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HomeMy WebLinkAbout020-1454-00-108 I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: $t. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487911 0 4 GENERAL INFORMATION (ATTACH TO PERMIT) g State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 1 __Foil fi.4 Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon Hudson, Town of My l i-t ±! —Z-10t CST BM Elev: f Insp. BM Elev: BM Description: Section/Town /Range /Map No: 100 ■ o boo ,o' l of , puC_ 0 , CS! ►�uA ( 36.29.19. TANK INFORMATION 1 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 60/p Erg .0 Ie- , \ Septic Benchmar +. ` w t �s� 1250 1 0. I icc Dosing (� Alt. BM r — k ) 2 . ° S ` 1 . 10 Aeration \ -- -- Bldg. S r (, f Holding � � >� St/Ht Inlet / -7_ �2 T 93.3 St/Ht Outlet / TANK SETBACK INFORMATION 7 --7 ' 1 s '3.24) TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ..________—. Septic - '• (4-) 3 3 r Dt Bottom l0 Dosing Header /Man. g — ��� 12.34, ' Aeration \ Dist. Pipe 'c" Kr t Holding Bot. System Ell D / / /, Final Grade r 3S � % r PUMP /SIPHON INFORMATION 7 ° Manufactur- Demand St Cover _..— �___...„ „„ GPM 3' 77 ..3c Model Numb- /✓'-- TDH 1Lift F"'ction Loss System Head TD Ft Forcemain ength p ia. Dist. to Well SOIL . :RPTION SYSTEM • !„,,„,,L,,,,, • idth ( gt r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN -. CI J RV r 2 l SETBACK SYSTEM TO , P/L BLDG WELL LAKE /STREAM nufr. INFORMATION CHAMBER LEACHING OR Ma (�t/�.�acture`C.�� Type Of System: S��/ .1 p' / ` UNIT Model Nut ( V a J !\ Jl �K � DISTRIBUTION SYSTEM • Header/Manifold . Distribution x Hole Size x Hole Spacing Vent to Air Intake y/ Pipes) �_ ---• > GO f Length Dia ` Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I j Yes ;] No 1. -1 Yes (] No C rl f 5:,, (Inc ce�ode discrepencies, persons present, etc.) Inspection #1: ( -- / C 77 . • 7-1 112--COS --- Inspection #2: / / Location: Hudson, �WI p 54 L 016 (SW 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 2nd Add Lot 108 Parcel No: 36.29.19. 1.) Alt BM Description = To? o�• k-M+a -- • 2.) Bldg sewer length = 3 r r - amount of cover = (p 4 3) wstc,:Ms Use other de for in Yes No 1 � 2 7 formation. DC 2 - _ Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) / 1/,. Safe `t' • uild = b mpiop tY / 201 ` W' o Ave., P. 3da Wu` 677 C score . t • y'` : 7 - 7082 ' • anitary Permit Number (to be filled in by Co. . Department of Commerce Nc CO 4 10 . T. '3/ Sanitary Permit Application �~ FT, 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, s 15.04(1 Xm) Project Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Name �� icel k Lot M k Y K � o S Property Owner's Mailing Addr 6/118 � Pro Locap /�(� City, State Zip Code Phone Number `J in, �" " Section // .cyo 42 '306 7 T d F ! /circle IL Type of Building (check aU that apply) N; R E of W • th or 2 Funny Dwelling - Number of Bedrooms S Subdivi' n Name CSM • ❑ Public/Coramercial - Describe ' Use C�J �`�' /�1 �¢ �� ❑ State Owned - Deecn'be Use ❑City_❑ i llage wnship of ILL Type of Permit: (Check only one box on line A. Complete line B if applicable) (4/5 - 71 A. 'New Systern ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• ❑Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Numbs and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that a..l dgrAr atig A Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable so 1 ❑ Mound < 24 in. A suitable soil ❑ At-Grade ❑ Single Pus Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Uoit ❑ Recirculating Sand Filter ❑ Reecirculatin S •thetic Media Filter s • cachin : Chamber ❑ Dri. Line ❑ Gravel-less Pik ❑ Other (explain) V. Dis • ersal/Treatment Area Information: frAli ' t fP Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal ea Required (sf) Dis • Are • po ...;, ' ystem Elevation ' 6 00 r 7 85 : = % 8 /.ao. /, O.S– r VI. Tank Info Capacity in Total Number Manufacture Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glus New Existing Tu Tanks Septic or Holding Tank Plig l015O _1E21111 D osi ng Chamber unit D -_ -- Dosing _ --- VII. Responsibility Statement 1, the undersigned, assume responsibility fort llation of the POWTS shown on the attached plans. Plumber's (Print) Plum Si azure _ j MP PRS Number Business Phone Number Pr (/ /- •WC ?s7 74-5 - a6 g-- 499.5 Plumber's Address (Street, City, State, Zip C c) VIII. County/Department Use Only `% Approved ❑ Dissp.roved Sanitary Permit Fee (i ludes Groundwater Date Issued Issuing :ent Signature o Stamps) Surcharge Fa) — 5eP r- 29 \ 1 ❑ eeuo • g enial Ja IX. Conditions • ppro --� ; �1 ' SYSTEM OWNER: 1 Septic tank, effluent filter 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. J3.dr .,7' i410--k3-02.5--61444A,+-* /J - il / 95 67 --1/ apia-erg 1 _7- - bo-f /08 P J3/x l /Do 1 7- . 3/q g iOvc_ BPI 7 99,26' TV 9 4 1 ` li/c 5 S sa l i l t = 9), o5 a2:2 _/ aS0 r S eq c* - in 1 r per x 44 I r - Fa - - 6 V 7 gip L` (7 .5/ 9 /,os I _i t �,l L: sa_2( ► / q ►, 1 ® , ® 33 6) -7S GO - o L '?/ - ail ro-o-(AA -7 , 1 , d 0 - 1Jd le- k C - 02 .5 eaLr2,4-PL . 1 p /v it 95 q - P . /4 ) /DU 71 3/� �v( (§) BPI . 3 - y ?o' T 34r ,Uc_ 5 s i2j , " --:* l 91,06 a? ,) —1 RSD r r. cee c_--k-61 it 1 i ---1 -F6-, ..... ,‘, 1 a k, 4 - 5-/ 6? 1-/ 5V 9/ o6- ( c -- I --(-) $'-'- ..., 3 1 1 6,,,,, eido,„ , ' � V, 4. onsln SOIL EVALUATION REPORT Page 1 of 3 #1634 Department of Commerce in accordaice with Comm 85, Wis. Adm. Code 9 Division of Safety and Buildings Steel's Soil Service, Inc. County Attach complete site plan on paper not Tess than 8% x 11 in ' size. Plan must St. Croix include, but not limited to: vertical and horizontal reference p 'n ), direction and percent slope, scale or dimensions, north arrow, and location a d 'stance to nearest road. Parcel I.D. Pending Please print all information. a we. By �7 mo o, , Date Personal information you provide may be ised fo G elyriva `aw, s. 15.04 (1) (m)). S • 29 c Property Owner Property Location Bast, Kernon APR 1 3 20-05 Govt. Lot na SW1 /4, NW1 /4, S36, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 948 Labarge Rd. ST CROIX COI INTY 108 na Cottonwood Ridge 2ND Addition City State Zip Cog)NI(iM@1 Ftl ber City ❑ Village M Town Nearest Road Hudson 1 WI 1 54016 1 715 - 386 - 7775 Hudson I Cty Rd N ❑ New Construction Use El Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: na Parent material Sream terraces and pitted pui /1 p /4,hs Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 91.63ft. Trenches spaced and depth to and recommendations: code 5.42ft below grade. 1 Boring # El Boring ❑ Pit Ground surface elev. 97.05 ft. Depth to limiting factor 120 in. Soil Application Rate) Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color *Eff#1 *Eff#2 1 0 -18 10yr3/1 none 1 2msbk mfr cs lvf .6 .8 2 18 -35 10yr4/4 none sl 2msbk mfr gw na .6 1.0 3 35 -56 10yr4/4 none sl 2msbk mfr gw na .6 1.0 4 56 -120 7.5yr4/6 none cos osg ml na na .7 1.6 of %pS / 72/1o$ 2 Boring # Boring ® Pd Ground surface elev. 97.05 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color *Eff#1 *Eff#2 1 0 -24 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 24 -55 10yr4/4 none sl 2msbk mfr gw na .4 .6 3 55 -120 7.5yr4/6 none cos osg ml na na .7 1.6 -72 / / _ * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5 < 30 mg/L and TSS <30 mg /L CST Name (Please Print) . . ure: CST Number f i ❑� David J. Steel , -� 248956 Address Steel's Soil Service, Inc. ` Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/10/2005 715 760 - 0347 SBD -8330 (R.07 /00) . Property Owner Bast, Kemon Parcel ID # Pending Page 2 of 3 3 Boring # II] Boring ❑ Pit Ground surface elev. 96.85 ft. Depth to limiting factor 120 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 *Eff#2 1 0 -24 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 24-47 10yr4/4 none sl lcsbk mfr gw na .4 .6 3 47 -120 7.5yr4/6 none cos osg ml na na .7 1.6 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # El ❑ 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5 < 30 mg /L 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 (8.07/001 Steers Soil Service, Inc. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Kernon Bast 994 200 St. CST - POWTSM SW1 /4,NW1 /4,S36,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. CeII (715) 760 -0347 Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449 Lot,108 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N 1 " = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe mil = Alt Benchmark Ele. 99.70 ft Top of 3/4" pvc pipe --� ❑ = Borings Boring Elevations B1 = 97.05 ft B2 = 97.05 ft B3 = 96.85 ft / B4= 0.00ft IVO / j � 1 if,rik . • 1p 9 \ - I 4 /0 . 7" , 4 � • . o I 104 co 1 — X LOT 96 x - • ,i),-,' X , :. , 216.84' c 2.00 Acres 1043.1 • D EDICATED TO THE PUBLIC o m I.B.A. = 2.0 AC 135 282.73' `° — — _ ! • . : / . . . . . . . . . . /1 041.1- \ / -- �� X 1 I r .4 / �1• / X • / �� / '/ • ' 1040 / 1 / LOT 110 tio, / 2.03 Acres ° LOT 111 / 2.01 Acres • 1 / N.B.A. = 2.0 AC N.B.A. = 2.0 AC I LOO / / X I -- . 1040.7 A/ ■ i / . • 't.Y / 35' 9 9. X I 1040.4 I : i :: X LOT 109 1038.7 22 Sg � • i 9.5 I 2.01 Acres N.B.A. = 2.0 AC WEST 1/4 LINE OF SECTIOR36 --- 0 4 1039.3 ($ o I - o CM . - • - • . LOT 11 : m I .1 Acres r I x N.B.A. = 2.0 AC X d©T : I / - • 1037.1 1037.1 — — — hi, 50.00' 6 e� , 414.54' o \ -. ROAD LENGTH 196' +I fill \ DEDICATED TO THE PUBLIC c' N \ 4 .00' I 1037.1 /•,-- \ X / 1036.4 X l W ' K r �f i X 103,. _ • LOT 107 ( -1 . . ' - - _ 2.03 Acres io I • cp . - N.B.A. = 2.0 AC 1 LOT 106 g2,, M d si 2.02 Acres o�' I 10. N.B.A. = 2.0 AC 17 x . - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner 3- Septic Tank Capacity /957, gal ❑ A A Permit # /Ip ` I' 0 { Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer M - �D k. ❑ NA Number of Bedrooms 1/ ❑ NA Effluent Filter Model fL ' S'Z.- ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ft NA Estimated flow (average) / d 0 gal /day Pump Tank Manufacturer ?DNA Design flow (peak), (Estimated x 1.5) 6 gal /day Pump Manufacturer ?DNA Soil Application Rate r 7 gal /day /ft' Pump Model ANA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit JA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection . ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event • Service Frequency Inspect condition of tank(s) At least once every: OR ❑ month(s) kyear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA R[ year(sl y Clean effluent filter _ At least once every: / - 11 ❑ NA I. Inspect pump, pump controls & alarm At least once every: ❑monthls) ❑ NA . ❑ years) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA O year(s) Other: ❑ month(s) At least once every: ❑ year(s) ❑ NA Other: 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. • START UP AND OPERATION Page Z of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. Iv T slue . .. -... . . . .. _ . . • - o • ing tank b. •. - • - • . . . .. ■.f.A.Thr e ai e• • • .. . ? TI fbb - A/61../ CaNST7e JC .1 orJ 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. • ADDITIONAL COMMENTS • POWTS INSTALLER POWTS MAINTAINER Name 1177,-Ael Name Phone 7/5 az S,. CP S Phone • SEPTAGE SERVICING OPERATOR (PUMPER) _LOCAL REGULATORY AUTHORITY Name Name 5 Cteo (V ( thy 2o f iij - Phone Phone — 1 /S 3 g q( so This document was drafted in compliance with chapter_Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;RTIFICA T ION FORM Owner/Buyer ,e,o6/� Mailing Address 71/r L40,ergEoeel eci3OX=91/ ! t // 5V L Property Address -t.tn (Verification required from Planning Department for new construction) City /State • 14(Gere9/ IV/ Parcel Identification Number ,e2 01 LEGAL DESCRIPTION Property Location 'SG'( ' , ) 'A, Sec. 3(e, T N R /e1 W, Town of hi - Subdivision K177 ' 2.40 , ''7AR) , Lot # / o2r Certified Survey Map # , Volume , Page # . Warranty Deed # 7e-ice") , Volume G2 -23 , Page # . Spec house 0 no Lot lines identiftablses 0 no SYSTEM MAINTENANCE Improper use and mamtenanceofyour septic system could result in its premaauefailuaeto 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. Crone Zoning Department a cation ftnm, signed by the owner and by a nsaster Plumber,]oumeymanplumber. restrictedplu tuber or a licensedpetmperverifying that(I) the on -site wastewaterdispoaal 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 requires 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 sating 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 expired date. TORE F APPLICANT DATE OWNER CERT FICATION 1 (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, / . • of a warranty deed recorded in Register of Deeds Office. DATE " Any information that is mis -reps may result in the sanitary permit being revoked by the Zoning Department ssswc: .. 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 • U 2 7 3 9 P 3 1 6 '7861 (2, KATHLEEN N. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/28/2005 03:15PN WARRANTY DEED THIS DEED, made between Neil L. Wilcoxson and Mary Jo E1 # Wilcoxson, husband and wife, Grantor, and Kernon J. Bast and Donalda J. Speer -Bast, husband and wife, Grantee. REC FEE: 13.00 Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 4212.90 COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A • Recording Area Name and Return Address: Edina Realty Title, inc. 400 S. 2 nd St. — Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 456780 . 1— 1•— — 1 • 020- 1110 -30- 000... 020- 1109 -55 -050 Parcel Identification Number (PIN) This is not homestead property. Dated this 28 • •r: y of January, 2005. ./ A /did r!" /I1 ( L. Wi cox '. * Mary Jo i oxson * tows' AUTHENTICA A, Ub D ACKNOWLEDGMENT Signature(s) No t '�k , SC Cr S1 � . � � ;.� STATE OF WISCONSIN ) c } q' ST. CROIX COUNTY. ) ss. authenticated this 28th day of January, 2005 Personally came before me this January 28, 2005 the * above named Neil L. Wilcoxson and Mary Jo Wilcoxson, husband and wife to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN , • , execut .le fore • oing instrument and acknowledged the same. (If not, i t /. authorized by § 706.06, Wis. Stats.) / THIS INSTRUMENT WAS DRAFTED BY *Chen =Town Notary Public, State of Wisconsin Peterson, Frain & Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 3/11/2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 . U 2739P 317 • EXHIBIT A Parcel 1: A parcel of land located in part of the SW Y4 of the NW 1/4 and part of the NW 1/4 of the SW '/a of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; more particularly described as follows: Beginning at the W '/, corner of said section 36; thence N00° 16' 10 "E, along the west line of the NW '/ of said section, 1248.49 feet to the north line of Lot 1 of Certified Survey Map recorded in Volume 3, page 669 at the St. Croix County Register of Deeds Office; thence N63 °02'59 "E 148.42 feet to the north line of said SW ''/ of the NW '4; thence N89 °26'58 "E, along said north line, 1182.70 feet to the east line of said SW ''/ of the NW 1/4; thence S00 °21'37 "W, along said east line, 350.04 feet to the north line of Lot 73 of the Plat of Cottonwood Ridge First Addition recorded at said office; thence S89 °26'58 "W, along said north line, 10.00 feet to the west line of said plat; thence S00 °27'24 "W, along said west line, 2096.76 feet to the centerline of County Trunk Highway "N" and a point on a 1999.00 foot radius curve, concave southerly, whose central angle measures 7 °10'30 ", whose chord bears N84 °30'41 "W and measures 250.16 feet; thence westerly, along the arc of said curve and said centerline, 250.33 feet to the point of tangency; thence N88 °05'56 "W, along said centerline, 83.64 feet to the point of curvature of a 2700.00 foot radius curve, concave northerly; whose central angel measures 3 °17'53 ", whose chord bears N86 °26'59.5 "W and measures 155.40 feet; thence westerly, along the arc of said curve and said centerline, 155.42 feet; thence N04 °29'56 "E 244.01 feet to the point of curvature of a 167.00 foot radius, concave westerly, whose central angle measures 34 °24'12 ", whose chord bears N12 °42'10 "W and measures 98.78 feet; thence northerly, along the arc of said curve, 100.28 feet to the point of tangency; thence N29 °54' 16 "W 274.22 feet to the easterly extension of the north line of Lot 1 of Certified Survey Map recorded m Volume 12, page 3456 at said office; thence N89 °' 12'45 "W, along said easterly extension, along said north line, and along the westerly extension of said north line, 670.44 feet to the west line of the SW ''4 of said section; thence N00 °37'50 "E, along said west line, 496.89 feet to the point of beginning. AND Parcel 2: A parcel of land located in part of the SW '/. of the SE '/ of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; described as follows: Beginning at the South '/, Corner of said Section 36; thence N00 °27'05 "E, along the north - south ' / line of said section, 1216.78 feet to the centerline of County Trunk Highway "N "; thence S76 °47'47 "E, along said centerline, 1354.82 feet to the east line of said SW ''/ of the SE ' /.; thence S00 °07'02 "W, along said east line, 897.02 feet to the south line of the SE '/; thence S89 °33'25 "W, along said south line, 1326.80 feet to the point of beginning. • • 3ord�o 0 oz . AIN °pa XI 1 N s0 Z to g z Nrlr g @ate a r N ; a; I 1 I PI U Q; o g �3 Z , 96 NW33Si01/4NN3111 1 I 1 if �r�� JoNtMSaNldo3Nntsv3 g _ y 1 SS; . 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