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008-1050-30-000
Wisconsin Department of Co~fnerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Rohl, Dan Eau Galle, Town of ;ST BM Elev: Insp. BM Elev: BM Description: /~i 13~c`n ~ CS ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ C~.1 ~~~~- ~ZSG Dosing [J' ~,. .~ ~~. ~ ~ , ~~ Aekttirnt ~ ~~, G~ ~ Z Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~:~ , c7t~ ` z t I ~ I .~ Dosing ~~ / ~1~, ~~ ~ (' Aeration Holding PUMP/SIPHON INFORMATION ~ Manufacturer °-7' ~ t r e~_ GPM nd Model Number G / . \ \~ ~Cf, ~~ TDH Lift . ~ Friction Loss! J System Head TDH~1~ ~t "~ Forcemain Length Dia. Dist. to wets S(~II ARSnRPTInN SYSTEM ELEVATION DATA County: i St. CrOIX Sanitary Permit No: 463463 0 State Plan ID No'. Parcel Tax No: 008-1050-30-000 Section/Town/Range/Map No: 17.28.16.257 STATION BS Z.G HI /C~~ FS ELEV. /G?~ Benchmark 5.4`1 ~OS•4-1 / cse 1i AI rM ~•,JK~C~b-~i ~ gyp. ~V / /' 1 Bldg. ewer ~, ~~'~.7 E~.Z~ SUHt Inlet ~' ~~ qv ~, 7. ~ SUHt Outlet 1~• ~ ~y ~. / 5 Dt Inlet ~, ' ,7 ~~ Dt Bottom ~ Zd ~~1 ,~ Header/Man. ~ ~ ~ 3u r Dist. Pipe Bot. System J. ~~ `~lt..`l Z. Final Grade ~, st Cover F'~. J.~ ~. /D z7 ~ 3 ~, ~ -~, ~. rl ~~ ~~. 1~:~14 ~3 .~S BED/TRENCH DIMENSIONS Width ~ ~ Length ~ / ~~f No. Of Trenc s ~ ~C. PIT DIMENSIONS ~ No. Of Pits ~ Inside Dia. - Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: i CHAMBER OR ~ INFORMATION Type Of System: ,~//l o ~> ~ < 4:~ < 33G ~ 44'~ /V UNIT Model Number: '~ I~ISTRIRl1TInN SYSTEM Header/Manifold ' Distribution C~, r t 1 I x Hole Size 1 j x Hole Spacing , Ve.~Sto Air Intake Dia ~ /Z' Length ~' ~ L Spacing ~ Length ~' ~` Dia f $ ~ ~ `~ ~ S(lll Cf~VFR „ ~~e~~„re c.,~4nmo n.,i., ,.v Mnnnri (1r At_r~rarla Svctams ~nlv Depth Over j Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center ~ `~ 7 Bed/Trench Edges ` Topsoil 1 ~ Yes i No No J ak /.5~ , COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / z / dJ Inspection #2: / / Location: 349 220th Street Woodville, WI 5402 (NW 1/4 SW 1/4 17 T28N R16W) 40 acres Lot ~ t ~ rcel No: 17.28.16.257 ~~- ~~ ~~o ~ P~6 1.) Alt BM Description = r1 2.) Bldg sewer length = ,Z ~ , 1.11~c:,~,r~-'S ~' OW Q ~~.. - amount of cover = ~ ~ ~4,k,~ ~ ~ Plan revision Required? ~ Yes ~ No I~ ~-7 ~!a (~ `~~~7~ Use other side for additional information. /_ ~ ~ ~ - Date Insepct is Signatu Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County = t ~ 201 W. Washington Ave., P.O. Box 7162 St. Croix ~scons~n Madison, wl 53707 - 7162 be filled in by Co.) Sani~ry pest Number ( (608) 266-3151 _ 3 ~ (,/ Z Department of Commerce l ~ , Sanitary Permit Applicatio smote P>an I.2 3 . Tom. ,~ In accord with Comm 83.21, Wis. Adm. Code, personal i~'ormati ~ Address (if different than mailing address) may be used for secondary purposes Privacy Law, s15.04( xm) /' 1: Application Information -Please Print All Information 5 C 3''~ 220` Street 1 / Property Owner's Name P # Lot # Blcek # IXCO Na Na 008 050- i Dan Rohl gT.CRO CE ~ ~ Property Owner's Mailing Address Property Location 1900 110i AVe. Gov't lot . NW'/s. SW'/~ Section 17 , City, State Zip Cock Phone Number (circle one) Baldwin, WI 54002 (715) 684-4098 T 28 N; R 16 E or W IL Type of Building (check all that apply) - / () ~ ~~~` _ ^ Xl or 2 Faatily Dwelling -Number of Bedrooms 4 _-C~C ~e GSI-I-Nmnbet-~ ^ Public/Commercial -Describe Use ..V~"`""'~'~ ~ • d Z dl.~t/1Ad ^ State Owned -Describe Use ity ^ Village ^Township of Eau Galle lIL Type of Permit: (Check only one bog on line A. Complete line B if applicable) ~ -~ `~' ^XIVew System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~ tt t 1 1V. of POWTS S stem: Check all that a 1 K z0 ~ ^ Non -Pressurized Tn-Ground ^ Mound > 24 in of suitable sot Mound < 24 in. of suitable soil ^ At-('trade ^ Single Pass Sand Fiher ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Fiher ^ Aerobic Treatment Unit ^ Recircalatiog Sand Filter ^ Recirculating Synthetic Media Fiher ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Iles rsal/Treatment Area Information: 30 11" Standard Bio-Diffusers at 31.1 . ft. EISA/chanlber = 9 3.00 . ft. ELSA Design Flow (gpd) Design Soil Application Rate(gpdsf) Area Required (sf) 'spersal Area Proposed (sf) ystem Elevation 600 gpd 1.Ogpd/sq.ft ASTM C-33 sand 600.00 sq ft 600.00 sq ft EISA 96.42' @ 23" above 94.50' contour 0.4 .ft native soil VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ,~Q ~ _ ~ (~ Concrete Co~truded Glass New Existing Tanks Tanks ~ Septic or Holding Tack (~p 1,250 1 Wieser Concrete X Aerobic Treatment Unit vosingChamber 1,000 1,000 1 Wieser Concrete X VII. Responsibility Statement- I, the ~dersigtted, respomibiHty for Installation of the POWTS sho~nt on the attached plans. Phunber's Name (Print) Si MP/MPRS Number Business Phone Number Mike McDonell MP #225036 612 865-1927 Plurober's Address (Strad, City, State, Zip Code) 1070 Hunter Rid a Road, Hudson, WI 54016 VIII. Coon /De artment Use Onl Approved ^ Sanitary Permit Fee lodes Groundwater Date Issued ing Signatut ) Surcharge Fee) .~ - ~ ^ en Reason "al ~ ~ ~ IIf. Conditions Approv 1 SYSTEM OWNER: 1 Septic tank, effluent hiler and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances, Attach rnmplete pkcn (to the County only) ror Ute system on paper not leas than 812 : it inches in size ~ 1 ~ nea ~ `efr~~0~e~/~y/:..e • Ex:~-~ ~.~~ e-ev~A T. a,~' ~a.a CaG~~ SSE. C~ ix Coy u~/. :~ ~~~ ,~r'ao(t 4~ bu.;lcln S•tC • Pro~s~u,~e.t/ lsca~o.~ _ ._ P~oPos.~d ~! b edreon+ R~s~dence. ~`sc4•s/0 P. d. C. bui I~linq ~owar ~lZ:std VJ;¢ser ('yncra~,e w~p ~~,me:s~;~~~~ k7/ ~1t(7t ~~'/A9t P~/keA~ - 2" Sc~C. ~0 P, d. c, ~arcen~a;n P~oFwsttl c.vrese,~C~rr~cr'e~ -.'c.~~P~an-.,,,ePk..,p Ci~aM6cr. x ~ ~ ~ ~ a. o~ ~ ~. a ~. ,, ~ ~~ ,,. `. a ~` ~ ~ a `~ ` ~ •, ~ : ~~ `` `~` Ppe. Elegy: _ 93,80.' PrOP03~ Mound 0.~3a~~~ ~Lf!/3~ t.~S;r /20~di3~.f~t/Ce/~ Fe'ur(~!J '~ ~+sGibctio.~ /aze~a~(s a..~ /yi;rs9,u' ~ ~~ _ !• ~`\ ` ~~ ~` ~~\ ~ ~~ a ~ 1 .`~~ ~ JC~~~ ~ ~~ ` - _.. ___ _._ ,_ ~ . ~~ a ,• a, ~ ~ _ `~ \ ~ ~ ~ ~ ~ ~' r ~~ T- of a~ O 4 .. ~ _ AssaMe~ e ~~~/' ~.e~~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 02, 2005 CUST ID No.225036 MICHAEL P MC DONELL 1070 HUNTER RIDGE RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/02/2007 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1132733 SITE• Site ID No. 697663 Dan Rohl Please refer to both identification numbers, Town of Eau Galle above, in all comes ondence with the aQenc . St Croix County NE1/4, SW1/4, S17, T28N, R16W FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1015739 Maintenance required; 450 GPD Flow rate; 13 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1); 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 "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are 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. • 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 ~,PP~ SEE C • 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. MICHAEL P MC DONELL Page 2 5/2/2005 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 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. • 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 maybe 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, ,/~ .~- Charles L Bratz ~ POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 James K Thompson qc~ ~ ~;,~ ~~ ~`~ 2s MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIG mops, Residential Application ~~ INDEX AND TITLE PAGE ~'t~' Project Name: Dan Rohl - 4 bedroom residential mound Owner's Name: Dan Rohl Owner's Address: 1900 11th Ave. Baldwin, WI 54002 Parcel Address: Pending Legal Description: NE1/4 SW1/4, Sec. 17, T.28N., R. 16 W. Township: Eau Galle County: St.Croix Subdivision Name: Na F Lot Number. Block Number. Parcel I.D. Number. 008-1050-30-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry ~iO.~nll Page 3 Mound drawings y ~ ~~~ Page 4 Lateral and dose tank ~ ~ Page 5 System maintenance specifications i of co,~ ~9ERCS Page 6 Management and contingency plan TEy Q~vcs Page 7 Pump curve and specifications l Page 8 Site Plan ~SPOND~NC Page 9 Soil Evaluation Report Designer: Mike McDonell License Number: 225036 Date: 04/19/05 Phone Number: (612) 865-1927 c Signature: ~ .c/~( Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01!81) Version 4.01 (R. 09/04) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet I Z ~~ /~ ~s3 Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of <= 36 inches. 600.00 Design Flow (gpd) 12.50 Site Slope (°k) 94.50 Contour Line Elevation (ft) 13.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distributio n Cell Information 120.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 7 Influent Wastewater Quality (1 or 2) Are the laterals the highest int in the distribution Y Pressure Disribution Information network? Enter Y or N (c ore) c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation ft) 4 Number of Laterals of the highest point. 390.00 Forcemain Length (ft) Does the forcemain drain back? Y 62.00 Pump Tank Elevation (ft) Enter Y or N 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 6.25 ft2/orifice 2.00 Forcemain Diameter (in) 6.50 System Head (ft) x 1.3 Vertical Lift (ft) 12.60 ,~rictioft Loss (ft) Total Dynamic Head (ft) Project: Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 x 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1200.00 Se tic Tank Capacity (gal) Wieser Concrete Manufacturer Dose Tank Information 1001.88 Dose Tank Capacity (gal) 27.83 Dose Tank Volume (gal/in) Wieser Concrete Manufacturer Dan Rohl - 4 bedroom residential mound 63.62 Forcemain Drainback (gal) 108.67 5x Void Volume (gal) 172.29 Minimum Dose Volume (gal) 39.54 System Demand (gpm) Manifold Diameter Selection in. dia. o tions choice 1.25 x 1.50 x x 2.00 x 3.00 Gallons/Inch Calculator (optional) 1001.88 Total Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) 27.83 gal/in (enter result in cell 649) Effluent Filter Information Zabel Filter Manufacturer A100 Filter Model Number Page 2 of 9 Mound Plan View 1_ 1/10 B • • observation Pipe '~' :~.'~.*' K , ~.1•~.1.~:t.ti.•,.~..•.~,~.~:...•,.1.ti.ti.ti.ti.ti.ti,ti..,.ti.ti.ti.ti.ti. •••.~: . . r, j,~ , •., f,•.,~ , f, •.. f,.,,.,r, •., ,r,r•r• f,••. f.r. ,••.,r. ~~ •. L J'~•. ti 5~•'.•ti,• :~`.~'.•' S '.•ti•ti~•.~•.•1~ti•5~•5~•'.•1•ti• ti•ti' ~ti '.L '•. ti'.titi'. ~.ti.`. ~'. '. tiS~Lti'. S'.ti•L 5~ti•`.: j.r:?:'rS...:j..r.•.:'r :...............:.':•if:~fifi~::~:',~: f: 'r._'ri:•._'.~. '••: '; ~.j: r:. - B i-U T I L Mound Component Dimensions A 5.00 ft E 30.50 in B 120.00 ft F 9.50 i n D 23.00 in G 0.50 ft 600.00 (ft2) Dispersal Cell Area 5.00 (gpd/ft) Linear Loading Rate H 1.00 ft z 18.40 ft J 7.00 ft -T .} -~ -Y K 12.06 ft L 144.13 ft W 30.40 ft 2808.00 (ft2) Basal Area Available 12.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.21 (ft) - ,,,rr r, . • H ~ ..rrrrriiir 2 rrrriir G •j rririr I F ::: ; ~ ......... 96.92 (ft) L Dispersal~Cell ateral 96.42 (ft)-~ - Invert Dispersal Cell ~ ~ ~ .D ~' ~ ~ t .. .. Elevation E . ~ ~ ~ . ...• ....• .....~ .....~ ...... u ....... ....... , Shading Key _ Topsoil Cap rrrr Subsoil Cap • ~ • ASTM C33 Sand Tilled Layer OS ~:: tirti Aggregate 12.5 % Site Slope ~ a o = 1.5 ft ~ ~ v~ 0 0 -i- Dispersal Cell l•r•r•,r•,r• j.t•'r • •' • . .ti • . , .• . ti,y ~ti (y t• t ;'M1f ti' ti' ~"••~ f ' ~'~ •~j ti'ti •ti • ' •%'rtir F ypical Lateral ~ ti r • •r~ _ y~~'tii i i ' ~i i ; ~ ~rti' ~'' ~'' ti' ~'?ti' ~'' :fi c l'. ....•f....r_ A -~ 50 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Dan Rohl - 4 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or oross to manifold at any point. I P •=Turn-up wf ball valve or IE X-jIEx12 I x!2 jl al ea nout pl u g Holes drifted on the bottom of the IateraL Laterals are identical Laterals & foroe main of PYC Sch 40 per COMM Table 84.30-5 s ,,L Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing i;)C) 2.52 ft Lateral Length (P) 59.22 ft Orifices per Lateral 24 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft2/orifice Lateral Flow Rate 9.89 gpm Manifold Length 2.50 ft System Flow Rate 39.54 gpm Manifold Diameter 1.50 in Total Dynamic Head 53.02 ft Forcemain Velocity 4.04 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ~ Comm 16.28 WAC ~ 4 in. min. Dis~ect `_ Tank component is properly vented Wieser Concrete Ca acit 1001.88 Volume 27.83 Manufacturer Gallons gal/inch Dimension Inches Gallons A 15.81 439.97 B 2.00 55.66 C 6.19 172.29 D 12.00 333.96 Total 36.00 1001.88 3" Bedding er tank. Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number BN 165 ~- Pump Must Deliver 39.54 gpm at 53.02 ft TDH ~- A B C D F- Alternate otrtlet location Forcemain diameter ~ 2 in. Weep hole or aMi- siphon device P, ump off elevation (ft) ~--`- 63.00 Dose tank elevation (ft) 62.00 Project: Dan Rohl - 4 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Mike McDonell Phone 612-865-1927 POWTS Regulator's Name St. Croix Count Zonin Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 800 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauencv Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for ondin and see a e once eve 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • ............. ............... Grade &8" Diameter Lawn ~ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Dan Rohl - 4 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules peRaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Famed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by Inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to main solids in the tank that may sough off the filter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge fkm~s or an impending continuous charm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid voume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation In the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shag be approved for septic tank use by the Department of Commerce. Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank tt shall be inspected and serviced as necessary. (Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded aril mulched as necessary to prevent erosxm and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cokl weather installations (October-February) dictate that the mound be heavily muk:hed as protection from freezing. Infhrent quality into the mound system may not exceed 220 mg/L BOD5,150 mglL TSS, and 30 mglL FOG for septic tank effluent or 30 mg/L BODS, 30 mglL TSS, 10 mglL FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing pant at the end of each lateral, and it is recormended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed tt should be compared to the inttial test when the system was installed to determine if orifice dogging has occurred and if orifice Leaning is required to maintain equal distributon wittmin the dispersal cell. Observ~icn pipes within the dispersal cell shall be checked for effluent porxting. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requmng additional, more frequent monitoring. Continaencv Plan If the septic tank or any of its componenrts become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump contras, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced wtth a component of the same or equal performance. N the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, tt will be repaired or replaced in its' present kx~tion by increasing basal area if tce leakage occurs or by removing biologically ologged absorption and dispersal media, and related piping, and replxing said ccemponents as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Dan Rohl - 4 bedroom residential mound Page 6 of 9 ~ nea ~e~~/O~grk~y/:..e •Fx:s~~~rndi eleda~aY, 5 c.a./e: / = s/0 .Lan 1P~/ /"~i~x+'~y Y/Ey~swys~ Sec.. /y 7, a{' Ea.k CaGC~ ~F~.e.oiXCn; ~~ _~ s ~ ~°. K `. ~, a. •, ~° y: ,,: `. ` ~ .~ a © `~~ ~•• ~ ,~ sed u.)e.ll Prgposccl c.Jreser~cre~ Ci,ambcr. :~ s 3 . . _. ~, e ~'9 ~ of 4~ `• ^ ® ~ i4SSccned ¢f~v' i ao. ro: ~I ~~ f~~ti ~~a~r Q~ =71 • ~tJ.~ P~oPo~.d ~! b eck'aam -2es~ der, ce. bui l~ln~ ~ ower w/ ~1tbe l.4-rte. e#'/aan~ - 2~ s~• ~o Pd. c. ~cema,~n P p~e. El¢~` = 93,80.' Pr'Op03~ Mound 0.E3at~~~f /'fl-.y/3~ 1 'USX iso'd.spcrsal ce/% Feu~(~~ 3 ~\ adstribufierl /a~•era~Cs a.~ /yj.`x59,u' '_.. ~~ ~, ~ ~f " Ori ~~GCS Spa tCa~Q.~ ~.5~,• ~ ! ~~ ~` ~` ~~ ` ~~~~ ~~ ~~ . `` ~` aJ , ~ \ ` ` ` ` ~ ~ . ~ ~i ~ •• ~ ~ ~ ` ~" Page ~ of 3 ' , tMSrrnnsm peParanent of Comtnerre SOIL EVALUATION REPORT • in accordance with Comm 85, Wis. Alin. Code , DhAslon of Safeb and 6u(Idings COUnty C'T . °L~ ~k ~ attach cpmplete 51te plan On paper not less Ulan 8 112 x 11 inches in 51xa. Plan must Jd ~ ` `~ S 0 - 3Q include, but not lirnitod to: vsrllcal and hortzoni~ai reference Point (e ~tan~~o e~~t road. P~Cei I D• Date percent SbRe, sr.9~lo or dimensions, north arrow, 8nd IC ,~,~,- ; ~ r • ReV;ewed by Please prir)t all !n t de may ee usemtor p~~~~~a~ ~'"• 5• tiS,cs (t) (M)3~ . personol inlormatlon you p~ ~ proPp{y (,.pCeti0n property gwner (~ ~,.~E~'•1~ a.' •' tJ E' era S ~J ~!a s t'1. T Z$ N R : ! 6 to (or w Se`!!~ 5~'R-.~'oY ~-0 Q v ETT ~,a .'.! tot ~ ' 6iock # Subd. Name or CSM# Property pYyngYs MtailinQ AddreSS ! t:.. /•'4 rST CiiOtX {~O7 ; .~ .--` Z ~3 ~{ CA~`C`~ ~'~ ~~:, sty ^ V~lage ®Town Nearest Road ~y tae zip a ,. phone ~p3~~ ~ ~ P,ti~ 2`Ll~ 7L•} ST• gp~~DWtrv wi, s~.nUZ ~t ~~.1~ -.:5~'f- .3cy , ` ' Row rate 00 GPD Code delved design . (~ New Construction Use: ® Residentlel /Number 0 ~•Replacern9nt ^ Pubtia Or ~mertial - Descrn~e~ ~ p ft .• ~ ~~ fsf1.. T,,,tL ~ Flood Plain akvation If applicable Parentmsterlal r _ _ _ _ _ --- _ t3eneret comments- - - MOUhJD W f 6~ ~~C l0 iJ ~ Ca L~1~ZL $U 1Z C)h,J C-•~t.~-, and n;cottlmendetiorts: 1M tn,l l,wt,ul4t Z4 Y 41= sf°t'JI.Q 1~=1C.L. , ~n~~OVtZ ~'V. ~. tL. S ' eortttp q, ~ , ~ ~~ ~ ~ around sutfaoe elev. ft- Depth to Iimllir-g fdCtOr L ~ ~, gpil gpAl'~cation Rs1 AR GPD/ft= th pominant Colo Redox DeSaiPti~ Texture 5truetwe Consistence Boundary Roofs ~Eft#1 •8~#2 Horizon ~ Gr. St:- 6h. in. Mur~sell qu. Sz. Cont. Color CS 1~ . ~ g ~ 0-1'3 LG~I.CL3t ~ s ~ ~ Z`Q-Sb~'t ~^~`~r T . ~o z. t~ ~tq Lo~-~t2 3!L ~ L~ 1 z`~`s b k wi..`f't- ~ 1 v-~ • y .~ 1~1-3~ -~SyRyI Cla . I C. 1 f3ortng M t~t~ 8~ GrDUnd surFace elev- .~ Z • 0 R R Depth to Gmitinq factor. ~ ~ Ire gds Appli GPO on fi lits ~ - ~ la9 Depth DaNrtanc Color Redox pescription i Texture 5tfuCture Consistence t3oundaiY Roots •EfRt1 'affil! a0n Hor Qu. Sx. Cant Color m. Munsait s i i Gr. 3z 8h. Z'~bk ~~ tn-~' `~ , ~ ~ o..~ iOyR..3~ ~ bk c~ ~~ tv'F- -s ,4 Z L-L~f LO`'GR~~ ~ `3L1 Z .. 1/2 `Fl ~ .v .0 '~.S ~Gi~ SAS ~ 1~1-3I7.5'ZI?~~ ~, ~ " . • effluent M1 = t30D~ > 30 a 22Q mylt and TSS >30 a 150 nt9lt fur'e 3T Nartte (Please Pdrtq ~~ ~,rthur L. WeRerer ~Sdegerer Sail resting & resign Service 421 i~. Bain St. River Falls, (JI 54022 ~ q{fYsent ~2 = BODs < 30 m0lt and TSS _< ~ ~ CST Number 4t-~3~ 220254 Eiraluatton ndueted TeleAhone Number {~ ~Z~O a 715-1i25-x165 04/21!05 THU 08:17 FAQ 715 386 4686 ~ - ~ , Parcel lD ~ ~ o~- L o S o- 30 P-rop^ert~~, owner F2L~ ~ l..l I ~ I Boring # ^ 8orlnq 1 ~ 1n• f Q~ Pa GrpUnd sur}aG9 eleV, ~ ~~ ~ ~ Depth to Ilrnitlnp tactaf ~-.- liprizon Dvplh In. Dominant Cd Munsell RedOx Dasarlptlon t]u. Sx. Cont. Odor ~ p _~ I.DKR ~ L - Z. $-L3 ~OY.2.~lb 3 1~ 2tf -~.3YlzKly .,~1~ ~•S~L IzSLB Boring >f ~ Bonne Pit ~ Ground surface efe~ Horison Deplh In. pomin tenon Cgtor Munatt Redox C c~u• ~• ' SL Si.t cr ~ tcftN~ont M1 ~ BOCie > 30 {220 nip~t-and 7SS a3t? c 1 BO mp1L ' EAluent #2 = $OGs < 30 mQIL and TS8 ~ 3$ mplL 'Phe Departmeat of Comntetce is as equal opportunity service provider and esnpbyar. If you need assistance to access services a need material in ^n alternate format, please contact the department at 608.256.31 S 1 or'C'IY 608-264-8777. . swu>.fR~ ~~. Z of 3 ~'7 n t~orlna r f Scale 1'-~10 ~if~ ~ ~LW -0,~ ~ ~'1~~-114 ~~D1 ~r A VC ~~L~~' ~f .L~r` ~~' ...- i~ pp p N y ~ I _.-.-~ C 3 90 ,'y\\ $f1 ~ \ g~ jv 9.3 \ \ . -- • --- -- -- ~ -tn rv~r C-~.P \ ~ tST~ 4~ 'ft1'L S !t'iZ~L"A . / ~ ~~ ~ \ \ ~ i ~ o r6- \ P • . .z~> ° ~a e.V ~ 9 swt ~i 6 eo7-~o+n u~ ~-et-c. ~-ev. q6.s ' l + Ln e~t"Skk~J S ~~ ~ . ~'~-tooo' 30'i'~I- RuE ,~~y( G-b~r CST Signature Date ~ 715-425-0165 220254 01-~~ Telephone tTo . CST Aio . Job N0. Wis;.onsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Y Divisior; of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ST • ~°, ~ `~ inGude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D . . ~ percent slope, scale or dimensions, north arrow, and to istance to nearest road. 0 8 _ `~ S O - 30 Please print all in t ~2~. ` ' ; , Revi ed by Date Personal information you provide may be usetifor purpose rivacy Law, s. 5.04 (1) (m)). ~,` ~l ')jam Property Owner ~.~ ~ C~'; vi Property Location "W ~ Rl~~.l~~ ~'~ Q V ~T~(i ..~~ 6evt-Fi.ot ti1E 1/4 5 W 1/4 S 1.~ T z~+ N R ; L (~ E (or W Property Owners Mailing Address y c.`` ` N _ ~~~' Lot # ! , _ Block # Subd. Name or CSM# Z t3 ~ covti~c `ZD ~- ST cFiax , _ City State Zip Code one G OFFICE ~ ity ^ Village ®Town Nearest Road Bt~c~-DWlrv w~ s~l~nZ ~ ?~~~~,6~~f_33 ~ GP;~.L ZZo ~n.-t Sr. New Construction Use: ® Residential / Number o Code derived design flow rate 6 ~ 0 GPD ~teplacement ^ Public or commercial -Describe: Parent material tJ L.P~ct°.l,Prt... T~I.L Flood Plain elevation if applicable >Ula ft, General comments and recommendations: M~Uri~ 11.11 6 `k L p p' p LS'~ZL 8U~ CytiJ CAL, 4`.-1 1IU L N1, V Mil Z ~ Y O)= Sf1-~ 1 ~l L L , ~hv~Ov2. ~Z~'V _ q ~ 5 ' Boring # ^ Boring ~~~ J~ tl•0 1 ~ pit Ground surface elev. ~ 8 • $ ft. Depth to limiting factor _~ ~c Rat "'" Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots • wr.~ e GPD/ft2 , in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~ o - i3 1 G-~ 2.3 ~ ~ ~ s ~ I Z`~S b-2 w-,~1-- CS 1`~ • S . $ z t3 _t9 lok2 31.6 - s t.c~ z~ b k --n..•ft- e 1 v~ • ~I . ~ 3 lq-3~ ~-S`~(ZYl C~~ ~ .S ~-t2S~$ e ~ O~ )vi `~ _ , p ,~ Boring # I^~ Boring Z I~1 pit Ground surface elev. ~ Z • 0 ft. Depth to limiting factor 1 y in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color r . z. Sh. G S •Eff#1 •Eff#2 1 ( O-~ 10y1Z31 -~ rf S1.1 ( ~1 µ ~ ~ \J~~ '•,,~}/-~~, Y,LI /' `~ 1 l~ ~~ ~~ Z $-~~ I,O`2R-4~~ -- sil Z,'~Sbk +~2'~{-- e-S l.v'F •s -F 3 ~~-31 ~.S`~V2-~~~ 'P~t.~ ~?,5~2 Slg cl o~,., -+ti~- - -c~ . o 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ,/Sign lure CST Number Arthur L. tdegerer oC. ~ ~- ~3'~ 220254 Address 4d e g e r e r S o i l Testing & Design S e r v i c e Dace Evaluation Conducted Telephone Number 421 i~. I~iain St. River r'alls, IdI 54022 6 -Z-O1 715-4.25-0165 ~' ~~ .~ ,~O r ti Property, Owner _ _ R~ ~ V ~rT'L Parcel ID # ~ ~ ~ - ~ d S ~ - 3 Boring # ^ Boring ® p;( Ground surface elev. ~ ~- ~ ft. Depth to Iimitlnn fartnr ~. 3 ' ! . ` ~ Page Z of Horizon Depth Dominant Color Redox Description Texture Structure -T Consistence _ Boundary Roots Sofl Application Rate GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0 -~' ~~ ~2 3 L - s c j Z`~'~b w~.`F1- cs 1 ~ . S - $ Z $-~3 10`C23lb - s L e.l Z.`~~ b-z M ~,,. es tV'(L • 4 . b 3 l3 2~ Z-SY24~ly ~-1~ ~.S'-L 2 SL8 Cj Or, vVt,`~.. - . p ~ p ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to Iimitlnn fartnr t., Horizon Depth Dominant Color ~~ Redox Description Texture Structure Consistence Boundary Roots Soil Appliption Rate GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ,. ^ Boring # ^ Boring ~~. ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant'Cobr Redox Description Texture Structure Consistence Boundary Roots ~ GPD/it2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/I. ' Effluent #2 = BOD, < 30 rr~/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-t370 (R6/00) ,~ ~~ a 3 Paae 3 of 3 _____ r--- CST Signature Date PLOT PLAPd ' Scale 1'=y0' ~0 /,~ $.~ r+--z - :5 • ~ ,~ ' ~ g~ ~~. ~ \ ' ~ ~,~ ~o o r~ u r C~J~ P ~-e-T ~ }z ~~ \ ~~ ~ ~ ~° ~ G ~ O i~6' \ \ 4 a.z~5~ G i 0 N N~ 3~ B•1 e 3rd t~l ~~ L~ e~~ s ~ti9 ~`~=~ooo G_b-c co~rtp~,Q ~V, q~_S. 3o~ow1 u~ e~~ rev. q6•S ' 30 n~ AUK, 715-425-0165 220254 O1_ X33 Telephone ATo. CST Alo. Job PTO. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/L~tu ~ n; 2 ~ /`Co~E Mailing Address J9G?~ /~ ~ ye ~F~e,~Y~/in GJ/, SS/G~~- . / Property Address Ciry/State 3 Y9 i~-~ ~ (Verification required from Planning Department for new construction.) ~ Parcel Identification Number 00~~ /OS-d'~~'~~ ~• 25~'} LEGAL DESCRIPTION ~/ r ~/ Property Location ~ ~~ '/< , S~ '/< ,Sec. ~, T ~0 N R ~G W, Town of G~ ~c ~ ~K~i Subdivision /7~ ,Lot # ~. Certified Survey Map # ~Q ,Volume ~_ ,Page # ~_ Warranty Deed # ___(0 9~~~ ,Volume 3 ,Page # 30 Spec house ^ y~ Q'~io ~~` '~ Lot lines identifiable ~s ^ no ~~+~[ SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted phunber or a licensed pumper verifying that (I) 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 I/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 W isconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoninb ent within 30 days o e three year expiration date. ~/ /?L/_~ x SIGNA E OF APPLICANT ~ DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the rty described above, b irtue of a arranty deed recorded in Register of Deeds Office. y SIGNATURE OF APPLICANT DATE ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Departrnent. ****** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map i1' reference is made in the warranty deed. 'J 1983P 30~ a ~ ~ navlT Or CORRECTION (TYPE OR PRINT CLEARLY IN BLACK OR RED INK) AFF[ANT, Ann E. Mor 1 eY , Itcreby swears or aftit~tts that a certain document recorded on the 19th day of ~p42 (year) in volume 1952 page 14 , as document number 687463 which was recorded in St o ix County, State of Wisconsin, contained the following error (if more space is needed, please attach addendum): 69 i mss KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09-19-2002 1:45 PM CORRECTIVE AF'i:IfiAVIT EXEI9PT tl REC FEE: 13.00 TRANS FEE: COPY FEE: CERT COPY FEE: PAGES: 2 See Attached Warranty Deed AFFIANT makes this Affidavit for the purpose of correcting the above document as follows (if more space is needed, please attach addendum): Northeast Quarter of the Southwest Quarter (NE 1/4 of SW 1/4) IXCEPT the West 2 rods of the South 78 rods thereof; AND the North 2 rods of the NortYwvest Quarter of the Southwest Quarter (NVY 1/4 of SW 1/4) Name and Return Address RETURN TO: TITLE ONE 706 19TH STREET SOUTH HUDSON, WI 54016 008-1050-30-000 Parcel Identification Number (PIN) As in Section 17, Township 28 North, Range 16 West, Town of Eau Gal le AFFIANT is the (check one): ^ Drafter of the document being corrected. ^ Owner of the property described in the document being corrected. ]!Sl Other (explain: Ti t I e Corrriany ) The original document (in part or whole) 24 is ^ is not attached to this description and names of grantors and grantees). Kay V. Palm / Notary Public Sigt,ed: (i State of Wisconsin Ann (if original document fs not aliaclted, please attach legal State of Wisconsin ) ss. County of S t . Croix ) Subscribed and sworn to (or affirmed) before 2c0D1125 18th ay of Se ternF~er m Nota Public, State of Wisconsin My Commission (expires) (is): /a ~~~D.~ _• TEt[S INSTRUMENT WAS DRA['CfiD ttY: Ann E. Moyle Title One Premier Groua nc. Tttis instrument pis [~ is not (check one) a conveyance of real properly as per s. 77.21(1) Wisconsin Statutes. (A Wisconsin Real );state Transfer Rentrn is re aired for instntments that do conve real ro er .) •Namcs of persons signing in any capacity must tic typed or printed helow their signature. 3~~•~S ~ 4/14/2005 12:11 St. Croix County STATE BAR OF WISCONSIN FORM 1 - 2000 ~%VAR)~A~i'~1~D~ED2 1 ~ Document Number This Deed, made between Gerald T. Rose, sr. and Pamela R Roa®. husband and wi£te Grantor, and Daniel Rohl , a single person Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in st. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): The Northoaat Quarter of the Southwest Quarter (NE-a of SWtt) Exaept the Weat 2 rods o£ acid NE'ti of SL+As, and the North 2 coda of the NortYiwost Quarter of the $OUthWeat Quarter (NW%J of SW{a) , Section 17 , Township 26 North, Ras>tga 16 Wast, Town of Eau Ga11a Together with all appurtenant rights, title and interests. Sharon Fuller->Dan Rohl 2/2 ~$~~FC-~3 KATHLEEIi H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 08-19-2002 1:80 P2! WARRANTY DEED EXEMpT ik REC FEE 11.00 TRANS FEE: 355.50 COPY FEE: CERT COPY FEE: PAGES: 1 Recording Area Name and Return Address Titl• Ono Premier Group, Inc. 706 19th Street Sovth Hudson, Wiaaonain 54026 OOB--1050-30-000 Parcel Idendflcation Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Dated this 15th day of August 2002 , AUTHENTICATION Signature(s) authenticated this day of _ ' o ary ubRc * vawav v ~~~-•- TITLE: MEMBER STATE BAR OF WISCONSIN ([f not, authorized 6y §706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Mi.chaal II . Foraclci , Attornay Eau Claire. Wisconsin * d T. Rose Jr. c;z~ *Pamela R. Rose ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. 3t . Croix County. ) Personally came before me this 15th day of August 2002 the above named r-a*~a~d T. Rona. Jr. ~d v:e °i a R Rose to me known to be the person s who executed the fo to in nt ac nowled ed the same. ~J g~~~ •T V Palm___ ___ Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: Si natures ma be authenticated or acknowled ed. Both are not nece ~ +~'di *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSiN FORM No. 1-2000 ttomey Michael H Forecki 1830 Brackett Ave. Eau Claire Wl 54701-4627 Phone: (715) 833-3029 Fax: (715) 833112 Michael H. Forecki T7633985ZFX WoQurae with ZlpFtxm ^' try RE FamsNN. LLC 1a023 Ftaeen Mte Rne4 Clkaon Townch p. Michigan 48035, leap) 9a3.9803 .387515 /)