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Wisconsin Department of Co me 1
Division of Safety and Buildi gs in accordance w' Comm 85 Wis. Tom Schmitt
ST. CROIX COUNTY
County
Attach complete site p 1W MIL 11 inc in size. Pla must St. Croix
include, but not limited to: vertical an nz t (BM), direct' and '
percent slope, scale or dimensions, north arrow, and location and distance t nearest road. I L D
Please print all infonnadon. S'i . %ROIX C01 irftyiewe* Date
Personal information you provide may be used for secondary purposes (Privacy Law, 1 1 N G OFF CE
Property Owner Property Location
Grand Properties, LP Govt. Lot NW 19 NE 19 S 17 T 31 N R 18 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
712 Rivard Streeet, Suite 300 33 Squaw Lake Estates
City State Zip Code Phone Number I City J Village II'f Town Nearest Road
Somerset I WI 54025 1 715 247 - 5900 Star Prairie I 95Th St.
New Construction Use: a Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement J Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a mound system. System elevation is 99.16' based off of contour line established at
98.32'. Slope is 13 %. Depth to limiting factor is 26 ".
Boring # Boring
i Pit Ground Surface elev. 98.49 ft. Depth to limiting factor 32 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
*Ef1#1 'Eff#2
1 0 -9 10yr3/3 none sl 2fsbk mvfr cs 2f .6 1.0
2 9 -20 10yr4/3 none sl 2fsbk mvfr gw 1f .6 1.0
3 20 -32 10yr4/4 none sl 2msbk mfr gw - - -- .6 1.0
4 32-48 7.5yr4/6 01 �5' S /3 sl 1msbk mfr cvv ---- .4 .7
5 48-61 7.5yr4/4 '" � r /2 /8 scl 1 msbk mfr — ---- .2 .3
F2 # Boring
V1 Pit Ground Surface elev. 98.78 ft. Depth to limiting factor 29 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
'Eff#1 'Eff#2
1 0 -8 10yr3/2 none sl 2mgr mvfr as 2vf .6 1.0
2 8 -17 10yr4/3 none sl 2msbk mfr gw 1vf .6 1.0
3 17 -29 10yr4/4 none scl 2msbk mfr cw - - -- .4 .6
4 29 -54 7.5yr4/4 ii2 10y I sl 1 msbk mfi - -- -- -- .4 .7
* 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
Thomas J. Schmitt / - z,_,.._s — 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 724104 715- 247 -2941
I
Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
3 ] F Boring # Boring
Pit Ground Surface elev. 94.43 ft. Depth to limiting factor 26 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
'Eff#1 *Eff#2
1 0 -11 10yr3/3 none sl 2mgr mvfr gw 2vf .6 1.0
2 11 -26 10yr4/3 none sl 2msbk mvfr gw 1vf .6 1.0
3 26 -38 10yr4/4 m 1 Oyr5 /6 /2 sl 1 msbk mfr gw ---- -- .4 .7
4 38 -64 7.5yr4/6 m2d 10yr6/1 sl 1 csbk mfr — . 4 .7
10 /6
❑ 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
*Eff#1 *Eff#2
❑ 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
*Eff#1 *Eff#2
* Effluent #1 = BOD s> 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD -i_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.
Page 3 of 3
Conducted boy. Conducted For: Ref No.1289
Schmitt Soil and Site Evaluations Name: Grand Properties, LP.
Thomas I Schmitt, CST 227429 Address: 712 Rivard St. Suitel00
1595 72nd St. City, State, Zip: Somerset, W1.54025
New Richmond, Wl. 54017
Phone: 715- 247 -2941 Subd.Name: Squaw Lake Estates
Lot No.: 33
i Legal Description: NW1 /4 NEI /4 S17 T31N R18W
71�I Township o£ Star Prairie, St Croix County
Bench Mark El. 100.00' Top of 2" pvc pipe
Alternate Bench Mark El. 100.1 V Top of 2" pvc pipe
Slope= 13% Contour Line El. 98.32'
Contour Line Length 80'
Scale 1" = 40'
/6
P3 1
I
I �
4°
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Buildiryg Divisi�q
INSPECTION REPORT Sanitary Permit No
i 463409 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:
Grand Properties L.P. I Star Prairie, Town of
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
17.31.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution I x Hole Size I x Hole Spacing Vent to Air Intake
Pipe(s)
l Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes ; -,i, No Yes No
� -
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 2178 95th Street Star Prairie, WI 54026 (NW 1/4 NE 1/4 17 T31 R1 8W) Squaw Lake Estates Lot 33 Parcel No: 17.31.18.
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? I Yes ; No
Use other side for additional information.
Date Insepctor's Signature Cert . No.
SBD -6710 (R.3/97)
Safety and Buildings Division County
201 W. Washingto v P
i seons�n Madison, 537 (EIVE 4 PIan ry Permit Number (to be filled in by Co.) ' G 608) 266 3
Department of C mmerce
Sanitary Permit A n APR 18 I.D. Number
2005 3
In accord with Comm 83.21, Wis. Adm. Code, personal in ormat on you provide
maybe used for secondary purposes Privacy Law, s15. (I Xm$T. CROIX
COUNT "Y t Address (if different than mailing address) i
I. Application Information - Please Print All Information
2 0 I U
Property Owner's Name Parcel # Lot # 33 Block #
1 r
Property Owner's Mailing Address Property Locatio
l S &W v,, /� ' /., Section 1Z
City, State Zip Code Phone Number
_ circle one)
oD TN; R13StW
II. Type of Building (check all that apply) 3 OK a.S P �'
Subdivision bdivision Name CSM Number
® 1 or 2 Family Dwelling - Number of Bedrooms n
❑ Public/Commercial - Describe Use t S
❑ State Owned - Describe Use Cp k ❑City_ ❑Pillage �Iowmship of - s7 /� L
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ Replacement System g P y
® New System p y ❑ Tre Tank Replacement Onl ❑ Other Modification to Existing System
List Previous Permit Number and Date Issued
B. El Permit Renewal ❑ Permit Revision El Change of ❑ Permit Transfer to New
Before Expiration Plumber Owner
P j
IV. Ty e of POWTS System: Check all that appl
❑ Non - Pressurized In - Ground 0 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 ❑ /
9q
•97
Pi ❑ Other (explain) C o'a`�r` /
hi Chamber ❑ Drip Pipe ( P )
Recirculating Synthetic Media Filter El Leaching C p Line ❑Gravel -less
V. Dispersal/Treatment Area Information: Bin
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (s Dispersal Area Proposed (s ystem Elevation
D -0
T o t al Number Manufacturer Prefab Site Steel Fiber Plastic 4
VI. Tank Info Capacity in of ,
Gallons Gallons of Units Concrete Constructed Glass
is
New Existing {
Tanks Tanks t `'
Septic or Holding Tank o �o - _ It
Aerobic Treautxnt Unit
_ 14
tt
Dosing Chamber f
V1I. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum is S nature MP/MPRS Number Business Phone Number 1
li
iI
lumber's Address (Street, City, State, Zi W de)
VIII. unty/ a artment Use Onl
Approved 01 pp ed Sanitary Permit Fee (includes Groundwater Date Issued Issuing enl SignaturWSLPS)
Surcharge Fee) �� C DO / ✓
O me ' en J ( J�
IX. Conditions of Approval /Reasons for Disapproval
SY STEM OWNER: a � 4 "ie `� O� Jd-- off
(b S tir. tank 0 hunt flit - tl
dispersal cell must all be serviced / maintained
as per Ana9eMaAZV4ftPMXided by plumber. �ef'w• t �--.
2. All setback requirerq*nts must be _ ffifttg v ned
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
j
-w -TES
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_
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pQoPeSF_1) PR0005 - D_. �
,pv �,T�c� - pRlvct - v
_-
-loan 4! 5•
_.
Lr 8 m --
AL
- i- -- - - — -- - - 1 -- - - — - 93.A x Z2. 6 -- -- - -- -
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�� - -� jQp
vlPi- - 7/'i7
Safety and Buildings
commerce.wi. 4V 4003 N KINNEY COULEE RD
g LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
isconsin www.w
www.coe.wi.gov/s
sin.go /
l t i �
e of Commerce iscosin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
March 07, 2005
CUST ID No.223760 ATTN: PO WTS Inspector
JOHN F SCHMITT ZONING OFFICE
SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA
586 VALLEY VIEW TRAIL 1101 CARMICHAEL RD
SOMERSET WI 54025 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 03/07/2007 Identification Numbers
Transaction ID No. 1114723
SITE: Site ID No. 695493
Grand Properties L.P/ Mike Germain Please refer to both identification numbers,
95th Street above, in all correspondence with the agency.
Town of Star Prairie
St Croix County
NWIA, NEIA, S17, T31N, R18W
Lot: 33, Subdivision: Squaw Lake Estates
FOR:
Description: Proposed Three Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 1007024
Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade
System(s): 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:
• This system is to be constructed and located in accordance with the approved plans, and the "Mound Component
Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.01 /01).
• The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /O1) "Pressure
Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the
sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS
(01/81)".
• 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.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil
compaction in this area is prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per Comm 84 product approval conditions.
P.O.W. T.S.
Condhi #
����� /cn
JOHN F SCHMITT Page 2 3/7/2005
• Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during
construction and open to inspection by authorized representatives of the Department which may include local
inspectors.
Owner Responsibilities:
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• Comm 83.52(1)(a) - 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 83.54(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. In the event this soil absorption
system or any of its component parts malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division of 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
&4G�� Balance Due $ 0.00
Gerard M. Swim
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633
jswim@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
u � FcF�U
SCHMITT & SONS EXCAVAnve*
586 Valley View Trail �� !' 1O0S
Somerset, WI 54025 �✓`
715 -549 -6651 , Z
7 *0
MQ UNl3 S ESTEhI
For: Grand Properties L. P. (Mike Germain)
Address : - 712 Rivard St. Suite 100, Somerset, WI 54025
Legal: NW .'g NE 4 S 17 T 31 NR 18 W
Township: Star Praire County: St. Croix
Squaw Lake Estates Lot33
C ontmts
Page I ,Plot Plan
Page 2 System Cross Section
Page 3 .Pipe Lateral Layout
Page 4 .Dosing Cumber
Page 5 Pump Curve
Page b Management Plan
Attachment I Soil Evaluation Report
Attachment 2 Map
Mound Component Manual (Version 2.0)
SEE -10691 P(N. 01/01)
Pressure Distribution Component Manual (Version 2 0)
SBD -1 0 706-P(N 01/01)
Zy:
MPRSW 223760
Date: 2/14/2005
DEPARTMENT OF COMMERCE DINGS
*\fjS LO
AFETY NDENCE
r 5GOAW Lq)`TE hsiAT9S
33
® �1 Pn� i or' `,� Z'' hvC Pier" C�, _ �o /.
TY pQel7e5FD PRvAoS�� �
�pG Lt: pq ve t%)A �r
S riCc r�' ,.
ALT 8,M
-
c,
/O��_- ror�ck
_93.ax Z2. 6'
_63M -- i11 u /v
8 pn
Cu L r 3 c
Ai (
i
)04 t2 n _57 J- tool --
_
mpes
Page 2 Cf 6
1 Straw, Marsh Hay, Or
Synth_ ettc Covering
ASTMC33 Distribution Pipe
Medium Sind
6 Topgpi! F SY& ELEV.100. 97
..r..J a 0
.3
% Scope
Bed Of 2 Farce Main Plowed
AQgrepate Layer
(6 below PI 0 +1 . QQ Ft.
E 1 48 Ft.
Cross Section Of A Mound System Using F 1. 79 Ft,
A Bed For The Absorption Area G 0.50 Ft. o.
r
f A 6.0- Ft. H 1_. 00 Ft.
Signed: g 75.0 Ft.
223750 K 9._1 Ft.
License it tuber: _ L 93.2 Ft.
Cate: 2/14/2005 5.6 Ft.
Alternate Position Y 11.o Ft.
of
W 22_.6 Ft.
Force Main �``�►
...,_.._. -- L -� --
ObeiN pipe .. .
' 115 To i /10 8 From 'EM of Bed K
r �. . �.�= .'err.. +rr - ► +rr�rw�rrr....rr +r +� ♦ r
A __ _ _ �__�� Force Main
+{ - - - - -- ...
Bed Of
7vstrlbufion re ate
Pipe A4g 4
1 Permanent Markers
Observation Pipe
116 To 1110 B From W of Bed
Pion
View 01 Mound Ustnp A Bed For The Abeo'rptlon Area
Page 3 of 6
p►cC88 B
rcw
Tup with Cleanout fi
Plug of B&H V"
nistribcttion Lateral
PVC Foroe Main
S PVC Manifold
P x x I
X/2
Distribution Lateral Layout
P 36.25
S 3,0 Ft.
X 30 Incha%
H Diameter 3 /_ Inch
Signed; Lateral 1 � Inch(e
223760 Kanifold " 1� Inche:
License Number: Inche!
Force Main
Date: .2/14Z20 5
# of holesJpipe 15_
Invert Elevation of Lateral s,
I .
i
PAOF 4 01' 6
PUMP CH ^1'1B CROSS SECT ?OBI AJ0 SPCCIFfCA
• YEUT., '"
4 %.I. VGIJT PIPC ' WCA T uER FK O OF APPROVED LOCKI&ACP
jusX -box • 7MANNOL COVKR
duJUuw u14 i 141601
Alk ujTAKC !
I
GRADE I
4 NMI.
COUDUIT �'
ll'
PROVIDE
.IfIiLET AIRTic:►iT SCAL
I►PPAOYED JOff.1'iI A wPYK,OVLtJDlsl' i
w/ ca. rips ! I I /C , PIPS
CMIJIMIJ& 3' ALARM LVEMOIWG 3'
OUTO 60610 %OIL ! r I OWTO SOU& 501, i
21.16 Gal. /Inch I 1
I t ou l
c I !
LLCY. -
t pf•F
a
C01JCKETE BLOCK
i
1
R16CK CXIT PCRMITTED WJLtf IF TANK MAIJUFACTURCK H^S SUG14 APPSLOVAL 3 AP
8[041 Nf
fsCPrlc f 5PEC(F1CATIOWS
DObi
MA►IUiACTtjftCR: - R C.P fJLIMOLR OF DOSC,: +or - PCR DAb
TA)JK LIZt: - - 80 0 &ALLOWS DOSE VOLUME
AL �5LA, MAuurArrujLcR: _Sept ronics Tankmate IOUCLUOIQ , SACKP60WS 87-04 GALI.oNj
MOGCL fJUMetK: _,TM -1 -- CAPACITIES. 19 IIJCHCS OR41+ 3 ' 44 4ALL0►lit 1
SWITCH - TgPC: Mercury dxs 4 .. 3 ._; 52- fi�1{LGIJS f
P UMP MAAIUPAtTURCR: Zoeller r in 4 _._. 114RELS OR 87 • 0 GALtiOUf
AkOOCL WUA16GR: — __ 152 Du 12 111fGHE5 01t 2 61 . 12 GALLOUG
SWITI:A T11PC: Mechanical uOTE: PUMP AND ALARM ARE TO SL -
MIIJImUm oiScIARGE FtA'rC 3 . 66 �G INStAs.LEO OU SEPARATE GIRCUITb
YEKTICAL Diff EXEMCK DETWCCW PLIMP OFF AUD,OIST(tIbUTION PIPt.. FECT
+ AiLlIMUM fNCTWORK SUPPLY 9RC6suKC . . . . . . . . , . 2.25 FEET
♦ _ 0 .0 rcET Of FOR MAIM X 3..2.� F Y p►LFKIC'f{0W FACTOR.3. FEET
T O'rAL DIJWAMIC. HEAD 16 - 49 L F EET
IIJ DIfAL,W%IQIJ OF_TI, K: �.,. ,� 37
�._.. _ E►UC.7K I LIgUID Or`PTH .....,r..�
514 IJCD: LICCUSE WUMBER: 223760 D4.TC.
i
TOTAL DYNAMIC HEAD /CAPACITY
HEAD CAPACITY CURVE PER MINUTE
PER
AND DEWATERING
MODEL 152/153
MODEL 152 153
50 �
Feet Meters Gal. Liters Gal. Liters
153 5 1.5 69 261 77 291
12 40 10 3.1 61 231 70 265
152
0 15 4.6 53 201 61 231
_ 20 6.1 44 167 52 197
30
z 25 25 7.6 34 129 42 159
r 30 9.1 23 87 33 125
0
a 20 35 10.7 -- -- 22 85
0 40 12.2 -- -- 11 42
4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m)
10 014508
0
20 40 60 80 100
GALLONS
LITERS 0 6 1/4
80 160 240 320 '
3 27/32 4 5/8
FLOW PER MINUTE
CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32
• Timed dosing panels available. Q e
3 27/32
• Electrical alternators, for duplex systems, are available and supplied with
an alarm.
• Variable level control switches are available for controlling single phase
systems.
• Double piggyback variable level float switches are available for variable
level long and short cycle controls.
• Sealed Qwik -Box available for outdoor installations. See FM1420.
• Over 130 °F. (54 °C.) special quotation required.
l
1521153 Series 12 1/8
1521153 MODELS Control Selection
Model Volts•Ph Mode s Simplex Du lex 5 1/8
115 1 Non 8.5 1 2or3
BN1
BN 152 115 1 Auto 8.5 Included 2or3 sKZOSa
E152 230 1 Non 4.3 1 2or3
BE152 230 1 Auto 4.3 Included 2or3
1
N153 115 1 Non 10.5 1 2or3
B 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE
230 1 Non 5.3 1 2or3 1. Sin le 1 back variable level float switch or double 1 back variable level float
230 1 Auto 5.3 Inducted 2 or 3 9 p g8y p 99Y
switch. Refer to FM0477.
I A CAUTION 2. See FM0712 for correct model of Electrical Altemator 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. All electrical and safety codes should be followed including the most
recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system.
f}
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL T0: P.O. BOX 16347
` Louisville, KY 40256-0347 Manufacturers of. .
' SHIP v 3649 Cane Run Road
® ®
Lou KY 800) 9 UMP Q=ffY 1 1A'Aff 5% YCi
http✓Avww.zooller.com PUMP �0 (502) 7 FAX(502)774-3624
( P
0 Copyright 2001 Zoeller Co. All rights reserved.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Grand Properties L.P. Septic Tank Capacity 1000 ga l 13 NA -
Permit 0 Septic Tank Manufacturer Week 13 NA
C .P.
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms O NA Effluent Filter Model A-100 ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity 800 gal ❑ NA
Estimated flow (average) 300 gal/day Pump Tank Manufacturer Wppk ❑ NA i
Design flow (peak), (Estimated x 1.5) 450 al /da Pump Manufacturer Zoeller ❑ NA
Soil Application Rate al /da /ft2 Pump Model 13 NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ■ NA'
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter O Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration O Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L O In- Ground (gravity) • O In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L d NA O At -Grade ■ Mound
Fecal Coliform (geometric mean) 510' cfu /t00m1 O Drip -Line O Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: O NA ` I
Other: O NA Other. ❑ NA
Other: O NA ; I
'values typical for domestic wastewater and septic tank effluent. t
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month(s) (Maximum 3 years) ❑ NAB
Inspect condition of tank(s) At least once every: 3 q year(s) F
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume ❑ NA-
O months)
Inspect dispersal cell(s) At least once every: 3 ®year(1) (Maximum 3 years) ❑ NA;
Clean effluent filter At least once every: 1.1 ❑ month ® year ( (sl ) ❑ NA' I
s)
O month(s) O NA
Inspect pump, pump controls & alarm At least once every: 1 ■ year(s)
❑ month(s) O
Flush laterals and pressure test At least once every: 1 M year(s)
Other: ❑ month(s) ❑ N A ;
At least once every: ❑ year(s)
Other: O -N 1
MAINTENANCE INSTRUCTIONS F
Inspections of tanks and dispersal cells shalt be made by an individual carrying one of the following licenses or certifications• 4
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator.` +:Tan +.
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks:or Ipaks
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground
The dispersal cell(s) shall 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 "th
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, tl[e entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chap &r: NR{ 1.,1
Wisconsin Administrative Code.
All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatman.
units, and any servicing at Intervals-of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. <. 3
:z
f~
.t
Page of
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 call(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 call(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:
• 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 soil 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 lines and wells. Failure to protect the replacement. area will.
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.
0 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 biomat 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
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER =t
Name John• Schmitt Name Owners choice
Phone 51 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY =.
Name w r choice Name St . Croix Ct . Zonin f
Phone Phone 715 386 -4680
This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code. r
f�
1289
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County
include, but not limned to: vertical and horizontal reference point (BM), direction and St Croix
percent slope, scale ordimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
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 Location
Grand Properties, LP Govt. Lot NW 19 NE 19 S 17 T 31 N R 18 W
Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM#
712 Rivard Streeet, Suite 300 33 Squaw Lake Estates
City State Zip Code Phone Number _f City rJ Village iJ Town Nearest Road
Somerset I WI 1 54025 1 715 - 247 - 5900 Star Prairie I 95Th St.
$ New Construction Use: 11 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
J Replacement J Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a mound system. System elevation is 100.97' based off of contour line established at
99.97'. Slope i43 %. Depth to limiting factor is 24 ".
❑ Boring # J Boring
�6 Pit Ground Surface elev. 99.92 ft. Depth to limiting factor 24 in. Soil Application Rate
Horizon I Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
'Eff#1 `Eff #2
i
1 0 -13 10yr3/4 none sl 2fsbk mfr cs 2f .6 1.0
2 13 -24 7.5yr4/6 none scl 2fsbk mfr
gw I 1 f .4 .6
3 24 -35 10yr5/6 r ja i sicl 2fsbk mfr gw i — .4 .6
4 35 -63 10yr6/4 c2d 7.5 /8 7 5 /3 sil 2msbk mfr — 6 8
a Boring # Boring
N Pit Ground Surface elev. 1 00.57 ft. Depth to limiting factor 27 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
'Eff#1 'Eff#2
1 0 -10 10yr4/3 none sl 2fsbk mfr cs ( 2m, .6 1.0
2 10 -27 7.5yr4/6 none sl 2msbk mfr
gw 2f .6 1.0
m2d 7.5 /8
/3 sl 1 msbk mfr gw 4 7
r6/4 cld 7.5 /6
4 43 -54 10
Y 7.5 /2 sil 1 msbk mfr .4 .6
e
' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD <_30 mg/L and TSS <—�0 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 827/04 715- 247 -2941
Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 _
3] Boring # = Boring
i/ Pit Ground Surface elev. 98.14 ft. Depth to limiting factor 32 in. Soil Application Rate
Horizon Depth I Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD z
'Eff#1 •Eff#2
1 0 -9 10yr3 13 none sl 2fsbk mvfr cs ` 2f .6 1.0
2 9 -20 10yr4/3 none SI 2fsbk mvfr gw 1f .6 1.0
3 20 -32 10yr4/4 none sl 2msbk mfr gw .6 1.0
4 32-48 7.Syr4/3 cld7.5yr6 /8 sl 1msbk mfr cw I — .4 .7
7.5 T6/3
5 48 -61 7.5 r4/4 m-d 7.5y 6/8 scl 1 msbk mfr -- I — -- 2 3
Y 7.5y6/2
I
F-1 Boring # J Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color ( Redox Description I Texture Structure Consistence I Boundary Roots
•Eff#1 •Eff#2
I
i
❑ Boring # J Boring
_) Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color I Redox Description Texture Structure Consistence ( Boundary ( Roots 2
•Eff#1 'Eff#2
1
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 ou need assistance to access services or
P� 9 PPo tY P Y
nitnrnnfn F f -boon —t—t t1.n 4—rfh++nnt at lnR_744_27 S1 —7TV fn4_74A -4777
- -- -- -- Page 3 of 3
-_ - .onducted' by'. - -- - - __. - Conducted For: _ -Ref. No. % 8 _
_ __ _
- - :Schmitt -Soil and Site Evaluations ._Grand Properties, LP.
__.
._. Thomas J. Schmitt, _C8T227429. ... _ Address:--- _ _ - .._712 Rivard St. S uit e l0U
1595 72nd St._ _. _ . _ _ _ City, State, Zip : _ _ -_ Somerset W1.54025
New Richmond, W1. 54
Phone: 715- 247 -2941 Subd.Name: Squaw Lake Estates
Lot No.. �3
Legal Description: IN) 1/4 At. 1/4 S 17 T3 IN RI 8W
Township of: Star Prairie, St. Croix County
Bench Mark El. 100.00' Top of 2" pvc pipe
Alternate Bench Mark El. /0/ di Top of 2" pvc pipe
Slope= -S Contour Line El. 99 97
Contour Line Length bw
Scale 1" = 40'
3 s
_ S
3 --
u (
i
I
i 17 7 - — __ - --
- This soil report was done to fulfill a zoning requir�l`nenL permanent*lot markers were at the time the test was �
i t
conducted. The area in- which itwas- done_may_cr_may_notbe_suitable_ for_ your_ use, or_�n_tti ocation shovsm _1_
i
1 t
Nv jot
MAP
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Ell
111
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6 W :CI
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e a!
L
1289
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt
Attach complete site an on County
pl plan paper not less than 8'h x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsiors, north ammo, and location and distance to nearest road. Parcel I.D.
Please print _all informaSon. — c-
r-- �,,,,,� Reviewed By Date
Personal information you provide may Ie used f rf " '�° ' Laws. 15.04 (1) (m)). D
Property Owner Property Location
Grand Properties, LP @ i ;Govt. Lot NW 1/4 NE 1/4 S 17 T 31 N R 18 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CS
M#
712 Rivard Streeet, Suite 300 33 Squaw Lake Estates
City State Zip CotdC P hoffe@Rk J City I Village I/ Town Nearest Road
Somerset I WI 1 9 715 - 247 -5900 Star Prairie I 95Th St.
New Construction Use: to Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
J Replacement Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a mound system. System elevation is 100.97' based off of contour line established at
99.97'. Slope iq8%. Depth to limiting factor is 2N'.
Boring # Boring
SM'f Pit Ground Surface elev. 99.92 ft. Depth to limiting factor 24 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
'Eff#1 'Eff#2
1 0 -13 10yr3/4 none sl 2fsbk mfr cs 2f .6 1.0
2 13 -24 7.5yr4/6 none scl 2fsbk mfr gW 1f .4 .6
3 24 -35 10yr5/6 "' 10 /3 /8 sicl 2fsbk mfr gW .4 .6
4 35-63 10yr6/4 02� 5 r /3/8 sil 2msbk mfr — - .6 .8
Boring # Boring
16 Pit Ground Surface elev. 100.57 ft. h to limiting factor 27 in.
Dept g Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
*Eff#1 'Eff#2
1 0 -10 10yr4/3 none sl 2fsbk mfr cs 2m,2f .6 1.0
2 10 - 27 7.5yr4/6 none sl 2msbk mfr gW 2f .6 1.0
3 27-43 7.5yr4/4 " � r / /8 sl 1 msbk mfr gW — .4 .7
4 43 -54 10 r6/4 cud 7.5 /6 —
Y 7.5 /2 sil 1 msbk mfr —
.4 .6
' Effluent 91 = BOO ? 30 < 220 mg/L and TSS ?30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <,90 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 8!27/04 715 - 247 -2941
I
r , Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
a Boring # Boring
ll!J Pit Ground Surface elev. 98.14 ft. Depth to limiting factor 32 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf
*Eff#1 *Eff#2
1 0 -9 10yr3/3 none sl 2fsbk mvfr cs 2f .6 1.0
2 9 -20 10yr4/3 none sl 2fsbk mvfr 9w 1f .6 1.0
3 20 -32 10yr4/4 none sl 2msbk mfr 9w .6 1.0
4 32-48 7.5 r4/6 cld 7.5yr6 /8
y 7.5 13
sl 1 msbk mfr cw — . 4 .7
5 48-61 7.5yr4/4 m2d 7.5yr6/8 7 5yr6/2 scl 1 msbk mfr — - 2 3
F—I 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 QPD
*Eff#1 *Eff#2
F1 Boring # Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
*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.
Page 3 of 3
Conducted by: Conducted For: Ref. No. Q8
�• Schmitt Soil and Site Evaluations Name: Grand Properties, LP.
Thomas I Schmitt, CST 227429 Address: 712 Rivard St. Suite 100
1595 72nd St. City, State, Zip: Somerset, WI. 54025
New Richmond, Wl. 54017
Phone: 715- 247 -2941 Subd.Name: Squaw Lake Estates
7 — v Y Lot No.: . ?_7
Legal Description: A/O 1 14)V C 1/4 S17 T3 IN RI 8W
Township of Star Prairie, St. Croix County
Bench Mark El. 100.00' Top of 2" pvc pipe
Alternate Bench Mark El. /o% 66 r op of 2" pvc pipe
Slope= 8 36 Contour Line El. 99 97'
Contour Line Length b6
Scale 1" = 40'
3 �
S
s'
3
1 ► �
R V
/
1
i
This soil report was done to fulfill a zoning requir enk No permanent lot markers were at the time the test was
conducted. The area in which it was done may or may not be suitable for your use, or in ocation shown.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �/Z/�nrf� ��a � - /rt'� l'�n/5",4%v'
Mailing Address
Property Address
(Verification required from Planning Department for new construction) Y
o3 .P - 1P; -- .>o - d d0 03.'- /47 / - -So -�
City/State r /3 &i, 2 c (�(�, Parcel Identification Number wk -/07 / - `. ng,
LEGAL DESCRIPTION
Property Location AW '/,, NU %,, Sec. 12 T,2_N -R Town of VZ a�,i
Subdivision � IQ U 14 U) L,4 /Tr C 5 7 ,4 Zr-- . Lot
Certified Survey Map # , Volume , Page #
Warranty Deed # 7 Volume A ZICIY2 , Page # 6
Spec house 0 yes ❑ no Lot lines identifiable ® yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenanceof 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
mastCrplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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
stating that your septic/system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
daw dPthe three veap expiraWQb date.
SIGNAII' �0,AVPLICXNT DA TE
OWNER CERTIFICATION
I (we) 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 abovei by virtue of a warranty deed recorded in Register of Deeds Office.
S GNAT'U�'E i LICANT DATE
ssss4r
Any / information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * « *«
«« Include with this applicAtion: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
U 2449 569 745747 `
STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO.. WI
This Deed, made between Robert J. Hansen RECEIVED FOR RECORD
Grantor, 11/05/2003 09:30AN
and Grand Properties, LP WARRANTY DEED
Grantee. EXOrPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00
TRANS FEE: 3180.00
(if more space is needed, please attach addendum): COPY FEE;
The NW 1/4 of The NE 1/ 4; the NE 1/4 of the NW 1/4 and NW 1/4 of the CC FEE:
NW 1/4, All in Section 17, Township 31 North, Range 18 West, St. Croix PAGES: 1
County, Wisconsin.
All that portion of the NE 1/4 of the NE 1/4 of Section 17, Township 31
North, Range 18 West, St. Croix County, Wisconsin lying Westerly of
Squaw Lake Recording Area
Name and Return Address
/2 � +6 8
P 6a x
dsc cJ 1 3N0 .10
038 - 1070 -70- 000;038 -1071- 50-000
038- 1071 -60 -000:038.1070- 30-000
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 this day of Ae4mbm NCry , 2003
* * Rober J. Hanse
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Robert J. Hansen STATE OF )
ss.
County )
authenticated / this day of October 2003
Personally came before me this -- day of
the above named
* Kristiaa Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland, At torney at Law
304 Lo cust S treet, Huds WI 54016 Notary Public, State of
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
• Names of persons signing in any capacity must be typed or printed below their signature. INFO -FRO (800)655.2021 www.infoproforms.com
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 2 -2000