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HomeMy WebLinkAbout020-1447-13-000 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463446 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Perso}nal information 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: Bast, Kernon Hudson, Town of 020 - 1447 -13 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 65 l �YV� 15.29.19.2844 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3 , / Z5d Benchmark c /101. Z J :.7 �.� A— Alt. \e)II, /05M Aeration Bldg. Sewer L to 2.5( Holding SUHt Inlet I C,`Iiiio TANK SETBACK INFORMATION St/Ht Outlet S 16 1 39 TANK TO P L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S 5J► i /8- Dt Bottom \ Dosing Header /Man. I t A56 , (AO - Ae ion Dist. Pipe � 1 (f ,I b 9`7.9(10 Holding Bot. System 7. 7s 1 01 %Z PUMP /SIPHON INFORMATION Final Grade 3 A0A 163, /Z Manufacturer Demand St Cover � G X0 9 GPM Model Number TDH ift Friction Loss Sy ead TDH . Ft Force Lent ia. Dist. to Well _T SOIL ABSORPTION SYSTEM BED /TRENCH Width Length, t No. Of Trenc f PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 4 � 17 „t � SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer (l,' J Q ,.�4 INFORMATION CHAMBER OR . 7 Type Of System UNIT Model Number. ^ J CoJ.Je , & � IT a DISTRIBUTION SYSTEM („fir ZZJ"Z3 Header /Manifold Distribution \ x Hole Size x Hole Spacing Vent to Air Intakes /, Pipe(s) Length Dia 4 4 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over i Depth Over xx Depth of xx Seeded/ Ned xx Mul K Bed /Trench Center / Bed/Trench Edges\ Topsoil es No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ! / Inspection #2: / / Location: 670 Pine Timber Lane Hudson, WI 54016 (NW 1/4 SW 1/4 15 T29N R19W) Coyote Ridge Lot 13 Parcel No: 15.29.19.2844 1.) Alt BM Description = ~ `g�_ Cap -�'`, � �+`g I--O `S G'��► 2.) Bldg sewer length = Zl - amount of cover = Plan revision Required? Yes No Use other side for additional inIformati n. 1 V� — - - Date Insepctors ignature Cart. No. SBD -6710 (R.3/97) l Vis con sin 201 W . Washington Ave., P.O. Box 7162 Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 Department of Commerce tare Plan I.D. Sanitary Permit Appli In accord with Comm 83.21, Wis. Adm. Code, personal tion you provide - may be used for seen pri{�tc�lsl5. IV* Q� 'I g 2 11 Address (if different than mailing address) L Application Information - Please Property Owner's Na me Parcel $ Lot H /Block M property Owner's M ailing Address Property Location oZo A1 1 k/ 1A, _rALJ 1t,Section _ City, State Zip Code Phone Ntrmber (circle one) 2 f / _ N; RL T_2 LE q0 II. Type of BuAding (check all that apply) Subdivision N e CSM Number U or 2 Family Dwelling - Number of Bedrooms am ❑ Public /Commercial - Describe Use ®T� El State Owned - Describe Use oZ DYST • 0 CL&S Z 2 2 City Qv illage l wiuhip of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' New System 0 Replacement System 0 Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System List Previous Permit Number and Date Issued B. 0 Permit Renewal ❑ Permit Revision 0 Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that I) / CEG C' 3 C� 2 C t_ (Leon - Pressurized In- Ground 0 Mound > 24 in. of suitable soil ❑ Mound < U in_ of suitable soil ❑ At -Grade liter` W 0 Constructed Wetland D Pressurized In- Ground 0 Holding Tank D Peat Filter 0 Aerobic Treatmeru Unit 0 Recirculating Sand Fitter 0 Recirculating Synthetic Media Filter 0 Leaching Chamber 0 Drip lane 0 Gravel-less Pipe 0 Other (explain) V. Dis reatment Area Information: Design F=(gpd) Desi gn 5oii Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) system Elevarione" VI. Tani. Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic C Gallons Gallons of Units Constructed Glass New Existing Tanks Tanks A — Septic orAlolilk%Tank Aerobic Treament Unit Dosing Chamber _ VII. Responsibility Statement I, We imiltnsigutn}, assume for installation of the PU1iV'IS shorn on the attaehed plans. Plume er's Na me (Print) _ Plumber's Si gmmre - 4tP/MPRS Number Business Phone Number Fogerty Plumbing 17,x Phmibe�e it Q.' zip Coat) Spooner, WI 54801 VIII. C Oni �,� Sanitary Permit Fee (includes G W J a L A Si o tamps) @ Approved 0 Disapproved Surcharge Fee) � l 0 Owner Given Reason for Denial IX.rovat/Reasons for p �� Septic tank, effluent filter and maintain aintaine dispersal cell must all be serviced as per m ment Ian provided by lumber. 2. _setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than $1/2 x 11 inches is size i - - a -pr' y- Q ng . - l�s%±bi a aie Rd. 301 F�4 - ,-�� (71 f- " .. -9 09 { L : } x _ �pEerd1G- t - , Yi- : W�44 : , s , l+ 1 , , , , t ; 't , , , w \ , ; i I ;I i ' plumbing Rd. {" s :,::5 -9609 LBT ciAAlAr/t _ s - f moo, � - f9• y s4 Id _ 4G7 . y ---� c- - t�/ 141f •G�LKTJ /S� 0 Owe ;w i O OQ f r cD rA GO ca v� .... pis•. ,• ��.x� '• - � C� ►�- CrQ tn CD CD' CD T . � o f �. a• r CD CD 1 c ^ N G II II ! 00 CD 94 r tm = W :* •e Q Q CD 0lD C, N` col W►- CD (I —CD ~ C 00 tR co ra � RECEIVED ,,,�" 3 Wisconsin DeperUnectof SOIL d/ALUATION REPORT Page � of Division of saf�rand Bt"W ��rnm i15. Vlis. Adm. Code Corny S T GR O! A oomplefe site Plan on not tl 112 x 11 inches 0 size. Plan n� rude. but not to: vertical G rl�d�pdb t (BM. direction and Parod LE) s��-. `0 W irercert slope, scale orc�r�tsian r1diGEYhra andtanoe to nearest road. Please print all Inl wn mdoa. Reviewed by Babe POMMOM WOFMOOnym (Mv+qrLmw. :4sa4(+)(041 NW 4 F S£ I SEIZE.I Pmpww owner PropmlyLocation k45 CRW0,V 13A-5 7 Govt. Lot Nib 1/4 im 3-17 T - / N R 4(or) W PWperiy0~4; Ad*m Let# 10o*# Scbd. Nam "CSMIi E'-* /N qy 14 • Ave 6-� / 3 1 a co yo rE ov sh" 20 code Phone Number o city ❑ Wage ® Town Nearest Road #0PSoA w/. 5 goI& ( ?I 38h• - n 75 hFvOso•j fmarry 1z'X - K MW QM*UCIM Use:jdRwdenmimxrjmofwdr== code derived design tow rate y,S•Q '-' O't7 GPo ❑ ❑ Public a cortrnarCM - Describe: Parent n> ft" _ - 4 y D y T w/!- Flood Plain eiemahm if applicable ft. amd loam - in a Svr7A41.p_ �A! tJ�•w T??arJ� -{., jam. 0. Ct, . T`.S . ❑� F/ �� # Pit GmM =face etav: fL Depth to irni ft #actor 7 fir. Soli Apploodon Rafe Ho tam Depth Dm*mm*Co1or RsdoK Dascription Texture Strrrkme Consiatenoa Boundary Roots GPM kr. Munsei Q L Sz cont. color Gr. Sz. Sh. *W 'EtW1Z l 0 ./ 1 4 /o Z G /.Kt ,rh . .,r► f2 2 S' 3 t • Y • G 2 1 /3 . * /o ,2.5 � 51L. If s d4,' 4-S /f • 2- • 3 is GS /• pti 2 # ❑ �o.fy p PH Oroarrd etev. tz D b > actor ' �O in. Sd Appksftn Rate Hodson Depth Don*xftCakw Red= Description Texhme Shudune ca"WenDe Bocrrdary Roots WON in. M m ei Qu. Sz. Cant. ootor Gr. Sz. Sh. -M -EW2 0. y i 2 --- L 2, f,5 hk d51-1 451 f . s 3 I •3o s SL h s a 5 -- • Y D - So 75 Y& --- S D c /• 2 o /6i s ' EtRuert #1 BOD -.W < 220 nVL and TSS , M : S 150 mglL Etluw t #2 = BOD <_ 30 nV& and TW <_ 30 M L =Nuttbar = N o R zt b h1 cG I 22 Cr 3 -15 Address Date Evakualion Conducted alrp wm Number Np�. r7 • 3 715. - q Private Sewage Consultants p 2812 10th Ave. AV 0 S / o�2 TOT�•G of O 0 Spring Valley, WI 54767 Z D • z. • ♦ ©1 • yp . a i /3,+5 7— �a f / 3 Z 3 Propert Owner Parcel 0 # Page of ❑ �r9 F-3 # A Pit Ground surface elev. 105 ft. Depth to factor > 4 7 0 / () jrL Sol Appkabon Rate Horizon Dept Dominant Redox Description Texture Structure Consistence Boundary Root GPWM in. Munsei I Qu. Sz. Cont. Color Gr. Sz Sh. - owl *e f#2 l o' /o z G 2 -FShK A 2s 3f . 5 • S' • l (v /D Y4 S Y)e Yd 4AOAOJJV, SL — ?S S S D, S �• Z F—I # � ❑ Pit Ground surface elev. ft. Depth b W i ft factor C - Hortm Depth Dominant Redox Desaipbon Texture Structure onsSenoe Rate Boundary Root GPDRf in. Munsd Qu. St Cont Color Gr. Sz. Sh. •M1 ❑ � # � Bourg ❑ Cw" surface elev. R to g factor in. Soli Rate Horizon Depth Dominant Calm Redox Description. T Structure C*nMstenoe Boundmy Roots GPDIff In. Muned Qu. Sz. Coro. Color Gr. Sz. Sh. 'E1ft11 •Etf#2 • Eftwd #1 = SOD > 30 < 220 and TSS >30 < 150 mO L • Bkw t #2 - BOD 130 ag& and TSS 130 mall The Department of Commerce is equal opportunity service provider and employer. If you need assistance to access services or need material in an a tc format, please contact the department at 608-266-3151 or TTY 608 -264 -8777. i sac- t3�opuoo► I • cn �y Hof LO D� va � s Al b = e 4,P fa tam 1,1,AA@ S `` pAI �1 F o s 1 t3 � r 4 �4 0 N� s _�— A- P r 0 � ys l i For issuance of permits and designing / tact: Ulbricht & Associates Con /©0 Registered private wastewater consultant and plat bOM 2812 10th Ave. Spring Valley, WI 54767 715 - 772 -3442 i FILE i wnmATION SYSTEM - Owner _ _ _ _ Septic Tank Capacity ail 13 NA Permit - Septic Tank Manufacturer CI NA Effluent Filter Marwfactvrer L ❑ NA DESIGN PARAMETEW ❑ NA Effluent Filter Model _ ❑ NA Number of Bedrooms - Number of Public Facility Units Pump Tank Capacity g� �? NA Estimated flow (average) ay Pump Tank Manufacturer C-1 NA Design flow (peak), (Estimated x 1.5) d Pump Manufacturer [� NA aY Purrs Model 17 NA Soil Application Rate _� /ft Standard Influent/Effluent Quality Monthly average= Pretreatment Unit CI NA Fats, ON & Grease (FOG) <_30 mg1L ❑ Sand /Gravel Filter O Peat Filter - Biochemical Oxygen Demand tBOD :5" 20 mgA_ ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mgr O Disinfection ❑ Other Monthly average Dispersal Cents) ❑ NA Pretreated Effluent Quality 13 in -Gr«md (pressurized) BwdmnwW Oxygen Demand (BODJ :530 mgr- (gravity) Total Suspended Solids (TSS) <30 mg1L ❑ NA ❑ At -Grade ❑Mound Fecal Cokforrn (geometric mean) 510 cful100ml ❑ Drip-Line ❑Other: Maoamum► Effluent Particle Size ys in dia. ❑ NA Other: ❑ NA Other: ❑ NA Othen ❑ NA Other. ❑ NA *Values typical for domestic wastewater and septic tank efiiuent. MAINTENANCE SCHEDULE Event Service Ftn'gc�rrcy Service 0 months) (Maxanrrrm 3 years) d NA Inspect condition of tank(s) At least once every: earls) Kt Pump out contents of tank(s) When combined skid" and scum equals orne-ihmd (XJ of tank volume ❑ NA ❑ month(s) Vdaidnam 3 years) 13 NA Inspect dispersal COWS) At least once every: 3 yeadsl � ����,, __,,,, ❑ nnont hts) p NA Clean effluent filter n &Vy At feast once every= ❑ rmarnHn(s) A Inspect pump, pump controls & alarm At least once every: 0 yearts) AN ❑ month(s) J3 NA Flush• laterals and pressure test At least once every: ❑ yew(s) ❑ monthis) —am Other:- At least once every: ❑ year(s) Q 1VA Dther. MAI(1j,TENANCE INSTRUCTIONS ore of the following or certifications: Inspections of tanks and dispersal ohs shop be.made by an individual carrying operator . Tank Master Plumber: Master Plumber Restricted Sewer, POWTS inspector, POWTS Maintainer: ide ntdY any cracks or leaks, inspections must include a visual inspection of the tank(s) to identify any tag or broken hardware, d surface. and sewn and to deck for any back up or Pig of affluent on the groom measure the volume of combined sludge and to check for any ping The dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and requires the of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a fang condition u immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any nk equ one-third � aac e c entire tank volume, the accordance w i t h c h a pter MR 113 contents of the tank shall be removed by a Septage S operator Wisconsin Administrative Code. pressurized Ail other services, including but not Taed to the servicing of effluent filters, POWTS M ' tam components, Pretreatment 1"u units, and any servicing at intervals of 512 months, shall be performed by a certified A service report shall be provided to the local regulatory authority within days of completion of any service event. ^HT UP AND OPER&PON od or other chemicals For new construction, prior to use of the POWTS check treatment tank(s) for the presence of pamMem9 pr ucts that may impede the t process and /or damage the dispersal cefi(sl. if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior tai use. System start up shall not occur when so p 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 cels! one 9e dose, overloading the cells) and may result in the backup or surface discharge of discharged to the disperse{ K O oc ' to restorin k removed by a Septage Servicing perat P g effluent. To avoid this situation have the contents of the pump tank effluent or contact a Plumber or POWTS Maintainer to assist in manually o Pe g the pump controls to power to the Pump restore normal levels within the pump tank. Do not, drive or park vehicles over tanks and dispersal cellq. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet o sl o p e d a of any mound or at -grade soil absorption area. str eam m improve the performance and prolong the fife of the ' "nation of the following from the wastewater s ma Reduction or elttr►t tr dial foss; diapers; disinfectants; fat; POWTS: antibiotics; baby wipes; cigarette butts; con cotton swabs, degreasers, ; Pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; foundation drain (sump 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. shall be excavated and removed or their covers removed and the void space filled with � After pumping, all tanks and pits , soil, gravel or another inert solid material. CONTINGENCY PLAN or,must be taken, to provide anode compliant If the POWTS fails and cannot be repaired the following measures have been rep a nt sy�iem` - be utilized for the location of a replacement sail sorption suitable replacement area has been evaltsaited and may riot be infr ad on by � S ystem. The replmamt area should be protected fran d"iSturbance an d c ompaction and should ORR&ff VW ea will cequir extstmng e, and wells. to Replacement ems �t must result in the need for a new soil and site evaluation to establish a mutable / omply with the rules in effect at that time. ❑ A suite cement area is not available due to setback add /or saoill liPOWT a in POWTS S. technology a holding tan may e s' as not evaluated entify a su' rep cement ar Upon fail the P soil and site v a i ust pe ormed locat a suit replacer tare . If no pia eat area is available a molding tank ma inst as a 1 rt to re plan 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 MSSAN� ro DEATH� MAY LT E OF A FALTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRg1NtST PERSON FROM THE INTERIOR OF A TANK MAY BE DIFRCULT OR IMPOSSIBLE - #221180 c e n nzle (715) 635 -9609 j POWTS INSTALLER POWTS MAINTA -v Name Name Phone 7' / - �3 ©� Phone — SEPTAGE SERVICING OPERATOR (PUNIER) LOCAL REGULATORY AUTHORITY � Name 41 Name F: Phone This document was drafted in compliance with chapter Comm 83_22(2)(b)l1)(d) &(f) and 83.54(1), (2) & (3), Wmwsin Administrative Code. I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerlBupec Mailing Address 5�elP Property Address ss �. (Verificatio�reuired from Plannifor n ew City/State Parcel Identification Number 020 —f '/q / 3 LEGAL DESCRIPTION � Property Location /� ,� , y zpy , Sec. TAN -R�� , Town of �Gt�fOil/ Subdivision P Lot # /_T Certified Survey Ma 3 d Y P Volume '' , Page # Warranty Deed # ,So 93 9 Volume .2 Y 9 ' , Page # - 7 SO C7 L/ . o? 'If - 7 Spec house 0 yes G'no Lot lines identifiable OR 0 no SYSTEM MAI 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 it in proper operating condition and%r'(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 returned to the St. Croix County Zoning Office within 30 days. of the three year expiration date. SIG ATURE OF AYPeICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form 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. SIGN OF APPLICANT 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 Parcel #: 020- 1447 -13 -000 05/04/2005 10:57 AM PAGE 1 OF 1 Alt. Parcel #: 15.29.19.2844 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/27/2004 00 0 Tax Address: Owner(s): * = Current Owner " KERNON J & DONALDA SPEER BAST BAST, KERNON J & DONALDA SPEER 948 LABARGE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 670 PINE TIMBER LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.100 Plat: 10/17- COYOTE RIDGE 020/04 LOTS 1/29 SEC 15 T29N R19W PT NW SE BEING COYOTE Block/Condo Bldg: LOT 13 RIDGE ('04) LOT 13 (3.10AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 15- 29N -19W NW SE Notes: Parcel History: Date Doc # Vol /Page Type 10/06/2004 776366 2671/97 VRNC 07/27/2004 769938 10/17 PLAT 01/07/2004 750940 2487/120 WD 01/07/2004 750939 2487/118 WD more 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/04/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 V G `� 1 1• 1 Z -7 50940 13 KATHLEEN H. WALSH • - REGISTER OF DEEDS ST. CROIX CO.. WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/07/2004 12:35PM WARRANTY DEED THIS DEED, made between Kernon J. Bast, a married person, EXEMPT # 914 Grantor, and Kernon J. Bast and Donalda J. Speer -Bast, husband and wife, REC FEE: 13.00 as Survivorship Marital Property, Grantee, TRANS FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 2 1 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2' St. - Suite 115 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 Parcel Identification Number (PIN) This is not homestead property. Dated this 6th day of January, 2004. --0-- 0: 1 * ernon J. Bast * * AUTHENTICATIONB,(O�JVn ACKNOWLEDGMENT pC1 Signature(s) G� , PoOl' STATE OF WISCONSIN ) • C1` ST. CROIX COUNTY. ) ss. authenticated this 6th day of J g 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 TITLE: MEMBER STATE BAR OF WISCONSIN acknowled the same. (If not, Fn�` authorized by § 706.06, Wis. Stats.) - THIS INSTRUMENT WAS DRAFTED BY *Cheri Brown Notary Public, State of Wisconsin Edina Realty Title - Doug Berg My commission is permanent. (If not, state expiration date: 400 South Second Street 4115, Hudson, WI 54016 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 STATE BAR OF WISCONSIN FORM No.2 -2000 750939 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIK CO., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/07/2004 12 :35PN THIS DEED made between Steven L. Bakken and Ca ye L. Bakken, WARRANTY DEED y EXERT It 17 husband and wife, Grantor, and Kernon J. Bast, married, Grantee.. Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 13.00 the following described real estate in St. Croix County, State of Wisconsin: TRANS FEE: COPY FEE: CC FEE-. PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2n St. — Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 412540 This deed is in fulfillment of land contract dated August 16, 2002, recorded August 20,2002 in book 1952, page 549, as 20- 102740 -000 & 30 -000 &20 -00 document number 687523 Parcel Identification Number (PIN) This is not homestead property. Dated this 6th day of January, 2004, B J � x B % ' * Steven L. Bakken * Ca ye L. B en * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) i;t oNNI I ST. CROIX COUNTY. ) ss. authenticated this 6th day of Janu 04 p Notary n s j'(1 Personally came before me this January 6, 2004 the above named Steven L. Bakken and Caye L. Bakken, husband and * St2i wife to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN forego' 'nstrument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) X THIS INSTRUMENT WAS DRAFTED BY *Cheri Brown Edina Realty Title — Doug Berg Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 400 South Second Street #115, Hudson, WI 54016 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 STATE BAR OF WISCONSIN FORM No.2 -2000 U 2987P 119 EXHIBIT A The NE '/, of the SE' /. and the NW '/, of the SE 1 /4, all in Section 15, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E %. corner of said Section 15; 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 08 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 01 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. g EQUAL 167.53 ACA u e w H w -_ U X F� bD CV co ro z f T29N, R 19W to a�N �x N x EAST - WEST 114 LINE OF SECTION 15 N8f x x x 386.8' x x x x x 396.64' x x x LOT 11 2.16 ACRES x 94205 SQ. Fr. x F o x LOT 12 �sd 3.65 ACRES 158947 SQ. Fr. ,x w z LOT 13 X 3.18 ACRES H V 1 0 1 SQ. Fr. cn ; 0 co v � ; ♦ ,. ��' ', �.♦�r `rte ♦♦♦ ,',/ , S� ! "`!l1��7 ' �� ♦ i ce . BENCHMARK / TOP OF 1" IRON PIPE Q .' O !�•�'� ELEV. = 868.62' _._._.._._._.��' ( LOT 14 2.05 ACRES r" !89484 SO. Fr. i L.B.O. — 866. /