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HomeMy WebLinkAbout026-1142-54-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 453362 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)(Mi ). Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam I Richmond Township 026- 1142 -54 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: roo•cr� CST fir^ tt 1 25.30.18.1038 TANK INFORMATION ELEVATION DATA � 4'Z - S 'Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ;vrti Septic Benchmark ^1 �7�.5 t f roo0 Q .cam 09, C 802 - Dosing Alt. BM Aeration Bldg. Sewer - 5.7o w.:t 3 Holding St/Ht Inlet r<)a ' alo 7.84 69" TANK SETBACK INFORMATION St/Ht Outlet 8.57 t�; TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Zo (\,C T yZ � Dt Bottom 43 G Dosing �ZO > fL N � Header /Man. I r .� -1 1, + �/ Aeration Dist. Pipe �• ? c 83 Holding _ - Bot. System 7 IPHON INFORMATION Final Grade 1 0. PU P /S Manufacturer Demand St Cover 3.4' ` o GPM / Model Number TDH Lift �+ Friction Loss System Head TDH Ft p Co �� �. Y. U3 .C1_i Forcemain Length Dia. Dist. to Well N o T =� 4 z SOIL ABSORPTION SYSTEM 4 - ( BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside ' DIMENSIONS ,-� 1-�C SETBACK SYSTEM TO P/L jBLDG IWELL LAKE /STREAM L RING nufacturer. INFORMATION AMBER OR Type Of System: "C' n I UNIT Model Number. III DISTRIBUTION SYSTEM - IVY -N� -t (8 � { �G-e -� Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) i Length 2 Dia Length 44 Z, Dia I �Z- Spacing < SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over '5 e. Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges (� a Topsoil 6 - Yes [] No 7 '! Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / 2 / o H Inspection #2: 7 / Z/ 0 Location: 1374 141ST St Unknown (NW 1/4 NW 1/4 25 T30N R18W) Red Pine Corner Lot 54 Parcel No: 25.30.18.1038 1.) Alt BM Description = �) •'T . + S �. CUB YS 2.) Bldg sewer length - amount of cover 3.) Contour = too, pl ou 70 (G' /e Plan revision Required? t °I Yes ; No I / Use other side for additional '1_' = SBD -6710 (R.3/97) Date J Insepctor's Signature Cert. No. Safety and Buildings Division Coun 201 W. Washington Ave., P.O. Box 7162 - C" tX c Madison, W1 53707 - 7162 San �y Permit Number (to be filled n by Co con in De artment of Commerce (608) 266 3151 Is33 Sanitary Permit Application State Plan I.D. Numbser��1 In accord with Comm 83.2 1, Wis. Aden Code,-personal information you provide �� Af I O,+ `ms �� may be used for secondary purposes Privacy _1'td' ""�" - -- I Project Address (if different than mailing address) ``�/ F1, r L Applicationlnformatlon- PleasePrintAllInfo tin t Property Owner's Name Parcel N Lot # BIcc, 1 ' D Sa- w\ 1'l�tllor a � Property Owner's Mailing Address I r Property Location ®Z(e - y t • sy - O O b City S t ate a / s / Zip Code Phone Number -'- + V`' AI %, Section 3 ff"L," ew / o T R�E 11. Type f Building (check all that apply) m — I or 2 Family Dwelling - Number of Bedrooms / � / 6, Pia A Subdivision Name / CSM N'um[ar ❑ Public/Commercial - Describe W4 P • "C)> d a ❑ State Owned - Describe Use $� '�p ❑City_ ❑village KTownship of RjCALY �p 111. Type of Permit: (Check only one box on llne A. Complete line B if applicable) A. New System ❑ Replacement System ❑ TreadnenUHolding Tank Replacement Only ❑ Other Modification to Existing System i b ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued Before Expiration Plumber Owner L m44 1V. Type of POWTS System: Check all that apply) — _ ❑ Non - Pressurized In- Ground Mound > 24 in. of suitable so ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter L J I Constructed Wetland ❑ Presstrized In -Ground ❑Bolding Tank ❑Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) ispenal Area Required (st) ispersal Area Proposed (s System Elevation /Dm.00'� �syv /. o /i 2S' y b oo' ;� 5 o D . So C s• zs �'o cod S' h'1.��.� r,, V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Ste Fiber Gallons Gallons of Units Concrete Constructed Glass New $timing / y� Tankr Tnnks (✓ S:riic or Holting Tsnk �v / �' S � i A.zwbic Tmumcot Uml Dining Chamber l VII. Statement - 1, the undersigned, assume responsibility for Installation of the POWTS shown on the sttacbed plans. y ' Plumber's Name (Print) Plumbers gignaturr. MP/MPRS Number Business Phone Number -- Plumber's Address (Street, City, State, Zip Code) V1 LL County e artment Use Only _ Ap proved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued lss g t Segnature (No ' amps) Surcharge Fee) g ❑ Owner Given Reason for Denial I.X. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attacb complete platy (to the County only) for the system on paper not Ins than 81/2 z 11 Inches in size SBD -6398 (R. 01/03) - - _ \ ' /Oil• E /air _ 9�y0,' ♦ E /edafio� joca. -�c d / p�qo. 83 1 � /ot sy, ecd A in e, Tn. of � ir►on d A� C$ b/ fa Proposed W tese rlonc. `�� � � � � wi-p AIR j o ` \ y9 Pnposed rn ocod a t 17. V � /OS:c s 4 `.4. ST q. 30 341 p ✓C� 4 / l�z "Y�s!.ZB �/ �o/"', a -t ;,it otAk o'F Sc/6%c - �nK Pro c�,e sar Pro w[ cCb - ntQ Spot %c we it Q(o� �1 /fera occ� /�t• Proposed 3 bcdr r Side.nc.e 0 co py �t�, Safety and Buildings 4003 N KINNEY COULEE RD commercem.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 • i seo n s i n ` w`ww•commerce.state.wi.us /sb www,wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary June 24, 2004 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE A.C.E. SOIL & SITE EVALUATIONS LLC ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/24/2006 Transaction ID No. 1014107 Site ID No. 685463 SITE: Please refer to both identification numbers, Sam Miller above, in all corres ondence with the agency. 1374 141ST Street Town of Richmond St Croix County NW1 /4, NW1 /4, S25, T30N, RI 8W Lot: 54, Subdivision: Red Pine Corner FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 965440 Maintenance required; 450 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Condi wxkfft stats. APrilet The following conditions shall be met during construction or installation and prior to occupancy or use: DERARTMENT 0 BM NO General Approval Requirements: SEE CORRES • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01 /01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. rage t 01241U4 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday -Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 DISTRIBUTION COMPONENT DESIGN r� MOUND AND PRESSURE DtS Residential Application 8 �0 INDEX AND TITLE PAGE ^ Project Name: Sam Miller 3 bedroom residential mound system /4; Owner's Name: Sam Miller Owner's Address: P.O. Box 151 Hudson, WI 54016 Pcl. Add.: 1374 141st. Street Legal Description: NW1 /4NW1/4, Sec. 25, T.30N., R.18W. Township: Richmond County: St. Croix Subdivision Name: Red Pine Corner Lot Number: 54 Block Number: na Parcel I.D. Number: 026- 1142 -54 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications 11711Y Page 6 Management and contingency plan Page 7 Pump curve and specifications �® Page 8 Site Plan - OMMERt: Page 9 Soil Evaluation Report AND %�G E O Designer: Mike Mc Donell License Number: 225036 Date: 06/11/04 Phone Number: (612) 865 -1927 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <= 36 inches. 450.00 Design Flow (gpd) 6.00 Site Slope ( %) 100.00 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.001 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disinbution Information network? Enter Y or N (c or e) c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 6.25 ft /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 93.00 Pump Tank Elevation (ft) Enter Y or N 1 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 7.00 Vertical Lift (ft) 81.25 5x Void Volume (gal) ?' 0.76 Friction Loss (ft) 87.77 Minimum Dose Volume (gal) y o v 14.26 Total Dynamic Head (ft) 29.66 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 750.36 Total Tank Capacity (gal) 1000.00 1 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) Wieser Concrete IManufacturer 20.28 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.36 Dose Tank Capacity (gal) lZabel Filter Manufacturer 20.28 Dose Tank Volume (gal /in) JA1 00 Filter Model Number Wieser Concrete Manufacturer Project: Sam Miller 3 bedroom residential mound system Page 2 of 9 Mound Plan View :0. J 1 /j_ B ; . Observation Pipe 3 W F . B . Mound Component Dimensions A 5.00 ft E 9.60 in H 1.00 ft K 7.33 ft B 90.00 ft F 9.50 in z 7.65 ft L 104.65 ft D 6.00 in G 0.50 ft J 4.56 ft W 17.21 ft 450.00 (ft Dispersal Cell Area 1 1138.72 (ft) Basal Area Available 5.00 (gpd /ft) Linear Loading Rate 1 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.29 (ft) C ,.f{ .f... 2 G F H t rr�rr�r�r �r.� {.���rf.. ; : : f rsal Cell 101.00 (ft) Lateral �ispe 100.50 (ft)- -► Invert Dispersal Cell Elevation E D �'�'• l 100.00 (ft) Contour Elevation 6.0 % Site Slope Geotextile Fabric Cover Shading Key �.— Dispersal Cell See lateral details on 10 ® Topsoil Cap °- 1.5 ft .•;;;;•,:•:: :•.:. ;,: Page 4 for number, Subsoil Cap 4 5 ,•p:($r 'j.':' size, and spacing of © ASTM C33 Sand Z I ���•a.:• F laterals. Laterals are 0.5 ft Typical Lateral ®� Tilled Layer equally spaced from 05 r':.�.:• Aggregate a °.•�. the distribution cell's *--- A TI centerline in the distribution cell (AxB). Project: Sam Miller 3 bedroom residential mound system Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical I P A = Turn -up wl ba I I va Ive or IE X --> J +x12 I W2 +I Laterals & force main of PVC Sch 40 clean out pl u g per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 44.28 ft Orifices per Lateral 18 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 7.411 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 14.26 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - -D Comm 16.28 WAC 4 in. min. Disconnect -------, Tank component is properly vented ilz ers a outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Cap acityl 750.36 Gallons Volume 20.28 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.50 375.14 C B 2.00 40.56 P � ump off e levation (ft) C 4.50 91.30 94.00 D 12.00 243.36 D Total 37.001 750.36 Dose tank elevation (ft) 3" Bedding un er tank. 93.00 Alarm Manuafacturer ILevelArm Alarm Model Number I DLV Pump Manufacturer JZoeller Pump Model Number 198 Pump Must Deliver I 29.66 gpm at 14.26 ft TDH Project: Sam Miller 3 bedroom residential mound system Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Jim Thompson #30021 Phone 715 - 248 -7767 POWTS Regulator's Name St. Croix County Zoning Dept. Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 ears Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum -up Detail Finished •...........•. ............... Grade \ 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Sam Miller 3 bedroom residential mound system Page 5 of 9 f Mound System 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 maintained in accordance with its' component manuals [SBD- 10691 -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 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 watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 84nches 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 fitter 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 fitter 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 a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum 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 Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least 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. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BODS, 150 mg /L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 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(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Sam Miller 3 bedroom residential mound system Page 6 of 9 r1 ' k1 r ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■N■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ELI■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ®, ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ R■LIENE■EE■E ■■■MINE �� ■■►\■ ■ ■ ■ ■■ ■ ■■■■■ „00MI\NN■■NE■■■■■■■ ■\, \ ■► \N ■N ■■■■NN■■■ \ ■ \ \I \N ■E■■■■■■ ■NE \I� ■N ■NMI ■MIN■■ \`■ OWN, . ■ ■N ■ ■ ■ ■■■■■ E\■ \11► ■ ■ ■ ■ ■■■■■■ \Es ■1`\ \E■ ■E■■■■■ WIN W■\■■■■■■■■■ R II \ \ ■ \■■■■■■■■ .1WO ■ ■►VAN■ ■■E■ SRI ■ ■■\\\■■■■MINI■ ■ ►` ►1 \ N■W.EN■■■■■ A ■NS 11 \ ■ ■E\\■■■■■■ ■ MII `v ■\NN\■N ■EN ■ ■ ■���h \ \. ■■► ■NMI■■ �� \ \ ■ ■ ■ ■\ \N ■N■ ' Nn�. ° i► 8 A 1 6-6-m . : 7 - 6,2 01" , e. 9790.' So// e ✓a 1 uw6 ;q, - \ ♦ E/edafidn / sy, ,Ptd /nine, Tn• of ��lnond � A \ \ � :5�-re e 17 7 0 / /}S5 u.rn L iv: _ / GJ• Gt�,' bl � � � �� \� o �- 0 P ✓,C \�:\ \ \ \ C\ \ \ Proposed w Fes r (Inc. • ��� \ \ wLp7s»• MQ _� �ou..,�O .. �, C4o,,, bey 4lz \ - \ `A•S. %»t. 3o3�1P. ✓.C` WJ S'X 9o'ds/ursa e��' /u en� /:rfQ• �' a/>'►�i'ces �ae c e d a.L � S o- y "sCA .s/o00 '' OF Sy6;c. to,," �. a Pro posed w; esar Cmxr'ek Proposed WLA /, oCb - rr� Q Se'o6 % it Q uo e w/ a6e/ A100 egAu4, t �,' /teraE ouf /ct• 0 ProPo� d 3 btd rca� -� residence 0 R.s�y Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ 1 -_ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code �1 County I St. Croix Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal re ftttt��(BM), direction and Parcel J.D. � percent slope, scale or dimensions, north arr aht 1 vitlor{ay�dOstance to nearest road. _ Ian g Please print41N mat 'on. Reviewed by Date Personal information you provide may be u Yef secon o LspZ, . 15.04 (1) (m)). Properly Owner ' ` operty Location Oakwood Land Development vt. Lot NW 1/4 NW 1/4 S 25 T 30 N R 18 ) F, (or) W nrrf Property Owner's Mailing Address 1 X 81ock # Subd. Name or CSM# 1611 HY. #10 NE. - 4 na Red Pine Corner City State Zip Code Phoc8 ^ , f=t(,E ;`� City ❑ Village )] Town Nearest Road Spring Lake yark,IMN. 554 � 614- 780 - 6. Richmond 140 St. a New Construction Use: ® Residential / Number of_ i ' Code derived design flow rate 600 _— GPD � ❑ Replacement ❑ Public or commercial - Describe: - -- Parent material cql ar-i a 1 rlri ff- Flood Plain elevation if applicable General comments and recommendations: mound @ el. 101.00', based on contour line of el. 100,00' i Boring a Bolin # Boring ® Pit Ground surface elev. 1 �� • �� h Depth to limiting factor 32 in. f*Eftl Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary RooGPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#2 1 0 -14 10 2 2 n mfr cs 2c .5 8 2 14 -22 10 4/4 none sil 2msbk 1m .5 .8 3 22 -32 10yr4/4 none sil M na qw na .0 .2 4 32 -49 10 4 4 c2d 7 5 5 6 2 5 49 -65 7.5 4/4 none sl 1csbk .4 .6 2 27 Boring # Boring © Pit Ground surface elev. 100-50 ft. Depth to limiting (actor 4 5 n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D_ /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E"l 'Eff#2 1 -12 10 2 2msbk mfr cs 2c .5 .8 2 2 -20 10yr4/4 none sil 2msbk mfr 9W 1m ,5 .8 3 0 -33 10yr4/4 none sil 1csbm mfi qw na 2 4 na 5 5 -65 0yr7 /3 c2p 7.5yr5/8 limestone residuum na na n n Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L (fluent #2 = WD ,: s 30 mg/L and TSS < 30 m g/'- CST Name (Please Print) Signature CST Number Gary L. Steel 02298 I Address Oat Evaluation Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -7 -2001 715 246 Property Owner CU WOOd Land De V , Parcel ID # pendign Page 2 of 3 �73 Boring # ❑ Boring ® Pit Ground surface elev. 97, 50 ft. Depth to limiting factor 40 in. Soil App 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 1 0 -10 10 3 3 mfr cs 2c , 5 , 8 2 10 -22 10 4 4 none ,5 ,8 3 22 -31 7.5yr4/41 none sl 2csbk mfi 1f 5 9 4 31 -40 7,5ry4/ none is M na 9W na ,5 ,9 5 40 -60 10yr7/3 c2p 7.5yr5/8 limestone residuum na na nr) nn I 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 GPDJF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soif lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2 I 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 serv;ces or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R &=) STEEL'S SOIL SERVICE Gan L. Steel 1554 200th Ave. CSTM2298 Oakwood Land dev. New Richmond, WI 54017 MPRSW -3254 NWJNWI S25- T30N - rl8W (715) 246 -6200 town of Richmond lot #54 -REd Pine Corner This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shavn as permanent lot lines were not established at the time the test was conducted. N 1 " =40' BM.= top of 1' pvc pipe @ el. 100.00' alt. BM.= top of 1" pvc pipe @ el. 97.90' � Gary L. STeel 8 -7 -2001 nsinDepartmentofCommerce SOIL EVALUATION REPORT Page 1 _of 3 L, on of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1I/2 x 11 inches in size. Plan must St Croix include, but not limited to: vertical and horizontal re eteReejxwt,(BM), direction and Parcel I.D. diri percent slope, scale or dimensions, north arr a I titlorf a d' ' tatance to nearest road. pen g ._.. ... e 'wed by Date Please prin IN t'on.'` _ Personal information you provide may be u ;For iecond y p os rivacy,L . 15.04 (1) (m)). r OLA& 0 2,2Z Property Owner ? ' '�- �' -` = s ••• operty Locatio Or U Oakwood Land Development r r a - vt. Lot NW ❑ 1/4 NW 1/4 s 25 T 30 N R 18 � (or) w Property Owner's Mailing Address -' L # Block # Subd. Name or CSM# 1611 HY . #10 NE. ' `� 4 na Red Pine Corner City State Zip Code Pho5 City Village f] Town Nearest Road Spring Lake ark, MN. 554 ? 614-780-491& Richmond I 140th. St. aNew Construction Use: ® Residential / Numbero'f • • ` Code derived design flow rate 60O GPD ❑ Replacement , ❑ Public or commercial - Describe: Parent material ql Aci al d rift Flood Plain elevation if applicable na ft. General comments and recommendations: mound @ el. 101.00', based on contour line of el. 100.00' Boring El Boring 1 g # ® Pit Ground surface elev. 1 ft. Depth to limiting factor 32 in. —'?°— Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I 1 0 -14 10yr2Z2 n mfr cs 2c .5 8 .40 2 14 -22 10 4/4 none sil 2msbk mfr CW 1m .5 .8 3 22 -32 10yr4/4 none sil M na 9W na .0 .2 4 32 -49 _ 10yr414 c2d 7 5 5 6 5 49 -65 7.5 4/4 none sl 1csbk .4 .6 Boring # El Boring 4 2 ® Pit Ground surface elev. 100.50 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ffl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 -12 10 2 2 none T. 2msbk mfr cs 2c .5 2 2 -20 10yr4/4 none sil 2msbk mfr 9W 1m .5 .8 %V 3 0 -33 1Oyr4/4 none sil 1csbm mfi qw na 2 4 3 -45 7 na 5 5 -65 0yr7 /3 c2p 7.5y limestone residuum na na np n i * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L * luent #2 = D < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gar L. Steel • 02298 Address Dat Evaluation Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8-7 -2001 715 - 246 -6200 I Property Owner Oakwood Land DeV Parcel ID # pendign Page 2 of 3 3� F Boring # El Boring ® pit Ground surface elev.97' 50 ft. Depth to limiting factor 40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -10 10 3 mfr cs 2c .5 .8 . f' 2 10 -22 10 4 4 none .5 .8 � 3 22 -31 7.5yr4/4 none sl 2csbk mfi qw 1f 5 •lv 4 31 -40 7.5ry4/6 none is M na 9w na .5 .9 5 40 -60 10yr7/3 c2p 7.5yr5/8 limestone residuum na na F-1 Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil 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 i Boring # Boring Ground surface elev. ft. Depth to limiting factor in. 11 pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E • - < < Effluent #1 = 8OD < 220 and TSS >30 < 150 m Effluent #2 - BOD 30 mglL and TSS _ 30 mg/L s > 30 _ nom- _ 9� s — 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 (Rb00) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Oakwood Land dev. New Richmond, WI 54017 MPRSW -3254 N4�1'- �N�'T' -� s25- T30N -r18W (�15) 246 -6200 town of Richmond lot #154 -REd Pine Corner This soil evaluation vas conducted to satisfy a zoning requirement, it may or may not be suitable for your use. They location of the test may or may not be as shown as permanent lot lines eere not established at the time the test was conducted. �N 1 " -40 BM. top of 1' pvc pipe @.el. 1 -IM' -alt. BM.= top of 1" pvc pipe @ el. 97 A(� G�irg L. STeel 8 -7 -2001 s� 2 /or POWTS OWNER'S MANUAL MANA MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity /po '7 5'o al ❑ NA Permit N Z Septic Tank Manufacturer W0 S �� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer f ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 04 ❑ NA Number of Public Facility Units A Pump Tank Capacity ? j0 4, al ❑ NA Estimated flow (average) 3 0C!> g al/day Pump Tank Manufacturer L�lc; S o✓ ❑ NA Design flow (peak), (Estimated x 1.5) Z/5-0 g al/day Pump Manufacturer Zo Z�, ❑ NA Soil Application Rate al / /f Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit ❑ NA 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 (SOD,) 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade /1 Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Oth�Tr 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: 0 m onth(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: :3 ❑ month(s) (Maximum 3 years) ❑ NA years) Clean effluent fitter At least once every: ❑ month(s) ❑ NA /, / years) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ year(s) ❑ NA 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 dispo$ed 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 impAde 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. T b e ai a �f10}1181T;✓T, �� N>� �ONS77ZClC�?'l � (ank 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 bt, Name Phone �Z. S Z a" Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S �' L P hone ` � a ZoAJr1cJ Phone '7 /S— 3 e(p— (p r] This document was drafted in compliance with Chapter Comm 8 3.22(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 SA i e Mailing Address / / Property Address 7 / �' 5 �� �-�� Aw A w o hk ,rp (Verification required from Planning Department for new construction) City /State P^&x W / Parcel Identification Number LEGAL DESCRIPTION f Property Location NW '' /4, I/W '/" Sec. J . T3 N -R W Town of e & 'n Subdivision k%Z ' �f ' i H C'ai' N a / . Lot # . Certified Survey Map # (ot'o 3 f - , Volume g . Page # 83 Warranty Deed # 7 5`8 9 , Volume Z f�oO , Page # Spec house V yes ❑ no Lot lines identifiable IS� yes ❑ no SYSTEM NANCE 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. 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 Zoning Office within 30 days of the three year expiration date. 11 01A ATURE ICANT DATE OWNER CERTIFICATION 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 above, by virtue of a warranty deed recorded in Register of Deeds Office. ti /Zo/ o Si ATURE OF PLICANT DATE t *kt•f kkkkkk Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •• Include with this applicatlon: 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 4 0 0 P 5 2 3 738849 �� KH STATE BAR OF WISCONSIN FORM 1 - 1998 REGISTER OF OF WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD Document Number 09/04/2003 02:30t'I4 This Deed, made between DevelgDment. Inc.. a Corporation Grantor, an Sam E. Miller single person, Grantee. WARRANTY ( DEED Grantor, for a valuable consi tion con o Grantee the following described real estate in St. Croix County State of REC FEE: 11.00 Wisconsin (the "Property "): COPY 607.20 CC FEE: PAGES: 1 Recordina Area Name and Return Address ®_ C)o`Z�o (130 — c00 Sam E. Miller --3� -( ' 0a (p ::k p �. aox �s - r -- 1 3�^ � - � N.w..aisan,e.+CI wI COO - -*.0 . S'fotco -� 0 a (0 -1 134_ 3y-cz1O Saco -tl3O 3s__ 926 1430 Parcel Identification Number (PIN) This Is not homestead property. (is) (is not) Lot041,32, 33, 34 and 35 Red Pine Corner. Lo Red Pine Corner First Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this I day of 2003 (SEAL) (SEAL) g2 �O&kwood Land .uci inc (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ) ss. St. Croix County authenticated this day of {- Personally came before me this day of ' IF , 2003 the above named 4 Greaory J. Peterson the vice president of Oakwood Lan v 2on n to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the p ;whoexecuted the foregoing instrument (If not, an ge th authorized by §706.06, Wis. Slats) ol THIS INSTRUMENT WAS DRAFTED BY �� •• !�'4 Coidwell Banker Burnet -F� ° ; A4o ry Public, State o isconsin 1301 Coulee Road ; Hudson, WI 54016 _ IJ TAMARA �yt �cImmission is permanent. If not, state expiration date: 2 -41070 s N t{ERgS Co (Signatures may be authenticated or acknged. Both are not necessary.) �'�i� 0 *.......... r - �— h,, OF )N\ - Names of persons signing in an ca act must be type or nnted below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 — 1998 Milwaukee, Wis. Ol Fy .�� 40 X o•. ?o� / v A . •,b V ip O e �2 r ..........,,• •, n, l b At e l l ..__ ��� ` ��""�;� �1 � � I I I I ® O — I \\ \ ' •.� s �,. �� ��� -.te / N •Og �� , L��'1�� , � ' � .�••'�7.:1 .. 'r••• �a ♦ � � •` C • •c' o S le I kh / O% /� 1 ,.•:.. fk;,. ` fir'.- -.. V4• , le JVA