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HomeMy WebLinkAbout032-2144-10-000 Wisconsin Dopartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463466 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Corbett, Tom I Somerset, Town of 032 - 2144 -10 -000 CST BM Elev: Insp. BM Elev: BM Descript Section/Town /Range /Map No: o �� /1 0 07.30.19.1256 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / a - Benchmark /• /der d Dosing VV y Alt. BM tm 1e� 2 � t/ IVK 1 Gv t' Ad"d Aeration Bldg. Sewer Holding SUHt� Inlet St/Ht Outlet TANK SETBA INFORMATION 00yk v TANK TO P/L WELL BLDG. Vent to Air Intake ROAD ' t Inlet Septic , �� So i 1 v Dt B ` Bottom �p 4, + eD Dosing , Head�r/M t( 111.66 ISYI Aeration � , Dist. Pipe -- 3 - (, / /i. Holding B 3- Z PUMP /SIPHON INFORMATION Fin Gra de 2. Manufacturer Demand St Cover Q GPM Model Number - I �r. /(O V1�5 rLis 6- TDH Lift Frictio LOSS System Head t_ TDH 2 Ft t ( ( / � Forcemain I Lth Dia. Dist. to Well N ( SOIL ABSORPTION SYSTEM I / 16 P t. BEDITRENCH Width Length No. Of Trenches PIT IM NS No. Of Pits Inside Dia. Liquid DeptM DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM L ICHING facture r: INFORMATION T m: CHA y S ste 2 D f-'> _ D Model Number: DISTWt9N SYSTEM Heade Mani Id Distribution x Int Hole Size x Hole Spacing Vent to Air ke Pipe( s) I N / 2 -2<i 4 Length Dia Lengt Dia 2 Spacin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded LxxMulched Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ' / 2 / tj t' s ort Location: 1642 40th i tre�m�r�pt, WI 54025 (NE 1/4 SE 1/4 7 T30N RI St. Croix National Estate f At 1 Parcel No: 07.30.19.1256 1.) Alt BM Descript n - 2.) Bldg sewer length - �(v rZr %fGlJ Ul rl (�� s - amount of cover =." / pk _� -- ' j '7 e) � low I , Use other side for additional information. Plan revision Required? Yes No Date Insepctor's Signa re Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division Coun r 201 W. Washington Ave., P.O. Bo l ✓b �. iscottsin Madison, WI 5 - t-cov nary �rm Number (to be filled in by Co.) 266 151 [{ Department of Commerce Sanitary Permit App li MA`l 1 3 In accord with Comm 83.21, Wis. Adm. Code, personal info ati ou vide may be used for secondary purposes Privacy Law, s15. 1)( S_ C4tO1X O IC 1 Ad (if different than mailing address) E �// .� I. Application Information - Please Print All Information tf�t� 7 yQ JU- Property Owner's Name �1 Parcel # Lot # Block # ; l.0 p (` low , 125 to Property Owner's Mailing Address > Property Location t [ J ALr - - %, Section ^� City, State I Zip Code Phone Number °v - , ? T N; circle R E W II. ypc of Building (check all that apply) Subo n Name CSM Humber 1 or 2 Family Dwelling - Number of Bedrooms '� rns �� Public/Commercial - Describe Use J7 JV ❑State Owned - Describe Use ,/ X ❑City ❑vill ownship of III. Type f Permit: (Check only one box on line A. Complete line B if applicable) A ' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal E) Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: eck all that appl ❑ 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 ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil plication dst} Dispersal Required Dispersal Area Propo (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Si Steel Fiber Plastic Gallons Gallons of Units //1►\ ��( Concrete Constructed Glass New E)dsting ((,,(( �•• Tanks Tanks Septic or Holding Tank / 7 Aerobic Treatment Unit / G Dosing Chamber VII. Responsibility Statement- 1, the undersigned, 29-me responsibility for installation of the POWTS shown on the attached plans. Plumber' ame (Print) Plumber's S ure .: MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip C VIII. Conn apartment Use Onl Approved ❑ pprove Sanitary Permit Fee (includes Groundwater Date Issued Issui gent Si o S Surcharge Fee) 5 er � on i 1 `7' Z� ' IX. Conditions of Approval/Reasons for Disapproval I r 3, Co 1 0 w s t r - 5 a. t_ ,YSTEM OWNER ,.. / 1. sa is taMt, eMueM final WA �i ( e- I ^ C'• l� 11a t fe n coda ordinal a.taR011c.a. Atmch complete plans (to the County only) for the system on paper not less than 811E x 11 inches in size SBD -6398 (R. 01/03) ��3rn�iq Y� bK• � r'.'+. ''If{ti !fT^ +!><CKf Rf^ 1`..'u ZB d06d?hd UA S t� �e PLOT PLAN PROJECT Tom Corbett ADDRESS 1671 Willis St. S. St. Paul Mn 55075 NE 1/4 SE 1 /4S 7 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 110.3 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of Wood Stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑BOREHOLE O WELL *H. R. P. Same as Benchmark 40th St. Scale = 1/4" = 10' AL Grading is to be done to diverts+ run -off away yk o from system 6 Pro 4 Be r om House Property Line b` not to scale QS Property Line (not t •' scale) ° 12% Huffcutt Combo Tank Slope B-1 Well is to meet all B-3 110' setbacks found in 109.3' Comm. 83 Area 15' below 108' system is to remain 106' undisturbed Tank is to be properly bedded v" and provided with lockdown covers with approved warning p y labels B M * Property Line PLOT PLAN PROJECT Tom Corbett ADDRESS 1671 Willis St. S. St. Paul Mn 55075 NE 1/4 SE 1 14S 7 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 110.3 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of Wood Stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 40th St. Scale = 1/4" = 10' Grading is to be done to divert run -off away from system Pro 4 Bedroom House Property Line not to scat B -2 Property Line (not to scale) 12% Huffcutt Combo Tank Slope B-1 Well is to meet all B-3 110' setbacks found in 109.3' Comm. 83 Area 15' below 108' system is to remain 106' undisturbed Tank is to be properly bedded and provided with lockdown covers with approved warning labels B. M. * Property Line UNPLATTED LANDS 261 .86', 334.82,(A N 72 96 , �R. 9' . 3 (r 2 �^ 1 00 N 30,594 Sq. Ft 130,641 Sq. Ft. 3.00 Acres 4 ` ° , 3.00 Acres N2414 24 E B.A. 3.00 Acres C.B.A. 2.99 Acres 1 �2� 6' jb'a 64.07 ti 4. vA. Z W • i OD O j OD ...: •,• — — 446.14' -- -- — — m - - -- N00 0 42'00 "W N DEDICATED TO PUBLIC CO LO 3 LO 2 ,x. C.S - -- Volume 6, Page 1620 C. S.M. — — — Volume 6, Page �;. MELCHERT WALKKY 126 second Stree ' landscape architecture Hudson, Wisconsin civil engineering Phone (715) 386 -77 land surveying Fax (715) 386 -7889 S' Safety and Buildings • commerce.Wl. ov 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i sconsin www. msco n sin. g ov msco ov Department of Commerce wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 09, 2005 CUST ID No.226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 05/09/2007 Transaction ID No. 1134716 SITE: Site ID No. 698155 Tom Corbett Please refer to both identification numbers, 40TH Street above, in all correspondence with the agenc Town of Somerset St Croix County NEIA, SE1 /4, S7, T30N, R19W Lot: 1, FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object TD No.: 1017279 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the R "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) CO3� (h and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01101). DEPAR ;M,F N 0l= F • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. e� Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersa SEE C01 RI ar e prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 5/9/2005 • 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. Stat • Comm 83.22(7) A cony of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 8354(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 ,J Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715 -246 -4516 Date: 4/30/05 Owner: Tom Corbett Location:NE1 /4 SE1A S7 T30 N,R19W Lot 1 St. Croix National Somerset System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section RECEIVED 4. Pipe Cross Section /Pipe Layout MAI 4 3 2005 5. Pump Chamber Cross Section S AFEN & BUtL��NGs 6. Pump Curve 7 -8. Maintance and Co i ency plan 9 -11. Soil test `i��r�xlly rF t V tIi Shaun Bird °' OF CQ►INERCE Signature jEY U CtNGS License numbe 6900 = sPONDENCE r Designer No Date Non -Woven Filter Fabric 4 Observation. Pipe Perforated �Dlstribulion Pipe Below Filter Fabric ASTK C -33 Sand -� H G Topsoil D^ 70 Slope i - Force Main ��Flowed �-- bed Of 'A 2 ' Layer Rock Drain Roc From Pump f �` f P Cress Section Ot A Mound 'System Usin F A Bed For The Absorption Area G A Ft. Ft. Ft. K. + Ft. L Ft. L 2�Observolion Pipe -� °' A J Force Main °- - - - - -- ----- ------ __--- - -���w From Pump L Distribution B Pipe ed Of �2 Drain RocK I � 4Observation Pipe '.!)C- �� c Permanent f Sf�.s' - �! ���� t5 �r�,�� P i pe- o r R o Pion View Of Mound Usin A Bed For 'The Absorptic Perforated Pipe Oetoit 1 E r� ,+ �FcrioFa�sci �. i+ PVC pipe S� o no Nofes LOCCIed On 6011*n' /�j \ .SO�� Are Equally 5aocea �I Pvc Forcr Main ^ y � f � F 1R5 T tt00..L titzxT ro Gannet }�cr PVC Manifold Pint hG S�f� p/f� distr flue +Bn t Pipe fix$ - 1 [� r� u�s P —7 Ft. E)isir Pipe Loyovl � , ' � n ' / . a _ LC/ Li I i `i !„'7'� R. X Inches y Inches / Signed: Hole Diameter 4 - Inch Lateral Inch(es License Number: Manifold �_ Inches Oate: Farce Main 2-- Inches # of ha7es /Qipe3 Invert Elevdtion of Laterals Ft. I _ z AND SPELLf ICA TIONS F O,OSS SECTI S MBE SIiPTle TANK p�3MP � , VEATHER"DOF APPROVED ,* MIN - k BOV E GRADE £ j- 014CTM4 3flX MANHOLE COV ER r YEMT PIPE 12 0 �� WITH CONDUIT W1 PADLOCK £ Cy D 40R, MINI? WARNING LABEL :. FRESIY LR ;�tTAitE !� �� rp I v r4 " HIM X' b' tSu M1M- GAS ' t • i ' O TI INLET GHT L —�-- , . VI� WATER TIGHT SEALS T SEAL- ALd'L "pROWIED PIPE �FiL1 � g H SOLID SOIL APp%O C r OFF pIpE 3 o m ELE� � SOLID SOIL pCiMp OFT gE37D�MG UHDF TA Y� CONCRETE PAD 3u API'RO /�_CZ� /�!'✓�i SPECIF ' CATIONS BER Op5£S P£g DRY = --�-" stpTIC / DOS£ ZIQCI.ETDZ1+1Q J GL- r FAG•�R£�L • I>OSE � t3..�1 g L�gaC : d �/ '� TAN MAbfj SEP'EIC � � =L _ 'J /. i1CHR ... 18m = S : r3osE � . 2 s GAL - GA GRPACI'TIES = � - �� INCHES ;� '� c, s cAL. v- r �'Ixcims =/ AIARH , N UTACWR Mg TyP : C GAL SWITCH tFACTi = ?i ILmR 16, WAC OD ;q`C NU �-' - PCt3iY �'M WxRTNG AS PER / JJ FE T(,�?j E GPM l B EET RE I,AED aIgCMARGE RATE ESPY put4P Or F AptI3 - f3IST1tISLL -E�� - ! r _--- FEET CE $ � �Z 3a VERTICAL DIF Q R rSUpFLY PRESS AE,F /IOD FT- ALTflYN�`�ICAIiE �� rEET ` MIN FEET £ORC£�SAN --=-"` �flT L,LI�tGTH `� TANK: INTERNAL �I �ENg ;Di�� ,IBB TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING MODEL 152/153 MODEL 152 151 W� 50 Feet Meters Gal. Liters Gal. Liters 5 1.5 69 261 77 291 153 } p 3.1 61 231 70 265 12 40 152 15 4.6 53 201 61 231 o�c 20 - 6.1 44 167 52 197 s 30 25 7.6 34 129 42 159 z , 8 30 9.1 23 I 87 33 t;'_S > 35 10.7 22 E5 0 20 11 42 40 12.2 - -- 0 Lock Valve: 35.0 Ft. (11.6m) 44.0 R. (134m) 4 014508. 10 0 � 20 0 60 80 100 GALLONS �' " 6 1/4 - •� LITERS 0 80 160 240 320 _ 3 27/32 I a s/8� I FLOW PER- MINUTE 13 27/22 I CONSULT FACTORY FOR, SPECIAL APPLICATIONS e — r 3 27/32 • Timed dosing panels available. I . Electrical alternators, for duplex systems, are available and supplied with an alarm. I ' • Variable level control switches are available for controlling single phase systems. 1 • Double piggyback variable level float switches are available for variable level long and short cycle controls. I • Sealed Qwik -Box available for outdoor installations. See FM1420. 1 • Over 130 °F. (54 0CJ special quotation required. 12 1/8 1521153 Series' - 1521153 MODELS Control Selection Model Volts -Ph Mode Am s Sim 10% ou iex N152 115 1 Non 8.5 1 2 or 3 �— sK2M BN752 715 7 Auto 8.5 Included 2 or 3 1 E152 230 1 Non 4.3 1 2 or 3 BE152 230 t Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 SELECTION GUIDE BN153 115 1 Auto 10.5 Included 2 or 3 back variable level float switch or double piggyback variable level That E153 230 1 Non 5.3 1. Single Pi99Y SE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. FA 2, See FMC712 for correct model of Electrical Alternator E - Pak All installation of controls, protection devices and wiring should be done by a qualified : 3, Variable level control switch 10 -0225 used as a control activator, Specify duplex (3) licensed electrician. A8 electrical and safety codes should be followed including the most or (4) float system. recent National Electric Code (NEC) and the occupational safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual Conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. 60X 16347 Louisville, KY 40256 -0347 Manufacturersof• r SNIP T0: 3649 Cane Run Road � / Louisville, KY 40211 -1961 Ugl/TY�UMPS S� E O li p Q (502) 778 - 2731.1(800) 928 -PUMP hitPJ /wwwaoeller.com FAX (5o2) 774 -3624 PLJIYl © Copyright 2000 Zoeller Co. All rights reserved. T PLAN Pa MANUAL. & MANAGEM EN of POV�TS OWNERS SYS ,rEM SPECIF ICATIONS Septic-rank t: 11Aa apac!tY al ❑ NA F: LE INFORMATtt rst � I t , ytfei�siter NA der � � Septic lank n . P Effluent Titer Manufacturer - NA ❑ NA C3 NA Effluent Etter Model al o NA i DESIGN PAR�E� -" Number of BWToMS Pump Tank CapaatY NIA Numbet of Commercial Units alida Pump Tank Manufacturer NA Estimated flow (average) �3 aild Pump Manufacturer EnA ated x 1.5) Model �� ✓� ' � l Design flow �Pank)• ( �rn f ; L2 gal/day/if Pump I Rabe Pretreatment Unit [3 Peat Filter Soo �WP 1 O n Monthly average` b M�=Me1 Filter IrttluentlEfftue Qua* sat) mglt- p l Aeration 13 Wetland Fats O0 &Grease (FOG) :00 Other m 0 pn Demand (BODs) 51 rn91L [3 Di SS 5150 m n Manufa: Gel Total SUS Solids R ) r5al t.elt {s) (pres surized) Monthly average" Dispe round (gravttY) / round (pies pretreated Effluent Quality y >�- S30 mgr ❑ !n-{J curd en Demand (BOD$) LE3 At -grade g ❑ O er_ Biochemical Oxy 530 mgr- Dri ire Total Suspended Sotids {T an) 5111` Gfu/100ml � rdar) wastewater and Fecal Cotlform (geometric mean) . values tyPICa1 for domestic Y, inch d "sameter sePW tonic efftuent �� rraste+l"�_ Maximum Effluent Particle Size values tYPi f ar pm MAINTENANCE SCHIEDULE Service Frequency Service Event 0 months s) (Maximum 3 yrs.) At least once every � equals on ird (1�) of tank volume Inspect condition of tank(s) 1tVhen combined sludge and scum e4 � ) ❑ mon s Maximum 3 Yrs -) Pump out contents of tank(s) At least once every r(s) Inspect dispersal cell(s) At least once every ❑ month U NA Clean effluent fitter ls & alarm At least once e �❑ months eats) contro inspect Pump, pump � O months earls) DNA tnspe At least once every ❑ year(s) 13 NA Flush latetgls and Pressure test C3 mon At least once every Other. At least once every 0 months Q year(s) ❑ NA ocher_ Identify one of the following licenses or �NANCE INSTRUCTION WT Manta Inspector- ppS iiner " , Septage tanks and dispersal Delis shat! be made by an t� d� wipe zany any m or broken I 6'ons: . Master Plumber Master Plumber Restricted s and scum and W check for any back UP S Operator. Tank inspections must include a visual InsPec�ian d the tank(s) th check the effluent levers hardwa Identify any cracks or ea ra leaks. measure the volume of combined a vis ually o round surface- The dispersal cell {s) shalt be visually inspe� lending f effluent on the or pond-Mg of effluent on the g nding of effluent on the ground surface. authofty in the Observation 1 c and a check for any Po titres the immediate notification of the local regulatory dicate a fairing condition and requires uaf-third {l�) or more of the tank volume, the ground may in R mula6on of sludge and scum► in any tank eq uals one rotor and disposed of in accordance with ch When the combined accu v b a Septage Servicing operator entire Contents of the tank shall be remo ed Y oornponenM. and any 11WJS 113, Consln Admiriistmtive Code. onentS. P retfeat a�ttient frient d pone S Maintainer. of effluent fillers. mechanical or pressurized POYY7 S comp firmed by The servicing at intervals of 12 months or less shall be l tenon of any service event. other maintenance or monitoring to the local regulatory authority within 10 flays of Come A selvi* rePort shall -be provi p ro d uc ts or other START UP AND OPE RATION for t h e presence of painting tm or to use of the POW fS �� t tions are if h cancer aulstruc�ion, Pn ers For new o Prior to use. emicals that may impede the treatment pr�� by da05 pig damage Pe for pr . g d► remo detected have the contents of the tanks) Page of s 1 k' ` - • ' I c onditions are frozen at the infiltrative surface- is ,restored the excess shalt not occur when Sa h hwater l evels pow m startup above normal tg the cea(s) and may result in the Syste � overloading D, powe outa9� pump �� tnaY c large dose. ed m the dispel ett(s) in one rir4sp tank removed by a v �rNn,11 tie dts�aMe of ett To avoid this situation have the contents of the P bacP S urface drschar9 powe to the effluent pump or contact a Plumber or POVYi'S Maintainer to age ServidnS OpexatoC P604 u�tn P reSWjing controls to restore normal levels within the pump tank asses in Manua o perating the p tk ovel, or otherwise disturb or compact Do not drive or park veiudes ov er tanks and dispeml cells. Do not drive or pa down slops feet e of :;fly mound or at -grade S011 absorption area. rfotmanoe and prolong the life the area within 15 from the wastewater stream may improve the pe or elimination of the foilovring ci butts; condoms; 00tton swabs; degreases; dental 9M*. diaper Reduction eCtit s, g a soline, grease*,- Fades; meat of the POW T& a3ntibkma: �Y'��' d water, fruit and vegetable pe ns and water softener brine. d fat fOunda6on drain (SUMP - pes u-"des; sanitary napkins; tampo scraW m e&a6ons; off; pain8ng ptndtx s: I - ABANDOMWENT a nerrty taken out of service the following steps shall be taken to Insure that the When the POWTS fails andlot is pew (lance with ch. Comm 83.33, yV A sea e Code rafnr system is properly acid sadeyndoned in comp i Wings sealed. .be disconnected and the abandoned pipe � e Servicing Operator. . All piping to tanks and p' its shall removed and properly disposed of by a Septag g Th co ntents of an tanks and pits shall be . frig, all tanks and Pits she![ be excavated and removed or their covers removed and the void space After pumping, filled with mil, gravel or another inert solid material. CONTINGENCY PLAN ired th following measures have been, or must be taken, to pro vide a code if the POWTS fails and cannot be reps lace p A suitable replacement area ment soil compliant replacement system: coon and should not has been evaluated and may ct d razed for the location o a rep absorption system. The replacement area should be protected sed stru disturbance and wells- Failure to be infringed upon by requ ired setbacks from existing and proposed protect the re pl ac e men t on by re area will result in the us ne ed f a new co mply with t soil a inteffect at that ti establish a suitable replacement area. Replacement systems m P i re tacement area is not available due to setba 's� o replace `� failed POWTS- advances in POWTS O A suita P be installed as a last technology a holding tonic may a suitable replacement area. Upon failure of the POWTS a soll.and - y -de has not been evacuated to identify Atheinffii luation must be perfomn� t° )orate a suitable replacement area_ If no replacement area is avai{ab a a tank may be Installed as a last resort to reps��� place following removal of the biomat at at Lade soil absor systems may mply with th rules in effect at that time_ and "g s of such systems must co Reconstro�on <<WARNING>> TANFCg MAY CONTAIN LETNAI- GAS SES AND /OR INSUFFICIENT OXYGEN. SEPTIC, PUMP AND OTHER 'TRSA 7i�iENT CIRCUMSTANCES. DEATH MAY DO NOT ENTER A SEPTIC, PUMP OR TME I NTERIOR OF TANK MA Y BE DIFFICULT OR IMPOSSIBLE. RESULT_ - RESCUE OF A PERSON FRO ADDITIONAL COMMENTS POWTS MASNTAINE POWTS INSTALLER Name � ENa Phone -� , 10715- c�7 LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PUMPER Agency EE Name y n� Phone Phone a9 fills document meets n Lake, Marquette and Waushard County Zoning and Sar�7tation - d,ment does not This document was drafted by the $tlft of the Glee e of this the rniniuno,n requirements of dL Comm 83.22(2)(bxt)(d)&{t) and 83.54(1). (2} It (3) Wisconsin 4dRtUUSUat� Cede. Us GLO (2101) guarantee the performance of the POWTS. 0 4 RECEIV Wisconsin Department of Commerce VALUATION PO T Pa g e of Division of Safety and Buildings , ►�'/ 9 2 in accordance WYtd'` 14dm�. Code ty Attach complete site plan on paper not less than 8 1/2 x 11 inche in size P �®ItLO C � include, but not limited to: vertical and horizontal reference point ( M), di? �pj(� OFFI 1 I.D. percent slope, scale or dimensions, north arrow, and location and ista road. O 3 Z -' Z I ` I ' J-0- Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 S Property Owner Property Location 73 "' "' / r>", Govt. Lot 1 /4„'� 114 S T 0 N R E (o W Property Owner's Mailing Address Lot # I Block # Subd. Nap1e or CSM# 7 s� ��. - �J State Zip Code Phone Number ❑ City C1 Village own Nearest Road j New Construction Us Residential / Number of bedrooms Code derived design flow rate 6 (�7r1 GPD ❑ Replacement Public or commercial - Describe: Parent material ✓ J Flood Plain elevation if applicable General continents / and recommendations: ti 71 Boring # Boring %��/ pit Ground surface elev.�L .'. Depth to limiting factor m. 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. •Ef1#1 I •Eff#2 4zZ ® Boring # (�'I Boring Mme 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 0 V I A"�4 Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Efluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Ddte Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516 Property Owner ` Parcel ID # _ Page of Boring # ❑ Boring Ground surface elev.ZI9– Depth to limiting factor in. Pit aRootsGPD Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '042 F-1 Boring # C] Boring 1:1 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 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 1150 mg/L ' 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 (8.6/00) i 1 Soil Test Plot Pla Project Name Tom Corbett Sh Address 5517 145th St. N Hugo Mn 55038 TM #226900 Lot 1 Subdivision St. Croix National Date 4/30/05 NE 1/4 SE 1/4S 7 T 30 N /R W Township Somerset [] Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Wood Post System Elevation 110.3' *HRpSameasBenchmark 40th St. Scale = 1/4" = 10' Scale is 1" = 40' AL unless otherwise noted Property Line not to scat B -2 Property Line (not to scale) 12% Slope B-1 B -3 110' 109.3' 108' 106' B.M. * Property Line i I T :39W 170TT62t7TS9 227:40 5003- 92 - tb0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBEtUM AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address .T. S Property Address CD ;L c5 (Verification required fimn Planning Department for new construction) City/State. Parcel Identification Number LEGAL D Property Location J<, ! <, Sec. �, TAN R 1��- _W, Town of r�o�.�� Subdivision c , C t . Lot # Certified Survey Map # 11 . Volume . Page # Warranty Deed # �q 3 S I . Volume Z 7 (9 . Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no YS-1 M.MA EMNANCE Improper use and maintenance of your septic system could result in its preamiatum failure to handle wastes. Proper maintenance censer of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What ym put info 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 certificatm faro, signed by the owner and by a phunbe4journeyinanplum1w. restricted plumber or a licen sedpumper verifying *a (l) the on -sift wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stat ng that your septic system has been maintained must be completed and returned to the St. Croix Comity Zoning Office within 30 days f the three ' n date. SIGNATURE OF DATE QWNER CERTIFICATION I (we) certify that all statements on this form are true to the bent of my (our) knowledge. I (we) am (err) the owners) of the prop ;�deescntlbed above, by virtue of a warranty deed recorded in Register of Deeds Office. -- �E2 Lk SIC'NATURg OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revolted by the Zoning Department. ` *" "" �* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Td ds2 :21 SO 92 -jdd Wisconsin Department of Commerce SOIL EVALUATION REPORT Page � of 3 - ':vision of Safety and Buildings a , "� in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ST. Cv:-o L X include, but not limited to: vertical and horizontal reference point B is direction and Parcel I.D. percent slope, scale or, dimensions, north arrow, and locat' ya Barest road. '� t' Z - 2t - o -0M( 12S'To Please print all infor at ed by Date Personal information you provide may be used for seco a • l rposes s.1S941ikm)). �J Property Owner Propeq, 0 t i c , ' n da SE 1/4 S 7 T 3D N R )9 E (or W Property Owner's Mailing Address ST CAOIx Lo # 1 al ck # Subd. Name or CSM# 60 �.�vL CLt��C�t I��. cOU��rTY s--• c"I.x �tt�lVit C. City State Zip Code Pho 4n�b ❑ Village ® Town Nearest Road tr�1�l�lvr2 f� niv ss3� 3 ( 61 Z)$o. (� New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate 6 O o - GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material L o�SS OU Z-� l_t_ Flood Plain elevation if applicable General comments and recommendations: j�pUy� w� q 'X 67 � L3'(RL6UY! tl� `�'ZL vim. i hJ t M U" t L" ()T-=- Boring # . ❑ Boring ® pit Ground surface elev. C.4 - 3 ft. Depth to limiting factor S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 D -$ 1 D`?R -37Z sL► z�sblz m om _.. �s _ z� •s :$ .. s i 5 - L+Sb►z Yn c W - • S 3 -8 �•S�irZ ft� , .s�ftZs�e L4f sI 0V' W'.4 -i Boring # t❑ Boring �y Pit Ground surface elev. C l Z ft. Depth to limiting factor Z• in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 _ q L c�`�i fL 3 Z Z _ _ s i l 't..�s � vz m �h cl�, z.: � , S • .� _ _ . Ot zb to'- Ltz -31G — g i I Z`�51�k m 3 S2 S `2►Z 3� L'F 1. S ` 2518 L OLsl • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L . CST Name (Please Print) A Signatuye CST Number Arthur L: Wegerer 0p- Z3 y - 220254 Address W e g e r e r Soil Testing & Design Service ate Evaluation Conducted Telephone Number 421 N. Main St'. River Falls, WI 54022 715 -425 -0165 1 . f Property Owner S• P• -� M'19(�hJ 't Parcel ID # ! AJ G Page �' of 3 Boring # Boring ❑ , © pit Ground surface elev: ' LOS _ 0 ft. Depth to limiting factor > g in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /flz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 lz N z 3-11 77- 3 i y n - P- 0w z-p S• - 8 LO`ttZ 311, s11 Z`FAb x vn - cf,J l'I' - S -9 3 31 - �L3 �.Sy231 s I a Zbk VA \)i�- y 3 -88 'A Boring # ❑ Boring S ® pit Ground surface elev. !D 3 • Z ft. Depth to limiting factor > 8 $ In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0 -9 Z _ si1 gb1Z 1n Cw Z , S , Z%9sbk ea s) \ csbiz Mv eg t13 -YOB zs- ta-31y - s 0 - o s9 ►� - .� 't`. Z ks p17 w s EM ,\UvrVI� D av F1 Boring # ❑ Boring El 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 /ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • 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. SOD -8330 (8.6/00) l PLOT PLAN Page 3 of � Scale 1' =S0 ' ti � M Awl L < 1 0 c °TCS�o�1, ►03 M a 3u o !os `` \ � 0 .3 0� � _ EL. L00_0" ' O'Q - 77'' H[Gtt-, 3/q . bIA; Pvc �f. tAVJSE - ME PrT LLvkzT 1 S ` F AAOut -b _ 4 - r* sT. 715- 425 -0165 220254 00 -Z34- CST Signature Date Telephone No. CST No. Job NO. I - - Wisconsin Department ofCommerce SOIL EVALUATION REPORT Page of 3 .Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 z 11 inches in size. Plan must County ST. Cv:_o LX 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 I.D. pllvtijilU G Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Lo o J • lam, Go 6euA 7 T 3D N R 1 79 E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 6o Z 6 kuJiF CL�'�Lt City State zip Code Phone Number ❑City Village Town 25 Nearest Road tf�11�]t- '�A.iyzlq. NN�� ® (6LZ) -��o Sow 1ZSf7 L4 p - 11}- s 7 - . [9 New Construction Use: ® Residential / Number of bedrooms - Code derived design flow rate b O O ❑ Replacement GPD ❑ Public or commercial - Describe: Parent material General comments Flood Plain elevation if applicable - ft. and recommendations: hpu* 1�1� 6�' �Ig`Tl'�LBU7Z(l� L`t;TZL FILL Boring # .. ❑ 9 ® pit Ground surface elev. q4 - 3 ft Depth to limiting factor S in. Horizon Soil Application Rate Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 , Eff#2 . Z $ - si �oKR3/6 sil 2�Psbh m�- cw - •5 .g 3 -S - ).Slur_ 31 f 1� -�: stit� sib L, � s a Boring # 1 ❑� Boring �Y Pit Ground surface elev. -7, Z ft, Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 . .E02 Z a tort tz _31L -a yyc(- 4 w 3 7b S2 S`22 - m-5A L Cal • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print), Signature CST Number Arthur L: iJegerer + 4�� f � z1 v 220254 Address We g e r e r Soil Testing & Design Service ate Evaluation Conducted Telephone Number 421 N. Main St'. - River Falls, WI 54022 ) 1 - ZI -�- 00 715 -425 -0165 Property Owner �• P �L(` h'l h1R '� Parcel ID # taalf/vG page L of 3 F-al Boring # ❑ Boring © pit Ground surface elev. 1 ID S . 0 ft. Depth to limiting factor > 8 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 a -°I 1 o 3tz — sj 1 t. 3 m\)iv- cS - -14 . 6 y L13-88 � - S 'iR- - t S a 'A F Boring # Boring ® pit Ground surface elev. ID 3 - Z ft. Depth to limiting factor > $ $ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 0 - l -Z bV Vn'f►- Z q, - 3 I 10`1 R 316 � ;1 Z'R � `�►- � 1`� . 5 . g . 3 31 -�I �.SyiZj _ s 1 cS Ti,- mv L/ , t- - - `12 - S st O S9 rn I - . - 1 1. Z - M} s pl WA EU r\ wyl,� D av 8 11-oo F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. (t. Depth to limiting factor in. Soil Application Rate - Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS, >30 -.150 mg/L ' 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•9330 (ROOO) .� PLOT PLAN Page 3 of Scale 1' =SO ' %M < . 99 � 10 Z F ) oS � \ �q �o MMILL El. LOO O C�v _ 4- 1f161+, 3[ � � . DtA - 1?'uc 1�LaE. . aw s E - M 6E PrT - L(-- - "r A.to�h1� i Z1_130 715- 425 -0165 220254' 0O -Z34- CST Signature Date Telephone No. CST N6. Job NO. < Parcel #: 032 - 2144810 -000 02/23 /2005 PAG 0 9:20 1 A Alt. Parcel #: 7.30.19.1256 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * J P GOLF MANAGEMENT INC J P GOLF MANAGEMENT INC 2310 HUNTINGTON PT RD WAYZATA MN 55391 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1642 40TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: 2497 -ST CROIX NATIONAL ESTATES N SEC 7 T30N R1 9W NE SE LOT 1 SAINT CROIX Block/Condo Bldg: LOT 1 NATIONAL ESTATES NORTH Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 30N -19W NE SE Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1200/189 QC 07/23/1997 1117/415 WD 07/2311997 830/160 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 11649 123,800 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 105,000 0 105,000 NO Totals for 2004: General Property 3.000 105,000 0 105,000 Woodland 0.000 0 0 Totals for 2003: General Property 3.000 105,000 0 105,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 •' U. 276 3P 148 789351 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., MI Document Number Document Name RECEIVED FOR RECORD 03/11/2005 10:00AK WARRANTY DEED THIS DEED, made between JP Golf Management, Inc. EXQPT # ( "Grantor," whether one or more), REC FEE: 11.00 and Thomas A. Corbett and Patricia M. Corbett, husband and wife TRANS FEE: 300.00 ( "Grantee," whether one or more). COY & PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Lot 1, Saint Croix National Estates North. St. Croix County, Wisconsin. Esveen & Og land 304 Locust Street Hudson, W154016 032.314" =fro 000 0 '3 Z - 214Y — /6 aL1D Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated , �t Z 6,57 7*Byv: a ement, Inc. (SEAL (SEAL) * and Hassel, Vice President (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STAF OF ) b r I A� ) ss. �Gtn rti �� n COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on R, C��G�I � • 1SS , (If not, the above -named JP Golf Management, Inc. authorized by Wis. Stat. § 706.06) By: Richard Hassel, Vice President to me known to be the person(s) who execute.&„ a &Mid THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the same. 0182 Attorney. David J. Estreen • f Hudson, WI 54016 * 1� Notary Public, State of Flo C I , c( - My Commission (is permanent) (expires: G f �r2 (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. 2-2003 " Type name below signatures. INFO -PROTM Legal Forms 800855 -2021 www.infoproforms.cort i