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HomeMy WebLinkAbout026-1137-20-000 r — — Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division .0 INSPECTION REPORT Sanitary Permit No: 420323 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: Halle Builders Inc. I Richmond Township 026- 1137 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: /da. D I 3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � � Benc C� a Dosing (rcl Alt. BM /� -�D d �d� .u.►� R t� i� 3 � Aeration Bldg. Sewer Holding SUHt Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO , 1 P/L WELL BLDG. FVentto Air Intake ROAD Dt Inlet Iv 0 Septic , It oo , i tl, Dt Bottom Y Dosing Header /Man. 9q -73 Eldin Dist. Pipe p k : y. Q �(,3 Bot. System ( c, i, '� ! L o Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover M N'r' 3 /o /. Model Nu ber 2 -- 9 /aa "7 TDH Lift on Loss System Head TDH 3 " as •� S, � /Do � Forcemain ength Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO v / P/L JBLDG IWELL ta4 LAKE/STREAM " Man r r: INFORMATION CHAMBER V Typ Of System: / ! > r Model Number: DISTRIBUTION SYSTEM 4atnd $M2 un �.aTam /cev._�iz. d Header /Manifpl i , (� Distribution t�- , I x Hole Size x Hole Spacing Vent to Air Intake K r • J • � T _ �' Pipe(s Ind — �/r ! Length Dia Length / Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only s Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center S Bed/Trench Edges Topsoil Yes � No �*, Yes [g No COMMENTS: (Inclu e e discrepencies, persons present, etc.) Inspection #1: 1 Z l 1 P 2 f 7 q Inspection #2:4L Location: 1083 148th Avenue New Richmond, 17 w \ } Parce o 0.30.18. chm d, WI 540 (SE 1/4 NE 1/4 20 T30N ) olf ie res L�� 4� 1.) Alt BM Description = D� ��4� 1AXII S B�(� S 0 1� - _3 r G� ec.t w rte- (04-4"4 4 1, 2.) Bldg sewer length = 2 V # # A (� C,1 7 �1 ` vGw_4,# 4 Al : 5 1 N�,3 �ypK4e4 amount of cover = / �/ n "" - Plan revision Required? Yes No � O � - — — - - - -- —' — J Use other side for additional information. 1 3BD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 *isc onsin Madison, WI 53707 - 7082 Site Address Department of Commerce /0 $3 A T Sanitary Permit Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Check if Revision may be used for secondary purposes Privacy Law, s15.04(1)(m) I. Application Information - Please Print All Information State Plan I.D. Number Pr ope Owner's Name Parcel Number /o /2 - �o Property Owner's Mailm Address �C CE ProperV_Location y G �S4N �k; S o T 3t� N, R// E City, State Zip Code PhQm Nt%er Lot Number Block Number v I�IU u TY Subdi into Name CSM Number CROIX COON AW- 444"1 wl e II. Type of Building (Check all that apply.) ❑ City ❑ 1 or 2 Family Dwelling - Number of Bedrooms ❑ Villa e ❑ Pubhc/Commercial - Describe Use g ❑ Townshi ❑ State Owned Nearest Road III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A7 10 New 3 ❑ Replacement of 6 0 Addition to System 2 ❑Replacement System Tank Only Existing System . For County use B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) 446Y Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other V U V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soft Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Q 7 7 Elevation 66o FS7 8'7l, 0 7 — �i6.7 /So. ©a VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks y Sep ' or Holding Tank /Z oo / zoo _ L_ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assum responsibility for installati of the POWTS shown on the attached plans. Plumber's Name (Print) I M Signature M umber Business Phone Number Plumber's Address (Street, City, State, Zip Code) 7 2 /fie S syl .e d 0 VIII. County /De artment Use Onl Disapproved Date Issued Is g Agent Si na a (No Stamps) ❑ Approved ❑ Owner Given Initial Adverse Sanitary Permit Fee (inc des Groundwater f Surcharge Fee) Determination aZ IX. Conditions of Approval/Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 05101) I I r -24 z 7 4 / 9 7 I i _ - , , r i , y j �i1'N _. V a I I 1 1. I ! I I I i I I ! �1y / I I ' I ! 1 I ;tit I I � '� I � i }. � /�►IZ � i I ! I ! l - -- I I , I t ; 1 � , z _ I i I I I I i 1 { a -_ _ -A Jil A Ito do : 1 -� } j z � Avi l � 1 T i I i i 1 : I i -- ��� ' f , 1 �--- � I I 1 I i i I I i l i i i ,I I l : I I I Safety and Buildings Division � 201 W. Washington Ave., P.O. Box 7162 County c, T, c o sin Madison, WI 53707 - 7162 Address 41k A � Department of Commerce -�S —Oz. &^F-0 Si OS3 Art Sanitary Permit Applications P t Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide �Zv ❑ Check if Revision may be used for !E2ydM purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number fir ,° ®� 1 7_ P Owner's Name Parcel Number .0 Property Owner's Mailing Address Property LocatioK2 / 7 q ;'JO2 l � / 3 Se i4 T N, R I City, State Zip Code M. W Number i Lot Numbir Block Number c AW t7 CSM Number IGu.k SYo 9 IJ�iZ�/G� �Q /3 II. Type of Building (check all th apply) acs ae! t 0% ❑City ❑ 1 or 2 Family Dwelling - Number of ms 1 ❑Village ❑ Public /Commercial - Describe Use ownship ❑ State O f Nearest Road M. Type of Permit: (Check only one box o e A (numbering scheme f ternal use). Complete line B V applicable) A. 1 gNe. 2 ❑ Replacement System 3 Replacement of 6 ❑ on to For County use stem T S S stem B. 11 Check if Sanitary Permit Previously Issued P Number D Issued IV. Type of Permit: (Check all that apply)(numberitfebo is for internal use) 44 Non - Pressurized In- Ground 2111 Mound V 47 ❑ Sand Filter [ k30 Co 22 ❑ Pressurized In -Ground 41 ❑ Holding T 48 ❑ Single Pass Dri AM 45 ❑ At -Grade 46 ❑ Aerobic t n nt XU 49 11 Recirculating Other V. Dispe rsal/Treatment Area Information: qV Design Flow (gpd) Dispersal Area /Area Soil A lion Percol stem Elevation Final Grade Required Rate(Gals. ys/Sq.Ft.) 97 y0 Elevation tilts 49Z '96, rod 0 VI. 'Tank Info Capacity in Total Number Prefab Steel Fiber Pl � Gallons Gallons o Concrete Co Glass New Tanks T i or Holding Tank ' Ob 0 Dosing Chamber II.. V Responsibility State t- 1, the undersigned, assum ty for a WTS wn ttached Plumber's Name (Print) P is Sigma r usiness P Plumber's Address (Street, City, State, Zip Code) VIII. Count /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse _ I� Determination I Conditions Qf Approval,�Reaso for Disappr `4, Attach complete plans (to the County only) for the system an pupa' not less then SM x 11 inches in size SBD -6398 (R. 05101) i R 'MM ' fr c� a +. At w r Q - I Is - ,v N 1$,tv - -- I J - I - - - 1 -- - OF 09 I - J - -- - -- �� 7 4 cb z i i o I ! I 1 I I J � 1 i I i � � I 'I j I I �I 1 I I a Ilk s t p- R � ! i — zz ; a r : �I Z t 2 At I ' J : � I � I i I I I I I : Z E ti i I ! : , I I i { i I I I I , 1 I I I r I I , I I l , I i I , I I I I I I i f I ; I I I I � I , I I I I I I I I � I II i I I I I I I I I I I I I I I Ai I ' � L r - - wsconsin Department of commence SOIL EVALUATION REPORT Page l of . Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S-� • C include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north anew, and location and distance to nearest road. ' - -- ' Reviewed by Date Please pdnt all 11 131 ` 1 Personal information you provide may be used for purposes (` (avr s. 15 -04 (1) (m)). Property Owner r .., _ ; petty Location Richard e Lot 5 114N p J/4 S Za T3p N R 1$ E (or)4( Property Owner's Making Address ` ' K AY 9 Lot Block # Subd. Name or CSM# t Cox 10 Z ' C- rol�view Acres State Zip Phone N" l,-, City ❑ Village [,Town Nearest Road Ate r 110 i - 6:5 1 ch MN-V6 / Y8 New Construction Use: ® Residential /Number r y - 7 Code derived design flow rate _ 4 5 � 1 to DD GPD ❑ Replacement ❑ Public or commercial - ' if a �" ft- Parent material CSC-' 4 t.c.> 4 S Flood Plain elevation applicable General comments S vv { V \ e-( , 7. -7 ° ��'`� e-- 176,- 7� y and recommendations: 14&4- G 1 G V • cb' s'o 4-`W Q✓ y (° Boring # Boring ® Pit Ground surface elev. /00. 76 ft. Depth to limiting factor 10kn in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munseti Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 "Eff#2 o - tz. 1 12 5i l 2 c Ivy 5 8 2 12 - 20 q 1 51 1 Z "4r- C-5 _ 5 3 20 -1 I r 4 1 U ry 1 - - • -1 / . 2 F-21 Boring # F1 Boring ® pit Ground surface eiev. 7010 7 0 ft. Depth to limiting factor /0 - 7 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 I b -12 ld �2 Sit Z mGbk ran - c S I v y • 5 . 8 2 i —2. `f Si ( Z CS 3 - M IS Cis 1 1 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 Name (Please Print) ature � Number Z533cA A 6o r�rn Schu ker Address Date Evaluaation Conducted Telephone Number 2113 gpri, C Sorners W 1 5" -102 S - - c� / (- 211 �l -ti�oX Property Owner N e 1 5o n Parcel ID # Page 2 of 3 31 F Boring # ❑ Boring d 0 Pit Ground surface elev. L ft. Depth to limiting factor y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 ► 0 -13 16 S l l Zrrobk n — , j r c Is f v-(� .5 -6 Z /3 -46 2 n-abk G S 3 % -//o 4 k C>5q wt 96 • �.�,LZ .6 Boring # E] Boring F E] 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 F -1 Boring # Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture 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 mglL * 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 (807/00) PAGE 3 OF NAME /V (5c, j /\ LOW Z 6 LEGAL DESCRIPTIONS t' /4NF' /4 Szo TSa N Rl $ E (or) Q / SCALE: 1"= 6 BM 1 ELEVATION _ 4Q9.0 BM 1 DESCRIPTION 1pe of BM 2 ELEVATION Q 2-,5 S QG` Z l BM 2 DESCRIPTION ".rX'O^ P j Q -e SYSTEM ELEVATION :o p 9 7 7d Gow -i 9 , 770 ALTERNATE ELEVATION fc, P Yu. SO t- CONTOUR ELEVATION v O 6 -3 „Vy � � Skap2 f � SIGNATURE ---- - , �— DATE Page J_ of POWTS OWNER'S MANUAL &MANAGEMENT PLAN FILE INFORMATI N SYSTEM SPECIFICATIONS Owner Septic Tank Capacity p Q al ❑ NA Permit # T-� 3Z3 Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA D SIGN PARAMETERS ❑ NA umber of Bedrooms ❑ NA Effluent Filter Model A /00 of Public Facility Units ❑ NA Pump Tank Capacity al I VA d e Pump Tank Manufacturer timate flow (av rage) al /da Design flow (peak), (Estimated x 1.5) y�d al /da Pump Manufacturer �RXNA Soil Application Rate al /da /fta Pump Model dFNA Monthl average* Standard Influent /Effluent Quality Y e* Pretreatment Unit 63 NA 9 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: 11 NA Pretreated Effluent Quality Monthly average Dispersal Cellist Biochemical Oxygen Demand (BOD 530 mg /L V,In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At - Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Other: [3 NA *'values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency ❑ monthls) {Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: years) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA xi Inspect dispersal cell ❑ month(s) (Ma mum 3 years) [3 NA s) At )east once every: lir—year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: 2 Oyear(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At Least once every: ❑ year(s) ❑ month(s) ❑ NA Other: At least once every: 0 y earls) 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) . 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 ar 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 cells) in one large dose, overloading the call(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. the Reduction or elimination of the following from the wastewater stream may improve the performance and prolo life o fat POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disi 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 6e taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail 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, aft 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 cam pIfant replacement system: r ,, 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 4 6 1 0#/ s , Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHOFJITY Name Name C�bli/9� Phone Phone - -3Z � $� This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer / �c�t%y`���,M /l�Z� Mailing Address Property Address (Verification required from Planning Department for new constriction) City/State Parcel Ident ification Number LEGAL DESCRIPTION AA�� cation '/4 (r� '/a Sec. T � W, Town of n�V ki_G Property Lo �0 � �� N -R Subdivi sion Lot # �;✓ . Certified Survey Map # , Volume , Page # Warran ty Deed # Volume 5 Page # '4g Spec house ❑ yes Q/n Lot lines identifiable es ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix 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. Uwe, 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 Zoning Office within 30 the three y do date. IGNATURE Q, APPLICANT DATE OWNER CERTIFICATION /I I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described abo e, by a of a warranty deed recorded in Register of Deeds Office. SI ATURE O APP IC DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. «« 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 f /l U 19 1 5 P `I 8 3 sa i?53Al- STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., VI This Deed, made between Hillvale Development Limited, a RECEIVED FOR RECORD Minnesota Limited Liability Partners ip, 06 -25 -2802 8:30 All WAVOT1r I>M EXEMPT t 17 Grantor, and Halle Builders, Inc. REC FEE: 11.00 TRANS FEE: COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lots 16, 19,98, 21, Golfview Acres, Town of Richmond, St. Croix SaCUM County, Wisconsin. 'W�harOAV161017 This deed is given in fulfillment of that certain Land Contract between the parties hereto dated July 30, 2001, recorded August 7, 2001, in Vol. 1694, Page 565, as Doc. No. 653153. Pt 026 - 1012 -50 Parcel Identification Number (PIN) This is not homestead property. DI;) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of November 2001 Hillvale Development Limited • By: Richard Nelson AUTHENTICATION ACKNOWLED.. iA,l, < STATE OF WISCONSIN ); ' Signature(s) r < <� C y County {) . I i ' - -• v authenticated this day of Personally came before me aX , November 20a erfla}ried Hillvale Development Limited, a Mina esq�ta LN&W �Igt Gility a Partnership by Richard Nelson"" - TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by 6 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY • 0.0. ? rc Attorney Krishna O land Notary blic, S e6 Wisconsin Hudson 5401 M Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not accessary.) I C ) • Names or persons signing in any capacity must be typed or printed below their signature. anannaaan Prceasno ub t ompny. F �46� STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 . 1999 El /4 comer Sec. 20 T30N, R8 Per Boundary Survey p by S S & N land Survey ing ht 5 �fthe SD1 /4 of the NW 114 lying pity oMZ I .ti Y »aaha Railroad. in Section 21. and part ' g o 18 f >� YE 114 lying Easterly and Southerly of o h n _� x ;n Section 20, All in MOO. R18W. Touin o; - (/1 s N Z west line of the __ - NW 1/4 of Sec. 21 -- 1 4BT 1 OF 3 ---- -- west line or the NW 1/4 of Sec 21 NOOS4 'w eza.et' _t 4 244.74' N00'ti4 W 521.30 _ - - -- -� - - W 1/4 coma _ East line of the Section 21 I n Y Hao26'02'w N WE 1/4 of Sec. 20. T30N, R18W oT O z ° al G n 5y �0ti GRAPHIC SCALE o lee a !0 Me tee ' L \ 22 I � ?� 9s. � yfaT � 2 I 87,373 sq.ft. - I , ( ) \ 2.01 acres y�, J'Ja u 2 � t Inch " 100 fill. rnl I� 8 fie, ♦ ASSUMED BEARINGS REFERENCED TO THE NORTH UNE OF THE NW 1/4 a _ \ I $ 7► OF SECTION 21, T 30 N., R 18 W.. ASSUMED TO BEAR N8950'17 ml \ r s: S J7• \ 4B F \ \ 2y �hr't3• H.W.E. \ a P� 945.5 25YR b b *e $ \ 943.3 IOOYR � rn n 21 Ln a %V .\ 87.263 aq.ft I St� \ // \ 200 acres 7JS Todd M. Merida shoff. RLS 2382 t 8 "yr \ �'j \� 7 ii �� �' , •J Registered Wisconsin Land Surveyor I •� 8 '��\ r J ^ 0 ry ,1 Dated this day of 2001- l e� \ I • �� by 201.7,T• Sv' 537. (re I ° In W.E. )r \ \\ BS * , 9 25YR / - \ . \ \ \ 2 U 6 . 00. 6 o S 100YR 1, 87,744 sq.ft. ` c� 15 \ \ \ 2.01 acres c - 'v / r .4.87.126 sq.ft. \ \ 7 \ 3 d8.,T0• I Mt W �• �8•� 2.00 acres 4. \ \ +! z ! I Z 0\ 4 IN q \� acres a j� \ $• \ \ ?0 �\ �� 'S tr i 87.443 sq.ft. y ti \ \47• 2 '3 p + 2.01 \ \\ \ noted) 1 8 \\ ` \ \\ 1 J ° 89.476 sq.ft. 00' RADIUS H T--WAY o) ' O� \ \\ i 2.05 aCflS AUTOMATIC CUL-DE-SAC TO NT L -DE -SAC 19E -. h Zi - \ AUTOMATIC CU VACATED :t H C \78 �, 87.126 sq.ft. �• \ \ ROAD EXTENSION TO THE SOUTH \ Iq •S 2.00 acres .'t.2 � \ \ \�• _ .� I i J �Y�•t0 ht Z' �e 32.70 ' M,2 41 p6,W 2s 1'! M e p r� 1,y Z•11'06 77.3 y ats 88.760 sq.ft.� an d BENCHMARK: WASH 2.04 acres \ \ � � � _ _ _ _ _ - 764 70 n went RR SPIKE IN NE SIDE ���,- - 9 6 ELE'vAr.ON= 963.24 .� T. OUTLOT 1 With O• Sj '4 1 06 E 65.361 sq.ft. Top Or qo.R i It 1 .50acres ELEV "!59.4 get FND. 3/4' `. 0.01' NOO'31 *31 "w 737.24' o t 00170'00•.3 South line or the -, 0'05" of the NE 1/4 of Sec. 20 h West line of the $E 1/4 NE 1/4 of Sec. 20 ° -- SW com4r of WE 1/4 Sac'. ; _:P _FITTED L4t1DS +D T30N. RIBW. Per CSM ° Doc. #605017 VOL.13. PAGE- WANES: 3665.0'iran pipe) TY COMPANIES SHALL MAINTAIN SOU Ih Iln< OI the NW i/4 of S<a 2 ENDS IN THE RIGHT -OF -WAY) w 1/4 comer Sec. 20 T3014, R`16411. Per m e remon+mentotkn free C.S.M. Dm./605017 MOL.13, PAGE 3663.- (Alufn. Co. Mon.) EYBN?' PREPARED BY: �l enty and Te.nehe wee. rule. and OWNERS: SURVEYOR ­01. t � D , etc.). Before purafla developing q ar developing N O ffi l� eW the atwoo late Teen Board far advice. .N OV R D 1062 ng. 10622 meet LLP. Todd M. H etro Land Surveyi endershot[ ay St. Gal. Cwnty Plann..q. Lanmq and a.O. 9oe h E Nh;te Bear Lake. MN 55110 332 „ourity Rood 0" _Itt:e Conado. MN 55117 y Todd M. Hsnderehott Sheet 2 of 3 Meets