Loading...
HomeMy WebLinkAbout004-1037-50-000Wisconsir, Department of Commerce "Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Hi h Ca arrel Farm Inc, aka Ca Industries Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / /2 ~ ~ Dosing f~ (1~ Q Aeration U i '' Holding TANK SETBACK INFORMATION ~~c..e- ~G~r.. TANK TO P/L W ELF - BLDG. Vent to Air Intake ROAD Septic I i ' ~~~ Dosin ~~` _ *, f1C ~ I ~ / Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number / S3 TDH Lift 6 . ~ ~ Frictio Low 2 •~ 5 Syste~ Hea 7 . Z~ TDH Ft ~(p .2~ Forcemain Len~h ~ Dia. v Dist. to W~ 7 ~ SOIL ABSORPTION SYSTEM Sy 8 BED/TRENCH DIMENSIONS Width Len th C ` No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~ I OS• SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACH Manufacturer: INFORMATION CH R OR Type Of System: ,f `I~ r ~ ~~ % ~'~ / ~ Model Number: DISTRIBUTION SYSTEM _~Ll. S ~11p~0.c~ n ~i /J~,IVr~ Heade Manifold Distribution / x Hole Size x Hole Spacing ~~ Pipe(s) ~7 E " r ~' S S i i ~' ~ 3 / ~ 2 ci % 2' Length Dia ng_ _ Length D a pac ri SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~( ~ / b$ Inspection #2:~ z /~~~ Location: 359 290th St/re+et~Wilson, WI 54027 (NE 11,/41S_W~1/4 16 T28N R15W) NA Lot ~/d(.~,~ ~1~ Parcel N :16.28.15.251 1.) Alt BM Description = ~(Tl'\~Q.`'~'~'~s'~"' ~"'~' G~~, 'P~ a ~ ~.~ 2.) Bldg sewer length = I~`~- " {1G( ~GGZ~~~,~ A - amount of cover = ~`~ .•~JJ n 11 1 , Plan revision Required? ^ Yes No other side for additional information. P~ -. I~~02 i Q~J Date ELEVATION DATA county: St. Croix Sanitary Permit No: 514998 0 State Plan ID No: Parcel Tax No: 004-1037-50-000 Section/TownlRange/Map No: 16.28.15.251 STATION BS HI FS ELEV. Benchm ark ~~~ /~ •b~ ~~ X07 C . Alt. BM~C:~/-'~t. ~ ~ L ~ / ' ~ f~v' ~ 0 Bldg. Sewer -M S D/D U t Inlet l/_ o~ 93• ~ ~- t/ t Outlet Dt Inlet a. 37 / . 5 Dt Bottom /,• / ~~ ~~ 7/ ~ ` ~3 0 Heade an. -3/ b'-1/ Dist. Pie s. 3/ . f Bot. System ~ /./ G, v S• q~/ ~,• ,L3 Final Grade Std _ - / S~.S /Za~Or- -~ ~~ ~. 97./3 Insepctor's f ~ i Vent to Air Intake (yeti ~bv^ a/O s w~ ~ _ _. Cert. No. `~~~~ rolmmet~ce.wl.gov Safety and Buildings Division ~rn~., s ~ 201 W. Washington Ave., P.O. Box 7162 / l ~ seo ns ~ n Madison, WI 537 162 « (tn be filled;" by Co.) Sanitary Permit Num b Oapsrttrtent or Contnssrce C t rj ~ ~ / Sanitary Permit Application State TransactionN umb« t 7~ ~ 5~ ~ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of thi+ form to the appropriate govemmrntal J unit is required prior to obtaining a sanitary permit. Note: Application fotnu for sta s (if different than mailing address) submitted to the Department of Comm«ce. Personal information you provide may be used f~~ v a_ t ~- { ~~ ~D -~H S~r ass in accordance with the Privac Law s. 15. 1 m Stab. ' / I. A 'catiast Information -Please Print All Wormation ~) L S !J ~ J~7 ~ pZ. Property Own«'s Name /'~ pn ~ Cam. l~~JJ,r `'s •es L ~ ~ rt? IUC t SEP 2 9 l # Ao~y /~3 7 • So Property Own«'s Mailing Address ST. CROIX C Lo ion ~ 2S 7 S~ ZT (f ~ ~~ ZONING O F C ~ City, State Zip Code Phone Number l! ~ ~ Yy ~'/., Section j~ ULI~ 0 I ~ / IV (~ i ~ N ~~ ~ / ~7 02 ~ 7 ttl / /.~ 7/ o~ ~ 7 `~/ S cle one T a~ N; R ~ E ort~ IL Type of Building (check all that apply) Lot # ^ 1 or 2 Family Dwelling -Numb« of Bcdr ms Subdivision Name Block # ^ PublidCommercial -Describe Uae ~t ^ City of ^ State Owned =''Describe Uae i ~ C Numb« ^ V illage of 7 X `'`' ?~ J ~ ~ Town of C ~~ IIL T ype of Permit: (Check only one boa on line A. Complete line B if applicable) A' ^ New 5 stem y R lacemrnt S stem ~ ep y ^ Treahnrnt/Holding Tank Replacement Only ^ Oth« Modification to Existing System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumb« ^ Permit Transf« to New List Previous Permit Numb« and Date Issued/ Before Expiration Own« IV. T e of POWTS S stem/Com nent/Device: Check all that a 1 i ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Cmde ^ Mound >_ 24 in. of suitable soil Mound < 24 in. of auitablt soil ^ Holding Tank ^ Oth« Dispersal Component (explain) ^ Pretreatment Device (explain) / V. Dis ersal/Tres ent Area Wormation: / Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Disp«sal Area Proposed System Elevation VI. Tank Wo Capacity in Gallons Total Galloro # of Units Manufacturer ~ ~ o ~ V v F New Tarilcs n~ Exis ' Tenlrs 1 i ~~ ~ 4:~ ~ u ti~ v8 b: w ~ v i ~ „~ 0/G. 0 v , 7 Septic or Holding Tank ~ /_ O / ~ / O ~ r S ~ 1 > ~~ o ~~ ~ ~ )` t k S ~ e• VII. Res risibility Statement- I, the undersi ed, assume responsibility for installation of the POWTS shown on the attached lens. Plumber's Name (Print) Plumb Si lure ~ MP/I~RS Number Business Phone Numb« ~fl WJ`' rvt ~ r i o?a.3 7th ~ 7 .~ - S'~-665' Plumb«'s Address (Street, Clty, State, Zip Code) ~~ h s® ,~ ltir~~s~T z s o a~ VIII. Conn /De artment Use Onl pproved rsa Permit Fee Date Is ed Issuin t Signature O rvrn Reason 'al LX. Conditt~g~j~easons for Disapproval ,3~ GO ~I~~"%or1.S /r/~ ~ ~ ~ a"~"" w 1. Septic tank, effluent filter and t ~f ~,, ~~.~,~„~• dispersal cee must all be services / maintaittad ~ ^ ~~' ~'/~ T-"`+o ~ as per management plan provided by plumber, ~ 11 n^,~ I-rte 2. AU setback necµtirarnents musj be rroit>tiuled s/f G'xir5 !~~ f'~[.tJ l.~ q~1 ~ aC /04 ~~ Attach to rnmplete plsm for the system end submfCto the county only err paper rid less than S l2 z ll Inches m size SBD-6398 (R. 01/07) Valid thrtt 01/09 ___._ .._. ____.-- . _ .__ ___._._ _ __ . Page._I of 7, _ __ N oRrt~ u,ts ~ o -- T _c 5 W U o c l (o~ ._ .~ ~ ~ZO~ ~y 9o s c.or' B3 79c SLQAE \ _ ~ ® ~ ~ ~ ~ -. d~ C-+~C•• P.G.• i ~~ _ \ -.. `~, ~ ~ f31 \ I Z ~~~- \ ~ OF~ wsnN6 lLCCCr~c ~S-T, ~ ,~ ~ ~ g111 EL, = J4~•~U TcP eh Z' N'1~NI~cCF cc^vrrf' ~,r• ~ ~ ~ . ~ ALT. di+1 _` J ~L_ = 9&~7 CEP c< vE~r r'irrt= cn; ~X,sr.,v~ ® IgAG~µ~~ ~~TS ~,laliNMEL ~~ _ ,y _ _ ~ _ ~LEPc - 7~~ _ ~,- _ ,,, o SF~ I~~~~/~{-L p~~:TC I~-D~ GO~!~T~c'N w tC ,,•~ _ _ EX/s>/nl to t~F -Vc~-~Sr ~a~i~ ~ yL~ t~ S>, L1 ~E0~2oem ,~ N~us~ _ ~X/S~I~L yti C LL ~~_ _ _ - ~ _ ~ ~ c~~e a 5 N ~"~ ,,~ ~. ~` - . ~ : ~~ 90 5 ~+~~ ~B3 ~9o SL~~E \ cEn~ uaN ®~ ~- V ~/ZO~ - ;. ~® c 8~ ,+, '~ ,~ , ~ ' far \ l Z ~ `!~~' ~3.8x Id4.~ ~ ,,. \Ff~~~~ 4' ~O rat cu N ~ e ~ ~ x~sT, ~ ~ ~'F ~~F ® ~,xsr~ N6 ~- g~1 EL, = 1©~-UO Teri e~ Z' N'1f1Ni~OCF cc",~rK' f,r...J!'~~ ~ ALi. C3 Wl ~L.. = 9& (07 T~ /~ CI= V E~11T Pi~~ G nt c.X~srav~ ® 141~1G1r/-Fc^~- ~~7-s ~ S ~ ~ I~V~~~4 L Pff~rc God LoC ~}TiaN nF tVc~-~ES~ ~a~k7 - ~X~S~'lNlo ~~usc ~wS~~~L W CLL r ,, , ~. J '!~ ~~ 4 h y e I~- va Q ty heaw„utc_~~e ~_ ___. _ }-FICN_ Cr~PPA~~2EL ~~~ INS. ~h~ ~Lc , _ f't'~ ~'Cc~_ ~ _ ~~a~~r~vt, ~ Y (o /G /J ~Ttl ~v~- _ _ _ ._ _ _ _ . ___. ~~`~cces~r W T S __ __ _ .-__ ~y~~-. _ _ ' commerce.wi.gov i ^ isconsin Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www, commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary September 23, 2008 CUST ID No. 223760 JOHN F SCHMITT SCHMITT & SONS EXCAVATING 586 VALLEY VIEW TRAIL SOMERSET WI 54025 ATTN.• POWTSInspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/23/2010 Identification Numbers Transaction ID No. 1591570 SITE: Site ID No. 742637 High Capparel Farm, Inc. Please refer to both identification numbers, 359 290TH Street above, in all corres ondence with the a enc . Town of Cady St Croix County NE1/4, SW1/4, S16, T28N, R15W FOR: Description; Four Bedroom Mound System /Replacement construction / 7% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1201249 Maintenance required; 600 GPD Flow rate; 23 in Soil minimum depth to limiting factor fran original grade; System(s): Mound Component Manual- Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual- Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsn 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • "The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of theeffluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the approved plans specifications and this letter shall be on site during construction and oven to mspection by authorized representatives of the Department which may include local inspectors. C~~rc~itaonc>f~'y ®~ DEPARTMENT OF COMMERCE JOHN F SCHMITT Page 2 9/23/2008 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. • 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). • 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 regzire 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' Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim @wiscons in. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. ~~~~~~~® SF° 7 °~ ZUE13 ~~'~~=~ ~': ~ ~~.~~L71~VG~ SCHIKTIT & SONS EXCA VATING INC. S86 VALLEY VIEW TRAIL SOMERSET, WI S402S MOUND SYSTEM FOR: HIGH CAPPARREL FARM INC. ADDRESS' 795112TH A VE S., BLOOMINGTON, MNSS42S LEGAL NE % SW % 516, TZSN, RiSW TOWNSHIP. CADY COUNTY ST. CROIX CDNTENTS Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 & 7 Plot Plan `System Cross-Section Distribution Lateral Layout Dosing Chamber Pump Curve Management Plan Attachment 1 Soil Evaluation Report Attachment 2 Aerial Photo Mound Component Manual (Version 2.0) SBD-10691 P (N. 01/01) Pressure Distribution Component Manual (Version 2 0) SBD-10706-P (N. Ol/Ol) By: MFRS: 223760 Date: September I5, 2008 IJI~I~~C~~V~Q.~f ~ktt~ 1~ HIYL L... ~.y... ~... -~ ~ SEE CGRIiES NDENCE Mound System Cross Section Page 2 ~l ~ . Synthetic Covering ASTMC33 Distribution Pipe Medium Sand Topsoil H - ~c Sys. Elev. 98.18 feet ~, T=if F _J ~ 3 E ~~ p ., • ~~ '!. Slops • ~- 2 Force Main Plowed . Aggregate Layer• . Signed: ~ • (,~/G~ License number #223760 Date: 9/15/2008 A = 7.00 feet B = 85.79 feet K = 9.40 feet L = 104.5 feet J = 5.90 feet I =10.90 feet W = 23.80 feet D = 1.08 feet E = 1.57 feet F = 0.79 feet G = 0.50 feet H = 1.00 feet Alternate Position . of • Force Main L •. Qb:ervation Pipe .} ~ 6 • • ~ 115 To 1h0 6 From End of Bed _, K A I' ~ - I Imo--- -------------- w L ~--------- ---------------------~~ Force Main - ----- - ~• Distribution ~ ~ 2'- 2 { Pipe ~ .` `Ob ti Q~gregate • aervo on Pipe i/S To 1/10 8 From End of Bed Permanent Markers Plan View Of Mound Page 3 of 7 Turrwp wf#h Cleanout Plus a' Baq Valvs PVC Fcroe Main P x ~ x ~ x X/2 Dlstributfon Lat®ral t_eyout P 41.40 feet S 4.0 feet X 32 inches Hole Diameter 3 /16 inch Lateral Diameter 1 1/2 inches Manifold Diameter 1 1/2 inches Force Main Diameter 2 inches # of holes/pipe 16 Invert Elevation of Laterals 98.68 feet Access Distribution Lateral PVC Manrford Signed: ~'~~~~ i ~~~L.~ ~- - License Number: 223760 Revised Date: 9!15/2008 ~. °~a. a. `1~C.I. VEUT PIPC ~ 25' FROM OoOR, wllJDOW OR FRESH A!R IIJTAKE Page 4 of 7 • RUMP CHANGER CRO55 SEC T IOr,I A~1G SPECIFICa•r10~!5 VEIJT CAP ;.er WEATHERPROOF APPROVED LOCKIn1G JUAJCTIOIJ BOX ~MAIJHO~E COVEF It'MIU. GRADE `1" MIIJ. 18'MIA1. IAJLET *~ A .ELEV. 88.68 FT. CO-JDUIT-~ ~-- 18" /`11U. PROVIDE AIRTIGHT SEAL ~ I ~ I 21.76 GALLONS/INCH '~ *APPROVED JOINTS WITH APPROVED PIPE 3' ONTO o - SOLID SOIL -- AL_HRM i 1~0ti. I I I PUMP -~ '-~ ` orF CO-.1CRETE DIOCK \,/ ;RISER EXIT PERMITTED OlJS~ECIFICATIO~~CTURCR HAS SUCH APPROVAL- SEPTIC & DOSE TANKS MANUFACTURER: WEEKS C.P. NUMBER OF DOSES: +or-5 PER DAY TANK SIZE: S00 GALLONS DOSE VOLUME INCLUDING BACKFLOW: 108.8 GALLONS ALARM MANUFACTURER: SEPTRONICS TANKMATE MODEL NUMBER:. TM-1 CAPACITIES: A= 19 INCHES OR 413.44 GALLONS SWITCH TYPE: MERCURY B= 2 INCHES OR 43.52 GALLONS C= S INCHES OR 108.8 GALLONS PUMP MANUFACTURER: ZOELLER D= 11 INCHES OR 239.36 GALLONS MODEL NUMBER: 152 SWITCH TYPE: MECHANICAL NOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS I~~[NIlv1UM DISCHARGE RATE: 42.24 GPM VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE: 10.00 FEET / ~ '~ ~ + I~~IINIMUM NETWORK SUPPLY PRESSURE: 3.25 FEET + 100 FEET OF FORCE MAIN X 3.66 FT/100FT FRICTION FACTOR: 3.66 FEET 2 -8S~ TOTAL DYNAMIC HEAD = 16.91 FEET DIAMETER OF TANK: 80 INCHES LIQUID DEPTH: 37 INCHES SIGNED: tom-. `~ LICENSE NUMBER: 223760 DATE: x/15/2008 6 . ~"' HEAD .CAPACITY CURVE MODEL 152/153 ~Iw 53 12-~ 40 0 ~ 30 z 8 r 0 a 20 0 4 -{ 10 0 20 40 60 80 100 GALLONS UTERS.O 80 160 240 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electriraf 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 Owik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 15?J153 Series 1521153 MODELS Control Selection Model Vohs-Ph Mode Am Sim ex Du lex N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 4xJuded 2 or 3 E152 230 1 Non 4.3 7 2 or 3 BE152 230 1 Auto 4.3 Inchided 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Aub 10.5 kiduded 2 or3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 O CAUTION All installation of controls, protection devices and wiring should be done try a qualified licensed electrician. A!I electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Ad (OSHA). 70TAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING Page S of 7 MODEL 152 153 Feet Meters Gal. Liters Gal. Liters 5 1.5 69 26 t 77 291 10 3.1 61 231 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.1 23 87 33 125 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) z~/ ~- 12 t/8 SELECTION GUIDE 32 3z 3 sKxow 1. Single piggyback variable level float switch or double piggyback variable level fbat switch. Reter to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level conVol switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. _- MA4 TO: P.O. BOX 16347 ~~ Louisville. KY 40156-0347 Manufacturers ol.. ~~ ~ SHlP T0: 3649 Cane Run Road ~'~~? ~ .e Louisville, KY 40211.1961 s (502) 778.2731.1(800) 928-PUMP Q<~rr P!/d/PB S,vCE /9`x`9 httpJ/wwwsoaller.com ~UMI~ ~0 FAX (502) 774-3624 ® Copyright 2001 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN ot;SiaN PARAMETERS Number of Bedrooms 4 O NA Number of Public Facility Units O NA Estimated flow (average) ~ S 00 aUda Oes)gn flow (peak), (Estimated x 1.5) al/da Soil AppUcaiion Rats 0 . 6 at/da /tt= Standard Influent/Effluent nuaiiiy Monthly average• Fats, OU & Grasso (FOG) 530 mg/L Biochemical Oxygen Demand (BODe) 5220 mg/L O NA Total Suspended Solids fTSS) 51 b0 mg/L Preueatad Effluent Quality Monthly average •. 8iochemica) Oxygen Demand (BODE 530 mg/L Tote! Suspended Solids (TSS) 530 mg/L d NA Fecal Coliiorm (geometric mean) S10` cfu/100m1 Maximum Effluent Particle Sizo Ye in die. r ~O NA ~zlws O NA •Valwa typical tot domestk wsstewator and soptic tank effluent. cvcrcu roil ICfCeT1ANS Pape ,6 of 7 .Septic Tank Capachy 2 6 0 al O ~" Septic Tank Manufacturer O NA Effluent Filter Manufacturer pot 1 ok O t~A Effluent Fitter Model PL- 5 2 5 O NA Pump Tank Capacity 800 al O NA. Pump Tank Manufacturer , ^ NA Pump Manufacturer e 1 r ^ ~ Pump Model ~ ^ NA Preveatment Unit ^ Sand/Gravel F(Iter ^ Mechanical Aeration O Disinfection ^ Peat Filter ^ Wetland ~ Other: ^ NA' Dispersal Cell(s) ^ ln-Ground (gravity) ^ At-Grade O Drip-Line ^ NA ~ ^ In-Ground (pressurized) ^ Mound ^ Other. Other. O NA Other: O NA Other: ^ NA MiUf\ ~ G\IV \ V G v v„w v w Service Event Service Frequency inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) 3 q oar(s) O NA; Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume O NA.; inspect dispersal coA(s) At least onto every: ~ edf~ j(s) (Maximum 3 years) 3 ^ NA; Clean oftluant filter At least once every: ^ month(s) 1 , ® ear(s) O NA~ ~ month(s) ~ NA Inspect pump, pump controls & alarm At least once ovory: 1 ^ ear(s) I ' ^ month(s) t~1A` ^ Rush laterals and pressuro Lest At (oast once eve ry~ 1 fD year(s) Oar' At least once Query: ^ month(s) O year(s) ^ NA; h NA~ ^ er: Ot . MAINTENANCE WSTRUCTIONS •'~` inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifica)ion, Master Plumber; Master Plumbet Restricted Sower; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. '':Tar inspections must include a visual inspection of tho tank(s) to identify any missing or broken hardware, identify any cracks.or leak: moasurs the volume.of combined sludgs and scum and to check for any back up or ponding of effluent on the ground'surfac~ The disperse! cell(s) shall be vlwaUy inspected to chock tho offluent levels in the observation pipes and to chock for any, pondir, ;;.. of effluent on the Around surfaco. Tho pondinp of offluent on tho Around surface may indicate a tailing condition and ~requirea~tJ, immediate notification of the local rogulatory authority. ~'~'h~n t;.c combined sCCtsmtaation of sludge and scum in any tank equals one-third IY,) or more of the tank volume, tho entu contonu o.f the tank shall be removed by a Septsge Servicing Operator and disposed of in accordance with chapter: NR,~j.,7M; .Wisconsin Adminlsuatiw Cods. .',:'u All other services; includlnfl but not lirnlted to the servicing of of fluent f titers, mechanical or pressurized components, preueauner units, and any servlcirtQ at (ntorvals•of S12 months, shall be performed by a certified POWTS Maintainer. ::.~~, .."•°-~ A service report shall be provided to the local regulatory authority wfthln 10 days of~complelion of any service event. •~~; !1F INFORMATION ~"~~ HiGh Caaparrel Farm Inc. Pemtiit 1 i Page ,7 0(~_ 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 tfis treatment process and/or damage the dispersal call(s). If high concentrations are detected have the contents of the tank(s) removed. by a septaye servicfnp operator prior„~p,use. System start up shall not occur when soil conditions are-frozen at the infiltrative surface. Ourinp power outafles pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one larfle 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 Septaga 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 rostore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Oo.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 al! 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 coda_ compliant replacement system: O 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 affect at that time. O 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. if 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. O 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 A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. 1DDIT10NAL COMMENTS 'OWTS INSTALLER Name John• Schtth.tt Phone ~ 9 _ 6 51 POWTS MAINTAINER Name Owners choice .Phone EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name w rs choice Name St. Croix Ct Zonin Phone ~ Phone 715 386-4680 ~ t: :~ vs document was draped in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ~ : 4c ''~~ ~ " ~\/isconsin Depaztrrter-t of Commerce SOIL EVALUATION REPORT in accordance with Comm 85, Vifis. Adm. Code #1603 page 1 of Schmitt Sal Testing, Inc. DIVISrOrr Or .7HICly ana ouuun n,~ ~~ P ~n mu~ lan on paper not less than 8'r4 x 11 ind-es in sme. site l t St Crooc o ' e p e Attach comp but not Gmled to: vertical and horimmntal reference po' (BM), include D Parcel I , percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . . pp¢1037_50-000 Please print all information. ReY~,d gy Date Personal information You Provide maybe used for secondary P~P~ (~•Y ~~ s. 15.04 (1) (m)). Property Owner Property Location S16, 728N, R15W SW1/4 NE1/4 High Capparrel Farm Inc. , , Govt Lot Property Owner's Mailing Address Lot # Bkx~C # Subd. Name or (,SM# 7951 12th Ave. S. na 40 Arxe Parcel City State Zip Code Phone Number ^ City ^ Vllage ®Town Nearest Road Bloomington MN 55425 715-772-4415 Cady 290Th St. ^ New Construction Use: ®Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ® Replacement ^ Public or r~rrrmercial -Describe: Parerrt material Glacial Drift (Santiago Series) _ Flood plain elevation, if applipble na ft. General comments and recommendations: Area is suitable for a mound system. System elevation is 98.20' based off contour line established at 97.10'. Slope~of area is 7%. Depth to limiting factor is 23".~ ^ Boring a Boring # ® pit Ground surface elev. 97.40 R Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft= in. Munsell Qu. Sz Cont Color Gr. Sz Sh. - 'Eff#1 'EtT#2 1 0-5 10yr3/2 none sil 2mgr ~ mfr cs 2c,2vF .6 .8 2 5-12 10yr6/2 none sil ~fsbk mfr gw 2m,2vf .6 .8 3 12-23 10yr4/4 none sl 2msbk ~ mfr gw 2f .6 1.0 4 23-31 7.5yr4/6 ~i~~ 6 sl lmsbk mfr gw .4 .7 5 31-63 7.5yr4/4 m~~ /8 scl lmsbk mfi - .2 .3 Boring # ^ Boring ® Pit Ground surface elev. 97.1 ft Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consist Boundary Roots GP D/ft= in. Munsell Qu. Sz Cont Color Gr. Sz Sh. •EtT#t 'Ett#2 1 0-7 10yr3/2 none sil 2mgr mvfr cs 2c,2m .6 .8 2 7-15 10yr4/3 none sl 2fsbk mvfr gw im .6 1.0 3 15-23 10yr5/3 rwne sl 2fsbk mfr gw if .6 1.0 4 23-34 7.Syr4/6 ~iWr6/2/$ 51 imsbk mfr gw .4 .7 5 34-62 7.5yr4/4 m2d 7.5yr6/6 7.5yr6/1 ~ imsbk ~ - .2 .3 t CM...-a ~nwc~ n x ~ - ovv5~ JV ~ cw mgrs ana r s~ >3U < i au mg/t ' Efliuent #2 = BODS < 30 mglL and TSS <_30 mg/L CST Name (Please Print) Signature: ~lJ /~ CST Number Thomas J. Schmitt ~~s~r'~L°'~`~~!~w'''~ 227429 ~~ Schmitt Sol Testing, Inc. Date Evaluation Corxluc~ed Telephone Number 1595 72nd Street New Richmond, VVI 54017 8!292008 715-247-2941 sanaaw ~mrool - __ _ - -- -- _ -- - - ----- --- - - - Page3of 5' - - -- 't inducted by: - - - - Conducted For: - -- - _ - _ - Schmitt _ Soil. Testing .Inc... __ _ -- _ Name:.. _- _ _ -High-Capparrel Farm Inc. . Thomas_J. Schmitt,_CST 227429- _ _- - _ Address;- __- _-_ _359290th_St._ - _--_ _ ___ _ _ .-- _ _ 1595 72nd St. _ _ ___ . __- _ _-- .City, -State, Zip; _ _ _ .Wilson, WI.54027 _ - _ New Richmond, WI.54D 17 - ---- - Phone: 715-247-2941 Subd.Name: NA 40 Acre Pazcel -_ - - - _ _ _ -- Si~ature Lot No.: NA 359 290th St. -- - - -- - _ - -- - -- Hare ~ ~G~' Legal-Description: NE I %4 S W l /4 S 16 T28N Rl S W _ _- Backhoe_-if - _ - - --- - _ _ _ _ _- To - - - - p wnsh~p, County: Cady, St. Croix County S-Bench Mark El. 100.00' 'Fop of 2 foot concrete-manhole cover - - Alternate Bench Mark-EL- 98:67` top of vent pipe on-existing drain field Slope= 7°!o Contour line _EL X7.10'-- __ __-.Contour-Lme Length 90'- - _ _. ___ -- ~ /~l ~~ SEA yE~ir~~ p,~lo n ~,~ L cc,~ ?tor! v ~ ,~Y~,9,e~i ~~..~ -- - - - Scale 1" = 40' _ / ~or~~i ~!/J!~ o _ __ -- - - - - - ~S_ 3Q ~ ~o ~ ~U~,~ ~~ y~o, - - -- \-- - ~ ~ 63- ~ ~~ ~ ~ - ~ , \ ~ ~ ~ ~ ~~- $2 ~ ~'~ -_ _- ~~ ~uS ~" z/~r~~ _ - - _ J . ~ gl J~ Q~ ~ ~S'Op~rT`/ - _ ~ ~'~ ~ i \l~ - _ ~~~~- _- _ - - _ P~` -_ _ - _ -- -- o~~ - - - ~' G - - - -- - _ _ r~ - - __ __ -__ - - - - ~fE -- ___ `-1SC0/IS%h SOIL EVALUATION REPORT #1603 Department of Commerce in aaordance with Comm 85, Wis. Adm. Code Page 1 of S' Division of Safety and Buildings Schmitt Soil Testing, Inc. County Attach complete site plan on paper not less than 8%: 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 dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 1037-50-000 se pri n D R i d P a on you provide may be sect fa~ 6~Prive Law, s. 15.04 (1) (m)). ewe ~ D Pr Properly Location High Capparrel Farm Inc. Govt. Lot N 1/ , SW1/4, S16, T28N, R15W Properly Owner's Mailing Address Lot # Block # Subd. Name or CSM# 7951 12th Ave. S. ST. CROIX COUNTY na 40 Acre Parcel City State Zip Coa®NIhRb~iVufrber ^ City ^ village ~ Town Nearest Road Bloomington MN 55425 715-772-4415 Cady 290Th St. ^ New Construction ~~~ ^ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ^ Replacement ^ Public or commercial -Describe: .~----- Parent material Glaaal Drift (Santiago Series) Flood plain elevation, 'rf applicable na fl. General comments and recommendations: Area is suitable for a mound system. System elevation is 98.20' based off contour line established at 97.10'. Slope of area is 7%. Depth to limiting factor is 23". Boring # ^ Boring Pit Ground surface elev. 97.40 tt . Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EiF#2 1 0-5 10yr3/2 none sil 2mgr mfr a 2c,2vf .6 .8 2 5-12 10yr6/2 none sil 2fsbk mfr gw 2m,2vf .6 .8 3 12-23 10yr4/4 none sl 2msbk mfr gw 2f .6 1.0 4 23-31 7.5yr4/6 c2d 10yr6/6 l0yrfi/2 sl lmsbk mfr 9w ----- .4 .7 5 31-63 7.5yr4/4 m2d 10yr6/8 10yr5/3 ~ lmsbk mfi -- .2 .3 Boring # ~ Boring ® Pit Ground surface elev. 97.1 tt. Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/fl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 1 0-7 10yr3/2 none sil 2mgr mvfr cs 2c,2m .6 .8 2 7-15 10yr4/3 none sl 2fsbk mvfr gw im .6 1.0 3 15-23 10yr5/3 none sl 2fsbk mfr gw if .6 1.0 4 23-34 7.5yr4/6 m2d 10yr6/8 10yr6/2 ~ lmsbk mfr gw -- .4 .7 5 34-62 7.5yr4/4 m2d 7.5yr6/6 7.5yr6/1 ~ lmsbk mfi - ------ .2 .3 * Effluent #1 = BODS> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt .~~s~~~ 227429 Address Schmitt Soil Testing, Inc. / Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 8/29/2008 715-247-2941 SBD-8330 (807/00) 'Property Owner High t:apparrel Farm Inc. parcel ID # 004-1037-50-000 ~ Page 2 of S Boring # ~ Boring p~ Ground surface elev. 96.20 ft. Depth to limiting factor 25 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. •Ef~tt 'Effk2 1 0-5 10yr3/2 none sil 2mgr mvfr cs 2c,2m .6 .8 2 5-15 10yr6/2 none sil 2fsbk mvfr gw 2m,2f .6 .8 3 15-25 10yr4/4 none 51 lmsbk mfr gw if .4 .7 4 25-34 5yr4/4 ~2d 7.5yr6/8 7.5yr5/3 ~ Om mfi gw -- .2 .6 5 34-67 7.5yr4/4 m2d 7.5yr6/6 7 5 ~ 1 sd Om mfi - -- 0.0 0.0 ^ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 *Eff#2 ^ Boring # ~ Boring pfl Ground surface elev. ft. Depth to limiting factor 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. 'Eft#1 *Etf#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L 'Effluent #2 = BODS < 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.O7H10) Sd1111itI $dl 7ES~ilg~ LIC. . Paged of ~- Conducted by: Conducted For; ' Schmitt Soil Testing Inc. Name: High Capparrel Farm Inc. Thomas J. Schmitt, CST 227429 Address: 359 290th St. 1595 72nd St. City, State, Zip: Wilson, WI 54027 New Richmond, WI. 54017 Phone: 715-247-2941 SuUd.Name: NA 40 Acre Parcel secure ~ , .~~~-~ Lot No.: NA 359 290th St. ~~ ~ ~ a 1 ~~'~ Legal Description: NE I /4 S W l /4 S 16 T28N R 15 W ^ Backhoe pit Township, County: Cady, St. Croix County ~ Bench Mark El. 100.00' Top of 2 foot concrete manhole cover O Alternate Bench Mark E1.98.67' top of vent pipe on existing drain field Slope= 7% Corrtour 1me E1.97.10' Contour Line Length 90' .~ ~~ ~~ SSE ~E2/~L P~ ~ . a,~ L c~ T~o~ a ~' /1/~.9,~~~" 2~~~ c'a `~~ S~ Scale 1 " ~ 40' ~' C, / ~~.s~ 1,lNE >_ ~ ~~,~~ ST.. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address 7 9~~ ~~~J~ a~M~,,,~}Toni ~~/ ~S~/2 s Property Address ~~ 90 Ty S l ,, (Verification required from Planning & Zoning Department for new construction.) City/State ~(f~~~/ ~~iJ'~° _ Parcel Identification Number po ~i ~Q.3 7 - 50 •--D oO LEGAL DESCRIPTION Property Location ~'/4 , ~'/4 ,Sec. ~, T ~~N RW, Town of l'.4d ,~ Subdivision ~/`~ ,Lot # ~_. Certified Survey Map # ~/Q .4CR~ ~ ,PCB ~ ,Volume ,Page # Warranty Deed # 3 ~ 7 y.~ 9 ,Volume ~s y7 ,Page # ~ 33 Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms c ~2 ~ ~/~~ SIGNATURE O LICANT(S) DATI ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) rsac 111V1.~ r~r')• r~.ry~- ~`_':: -- 7 (j'~~ ' . _ '~Y~_1~~'~ " TY C~ s~,AGS A+r/yCalL!K:~~~a~!~"~! OA1A 1~~~ ~.!C7~1TtrpR _ t{fr= 3Qth ~ i?f~_ 1~@C!!.~}~'g~_..__, Ar 1~.~ ttl ~~ . _~~ -1i6.4+7'R ~ ' -;- '. `•t~[e P-["i`n 'Ca a)ad Ea Cher i4; . Ca tttsa _ e) ~ C ~•,~c ~~i .• - bei•oeea _____ _-_.~~ _~.__wt _ gR,,____~~ aa~d W°i.Ce_,__•~ - _ Ite+c'd~ lid _-h _ - __ _Y- _ _ ~~~~a OY *_1Ze tzl[5+2 p2[2 3A~ .^!~ ~-. s t~orpo tp ygp~~s~~ai~z~~ed snQqd~~~~tmcc.i~s/tiyng~~~ya~cl'~tr ya,~od,. fbg vsciticQo~f.~t6a l^aJws of tiye ~ "t"• tom' 44' ~!-iC.7.cCa '~J.i=int.S/1G._.JG_~44Ri_-i.`~~ui•~fi~_i/fiJS~_~1.~~? 1.1_ ~.~, ~ _-~ _ - - -_- -. `_ . _ _ }1~~, Pam! of the snood part. ° .ocr-~+ ro r~rf~c3_ J_ :r.K-t`.c:'l /-~-:ck 'Aitnrssttb, That the sitd pYrt_:i~_.. of th..e first part, for Pod in coasideat>os cf ~ =-acG Jim' ~.:e'~ ."(~"~ the sew oF~ Os~,_B.ul.lar._._L$'-Va~~BD'~.. o_ Ch~r_,t~ood anted va;.uable _ ark f`' ~/ ~oA ~'y to~__t~ _ io hood paid by the said parry of the second part, the receipt ~h ~f es Exe=e3p coate~ed abd .~~rl, - ha_¢e.~ given, Granted, bargained, sold, remised, r~ezsed, alined, conveyed uad coahrmtd, and ba t#xest-dsreseo~ do ~. - gi.~e, groat, bztgaiA, self; remises rdtsse, ateea, convey and cco.bim onto the said Dxd= of tlue ~~*d ~ar3, :t3 and _ assigns forever, irha f:olla~ying described real estate, citnat=e+d im-the ~otmty of_.__._.____-~1~.-O~ti'~..____~- -- :n.? S~sEe_ - of Wi ~=i4„ 'to-wit.: _ - - - the f3ortl~aeat f~iarter (td4i 1/4) ascent the 1?.aat TeTt (10) coda thereof' assd tb~ - F.sat I3a1f (E, 1/2) of the Soutlivest Quarter (StiF 1/4) and ttte 2torth Srvro snsi tTa~ta~~"Zd 1/~) ocean of ttte .ore sect etc ll~l) of the ~o~Clrvsrrt - Quarter CSt1 1/4), all, in Section 1b, Trnrna4tip x8 north, Range 1S West. - -- - ~~ ~_ SLb,',ecC to Jlig)iways and Eaaementa of. record.. - - ~~~ '- ~~~~~~ ~ ; c- ~f , ('[T' 2,`Df.)~aa.F.Y. CohTCh-[IlS 9Ii~C._.ICPTSO~ Q-V R.l'F-E~ES$ =rGnL) x X ?ogezhet witk+ akl sad singulae Ehe heredityu!a)~rnts sad aQpurtenanct_ thereuatu belonging qr it) Trap 1<+'iSe apperru~i~ng; - aad all the estate, right, tatle, interest, daiaa or demand. wl>Stsoever, c+f the said part...~P,~ of the first i.•as4, ttitlrse ~ ua ac eyc)iij. ~ either in posszssion ar espectaory of, in and to the above bargai~d prr~ises, and the%r hceditaraenr/ and app!uRtmar>et~ .- s ~ ,' _,_ ,. _ ..-. TB ,E[ape !~.~, co i•fotd t'.hr. saic_s-premises as above described +t~ith the hereditame3fs sad a}~put#+~uytljces, onto' tiher said '' - pulp of ttty seroa!d part, and to its successors and assigns IGORL-'VEFL. -~_ ~ - ` And the said ~tialctin__CapR~a)ati..EBtis~s__.~L.__~aP~,_.~itzabanri_a~n!a.~,rif~,._.-_.__..__...-...-~.9. _... r ~- for..thEmAelj[l~t.._Che.'..1:__. baits, ezecutors and administrators, da~._.-~ C4ReaAnt, ~tfint, bat-ga:ct ~d agpoe to sad nv.~( e= the said party of ~khe second pint, its saccesso:.s and assigns, that at the time of the nne~t:tsg and. deiivsrp of theme ~Sreaectts -S~BJL.arr~~__.. well sei2ed of the premise shave described, a~ of a gssod, sure, periett ~~o[tate end-iadefcasibs~ estafc ~ - of inheritance in the law, is fee simple, and that the same _e fs,:.• a_n~i dear fror_ta all i!nzumlxrannes 4rbstev~rr,x__.~..~:._...._ ~~ ._ sad that the above bargained premises is the guia:t and peaceful passess~na of tine said party of Ltse secaad pxtt,-its snectssata r= .- arld assigns, against al! sad e. -ry pecsoa or persons lawfuLy claiming the w5ole or aAy past thereof,w.,_,~At~~~.....__..-_.._-. will forever WARRANT ANf~ OFFEND. In Witness ti'r!lhertiwf, the saiS part..~e6_.. o[ the best pars h3~g._~.. heceuntp set_..:.._ H hand... arxd seat...-,.. ths..__.,~Oth.._~_._. day of...-~l2er~ta$~~_._-.....__..._.._._, A. D., 29__ 36.. ~ ~ 6:~'W' NED AND a1gdL$D t,H PRLBENCE aF _~.-.~.._ (Stslil.) iVlar t in Ca r .arha.r p ~_ l~iinntraata d.~__._ --- . Seate ofs~, County of .-__~M~EY ~ --• Personally came before me, this..._.._..30Lh......_.. day of......_•.._.._...__IleC,e3ober..._....____.._._____._ __.__.__._._, A. LS., t9... ~~, the above named ---.~Xt~.xt..St3pR---and__Fat1i~?F.__kSe..~~D-P.r.__~'-u~b~d_~a-~'-~,fe,•----...----•-•----.---.------..---•---.__._.... io me known to be the person.~_.. who executed the foregoing Instrument and acknowledF!ed~~JJ , z - e_ a, ~r -pa Sa anjo THiS IN6•tRUMENT WAS D!:AFTED BV Dohest;., Rumble Fa Butler oTaRr gamey Minn. I~otac Public, ~x E-1500 First National Bank Bldg. e>:;af. Y ....__....__.. ............................•_-----...-;;~,t~tR,C~ , t Paa1. MinneBOta 55201 M comcr:ssion jez s j Sain 9 P• -MA~'k:t7+1-•SA13/4Wa-.._a_ _~~ _ tt(ST•~Iti"' FRBGIt~-RtR>•fSOTRz _._ (.Seetioe 1y.37 (I) o/ the Wsconsin Saru~es Prwidu :hoc a!1 inswm rrs tq be aarded aha)1~ 1 nes$ rn~LUty - • the came of the 8nrttats, t~rEspPltd~iin~~ - araotty. ,vir.nmes end rtotc[y. $ectioo 59-. ~) s:milarl7 feCa'res t6 ttie ame mrntal agency which, dcaRed such instrumrnt, shall be Printed, rypewrrtteo, -tamped or ~nittc~eneseoo ia.--m eg~o~e mames.y f3T'A'EE OF Sr[BCOFBTF IrVN~Nw.'VVMN/V~ft~l~~~ to VCama~s -~ {AASSd27'l'Y DEED - To Co~sotrt)"oo TO$3i tio. 4 ~ MnwauYee. ~gYtai, !Job !1688 ) - ~ Parcel #: 004-1037-50-000 09/30/2008 09:01 AM PAGE 1 OF 1 Alt. Parcel #: 16.28.15.251 004 -TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O-CAPP INDUSTRIES INC, HIGH CAPPARREL FARM INC HIGH CAPPARREL FARM INC CAPP INDUSTRIES INC 7951 12TH AVE S BLOOMINGTON MN 55425 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 361 290TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 16 T28N R15W 40A NE SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-28N-15W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 449/442 12/30/1976 337439 547/233 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 03/31/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 225,800 253,800 NO AGRICULTURAL G4 10.000 1,600 0 1,600 NO AGRICULTURAL FOREST G5M 28.000 42,000 0 42,000 NO Totals for 2008: General Property 40.000 71,600 225,800 297,400 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 71,700 225,800 297,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00