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HomeMy WebLinkAbout020-1395-37-000~ I O I o 0 ~ ~ i ~ I 'r y ! ~ 0p °ip i ~ y 0 ~ 0., i o ~ i o I ~ ~ 3 o I -° I w ~ 8 i H ~ I ~ I ~ ! I x 7 ~ I i N "C ~ ~ I Oyi i N ~ «~. .C °= d 3 I ° z ~ ~ I ~ ~ > 0 rn ,? m v Q y ~ I ~ I v I ~ + I I ~ ~ ~ Z w ~ E ° c I ~ ~ v ~ Z ~ Z ~ m D. N ~ "> o. ~ N ~ ~ c I ~ ~ O C O ~ O Z a :. I c ~ '- I != N Z~ ~ F- ~- ~ C~ K Z I N C v U TY O M N t. uGy~1 C N O ~ 7 C y y ~ O ,~ I a i P 3 av O -y d '~va> C ° I . G C Y ~ Q f0 ~ O ~ C Z (~ ~ i.: Z I c I ~ co c I p N N _ _ ~"' Af O • • Of ~j ~ l~ e~+ ~ Y C W d c0 <n ~ y a ~ o ~~ ww aa ~+U I= a ~, I a ~ - '~ ~ ou~i i m i~oo 0 I (n J U ~ N N N ~ ~ Z O . - ~ \ N ~ ~ N N ~rN - ~ O1 ~" r. O ' = ~ ~~ m m ~ w a cn az~n a I °? ~' ~ o I c 0 a ° N ~~ i E I ~ o ~~ 3 v ~ ~ v a U L o ~~ H 7 C c f0 N Q C~ m C ~ I m p i ~~ ~ C 7 N ~ ~ ~ N ~ t C ~ Y ~ ~ I ~ ~ O N S i m~ 0 Z C 4. ~ fn O ;r ;: ~ . ._ ~ ~ ~ i =€ v~ ` ' €a I ~ ,# a `IV w E ~ ~ ~ ~ r r A va ~ Ov~iti Wisconsin Department of Com~neice a PRIVATE SEWAGE SYSTEM Safety and Building Di~;ision 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 Bonfe Builders, Inc. Hudson Townshi CST BM Elev: b~°v Insp. BM Elev: ~Ub•v 8M Description: G- a~hJ °~ J TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic "' I~ Uv Dosing ov Aeration Holding TANK S~ K INFORMATION TANK TO P/L w~. ~- WELL BLDG. Vent to Air Intake ROAD Septic ~~~ ~ / ~~ ~l/ ~ Dosing ~ ~ ~ ~Q,y~ Aeration _ ~~ _ `~.- Holding PUMP/SIPHON INFORMATION Manufacturer / . Demand -// ""l/ LIDS L GPM Model Number ~~ TDH Li ~ Friction Loss System Hea ~ TDH Ft Forcemain Len ~ Dia ~~ Dist. to ell SOIL ABSORPTION SYSTEM ~ ~ /~~~~~, "ELEVATION DATA county: St. Croix Sanitary Permit No: 420530 0 State Plan ID No: Parcel Tax No: 020-1395-37-000 STATION BS HI FS ELEV. Benchmark V tirZ ewe ~•~- D. lac7.v t. M C.~ ~ , Bidg. Sewer ! ~ ~ ~ St/Ht Inlet a -~ . ~ SUHt Outlet Dt Inlet ,,/ ____-- Dt Bott ~~ , ~ ~, 3 Hea an. ~ 3 ~ ~O- Dist. Pipe p e h~ (~ .~ 5 . ~/ .~] I Bot. System ~ ,7. "3 , Final Gr e saner ~ f +~- ~ . (bb .v t over gG. 7^-~? i s ~ 9•? BED/TRENCH DIMENSIONS Width / ~ ~ Length l / 1 `-1 No. Of Trenches PIT DIMENSIONS ~ No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA G CHAMBER OR an u er: ~~ I Y' Typ Of System: -Y~ ~ ~~ ~ UNIT Model Number: DISTRIBUTION SYSTEM /~//~/-'~=r'!>r.~flir~n.cc',~ -v~~'l~' >>'na Header/Ma 'fold Distribution x Hole Size x Hole Spacing 1 h Pipe(s) ~ i , r/'T ~ ~ ~ ~ „~ ~,~-~" ~~ Length Dia Length Dia I pacing / SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv nt to Air Intake 7 5D , Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes U No ~ Yes C 1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~ / ~ Z Inspection #2: / / Location: 804 Highlander Trail Hudson, 154016 (NW 1l4 SW 1l4 25 T29N R19W) Scenic HiIIs Lot 37 Parcel /N~o~:~25.29.19.2431 1.) Alt BM Description = , ~~ ~'.." "- C ~~ ~V £1 Y "(~ , "~'(~.~ .w"°1~,..av'K ~~~6'h..- 2.) Bldg sewer length = ~5yi T-'I ~Q ~ ~Gl~vt,~ (',~r1/~- -amount of cover =~/l~ ~ ..L-~ Plan revision Required? r ' es ~~ No ~ ~~ ~' i Use other side for additional information. -J ~_____. --_-__ _ I L- __~____ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division C0LL°h' • ` ~ 201 FV. Washington Ave., P.G. Box 7162 5 ~Ctid ~ 'x Madison, WI 53707 - 7162 Situ Address c Gi'i~G~-~'/t- ~SCb~S~Ce ~~o X70 - /~-/z.~2-- gb I~ De art Sanitary Permit N r Sanitary permit Application ~a o 5-30 Ia accord with Comm 83.21, Wis. Adm. Code. persooal informaflan you provide ^ Chockff Revision ma ~ used fat. Privac Law, a15. 1 m Staff p~ I.D. Number I. Applicstian Iutonmatioa - Pleases Print Ail Information ~l/ parcel Number Property Owoer's Name ~- d ~(J ~e ~ e L ~' f3 d - 3 - - DO'd Property Location ~ / toperty Owner's Mailing Address r f City. Stat© Zip Code pa ~ Let Number ~ Block Number V ~ ~~0~ Subdivisiaa Name CSM Number W~adb~Y m 5'S/~S •` ~ See `c: f/,'~'/ II. Typo of giltlinB (check aaI that apply) ~~,'~ ~~ 1 ar 2 Pam'sly Dwelling 'Number of Bedrooms ~i~ZEo ..~! ^ Publie/Commorcial -~D^eacaiba Use ownshi 7/G~G~SO/~ ^ Stara Owned o2 l Lv/ /S ~ ~~yy~~ ~~ 3 X ~~ Narest Rand ~U Tom. .~ ~~r T III. Type of Pt~mit: (Check only oae box on line A (ntrrnbering scheme for Eaterust ttse). Complete line B u appllcsble) A For Cotmty trsr; 1 Naar 2 ^ Replacement System 3 ^ Replacement of 6 0 Addidt~ S stow T~ O Date Lrnted B. ^ C'hacit if Sanitary Permit previously Itsuod Permit Number IV. Type of Permit: (Check all that spply)(numbering scheme is for internal use) ~A-ch~~ ~yn,~~iti~~.s S' i~ _ Is--Ground 21L~ Mound 47 ~J Sand Filter 50 onstructed Weiland ~/ / ~- L%`'L 44 ~ Nan Praasunzed / ~ ©pressuriyed ~~~ 41 ^ Bolding Tank 48 D Single Pass 51 D Drip Line 4S ^ At-Grade 4b D Aerobic Trwtn3snt Unit 49 D Recircula ' ~ fl ~ V, t Ares Information: ~~ Plow (~ ~~] Area Dispersal Area Soil Application ptsrcolasian Rata System Elevation Final Grade Required ~; Proposes .33 Rate(Gals.lDays/Sq.~) (Min./lncb) ~6~ ~~ ®/ ~0 ~ ,~~ Tank Info ~~;ty ~ ,Total Number Manufacturer Prefab Sits Stet Fiber Plastic i dtaioas t"salioas of Tanks ~ ~-/DA Cotrcrote Conatntctad Glass Nt»v Exisdnt /~ ~ Tadrs Yantis Smile m HoWina Tact - ~a J I,. `P_ S.e /~ VII. ~ Statement_ ~ the ed, assume tl-tY for flea of the POWYS ahowm oat the attaclud . Plumbar't Name (Prinq Plutuber's Signature RS Number Business Phone Number ~~? - plumber's Address (Street, City. State, Tap Code) ~ c L/ SAD ..lJ ~ ~~ L1l ym IDs attmerlt Use Onl Si tine Sumps} Salutary Permit Fae (includes Groundwater Dau Issued i~ 8~ Approved ^ Disapproved Surcharge Pea) 0?7 iI ~~ { ~D ~ [] Owner Crivaa Initial Adverse ~ 2 ~ J Determination ~ LUy ~ _ ` / , I - _ S~ ~,m I7L. Conditions of ApprovsUReasoas for Disapproval T,,u"'L' G~u'n ~t ~,.~ s S;,Q~vaJ rtl.a~fet? ,0~4lL~sy ~~~.v '~'~ (~o n or h~~i~~ ,A-u,~,~ ~~+~s Sys; cµc,~ ~_ CJ~,~ -f~ 13 L d -f~ y a t-~- ~ de,,~, ~ bvr~~~c •~ skkm~ 3 ~ 1~.~ ''' ~ ~ the C ~7) for} ~, n~~ sot less dl~i s 11 SBD-6398 {R. 4 JOl) Safety and $uilditt8s utvtswn 201 W. WasttiaStoa Ave., P.O. Box 7162 ~~~~~~ ~ Madiatm, WI 53747 - 7162 tment of Commerce sanitary permit Application In axotd with Comm 83.21, Wis. Adm. PrtvacY Law s~13~o4(1X)m Provide rasY be used tflr eaeondarY WtPO~ ~..-, iflt~n -Please Prbtt All Intormatitw Property G .13e,._.`, 2S /cj ~ 1 ~ ~0~2 ~i3eadba r m 5.S'/~ S ~ II. Type of tsil8ia~ (cl-eck al[ that apply) ~~,C' ~ ~ ~R~~~ OFD ~~=, i or 2 Pamsly DweUiag -Number of Bedrooms (p ^ Public/Commerciai - Dtscsiba Use a staoa owned ~ '~ vv/ /S ~ ~c~~z,l,~t~v .2a~ • 3 X y 3v To~-P. III. Type of Permit: (Cb-edc only one box ~ liae A (numberbYg schaae for bricrnal tree). ~ For 1 New 2 ^ Replaeement Syaem 3 ~ Replacetnem of 6 ~ Addi ~m sbm Tank 8. ^ Citeeft if Sanitary Petati< Ptnvinusly Issued Permit Number cavatrj„TC'ro ,' sisa Address ~ a,~.u%~-T 40 Sanitary permit N r o Check if Revisiwt ~a o ~v _ / ~4.~".- 47- Did ti4 iE' J eC .~ 1 7 +~ a ~ ~ i.ot Number ~ Block Nusaber Subdivision Name CSM Number See `~. ~i:'l/ Ocl~y _ Ovma~e ~'1'Awnshio ~Ltl.~.5~0// _ B if applicable) tree IV. Type of Pertntt: (Clteclt all that spply)(nnmbering scheme i$ for internal rue) ~~-ch~,,;.,~j ,~tin,(~~~~5~' S~ i~ - round 210 Monad 47 ^ sam Fitter so LJ-Coaatnicccrd'Watlsad 3/, / ~ C%~'1 4t ~ Nan Preasurirad Ia.G / ~ 0 p~ ~~~ 41 ~ Holdistq 'Panic 48 ^ Sittple Piss 510 Drip I.uu ss ~ At~(irade ab ^ Aezobic 'lteamtent unit 49 ~ Recitrxita ' 3o Ll t?d>cr V, Area Ini'ormation: percolation Rase Sysoesn Elavuioa Flml t3tadc ~~ tea, (~ T Area Dispecsat Atea Solt Applicatton Bleva z Proposed 33 pate(crala.rnar~l•~) eMinJlaeb) ~6, g~ ®r ~0 ~ ~ Gard ~,5-~ ~~ ~S 7 ~ ;1 ~Ja-' q,S- a~ 9~. 3a ~~a' VL Tank Info Capacity in Tool Number A+tamtfacwtrer profab Sine Steel Fiber Plastic ~/ a,~~ ~-/oL2 ~~ Cottatcttcted class (mat Gallons of Tanks NaW P.xiadat Tsdcs seatie or iiolaiat ~ - ld? / ~i`c°S'~ ~' VII. ill Statetttent- I, tits , ttasume ~ for of the powrs shrnra on the ettecu~ea . p{umber's SiBtature Number Btuiaess PhotYe Number ph:mbar's 11sme (Feint) _ l pktmbec~s Attdtxss (Stttxt. City State, Zip Code) ~ ~ ~ sa .,~ "< Dl VIII /De artmtutt Use Oat Data Issued in8 Sigaanus saatpa) Sanitary Perasit Fee ('tncludaa t3royndwater Approved ^ DisaPPt'o"~ Sytrcbarge Pee) dU I I ~~f/ylis., [] Qwar Qivea Initial Adverse ~ 2 ~ ~, "J I ~~ ~ Determination G'a~~'1/ yndr~ ay/Iti ' ~" IIC. Conditfaos of ApprovallAeawpa for Disapproval S dn~ ~~ uM;2~' ~~~Qa~.Q~LI -~ T32 - dpi ~R-~~-a!tz'fz.`'~` . ~ dej~'s'' Un barrh~c -i`-fl sha,.r 3~ !~ ~~ vn t~ed.swr.d-s/o•~~Pdf~~ aPP ~ /~l . P/~,~t. ~) the 7) for ~ not Iw 83f1 x 11 toeha m SBD-b39$ (R. 0 102) ~s , %U~e c,/ P h h. ~ ~ ~ ~, ~ ~ y ~ __ _. .___ __, c / ,~ 4 ~ o` T~ .~~X ~ ~ 2 3X951 Trc„vG`ilp ~°~ a.. ~-. ~~ia,r.6eys ~ ~ ~ ~ e ~ :~ o ` ~~ ~ ~ rl ~ ~ Q L L~ ~~ ~'~'V~e W ~ y ,~ ~, ,,. ~ ~ • cam, T N - ~x ~ ~ 2 3xgy Tr*.~.vah~ °~ o ti. ~, ~~ia;~6~ys ~ ~ '`- 0 d ` ~~ .~ ~~ .-.~ ,~ ' a ~---a ~~ ID r •• 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 Onsi#e Was#ewater Treatment System (POWYS) shall include information and procedures for main#aining the system within the parameters of Comm $3 and 84, and the conditions of approval by the department, agent, or governmental unit. Ths approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD~-~ ~~~J 10567-P {R.6/99). ~D / /~` ~~~~~~/~' Table 7: S stem Desl n S ecifications Sanita Permit Number U 5 Number of Bedrooms Desi n Flow -Peak ( pd) oc~ Estimated Fiaw - Avera e ( pd) l~ Septic Tank Capacity ( al) Soil Absorption Component Size ) T pa of Wastewater Domestic T961~ 2~ Sell Abserntien Comnenant -Limits of Reliable operation Septic Tank Component Soil Abso lion Component Desi n Flow -Peak ( pd) Maximum Influent Particle Size (in) 1/8 Maximum BODb (m /L) 220 Maximum TSS {m /L) 150 Table 3: Maintenance Schedule Se tic Tank Inspect and/or service once eve 3 yea Outlet Filter Inspect once a year and clean at Is once every 3 ears Soil Absorption Com anent Ins ect once every 3 ears Seatic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable , Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the . Management Pfsn for a Septic i`anK and Sal. AdSarptlari Cam,po:~$nt _.,.., filter is equipped with an warm, t~,e fifer shad da serv[aed if the alarm [s ictrvsted ~xntirruaus[y. {ntarrriidert Altar atarsrts may lndlCate surge flows or •n impsndir-g continuous alarm. the espf3o tank ahel! have its oon~tm romoved when tf~e v0lurrte of scum +snd sludge 1n the tst~k ex~a-eds 413 the liquid voturne of the tank. If the oantents of the tank aro net removed it tine tune of an awe~amont, malntenanre personnel shall advise the owner of when tl» next wN[ce needy to be perfon~d to rniint#In ices then rrwcirnum scum and sludge rccumulation to the trek, [Wanhaie rlwrs, socwar risen and covers should be Inspaacted for watery tlghtn®ss and eoundnsw. Aoopw openings uRed for service and eurwsimsrnt shall bs sealed watar~ght upon tie aamplartion of eervioe. Any opening deemed unsound, defea~lvef or sub,~ect to htiiura rr,~,st be- replaced. , ~rcposed acessar openiragt griller than 8-Inohes to dwntet*r shalt be secured ay an arfrirctt~re loaakiny dawlae to p»vent aaaddentel ar unaulhorlxed entry Irrlo the tsr~ 1Vo sole at-astrld arnierr i aepNr air other trwbnerrt asr ho1dM~ fink lror any iwaraxr whi-oth befrd In fuiit oamplbtnae wldy ~~ ~ndarrda ~' t'1nQ a nrd apr~. the ~tma wfd-i'n tea ~ ear oara~ trrtsbne+rt of` 1~o~atlr~- tantt M.y oeotntn teM,aJ end r of i peon f~ !lu Jn~rlor oi- ~Ita ~arNr »r!y da drlt a tMpotslblr, tank aba~lrx~mertt shall be rn aa~ordanae with Comm 33.33, Wis. Adm, Cods w>,en the tank Itt no Iong+K uwd as a POVY1'8 componsrtt. The soil absorpttor~t~l fact ~ The iim is of open oniaf trite componenters awn n wastewater from a residaq+ ty TabiaN 2. "1f'h~ is~r-gevity of er soli absorption Qontponent depends greatly on prepay and tlmariy m~[intananae, and system use wtthln or below trio limits of rollable opecatlon, Qood water coneexvatlc~+ praoticw by all oocupant~ and thf instellatlon of water conservln~ piumbingi fixtures are lcey faa~ora in extending the useful life of th{s ~ppr~tr The soil absorptlott component's eperatyor3 must be aswswd by inspedian at iaer~t ortar every three years, The Inspection :hail include recording the levels of panding~ if any, in ~e o~rrvat{on pipes, et~d ir[ v}coal inspection for any ividena:e of surface warpage or d:sct~args from the oomponont, On steeply atoptr~ Bites, a~ s o® of ddom~stic wa~ watdr~a seweg~ reported to t1~e owner for tepalr. The surfea d s ~ from ti^rar system is prohlbitird end cnneidered • Iwman heNth hasard, TrafAc #round or ov4r the sail absorption oamponent eno~ia-er the ofl~mponertt jmaY lead during winter n~enther, The compaction or nmavai of snow cove to hydraullo failure by frrezing. This type of iaiiure [s usually temporary, but is dtifia~ait or ~poset~ie tp repair unto Wal#thar candittanat improve. In generic, sa~f compactlorr over this component wilt reduce d~fusbn of oxyger- IMa tree soli and disperser ati, wt,tah may [sad to morn intens~a, and earlier, or~antc cioQgirtg of the coll. Z Management Pian for a Septic Tank and Soii Absorption Component Plantings o[deep-rooted tress and shrubs directly over of within ten feet of the compor~nt should be avoided since root intrusion into the component may obstruck wastewater flow. Contingency Pian In the overt of system failure, a new system could be instelied in an alternate area. With the it~stailation of a diverter valve, the existing system could also be reused after a period of three to low' years. it is the property owners responsibility to maintain the alternate area irss from any planting of trees, shrubs, etc. in case of taliuro of the original system, the aitemsts ana will be needed. if any trees, shrui~s, etc, hrve teen planted on the alternate area, they will have to bs removed at property owner expense. N alternate area is destroyed, there are other alternative systems that can bs used, in which, oouid result In added expense to the property owner, Any tank abandonment shall be done in accordance with Wisc. Cods 83,33, Any questions regarding this Dods, please contact your local Zoning Otilce ar confect the installing plumber. Sc.~,~..~-.0~.1,~~.~t t~1. v~t,r, b r n~cJ (~ t5~ 3 8 b • 31 ~ 1 FROM Schumak~r Plumbing OwneriBuyer Mailing Address Property Address FAX PLO. 7153863121 Aug. 08 20Q2 ©7:14AM P2 ST CI20IX COUNTY SEP 1'1C TANK MAINTENANCE AGREEMENT AND ,~,, ~ -ZSHIP CERTIrYCA'TIOl~ ~FO~tM~ - T . r,._ ~ff ~i l cL2~ , -~',v, ~+ ~~~ (Verification required a i ~o~fJ it~~ ~ / .. ~ ~~~i Department for new City/State ~ V ~. S <~ v~ ~ C parcel Identif cation Number C'3 .~-~ " ~ 3 ~7 ~ ~3 ~ ~ ~ d LEGAL DESCRIPTION Property Location ~ I/,, ~ '/., Sec. ~.~ . T ~g N-R l ~ W, Town of ~~d~~-~ Subdivision _ S e--L'. mot. ~ C _ ~ i `l `J - _ .Lot # Certified Survey Map # .Volume .Page # ~93~0~~ 2 0 ~y3 Warranty Deed # _ .Volume Page # . /D~//~Q ~ Spec house ~ yes ^ no Lot lines idcntif:able ,Q1 yes O no SY~~VI MAINTEN,~I,NCE Improper use and maintenaaccof your septic system could result in its premature failurt to handle wastes. Proper maintenance consists of pumping rnrt 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 masterplumber, journeyman phunber, restrictedplumber or a Iicesuedpumper verifying that (I) the on-site wastewaterdisposal system is in ptvper operating condition and/or (2) aRer inspection and pumping (if tuecessary), the septic tank is less than 113 full of sludge. I!we, the undersigned have read the above requircmcats and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Iepartment of Commence sad tlse Deparrrnent of Natural Resour+cos, State of Wisconsin. Certifuatioa stating that your septic system has bees maintained must be completed and returned to the St GYoix County Zoning Office within 30 days of the three year expiration date. SI A OF APP CANT DATE ~ OWNER CERTIFICATION I (we) certify that all statements on this form are true w the best of my (our) knowledge. I (we} am (are) the owner(s) of th raperty described move, by virtue of a wamaty deed recorded in Iteaister of Deeds Offrca~ SI ~ OF APPI:I DA'I'S ****`* AaY information that is mis-rep~reseated tray tesuli in tht sanitary permit being revoked by the Zonins Department. **s*** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the ctmfied survey trap if reference is made in the warranty deed ~~ - U P008P `f43 State Bar of Wisconsin Form 2 - 1982 DOCUMENT N0. WARRANTY DEED 020-1395-37-000 Parcel Identification Number (PINj Carriage Homes XXI, Inc., a Minnesota corporation conveys and warrants to Bonfe Homebuilders. [nc. a Minnesota corporation the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACKED EXHIBIT A This is n homestead property. Exception to warranties: any easements or restrictions of record, if any. Dated this IOth day of October, 2002 /age Hom XXI, lnc. ii%>.r~,r - ~w (SEAL) • Dwight S. Harvey, Preside t (SEAL) AUTHENTICATION Signature(s) authenticated this 10th day of October, 2002 TITLE: MEMBER STATE BAR OF WISCONSIN Qf no[, ______ authorized by § 706.06, Wis. Stats.) THIS 1NSTRUMEN"I" WAS DRAFTED BY Gregory A. Booth, Atty, 1900 Silver Lake Rd #200, New Brighton, M N55] 12 6 9 3 6 0 9 HATHLEEN H, kALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 10-11-2002 11:00 AM UARRANTY HEED EXEMai # REC FEE: 13.00 TRANS FEE: 199.70 COPY FE£: CERT COPY FEE: PAGES: 2 THIS SPACE RESERVED FOR RECORDTNG DATA Name and Retum Address: Land Title, Inc. 1900 Silver Lake Rd k200 New Br1ighton, MN 55112 1`~~ (SEAL) (SEAL) ACKNOWLEDGMENT STATE OF MINNESOTA }SS. WASHINGTON COUNTY. Personally came before me this 10th day of October, 2002, the above named Dwight S. Harvey, Presdient of Carriage Homes XXI, Inc., a Minnesota corporation to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public, Washington County, Minnesota (Signatures may be authenticated or acknowledged. Both are My Commission Expires: not necessary.) *Names of persons signing in eny capacity should be typed or printed below their signatures. ~~ • ., ANNE;T7E p. THEIS NOiARYgUBtIC-MINNES07q My Comm. Expires Jan. 31, ypps .. ~tZ , r~'•. .. t~ ...,~'°' . ~a r rw~"~ ~cc.~ .. .... ,,, . ,. ~. Y4' ~ Vi ~ ~ ~~4~ .: ~~~ ~~ ~~~ ~dy~ ~,~ ~ ~ 5 N o-r a ~ -e w~ • ~ ~ ~"~~~ °~ ~ ~-f (~ 648604 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06-1A-2401 1~:~5 PM WARRANTY DEED EXEMPT # CERT COPY FEE: COPY FEE: TRANSFER FEE: 9900.00 RECOkDING FEE: 19.00' PAGES: 3 ~~~ ~ .. Name aad Remra Address goo ~'~lvc ~ Lo.k a Zoo.d /Vc ~,.~ ~ ~~~k. f,on ~ M N SS/! z _.02.0 - 1069 - 70 - oo n Parcel IdmtiScation Namber (PII~ C~ZD- lC~6q-DSO-vap (j 2 © ~ 106`f - ~JO - v ov C7 Z v - 1 f~7 0 - c~ o - Cx~p 020 - X070 -- ~v ~-~ao v 20 -~ ~ o ?d - zo -~ "ISIS PAIGE YS PART OF IBIS LEGAL DOCOMENT - DO NOT RF?fOVE" Ibis iaformuioa mwtbe oomplated by wbauua: dono~+a+t ade. name k anan addrrss. and SIN (,f+Y4utru(J. Odor Jrr,/onnarion such ar da t~l mow. ktal ~~P~. ~ ~' bt plated on rhirlir+'tPalr elf die doe+anent or ~' be placed ow aCQutonal pate of da . ~ - doeYancnt ~r Use of dds ooMCr'pate adds one pate w your doe+onuu tod £,2.00 to the neonGnr fce. Wirconrin Sratraei. S9 Sl R WRDd 2J96 'i ;;~. ~. . ( NO. ~ WAAMNTY Dh:ED ~- ~I 6TATE OR WISCONSIN-FORM 0 ~ •e1- .1662iPAGf ii TNI[ RpAC[ RE[ERV[D FOR R[CORDINO DATA I ~~~ L_.__:. _....._. _._._ I' /~FIIS IlVDBNTtJRE, Made b RICHARD N PEARSON and JEAN M. I PF:ARSON, husband and Wife., .............................................................................. ~~ ..»........_:S_.. . St. Croix--• ....................................................................................I~ ... gtaatot...... of......._.......--• .......... ..................................................Count , Wisconsin, i~ - hpteb conveys and warFants to....CARRIAGE HOMES XXI , IN . , a II ...........................................................•• i Minn • sota corporation ....... ........... .......... ..................................... - I ........................................................................................................................................ ~j ..... ..._....,_......_......_.._ ........................................................... ralltee........ of II Washington y '"~~'~~ ......._ .:....................•---_.........................---~-----.......Count , or the sum of;' Qn~,Dollar,;and no/_100 (~1:00)...and other ~ood..and.valuable..I~ ETUR LtiN Tai ~~. C i on ~75Pv'3y~13 / `lf 2 v Us ~ ~ ~ ~ Lca.l c (Zc~ . S~?!1$.. 4i ~J~ ~ ~ ~ ................. ............................ the .following tract of land in.....$~.~...Croix,.-..--„ .......................................County, - SSf/2. Wisconsin: .A~l...of-,the,-~lorthwest--Quarter.••jNWA)-.-and., North-.HaLf° (N'~) of the Southwest Quarter (SW;) of Section Twenty-Five (25), Township.Twenty~Nine (29) .North, Range Nineteen (19) West, St. Croix County, V~isconsin, except Lot One of Certified~Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as Document No. 518444. - See Attached Exhibit A ~~ Parcel Identification Number is it ;~ This is not homestead property In Witness Whereof the said grantor. S.. haVe...... hereunto set......... their...,,.,-•,• hand 5..: and seals.... this ....._........... day of.-- ~a~ ...........................:........... A. D., Y~C.:2QD~. BIONED AND SESALED IN PRESENCE OF Startr; of bek'ihta _ 1 Was i natnn .-____._ ) (SEAL) (SEAL) ................................................................................... (SEAL) ' ` '. ry .. 020-1069-70-000 ` ~ 020-1069-80-000 020-1069-90-000 020-1070-00-000 020-1070-10-000 ,. - 020-1070-20-000 :r:~_ .~: . vni.1662PA~~ 291 EXHIBIT A Parcel Identification Numbers ` Wisconsin Deparhnent of Commerce - SOIL EVALUATION REPORT Page 1 of D'nrision of Safety arM• Buialin9s rn aocoraanoe wim ~;omm ~, vws. f,am. was qty ~ i 8 11 i ~ st Pl ¢ 5 C o c ' an mu res n s e. 1/2 x rx Attach complete sibs plan on paper not less than inducts, but not limited to: vertical and horizontal dir~ectiori and Parcel t D. ~ ' ~ 3 I r ' 3~ ~~ percent slope, scale or dimensions, north arrow, a nearest road. - U . - p ''-~_ _ n. ~ Please print all f Date . y ~ ~ Personal ir-formattori you provide may be used for ry pu s. t5. (~) (m)).. / Z ~0 Property Owner - , Propis Location ~ - ~ ~. J~r~ z ~ Govtt iliw 1/4,~~t, 1/4 Sy$-TZ9' N R /9' E(or)Q Property Owr-er's Mailing Address f~ Sl' (:AOIX Lot#- Block # Subd. Name or CSNfIf Co ~ Z C~ S-~ i I ~ Wcx Oki rVTY ~ S G t ` City State 27p Code ~IWnber iry ^ ~fdlage [,~ Town Nearest Road ~ST i' I l wa.~r rat v\.. ~So ~z ( ~ U S 'ten ~~ ® New Canstructiori Use: ® Residential / Number of bedrooms _3 "`{ Code denved design flaw rate LSD J(o O O GPD ^ Replacement ^ Publ"ic or oommerdai - Desccxitie: Parent material OU fc~C~.S l.. Flood Plain elevation ff aPP ~!~ R General comments S S ~ rvt ~ l e J0. f ~ b /~ - ~o G • 8 d. ri o w -~ r ri ,~ o d and recommendatwns: ~, (.,~ e.1 ~,t! 0. : o >~ - ~~ 9 3, U o ~O~'' ~''- QZ- Gd V 1 !/ i:pi Pit Ground surface elev. 9'7 ZD2D ft Daptl~ to limiting factor 1 ~ c~ in. Sod " n Rabe Horizon Depth Dominant Cob Redox Desgiption Texture Stnu~ure Consistence Boundary Roots GP D/fl: in. MunseO Qu. Sz. Coat Cobr Gr. Sz. Sh. `Effl~i "EYf#2 1 p- i y l ~ r ~~ Z _ 5~ 1 L rnckb ~-~ ~ 5 I ~ . 5 S 2 _.~g iy I yl~l Si~l ,L ~ m-~ cs _ . ~ . ~ 3 _ I -IZo i `t ~ -• m S Cis m I - - .~ /. Z ®Pit Ground surfacselev. ~~~' `''y ft. Depth to limiting factor 11 O in. ~~ # ^ ~~ Sod Rabe Horizon Depth Dominant Cob Redox Desaiption Texture Structure Consistence Boundary Roots GP I in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. ~ 'EtT#'1 •Eff#2 6-t 2 10~ r ~ -~ ~ ~ I k. .rn c ~ v-~ . 5 .8 2 12_y~. _t y -~ .. S~cl 2 m~' c - . LI . 4 ~ ~~ ~•Z l~t~r,-~i~S Cvsc,~ ~ ~D~, O Goz'r Flo • 0 = ~` `' • Effluent #1 = BODe > 30 _< 220 mglL and TSS >30 < 150 mgll. ' Effluent fK1= B()t)s < 30 mgrs. ana i Sa < su mgt CST Name (Please Print) S' nature CST Number Address Date Evaluation Conduc6ed Telephone Number 2113 8d_"' ~ ~~r~~er5-~-,~-.~~1 ~`IU~S ~-/-r~ ~~~s~2~f~-~-1bo~' ,, Property Owner t~. r k~- ~ ~ Parcel ID # Page z of,~ Boring # ^ Boring ~ ® Pit Ground surface elev. Q~ 3 ft. Depth to limiting facKor ~ I U _ in. Soil ication Rate H ri D th ant Color D i Redox Description Texture Sin~cWre Consistence Boundary Roots GP D/f~ o zon ep in. om n Munsell Qu. Sz. Cont Color Gr. Sz. Sh: 'Eff#1 'Eff#2 I 6-~y IL~~ r 3IZ ~-- S~ I Z m ~S Ivy . ~ . 8 3 - Io I~ ~~I~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ ~~ Rate Horizon De th Dominant Color Redox Description Texture Structure Consi~enoe Boundary Roots GP D/iC~ p in. Munselt Qu. Sz. Coat Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 Bonng # ^ Bamg ~ - ^ Pit Ground surface elev. ft Depth m limiting factor in. Sal ication Rate Horizon Depth Dominant Rector Description Texture Structure Consistence Boundary Roofs GP D/fP in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#'1 'Eff#2 ' Effluent #1 =- BODS > 30 < 220 mg/L and TSS >30 <_ 150 mg/l * Effluent #2 =GODS _< 30 mg/L and. TSS _< 30 mglL 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 (R.OJ/00) PAGE J~ OF~_ NAME 14 r ~ •e- ~ ~ LOT# 3 ~ LEGAL DESCRIPTION Nat '/esw'/4,S?,ST zy(N,R I Q E (or) SCALE: 1"= yU 1 BM I ELEVATION /CX~ • o BM 1 DESCRIlTION dD~jz~v~- P: ~- BM2ELEVATION qg•~ z SeC•2b BM 2 DESCRIPTION -bp 6~ I ?~P_'D~ K ~ SYSTEM ELEVATION•b~ 4G•SO Law~~ qs•®B •^ -f-- ALTERNATE ELEVATION pup q3.o ° lam,,., ~ 9Z • o ~ I CONTOUR ELEVATION ~/, vv~~,DU ~ ~ol• ~ .~ ~~~~ h~ 3+^` ,~o f _~ ~~ 6'~ ~°~ '~ s ~ ~~, ~. ~ ~~ c z ~ ~ ____ . ~~ ~~ \ ~~~ ~ o .~ p .a 0 s c s •o rg~ /~ s n ~r x /~ ~~RI VE 949 -~~ ~9/ /~' ~-- 980.0 ~ ~ ~` ~~~ ~ . ~ ~ ' ~ -36 ~. N _ ~ . 87,120 SQ FT • I ,~ .zooo ACRES • . eo~+e~a>~nc:-roP of r / ~~ "'~"~ 1Fi0N PIPE. Ei.EVATION 978.0 ' . • • / ~~ =589°59'~6"IN•48i.43~ , ' / / 'ter 23.10 • ' / ~ I ~ .. . ~Z • • / I / ~~~ /./ . 1x2,7 Fr , • / . _ / I ~ ,LO / z / / / /~ ~~ /~ ~. .;. , ~ / / . / ~ '~ I I ~~ ' ~' ~~ '~~~ ~ / / . ~ , • '!06,674 SQ FT W ( ~ ~ ~ ~ ~ ~ y ' 2:449 ACRES ~ -----~- "~' car C~2 `~' / , 5S47'E - II'I 10.00 ~ $89"8S4TW , ~' ~''A n ~ 10.00 _ ~ 7 ~ G21 -•'' ~c~ .2 13 ~ ~ '~~ 3, • ~ ,. 100- X39 N I ; ~ 120.487 SQ Ff _, - i - I~ $$ a 2.766 ACRES m ~ 'Q i ~ 93.570 SQ FT 1 ~ ~ ~ ~ ; '2.148 ACRES ~ " I Y ~ _/ %r ~~ I ~ I r~ ~ 7. ~ I`LW.L =978.0 % i '~ ;, I .1 .2606.: I x;.eg ~ _1 so8.1r 2aoao~ 219.32 ----- - ~ N89°42`16'E:2630.40