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HomeMy WebLinkAbout018-1006-60-000 ~ ~ o ~ ~ ~ ~,; ~ ~ ~ '~ ~ ~ ~ ' ~ ~ .~ _ ~ I m ~ 3 .. 3 ', ~ '~ ' a~ a a C ~ O _ ~ N Oo i ~ o. ~ m m N ro zn W o .. - '. .. ~ , ~ O o ~ cD ~ ~ N w j ~,... _.ga.. ...~ ~.. ~ 7 v O O N Q AJ ~ ~ N a ,`~ a ~ A ' O O ~ ~ N C CS f~D CD ~ fD h N ~ ~~ '., I O ) ~ O ~ ~ O 3 N N ~ N ~ °~ O ~ ~ A w m v,> c~°' v ~ D w ~ d a o s I ~ ~ ~~ o ~ ° D m I ~ ~~ ° f= oo I N Z (\ND A N ~ ~ o o ~ n r cn ~ C d '~ ~ ~ D. ~ 'D ~ ~ I, `` ~~ ,,~. i A O ~ ~ CTI ,, ~~ O n N ~ ~ N f% N f A ° °t ' ry ~ V D _ ° ° o a' m ~ O O o \ o m :: t N 3 °1 li ~ j Z •• ~ Z Z o ~-~-~ l~~ ~' ~ D D c ~ \ ~ ~- n ~ . ` \ ~ ~ m cam., I W m n ~ ~„tC~ Z ° ~ ~ i +' -1 Z to n N ~ l "A .. ~ N A ' ~ 7 i Z N W \~' A ~ ` ° ~ m ~ ~, O ~ ~ ~ A z - Zl ~ 3 m ~ \ fD ? ~ ' ~~ W I I ~ a CC j ~~ p. G N C ~ ~ Z C ~ ° .. CD N ~I \~ ~~ /~\\ '~ ~l \ I \~, '," I O ~ 'i ' ~ ~ i 69 O ~ O ~- Parcel #: 018-1006-60-000 o4/os/2oo7 05:09 PM PAGE 1 OF 1 Alt. Parcel #: 03.29.17.46 018 -TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 =Current Owner, C =Current Co-Owner O - FORLITI REALTY INC FORLITI REALTY INC 201 PACKER DR A ROBERTS WI 54023 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 1892 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 03 T29N R17W 40A NW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 08/26/2002 688263 1959/112 EZ 01/10/2002 667781 1811/328 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/24/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 16.000 2,000 0 2,000 NO UNDEVELOPED G5 4.000 1,000 0 1,000 NO AGRICULTURAL FOREST G5M 20.000 20,000 0 20,000 NO Totals for 2007: General Property 40.000 23,000 0 23,000 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 23,000 0 23,000 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 7epartment of Commerce PRIVATE SEWAGE SYSTEM wilding Divisian + * INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. permit Holder's Name: City Village X Township Forliti, Eddie Hammond Townshi ;ST BM Elev: ~ l ~ ~ Insp. ~M EI~ BM Desc~tion: ~' SANK INFORMATION G,~QI A~1+• ATION DATA TYPE MANUFACTURER CAPACITY Septic ~~ ~ d~O Dosing cbd~~ ~C3(S ration ~---_ _ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic r ~~. 3~ c 3 i ~r X Dosing ~~ l 1 ~ ~ t ~ `~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~ - ~ Demand GPM Model Number ~ ~~ .L~ t0 TDH Li ~ ~ `~~ Friction Los ` System Hea~•5 / TDH +~ ~ Ft Forcemain Length ~ r Dia.`' n Dist. to weu ", ~~ SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 420308 0 State Plan ID No: Parcel Tax No: 018-1006-60-000 STATION BS HI FS ELEV. Benchmark S.~ ~~y,`~ ~~~ Alt. BM j_ Id ewer j~.~aU ~Z ~~ t/Ht I et l ~•~b SUHt Outlet Dt Inlet Dt Bottom 2Z . 2 Header/Man. Dist. Pipe p~ 5'W /~ `T Bot. System 6 ~ bc~ ~ D~ a Final Grade St Cover ~Z.. l~ / ~~° 1P NC idth t Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liqu' - epth DIME NS ~ i ~Z, ~ 11 j SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact INFORMATION CHAMBER OR Type,O^f,~System: 1 "~~ , Z7 ~ r "F 2~ r -~J (~ UNIT Mo r: D15TRIBUTION SYSTEM e anifold /. W ~` Length ~ Dia Distribution pipe(s) ~~ Length_~,~ Dia ~ Spacing ~ x Hole Size ~~rr f~ `~ x Hole Spacing S -rJ~-.ff 3 Vent to Air Intake SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No ~~ Yes ~ No V COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:__~__/ ~~ /~ Inspection #2: / / Location: 1892 110th Ave Hammond, WI 54015 (NE 114 SE 1i4 3 T29N R~1.7`W) NA Lot q [ J Par el No':c0/~,3.,2,`9~.,1~,7~4p6j,~ 1.) AIt BM Description = ~~ ,~ tiV ~C~ y' I~C.G~ly16~u7 N~ ~ta ~ ` ~ ~~~~w~Kl It V ~"~'6~ 2.) Bldg sewer length = 3 (~ ~ ~~ , _ _ III -amount of cover = i< f ~•~'~ ~') u' ~ "°""t ~ LI - l~ aA ~~ :'~~.) Contour - `a ~ ~~."~.(J ~'~ J I M~ ~Lc~ ~l ~~~" ~,q, $ -~ Plan revision Required? f ~'; Yes ~] No ~ ~I Use other side for additional information. '~_ ~ ~~'__ _ __ i _.~ I, SBD-6710 (R.3/97) Date Insep or' Sig Cert. No. 1gg~ i t b~~~~e Sanitary Permit Application ~ Safety & Buildings Divi 1 ~ ~ In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington A PO Box 73~ `~sconsin See reverse side for instructions for completing this application personal information you provide may be used for secondary purposes Madison, WI 53707-730: Department of Commerce ~d Cy Law, s. 15.04(1)(m)) ~,~a? 7' (Submit completed form to county if not state owned ) ~ ~~,~,,,,i- . Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. Coun State Sanitary Permit Number ^ Check if revision to previous application State Plan I. D. Number ~ I. Application Information -Please Print all Information ,. Location: Property Owner Name / , perty Location t/ ~/r ~VV~L ~h~t 11 2 ~1/~~ 1/4,S3'1I7`q,N,Rr(E(or Property Owner's Mailing Address Lot Number Block Numb _ ,c~ ©~ ~x ~t ~f (3b sr. ,, City, State Zip Code • Pho a Numbgpl~; r~~, c ~F~~CE Subdivision Name or CSM Number II. Type of Building: (check one) ./~ -1-t3r-=ti~anttiynweiiittg-r. ~~- Sin ~ I ~e9~ ^ ^ City ' ^ Village 1~ j~~~YL~ ` own of PubliclCommercial (describe use):_ - ~// / 1 r / '~ ~~ ~ ,~ j> ~ ~' ~ a.v 4.v. T tu/ ct f ^ State-Owned $C.G <cT / C~ P~, p~ /~ lDO.S- SO"ODD O/$-/Ov6-,~C3-OUO ' Nearest Road O'rYn c~/ 8 " / a= 6 - ba ` ADO /8 - /O!~(,' "70 -1,b0~ LYe 7~~ ~ Parcel Tax umb s 000 III. Type of ermit: (Check only one box on line A. Check box on line B if applicable) A) 1. New 2. ^ Replacement 3. Replacement of 4. 5. 6. ^ Addition to System li~ System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ^ Non-pressurized In-ground Mound ~ ^ Sand Filter ^ Constructed Wetland - [~ Holding Tank ^ Single Pass ^ Drip Line ^ Pressurized In-ground ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. DispersaVTreatment Area Information: ~ ~ 5. Percolation Rate 6. System Elevation 7. Final Grade 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Elevation Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) 9~ 3 ~ ~ ~ 1~~. 3 l2~ v~ ~ 3 ~ ._._- VII. Tank Capacity in Total # of Manu~'acturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks W ' b~ ~,~ , ~L Obb C~ ~- ^ ^ ^ ^ ~ ,~, ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility r installation the POWTS shown on the attached plans. um ber Business Phone N o S N Name (print) Plu is Sig ( stamps): MP/MPR m is Plu `` 7 ) r 2 ~ j / m Plumber's Address (Street, City, State Zip Co S ~ ~? ~ ~r~a t~ te)~. ~S~6a q 7a~ IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu A nt Signature (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Feed{ 3 a~m/ ~ ~7 ~ " `~ ~ ~,Z Determination D X. Conditions of Approval/Reasons for Disapproval: •~ . f ~t!( ~baoks Haut b ~ /Gr; ~; i,.~ prier -f~ Cawr wt~`I c,/ ~y~.~-(y~t~i~ , $Gor~(kkGr Sa~~S ~ppl .~~o,... ~// n.k~i~dt.b~-~ M/a-{ctr ba~/~~Sflevr5¢S . ~7S-.C},4'ro~.-Ftr.... Q1kM/.M~ i~l:f ~>•vQ~~`~-'{r) iS Z6''t.rof ~y• 12P.3• -Uht~ m'-e. ~lixciQwl dwtl(;),~ ~5 ~ 6~ow~mt ~1niS ProP~/~`~' b n,, INC. pl~w,.4+-+r' ska.G( S"'P pfo~p~ ~fk.¢ oar tkkarY•~.scfixvr ox.`{at I,ku;v4eK,~cc /~ `f>,r Sepfr~ ~wlLe~~la.ar..~ ~i (-rtv r'~si-o~~ ~~ Cu.c1 ,t o Sanitary Permit Application aarery ~ nurramgs Vr~~sio, 201 W, Washington Ave_ In scwrd with Comm 83.21, Wis. Adm. Code PO $o>< 7302 `~ Sec reverse side for instructions for completing this application Wi 53707-7302 Madison Jr' ~rQ~S~n Personal information you provide may be used fot secondary purposes , (Submit completed form to county if not Department or Commerce (privacy Law, s. lS.t34(lxm)J StAte owned.) Attach complete plans (to the county copy only) or the system on paper not ass arr - 2 : 11 inches to stn. County 5tatt Saniwy Perrttit Number heck i revi~(gpnta _ nation State Plan 1. D. Numbt:r l~/O7 Y __,;~, I. Application Information -Please Print all Informstiort ~ Tlocatian: perry tw trine 0~ ~ ~Del~7~ ~ Zooz ~ ~~ ~ .. _ Property 1-ocarion 1/ 1/4, E or ~ ~ 53 ~ .It7 r Property s ailingAddtess b~fl7t ~ {~ ~l ~'f .a.t. Q I~tNumber lock Number , ~ Liry, Stare Zip ode • Phone Num M r ._~ Subdivision Namc or M umber II. Type of Building: (cheek one) drooms : ~~~~ ®~ b lli N fH il ~ C`ry ~~~ ^ village /L1 ` ~~ we ng - ~e a y Q~ 1 or 2 Fam I'owr of ,~ ^ publidCommerciAl(describc use);~ ~~~ ^ Stoic-Owned Ncarsst Road Pane ' ar um er(a) III. Type o ermit: (Check only one box o~ line A. Check box on lint B if applicable) q) 1. Ncw 2, Replacement 3. Replacement of 4. 5. 6. ^ F-ddirion to Existing System System 5 stem Tank Only B) permit Number Dste Issued ^ A Sanitary Permit was previously issued IV. Type of POV1rI' System: (Check all that apply) ound ~ Sand Filter ^ Conswdod Wetland ^ Non-pressurized In-ground ~ Prr,SSW'ized !n-ground Holding 'Conk ^ Single Pans ^ Drip Line O At-grade O Aerobic Treatment Unit ^ Recirculating ^ (7ther: V. Dispersalll'restment Area Information: 1, i]esign ow (gpd) 2. Dispcrsst Area ispersal Area oil Appl~cstlon eroo anon [tare 6. System Elevatron 7. Final Grade Required Proposed Ratr (C3alsJday/sq. fL) (Mintnch) 61e~ation ~ ~ f ~~ 3~~ , 3~ , 3 (O/• 3 VII. Tank Capacity in Total # of Manu~aclurcr Prefab Sitc Stal Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass utt t d t e s e r New Existing cra Tanks Tanks ^ ^ ^ ^ ~{ T G /OoU --- DOn (~.tl 1 ^ n ^ ^ V7IT. Rasp nsibllity Statement the undersigned, assume responsibility f installatio o c POWTS shown on the attached plans. 1 , Plum jS Neme nnr s ipna n ps): /MP No. usmess Phone Number 39~fb Z l~~- Z.b ~ z /'~~ 1 S / , ti ~ umber's Addrr!ss (Sueey City, Start ~ ip ) p iX. ouoty/Department Use Only Disapproved Sanitary Permit Fee (Includes Groundwater a issued Issuin6 AStnt ignature (No stamps) ^ Approved ^ Ovmer Given Initial Adverse Surcharge Fcc) Derermination X. Conditions o[Approval /xeasons for utsapprovat: ZO pl ~11IfiJI11'IdZlSIS'I,L Z65Z5CZ3TLT %V3 TB ~ OZ ZOOZ/ZT/80 ~; w~ .0 r ~ N 6 ~~ r ~"' c C_ ~ W ~ ~~ • ~~ r~ G ~ ~~ v ~ O~ i ,~ ;~ ~~ C f N • S o ~ h~ ~ ~ r ~~ P ~' t ~ /~~~q F M s o-^ ~- ,Q ~` ~ ~ /~ N' <' V ' ~- N ~ V ~' t ~o 0 Q r ~ ~ F .~ F f, ~ o r ~~ ~r ~ +c -~ { ~~ ~° ~~i++ NG 0 Z P v 6 ~ -~ ~ .~- f~. Vr„ r T~ ~ ~: ~ O ~'~r 'S n ~V L ~~ F ~ . , s ~ ¢~ V ~ ~f l n A a ~ y ! ~' ~ r -, d ~c h ~~ ~ 'V k F~ ~ t h t .~ ~ ~~ ~ ~ ~ (~ // ~~ "G K ~` J '" N '~ f Y f 3O u ~- OS I ~ ds r _---- __. ___.. ~, 1 l ~ ~' _l.... r .~ C6 ~ f ~ r r r y.l 1 F jN r 6 ,+,I J C L isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD lA CROSSE WI 54601-1831 TDD tf: (608) 264-8777 www.commerce.state.wi. uslsb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary May 20, 2002 CUST [D No.139462 TODD L SINZ T L SINZ PLUMBING [NC ES609 708TH AVE MENOMONIE Wl 54751-5520 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/20/2004 A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1 lOl CARMICHAEL RD HUDSON WI 54016 SITE: Eddie Forletti I I OTH Ave Town of Hammond St Croix County SEl/4, SEl/4, S3, T29N, R7W FOR: Description: Three Bedroom (two structures) Mound System Object "type: POWT System Regulated Object lD No.: 847786 Identification Numbers Transaction ID No. 727816 Site [D No. 643463 Please refer to both identification numbers, above, in all corres ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been COND[TtONALLY APPROVED. The owner, as defined in chapter IOI.OI(l0), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/Ol) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.OI/O1). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • Tl~e well must be a minimum of 2S feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 81 l & 812c • This plan was submitted with a copy of a recorded legal document to satisfy the requirements of Comm 83.22 (2)(b) S.b. • 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. C AP PM C 8EE G • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. TODD L SINZ Page 2 5/20/02 • The changes made to this plan on 5/20/02 by this reviewer were acknowledged and approved by the system designer. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely. Charles L Bratz POWTS Reviewer If , 1-ttegrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state. w i.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 Henry F Grote ,Certified Soil Testing Eddie Forletti -Mound Transaction # Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Location: Date: Owner: Address: Plumber: Signature: License # Attachments: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (01 /01) SE 1/4, SE 1/4, Sec. 3, T 29 N, R 7 W Town: Hammond County: St. Croix April 16, 2002 ~~C ~q ~p ~~~ Eddie Forletti ~~ '~',~' ~, ~~ " ~ Z00 PO Box ,Suite 130 ~~~^^ Lake El , MN 5504 ys~ ~~ Todd i z _ i 6748-Plan Approval Application SBD-8330 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management ~fi~nall ®V y VT p~ CpM ~Lr ~T MERCF ~~p..~G3 ZESPpNpE page 1 of 8 0519/2002 21:12 FAl 1715252592 TLSINZPLLi14iBING (( (~ o ., l ~ ~ •~ - v avert •~C _ ~ j ~ w.S 1 ~~ ~ ~-1 ~ St 1 l,a Design Criteria Yt'S Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg(t Fecal Coli.form > 10,000 clu/1 OU mL Fats, oils, grease < 30 mg/L ~ Bedrooms x 100 gal/bedroom day x 1.5 ~~ gallons/day hydraulic load Design Calculations !n situ designed loading rate o• 3 ~ gallons/sq. ft. per day Depth to estimated high ground water ~~ ~ ° in. Depth to bedrock ' ~ in. Cross slope at system ~• "~ Force main tength `°' ~- ft. of Z- in. Manifold/tteader length ~~ fi. of ~- _ in. Drain-back ~ L-S gallons Lateral length l @ l `' ~-s ft. of ~ in. Lateral elevation ~ ~ -~ ft. ~ bottom of lateral _ Lateral hole size ~~tz- in. @ 3s'~Z in. ( Z--`~ ~ ft.) Spacing 3~ holes!lateral ~g holes total Lateral volume ~ ~''~ b gallons Total lateral discharge rate ~"'S Z gallons/minute ;a ~'~ n. head 1\etwork pressure compensation losses t'aS ft Elwation difference t ~ 'O S~ ft. hrlctlon 1055 t ~t4 ft ~ zi gallons/minutz Total dynamic head z~''s 4 tt. Pump/st~ion Z 3 gpm cr z ~ ft. of head Manufacturer ~~ ~<<0~ Model ~t t ~ z Uose volume ~ Z-Z gallons Lift/si,pkfon tank ,~ -~'~~ ~ ~~-~ ~o L°w~ ~0"'° gallons Septic tank _.~ '~ t ~''"~ gallons Effluent filter ~ w~ ~ _~ J t °`° Measurement pump on and off '~'Z ~• l in. Height alarm from tank bottom lb'Z- in. Reserve capacity 3 ~ ¢{ gallons ipr[i.C~I CS fC5 X10 2 Page ~- o I' ~ 3 J ~~ ~ ~ ~ 9 3 1 ~ ~,q J 1 ~1 I~ (l /+ r t:. 7 ~ i ~~ . I ~ ~ ~ _ ~ ~ ..~ u ,.y d ' i w ~ ~ v .~.. ,~ f J ~, ~.. ' O f I ~ ~ ~~ ~II~~ r ,~ ~ c'1 '3 [ / ~ ..~ i J? ~ '~' ft" `3 u 0' / =, ~' ~ o~ a N ~ .~ J+ i ~ _ .. „ -~- ? . ~° t ~ ' j ~~ J ~ ~ e1 ~~+ ~1 d f / ~ ~ p~ ~~ s N ~~ ~~ 0 MI cr ~1 - 05/19/2002 21:12 FAY 17152x52592 TLSINZPLtiMBINGI ,~i (~0:~ ' ~ ~ o r 1 e. ~t'~~ - ~ °-ve'1 ' ~ t ~` ~ C. ~ 0 4 S ~ ~- Q, ~ ` °~ `l~ Y a.ri ~ Ll 1~ ~ Z}Q t b reek ~t.dr ~O4rtgQ~~t ZD'~ ~a~.~awl Z~. / ~ \ ~ ~ ~~ Out l ~.lt~v..~ 4~..e... ~~, g ~ 3 ~ ~ o \ ~ ~ ~ ,-~ ,..~. S1 to s w~ c o s~-S1 ~ wv~~, q ~•~ 2ag ~ ~ ~g.s' 8 05/19/2002 21:12 FAT 17152352592 .~ TLS I NZPLUMB I NG ~\('~J ~ t ~ C ~ . ~ Y ~~ aiL V 0'W~ 1 ~..• ~ ~~~ Q-o3 (s.~' -~, 4.~ ~ 8-s ~•o ~r ~ ~' ~ ~ ~ ll2.t' ~zq,~, ~" f fO~G4 ~~• ~ z~1 P ~ 4 z..~ ~ ~,ti~~ i I -, ~ l oq.s' S ~ 1 ~ !~ l Y\ a 1 L-(~ O "~ ~ w.~ ati CA.+r "'F o-h., b O~ O 1~ l . w. ~ ~ ] S. s Z. ' 0.,(7 ~r~ (Z . ~ ~ ~ ~a~~ ~L ~ ~ s o~ ~ ~~ . ~ ` ` 1---- h'1 A i N • WEATHERPROOF LOCKING~COV~R ,TUNCT~oN ,c A3E~C . Sax Lt/A/t'N ~iuG 41~ICK G~~coy~~GT---1 ~~~ ~ ~ ~ ~4'' I = ice., ~ ~ J. DIVE 3 P~ f1U NO-gTua6E0 ~ ~ o SOIL. Z4u t.'D. ~~~ 4 Y>:NT MANHOLE ..... ~ ~ •-4 r' i~wcs r ____~ . ' urirL~ .. _ p ~~wcco Z~'•8 y: H~ ~~~ Q~ 4W KOYr<.D A s..~, 5!(ET ~M'~ _~ BAFFLE 1 AL 3' o.+-ro ~ PIP'fi- - a ,rwELTIONS ~"'/C 1ZL.i.~.~, Q~ ..~`V"c.'~ 1 pN' G~uKG Clev, ~ '•j' cs4. • ~-~ ~ OGF PwyP D ~„ l CO~ltRFTc' r ~~v _ T b~oG~C SPEGIFt•GATIOI~IS SEPTIC E Q ~ DO 5 E ~ ~ ' ~, ~- - ~w TA1.J~.5 MAWUFACTURCR: IJUMB S , a I ER OF DOSES: PEK 0~~ TANK SIZC : ~ ~d ' ~~ GAL.LOUS • .DOSC VOLUME ALARM f'IMJUFACTUKCit: S `~ 17~ ti~Y~ IWCLUDIAJG OACKFI.OW; 1 2Z (,A~~ONS P1000L 1JUIM~fR: • 1 ° ~ 1"4 ``~ CAPACITIES; A. ZS' g IuCHCS OK 3 ~¢'~C.A~1.045 SWITCH TyP[: ~~~` "'`b Z 2R•~ B= i-JCNES OR GA~~OuS ~~Q. ~ PUMP MA-JUFACTURCR: ~_ C . $''~ ~iuC S ~'° G ~ t _ .~ MODEL WUMD[R: `S 2' NE OR Ou ~a~- ~ D~ IN~:NES GR G~~~ON:. SWITCH TdPC; ~~"`~ " AJOI'E: PUMP A1J0 ALARM ARC TO 0L MIAIIMUM OISCMARGC RATE~...G//~ INSTALLED OA! SEPARATC CIKC~.~TS VORTICAL 01ifERCAtCC OfTW[CU PUMP OiI AAIO OISTRIDUTIOIJ PIPE.. ~'~~~~ FECT + MIUIMUM NETWORK SUPPLY PilfitURE .. ~ ~ ~'S~ ~•~~~ FCCT ~ ~ + lciZ FCET OF FORCC MAIIJ X ~~,~~ ~ ~oortFKlCTIOU FACTOR.- ~'~~ 2.1 ---_ FEET ~ G ,~ ~,,,,~ TOTAL DyUAMIC HEAP zo•~-~- FEET a I-JTERIJAL. DIMCIJSIOAJR •0I TA1JK: LE1.lbTH ~~.;W~DTH ~2' ~ LIQUID DEPTH ~Au~ 6 ,~ R ~ ~~ ~ . HEAD CAPACITY CURVE MODEL 152/153 w~ ~, W ~ ~ 50 153 12 40 152 o w 30 ~, z 8 r 20 0 4 10 TOTAL DYNAMIC HEALS/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gal. Liters Gol. Liters 5 1.5 69 261 77 291 , 10 3.1 ~ 61 231 70 265 ~ 15 4.6 53 201 61 231 20 6.1 44 167 52 I 197 25 7.6 34 t 29 42 159 30 9. t 23 , 87 ', 33 I i 125 35 i0.7 '~ -- ' -- 22 85 40 i 12.2 -- i -- ! ' 1 ' 42 Lock Veive: I , 38.0 Ft. (11.6ro) 44.0 Ft. (' 3 Grr;'' oiasoe 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Owik•Box available for~outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series 6 ~/a 3 27/j2-}~+-4 5/8-+ I ~-~ 1 C~%jL 3 2'%~2 T----- /.~ J__- _-T - i° ~- sKZOSa SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. O CAUTION 2. See FM0712 for correct model of Electrical Alternator E•Pak. Ali installation of controls, protection devices and wiring should be done by a qualNied 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the moat recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). Or (4) float System. ~ ~~ ~ RESERVE POWERED DESIGN ~ O For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ,, . ~ MAIL TOr P.O. 80X 18347 O Louisville, KY 40256-0347 ,~ Manufacturers of . . ~ ~ ~r ~ ~ i ~ SHIP T0: 3649 Cane Run Road /pqp ® Louisville, KY 40211.1961 Qva[/Tr PUMPS SNCf /j~,JJ u http://www.zoelleccom PUMP !O. 021778.2731. 1(800) 928-PUMP FAX (502)174.3624 ___ 1511153 MODELS Control Selection Ir Mo_del _ Volts•Ph Mode Am Sim ex Du lex Nt52 tt5 1 Non 8.5 1 2a3 BN 152 115 1 __ .--- __ Auto 8.5 Included 2 or 3 Et52 230 1 Non 4.3 1 2a3 _ BE t 52 230 1 Auto 4.3 Included 2 a 3 r Nt53 t15 1 Non 10.5 1 2 a 3 BNi53' 115 1 Auto t0.5 Included 2 a 3 E t 53 :__230 1 Non 5.3 1 2 a 3 BE t 53' 230 t Auto 5.3 Included 2 or 3 © Copyright 2000 Zoeller Co. All rights reserved. • .~ • ~ System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715-235-2644, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 1 1. if construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15` down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 Wrscronsin Department of Commerce ~ SOIL EVALUATION REPORT - Page ~ of~ Division of Safery'and Buildings in accordance with Cornet 85, Wis. Adm. Code County /~ ~ ~ r. Attach complete site plan ~ paper trot less than 8 12 x 11 inches in size. Plan must r include, but not limited to: vertiq! and horizontal reference point (BM), direction and Parcel LD. percent slope, scale or dimensrons, north arrrnv, and Nation and di rest road. Please print aii i ,E,vE~ Reviewed by Date Personal mfortn2tion you provide may be used for (Privacy law. s. 15. (1) (m)). ~ B '/ 4 _ 0 Property Owner MAR 2 6 2 Pro Location l~ ~ ~ I, ~ F~> ~ ~ ~ -~- ~ ~ ovL a ~. 1/4 5~ 1/4 S ,3 T Z ~ N R ~ ~ E (or~ Property Owner's Mailing Address .~ CROi F{ Lot # Block # Subd. Name or CSM# pO, ~~ ~~ S ~~~N~ Ciry~kG ~{ »no State Zip Code P r ^City ^ Village ®Town Nearest Road ®Near Construction l1se: ® Residential /Number of bedrooms 3 ~ `' Code derived design flow rate ~.5~ ~ O GPD ^ Replacement ^ Public or carirriercial -Describe: ,~1 Parent material ~i~ ~ / Flood Plain elevation if appligble ~/ ~` ft. General comments S'`/sy/r~ ~ ~t iI + / ~~ S ~ 'and recommendations: 7 / ~CJ/l lemur e~C(/', ~ 7~'~~ © Boring # ^ Boring ~ [~! pit Ground surface elev. ~ Q fL Depth to limiting factor 3 ~ in. Sa'I Application Rate Horizart Depth Dominant Color Redox Descxipf(on Texture Structure Consistence Boundary Roots GPDlft2 in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ 0 - ~ ~ ~ X3/3 - S,' l ZmAb/c ~r G s v ~ , -S' ~ g Z l ~~ ,~ /O r~~~ -` Sc.L Z yrr sb IYi ~r CS - . !~ 3Z"~ /D ~ 3lw C z 7, ,5'. / l'/ Sc-L Z ms6 Y1? r - -- ~ `~ . ~ a ~~ # ~ 8onng 3 y y ~7 pit Ground surface elev. / D ~ ft. Depth to limiting factor in. Sol Application Rate Horizon Dept Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R= in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eif#2 ` Effluent #1 = BO05 > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS _< 30 mg/L CST Name (~ Print) M ~ gar atCire ~ /~~ ~ 2 ST Nu30 Address /Dat/e Evaluation Conducted Telephone Number ZI~3 ~4~'~~ .~? ~~, _ w/ ~'ti'a?S-_ Z --/~- a z 7rs-Zy~.yoa~r r Property owner ~U ~ ~~ ~ i Parce11D # Page „~_ of Boring # ^ Boring ~] Pit Ground surface elev. -~~ ft. Depth to limiting factor ~ in. Soil Applic:atian Rate Horizon Depth Dominant Color Redox Descxiptian Texture Structure Consistence Boundary Roots GPD/ft2 in. MunseN Qu. Sz. Cant Cobr Gr. Sz Sh. 'Etf#1 'Etf#2 3 Sc~.. z ~ ,-- ~ _ . ~ , ~ ~- S~-~ z mfr ~ - ~G/ -~ 0 f! Olt r'a l~.tJ~.t. ~t~ii 1s0ri IS Si~+"+~ ^ Ong # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soli Appliptron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 eonng # ^ ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Hor¢on Depth Dominant Color Redox Descrtptian Texture Stricture Consistence Boundary Roots GPD/ft~ in. Mansell flu. Sz. Cant. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or ne,~d material in an alternate format, please contact the deparhnent at 608-266-3151 or TTY 608-264-,8777. PAGE~OF~ ~; p ASE ~o r ~-e -E''F ~ LOT# LEGAL DESCRIPTION ~ L4 ,S T .N R Elor)W SCALE: 1"= ~~ / BM 1 ELEVATION /~~~ - c) BM 1 DESCRIPTION ~P a ~ ~ ~~ ~ ~ ~~ U ~` BM 2 ELEVATION ~ y S C) BM 2 DESCRIPTION -~oQ a ~ ~'~ (' n r~cS~ ~ ~~ ~-- SYSTEM ELEVATION. g~~ Sy ALTERNATE ELEVATION ,~///¢ CONTOUR ELEVATION 9 ~, h0 Dn ~ G~ 9K~, ~ v BmZ gW- ~-Z SIGNATURE- ,~'~-__-_, ~ ~-.- ATE Z //D'='~ ~r~.~ U.i~y3P 326 POWTS Requirement ~~ 6 7 9 3 4 9 KATHLEEN H. 1tALSH REGISTER OF DEEDS ST. CROIx CO. , YI RECEIVED FOR RECORD 05-17-2002 3:00 P~ NISCELLA~EOUS EXEMPT ~ REC FEE : 15.00 TRANS FEE: COPY FEE: 4.00 ' • CERT COPY FEE PAGES: 3 Reoocdia= Mea Name and IR~cs Addnas Ed Forliti P.O. Box 876 ' Lake Elmo, MN 55042 018-1006-50-000 018-1006-60-000 018-1006-70-000 PaiOll Ideab6udOn Nambrr ~II'1) 018-1006-80-000 "THIS PdGB IS PART OF THIS LEGlIL DOCOlQ:NT - DO NOT HEKOVS" 11L ialbem~iea aatla eea~{at~d ri~- au~.iwe: . w.r~ t .r., ~I~~..~t ~(tV• ~ ~^"a'~0A "~ tt ~[ jl~lij a~. ~ ~.."~-"'. fK. aM' ~t fja~Y+j M ~~~M~ 7 ~t K Ay) jt ~OC~/ M II<~NM~ jOsif ~~t . Iea+.~ou. (~ Ws d~ errar~te rftr ans ~s r yar los~ase+nt d ~'?s?-m~dk nre+~nr tee. IRreewin Srartn. J9.S17. p1tDA 1J9~6 U 1893P 32? A parce! of land located in the SE'/, of Section 3, Township 29 North, Range 17 West, St. Croix County. Forliti Realty, Inc (Ed Forliti, representative) is the owner of the land described above, recorded in volume 1811, page 328, document #667781. 018-1006-50-000 018-1006-60-000 018-1006-70-000 018-1006-80-000 (PIN numbers) As owner of the above described property, I acknowledge that the designed septic system is to serve a house and shed in combination. I own all the above land and do not intend to separate the shed from this parcel of land. The shed will be used to store my vehicles and as a workshop. ~ do not intend to conduct any type o~ commercial or home business oti this sits. The septic system is identified on page 8 of the design plans under transaction 1D # 727816 and Site #643463. .~ .• N .'A~;. may. Off. •-y, . • ~.- ~j c State of Wisconsin) )ss. St. Croix County) Personally came before me this~~ day of May, 2002 the above named Ed Forliti to me known to be a person who executed the foregoing instrument and acknowledge the same. Notary Public, State of Wisconsin My commission is permanent. If not, state expiration Date: 9- Z~'U.3 raF~d bL~ ~ Ro~~ c ~ ~n-~e ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~ TOY' (~ Mailing Address Y `~ ~-`~~ ~ ~c® l„-C~C.' ~W~~ ~ ~ ~~~~ `~ Property Address _, I (Verification required from Planning Department for new construction)_ City/State ~~W ~ ~ ~~ Parcel Identification Number ~) ~-~~~ ~~~-~ LEGAL DESCRIPTION q j~ property Location ~~ %., '/., Sec. ~ . T~ / N-R ~ ~W, Town of / I~`~ Subdi~~sion .Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # ~ ~ ~ ~~ ~ .Volume ~ ~ Page # Spec house ^ yes ~ no Lot lines identifiable ^ yes ^ no S~YST'EM M~iINTENANCE 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 masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposalsystern is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office withm 30 days of the three year expiration date. ,~ ~ ! a i / Oa SIGNA O PLICANT DATE OWNS 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 decd recorded in Register of Deeds Office. ~ ^~' ~ IQ ~ 1 a~ SIGNA ICANT DATE ****** ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *• Include with this applicsrtion: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~~~~ l~q y 110*-~ ~ ~~ r~-~ ~ys~em a 3~ TOwr~Sh.~p r~~ .~ ~amrn~ °d . _~. ~ ~ n T ~c~ ~r I ~,~~~ rope.,r~~t s ~p y:~ t' 328 ~ , QQ Ui 'n` 't'~~oAr,E~.~~, 8 ' I Docutneat Number STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED 667781 KRTNI_EElJ H. WALSH REGISTEF.' OF DEEDS aT, ~RCil'X CU. , WI keCF.TtiED FDk RECOkD (~i-lG-c"?Gi? 9:30 Ad YARRANTf DEED cXE:1pT 11 CERT COPY FEE: CORY FEE: TRANSFeR FEE: :58.00 PtC~SDINO FEE: 11.44 This Deed, made between Sammy Morrow, aJk/a Sammy L. Morrow, afk/a Sammk L. Morrow Fort{t~ Grantor, and ~orllFRealty, Inc., a Mlauesota Corpontbn Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Rentrc: Address SE %. of Section 3, Township 29 North, Range t7 West, St. Croix County, ~~~~- Wisconsin EXCEPT the SE %. of SE %. thereof. Arm p/fir X33 Part of SW 'l. of NW 'l. of Section t, Township 29 North, Range 17 West, St. Croix County, Wisconsin described as follows: Lot 2 of Certified Survey Map filed October 1, 1980 in Vol. 4, Page 996 as Document Number Pt of 018-1005-50.000, O18-100650-000, 36ti744. 018-100ir6o-ooo,ols-)ooh-70-0oo,olg-loos-so-ooo Parcel Identification Number (PIN) This is not homestead property. 01) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this -y~ day of January , 2002 AUTHENTICATION Signature(s) Sammy Morrow, a/k/a Sammy L. Morrow, a!k!a Sammie L. Morrow M authenticated this 4 day of January ~ 2002 • Kristine Ogland TITLE: MEMBER STATE BAR OF WISCONSTN (If not, authorized by ~ 706.06, Wis. Scats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland udson, 154016 (Signamrcs maybe suthenticeted or acknowledged. Both arc not necessary.} • Names of persons signing in any capacity must be typed or printed below thei WARRANTY DEED • Sammy Morrow, ^ Sammy L. Morrow, alk/a Sammie L. ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of Wisconsin My Commission is permanent. ([f not, state expiration dater •) nature. Mrorma~on vmrwion.r canpry, Few a tK wt eoo-ass-mtt STATE BAR OF WISCONSIN FORM No. 2 -1999 i r T.L. Sinz Plumbing Inc. ES609 70$th Avenue Menomonie, WI 54751 Date: ~~~ 3~0 Z Phone: (71 S) 235-2644 Fax: (715) 235-2592 No. of Pages: (including cover) Ain: ~o ~ ._--, From: ~ 0 J D ~ ~ L Subject: ~l~l ~ ~O~L~TI/ J~GtJ~ Message: T~ Signature: Tof~j 9HI~I1'IdZHI5'IZ Z65Z5CZ5TLT %V3 iC ~ oZ ZooZ/ZT/8o ~ r