Loading...
HomeMy WebLinkAbout026-1025-10-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division, INSPECTION REPORT Sanitary Permit No: 479482 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: _ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Family Home Builders, Inc. Richmond, Town of 026- 1025 -10 -200 CST BM Elev: I Insp. BM Elev: t BM Description: Sectionlrown /Range/Map No: Q op 1 C75 CST Qrl.16 2— 07.30.18.97C TANK INFORMATION ELEVATION DATA TYPE P MANUFACTU I� CAPACITY STATION BS HI FS ELEV. SIM • .�qr Septic V 1 � O Benchmarly(, / ((,``1I��' t Dosing Alt. C •6D . c TZ Aeration Bldg. ewer •a OR•yo Holding St/Ht Inlet % � to • / TANK SETBACK INFORMATION St /Ht Outlet 94 , • TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic + 12 t Dt Bottom Dosing Header /Man. [Hol ation Dist. Pipe 4 1 1 0 # 0 9Y- yO / Bot. System . O 7 O / ILib PUMP /SIPHON INFORMATION Final Grade dLoL Manufactu r Demand St Cover GPM ),C Model Num er 'z • o rt ors 7 •�� q9 �D TDH Lift N Friction Los System Head TDH Ft Forcemain 2 I I D SOIL BS PTION SYSTE 3 K4fTFTlENGW Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth D I M11q 9 r6 N S SETBACK SYSTEM TO P/L DG WELL LAKE /STREAM LEACHING Ma elureq� INFORMATION CHAMBER OR 'l—t Type Of System:�t 2-11 UNIT Model Nu DISTRIBUTION WSTEM (L.t�• GS� Heade anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pi ` / Len DO Length Dia Spacing S L COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only De ver Depth Over xx Depth of T eded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil i Yes �z_I No � Yes J No M�� fEjVT ( Incl e d iscrepe, i persons present, etc.) Inspection #1:Q 7i `� Inspection #2: ation: 902 160th, New Richmop WI 54017 (SW 1/4 SW 1/4 7 T30N R1 8W) NA Lot 2 Parcel No: 07.30.18.97C III / � �` (� L 1.) Alt BM Description 2.) Bldg sewer length = Z. - amount of cover Plan revision Required? Yes o I�� � Use other side for additional informa'oln � Date Insepctoi's Signature . No. SBD -6710 (R.3/97) l Safety and Buildings Division County - - 201 W. Washington e., P.O. Box 7162 5 ,s�On � Madison, WI 07 162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) q LE2— Sanitary Permit Applica Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal informat on you provide may be used for secondary purposes Privacy Law, s15. (1 xm) Proj ct Address (if different than mailing address) F t If I. Application Information — Please Print All Information (,o z l /O z6�v 7 L� t Property Owner's Name_ Par el # ZONING OFFICE 1 Block # Property Owner's Maill Address �y Prope Location 7 / t V., 15 M 'A, Section 7_ City, State Cr Zip Code Phone Number t title e) L T 3© N; R�E o W 11. Type of Ofuilding (check all that apply) � aQ t (A _ L 1 or 2 Family Dwelling - Number of Bedrooms _ _ Subdd'vis / ion Name 6,5-aya L 7 CSM J lumber lW ❑ Public/Commercial - Describe Use kA-4�, -S - / - V - )� / 7 ❑ State Owned - Describe Use h ❑City_ ❑Village Hvtsh' of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) 024, — 1 02 5=/o — Up C K Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of sut able soil ❑ At - Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: c — Z CiLus Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 1 /5 - 0 6vd 1 93,15 ' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Ibbca 0 0 0 t Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for in tallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Sign ure MPRS Number Business Phone Number Plumber's Address (Street, City State, Zi ode) Jl Aj V VIII. County/ e artment Use Onl &l Approved ❑ Disap ro Sanitary Permit Fee (include Groundwater Date Issued Is ui N ng ent Signature o Stamps) Surcharge Fee) El O oe Rn eason for`Denial (j IX. Conditions of rov R SYSTEM O R: 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. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) 3 p " J00 r 1, /DOD w GAO. � -� o /Ocso � ..c a -, l I �D a . w 6�j po ° ia6° 4 P-1 k X a P IE— C)3 A Wisconsin Department of Commerce SOIL EVALUATION REPORT P f J 2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �• o Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must 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. Please print all information. R Dat � q Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). J a Property Owner / /' Property Location G ICI - Ce j /\ eC/c A Oe �e G* Lot ,S4u 1/4J 6 - ) 1/4 S 7T J N R 15 •(or W Property Owner's Mailing Address ot Block # Subd. Name or CSIM /-S / 1,6,z 9 ffi City State Zip Code Phone Number v Ej City ❑ Village aTown Nearest Road N et, , RA h r— J I &T syo /7 1 (77-r) ZV 6- S3 73 New Construction Use: a Residential / Number of bedrooms /c Code derived design flow rate X D D GPD ❑ Replacement ❑ Public or commercial - Describe: — /� ft. Parent material � N Z �P� Z 7 %�� f/t� �i. �� Flood Plain elevation if applicable General comments P � � S yrte ��. X1 i j _ • rn r `, and recornmendations: Lf orx r E � E ❑ Boring WGOFFIC ��, Boring # • ® Pit Ground surface elev. S� 6 ` S ft. Depth to limiting factor / in. a t. 'll io;� -Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots " _ yGFD/ff ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 l 0 -4y L-S //1 G Ge . / 2 4 7R � /I/4- L J IMSS ^4- C 3 z -s3 7, y,� 6 A7 J of Z- g3• /S =----- ---- -- o � 2 Boring # a Boring ® Pit Ground surface elev. �7 �f ft. Depth to limiting factor 2 / in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I a- o y i A/ - I N L a Z c . 7 1.2 2 - ZzF / 0/ - X % AV 1 4fik I'F " I (f Ys2 7,� SIM Z ELY L /� lzcf 11 1 .2 • Effluent #1 = BOD 2 < 220 mg& and TSS >30 _< 150 ffQ& ' Effluent #2 = BOD < 30 mg& and TSS 130 mg& `Name Please Print) Sr �3 � CST N umber rl�.. crime /� d3— �� Address Date Evaluation Conducted Telephone Number /'P� 6 -/6 -6/ 7 --7 1 Y Lo-t 2 Property Owner kFe C i Parcel ID # Page 2 of F3-1, Boring # a Boring Q Pit Ground surface elev. 3 1 I ft. Depth to limiting factor 1� O in. J !*E!fl#1 -cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/fF In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#2 1 0 -/0 /oYk 4 /IS 3G . 7 1,2 Z j - 2 1 � D �y W,) 11 � 5 //nS r<r C w I 7 /12 y 5 64 2 a 7� Y2 J �,S /h — l -7 ld Z Fy� Bing # Boring ® Pit Ground surface elev. �, I � 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. •Eff #1 I •Eff#2 © DytJ/ ,rJ� i4o a les 3C ,7 11, Z - / -- Zz )Mljk 1 fi C G-- C 22 -51 7 S ;Q / 1 S /'l L G 4� /�i -.7 1,2 5` sy -iii , f kK Aid O Bori a Boring # 0 Pit Ground surface elev. 9 6 s ft. Depth to limiting factor ? f / Z in. P*Eff#1 l ication Rate Horizon Depth Dominant Redox Description. Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E{f#2 C � /Z'i A GS ry r C 7 2 1 f /j/ LS /r�s6k h►�r w Z C 7 1.2- Z 9/ 7Trk 6 IfI4 ALL Os /1-1 t- CC- 1 �-� s 7 � Z Effluent #1 = BOD, > 30 1220 mg& and TSS >30 1160 mg1L • Effluent #2 = SOD, 130 mg& and TSS _< 30 mg& 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. sso.asw tit j ' ,.MANER Page 3 of 3 Name e,-c- Id kte' A Oe 4 r Brian Parnell Address 19S— �A -r CST 231314 R. Chr',.,,O Date 6 A& Benchmark I ? AL Benchmark 2 TO ❑ Soil Boring Suitable Area 1 40' Scale AL 0. U CAIZOLI --4 . 031 D TT . .............. 116 - T 30 Fri -F-T i a i CERTIFIED ' 3URV MAP Located in Part at the Froctlonal Sauthwoat Quarter p( the 5outhwoet,Wwoptpr and port of the Nor haaot St. C r a of the Northwest quarter ah in Seetton 7, Tgwn hlp 30 North�,Mptangs 6 Woet. Town of Rlahmonct. St. Patt County, Wlaetmam North,' � Prepared for and at the raqueet at: jam; i! Cardd c Section Comer MOn II oht ,, Gaa�add A. Kisckhofer � uM Rd in Mille Ins. r f fieoard 186Stn S rae s 5ek 1,° w 24` Iran FjI p wal Inp Now Rlohmcmd, VA 54017 1.13 pounds per line WO fast Drafted by. Ty R. Bad%* ......... 4ullging &otaaak Wit! x(190' t of Way) a ��600NSj�r f i a'y � wsr 7vs N OOOG �* Sa:C74Y 7 A7-7a �ror,Alo �• Mrcw, s•24a4 h ^vLEAR M LA 11N , ov ^ PlATTE6 GIPS pF OWFIER j Ak��"U h1 4 j� No p6 u 656 W I C4 210.04' 210.6,4 C LOT 3 l Lo{ I 4 ' LOT 2 TOTAL 5 sod FT. iB ;So.' ! TOTAL AREA: 3.20 ACRES 3.24 A r j 1'38,255 5o. IrT. AREA M. ;Nro -* AREA K E �R­ Mk ! ! 3,20 ACRES 132.324 S0; Fry, 132,32 S0. x AREA EPIC. R -O-Wt 104 ACRES 3.04 Ai IiE to 132,324 SO, FT. y II I 3.04 ACRES $ o �y I I I r+f q ' � I t ♦ ~ 410.64' i �. 0 �° g 04' "u r ~ 2 0 64' .. 21 21 ". 2.10.0 ' t ,E4 ,� h18BYfd'52"E 9048.46 'CS62 MOAT -, .,...,' SGU7Ht1[ST - • ^•»5gg'00'3� °Yf T494 , _ -� 5aIC7AG1A/ 7- .7rHrA `` �17UW LAME AC SW 114 � , SttU1H &4 (MM AL&Od uNP -� T= LANDS SECT7LW r -JO fB tlil COt v W,vlWtlattiy --------- - I MX" A 4 r� , I NOTE'-: The portals shown on thin map ore auo)set to '$tat4, County and Township Iowa, rufos and regulations (i.e. wotlands, mitjlmum tat elt ®, oa, eps o parca" etc.). Before purchasing or developing any portal, cor,toct tha�SY. Croix County Zoning Office and the appropriate Town Ceara for advlaa. ,f0s M W16a7sU31 j Prepared by: tea too N � TH �E® CWtBt Q7DOi►, hIC �4R"NRHIC S ALE - Phan* 4..0. (715) 244,4319 SCALE IN FIE qT'. t In h v 160 fast ;`ax Na. (715) 244 - 311,30 BEARINGS ARE{ kFEA NUG TO THE %WTH LINE OF THE P,O. O 325 SW 1/4 OF IFggllQN TOWNSHIP 30 N., RANGE 18 W Naw Rktarlend, YM 5 +017 WHICH IS A,S>p;:l it BEAR SdR a5'52 - W. Sheet 1 of 3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner l Septic Tank Capacity /000 al ❑ NA Permit # �T p� Septic Tank Manufacturers ❑ NA DESIGN PARAMETERS O Effluent Filter Manufacturer ANA Number of Bedrooms ❑ NA Effluent Filter Model , j ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) o 6 al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA Soil Application Rate g al/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg /L El 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 *n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) s30 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: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) 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: j0 year(s) s) (Maximum 3 years) [3 NA ❑ month(s) ❑ NA Clean effluent filter At least once every: 9 year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) A ❑ year(s) Flush laterals and pressure test At least once every: ❑ ❑ year(s) month(s) ) m A Other: At least once eve ❑ month(s) A every: ❑ year(s) Other: A 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) Page of START UP AND OPERATION 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 dispersal 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. ❑ 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 �(r Name Phone S — _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name '37.Gip(K- CAN y �-Zorj/tJ Phone Phone 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 CERTIFICATION FORM Owner /Buyer ]� 0 rL Mailing Address S 7 l �/� . tz1-Z7 j 5/b Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 5 6U 1 /4 , ,5 14 1 /4 , Sec. 7, T 3 0 N R28W, Town of Subdivision // , Lot # Certified Survey Map # y 07 c /a �d , Volume 5 , Page # ys Warranty Deed # g /sl C , Volume 7 , Page # Spec house fyes) no Lot lines identifiable 4 io 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 (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms -7-/�/? A OF APPLICANT& 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) U, 2874 P 616 era4sie State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., III Document Number Document Name RECEIVED FOR RECORD 08/25/2005 02:30PH WARRANTY DEED THIS DEED, made between Gary B. Fletcher EXEMPT f REC FEE: 11.00 ("Grantor," whether one or more), TRANS F 192.00 and Family Home Builders, Inc. CC FEE: PAGES: 1 ( "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 Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space Estreen & Ogland is needed, please attach addendum): 304 LOCUSt Stre That part af IRW '/4 SW '/. and NE 'V, NW '/ Sec. 7- T30N -Rl8W described as Hudson, I 540 follows- of 2 f Certified Survey Map recorded in Vol. 15 of Certified Survey (S Maps, p e 41 a s Doc. No. 652926. St. Croix County, Wisconsin. 026 - 102$-10-200 Parcel identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -w yo ecord, if any. Dated it AZ Z�� � (SEA --`" (SEAL) * Gary B. etcher (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gary B. Fletcher STATE OF ) authenticated on 'Z U ) ss. COUNTY ) *Kristina O land Personally came before me on , TITLE: MEMBERS ATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Oeland Notary Public, State of Hudson. WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO - PRO"" Legal Forms 800- 655 -2021 www.infoproforms.corr+ w .� 652926 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FM REC - CERTIFIED SURVEY MA '6 - '4001 4:25 Pd Located in part of the Fractional Southwest Quarter of the Southwest Quarter and part of FOCO 14.00 Quarter of the Northwest Quarter all in Section 7, Township 30 North, Range 18 West. Towrtpffitgilchmond 3 St. Croix County, Wisconsin. Prepared for and at the request of: 1 Futon- 0ER Gerdd A. Kleekhoefer Q� Section Comer Monument Railing Hills Dak-v Inc. of Record 1628 95th Stree • Set 1" x 24" Iron Pipe weighing New Richmond. WI 54017 1.13 pounds per linear foot Drafted by. Ty R. Dodge • • • • • • • ... Building Setback Line (100' from Right of Way) APPROVED ST. CROIX COUNTY ! ' 9 11>£ST 11 4 CORMcR Planning Zoning and Pans Cr—:•rF -e r I O OU ND 1" N1P /PE) AUG 3 2001 If not recorded within 30 days of y UNPLATTED LANDS OF OWNEIRPproval date approval shall be m -------------- - - - - -- null and void cc V I N89 05 630.12' � j 210.04' 1 210.04' 210.04' I z o ° LOT 3 LOT 4 Z I z � C C ) \ a / TOTAL AREA: TOTAL AREA: w $ j 139,255 SO. FT. 139.255 SO. FT. C? m "AREA: 3.20 ACRES 3.20 ACRES ■ I r j 139.255 SQ. FT. AREA EXC. R -O -W: AREA EXC. R -O -W: N 1 a I 3.20 ACRES 132.324 SQ. FT. 132,324 SQ. FT. 3.04 ACRES (A z AREA EXC. R -O -W in o 3.04 ACRES w O° 132.324 SO. FT. en o o I c to y D in 3.04 ACRES °o o v 2 Il w rn w C" °- r1i r'I w � w w �i 1 w 3E o rn I `2 - rn C" iZ y w W w f w IM p] N ti N 10 I 1 I � ................. w 00 1 • W � • W b 1 i 1 - - C 2 - N89'OS'S2 "E 630.12' - 2 T� _ 210.04' _ _ �i _2 �NX GF1T -� WAY — 210.04' ` 210.04 r 210.04' �� N89 20 ` w ` S89'OS'52`W 630.12' — — — 1NE` + — — i - - •�, -_ - - - - 1f60TJY A VF/VL1E SOUTI/HEST CORNER - - 589 05'S2'W 2699.77' - SECAON 7 -30-18 SOUTH LINE OF THE SW 1/4 SO �4 C R (FOUND ALUM /NUM UNPLATTE LANDS (FOUND ALUMINUM COUNTY MONUMENT) ---- COUNTY MONUMENT) NOTE: The parcels shown on this map are subject to State. County and Township laws, rules and regulations (i.e. wetlands, minimum lot size. access to parcel. etc.). Before purchasing or developing any parcel. contact the St. Croix County Zoning Office and th pproprlate Town d for advice. JOB # VA057SU31 L��tlWIMIfI111 /,u�� Prepared by. ` "���a 1N" 15d 0 150 .�`�' ��c�C,ONg�� N TM J COV)3Wb1I� * :' • Ty R. GRAPHIC SCALE Phone No. (715) 246 -4319 DODGE - SCALE IN FEET- 1 inch = 150 feet Fax No. (715) 246 -3830 i S -2434 = BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE P.O. Box 325 = CLEAR LAKE, SW 1/4 OF SECTION 7. TOWNSHIP 30 N.. RANGE 18 W. New Richmond. WI 54017 Wi WHICH IS ASSUMED TO BEAR S89'05'52 "W. Sheet 1 of 3 � f • -- Q` O . Vol. 15 Page 4145