Loading...
HomeMy WebLinkAbout026-1167-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St, Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463023 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Environmental Holding Company LLC Richmond Townshi CST BM Elev: Insp. BM Elev: BM Description: Se tion/Towh /Ran /Map No: Do D G- 0 1 27.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ l Benchmark C D a Y � 1 2- Dosing � (/ Alt. BM Aeration Bldg. Sewer a /0 /. 7 4 Holding S t Inlet ( ,o0 . 93 TANK SETBACK INFORMATION S t Outlet TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Q / Dt Bottom Dosing Hea - d • l� Aeration Dist. Pipe � a Holding Bot. System r 1 Q r_ . Z lD t0 PUMP /SIPHON INFORMATION Final Gr s'33 Manufacturer DerrrJnd St Cover g GPM 2- 3 . d Model Number / TDH Lift Friction L Sy ad TDH Ft Forcem ' ength Dia. Dist. to well SOIL ABSORPTION SYSTEM - 3Q S U BED /TRENCH Width 1 Length f No. Of Trenches PIT DIMENSIONS Of Pits Inside Dia. Liquid Depth DIMENSIONS �n /1 SETBACK SYSTEM TO lJV P/1_ BLDG IWELL LAKE /STREAM L G Maryefdcta6er:� /� INFORMATION C R OR L L / Typ Of System: \ , f l t UNI Model Number. DISTRIBUTI SY TEM > Hea anifolfl Distribution x Hole Size x Hole Spacing Vent to Air Intake I Pipe(s) N f _ ✓ �— r Length a Lengt Dia _ Spacing �! SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over f Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center (� Bedlrrench Edges Topsoil ` E] Yes No Yes U No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 10 / 30/ Inspection #2: / / Location: 1392 129th Street New Richmond, WI 54017 (N 1/2 NE 1/4 27 T30N R1 8W) Lundys Preserve Lot -`) ' ",/�P,arrcell No: 27.30.18. 1.) Alt BM Description = ST V02 WO ��� � aYw� w 1/h. 2.) Bldg sewer length = 00 - amount of cover = .1, Plan revision Required? 4.I Yes -- - �� r — - -- r Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Sr nature Cart. No. Safety and Buildings Division, County .S 201 W. Washington Ave., P.O. Bo r0 Madison. WI 53707 - 71 e� Sanitary Permit Number (to be fUled in by Co.) FDepartment of Commerce 1 (608) 266-3151 3 0 Z3 SaWtaU Permit APPlicatia REC I.D. Number In accord with Comm 83.21. Wis. Adm. Cote, perteorst you provide may be used for secondary purposes Privacy Law, s15.04( )(m) C E Pra' t Address (if different than mailing address) L AppBcathm InforMation - pkwe Print AU hdatrtnation J 7 L � i t ST. Ciz01X Property Owner's Na me NG OFFICE f Lot* S Block ;► \ -to -lo . e m dD�d `� a L L� to - 107 S _ _ U $ Property Owner's M ailing Address Property Location t ��\ S n [� '�.S «t�t� City, State zip Code Phone Number �- t V L- 5 0 [P 7 1s 3 - e�� I ) II. Type of Bide (ckeek aH that apply) T N: R L E t> or 2 Family Dwelling - Number of Bedroom __ -� - Subdivision Name CSM No ❑ PubliclCommercial - Describe Use — ' -r °' Lk e vim_ El sum owned - Desc fibe Use _ U .ity Village Wfownship of M. Type of ' - (check a+ty one box awfim A. Complete line B if applicable) A / A 6New Systerr+ ❑ Replacement System ❑ TrestmendHokiing Tank Repla"ment Only Lf Other Modification to Existing System �. ❑ Permit Renewal Permit Revision l_) Change of Before Expiration Plumber O=mit Transfer to New List Previous Permit Number and Date Issued - -� IV. Type of POW'I S (Check an that ) - K Ntm - Ptimurimil I- Ground L3 Mound > 24 in. of suitable soil I_1 Moenrd < 24 in. of suitable soil IJ At -Grade El Single Pass Sand Filter ❑ Constructed Wetland Q Pressurized hr- Ground L1 Holding Tank U Peat Filter U Aerobic Trawnem Unit U Recirculating Sand Filter ❑ ReEkculatitig Synthetic Media Filter ❑ Latching Chamber ❑ Drip Line ravel -less Pips ❑Other (explain) V. DigmissalrhysuBmt Area Reformation: Design Flow WO Design Sail Application RaWip - ds0 Dispersal Area nspasa Required Of) Dispersal Area Proposed (sf) System Elevation t So VI. Tank Info Capacity in i Twal Number Manufacturer Prefab Site Steel Fiber Plastic i Cations New Existing Gallons of Units - oReio - t Lo $ to ul tiz F1' QW Concrete Constructed Glass Tanks Tanks Holding Tank `masers Aerobic Tm4mviil Unit Dosing Chamber Vim R eSPOnsibft SWCMtW 1, the tmelnsigrad. ag po�ihlihy fen ' the POWTS shown an the attached plans. _ s Na rte Pri •s Si tune /MPRS Nu Business Phone Number d:L � cr -�.e- 8 s 3 I s e s 3s Pkimber's Addre ss (Sum, City, State, Zip C ) A? tc A4 v R � mo 0 L_�- m_ vae Only Approved t0!0wn:er soved S anitary Fee) Fee (i udes Groundwater Date Issued Issu' Agent Signa (No Stamps) Given Re ason for Deaisl p ],� tog rt ItX. -'—f — J t:. � A vaURmsons for ttla''o► Disapproval 1 SYSTEM OWNER: 3) mo -Al. 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. .� � ��� � .� o- CLe+�tio��, 2. All setback requirements must be maintained (� ✓� i AA% as per applicable code /ordinances. Co�LS j '► Pis lO +he con"Y omp nor paper as loss ftm ale x 11 bubo in sbCe � cs� �esS �o--- � • � / Z F'n%j,ro^ nw - A - W T1o1�,r.� ( y U ., N'( N 5-& S a7 T3 o 1v 1iz$ -) �C0.SO U - ) -l- SY017iYho�l i'c�✓`c.� � oau -10 — to ���� v ac to - 3C5 3 't 10c) F- Q l 3 `� � 3b S,eco 1�to "T�' Cr s_7 A e m 't c� s ' E( 17 V�Ft1 N M�P C C 4 R[t a fi d � O ff. ol �v vw" Li� 1 p oti . W Q " G a7 Tao Sir , UJ-1-- SYO l 7 n icor1 t cx� Fj Q 3 `l t 3cU s ie C oz o �orTi' -T -Uy s A - toe A 3 � P C� E ( 17 pK%Ftl � r% C O 'X fLli� 4 �q t RECEIVED . 0 rt JUN 01 2004 Lundy's Preserve Comments: ST. CROIX COUNTY ZONING OFFICE The soils in this subdivision are quite variable and differ across the 80 acres. Some consist of a clean outwash sand, other consist of glacial tills. In certain areas, the medium sands have a very deep red color unlike I have seen in all of St. Croix county. The color does not indicate high ground water because the color is so consistent. If you go through the red sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam Quinn from zoning, she commented that there could be a different chemical reaction with a sands. I believe this is the case for the sands have a consistent size, and no mottles were found above or below the sands. Sometimes bands were present, but were very slight, and were mentioned to have the systems sized a little bigger in order to accommodate for any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8, and 9 have a extremely poor soil present not suitable for a mound system. The surveyor and I discussed this condition, and the resulting tests were spaced as far away from this area as possible. All the soils tests were done to the best of my ability and I hold no liability for anomalies and other oddities that can be found on this site. Shaun Bird CSTM #226900 i 5/28/04 r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 ric es X i include, but not limited to; vertical and horizontal reference int (QI� �9 d'� F Parcel I.D. percent slope, scale or dimensions, north arro , and ti n and distance to nearest road. Please rint al Reviewed by Date p �V JUN 0 � zoos Personal information you provide may be used for p es (Privacy Law, s. 15.04 (1) (m)). Property Owner (. CkK IRrtidt4�Ldcation - / / _0 Oi=F1 4 - 1/p �/4 S T _ N R E (o W Property Owner's Mailing Address Lot # Block # Name or CSM# � rf City State Zip Code Phone Number 0 City ❑ MIlage wr Nearest R90 New Construction Use: Residential / Number of bedrooms Code derived design flow rate e Ud GPD ❑ Replacement Public or commercial - D scribe: - - -- -- -- Parent material t:L� `� levation if applicable / ✓� ft r General comments L - �, ��� � u 0 , q f and recommendations: 5�5��� l� //cI��Z/> Z Boring F-/1 # ring (' Pit Ground surface elev. �! Depth to limiting factor in. Soil ication 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 C "// -31Z- S 1Z aLAI C Q— .i / A Ink �✓l l jQ- a Boring # _ ring Pit Ground surface ele��` n• Depth to limiting factor �� in. Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 z Y77 3 Effluent #1 = SOD > 30 1220 mg/L and TSS >30 1150 ' Effluent #2 = BOO- <_ 30 mg/I- and TSS < 30 mg/L CST Name ( � m Pry) lure CST Number 226900 Bird Plumbing, Inc. Shaun Bird Telephone Number Address - 246 -4516 Date Evaluation Conducted 1008 192nd Ave, New Richmond, WI 54017 --� 715 Property Owner Parcel ID # Page of Boring # Boring 5-1 Pit Ground surface elev. D2, Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E##GPDlfFEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 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 GPD/fP in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. •Eff#1 •Eff#2 ❑Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD1fP in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 <_ 220 mglL and TSS >30 1150 m9A- • Effluent #2 = BOD, < 30 mglL 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. 90-8330 (RAN) M Soil Test Plo)te PI Project Name Environmental Holding L.L.P. t Bi Address 706 19th St. S. Hudson Wi 54016 TM #226900 Lot 5 Subdivision Lundy's Preserve D 5/24/0 4 N 1/2 NE 1/4S 27 T 30 N/R 1 8 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 9 8.698.2/97.8 *HRPSame as Benchmark Alternate Benchmark Top of Survey Iron @ 96.0' B.M. 175' 374' Property Line 108' P. B.M. 20' B - h01' 103' 5% Slop 0' B -3 6 10' 13- Please note:Soil was done to satisfy county zoning requirement. Soil Scale is 1 „ = 40 test may not be unless otherwise 218' Property suitable for owners Line desired building noted location. CY\u YY\i? 4P � Cd Y i r I EZ 3 TT..T. � . ° s '.. ..i.Ri1 !� ♦rte " 1 * `. 1R 7 , 2 4 " �. ♦ x . Ww ... f`* i .:; ... .. „ i V v ::" V2 Circ, wv vw •11 ••..i�• � * l ►. - . �. a _ `"—_— 12 -112 DIA (typ ) Void CoetTNC m A 1r � lSt� 0 3 a.6%. p4Pe - 6 azs `>+° per 1� R - 3-,a- a t,Liia t2a, S 3;j � ( rzsra�� 'tb lft i t v F.[af Seil Iwterlsrr Are. -- tr ` j oat voh~ . smulesaft of Ccew tya'der. 1. o. -� 6"?sr -t' * .J , 2s - ' 1 5. 14 S(�_ I t ?ire , 14 j _ 1 374 422 ft ° •die Cylondm • 12 va.d uoturtee re aues+dr crt' � eaa ��Jeet� Trenef Area t Srdea-al! h ,,h ° 12 ,n - 2.00 � ti o�t1 .alb at Sq. Ft , xx,ma, t,er,�n.,. c.�t,w,Jt,S jj s't•• e„ , , 8oteo,n = - {)baefi -, r' �' 1. ea [ 3b 3 i10 t. �4 R 141 ,n Sq-F t a;r , tt J ' o i s ff. P^►lected Tr t f bow va(ym +e 1 sC� Afli s gp C O ..k b0(tp. X175 (li? Of vO,d YpiNmC Sq.R/. � ) To,h1 Yettd , •alame • 117.0422+0901 GaQonx . 0 ?IS - 0.,08 - d 7.3 7 ii3 3K 7.69 - , I 26 6 'r t � I F �,99'egcrie ystem Q3H r ' i'"g Industrial Group �flU i�V rr 65 IndusViol PQr1t Rd. aakland TN POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ILE RATfON s1STBMl Owner E vl V t ro r% K,Q � © `1 r\ C© Tank- marlufactur r �pj �2S'Q O NA 6 Pern-lit /43 Z septic O uoae ❑riot Vol. j oat Tank Manufacturer ❑ NA OEUM PAfiAMETERs Number of Bedroom C! NA O S Dom D Hofdi� vol. 9a) Number of Public Facility Units C) NA Effluent FftW Manufacturer ©P`Q tiC a NA Estimated leverage) fir q 0 0'. Effluent FAW Model 1 Design {peak) flow = (Estimated x 1.5) o Pump Maw ❑ NA Design SoN Application Raft � Pump Model Standard inflhterd/Effkmd Ouaky MomMy f'reoreaul Chit C) NA Fats, ON & Grease (FOG) 530 mg/L ❑ Sar%LGraval Filter ❑ Peat filter siochem+asl Oxygen Demand (BOD 5220 mg/L ❑ NA ❑ Mechanical Aeration 0 Wetland Total Suspended Solids (M) 51 60 mg/L ❑ Disinfeclin 13 Other: Pretreated Effluent Quality Monthly average Manufacturer Biodwnieal Oxygen Demand (SOD,) 530 mg/(. Dispersal Cel(s) ❑ NA Total Suspended Salads MSS) 530 mg& O NA Vin - Ground (gravity) © )n -Ground (pressurized) Fecal Fecal C.oliform (geometric mean) 510 cfu/1 At - Grade ❑ Mound Maximum Effluent Particle Size Y, in die. ❑ NA ❑ Drip.U(w Ci Other: Other: a ❑ NA 'VMLM typical for dwnssft wastewater and septic tank effkumt. Otfter O NA MAlNlDllA SCHEDULE Service Event Servfoa p"e'g1► Inspect condition of tankts) At least once every: $} combined sludge and scu equals One- third (K) of tank volume Cl NA Pump out contents of tanks) ft scum equals water alarm is ac,Kiaated tnoettft(sl PA wt k n won 3 years) Cl NA Inspect disperse{ cafi(s) At least once every: ) Clean effluent filter At least once every: rraottd(s) ❑ NA Cl O numth(s) ❑ NA inspect pimp, Pub controls & alarm At least once every. El s) (3 rnontlh(e) ❑ NA Flush laterals and pressure test At least once every: CY (s) (3 months) 0 NA At feast once every. p Vearw ❑ NA WASTRUCTItNtS )rtspections of tanks and dispersal calls shall be made by an inn visual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted S ewer , POWTS kapector; POWTS Maintainer, Septage Servk*V Operator (pumper). Tank inspections nit dude a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks w leaks, measure the volume of combined sludge and sctan and a check for an y back up or poncflng of effluent on the ground surface. The dispersal cell(s) ahall be visually d to check the effluent levels in the observation pipes and to check for any pond)ng of effluent on the ground surface. The ponding of affluent on the Wound surface may indicate a fading condition and requires the immediate notification of the local regulatory authority. When the aex+umeulebon of sludge and scurn in any treatment tank equals one -third (Y or more of the tank volume. the entire contents of the tank shalt be removed by a Septa" servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Coda. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretrestme:n 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 sutlmrity within 10 days of eetion of any service event. GMW {2/p2} P START SIP AND OPERATIOW Paw, o f For new lion. prior to use of the POWTB n a'aatrnent tw*ts) for the presence of painting products, solvents or other duels that may impede the t PMOm and/or damage the wid aalmad cagla}, If high concentrations we detected have the contends of the tonk(s) rMnoved by a sepop swvickq opwaor prior to use. SyWWn start up shall not occur when sod owXytknis are ho=en at the infiltrative surface. During WMKIded wastewater will be o� purnp tints m y fill above normal hrkoswater levels. When power is restored the excess ged to the disperad call(s) in one large does and rmy overload #ham roauNaV in the basdcW or surface urge of effluent, To avoid this situation have the con to of the purnp tan: removed by a Septoge Senridng Opermw prior to reatering Power to the effhisnt Pump or contact a Fkm*w or POWTS Millintminor to assist in rnarwekY operating the purnp Omit"" to restore now* levels within the pump tent. Do not drive or Park vehicles oYer tanks and dkpwsd calls. Do not drive or park over. or otherwise disturb or compact, the area wi n 15 feet down slope of any nohrhd or art -grade sod absorption area. Reduction or eleni adw of the following from the wastewater stream "my Pmya the perforrrhenc�e and POWTS: antl6itrtics; baby wipes; a e widoms; cation swabs; : dental floes; di prolong the fife of the foundation drain aperca; d medl ct dona fat; Painting proms; w 9m herb ABANDONMENT . i eres; reheinrt sups: �; out; When the POWTS fails and/or IS permarrerntiy taken out of service the tWWWN g steps " be taken to irhshre that the system is properly and safely abandoned in compliance WM chapter Comae 83.33. Wisconsin Admirnietrative code: • AN prying to tanks and pits shad be dismviected and the abandoned pipe openings sealed. ' The ahntanes of all tanks and Pits shall be reornoved and propady disposed of by a Septage Swvwing O perator. • A fter purnpi a ll t and p s shad be excavated and removed Or their covers renamed and the void s pace fl))ed with sod, gravel r inert sapmaterial. CONTINGENCY PLAN tf the PO WTS feft and cannot be repaired the following Measures ham been. or mgt be taken, to provide a code comp#ant A suitable replacerrient area has been evaluated and may be utilized for the location of a replacement sold system. The repla�hhent arse should absorption be protected frtnm regedrod setbacks fro .m exiahtirhp and proposed �ab°nO° and c� end should not lea iltged tipati by raw* d the need fora new soil and site ' lot lines and wells. Failure to protect the mp�mnt area will evaluation to esto idn a suMdAe n ment area. Repko smerht systems must mph► with the rules in effect at that tune. D A suitable replacement was is not availatde due to eatbar# and/or WN lie tenons. to �WkW a holding tank may be instated as a heat resort Barring advances in POWTS replace the failed P"OWTS. A The aka has not been evaluated to identify a s uitable replacement area. Upon failwe of the POWTS a soil and site evahhatiO must be performed to locate a suitable went area. If no replacement wen is available a holding tank may be installed as a last !'as[IIRt to replace the faded POWTS. ❑ mfl�a� surface R� of such may be e foMo� of the hiamat at the s"tarras must canpty with the n*n In effect at that tine. c c WARtWNG> > I�IEP7lC. POMN ! P A ER IEAT IM t�NM 6ES IOR M IT OXYGM. DO NOT �� A ��• �JMP OTH OR OT Ti1E ATM TANKS ENT TANK AM LMIQEft NTA ANY LETHAL tM�llifiS AND S. DEATH MAY RESULT. RESCUE OF A THE INTERIOR OF A TANK MAY BE VWFK; R.T OR E. POWTS 11101MALLER POIIYiS MADITANINM Nahhne t W Nerve ` t9- 1'Fnorw tS o2 f Phone SEPTAGE SERVICING O PF.AATO It (PUMPER) LOCAL IWGULATC)RY A UTHORFTY memo Ptnor►e b arrue OL Ids hone `7 S 3 �(o (q vvas drafter! the staffs of the Crean lake. Muqusthe and Wauahara CarntV Zoni v and Sarin aDwmlas in ="%*or" with inaRtar Comm 83 . 22 (21Eb)ti)tdtatf) and 83.64((). (2) & (3). W lsconsin Adr"inimirfive Cadgi. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L L Q ! E v " r�o vy q;�" q of ` �rA QS c vk LL -- Mailing Address 1 S Property Address 3 q . - L (Verification required from Planning Department for new construction.) City /State Parcel Identification Number 0.2& /b7 b / D - 06 (33-t0 -107b LEGAL DESCRIPTION Property Location %4 , %4 , Sec. c-;� 7 , T G N R / W, Town of 4 C." G d Subdivision 'Pl S - , Lot # . Certified Survey Map # 4- , Volume , Page # Warranty Deed # I (P 5 W8 Volume (,* 0 , Page # S Spec house 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. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your se p ' s stem has been maintained must be completed and returned to the St. Croix County Zoning Department within 30 days of a year expiration date. ll�/l 4� SI NATURE OF APPLICANT DATE OWNER CERTMCAT N cert' t a 1 s t ents on this form are true to the best of my /our knowledge. Uwe amlare the owner(s) of the prope desc 'be , b e of a warranty deed recorded in Register of Deeds Office � / ice / Oq ATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. • . STATE BAR OF WISZOASIIV FOR(N lJ 2 ? 6 ? tS S 6 WARRANTY DEED .P KATHLEEN H. WALSHH Document Number ST. CROIY CO., MI This Deed, made between John Schommer and Barbara Schommer, husband and wife RECEIVED FOR RECORD Grantor, 07/01/2004 01:15PH and Environmental Holding Company, LLC WARRANTY DEED EXEWT 1 REC FEES 11.00 Grantee. TRANS FBlis 2514.20 Grantor, for a valuable consideration, conveys to Grantee the following CC FEES described real estate in St. Croix County, State of PAGES: 1 att Wisconsin (the "Property ") (if more space is needed, please ach addendum): Late.I through 33, inclusive, Lundy fs Preserve, Town of Richmond. Recording Area Name and Return Address Title One Premier Group 706 19th Street South Hudson, Wisconsin 54016 26-1078 -10 -000 026- 1078 -30 -000 Parcel ldentMostion Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is: good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record Dated this 30 th da of June 2004 o p •Jo Schommer * Barbara Schommer t+ y AUTHENTICATION ACKNOWLEDGMENT : , P¢Y pU6 STATE OF WISCONSIN Signature(s) ) ss. St. Croi County. ) authenticated this day of Personally came before me this 30 t_ day of June 2004 the above named PALM John Schommer and TITLE: MEMBER STATE BAR OF $arbara Schomer (If not, OF yYiS�. to me known to be the person a who executed authorized by §706.06, Wis. Slats.) the fore o' instrume ac 1 ed the same. THIS INSTRUMENT WAS DRAFTED BY Michael H. Foreeki, Attorney Notary Public, State Of Wisconsin Eau Claire, Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures m be authenticated or aoknowled re ed Both a not a ccess r 2 of persons signing in any capacity must be typed or printed below thetc signature, RANTY DEED STATE BAIL OF WISCONSIN , FORM No. 1.2000 Michael H Fomckl 3452 Oakwood Hi1Is.Pkwy. Ste 1, Eau Claire WT 54701.7928 Phone: (7 1P 835.3029 Fax: (713) 835 -4112 Michael H. Foredd T4468638= ft&mod wAh ZWormw by RE FamNNK LLC 1aWs FMwn Mb Raq Ckton T --hip, MMW MOW. (000) 303-OW Awl \ .�� — .— .. --- — --- --- —. --- --- --- — - l.il 77 • N r NNNf.. N........N.NN....N.N.N..N..NNNM .NN »N.NNNNi.NNNN. •••••••••N••••• sic : 7 � • r � r -M amma \: ti 1 . . N..NNN.N.. a A••• a � 1 i I b af . � ...•''�'�1� �1 fir• F 9 -- - -•— J . tr - � W � RR 1 / 0 F : J ' .................. r I J J Ito Ig is It 19 i i s �K s_ g