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HomeMy WebLinkAbout020-1412-20-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERN]IT) 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 Nelson, Gar Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: vlA.~ M.t. OD , ~ r ~ . ~r a,/ ~.oer v~7.Q, TANK INFORMATION County: $t. CroiX Sanitary Permit No: 420643 0 State Plan ID No: Parcel Tax No: OZb'I ~ h ~ ~'a~ Section/Town/Range/Map No: 10.29.19. v ELEVATION DAT - TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ / / 2G v Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand M Mode tuber TDH Lift n Loss System Head TDH t Forcem ' Length Dia. I SOfL ABSORPTION SYSTEM f I l )rd n.,,,,,_I,.~,-~ ~;~...6. . STATION BS HI FS ELEV. Be hmark ~ ( ~ ~ ~ ~ t) Alt. BM Bldg. Sewer ,8~ ~ qs.a~ SUHt Inlet • ~O ~ SVHt Outlet •~~' ./°I Dt Inlet Dt Bottom Header/Man. ~~~ f 9~f~ Dist. Pipe ~~ ~.. f 9 .a Bot. System )o.9Z ~~ D `~ Final Grade R9"- ~ St Cover BED/TRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '?J Z1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact rer INFORMATION CHAMBER OR Type Of S~ ystem~ r ~~ UNIT Model Number. . ~..-o' ~ ~ ; ~2 DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe( ~ }Si Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Ed es g To soil p J Yes ~ No ~ Yes ~ No COZM1~1 ~NT~Inclu scode isc pencies, persons present, etc.) Inspection #1,L~ AZ 1 ~3 Location: 636 Wildflower La Hudson, WI 54016 (SE 1/4 SW 1/4 10 T29N R19W) Burkhardt Prairie Lot 2 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3) Inspection #2: Parcel No: 10.29.19. ZSR~ ---- Plan revision Required? ~] No Use other side for addition I information. , ~__ ~ SBD-6710 (R.3/97) ~ '~0~'~"`~~.Q~-~~`'~ Date Insepctor's Signature Cert. No. `'r-`.~v~ ~~ . Safety and Buildings Division County ~ 201 W. Washington Ave., P.O. Box 7082 ~ IvCOI1SIII Madison, WI 53707 - 7082' Site Department of Commerce ~ i Sanitary Permit Application Sanitary~^P~ermit Number ` ~O In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ma be used for secondar ur oses Privac Law, s15.04 1 (m) I. Application Information -Please Print All Information State Plan I.D. Number Property Owner's Na me P cel Number 02~_ /L~~ l/Z Property Ow r s M ailing Address ?003 Pr perry Location I ~ -., ~ ~,d ~ , ~k ; S T N, R ~" City, Slate Zip Code one t~RANG UrF~Cc Lo umbe Block tuber S i ' ' n Name m~er 1 ~5 ' ~ C - II Type of Building (Check all that apply.) QS `! ^ City 1 or 2 Family Dwelling -Number of Bedrooms Village ~ Public/Commercial -Describe Use _ Townshi Q State Owned ~ 1 _ ~I ~7~"~"~,." ` ear st .Type of Permit: (Check only one box on line A. Numbering is iar internal use.) (Compl ete line B, iP applicable.) A. New 2 O Replacement System 3 Q Replacement of 6 O Addition to For County use S stem Tank Onl Existin S stem B' ^Check if Sanitary Permit Previously Issued Permit Number Date Issued ~ IV` 'Type of POWT System: (Check all that apply. Numbering is for internal use. '~ y 44 Non -Pressurized In-Ground 21 D Mound 47 ^ Sand Filter 0 O Constructed Wetl nd _~~}. '~ 22 l7 Pressurized In-Ground 41 ~ Holding Tank 48 Q Single Pass 51 Q Drip Line ~V 45 ~ At-Grade 46 QAerobic Treatment Unit 49 Q Recirculating 30 QOther V. Dis ersal/Treatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soi- Application Percolation Rate System EI anon Final Grade Required Prupusrd Rate(Gals./Days/Sy.Pt•) (Min./Inch) Elevation ~ S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallotu of Tanks Concrete Cons ed Glass ' New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. Plumber' a m (Prints Plumber' i g ~ MP/MPRS Number Busitless Phone Ntunba' ) Plumbers ddr ss (Street, City, State, Zi Code) ~~ VIII. Count /De artment Use Onl Approved Disapproved p Owner Given Initial Adverse Sanitary Permit Fe (includes Groundwater Date Issued Issuing a ignattue (No S ps) Determination Surcharge Fee) ~- ~S IX. Conditions of Approval/Rea~~~ r Di pprova5~ _ ~ ~ .rN. , .~ ~ ' Uttach complete plans (to the County only) for the system on popef~ not icss than 81/2 x 11 inches in size ©Nd ~~t' ~ cam' urD I,~- Lti~~,to~,e,wte~c~~ a.Qk!dltu'c~Q .~,;,~ ~a,ewiagc -~~e.ot~e¢,~i~ 5~-w•. c, ~ a~stao SBD-6398 (R. OS/O1)~ ~' ~~~ "~ C~°~" ~ °"~~ ~ ~ InroM,,~. S S~ '~ s . ~~~,~~s ~r s~?3 _ ~e- / ~ N.9{F ~ I .B~J~//7/e,PKJ J~a~ a~~ /'~ _fs..(/GD,O ~ ~' Sri Ol ~l~nJha.+~ ~ _- _ _ _ - p ~~.-/ ,6of''~ S /tar ~ ~ ~ ]i.~ ~6 i~~ ~ ~~ ~ ~~~nc ~~ /~oo"y,~~ WEB ~ - moo? ~~,,,,~,~ ~~~s /i„/~~ / - ~~ ..~~~a ,w ~ ~~ .~ _~ q ~,~~i _, ~- ,o~'~Jt w.~~ ~~o~~ n/5';.~J~iCs ~p py '6? ~ ~ ~~~ ti` ~ S'a' r / / i I / , y j~~x ~~ /~ k /, ~ ~~ ;~ B ," ~~ ~ ~ r,~R,~G ~~~~X~~ ~~~~~s ~~ ~-3 C~~ ~~ s~r~ ~~t~~aN it _- __.~_ _, ~r ~ ~ `^ '~ '~~~ -~ ~~ ~~ ,w~ ~x _~ h/!,a ~~ tls~s~ rs~ - 1- ~~/~ r~-~,~~ ~- ,orc'iJ.~w~ - ~~ - .~~ ~`~ ~~. a~ / ~~ ~/µ.',1,~./~1~ a`N / Y !~' `' /~y' l s'a , ,- / ~ r %~~x l ~~/ow~~ uJ~~~ ~~~~-~~/~~ ski/~ -r~9,v-~ip~ ~~SO~ ® ,B~Jc,/{1~.~~ ~ ~ /~P ~~/'i'Jc -rte i~.>, a '' ~So; / ,.~c~c' s ,,; ~~, ~ 5.~,,~ ,~ ..~ ~ ~` ~~ E~-i~ ,~ , .,~"~ g LY ~~ ~K . WiscGnsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arrnrrlanrY± with r'_nmm A5 Wic e~m r•.,,te _______ Page ( of ` Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 1 1 1 include, but not limited to: vertipl and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi ed `y Date Personal information you provide may be used for riva Law, s. 15.04 (7) (m)). ~ ~ 8~„ Property Owner P perty Location G ~ G vt. Lot SF 1/4~(~ 1/4 S~Q T ~ N R E (or) IC~ Property Owner's Mailing Address s U L 2 6 2002 L t # Block # Subd. Name or CSM# Z ~ o t s ~ Pr ~ ~~ City State Zip Code Pho CuLi~~.T'~ LuP l ' City ^ Village (~ Town .. Nearest Road ~ lv G OFFICE w ~ vU U ~ ~ e ~ ~- k~l-. New Construction Use: ~ Residential /Number of bedrooms 3 _~E Code derived design flow rate ~f 5z.7 po GPD ^ Replacement r ^ Public or commercial -Describe: ' Parent material __rj Gl-tt~.rc.~ („ Flood Plain elevation if applicable _ of /`¢ g, General comments SY ~ e ~,,,~ e1e ~ • ~ P ~~ ~ L ~ w -er y y, ~ p and recommendations: Boring # ^ Boring Pit Ground surface elev. ~Q ft. Depth to limiting factor ~0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •EffiY2 ~ o- v (L~ 2 - ~ s~ l Z c g I v y • 5 ~~ Z I - y l~ ~~ l 2msb1< ~ - ^ 3 2 -y~ ro yJ ~2P ~.5 til 5~ Zmsbk mfr c~ - . 5 .9 Boring # ^ Boring c7 ^ Pit Ground surface elev. / ~ QD ft. Depth to limiting factor ~~ in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I 0--(Z l~ Z -- s~ k ~r e I v-~ . g 3 24-y 3 10 3 CZ ~.5 ti~ Si_ Zn-,sb~t m~r C;5 - . `J ~ 3- lU ~l~ _.- mS ~~ rYi - - . ~ (. 2 uaucm fr ~ - ovus ~ JV ~ ccv myil anu ~ ~~ ~s~ ~ i au mg/~ 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature --- CST Number ~-~ ~ /' Address -~" ~ ~ ---- _- -_ ~ ~- ~-, r Date Evaluation Conducted Telephone Number ,~ /~ _ ~ ~~ _.(o ,C:,Y ->L ~i ~~ rte' `' ~ - ,1 ~ -~' ~ ~ ~/5 - ~ ~~-~C,~; SBD-8330 (R07!~01 ~~ Property Owner ti`~~ G a-Q ~ Parcel ID # >"-~: - • •. Page ~ of _~~ Boring Boring # ~ ft. Depth to limiting factor ~^ in. Ground surface elev. S li ti Rate il A ~ _ p pp on o , pit tion x Descri d R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth Dominant Color p e o ' ' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Eff#1 Eff#2 Si( Zrrt~bk ~5 lv.~ .8 I o-~2 ( 2 ' g' 2 ~_ _' Si I r c w . 3 -4 t ~(3 CZ ,5 SL Sbk rr,~'r c..s - . 5 .9 r w w 9 Boring # U Boring ~'~ ^ Pit Ground surface elev. ft. Depth to limiting factor 'n• Soil Appligtion Rate tion dox Descri R Texture Structure Consistence Boundary Roots GPD/fP Horizon Depth in. Dominant Color Munsell p e 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 i tion c D d Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p r es ox Re Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #i = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 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. ssasaao trt o~roo> ~ -+ -. PAGE ~ OF ~ T~TAMF~ NYha~ ~,~ TOT# g T EGAL DESCRIPTION SF ~.~~/ to ,S /~ T Z~ .N.R. /9 E(or)~ SCALE: 1"= ~/O ~ BM 1 ELEVATION YGU • ~ BM 1 DESCRIPTION {per ~~ ~ ,Ouc ~~e BM 2 ELEVATION j % ~j0 BM 2 DESCRIPTION ~p Q-~/ ~~ ~~~e ~~~ SYSTEM ELEVATION ~~ q~, Gy (~ w e~ %'y (D D SYSTEM TYPE (`~ ~,~{,~,~-~ o~a-~ CONTOUR ELEVATION l~•GU (' qY GU SIGNATURE N ec• ~0 1 ._ ~~ --- DATE C' `„i 7! Cj~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFO ATIO Owner Permit # ~ C) (e~(3 DESIGN PARAMETERS Number of bedrooms ^ NA Number of Commercial Unit I~NA Estimated flow avera a al/da Desi flow eak , Estimated x 1.5 ,'' al/da Soil A lication Rate al/da /ft Influent/Effluent Quality Monthly Average* Fats, Oils & Grease (FOG) <3U ntg/L Biochemical Oxygen Demand (BODs) <220 mg/L Total Suspended Solids (TSS) <150 m L Pretreated Effluent Quality ^ NA Monthly Average** Biochemical Oxygen Demand (BODs) <30 mg/L Total Suspended Solids (TSS) <30 mg/L Fecal Coliform eometric mean 4 <]0 cfu/100mL Maximum Effluent Particle Size '/e inch diameter MAINTENANCE SCHEDULE SYSTEM SPECIFICATION Page ~ot Se tic Tank Ca acit al ^ NA Se tic Tank Manufacturer o NA Effluent Filter Manufacturer - ^ NA Effluent Filter Model o NA Pum Tank Ca acit al ~'NA Pum Tank Manufacturer ANA Pum Manufacturer ~ NA Pum Model ~a NA Pretreated Unit ^ Sand/Gravel filter ~~ Peat Filler t'i Me.chanical Au•afian ^ Wrfland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ~'In-ground (gravity) ^ In-ground (press urized) ^ At-grade ^ Mound ^ Dri -line ^ Other: * Values typical for domestic (non-commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater, Service Event Service Fre uenc Ins ect condition of tanks At least once ever ^ months ears (Maximum 3 rs) Pum out contents of tanks When combined slud a and scum a uals one third '/3 of tank volume Ins ect dis ersal cells At least once eve ^ months ears Maximum 3 rs) Clean effluent filter At least once ever ^ months earls Ins ect um um controls & alrrnn At Icast once ever ^ months ^ earls ANA Flush laterals and ressure test At least once ever ^ months ^ ear(s) ~a-NA Other: At least once ever ^ months ^ ear(s) NA Other: At least once ever ^ months ^ ears ANA 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 ol'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 tht: 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 ] 13, 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. Owner: ~~ 1 Page~oe~ System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal 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 soft absorption are. 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. ABANDONEMENT 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 ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 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 by required setbacks fromexisting and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. o 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. o 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 the time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL Name '~ 1' ~ Phone SEPTAGE SERVICING OPERATOR PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHO TY Name ,~~ ' Phone ~ ~ ST CROIX COUNTY _ SEPTIC TANK MAINTENANCE AGREEMENT AND GWNCRSHIP CERTIFICATION FORM OwnerBuyer Mailing Address ~, Ci , _,,~~G~~~ Property Address -- (Verification required from Planning Department for new construe OiY C') ~ /o Cit /State ~ Y c.( D,~G~n/ ~~-1 Parcel Identification Number C9 ~~ ~• l d / 1- `r~0 ~ y coo ~- v:,tn ° lok :~u ~c.~ LEGAL DESCRIPTION Froperty Location ~_ '/,, w /4, Soc. ~, T~Z`~,N-R~_W, Town of ., ~ Subdivision ~ u /~ ~!' !-{ /~JZ b7' 1~~' ~~- t Zit= ,Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # ~ y~ ~~,~ /~, Volum - ,Page # ~~. Spec house ~ yes ^ no Lot lines identifiable ~ 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. `' ~ /~/4~ SIGN TI E F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this farm are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATUR ~ O APPLICANT ~"' / O~ 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 r ~ ~ ~ ,~ r s ~ J Li STATG I3AK OF WISCONSIN FORM 2 - 1999 ~~,~~~~nent Number WARRANTY DEED This Deed, made bete-een .James D. Henry and Allan C. Nyhagen Grantor, and Gary D. Nelson and Jillienne J. Nelson, husband and ~~ ifc, Ciranlee Grantor, for a valuable consideration, conveys to Grantee the tbllo~~ing described real estate in _ St. Croix _ County, date of Wisconsin (if more space is needed, please attach addendum): 1 ? flat of Burkhardt Prairie in the Town of Hudson, St. Croix County, .. isconsin. 7ca~.Q~31 KATHLEEN H. 4lALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR, RECORD 12/30/2002 02:00PK EXEMGT # REC FEE: 11.00 TRANS FEE: 194.70 COPY FEE: CERT COPY FEE: PAGES: 1 Recording Arca Name and Return Address EAGLE VALLEY BANK, NA 1301 Coulee Rd PO Box 70 u. ~a~.,., wl ~nni a Part of .020-1011-1C}-000 &020-1010-ZC}-100 Parcel Identification Number (PIN) This is not homestead properly. (}~) lis not) Exceptions to ~ arranties Easements, restrictions and rights-of-way of record, if any. qti, Dated this ~U day of -December 4UTNENTICATION ~ienutur.ts) James U. Henry and Allan C. Nyhagen j - - -- __ .._-- _ ---_-------------- ~ ,,u~hrntic,ird this /day ol~ December _, 2002 ~- -- • Krishna Ogland l ITLE ~~1E:ME3ER STATE [3AR OF WISCONSIN Ilf nor. author~zcd by ~ 7U6 U6, Wis- Stats.) '~~ ~rtiis i~~s~rKUMF:N-r was nRAFTF,t~ t~Y I ~\ttorne~ Krishna Ogland ~ Iludson,lVl 5016 I (tiien~tnirrs m:~y be authenticated or acknowledged. E3oth are not necessary.) ~nn~ ~ ~~ ~ -.~ * am~eps~D. Henry "~ y _ ti°- * Allan C. Nyhagen ACKNOWLEDGMENT STATE OF WISCONSIN ) ) SS. -_-- County ) Personally came before me this day of ________ the above named to me known to be the person(s) whu executed the forcgoin ; instrument and acknowledged the same. * ___ _ Notary Public, State of Wisconsin ~ r My Commission is permanent. (]f not, state expiration data ) V.uites ~:~r per,ons zignine in anv capacity mull be typed Ur printed below their Signature. inmrmaron Proress~onais Company, rood au lac wi ` ax-ess-zcr~ S'1~.4"hE BAR OF W ISCONSIN \\':1RRANTY' ~t:ED FOR~1Vv.2-1999 ., . BENCrMARK TOP OF IRON PIPE ELEVATION=917.80 ~t~~ /~ (S89'48'42'E) ~ uv U' t_`~[:.1~ 200.99' , 4a.~a • 20' C~RAINAGE ~ - 45' 45' .% - - - _"' . `.' . ~. EASEN~NT I/.. •... .. Q~ ~ ~ 9a ~ ~.•......•. ~ ~. ..• ~.. dQ4 \. • ~ ~ H.W.E 917.0 •/ (A BENCHMARK TOP - ~_ I \. . Q• . . ~ ~ iROIV PIPE EL~/Al J 10d -~-~ . ,r . . / S ~ ~`~--~~~ '( Sri • ~ 8 LOT ; 1 ~~ ( L.e.o. =>MS.o ~@~ vl 2.080 ACRES r~ ~ LOT 2 1 r,~ ~~ I (90,624 sq. ft.) of ~ ` 2.017 ACRES ~ •• ?r?' ' QI ~i ~°~ I (87,872 sq. ft.) .' ~ ,, ~I }I I 25' DRAINAGE EASEMENT / , ~ o o ~I ~ L.B.O. a924.0 i I N ~'ti= ~°j i ~ 51 13 ~ 4~0 ~~ i ~ ~ :...........~ .1...... .... ~~ 56,E ~ a 3 ~I ~, c i I .$°°6 ~, a ~, ~ OO I =i p ~ . - -zo~bo~ . - ~o:o~ -~ 1 ~6 656 C~- ~ m ~ ~i ~i ~ W °o ~ 89°58'03" 91. c, 5~~0 ~~ o ^ cD ~ G8 ~ ~ ~ U Qa i ,~ ~ Kf " N89°58'03°W 291.00' G~0 o ~ ~ i 0 (- - - 30.12' o a rn ~ ~ Z I :............... .... ....... ~ 2 I o o , ~ ~ I I s~ rv a ~ ~ I .I : N ,, I I L.B.o. l~2a.o 0 Cd' ' I I I 1 oa _ ~' O ~ U ~i O~I I : M ~ a~ / i I L.B.o. =oza.o ~ LOT 4 v N 'o V I II I ~ 2.339 ACRES ~ .- ~ ~~ LO'r' ~ ~ (101,906 sq. ft.) / ~ c'iJ I ~I 2.311 ACRES i i / / / •- ~ ~ II I (100,662 sq. ft.) o / / aE~ a / / o '~ E '~ o I ~ / u's, / N .~ / I, I / / ~~a i ~ / o ° a~ I / ~ 3 0 45' 45' I BENCHMARK TOP OF / / p _ a 9110 IRON PIPE ELEVATION=926.82 / / t v ~, I \ / / h .~ C \\` " o I~ 260.88' 236.88' U ~ ~ N 0 0 .~ .~ I S89°44'SO"W 497.86' S BENCHMARK TOP OF a o o~ t ~ y o I IRON PIPE ELEVATION=921.72 U ~ > ` p yaJp .I reguiosane t~.e., wauonds, minlmum lot eize, pccesa to paeN. utc.) Before purchaetnq or- dawlopinq ony Dorset eonlae~ '`a St. Gola County 2oninq Offks and the Town of Muds for odtice. ~ .~~ 02a-~~i 2 -a2-~~9' .. ~ __ ~ ~~l~I,~TY:7_RUNK ~i1tQ,MW4Y'A' ~ ~H .~- ,..a~.,..a.~~,..~ .r_.ay.,~ N00+'Oi'!S7'"E003.4a' ~ G fi427.Bt' _._~.~_._ _. .~.._.~ _.__.__._ _. _....,..__. • ~ 33' 39 QO ~P~ ~~ ~ ~~ .8~~ P ~~ ~ ~ ~ ~~ :.`mow' .~ a ~d;A ~ ~ ~~ ~w~ . ~ I ~ 1 I__~~4~1_~1.~.~1^!~ i.ip':~' gT~9'1 m ~ ~a ~ //// S00'01'57"W 365.21' ~ ~ ~ \\; ~; ~ : /' (A 1~ ~ ~ y g P ~I, i ~ ~ 14 ~ A N I ~v ' J G • ~ 11 ~ m y ~ ~~ ~ ~ ~ ~ A ~ .~ ~4 i 7"l.ar ~ I ~ ~ ~~ ~ ~ '~ ;~ ~ I ~ ~ A I w~ /~ \\ \ ~ ^' /Y ~\ / ~Q Ids I ' ~. ~ ~ ~ ~ N I ' ~~, ~~ ~~ ~~ t ~`~ `tea N\ oy~ C ~ ~~. ~ .~ ~` ° ~ ~~. ` $r ~ \ \ InD \ / " ~ ` \ ~ d r- `` y \ ~ \ P to ~A „~ O `.ltd ~ '~tj'd~9 \~~ \ ~ CD J m r D ~y ~~ iP ~`o \\\~~~~jj\ \ ~e tml~ Q ~ ~ Sn aNp ~ ~'i a N ~ ~ i~ \ \\~~'\ \ x m ~IGi N tp -~ y ~~ M Id \\`\ \ ~~ ~~ D y a 1t,~a~ m -~ m ~ ~ o _. ._. _. e~ ~3 NC~TH_SOUTFt 1/4 LINE _ _ _ ~~~--++ QQ ~ ,`t°i rn ~~ tai o m I O. 0 ~~°. 1 R ~ ~~~ T ~ t $- ~ ~ ~ ~ ~'' t /~ ~. - .-• v nr ~ w n .. ~rafrfi ,~{n~ ~ Tx .~ .. ica t9~ ~: TOTAL P .1_11 ~ c 3d o C ~ c ,. > > ~ 3 ~ ~1 ~#~ I ~ ~ ~ I ~ =~ ~ o 3 y ° O ~ ° • ~ ~ < Z'p' 7 N ~ H O W hl Q <O ~ ICI p' I~c~ N O~ ° w ~~~ ~ n 'D ~ o~i ~ E N O ~ R O C ~ °'3 C w ~ ~~° I a a rn ~ ~ o ~ o ~ ~ I v N A N ~~~ rn v I ~ ~I ' W a ° C 3 ~ ° ~ °~ ' ° ~ N I ' ~ J O ~ N N I z ° w w ~ y~~ m a ~ 3 ~ H• a ~y,~ 0 0 0 ~ o O ~ ~ ~ ' N W I ~' I 0 3 ~ ~ cn ~ ~ v_ o rn ~ ~ ~ I ~ m - n ~ ~ ~ o i a ~ d •• ~ -o N 3 3 °_' .. a~ o. ~, • m ~ z .. ° c z z i =^ ' v ~ ° y D ~ fD f ~ N °~ '~ C ~ 0 ~ N. 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