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HomeMy WebLinkAbout026-1304-18-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1 Permit Holder's Name: City Village Township Rivard Developers TOWN OF RICHMOND CST BM Elev: 1Insp. BM Elev: IBM Description: IHfvn mruKlvlHi iuty TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Ell Forcemain Length Dia. Dist. to Weil 501E ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 624850 Staie Plan ID No: Parcel Tax No: 02&1304-18-000 Section/Town/Range/Map No: 0703011801607 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SbHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man, I. Pipe Bot. System Final Grade St Cover CtU/ I KtNGM vvioth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) Length Dia Length Dia Spacing JVIL I,VVCt'C x Pressure Systems Only xx Mound Or At -Grade Systems Onlyte Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil � Yes COMMENTS: (Include code discrepencies, persons present, etc.) Location: 1603 92ND ST 1.) Alt BM Description = 2.) Bldg sewer length = amount of cover = Inspection #1: Inspection #2: Plan revision Required? I Yes No Use other side for additional information. __ __ Date SBD-6710 (R.3/97) Insepctor's Signature Cert. No. i .._ � -) -I-- � _._��.,�_ � '__-jam �.- � � � , '•- - �--{- -!- ' .__ � _--.�-_._.' '----�'._ !-- �-- i -� ' -- i '- I I I .`"��nnr�,n�y f � I I \V �` � �� J — D Industry Services Division ounty J � L� LJ 1400 E Washington Ave �' �`'��f Q S �- P.O. Box 7162 ' Sanita Pertnit Num er to be filled in by Co.) P J U N 11 202 ,1d� � � Madison, WI 53707-7162 ��1 �(J �l _J �FF5170�h15� lJ Dent Rt ��� pplication � State Transaction Number In accordance with SPS 3 m. o e, su mission of this form to the approp ental unit Project Address (rf different than mailing address) is required prior to obtaining a sanitary pemut. Note: Application forms for state-o�✓ned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provrde maybe used for secondary pu oses in accordance with the Privacy Law, s. 15.04 1 (m , Stats. �� I. A lication Information —Please Print All Information � _S� Property wner's Name r!'� � Parcel # Prope Owner's Mailing Address Property Location - Govt. Lot /a, ,Section � r �� ,� City, S e Zip Code Phone Number t•- rcle one I ��� � V T �� N; R E or II. Type of Building (check all that apply) Lot # / Subdivis' n Name 1 or 2 Family Dwelling -Number of Bedrooms �// �� Q� hGVjC 4lar�l a ,;,J 7 L Block# ❑ Public/Commercial -Describe Us L � 1 ` ❑ City of ❑ State Owned -Describe Use ❑Village of CSM Number �. 2 t STTt.1 tT�l �N 5 W � /� L1,�/1 f� CI�J C l.r 11 '' • `i�L 1�� [� Town of '� ,i�i��� )n III. Type of Permit: heck only'one box on ne A. Complete line B if applicable) A' New S stem y ❑Replacement System ❑ Treatment/Holdin Tank Re lacement Onl g p y ❑Other Modification to Existin S stem ex lain g y ( p ) B• ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner '' IV. e of POWTS S ste Com onent/Device: Check all that a I Non -Pressurized In -Ground ❑Pressurized In -Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑Mound < 24 in. suita a soil Holding Tank Other Dispersal Component (explain) ❑Pretreatment Device (explain) V. Dis ersal/TreatmentAraa Information: Design Flow (gp�) Design Soil Appli�ion Rate(gpdsf) Dispersal Area Required (sf) Dispersal Ar� Proposed (sf) System Elevation p`l r � � I VI. Tank Info Capacity in ota # of Manufacturer , Gallons Gallons Units � f I� k �� �� � � U '� N N � ,� New Tauks Existing Tanks W � � o y; � � p � py t) Cq y ra (�r �' Qi Septic or Holding Tank �� � r Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume esponsibility for installation of the POWTS shown on the attached plans. Plumber's ame (P t� Plumber s S' afore • MP/MPRS Number Business Phone Number � mil-%1 Plumb 's A ass (Street, City, St e, Zip Code) " VIII. Coon /De artment Use Onl Approved`Disapproved Permit Fee Date Issued I i Agent S'gna e $ � OO � �� ❑ Owner eason for Denial � IX. Conditions of i+g��/$�t4s14Ai�-fsr Disapproval fj �� �.,- S<„�(�pr� -�p �(� filter and 1. Setrtic tank, effluent t,e serviced/maintained ;� Qa-��� dspersal rell must as per managtln�ent plan provided by plumber. / �C 2. All 5@tFYal'k rtlyUirk+nyet�ts must be maintained C /� 0 /,� l ati t•/df a►lr)IIfO 18 rLt)tfh/tyfilltlNtiG89: �� �l `%M�[,� � SuP � W �/1 � V Attach to complete plans for the system and submit to the County only o r not e s n 8 r c es in sr l � (.,a�hrac�pr -ib �ro���.Q � hoM— '�c�/Ni�. (NO �Cco��d ��2s� 2.0 .. . W � Mann-�e.�� I�YM�i'►a� �. SBD-6398 (R. 08/14) All COLItl �� 61ir I page Inclax and Ude g2 Mot.r ■. ::«x1 ' , 'ti;s": Y,i ! is Crosn Page . d a e' , } rinfbff., i >'t ' Page • Murdgement page t Cty F! "" Tank AbFmtwancei z ad k " 1 i " ON i -ii -1: �•1 t T}Hill INli 'IIII ((1I�Illf[(II�IIfl�i[{i�ll�1I111�1111f[�1111111II{l�;ir�11 Li rr_ft:fa ..t �ittllll i; - 1 lltn �� .f,• Ira i--:If:t yY.f{' z 1`7"Od;�, rrrr --irk /J� /r�/rr [( J`//�ivi +� jTrr 3. = :.. t a-, Po[ytok, [nc is pleased to add its now commercial filter to its existing line of quality effluent filters.The 136525 is rated for over 10,000 GPD (gallons "per day! making it one of the largest commercial filters in its class. It has 525 linear feet of 116a filtration slots. Like the Polylok P6122, the new Polylok P6525 has an automatic shut off bail installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. No oilier f>ftr on the mairet can make that claim! i he P6525 Effluent Filter should operste efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner vrill be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer, 1. Locate the outlet of the septic tank. 2.`Fiemove lank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL525 out of the housing. 5_ Hose off filter over the septic tank. Make sure all solids fall bade into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter.is properly aligned and completely inserted. 7. Replace septic tank cover. Alarm acceSSHATAy 525 imearfeet Of 1116" filtration slots Aocepis 4 & 6" �' scHD_ 40 ripe` U_� i dtent IVo€ 6.015,Aa8 5,o^79,S4d ft Ideal for residential and com- mi=rcia[ waste flows up to 10,000 Gallons Per Day (GPD)_ =a'1 _�'•���=�1 extension handfe Rated fior over 70,000 GPD Gas deflector Automaticshut-offi 6a11 when filter is removed 'i_ Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4u or 60 outlet pipe_ If the filter is not centered under the access opening use a Polylok Fxtend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace the septic tank cover. POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFO wner i Number of Bedrooms: ❑ NA Number of Public Facility Units: NA Estimated (average) Flow: (gavday) Design (peak) Flow = (estimated x 1.5): RP �, (gal/day) In Situ Soil Application Rate: (galfdaye) Standard (Domestic) influent/Efifluent Monthly average A Fats, Oil & Grease (FOG) <.30 mg/L Biochemical Oxygen Demand (BODS) << 20 mg/L ❑ NA Total Suspended Solids (fSS) s150 mg/L High Strength Influent/Effluent Monthly average (FOG) >30 mg/L (BOD5) >220 mg/L NA (fSS) >150 mg/L Pretreated Effluent Monthly average (BOD5) <30 mg1L NA (TSS) G30 mg1L ld Fecal Conform (geometric mean) !! 1W Maximum Effluent Particle Size 3fi in da ❑ NA Other ❑ NA ww w 1w1TCw■ w wink c�l�uC[11 tt C SYSTM S EPECIFICATIONS Paige S of Tank Manufacturer_ /1 //S c° ❑ NA ❑ Septic [IDose El Holding Volume:�S (gal)Tank Manufacturer_ NA ❑ Septic 13 Dose ElHolding Volume: (gal) Vertical Distance Tank Bottom(s) to Service Pad: (tt) Horizontal Distance Tank(s) to Service Pad (It) Specific serviang mechanics must be provided if vertical is >15 feet or if horizontal is >150 feet Specific instruction to be provided on back. Effluent Filter Manufacturer m Effluent Titer Model: Pump Manufacturer_ _ E�rNA Pump Model: Pretreatment Unit Manufacturer JANA © Mechanical Aeration [IPeat Filter ❑ Disinfection ❑ Welland ElSand/Gravel Filter El Other Soil Absorption System [4 in -Ground (gravely) Elln-Ground (pressure) NA D At -Grade ❑ Mound ❑ Drip -Erne ElOther. Other. p NA 1tltltiv t C:/Y/YtrVL �7Vt /LV VLL Service Event Service Fnaquency When combined sludge and scum equals one-third (Ya) of tank volume Pump out contents of tank(s) ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: U year(s s} (Ma)dmum 3 years) ❑ NA Inspect dispersal cell(s) At least once every. _3 y aKs}s} (Ma)dmum 3 years) L7 NA Clean effluentfifter At least once every: ❑ month(s) year(s) ❑ NA Inspect pump, pump controls & atanti At least once every: 0 month(s)El � Flush laterals and pressure test At least once every. mean() 14 NA Other. At leasf once every. mYs)s) ear(Other ❑ NA ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the fallowing licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shalt be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent, on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local requfatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent fifters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWfS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS% antibiotics; baby wipes; cigarette butts; condoms, cotton swabs; degreasers; dental floss, diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: ® ll piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. A The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e After pumpings all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon b required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wilt result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the b(omat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS iNSTALLE Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone nf11flITC` flRAtfltTAiflICR Name Phone LOCAL REGULATORY Name This document was drafted in compliance with chapter Comm 83.22(21(b)(i)id)&(f) and 83.54(1), (21 & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Rivard Developer's Mailing Address 409 Co Property City/State ulee TrI. Hudson WI 54016 ddre s 1603 92nd tit., New Richmond WI 54017 (Verification required from Planning & Zoning Department for new construction.) New Richmond WI Parcel Identification Number 02& 1304-18'000 LEGAL DESCRIPTION Property Location''/a ,a ,Sec Subdivision Flat: 7 , T 30 N R 1 8 W, Town of Richmond Certified Survey Map # � i � (.� � �r ,Volume Warranty Deed # Spec house ClyesOno (before 2007)Volume Lot lines identifiable�yes�no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Page # Lot # 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 §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, joiuneyman ph�mber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue o warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 t/ f7 2020 SIGNATURE OF APPLICANT(S) 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 from the Register of Deeds Office and a copy of the certified survey map if reference is We in the warranty deed. (REV. 04/12) r D Z `5 �gg� D�K+L'HNzo ? Q nN0 3 a a Wo 4 @aa "' p avi m L] oOy+oAm mmF$a Nm p8mm a zcr4iio �yy�y Fa n j=fnm Dylym mO ^•3y3 } yOM 2 ***PRELIMINARY DRAWINGS ONLY - NOT FOR CONSTRUCTION USE*** m �� SCALE IS 1/2 AS SHOWN IF PRINTED ON 11X17 PAPER " PAGE: , �' LUKAS RIVARD Protect# 79-044 Sales Rep: Cd ldr,c o$ IMPORTANT Colorado Springs Spec cJ.remoRQbmr.com����� SWIDab: QS1P-iB �nwp ew remeee.�Aeer�s�+n nepye. 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I I I edtr L8a- WJ5 U�11 Tr �� 11 4r7 lobby old do K s I I }'q} g. l yold am, 2.19pgaes 4 I ( I O 20.T oars �l 1 I ^ A�511 sµ !L car 2 i LDr 3 I cor g 59,40i sµ D, x� m • CFRJIREO SURVEY bly Mi1P a m ..!5. � /f 66 WL 15 PG 4145 I rd loss V' m xmt emu• IN wt lobby.! { 1 s L / m I I 7.1J dopes i •"�•y' 27J cav sq. ( � .fly .............................................. �b 1ty. Wood I Poll,°�' e — q I �'Ss1a7M'q old ~�-d\- 'swral4'i � — ��-1 589U8'S2�W m 00y .. �.. . _ .. _ .. _ ..ievnHAME V ' S8jor 9'09' 2_W_ 027 '_ _ - " _ SarES I/e rem • 58495'S2'W 63D.1Z' - If `••`� - _ Sect4» bldbld 7obodyd-.I0=16 t 58965'S21Y 2699.77' (frond Mrafam bl AwM lho Nine sw 114 t �p ayN /gyp ranylR. ma7U Sa7arra7 Clxnx �.�—._,. EA ifli"iE'RY secrM T�w-ta Uh'FLA[7ED LANDS dri&'A:z_ (fm a /dxrhwa -- anry u wns U UNPLAFR77 [ANDS LEGEND ' fIW\ll r IVIMI tOYrY DF RICf1U0HD, 5T. CRfkX OIXINIY, 4A N0T ro sruEPFF vamwuE � I,. NW RE ¢ cYip� E_..T..--b•_ S W.. SE 1 ,�...-...W� -, Add 1601W sovVE OEARRCS If+P RE7ERE= TO THE MITT MIT OF mbstm O TTHE SW O BFNt RDOTd539L R16N. WOEN IS ; A 5� Corner Ymume�l el Rsasd o FaMd Is eal Ppe p Sel tyd s Is* Iron RtW (Wdsle CW fos Pa Iklm WO Ill OTI LOT CoadISS UAFXED ea1H A t' s Ism RCN PIPE twuGitN0 L1J IBS Fill UREA9 FOOT) U78ESS 0111E mm SHokl. . ••••••• •044N Seaga We (IW Iron Ri9Ht of .ah ._ . ad. foodAPxaswwlo Orl'.e.oy laratlm RAW RUWO d a Lo.a DMIsoe of East Ad937ur'le DPId KISE, tDold H%h Water O+v7L'an Umtlx'a4 - UP of km RAcv a Poo— — — IV Utaly Eoswamt dma^ 9 ro.oys CURVE TAP,t.E t ,.a In ,>..r vila ., .-. .. Now Rkhroexid, SHEET I OF 2 SHEETS P / 1. 5 499. I acres sq. ft. 6 State Bar of Wisconsin Form 6-2003 SPECIAL WARRANTY DEED Document Nnnw THIS DEED, made between ANX z ank. FSR ("Grantor," whether one or more), and David Kiec{thoefer and Pam Kieckhoefer, husband and wife ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, ink QWL County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lots 11 29 3, 49 5, 69 819,10911912913914,15,16417 and 18, Hoyden's Rolling Acres, St. Croix County, Wisconsin PIN: 02Cr1304-01-000;026.1304-02-000;026-1304-03-000;026-1304-04-000;026- 130445400; 0264130"64009 02&130448400; 026.130409-000; 02&130410- 000; 02&130411400; 026430412-000; 026430443-000; 02&1304=14-000; 026= 130415-000; 026430446-000; 026430417400; 026430418-000 Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encurribmnees arising by, through, or under Granter, except: casements, restrictions and reservations, If any, of record. s 111111111111111111111111111111111111111111 2 915125 BETN PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 05/17/2010 11:50AM SPECIAL WARRANTY DEED EXEMPT I REC FEE: 11.00 TRANS FEE: 375.00 PAGES: 1 Name and Return Address KRISTINA OGLAND ESTREEN & OGLAND 304 Locust Hudson, WI 54016 Perce3 Identification Numbs (PIN) This la not homestead property. (is) (is not) (SEAL) (SEAL) e + AUTHENTICATION Sigttature(s) authenticated on *TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 106.06) THIS INSTRUMENT DRAFTED BY: IN ACKNOWLEDGMENT STATE OP WISCONSfN ) COUNTY ) ° ``"'`�avutA Vgi Personally came before me on ►.,i `7 , 2° t _�SP..••...:OT4% y��*I e above-namee�d Aneh Rau Q "�5;��A (Wtte1Z,('A� o0%) i v 02�known to be a rson(s) who executed the foggSF&4 i s ent d ackn wle ged a same. ' fitineO>taa.Ran •0'#C` 5��; 04 I ncuat Stt ect. Ilud�on. W 15401 ¢ • ��� S C QN"v Notary Public, State of / �rt�u'�uta� My Commission (is permanent) (expires. rc !� ��� (Stgaaturea may he authentleated or aeknowledaed. Both are not necessary.) NOTE: THIS IS A STANDARD FORM, ANY MODIFICATIONS TO THI3 FORM SHOULD BE CLEARLY IDENTIFIED, SPECIAL WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO* 64003 ve,4k Jinches r Wisconsin Department of CommerceI.UATION REPORT Division of Safety and Buildings SWON , Wis. Adm. Code County Attach complete site plan on paper no Qn 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. Parcel IDS Please print all information. Reviery Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). Property Owner Property Locat on St. Croix Grand Properties, LP Govt. Lot 5E 1/4 SW 1/4 Sr 7 I Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 40 City State Zip Code Phone Number _J City ,;,J Village 116 Town Somerset ( WI 1 540251 715-247.590 Richmond 1374 page 1 of 3 Tom Schmitt ayden's Rotting Acres Nearest Road 160Th Ave. / 5 New Construction Use: �i Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent materiai OutWash Flood plain elevation, if applicable na General comments and recommendations: Area Is suitable for a conventional system with a 0.7 gpd/sq It rating. Possible system elevation foCre high trench 94.5', low trench 93.5'.,Slope is 100io. 1) f Boring # � Boring �/ J i/ Pit Ground Surface elev. 9$.0 fl. Depth to limiting factor 97� in• Soil Application Rate lorizon Death I Dominant Color Redox Description Texture Structure Consistence Boundary Roots 1 0-7 10yr3/3 none I 2fsbk mfr as 2vf .6 .8 2 7-13 10yr4/6 none si 2csbk mfr 9W 1vf .6 1.0 3 1349 10yr5/6 none s OSg ml OW -- .7 1.6 4 49-68 7.5yr4/4 none sl 2fsbk mfr :#SSS.SSSS— .6 1.0 5 86-$1 10yr5/4 none Ifs 1csbk ml -- .5 1.0 6 B1-97 10yr5/6 none_ s Osgml ---- .7 1.6 Bonin � Baring # J 9 . 100+ II'l Pit Ground Surface etev. 9$.Q ft. Depth to IlmNing factor ._ `in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/fl'E� 'Eff#1 1 Otte 10yr3/3 none sl 2msbk mfr as 2vf 1.0 2 6-12 10yr4/6 none sl 2msbk mfr gw 1vf Lo6 1.0 3 4 12-39 39-77 7.5yr5/6 _ 10yr5/6 none none Ifs cbcos 1 csbk Osg mvfr ml cs cs --- .5 1.0 5 77-100 10yr6/4 none A.SWI grs Osg ml -- --- .7 1.6 II r i 2 ` Effluent #1 = BOD 5> 30 <_ 220 mg/L and TSS >30�< 150 mg/L " Effluent f12 = BOD 4S30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt \_^ �� ` 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1695 72nd St., New Richmond, WI 54017 620105 715-247-2941 L 4L , Property Owner Grand Properties, LPParcel ID # J a Boring # J Boring — �IJ Pit Ground Surface elev. 95.30 ft. Depth to limiting factor 98+ in. Fmsoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eft#1 !*EEME2 1 0-7 10yr3/3 none sl 2fsbk mfr as 2vf .6 1.0 2 7-14 1Oyr4/6 none scl 2msbk mfr gw lvf .4 .6 3 14=22 7.5yr4/6 none Is 1csbk mvfr 9w — .7 1.6 4 2242 7.5yr514 none grin Osg mvfr 9w --- .7 1.6 5 42-63 10yr5/4 none greos Osg ml cs — Y 1.8 6 63-77 1Oyr5/6 none fs Osg ml cs -- .5 1.0 7 77-98 10yr6/4 none s Osg ml -- ----- 7 1.6 Boring IF Id Boring Pit Ground Surface elev. 99.68 fl. Depth to limiting factor 99+ 1n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDV *Eff#1 *Eff#2 1 0-9 10yr'3/2 none sl 2msbk mvfr as 2vf .6 1.0 2 9-21 10yr4/4 none Is 1csbk mvfr 9w lvf .7 1.6 3 21-36 7.5yr4/4 none Is 1csbk mvfr gw ---- 7 1.6 4 36-98 10yr5! none gm Osg ml — — 7 1.6 rt i t ❑ Boring # Boring Pit Ground Surface elev. �__�.�___. �Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD � 30 < 220 mg/L. and TSS >30 < 150 mg/L "Effluent #2 = BODS <_30 mg/l. 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. �. , -'� Conducted by: Schmitt Soil Testing inc. Thomas 3. S'chmdtt, CST 227429 1595 72nd St. New Richmond, WI.54017 Phone: 715-247-2 4,� Conducted Por: Page.3 of 3 Ref. No. 1/ 7� Name: Gxand Properties, LP. Address: 712 Rivard St. Suite 100 City, State, Zip: Somerset, WI. 54025 Subd.Name: Hayden's Rolling Acres Lot No.. ;02 -Cl S Legal Description: �1 /4 5411/4 S7 T30N R18W Backhoe Pit Township of Richmond, St. Croix County Bench Mark El. 100.00' Top of �?`'/�T.�G ,�i,LyL © Alternate Bench Mark El. �'�S`��Tap of � "��11����'- Slope=� Contour Line El. dYsSr Contour Line Length /Yf,� Scale 1" = 40' %d t�r'��..d �OUJ�✓ f�a.SL� This soil report was done to fulfill a zoning requirement. The road and permanent lot markers were not in at the time the test was conducted. The area in which the test was done may or may not be suitable for vour use. Code Adminis 715-3864680 Land Inforntation � Planning 715-386.4674 F'AX MEMO DATE: FAX NUMBER: FROM: ` FAX NUMBER: 715-386=4686 PHONE NUMBER: NUMBER OF' PAGES, INCLUDING COVER SHEET: ST. CROlX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HuDsoN, Wl 54016 entotCommerce pRNATE SEWAGE SYSTEM division INSPECTION REPORT IFORMATtON (ATTACH TO PERMIT) n you provide may be used for secondary purposes (Privacy Law, s,15.04 (1)(m)j. Permit Holdels Name: Grand Pro erties L.P. City Village X Township Richmond, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK 1NPORMATI�1� TANK TO P/t. WELL BL Veni io Air Intake ROAD .58ptIG Dosing Aeratian Holding PUMP/SIPHON INFORMATION SOIL_ ABSORPTION SYSTEM DIMENSIONS INFQRMATION DISTRIBUTION SYSTEM SOIL. COVER Center Edges COMMENTS; (Include code discrepencies, persons present, etc.) ELEVATION t�►TA St. Croix 487987 0 ID No: wn/Range/Map No: 07.30.18. /�7 STATI BS HI FS ELEV. Benchmark Alt. BM Bldg. S er SUHt let SU t Outlet Inlet Dt Bottom Header/Ma . Dist. pipe Bot. System Final Grade 5t Cover xx Mound Or At,Grade xx Depth of xx Topsoil Inspection #1: / /. Location: New Richmond, WI 54017 (SE 1/4 SW 1/4 7 T30N R18W) Hayden's Rolling Acres Lot 18 1.) Alt BM Description 2.) Bldg sewer length = amount of cover Plan revision Required? [] Yes �.� No Use other side for additional )nformation. Date Insepctor's m r'�! Yes i No � ,� Yes [] No Inspection #2: ! / Parcel No: 07.30.18. ���� Cert. No, I C y and Buildings Division % Z W. on A ., � G-- Sanitary P it Number {to be filled in by Co.) ��n�.� M , WI 6 7051 "' De ar�t7ment of Commerce Sanitary Permit App11 tl Plan .D. Number �t,/Jl/�J" 1n accord with Comm 83.21, Wis. Adm. Code, personal info scion provide ST�. CROIX C 'ect Ad ess (if different than mailing address) may be used for secondary purposes Privacy Lnw, sl (1 xm ZONING OF I ��� yap I. Application Information — Pleasc Print Ail Information � Property Owner's Name � vP� m� [.0�-s.��p- t Block k . �,2 - �. ��-- �. o Property Owner's Mailing Ad cess Property Location / � �„� � :S'' % ��, y., �'/, Section __� City, State Zip Code Phone Number ,(circle Vie) [I. Type of Building (check all that apply) t?k, � (��, a ub..r.:�k Subdivision Name CSM Number I or 2 Family Dw^cling - Number of Bedrooms �^. o J'Sw I p��,,�- ❑ Public/Commercial -Describe Use 2 O��„ ��� w � �.. � ❑City_❑Village �i'ownship of /Q/__ L`�tD[I ❑ State Owned -Describe Use 1 )II. Type of Hermit: (Check only one box on line A. Complete lino B if applicable) A' ®New System ❑Replacement System ❑ TreatmendHolding Tank Replacement Only ❑Other Modification to Existing System List Previous Permit Number end Date Issued B. ❑Permit Renewal ❑Permit Revision ❑ Change of ❑Permit Transfer to New Before Expiration Plumber Owner IV. T e of POWTS S stem: Check ail that a Non —Pressurized in -Ground ❑Mound > 24 in. of suitable soil ❑Mound <24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑Pressurized in -Ground ❑Holding Tank ❑Peat Filter ❑Aerobic Treatment Unit ❑ Recircu{ating Sand Filter ❑ ❑Gravel -less Pi ❑Other (ex lain) t Rccireuiating Synthetic Media Filter RLeachi amber ❑ Dri Line Pe P V. Dis etsal/I'reatmentHrea Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (s Dispersal Area Proposed (� �/te � �, sty n o J � ✓/ � V1. Tank Info Capacity in Total Number Manufacturer Concrete Constructed Steel Glass Plastic Gallons Gallons of Units New Existing � �) Tanks Tanks Septic or Holding Tnnk � — ' L.�""" Aerobic Trcatnxnl Unit . Closing Chornbcr VII. Res onsibility Statement- I, the undo i ned, assume responsibility for installation or the POWTS shown on the attached plans. Plumber's Name (Print) Plu r' Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip C e .--�.- -� E V111. Count �/De artment se Onl Sanitary Permit Fee (includes Groundwater Date ssu Issuin gent Sign ure ( s proved ❑ isappr Surcharge Fee) }x� �U� � C� // � S ❑ rven Reaso enial IX. Conditions of Approval/Reasons for Disapproval � r SYSTEM OWNER: 3� 1 ,�S lS 0 /�'` 1. �Steptie tank, effluent lifter and l ,/�) � �. I � � S-�,ivt�r I � i'� � r ` dispersal cell must al{ � setvicets ! trlaltttainad Gi,11 � � eCx. , � as par management plan provided by plutrtMtr. 2. AN sst�ack raquirttmartts must be ntafrttaktad (�t�,�-t � �� (} �� � .rJ. t �c..j�, CL / cis par appilCsbls tads / ordir►ttices. less than 81R z 11 inches in size Attach eomptete plans (to the County only) fort system on paper . ;� � t � e.�' rn (15�' Sv � 6 w� er /yl ai n'�rtanc22, SBD-6398 (R. Ol/03) �- �'�,� �,,tn, ��'�' P � J _ _ _ , I IF IF .. _. ........ _1^ _. �. j .... _.... _ _ . .. ._ ,. .... _ ... .. - ..__ _ _. __ . - -_ _.y_.___... __ _ .. r : 1 I 00 � SSl� 1 1 �' �5 i --- IF _ vel IF OA .n� h pR cCo s c �^ Q 14 3 Rya1000 , rF&F 9y' � 110 'rA 1 ,t. OwnerBuyer Mailing Address . sT cRorx cavrlTsr SBPTIC TANK MAINTENANCE AGREBMBNT AND OWNERSHIP CERTIFICATION FORM Property Address ,. `� � (�_.�tin1`"u.klr`1 y'' - (Verificationrequired from Planning Department for new construction) dal � --l0�,5� -ZO -aoo City/State ����t��'� ,y �o�v %�. Pazcel Identification Number h� � �id�s - /D -GSO LEGAL DESCRIPTION Property Location ,,�'/4, � �> .. %., Sec. ,,,�_,, T,.,,�Q_N-R�(g,_W, Town of i ff/��.�/J Subdivision �,4 U Y► �� � S I�DL c ,� � f�_.�c,� r �.L�-m�i- .Lot # �B Certified Survey Map # ,Volume _,,Page # Spec house la yes O no Lot lines identifiable � yes C] no �" 5�. ,YSTEM l�f.[AAiIyTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a i masterplumber, journeymanplumber, restrictedplumberor a licenscdpurnpervcrifying that (1) the on-sitewastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fuU of aludge. Uwe, the undersigned have read the abovo requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as sat by the Department of Commerce and the Department of Natural Resources, State of Wisconsin, Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three yofa�r�expiration date. ��— SIGNATIIILE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owncr(s) of the property described above, by virtue of a warranty deed recorded in Rtgister of Doods Offices SIGNATURE OF APPLICANT DATE u ««*«*« Any information that is mis-represented ma� result in the s�itary pemut being revoked by the Zoning Department. **««** . .. _ _ ... ...--�.,__.._�... _._�__a ....,_...._... a__a a.,..:, a., rz..hict�r �f needs office , , . -. rid t{� t .. :., ... 1 �(, POWTS OWNER'S MANUAL & MANAGgEMENT PLAN nf'c.tlu>=AtiMeT1AN. - � SYSTEM SPECIFlCATIONS owner ,�d. . Parmit � ncclrlu aeQeiu�Rc Number of Bedrooms ❑ NA Number of Pubic Facility Units li NA Estimated flow (average) al/da' Design flow (peak), (Estimated x 1.5! ai/da Soil Application Rate , ' al/da /ft= Standard Influent/Effluent Quality Monthly average• Fats, Oil &Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODY) 5220 mg/L ❑ NA Total Suspended Solids (TSS! St 50 mg/L Pretreated Effluent Qualify Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Coliform (geometric mean) 510' cfu/t00mi Maximum Effluent Particle Size Ya in dia. ❑ NA Other: � ❑ NA 'Values typica{ far domestic wastewater and septic tank effluent. Page of Septic Tank Capechy al ❑ NA Septic Tank Manufacturer -- -- ❑ NA EHivant Filter Manufacturer ,: �(,,,,, ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity ai ®NA Pump Tank Manufacturer ■ NA Pump Manufacturer ■ NA Pump Model � ®NA Pretreatment Unit ®NA ❑ Sand/Gravel Filter ❑Peat Filter ❑ Mechanical Aeration ❑Wetland ❑ Disinfection ❑Other: Dispersal Cells} ❑ NA f in -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑Mound ❑ Drip -Line ❑Other: other: ❑ NA Other: ❑ NA Other: ❑ NA MA1n11CIVHIYIiC Jti1lCVVLG Service Event Service frequency Inspect condition of tanks) At least once every: ❑ ® month(s) earls) (Maximum 3 years) ❑ NA Pump out contents of tinkle) When combined sludge and scum equals one-third (Y,} of tank volume ❑ NA ❑ monthls! (Maximum 3 years) ❑ NA Inspect dispersal ceil(s! At least once every: f year(s) t month(s! � ❑ NA Clean effluent filter. At least once every: � 3 ❑ yearts! ' ❑ monthls! � ®NA Inspect pump, pump oontrols &alarm At least once every: O year(s) • ❑ months) ®NA Fitish laterals and pressure test , : , At least once every: ' ❑ years! �'+w ■ NA Other �fi,� � z y' At least once every: Other ��,rx��rt � �� , , � ❑ NA� �t;� � . ,..: _ :,r,, � u: i,. � rid a , t , . _ ,_ .. , .. - IAINTENANCErINSTRUCi-IONS �. . ' , . .' Inspections of tanks and dispersal cells shag be made by an individual carrying one of the tollowing_licenses�or certific� Master ,Plumber, Master .Plumber Restricted Sewer; i OWTS Inspector, POWTS Maintainer, Septage. SenilclnsgrNOpe�ator.� inspections must include a visual inspection of the tinkle) to identify any missing or broken hardware, identify any cracks or measure, the volume of combined sludge and scum and tocheck for .env back, up . or,ponding ;of effluent on ,the ground a� The dispersal celi(s) shall.be .visually inspected to check ihe.efftuertt levels in the obseniation pipes and,fo check for any p! of effluent on'�theFwground surface The ponding of effluent on the, ground surface may indicate a failing condition and trequlr immediate"riotiticaUo'n'ctSLf the localdegtilatory,authonty ,y i >� `asr `'` -� s_S } isi V�k. �G r .. ,, ., �. 'Y f . ` � , ., i i 1 !� 'j�k�'� �! �! -�II��i utii�l'%"�t � :k�p When the combined accumuls�ion of sludge;and scum in any tank.;equats_�one third-(Y,!_or more. ofrthe�tankhvoh � e�tNF n �� ,- ; �f• 1 �� ��� i '[��t.l ;� � 3 �. ;i }�; .�. I;. �'"�,�. a�"'r ' .��� E :��ti i a, �� ,.. z , .t ' ti� c e t t,n� 4,� fie• r r ,!�' P0g0 Of S�A:�'i't.tJP AND OPERATION �' A�-s .,,, '.' , `:• ' ' ,'� For riew construction, prior to use of.tha POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatmept process and%or damage the. dispersal cell(s). It high copcentrations are detected have the contents of tfie tankls) removed by a septage seivicing'operator p'rlor to use. System start up�shell not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellist in one large dose, overloading the cells) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump ar contact a Plumber or POWT5 Maintainer to assist in manually operating the pump controls to restoro normal levels within the pump tank. ' Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. IReduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. I ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is , '; properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Cade: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. ' • The contents of all tanks and pits shall be removed and properly disposed of by a septage Servicing Operator. ! • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with { soil, gravel or another inert solid material. CONTINGENCY PLAN ' If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: . ■ A suitable replacement area has been evaluated and may be utilized for the location of a replacement sail absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot tines and wells. Failure to protect the replacement area will result in the Head for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable �replacament area. Upon failure of the POW7S a sail ,and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank . , , may ba installed as,a Iasi resort to replace the failed POWTS. <i .r ❑ Mound and at -grade soil absorption systems may be .reconstructed in place following removal of the biomat at'the r infiltrative surface. Reconstructions of such�systems must comply with the rules in affect at that time. I� .. Y a k: «WARNING>�? ;; � f. ;. ;: , � � ,; .. �> � �>._s SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN D0, NOT = ` �'G ENTER ASEPTIC, PUMP OR OTHER TREATMENT TANK UNDER .ANY;GIRCUMSTANCES. DEATH MAY RESULT ,RESCUE OF A �4i ! i�,' PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE t � '� ApD{TIONAL COMMENTS ' ` .3;, '� x '� � k,Cd �,�ij:�y" 7 .. ..• rt• . . � ;,y 'pWi'S INSTALLER '. ' � �` Name �s' ""` Phone.� ?� ', \`�' , ��� :Farer.� :RFRVir1Nr;'ApERAT�R fPUMPERI '� '�"�5���;° �� _' '" �-° �'�� � f s Name i,y t f i-0���4���a� �F � (; � ' �.,. ;�, This Mk U 2813P SS8 State Bar of W isconsin Form 2-2003 WARRANTY DEED Document Number I) Document Name THIS DEED, made between Ro11in�,Aiils D�r„y, ing. ("Grantor," whether one or more), and Grand Properties, LP ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum). See Attached Exhibit "A" Exceptions to warraanties: Easements, restrictions and rights•of--way of record, if any. Dated d �! ZG�O� Rolling Hills Dairy, Inc. ,rr♦., b gt_ _ . n� A/L 0 ( ? wee; 1 4 KATHLEEN H, WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12:3@Pn WARRANTY DEED EXEMPT # REC FBE: 13.@@ TRANS FEEL 1397649 COPY FEE: CC FEEL PAGESt 2 Recording Area Name end Rdum Address David J. Estreen 304 Locust Street Hudson, WI 54016 -Q26-1025-20-000: 026-I 025-10050 Parcel Identification Number (PiN) 'This is not homestead property. (is) (is not) AUTHENTICATION ACKNOWLEDGMENT Sigttature(s) Rollin¢ Hilts Dairy, Ina _ BY: Gerald A. Kieckhoeferr and Rita A. Kieckhoefer STATE OF ) } ss. authenticatedpn I-ti U COUNTY ) 'TITLE; MEMBER S�i'ATE BAR OF WISCONSIN authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Attorne l ristina Q,giand ,Hudson, WI 54016 Personally came before me on , the above -named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknawledgcd. Both arc not ncceesary.) NOTE; THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF W ISCONSIN FORM N0.2-20U3 • Type name below signatures. INFO -PRO'" Legal Forma 00455.2021 wvrw.lntoprotams.com 1 �f U 2813P SS8 State Bar of W isconsin Form 2-2003 WARRANTY DEED Document Number I) Document Name THIS DEED, made between Ro11in�,Aiils D�r„y, ing. ("Grantor," whether one or more), and Grand Properties, LP ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum). See Attached Exhibit "A" Exceptions to warraanties: Easements, restrictions and rights•of--way of record, if any. Dated d �! ZG�O� Rolling Hills Dairy, Inc. ,rr♦., b gt_ _ . n� A/L 0 ( ? wee; 1 4 KATHLEEN H, WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12:3@Pn WARRANTY DEED EXEMPT # REC FBE: 13.@@ TRANS FEEL 1397649 COPY FEE: CC FEEL PAGESt 2 Recording Area Name end Rdum Address David J. Estreen 304 Locust Street Hudson, WI 54016 -Q26-1025-20-000: 026-I 025-10050 Parcel Identification Number (PiN) 'This is not homestead property. (is) (is not) AUTHENTICATION ACKNOWLEDGMENT Sigttature(s) Rollin¢ Hilts Dairy, Ina _ BY: Gerald A. Kieckhoeferr and Rita A. Kieckhoefer STATE OF ) } ss. authenticatedpn I-ti U COUNTY ) 'TITLE; MEMBER S�i'ATE BAR OF WISCONSIN authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Attorne l ristina Q,giand ,Hudson, WI 54016 Personally came before me on , the above -named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknawledgcd. Both arc not ncceesary.) NOTE; THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF W ISCONSIN FORM N0.2-20U3 • Type name below signatures. INFO -PRO'" Legal Forma 00455.2021 wvrw.lntoprotams.com 1 �f U 2813 P 559 EXHIBIT "A" Located in part of the Fractional Southwest Quarter of the Southwest Quarter and part of the Southeast Quarter of the Southwest Quarter of Section 7, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin, being more fully described as follows: Commencing at the Southwest corner of said Section 7; thence North 00 degrees 10 minutes 53 seconds East, along the west line of said section and being the west line of Certified Survey Map Volume 15 Page 4145, a distance of 663.12 feet to the point of beginning (POB), thence continue North 00 degrees 11 minutes 01 seconds East along said West line 640.71 feet; thence North 88 degrees 43 minutes 22 seconds East 1676.75 feet; thence South 01 degree 01 minutes 04 seconds West 1315.31 feet to the south line of said Section; thence South 89 degrees 05 minutes 52 seconds West along said south line 1027,21 feet to the east line of said Certified Survey Map; thence North 00 degrees 10 minutes 53 seconds East along said east line 663.12 feet to the northeast comer of said Certified Survey Map, thence South 89 degrees 05 minutes 52 seconds West along the north line of said Certified Survey Map a distance of 630.12 feet back to the point of beginning. St. Croix County, Wisconsin. CL i % %j X ®rx ox � �^ X CA x� t 4 CL pp SCALE: 0� 9 _ X& % mn¢rna ruv rta os-9 _ dN \ WIOMD44 APR 2 6 2005 xw ST. CROIX COUNTY m ZONING OFFICE """W garr> w 1