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HomeMy WebLinkAbout008-2007-04-000St. Croix County Planning and Zoning Detail Sanitary Information Thursday, December 21, 2006 at 4:18:56 PM Page 1 oJl Computer #: 008-2007-04-000 Sub/Plat: Star View Acres Section: 19 Parcel #: 19.28.16.563 Lot: 4 TN/RNG: T28N R16W Municipality: Eau Galle, Town of CSM: 114 1/4: SW 1/4 SE 1/4 Owner: Everts, Justin 223 215th Street Woodville, WI 54028 State Permit: 487935 Issued: 10/12/2005 POWTS Dispersal: Mound less than 24" suitable s Permit: New County Permit: 0 Installed: 08/09/2006 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuedlnsaector As Built Plumber Other Requirements Kevin Grabau NA Hawkins, Jacque KG has paperwork in office Kevin Grabau Signed Off: No Additional Notes Monev Owed 8/1/06- Owner cut grass over mound site and then $0.00 stripped 3-4" of topsoil off area. Jacque called us to find out what to do!! No tanks to be installed until the alternate mound area (if any can be located) is identified and mound revision plan is approved. Permit and file folder not in correct location in files!!! Maintenance Scheduled Pump Date Pumaed 1st Notification 2nd Notification 3rd Notification 8/9/2009 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 ~~ ~, Wisconsin Department of Commerce 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)1. Permit Holder's Name: City Village X Township Everts, Justin Eau Galle, Town of CST BM Elev: Insp. BM Elev: BM Description: 02. pd a ~ .P~ ~-~2~~~ ~- ~ 3 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ K~~~ ~,,,,~/~~ "`~ Dosing ~a ~ l~t,M. Aeration Holding TANK ~ETBACK INFORMATION TANK TO /L 7 zs- WELL BLDG. Vent to Air Intake ROAD Septic 1 ,,,, , /D ~ 1 ~- Dosing t~ t. Aeration Holding PUMP/SIPHON INFORM~,ecTi~N Manufacturer Demand GPM ~2~ del Number /~ - Lifk~ ~ ~ Fri 'on Loss, System Head , ++•.~t o l~ •ro 3 . Forcemain Len J ~ Dia. ~ i t Dist. to well C(111 ARSARPTICIN SYSTEM ELEVATION DATA County. St. CrOiX Sanitary Permit No: 487935 0 State Plan ID No: Parcel Tax No: 008-2007-04-000 SectionffownlRangelMap No: 19.28.16.563 STATION BS HI FS ELEV. , Benchma~~~,3 ~ 1 ~2. Alt. ~1~~ ~p~' ~•r!v0 ~C7D • Bldg. Sewer ~ SUHt Inlet /~~ l )3•e~ ~ `~ ~3 SUHt Outlet Dt Inlet Dt Bottom ~ ~. ~`~' Header/Man. ,3. b a X03 ~Z Dist. Pipe 3. b~ 3 `~ •~8 f 03.~Z Bot. System ~• 3S 3S • 31-1 7 ~ ~~~ Final Grade ~~ cl~ rJ a-~ ~ 6c ~ ~ s GII~ ~' I ° o . D / <~.d/ . I. ffo ~~ BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Pits Inside Dia. iqui Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAC G nufacturer. INFORMATION CHAMBE Type Of System: ~.~ Z ~ t ' /~ `' ~ i J UNI odel Number: nICTRIRI ITI(1N SYSTEM / /'t[~e•DOO 1 Lewd- Y/L \ HeaderlManifold ~ l Distribution ,~ ~ x Hole Size ~ x Hole Spacing ~ Vent to Air Intake ~ r ~ 2 ~ ~ Pipe(s) ~/y 3. ~ i Di ~ S _~ r " " ~ Length • Dia pac ng a Length Still CnVFR v Drncmvo Cvc4nme Anly YY Mnnnd Ar At-Grade Systems OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ''; Yes ";.i No ~-J Yes ~ .°j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ Location: 223 215th Street Woodville, WI 54028 (SW 1/4 SE 1/4 19 T28N R16W) Star View Ac 1.) Alt BM Description = Sw/, l ~~~I n 2.) Bldg sewer length = 3't' r ~"~ -amount of cover = ~V 6 Lf~~~1 e ~`-~ - G(~'r~ Plan revision Re ulred . I _; Yes No ~ l~ j;---~ Use other side for additional information. i___._~_~>- ,' ~ ~.__._/ .__1--__ Date Insepctors Signature SBD-6710 (R.3/97) ~~~ ~ ~.ot 4~ ~ ~ , s Inspection #2: / / Parcel No: 19.28.16.563 e /~'~1OC _ ~ ~ .~ O.9a Cdr ~.o g. i~,l die I ~ ___Q~ -----~~ v~ Celebrating 40 Year Of Excellence wieserconcrete.cOm - _ ~ ._. t ~U'~/~~_ ~~ ~~ 5 ~'7 ~ ~~~ ~ ~~-- ` / d-~-~~ (~ .~.----- .~-~-~'~ ~~ ~~. ~r_ t { e~- ..,~-- I~0) 325-8456 Fond u Lac, (800) 641-5937 ~2-7220 Spooner, WI (800) 336-3416 "~L )y ' ~ Safety and Buildin County ~ ~ ` 201 W. Washington Ave., P.O. Box ~~'- ~L e :' k IS~~~S,~ Madison, WI 53 - `I (608) 66-31~~ ~~w~ ani Permit Number (to be filled in by CoJ ~-$~' 3s De artment of Commerce a.• 1 Sanitary Permit Applieati n yrr}} state Ian I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informatio you prla~~~ (" ~ Lt1 p ~ 3~ 0 -T(L~'}/l1s . may be used for secondary purposes Privacy Law, s15.04( (m) Projec Address (i different than mailing address) pUN Y~ 1~ I. Application Information -Please Print All Information ZONING OFFIC ~#, ZZ 3 2. ~S~ 5+ Property Owner's Name Lot # Block # U~~`,N ~V~ ~f.3 , ~ Property Owner's Mailing Address Property Location !~ z 3 a v~ t~ ~V >~ c / 9 SW ~/ J L ~/ t S City, State Z ip Code Phone Number <, ~, CC lon '' -- ~l`.~ W1 S~'8S3 ` / e ~,J 7~S Il~y~~ '~ro`/~lo R~~(cEorWe) T LBN II. Type of Building (check all that apply) S ; ~ bdi i S i N CSM N be ~1 or 2 Family Dwelling -Number of Bedrooms ~ Q,~~ , v s on am e um r u` ^ Public/Commercial -Describe Use ) - ~ / to ie'" v~ £-t"~ QC!L~''r ^ State Owned -Describe Use ^Ciry_^Village Township of ~ /t- III. T ype of Permit: (Check only one box on line A. Complete -ine B if applic le • O0 _ 2 pp _ p ..- ppp ,,~ ~j '~ ew S stem y ^ Re lacement S stem p y ^ TreatmenUHolding Tank Replac nt 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 ll I IV. T e of POWTS S stem: Check all that a 1 K = ZO.o .!o ^ Non -Pressurized In-Ground ou d~A~tn. a email Mound < 24 i suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) 1 V. Dis ersaVTreatment Area Information: = Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ~f5d /, ca S'So '~/sa /~'3- ~7 VI. Tank Info Capacity in Total Number ~ Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks epti r Holding Tank UO~ p B D ~t G.t~ R;vF DU Aerobic Treatment Unit sing C Cvd ~ fouU VII. Responsibility Statement- I, the undersigned, assume responsibility for instal of the POWTS shown on the attached plans. umber's Name (Print Plumber's Signature M Number Business Phone Number Plumber's Address (Street, City, State, Zip ode) / / VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (' dudes Groundwater Date Issued Issuin Agent Signature (No Stamps) ^ Surcharge Fee) ~ ~ 2 O eason or nial D IX. Conditions o prov 3 ` ~ ~~ 5 ~ ~~ (, ~ n ) C,~ SYSTEM OWNER: 1 Septic tank, effluent filter and ~1.1L 3SD • c) ~ ~ ~ In/~.ou ~, I dispersal cell must all be serviced /maintained ~ , I~ r_ as per management plan provided by plumber. ~ S ~ o` ! r-~-- 2. All setback requirements must be maintained ~ as per applicable code/ordinances. ! Attach complete plans (to the County only) for the system on paper not less than 812 x 11 inches in size ~> ~1 SBD-6398 (R. 01/03) 1`f-d~ ~ }~aKa 4 1t'1P~-S Z_ZL87~.- DQq~ e~ w.cl r/;6 ~~1~ ` ~~~ ~s ~~~ ~flt l8 "~ +, s . JZ - ~ ~~,. • rp~. ~ ~ ~ ~ ;c ~~'~ou~d ~,~a~ - 3 ~/f~ ~ /a .l'1 D ~~ / t e ~~ SI ~~ 1 $ ~ ~ ~~ A i" A Z! r commerce.wi.goV isconsin Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary September 20, 2005 CUST ID No. 222872 JACQUES M HAWKINS HAWKINS SOIL TESTING & SEPTIC 2659 150TH ST LUCK WI 54853 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/20/2007 SITE: Justin Everts 20TH Ave Town of Eau Galle St Croix County SW1/4, SE1/4, 519, T28N, R16W Lot: 4, Subdivision: Star View Acres Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www.commerce.wi.gou/sb/ www.wisconsin.gov Identification Numbers Transaction ID No. 1198368 Site ID No. 704984 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Mound System for Justin Everts Object Type: POWTS Component Manual, Regulated Object ID No.: 1041406 Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.01 /01) 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.O1/O1). • 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 (O1/Sl)". 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. JACQUES M HAWKINS Page 2 9/20/2005 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, V~ ~• Keith A ilkinson POWTS Plan Reviewer ,Integrated Services (715) 524-3630, Fax: (715) 524-3633 , M-f 7:45 am - 4:30 pm kwilkinson@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 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: Legal Description: Township: County: Subdivision Name: Justin Everts 3 Bedroom Mound Justin Everts 1723 240th Ave. Ludc WI 54858 SW1/4-SE1l4 Sec. 19 T28N-R16W Eau Galle St. Croix Star View Acres Lot Number: Lot 4 Parcel I.D. Number: Plan Transaction No.: Page 1 ~'`~°~~~• Page 2 c • ,` d r ~, ~ ~~~ ~1 ~~ l! ~~~~ Page 3 ~ ~ ~ Page 4 z .. ~ . ~~ Page 5 ~~ ,,r;~,~r~, ~c~ Page 6 N +~r ~.ii-~` 1' NPSU Ei1JiL`JiPIGS Page 7 Page 8 a ,_ ~ ~~ ON~C~~CE ~a Block Number: NA Index and title Data entry Mound drawings Lateral and dose tank System maintenance specifications Management and contingency plan Pump curve and spec cations Plot Ptan ~ECENED S E P 1 9 2005 SAFETY 8~ BLDGS. DIV, Designer: Jacque Hawkins License Number: MPRS# 222872 Date: 09/12/05 Phone Number: (715) 472-8446 Signature. ~ _ Designed Pursuant to the Mound Component Manual far 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 3.11 (R. 06/01) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Inform ation (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 8.00 Site Slope (%) 101.50 Contour Line Elevation (ft) 16.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpolftZ) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c ore) c Center or End Manifold 3.00 Lateral Spacing (ft} 4 Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0.25) 2.25 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 340.00 Forcemain Length (ft) 78.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 24.83 Vertical Lift (ft) 5.19 Friction Loss (ft) 36.52 Total Dynamic Head (ft) Lateral Diameter Section in. dia. o bons choice 0.75 1.00 x 1.25 x 1.50 x x 2.00 x 3.00 x Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 3g inches. 6.00 Cell Width (ft) Are the laterals the highest int in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. 7.03 ftz/orifice Does the forcemain drain back? Enter Y or N 55.46 Forcemain Drainback (gal) 67.41 5x Void Volume (gal) 122.87 Minimum Dose Volume (gal) 26.36 System Demand (gpm) Manifold Diameter Selection in. dia. o bons choice 1.25 x 1.50 x x 2.00 3.00 GallonsMch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1039.00 Se tic Tank Capacity (gal) Total Working Liquid Depth (in) Skaw Precast Manufacturer gallin (enter result in cell B49) Des Tank Information Effluent Filter Information 642.33 Dose Tank Capacity (gal) Zabel ~ Filter Manufacturer 16.47 Dose Tank Volume (gal/in) A100 Filter Model Number Skaw Precast Manufacturer Project: Justin Everts 3 Bedroom Mound Page 2 of 8 Mound Plan View 1- 1_ 1/10 B •' • ~Obaervadon Pipe 'Q' K:: ?~:,~-~~ - ~5« - :;~'~^ ,~ °""~°~ :.~ -T _} _~ -I Mound Component Dimensions A 6.00 ft E 25.76 in B 75.00 ft F 9.50 in D 20.00 in G 0.50 ft 450.00 (ft2) Dispersal Cell Area 6.00 (gpd/ft) Linear Loading Rate H 1.00 ft I 13.57 ft J 7.16 ft K 11.10 ft L 97.19 ft W 26.73 ft 1467.93 (ft2) Basal Area Available 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 104.96 (ft) +~-2 H F Dispersal Cell ~~ 103.67 (ft) Lateral 103.17 (ft)-- - ~ : ~ Invert Dispersal Cell :[~ . ~ ~ ~ ~ ' ' ' ~ ' ~ ' Elevation s •E. ••D ~ ~~~•~,~~= ' 101.50 (ft) Contour Elevation 8.0 % Site Slope Geotextiile Fabric Cover Shading Key ~ ~ ~ Dispersal Cell See lateral details on [~ _ Topsoil Cap o a 1.5 ft ~, « . ~ "' ~ •~ : «.; ~, m ~ ; ~ -; ~ ;..„ Page 4 for number, size, © ,~,rr Subsoil Cap ~ o « ~ and spacing of laterals. ASTM C33 Sand " '~° ~ "~",«~ °`,~ F Laterals are equally Z 0.5 ft ,'Typical Lateral ,°.n spaced from the Q Tilled Layer c ~ - - , «~"' © Aggregate a ~ ;~:~ I distribution cell's "~° "~° ""~ "":'": °~~° " °"«'""^~""~°''~° -{- centerline in the ~- A -'* distribution cell (AxB). Project: Justin Everts 3 Bedroom Mound Page 3 of 8 Center Connection Lateral Layout Daigram Foroe maf n connection yla tee or Dross to manifold at any point. ~~ P •=Turn-upwfballwlveor ~X-~IExf2 xf2~l oleenoutplup Holes driled on the bottom of d+e lateral. Number of Laterals 4 Orifice Diameter Lateral Diameter 1.50 in Orifice Spacing (X) Lateral Length (P) 36.74 ft Orifices per Lateral Lateral Spacing (S) 3.00 ft Orifice Density Lateral Flow Rate 6.59 gpm Manifold Length System Flow Rate 26.36 gpm Manifold Diameter Total Dynamic Head 36.52 ft Forcemain Velocity Dose Tank Information Electrical as per NEC 300 and --~ Comm 16.28 WAC Disconnect Laterals are identb al S .]k_ Laterals & force maln of PVC Soh 40 per COMM Table 84.30.6 Tank component is properly vented Skaw Precast Ca ci 642.33 Volume 16.47 Manufacturer Gallons gal/inch A B C D Dimension Inches Gallons A q, r 321.82 B 2.00 32.94 C 7. ^' 122.87 D 10.00 164.70 Total 39.00 642.33 3" u Alarm Manuafacturer S.J. Electro Alarm Model Number 101-01H Pump Manufacturer Goulds Pump Model Number rWEO 5HH Pump Must Deliver 26.36 gpm at 36.52 ft TDH Locking cover with warning label and lodting device and sealed watertight i 4 in. min. ---------!ll--- -~...~ E- ARernate outlet location Foroemain diameter ~ 2 in. Weep hole or anti- siphon device P, ump ofl elevation (R) 78.83 Dose tank elevation (ft) ~i 78.00 Project: Justin Everts 3 Bedroom Mound Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Tri-Conn Sanitation Phone 715 386-0114 POWTS Regulator's Name St.Croix County Zoning Phone 715 386-4680 System Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mglL Septic Tank Capacity 1039 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Servile Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ct and/or service once eve 3 ears Should ins ct 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 ct for ondin and see a once eve 3 ars Miscellane!ous_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 6-8" Diameter Lawn --..~ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral _~'y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Justin Everts 3 Bedroom Mound Page 5 of 8 ' 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 (01181)] and local or state rules pertaining 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 accorciance with Comm 83.33, Wis. Adm. Code when the tanks are no bnger 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. Exposed 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. Seotfc 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 filter shall tie leaned as necessary to ensure proper operation. The filter cartridge shoukl not be removed unless provisions are made to retain solids in the tank that may slough off the filer when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the caitents 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 shall 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 filter is installed within the tank it shall be inspected and serviced as necessary. AAound and Pressure Dlstrlbution Svstem No trees or shrubs shoukl be planted on the mound. Plantings maybe made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion 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 aeretan of the infiftretive surface within the mound and snow compaction in the winter will promote frost penetration. Colo weather installations (October-February) dilate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow speafied in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is perfom>ad it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 8 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continasncv Plan H the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. ff the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with 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, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically cogged absorption and dispersal media, and related piping, and replacing said components 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: Justin Everts 3 Bedroom Mound Page 6 of 8 Page 7 of 8 (~ GOULDS PCJMPS ^ Shaft: Corrosion-resistant , stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation, ^ Fasteners: 300 series stainless steel. ^ Capable of running dry without damage to componerrts. ^ Designed for continuous operation when fully submerged. PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPUCATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: '/,° maximum. • Discharge size: 2"NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104"F (40`~C) continuous 140°F (60°C) intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ^ Impeller; Cast iron, semi- open, non-clog with pump-out vanes for mechanical seal protection, Balanced for smooth operation. Silicon bronze impeller available as an option, ^ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge. ^ Mechanical Seal: SILICON CARBIDE VS, SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. ~ 2001 Goulds Pumps Effective November, 2001 83885 MOTORS ^ fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation. METERS FEET 40- 130 WE15HH 120 35r 110 WE20H 30I 100 9 90 WE i 25 80 E10H V 70 07 zo ~ 60 o - 1 S - 50 E04H ° ao 10 30 WE03M 20 WE03~ s 10 0 0 0 10 20 0 5 Submersible Effluent Pump 3885 Single phase: • Built-in overload with automatic reset. • All single phase models feature capacitor start motors for maximum starting torque. •'h and'/z HP -16/3 SJTOW with 115, 208 and 230 Volt three prong plug. •'/~-2 HP -1413 STOW with bare leads, Three phase: • Overload protection must be provided in starter unit. •'/z-2 HP -14/4 STOW with bare leads. ^ Designed for Continuous Operation: Pump ratings are within the motor manufachxeT's recommended working limits, can be operated continuously without damage when fully submerged. ^ Bearings: Upper and lower heavy duty ball bearing conswction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS S ~ ® Tested to UL 778 and csA z2.z loestarberds aY Caredian Staralards Association C US nle ArIR36549 cards Ptrrlps is ts0 9ooT Regateted. SERIES: 3885 SIZE: '/:' SOLIDS I- --- ~ RPM: 3500 & I - 1750 ~}f' S GPM ~_ SFi 40 50 60 70 80 90 100 110 120 130 140 180 160 GPM 10 15 20 25 30 ~ 35 m3/hr CAPACITY Goulds Pumps m ITT Industries .fir ~~ s ~ ~~ ~~ 1 l 3f8~. !2N '' '~ ~' ~. ~ w ~~ ~ ~VK~ ~ ~~ .• ~ ~~" - ~' f e r • !Pf , t3 N~P~-S ~ Z~ ~- P g~ a9~ P~~ ~ ;c ~~ ~mou~d ~/f~ s /03,17 D ~a St°~ s ~~= Q A 1/ Wisconsin Department of Commerce Division of Safety and Buildings in accordance wi Attach complete site plan on paper not less than 8 1/2 x 1 inGude, but not limited to: vertical and horizontal referen percent slope, scale or dimensions, north arrow, and Iota Please print all informafi Personal information you provide may be used for secondary pu Property Owners Mailing Address t `l ~ lit 3 s SOIL EVALUATION REPORT _ Page ~ of 3 mm 85 Wis. Adm. Code • pp CC ^^ ~ County. 1 inches~l-F~~~p s-r-. C 20 1 X ce oint (BM), direction and Parcel I.D. Ppvp ~ }~,) 6 ti nand ~i~~c to nearest road. /~ g 202 evie d 6y , Date rp ses (PJ~ty,~J~ t>~41I(J7bn))• ,. I o c.7'. J'z, ~w~ t~51 ~vl I s~o zZl c ~ts~ uZb-t~~~ ~evt:-Loi 'S 1ti.1 1/4S~ 1/4 S ~ ~ T ZS N R I (~ E Lot # Block # Subd. Name or CSM# `~ - ~p~ s~9T~z v ~~ wfec ^ City ^ Village ®Town Nearest Road [~ New Construction Use: ~ Residential / Number of bedrooms -? ~ Code derived design flow rate aO ^ Replacement GPD ^ Public or commercial -Describe: Parent material G L.'P~°.~'R-L ')'1 L Flood Plain elevation if applicable N General comments ft. and recommendations: t ~ r'1,ovr.,,D ~,, lq ~~~' ~rs72t.gv`n~>v e-~2L_ `°; G~da-liy.~~ y„11tilMVsH ~-b`` oF; s ~T~ Boring # ^ Boring ® pit Ground surface elev. l l)U • O ft. Depth to limiting factor i ~ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in• Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-~ 1~~R 3 t z - s~ I Z`Fsb~c m ~F>-- ~, Z ~-~6 t.uK~ 31 ~ - s) ~ Z'~hk mfl- ew 3 16=29 ~.SKrz yc ~l'F~SY2Slg sic L~bk v>Z~-- Boring # ^ Boring ~ Q ®Pit Ground surface elev. (fib c ~ fL pPnth to limi-inn hrfn. t 1 Roots GPD/ftz 'Eff#1 'Eff#2 - .s .~a ,~ _ .S '~, (~ - . Z -3 Horizon Depth Dominant Color R d Soil Application Rate in. Munsell e ox Description Q S C Texture Structure Consistence Boundary Roots GPD/ft2 u. z. ont. Color Gr. Sz. Sh. 'Eff# ' 1 Eff#2 Z 0-9 L9 1.o~23LZ. - s~`1 Z`Fsb~ rv1 Cw - ,5 •~ 3 9 - Lp~-l, R 3L ~ _ s 1 J Z'Fsb1•c h'1'~1- Ct.J -~ . S - 'Li tq -33 7 5 ~? 2 i~! f1.~ ~ • S `~t Iz S~t3 S iCl t esbk h~'F1- -- • Z . 3 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOps < 30 mg/L and TSS < 30 mgJL CST Name (Please Print) gnature - Arthur L. Wegerer ~\_ CST Number Address ~` ~ - ~ 220254 Wegerer S 011 Testing & Design S e r V 1 C e Date Evaluation Conducted Telephone Number 421 ~7. I•iain St. diver calls, f•TI 54022 Z_ !-,_J'17 ~, c_~.~~ ~,._~ . ~° - - - ~ • ai -r c.,J V 1 V J .~ Property Owner ~' U S ~ L ~ ~ - Parcel ID # ~~~~' ~~ ~ G P ~ 3 Boring # ^ Boring age - of ® Pit Ground surface elev. ~ ~~-- ~ ft. Depth to limiting factor 1 ~ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 p -g log tZ31 Z- ~ si J Z'Fs bk t'rt ~r ~g - , S , ~ ~ Z . 3 ~ -l b 1~KR ~l~ - - sicJ Z'Fsbk in.'f~ e~ ~ • ~ ' b .'~ ~ b 3~ ~ s~r~ ~~~ c~ ~ •s k~s/~ e 1 l.cs 6 k rn~i. _ • z. • 3 _... Boring # ^ Boring ^ Rit Horizon Depth Dominant __ in. Munsell Ground surface elev. ft. Ueplh to lirniling factor / in. Soil Application Ra ;olor Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 Qu. Sz. Cont. Color Gr. Sz. Sh• •Eff#1 ~ •Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor (n. ~ Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/it' ln. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 ~ •Eff#2 Ef0uent #1 =BODE > 30 < 220 mg/Land TSS >30 < 150 mg/L • Effluent #2 =BODE < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opporhtnity service provider and employer. If you need assistance tv access services or need material ut an alternate format, please contact Qtedepartment at GOS-2GG-3151 or T'TY G08-2G4-8777. SDQbJJO (R.N00) PLOT PLArd Scale 1' =L10' ~T y ~ c~~ ~-- ~ ~,~ ~- v.~ LoT 3 _~ J J Page 3 of 3 Do ~ or e.,o,~, ~~~T- a~ oiz D~s7rv~Zt3 7~t~ s ~~ ' ' ' . .s , ~ i • ~~ i a~ ~•~ X33 a ~ r ~~~s a '' /~ \ ~ ~ ~`` ° 33 g `o 1 3 C°AhlhlvR ~,. 1 ~ ~-S ~otT'~ of . C~tL - ~. X03. Z, ~o T ~r rv 130, ~T 3 -- $r'1 t+1 -- --~-=_t_bo.__O .'._~ 9 '~"PC~~, 3EE'~"_ U~ ~1 ~ -._1~~8~wnZ : t•~ l.L . -- ,~ --- - F3~'`9 ~ Z lob 5 J 1 ~,~/~jr/~a~,,~,~ Z-(o-U~. 715-425-0165 220254 C~ ~_Z$ -Y CST Signature. Date Telephone rto. CST Alo. Job rJO. ~_ P • N _ c:.4 ~s 4 ~ ~ <''"~ w P>OWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner S} ~~ ~ C.. V E .L+ 3 Permit # ~ 93 S DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units $IQA Estimated flow (average) ~D gal/day Design flow (peak), (Estimated x 1.5) ~-~ ~ gal/day Soil Application Rate /~ d gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand IBOD51 5220 mg/L ~0"NA Total Suspended Solids (TSS) <_150 mglL Pretreated Effluent Quality IJionthly average Biochemical Oxygen Demand (BOD5) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L .S-NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size %8 in dia. NA Other: L~-NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity f p 0 0 gal ^ NA Septic Tank Manufacturer ~" ~w ^ NA Effluent Filter Manufacturer ~ 4 /S ~~ ^ NA Effluent Filter Model A O D ^ NA Pump Tank Capacity (DV 0 gal ^ Np` Pump Tank Manufacturer ~- ~ ^ NA Pump Manufacturer ~ u ~ ^ NA Pump Model ~ ~ ~ S ~ ~..~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~'NA Dispersal Ceil{s1 ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade 'Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Ins ect condition of tankls- p At least once ever y' ! ^monthls) (Maximum 3 ears) $year{s) y ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal ceII1s) At least once every: ^monthls) (Maximum 3 years) ^ yearls- ,J3-Pd'A Clean effluent filter At least once every: ~ ~ yea~lsl{s- ^ NA inspect pump, pump controls & alarm At least once every: ^ month(s) .B-year(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ~year{s) ^ NA Other: At least once every: C month(s) ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls- to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls) 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 the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 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. 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 cellls-. 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 cellls) in one large dose, overloading the cellls) 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. ^ 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. < < WARNIPJG ~ > 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. ADDITIONAL COMMENTS POWTS INSTALLER Name ~,,, K~ -}; L Phone ~~ ~-.. SI7L~ ~ `~ Z- + SEPTAGE SERVICING OPERATOR (PUMPER) Name ~ 5 ~ Cc_. ~ t~.C,.c.. c,'c.. Phone ?~~ . ?,~S-5/888 POWTS MAINTAINER Name ~ Cat G k. G(t a,., ~,~, S Phone ~ 3 - y7L - Z ~! Z, LOCAL REGULATORY AUTHORITY Name Sf. t~,Le.'K. ~ou,~.~" 2 ti - Phone ~f " 3 ~ ~- y(o a~ U This document was drafted in compliance with chapter Comm 83.2212)(b)11-Id1&If- and 83.54(11, 121 & 13-, Wisconsin Administrative Code. ST. CROIX COUNTY SEI?TIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~.. ~ti s ~"; n~ _ _ ~ 1.~ ~,cf Mailing Address ~ 7 Z Property Address ~ o f ~` ~ Gt'v E ~ U C17~ ~~ S X18 ~ as ~ ~ ~~ ~ e:-~- (Verification required from Planning & Zoning Department for new construction.) City/State 1iy; s , Parcel Identification Number - v LEGAL DESCRIPTION Property Locations w 1/a , `S ~ '/a , Sec. ~ ~ , T ~ 8 N Rf lP W, Town of ~ u ~a /~~ Subdivision ~~"4 Jc. 1/ j ~. w ~[ ~ ,` ~ .~ ,Lot # ~ . Certified Survey Map # Volume ,Page # Warranty Deed # 4 % .3756 ,Volume Z 3 °I / ,Page # ~ `~ 2 --r Spec house yes Lot lines identifiable ~ 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 _ SIGNATURE OF APPLICANT(S) /G / ! /o.~ DATE ***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) Sepp30 05 08:36a Justin Everts 651 748-3611 p.6 von 2~~1 ir,~r~~2 STATE BAR OF WISCONSIN FORM 2- 2004 WARRANTY DEED THIS DEED, made between F & K Trucking and Excavating, Inc., a Wisconsin Corporation, Grantor, and Justin B. Evans and Corrine R. Everts, husband and wife, as Survivorship Marital Property and Jarnes L. Baldock and Joyce A. Baldock, husband and wife, as Survivorship Marital Property as Joint Tetlants, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 4, Plat of Star View Acres, Town of Eau Galle, St. Croix County, Wisconsin. Metro Legal Serricey EDTkZET ~G2Si~8 A .95937 t~-D 32919 Rceording Area -~3~75i0 I;ATHLEEH H. NIALSH REGISTER OF DEEDS sr. cRazx co. , 1tI RECEIVED FOR RfiCORD 08!27/2003 01:30P1! >dARkAHTY DEED EXEP~'T # REC FEE: 11.00 TRANS FEE: 189.00 COPY FEE: CC FEE: PAGES: 1 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Name and Return Address: 1 A~ ~~ ~ ' ~,.• Ann n wnA n. _ ~O ~ J Htidstnt;'ib`f~16 .J ~]~~ , Mme. ~~, ._ fit} 8-1057-SO-000 Puce! Identification Number (PIN) This is not homestead property. Dated this 4th day of August, 2~J03. F&Ik Trucking and Excavating, lnc., a Wisconsin Corpo~rati~on B r ~~~ * Chris Kusilek, President for F & K Trucking and Excavating, Ina. AUTHENTICATION S.` gnature(s) .~`1'n ~(\ ~'~ ,thenticated this 4th day of August, 2 3~t<a'(y ,~,0'~ O~ * -nTr'?~ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ authorized by § 706.06, Wis. Stats.} THIS INSTRUMENT IIiAS DRAFTED BY Edina Realty Title - Daug Berg 400 South Second Street #115, Hudson, WI 54016 (Signatures may be authanticatcd or acknowlcdgcd. both are not nccessar}•.) 'Names of parsons signing in any capacity must be typed or printed bcbw their signature B~_1~~~' r~l * Dtanna Kusilek, Vice President for F & K Trucking Excavating, Inc. ACKNOWLEDGMENT STATE OE WISCONSIN } ST. CQiYbefore me this July 31, X03 the above named Chris Kusilek, President and Dianna Kusilek, Vice President of F & K Trucking and Excavating, Inc., A Wisconsin Corporation to me known to be the person(s) who executed oregoing instrument and acknowledged the same. *Cheri Brown Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/11/2007 ) WARRANTY DEED S'rATE BAR OF WISCONSI\ FORM No.2-1A(10 I • ~ ~ _~~ LL~1G~D~ OL~[r~f~D ° IJ ~ G NORTH LINE OF THE N 3~7~~ 1]~7.~~___.-K SWi/4 OF THE SE1/4 .n86 I I 1 1' i ~~~~ '------------- 566.48' --1 I 1 `~ ' ~ .• ~ ~. •~ • . ,~ ~~ ~ H.W.E. = 1171.5 1 i ~_. LOT 4 • 7.000 AC S ' ( . Ff.) ' M.F.F.E = 1173.5 ,S4°56'28°E LOT 3 3.65~'pCRES (159,11 Li SD. FT.) .., ~. sv. 141 H•WY. 35 RIVER FALLS, WI 54022 6'± WT T W N LLW o~ w~ ZO J ~ f- ~ '^ T '^ I~ ~~~I ~~ ~~ W~ ~~al ~ ~ Q~ N~ ~~ ~I a ~~ oo ~ ~~ ~~ Z ai ~i 9~ ~~ .~,~i(., HIGHWA THE HIG SHALL 8 RIGHT-O CENTER DISTANC ARE ALLY THE HIGI INCLUDE PARKING SEPTIC BEING E) RESTRIC'