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HomeMy WebLinkAbout020-1458-01-000Wisconsin ~Ppartment of Commerce PRIVATE SEWAGE SYSTEM SzfiYty and Building Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Welcome Homes LLC Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ~~. ti~ Q -3 cs ti TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ /, S , F.V ra ~a~ ~JzS Aeration o rng TANK SETBACK INFORMATION ~,Je~~- . en o it n a e ep Ic ~ ~ 1 ~d ~ / Z ~ 3(p ' --~ osing era lon o mg PUMP/SIPHON INFORMATION anu ac urer eman GPM o e um er ric ion oss ys em ea re g i JVIL H6.7V1[I"' 1 IVIV J T J I CIYI ELEVATION DATA county: St. Croix Sanitary Permit No: 488OfiH ~ State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 16.29.19. STATION BS HI FS ELEV. Benchmark Alt. BM 84,~.w~' ~ r" ~ 3.3 99 , 3 8 Bldg. ewer •$5 9'7• ~ t/ t n et 5.95 5'x.75 t t ut et (p ~ 3s `1 (0. 3S ne ~ ~ 0 om _ ~ ea er an. 7 ~ 95. (~ is . Ipe 7• ~ ~ .gyp o. ysem $,• 5~/ 9~• SRS ma ra e S g5 g(o. 75 over F;11z.~-- C.,~~s.~... ,~. bid ~J9, ~Z. DIMENSIONS ~ / $,~, ~'g'd' ~ ~ ~Q ----~-_ ~~ ~~ INFORMATION CHAMBER OR ~ ~~ ~ ~-(a,'~'~'` Ca r~~.vl-TI O ~ S ~ 3lD 1,t ~ ~ /" /~ fT1 UNIT , ~t) i ula 1 r~loV 1 Iv1V .~ r.~ ~ ~~r' G.'S ~ L.G ~ . `7`"J Cir2Slrb„ ~ ~~ Length ~ Dia ~ Pipe(s) ~ \ \ Length Dia Spacing ~ \ 3r- ~~,,~. Q,~, 5 w~~ uvv~r~ x rressure systems vnry xx rvwunu vi n~-v~auc oya~cuw vnry Bed/Trench Center ~ r ~~ ~ Bed/Trench Edges \ Topsoil ~ Yes ?i No Yes i it No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 599 Grange ad Hudson, WI 54016 (NE 1/4 NE 1/4 16 T29N R19W) Willow Bluff Lot 1 ~u-S¢.w.s.Jk- ~/DO r 1.) Alt BM Description = ~ ~t,e.,; ,.~~ ~'` ~,O ~,, 2.) Bldg sewer length = Zy - amount of cover = /g ~/ Plan revision Required? [ ]Yes I~No (( Use other side for additional information. 5 ZJ--Date--~' SBD-6710 (R.3/97) InspecUOn ~z: i i ~ ~/~, Parcel No: 16.29.19. \~_ ~_ ~T~~J ' i .~.. ~ani>iary P m p ' In accord with Comm 83.21, Wis. A C n l i ati~CEIVED formation you provide may be used for s~ondary pu Pn , s 15.0y3(~gt) c O ~ o O C r ttf V U I. Application Information -Please Print All Infor tan ~ P perty Owner's Name y F Cl= arppP# _ Lot # Block # ~) ...~ perry Owner's Mailing Address ~ 17 ~ . lJ -------.~...-- Property Location Nr_ / ~ City, State ~ / ~~ ~ N Zip Code ~ ss V rJ Phone/Number,/ / ~ ~J/ `J~/ -~(o`7G T ~~ N- R~E IeW II. Typc of Building (check all that apply) 1 or 2 Family Dwelling -Number of Bedrooms ^ PubliclCommercial -Describe Use Subdivision Name CSM Nutn(~ r a ^ State Owned -Describe Use ^City ^Village ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' (~, New System ^ Replacement System ^ TreatmentMolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal Before Expiration ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Previous Permit Number and Date Issued IV. T e of POWTS S stem: Check all that a 'Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Motmd < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Conswcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ . Recirculating Synthetic Media Filter Leaching Chamber ^ rip Li ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/i'reatmentAtea Information: ..5~ r - Design Flow (gpd) ~ ®D Design Soil Application Rate(gpdsf) ~ ~7 rsal Required (sf) ~ s 7 Dispersal Area Proposed (sf) ~s Syst Elevation ~ ~' ~'= 93 s ~~ - ` VI. Tank Info Capacity in Gallons Total Gallons Number of Units Manufacturer t,,, ~ Q~ f,,~ D~ SZS' " Prefab Concrete Site Constrocted Steel Fiber Glass Plastic New Tanks Existing Tanks ~ ~`"'- / ~P~ "~ Septic or Holding Tank /~st~ „" ~i~s-V J ~ ~ p ~~ ,/~ ~~~^";'.j'OC Aerobic Tn~tment Unit Dosing Chamber VII. Responsibility Statement- 4 the uadersiigtted, assurtx responsibility for installation of the POWYS shown on the attached plans. Plummber's r~Name (Print) /~ !( ~Cr Plum 's Si acute .. /MFRS Number Business Phone Number 7~.5' ~' Plumber's Address (Street, City, State, Z,ip,~ade) _ VIII. Conn /De artment se Onl Approved ^ Disapproved ~~~~ ^ O Given Reason for Menial Sanitary Permit Fee cltldes water Stu+charge Fee) L~~j ~ I `~" Date Issued ~y ' ~ l~ tssuing Agent Signer (No Stamps) IX. Conditions A pro SYSTEM NER: 3 ~ ~ ~ 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained C~ ~ as per management plan provided by plumber. ~pe.~,,~ -~ 2. All setback requirements must be maintained - t as per applicable Code/prdinances. ~ C'"""'~`~" a-~^'~ ~ t "~`2 ~ • ~S / ~S~C ?sty ,S~(-t`~,~ ~ ~Q ~ ~r'~~2 Attach complete plans (to the County only) for the system on paper not less dwn 812 x I1 inches in sin s~; ry 0 ect Address 'l '''~S SBD-6398 (R. 01/03) ~, ~` 1 ~- ~~- Ncr Uu:~. ,~~~ ~ ~.~-. ~~ ~ ~ y ~`- ~ = as ~ ~ `~ y / /' y r- ~ y ~ ~--a ~~," ~ ~ Qi~ ~ ~ .~ '~ 3 A„\~ /~,1 y~, s t-~ ~3 ~ FG. ~~ ~ ~ =- ~ D ~, P _ ~ ~~ ~~~~ c°P ~~ a ao 3S7 ~y- ~as~ Na~ u~.e-Q~ l~I ~~ ys ~- y- ~S~sy" ~- a = as q ~ `~ s ~i.~ : 7= ~_ y~~, s a. y3 , v\~ ~l '~-1 q~, S ~~~/ ~- e~ ~. ~~ ,~3- 3 1 ~~ e ~ ~ ~o t-a ~'~ ~~ N3' J~1~ aao3s~ .. Z Wisconsin Department of Commerce Division of Safety and Buildings _ .w. SOIL EVALUATION REPORT in..accordance with Comm 85, Wis. Adm, Code 1584 Page 1 of 3 Steel's Soil Service, Inc. Aitach complete site plan on pap~r'rriatd~~antB'~7tn~m ` „~ Ian must County St. Croix indude, but not limited tQ: vertical and horizontal refe c ~ and percent slope, scale or diimemsions, north arrow, and I a dis{i~p Q road. ~ / Parcel I.D. Pending , P~ease'printall ir~fdion. ; ewed B Date Personal irdorrnafion yotg provide may tie used for secondary purposes ~Pdvacy Law, s. 15.04 (1) (m)). y ~ . 'Z ' ~ .,' ~ t'~~ Property Owner ~.w_ Property Location M ..w..:..~~..-...-. Hieb, Matt ~ ~~``"`~ Govt. Lot na NE 1/4 NE 1/4 S 16 T 29 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# (~j 1271 140th St 1 na Willow F,alits, Pending City State Zip Code Phone Number ~ City _j Village ~ Town Nearest Road New Richmond ~ WI 54017 715-381-5277 Hudson Grange Rd /.._.~ New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ~ Replacement _] Public orcommercial -Describe: Parent material outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional design, system elevatio 5.50ft. Trenches snpac_'ed and depth to code 3.OOft belo ~ grade. ~ ~ ~~ Boring # ~ Boring Pit Ground Surface elev. 98. ff. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP *Eff#1 D/ft= *Eff#2 1 0-14 10yr3/1 none I 2msbk mfr cs 2f .6 .8 2 14-60 7.5yr4l4 none cos osg ml cs na .7 1.6 3 60-120 7.5yr4/6 none ms osg ml na na .7 1.6 a~' 9S•S~ ~3 •S~ 3(0 /~L (moo ~' ~ Boring # ~ Boring Pit Ground Surface elev. 98.50 ff. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stmcture Consistence Boundary Roots GP Dlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-16 10yr311 none I 2msbk mfr cs 2f .6 .8 2 16-55 7.5yr4/4 none cos osg ml cs na .7 1.6 3 55-120 7.5yr4/6 none cos osg ml na na .7 1.6 Ti ~ "~.~ * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L anq 755 < 3u mg« CST Name (Please Print) ignature: , CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. ~ Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 11/8/2004 715-684-5680 Property Owner Hieb, Matt Parcel ID # Pending Page 2 of 3 Boring # Boring Pit Ground Surface elev. 88.10 ft. Depth to limiting factor _ 7~$ F. _ in. Soil Applicaafion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 *Eff#2 1 0-16 10yr3/1 none I 2msbk mfr cs 1f .6 .8 2 16-31 10yr4/4 none sl 2msbk mfr cs 1vf .6 1.0 3 31-51 7.5yr4/4 none cos osg ml cs na .7 1.6 4 51-78 7.5yr4/6 none cos osg ml cs na .7 1.6 5 78-96 5yr4/4 none scl om mfr na na .0 .0 ^ Boring # -~ Boring ~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/Land 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. STEEL'S SOIL SERVICE INC. David J. Steel CST-POWTSM Lic. #248956 Matt Hieb NE 1 /4,NE 1 /4,S 16,T29N,R19W Town of Hudson, St. Croix Co. Willow Falls, ~ Lot 1 ~r \\.. a6~ _2~ ~,~ ~,, ~~~~,. ~~5 ~~D ~, .-.rte a N~ ~ ~~~ ~ ~'^'" C~ `~~ 994 200' St. Baldwin, WI 54002 Bus.(715) 684-5680 Fax.(715) 684-3449 Legend 1" = 40' l • =Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • =Alt Benchmark Ele. 100.65 ft Top of 3/4" pvc pipe ^ =Borings Boring Elevations B 1 = 98.50 ft B2 = 98.50 ft B3 = 88.10 ft B4 = 0.00 ft ~~v(lp t3 Z 3of3 N --_~_ ~F < . S~ s-a,~,` -_.. ~~ ~~ s 6,c~~\ ~~< ~-, ~~` ~' ~ \``- 8"~ ~ a~~ ~ . id ~~ rUw 15 UWNER'S MANUAL & MANAGEMENT PLAN Page I of v FILE INFORMATION Owner ° Permit # ~'D~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) (~ Q al/da Design flow (peak), (Estimated x 1.5) (~Q al/day Soil Application Rate ,~ gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BOD5) _<220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L .Pretreated Effluent Quality - Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids ITSS) 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. SYSTEM SPECIFICATIONS Septic Tank Capacity o~s~ al ^ NA Septic Tank Manufacturer L~~' „J~ ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model ~ ~DO ^ NA Pump Tank Capacity gal A Pump Tank Manufacturer C~NA Pump. Manufacturer NA Pump Model NA Pretreatment Unit Sand/Gravel Filter ^ Mechanical Aeration ^)~isinfection ^ Peat Filter ^ Wetland ^ Other: ~IA t ~" Dispersal Cell(s) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) z~ ~( earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ~ month(s) (Maximum 3 ears) yearls) y ^ NA Clean effluent filter At least once every: ~ ^ month(s- yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) ^ NA Other; At least once every: ^ month(s) ^ 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 Ptumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third 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 shat) be provided to the local regulatory authority within 10 days of completion of any service event. ., Q.2 ~ z 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 fallowing from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • 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 faits 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 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. ^ 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 Iasi resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name (,[~r!r/Q- Phone 7/~ - SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY ..Name ,rj <:~=~~~ C~n~ 1^`t' V~""'~ll~(f Phone ~/f ,3 ~~j '- `~~ g~ ~NI This document was drafted in compliance with chapter Comm 83.2212){b)i1)Id)&If) and 83.54111, (2) & (3), Wisconsin Administrative Code. _ ~ ~~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ~.~` ~ V 4 AND /'' ~ OWNERSHIP C~aR.TIFICATION FORM / OwnerJBuyer ~ ~ f~ ~ iVlailirzg Address ~- U. Property Address -------- ---- { Vesificatiaa re d Planni - ~-- Qmro ng Department for new onstruct' Cityr~tate/ ® 1 ~i~ ". Parcel identification N ~ ~ ~ ~' 1(1 Z ~ -. V U - 0 0 1 LEGAL DESCRIPTTOI~i ~~ ~---~ Property Locarion /U,~'l, tU ~ ~/~, get- ~ T s /N-R~W, Tawn of -~ ~l ~ U r.~~5~+~ SuGdivisioa lv tAt ~ ..~ . Certified Sttxvey Map # Volume ~ _ Page # Warranty Deed # Volume ~ ~~ ~ 3 Page # 6 ~~- Spec house ~ yes ^ no Lot lines identifiable ~res ^ no SYSTEM MAIN3'EN CE Improper use and mainte~,~~y~. s~ system could result is its consists of pumping out the septic taa~ erery mix years ar ~tlatt to h-mdIe wastes. Properm zaa a$ect the fcmcfiau of Sue if needeaby a liccasad pumper. what you pot into the system septic tank as a tr~eamuent stage is the waste,disposai syst,~, T~ P~rt7~orvaea agues to submit sa St G~anc Zoning Depa~meat a catificatioa form, sagnod by ffie owner sud by a auastGr P.]~eyman Ph~er, ~ieecdph+mber or a lioeasedpumpervrxifying mat (1} the on sift wast~:svaterdisposa! system is is proper operating condition and/or (2j after iaspeakiou and pumping (iftaecessaiy), the septic took ~ less tluta 1/3 full of sledge. I/wo, the underaigacd have read the above his and agroe to me set forth, hernia, as act b the D pavan ~~ ~m with lire standards Y epertment.of Commaxx and the Department ad'Natunl Resources, Stste of y{~ia..,..,.:., Certi6catiam sf~uig tbax y°°r system has been mauntained must be completed and resumed to the St (lions County ~S Office withiua 30 days of the thret year expicati~an date. ~r ,z~, D~ GNA F APPLICANT DATE OWMFR CERTII•'ICA1'ION I (we) certify that al! statements on this foam are true to the best of my {our} knowledge. i {wa} am (are) the awaer(s of the pmp described aba by vittue of a warranty deed recorded is Register of Deeds OtISee. ) IG23ATURE APPLIC~AN'I' 4 ~ /~! D ~p . DATE «s.«** pay infotutation that is rnis-reprsscated may result in the saaita .*.,.,.. ry permit being revoked by the Eoniag Daparbneat_ "' IRClude 1Yith slur appEicatioa. a stamped warranty deed from she Register of Deeds office a copy of the certified survey map if reference is trade in the warranty decd g•d trbbZ-9bZ-S61 ~~n~~ niniH Hen ~~~•~~ ,,,. „~ ~~n,. ~~ ~ ti s~ s e o o iWar~t~VYh( ~Q.4-~ ~3 1 1 2 7 8 KATHLEEN H. 1tALSH REGISTER OF DEEDS ST. CRO~X CO., MI RECEIVED FOR RECORD iiie4i2ees 18:20An MARRAHTY DEED ElfEp#~t # REC FEE: 13.80 TRANS FEE: 307.50 COPY FEE: CC FEE: PAGES: 2 Recording Mu Name and Rehun ,tddrrss Universal Titlo 7235 Ohms Lano Edina, MN 55434 ATTN: Recording Dept. ,__ ..__ t~2~- f02~ -OQ - ~O~ Ponce! idmtificatioa Number (P[N) ~r ; Thi+ inlormnion must be completed Ly wbmittsr: doettmsntlt'de. name ,4 rEmrr! naW,(Slr. anA ~ ({f required). •Othsr fr~forn+adon +uch aJ Ais gra~nng claius+, legal ds+e-iprion, car. may bs placed on ~ht+ ffr+t pods ojrhe document or may bs placed on nddldonal page+ ojrhs document, V, nra; U+s ojihu cover poge addr wis pugs to yonr document Qnd ~y Q~(f tq. ht rt~rd(n~ R`i+coruin Staruru, 39.317. IVftpA 1/-rf '~ ~ `~ ~ ~ ~~ 0 ~ State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number Document Name THIS DEED, made between Matthew D. Hieb. ("Grantor," whether one or more), and Welcome Homes. LLC ("Grantee;' whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is please attach addendum): Lot 1 Plat of Willow Bluff in the Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Address RVAT 2684959 02o-loss-oo-ool Pazcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated October 18, 2005 * ~i~~ *1V~'atthew D. Hieb (SEAL) (SEAL) * * Signature(s) _, authenticated on * TITLE: MEMBER STATE BAR OF (If not, authorized by Wis. Stat. § 70i THIS INSTRUMENT DRAFTED ACKNOWLEDGMENT STATE OF Wisconsin ) ss. St. Croix COUNTY ) ~-itt N~~4 -~si' ~ Personally came before me on October 18, 2005 ~ ' ~ ' . G.l;the above-named Matthew D. Hieb ~~~0 ~- , ;~ . ~ ; ~o me w to be the person(s) who execut the foregoing 'k ', puB~~V ; ~nsttu nt d acknowledged the same. y~sj,' • Gp'': ~' ~ o ~1 ~~.,,,.__ . ,....~-~``~ * onnie M. Gullix on Notary Public, State of Wisconsin My Commission (is permanent) (expires: '- - ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO.2-2003 AUTHENTICATION • Type name below signatures. INFO-PROTM Legal Fonns B00-B55-2021 www.inioproforms.com Q O K ~ s o d = r W Q ~ \~ ~. ~ ~~~:~. . .. z z r ~Z~ ~ ~ a v 0 0 ~ ~ ° ~u Z v ~ w ~~ a a ~ z C pz p O w Z ~ O ~ rc >w ~ ~ a~ a ~ rc ~ 3 ~ o o g~ o J ~ fJ X e oZ o ~ wO m ~ g g < $ 3 m 3 ~ rc R ~ U O O O ~ ~ w J O 3 ° ¢ O X N ~, ,~ o g H a ~ m m R W ~ I = ~ ~ ~ vi r o~ ai ,~~ ~~ ~~ ~~~ a ~~ w~0 a ym0 ~~Z s~ w ~/ LL <GK ~8~ ~~ ~ ~~~ ~~ .F ~~ ~~ I"~ Q m s i Q Z to ~ ~ W ~~.. ~ a MJ/y~ ~ W VI _W Z~Z 0 = W J~N N sir wa 1 OF 1 ' CURVE DATA TABLE NUS Radius Length Central Angie Chord Bearfrg Chord Lem A~ ). ~ >~•~' 32°5t'01• N60°58'59.5 E 4524' 45.8T C2 80.00' 45°04'10` N6TOS34'E 61.32' g2,gg q Cesar ss°2s12• lJ3;i•0527'4Y ts9.9lr at129' SEE COVENANTS FOR LOT OWNERS RESPONSIBILRTES REGARDING MAINTENANCE OF DRAINAGE WAYS AND STORM WATER PONDS LOCATED ON THEIR LOT. SEE COVENANTS FOR LOT OWNERS RESPONSI81LI1TES IN PREVENTING EROSION ON THEIR LOT. EACH PARCEL SHOWN ON THIS MAP 6S SUBJECT TO STATE, C~IAVTY AND TOWNSHIP LAWS, RULES AND REGULATIONS (I.E, WETLAND, MINIMUM LOT SIZE, ACCESS TO PARCEL, ECT) BEFORE PURCHASING OR DEVELOPING ANY LOT, CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE TOWN ~ HUDSON. NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH i~FERE WITH OR CWWGE THE ~c~ oa`~ 8 M OF THE APPROVED COMPREH OPERATION g~` AND SOIL EROSION PLAN FOR THIS PLAT. THIS INCLUDES ~~ ~~ \ BUT IS NOT UNITED TO BUILDING UPON, 200 ACRES a-'fE~IG FILLING OR EXCAVA Cam' ~~ g~' ~ 87,183 SQ. ~"I' ANY POND EASEM ~~ ~ PLANTING ~ L6.0.= 897.0 ENTS, WATER DRAINAGE DITCHES, ~ p jr WATER RUNWAYS. WATER (~.ILVERTS, BERMS OR GRASS ~ 5"' ' ~ •Slc sEEDINGS. UTILITY EASEMENT DEFlNED An unobstructed easement for the construction and maintenance of all necessary overhead, underground or surface public utilities. including righ#s to conduct trimming on said easement. This easement shall have no permanent obstructions (fences, trees, shrubs or other obstacles) that interfere with instillation, function, or maintenance of utility systems. Public utilities shall not be held liable for any damage to prohibited obstructions_ ~' of wise vj DOUGLAS J. ZAHLEp i ~~r El~A~ h ~~. Zt1~'y~ZO B2 ~A ~+° , ~A ryryb 'ice ~ tX'11~~~ ti tN2lUMAGEAEASET-IENT ~ ~~~~ Cl~tlo ~~ 1~1~ ~l CPC~a 9~ LQT 1 LEGEND • ~ FOUND 1.OUTSIDE DIAMETER IRON PIPE ~ FOUND 2 OUTSIDE DIAMETER IRON PIPE LB.O.= LOWEST BUILDING OPENING dOO 4 9 NOTE: NO ACCESS TO ~ MccuTC>•tEav ROAD `,~ ., s. ~ ~ 1... ~,©4 ~ O ~ ~ N v ~ 6 w ~ (~ o -__._ u~U~~ u ~ rMi ~Q[~ l~°n ~ d D i. aouglos J. Zahter, Registered Wisconsin Land Surv~eyvr, hereby certify thot this Certificate of Survey was prepared under my d~ect supervision and is correct to the best of my knowledge and belief. o ~ $ o ~ o b s p ~ ~ ~ ~ ~' ~~~ ~ ~~~~ x ~ ~ '~; .~ ~ #~ ~p 2 ~~ m~ 0 ~ -J D ,- ~= s ~ v~ i~~J~~ tiry -•: 'o ~.v •a~ ~~ ~~~ ~~ it~ ,,~~ ~,^" ~ """ r, o, I~r LOT 1 2.00 ACR . FL L.B.O.= 897.0 ~ ` G,75 ~ ~ \<,?d` STORM-WATER ~ DRAINAGE EASEMENT ~~ HWE 895.0 ~`~~ dl ' ~ l~ ,,pG 1882 ~ I Mc length Tangent In Tangent Out 211.29 N00'22'21 "W N65'48'33"W (N00'12'49"W) (N65'39'O1"W) 62.93 S89'37'39"W N45'18'11"W 377.18 N45'18'11"W N44'33'29"E 47.81 N45'18'11'W N79'32'36"W 109.75 N79'32'36"W S21'S1'09"W 79.54 S21'S1'09"W S35'O6'S8"E 94.21 S35'O6'58"E N7T24'30"E 45.87 N7T24'30'E N4433'29"E I, 62.93 N44'33'29"E N89'3T39"E w u V B° o \ BM TOP OF IRON PIPE ELEVA110N=889.4 ~L \ .~ \ ,1 ~\ ~~ ~\ ~\ \~~ LOTS LOTb UAUFlED AND ACTING :REBY CERTIFY THAT THE TAX SALES AND NO UNPAID ~CPrpr~~/?may ~EC11NG BLUFF. ~~-/R GL5 DATE 2 8 1 IJ 1° ~ 'I C D O N N .. ~ N ~ z N m 1= N O f+ ~ i N .. m V m O iro ~ I~ O y N i0 ~ 1 h1 O ~ z I I ~ I~ I~ IC I~ I t-+ I t.. 1~ 1 m NO ACCESS ----1-~-f------~ S89°56'27"W (Nes'S4'otwh w 33.00' w McCUTCHEON ROAD land described on this Plat to be epresented on this Plat. I also OUTLOT 2 NORTH LINE STATION ---------------------- LINE DATA TABLE NUMBER DIRECTION DISTANCE L 1 N00°22'21'W 143.43' L2 N00°2271°W 125.86' L3 N35°14'42°W 148.80' L4 N35°14'42"W 154.31' L5 N63°5908'W 191.80' l6 N63°59U9°W 182.48' L7 N63°5909"W 151.02' L8 N83°5909"W 31.48' L9 N77°18'49°W 183.58' L10 N77°1849"W 185.17 L11 N26°56'13'E 70.35' L12 N21°42'32°W 28.15' L13 S22°3534 72.64' L14 S04°54'12'W 57.82' L15 S40°58103°W 160.08' L16 S23°5832'W 168.35' L17 S87°2835°W 60.20' L18 N21°35'12°W 131.37 L19 N28°51'28'1_ 60.83' L20 N80°OB'S1"E 43.98' L21 N28°07b6'E 70.59' L22 N14°3373"W 143.81' L23 N70°53'18°W 73.98' L24 N35°1832°W B5.30' L25 N69°4144°W 71.53' L26 N21°35'12"W 13.91' L27 N89°4934"E 402.23' L28 S69°3174'E 116.78' L29 N21°35'12°N/ 35.85' L30 SB5°4833'1= 183.48' L31 N57°57'13 E 65.31' L32 N83°2848 E 59.84' l33 S72°5835 E 151.05' L34 S72°5835 83.33' L35 S72°5835 87.72' L36 S60°33'17"E 85.03' L37 S48°19'45 E' 101.59' L38 S00°2271"E 385.17' L39 N30°3377 E 121.00' L40 S27°5775°E 42.50' L41 S69°3174 E 71.96'