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HomeMy WebLinkAbout012-1048-20-000onsin Department of CorrAnerce PRIVATE SEWAGE SYSTEM ,rety 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 Hermansen, Brad Erin Prairie, Town of SST BM Elev: Insp. BM Elev: BM Description: bl} a _ v ~, I~ I GS TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~ c..~-Iw I v V v V Aeration ~ ~ / 0 ~ ~ Holding '~ TANK SETBACK INFORMATION TANK TO P/Jt' / WEL B~ vent to Air Intake e--- ROAD Septic ~ / f< Dosing ' ^~ ~ ` ~~ r 4YL. Aeration Holding PUMP/SIPHON INFORMATION ~, ~/ Manufacturer Demand GPM Model Number TDH L~ • Frictio Loss ~ System He Tom, •f j Ft '1 Forcemain Len Dia t, Dist. t t dell t) !" ELEVATION DATA county: St. Croix Sanitary Permit No: 463378 0 State Plan ID No: Parcel Tax No 012-1048-20-000 Section/Town/Range/Map No: 21.30.17.324 STATION BS y~ H ~n~. FS ELEV ~aa. -~ Benchmark 9 /3 9,/ ~~ Alt. BM w~.4.•~ ~ ~ ~ 3 Bldg. Sewer ~6~~ l / . ~ ~~ Y St/Ht Inlet d.~ ~, 9~ St/Ht Outlet I '~ ~v- Dt~t .0,6 9~• ~ Dt Bottom ~ / G ~ ~ ~ `• LG ^^'./ Y j Heade an. ~ /•~' tj2 67.3. Dygt,.L'.tpe ~•) a 2 . ~O 7 Bot. tem K.~ ° 3 . o ~ ~- `1 Final Grade ' ( S , ~S~ . O v s-~ o Cover ~.-^ t - t + /h ~ oo. ~ o,n~ J '~. 33 / a~F. 8 0 SOIL ABSORPTION SYSTEM BED/TRENCH Width t Len th~ ~ No. Of Trenches PIT DIMENSIOf~S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /) SETBACK SYSTEM TO P/L BLD WELL LAKE/STREAM ACHING anufacturer: INFORMATION CH E R Type O^f/Syste~ m: ~ , ~ r ~ ~ '~. U I~ ( ~t/,~LtiG,I- Model Number: DISTRIBUTIZpN SYSTEM Sn..,-~ f,_1,.~ I_,.io f Gn~ti Head /Manifold , istribution f Ip ' s) x Hole Size / • x Hole S acing i Vent to Air I taQ ke /~n ~-f'Gt Len th Dia ~' ~~ (~} Len th Di S i ~ ~ ~ ~ ~ b , ~„ g a ac n 9 Jam P 9 _ SUIL GUVtK x Pressure Systems Onlv xx Mound Or At-Grade Svstems Only S ', Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mul d Bed/Trench Canter Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~! L ~/ ~ S Inspection #2:~/~/ ~?_~~ Location: 1749 County Ro/ad G New Richmo,~njd~,/WI 54017 (SE 1/4 NW 1/4 21 T31 N R17W) 40 acres Lot ~ Parcel No:~ 21).30.17. 4 1.) Alt BM Description = f/~Clu~''~j~/(.{~/ '~Vfi 6~~-~/~, ~i ~ t S,cJ(~ ~~d t,._J lJ 2.) Bldg sewer length =/ 6 ~.._,1~.~/ tl ~ /~~~- ~~d~ - amount of cover = > ~ r~~~ G~ e ~/~/ ~~ ~~'~7"~~ ~~~ Plan revision Required? ?~ Yes No (J j _~' ~ ~ / ~ ~ / ~ ~~~ Use other side for additional information. ~ , ~ G~~~~.~%C~=- ~~~~Zri/ cv SBD-6710 (R.3/97) Date Insepctor's ure Cert. No. ;~ Safety and Buildings Division County ` m ~ 201 W. Washington Ave., P.O. Box 7162 ,_ ' , ~seonsin Madison, WI 53707 - 71 62 Sanitary Permit Number to be filled in by Co.) De artment of Commerce (608) 266-3151 ~ 3 ~~ Sanitary Permit Application O State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide b f ~ ~ ~ ~z ~ = ~~ S . ! ~ ~'> may e used or secondary purposes Privacy Law, s15.04(I~m) ~ Project Address (ifdifferent than mailing address) I. Application Information -Please Print All Informatio RECEIVED ~ Property Owner's Name P e _ Block # . ' ~ APR ~ - - ~ Z Property er s ailing Ad ess // " Property Location T~ , ST. CROIX COUNTY , / City, e Zip Code 1 '. ~-~ ~", ~k~--%,, Section r~ f ' ~ (circle ) ~ I. Type o Building (check all that apply) ~ T N; R~E o[ 1 or 2 Family Dwelling -Number of Bedrooms S dt°rsr°rr'I'lefne' G6M3+lntrrbar ^ PublidCommercial -Describe Use t~ w. `~.1 ^ State Owned-Describe Use ~ ^Ci ^Vill ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~ I ~. - ~~~,(,~ _ Z,p - ~~ ~ 32 `~' New S stem Y ^ 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 IV. T of POWYS S stem: Check all that a ^ Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ~ Mound <24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Ch ber ^ Dri Line ^ Gravel-less Pipe ^ Other (expl i V. Dis ersal/Treatment Area Information: G k~'S " = Z3. r7 ~ 2 Design Flow (gpd) Design Soil Application Rate( Dispersal Area Required sf) Dispersal Area Proposed (sf) System Elevation ~? / VI. Tank Info Capacity in Gallons Total G ll Number f Manufacturer Prefab Site Steel Fiber Plastic a ons o Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, ass me responsibility for installation of the POWTS shown on the attached plans. ' Plumber s a Print) ~ ~ Plum is Si MP/MPRS Number Business Phone Number i .. 5 Plumber's A d Street, ity, S ,Zip L VIII. Coun /De artment Use Onl ~pproved ^ Disap~ ~ Sanitary Permit F~(includes Groundwater Date Issued I uing ent Signature (No Stamps) ,, /l Surcharge Fee) ~` -- ff ^ Owner~venR~forDenial 2S-"'-~ G~ IX. Conditions p~~Approva~t - ~~ / ~ ~` SY ~ ~ S7EINIUWIV~ : Lvr , 1 Septic tank, effluent filter and (`l 2 ~ a c . '~ / S~ 3 S-x}- V'e~ ak-~ ~~ . dispersal cell must all be serviced /maintained as per management plan provided by plumber. ~~.~ Z~j 2. All setback requirements must be maintained as per applicable code%rdinances Attach complete plain (to the County oely) for the system on paper not less than 81/2 :11 inches in sirs SBD-6398 (R. 01/03) 'f .~~ .~ i ~ ,, .~„ ~ ~ _:i: --t ~, ;~ ___.~ ._ ~~ ~~~ ' ,. _~ ~ ~ .~. ~. _. . , . ., /,1 __ _ _ ._- . - - i,~; i _i ~~ _ _~.~ ~I -- ~ , ..__.. ~ _ __. , ~ __ _._. ---'t- -- . , i ~ I ~oa~,.~ ~JE %; a i `C _~ _ _, _ _.1. --+ - ~. __~ _' t" 6 _. _. commerce.wi.gov ^ ^ isconsin Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 29, 2005 CUST ID No.224263 KIM A O CONNELL K.O. CONSTRUCTION 504 3RD AVE OSCEOLA WI 54020 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1112020 SITE• Site ID No. 695029 Bradley Hermansen Please refer to both identification numbers, CTH G above, in all comes ondence with the a enc . Town of Erin Prairie St Croix. County SE1/4, NW1/4, S21, T30N, R17W FOR: Description: New mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1005353 Maintenance required; 450 GPD Flow rate; 13 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1) CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/29/2007 • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes F? ~,~ and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in CnhCllt~ 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, P stats. DEPARTMENT I OF SAFEI The following conditions shall be met during construction or installation and prior to occupancy or use: .._..__~-" General Approval Conditions: SEE CORREI Key Item(s) • A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. Changes to the approved plan must be submitted for review and approval. Failure to properly attach the approval and index page to plans that match the copy on file with the Department may result in enforcement action under s. 145.10, Stats. (Note: the reviewer has attached a copy of the approved revised pages 2-4, dated 3-28-05, to the index sheet that was provided.) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder KIM A O CONNELL Page 2 3/29/2005 • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. 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 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 o_r=aintenance of the POWTS. 1 0.1.1 1V10. L U110.111AVai POWTS Plan Reviewer , Inte at (715) 634-7810, Fax: (715) 634-. pshandorf@commerce. state.wi.us 3 Services 150 , M-f 7:45 am - 4:30 pm cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: BRADLEY HERMANSEN Owner's Name: BRADLEY HERMANSEN Owner's Address: 1098 130TH AVE NEW RICHMOND WI 54017 Legal Description: SE--NW--SEC21--T30N--R17W Township: ERIN PRAIRIE County: ST. CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 012--1048--20--000 '~ T. $, .~hll~ Plan Transaction No.: ~ t~ Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN -~-g ~G~NGS ~PpNDEN -- /~~aoac~ Designer: KIM A OCONNELL License Number: 224263 Date: 02/16/05 Phone Number: 715-755-3145 Signature: 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 3.0 (03/01!01) Page 1 of 8 03/28/2005 14:1 FAg 1 715 247 3038 BELISLE EBCAVATING Mound and Presslure Distribution Component Design Design Worksheet Site Inform ation (r or c} Residential or Commercial Design r-~ 300.00 Estimated Wastewater Fiow (gpd} 1.50 Peaking Factor (e.g. 1.5 =150%) 450.00 Design Flow (gpd} 3.00 Site Slape {%} 104.80 Contour Line Elevation (ft) 13.00 Depth to Limiting Factor (in} - 0.60 In-situ Soil Application Rate (gpolft2) Distribution Ce11 Information 75.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) L_.!J Influent Wastewater Quality (1 or 2) Pressure Disribution information (c ore) ~, 3.00 Center or End. Manifold Lateral Spacing (ft) 0.125 Number of Laterals Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft} 2.00 Forcemain Diameter {in) 80.00 Forcemain Length (ft) L_ 93.501 Pump Tank Elevation (ft} 6,50 System Head (ft) x 1.3 12.72 Vertical Lift (ft) 0.77 Friction Loss {ft} 19.99 Total Dynamic Head (ft) Lateral Diameter S election in. dia. o lions choice 0.75 1.00 .1.25 x 1.50 x X 2.00 x 3.00 x Treatm®nt Tank Information 1000.00 Se is Tank Capacity (gal} WEEKS 1 Manufacturer Mote; .Sand fiA (D} calculations assume a Table 83-44-3 in-sloe sot treatrnent for feel coNfonn of ~ 36 inches. 6.00 Cell Width (ft} Are the laterals the highest oint in the distribution Y network? Enter Y or W ff N above, enter the elevation ft of the highest point. .._ 9.00 ftz/or~ce Does the forcemain drain baok? Y Yo+rAi 13.05 Forcemain Drainback (gal) 67.38 5x Void Volume (gal) 80.43 Minimum Dose Volume {gal) 20.60 System Demand (gpm} Manifold Diameter Selection In. dia. o lions ice 1.25 x X 1.50 2.00 3.00 Gallonsllnch Calculator (optional} 1000.00 Total Tank Capacity (gal} 52,00 Total Working Liquid Depth {in) 19.23 gaUn {enter result in cell B~F9) Dose Tank lrrformation Effluent Filter Inforn~ation 800.00 Dose Tank Capacity (gal} Zabel Filter Manufacturer 21.76 Dose Tank Volume (gallin} A100 Fitter Model Number WEEKS Manufacturer Project: BRAD MANSE ~ ~~~'~ ~~~. Page 2 of 8 ~ 002 /28/2005 14:1 FA% 1 715 247 3038 BELISLE EgCAVATING Mound Plan View 1_ . : 1110 ~ ~ ;•,pbBervadon Pipe., ~l~J•:,:':: ;.'r',•r;! .~ .. ,.. CI,~Ce'.,'•i~1'1'!,••t~,•~'7=~•~'t.~fa ~~.~+tr't.• -~ti ~~ . B ~; -T -~ -~ -i ~- L Mound Component Dimensions A 6.00 ft E 25.16 in B 75.00 ft F 9.50 in D 23.00 in G 0.50 ft 450.00 {ft2) Dispersal CeH Area 6.00 (gpolft} Linear Loading Rate H 1.00 ft K 11,40 ft I 11.17ft L 97.79ft J 6.83 ft W 26.00 ft 1287.77 (ftz} Sasal Area Available 7.50 (ft) 1110 B Obs.-Pipe Placement Mound Cross Sectlion View Aggregate Dispersal Area Finished Grade 108.51 (ft) IF 106.72 {ft)-- :;t~~~ Dis ersal Cell ~°~~~`~`'' a p :; jj.; i::; G:~ Elevation ~Eii~~E°~~.:~', :;i~:::: jpj,.;:;17; i;:7;~~ :: j:::: ;:ilk:: :•1~.~: . ..., ~:. , Shading Key 1~ Topsoil Cap ,/„ ~// Subsoil Cap ASTM C33 Sand ®~ Tilled Layer ©' ,;•.,;,si;: Aggregate ":..,,... G ~ H I//////N/Ni. .//Ii l///N///II :,::.:.:.;.; :.:.:.:.:.:.:.. 107.22 ( :1:.:.:,:,: ..... .,.;,;:;,;,jj;j;:. ft} Lateral •;:;:;:;;,; Dispersal Cel I:~:.,:,r;;,;•;•!~~='•, ~•~•~•~•~ ~ °j:;:•::;::~.:;:;:::~'• Invert j: j:::;::~:.;.:. ;j:j:;j;::;:l::: j:j:;i;:;:~1~: ~'t~•'`: ~ :'~k 3.0 % Site Slope .:;.;.;. ~.;r:::,:,:.; ~1: '1' '' : : ~~ / . 104.80 (ft} Contour Elevation ~ ~ Dispersal Cell , m C a ;,.., ,.ir;: ~ ~ 0.5 ft '' .Typical Lateral ~.:•:~;:: ~ o - ;,;, ,;~~ T ~ ~ A /~ Geotextile Fabric Cover / See lateral details on Page 4 for number, size, and spaang of laterals. Laterals are equaly F spaced from the l distribution celPs t _ centerline in the i distribution cell (Ax8). Project: BRAD ERMANSEN ~r~~„S~~CJ ~,~-,~, Page 3 of e ~~ ~ 003 03/28/2005 14:2,0 FA% 1 715 247 3038 BELI5LE E%CAVATING f~j004 End Connection Lateral Layout Diagram Laterals ~q-re over tNe f# ~ B mensio" • =Turn-up rnl bel l w1~o or dee n outplug P F15lattraLs are idendoal IF ~c~' HOIes dn~led on eha bottom of the lateral S Qaually spaced Force maw aomeation via tee yr cross to manifold at .an9 Pa"t• laterals ~ foroe main of PYC sch 40 (per {~MFA Table 84.30.5) Number of Laterals 2 Orifice Diameter 0 Lateral Diameter 1.50 in Or~ce Spacing (X) 3.06 ft Lateral length {P) 73.44 ft Orifices per lateral 25 ~ t~~°rlfice 9 Lateral Spacing (S) 3.00 ft Orifice Density • Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 20.60 gpm Manifold Diameter 1.25 in Total Dynamic Head 19.99 ft Forcemain Velocity 2.10 fttsec Dose Tank lnformatiOn Locidngcrnrerwitl,wami-g label and locking device end sealed yvateAlght Electrical as pet NEC 300 and ----~ ~ 4 h. mn. Comm 16.28 WAC plscannect ~_ F-- +gltemate outset Tanis component is properly vented location WEEKS Ca a ' 800.00 Volume 21.76 Manufacturer Gallons gal/inch Dimension Inches Gallons A 19.07 414.93 13 2.00 43.52 C 3,70 80.43 p 12.00 261.12 Total 36.76 800.00 3" Forcemaln diameter ~~ 2 in. -r A Weep hole or anti- B siphon device C P'~ ump off'ele~ti~ tiq 94.50 D p• a~tank elevation un er tank. 93.50 Alarm Manuafacturer S .! ELECTRO Alarm Model Number HW .101 Pump Manufacturer GOULDS Pump Model Number WE0311 L Pump Must Delivsr 20.60 gpm at 19.99 ft TDH Project: B D HERMANSEN s ~ Page 4 of 8 ~ l~r~r'~ G~vS , `~ /~ --~ "~~ Off' e~.~Tc7~~~fo~ C~ 7~ Mound Svstem Maintenance and Operation Specifications Service Provider's Name KIM A OCONNELL Phone 715-755-3145 POWTS Regulator's Name ST CROIX COUNTY ZONING Phone 715-386-4680 Svstem Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfuI100 mL Service Frequency 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 ears 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 ~ """ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box ........ _ .. Plug or Ball Valve Project: BRAD HERMANSEN 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.01101) and SSWMP Publication 9.6 (01/81)] 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 presets 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 watertightness 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. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. 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 finer shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 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 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. 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 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 aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heaviy mu~t-ed 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 mglL BODS, 30 mg/L TSS, 10 mg1L 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 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 performed 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 shalt be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If 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. If 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. If 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 clogged 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: BRAD HERMANSEN Page 6 of 8 ~er~or~n~nc~ Curves MET':R8 FEET ~ ~ ?5~ ,~ ;~ 0 ~ 15 a0 ~0 ~ ?0 5 IO c_ u ~~C~J~ I ~~'N ~It~J!1~ r ~~~~ ~ ~ ~' U r~1 ~ ~ ~~~~ - 5 •MOOEL 388 - , , SIZE ~/~" Solids' ., WE 15N - -~ r W H07H• WE05H i WEOJM j _ '~~. "' "T'"" ~ , T ~ rYE00l ~ ~ _~ , ---~ ~- .~ -;r ~ , t 0 I 0 10 30 90 5G f~J ' ~ 8G 90 I OJ i '~ ~~ ~ V r M L - .. ~._._ . ..~ ..l 0 i0 ?0 ' yJ mvh CAP~,C ITY ~~GOULDS PUhgPS, INS.. seric~+ Fes: kw 7Cc« ~;,. METERS FEET -• ..,~„ 1 10 (- W E 15 H H - -~--- f- - -' . ~.~.. ._.», ._. ...t.. _.,_ .T r ~ ~'7"~' ~w ~ •- ` so ~ ~'~` _-~- ~_. _ ~ ~~ ~.~_ ~ ~ _ I 70 ~ I , zo ~ ~~ ~_ --r- I ...~kOGiir ~h~ ~ -~ .~ .._..;..• I ~~r,. s - ~ ~ ", I o _:;_ .- -- of 0 _ 0 I.0 ~ 20 00 a0 : > O~0 70 00 .90 100 110 1Z0 GPM 20 a rn+ih - %APACITY ~~ ~ 1965 OC . ;~ Pympf• InC. _~.._..... irr:~r1 w~, poi C ,; ~j 7 ~~ ~ _ __. ~ .. ; , _ ~ n .. ~ -- ~ r __ _ _,. -..__ . -~ ~. ~ _i - _ __ _ _~_ . -~ ..t_...., ..~. __.. ~.. _. _i ,..._..... __ ..~~ '. j I ~,' ~ 'I ~ ~i,_ y t~ go~~'_ _ ;~' -.~- __-,_- - f i ._~._ ;_ --{~ :. i _ ~_ . - / _' ~. ^~ i " , Wisconsin Department of Commerce Division of Safety and Buildings Q S~~VALUATION REPORT Page 1 of 3 in acc~iaance wrtn-ao[r,~,ao, vvis. r~arn. ~.we County St. Croix Attach complete site plan on paper not less than 81/2 x 11 ' ' e PI must . include, but not limited to: vertical and horizontal 'q irecti and p~ I,p Q~~ percent slope, scale or dimensions, north a , an d distance to crest road. ~ `) ~G~ Please print all 'reformation. Re 'wed Date ~ 6 ~l Personal information you provide may be used fors ndary~gr~oSes'(Pnvacy Law, s. 15. (1) (m)). ~ ~ PropertyOwne ~~~ S h y~ u;,; j~~;~ F~~ F Pro Location ^ ~ a Bradley Hermansen ~ ti~~1~N~ ~ Govt. Lot SE 1/4 NW 1/4 S 21 T 30 N R 17 r Property Owner's Mailing Address Lot # Block # Subd ame CS !/ 1098 130th Av - - 3 ~ ~ - ~ T Cily State Zip Code Phone Number ity Village ^ Town rest New Richmond WI 54017 ( 7~5-246-9915 New Construction Use Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement ^ Public or commercial -Describe: Parent material Lcess over glacial till Flood Plain elevation if applicable ~ /,, - I ~TA• ft General comment' Site is suitable for a mound system. frA'~ v~! ~%'`tiC1l~C and recommendations: `d"vlN~ ~' 1^ Boring # ^ Boring Q pit Ground surface elev. 104.30 ft. Depth to limiting factor 18 in. Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DJfl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 7-18 1 - sil 2msbk mfr c"r, if .6 .8 3 18-32 7.Syr4/4 ~~~/8 sl Om mfi cw - .2 .6 4 32-39 7.Syr5/4 c2d5yrs/8 sl Om mi - - .2 .6 ~' r, 2 Boring # ~--~ Boring 105.00 ~~ Pit Ground surface elev. ff. Depth to limiting factor Sal liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 8-13 1 4/4 - sil 2msbk mfr cam' if •6 .8 - 7.Syr4/4 f2dsyrs/8 sl Om mfi cw _ .2 .6 4 17-32 7.Syr5/4 c2dsyrs/8 sl Om mfi - - .2 .6 * Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Name (Please Print) Signature ~! CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number ~`~3 a I ~ 0 ~`'$~' . i/ee.J P-c c(1 w~ur~ f,(~( 5~fi o 17 ~ ~ ~ /S ~Z~D ~7i3', a Ll ~/ "a ~lS~l Property Owner Hermansen Parcel ID # Pending ,~ Page 2 of 3 3 ^ Boring # ''~' ~nng 105.40 ~2 ~ Pit Ground surfaace elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 9-19 _ sil 2msbk mfr cw 1 f .6 .8 19-24 7.Syr4/4 f2d5yr5/8 sl Om mfi c~'~' - .2 -6 4 24-32 7.Syr5/4 c2d5yr5/8 sl Om mfi - - .2 .6 ^ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ 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 Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D1fF 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/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL 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. car~a3anT~r ~ minni c-r~ ~ G w ^^ ^ ^ ~i ~~ i3~o~ ~~~~- Scale 1" = 30' BM1 Top of conduit 100.00' ~M~-TaQOtc~vnduit 100.62' Thomas Nslson B1 104.30' 999'tfl7 nn~ t~L1 . o $3 ~ [vS-~ ~sraa~ey nermansen SE 114, NW 1/4, Section 21, T3ON-R17VU (02 Parcel #: + 012-1048-20-000 02/2212005 08:32 AM PAGE 1 OF 1 Alt. Parcel #: 21.30.17.324 012 -TOWN OF ERIN PRAIRIE Current ~X; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " =Current Owner *HERMANSEN, BRADLEY J &PEGGY J BRADLEY J & PEGGY J HERMANSEN 1098 130TH AVE ~YYLQJ'v NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description SC 3962 NEW RICHMOND ,~ p 'v~~/1~~~/~r~ ~~~~~~a SP 1700 WITC (f ~ _ 6 ~~~~~ ~' Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 21 T30N R17W 40 AC SE NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 10/13/2004 776899 2674/594 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 16881 Use Value Assessment Valuations: Description Class AGRICULTURAL G4 MANAGED FOREST LAND- ~ W7 Totals for 2004: Last Changed: 06/15/2004 Acres Land Improve Total State Reason 15.000 1,600 0 1,600 NO 25.000 27,500 0 27,500 NO General Property 15.000 1,600 0 1,600 Woodland 25.000 27,500 27,500 Totals for 2003: General Property 15.000 1,700 0 1,700 Woodland 25.000 27,500 27,500 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 ~ ~ y raiser ~ F- ;~, B - Olson :u ~y so Carol & Pat<3cia u S ~" ~ C 66 r ~ ~~ a ~-= v TT ~ ~ "' ° ev ~ o 118 ~ a Hessellnk o Mar'' Dittman 76 Casey ,~ 149 '.~" 4 r 98 ~~ x a ~ Kew 6~ 5 2 ~ ~ h ~ 19 $ T 80 Kathleen ° ~ ~ a N ~ _ Monty ~ 36 ~ ~ ~ ~ernell & _ Dunn 1 erms ohn 8c h ~dyk Trust ~ w Lar rIe n r aaa a aavq ..~.. Ri~Ck ~` y . , t~tipp oldt T koglund N Q~ r am .p Pro - e L- ~p g ~ ~~~ 125 Smith ~ T m ohy ,~ TL as ern s LLC 146 ~ Rlckacd 239 60 ~ t o 120 ~ 10 240 226 r ~g O1 ~0D° ~ P ; J :°. 2 $ ~ 170th AVE J Steven ~~ ~ r ,~ .^. ehu 1 ~ ~ Gerry k 42 M'^ ~ O y ~' ~ ~ ~ & ~9 R°ch~e ~~ gp~. i aton @ h. DeMW16o6 ~ ~ ~ ~~ & 39 d ~ ~ Ib Q[- w RkiM v 14 2 ~ ~ ~ ~~ ,~,. Matthew & Stwn ~_ o a ~ t ~ ~ ~ ~e Gillen ~ ~ ~ ~ 58 .- Dunn ~~ O OG Thom as a Bey 69 ~ \~ ' , ~ ehdt ~ o ~ ~ etal 3 of ~ , ~ , 40 u 1 40 ,p! v T 160 ., h AVE J MtlEon do I ames & Jerry ,a ~ ~~ ayne, ~ ~ ~ ~ Y Ewa r 60 239 40 280 ~~ 157 40 ~ ~°- z a'od 4U Laurie Qlldm m Eleanore 30 1,~y a ~«. T o tiaa rmond 1K Borgsirom ~ Lorraine ~G° n w a L1 d "R ot~- 152 75 _160 12~ 1sOtn AVE is8 n 6 an n a o~ ._ ..~..n a n 197 ,nc Parcel #: 012-1047-90-000 02/22/2005 09:33 AM PAGE 1 OF 1 Alt. Parcel #: 21.30.17.321 012 -TOWN OF ERIN PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 16878 Use Value Assessment Valuations: Last Changed: 06/15/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 29.000 3,600 0 3,600 NO UNDEVELOPED G5 1.000 100 0 100 NO PRODUCTIVEFORSTLANC G6 10.000 11,000 0 11,000 NO Tax Address: Owner(s): * =Current Owner *GEURKINK, JEFF JEFF GEURKINK 1722 CTY RD G NEW RICHMOND WI 54017 Districts: SC =Schoo l SP =Special Property Address(es): * =Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Gres: 40.000 Plat: N/A-NOT AVAILABLE SEC 21 T30N R17W AC NE NW ~~ Block/Condo Bldg: ~ I, 1n~, ~ Tract(s): (Sec-Twn-Rng 21-30N-17W 401/4 1601/4) Q~~n~ ~~ vv Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1248/404 QC 07/23/1997 859/162 07/23/1997 847/293 07/23/1997 635/249 2004 SUMMARY Bill #: Fair Market value: Assessed with: Totals for 2004: General Property 40.000 14,700 0 14,700 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 14,900 0 14,900 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 Parcel #: 012-1048-30-000 02/2212005 09:31 AM PAGE 1 OF 1 Alt. Parcel #: 21.30.17.325 012 -TOWN OF ERIN PRAIRIE Current [X; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " =Current Owner `NAGEL, VERNON L & REBECCA A VERNON L & REBECCA A NAGEL 1750 140TH AVE NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 21 T30N R17W 40 C NE SW Block/Condo Bldg: ~ I/~ Tract(s): (Sec-Twn-Rng 401/4 1601/4) S ~. ~\ 21-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 772/547 07/23/1997 726/58 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 16882 Use Value Assessment Valuations' Last Changed: 06/15/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 26.000 2,900 0 2,900 NO UNDEVELOPED G5 14.000 1,700 0 1,700 NO Totals for 2004: General Property 40.000 4,600 0 4,600 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 4,800 0 4,800 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 . ~ Parcel #: ~ 026 1085-90-100 02/2212005 09:27 AM PAGE 1 OF 1 Alt. Parcel #: 29.30.18.455A 026 -TOWN OF RICHMOND Current '~,Xi ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner *HERMANSEN, BRADLEY J &PEGGY J BRADLEY J & PEGGY J HERMANSEN 1098 130TH AVE NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 1098 130TH AVE ~ SC 3962 NEW RICHMOND ~ ~~¢' SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.110 Plat: N/A-NOT AVAILABLE SEC 29 T30N R18W PT SE SE LOT 1 CSM Block/Condo Bldg: 8/2222 2 11 AC . Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 09/04/1997 1262/121 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 20286 133,700 Valuations' Last Changed: 06/30/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.110 41,000 80,300 121,300 NO Totals for 2004: General Property 2.110 41,000 80,300 121,300 Woodland 0.000 0 0 Totals for 2003: General Property 2.110 41,000 81,200 122,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 123 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST CROIX CO"LINTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwnerBuyer Mailing Addrf Property Address (Verification required from Planning Department for new constTUCtion) ~`~ ~ City/State ~ S- Parcel Identification Number t:~l'd- ~Cjy~ ~(1-t'.~0(~ ~~ 32~) LEGAL DESCRIPTION Property Location ~ '/4, ~_ ''/a, Sec. ~_, T~_N-R_,~„W, Town of ~.civm d~ iYi ~ . Subdivision ~ ,~~~~ ,Lot # Certified Survey Map # Volume ,Page # Warranty Deed # 7 ~~~~" ,Volume ~><?~~ ,Page # ..~_rC_z____._..... Spec house D yes ~ no Lot lines identifiable O yes O 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 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 wastewaterdisposal system is in proper operatinb 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 6e completed and returned to the St. Croix County Zoning Office within 30 days of the three y ar expiration date. / / SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~C, / / 1 SIGNATU OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty decd from the Register of Deeds office a copy of the Certified survey map if reference is made in the warranty deed OWNCRSHIP CERTIFICATION FORM ~~~~~"~~ ~/1~ ABSTRACT OF TITLE TO LANDS IN ST. CROIX COUNTY, WISCONSIN as follows: No. 1050 THE SOUTHEAST QUARTER OF THE NORTHWEST QUARTER (SE%/NW/) OF SECTION TWENTY ONE (21), TOWNSHIP THIRTY (30) NORTH, RANGE SEVENTEEN (17) WEST. TOGETHER WITH ENTRY WAY DESCRIBED IN DEED RECORDED IN VOL. 184, PG. 250 FROM JOHN LYNCH AND WIFE TO JOHN J. STEPHENS, MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT THE NORTH SIDE OF THE WEST HALF OF THE NORTHEAST QUARTER (W~/NE%) OF SECTION TWENTY ONE (21), TOWNSHIP THIRTY (30) NORTH WEST, AND EXTENDING SOUTHWARD A SUFFICIENT DISTANGCESSO ASETO GIVE AN ENTRY WAY, 16 FEET WIDE, FROM MAIN HIGHWAY TO THE NORTHEAST QUARTER OF THE SOUTHWEST QUARTER (NE%/SW%) OF SAID SECTION. t :;~ ~~~U , . ,. _ , ~ .- ~ Ni)M$ER ,~ ^~ ~~~~ ~ ~ ~ ~ b~tNeen ... ~~ ~•L ~f Made t}ua _ . .....l,ri ;.: day of .:. ~.14~k-t, ,. ._; <,_,- .:.: .. A:, ~ ~ ~ ~j y _ [.Cr t2 t I , 15~3~"i~ (/ .21 L;1~ ~,~ ~ ``~+~~~~ t ..r~~: ~i„u.~;tiu~~ ~'~ ~~~,ct,N,~li~C,tiu~~G1/~c~.r~.,.u,~ _ ~ ~ ._... ..... .:. .....part e' ,.-- .:..... .~pAanrt~~ f tha;'. i ~' WITNES E~TjH, Thatthe said-part_A-P/?: .:..:of Ehe' flYeE part,.tbr an81n co7faideration of -the atton of::61~.11~1/~~~_~• ~~u~J~ to...:.:... ~~Lil.tdit~......ln hand paid 6y the said part.... /lt..c! theaeeond Part, the receipt whet'ebf3g~hereby coatessed sad ackuowledYed at.lla.:._; ba ained, sold, reiniaed, released, aliernd, wave od ahd conflrm'ed -arid b these resanta do ve, grant, b aia, Bell, remise,-teleaee, a ~ Y 1 - .~?a.4. ... y...--.heire'.amf asdgkntatirew~t•, the fol'}ovoing d~ertbrd Heal Idetekgy. ~~,, confirm unto the acid part._.~_. of the second part, '~ ' -EounLy..ot BE. Crofz, aad StateOf-Wiaeoaaia, to-wit: ........ _. ..... ... .. ............ ..:.: ...:.._ '.::::._ :..:.:..... .___.. ...;. _ _ ~_-_ 1~-1[-~ NL~LZ~~~t~y/GCyL[ Nl~ ~o~O,J-~lJ~~(e(:ffu~ ,.~0~1~:~r,~ia.o~ ~~~ ~ ~ ~ ~ ~~,,~~~~ I __ . _~ ----- _ ;. __ _ o.~. ~~ ' • . ~..< - ~. __ ___. F, ~, i ., '. ' ' TOGETHER; with all and singuiar, the hereditaments and appurtenances thef•ednto helonging,'ot• in anywise appetEaining;and tdl. ~' ~- I. interest, claim or demand whatsoever, of the said part.,ii4...of the flrat part, either in law or equity, either in possession or exp' nbove bargained premises and their Hereditaments and Appurtenances. ~.. - TO HAVE~IND TO )GOLD theaaid premises as above described, with the $ereditavregte~atfd Appltr~kef5ances, unto the avid part ~.}.:; '~ ! antl W v1.1.4 .. .heirs alai FORE~/ER. (. KAFD THE 9AiD. ~:.041,~/~~%.1L~(,/~J~t°~~~j~C ~~7~~~ . . for..:..~ ./tt1A~ ~ ....heirs e3lcatore Bnd xdroinrsEratore,do .....:.oavenant, grant, bargain and. ~I ~. preeante P escrl4l~Qy ~, ~ pe fect r abeohite n ed indefeasible eatxte of inheritance m the ]Bw, m ~~fee ermple, ~aad thatatheBesaweofa t3fe~~ tarrtl~~rov ~d death ali S* ~ _ .. ._.. _.. t~ r°- ~ and tLa4 the abp#e bar~arned prem:aea, in the quie6 and peas able poaaeemoit of the Baid~ p3Ft ~ .:oi the second pnrt._ ~G~.' .,r ` ~ j ..:.. ... :.. .'.heirs and assigns, xgeinst nll and e -cry pereon or persoae lawin#l~ ola mialq'the whole or nny pert [hereof,. :; ' ' ~. will forever WA]@R:tNT AND DEFEND. ~ i ( IN W$88 WRIlREO the card pa t,~e.a of thefFicak'part ha~~...hereirnto set <1r~C-4f/.. ..::haud~saad aeaM _-...th A .. ~~ ~ I da uf; .,'R . .... see • A. 1,., T8~'...'fe,• n i 9 ......... tp (~ ...._._ ..... _.. b' ned an %ealed n Pre osdf1 ~~~~~ ~ .. ~~ ~ // ~ ..__ .... _/!!L.~r~ ...._ .......................... t _ ~ ;.~~~ ~ ...._......... _. ,: 1, ].~ 'at STATE OF CONS ~ ee ,,, ~- ~:: r i ! f _._._ __ '~. /~t.u -- Oounty. ~ ~' i p i , ~ - Poraonally ca bef a me, his.. ..... ........ ::. ..d 9 of.. ~ - - -~ - II the above'named_.... G~~c,~'J~%Ci~..P~~~,sA.C~i..~t.a::.Ll.9~..::..:. - I to me known. to be the person S who ~tse~t~# t1M-ilby~ofng fastevmeat t@d a ckuowledged bhe'eamte. -...-_- '~ Rae wegdor Record tine ____dav of /[/~/ T~ ..._ ~:./ / ~ ~ glad ,.~-m. _.~{_4, A ~Y No Public. ... • ~' '. :~ . s:.~ ~"~ i ,, ti ., ,.,..... INY eomaneelon .ea[plrtis..., ~°~ ~ 8'~ ~~ .U; ~C674P 59~i STATE BAR OF WISCONSIN FORM 2 - 1998 This Deed, made between Ro n and Ruth Johnson husband and wife, Grantor, and radlev J Hermansel~ and Peggy J. Hermansen, husband and wife as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): The SE 1/4 of the NW 1/4 of Section 21-30-17. 7 7 6 8 9 9 KATHLEEN H. MALSH S'1~. ICROIXOCODEE~ RECEIVED FOR RECORD 10/13/2004 10:00AN MARRANTY DEED EXEMPT • REC FEE: 11.00 'TRANS FEE: 180.00 COPY FEfi CC FEE: PAGES: 1 Name and Retum Ronald L. Siler VAN DYK, O'BOYLE &SILER, S.C. P.O. Box 118 New Richmond, Wl 54017 olz-1048-20-000 Parcel Identification Number (PIN) This is not homestead properly. Exceptions to warranties: Easements, restrictions and covenants of record. a+- Dated this f Z day of ~c'~~e,r- , 2004. *Roy Johnson * AUTHENTICATION Signature(s) Roy K. Johnson and Ruth Johnson ~ ~ ~*-- , 2004. authenti ated this /2 day of ~r * Ronald L. Siler TITLE: MEMBER STATE BAR OF WISCONSIN ([f no[, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAF TED BY Ronald L. Siler VAN DYK, O'BOYLE &SILER, S.C. P.O. Box 118, New Richmond, WI 54017 (Signatures may be authenticated or acknowledged. Both are no[ necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - [998 *Ruth Johnson * ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) Personally came before me this day of 2004 the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: .) INFORMATION PROFESSIONALS COMPANY FO[JD DU LAC, WI 800.8552021