or Observation Pipe Charnbers
V Dia.
Trend 2 Header
Leaching Chamber Sne caffons
Manufacturer And Mode(
ElSA Rating sq ft per chamber Soll Application Rate gpd/a4 ft
,dao_ gpd Design Flow 7 Soil Application Rate ~ EISA = Chambers
2 rows of_,,,~, _ chambers each.
page ~ o
J
7
r~ INSTALLATION INSTRUCTIONS
s~+.n„~ J1t~mdPary~ke~
PL.,-525/PL-625 FILTER
INSTALLATION INSTRUCTIONS
centerfilter
w, cpwft
SfM ^-rt tY'I~••t?.ri jk .ej'•
I -g'
_4 LU
Y } ~ ~ t N • 4Llvt RJ
( } . 1 L ;fit -0L r]r
Ls.~ ~rµ ~~.~.w ~iT• Y
} a is r y4~r yt
? - A 4 5 `CT•_ ' ••l~ 't n I.. it
Step 1: Step 2: Step 3:
(A) Locate the outlet of the septic tank. (A) Before installation, piece the (A) Glue the fNber housing on the
(B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe.
If necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the
is positioned so the filter can be housing, making sure the fitter
removed from the tank for cartridge is properly aligned and
maintenance and service- completely inserted in the housing.
MAINTENANCE INSTRUCTIONS
Lv JLti T ! Y dom., YS ~+'nss < 7 t4v.
E °.i ?4i„~. oj-y'+ iC w,c~s+K€'x ,C i ~ . ~z~1 ® .+~y <Z. ® • t .',t)r~rY L~'isTi: no
9- z+`:a J a. yy~SP•eti2Yi n 7'1-.
5.• rt m 1 r .t"w ~ r~~' i~~ r`i~ 'vss,c
M1>4 v ,<.•~;~'a+w k y' f~',,~ ~ ash. s F '.a
'
Ste 1: Step 2:
Stop Step 3•
-
Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter carhidge back
if necessary. into the the housing making sure
• NOT USE PLUMBING
the filter is ar hed
WHEN FILTER IS (B) butt the filter out of the housing. pr Y 9
aREMOVED (C) Hose off the filler aver fie septic flank and completely inserted.
' =t~5 tdUB ER;GC t?VES~ ` Make sure all solids fall back into the Replace septic tank cover
. ~J►llit~hl~.~~EA(?I+1j~.GF?L'`i'ER.~''.... septic far*
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Aleof.
FILE INFORMATION SYSTEM SPECIFICATION
Owner Septic Tank Capacity al o NA
Permit Se tic Tank Manufacturer - ❑ NA
Effluent Filter Manufacturer o NA
DESIGN PARAMETERS Effluent Filter Model o NA
Number of bedrooms o NA Pump Tank Capacity al tarNA
Number of Commercial Unit O NA Pump Tank Manufacturer r NA
Estimated flow (average) eo gal/day Pump Manufacturer aNA
Design flow (peak), Estimated x. 1.5) gal/day Pump Model 0 NA
Soil Application Rate , gal/day/ft" Pretreated Unit
Influent/Effluent Quality Monthly Average* o Sand/Gravel Filter o Peat Filter
Fats, Oils & Grease (FOG) <30 mg/L n Mechanical Aeration o Wetland
Biochemical Oxygen Demand (BODs) <220 mg/L ❑ Disinfection o Other:
Total Suspended Solids (TSS) <150 mg/L Manufacturer
Monthly Average" Dispersal Cell(s)
Pretreated Effluent Quality Q NA & In-ground (gravity) o In-ground (pressurized)
Biochemical Oxygen Demand (BO Ds) <30 mg/L o At-grade O Mound
Total Suspended Solids (TSS) <30 mg/L ❑ Drip-line ❑ Other:
Fecal Coliform (geometric mean) <104 cfu/100mL
Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non-commercial)
wastewater and septic tank effluent.
Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event r Service Frequency
Inspect condition of tank(s) At least once eve o months p~ ears (Maximum 3 rs)
Pum out contents of tanks When combined sludge and scum a uals one third of tank volume
Inspect dispersal cells At least once eve ❑ months Z id s) (Maadmum 3 rs)
Clean effluent filter At least once eve o months WF ears)
Inspect um um controls & alarm At least once eve ❑ months o ears 0 NA
Flush laterals and pressure test At least once eve o months o ear(s) a-NA
Other: At least once eve o months ❑ ear(s) im NA
Other: At least once eve o months ❑ year(s) 6 NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator.
Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify 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 (%3) 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 ch. NR 113,
Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other
maintenance or monitoring at intervals of 12 months or less 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.
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 my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have
the contents of the tanks(s) removed by-a septage servicing operator prior to use.
Page ~7 of T
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:
0 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
~8( A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon b
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wi~.
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ 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 INSTALLE ` POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MART=ANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer 21uZ1_ 2 , 11r J
Mailing Address
Properly Address
(Verification required from Planning & Zoning Departr ent for new construction.)
City/State Q,,, ~PSF J L _ Parcel Idem ification Number 0
,_,"?~1~
LEGAL DESCRIPTION
Property Location V, , Sec. 2 7.2 N I€J2_W-, ?own of - k),l
Ss,l?davision_ 27 ,Lot
Certified Survey Map , Volume , Page #
Warranty Deed*# 2<_6Y,. f,r' , Volume , Page #
Spec house ~~_Uo Lot lines idew fiabl no
SYSTEM MAILI'TTENANCE AND OWNER CERTIFICATION
improper use and maintenance of your septic system could result in its py re failure W handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner,, if needed, by a licensed pRmaper. what You }rot into
the system can affect the function of the septic tank as a treats neat stage in the waste disposal system. Owner maimtemmce
responsibilities are specified in §Coaan. 83.52(1) and in Chapter 12 - St Cmi x County Sanitary Ordinance.
The property owner agrees to submit to St Croix Cowaty P1ainung & Zoning Department a o t r,,ft, form, signed by the
owner and by a master plumber, journeyman plummber, restricted phimber or a licensed; 'apet' verifying that (1) the on-site
wastewater disposal system is is proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 fall of sludge.
L'we, the vaderwsmed have read the above requirements and agree to maintain the private sewage disposal system with the
s:aLdards set forth, herein. as set by the Department of Commerce and the Department of Natm al Resources, State of Wisconsin.
Cerdficatian stating that your septic system has been maintained must be completed and returned to the St Croix County P1RMnmg &
Zonin- Department within 30 days of the three year expiration date-
L%we certify that all statements on tbis are true too the best of my/oar knowledge. Uwe amlare the owner(s) of the
property described above, by virtue of a 7' deed recorded in Register of Deeds Office.
N er of bedroo
SIGNATURE OF APPLICANT(S) DATE
* Any information that is misrepresented may result in the salary permit being revoked by the Plaximug & zooming Department
sae pith this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
~-e ce is made in the warranty deed.
.
Commerce 'SOIL EVALUATION REPORT Page of
Wisconsin Department of
Division of Safety and Bylildings
in accordance with Comm 85, Wis. Adm. Code County `
Attach complete site Plan on paper not less than 8 1/2 xi11 4and Pr{d1 Parcel I.D. include, but not limitedte, •u I a~ ontal refere + f% l dp percent
slope, scale or dimensions, nor9i Xrrd tioad. Date
R •ewed by
Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
PSK Property Location
Y O 7? Govt. Lot 114-,, / 1 /4 S T,31 N R E (o W
Props er's Mailing Address Lot # Block # Subd. Na or CS
City S to Zip Code Phone Number ❑ City ❑ Village Nearest Roa
f l y c)r o~-R--~
GPD
New Construction Us Residential / Number of bedrooms Code derived design flow rate
loo
❑ Replacement ❑ Public or colinmercial - Describe: -
Flood Plain elevation if applicable A ff'
Parent material e12 l
General comments
and reconmendations:~/--ao
Boring # Boring
F-11 j~ n.
Pit Ground surface elev. f~'~ ff• Depth to limiting factor Soil Application Rate
Horizon Depth 1T~~Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
Gr. Sz. Sh. •Eff#1 -Eff#2
in. Munsell Qu. Sz. Cont. Color
/ ~4 .
Io3 Zo
D
Boring f
®8orirg # it l
Ground surface elev pzz ft. Depth to limiting factor in• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f1?
.E 1 •Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. J V
0~ (r s
46 2:7 16
-,s
/03.20
• Effluent #1 = BOD > 30 < 220 mg& and TSS >30:< 150 ' Effluent #2 = BOD < 30 nig/L and TSS 30 mglL
CST Number
CST Name (Please Print) Si re 226900
Bird Plumbing, Inc. Shaun Bird Telephone Number
Address Date Evaluation Conducted
715-246-4516
1008 192nd Ave, New Richmond, WI 54017
x
e - +
Property Owner _ Parcel ID # Page of
Boring # Boring ~q
a Pit Ground surface elev. ft. Depth to limiting factor in.
EI Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I
❑
Boring # Boring
in.
❑ Pit Ground surface elev. ft. Depth to limiting factor Soil iption Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate .
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
• Effluent #1 = BODp > 30:< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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 (8.6100)
I
r t
Soil Test Plot Plan
Project Name P.C. Collova Blyds. Inc. Shaun Bird
Address P.O. Box 489
Somerset Wi 54025 CSTM #226900
Lot 33 Subdivision Wild Turkey Retreat II Date 11/18/04
NW 1/4 S W 1/4S 12 T 31 N/1419 W Township Somerset
❑ Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System-Elevatio 103.2/105.0 *HRPSame as Benchmark
Alternate Benchmar Top of 1/2" pipe @ 100.3'
Scale is 1" = 40'
unless otherwise
noted
Please note: Lot lines were not
adequately staked at the time of
testing. Installer must verify all lot
lines and setbacks before installation!
432' Property Line
113'
45'
110' 30'
90,
107'
B-2 20% B-1
Slope
B.M.
428' Property Line B.M.
J , 4 B.M. TOP OF 3/4" 80 RAUws
IRON PIN ELEVATION TEMPORARY
987.24' CUL-DE-SAC
EASEMENT, TO 8E
W 1/4 CORNER OF SECTION 12, REMOVED UPON
FOUND 3" ALUMINUM MONUMENT NORTH LINE OF THE NORTHWEST 1/4 OF THE SOUTHWEST 1/4 EXTENERLr
_ S 89'06'44" E 1339.17' ROADWAY
/ 361.86'
/ 360.26' ~1 660 I I 55.05' "
/ -722.12'- S2'17'07".V /
I 91.<7'
TO CENTER OF
I /r r EASEMENT
LOT 30 r I I
00
Mao Rv 131362 S0. FT. Ur LOT 28 N
CUL-DE-SAC
Leo . 2N.00, 131058 SO. FT. o
EASEMENT, TO BE 3.01 AC.
REMOVED uPON 3.00 AC.
WESTERLY
EXTENSION OF In LOT 29
EXTENSION
ROADWAY N 131754 SO, FT. /
p 3.02 AC. N 89'21'04" W 599.04'
279.20'
319.84'
S67'33'00'W
TO CENTER OF ll~
EASEMENT vJ / B.M. TOP OF 3/4'
IRON PIN ELEVATION
-S 89.57'58" W - - - - _ 998.04'
m 193_98' n~ 795 32 ti / 63 J3 / / / y
o 0
° 193.98' It n AVE TFj ~U\\ ~,^rybry0
N 89.57'58 El- -1VUE Cg 1345002 5O.~ T. 1O- w 13LOa 525 T.
\ _ / ,yohry~~ 3.08 AC. 3.00 AC. p
B.M. 70P 3
1.fj `SJ• / IRON PIN ELEVATION
y Z - - - - 2 >>J y / / a 997.77'
fz to m 00 N 83'20'23" W 535.03• o
-IL o d \
D N o 0 ~wc . vso.oo• I / r I l \ / - - - - 1n
N ns LOT 31
n f m 137273 SO. FT. I f I \ LOT 26 i 0 0
I~ N c 3.15 AC. / AMENS i I ; 'l 731230 S0. FT, ---N 8933'57" \ W.
~D o = (A B.M. TOP OF 3/4" EAS N 1 \ 3.07 AC.
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' 825865
KATHLEEN H. WALSH
State Bar of Wisconsin Form 2-2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO.. WI
RECEIVED FOR RECORD
Document Number Document Name
85/22/20% 03:29PH
WARRANTY DEED
El(EIIPT t
THIS DEED, made between P. C. Collova Builders. Inc.. a Minnesota Corporation
REC FEE: 11.08
("Grantor," whether one or more), TEAKS FEE: 236.70
and Donald W. Paulson and Jane E. Paulson, husband and wife COPY FEE:
CC FEE:
("Grantee," PAGES: 1
whether one or more).
Recording Area
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 ("Property") (if more space W EstMn & Nland
ny ,please attach addendum): 304 L WUSt Str2at lQb
Lo 33 ild Turkey Retreat H in the Town of Somerset, St. Croix County, Hudson W154016
Wisconsin
i
Part of 032-1034-50-025
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated P. C. Collova Builders, Inc.
(SEAL) /~.t 1 \CW1~1 V y J VT (SEAL)
* *By: Marcy M. Hesse, Vice President
(SEAL) (SEAL)
* s
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) P. C. Collova Builders. Inc.
B : Marc M. Hesse Vice President STATE OF )
authenticated on ) ss. - 457 1 (b 040 - COUNTY )
*Kristina Oaland Personally came before me on ,
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
s
Attorney Kristina Ogland Notary Public, State of
Hudson. WI 54016 My Commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
' Type name below signatures. INFO-PROTM Legal Forms 800-855-2021 www.infopmforms.cor.
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