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HomeMy WebLinkAbout032-2191-18-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Kim Demeny TOWN OF SOMERSET CST BM Elev: Insp. BM Elev: BM Description: n f%�Gt vt , TANK INFORMATION TYPE MANUFACTUR�2, CAPACITY ►1 Septic cmmo� Lk Dosing , / Z.5 ►M 6a ��-r: z . Aeration Ihig � L; fl,, TANK SETBACK INFORMATION TANK TO P/L uj WELL BLDG. Vent to Air Intake ROAD Septic 2 � 3 L/ Dosing 2 3• Z 3 1 Aeration Holding PUMP/SIPHON INFORMATION �t' '10ritos Manufacturer Z'0e1 �r Demand GPM AT Model Number EN Z TDH Li Friction Loss Syste ead T H Ft Forcemain Length � 7S Dia., j Dist. to Well k SOIL ABSORPTION SYSTEM BED/TRENCH Width � Length i+� DIMENSIONS a —7`�JC SETBACK SYSTEM TO P/L BLDG INFORMATION Type Of System, q` f O V h0 1(p DISTRIBUTION SYSTEM .� r ELEVATION DATA c°unty: St. Croix Sanitary Permit No: 617803 State Plan ID No: Parcel Tax No: 032-1073-30-000 Sectionlrown/Range/Map No: 26231 a196359 STATION BS HI FS ELEV. Benchmark � / Alt. BM Bldg. Sewer �7 75 q SUHt Inlet l� SUHt Outlet Dt Inlet _ Dt Bottom 11,75 a q `O . 1 ^j HeME ader/Man. Z .56 66.1 Dist. Pipe 2.3b /00 rY Bot. System ?� 7 Final Grade St Cover v ` L opt yr ; . Y F. 85 PIT DIMENSIONS I No. Of Pits IN Header/Manifold % t, Distribution � ► t , x Hole Size � �` x Hole Spacing ,� Vent to Air Intakle Length YdO Length' Dia SOIL COVER Depth Over A+% Bed/Trench Center f / ►^ • IV f x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over % xx Depth of xx Seeded/Sodded p Bed/Trench Edges * Topsoil ', l 4 [XYes No COMMENTS: (Include code discrepencies, persons prese t, etc.) �s d- C�•� ;h5 Location: No Address Available 1.) Alt BM Description = �K� 2.) Bldg sewer length = 23 ` - amount of cover = 7 1 2 Plan revision Required? � Yes No r additional informati d -f- Inspection #1:.rJ'Lj � Z p ,.ytspection #2: � IIV1 ® /e7S of CAM Li 6 � Dt 1) Cert. No. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM G�C�C�I��MC�D JAN 03 2020 St. Croix County Community Development i Owner/Buyer. j M Mailing Address .10 L20 aY l l a V It(�7 M . � L ?� Property Address X X X "� ar�i ��/`� • 'RNLI X VL iM 'tV1 (Verification " required from Planning & Zoning Department for new construction.) City/state &Nell 9/ w, V Y � Parcel Identification Number LEGAL DESCRIPTION Property Location _'/a ,'/a ,Sec., Town off - Subdivision Plat: Certified Survey Map # Warranty Deed # Spec house []yeio Volume ,Page # (before 2007)Volume ,Page # Lot lines identifiableff]yes[]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 an every tlnee 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 §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning &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. Ilwe, 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we an>/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms_ GNATURE OF APPLICANTS) 1/ /2020 DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning &Zoning Department. *** Include with this application a recorded warranty deed fiom the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (�w zjarety ana t3untlmgs Division C ' ' 201 W. Washington Ave., P.C. Box 7162 Sanitary Permit Number (to be filled in by Co.) ■'`*, Ma ison, WI 537074182 ;C •. _-. % t Q State Transaction Number p pity Nit Application 3/) 0 We 600 n accordance with SPS 36. ), Wis. Adis. Code, submission of this form to the appropriate governmental unit ; required prior to obtaglltl Aanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) he Department of Safety and Professional Servies, Personal information you provide may be used for secondary ses in accordance with the Privacy Law, s. 15.04 ] m , Slats. Afm A 637 /1 n kete .. A licMlon Information — Ple o Print All Information! eJ �(I 'roperty Owner's Name Parcel # 037 _/ Q7 _ cob1 oan 209PNO.roulk ?roperty Owner's Mailing Address Property Location' Govt. Lot City, State Zi Code f� Phone Number /,, 3 IA, lr Section ctrcie one),, II. Type of Building (check all that apply) Lot # T N; R E o�{W *r2 Family Dwelling -Number of Bedrooms (\ Subdivision Name V' ak as Block # (� — 17 %� ❑ Public/Commerciai - Describe Use v 4600 �❑City of El State Owned- Describe Use L CSM Number ❑ Village of �%S_ /OJ Q Town of Sailv��b cl� j' Permit; (Cheek only one box on ti v System ❑ Replacement System B• ❑Permit Renewal ❑ Aermit Revision Before Expiration e A. Complete line B if applicable) ❑ Treatment/Holding Tank Replacement Only ❑ Change of Plumber ❑ Permit Transfer to Now Owner ❑ Qther Modifieakion m Existing Previous A.. ■ c o■ a vn a o 0 31C111!<.Vlll unentJuevtC¢i l;neCK all tnat a I V ❑ Non -Pressurized In Ground ❑Pressurized In -Ground ❑ At -Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Fiowpd) Design Soil Applicati n Rate(gpdsf j Dispersal Area Require {si) Dispersal Area Propos (s System Elevation D f (e,(,a p3 ys VI. Tank Info Capacity in Total # of Manufacturer , Gallons Gallons Units $ New Tanks Existing Tanks r ,, , Septic or Holding Tank G 20 Dosing Chamber l V1I. Responsibility Statement- 1, the undersigned, assume responsibility for nstallalion of the POWTS shown the attached plans. Plumber's Name (Print)-PlumbeZature / P umber Business Phone Number U " F fC> i ZZ3Z 715 Y91 `��8 Pipinber's Address (Street, City, State, Zip Code) ov �V /o S6,6 EsS I W1 G Vrrr Approved El Disapproved Sermit Fes Dal Issued Issuing _ t Sign ❑Owner Given Reason for Denial 44A cc' IX, Cogp 9"fC4MMal/Reasons for Disapproval ` / _- 1� GG 1. Septic tank, effluent filter and e7 �•Or7� 1�ry�lam, I �ae � dispersal cell must be serviced /_maintained /ti GdtCty�+ l,•�M Gt+� t �� as per management plan provided by plumber, 2. All setback requirements must be maintained 14 ������ 1 aq fp=afli�icalilno Attic toerdinieltlep p p� Attic to comp ete p ans for the system and�ubmit to heCounty a on a er of less t wf � . ZOZd " otS z l 1 inches in size AWMA t�;�-- SBD-6398 (R. l I/1 l) 1% • Slo Wiese Septic + q•3 �.D J1V G K«�� Dc'c.�F �y �- i��� � sutra � S E 11� S w� r�4 S z� � .3) N� �. �;� �o ���� i=� '� �-o�ry a� . !/ ��` ��MP� zZ:3zyz. .` Q2 Mound with '� , 75' x 8' cell '\ � \_ ,,. � � '• '� �33�' •- �, aM� ��}� . 12ooisoo ,�s' � Pump tank �1 , N 99Sy. NO WELL .� S it Verification , R quired prior to in tallation q� � �• � , — 2" S`ch�40 PVC y �3Q�N�—____.. 1-(oUS � ���-��(�G � r e�ty 4" Approved Pipe � • L�, i�C--,N��IMNfL.IC �� �TDc �r dtZVa�' �i i��� EL. =1DU� . •,� %-.�" i�C'+tN\ralLiC #2.� �T�r' C� "� yEL1_D HJ f 1!'� � L � IbO, Z n SOIL �o2���GS '��= y0' January 7, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-01-07 Plan Review: PWTS-012000027-C JEFF FOX PO Box 565 Dresser WI 54009 SITE: Kim Demeny and Doug Sutton Lot 70, Pine Cliff 4th Addition St. Croix County Town of Somerset SE % - SW % - S26 — T31N — R19W FOR: Description: 4 Bedroom Mound — 600 GPD — New Construction -44" to limiting factor — Effluent Filter- Maintenance required DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 5484M462 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Tony Evera -Governor Dawn Crim - Secretary CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES CIet� uct SEE CO ESPONDENCE Mound Component Manual —Ver. 2.0, SBD- 10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual —Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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: Reminders • Prior to construction of the dispersal cell, an additional soil boring shall be done to confirm suitability and depth to limiting factor as shown on the plot plan. • The mound site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 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. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • 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 • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. In granting this approval the Division of Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, CeCe (Elizabeth) Rudnicl<i Wastewater Specialist/POWTS Plan Reviewer, Division of Industry Services (608) 400-3186 elizabeth.rudnicki@wisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name; Owner's Name: Owner's Address Legal Description Township: County: Subdivision Name Lot Number: Parcel I.D. Number: Plan Transaction No.: Designer Date: Signature: Jeff Fox I<im Derneny &Doug Sutton 744 Ryan Drive Hudson Wi 54016 SE1/4 SW1/4 S26 T31 N/R19W Somerset St. Croix Pine Cliff $th Add 70 040-1322-11-000 Block Number: CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Cepq VA SEE CO ESPONDENCE License Number: MPRS 223242 Phone Number: 715-491-3458 Designed Pursuant to the Mound Component Manual for POVVTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Neiworks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver, 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 7 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) r Residential or Commercial Design _ 400.00 Estimated Wastewater Flow (gpd) 1.60 Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) 1.00 Site Slope (%) 99.00 Contour Line Elevation (ft) 44.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (C or E) e' Center or End Manifold 40001 Lateral Spacing (ft) 2 Number of Laterals 0.156 Orifice Diameter (in) 2.30 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) 85.00 Pump Tank Elevation (ft) 4.55 14.09 2.51 0.00 21.15 System Head (ft) x 1.3 Vertical Lift (ft) Friction Loss (ft) In -line Filter Loss (ft) Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 1.50 x x 2000 x 3.00 x Treatment Tank Information 1200.00� Septic Tanlc Capacity (gal) Wieser i (Manufacturer Dose Tank Information 800.00 Dose lank Capacity (gal) 22.20 Do_s_e Tank Volume (gal/in) Weiser I Manufacturer Note: Sand fill (D) calculations assume a Table 383-44-3 in -situ soil treatment for fecal coliform of <= 36 inches. 8.00 Cell Width (ft) Are the laterals the highest point in the distribution network? Enter Y or N If N above, enter the elevation (ft of the highest point. 9.38 ft2/orifice Does the forcemain drain back? I Y= Enter Y or N A Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Gallonsllnch Calculator (optional) Total Tank Capacity (gal) I 'Total Working Liquid Depth (in) L� gal/in (enter result in cell B49) Effluent Filter Information Life_ time Filter Manufacturer 8 Filter Model Number Project: Kim Demeny &Doug Sutton Page 2 of 7 Mound Plan and Cross Section Views �1/10 B®' ' ' ' ' " ' ' ' • ' • a • Observation Pipe :T•! : :if * IV a o 4 o 0 4 1 0 1.14 .4 *Af It � IVA % N I A I A t'i I: .�. B I e— L Mound Component Dimensions A B D 8.00 ft E ft F in G 6,96 in H in z ft J 1.00 ft K ft L ft W 7.00 ft ft ft 75.00 9.50 5.79 88.99 6.00 0.50 5.22 19.01 600.00 (ft2) Dispersal Ceil Area 8,00 (gpd/ft) Linear Loading Rate 2 1034.15 (ft) Basal Area Available 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.29 (ft) 99*50 IF Dispersal Cell :;� '6 ; ;`9 0 Elevation o Shading Key 20 �������� Subsoil Cap © H ASTM C33 Sand ®0 Tilled Layer Aggregate �I H Dispersal Cell 100.00 (ft) Lateral Invert D, :: ,X_ z ., Fly,:.:.{ <.'^,. .t 4J,�.?...�. J A �.. .1. .: t�:r. �: ,Lti •� l^,..:.}:fir,-•.. . ,,..._.. .,. 99.00 (ft) Contour Elevation 1.0 %Site Slope Geotextile Fabric Cover a �— Dispersal Cell See lateral details on Book CL 1.5 fta p7oo::;•;•,•;•r••ti.•a%A-4••;ti••.ACal, •.• Page 4 for number, size, o ;. at 'a •'' r`;?r and spacing of laterals. :•' W.' Laterals are equally w ;ti;; •. ; 0.5 ft a:::i F spaced from the Typical Lateral v .• cell's ;4 %A%;. ,� : ,1 : :; distribution 'd o "ts f' ~•�`':`'orA S centerline :a: �:• �: in the AAR } A distribution cell (AxB). Project: Kim Dement' &Doug Sutton Page 3 of 7 End Connection Lateral Layout Diagram Laa?raL. cintc red o�er the p A, �a � dimension _ •=Turn-ur?v�i ballval+.raorcl9anoutplug All laterals are ipientioal IF X I HoloF dillled on the bottom of the lateral awally spaced `' ForeP main ec onriu0tion via tH8 or Cfoss Laterals 8tforcerwnin Sci] 41) PVC to manifold at anq point. per SPS Table, : 84 *30-6 Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head 2 1.50 73.47 4.00 17.23 34.46 21.15 Orifice Diameter in Orifice Spacing (X) ft Orifices per Lateral ft Orifice Density gpm Manifold Length gpm Manifold Diameter ft Forcemain Velocity Dose Tank Information Electrical as per NEC 300 and SPS 316.300 WAC Tank component is properly vented Manufacturer Gallons Dimension Inches Gallons A 19.36 429.90 B 2.00 44.40 C D Total 3.77 10.90 36.04 83.72 241.98 800.00 Alarm Manuafacturer Rhombus Alarm Model Number MJ Plugger _ Pump Manufacturer Pump Model Number Pump Must Deliver Zoeller BN 152 34.46 gpm at 21.15 ft TDH 0.156 2.37 32 9.38 4.00 1.50 3.52 ft in tt2/orifice in ft ft/sec Locking cover with warning label and locking device and sealed watertight 4 in. rein. Alternate outlet location Forcemain diameter Weep hole or anti - siphon device Ptno off elevation (ft) 85.91 Dom se tank elevation (ft) 85.00 ote: Switches N containing mercury may not be used in this system. Project: I<im Dement' &Doug Sutton Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name POWTS Regulator's Name Design Flow -Peak Estimated Flow "Average Septic Tank Capacity Soil Absorption Component Size Type of Wastewater Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Jeff Fox St. Croix County Zoning Phone 715-755-2461 phone System Flow and Load Parameters 600 gpd Maximum Influent Particle Size 400 gpd Maximum BOD5 1200 1qaI Maximum TSS 600 ft` Maximum FOG Qomestic Maximum Fecal Coliform Service Frequency 1/8 220 150 30 >10E4 Ins ect and/or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards in mg/L mg/L mg/L cfu/100 mL 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code, 3. All gravity and pressure piping materials conform to the requirements in SPS 384, 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. Finished Grade 6-8" Diameter Lawn Sprinkler Valve Box Distribution Lateral Lateral Turn -up Detail Project: I<im Demeny &Doug Sutton Threaded Cleanout Plug or Ball Valve Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Page 5 of 7 Ins ect and/or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards in mg/L mg/L mg/L cfu/100 mL 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code, 3. All gravity and pressure piping materials conform to the requirements in SPS 384, 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. Finished Grade 6-8" Diameter Lawn Sprinkler Valve Box Distribution Lateral Lateral Turn -up Detail Project: I<im Demeny &Doug Sutton Threaded Cleanout Plug or Ball Valve Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Page 5 of 7 Mound System Management Plan Pursuant to SPS 383,54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained In accordance with its' component manuals [SBDA0691-P (N.01/01, R. 11/12), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01101, R. 10/12)j 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 SPS 383.33, 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, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by Inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids In the tank that may slough off the 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 filter alarms may Indicate surge flows or an Impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum In the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance Is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be Inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction In the winter will promote frost penetration. Cold weather Installations (October -February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODE, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS,10 mg/L FOG, and 104 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. Pending levels shall be reported to the owner, and any levels above 6 inches considered as an Impending hydraulic failure requiring additional, more frequent monitoring. Continaencv 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The Information and schedule of rnananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. i �t3 '�� 11� C K ���� T� �F� � y -�- Llv V � S U�TI � �� L��" � O t i �L LLI FF �I�{, \(� To � !v o F S o r�,tzs E� t' U ��` ��nnP� z Z 3 z y Z. +32 Mound with 75'x8'cell 1% • Slop / \ `\_;\ ` ' • �i • � 99 Gz ', �� Wiese 1200/800 Septic Pump tank _ 98 - �— 2" Sch,40,PVC _.__ I I ^• I y (3Q�N� I-lo�s If�t��A�G NO WELL ., S it Verification , R quired prior to in tallation i � <.y �- � 4" Approved Pipe � T • �. Vie. N��11 M Nr��c � I 70 � � r- �cz�u�,� ��� �E- � � = � o o ' . A R�.i.�C-IW\�1t�� #2.� TUi' �� yEi.L�w I��r'� E 1. � /b0, 2�� a SOIL �oR���GS �cr� •I'�- yO' Site Search " Zoeller Pump Company Page 301 12 10 GALLONS FLAW Phi? i�11NUTG o��sas littp://www.zoellerpumps.co�n/en-na/distributor/siteseacch?se�•ch=152 6/2/201; Wisconsin Department of Safely and Professional Services Page of Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 3850 Wis, Adm. Code County VwF Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, `' C but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 3 2 ' 10 V13 % 00 Please print all Information. Reviewed by r Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.041711m)). Property Owner � Property Location ❑ Q 1 t' 1 f 1 e l i I F i 1 L�► C. rti .1 i1 i Govt. Lot n J t-'. �? A! /. S 2( T 3 1 N R' 9 E (or) W Property Owner's Mailing Address Lot # Block 11 Subd;_Name or CSM# f /-i 11 L L Y N 0 t ?1 t 1 U� �'O rill:: � ,r.l i":�: T City Slate Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road t 4G ) �,rrse*+ Now Construction Use: ❑Residential/Nurnberof bedrooms „> Code delved design slow rate GPD ❑ Replacement ❑ Public or commercial _ Describe: Parent material General comments and recommendations: ® Boring 11 Plan elevation if applicable it, Boring q Pit Ground surface elev..00r t{ Depth to lirniling factor � In. Soli Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots GPD1Ft2 'Eff#1 'Eff#2 c5- b /b\ q'� SL 2.rn r on �1-....()%.1 C':2 /�._) J f {:;,� tat') 1\11 , ly �, t*) Boring # ❑ Boring ❑ i rl Pit Ground surface elev.IUG tt. Oaplh to limiting factor � In. Soil Annlicalion Rate Itc Horizon Doplh Dominant Color Redox Description Texture Struoture Consistence Boundary Roots GPb1Fi2 'Eff111 'Erf#2 In. Munsell Qu. Az. Cont. Color Gr. Sz, Sh• �4) o P 4 �5 0 V'O fir nr (�•'�wo r-, rJl �lv !? \ F'.%iJ1 �. f ;i�ti .� t`Yl �i �� Y 1 In i1 0 �4 ;) ..#-(,.(of r I ERA 1 RM •/.rr1�\ / o ' YY1 U' 0 r l_.( 7-1) Li � i ItrTS.1 Ff5 8:1�11i7C11LtiYllf iTT/ �TiTi �!.'tC1f7C11 Fy! �lii iTill!_i� Gi i Inrc7il i:ri�:1�J ��1Gtli_7'.►4111iL 111[211rf � [�'hT1111F�f/1t111{S il' CST Name (Please Print) Signatu CST Number n C C ;fir^ , �, ,, � ,•� ., ► � . 1 r � 5 .. Address Date Evaluation C ducted Telephone Number SC'1 Boring It ❑ Boring , Pit Ground surface elev. Roots GPD/Ft2 p4r Depth to limiting factor In. Soil A Iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ❑ Boring # ❑ Boring ❑ Pit Ground surface olev. ft. Depth to limiting factor in. Soil Aaalicatlon Rate Horizon Depth In. Dominant Color Munsell Redox Description Out Az, Cont. Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPD/Ftz `Effill 60112 Boring # ❑ Boring ❑ Pit Ground surface elev. fL Depth to limiting factor. In. Soil AI oolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Effil1 'Eff#2 ` Effluent ll1 = BOD, > 30 5 220 mg1L and TSS > 30 S 150 mglL ' Effluent fl2 = BOD, > 30 5 220 mglL and TSS > 30 s 150 mglL �.or ��. ��N� ��a�=c� �v� �pu�rrc��v �9? IUD �D.9 �:6�MC •� 4:La� f� � . / � •• ' � � 1 �-- � j �' ����� Iy , I •,, o• 4 � ���. AD o • �•�r� . I e\� • n h� NORTH SCALE: 1"= 40' I� .' � (jt, 0 20 ao no ALLELEVATION5AREREFERENCEDTOTWE • NORTH AMERICAN VERTICAL DATUM OF 19DD, I ICONTOUR INTERVAL IS 2 FEET I� � �— l " � INDEX( CONTOUR / INTERMEDIATE CONTOUR I � '---'- �-- MINIMUM BUILOINO SETDACI(S: -� � ROAb a 50 FEET \ � REAR � 25 FEET 51DE = 7.0 FEET •--�`- � � DRAI�GE EASEMENT .. \ �` 42•FOOT WIDE UTILfTY EASEMENT (;� SOILDORINQ LOCATION WITW ELEVATION -�� DENCWMARI( LOCATION WITW ELEVATION 4•�,,.�Cy :.� Sep 16 2019 0293OPM HP Fax page 1 n APPLICATION FOR REVIEW Pri n $P ocontpleto all panes. Wastev NOTE: Personal Infarrnatloa you pmvido may be used for secondary purposes ,*L q vv. (Privacy LAWS, 15,04(1)(m), Slats,) ; Division ( PI ns to be E-filed, Provide SharePolnt User name below: FFor.p1sn status, checkour wehshe of tip odutleal code questions to roaaljto: LS sever I counties Have been delegated certaht authority to revlow plans In Ileu of Division of Industry services, counts s and their desi nation chuck our wobsito at ://d s.wl. v 1. Pr oat Irrfermnllon • Pill In all known Information. Confirmation of asalgnment Pro)sct(Silo Name: 'NI-��ta� Trartsactlon IQ: Lacallollh, Number & Street of project (If unknown, Indicated nearest road) Provlauo Relatod Trans, ID: Goun " C] Cil t y ❑ Vilioge'a Totwt of 2, Aftct plans are rovtowo<I, please: (cltook all thot apply) LJ Call customer 1, 2 (circle number)" ❑ Req�esthtg party will pick up IQ Mailllplans to customer 1, 2 (circle number)` *Refers to customer number from below. Estimated Gonlpietion Date; Asslaned navlewer: Assigned Office: Mall to your otflco aPcitofco below: La Crosse, toroen Bay Nt)Tt3: Wo rosstrVo file right to re•dlstribulp needed to reasonably balance tumaround 11 jL. �� twL11n euar�aua.wl nov for next available review 4 3. Co isle Ute following deetgnorfownerlraquosting Intorma0on. Ullllzotfte chock boxes when deal0nar, awnor or avei�roltoating Infornrntlon. Dosl First Prtolte (area c Infornrntlon (Cuatomor � Last 17SP5 4 (9 dlglis) pho�ne % mrormar on anq Plan Submittal Chacitllsts. To request aloep wit t your registered SharePolnt u0omrtme to DS S91 will be as Igrted to a reviewer after receipt at a DSPS office, appearin, On the POVYTS nmrimm a _ La Crassqq' Aroa DSPS 3024 L'roe{:slde Ln Holnton,r 54&3G Fax: 1 Small: Make Clter�s Payablola: Division of IndtratrySorvlcea qR j] Chek box ko Invoice dealgner and sign below Ueslgnat�8{gnatura 5flD-10577 (f� +Vila) Olhor Please 5peclfy Holow (Cuafiomor 2) Flrat Namo Last Neme Alone Nun (area code) UK a eppucamo or epaciry rolallonship Ownnr Other—e ed relailonshl review complete the appropriate applirg le(iz�Wlsconsht oov, If plans are being st fists can be to lid in each applicable Qraen Croy D8P3 2331 San Lull Place Croon Boy, WI 54304 920-492-5601 Pak 020.492-6604 Email: UspsSbAlanSchedulealvd oov TpTAt, AMt)UNT UUE te? C)nsire fir Treatment Industry Services a cuntenl IIsI of titase a reviewer. to anotHor pfflce if Chock party is the anmo to DSPS Custcxnor Number rm and a -mail it, ti via papor,lhay ment manual RoWew Coda 7t333 Sep 16 201 u4 9 02,30PM HP Fax page 2 LE pQ0 v QC)00 tl0 �-^ 00p p tl 4.G pIN�� N p G. V p00p Q04p N �0p0OG(OVt � (OV tl t7 .4t If] Op lt) tS 0. 0 4n Zy 999 N p m f,9 L9 a N� A p j cA t~A b v (�V c N lR lA (9 fi1l� a 0 a 2!m via m a Efti LbtOL vCi C SiN 3 �'QF O rn y`O O � tom, S�' �r r. ['S ❑ r "� EOM N �n �Q - m Ina aQ ]£' N IT O'CL er 41 O FmmEL O� C3 0 IG •N C N O0Q Cpppp 0 0 In In h7 T O C .X C' �-pr 3 N 'O TN ro N .p O to �3<ul R O M 5 ry Op I z E a3 � N t � E � � v� — rX cv � � r y >• v c m C o, t o o ;" I I �� v'^ rn I vim c rn I F OR o00 ' mp, ctl`i�" `oppPpS �� °a' $o�NU ' N O 0. = E N 0 p ,r N P 0. ltj b7 i t?. ❑ 4] U] �1 !I n t E o 3R ' n D �! Dtiu c � a O1a0.'v`I p rna°a (d �'LL� p j�a p IrOFFX CL 0. 0'�° � media I� o I0 4#a IU` U N O W ? C� m N CD � ' " e 5 a O to C Off Lu2 eEtv B � N`rJN77 wN r � yyN CA m N Q G f0 Al iG'. MM� C NCL E t0 5 Q' T' R' p C U C) a (7 N. yj rai E r`Y ct . U Vj q 4 ,G N 4 ` c n�oa� troy V�u) �t�7 a e m ��01j �'E a �'u01!.c m w tl u Cp is t E `� 3S �' 7 a d r o rn� �i ID��w ii 6 to E dQ a %0 a to o o48 S4 ��CS I °J° ��d a) E m~ �'� tJ c�Q oa yr ' o q c''3 O C4 CV �: D O pppt... U 2 a L2III � N :g r.. � T b� «i E J O Ndi 44r) Ica c L^ a I O y N c0 in�$(15 CX j m a a FC�� O O W N C �bo�a tq c yam E;� ro. �C41• p4 w ":5}�7{ Q v .Id ;cr v ti `> c F j ILLU1 ni W N U fJ E '47 C m is 6i io 7 U� m d _ p Q ri �' n c n ot fl z ,� u 0 a 0i kU IW •O �l YG •r0A y � }� �a �i CL �ti c tj ��d u �� '� y� U1 �c� cro— w yE �7n I Es N E ff_�'1v�v��11ffk �f--o� pd z a o U v °' S r m ❑ (q ❑❑ Ll 8 ❑LIC�1DE] ❑❑0❑0❑ g a ❑ ro z 73 T3 a o t m C w 1:1 El nCL ;JCL N to N to °05 42"E 57.50' )RA/NAGE EASEMENT BM -CENTER OF CULVERT FLARED END = 853.8 C23 B 96627' _ M m 1 _C9 ` CIO C10.��� C11l��� I 40' _ o N 20 N I. /a O' r _ cn 60. 3 M 159,95' o � 1 z DRAINAGE EASEMf/yT \ o. \NI { N88 °35'15 "E 192.44' 477.02' i! 12.00' S88035'15"W 573.29' S88035'15"W �j N88°35'15"E 581.59' 147.41 ' 307.36' y p'Sy a3 SOT 70 138,800 SQ. FT. ± 3.19 ACRES 51' • S88035'15"W 235.63' N E-SW SE -SW 13, f = LOT 71 263J00 SQ. FT. 6.04 ACRES / / S86051'0711E 209,32' N87°28 o8"w °58'S1" / 30'± / -�- r_ 27.9 $65 /GE EPS / �± \ 30 P�NA 151'1� 1? S42°38'45"W\ ��° \565°58 57 } O 0 N87 28'08"W 40 Ott` 21.03' 4 S42°38'45"W \ 1� �00 oe 0 30 _ et , / \ APPROXIMATE�� 1 Wisconsin Department 'of, 6tety a6dl Kb'f�ssional Division of Indu 3try Services St. Croix County Community Development ss 2 Page of SOIL EVALUATION REPORT n ac"cordance with SPS 385, Wis, Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. County it; 4� Parcel I.D. 32 � 1073 Personal information you provide may be used for secondary purposes Privac Law, s. 15.04 1 m W" ` v 99 Property Owner Property Location / El Pt nG' L i h�r��rN�Rsh, Govt.Lot ,`>;' '/ `,It1 '/<S 2( T 3 1 N R 19 E (or) W Property Owner's Mailing Address Lot #. Block # Subd. Name or CSM# Y N �'� Src- I42 j IJI AILCL� l l City State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road t-1 U DS n N I W i I `' '" ) I c ) I I �omcrtse� New Construction Use: ❑Residential/Numberofbedrooms Code derived design flow rate GPD S inpctl�rl OA /�1 Replacement El Public � X ntc2. N�i Public or commercial — Describe: J ElC.Srt_ �Pl 1tZ r• Parent material Flood Plan elevation if applicable ft. General comments and recommendations: �r ❑ Boring # ❑ Boring Pit Ground surface elev. c'J/, �f� $�p �, Depth to limiting factorc��in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 U b / 0 2 3 -., S L 2, rrn q r U 2 A D S v d � p E_ Y I�IJ C tM �T Tt. r ❑ Boring # ElBorin g , ❑Pit Ground surface elev. � �� ��-''(Y ft. I (p 2.� Depth to limiting ctor � i oil Anplic tion Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots PD/Ft2 *Eff#1 *Eff#2 yG-Gv , It f ,rn k` r, O '�WC-CN ERA F) 2M 5P%,N jV LoP. V)b a T1 • Effluent #1 = aoo. > so <_ zzo ma/Land i ss > so <_ 1 so ma/L - tttwent ;7z = tiw. > Ju s zzu ma/L and i ZjZ:i > Ju s 15u ma/L CST Name (Please Print) Signatu CST Number U r\ Address Date Evaluation C ducted Telephone Number 125 H 1'0 1 feC4 S� C e 0 L�t S'vUz� 88U-8330 (tl04/1b) ❑ Boring 1 14l f Pit Ground surface elev.� eft. / 9• S 1 Depth to limiting factor 7 in. ii Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 Z I�- yq d $ 0 OSq e'er 1 �5 `�. a 7 1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Annilvation Rate Horizon Depth ' In. Dominant Color Munsell. Redox Description Qu. Az, Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * EfFluent #1 = BOD, > 30 <_ 220 mg/L and TSS > 30 <_ 150 mg/L * Effluent #2 = BOD, > 30 <_ 220 mg/Land TSS > 30 <_ 150 mg/L I LOT 70. PINE CLIFF 4TH ADDITION 193RD AVENUE I, I f i I 869.84 To ,p � � p Pllk% (L03 LOT 70 �. _ , 00 P7 i 0 862.59 op 0 -F �� e 1 I ow el � e o• pp, �g r-T I �861.53 jjj�h862.64 I vi 862.41 NORTH l 1 SCALE. V= 40' 0 20 40 80 \ ALL ELEVATIONS ARE REFERENCED TO THE \ NORTH AMERICAN VERTICAL DATUM OF 1988, ICONTOUR INTERVAL IS 2 FEET INDEX CONTOUR ( / INTERMEDIATE CONTOUR I- - - - MINIMUM BUILDING SETBACKS: -� ROAD = 50 FEET \ / REAR = 25 FEET SIDE =10 FEET 12-FOOT WIDE UTILITY EASEMENT SOIL BORING LOCATION WITH ELEVATION �- BENCHMARK LOCATION WITH ELEVATION CGw tl4)19� S ,` Document Number State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Name THIS DEED, made between Pinecliff Partnership, LLC, a Wisconsin limited liability company (hereinafter "Grantor," whether onnfe_ o, �more), conveys and Warrants to Kimberly Demeny, (Y1R �Q,{Z,l�� ��►V�J�► (hereinafter "Grantee," whether one or more), the following described real estate in St. Croix County, State of Wisconsin: Lot 70, County Plat of Pine Cliff Fourth Addition in the Town of Somerset, St. Croix County, Wisconsin. Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated �( _ �j � 201 Pinecliff Partnership, LLC, a Wisconsin limited liability company EAL) * By: Michael J. Hartman, member AUTHENTICATION Signatures) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: St. Croix County Abstract &Title Co,. Inc., by Andrea S. Carpenter at the direction of the Grantor. l9-S 17158 uiiimiiauuiuimi�i 1095014 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI O1/03/2020 02:18 PM EXEMPT#: REC FEE TRANS FEE Recording Area 30.00 795.00 PAGES: 1 Name and Return Address St. Croix County Abstract &Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, WT 54017 032-1073-30-000 (Part of), 032-1073-70-000 (Part ot) Parcel Identification Number (PIN) This IS NOT homestead property. ACKNOWLEDGMENT STATE OF WISCONSIN ) COUNTY SrV`-�X j ss. Personally came before me on �(_... 3 � � Z�� � , the above -named Pinecliff Partnership, LLC, a Wisconsin limited liability company, by Michael J. Hartman, member to me known to be the persons) who executed the foregoing Notary Public, State of Wisconsin My Commission (is permanent) (expires: S�Z2-/%fib ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. St. Croix County 1095014 Page 1 of 1 x