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HomeMy WebLinkAbout261-1283-21-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 556329 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: X City Village Township Parcel Tax No: Dynan Properties, LLC City of New Richmond 261-1283-21-100 CST BM Elev: Insp. BM Elev: BM Description/::~ Section/Town/Range/Map No: 160 13 6 I G S T 33.31.17. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER n, CAPACITY STATION BS HI FS LEV. ZF5 Septic 3 Benchmark Dosing &00 5 lv d' s 3.15 ?9-4 Am "IM Q Bldg. ewer 7 .3 s ~(5 Holding St/Ht Inlet 9Z ✓5 1&7. TANK SETBACK INFORMATION St/Ht Outlet \ \ TANK TO oP/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 3to l 1JA- ,76' Dt Bottom Q g W' 05 Dosing - Header/Man. 7 U 3G ` N f4- 76' -76 ' :3.6S, TL 8 Aeration Dist. Pipe 3.a5 9~ .g Holding Bot. System. 3- ~a0 , B PUMP/SIPHON INFORMATION Final Grade Z ,6S Manufacturer f / GP Aand St Cover [ g, 9S, cL5 ~(r2 (a J 6 J Model Number ? 6t4" Z, ~1-, ~ 3.7 T TDH Lift Friction Loss System Head TDH t 75 p, r'8' 4, 17 3 Forcemain Length Dia. 11 Dist. to Well Z SOIL ABSORPTION SYSTEM 3.7 BED/TRENCH Width 1 Length No. Of Tre hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 12- S►b Red SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION T S ste ;0 1 CHAMBER OR yP~1Of y z& / a ) ~ UNIT Model Number: DISTRIBUTION SYSTEM old (7 ~v /V!s Header/Manifold Distribution x Hole Size Ix Hole Spacing [Po Air Intake Pipe(s) ~Length Dia Le Lengthgth Dia Spacing ? SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over \ xx Depth of xx Seeded/Sodded Mulched Bed/Trench Center Z Bed/Trench Edges \ Topsoil Yes 0 No r \es No COMMENTS: (Include cock d~screpencies, persons, p esent, tc.) Insp tion #1: 9 / Z1/ ~L Inspection #2: I'Vey CaaV, 7lid' L ~r;Us5 bfe- -ir /6,ff6, /&70 Location: 2444. Cty Rd K New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T31 N R1 7W) NA Lot 2 Ct% Parcel No: 33.31.17. 1.) Alt BM Description = ~t I'^- c, Jam- /6 C) io__~ J 2. Bldg sewer length = r [ ~ o ~ j v - amount of cover = n f 44^ 4 Plan revision Required? ❑ Yes N X /_'T A777- o 7 & ' ~3j-7~ '77 ~L Use other side for additional information. 1- J SBD-6710 (R.3/97) Date Insepcto SignatLY6 Cert. No. PLOT PLAN PROJECT DP Dunan Properties ADDRESS 3151 Ctv Rd K New Richmond Wi 54017 SW 1/4 SE 1/4S 33 /T 31 N/R 17 W City New Richmond COUNTY ST. CROIX SYSTEM ELEVATION 99.0' 3 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none Ilk BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEAR ❑ BOREHOLE O WELL *H.R.P. Sameas Benchmark M. * Area 15' below ~ AL system is to remain V B-1 undisturbed 98' 8% Slope B-2 99 Huffcutt Combo Tank 10 Acre Parcel 100, , Well is to meet all WDNR Setbacks ® Y B-3 ` 6ee,^ J Pro accessory building Tank is to be properly Pro 3 bedded and provided with Bedroom 0 GPD lockdown covers House with approved warning labels Grading is to be done to divert run-off away from system Scale = 1/4" = 10' 365' Property Line County Road K County Safety and Buildings Division + 201 W. WashTirll#ton Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madis AWI 53~ 1QT3~~ Sanitary Per bit Application State Transaction Number t , In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the app~ro~ is required prior to obtaining a sanitary permit. Note: Application forms for state-o are submitted to P9'ec ~ddr j1daiffftere than iii ad ress) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary u oses in accordance with the Privac Law, s. 15.04 1 m), Stats. I. A lication Information - Please Print All Information 1.> Property Owner's Nam Parcel # 2 Z 2r Property Owner's Mailing Ad ess / Property Location / & T/,{,I} ^ / E 2 J l Govt. Lot C 6 Jl City, State i Zip Coe Phone Number %4, Section c cle CIW T N; R E I. Type of Buildi g (check all that apply Lot # Subdivision Name El 1 or 2 Family Dwelling - Number of Bedrooms 3 C~~) ok Block # ❑ Public/Commercial - Describe Use w d%-► City of ❑ State Owned Describe Usi CSM Number ❑ Village of ❑ Town of A ! 5; 1 na J~) ri III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. XNew System ❑ Replacement System El Only El g y (explain) Treatment/Holding Tank Replacement Other Modification to Existing System stem B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground '4At,.Grade ❑ Mound 124 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)-~ retreatment Device (explain) V. Dispersal/Treat ent Area Information: De Flow (gpd) Design Soil Application Rate dsf) Dispersaall AAreea Required Dispersal Area Proposed Sy Elevation 2e,, ~ 0 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n o New Tanks Existing Tanks n o ~ 2 a u in V vs w C7 G Septic or Holding Tank ` L Dosing Chamber D VII. Responsibility Statement- I, the undersigned, assume o ibility for installation of the POWTS shown on the attached plans. Plumber's Nape (Print) Plumber's a e MP/MPRS Number Business Phone Number Plumber's Address ( treet, City, Zip Code) z -S/V/~/ 7 VIII. Coun epartment Use Only proved Disappr Permit Fee Date I ued Issuing A Signature er Given Reaso enial $ 10~~• ~A- IX. Condi#p9TRM00VM LReasons for Disapproval Q/ ~-O 4C4, e 3) 1. Septic tank effluent filter and 1 d dispersal cell must all be servke I mafntained IA, e P 'e-c l L"I as.per management plan provided by plumber. 2. AN se(backrequirements must.be maintaindd U pst• allppkw* code / WdiMm" Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R- 11/11) oYraragNro Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 3 & K Contact Through Relay y www.dsps.wi.gov/sb/ www.vAsconsin.gov °s[ONPys~ Scott Walker, Governor Dave Ross, Secretary August 31, 2012 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES. 08/31!2014 Identification Numbers Transaction ID No. 2144480 SITE: Site ID No. 783521 Dp Dynan Properties Please refer to both identification numbers, 3151 Cty Rd K above, in all correspondence with the City of New Richmond, 54017 a envy. St Croix County SWl/4, SE1/4, S33, T3 IN, R17W Lot: 2, FOR: Description: At-Grade, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1389884 Maintenance required; 450 GPD Flow rate; 41 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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 enclosed approved 1 s with t- e Component Manual, Version 2.0, SBD-10854 (N.03/07), and the Pressure Distributi po 2. 0, SBD-10706-P (N.01/01) CW In the event this soil absorption system or any of its component parts malfunctions so as to ere ealth~'~iizard, the property owner must follow the contingency plan as described in the approved plans. In addi e owner must comply with the operation, maintenance and monitoring duties as described in section VIII of tie at-grade component manual. A copy of this information must be given to the owner upon completion of the project. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 8/31/2012 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)(4), Wis. Stats. Owner Responsibilities: • SPS 383.52 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. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 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. 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. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Si el_y, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2 , Integrated Services Pavment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave RECEIVED New Richmond Wi 54017 AUG 2 7 2012 715-246-4516 TY & BUILDINGS - Date: 8/25/12 Owner: DP Dynan Properties Location:SW1/4 SE1/4 S33 T31 N,R17W 920 3151 Cty Rd K New Richmond System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications Shaun Bird y+.~ Signature License number 6900 2 ~~2 ~p PLOT PLAN 11 1 PROJECT DP Dunan Properties ADDRESS 3151 Ctv Rd K New Richmond Wi 54017 SW 1/4 SE 1/4s 33 /T 31 N/R 17 W City New Richmond COUNTY ST. CROIX SYSTEM ELEVATION 99.0' 3 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEAR ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark B . M . * Area 15' below system is to remain B-1 undisturbed 98' 8% Slope B-2 99 Huffcutt Combo Tank 10 Acre Parcel 100 Well is to meet all WDNR Setbacks B-3 Pro accessory building Tank is to be properly Pro 3 bedded and provided with Bedroom 0 GPD lockdown covers House with approved warning labels Grading is to be done to divert run-off away from system Scale = 1/4" = 10' 365' Property Line County Road K At-grade System Sloping Site Cross Section and Plan View - E L Dimension Feet 'L•L L L5L•L L•r r;•L •L L 55-515-5-5",",51.5 L K•r•L•'L L L•L•L L•L•L L L•L+L•L L•L•L• A r•~ r r•~ r•r r j••j•j• r•Lr•r••Lr r•j.r•r r•r•r•r r r•r•r r J•r• I L L; L L L•L•'L•L••L•L•L■L•L•L•'6•L■L■yL•L•L•'L•1i•L•S••L•L 'L"L•L•1~ L ti•L•L L•L•'. 1'•r•l•T•Ar•r•r•r•r•r•r•r•r•r•J•r•r•r•r•Ar•r•r•r•r•r•j•j•j•j•r•r•r•r•r•r•r•r•r•r•r• ' B ■j. 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L•L•L•L•L•L•;•L•L•L•L•L ;•L•L•;•L•;•L t ~ L E 1/6 B W 2Z E I B _ L /1 S10 e 1 = Plowed 4g;%; = Clean aggregate = 4 in. sch. 40 pvc L■L• - basal area rtirti• '/2 to 2'/z in. dia. observation pipe Lateral with 2" Topsoil Cap aggregate over pipe Observation Pipe Geotextile G With Cap Fabric r•rti Ft Lateral Invert r•r r r•r L L•ti•L•L•b r■r r■r•r•r•r• ■r:r~r■r•j~r•r•r•r• "1 TOy~SO11 Cap L L '6.•..ti•ti•L•L• S L•L•'L •'L•L•L 1.K•`.•'L j•r•j r•r•r•jM•r•~ 1'•r•r•r•r•r•r•r•j•r.r•r Y Y r r•r•r r r■r•r r r r r r r_,r_.;r.r,r:r,rr.r,r, , - r,r_,r r r•r•r r•. •r r•r~ r■• + ti. L•ti•LJ'j Q Ft Contour tdLL•L•7'021'% ~■r■rtifti•L•ti•L•ti•.•;-.e Jirl.Nr r~r~r•r r•r•l•r r r•r■J~r r•r D Plowed Surfac,, C Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a V4 inch soil wire when a sample is rolled between the palms of the bands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. Aftel'the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05 lgj Page of 1 Pressure Lateral Layout One Lateral - End Manifold 4- Threaded r Cleanout Force MaiLateral Turn-up Plug X L Long Sweep 90 Bend Pressure System Construction Distribution Network Specifications Lateral Diameter Z- In. Laterals are constructed of Schedule 40 PVC Orifice Diameter S SZIn. pipe. Orifices are drilled perpendicular to X Orifice Spacing) 2-1 In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded Force Main Diameter In. cleanout plug and are enclosed in a 6-8 inch Force Main Length p Ft. diameter lawn sprinkler valve box accessible from finished grade. •w••• Grade Inch Lawn 6-8 Sprinkler Valve Box 03/051gj Page of Septic-I:)ose Cross Section And Pump Performance Specifications Pump Manufacturer p Manufacturer Pump Model Nuntber 1G~ _ Tank Model Number Total. Tank Capacity - - Alarm Manufacturer U~ Max. Bury Depth _ Alarm Model Nwober. G-!/- ;Filter Manufacturer Total Dynamic Head (TDH)_ Feet - g~ - Elevation Head v Filter Model 'Number Distal Pressure Network Loss Minimum Pump rerformance Required Force Main Loss GPM. S' 3 Ft TDH Total Outlet Manhole Min. 4" Above Grade With I. Manhole Min. 4" Above Grade oeking De~tice. Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted Weather-proof 1 Junction Box Finished Grade ~ fY!•1 Vent Min. 12" Disconnect Above Grade Means With Vent Cap • Y Y~ tt, } Y tf> t Y<, . r r , rtY , t , , 1 • , , . Y~ <Y r Y Y , L If • : ~a>~ Y i i Y r i Y•r •:~r :Y'f `'Y`:: Ir`i Y • •r`Y< : 'Y ~ 1, Y r Y Y;1 , Qutiet Filter inlet Baffle inlet r--- l; f;f M, f '/a" "switch nett ngs and Reserve Capacity A Tank Volume GPX Weep Dimension: Inches Volume Gal. B Hole 1-7 y(reserve) A; 5- 06 : (alarm) B 2 ~ O levation C (dose) C : 97 f (dead) D Bottom D Elevation Total I .tY Et. 3-7 :ti'f rr.c.rc~rrzrrrrcrsrrrrrr-rrfc-~r,TSZr:s-{ f 1 i< s 1, f 1, a l t a 1 1 1 a 1 1 f/,; 1, t{< I t< f i f Y ♦;:f ,`r t , Y r<4 fa a• > f , • Y Y ! i':1'Y Y I Y'i'ra1 ts)`f'i•,<:~ f`i'Y`t•/'f•:,'f `♦<,<• , Y • • < ' ' {rl',':1'{t•:f•i 4,f : : f• t < f f <,1Y• a,I~f <`I~1;<;<'t < t • lf~f <Ytf,~ , <,t i ,YYY{Y/ 1 IY{,1 4 1~1~ ,1,1~,•i 1 1•,'i { ~ ~ {•,•<'1•s•a•:1't GENERAL yINSTALLATION: The is/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as spe4ified by the manufacturer may not be exceeded without for ~►roval. Manhole covers exposed to PX PP grade have an effr'ctive looking device (padlock) installed, Piping at the inlet and outlet is of approved material, connected to the taltk with watertight fittings, and laid on stable soil to prevent 9@ttling or sagging. The force main is sleeved with 4" ';ch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comtn 16.28, 02/05 U Page of AP LaserJet 3100; 1 710 0521 tiodef PAtly-O-uo c.uVr-ol, ..y, 9EH SERIES SUMP/EF'F'LUENT PUMP 11.85 8.95 Q C) o Specifications Am ca s4Mts>4tE Atlas Aiw Q ssBFNF rs1 rrlt tAR .wn pMMMJ4Ms 4N. MR tt4MMi OF R Gk. k) AMRAtAtt9 p tr 8' g 411 At.l AAat MAIN 91H-OM 509330 ULGA 4110 115 314 13.0 1000 70 64 55 41 32 13.8 20 24 9.11 x 11.64 x B.94 99I c" 50934o MOA 4r.6 3 d0 314 6.5 1000 70 64 55 41 32 118 20 24 911 a 1164x6.94 991-CA-An 508350 WA 41•0 115 34 13A 1000 70 64 55 M 32 13.8 2Y 27 9.11 11.64 1L94 WD&WS 509360 OUfSA 4"0 2D0 3N 6.5 1000 70 64 55 41 32 9.8 2q 27 9.11 x 11.64 x 8.94 Ca~linuaus OutyReled -"Link fsmt Wasoswstefpumpsare raledcomiweusdu,yas bnpaslhsyararunwNhw pupl~KaAedrlAlnpatufiese purpps. FLOW- LITERS/HOUR Construction 0 1000 2000 .1000 Motor Housing _Epoxy Coated Cast Iron Impeller Material Poly Carhonatc 10 Impeller'fype Closed Vane 30 . Volute _ . ABS 7.5w Power Cord _ SJTW-A 20 Mechanical Shaft. Seal N itrile with carbon and ceramic faces w Fasteners Stainless Steel 10 = Shaft Stainless Steel Bearings Upper Sleeve and Lower I Ball Bearings 0 0 20 40 6'11 90 FLOW- GALLONSP41NUTI'. PUMP PERFORMANCE CURVE Little olant Pomp Co. 115V 6oHZ I ro sex I2.41t41• 0141aAema City, GK 13157 rite=. 405.947.2511 • Fu: 405.228.1550 Email: custwuenervlee,tlHttlsgiut.eom Www 1ttleG1antPumpx0rft Ftxm 445235-07103 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION _ SYSTEM SPECIFICATIONS Owner Septic Tank CaPacit y _ El NA -4, 042 e - Permit # - - - '33 ]2 ~ Septic Tank Manufacturer 1:1 NA DESIGN PARAMETERS Effluent Filter Manufacturer p NA Number of Bedrooms ❑ NA Effluent Filter Model _ ❑ NA Number of Public Facility Units NA Pump Tank Capacity T❑ NA al Estimated flow (average) C7~ gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.G) gal/day Pump Manufacturer ❑ NA Soil Application Rate al/da /ft p 2 Pump Model _ ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease ;FOG) 530 mg/L ❑ Sand/Gravel Filter D Peat Filter! NA Biochemical Oxygen Demand (30Ds) 5220 mg/L 0 A ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids {TSS) 5150 mg/L 11 Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (3ODs) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/L NA At-Grade ❑ Mound Fecal Coliform (geometric nean) 5104 cfu/100m ❑ Drip-Line ❑ Other: A Maximum Effluent Particle Size in dia. ❑ NA Other: -INA Other: Other: - -T - - - A *Values typical for domestic wastewaterind septic tank effluent. Other: MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) (Maximum 3 years) ❑ NA _ _ oars _ Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume p NA Inspect dispersal cell(s) At least once every: ❑ month(s) year(s) (Maximum 3 years) 11 NA Clean effluent filter At least once every: / p months) ❑ NA Inspect pump, pump controls & alany, At least once every: n month(s) A c_~ ear(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ~i ❑ NA gear(s) Other: At least once every: ❑ month(s) Other: - ❑ NA 11 year(s) ^ ❑ 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 tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to <:heck for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a 3eptage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not 1~mited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :51 > 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. -START UP AND OPERATION Page of For new construction, prior to use of the POINTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or MIS the dispersal cell(s). If high concentrations rare 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 cell(s) in one large dose, overloading the cell(s) and may result in the oackup 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; diapnis; 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 Septagc 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 !:aken, to provide a code compliant replacement system: 0 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 >iystems 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 llie POWTS a soil and site evaluation ust 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, d and at-grade soil absorption systems may be reconstructed in place following re,-noval 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. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAIN R Name I 1 Name '2_ l Phone v = Phone J--1-741 SEPTAGE SERVICING OPERATOR PU PER LOCAL REGULATORY AUTHORITY Name - - _ Name , Phone _ - l - Phone This document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)&(0 and 383.54(1), (2) & (3), Wisconsin Administrative Code. FILTER CARTRIDGE INSTRUCTIONS :^lOag ./m Installation ST ER I Dry fit the filter casa onto the end of the outlet pipe to ensure it is ' centered under the access opening. It not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional i e pipe, p p onto the outlet S k 2 While the case is still dry fitted on the outlet pipe, measure the length of a7/.-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method Is not utilized, proceed to step four. ' 7'r3' For installations Mill dng the optional supplemental side support- solvent weld the V!.-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. Solvent weld the flitc.r case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. Ifs V •4...,.."•r~'> k5 switch is utilized: insert into the filter and lock by turning r•R; clockwise 401, Maintenance 1. The effluent filter should bt. cleaned every time the septic tank Is serviced. 2. open the outlet access ope.• ing to Inspect the tank and filter. 4 3, Pump the septic tank compietely, making sure to remove the sludge ° layer on the bottom of the ~:ank and not just the scum and effluent. 4. once the effluent level has ;3een lowered below the invert of the outlet pipe, firmly pull up a,t the filter handle to dislodge the cartridge from the case, S. Slide the cartridge up and out of the case for cleaning, yy 6. If a VRS switch connected tr an alarm is present, the switch K should be removed by turning counterclockwise 90° and cleaned with water only. 7. While holding the cartridge iin its side (large flat surface facing f down) over the access opening, rinse off the cartridge with water only, making sure all septaga material is rinsed back into the tank- t:•'.. . a. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90*, t 9. insert the filter cartridge back into the case , pressing down until - tF'• " ~",'L~• the filter locks into the bottom of the case, y. 10. Replace and secure the acce:,s opening on the tank. » 1' 1>••.7r(`:.- -:+1 A, a'N.rC i44:.. „1 tt.: www Bearonsitexom 877-MLFILTERS (6534583) ~2 f(- Wiscbnsin Department of Comme& 2 3 ~01 > SOIL EVALUATION REPORT Page L of Division of Safety and BuildinFgs 4 MANN;NG R Ziin accordance with Comm 85, Wis. Adm. Code minty t Attach complete site plan on paper not less thanoPfg c 11 inches in size. Plan must ' ` include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nWest read. Z ' 7 e 3 2~ /t i Please print all information..- reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.14 i"' Property r PropertyLocatiori'- 2 1 j~ e Govt. Lot J 1 /4 s51 /4 S I J/ N R f or) W AH~ Property Owner's Mailing tot # Block # Subd. Name CSM# 7i-~' y 3 7y City Sf-ate,/ Zip Code Phone Number City ❑ Village To Nearest Road / ur V-k V _L4 New Construction UseX. Residential / Number of bedrooms Code derived design flow rate ~y GPD ❑ Replacement Public or commercial - Describe: Parent materials (l Flood Plain levation if applicable l> ft. General comments and recommendations: System TypeT~- G System Elevation Boring # E] Boring /~4 pit Ground surface elev. I ft. Depth to limiting factor in. F Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 r-- Z 3- 01 _ZZ Boring # ® ❑Boring IR l Pit Ground surface eleJ , / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z r a 3 8- 42 e Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird lure 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, W 17 2- 715-246-4516 r 1 Property Owner _ Parcel ID # Page of Boring # p❑-1 Boring R ~y pit Ground surface elev. ` ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 5 J w. K. Y_ ,~k m N A ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30!i 150 mg1L ' Effluent #2 = BODS < 30 mg/- and TSS < 30 nVL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330 (8.6100) Property Owner Parcel ID # Page --of Boring W ❑ Boring L? Pit Ground surface elev. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color, Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 t t, Z Z C r~ U Boring # ❑ Boring ~--J ❑ Pit Grow 7d surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Bonng # ❑ Boring F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil 8pgi ion Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~I Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30:S 150 mg/t- ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce it, 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 (RAW) c • Soil Test Plot Plan Project Name DP Dynan Properties Shaun Address 3151 Cty Rd K New Richmond Wi 54017 C M #226900 Lot 2 Subdivision Date 8122112 S W 1/4 SE 1/4S 33 T 31 N/R17 W Township New Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 99.0' *HRPSame as Benchmark B.M. Scale is 1" = 40' 98' B-1 8 % unless otherwise Slope g - 2 noted 10 Acre Parcel 99, 100, B-3 365' Property Line County Road K a CERTIFIED SURVEY MAP ,o as located in part of the Southwest Quarter of the Southeast Quarter and part of u1Mo9 the Southeast Quarter of the Southeast Quarter all in Section 33, Township 31 s W=W.I We North, Range 17 West, City of New Richmond, St. Croix County, Wisconsin. ~wa60m m .auo rn~+~ NO TH V' axOxG,N A N r o, WOWN MWw + = SEE SURVEYORS REPORT ON SHEET 2 NUMN MG, N BEARINGS ARE REFERENCED TO THE SOUTH LINE OF 150 o Iso MW6F~1W aho .u\ Wp;o THE SE 1/4 OF SECTION 33, TOWNSHIP 31 N,, RANGE ~lCaNWxo Walla 17 W. WHICH IS ASSUMED TO BEAR N89'53'19"W. MONUMEN70 BIER 114 CORNER GRAPHIC SCALE SCALE IN FEET: finch =150 feet I SECJJ-Jf-U r i (FOUND 4' H*15OV MONUBT) UNPLATTED_LANDS UNPLA---- - S01'06'35"E .,017219 W , N . I 2221.84' 11,15 S89'53'1 9"E 1615.61' -NESr X Or IHE 5014-Z14 ► 0 kak,N89'53'19W 600.00' wo ~Omll . 0 (D LOT 2 o R-N 9JJJ1 W •o rt .`r ' ~e I W W TOTAL AREA: 0 0' f, a 7i a N WI N c0 Z 435,658 50. FT. '~:W ! £ m 0 10,00 ACRES h LOT 1 W N o e Q~ o a~; i N 3 r' AREA EXCLUDING R.O.W„ ° w o 3 N DRIVfwArfASEMENr Zi n 4 II 0 Qi 398,084 S0. FL N CERTIFIED SURVEY MAP ASZ2E IN W RRANIY 0 $01'06'35"E <t r 9.14 ACRES VOLUME 11 PAGE 3076 0 DEED 0-1171 PACE J9. W W + ; v t z N o 2 52.84 OR o0 ZI 17- c0 p IN TOWN OF STANTON Z• ERR o~ gW I~ a j o Sri" 0 z' { - o m R,2 '~~9 VOL_ 521 6cD'~ PG_ 393 1 N M) > u' N89'49'36"W 385.15' a o o N89'ST28"W 398.15' i _C_.TH'K' N899°Wb N89'53'19"W 385.61 -N89'53'19"W 600.00'- - N89'S31fW 39816 h 1251.84 h n CENIERUNE CI.H. 'K' " --N89'53'19"W b 2635.67'-- SOU7H UNE OF >HE 1114 ~ e " SOUIN I14 GARNER - - - - - - SrC I J1_17 RV OF WAY R=S89',T,T',T 1'E Prepared by (FOUND SURIfY MARKER NAlLJ UNPLATTED LANDS J1l CORNER 9-9 Coasu~irlg Group, Inc, Prepared for and at the request of. Section Comer Monument (FOUND 4' HARRISON of Record MONUMENT) Steve Ulrich Phone No, (115) 246-4319 1838170Th Street Set 1' x 18" O,D. Iron Pipe 1.13 pounds per linear, fotweighing Fax No. (115) 246-3630 New Richmond, W, 54017 P.O. Box 325 Owner Steve Holleen Found 1-1/4" O.D. Iron Pip ; New Richmond, WI 54017 Drafted by Jesse 8. Satan R- Re6r~ -e _ Sheet 1 of 2 JOB I 1057SU165 Parcel 261-1283-21-100 08/27/2012 08:46 AM PAGE 1 OF 1 Alt. Parcel 261 - CITY OF NEW RICHMOND Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 05/02/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ULRICH, STEVEN M & NANCY D STEVEN M & NANCY D ULRICH PO BOX 117 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 10.000 Plat: 4976-CSM 19-4976 261-2005 SEC 33 T31 N R17W PT SW SE ANNEXED ('04) Block/Condo Bldg: LOT 02 FKA 036-1086-90 (527A) NKA CSM 19-4976 LOT 2 (10.000AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 33-31N-17W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 10/17/2005 809518 2909/630 QC 08/26/2005 804659 2876/012 LC 05/02/2005 793799 19/4976 CSM 05/26/2004 763915 2581/411 ANNEX more... 2012 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/15/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.000 53,200 0 53,200 NO Totals for 2012: General Property 10.000 53,200 0 53,200 Woodland 0.000 0 0 Totals for 2011: General Property 10.000 53,200 0 53,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 4 3K ~Agp: ~ ~ y m U z O y~ Y Yf ` Y Y d v Y 2 ~ ~ ~ ~ I f Y'' $ 9 fix. ~ ;yg 3 7f~ j 1B1~ w l1F ~ I+E e a ~ ~~f g 3 : ; ---n*r`-~rt 1 I - NNNNIkt y a~i~aa~ M L-H t+bbbbbb bbbbbbb I m I sv 1 1 m~~o I I , 4 'S aa yii • i I I I I ~ I ~ - - I I , I I ~ I Itil ~ I 1= ~ I Ib ~ I I ~ I I ~ I ~ I Ir I ~ , sus I I I , aua j W4 ;l if 1 11 ~i ; r- I u I , „ ST. CROIX COUNTy SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer r Mailing Address Property Address / (Verification required from V ng & Zoning Department for new construction_) City/State Parcel Identification Number LEGAL DESCRIPTION Property Locatiotlf G..2 %,a , 5E !/,,Se c. 3 T N R)_ of- Subdivision Lot # _ Certified Survey Map # Volume , Page Warranty Deed # ----s-----_--_____~, Volume Page # Spec house yese Lot lines identifiable (5no 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 li~.ensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal systt m. 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 (l) 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 113 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. I/we am/are the owner(s) of the property described above, by virtue of a wa my deed recorded in Register of Deeds Office. Number of bedroom SIGNATURE APPLICANT(S) .D rra ATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Phknning & 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) II1111111111111111 IIIIIIIIIIII I State Bar of Wisconsin Form 2-2003 8 0 7 0511 9 j WARRANTY DEED 960479 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Steven M. Ulrich and Nancy D Ulrich husband and 07/25/2012 3:21 PM wife EXEMPT#: NA Grantor," whether one or more), REC FEE: 30.00 TRANS FEE: 149.70 I and Dynan Properties, LLC ("Grantee," whether one or more). PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property"): Name and Return Address Ogla That part of the SW1/4 SE1/4 and part of the SEI/4 SE1/4 of Sec. 33-T31N-R17W Estre na streen & Ogland gland described as follows: Lot 2 of Certified Survey Map recorded in Vol. 19 of 304 Locust Street Certified Survey Maps, Page 4976 as Doc. No. 793799. xudson, w154016 261-1283-21-100 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated ?107 /~7-- (SEAL) .*Steven M. Ulrich e (SEAL) (SEAL) *Nancy . Ulrich AUTHENTICATION ACKNOWLEDGMENT Signature(s) Steven M. Ulrich N nc D. Ulrich authenticated on 2/2 212 Zt9 Z- STATE OF ) ) ss. COUNTY ) *Kristina O1r-land TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, ' authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Oaland Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS 1S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO-PROTM' Legal Forms 800-655-2021 www.infoproforms.com 1 of 1