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HomeMy WebLinkAbout020-1395-57-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Duffee, David Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: .c e; ~. C, ~ 5 7 t~ µ- ~- 1 3.;t ~.~ rr cE , s TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic -~,, . Dosing Aeration Holding _~, TANK SETBACK INFORMA -"~~~~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ /c~'~ r S f ~ I ; ~~> Dosing _.. ~_+ Aeration Holding - PUMP/SIPHON INFORMATION Manu cturer Demand M Model Num TDH Lift Fric oss System Head TDH Ft i Forcemai Length Dia. Dist. to a -- SOIL ABSORPTION SYSTEM. ELEVATION DATA ~ County: St. Cr01X Sanitary Permit No: 453284 0 State Plan ID No: Parcel Tax No: 020-1395-57-000 Section/Town/Range/Map No: I 25.29.19.2451 STATION BS HI FS ELEV. Benchmark « r; / t~ ~~ ~ v ` Alt. BM ~ ' i . L. C ~i '~ ~'~ Bldg. Sewer 1. 1 ~. / ~ `I SUHt Inlet ~ c' ~ ~ / SUHt Outlet ~ 1_~ti 47.7> Dt Inlet Dt Bottom Header/Man. Dist. Pipe w~~+ „~~ Bot. System 5 ~- SL•u i - 8 ~ i(y.~~~ - ~ . /S' ~i~i .iS Final Grade ~7.7~ ~i:~.2) St Cover U ~ j t BED/TRENCH Width Length o. Of Trenches PIT DIMENSIONS No. Of Pits Iriside Dia. Liquid Depth DIMENSIONS _:3 __ ~: ( ~ ~ ~ `~ SETBACK SYSTEM TO BLDG WELL LAKE/STREAM LEACHING Manufacturer; ~. •'' ~ ' f I- S INFORMATION CHAMBER OR `"- n Type Of System: Cc:,~,.z,n~~ :r.~,:~ , .~~~: ~'7 ~ ref' ~1 UNIT ZZ- `"~ Model Number: [~~~~: ~ ~ ~-~ DISTRIBUTION SYSTEM `~'L '~ ~ r-'~ r '-~=~ `~' µ 5 ~ ~ 5" = c7~ He anifold Distribution x Hole Size x Hole Spacing ent to Air Intak "' ~ ~, ' '~ Di `"[ Pipe(s) .._ _~_, .~ 7 f' Length a Len th Dia Spacing x PrPSSUre Svstems Only xx Mound Or At-Grade Svstems OnIV ~_ /~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center -z ~- ~ < ~ Z - Bed/Trench Edges ,. Topsoil ^ [l Yes L~ No [~ Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /~ 2 / ~> Inspection #2: / / t~s.., c Location: 855 Highlander Trail Hudson, WI 54016 (SE 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 57 Parcel No: 25.29.19.2451 1.) Alt BM Description = S. '~ - c ~: ~ ~--'~ r 2.) Bldg sewer length = a? t, a `' ~ y -amount of cover = , H ` T-- ~ - - - --- -- -~ • -- -- - - - Plan revision Required? ~ Yes No ~~' ~ ,z~~~,_ ~ ~_. ~ Use other side for additional informati n. L_- _1-___ ~_~ I (~ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Z-'d!/~ ` c,~ ~ ~l9s ~ 5 ~,/J~ d C~ ~ ~ 7 T~~ ~ ,cJ,' G fi i 11.5 ~Gcs~!~•a.~ ~~i ~ ~ 1 ~-~ '',, ~ ~~9~~ ~~ s,~ ~ i't~ .~~ a~ ~~~ ~ - ~~~~ ICI i ~ s; n~ ~~~ O ~ ti ~ ~ „'` ~' I ~n ~,.:~ ~v f,~G3 ,5°,~/~ ~ fv'~~z~6,C ~c /Gd • ~ 5atcty and Buiiiiings Uivisiun 2Gi w. Washington Ave„ F,O. Box ?16« ®5~~~/~S~l t I Madtsan, WI 33707 M '7162 bepartmertt of Commerce__ I tb48) 266-3151 Sanitary Permit Application ~~~ !n accord with Gorntn 63.21, Wit. Adm. Cade, personalrnformatian you pro e tray be used for secondary purposes Privacy Law, s15.t74(1}tm) I. Application IaPormation r Please Print AU Information G' City, State ~ i J6'~/ / II. Type of HuUdiag (elaeck ail that apply) ^ 1 of 2 FunUy Dwe3ling - Number of Bedrooms ~_~~"~ ~~ C PubliclCornmerci4l -Describe Use_-~y~9-, "'i I ^ State Awned -Describe Us~ C~'~--~ . ~~-~Z~. J L9 N 0 2 2004 ~~.~;~~ u~i:G! ~iv~. ON'tuG UF~i~E ~~ III. Type of Permit: (Check only one box on line A. Complete Hne B iP applicable) A' ~ New System ^ Raplacement System i~ Treatmendtlolding Tank Replacement Drily ^ Other Modification to Existinb System i $. ^ Permit P.enewal Permit Revision ^ Change of - rmit_Transfer to Naw ;List Previous/Permit Number and Date Issued ~ Sefore Expiration ~_ Plumtxr Uwner i ~ 3 d ~ 3 ~ j ~d j0 3 -~, Non -Presaliriud in-Ground ^ Mound > 24 in. of suitab:e soil ^ Mound ~ 7tt in. of suirgbie soil ^ At-G:'ede ^ Single Pass Sand Filter n Constructed Wetland d PreasurixeA rl~nrGround ^ Holding Tarix ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculatins Sand Filter ^ Recirculating Syntttaclc Media Filter ~i.eaching Chamber r! Drip Line I_~G,ravcl-less Pipe ^ O, rJ(ex~lsin) r ~;,.., V. Ait¢pe>'eallTreatment Area In[ormation: ~~j' /'F._y~r_,c~a_~~~k~~ f,~-~:.-:_---~ `~~C..S ~~_ o o_fi beaign Flaw (gpcl} ~ Deaigrt Soil Application Rate(gpdsf) '~ Aisperaal Arrx Requir (sf) {Dispersal Area opoaed (sf) ~ Sys 8levacion .~a'D ~ ~ ~ VI. Tank Info ~ Capacity in ar Totat Number Gallons of Units W, `CS"~ i!i County , _. _ _ . Scmtary Permit Number (to br, filled in ~/S-3 Z~~ State Plan I.D~ mbe~ Pro3ect Address (if different than ntai{ing address) ' Parcel k Lot ~' Stock # ~ ~~_ _ _ i Property Location ` Z ~ ~/ J`~~ ~k,~~ ;,.Section a?~ E (circle o i T ~, N; R~„-E o~ i Subdivision Name CSM Ntunber C!City~^rVillage~Tawnship ofJc_~~/ Concrete I Constructed I 00 Plastic Glass VIL ResponeibWty Statement- 1, th! undersigned, assttate respansiltflity i'or 4 allatian of the POWTS shown an the attached plans. ' PIumbe/r's Na me (Print}/ Plumber's Si 8nature PRS Number ~ .B.uysiness Phone Nu/mbar Plumber's Addre ss (Bases, City, State, Zip Code} i ~pprovgd ^ Disapproved Sanitary Permit Fee {includes Grcwrxiwattr D~ isstt ! ssui t Sig re (~ps} Surcharge Feo? ~ ~ /{ ~ str ^ Owner Given Reason for AenialJ7~ ~ ~~ IX. Conditlotle of ApproWa!/Resisops for Alsapproval ` ~ ~ 1.C1 ~ n~~~ ~~ J ' ' SYSTEM OWNER: ,6-~ivta,t, ~ ~ t ez~- ~ / 11 ep is an , e uen lifer and `,~, ' YLZ(,t, I dispersal cell must all be serviced /maintained ~~~~ ~ T~ as per management plan provided by plumber. VYt >~ 2. All setback requirements must be maintained -~ Ck~~yt°~. as per applicable code/ordinances. J Attach etxaplete platy (to ttaty o y} for the ay tem on paper sot to than 82/2 x it in ai:e -~. ~1 ~ 5' ~~ ~aU Si`t~ ~~" ~~ 7 ~~_ `,~, r ~1~r 0/~ ~ l ~ G~~ r ~~ ~~ _/~ / ~~ St f-~~~~. ~~ e 1 ~ ~ , ~ l~~ /4d . ~ ~ ~. i .~ ~ ` =~-~ ~ 3 I ~~ -~ L~`i~ ~- Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _~ of _,j Division of Safety and Buildings in accoroancewrin t;omm a5, vvts. aom. ~.ooe t i l _- County `~ ~ ze. P an mus Attach complete site plan on paper riot less than 8 1/2 x 11 inches in s include, but not limited to: vertigl and horizontal reference point (BM), direction an percent slope, scale or dimensions, north arrow, and location and distance to ne st roa parcel I.D. 5- 7 ~ ~- ~ 39r- . Please print all fnfiorntaflon. P~D Personal information yov provide maybe used for aeconda urposes (Privacy Law, s: 15. 1) (m)) Re awed by Property Owner ~ ~~.,~ ~ ~, ~ C p Property Location `, r Q Govt Lot ~ ~ 1!4 ~W 1/4 S ~`~ T ~~ N R ~ 1 E (or W Property Owner's Mailing Add' Lot # Block # Subd. Name or CSM# City Sta Zip C Phone plumber t [l~ N 55 oSa ( ^ City ^ Village [Town Nearest Road ~s~ ~c` ~ l~ii ® New ConsVuction Use: ® Residential /Number ofi bedrooms ~' = ~_ Code derived design flow rate _~w ~f2 ~ _---_-__ GpD ^ Replacement rr ^- Public orcommercial -Describe: _ -_ ----- ---,n --------- Parentmaterial __ ~(~`I'l~~.S ~ _---_--_- Fbod Plain elevation if applicable _-__~ti_/ v`t-__.-_-_- ft• General comments 5\ s/ l ~ O ~ ~~Lkj~ 2 ! 7/D~ and recommendations: 7 i P /~ ~~ 2 J ' ~ ~ t/ 7 -1-~ ~ u~,c,~-o~- C~ n~i ~~ ~-~-~ -vt-a-~ Boring # ^ Boring G ~ `~ ^ Pit Ground surface elev.~~ ft. Depth to Ilmlting factor _11.2-- in. Soa A lication Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF p in. Munseit Qu. Sz. Cont. Cabr Gr. Sz. Sh. 'Elf#f 'Eff#2 1 4 _ ~;l ~ m~~ c v S 33_~l i6 ~ ~ ~ a ~ - y Boring # ~ Boring ^ pit Ground surface elev. / ~ ~ __ ft. Depth Fo limiting factor _~~- in. Soft A liration Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft= in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 1 4~(~ o ~ ~y /' ~ Z ~-II (o o - O S - `- ~ ~~ S - ~ Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 <_ 150 rnglL 'Effluent #2 = BOD < 30 mg/L and I SS < 30 mg/L CST N (Please Print) i nature ~ CST Number ddress '~ Date Evaluation Conducted Telephone,Number ZII~<J~'S/' ~on~z~~~ ~~l ~yo~~ .S'~ ~/_oy 7/.S-%7G a' ^az-~5 ~~ ~~ i/ Parcel tD # Property Owner _OMLt /~ _-- ^ 8 ng Paga _ ~ _ of __ 3 Bo J I Horizon ring # ~ Depth in. O] Pit Grou Dominant Color Munsell (QV fi. D nd surface elev. _(~_._, ,. Redox Descript' ri c Tyhcture ,~,~ Du. Sz. Cont Co epth to limning Structure Gr. Sz_ Sh. factor f r~V Consistence in. Boundary Roots Soa A ication Rate GPD/fF `Eff#1 `Eff#2 3 yz~~z~ ~ ~ _ s os ~ _ ~ ` ~ U Boring Boring # Ground.surface elev. - ___ ft• Gepth io limiting factor __ - ~n• Soil A fication Rate ^ Pit Horizon Depth in. bominant Color Munse-I _ Redox Description Qu. Sz. Cont Cobr Ta;rture ~irudure Gr. Sz. Sh. Consistence boundary Roots •E~GPD1ft2Eff#2 Boring ^ Boring # Ground surface elev. ___-_-__ ft• Depth to limiting factor _____. in. ^ pit Soil A lication Rate Horizon Depth in. Dominant Cobr Munsell Redox Description Qu. Sz. Cont Cobr Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDlfP 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL "hhe Department of Commecce is an equal apportunity 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. sno-a3~o~n.oi~oo~ ~ ~,,}s _ ____ PAGE ~jOF~ NAME: 4'h~ nr.~.,.~~-Q-r LOT EGAL DESCI~I ION:_1/4_1/4,S~T_,N,R,IE(or)W SCALE: 1"= ~O ~~~~ ELEVATION: IQd- ~ BM 1 DE5CRIPTION:~~6m /1~ -~~_ BM 2 ELEVATION: BM 2 DESCRIPTION: SYSTEM ELEVATION: ~~~ ~© SYSTEM TYPE: ~o dl,ct~e ~ ~!~ /~et-( _ SIGNATURE: ' 4 DATE: -S~l/- 6/ ~- ~ ~ ~ Q' U 2510 P 339 STATE BAR OF WISCONSIN FORM 1 - 2000 WARRANTY DEED THIS DEED, made between Carriage Homes XXI, Inc., a Minnesota Corpoaration, Grantor, and David A. Duffee and Cynthia J. Duffee, Grantee,stlrvivorship marital property Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A * Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road New Brighton MN 55112 Together with all appurtenant rights, title and interests. 020-1395-57-000 Parcel Identification Number (PIN) This is lt~tchomestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 19th of December, 2003. C ' ge Ho s XXI, In . * Dwi t S. arve ,Preside AUTHENTICATION Signature(s) authenticated this 19th day of December, 2003 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Gregory A. Booth, Atty, 1900 Silver Lake Rd #200, New Brighton, MN 55112 (Signatures may be authenticated or acknowledged. Both are not necessary.) +Names of persons signing in any capacity must be typed or printed be)ow their signature WARRANTY DEED 754357 KATHLEEN N. MALSH REGISTER OF DEEDS ST. CROIX CO. , NI RECEIVED FOR RT~ORI~ 02/17/2004 10:00AM MARRAIITY DEED EXQPT # REC FEE: 13.00 TRANS FEE: 257.70 COPY FEE: CC FEE: PAGES: 2 ACKNOWLEDGMENT STATE OF MINNESOTA ) WASHINGTON COUNTY. ) ss. Personally came before me this 19th day of December, 2003 the above named Dwight S. Harvey, President of Carriage Homes XXI, Inc. to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Annette D. Theiei `+ Notary Public, State of Xiit~B;tDI Minnesota My commission is permanent. (If not, state expiration date 01-31-05 ) ~. - ~, i ~ ~ ~ .d \ t STATE BAR OF W ISGON5IN FORM No.1-2000 1~ O V7 O ~ O N o m a fn z rD co D Imo: Q C O Z 0 O C c 3 ~ ~ N CC~D C m' o ~ c~DO v m a ~ ~ ~n ~ O N ~ 7 ~ f~ C o = 0 41 m ~ a N N ~ N a N N N ~ ~ o m O ~ O N S O a ~ o' a w N Z O CNJi N fD N fD (D 3 m a m O CAD N a c m 0 N cfl N O d c> to p ' c °.: ~ ~ ~ ~ ~ ~ .^. .. i o w ~ 3. I A ~ 0 I 3 ~ w ~ I M c ~ ~ ~ ~ I ~ a ~ I a ~ ~ I 0 i O N N d °o ~ W ~ o> ~ '9 '0 2 0 0 o a N ~ ~ ~ ~ ~ o v ~ ~ w M N (~Tn~ c'o ~' ~ .p I d 3 °t rn I ~ ~ I ~~ I ~ ~ o ~ w ~ 'o ? v I ~ -' ~ y I n N N v a I ~ ~ I C a I I W ~ a 3 I O :- O .. N Z N A ~ c ~ a I I I I Ol y O 3 ~ ~ p o y cnZD D N o. W p .' Z 0 n ~ c c 3 3 ~ G1 fS~D of 3 ~ O ~ m ~ ~ _, N ? N 7 b ~ C m m o ~ ~ N (D .~. :•i U! N -w _C ~p m ~ ~ ~ fA O ~ (p 3 ~ ~ p ~. a ~~o- `G ~ ~ N Q ~ F O N wa m v o ~ D f ~ ~ o a ~im~-p~i o am~ad a ~ a ~ m Z 7 ~ ~ N O (D ~p Q fD y O y ? d j = O ~ ~m m ~ < N ~° ~ a N 'O O O Q 7 (=D (gyp (7D a .~' f g d o. _. m = N O c m ~ 0 m N O Vt F O ~- ~ ~ ~ ~ o a p O+ c 1 ~ ~ pi a to vNi can 5i ~ 2 a a ~ a 0 V ~ ~ N ~ ' ~O = ? C a. fA '', O ': 'D ~ ~ ~~~~ fR fA fA ~ i v v v ~ w 91 'O ~ ~ <D M 3 °-' ~ .. M ~ ~, o x ~ o ~ ~ 7 ~ y ~ p N C C n N a w ~ Q O O C u~l n ~ ~ a ~ w H ~ N ~ y N c a 3 d n ~ ~ 3 ~ ~ ~ d ~ ~ C ,CNJ1 N a N o O ~_ ~ ~ ~ ~ tO ~n O ~ ~ N o ~ o o ~ o c 3 ~ ~ .. ~ m V n m n 2 N A Z n ~'A .r A ~ ~ ITl N ~ -' Z <A c tD ~ { A Safety and Buildings Division Counry ~ ~ 201 W. Washington Ave., P.O. Box 7162 $~G ~ ~' ~5~0>~S,i~ Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (~8) 26b-3151 30 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Ad s (if different than mailing address) I. Application Information -Please Print All Information ~_ Property Owner's Na me ~ ~ lJ~/lJ ~` (~A ~.~~~ '° P el # Lot ;f Block ~ ~ ` t ~` ~ <PB Ju ~ S' r*- j '~ Property Owner's ailing Address - Property Location ?..~Q ` S~ ~ 7`rr ig~G City, S-~tate Zip Code ~ Z~ n,Rhotteu'SG~hcr ~~ 'k~~ lG,Section 2~ II. Type of Banding (check all that ap ) bM2 - T ~ N; R~-E o, 't ~I or 2 Family Dwelling -Number of Bedroo ~ ,~ ~, ,,ttr, Subdivision Name ' ~ CSM Number -D H~blic/Commercial -Describe Use -8'Q~S -.~-vu~ SC e-U G fir ~ll.S ^ State weed F Describe Us ~ Z ~ ^City_^Village ^Township of ~c~so.U 2) 3 xS ~ Sb' III. Type of Permit: (Check only one box on line A. plete line B if plicable) U2D - ~ 39,5- S ~ - 6D'p , 2 f A' New System ^ Replacement System ~i Treatm dHolding T k Replacement Otily er Modification to Exis ~ ys I B. ^ Permit Renewal ^ Permit Revision 1~~ l ~st Pre 'ous Per ate Issued 1 , ^ Change of Permit Transfer to irew Before Expiration ~ Plumber caner N. T of PDWTS Svstem: (Check all that a t) ~' Nan -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 4 in. of suitable soil L.~ At-Grade ^ Single Pass Sand Filter j ^ Constructed Wetland ^ Pressurized In-Ground ^ I-Iolding T nk ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter DATE - l~~ ~ 3 R C E I PT 13 5 3 21 :nation RECEIVED FROM Od Address feel Fiber Plastic Glass c c FOR DOLLARS ~ ~~ L- G 1- ~ ~ Sc ev, ~ z. ~~ ~lr ACCOUNT HOW PAID BEGINNING CASH BALANCE AMOUNT PAID ~~ - ~ HECK BALANCE MONEY ^•-~ .DUE ORDER `/ BY Cd 2001 REDIFORM 5165]N-CL Approved I ^ Disapproved Sanitary Permit Fee Surcharge Fee) ^ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNED; 1 Septic tank, effluent flitter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. SBD-6398 (R, 01!03) Attach udes Groundwater zsa plans (to the County only) for the system on pal Date Issued Is in Agel ~r sty aI1S. ~ le Number .~1~ l Signature (No Stamps) Gccrv •' a ~ !To lam- ~ 5' .,~i`~ ,l o ~ S,~ ,~'c~,v < `G ~J '/~,s %D.t~.v ~ ~ loa. ~S~,.1~ v sc~,C-~ l ~=~'4 ,- .~- Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Saltily and Buildings m aocoraanoe vvim ~:omm ~, vvrs. rwrri. was Pla m st 81/2 l t ~~ 5 c ro han Attach complete site plan on paper not ess s¢e. n u inducts, but not limited to: vertical and horizontal~~x~~ percent slope, scale or dimensions, north arrow 'y""")y and and dt~tanb~ nearest road. Parcel I.D. D Z 0 ' 13 ~ S ' ~- - ~ v Please print ''~ ~-. "~- w Date ~ . Personal iMormation you provide may be used dary ~ A r Law. s. 16. (1) (m)).. p G,~~ ~ 2 ~ 3 Property Owner ~ ~, ~, i Preps Location - ~ ~ . ~~ Goit: of 1/4 w 1/4 S zS- T Z N R ~ E (or~ Property Owr>ers Mailing Address t '. ~, ~ COU N?Y ~;~ Bbdc # Subd. Name or CSMfi# ` ~ tudUFFIGE '~ S ~ City State Zip Code ~, .City ^ Village (~ Town Nearest Road ~ST% I L wa.~r VYt i~.. ~D ~Z. ( s ~ ~i 9'r u s ~ ~ ~ ecf ® New Construction -Use: ® Residenfatl / Number of bedrooms 3 _ `I~ Code derived design flow rate LSD ~~ O d GPD ^ Replacement Q Public or oommerdal - Descxibe: Parent material OU fc~a.s (.~ F=lood Plain elevation iF applicable ~~ ~' R General oommerrts S S ~ wt C.l e.J0.f .b n - 43• <3 0 .. >a.e- a~,~c~-c- .~ir-'~l~ £/s~ii/ ~ and recommendations: ~ ~ ~ .~, a : o r. - z - G=Ci~~.~/vy- ~~-d~ Boring # ~ Boring o Pit Ground surface elev. 4'S P ft. Depth to Limiting factor ~ ~9 in. Sort ' n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ . in. Mansell QU. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 , z- Z. 3 16 r `I ly s.1 2 ~1 m ~r' c s : 5 , 8 3 Z3- a I D ~ ~ (~ 5 b rn l - _ .~ 1. Z ~/ c ~- tS qz.q Z Boring # . ^ BOd~ ®Pit Ground surface elev. ~ ~ 3 o ft. Depth to limiting factor ~ ~ 3 in. ~ Rata Horizon Depth Dominant Cob Redox Description Texture SWdure Consistence Boundary Roots GP D/IP in. Mansell Qu. Sz. Cont. Cobr Gr. Sz Sh. ~ 'Eff#1 *Eff#2 Z, Il - 3'-1 ~ ~j y 1 ~I 5 i I 2 rY~ab I im~'r ~ ` _ ~ 5 ' ~~ - ~ 0~~ 'Effluent #1 = B~D_ > 30 < 220 ma/L and TS5 >30 < 1 50 mall. ' Effluent #2 = BOD. < 30 mglL and TSS < 30 mg/L CST Name (Please Print) ,,~ Signature /~ CST Number Address Date Evaluation Conduced Telephone Number 2 l l ~ ~j-'' S"~ So~-~, e ~F-~ , ~~i Sz1C~ ttr ~ l /- ~ ~ `-1I ~- 2~-I ~ - ~~ Properly Owner ta.r k~ l j Parcel ID # Page z of _ 3 Boring # U Bow 3 ®Pit Ground Surface elev. 9S ~~ ft Depth to limiting fad~'~ in. Soil I"nation Rath Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fi? in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh: "Eff#1 *Effaf2 o--~ 3 I C~ 31 5r I zmabk r~r L~ I v ~ • 5.' - ~ 2 13_20 I ~I~~{ S' I ZmG-bk rn-~r c s ~ ~ ~ $ X12.9 3 i . 2'' ~ . z `~ _ _ __ - . ~~ # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ ication ~~ Horizon th De Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/ff p in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 "Eff#2 a Boring # ^ Boring ^ Pit Ground surface elev. ~th Depth th limiting factor in. Soli ication Rate Horizon Depth DonNnant Color Redox Description _ Texture Structure Consistence Boundary Roots GP D/ff in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 " Effluent #1 =GODS > 30 _< 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 = BODS < 30 rrxyl. and TSS _< ~ 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 (R.OT/00) PAGE ~ OF_~ NAME ~ Y` k-e. ~ I LOT# rj LEGAL DESCRIPTION SE `~+~W'~<-S ZS Tz9 .N.Riq E (or)~ 1"= yU 1 SCALE : BM I ELEVATION /C' O • y ~ K BM 1 DESCRIlTION fa p v -~ ~ ~ ~ ~1 J ~ D ~'p ~ -' -t- BM 2 ELEVATION 9 g ~ S ~" ( S eC ~ Z. BM 2 DESCRIPTION {op a ~ ~~ u~ ~,'~ SYSTEM ELEVATION 93 . ~ y ALTERNATE ELEVATION ~I2• Cz o CONTOUR ELEVATIONr{S.ov g 6.oc~~ Q~.OO ~_. ~~h~~ ~~ r ~ ~,J 1C` V ~` ~p1 t1b ~~~~~ ~ W ~~~°_(1 ~`~ -- ~ 5~2 I~\ ~yo~ g-Z `~ ~i, n`°h' 10~ S~ \O G ~c o a DATE G ~ - ~~ v 6. ~. L 1 V ~! ~ ' • .--wy,.~„y,~ .v „ CI V ENT ,PIPE 12 "' MIN , f+8OV E G:~F+,D ~ g > 25' FROM DQOR, WINOpW OR FRESH AIR INTAKE F`NIS1~E GRADE ?8" 'MIN, ~ oer :.~Ir4T ~ "` C I RISER ----~~ c ..`' ..I I f~' ~ ~ 1 E~ WA:£R TIGiiT SEALS "~ n ~-r A ~APROYE~3 , ~ .i... r ~O.L PUMP pfF I:LEV . .,,,,,,~,FT . _ ~..,. ~D i WEArN~R~RQC~ JUNCT1pN BCx WITH C4NbU'IT .. *1 ~~' ~ t « t GA5- ~ ' ' T1G:iT ~ `~ SEAL 3 i ~~ 3" APFRaVED BETS©ING U`DER :ANK SPECIF?CAT. ~:NS APPROVED `'IP.IJNC1iE CGV ER W/ PADLpCK ~ WARNING LAB£~ ......4" Ntih'. ~~ i ALM ~ APPR4VEO AYP~ ON ~ ~ C ~ 5Ol. 2D. SOi~. ~ Or z ~ ~ R I'SER EX I T ~ ' ' ~ Q~RMr ~ TED cx~,Y IF TANK ~~ MANUFACTURER HAS APPROVAL ~ONwR£2'E pAD a£PTIC r' DOSE "ANX MANL'FACT'~IRER; r t' ,r~..__..__ NU?~SE'It DOSES PER DAY: ."ANX. SIZES: SEP^SC ~ GAL. DpSE VCLU!~E 2NCwJDrNG DOSE e'dr.___._~ GA.L. FLOWBACx: r GAi.. ~L_~ MANUFACTURER: ...~skr~..?.,..~ M OI?£ L NUM3lER : .... ~,~ ~~.. ~..~,,,.. SWTTCK TYPE' Irisrc 'U1 P i'7ANLJ~'ACTURER : MODEL NUMBER: SWITCH TYPE: EQUiREA DISCHARGE RA,T~ ~'p G CAPACITIES: A : ,~a_ I:vC~:ES s,~~~~«.»aAL. 8 = ~_ I NCHE 5 = ...~.~.... GAi . C r ~„ INCHES = t- C~aAi.~. A = ....~_... INCHES = .,1.~.~r......_G~ L . PUMP ~ ALARM k'lRSNG AS £R ILHit 16.23' w'RC j ERT+CAL DIFFiRENCE BE:~'~,Ex~l ~,,~ t~s i' AND ~ISTP.IBUTIpN PIPE ~.2 FEE~-' MINIMUM NETWORK SUPPLY PRESSURE """"'; FEET ~„~,,, FEE2' fORCEMAiN X ~~0 FT/100 F:, FRIC2.pN FACTOR FEET T.0'*.4I, DYNAMIC KEAD s ~ F E '" ;7TERNAL DIMENaI0h5 c:F F~;MP ':'A,,t}~; LE'~GiH -----~'- ; WIDT~i ^"' ; ~T ;TER ~~ ~ IGNED: ~~~~~ ~ i.iCEN~:, h~MEiR: ,~~_~F~'D! EA':F.t /88 V ~~ l,a .. U I iJ v ~ ~~'~ L ~• Submersible ~~ ~~ ~N,IGAt'101l~ for the •~~ + ~omee Fcrm3 .d • Otwuhrln~ ~~ • ~ a i~ gp~alAl~t; ~li~ mudrnnm. up to 3is GPM. • ~+~ Luc ~ w 2~1 test. • Dteotu-r~e tics: t~~"trt~'t', • Mech,a++ai aa~: cerbarr ra'ta_ !~/aramkrat~lonaty, 9~1 a~arrrera. r ~ 40'C} 00l6iJ1v4u8 44Q'F ~e4•C} ~r~~, Fa~rnt's: ~Op tents • dwldw~ut ~o ~~~ • Sdf~ hindlM~ gpabiUty; ~t~ tV~lfrluril. • ~(pt16lI: tip t0y$10~ GPM. • GisoharQe 1~ 1~4` NPT. • ~IftafMnbl! ~: Cal'b0A• ~(~"~ 1~Di1~ryl • t a~Fn~ nilOt~ i40"f. Interrn~nt. a) Eifluant Pump ~~~~~ 3871 E • Puny sabma~td in high prtda tutWne di for i~t~riudora aJid effir~rit heat trarafer. Avali~ for ~utomaua ~d n~aaaa~ opu~tloa. Anna modal loaitid~ I~aalnnial M~ iall~b aaa~tad and prtpi ~t iha holory. att i~ 1tn~rllat: Tttertrro- l~ri S~ desk with pump out wrtea for maat~anlt~! cal Qrat~titpn. ^ Ew16 #r. ThOrt~ phastic analaaA c~pn ~r improved partartnace. ~ #nd Wa: ~u~td therma~~ detipn pro~dee superior et~+er~t and t~trQBi~rI~ Naa~1C$. ^ tttofor M; Cat trop for atllCiant heat trluater, suets~h, #hd dulibllllly. Notor'`~t; 'Ciarrnop~s- ~ tom' ~h InteQraf h~#e awi~h ~rlt ~ Irowrr Ctbla: Swera d~~ ntrd od and war t ^ : Itpper ~ Iowar hatyr da~yy b~tJ b~uirNq aaradruation. AB~OY W#'i~A jCSA Naiad made} nurn~ro and M "F" or'AC".; ~ I _.~._._,.. _..^l.._. ~ ; ` T----•; .,, t i 30 ? ~~ J r ~ I ~ ~~ ..,. SiC ~ ~ I I ..... i ~ .... , ~""~'~.~~ f t6 i - ~ ~' _ --~ -~-~-;--- ~ ~ ~ I t4 6 , I ~ Q ~ ~ Q a ~ ~ ~~m ,... !! 1408 P~h11 lktlgtri i!'1~. • C~'lara; 8fl~ cartes Iiblidea anat. ~ ~ tUAttiRQ ~ soeto IV~Or; • EPOS 8 t!ase: Q.4 HP, 11~ ar Y, 60 t4z,15~ RPM, but(i is ovatioad with ~1~tOt1latiC r+eat • 81n~Je phase: ia.5 NP, 1 i5 V, Ot07 Firs 1~0 A~~III, built In auatload with ~~ net. • t cord:l0 foot etarrdard tMtgfh, X8/3 5.11'p with ihrre prrao~ Ground!nq hunpih,161'3 S,1T4V with thrlt pronQ gtoundtnp plug ;standarld on EFp5), Nl~r~lt3 ~ ITT i~Otlw'wI{tY. 1~6 ~~ ' PQWTS Z?WNER°S MANUAL & MANAGEMENT Pi.AN Page of FILE INFORMATION owner C~~I~C~~ 5 Permit q ,? ~ !~,? c~! DE8lON PARAMETERS Number of Bedrooms y p NA Number of Public FacilRY Unite ^ NA Estimated flow !average) of/da Design flow (peak!, (Estimated x 1.51 ~~ Q al/ds Soil Application Rste al/da /ft~ Standard MtluentlEfffuent Quality Monthly average' Fats, Oif & Grease (FOGI S3Q mglL 13iochgmicai Oxygen Demand iBiJDeI 5220 mall. ^ NA Total Suspended Solids (TSS) 5160 mglL Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand {80D~i 530 mgll. 7ote1 Suspended Solids (TSSI 530 mg/t ^ NA Fecal Coliform (geometric mean! s14` cf~+/100mt Maximum Effluent Particle Size Yt in die. p NA al'°r` O NA "Values typical for domestic wastewster and wptic tank eftkrent. SYSTEM 6PECIFlCATIONS Septic Tank Cspaoity ,~ ~ al ^ NA Septic Tank Manufacturer ~~, d NA Effluent Filter Manufacturer ~ ~ ,~ ^ NA Effluent. F'sfter Model S~' O NA Pump Tank Capacity d al f3 NA Pump Tank Manufacturer free ~~ d NA Pump Manufacturer ~,,,~ / O NA rump Model Pretreatment Unit Q Sand/Gravel Filter ^ Mechanical Aeration O (3iefiteetion Ll Peat Fllter I l~ wetland p Other: /'-' / ' Dlspersai Caii(sl ~rnGriaund (gravity! O At-Grade O Orip-Line O NA Cl En-Grotmd (pressurized! D Mound ^ Other: Otl-sr: p NA other: CI NA Other: DNA MAINTENAIiIICE scFleoul.a: Ssrvlioe Ewn! Service Fraqusncy inspect condition of tank(s) At least once every: 3 ~)~ s lMaxMtum 3 years) O NA Pump out eontants of tank{ei When combined sludge end scum equals one-third fY~) of tank volume 1~ NA inspect dispersal cell(s) At !asst once every: 3 es~rt~f e) (ii<Ilaximw» 3 Years) O NA Clean effluent fileer At Ieast once every: ~ ! (e1 sl O NA Inspect pump, pump controls & alarm At feast once every: ..-- ~~(e) d mtel ^ NA Flush laierab and praswrs test At least once every: .- Q RfOn a1 e) ©NA ~: At least once every: „_ momh{s) O yearlei ^ NA 4tlwr: D NA MAMITENANCE IN8TRliCTIONi3 Inspsationa of tanks and dispersal Della shall be made by an individual carrying ans of the folbwing liosnees or certifications: Master Plumber; Mosier Plumber fiestrii:ted Sewer; PQWTS Inspector; PQWTS MaintaMar; Septage Servicing Operator. Tank inepeationa 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 eomWned sludge and scum and to check for any back up or pending of effluent on the ground surface. The dispersal oedf(ai shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of affluent an the ground surface, The pending of effluent on the ground surface may indicate a failing condhton and requires the immediate notificatlan of (the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents ®f the tank shah be removed by a 5eptage Servicing Operator and disposed of in accardsnce with chapter NR 113, Wieoonsin Adminlstretive Code. All other wrvioas, including but not limited tc the servicing of affluent tfltsrs, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5'! 2 months, shall be performed by a certified PQWTS Maintainer. A service report shalt be provided to the local regulatory authority within 10 days of completion of any service event. Page at _____ START UP AND OPERATION roducts or other chemicals For new construction, prior to use of the POWTS check treatment tankls} for the prese!tee of painting p that may impede the treatment process and/or damage the dispersal calllal. if high concentrations are detected have the contents of the tanks} removed by a saptage servicing operator prior to use. System start up shalt not occur when soil Conditions are iroxan at the infiltrative surface. Our#ng power outages pump tanks may fill above norm~erloadint the dints} andnmaY 8esuitenttttebackuP a$svrface disCha gie of discharged to the dispersal celNs} in one large doso, o g effluent.o [heaeffuents um~'on ontact a Plumber or OWTSpMaintaineroto~assist n manually apera0rpgr~eor~mp controls~to power t P p restore normal lave#s within the pump tank. t3o not drive or perk vehicles over tanks and dispersal ceNs. Do not drive o- park over, or otherwise disturb or compact, the area within 15 feet down elope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the PaWTS: antlblatics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump} water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins, tampons; and water softener brine. ABANDONMENT When the POWTS fails andfor is permanently taken cut of service the following steps shalt be taken to insure that the svstem es properly and safely abandoned in Compliance with chapter Comm 83.33, Wisconsin Administrative Code: • AN piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of ail tanks and pits shall be removed and properly disposed of by a Soptage Servicing Operator. e After pumping, aq tanks and pits she#{ be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINQENGY PLAN if the POWT$ fails and cannot be repaired the following measures have been, or,mu:t be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized far the location of a replacement soli 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 Gnes 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. O A suitable replacement area is not available due to setback and/w soil limitations. Barring advances in POWTS technology a paid'ing tank may be installed as a last resort to replace the failed POWTS. ~~ © sit d site e tank O Mound and at-grade sail absorption systems may be reconstructed in place following removal of the biomat at the a~fiitrativa surface. Reconstructicns of such systems must comply with the rules in effect at that time. < < WARNiNa > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFiGIENT GXYOEN. DO NfJ7 ENtfER A SEPTIC, PUMP OR OTWER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESiJLT. RESCUE QP ~ PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR tMPOSBIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~~1~•cc ~v+ ~' ~~aJ~ Phone 7 ~ _ ~. ~ .'Pry' POYVTS MAINTAINER Name Phone SIEPTAGE SERVICINQ OPERATOR iPUMPER) LOCAL REGULATORY AUTHORITY Name Name ~ ~0 / p.{~ j N/~ Phate Phone `~~, 7j~p • ~1 This document was drafted in eompiisnce with chapter Comm 83.Z2t2ilbi(11(d)&(f) and 83.5411). (11 S (3), Wisconsin Administrative Code. -+'= f'• l~J GLMJJ E:IJ. YJS]I'1 ~1 7'~~-1 sic c~atx covrrr~r SEPTIC "TANK 1~~AIN'i'BNANCR At3REBMENT ANU OWNERSHIP GLRTIFICATION FORM. Ownc~rrlBuyar l ~?Q~~ f,~~' f s'. ~' ~c .2 i~v M8iling Addtrss 7S"O 5 •f-~ / /w~~ti. ~ AOcn Ski G Cvr~ h SS'a~ P`ropacty Address ~,~.~ ~'r`~x ~d~~al ~,~ % ~ //I Y tT~ ~ r+_ (Ycrifiatioa roquirod finm Planning Department for stew aoaattuctiaa) ~^ C~tty/Statc w~ s d- psmcl Idtmtifieatitm Number G o L~:GiA.~.~E~4N ago -13RS -s-i-~Z~S"/) Property Location ~ ~/., ~~ : y, Sx. ~S . T~ l N-1~W, Towa of ~i~.~S~.~ „_ Subdivision S~ ~ ~' i ~ ~ t~ <~ Lot # ~ 7 -. Certified Survey Map # ~.~.~, , Valume _ ,Page # Warranty I3ced # _~ ~ ~ Cr o ~ ~, Volume l CP 6 2 .Page # ~ 9 - ~ o Spec house ~ yes ~. no 'Lot Ilnts identifiable ~ yes D no ~YST~IVI MAYNTIrNANCE Impc+oper use sad matate~ace of yoar septic system eaald result In its premature failure to handlo WasOe~. Poopor tuaiatenaace Cansista of pumping out the ecplic Cask tvety thrac years or sootscr, if needed by a ticeused pumper. What you pat unto th,e systaxi can affoct the function of the septic tank xs a acatmcnx atagc in the ~eaatc disposal eysbem~. 'Ihe prdporty owaar agnxx to cabmit to St. Croix ?Aamng Depattinuemt a etrtlRcatian farnr, sigrmd 6y the owner Attd by a P~~. jauxncYaraxrP~~+~~Por a liceu.4odproc~sttv+erifynog that (I) th,e oa-~ltewattearamsdispesal systam is i3n proper operating oondltioa and/or C1) sty iaspectiaa a~ p~8 C~ ~Y). ~ ceptia tank is Iesc ~ 1/3 full of sludge. I/we, the vadcrsigaad l:sva rated t5e abeve rcquircments and agroe to sruaasaia tl~e private sewage dispostt sysbam wl~ the ctzadards set fvct5, hcxrsia, as set by the t of Commerce anfl the Depastmerrt of Ilatural Resources, Stata of Wisconsin. ~Ctificsdon stating that your septic been maiutaiucd mast bo courpleLod And returucd to the St. t~eoix County ZoniAg Of~ee within 34 days of date. <u ~~ ~ ~ ~ ~.~..~. SIC F T.iCANT AATII 1(wc) lI ctatcments on this form art t:tte to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro do 'lr~d vG~ by virtue of a warranty deed recorded in Register of lae~is OfT3a. I A APPLICANT AATfi +. «. • ~ ,gay information flat is mts-represented may rosuie is the san3cary pcsmit being revolved by the Zonjcg Department. `*"'` r •" Include witfz tbls appl(c:tlon: a cGuapcd warranty deed frvai the Register of Dads office a copy of the certified survey snap if reference is asado in the wArrAaty deed !N ' ~~~,1.GG2P~~289 • 648604 DO"' N° KATHLEEN H. WALSH nxnmm de REGISTER OF DEEDS 1,..)arrwti'~ ~cc~ ST. CROIX CO., WI RECEIVED FOR RECORD •• 06-1A-2001 12:15 PM ~;..., YARRANTY DEED EXEMPT N _ CERT COPY FEE: CODY FEE: TRANSFER FEE: 9900.00 RECORDING FEE: 11.00 ' PAGES: 3 Axoedia~ ARa Name Tad Rdata Addrsn L~l T~-F'~i Inc. :90o S'~lvcr /eke ZoG. Alew $r~~k.{on ~ MN SS/l Z d Zo - 1 OE,q - 7O - oo p r.~i tdma~„ x~ 0'~ (~ZU-lO6Y-'ESO•-vUp O z o ~ ! v65 - ~JO - v av O Zo - 1070 - coo - ~jo 020 - to7o ,.lv -aUo U 20 - 1 p 7C'j - zo -~ °THIS PAGE IS PAST OP THIS LEGAL DOCD'i~p - DO NOT RFIIOV'E° ~ietawCps saq b~ oe~Lted bj, a~lmiaer~ ~osanau tlde ~4 noun addnn and N ~^t daara,fgd airy P~ on d~G "e lea Qoe+ow~t one We oJdlft ee~~~~r aw ~ ~ P~t~ ~~ Qoe~neu x wa7 ~ adddenaf ~ P'al~ +e ~w do~sw~av and Tl.IXI rs d1K m+e PQL~+ ~~s ~„ es Wireauia Swpe~, JD.Sl7. ANDA 2/916 r ' DOCUMENT NO. jj __ ww11N.,sxTY DE~n BTAT[ OF W18CON81N-FORM O • ~(1-.1662~~ 2~j TNI/'a~AC[ R[aMV[o FOR RacoROIMO DATA PF~AR30~N ENTCTRE, Madc b .RICHARD N. PEARSON and JEAN M. ' ............ ,husband and (t~ife, .. ................_.................... gtantor_S.. of..._St... Croix..._ ...................................................Countyy, Wixonsin hpteb conveys and warFants to..._~Rl?IAGE HOMFS XXI, INC., a Mlnn~sota corporation, ..............._......................- i~1asfi~ing£on .._..---...._._ ................................................... lgg~~~rautee........ of ......._ .........................._.._.---.._...................._........Count , ~( 0!?4_pollar,: and no 100 11.00 and other r^7ood and valuable fi; 1 ..............~...........~%'..........~............._.............1................................. R[TURN TO L r1 N(.1 T l T I S` • - ....;. CQ0.,~3d~K.?t~4(1 ............................................................... _. ................;iSli~:lyt13 /6jC`c Srlur/ Lttl~e 1~. ..._ ............._.................._......_.........._.._.................................._....._...........---..................... , S f 1 c C the following tract of land in....$1<...,_C[oig-.._....-•..... /L'E •~'' ~r ( J ~(~c,,J Nl ~l .................................Coontyty~~ i T// t Wixonsin: .~1~.I...4~..khe,-jVOS.>Rhw~S.t Q~tarl;er,,,i(~ry11;~..and_,{~Ior~h..Half (N~) of the Southwest Quarter (SW~) of Section Twenty-Five (251, Township Twenty-Nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin, 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. 518944. See Attached Exhibit A Parcel Identification Number This is not homestead property pn Witness Whereof the said grantor. S_ haVe...... hereunto set......... their hand 5... and sea15._. this .......... day ot.._~aY ........................................ A. D., Yp(..2001 _....._..... a76N1[D AND SEALED IN PR89HNCE 06 .................................... ~ ... ....~~ .(SEAL) .................................... "'(/ k-...0'Y~-~.......... (SEAL ) M:' ~t501v, .............. . I ........_ .................................................................................... (SEAL ) Sta~ic of .~,b00~spta ,. WaShltlgtwOn~t_ol~~unty, Personally came before me, this.~~:.`~:.- day of.. ~.'..~,, ,,,,,,,,,,,~ A, D., 14~..~Q,01 the above named ..RICFT.ARD N. ON and JEAN M. PEARSON 'husband and wife ........... to me known to be the Persolts.... who executed the foregoing instrument and acknowledged the same. T})18 INeTRUMENT As) O AF'tED T I 1~X-MOUNTAIN Richard J. Ga~rle~, #3264 •• tSt 880 Sibley Memorial N 6ALT Notary Public, . ~~~' ,KQT(~RY.PUBLIC-MINNESOTA sOqunty, Wis. Hwy . , # 114 My Comm. Ezp4ss Jan. 31,2005 SZ ate..a..r.... a.,.: 7~~~T a t:t:, , D-1736 ~`°'-"°''~"'O My commission (c1t [ (Section )9.71 (11 of tha Wiaomie StaNtn pro•idn That al( inatnrmemr to 6e retarded dull ba.e plainly printed or the namn 0( the ~rantora, aranteq, witnnan and notary. $ectloa )9.5(i timilarl7 requirn that the name of the bpswr'ttrn thueon tatatal aaenaT wMch. dnlted Rah inarumrM, shall Ir printed,ty perri!tcn, wmyed or wrillsn thnaon in a le ~k mannei.) aovrrro WARRANTY DEED STATE OF WISCONSIN ImR[1 No, [ Wlseerule Legal Blank Oampaay Yltwau[ee, Wle, (Job JJlill ) .. - ~ ~~~ 1G62P~~:291 EXHIBIT A Parcel Identification Numbers 020-1o69-7aooo 020-1069-80-000 020-1069-90-000 020-1070-00-000 020-1070-10-000 020-1070-20-000 ova. as 27 ~, 105, 542 SQ FT ~, 2.423 ACRES N Y N .' ~~~.~\ HW.L..=1021.0`> i ~ ~,_ r ~~ Z1~g4 ~~~ N ~\ ~; o, o~, ~,, ~ \\ ~ \\ \ ~\~ F ,~s's. ~~ 24 ~ ~~\~ 97,419 SQ F7 N ~\ ~ 2.236 ACRES ~~y N ~~ ~ _ ~\ 92,885 SQ FT v ~-- 26 '" ,\y 96,822 SQ FT ~ 2.132 ACRES 2.223 ACRES N ''' 1 ~ H Ud L =992 I 1 ~~ ~. • ~ --'' G . - -6g.4T . - 101.7 Ng1"4i'OTE 372.~1' ' ~ g19~` C 15 ~--_" - w rn ~ 67.pp' Sg1°41'0~'~ - . . a~~ X20 ' Sgt°g1'O7'JV 239.2~~ - - 6 -~ ~ ~ ~~ . . t~ - ~~ ~ • N ~ i i l .~ ~ S7 ' ~ ~ ~ 1 `\ ~ ~ 1012.0• ~' 89,122 SQ ET ~ ' ~ ndr; et,RFC ~ ~ f e~ w .~~~ TfiIS INSTRUtrIENT DRAT-fED EiY: ~'~'fLLlAtvl KAfVE JOQ NQ. 6050-Ot GATir. 06(07/Zpp1 f