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HomeMy WebLinkAbout026-1142-55-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430365 0 GENERAL INFORMATION . (AfTACH TO PERMIT) ate Plan ID No: '�f- Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. OSS3� — T ro1dS Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam I Richmond Township 026- 1142 -55 -000 CST BM Elev: Insp. BM Elev: I BM Description: ' e Section/Town /Range /Map No: U0.0 ( �•0i 0f- �e = C� �O 25.30.18.1039 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � 6't ` /j � Benchmark Dosing ( t I I t i V Alt. BM Aeration Bldg. Holding St/Ht Inlet 1 f Z.yo SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' Dt Bottom i },p(� _ (� �' - L 2 / • T I Dosing J tl Header /Man. 1 l0q. Aeration Dist. Pipe �. I.gd /cry.)o I 1• )OC Holding Bot. System Z , S p Z. I° • 167. 103 •`S Fi al Grade PUMP /SIPHON INFORMATION wi 1•a,C 1Z% ) Manufacturer 11 emand St Cover t '% PM odel Number / r�fP.N � ' r q1D Ir H Lift Friction Loss S s em Head t TDH Ft Forcemain Len th Dia. Z �/ Dist. to Well (A) o SO ABSORPTION SYSTEM 3 lio 3.0) _ DI Width Length I No. Of Tsooehes PIT DIMENSIONS No. its Inside Dia. Li uid Depth DIMENSIONS � ID Z i ds SETBACK SYSTEM TO P/L jBLbG WELL LAKE /STREAM LEACPRN Manufacturer: INFORMATION CHAM R Type Of System: , NIT Model Number: DISTRIBUTION SYSTEM J Header /Manifold, Distribution t x Hole Size x Hole Spacing Vent to Air Intake �1 Pipe(s) /IQ �d� /Qp•� Length . '' Dia I' Length TJ�J � l Dia_ Spacing Z • /g ,Z • M SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded j xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes Na Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection l 12 I w�w� a tiro #2' . Location: 1368 141st Street New Richmond, WI 54017 (SE 1/4 NW 1/4 25 T30N R18W; - Red Pine corner 1st Addition L Par'f;e No: 25.30.18.1039 1.) Alt BM Description = l B �I k. ��+y►�4�teN PQ 's ' P Sy co�..•E,;.. -6 i — 2.) Bldg sewer length = 16 k !-" tf n 4. 10 amount of cover - = � 3 �f C'�w• ' �' �'`���� 6 S�+•1oX es.••M� ; vz . 3 o Plan revis s Re ❑ ms ion. de for additional infor No Use other L_ —_ . _____ to � SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. I f Sf S. anitary Permit Application Z . Safety & [i a s h n s Division in accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instrueAons for completing this application PO Box 7302 Madison, WI 53707 -7302 1\4seonsfn Personal information you provide may be used for secondary purposes Department of Commerce (Privacy Law, s. 15.04(1)(m)) (Submit completed form to county if not state owned. Attach complete plans to the county co only) for the system, on a cr not less than 8 -112 x 1 I inches in size. county State SjLnitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number •' �• . Cleo 13 s- g ib w3 s I. A Iication Information - Please Print all Information Location: Property Location Owner Name Property �) 7 ,N, RI � e� F-1 /44 1 S � J T RISE or Property Ownees Mailing Address C ?oo3 Lot Number Block Number Subdivisin N or CSM Number City. State Zip Code1 UNT'r' ty. FFI uc \SO ►. L�? 1 'y f� l G. le rn� ✓- ❑ City Building: check one Villa II.Type ofB g ( ) ❑ e g 1 or 2 Family Dwelling - No. of Bedrooms : —L— Y of ❑ Public/Contmercial (describe use):_ ✓ ❑ State -Owned " ) Nearest Road Parcel Tax Number(s) III. T e of P ermit. Check onl one box on line A. Check box on line B if applicable) O 5 �V 2 6. ❑ Addition to A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. Existing System S stem System Tank Onl Date Issued Permit B) ❑ A Sanitary Permit was previously issued Number IV. Type of POWT System: (Check all that apply) 7 Lyf * � `jV• �� ❑ Sand Filter ❑ Constructed Wetland Moun • Non - pressurized In- ground i ❑ Single Pass ❑ Drip Line • Pressurized In- ground O Bolding Tank g ❑ At- rade n ❑Other: ❑ Aerobic Treatment Unit ❑ Recirculati V. Di ersal/Treatment Area Infurmatio -2-4 1 A ® c l .Design flow (gpd) Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation TE tion G rade Required Proposed Rate (GalsJday /sq. A.) (Mi+linch) �D � I �� ' 4 VII. Tank Capacity in Total # of Manufacturer Pre1 ,b Site Steel Fiber- ass Plastic Gallons Gallons "tanks Con Con- g Ltformation — crete structed New Existing Tanks Tanks ` ❑ ❑ ❑ ❑ 6 __ \ l6Alh �LQ D I t S C� ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undCrsigned, assum res onsibili for installation of the POWTS shown on the attached plans. BLLSincss Phone Number Plumhces Name (pnnt) Plum Signatu (nos ps : 1.1P/h1l'ItS No. Plumber's Address (Street, City, State, Zip Code) /10170 14 60.�iW- IX. County /Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signatur (No stamps) =PXqApprovcd C3 Owner Given Initial Advcrsr: Surcharge Fee) Determination X. Conditions of Approval /Reasons for Disapproval: SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained 2. All setback requirements must be maintained as per applicable code /ordinances. E ' a 5 ,eed 1. s � e e¢�r A, r ad Co : Z t s r .S c d �° / �l S� � I Sea /e /w a•rrt�e o.E•— P b w � d c.+� sewer' 3 bedra�rn r at res dem ce, Proposed w ieSe/' WLP ,�/ G 'e Co m b ,'rizovar» - A tp X19 - /a t` lte.r cc4— .5.rowklet, ao kQ.Q ✓ply �,%cro Marc ma;n. pine's opt-r) .P ; e Id P r opos Ace 90' ; ' \ \ mac y '� gg sS i, �? � �. /a -6!ra lS a w/ Yg or %4'ces aE °.� •o u.Vc - ro o F C'a S,yw. Elev /01 s ss wM r Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 erc N*isconsin www w ww.commerce.statemims/sb ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary September 17, 2003 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE MILLER CONSTRUCTION ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/17/2005 Identification Numbers Transaction ID No. 905535 SITE: Site ID No. 664592 Sam Miller Please refer to both identification numbers, 1368 141ST St above, in all correspondence with the agency. Town of Richmond St Croix County SE1 /4, NW1 /4, S25, T30N, R18W Lot: 55, Subdivision: Red Pine Corner FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 919462 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes CoIrrlit and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in A PP IN i MOP chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. DEFAf2TMENT 1 The following conditions shall be met during construction or installation and prior to occupancy or use: N OF General Approval Requirements: ---� SEE CORRE! • 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 /O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST SAS (01/81). • The minimum dose to the system is 95 gallons, which is 5 times the void volume of the distribution laterals plus the flow back volume in the force main. • 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. • 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 f - MICHAEL P MC DONELL Page 2 9/17/03 • 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 J POWTS Reviewer 11 , 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 I I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE A� CF Project Name: Sam Miller 3 bedroom residential mound system Owner's Name: Sam Miller 41 - ,- Owner's Address: P.O. Box 151 Hudson, WI 54016 A Pcl. Add.: 1368141st. Street Legal Description: SE1 /4NW1/4, Sec. 25, T.30N., R.18W. Township: Richmond County: St. Croix Subdivision Name: Red Pine Comer Lot Number: 55 Block Number: na Parcel I.D. Number: 026- 1142 - 55-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry � C� MERCE Page 3 Mound drawings D11VGS Page 4 Lateral and dose tank Page 5 System maintenance specifications ' Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike Mc Donell License Number: 225036 Date: 08 /12/03 �/J Phone Number: 715 - 386 -8692 Signature: � �{ DesWwd 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 Plan View . Observation Pipe . • . • FK • ., .... ti . ti .................ti..,. ti. ti ..ti.ti.ti . r rS: •r.: •r•r.r.t.: •::r.:. r.: •r•. r�: •r•r•r•:•r +:•r• • r•:• :ti •.,•�• ;:ti :; •; :•; :; •.'•.`.• ti:ti•ti•L•• ;• ti.ti. 1 •:•r•:�r�r.rSr•r.• •rS, :•r•:•r• :•r•• •f• r- :•r•r•r•r, • •• •• W ... f . B - _ I i - • L _ - I Mound Component Dimensions A 5.00 ft E 7.80 in H 1.00 It K 7.10 ft B 90.00 ft F 9.50 in z 6.40 ft L 104.20 ft D 6.00 in G 0.50 ft J 4.93 ft W 16.33 ft 450.00 (ft Dispersal Cell Area 1 1026.10 (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 104.79 (ft) —� � . frr.rrrr�r 2 frrrrfrr. -. :.. Z F Dispersal cell 103.50 (ft) Lateral 103.00 (ft)-10- - :: Invert Dispersal Cell Elevation E D ... 4 w _ • ° ' 102.50 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key _�,- Dispersal Cell See lateral details on 10 = Topsoil Cap a 1.5 ft • + • Page 4 for number, © f::f Subsoil Cap '" :•�• ti.�' �:ri size, and spacing of ASTM C33 Sand 4 rs;•' •• • •• a ••�:�:ti ��ti�'•� F laterals. Laterals are 0.5 ft Typical Lateral ® Tilled Layer c • ti - t 'j�j equally spaced from Q5 f:r:r: Aggregate v o ••:�:: ":':f �' �� I the distribution cell's t 40 — A ---* centerline in the distribution cell (AxB). Project: Sam Miller 3 bedroom residential mound system Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A & B dimension • = Turn-up vdbali valve or cleanoutplug ,I P AN lateral, are Identical k- X—j�I Holes drdled on the bottom of the lateral S equally spaced Force main connection via tee or cross to manifold at any point. Laterals & Force main of PVC Sch 40 (per COMM Table 84.30 -5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 88.55 ft Orifices per Lateral 36 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 1 Manifold Length 2.50 ft System Flow Rate 29.66 m Manifold Diameter 1.50 in Total Dynamic Head 21.611 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight LL Electrical as per NEC 300 and —► Comm 16.28 WAC Disconnect 4 in. min. Tank component is property vented ARemate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 646.00 Gallons Volume 17.00 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 1$:54 315.23 B 2.00 34.00 C Pu off e levation (ft) C 927 90.00 D 12.00 204.00 D Total 1 38.001 646.00 iF 17, D ose tank elevation (ft) 3" Bedding un er tank. 89.00 Alarm Manuafacturer LevelArm Alarm Model Number I DLV Pump Manufacturer JZoeller Pump Model Number 1140 Pump Must Deliver 1 29.66 gpm at 21.61 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 #3 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 Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Freguency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System I Laterals should be flushed and pressure tested every 1.5 ears Mound inspect for ndin and seepage once eve 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 Turn-up Detail Finished ............... Grade \ ,-/ 4 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 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 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, State. 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 finer shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent 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. Puma 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 finer 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 BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 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 I i ftl r < M HEAD CAPACITY CURVE EFFLUENT ' \NOON ■ ■ ■ ■N ■ ■ ■ ■ ■■ ... . . . . ... : . . . . ■■ ■SON �� ■ON ■ \� ■ ■ ■ ■ ■ ■■ NOON■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ NOON■■ ,\■\■■■■■■■■ MEMO ■■ ONO\■■■ ■NON■■■■ .. ■\ ■\N■■■■■■■■■ ■■ ■ \,\■►\■■■■■ ■NN■■ ■■ ■\\I\■E■■■■■■■■ ■■ WNWIN ■EE ■E■■■ ■ ■ ■■ \�\ ■l. ■ ■ ■m ■ ■ ■ ■ ■ ■ ■■ ■ \ ■ \I1\■■ ■■E■■■■■ ■ ■■ ■1` Wilk ■■N ■NONE ■ ►� \I \ \ \. bNO ■ ■ \\ ■� ■� \N \I ■ ■■D\\OEE■ ■E SUN *10MOO alI'molmommom ■E■■■■ s \ ■ 111 rAr ll►V ■ONNE■■■E■ 1 : %El11\.\■N\ ■■■EN ANNE= WIN M���MLX�_'J�� \ \►�N ■ ■ \� \ON■ ■N► l 'm!\ \\SON ■\NN■ ONE . L EI ► '` ■ ■N► O■ ■NE ■■ �■EEm■■ t (oracle e t .� as 5,6:te / —�-- EXi sE� Fcnct /i �2 A I Scale: "40" H wy dC �! "s�,.�oP. ✓,e. Proposed 104,; )d;r� SevAX 3 be en, Prop oSe.J LA,e5cf WLP 1, 00 014o 50 1nk re- !"& enC --' w/ Xa" 1,4 - i urn e 94L" 14 o p;l�e.r a-� g.rowf.fe�, ape") i-re (cl \ �ro /h -nd a�. v\� /G, 33 S'X 90' of `:\ EXiSfi'n y �en & be d 5Per5a ee! /. Two( \ re.nod€d w- o \\ L u 5,��q. Eke - /oy S5�' � Ka./' : � o F l U r 5S L m C lev: x /lo. cc' • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St- Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal referep�ev q Int (BMZ direction and Parcel I.D. percent slope, scale or dimensions, north arrow / ,.a�aib Qon'and distahse to nearest road. pending Please print alVig' illation. Reviewed by Date Personal information you provide may be used arsecondary pure (T racy Law, s. 15:14 (1) (m)). Property Owner ie r.l Propefty Location OakFA00d Land Development Govt of SE 1/4 NW 1/4 S 25 T 30 N R J (or) W Prope Owner's Mailing Address 1 Lot # Block # I Subd. Name or CSM# 1611 HY. #10 NE. fir. 5 na Red Pine Corner City State Zip Code Phone City [j Village Q Town Nearest Road Spring k - An ` Richmond 140th OcNew Construction Use: R] Residential/ Number ' o " y r Code derived design flow rate 600 GPD ❑ Replacement , ❑ Public or commercial - Describe: Parent material gl,ari a 1 ti-rift- Flood Plain elevation if applicable na ft. General comments and recommendations: mound @ el. 103.00; based on contour line of el. 102.50' ❑ Borin # 1:1 Boring 1 g ® pit Ground surface elev. 103.00 ft. Depth to limiting factor 51 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I - Eff#2 1 0 -10 10yr2/2 none L 2msbk mfr cs 2f .5 1.8 2 10 -24 10yr4/4 none sil 2msbk mfr 9W if .5 1.8 3 24 -51 7.5yr4/4 none sl 2msbk mfr qw na .5 4 51 -74 10yr7/3 c2d 75.ry5/6 limestone resil luum na na n alp ❑ Boring # Boring 103.00 38 2 ® pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 I 'Eff#2 1 0 -12 10yr3/3 none L 2msbk mfr cs 2f .5 .8 2 12 -23 10yr4/4 none sil 2msbk mfr qw if .5 .8 3 23 -38 7.5 1 4/4 none sl ms bk mfi aw if 2msbk mfr QW na .4 .6 5 50 -65 10yr6/4 c2d 7.5ry5/6 fractired lime tone na na np n Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ,;Effluent #2 = D < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gar L. Steel 02298 Address a e E n Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -7 -2001 715 - 246 -6200 Oakwood Land DEv Pro Owner Parcel ID # �� n g Page 2 of 3 Pro 9 3] Boring # E3 Boring Pit Ground surface elev. 102.20 ft. Depth to limiting factor 59 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ;mfr ce Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont: Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 -12 10yr3/3 - none L 2msbk 2f .5 .8 2 2 -28 10yr4/4 none sil 2msbk if .5 .8 3 8 -59 7.5yr4/4 none sl 2msbk mfr qw na .5 .9 4 9 -70 10yr7/1 c2d 7.5ry5/6 limestone residuum na na n Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # F] Boring 1:1 Pit Ground surface elev. D limiting t ft. Depth to mng facor 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 Effluent #1 = BOO, > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, E 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 (R.6=) Property Owner Oakwood Land DEv Parcel ID # lending Page 2 of 3 3] Boring # ❑ Boring 59 Pit Ground surface elev. 102.20 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 -12 10yr3/3 none L 2msbk mfr gw 2f .5 .8 2 2 -28 10yr4/4 none sil 2msbk mfr 9w if .5 .8 3 8 -59 7.5yr4/4 none sl 2msbk mfr qw na .5 .9 4 9 -70 10yr7/1 c2d 7.5ry5/6 limestone residuum na na np F Boring E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture StnxxAure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Etf#1 •Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struck" consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD > 30 S 220 mg& and TSS >30 < 150 mg1L ' Effluent #2 = BOD < 30 ffKA and TSS —< 30 mglL 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. saauw (X6=) STEEL`S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Oakwood Land Dev New Richmond, WI 54017 MPRSW -3254 SE4Nw4 S25- T30N -R1 8w (715) 246 -6200 town of Richmond lot #55- Red pine Corner This soil evaluation vas conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test nay or may not be as shown as pest tot lines here not established at the time the test Vas conducted. N 1 11 =40' BM.= top ofSE lot std@ el.. 100.00' alt. BM. =top of 1" pvc pipe @ el. 103.55' A e .s J AY) ,V 4 0 .1 Gv Y L. Steel 8 -7 -2001 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 Division of Safety and Buildings _ of 3 ' in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must C ro i x include, but not limited to: vertical and horizontal referePw direction and Parcel I.D. percent slope, scale or dimensions, north arrow,,ar 1'196 tbn'ar3d distance to nearest road. pending Please print alilinlation. , R revved by Date �rm Personal information you provide may be used tGtsecondary pur ¢ (rA4acy Law, s. 1 S (1) (m)). ? Property Owner ; ,l Prope{ty Location Oakwood Land Development . r Govt of SE 1/4 NW 1/4 S 25 T 30 N R 1 )t (or) W Prope Owner's Mailing Address 4 ^ W Lot # Block # Sutxi. Name or CSM# 1611 HY. #10 NE. 4�.,sr, 5 na Red Pine Corner City State Zip Code Phone NCIM City El Village (;j Town Nearest Road Richmond 140th Spring k - l i�'A"3% " 't 7 [3( New Construction Use: ® Residential / Number o' . Code derived design flow rate 600 GPD ❑ Replacement . El Public or commercial - Describe: Parent material gl acial drift Flood Plain elevation if applicable na - ft. General comments and recommendations: mound @ el. 103.00; based on contour line of el. 102.50' ❑ Boring # Boring 1 ® pit Ground surface elev. 10 3.00 ft. Depth to limiting factor 5 �— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I `Eff#2 1 0 -10 10yr2/2 none L 2msbk mfr cs 2f .5 .8 2 10 -24 10yr4/4 none sil 2msbk mfr 9w if .5 .8 3 24 -51 7.5yr4/4 none sl 2msbk mfr I qw na .5 4 51 -74 10yr7/3 c2d 75.ry5/6 limestone residuum na na n Boring # Boring 103.00 38 2 ® Pit Ground surface elev. ft. Depth to limiting factor -- in• Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I `Eff#2 1 0 -12 10yr3/3 none L 2msbk mfr cs 2f .5 .8 2 12 -23 10yr4/4 none sil 2msbk mfr 9W if .5 .8 3 23 -38 7.5 4/4 none sl lmsbk mfi aw if 3 2msbk mfr qW na .4 .6 5 50 -65 10yr6/4 c2d 7.5ry5/6 fractured limestone na na np n Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L . ,;Effluent #2 = lfflD 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gary L. Steel 02298 Address - -tfaffi Ev luition onducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -7 -2001 715- 246 -6200 1 Property Owner Oakwood Land DEv Parcel ID # pending Page 2 ' of 3 ❑ Boring # ❑ Boring ] pit Ground surface elev. 102.20– Depth to limiting factor 59 in. mil 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 1 -12 10yr3/3 none L 2msbk mfr 9w 2f .5 .8 2 2 -28 10yr4/4 none sil 2msbk mfr 9w 1f 1 .5 .8 3 8 -59 7.5yr4/4 none sl 2msbk mfr qw na .5 .9 4 9 -70 10yr7/1 c2d 7.5ry5/6 limestone residuum na na np n E Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R6=) STEEL'S SOIL SERVICE Gary L. Steel 1554.200th Ave. CSTM2298 Oakwood Land °• New Richmond, WI 54017 MPRSW -3254 sE4Nw4 s25- T3oN -R18w (715) 246 -6200 town of Richmond lot #55- Red pine Corner This soil evaluation vas 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 shown as permanent lot limes were not established at the time the test vae cm ducted. ,1 " =40' _W= top ofSE lot std@ el.. 1 00.0 ' =top of 1" pvc pipe @ el. 10 d s to Gary L. Steel 8 -7 -2001 r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2 FILE INFORMATION 'La ASS SYSTEM SPECIFICATIONS Owner S !'Yl rn L L J57 le Septic Tank Capacity 00C) gal ❑ NA Permit p O 365"' Septic Tank Manufacturer _T I F ❑ tuA DESIGN PARAMETERS Effluent Filter Manufacturer 2,114 4C 1E a NA Number of Bedrooms 3 ❑ NA Effluent Filter Model _100 ❑ NA Number of Public Facility Units 1(NA Pump Tank Capacity �SO al ❑ NA Estimated flow (average) al /da y Pump Tank Manufacturer wF f S EZ ❑ NA Design flow (peak), (Estimated x 1,5) $ 0 g al/day Pump Manufacturer Z t C; r,A Soil Application Rate f SV gal/day/ft' Pump Model ❑ NA j Standard Influent /Effluent J Quality Monthly average* Pretreatment Unit ^ � 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: Pretreated Effluent Quality Monthly average Dispersal Cell(s) C NA Biochemical Oxygen Demand (BOD,) 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurizeo) I Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ,Mound Fecal Coliform (geometric mean) 510' cfu /1OOml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other ❑, NA Ot Other: NA Other: ❑ NA vawes typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ month(s) y �� earls) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume r::, i nspect dispersal cell(s) At least once eve ❑ month(s) r y : 2Q 3 year(g) (Maximum 3 years) E: NA Clean effluent filter At least once every: �, ❑ year(s)month C rvA. j Inspect pump, pump controls & alarm At least once every: s) ❑ year(s) NA i Flush laterals and pressure test At least once every: 1) month(s) ❑ year(s) ❑ Other: ❑ month(s) At least once every: ❑ year(s) C 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. Tar.• 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 pone;r,_: of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires tn� 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 ent,r_ contents of the tank shall be removed by a Septage Servicing Operator and dispoged of in accordance with chapter NR 11 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. t' IJ /7 UP A'ND'OPERATION Page of r new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemica,s 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 or 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• o 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 ;s 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 filleo 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 absorpt or, 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 w c 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 A technology a holding tank may be installed as a last resort to replace the failed POWTS. T aluat � b a o ing any. e are �� Di 1817 �o � N/,✓1✓ �NS77Z v� o � )C Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat a: "re 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. i s ADDITIONAL COMMENTS n� .e the POWTS INSTALLER POWTS MAINTAINER Name E < Do Nye. L. Name �tre Phone ( Z _ (•S_ ! Z 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY n `'' Name /r Name C� ( b 20r1/ ( ti 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 S -A1A_Z -Zz -- Mailing Address -ef�oX �S/ Property Address Z4 N S (Verification required from Planning Department for new construction) City/State g o� LV RICH MbN Q Ci) l Parcel Identification Number 107('21y Z " S3 - C D o0 LEGAL DESCRIPTION Property Location S E_ r /., A( w r /., Sec. Z . T CD Town of 9 L LP Nk b H A) ,liubdivision c2c �; ✓�� �✓ `°''� ,Lot # S � . Certified Survey Map # Volume _, Page # 4 Warranty Deed # 7 - J 'Z- l $ s Volume 2 3 3 2 . Page Spec housez yes ❑ no 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, asset 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 retufrted to St. Croix County Zoning Office within 30 days of the thr a year expirat date. / ZO/ 03 A F APPLICANT DATE ': QWNER CERTIFICATION ;'(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 propttty.desc'bed a ve, by virtue of a warranty deed recorded in Register of Deeds Office. A PLYCA 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 t` J 2332P 465 732165 STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Oakwood Land Development. Inc.. a 07/28/2003 08:30AN Corporation ; Grantor, and Sam E. Miller, a single Person Grantee. Grantor, for a valuable consideration conveys to Grantee the following WARRANTY DEED described real estate in St. Croix County State of EXEMPT # Wisconsin (the "Property"): REC FEE: 11.00 TRANS FEE: 508.50 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Sam E. Miller 1408138th Avenue New Richmond, WI 54017 026 1130'115 006/026 1130 28 000 Parcel Identification Number (PIN) c97 - P4 a sS — o a O This is not homestead property. (is) (is not) Lots 16, 28, 40, Red Pine Corner and Lots 46 an 55, ed 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 IC � day of (SEAL) (SEAL) Oakwood L eveMpm811t`lnc. (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ' ) ss. St. Croix County authenticated this _ day of l Personally cam b �f e me this �C day of 14 the above named Greoory J. Peterson. as Vice President to me known to be the person who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledge the same. (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet Ca Jr < , Public, St t of Isconsin 1301 Coulee Road ioly cnmission is permanent. (If not, state expiration date: Hudson, WI 54016 !F. -< / � ) Q q 2 -41063 _ • . 1�2(�(� (Signatures may be authenticated or acknowledggd /C Both are not necessary.) 1 Names of persons signing in an ca aci must be Lied or p rinted below below their si nature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 —1998 Milwaukee, Wis. �S w 01 0 V 'l C4 "7 Q ''' p 3 i ,' I � ®/ �..- � .• , � � �,•,s8 8f of do w / / •• •. ' _o • / •. d , *Zgj ro o • „J ry�. .60 3I� i Jessie Nye Subject: red pine - -lot #55-- #430365- -mike mcdonell -- plow /contour Location: Richmond Township Start: Tue 10/14/2003 9:00 AM End: Tue 10/14/2003 10:00 AM Recurrence: (none) 026-1142-55-000 25.30.18.1039 i