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HomeMy WebLinkAbout030-2131-31-000 Wisconsin.,DepartmentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515149 � GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: p N, 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: Bergman, Mark & Heather I St. Joseph, Town of 030 - 2131 -31 -000 CST BM Elev: Insp. BM Elev:, BM Description: Section/Town /Range /Map No: t Z C,57 23.30.20.1085 TANK INFORMATION a ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic N J d�vA_ /Z Benchmark O g Alt. BM a, 4 *1 -7 Aeration Bldg. Sewer '� 'b3 Holding SUHt Inlet � J�, ISS BIZ • S S TANK SETBACK INFORMATION St/Ht Outlet 5 3 9 2 ­3 TANK TO lL WELL BLDG. Vent to Air Intake ROAD Dt Inlet �_ of Septic Dt Bottom 7 5 / J , 7 rQ i \ Dosing Header /Man. Aeration Dist. Pipe ! 9 IS .45 Holding Bot. System to j q PUMP /SIPHON INFORMATION Final Grade / , - 7 95 ✓ Manufacturer Demand St Cover / GPM c 7 - 7 Model Number It TDH Lift Friction Loss System H TDH Ft � 1Jar 7. Z y • `j Forcemain Dist. to Well SOIL ABSORPTION SYSTEM Tn� Q,' n Gc,,-,j , /. 8 55 $ BED /TRENCH Width Length / No. Of T renche s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r 3 z I SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR �- Type Of System: �.�.�C. vZ 1 J � I — UNIT r: /ll Model N um b er: Go n,v� ' 0 5 v ,, DISTRIBUTION SYSTEM /Uef1� /�� Ala: ZZi-ZZ = Aly 16 Header /Manifold Distribution j xH ole Size x Hole Spacing Vent to Int 5 Pipe(s) � Zw k� Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only G�- Depth Over �, Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center N ' 2 Bed/Trench Edges \ Topsoil \ yes No�Yes No .✓ ` J — > COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1431 Thelen Farm Rd. HOULTON, WI 54082 (SW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 31/I Parcel No: 23.30.20.1085 1.) Alt BM Description = ' C �a : �S �- 4 0C,&_6 O 2.) Bldg sewer length = 7 6 amount of cover = p /- �- $ O /ln 1 � • t O � Plan revision Required? El Yes No Use other side for additional information. _ _ SBD -6710 (R.3/97) Date Insepcto Signature Cert. No. J ItSCO ,W1 , Safety and Buildings Division Cody 201 W. Washington Ave., P.O. Box 7162 /1 t Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) 515 Sanitary Permit Application gd- .r ......N" � In accordance with a. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental / )k unit is required prior to obtaining a sa rlitary permit. Note: Application forms LP S are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provi for ndary s es in accordance with the Ptiv Law s. 15.04(l)( _ LApplicatio n IntormaBon - PI Print All Info Property Owner's Narix Parcel # q,,, 13er �i �:r2JIXi.UU Property Owner's Mailing Address P Property Location / GOVt. t x City, State Zip Code Phone Number V xv A., Section a U T N; R H. Type of Building (check all that apply) , /f' Lot # Subdivision Name ❑ 1 or 2 Family Dwelling- Number of bedrooms �., ar; g >; n,a ❑ Public/Commercial - Describe Use City of ❑ Village of ❑ CSM Number — State Owned - Describe Use own of - �� - - �► h/ 22t C��a«► W. Type of Permit: (Check o one box on line A. Complete line B N applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Pit KPermit Revision ❑ Change of Plumber ❑ Permit Transfer to New �, 1is Before Expiration Owner IV. a of POWTS S tem/Coni onent/Device: Check all that a - Pressurized In- Ground ❑ Pt emurized in -Ground ❑ At -Grade ❑ Mound ? 24 in. of suitable soil ❑ M and < 24 in. of suitable soil ❑ Holding Tank Other DispersaliComponent (explain) ❑Pretreatment Devi xplain) V. Dis rsal/Treatment Area Information: Design Flow (gpd) Design Soil f) Dispe Application I�Re(gpds J ea Require d ( Di spe 1 Area (sf) S s levation / — _ �� VI. Tank Info Capacity in Total # of Manufacturer g Gallons Gallons Units L _ I cis New Tanks Existing Tanks a F3 1 2 Ci rn w F, Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - I the undersigned, assn asibility for installation of the POWT3 shown on the attached plans pr)s Name (Print) Plumber' tune MP/MPRS Number Business Phone Number ��- Plumber's Address (Street, City, State,2ip Code VIII. Conn /De artment Use Ohl Permit Fee Date Iss Issuing A Signature Approved ❑ Dia $ 1 /6 v I ❑ Reason for Denial IX. Condi easons for Disapproval GO L 1. Septic tank, effluent finer and dispersal cell must all be servkes / maintained aS per management plan provided by plumber. 2 AN setback requirements must be maintained 88 0 q. system and submit to the County only on paper not less than a 112 x 11 Inches In sbx SBD -6398 (R. 01/07) Valid thru 01/09 a Soil Test and System PLOT PLAN PROJECT Mark Beraman ADDRESS 1431 Thelen Farm Trail Houlton Wi 54082 SW 1/4 SE 1 /4S 23 /T 30 /R 20 W TOWN St. Joseph COUNTY ST. CROIX 9/28/09 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXXX IN -GROUN ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44 IL BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 90.8/90.3 6' below qrade Well is to meet all setbacks required by WDNR Pro 4 �! Bedroom tib House I G�0 25' Property Line T a B.M.* 0' 45' 45' 0' - 97' ents 30' 95' Plans Designed Using Conventional Powts B -3 Manual Version 2.0 9% Slope Vent >6 „ Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 5.8ft ^2 /pair of end caps 4' Long 2 250' Grade at System Elevation 34' Thelen Farm Trail 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 inches in size. Plan must ' include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location anc_jstar"tyearest road. Q�Q ! 3 — 3 / Please print all informaullft. GV Revie d by Date q Personal information you provide may be used for secondary purposes (Pri 15.04 (1) (m)). / all /o f Property Owner roperty Location iv i .tS�ts� 11454 1/4 S T F N R2- a (or -r K t Property Owner's Mailing Address pLA Lot # Block # Subd. Name CSM# 3 ) r --s � I-Se 1 6 fP�✓ city State Zip Code Phone Number ❑ city El Village To Nearest Road W New Construction UseResidential / Number of bedrooms Code derived design flow rate 6 027 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable �� J ft. General comments Q, ' and recoounendati System Type ���L� e System Elevation / !✓ /� 3 7 Boring # A Boring �` / Pit Ground surface elev. 1 ° ' ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2 o O -31. �-- - - v . 1/0 0 /0 D• ,l tr �z Fa Bori # ° gyring Pit Ground surface elev. . ft. Depth to limiting factor � / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z 0 2. 1 47 of rl Effluent #1 = BOD > 30 < 220 mg/L a4 TSS >30 < 150 - Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Pnnt) g CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 9 ��— 715- 246 -4516 Property Owner _ Parcel ID # Page of N Boring # F] Bating Pit Ground surface elev. � � ft. Depth to limiting factor ! J 0a, in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-i3 o� 0� F-1 Bating # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. — So — ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDiTf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate 1:1 Pit Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, 130 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -9330 (8.6/00) Property Owner _ Parcel ID # Page of a Boring # ,❑ Boring ( J& Pit Ground surface elev. ft. Depth to limiting factor J in. F Rate Horizon . Depth Dominant Color Redox Description Texture Structure Consistence inda Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 op - J-3 - 31 z- - ---- -- 5/ ,,� 2 - /3` ,-� C / W e 1 4 F -1 Boring # E] F1 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. 1:1 pit Soil Application Rate Horizon ")epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.6100) PAID f Safety and Buildings Division county 1 c 201 W. Washington Ave., P.O. Box 7162 tq s= con S 1�1 Madison, wl 53707-7162 Sanitary Permit r � be filled in by Co.) Sanitalry Permit Application A Q In accordance with s. Comm 83.21(2),1 Vis. Adm. Code, submission of this form to the appropriate govemmental / unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Comrderce. Personal information you provide may be used for secondary es in accordance with the Privacy Law, s. 15. 1 m , Stats. I. Application Information - Plemic Print Aim Information P-pery Owner's Name Pare ' _ U Gti rty er's Mailing Address coUN t Y Property Location CK� FFIC Govt. Lot (. d ( CLA"t", /yam^- z3 try, State Na;at de ., R_ %y Section T N; R L V I E o� II. Type of Building (chec # ) _ / S C ion 7 Name r 2 Family Dwellin N Block # � ❑ Public/Commerci al csc ❑ City of CSM Number Village of ❑ ❑ state Owned - Describe Us- -_ own of J S III. Type of Permit: (Cheek only one boa on line A. Com tine B if app ) A ' System ❑ Replacement System ❑ Treatmen (ding Tank lacement Only ❑Other Modification to Existing System (explain) List Previous it umber and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plum ❑ Permit Transfer to New / Before Expiration Owner ^ N. a of POWTS S temiCond onent/Device: Check all "v e 11 Pressurized In- Ground ❑ Pressurized In- Ground At -G e ❑ 0 4 ' . of suitable soil �❑ o < 4 t f s • ble soil spersal Component (explain) n "c `� ❑ Holding Tank ❑ Other Di V. DisDersalVT reatment Area Information: Ar I , proposed Design Flow (gpd) Design Soil Application RaWWIsf) 73p-sal Area Required (sf) sperss 9y 3. VI. Tank Info Capacity in Total # of cturer & Gallons Gallons Units New Tanks Existin anks S m U Fn on Septic or Holding Tank Dosing Chamber r , ti VII. Responsibility Statement - Ix the an igried, am Dusibility for Installation of the POWTS shown on attached plans. Pilunber's Name (Print) Plumber' Lure MP/MPRS N Business Phone Number c —7 2� S Plumber' Address (Street, City, State,!Zip Code) L?) VIII. oun /De partment Use Onl Permit Fee Date Iss I mg A t Si Approved ❑Disapproved E X ❑ Owner Given Rekson for Denial J ` 3 IX Conditions of Approval/Reasons for Disapproval S / . moo,(/ Cs7"-�r SYSTEM OWNER: 1 Septic tank; effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. ` 2. All -setback and mbgtlt totbe boa only on paper not in as per applicable code /ordinances. SBD -6398 (R. 01/07) Valid thru 01/09 LOT PLAN PROJECT Mark Beraman ADDRESS 1431 Thelen Farm Trail Houlton Wi 54082 SW 1/4 SE 1 /4S 23 /T 3 :N/R W TOWN St. Joseph COUNTY ST. CROIX 9/23/09 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL I:fK ND PRESSURE CONVENTIONAL LIFT )00X HOLDING TANK MOUND SEPTIC ZE 1 255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1217 # of chambers 60 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Please note: a new SYSTEM ELEVATION 94.093.8/93.6 1' below qrade soil test will be done Well is to meet all setbacks required by on this site to install WDNR system in a proper location and depth Vent >6» Quick4 Standar Plans Designed Using Cover Leaching Cha er Conventional Powts with 20.0 f f Area Manual Version 2.0 5.8ft ^2/ of end caps Gr e at System Elevation Pro 4 Bedroom e 15' ffcutt Combo Tank 40' B -3 2% Slope 0 ' B -2 B -1 15' to Be >5' 20' B.M. #1 Property Line -N 20' 130' B. M.42 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 :#1. ncy.. Plan Optio If s tem_fails, determine cause of failure, use alternate area and install new s ested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE A CIMMENT AND OWNERSHIP CERTIFICATION F RM ownermuyer A -f u r� Mailing Address le" c �V I Address /��- Y/e�v'a ,� ��f� Pro perty (Ver&.&. required $om Planning 8t zoning DepubMW for own-) C ty i /State )J0 N Gkf Parcel wentif ication N mbe r � LEGAL DESCRIIPT M 1� �r . �3 T � ©rift ,� ,Town of / ' `�t7 ,✓ Property LocStlon Y4 74 , S ee . s Subdivision CertMed Survey Map # - , Volume - , Page # Warranty Deed # Volume _ - house yes no Lot lines it no Spec STE CATION s could malt is its g�osture faf m to lamdle wastes. Proper Improper use and ice of y septic Ys if by a licensed pram P= you Pw into zoaintenaace consists of pamoping out the septic tank every' One � of the c tank as a treat ag MV is the disposal system. Owner the system Can affect the flmctitome � 12 - St. Croix COU � Ste' O• responsx'bilities are specified is §Comm 83.52(1) sad is Chapter certification form, signed by the The property owner agrees to subnvt to St. Croix CMUdY Phasing dt Dep 0a0t a that (1) the on site owner :md by a masw pb bar, jownyman phimber, rest<icted plambar or a li P verifying tank is write mter disposal system is in proper oPw8fing condition and/or (2) after ' and pampiag (if necessary), the septi Jos than 1/3 frail of sludge. have read the above requirements and agree to Pti with the Uwe, the m4dn+od of Natural Resources, State of Wisconsin. madams set forth, bra. as set by the DePar4meat of Commerce sad the D Certification, sta#iag that your septic system has been m must be compl and ret=wd to the St. Croix CouirtY Piaanmg & Zoning Departraent witbda 30 days of the three year expiration date. f atar�ents on Chas form are true to the best of my /our knowledge. i/we a�n/are the ow ner(s) of the 5i s f a v nranty deed recorded in Register of Does Office. DATE O APPLICANT(S) ** *Any iafonmatioa that is miarepresented way result in the sanitary permit being evoktid by the Planning dt Zoning Department' ** hwJude with this application a recorded waamty deed fiom the Register of Deeds � fficc and a copy of the certified survey map tf rr.fteaw is made in the warrrmdy deed. I (REV. 08" j �I Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer ZE f i Tank Model Number S Pump Model Number Total Tank Capacity Alarm Manufacturer S Max. Bury Depth '- Alarm Model Number I- v Switch Type �/. C� P Filter Manufacturer Total Dynamic Head (TDH) - Feet Filter Model Number /=) 0 - Elevation Head J�- Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss /U GPM', 1 Ft TDH Total . Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted Weather -proof Junction Box ., - — -- Finished Grade Pd__ Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter - - - - - - Inlet Baffle - - - - -- Inlet � - - - - - - A 1 /4!, Switch Settings and Reserve Capacity Y. GPI Weep Tank Volume = Hole Dimension Inches Volume Gal. B IX (reserve) A' (alarm) B 2 Off Elevation C (dose) C Ft Bottom (dead) D D Elevation IX Total Ft ---- -- GENERAL INSTALLATION: The septic /dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 LJ Page of .Sent By:' H' LaGONet 3100; 1 775 a aazr ; t mom v �. 9 E H SERIES SUMP /EFFLUENT PUMP aAs _ O OL ..,.� on v +ros er.W aams 9 +r _ �, an tM 7p 3b 3g &" sttat '%*= Yi0 , tIS tas 78 S` ``5 H 32 as v $tt s1184:LU 991-m wam a 1 tS0 84 a ffi tsQ t dn�lr0�� �eo�sgo lrR�td-- r[T�e��R�iibai�f� . C ptasteYCtio� Coacnd c� Iron - ° - isapelkr Ntetzriat Closed Vaac — _ . io sjrw-A Seat a� osr�'°r' and Shaft LIZ - - �7pprx Stsum and Lin Beats�8s 8ees'tn Batt 8s 20 40 Go 0 eo room WW.O *sW4c ft OK i i - I Ililll IIIII IIIII !1111 IIIII IIIII ill! IIIIlI IIlI IIII 9 0 4 0 4 6 1 State Bar of Wisconsin Form 6 - 2003 904046 SPECIAL WARRANTY DEED BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 09/21/2009 10:50AM SPECIAL WARRANTY DEED THIS DEED, made between Lakeland Construction Finance, LLC, a Minnesota EXEMPT t limited liability company REC FEE: 11,00 ( "Grantor," whether one or more), and TRANS FEE: 135.00 Mark D. Bereman and Heather K. Bereman, husband and wife PAGES: 1 ( "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, in St. Recording Area Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach '+ addendum): Name and Return Address t Lot 31, Settler's Glen, St. Croix County, Wisconsin �e k4w �7c �0 1 ��b GS I Vx- 11 ;y U 030 - 2131 -31 -000 Parcel fdenti6cation Number (PM) 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 arising by, through, or under Grantor, except: easements, restrictions and reservations, if any, of record. Dated 5M bm L keland Co structi nee, LLC (SEAL BY., (SEAL) * *Richar erew vice resident (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF MINNESOTA ) / �COUNTY ) q * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named Lakeland Construction _Finance, LLC, a authorized by Wis. Stat. § 706.06) Minnesota limited liability company, by Richard Lerew, vice president THIS INSTRUMENT DRAFTED BY: to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Kristina Oeland, Estreen & Oeland 304 Locust Stre C l, r IJO THOMFORDE Notary Public, tate of At 'W- ry Public-Minn My Commission (is permanent) (expires: fission Exphes Jan 31, 2014 ted or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. SPECIAL WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 6-2003 " Type name below signatures. INFO-PRO­ legal Forms 800. 655.2021 www.inloproforms.com 1 of 1 1 -v . e RL 1 Ah Sp7 2 �1 138 t d' w LL ti• Cc CY �. x+ U I N O 000 : J 8 90 a �.°�. / O (O O Ch O 0-4 �.'. a' ~ o T a co (Y) �, M o W;4 V w T wZ p CO o :3 `' N �{ 4-_ CIA _ / w W w LL LL WOQ� N M cl ° o A z / ck� w U) o : W wZ� OOON� R.ui w A, cc CY yj 000 z � O g :, J `r' `r m Lb E- O W LL , e aa • . E-+ 36V2 523.4 SO4028132 E isoei 6E) Y' e _ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County , Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. a Please print all inf raryi t ; ~° -- ed b Date eY 3 t3 D Personal information you provide may be used for sew purpo ses (PinJa�y t�Vr (1) (m)). �/yi2 3 Property Owner , i, Prope Location H 2 0 0 'Govt. of S j 1/4 5 C 1/4 S Z T 30 N R za E (or) Property Owners Mailing Ad s s - Lot #, B Subd. Name or CSM# 2Q� 1'"`t City State zip Code Phone Number ity ❑ Village gTown Nearest Road HN IM ( (05 3q -Z I _ oy 3 [gyp New Construction Use: ( Residential / Number of bedrooms Code derived design flow rate O GPD ❑ Replacement r ❑ Public or commercial - Describe: Parent material 6u -S Flood Plain elevation if applicable General comments j _ l2 W Zz-+ ( and recommendations: S" s7 � Q V ` S� j`� 6*' � Sys =�w�. -5d-d"' � . S `oG2 �t can- Un a S Boring # ❑Boring pit Ground surface elev. Depth to limiting factor f 3Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 D-j -- 10 r ,3H 5L k �s Z l f 41 3 5 L 2ro--�bk mWr cs 3 2 IU C3p -- . 5 i - `+ ko cL Zi nSbk M- 'I C>ti — • `� 72- 10 OY Boring 2 Boring # ❑ _ ® pit Ground surface elev. 9s 0 0 ft Depth to limiting factor �d Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 SL c 5 I v 5 9 SL Zrn k. Y c 5 — '9 3 50 -T4 10 '� �.5 79 -1 40 I 9' v', Effluent #1 = BO s > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number the er 25330°1 Address Date Evaluation Conducted Telephone Number • f JJ 1 I• 4 Property Owner ) rrl t e S Parcel ID # „ e Pa [� Boring g of Boring# qy �� :. q. . 7 : &pit Ground surface elev. � ft. Depth to limiting factor �JO In. "on Depth Soil Application Ra pth Dominant Color Redox Description Texture • Structure Conststence Boundary Roots GPD/it' In. Munsell Urr. Sz Cont. Color -: Gr. Sm Sh. 'Eff#1 - 'Eff #2 � _ 2- t D rely. �Sz • • Zrno,bl� r�r c S � v Z I `t 5 F] Boring # Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth . Dominant Color Redox DesatpUon..- Texture Stricture Consistence Boundary Roots GPD 1ft In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor I Soil Application Rah Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Elf#1 'Eff #2 j Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mcyL ' Effluent #2 = BOD < 30 myl. and TSS < 30 mg /t. 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. SB693 r0 (R 07/00) i PAGE - 5 OF _ 1 Z NAME c LOT# 3/ LEGAL DESCRIPTION Sw X St ,S 2-3 T 3U N R Za E(or) SCALE: V'= GNU BM 1 ELEVATION /00 ° I i BM 1 DESCRIPTION ? '` _; ".1 " art e BM 2 ELEVATION BM 2 DESCRIPTION 1 SYSTEM ELEVATION SYSTEM TYPE ('onje „4 -,,,f J CON'T'OUR ELEVATION f / • a� yv g” J C' ,2 F 1 4s`' SIGNATURE /��---- ' /�i�— DATE e � �a�, �,�, ���'.� ►�1'II' I II' IIII' I' IILIIIII'' I'�'IIIIIIII�iIIIIPII�lllllll _I I O L � ■ ■ ■■ I `� i t II l i l ��' i ■ ■ ■� � ( � ; , VII I II � � ■■ � 'i ' �� I I II !•I 'r;�llllllllll I �I��L,I ;;� I_�,I :, to I'VI pI� 1111 � I I I� 11111 ��, � mnnm ............. n►nun <D (IIIIIIIIII IIIIIIIIII - i ;I l Ij;j,i' � � I � I � w 1 II �II LI Iili11 � J ��imumummmmu� 1lllllllllllllllll[Illllllti S P. 2 2. 2009 3 57 PM No. 0855 P. 3 i II :LEAS ---------- ------- --- --- R 61 It pril f;!,,F mil im" S i � a [7 O' �� °[ � -- Y t j C Hir 1 1 t 91 1 M I 5.3 ...... o7• 214- 13 N 1 1'' // / W LL IN Il h/ w N U =1 / - cn V Z / ti ' oC Q c� qr W O o c°0o LL V v. �• ' N o � : J o � ya g/ �„ °o.o A CT d ri co Y r J T C CJ E., �, wZ : o� Wz� _� W [mg W COQ N M Q� 0 U E. Q C) 0 j (D J o o 0 C . � Q LU < W W O W w : W M n Ld w N w Z r �., � z `� O ON z E (~ r �i cn Vi c' w: N N w aW � O T z S° ►- O z � M A E'" H r w cc W w �W E O WW O a x U - 15e �_ SO W 2W3 523. I o (Soejao E) • n Q 6 ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ! of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must C roix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all inf rnna> -- b Date x Personal information you provide may be used for sec+ ary p(Prii Y taw ° s. 15. � e d 2 3 Property Owner , US c Prope Location �T 1 l S N S 2 8 2 ri 'Govt. of 5 �/ 1/4 S C 1/4 S L T 30 N R Zp E (or) Property Owner's Mailing Ad s S­ Lot #1 Block # ubd. Name or CS 20 r.I; ASPS tat' City State Zip Code Phone Number ity ❑ Village STown Nearest Road M ff 82 c I) 3a?1 1 o h 3 New Construction Use: Residential / Number of bedrooms _3 __� Code derived design flow rate O O GPD ❑ Replacement rr �❑� Public or commercial - Describe: Parent material U +C''C S i'\ Flood Plain elevation if applicable �/ ft. General comments j _ S-hsc 4 tod �� CL za► �- c -d ( � w and recommendations: S s7 l V ` ' Sys ." Gn Qp�aQ, S S lo Ga�zon 6n ee S a Boring # ❑ Boring Pit Ground surface elev. 9 CPO ft Depth to limiting factor I in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 - Eff#2 5L k C-s 1v� Z l l y 3 5L 2m�I1ok mfr CS - . 5 . C) 3 2 IU 31to C3p - 1.5 ry Co cl 2inSbk mil c — . L4 72- 10 4/ co co O m 72 f- = I32 brti o� d 400- 27 Boring # ❑ Boring _ 2 ® pit Ground surface elev. 95 ft . Depth to limiting factor �� Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. *Eff#2 0-1 --- S t_ V C� I .5 SL 2.rnSb IC, YYm�r c 3 56 -14 10 J 7.5 1 4 Se_'_1_ ZrrnSbk 79 -1 90 1 D C L O y " Co - q v'� x'7.& A Effluent #1 = B06, > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Please Print) Signature CST Number --� 25 3 - 3-C , 9 Address Date Evaluation Conducted Telephone Number 213 � /F - - cam 7 (15)2- 9 7- y v0a" f s Property Owner ) r� e S Parcel ID . # 3 Page of P;1 Boring # ❑f�7t Boring q '; : tTPit Ground surface.elev. _ F = fL Depth to limiting factor �JO In. l Ap Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary F plication Fla Sol GPDIiI= In. Munsell Qu. Sz ConL Color Gr. Sz. Sh. 'Effk1 ° 'Eff#2 2 10 r3��+. Z 12 S'5 U L_ 2rbk, ,tier c 5 — 5 9 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth . Dominant Color Redox Description..- Texture - Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 0 Eff1/1 'Eftt2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Soil Application Ral, Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ftt In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EffN2 Effluent #1 = BODS > 30 < 220 mg/_ and TS >30 < 150 mg/L • Effluent #2 = BOD < 30 mgA and TSS < 30 m9 /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBM13)0 (R07I00) i r - PAGE 3 OF NAME a f • ce 31 LEGAL DESCRIPTION Sk X I4 L 1 U N . R , Za SCALE: 1"= BM 1 ELEVATION /00 BM I DESCRIPTION 13M 2 ELEVATION ys' 6 C Sg Z-3 BM 2 DESCRIPTION Ap _I } SYSTEM ELEVATION }� SYSTEM TYPE ('a ✓wti � CONTOUR ELEVATION l • q� 5v e " u J� - C c SIGNATURE �� --- - -i,—' `�--- DATE {� d � "' r���' - 1'! �i1111��IIIIII�IIU ;'iIIIII�IJIII(I�I� �� � � ��`r� `� � ��!'I� II'llli�'lll II' IIII 'IIIIIV'liilllll'�Jillllill a IVY mo� I I, �n■ I j 1'.11 ■ ___.. �. � I � °III �;! l ,,;IIIIIIIIII �I'fl ! �lii ,�I� OI � "► l ig , IIIIIIIII CD NONE MNo ti some uI' / I 111111111111111111111111111 S-ep-22. 2009 3:57PM No.0855 P. 3 i opr El ------- --- ------------- if i t = p Ol 7MTTMDMTI 011 t o 2 f 1 r rn I f i I is I J � - i Y 01 pot