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HomeMy WebLinkAbout020-1059-80-000 (3) Wisconsin Departneent of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT sanitary Permit No: 405183 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Bast, Kernon Hudson Township 020 - 1059 - 80-000 CST BM Elev: Insp. BM Elev: BM Description: 6. D /Do. D � / PVC W It &-kt TANK INFORMATION VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 450A Dosing A _ 10D Alt. BM STS Aeration (/ Bldg. Sewer 3 { q oq Holding St/Ht Inlet 7195 q l , 6 Z TANK SETBACK INFORMATION St/Ht Outlet 0 TANK TO P L WELL BLDG. Vent to Air Intake ROAD Dt Inlet oa Q2 Septic / / r .l I ; Dt Bottom f _ Dosing ' Header /Man. Aeration Dist. Pipe G•3• L v Holding Bot. System '�' -ll q2 / o. z, a PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover v �S7 -7• y Model Number TDH Lift Fric ss System Head TDH Ft Forcemair Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM C BED/TRENCH Width ILength I N o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P /LS BLDG WELL LAKE /STREAM EACHING nufacturer: INFORMATION CHAMBER OR T e Of System: / UNIT + � 7 /� / ✓ Mocjel jJu er: //_ it ` ' 7{ilr f0 DISTRIBUTION SYSTEM dFiom13M Header /Manifold IDistribution Tle Size x Hole Spacing Vent to Air Intake g / nr L / <I Pipe(s) y ,,1," p L / ' �� ' I „� i Len Dia _ Len g th Dia r S acin V/ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only o2Ad 1n= {rDr►�L Depth Over epth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil — �_,{ Yes i No [ j Yes [ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 0 / Inspection #2: Location: 846 Ross Road Hudson, WI 54016 (NW 114 SE 1/4 22 T29N R19W) Pheasant Run Lot 9 "' Parcel No: 22.29.19. 1.) Alt BM Description T/ll�vG {� o►z?r� Sa�C.f V`P✓t z'Tr.� — /Ze 2.) Bldg sewer length =a,� .ejC Q �" ��C�t'{T.�ly► "/ fey, l� �► �r�21�'i - amount of cover Plan revision Required? Yes t No 10 2� 1� , / �I S Use other side for additional information. _ tip - Date Insepctor Signature Cert. No. SBD -6710 (R.3/97) I Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 � Vslconsyn Madison, WI 53707 - 7162 Site Address Department of Commerce b —L s -d'z- s� /�� 1' f y u Sanitary Permit Application Sanita Permit Number y9s7l r? In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Informa ' State Plan I.D. Number Property Owner's Name Parcel Number Property Owner's Mailing Address 002 Property Location ST. CROI !�'k 6 'A; S L TAT N, R City, State Zip C NI ph9e r Lot Number Block Number ./ Subdivision Name CSM Number H. Type of BuAding (check all that apply) ab s el, ''� Q'"" ❑City Ud'1 or 2 Family Dwelling - Number of bedrooms ❑Village ❑ Public /Commercial - Describe Use ZI " _410 W, nship ❑ State Owned T' /11 S,j, ,3/,.O _ •)7 �� .2j' �~'�"� Nearest Road �) �J' ,E f'S / J� M. Type of Permit: (Check only one box on line A (numbering scheme for inteYnal use). Complete line B if applicable) A. 11R I Ne w For County use 2 ❑ Replacement System 3 ❑ Replacement of 6 11 Addition to m Tank Only Existing System B. El Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ly'Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 5011 Constructed Wetland 22 ❑ Pressuri;ed In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Eleva ' )Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Ivlin./Inch) /Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel 'Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or mding•Tank 1 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature 9rSflMIPRS Number Business Phone Number .� P umber's Address Street, City, State, Zip Code) ,EGG — 42 _,21 VIII. Count /De artment Use Onl Approved 11 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Determination L� IX. Conditions of ApprovaUReasoips for D' approv�I t r L �� mpt.� (to theeot)gt�y�nly) for the s tem o less 81fZ :1S s «� ske t4 . ^ SBD- 6398 - (R. 05101) t 1 I j 611Ad .- 1 1 � I 1 I L{ A 1 z n a f ti 9x A EE 7 OD Q) - a i i '1 n .o � N o �r c � Lo 00c-) 00 O r-f n cm O � � V v� ©•�, I : I i j - i I j I I ; I i r , i , w I •- I yy r i I I 1 h- I i ; I r r I r 1 i I 2 r I -t- 1 _ I t : I i I r , r : r r r , I I. , i I - W isconsin Department of Commerce SOIL EVALUATION REPORT Page ( of Division,of safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Pa �� E I V E D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed by D ate Please print all information. Personal inforrnation you provde may be used for secondary puffs (Privacy Low, s. 15.04 (1) (m)). 2, Property Owner Property Location 5T_ CR1 ®UN7Y e Govt Lot , f 1/4 J'!�,% ., T N R E (ol liy Property Owner's Mailing Addre� �a &r n � Lot # Block # Su. Name or CSM# ` r - ' ' 1LA u � Run ity State Tip Code Phone r ❑City ❑ Village IB Town N t Road c� �S4 P New Construction Use: Up Residential/ Number of bedrooms Code derived design ftow rate 0 GPD ❑ Replacement ❑ Public or commensal - Describe: Parent material 'o u AJ C c 5 Flood Plain elevat if applicable ft. General comments Sf�� ��� �' �P �S GD 9/ 2l� and recommendations. ale- 010o Z- ( _-e V y02- 0 Boring # ❑ Boring pit Ground surface elev. 2 0 ft. Depth to limiting facto in. Sa'i Application Rate Horizon Depth Dominant Color Redox Description jTexbjre Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Col Gr. Sz. Sh. 'Eff#1 'Eff#2 Z'-Phk c.3 � , 5 y 2rnS cs S 3 -iro 10 ry m 5 - _ 2 ash � Boring # ❑ Boring d F-2-1 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 L Z,n-hk mfr CS I S/1 ' 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 Prin�� S nature CST Number A rn Address Date Evaluation Con u Telephone Number qW Property Owner �� Parcel ID # /Q Page of a Bonng # ❑ Boring i n. Pit Ground surface elev. q ft to limiting facts � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 - lo 3 SL 2mc� mfr c-5 Z y- 0 r 1 [ S ' l y G�> m r qz.o F-1 Ong # ❑ 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/W in. Munsell Qu. Sz. Cont color Gr. Sz. Sh. 'Eff#1 '042 F-1 Boring # ❑ 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/ftz in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mgA- and TSS >30 < 150 mgfi- ' Effluent #2 = BODS < 30 mglL 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) • ' PAGE 3 OF- NAME TOT# LEGAL DESCRIPTION w X 5 E Y ,S Zz T a `C ,N,R, SCALE: I"= yo BM I ELEVATION !aa• o BM I DESCRIPTION {a 0 BM 2 ELEVATION 51 .3 6 BM 2 DESCRIPTION =,o C'0 &dU , - 4 - SYSTEM ELEVATION �,P 15,20 GQwer 9y Z6 ALTERNATE ELEVATION I g3,za L-o ,,-r — CONTOUR ELEVATION 0 o �ba 0 n $3 Cl Z qc $m2 SIGNATURE DATE - O -OZ- Q O �C p C c� t co a` a• W .0 �; CD 0 Ln CD CD r CD �� �� c� ' ..�. �.... •. �•� � 4 O CD CD CD CD CD a CD cr >✓ ° \ � CD � \ �. C/1 • • `mil !-D � rJQ (IQ m v lD N '. CD W - n ►•t tD Q+ N r. w � C co II II ni 1O�N.03 .—+ y N Q LO _ cv , .. a as V II 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 Number of Bedrooms Design Flow - Peak (gpd) Ale Estimated Flow - Average (gpd) ARLO Y�o Septic Tank Capacity (gal) 1A? Soil Absorption Component Size (ft') �- Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) / 2 0p ,CAL = 6d= l 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 tank 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 condition of the sepf t nk and outlet filter shall be assessed at least once every 3 years by inspection. Th out et filter hall be cleaned as necess ensur proper operation. The filter cartridge shou not be emove un ess provisions are made to ain solids in the tank that may slough off the filter when removed from its enclosure. If the r - 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 septic tank shall have its contents removed when the volume of scum and sludge in the tank 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. 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 e , Mound System Management Plan Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stars. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the lank that may slough off the filter when removed from its enclosure. It the 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 septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the 104jid volume of the tank. If the contents of the tank are not removed at the time of a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verity proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 mofiths. When a pressure test is performed it should'tr6 compared to the initial test vxhpn the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its component manual (SBD- 10572 -P (R. 6/99)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ndonment shall be n r acco dance Comm 83 33 gases s. Adm. Code could cause are nolongerr use d d as pump tank aba POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access emed n of service. Any openings used for service and assessment shall l b seale Expo access openings e grealer than 8 inches opening n diameter shall unsound, defective, or subject to failure must replaced. be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contindency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. ; wastewater If the mound component fails to accep wastewater of begins to discharge o r replaced in its' present location by i c. 9 basal a ea f toe leakage occurs orby removing biologically clogged adsorption o and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. f Questions on the operation o r maintenance of this system should be directed to your county zoning or health inspector. a i • Fogerty Plumbing � ,�,. 6 40 , . , . #221180 28288 McKenzie Rd Maintenance Spooner, WI 54801 (715) 635 -9609 is a The interval for servicing septic tanks is set by state and local re ulato agent the United States es suggest two to a years. wide difference of opinion on what this interval should be, but m ost g rY when the The Zabel"" filter, which does not increase the f However, our filter ivirtually self - cleaning• The c ony c action septic tank is normally inspected and pumped of the anaerobic organisms on the Zabel filter causes I w will be p artic l es ot fie by an alarm when the filter needs o ervic g. the tank. If your filter contains a SmartFilter" alarm, y o u or To service the filter: 'Servicing any zabel filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. Firmly pull the filter handle and slide the cartridge out 9 2 Remove the tank cover of the case. and pump the tank if 'Note: A tee handle may have necessary to prevent to be used if the filter is too tar level to reach. !P below - ground any solids from '� Contact Zabel for info on tee. escaping to the field handles when the filter is,f` removed.. M W While holding the cartridge over j the access opening rinse off the Insert the filter cartridge cartridge with fresh water, being back in the case making careful to rinse all septage material sure the filter.cartridgeis: back into the tank_, properly_alignec.and,; the �ifter r _ completely i 'Note: it is not necess . ' dean_, 4 ' spotless ". The biomass Qrowlrag.wrth6l�ler ' aides in the pretreatment�prciOesS „ V be left on the rifter. (If n 4 Replace t may be disassemble w , uAOE NI The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,7590985686Des. 5.7 5,593.584.5,795,472,5,736,035, Canada: 2,135,937; srael: 111574; New Zealand 2648242 621 U .S. Des. 386,241, 349067, 4605501,5 Other Patents Pending a Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1 -800- 221 - • Website httpJ /www.zabel•co A t 00r300-1-►d.6V INSTALLER'S NOTF,S: RECYCLE GREASE! Do not pour grease down the drain. Your septic tank and filter will not handle it. NO BLEACHES! Do not introduce bleaches into your system. The bacteria in-your septic tank is what makes your system work. Bleach kills the bacteria. When that happens, your septic tank will no longer function correctly. This will cause premature failure of your system. WATER SOFTENER! Do not run the brine solution into your septic tank. This solution has a high concentration of lime (that's what makes your water hard). The lime tends not to settle out in the septic tank but goes directly to the drain field. Lime is an excellent sealing agent, and yes, it does the same thing in your drain field. Think of your sewer system as you would your car. Treat the attached information as you would your car manual. Remember, also, that your car requires regular maintenance. 'Care must be exercised as to what you put into it. And like your car, your system eventually will wear out. The question is - how quickly. If you have any questions, please call: Dave Fogerty 715- 749 -3656 - Roberts _ 715- 635 -9609 - Spooner If you have an emergency, and you only get voice mail at these two numbers, call Keith Knutson at 715- 796 -5436 - Hammond I have read the attached information regarding the construction and maintenance of my sewer system. Owner's Name Date ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /ZOX i Mailing Address 9 W 4 / !{ DSDI/ C - g1916 Property Address w p (Verification required from f lanning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location ' /., SAff _ ' /,, Sec. �.2 T N -R J Town of . Subdivision _qtr �![.r/ , Lot # _ . Certified Survey Map # A2eA G' , Volume , Page # Warranty Deed # .Z S Volume / S7-7/ , Page # VXY — Spec house D yes 09"ho / Lot lines identifiable ff'Y'es O 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 wastewater disposal 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 returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. !ice G/! too , SIGNATURE OF PLICANT 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. Dp i SIGNATURE OF PLICANT DATE ssssss 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 153 P y3-3 �Y 627510 STATE BAR "L my 3& KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Marie A. Shlmon, a single person, RECEIVED FOR RECORD _W 08 -02- 22000 3:00 PM WARRANTY DEED Grantor, and Kernon J. Bast and Donalds J. Speer -Bast, husband CERTCOPY FEE: and wife, COPY FEE: TRANSFER FEE: 846.00 RECORDING FEE: 14.00 PRGES: 3 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 (See Attached Exhibit "A ") Name and R "? NA OG LA ND Zilz, Estreen & Ogland P•O. Box 359 Hudson, W1 54016 020 -1059- 80-000 Parcel Identification Number (PIN) This is not homestead property. 00 (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this to 4 day of July 2000 * Ma )U A. Shimon AUTHENTICATION ACKNOWLEDGMENT Signature(s) Marie A. Shimon, a single person, STATE OF WISCONSIN ) ) ss. I County ) autheAtl Kp �1/' day of July 2000 Personally came before me this day of 'r :. , '• the above named • j(rjstillf �`t � en , ;l TI'li • �B,EB,§'1'ATE BAR OF WISCONSIN �* .,•• t it to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. autho ' § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, W 1 54016 My Commission is permanent. (If not, state expiration date: (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. Mkvn oian Profsumn*W comvsnr. F°"° du lae. VN a004515,2021 WARRANTY DEED STATE BAROF -1999 SIN FORM No. 2 - 1999 voi• 1531PAGf 434 EXHIBIT "A" A PARCEL OF LAND LOCATED - IN THE NORTHWEST QUARTER OF THE SOUTHEAST QUARTER (NW 1/4 OF SE 1/4) OF SECTION TWENTY TWO (22). TOWNSHIP TWENTY NIME'(291 NORTH. RANGE NINETEEN (19) WEST, MORE FULLY DESCRIBEE AS FOLLOWS: Commencing at the East Quarter corner of said Section 22; thence-North 0 degrees 02 minutes 57 seconds East along the East line of the Northeast Quarter of said section a distance of 40.00 feet; thence North 89 degrees S7 m1 nutes•16 seconds West 750.00 feet; thence Westerly 450.47 feet along the arp of a 905.17 foot radius curve concave Southerly whose long chord bears South 7S degrees 47 minutes 19 seconds West 445.83 feet; thence South 61 degrees 31.iRinutes 54 seconds West 135.86 feet to the point of beginning; thence continuing South 61 degrees 31 minutes 54 seconds West 150.12.feet; thence Southwesterly 297.89 feet along the arc of a 740.00 foot radius curve concave Southerly whose long chord bears South 49 degrees 59 minutes 58 seconds West 295.88 feet;.thence South 53 degrees 22 minutes 26 seconds East 409..87 feet; thence South 0 degrees 15 minutes 46 seconds East 687.10 feet to a point -on the South line of the Northwest Quarter of the Southeast Quarter of said Section 22; thence North 89 degrees 57 minutes 16 seconds West 1269.89 feet along said line to the Southwest corner of said Northwest Quarter of the Southeast Quarter; thence North 0 degrees 16 minutes 35 seconds West along the North -South Quarter Section line a distance of 1296.23 feet; thence North 89 degrees 50 minutes 17 seconds East 651.01 feet; thence North 0 degrees 11 minutes 41 seconds West 22.40 feet to the Southwest corner of the Certified Survey Map recorded in Volume 7 of Certified Survey Maps, page 1891; thence North 89 degrees 50 minutes 17 seconds East along the South line of said Certified Survey a distance of 651.09 feet to the Northeast corner of the Northwest Quarter of Southeast Quarter, * thence South 0 degrees 15 minutes 46 seconds West along the East line of said Northwest Quarter of the Southeast Quarter a distance of 129.94 feet to the point of beginning. ALSO subject to that part of a 66 foot wide easement reserved for future township road included in the above described parcel, said easement being 33 feet equidistant and at right angles to the following described reference lines: REFERENCE LINE NUMBER 1 Commencing at the East Quarter corner of said Section 22; thence North 0 degrees 02 minutes 57 seconds East along the East line of the Northeast Quarter of said section a distance of 40.00 feet to the point of beginning of the following described reference line: Thence North 89 degrees 57 minutes 16 seconds West 750.00 feet; thence Westerly 450.87 feet along the arc of a 905.17 foot radius curve concave Southerly whose long chord bears South 75 degrees 47 minutes 19 seconds West 445.83 feet; thence South 61 degrees 31 minutes 54 seconds West 285.98 feet; thence Southwesterly 297.89 feet ilong the arc of a 740.00 foot radius curve concave Southerly whose long chord bears South 49 degrees 59 minutes 58 seconds West 295.88 feet; thence South 38 degrees 28 minutes 07 seconds West 100.00 feet; thence Southwesterly 381.99 • YaL 1531PAGE 435 Exhibit "A" - Page 2 feet along the are of a 427.00 foot radius curve concave Northerly whose long chord bears South 64 degrees 05 minutes 43 seconds West 369.38 feet; thence South 89 degrees 43 minutes 25 seconds lest 546.65 feet to the end of said reference line. REFERENCE LINE NUMBER 2 Commencing at the East Quarter corner of said Section 22; thence North 0 degrees 02 minutes 57 seconds East along the. -East line of the Northeast Quarter a distance of 40.00 feet; thence North 89 degrees 57 minutes 16 seconds West 750.06 feet; thence Westerly 136.81 feet along the arc of a 872.17 foot radius curve concave Southerly whose long chord bears South 85 degrees 42 minutes 57 seconds West 136.67 feet to the point of beginning of the following described reference line: Thence North 269.97 feet; thence Northwesterly 350.77 feet along a 500.00 foot radius curve concave Southwesterly whose long chord bears North 20 degrees 05 minutes 50 seconds West 343.62 feet; thence North 40 degrees 11 minutes 41 seconds West 70.00 feet; thence Northwesterly 158.48 feet along a 227.00 foot radius curve concave Northeasterly whose long chord bears North 20 degrees 11 minutes 38 seconds West 155.28 feet; thence North 0 degrees 11 minutes 41 seconds West 500.06 feet to the end of said reference line. All in St. Croix county, Wisconsin. .a COUNTY PLAT OF: LOCATION SKETCH l �' �; ANT RU N THE NW1 /4 OF THE SE1 / UNION PACIFIC RAILROAD SON, ST CROIX COUNT y U. S. H.12 currrs � TRAIL / �- .----- - - ---� Chu = �9- -- BADLANDS ROAD M 0 NORTH LINE OF THE NW1 /4 OF THE SF to W SECTION 22 T29N, R 19V N89 00 29"E H.W.L. =920.3 3.8 16! N w Z JILDING o v = 931.50 w U 0' p ` T ' �a�� q z s' la IVA G � EEA SEM $fi > i F N ca \� Z \ i m z cC1 9� "E 4 94 . 3 \\\ \ � \ d \ \ H.W.L. 19 �.0 7 gory � ]`S OFFICE 2.19 ACRES 95,291 SC. FT. ��