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HomeMy WebLinkAbout026-1007-20-000 .Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 515260 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Harris, Martin & Sara I Richmond, Town of 026- 1007 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: a Section/Town /Range/Map No: 161-0 /0(i a 1" l/�v �'I.t� JI�G+� 03.30.18.286 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / fT /0 17 Benchmark W !� 5• Dosing J�� O Alt. BM —T3p O L } 2 Aeration �( "I I ,. V Bldg. Sewer n' f Holding St/ t Ind t / 2, Itiy, 3 z TANK SETBACK INFORMATION f!1' t Outlet r- y, v'7 TANK TO WELL BLDG. vent to ROAD Dt Inlet Septic ,� 1 / �� �-/ Dt Bottom Dosing eader /Man. g Aeration 2. Yi Dist. Pipe �,7 fb. S@i Holding / U 0 Bot. System � � 5,5 dK Final Grade PUMP /SIPHON INFORMATION 1 3 ) — , t4A 4 o /m, Manufacturer Demand St Cover / �, GPM / . O Model Number TDH Lift Friction System Head TDH Ft � � �; � f�,� i � • 4 � � , n Forcemain Len I Dia. S 0 / �3 �7z SOIL ABSORPTION SYSTEM Q BED /TRENCH Width / Length / No. Of Trenches PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / b ZO SETBACK SYSTEM TO / P/L BLDG WELL LAKE /STREAM EACHIN Ma eture INFORMATION CHAMBER R Ty a Of System: L UNIT H T� !� Model Num er: c D . RIBUTION SYSTEM Header/ aQnifold ' / Distribution x Hole Size x Hole Spacin Ven to it Intake Length ` t Dia `1 1 Length Dia S g I / SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over 1 Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bedrrrench Edges Topsoil 1 19 Yes R No Fx Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: S // V Inspection #2: Location: 1206 Pinecrest Lane New Richmond, WI 54017 (NW 11/4 N�NW 1/4 3 T30N R1 8W) NA Lp � _ `" �{ t? ' t 4 JJ Parcel No: 03.30.18.288 1.) Alt BM Description = 4U(A— _4I 2.) Bldg sewer length II ,C / 0YJ^3 ICJ - amount of cover = r C41 Plan revision Required? Yes No Use other side for additional information. _ !� _ SBD -6710 (R.3/97) Date Insepctor's Si nature Cart. No M 4i l iA- commerce .Wl.goV ety and Bw dings Division Coun n 201 W. Washington Ave., P.O. 7162 t 1 s con s in Madison, WI 53707 - 71 Sanitary Permit Number (to be filled in by Co.) epartment of Commerce Sanitary Permit Application S ansaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate govemme r" unit is required prior to obtaining a sanitary permit. Note: Application form j�te_- -oed POWTS are ect Address (f different than mailing address) submitted to the Department of Commerce. Personal information you provde � i ; wn d for secondary 12 . } . ►. c (�� S 7 p urposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. ' {{// I. Application Information - Please Print All Information Property Owner's Name Parcel # 114� 1-4) � f��,�,� -; s `�hk' ���, 410 (9 ZZ -IU6 -46 -o 0 v Property Owner's Mailing Address t�Iy Property Location r ' An D A. Govt. Lot • !J City, State Zip Code Phone Number /t/by y. �6 /e, Section N; EorW e+^� �.3 � 7 Z 4 Z �O / l e i (• / L ' l ' Y� 3 ircle one) /l ; G {� /Ylr d l�- �.. �/�J R 11. Type of Building (check all that apply) Lot # LJ�1 or 2 Family Dwelling - Number of Bedrooms � T �'� 1 S �1 t is (/ `'� Subdivision Name d Block # A ❑ Public /Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number r_- Village of V o i Y VTown of , cA , " t A., i ZL s III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System y p y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New , List Previous n Permit ' Num t berand Date Issued Before Expiration Owner IV. Type of POWTS System /Component/Device: Check all that apply) X-Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component ❑ Pr lain) V. Dis ersal/I'reatment Area Informati - Cc 5 5 88 `� •'G s `yfA Design Flow (gpd) Design Soil Application Rate gp yytem Elevatio VI. Tank Info Capacity in Total # of Manufacture'(// Gallons Gallons Units n c New Tanks Existing Tanks o E R U v5 vn w 0 e e t r Holding Tank /Z- Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Business Phone umber's Name (Print) Plumber's Signature M P Number Number C.c t,1 L l�dw z Z /M Z- 6 �71- - 4`1' Z� PI tuber's Address (Street, City, State, Zip Code) VIII.90bunty /De artment Use Onl pproved ❑ Disapproved Per(miit Fee 00 Date Issued I El Owner Given Reason for Denial $ / ✓ 5 // �V 1, Conditions of pr vaVReasons for Disapproval SYSTEM OWNER: CILI lle sntu ll au es.lausi 1 Septic tank effluentlR* t§Ati plete plans for the system and submit to the County only on pa not less than a vz x I I pt919e3jtn#jju9nl4a 'Num lnri— dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained �3 SBUS6398 N.%5/89 tPft /ru Ices. i 3 A 6 o 0� a w L � ti All h ' 3 0 0 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: A,, ,/ :x Owner's Name: A c.7 L �x/_J Owner's Address: / 2- A r - ( i , C z, DL �JC /� cG+ .• A-C/ s y a d - 7 Legal Description: g7c. 3 O LA_/ Township: JC1 C4- ,�,., -, County: x Subdivision Name: Lot Number: 7 Parcel ID Number: o 2—G—/06 - 7 — Z 0 — d " Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross - Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenanc Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer /Plumber: f License Number: 2-1 Z- 8 Z— Date: — / / —/D Phone Number 1 47 2 — ZY-Z 1 Signature Designed pursu.,o to the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01/01). Page 1 O Z lot CV (N) a o t � A R U v. o � 1 W ..tD d l 1 Soil Absorption System Cross Section 9p ft Final Grade 4' Schedule 40 PVC Vent f / Q� Pipe _ 7 With Vent Cap Leaching /9V Chamber --► �qS ft System Elevation .3 ft T_ ft Soil Absorption System Plan View ft I 3- ft '57 ft Leaching Trench 7i Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber specifications Manufacturer And Model EISA Rating Zd 4 sq ft per chamber Soil Application Rate gpd /sq ft gpd Design Flow + • ? Soil Application Rate + Z 0 EISA = Y3 Chambers 2 rows of Z chambers each. j Page of w a, �. LL ,.n V N O Q O L �/ Q. 0 w e h- 0 R An C - G :. .... Z 7 � -~ a U y,p W C A L ' RI jSO L � o >oo�u- o , owe o Y is =v yy u � c V •d• d Y f7 A d • r N A m 2 U a r a� L UX t u 0 IS M S Z do ma E M A d [ 0 d d N •O a Z F"' w O 4n F y 'a E cl Z Y r d 'a is V �n • C T O p• a t a L 3 G L d d d E s+ T a• & a L- �o43a 7�0 CL Q T V H � `p_ W N � A V 16 — O_ Q a W a t + m 2 !' h O Hq 6 d O a C d C G m m. c alv�iw 1 cos m rm O�� d w a d d W y k �' Y 1 Y ■ IL a s a a d •p Q! 1 1 V! C E e vs cd°od 1 «o -► � o 1 .. 1 O _ T a- o •,� c. 0 o Y 1 K a 1 Q £ V N A t � E !• v � © N i d m o N K 147 O y U4� u,e a C � 1 r.j 1 .� O C O 1 Q a ' r r "daa • ' + 1 1 I ra W � e. r a v' L c7 1 v� • ,�. 1 N V h C 1 F� I INGROUND SOIL ABSORPTION MANAGEMENT PLAN PURSUANT TO COMM. 83.54, WIS. ADM. CODE General This system shall be operated in accordance with Comm.82 -84 Wis Adm. Code and shall be maintained in accordance with its component manual [In- ground Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (n.01 /01) and SSWMP publication 9.6 (01/81) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic tank or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm. 83.33, Wis Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed and watertight upon the completion of service. Any opening deemed unsound ,defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis Adm Code. 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of the triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maxium scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Dept. of Commerce. Pump Tank The pump tank shall be inspected at once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Soil Absorption System No trees or shrubs should be planted on the absorption area. Plantings may be made away from the cell's perimeter, and the area shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than foot or for vegetative maintenance) on the area is not recommended since soil compaction may hinder aeration of the infiltrative surface within the system and snow compaction in the winter will promote frost penetration. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired of replaced with a component of the same or equal performance. If the dispersal area fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Replacement in a suitable area nearby is also an option at which point a diversion valve will be installed between the old and new systems to allow dispersal cell rotation at a schedule to be determined at the time of cell replacement. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address 1 Z U(, Tjr-C ej — car' -4 ttom; T ice Property Address (Verification required from Planning & Zoning Department for new construction.) City /State /Lew l - c A,,., a � e/ L lti y Parcel Identification Number -2 - 00 ' � 0 06 D LEGAL DESCRIPTION 1 Property LocatioW '/4 , ; Ili L '/, , Sec. , T �P NR /e W, Town of Subdivision Plat: , Lot # r Certified Survey Map # , Volume J , Page # Z 3 Warranty Deed # �� f (O 5 42 (before 2007)Volume , Pale # Spec house yes Lot lines identifiable yes i no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than U3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we ain/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms r -J S1 SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of ?� FILE INFORMATION SYSTEM SPECIFICATIONS Owner } - N k � ti s Septic Tank Capacity ' Qv al ❑ NA Permit # �7 J/ 5 Z Septic Tank Manufacturer S /YN ",,,, ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer r4� 7 ❑ NA Number of Bedrooms 4 1 ❑ NA Effluent Filter Model r��d ❑ NA Number of Public Facility Units -0'I l�A Pump Tank Capacity a l •-EMA Estimated flow (average) 40 g al/day Pump Tank Manufacturer -6 Design flow (peak), (Estimated x 1.5) 475 g al/day Pump Manufacturer 43 Soil Application Rate t - 7 gal/day/ft' Pump Model 0 Standard Influent /Effluent Quality Monthly average* Pretreatment Unit C1 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L -49-MA ❑ 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 keIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ANA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu 1100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. -EMA 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: 3 monthls) (Maximum 3 years) 13 NA y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume [3 NA Inspect dispersal cell(s) At least once every: Z ❑ month(s) (Maximum 3 years) [03 NA year(s) Clean effluent filter At least once every: 1 (� 13 yea�(s)(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) [3 NA � .0 Flush laterals and pressure test At least once every: Z month ❑ NA Y Other: ❑ month(s) [3 NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master 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 cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (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. GMW (4/01) I P 21 - Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O Z L - p D 7 O Please print all information. R�eewe;d b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)). 7 A) Property Owner ) Property Location /11 Gr i GT 11/ 1c cf Govt. Lot f�l w 1/4/tA J1 /4 S 3 T 3 b N R/,6 E (or) W Property Owners Mailing Address Lot # I Block # Subd. Name or CSM# 6-IS DA- v0f Pg 1 Z� City pQ State Zip Code Phone Number ❑ City ❑ Village [B Town Nearest Road lvi yYoe (l�1Z ) Z 3L - 8962 �` d' ❑ New Construction Use: OrResidential / Number of bedrooms Code derived design flow rate 6 0 0 GPD �teplacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable R. General comments 9.5. and recommendations: ` Boring # Boring Q 6Z Pit Ground surface elev. ft. Depth to limiting factor > / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E I *Eff#2 ys 7 VY" F�] Boring # E] Boring } a R pit Ground surface elev. 98 3 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 j 1 3 J7 / R Y2 - /D -Yl S o s .-� • 7 ! z * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N (Please Print) Signature CST Number Gt C 14 t d w 2 Address Il Date Evaluation Conducted Telephone Number 2 t 1 ��. i�aG �� Syg53 7 /o Y 72, -2 I Property Owner �' ' ` Parcel ID # Page Z' of 3 a Boring # ❑ Boring 98 8F f t . ® pit Ground surface elev. ft. Depth to limiting factor U U in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 `8 t o "r "'/ --- S 1 l ��,� a s a i/- 1P a - X 4 S l K vim- a �3 ZZ :3 / s> /.m �x �- as ��' •41 4 3� 88 04./ - o .�. 1 -- . - 7 �. z E 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring F El # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff 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 < 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 (R07 /00) C4 El �1 QI— —� \ a 1 z � 4 l J r N N � N i 1 f fflfNll f fllflf flfif lfiff ffli! ffifl If1ff I!1 ! ! I! 8 5 1 3 6 0 2 State Bar of Wisconsin Form 2 - 2003 851360 WARRANTY DEED KATHLEEN N. WALSIi Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 05/25/2007 11:00AM THIS DEED, made between Gary H. Baillargeon and Bonnie F. Baillargeon, WARRANTY DEED husband and wife EXEKPT t ( "Grantor," whether one or more), REC FEE: 13.00 and M g j tin P Harris and Sara M. Harris, husband _ TRANS FEE: 960.00 and wife PAGES: 2 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Title Recording Services, Inc. 520741 interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is 79 western Ave N needed, please attach addendum): St. Paul MN 55102 �L 700026 ST. CROIX A TOWN BASIC 026 -1007- 20-000 Parcel Identification Number (PIN) This _ homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated i Z- KA4kX -Uf '7. (SEAL) (SEAL) .Baillargeon (SEA (SEAL) * onnie F. Baillargeon AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gary H. Baillaraeon and Bonnie F. Baillargeon. husband and wife STATE OF ) authenticated on Z ) ss. j� COUNTY ) * Kristina !20and Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Ogland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS 1S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO- PRO'm Legal Forms 800- 855 -2021 www.infbprofonns.com 1 012 EXHIBIT "A" Part of NW /14 of NW 1/4 of Section 3 -30 -18 described as follows: Lot 4 of Certified Survey Map filed March 23, 1983 in Vol. 5, Page 1263. Together with and subject to roadway easement described in Vol. 1, Page 65. 2of2 FIL MAR 231983 ssgw of O..aa ' A Wh000h '�► 3 8 3425 £ z 5T. CROIX COUNTY CERTIFIED SURVEY MAP LOCATED IN THE NW4 NV-L SUCTION 3, T30N, R W, TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN N 0 30'0.2 " 3 50.00' o 1 0 4 : �. /g 46 3 4 O SEMENT 2' 0 ' a N!w, COR. Caun/TR r — A =1.32 qc 1 P-4Rk P4AT ° Excl. . ° a_�_ ° fl RpulY• yA Go N `fl EASEAIEAlT 1 16 S c M O A o � 92a � N48 ° 3Z'B 3 `y� yh � . �'0 �� 5 2q °51 ORE _ q 11-0 40 0. � ' q I yA- � s 100' 0 100' 200 00 Scale: 1" = 100' Bearings referenced to the North LEGEND line of the NW4, Section 3- 30 -18, s 1" Iron pipe in place bearing N 88 0 44' 00" E (Country 0 1" Iron pipe placed Club Park Plat). 24" long, 1.13 lbs./ft. NOTE: This is a resurvey of C.S.M., vol. 1, page 65, Lot 4, with the triangular portion below the SURVEYORS CERTIFICATE dashed line being added. I hereby certify that I have surveyed and mapped the land shown hereon at the request of W. T. Doar, Jr., agent for John Doar,-owner, and that the following is a true and correct description of said land. A parcel of land located in the NW4 of the NW4, Section 3, T 30 N, R 18 W, Town of Richmond, St. Croix County, Wisconsin, further described as follows: Commencing at the Northwest corner of the Country Club Park Plat, City of New Richmond, Wisconsin; Thence South 0 degrees 46 minutes East 1429.0 feet along the West line of said Plat; Thence South 89 degrees 19 minutes West 1175.95 feet; Thence North 0 degrees 36 minutes West 161.68 feet; Thence North 48 degrees 32 minutes East 317.13 feet to the point of beginning; Thence continuing North 48 degrees 32 minutes East 19.06 feet; Thence deflecting right along a tangential curve, radius 286.48 feet, central angle 24 degrees 11 minutes 16 seconds, chord length 120.04 feet bearing North 60 degrees 37 minutes 38 seconds East, 120.94 feet; Thence North 12 degrees 30 minutes 02 seconds West 350.00 feet; Thence South 55 degrees 28 minutes 17 seconds West 216.01 feet; Thence South 33 degrees 23 minutes 52 seconds West 43.73 feet; Thence South 44 degrees 05 minutes 40 seconds East 113.02 feet; Thence South 24 degrees 52 minutes 40 seconds East 190.78 feet back to the point of beginning. This parcel is subject to a 16.5 foot wide roadway easement as shown. I have complied with all the provisions of chapter 236.34 of the Wisconsin Statutes in surveying and mapping the above described land. The mdp shown is a tr�,q„a>fd,,gorrect representation of the boundaries of the above described land. �.� *��sc oA , Mar. 10, 1983 ' Charles S. Djock - Re CHARLES Land Surveyor ' DJOCK S -1091 EAU CLAIRE = WIS. VOLUME 5 PAGE 1263 '. Cy,� •' •. • • • • MAPS CERTIFIED SURVEY