Loading...
HomeMy WebLinkAbout026-1163-03-000 Nisconsin Department of Commerce • PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479435 0 GENERAL INF (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: Oevering Homes I Richmond, Town of 026 - 1163 -03 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: / (a S t 25.30.18.1253 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing ` Alt. BM 1 60. c i Aefat Bldg. Sewer / a' t f Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r d I - k 1 _ Dt Bottom J � Dosing f (n 36 r / Header /Man. AZA Aeration Dist. Pipe /6 25 Holding Bot. System , G� r Final Grade PUMP /SIPHON INFORMATION �� 63 Manufacturer Demand St Cover q GPM ` D 160 • / Model Number ^ � t 5� �7 I) f� l L ' 7 '` J v�T 3,4 TDH Li� Friction Loss System Head TDH Ft Forcemain L / Dia. 1 1 I Dist.toWell + 17 i I z SOIL ABSORPTION SYSTEM 3, BED/TRENCH Width Lengt / No. Of rench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `7 O SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type XT tem ` ) I �� I � NA— UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution I 1) x Hole Sizer II x Hole Spacing r Van t jo Air I ke Pipe(s Length \ Dia \ Length V V Dia Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only C4 V% '_ Depth Over r Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ' Bed/Trench Edges Topsoil 1� s (_j No es J No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: a / - 7 1 6 - 5 Inspection #2: Location: 1412 131st Avenue New Richmond, WI 54017 (SW 1/4 SW 1/4 25 rN R1 8W) Hollow Pond Lot 3 p Parc/e,�,N�o�5.30.18.1253 1.) Alt BM Description= �`1 Ct9v �-•- Gw, ,.- �-' ' t �� " �- 2.) Bldg sewer length = 36 r P'd L - amount of cover = y _ Plan revision Required? Yes o 1� Use other side for additional information. - Date InsepctorWSignatur Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County / 'I� 1 tY-- 201 a W. Washington Ave. P.O. Box 7162 's L (1 vhico n�,,� Madison, WI 537 Sanitary Permit Numb �t� e n by Co.) (608)66- 51 Department of Commerce Sanitary Permit Applicat' ` ; P umber &/ = �S, io to i, , In accord with Comm 83.2 1, Wis. Adm. Code, personal in ❑ eject d s (if different than mailing address) may be used for secondary purposes Privacy Law, s 1A C FApplicati0 n Informatio n - Please Print All Information �` ;'� O OUry OUry F arce # t# Block # Property Owner's Name T �`� "' t l 1 Property Location property Owner's Mailing Addres Section City, State J `7 Zip ,c / Phone Number _ C �C �� ��� %r W e T N; II. T pe of Building (check all that apply) y Subdivisio Name p CS M Subdivisio Name CSM NN OFF LI 6 / 2 Family Dwelling - Number of Bedrooms P,( Co %nn E A- gG �QC90 l ❑ Pub] ic/Commercial -Describe Use []City_❑Vill of ❑ State Owned- Describe Use I (2 $ 3 line B if applicable) III. Type Permit: (Check only one box on line A. Complete cable) 0'2 (o - ) I b 3 0 0 3- A ' New System ❑Replacement System El Treatment/Holding Tank Replacement Only [j other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal El Permit Revision [I Change of hermit Transfer to New Before Expiration Plumber IV. Type of POWTS System: Check all that apply) de ❑ Single Pass Sand Filter ❑ Non - Pressurized In- Ground ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank El Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand ilter 11 F ❑ Drip Li ❑ Gravel -les Pip ❑ Other (explain) Recirculating Synthetic Media Filter ❑ Leaching Chamber V. Dis ersal/Treatment Area Information: D ign Flow (gpd) Design Soil Application Rate(gpd s fl P Dis ens ea Required (sf) Dispersal Area Proposed (sf) System Elevation es � � Manufacturer Prefab Site Steel Fiber Plastic VI. Tank Info Capacity in Total Number Concrete Constructed Glass Gallons Gallons ofUni IM�.) New Existing I CID Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber 3 installation of the POWTS shown on the VII. Responsibility Statement- I, the undersigne me responsibility for Buss Bess Phone Number to MP/MPRS Number ✓� Plumber's Plumber's re a (Print) (� J Ql& J Plumber's Address (Street, City, VIII. Coun /De artment Use Onl g ent Si attire (No Stamps) Sanitary Permit Fee ( dudes Groundwater Date Issued Issuing g gn ? ❑ Dis ved Surcharge Fee) e l fps ❑ - ' en Reas or Denial IX. Conditions Ap rova 0.� SYSTEM OWNER) 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintain as per management plan provided by plumber. 2. All setback requirements must be maintained ttach complete plans (to thhe system on Paper not Tess than 81/2 size x 11 inches in size e County only) for t SBD -6398 (R. 01/03) 7L PLOT PLAN PRQ4ECT Oeverina Homes ADDRESS 838 Summer Pines Circle Hudson Wi 54016 SW 174 SW 1 /4S 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 100.5' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Pro Town Road to 140th St. Scale= 1/4" = 10' Property Line Pro 3 Bedroom Well is to meet all House setbacks found in Comm. 83 Huffcutt Combo Tank B-1 Tank is to be properly bedded and provided with lockdown covers Grading is to a with approved warning labels done to divert run -off away from system Area 15' below system is o remain undisturbed B-2 6% Slope B.M. * 100.5 99.5' It. B.M. Top of 112" pipe @ 100.3 O G Property Line r Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 ■ TDD #: (608) 264 -8777 i s co n s i n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary August 25, 2005 CUST ID No. 226900 ATTN. POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/25/2007 Identification Numbers Transaction ID No. 1188561 SITE• Site ID No. 703504 Overing Homes Please refer to both identification numbers, 140TH St I above, in all correspondence ondence with the agenc Town of Richmond St Croix County SWIA, SWIA, S25, T30N, R18W Lot: 3, Subdivision: Hollow Pond FOR: Description: Three Bedroom At -Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1035653 Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System: At -grade Component Manual, SBD- 10570 -P (R.6/99); 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and with publication SBD- 10570 -P (R. 6/99) "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems ". • The pressure network is to be constructed in accordance the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • 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. COnI • 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 D ARTMENT • A Sanitary Permit must be obtained from the county where this project is located in accordance with the ON AF1 requirements of Sec. 145.135 and 145.19, Wis. Stats. z SEE CORRE • Inspection of the POWTS 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 SHAUN R BIRD Page 2 8/25/2005 • 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 G Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART coder 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 Cover Page Shaun Bird DECEIVED Bird Plumbing Inc. AJI1 i 1 g 2005 1008 192nd Ave SAFETY L New Richmond Wi 54017 715- 246 -4516 Date: 8/16/05 Owner:Overing Homes Location:SW1 /4 SW1 /4 S25 T30 N,R18W Lot 3Hollow Pond Hammond System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil test Shaun Bird Signature License num 226900 OF CCU SPONDENG PLOT PLAN PROJECT Oeverina Homes ADDRESS 838 Summer Pines Circle Hudson Wi 54016 SW, 04 SW 1/45 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 100.5' 3 BEDROOM CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Pro Town Road to 140th St. Scale = 1 /4" = 10' Property Line Pro 3 Bedroom Well is to meet all House setbacks found in Comm. 83 Huffcutt Combo Tank B-1 Tank is to be properly bedded and provided with lockdown covers Grading is to be with approved warning labels done to divert run -off away from system Area 1 S' below system is to remain undisturbed B -3 B-2 6% Slope B.M. * 100.5' 99.5' It. B.M. Top of 1/2" pipe @ 100.3 Property Line L > 5t B '— 5 P Fo p"LLmA1N ...� 5 1 LATILMAL 2 � ups t— DtSTlC1 s.1TtOnt W A STA$ii i �D O'•YhTtON V� Ir E i.L ?:5 1 1 /2B C = f= _-- R CELL O '' Ft Pb%tEb SYMT *EnL Fabric Distributio n Lateral �- Soil Cover STRI 1161r_b Observation - --..� Wei 1 6.} _ i .g tWEb LAVEX > 5` A ` : > 5' s plan Vi and Crass Se -grade Unit ction of Wisconsin At with a S,Vgle Absorption Area on a Sloping Site �sv�ia7u RE Pa a 'Of 9 — Distribution PiPe DetAil For Lateral Metwork TuRN -UP� (CuRT40Ut� - PVC Force Main PVC Distribution Pipe P Last Hole Should Be Next To Q P Ft. Nome Diameter ch O � Inch(es) X �' Inches Lateral Diameter Farce Main Diameter ' Z" Incites T r Inch �— # Of Holes/Pipe J invert Elevation Of Laterals l Ft. Signed: License dumber: Date: r CR{75S S£CT10 AND SP£Cir IGATIO1vS SEPTIC TA2d1C C14AMBER WEATHERPMOF APPROVED Z" 241N- ABOVE GRADE ,�i3NCTION BOX MANHOLE COVER w == G VENT PIPE ZWINi�{Ii+ 4R WITH CONDUIT �d J PADLOCK 6 }` AIR DOOR , WARNING IABEL FRESt iA ii�TAiEE FIi4 GRADE Mtils- _• It4LET GAS- `�JpgpYED TIGHT SFAS TIGHT' •. jotw s WITH DATER SEAL APPRDM PE �F3LTER _A_ s ' ON 33# 09 SOII i i APPItDVED C. DIRE 3' O FF om SOLID. I L7 FT - _ D SOIL PUMP OFF ELEV - _---- D 3sas APFROUED BEDD - ING UNI>ER TANK. ONCRETE PAD SPECIFICATI 1+Ft1�IBER DOSES ?Eg I3l4Y = SEPTIC ! DOSE ��zN� '� rPT MAVjrACT I305E y£3 ME E-LOWBACK: /' GAL. TAIiK SIZES : SEPTIC r - --- 6RL. v , a JNCHES _ DOSE _.- -""'g rKti CAPf4CI3i IES = A —' A'lAR I M MANUFACT _ / / _g . EL NuKs : a —INCHE S __-- -- ,SWITCH TYPE = f ' �� C - � pump 1 �W�TFpCZ�iRF.R= WAC MODEL NUMBER: � 1 S f�� � idZRltsG AS PER ILHR 6.23 SWITCx TYPE= GPM PuM A / FEET c� PIPE - DI SCHARGE Z g€dT I C p EET REQUIRES p,,, OFF AND DISTR _ _ �' FEET BETWE 'N _ FATOR vER'fiCAL DIFFERENCE rTJlt�g F.F- •pgICTION C PRESSURE ? A P E PpI.Y NAMTC "EAD r IrIUM NETWORK SD TOTAL DY + C) ' EET FORC AZA� 9 - . W DTt - DiAMCTER UMP TANK: INTERNAL I71IytEYr1SI0At5 '4F P I -IQ`� _ DATE= TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE ' HEAD. CAPACITY CURVE EFFLUENT AND GEWATERING MODEL 152/153 MODEL 152 153 Feet i Meters Gol. I Liters Got. Vters 50 5 1 -5 69 251 77 291 153 10 3.1 61 231 70 1 265 15 4.6 53 2p 1 61 231 12 40 152 20 .I 6 I 44 167 52 ?97 s ;5 159 30 7.6 34 129 42 C 87 33 125 z 4 22 85 —,—� 10.7 I 70 ;p 12.2 -- 11 42 1 Q o Lock Volve: 38.0 Ft. (11.6m) Ft. ( 1 3.4m )I o;ssoe 4 10 p 20 1 40 60 80 100 1 GALLONS 1 &0 240 320 3 27/.12 uTERS 0 BO FLOW PER MINUTE I , 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. Electrical alternators, for duplex systems, are available and supplied with an alarm. sin le phase • Variable level control switches are available for controlling g 9 ; systems. • Double Piggyback variable level float switches are available for variable I 1 1 level long and shod cycle controls. i • Qwik43ox available for outdoor installations. See FM1420. Sealed • Over 130 ° F. (54 °C.) special quotation required. ' ,2 1/6 I 152x153 Series 1 / oln•P 152h53 MODELS ontrol Sel on I 5 1 /8 Model Vh Mode Am Du le: i Sim leY 2 or 3 N152 115 1 Non E.5 1 _]_ sK2ow 8.5 Included 2 or 3 I BN152 115 1 Auto .3 1 2 or 3 4 E152 230 1 Non 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 SE15 115 1 Non 105 1 SELECTION GUIDE 10.5 Included 2 or 3 back variable level float BN7 115 1 Auto 1 2 or 3 1. Single piggyback variable level float switch or double pggy E153 230 1 Non 5.3 BE153 230 1 Auw 5.3 Included 2 or 3 switch. Refer to FM0477. o cau>7oN 2. See FMO712 for correct model of Electrical Alternator E-Pak du Iex 3 All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a Control activator specify P ( ) licensed eteattgatan Ag etedxical and safety codes should be followed including the most, or (4) float System. recent Nadonal Electric Code ( NEC) and the Occupatior►al Safety and Health Act (OSW+)• RESERVE POWERED DESIGN um Zoeller . For unusual conditions a reserve safety factor is engineered into the design of every P P X411 To: P.O. BOX 16347 Louisville, KY 40256.0347 Manulactumrsof SHIP TO, 3649 Cane Run Road • Louisville, KY 40211 - 1961 Q�,7 r P LM-05 51y /999 ® (504 778 - 2731.1(800) 928 -PUMP FAX (5o2) 774 -35244 htrp:7/vww'-z0 com C Copyright 2000 Zoeller Co. All rights reserved. . . P Page of R'S MANUAL. & MANAGE POINTS pNE SYSTEM SPE cIi✓(c ATloHs C ga l D AIA Septic Tank p acItY ❑ NA ter Ff (NfORMAn014 tic Tank Manufacw C1 NA own er # �I 4 SS went Ft lter Man ror p NA Q NA Effluen Ftter Model n at 13 NA Lot ofeN P� pump -Tank CsPadty ❑ NA Numb of 00fM12s pump Tank Manufacturer comme Units boa � Number O Cow M an � d "-� .Pump � 1 S Es*nated tow ( ge ( mated X 'IA � ally lfca Pump Models Unit yin Aaw (P Pretreadmen 17 Peat Fitter Soo t+Pp Ion Rate Monthly average` O Sand0mve! Filter n 0 Wedaand {fluent Quality FOG) 00 mg/L O Me�anica ❑ Other. Fats 00 pema�nde (BOOS) S�fl mg t Ma wgen Biodhe � pendied Solids (TSS) stoma ecage.. Dispersal C1611(s) LI In - ground (p�uf¢ed) Total Monthly [3 ! ground (gravity) p Mound p� went Qua g0 s) 30 mg1L -grade 0 Other_ BiocherniCat oxygen Daman( ASS) 530 mg 400m( ❑ ne pical for d non oo"`d'n"�'tON'*t0fn0 Total Suspended SoL mean) 510 Varuas tyomes Fecal C00form (geometric sePtio is or � ,,ated -- ""W+ur Y. inch diameter Mro�num EfYtuent Particle Size values typ Serv(ce Frequency CE SCHEDULE a d s ) (Maximur++ 3 yam') MAN � p months Ser+rlre Event At one -third (K) of yank volume At Least once every a and scum e4 3 ts.) When combined siudg earts) (Maximum Y ins oondbon of tank(s) 0 months tank(s) Pump oUt pOntents of At least once every 0 months r(s) . Inspect disPersal oell(s) At y once every C3 months r(s) 0 NA At least once every s ) D NIA r ieffluent filter controls alarm O months Inspect pump, Pump At least once every 0 m onths © year(s) 0 NA Flush lataral and pressure test At least once every ❑months 3 year(s) 0 NA o0+ar At least once every oa+ef llowing rcertses or one of the N�Np1yGE (NS7'RUCTIO Ce l ts shall be made r pow•S Inspecto ec * any n mrssln9 b n t ►1 ks and dlspe r Restn C; of the rank for 811Y back up lnspe s of M SW plumber Mater plumber visual Inspection n m a nd Lek the e ffl ue nt levels ns ns must induce a of �mbined sludge and sc um ton the S uer lmO��r, Tank inspe�ks. m easure the volume )� visually ins of effluen any crate or tea rsal cetl(s) shalt nding authority. ident�Y The dish round surface• The lo round surface- riding of effluent on the,A tion of the volume, the h of effluent on the 9 for any Po wires the Immediate nobf orP pipes and to chedt n and requ or more NR in the obsen n indicate a failing COndM0 m in any tank. e4�ls one - l disused of to accord ante Wi ground surface s l u dge and scu favor and When the combined accumulation of moo by a Septage Ser�ng Ope and WY k shall be rem meat Components., entire contents of the tan a comp onents. pretreat# S Maintainer- to AdmitiWMtrve fessurized POWTS come ed by a certified POWT 113, Vag me chanigi or p ce event of effluent mis of months or less shalt be Q?rf0t'r" � of any 5 er� The nee or monitoring at inwf authority min 1 Q days othermaintena tied a local regulatory yoducm or other A serviQe repot shad'be p n Ce of painting P eatment tan k(s) for the p . if high concentralO nS are START UP AND OPFMATIO� use cf the pOWrSs check �daltla9e the dispersal 8 u Pr ior For W OOI�stNt' petie the treatment e a septage servicing ope _ chemicals that ""� rm its of the Wk(s) detected have the oonte / Page of, fro zen at the infiltrative surface ! conditions are fro men is reswred the excess System start UP snort not occx it wtted sa hwater levels. the {s} and may result in the fill above normal c9 by a During per outages Pip mo pe nal cett(s) in on 9haYe the contents nof the m or poWrSS�Matntainer to Du yh � be disd+a l� L To avoid tf�ws contact Plurnt r dsdvarge of effIVOP the effluent Pump t>ad�p w oe Opera' P�� �nt0 to restore normal ieyels whin the pump tank SetatagO manually operating the PUMP controls Oo not drive or park over, or °theme disturb or compact, asses vets o�' tanks and dispet3al grad po not drive or park lion area �,i 15 feet down sbpe of any motsnd or at sal a m m a the performance and Pig the fife the area from the wastewater stream may imp deglgas�: dental flow- daP� Redu ce or-eraninadw of the folio - tte butts; condoms; Lytton swabs, herb'tddes; meat of the PO WTS- artti wdos; -baw Will. 4 • ater, fruit and vegetable peelings; gasoline; grease; di�ahi (scxnF P�P3 nap kins: tampons:,and water softener bane. fat meting products: pesticides; sanitary P scr .W mecoca0w, ��y.taicen out of service the fottovving sbet� shalt ize taken to insure that the ABANDOWMEXT andtor is pew sin Administrative Code- When the POWTS falls aband � in co wtth ch- Comm 83.33, 5C°n sealed system is properly and sm-ely disconnecte � d and the abandoned Pipe ' Inge servicing Operator. All piping to tanks and pits shall be disposed of by a SePtage • shalt be removed and Property d� o tirect.and the void space The c ontents of air tanks and p its Shall be excavated and removed or their covers rem After pumping, all tanks and per filled with soil, gravel or another inert solid rrtaterial. vide a code CONTINGENCY PLAN the following measures have been. or must be taken, to Pro If the POWTS farts and cannot be repaired the- soil compliant n �cernent system evaluated and may be utilized for the t°ce an of a r ep l a ce ment and should not nt'ar+ea has been rotected from distur a bsorption system- bance and cornpa p A suitable reptacem roP��t area should be P proposed strucu. tot Fines and wells. Failure to lied cemen from existing and propo be infringed upon by re s e pa in the need for anew soil and site evaluation w establish a suitable pro fit the replacement area ms must comply with the rules in effect at that ti n e• advance in POWTS r e p l a c e me nt protect the area- Replacement syste is not available due to setbactc andl arc^,e `� failed POINTS- p A suitable replacement area be installed as a last resort to rep technology a holding tank may a suitable replacement area Upon (lure of the POWTS a Sob and e Site has not been evaluated � identify if no replacement area is available a locate a suitable replacement area . site uation must be perms lace the faled PO�S- c ling tank may to installed 2s a Last resort to rep lace following removal of the bto at n systems may be reconstructed in P curd and et'9�� sod absorption i of such sys's must comply With th in effect at that time- the rnfiltrativ 7'MMENT TANKS MAY CONTAIN LETHAL GASSES �gf,ID10R INSUFFICIENT 07(YGEN. <cylfARNLNC.» CIitCUMSTANCES SEPTIC, PUM . DEATH MAY P AND OTH PUMP OR OTHER TREATMENT TANK UND DO NOT EKTER A t'sEPTiC, PUMP l:.R RESULT.. RESCUE OF A PERSON PROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS MAINTAiMER POWTS INSTALLER Name w' Name ' Phone Phone � 1 Z, i 'F UMPER LOCAL REGULATO �,�' RY AUTHORITY THORiYY SEFTAGE SERVICING OP ERATOR P C u . Agency 5 . 1 Name Phone 1 - 7 J " ntis doa"nt uette and Waushara CountY Zoning =W SaPL6M ague.- es nt do not 7ltis flppxnent was drab by the std of the G.ree tLske, 83 56(1). Cly (3)• Wscnnsin A6rnU►YsVat"1e Code Use of tuts dourme r� (1101 ) me R,nimwn raqu; arts of dL Comm 83 }(Q)&(fl wA the nV UM the performance of the POWrS- Wisconsin Department of Commerce i, a� , x 5���y EV EPT7 R7Y - Page _� of — 73 Division of Safety and Buildings tL'.`' in accordance with Comm 85, is. Ad od SST. CR County• C. ✓'t9 3 r 7� Attach complete site plan on paper t less t in si . Plan must J include, but not limited to: vertical an BM , irection and Parcel I.D. �" percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �1U �� �O — 0 3 Please print all information Re ' wed �by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I S 6 Property Owner Property Location V e Govt. Lot L4 " 11 j!) l4 S 2- 30N R E( ) W J Property Owner's Mailing Addr Lot # Block # Subd. Name or CSM# Zoe 6Y 3 .3 - State Zip Code Phone Number [:I city ❑Village Town Nearest Road vim' ( ) D/ J . A1 New Construction Us esidential / Number of bedroom Code derived design flow rate G ❑ Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable General continents and recommendations: '61, 1&1,( 1,�;F`V . 75 V Boring # Bo ring a Pit Ground surface elev. �� � ft. Depth to limiting factor in. Soil Application Rate Consistence Boundary Roots GPD/flz Horizon Depth Dominant Color Redox Description Texture Structure Co ce P ry in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 o- , 3 /tr - 5 Cam // Z (i J J ^^ ^- 4 ✓® � a ® Boring # 4it ring Ground surface elegy/ �' � 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 Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si re CST Number Bird Plumbing, In Sh aun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �_� ��� 715- 246 -4516 Property Owner_ Parcel ID # Page of F,_31 Boring # ❑Boring A 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 1W / oZ F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD, < 30 rng/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 (8.600) i oil Test Plot Plan Project Name Ken Oevering ��J2r; Shau 'rd Address 838 Summer Pines Circle ' f k " Hudson Wi 54016 C #226900 Lot 3 Subdivision Hollow Pond Date /3/05 S W 1/4 S W 1 /4S 2 5 T 30 N /R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey iron System Elevation 100.5' *HRpSame as Benchmark Alternate Benchmark Top of 1/2" pipe @ 100.3' AL P roperty Line Scale is 1" = 40' unless otherwise noted 100.5' 99.5' B -1 5' B -3 35' 20' 6% Slope B -2 40' 30' B.M. 11t.B.M. Property Line f 'is' RIVED Wisconsin Department of Commerce SOIL EVA UATION REPORT Page of 3 Division of Safety and Buildings rif� Cj5, Wi . Adm. Code minty St. Croix Attach complete site plan on paper not 11 inche :(n size. Flan must include, but not limited to: vertical and &- jai lWI), direction and Parcel I.D. percent slope, scale or dimensions, no to nearest road. Please print all iMbfmation. R 'ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 1:1 El Greg Peterson Govt Lot SW 1/4 SW 1/4 S 25 T 30 N R 18 Property Owner's Mailing Address ;itiy Block # Subd. Name or CSM# 1611 Hwy 10 Hollow Pond City State Zlp Code Phone Number n Village ■ Town Nearest Road Spring Lake Park I MN 1 55432 1 ( 7¢3- 780 -4996 140th Street 0 New Construction Use] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD 0 Replacement Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable MA ft. General comments e_ _soils w' stem being used by the d recommendations: installin ontractor. recommendation woad also be nsider a pressurized s s here the effluent can I ose over a entire dtstn ution area. Not required, but recomm ded. 4 This site is suitable for a below grade conventional system. ��B4M ❑ Boring # ® Boring (� El Pit Ground surface elev. 100.49 ft. Depth to limiting factor >85 in. Soil lication 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 1 0 -9 10yr2 /1 sil JqQ mfr aw 2f .2 .3 2 9 - 12 7.5yr4/4 sicl I PI mfr cry if .2 .3 3 12_28 7.5yr4/4 scl lmsbk mfr cw if .2 • 4 28_37 7.5yr4/4 sl Irpsbk mfr cw - .4 .6 5 37-44 7.5yr4/4 Is mvfr cw - 7 1.2 6 44 -85 7.5yr4/4 sl O Infl - - . 2 Ong # Boring 100.60 >84 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appficattion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 1 0 -9 10yr2/1 sil 1 pl Infr aw 2f '`8�` 2 9 -13 7.5 4/4 sicl 1 cam' if •2 •3 3 13 -25 7.5yr4/4 scl lmsbk mfr cw _ .2 .3 4 25 -3 7.5yr4/4 is In mvfr cw - .7 1.2 5 6 -84 7.5yr4/4 sl Om mfi _ - 3 .5 v " 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) Signature - �.. CST Number Thomas C Nelson �` T �"� 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 7/3/03 715 -246 -2454 Property Owner Peterson Parcel ID # Page 2 of 3 3 Boring # 'fig g Pit Ground surface elev. 95.70 ft. Depth to liming factor >84 in. Sal. ApplWation 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 -8 10yr2 /1 - sil imsbk mfr aw 2f .-Z 3 2 8 -18 7.5 4/4 - sicl I msbk mfr cw if .2 .3 3 18 -25 7.5yr4/4 - sl lmsbk mfr cw if .4 .6 4 25 -84 7.5yr4/4 - Sl Orr mfi - - .5 F-1 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 GPDMF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 . Boring # Boring F-1 H pit Ground surface elev. ft. Depth to limiting factor in. 9 Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- * 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 - 2648777. SM- 8330'rest (R.07M) y 0 POW-1) LOT 3 BM2 BMI 10 m 23 ' BI 3- 38 1 129' �I 147' 2% SLOP 5% SLOP B2 94' 96' 98' 1 100' SCALE 0 l P OF I8Ow PIPE 100' ABM TO OF COBDZ7IT PIPE 10 100.49' 192 100.60' B3 95.70' S� THOMAS WELSOW 227387 ^' • ECEIVED PRELIMINARY PLA' (A CC - OCT 2 S 2003 Located in port of the Southwest 1 4 of ST. CR01X CO North, Range 18 West, Town of ZONING LINTY Sect come. OFF Mst bn ?S- JO-Ia ICE (Eetab/Lshed ham 7Hs) _ OT 2 SI R1 RICHMOND - - :L MAP "C UME 1 yyl f ems_ 3�CC CT 5 LOT I — n NB '55'25 "E 1315.51' Jag 20' , NET BUILDABLE AREAS: LOT 1 65,803 eq. ft. QI 1.51 scree z l 1 _ . LOT 1 LOT 2 OT ' LOT 4, LOT 2 5 139 sq. n. �; s 6 60 sq. ft. 65,603 sq. ft. ` ' sq' J8,540 sq. ft LC 1.33 acres ` 8 ' 1.51 acres 1.51 acres 5 ` 1• 9 acres t 1, 80 acres.... LOT 3 s3,DS7 . n. ��g (�,B O. =1021 D' 1.22 acres L.8.0 = 10 ?1.0 e\ 97 251 ., 7e LOT 4 saD sq. ft. .. i , 2 23 1 ! I l I \\\ .80 acres LOT 5 97.292 sq. ft _ _ — / r 2.23 acres - ?05' — — ?a5' - 4- LOT 6 $1,923 sq ft, _� 4JS' - 1.00 acres j M y P1 {6�D- - AW— AVFACE ---:_ R roo - Z- LOT 7 128029 sq. ft. N �' 5. 2.94 acres j err A y r -- — ?15' 90.386 sq, ft. LOT 8 2.07 acme k+l r lFF Eent� '► '�� �' 050 01) �.- LOT 9 89,4 aq, 2 .05 acres N 1 ,' .. ..,..,,,.,,.a1„ ...,t, v LOT 10 81,266 sq, ft. 1.87 acres aAN U LOT 11 91.632 sq. ft. I l I I I� QE .PIT A4 A 2.10 acres _ L, (SEE W- a. LOT 12 7 7 7 s ac r ft. y LOT LOT 9 `` � \LOT 8 1.7 acres �� I�I LOT 10 " 102,.#62 sq. 76,653 sq. ft. Q 91, E31 sq. ft. 81, 266 s ft. '`2 35 acres LOT 73 1.77 acres I . 2 10: acres q• 89,416 sq. ft -� R3.544 s rt. 1.87 acres 205 acres. - ,Et .B.0.= 1033.0' _ LOT 14 2.15 scree w j Stnvorursp ro r l - be Removed LOT 15 $2.292 sq. ft. :.RAIN 1.43 acres JI • a I IN' LOT 16 65,401 sq. ft. Zi N IK .�' = ', 3AFN - '' 15' JB?' 1.50 acres H -IOJLL 417 EX SIIN s LOT 12 LOT 14? T 1�4 7776,883 WET Add \ 1 ,199 sq. . n sq. ft. f• c Nom ' ' LO - L ft .�, t� -- � ., 136, 339 sq. ft. t� �{ ?, 1.7 ? acres 1.77 acres 313 acres 4 ®.,. .. •,.. 4,�0= 10330' I i — - - -- — — Jr - T I N - S89'43'24 "W' - r - -1322.24' ----- - -- RITY _ ?B44t48'„- ST. CROIX COUNTY uthwest Comer ection 25 - -18 PLED AREA IS ZONED: AC -RES (end 7/b'rebw) U J'LATTED_LANDS CURRENT USE: AG -RES ADJOINING LANDS ZONED: AG -RES CURRENT USE: AC -RES AREAS TOTAL AREA OF LAND TO BE PLATTED: 1,943,952 SQ. FT. I hereby os• 35.44 ACRES direct super MINIMUM LOT SIZE REQUIRED: 65,340 SO. FT., 1.50 ACRES NOTE: The parcels shown on this map are subJeat to State. County and Township knowledge or AVERAGE LOT SIZE: 87,553 SO. FT., 2.01 ACRES laws, rules and regulations ( i.e, wetlands, minimum lot size, access to parcel, the laws of THIS ADDITION WILL CONTAIN 16 LOTS eta.). Before purchasing or developing any parcel, contact the St. Croix County PROPOSED TOTAL LENGTH OF TOWN ROAD: 737 L.F. Zoning Office and the approprlote Town Board for advice. R.O.W. DEDICATED TO THE PUBLIC: 142,705 SQ. FT., 3.28 ACRES TY DODGE, F ST. CROIX COUNTY WISCONSIN ZONING DEPART MENT �\ I I lip w w ■ w ■ r���r. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 M emo to Folle From: Pam Quinn Date: 7/21 /2004 Re: On -Site Soil Report Verification for Lot 12 Hollow Pond Subdivision (SW % SW ' /4 Sec 25 Town of Richmond) 12 13 & On Jul 9 2004 a site visit was conducted to evaluate soil conditions reported for Lot , July p 15 within this new subdivision. After making observations in test pits and subsequent review of all soil reports submitted for lots in Hollow Pond, it appears that the recommendations for installation of pressurized conventional (in- ground) systems may not be feasible. The weather was sunny, temperature in the 70's, with good light conditions for color determination and no precipitation for >24 hours. A sanitary permit was issued for this lot and excavation for the foundation had exposed soils that caused concern for installation of a v p conventional system. Test pits on lot 12 had been excavated at the approximate locations of B2 & B3 on the original soil report. At B3, the soil profile was similar to that reported, but redoximorphic features (iron deposits and high chroma concentrations) were observed at the irregular boundary between a sandy loam horizon and fine sands below, at approx. 60 inches. The fine sand horizon from 60 — 88" appears to be weathered sandstone, with extensive iron deposits throughout (2.5 YR 7/8) in a matrix of 10 YR 8/2. Bands of 7/5 YR 4/6 sandy loam were observed starting 6" below the textural change. A test pit near B2 showed massive sandy loam transitioning to fine sands at < 48 ", again with redox features along the textural change and much higher concentration of iron staining in the fine sands. Redox features at less than 48" would limit installation of a pressurized in- ground system to less than 12 inches below grade. This would place the system on Lot 12 in silty clay loam soils with an application rate of 0.2 gpd/ft Recommendations for "pressurized conventional systems" would require a minimum of 2250 ft for a 3- bedroom house, 3000 ft for a 4- bedroom system. Due to Dept. of Commerce code changes, effective as of 2/1/04, massive sandy loams now have a soil application rate of 0.2 gpd/ft On many lots these soils were encountered in a third horizon at depths of less than 24 inches from the surface. Pressurized pipe, not a dosed system using leaching chambers, would be needed to achieve even distribution of wastewater throughout these soils. Costs for design and installation of an in- ground pressurized system should be compared to a traditional mound system, the latter having the option of being reconstructed if a failure occurs. The existing tested areas for all lots within Hollow Pond are not large enough for installation of a 3,000 square foot system and another equal area for replacement. Additional soil evaluations will be required and the replacement areas will have to be preserved from any construction activity for sites proposing to use this POWTS option. Mound systems for lots in Hollow Pond would require designs with lower loading rates where soils exhibit platy structure in the upper horizons and/or have <0.3 soil application rates within 12 inches of the surface. These long, narrow systems would, however, fit within the existing tested areas provided on the original soil reports. Sanitary permit applications for conventional POWTS will not be approved for these lots based upon this on -site determination unless the following items are included: 1. Additional soil test pits have been evaluated to provide both primary and future replacement areas. 2. Documentation that redox features are >36" below any proposed system elevation. 3. The soil application rate used for sizing the system extends a minimum of 6 inches below the proposed system elevation. For example, if the system is 18 inches deep and a massive sandy loam begins at 19 ", a soil application rate of 0.2 gpd/ft would be required for sizing the system. Cc: Greg Peterson, Subdivision Developer Oevering Builders, owner Leroy Jansky, Regional Wastewater Specialist Tom Nelson, CST #227387 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer GV C� r ' 1 1,". 12 Mailing A 3 3 S� M rev ` Address ,I Property Addr on Dep artment for new constru )- _- ___-_► f rom pl anning p aired fr g (Verificationreq 2,6 City/State � /� ��✓ � � ��/ Parcel Identification Number � l LEGAL DESCRIPTION �j{ � � . � 1/4 // ' '� �I� -R�___ -w� Town of _ Property Location �" ��•, sec. T — Lot Subdivision �- - Page # � Volume --� g Certified Survey Map � Page # 62 Volume - P g Deed , ArrAII — W t3' nti fiabl es 0 no Spec no hour D Lot lines ide SYSTEM MAINTENANCE premature failure to handle wastes. Proper maintenance roper use and mane your septic system coul eTe u named by a licensed pumper. What you put into the system if Imp ears or soon every three of pump out the septic tank e ry Y waste disposal system. resists P� in the � trea stage can affect the function of the septic tank as a tr g standards certification form, signed by the owner and by a D a sal system The property owner agrees to submit to St. Croix Zoning Dep vorifyiing that (1) the on-site wastewater dispo masterplumber, jouineynPlumbcr, restrictedplumber or a licensedpumper the tic tank is less than 1/3 full of sludge. tin condition and/or (2) after inspection and pumping (if necessary), �P ra g proper oPe the is in p Pa with Uwe, the undersigned have read the above requirements and agree to maintain the Private sewage State of Wisconsin - Certification ent of Commerce and the Department of Natural Resources, O ffi ce within 30 set forth, herein, as set by the Departin comp leted and returned to the St. Croix County Zoe stating that your septic system has been maintained must be comp da f the three year expiration date- / 2� y DATE SIGNATURE OF APPLICANT OINNEi R CERTIFICATION our knowledge- I (we) am (are) the owner(s) of to I (we) certify that all statements on this form deedreco re corded Register of Deeds Office- the properly described above, by virtue of a warranty DATE SIGNATURE OF APPLICANT « « « « «« A information that is mis represented may result in the sanitary permit being revoked by the Zoning Department. « « « « «« y «« Include with this application: a stamped he waay c cer t tif deed ed surve y ma if a copy of t is mad in the warranty deed he erfive P U 2685 P 179 • 7 7 B 3 7 0 STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIK CO.. WI RECEIVED FOR RECORD Document Number This Deed, made between Silver Lake Land. LLC. a Corporation 10/29/2004 08:25AK Grantor, and Kenneth J. Oeverina. # . _- _ - _. Grantee. WARRANTY DEED Grantor, for a valuable consideration conveys to Grantee the following EXEWT f described real estate in St. Croix County State of Wisconsin (the "Property"): REC FEE: 11.00 y � K TRAYS 1272.00 71r COPY FEE; CC FEE: PAGES: 1 Recording Area Name and Return Address _ . J.;N TO: 'urnet Title �r I'rance Ave_ S. MN 43 026 1073 50 001 Parcel Identification Number (PIN) This is not homestead property. (Is) (is not) Lots 1 through 11, Hollow Pond Addition, Town of Richmond, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except 4 Dated this � day of October 2004. (SEAL) (SEAL) Gregory J. Peterson, Presiden Silver Lake Land, LLC (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, I ss. WENDY SWATZINA St. Croix County �. authenticated thi$ Personally came before me this 11?r day of STATE OF WISCONSIN October 2004 the above named Gregory J. Peterson as President of Silver Lake Land. LLC.. a Como ostion to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person who executed the fgregoing instrument (If not, and ackn wledge ie same. authorized by §706.06, Wis. Slats) THIS INSTRUMENT WAS DRAFTED BY ndil :sw no- - Coldwell Banker Burnet Notary Public, State 6f Wisconsin 1301 Coulee Road Hudson, WI 54016 My commission is / permanent. (If not, state expiration date: 3 -66215 Q l0 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons sinning in any capacity must be typed or orinted below their signature. I YJ. ,fT iA s n to LO V UI I N .( . r .M.. N �- 01 \ . J O kk 08 L q \ o O OOZ BIN1 •' . / Q 8 �f Cq Ln ci S2- ' J i w ,C) I I LO o ins , 69 .Z 0) 8 ,l0'OZ£ W / ���3„9£,S'Z.00N I 3Nss.1 00 4 3 O O O C N C p '` O O N Ooh o I M LO > ° � I I W I O I , l0'OZ£ ,Z8' N 01 :101 3„ S£,SZ. ON I 3„ S£,5 W 3 u p of O w N CI O J � 1 >1 �� 1 LO C L I „I Q I O h V r- cp cn ' V �I a_ ) �I 0 ...............0.,x,0........ z I 000 ui N• Wi a l N J h " N N ................... � Ul �i N ° ` O , 1 en N ,S8 OL i ,10'OZ£— ,00'99 3 «9F,SZOON ' 09'6£ll M,.S£,c J AM L */l MS 0 40 jo auil - --- zL« 3nmOA ��ddt �� 9 10� I L � ^ I o ~ 0