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HomeMy WebLinkAbout020-1376-28-000 ' Wis&4sin Departmeip of Commerce 6afety and Buildings Divisi PRIVATE SEWAGE SYSTEM Count % INSPECTION REPORT St. Croix GE14ERAL' 370 INFORMATION (ATTACH TO PERMIT) SanitaryP 34 2 o.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Village ❑ T6Wn of: State Plan ID No.: Stout, Richard Hudson Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020- 1376 -28 -000 TANK INFORMATION ELEVATION DATA l `(, 2- 11 c 22-84 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , • w , P, ZCc@ Benchmark (o• p .D Dosing Alt. BM T Z a2 -2v I 6 5,� od• }o Aeration Bldg. Sewer Holding St /Ht Inlet (p.3cv ap,p� ANK SETBACK INFORMATION St/ Ht Outlet .� 99•roo ,T NK TO P/ L WELL BLDG. ae intake ROAD Dt Inlet eptic ? �>100 1 2S'' NA Dt Bottom Dosing NA Header / Man. 1 c' 2-4 / Aeration NA Dist. Pipe Holding Bot. System lo•fos ( ° Q S'• 0 { Yea. PUMP/ SIPHON INFORMATION Final Grade g.p Man cturer Dem nd St cover Model Nu er GPM TDH I Lift L ction System Ft For ain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM Ke /kjR Width Len th \ No. f Trenches PIT No. Of Pits Inside D;a77 Liquid Depth D IMENSIONS 3 �--� J DIMI I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu re : SETBACK INFORMATION Type O r toy /r'� � CHAMBER od e[ Numb System: r _ . J- a y O v- OR UNIT — a DISTRIBUTION SYSTEM U eC 1 3.0 Header /Manifold 1 w Distribu ion Pipe's) x Hole Size �Hole pa cing Vent To Air Intake Length � Dia. q Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched r Bed / Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc_) Inspection #1 • & /2 d( Inspection #2: Location: 881 Fraser Lai & Hudson, WI $4016 (NW 1/4 SW 1/4 14 T29N R19W) - 1429192289 Sweet Grass Farm -Lot 28 1.) Alt BM Description =t 2.) Bldg sewer length= - amount of cover 1,41`� Plan is n req Ire U er Id for additio tr�ation_ 7t SB -6710 (R.3/97j � �t -�q�'— � - �� u� MR K�' � Cert. No. 3ew u ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i - - - - - - - - 41 I t R• f n 3 i ! � fl f 3 pp e x r Safety & 13u D)vtStor iiCiltiOn mot K Washington Ave 4 Sanitary Permit APP pp Sox 1302 !� a:cord •�.tn Comm 8� ? 1 '%k:5 Ad"r, Code Sea re�'ersc side for instr;ct Crx for compietin& th,s appi +catIor I Mad +son, W1 S3 —730 (5ubm:t Completed form to cowkly if r ao /aconsln Personal irfurmatio .p y vide S) O4i51 ?lm)) ieuUMoan purpoie3 i slats ownt Attach coat !� to fans to the count ca ' only or the s�'sum, n oar nat less t n 8.1/1 ti' I i jehe( State Sanitary e t Number heck revision to pm WO State cwq 5p TC tr d r` do ' I. A DU ! r t' n • P int it I ! tion Ptow pfqw !' a GtI41s �G�1 t14. S l` :� ti. taf! r�C s a w t um ► lock Nusrt r w� =,e u ivision Name or SM amber ; crt , tY� tie f 1 SWB e7A e City g ype of Reading-, (C #Ok one) � _ �'v� � 0 Villag l or 1 Family Dwelling — No. of 13edroomc 4, e_ 9ublic/c mMmiel (4es Hbe useY {� S te•o t3sarat Road Z IU y �. o ermkt (C elk on y ore box on ine A. Chock box on line 8 i appl cable) aroslTax Nutn aria) A) 1. New 5yettnt 2. Q Replacement 3, D Replacemesst of 4. 0 Addition Wrn O 01-0 �. 7 — —6tTo cm Tank OA d remit Number l9 A ita Patselt w s via issued V p� gystmrtt (Check all that apply) O Sand Filter O Construes Wetland oa pnerurtead In -wound G Mound G Single Pave C Drip Gin* usiaed yrtaott:td O Holding Truk Aaro is Tr*atme it D Recirculating D ntlier t 3 x 3 •te t J t' ya iara re spa << 1t� cotton 1 Elevation 1wMind proposed Rote lOt4ildsy /sq n f 4MinJindt} � r l � I Q3. a D 1.184 1 a Q'd P l astic 0 o anufacturer Prow Site Steti ibm- VI Tank ty in Con- Con. gleos Ietonaift�ori G a l lons Gallons Tanks crew strutted ew Exist Tanks L_ t s� , 1 fif Rupongbility SIMMoat he k.4jW" bliit trr kn 1 n aithe P WTS o t nd Teets. ustneu Pbene Number v 17, V, �" a A" sc�ll� �n a�(�y G✓ M aa7��d � ?a "VffC_jvxjyM*partms8t UN Oaly t i uro o ststnps; tart' arm t Fee (n u es rou tester ssue souing pproved D OWtta' Gwen Initial Adverse �b►� t o laA —266D \ itution S`4t'ota'S)� 1 IX. Cotaditgose of ApprOM MMUOGS Mr Diaspproval: e►ri e•. �eQe -� ° - }c ve.� Wir 0. C. saD.6398 M 07100) Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety.and Buildiflgs Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Cam. include, but not limited to: vertical and horizontal reference point (BM), direction and V - p ti percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please pri ,all information. Reviewed by Date Personal information you provide may be used for second purposes nv cy" L whs. 15.04 (i} (m)). Property Owner Prop Location lC k Govt. 4t ZjW 1 /4 1 /4,S T Z q ,N,R /Q E (or)� Property Owner's Mailing Address Lot # , Block# Subd. Name or CSM# e4 Cira City State Zip Code one Nuttibefl( >( , ' ❑city ❑ Village Town Nearest Road ( } 1 I U� iCks er L v) T New Construction Use: ❑'Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 0 gpd Recommended design loading rate 7 bed, gpd/ft ' trench, gpd/ft Absorption area required /mil bed, ft2 /�2 trench, ft Maximum design loading rate ? bed, gpd/ft - trench, gpd/ft Recommended infiltration surface elevation(s) T f ' /0 ft (as referred to site plan benchmark) Additional design /site considerations .� L f ' Z' 8 Parent material U y AL ( S � Flood plain elevation, if applicable � 14 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ®S ❑ U S ❑ U [a S ❑ U 0 S ❑ U ❑ S ®U ❑ S EU SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots a : in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench v E Z 3 J 3: 2 I2 16 r q 5i S Ground 3 - m5 0 m t c elev. Depth to limiting factor 109 in. Remarks: Boring # Z 3 I 6 J2 5. ' 2 2 1Z-"il I I Z mab m�i C S qJ CS Ground lev. Mo t. r fS 4 0 Depth to -- 5S limiting factor 116 in. Remarks: CST Name (Please Print) Sign a Telephone No. 4ACV11 Schu k e (1(5)2y7- -400 Address Date CST Number Z5-530 Sy PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 1 . , PARCEL I.D.# t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench c-S 2 ,, 39 ra yl s c-5 - s Ground 3 ap l� r y I a (YES 5 c 5 1 g elev. Depth to limiting factor /0 in. Remarks: Boring # MR I o -g (6 r3 Z — 5. k 65 y 2 y Z ' A g -24 D `� S; I ck c 5 . S Ground -� elev. Depth to 2'Rr limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # yf - 42f mS D� ml 5 -- Ground elev. 9 by ft . Depth to limiting , factor w Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R.9/98) PAGE 3 OF_ NAME :540 J LOT# 2�i' LEGAL DESCRIPTIONN(-J' /4Sw' /4,SZ3TLa ,N,Riq E (or)D SCALE: I II= loo X ` 1 ELEVATION /UO, d J BM ESCRIPTION '`j2J� BM 2 ELEVATION / Q DESCRIPTION t °P 2'' PJ� E7; p� e L„ - thcdI tA5 SYSTEM ELEVATION �� f (� ALTERNATE ELEVATION T Z, d CONTOUR ELEVATION 5 t3Z 4y �• 43 n G pwr aJ 17✓ • � M ocaa t (Lai SIGNATURE _ DATE pt`G S wok7' 2o rag 5;OOC2 ve. / S e r 4 `Y 5'c��cl "sYD' fyf � /JG U' d µ� / d U 1 Qu 0 ,ESA` 0 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 1 3 10 S If Z Number of Bedrooms Design Flow - Peak (gpd) cl 60 Estimated Flow - Average (gpd) Septic Tank Capacity (gal) oar Soil Absorption Component Size (W) Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) 7- Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tan k shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating conditio n o th f septic tank and outlet filter shall be assessed at least e once every 3 years by inspection. The utlet filte hall be cleaned as necessary to ensure proper operat The filter cartridge should not be removed unless provisions are made o retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component' filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The is contents removed when the volume of scum and sludge septic tank shall have i co a in the tank 9 P exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. I No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 -FF'QM Schumdker P1Umhinq F;X HG. : 7153063121 Sep. 10 2000 07:2800 P1 ST CROIX COUNTY SB T1C TANK MAINTE14ANCE AGREEMENT AND OWNERSHIF CUTtFICAMN FORM Owner /Buyer Q mi- M Addre ! 3...r+ � .. � r�. u. w� _ W`L Saul l ptopedy Ad u 8'9 ( ras La n e— (liexiS+, doe mquhvd t= ?IM4 ovatmat tar otw aoasWa OR) citymb" Pug ldaaU%dw Numbac Fapmty L*Qsd= � %maL V4, Sec. .� T -F � W Tow- of �A \kL U SnbdivWoa g4 #y{ w rrr� 1'e �� �.�iws..r•�rrrrwrrrr� rya rrr R�39, !r `r�,��,• CuAW Suuvq Map i R� iJ� 1f' r ru 10 � 1 1 2 I �r� ' •r r wwJ T� w� ^ • 1'E - �!. S'pao bWAW D YN CT no 10 Um idagithbtel ya 0 no p= ca do 44* f ew ym W Nam #!'sy mww s 7Gbm" O mnm vut ywfat inm im Kydm eea:e dir bomm eftlW q U,aWommaorken� " y! 'ere io 'to fit» �iocdac t Oldika#3a ice, WMd by to OWM =d a aCs+iz+m :& , Fo � ��Ibe�e► i�uaa+vaDatd o�tsya z � i� i cam' oao�doaeasdliRoc� a�f�dPa,f��.� �aptie~tmiEts ksas'iseu U�'�i ol3dnd,� srR '� cafe by m. � eta sad �e � of I iba000no�� ad' �. �aa + ba bae� ed t ba aaa�koad vadwd to dm SL Cmc.Cvaly L+a * Offimvid0z so ap p ' m daft. " - ' , %UL t� o0 SMNAVM CM APB uls t ( oet+* Od d 9WOMM an th Jb= an to to 60 bad of My (ter) I I9a. z (We) SM ( tb5 ads) o f 6+ FMPUV dumfild a by vhtm vl s i *A&W of la•e offie.• aaw► s OF A MWAN T DATE ***"* 00partmIt "" « « «• "" ll�alateXe �ad� ap�ues�tgaa: a dacd lcn�n fly � oi' beads nt�taa it copy of tM m0ed puvey ap if rduc= is ma& in tiia warn my dead VOL 1539 PAGE $j • 6 2'9124 • . STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., WI This Deed, made between Donalda Speer, aWa Donalda J. RECEIVED FOR RECORD S eers, a/k/a Donald J. Speer and Kernon Bast, wife and husband 06 -31 -2000 1:30 PM a/k/a Donalda J. Speer -Bast VARRANTY DEED EXEMPT 1 3 Grantor, and Richard O. Sto and Janet P. Stout, husband and w ife, CERT COPY FEE: COPY FEE: TRANSFER FEE: — —.— -- RECORDING FEE: 10.00 PAGES: I Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in. St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area All of the Plat of Sweet Grass Farm in the Town of Hudson. EXCEPT Lot I Name and Return Address of said Plat. �&044 0' 5 . This Deed is given to correct the ommission of additional lots in the Plat of 353 AWkrA&E — fi ( A tL — Sweet Grass Farm between the above Grantor and Grantee hereto in that OJ450 -0 wr S'•{Ot (v certain Deed recorded in Volume 115 3 ? ,Page IG , as Doc. No. l0a q 0 S 0271021 -60, OW-1021-80,0 20-1021-90,020-1022-00 & 020 - 1062 -20 Parcel Identification Number (PIN) This is not homestead property. OE) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ( day of August 2000 • + Seer, alWa Donal�JS s, a/Wa Donald J. Speer + • ernon Bast AUTHENTICATION ACKNOW LEDGMENT Signature(s) Donalda Speer, a/k/a Donalda J. Speers. a/k/a STATE OF WISCONSIN ) MI J eer and Kernon Bast, wife and husband, ) ss. County ) �authcnticatcdthis �y of August _ 2000 Personally came before me this __ day of J the above named • Kristina Ogla TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not. instrument and acknowledged the same. authorized by § 706.06. Wis. Scats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina O land Notary Public. State of Wisconsin udson, WI 340 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _. ) • Names of persons signing in an capacity must be typ ed or pr inted below their signature. u,ro m STATE BAR OF WISCONSIN x� vole•• once• coma.�r. cad du c «. wi pe gn g Y Y tYP W g t100-0SS2021 WARRANTY DEED FORM No. 2. 1999 i I _0*'gZGa �_ 17_Dag@ A® aJWK( I wruva Gut SEW STEW - N C 4 ° d9�ifiJG11 m (� I �+ 3N3e No�sN3 Noona�r+si� 8Z NOLL33S il0 4 /LMN 3H1 j0 3Nn IS3M 0 O I 3B 0 , xw w SV3 OV$-3C I IZb'OSR M.6Z�S"ON z AtlVkrOdW31 SnplOt z r' I m 4 4938 90 dL'99L Qj c9 cs� T 0 • '� M•N i Z � 2 1 CC) 01 ; 8 O °� as CA) Os p } Of z bs ` `0 \ �� , Q In ` Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County :S+ . Cro ! Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical 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. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt Lot S w 1/4 x ,1/4 S 4/ T N R E (or)a Property Owner's Mailing Address Lot # Block # S Name or CSM# / fir. 2 S' iPC 4 Gras City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ual ! (/ ) --107 3 I A d 1:7 re Lian e- New Construction Use: ® Residential / Number of bedrooms �_ Code derived design flow rat GPD ❑ Replacement ❑ Public or commercial - Describe: ' Parent material O L'r+ La .S Flood Plain elev lion if appli b' ti � -_` ft. General comments $ y 5 w• el e U• 7`oP ?Z. /0 Go�..e.^ U• Ca ` ,i" V and recommendations: I� (�- -e le u' 7 9a• d a G O LA) �' � � 9 / EJ IfA Y 1 4 t ' Sr CPO, ? ©(I J J F F1 Boring -, NU G OFF� ! 1 Boring # Ground surface elev. Z y U - . _ (�� II Pit �_ft• Depth to limiting factor App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence B GPDN in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 I o - 1 r3/2 ---- 511 TyYpi C's 1 . 3 t r / F?--] Boring # F] Boring 54 ''d — pit Ground surface elev. 22. ft Depth to limiting factor 1 Z8 in. Soil licetion Rate Horizon ; Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 i z 5i 2 � r !D Si 2 Y m i c. 1v� Q ms 1 — _ /.2 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) � Si nature CST Number �u rte, C� �� �� �� j� - - -- 2 Sao Add Date Evaluation Conducted Telephone Number r r Property Owner Sto Parcel ID # /0 7� Z <� Page 2— O F3-1 Boring # E] Boring ® pit Ground surface elev. ft. Depth to limWng factor /An in. Soil nation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(F in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 6-1 / )2 S. I 2m I m c s 1 v.0 . 5 • B 2 2 Ab Z nnaL& my 3 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I Boring # F1 E] Pit Boring Ground surface elev. ft. Depth to limiting factor in. 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 = BOD, > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS _< 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD- 8330 (807/00) r PAGE 3 OF 3 NAME LOT# 0 $ LEGAL DESCRIPTION SW ` /45w` /4,S / jTZG,N,R ! (or) dQ SCALE: F'= 4 BM I ELEVATION /O o • O BM I DESCRIPTION ria,'( .'et 3d "Co4-4a d tr—c BM 2 ELEVATION q O• 7 S ec- �{ BM 2 DESCRIPTION 4.j2 o4 l��ti S " ibo u e 6, rovn4 SYSTEM ELEVATION /O Gow c 90, 61 d _ V ALTERNATE ELEVATION �Q.00G CONTOUR ELEVATION 9°Iact g 5•S O 1 4 -L V Ol + q 5.50 g3 rA z a 3 V p ,; B-3 L� Q SIGNATURE - - � DATE / / _ U LI) I voi.1556 ' AFFIDAVIT 6* 33011 Document Number KATHLEEN H. WALSH Document Title REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD • 11 -03 -2000 1:30 PM AFFIDAVIT EXEMPT M CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 12.00 PAGES: 2 AFFIDAVIT Recording Area State of Wisconsin ) Name and Return Address ss. Richard & Janet Stout County of St. Croix ) 1353 Awautkee Trail Hudson, WI 54016 620 - 1 6'd? -0eo Parcel Identification Number (PIN) IL u. a�q 0 Sro,Ar A nei 5a g tr P Sr , being dully sworn, states, under oath that: 1. He/she is the owner /part owner of the following parcel of land: A parcel of land located in part of the Southwest Quarter of the Southwest Quarter of Section 14 and in part of the Northwest Quarter of the Northwest Quarter of Section 23, all in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin; being Lot 27 of the plat of Sweet Grass Farm, as recorded in Volume 8 of plats, page 8, in the office of the St. Croix County Register of Deeds. 2. The above parcel has had added to it the following described parcel recorded in Volume I56b , Page Document No. ( St. Croix County Register of Deed's Office, resulting in a single parcel: A parcel of land located in part of the Southwest Quarter of the Southwest Quarter of Section 14 and in part of the Northwest Quarter of the Northwest Quarter of Section 23, all in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin; being a part of Lot 28 of the plat of Sweet Grass Farm, as recorded in Volume 8 of plats, page 8, in the office of the St. Croix County Register of Deeds; described as follows: Beginning at the northeast comer of said Lot 28; thence along the east line of said Lot 28 S06 °45'31 "E 206.29 feet; thence S66'1 5'00"W 150.24 feet; thence N06 °45'31 "W 209.13 feet to the north line of said Lot 28; thence along said north line of Lot 28 N66'1 5'00"E 100,28 feet to the point of curvature of a 300.00 foot radius curve, concave southerly, with a central angle of 04 °02'02 ", a chord that bears N68 °16'01 "E and measures 21.12 feet; thence along the are of said curve and said north line of Lot 28 21.12 feet to the point of tangency; thence along said north line of Lot 28 *170 °17'02 "E 28.09 feet to.the point of bebian; ng. Containing 29,993 square feet or 0.69 acres. Subject to all easements, restrictions and covenants of record. This information must be completed by submitter: document title. name & return address, and PIN (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one page to your document and 2.00 to the rccordin fee. Wisconsin Statutes 59.43 2m WRDA 2/99 ` S 1556PAGt333 3. The addition is a transfer exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05 (A) (3). 4. The purpose of this affidavit is to notify the public of the addition and the resulting parcel, Subscribed and swom to before me this ra day of , F. - i o Public, State of Wisconsin 3 � EE ' 01-60% f My commission expires: i•••yN �•NN111N40 \ \\ This instrument was drafted by: a N �`� S V�J11Q� 'X -1N d7 I U) I M t�D I M (0 A tZ Sib OD N N M c0 N h M f p. 01 cu t M to '� Cs N N N M AP N N N • � , 1 5902 , O9'SZi � 8�' g� ' OOZ , 9£'O� £0'961 ,S<O'S61 � R N I N to n I cn N Al •\ t� �5M ,°� M � ti OD M N �N CA S AN v � M N N 0 N N ly� � N M Q N � O 5 3NV7 I SON - 9807 -4 V VVV ` W 7(; N t0 0) M d V a M N rMN M M N to N N u ZZ ZI'96g 3 1�9bZ 96'4bZ 1 3 IV990 OD N a.l J N w OD w N N \ 21 N O Di 50' 5195 0 >I x gg519 ~o CID N In C a CY 0 N'N N N N N a OD W `cl N N N ! N N �. c! W) \ N U l N N N N r N AN aC ,�-- m a � N N� `C M N w .9 M N g N N N e� N N N — 3 , 19'l6i N N f U ' W