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HomeMy WebLinkAbout020-1447-06-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT ~ S GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes (Privacy Law, s.15.04 (1 }(m}]. ermit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi ST BM Elev: {nsp. BM Elev: BM Description: OZ~ / n ~'~ l ~, TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ,, t,~.~t ~~-- z~. e; ~,sc~ Dosing ~ ~~ ~ ) Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~ i r^ 1~J ri, '~/ /g i Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model tuber TDH Li Friction Loss System Ft Forcemain Length ia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrOiX Sanitary Permit No: 453455 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 15.29.19. STATION BS HI FS ELEV. Benchmark 1.55 ~ai.s5 /aZ; Alt. BM ov S .~S ~s ~? Bldg. Sewer SUHt Inlet SUHt Outlet 7, os 9'y - 5 Dt Inlet ` .~ Dt Bottom ~ `~ Header/Man. ,7. ~~ ~~ ` ~~ Dist. Pipe ~j . 2.0 ~•9 j 3 3 •s9 Bot. System • Zo 9 • ~ ?2 .3 9z • SS Final Grade ~, ~~ ~~ ~~ St Cover S .Sb ~• T BED/TRENCH DIMENSIONS Width i ~ Length ~ i li~ $g No. Of Trenches ~•~f TQ~ ~ i PIT DIMENSIONS \ No. Of Pits ~ Inside Dia. \ Liquid epth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~ nd- Type Of System: ` Q ~Y r u Z~ ~ ~ A /~ ~~ UNIT Model Number. DISTRIBUTION SYSTEM ~ ~ 7 "'~ d.. Z? . ~ SS lhcFaX- Header/Manifold ~~ g ,~-~ Len th Dia ~ Distribution Pipe(s) ~ ~ \ Length Dia Spacing x Hole Siz ~ ~ Vent to Air ntak@ V Qi ~ ~ SOIL COVER r prPSS11rR SvsfPmc [)nlv rY Meund Or At-Grade Systems Only Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~ ~ 1 Bed/Trench Edges \ Topsoil ~ ~' Yes ~] No es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 940 Pup Circles Hudson, WIc540[16~ (SE 1 NE 1/4 15 T29N R19W) Coyote Ridge Lot 6 1.) Alt BM Description = ^.~ u`' ~ ~ ~ ` r O v ~ r`' C~°~~~~ ~ ~~'~ O Yom., 2.) Bldg sewer length = ~ ^1 _ , - amount of cover = , $ ~ ~~ ~ l ~! 3' {{{ _. ,-_ _ Plan revision Required? Yes ~ -. No q ZL O Use other side for additional information. Date Insepc s Signat SBD-6710 (R.3/97) Inspection #2: / / Parcel No: 15.29.19. ~~ Cert. No. 0 Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County , ` iseonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co ) (608) 266-3151 S3 Department of Commerce State Plan I.D. Number Sanitary Permit Application _____ ou provide l information Ad C d 1 Wi y e, persona m. o , s. In accord with Comm 83.2 may be used for secondary purposes Privacy Law, s15.174(fixrrt) - am -8soject Address (if different than mailing address) B ,y r._'+ 1 r ~,.' C . s . Application Information -Please Print All Information 1 Q ~ f ~ ~ . ~ y~ ~ `~ - Property Owner's Name f _ ~~ '' (~ '~ k Bloek Pa(cel # /L/mot N n ~ /~ P rty Locati Property Owner's Mailing Address " -. -•" - ._ ~ 'J~ ' Section L~14 ~ `S , ., ~ City, State Zip Code Phone Number f~ f~ ,~ / p ircle one) V( (4 J T~N; R EorW II. Type of Building (check all that apply) ~ /~n ~~ Subdivision Name CSM Number 1 or 2 Family Dwelling -Number of Bedrooms T-~ t ^ PublicJComtnercial-Describe Use ~lST CAL ^City Vil g o ship of ^ State Owned -Describe Use 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 ..___--^ B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that a I ' ^ Non -Pressuri~~rd In-ground ^ Mound > 24 in. of suitable soil ^ Mottnd < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constructed Weiland ^ Pressurized In-Ground ^ HoldingTank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ lain) V. Dis etsallTreatmentAgea Information: L _ Design Flow (g ) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) is oposed sf) Sy~em E e ~tion~ ~,Sa ~ ~' ~ ~ ` ' - 7 VI. Tank Info Capacity in Total Number anufacturer Prefab Site S I Fiber Pla tc Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank )~D / ...,~ /~ ["O J Aerobic Treatment Unit '/ Y Dosing Chamber VII. Responsibility Statement- I, the undersigned, ass me nsibility for I Ration of the POWTS shown on the attached plans. Business Phone Number Plum 's N e (Print) Plumber' ign PRS Number ~ a ~.~-~~ _~s-~ a~ ~ ~~ lumber's Ad ress (Street City, State Zip Cod \'[[l. unt !De artment Use Onl Sanitary Permit Fee (includes Ground Dat Issued ssuing Ag nt Sig lure o tamps) pproved ^ Disapproved Surcharge Fee) ~ ~ ~I~ ` Q?J gd!- ~ r ~/ V~ ^ Owner Given Reason for Denial 1X. C'onditions of Approval/Reasons.for Disapp~roLval (~!^ ~~ SY TEM OWNER: ~LI//~ /^~'~"r,',_`,"~' !'"~ ep Ic an , e nt filter and ~ -~Y~ ~t/2 I,~UYi~z~ CC~.2- dispersal cell must all be serviced ! m Inta ained O S' ~~w 3 S as er mana ement lan rovided b lumber ~ / 6 p g p p y p . ~jy~ d a 2. All setback requirements must be maintained ~ ~2 ' "~~~' as per applicable codelordinances. _. ~....1.... if n . l r i..'h.a in 6n wttun etrfapiere pfam tro toe a.fwnry furry/ rug suc,~..~....... f.-f... -_. ---- . SBD-6398 (R. 01!03) '(3Z 1>3T. CROIX COUNTY QOYERIO~NT`CENTER 1101 ~ARMICHAEI ROAD HUDOON,IAA9CONSIN X4018 „- - 1 `~3 0 ~ ~~ ~ ~~ ~ ~ ~ ~sX i~. ~ = ssy a = aa~ ~- ~~ '~ 1aso ~ -boo ~~, ~ -- j t ~~ ~ ~ ~' ~~ ~~ ~ ~ ~ `~ ~ \~ ~ ~~ 1 ~ 1 =3© l~ ~ ~~ ~ , _~ ~~ ~t ~~ ~ ~, LIB` X ~~, I ~s ~ = ~ ~- a a ~- l~ ', ~as~o '~ 7 = f + y,a, so ~ 9 a, .3o f ~a~ a~ f ~~ ~,~ ^ a ~~ w` ~~ \ v° ~~ ~ ~, ~~ ~, _~ ~ ~~3 ~' ~ I. ~ ~ or -'~---SE~L EVALUATION REPORT cli~lon~s-ana '~REC E I VED 3 ~ ~ _.~.,~,...A...,~.•~,..~,......,~,..,W.......~ .,.~.a C«~r ST cr2©~~ Aitac~r site p~ paPeq 6~ 11 inches m sine t''1~ rru~st ~ . irx~de, txat not 16t~ted ~: ~I~~h f~t~t d~ p~ {Btu. won ~d r>T err t t Pa~o~ I.U. ~`C ~ `Q ~ p ae s ope,sca eor nortt~arr+aa•Aridlocatton distanoetonearestroad. s~ ~ ~ ~' ~ ~" ~~ Reviewed dY D ,,r~~.,-w +~~i~•~r~.s. so4c,tt~+n. Nw of s si::cr• l ~ ~C~iE3vo,V ~~S ~ t~ropertyLocaGeorr Govt to Nw va~w ,ra s r q iv rt t-(~ w Y Orrrers Adcksss ~l Y L~ • ~B~ti2 Cs-E' ~'D • Lot # (o 81odc # Subd. Marne a CSIIAk Ew N ~ Goo yo 7"~"' ~ /p~E " ffUDSo~ W . s olio HISS 38 •~? ~~'' ^ r~;°"""" i-I~ ~~ ~ user[ ~a r NNatd>~ oF+beairJOe,~ 3 ' Code deti~ti desrgn >bnnr ram y.SO - ~ i;~ O ~ I] tic«~- oes«ibe: ~a ~ • ,Q~l~'A- '7~57'~ i S Svl7~X3t~' ~?1,Q rt~/ %N~j~avN~ coN UF,uT[o~lrtic. S yST~M C T'• D. to . T 5 •~ - ~3i•®~?i~vs~ 7~'E~~- C~el~S ~ ~ GrDrrd sur#aoe stay ~~ ~ b~ 1t. DeP~ b th~ilin8 r ' ~~ ~• Sd ce~ia~ Ei'sls Hoataon DePW Oomirr«arrt fisdootDesaipilon Texture 8trudus C+ars~enoe t3ount{ary loots tn. Mur~lt Qu. St Cord. Cafor Gr. 5z. Sh 'f~1 'Ei~2 o - io NR .3/ --- ~ / sh W ~f • ~ 75 S ---- SL GS -- S ~ n ~ ? 2 8°'Ire ~ ~ caeele~r. q~ g ,~ , b~ 9L t Depth Dptt>hant t peeaipUo~ ~ex~ S4ud~re Caere irr. tau. sz. Conc cow a SZ sn. o•~ L s w • 3 0 ____--- <S~ L c S~_ / c ~. 2_ -. ~ /.2 _ 1 ''f - ~~~c L ~ li t~Ruerd #! = t30D y 30 ~ trtgrl and TSS >30 ~ 150 rrrgtl. • t:IMtrent ~ ~ BOD ~ 30 ~ 30 melt. CSTARarrber t ~ ~.r- 2t tb ~t cG i Zzc~ 3 z s Teeptlone ttr.riber lli~v• ~~• ~ao3 ~~s•~~a•3~~z- Private Sewage Consultants O 2812 10th Ave. ~ jN ~S 1~.oi2 7'°OT,~,L, of O 4 Spring Valley, WI 54767 Z O . !017 • ~., o • D•~ ?-o • l0~.7 . 30 - o~-a 20 • iol•~ , yp • Da'~ .. ~~Rtia~ ~~-s 7- ~t ~! ~yo TE ~;~~ P~lo# Ld7L'~l0 ~ 3 Page of ~ri GrourM surface elev. R Depth to factor ~ in. Haiaore Deptl~ Danpnar-t Redoa Description Texture Struchxe C.onsis/enoe Boundary Roots ~ OPDAf Rate ~. Munse9 t]u. Sz Cont. Cola Gr. Sz Sh. •Etilll 'Eff#2 • l3 io SQL / s w • ~- - 3 s ~ 5L ~r ~ a • 3 0 /b [~ , ^~~ ~ ^ Pit Ground surface elev. ft Depth b 8 tacbor • in. Solt Rate Horizon Depth Dominant Redox Description Texture Strt~ure Cortoe Boutdary Roofs Gl~ h. Munsea Qu. Sz. Cad. Color Gr. Sz. Sh. 'tit 'Etf~2 ^ Pit Ground surface env. ft. Depth tD ~ lector in. t~J ~ # ~ ~ Sal Rate }fortaott Depth Damr-ara Redar Description. TexWre Catsistenoe Botxrd~y Roots GP D/ff in. MurttaeN t1u. Sz Cont. Color Cx. Sz Sh. 'EfUf1 'Eif#2 ' t~lkretrt #1 = BODs > 30 ~ 22Q and TSS >~ < 150 rrglL • E1ltiient #2 =130Ds < 30 rrrgf(, and TSS w 3p rnglL The Dcpartmem of Commerce is equal opportunity service provider and employer. If you need assistance to access services or need material in an a to format, please cattact the department at 608-266-3151 or TTY 608-264-8777. s~-p~o~edont for issuance of permits and designing Contact: tllbricht & Associates Registered private wastewater consultant and pltar~s 2$f2 iUfitAve. Spring Valley, WI 54767 715-772-3442 ~~ ' v r~ q, b ~ . / 30 I SG ~ ' ~~ j v Q Z Ste; ~,M ~~-- ',.g~ ~~ y~'' sfeel~- r 9~ ~--~-' ~ ~ ~ ,, d~ X33 z Z S oG 1. ~~ ~-p cam. z os `~- ~v v /~~ ~~ M~~ 5~~~~ ~ `! ~~.~- ~'~ y i~b'°~ ~~ l '6 V _ ~/ ~G tp , . y~~ ~'~ o~ ~~ y ~. k ~,~ I ~5~ ~D n J V ~~ POWTS OWNE~R'SM~A~NUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION UV C.I~C~(rL SYSTEM SPECIFICATIONS Owner ~Q,r ~ ~ ~..~ Permit # S DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~~ 0 gal/day Design flow (peakl, (Estimated x 1.5! oQ galJday Soil Application Rate ~ gal/day/ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease IFOG- S30 mg/L Biochemical Oxygen Demand (BODS) <_220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) Total Suspended Solids (TSS) <_30 mg/L 530 mg/L ~NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTFNONCF SCHFDl1LE Septic Tank Capacity ~ al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer Z ,. ^ NA Effluent Filter Model D <~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cellls) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^monthls) year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ~ ea~ls~(s) Y ^ NA Flush laterals and pressure test At least once every: ' ^ month(s) ^ year(s) ^ NA Other: At least once every: ^monthls) ^ year(s) ^ NA Other: ^ 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 tankls) 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 IY3) 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. Page ~ of Z START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tankls- for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(sl. If high concentrations are detected have the contents of the tankls) 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 fife 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: • 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 POWT fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacem t 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 from existing 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. ^ 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. alua ' a o ing ank I`~ ~ T b e ai a ~RD{d1817;/a ~R- A/~b/ CaNS'??zfJ~?'tf~~ ^ 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 INSTALLER POWTS MAINTAINER Name Name Phone l _ ~ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name s^r, ~ l aUtil ZD~JI~cJ Phone "'~(S- 3~(p_ (A (7 This document was drafted in compliance with chapter Comm 83.2212)Ib)11)Id)&If) and 83.5411), 12) & 13), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer X~~ ~~,/ ~~~~'"~ Mailing Address Property Address ' ~~~ (Verification required from PIanning Depati<nent for new City/State ~~ Parcel Identification Number ~P~ ~iYi c,~ y~v .SGT-G~ ~ar4'r~ s LEGAL DESCRIPTION Property Location /U ~'/,, .SGiI '/4, Sec, ~ T~N-R~W, Town of Subdivision _ ~D~OT~ ,(~G~ ~' Lot # _,~_. Certified Survey Map # Volume ,Page # Warranty Deed # _ 7J~ ~ ~ ~® Volume ~~~ Page # 1 a 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 ProPunY-owner agrees to submit to St. Croix Zoning Department a certification fomn, signed by the owner and by a masterplumber, journeymanplumber, restrictedpiumber or a licenscdpumperverif3ring that (l) the on site wastewaterdisposai 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. Uwe, 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 rctumed to the St. Croix County Zoning Office within 30 days of the three year expiration date. ~'~/3~ v G A OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that ail statements on this forth are true to the best of my (our) knowledge. I (wc) am (are) the owner(s) of the property described abov ~fiy virtue of a warranty deed recorded in Register of Deeds Office. //~ / SI NATI3RE OF PLICANT DATE «««««« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Departzrrent. «««««« ~~ Iaciude with tiris application: a stamped warranty deed from the Register of Deeds offce a copy of the certifed survey map if reference is made in the warranty deed v~~~~~~. ~zQ Document Number _ _ STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS. DEED, made between Kernon J. Bast, a married person, Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Recording Area 75m9~+0 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIx CO. , liI RECEIVED FOR RECORD 01107/2004 12:35PM YARRAHTY DEED EXEMPT # 8M REC FEE: 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 Name and Return Addcess: Edina Realty Title, Inc. 400 S. 2"d St. -Suite 1 15 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights-of--way of record, if any. 412540 20-1027-40-000 & 30-000 &20-00 Pazcel Identification Number (PIN) This is not homestead property. Dated this 6th day of January, 2004. * eLnon J. Bast AUTHENTICATICtNgCOWn Signature(s) GO C~-~ bbl authenticated this 6th day of Jag TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Edina Realty Title -Doug Berg 400 South Second Street #115, Hudson, Wl 54016 ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this January 6, 2004 the above named Kernon J. Bast, a married person to me known to be the person(s) who executed the foregoing instrument and acknowled the same. ~~/v`'' ' *Cheri Brown ,( Notary Public, State of Wisconsin My corttmission is permanent. (If not, state expiration date: 3/11/2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) •Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED S'L'ATE BAR OF WISCONSIN FORM No.2-2000 U 2'~87P 12Z ., .. EXHIBIT A The NE'/. of the SE'/. and the NW'/. of the SE 'h, all in Section I5, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E'/, comer of said Section I5; thence South 00 degrees 47 minutes 33 seconds East, along the east line of the SE '/. of said Section, 407.27 feet; thence South 89 degrees OS minutes 15 seconds West 535.46 feet; thence South 14 degrees 10 minutes 34 seconds West 93.31 feet to a point on a 80.00 radius curve, concave southwesterly, whose central angle measures 25 degrees 34 minutes 33 seconds, whose chord bears North 54 degrees 32 minutes 33.5 seconds West and measures 35.41 feet; thence northwesterly along the arc of said curve, 35.71 feet; thence North 14 degrees 10 minutes 34 seconds East 76.12 feet; thence North 0 I degrees 07 minutes 26 seconds West 400.07 feet to the monumented south line of Certified Survey Map recorded in Volume 1, page 217 at the St. Croix County Register of Deeds Office; thence North 88 degrees 51 minutes 13 seconds East, along said south line, 570.78 feet to the point of beginning. v d04 ~3 ~I©do 9 9 pC~o X39 ~ ~ ~~ i ~ ~~ 41I 00 ~~ ~~ >h BENCHMARK TOP OF 1"IRON PIPE ~~ `~ y. ELEV. =901.36' ~ ~ ~ LOT 7 Q~ ~ .. ~' x x y LOTS ~ ~ 2.18 ACRES ~ `~ 'S 94880 SD. FT. ~ ~~~~, L.B.O. =906.50 'i, ~~ ~ ~ _~~4i~ ~F ` ~. ..~ ~ ~,, ~ ', ~~ 4s ~` ~. ~'`r DRAINAGE EASEMENT '` L44 L43 100 YR. H.W.L ELEV. =804.45 \ \ L 2 '~• ~~ . ~. :~' '~LOT6 ~- \ 2.04 ACRES~\ .~ ~ ~` 88648 SQ. FT. ~, \ ~`~ L.B.O. =906.45 P~ .\` ~\ ~ \ b0.~ •\ ~. a .. ~. LOT 19~~~ .. `~~ ` ~\ ~`., ~ ~\ ~ 323.62 `~ ~F` ~\ `. ~~ \ ,, >~ ~` ,,. .. .\ ,~ ~ ,\ ~~ LOT 20 ~ ~`, \, ,-~ ~~ r i ,1 it / ~ ,= Q joc,~A~~P, /OQ ~ ,% QQ•~~~ ~, ,~' LOT 2 '~ 2.16 ACRES 93905 SD. FT. ~ L.B.O. = 876.00 - . - ~~ . - --~--f-~--~--~-- -- - ~ I I L5 CO; ~ Cho c~;, ~IOdo_ 5 ~8~61'13"E 967.99' ~~ TEMPORARY PRIVATE ROAC ____; EASEMENT PROVIDED FOR '~ RESIDENTS OF BAKKEN RO, eA `.,. ~ .~ 13 L.B s~a.~~ ~`~~r