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018-2009-03-000
Wisconsin Department of Commeme r ~ PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. . ermit Holder's Name: City Village X Township Pa ne, Scott & Jodi Hammond, Town of ST BM Elev: Insp. BM Elev: BM Description: '~ M ~ G5~" 5 /9 b5 ~ SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~' .~~... 3 ~ / 7~p Best. fir'; L ~ a., w~. ~~ ~ lam- Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ / ~ .~, G i ~ S / 7 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer mand GPM Model N TDH Friction Loss System Head T Ft Forcemain Length Dist. to well SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 463465 0 State Plan ID No: Parcel Tax No: 018-2009-03-000 Section/Town/Range/Map No: 04.29.17.987 ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~~OS ~Q'7c(o ~~ Alt. BMJ` `~ ,, (( ~C ` J,a ~~' ~ 1 ) w er Bldg. S e ~ ~~ ~ SUHt Inlet t}~ b ~~3 , o St/Ht Outlet ~' ~$ 'd ~ • c.7 7 Dt Inlet Dt Bottom Header/Man. S `° /15Z•ot Dist. Pipe 5-(0 '~ • JrS /OZ •0 ~ / Bot. System O Final Grade St Cover ~,, ~~~ ~ ~ b ~d~ - l01 'ft Q ~ i BEDITRENCH Width / Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ o~ / ~ I ~ ~_ ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ ~ 1 TION CHAMBER OR ~ J ( .~ INFORMA Type Of Sys m: 1 ' O/ ~La ~ ~ / / / 1/~ 'rt' UNIT , , Model Number: ' a/l X'' T' N a, ac, ! G DISTRIBUTION SYSTEM (1,x•..1) 1~. z.~=l.J Vey = / 2f `lb~t-~l~ Header/Manifold ~ ~~ i ~ Distribution Pipe(s) ` S i g L th~ Di x Hole Size \ x Hole Spacing Vent to Air Intake i1 1 (I _ _ J~ r ~C _ D Length a_ pac n eng _ a , S(lll CnVFR Y nro~~~~~e e..~+omo n.,t.. YY Mnnnrl nr Of.Grade Systems Only L~tJ~J~ Depth Over i Depth Over I xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ `~~ Bedlfrench Edges Topsoil ,Yes i No Yes ' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /_ Location: 1105 178th Stmt a~mm. ond, WI 54015 (SE 1/4 SE 1/4 4 T29N R17W) Hillside//Heights Lot 3 1.) Alt BM Description = ` ' ~' ` / ~~'~~- ~~~ 'mss ~ h--b ~ ~ 2.) Bldg sewer length = 7i 5 ~' ~ ~ra~~ mt of cover = / ___ ___. ~ -_7,1~ C3 luired? j Yes No ~ r I I~ r additional information. ,___ i Date Insepctor' ignatu Inspection #2: / / Par I No: 04.29.17.987 ~~~ ~~~ ~ ~ ~ ~'+~ 1 ~~ ~,_~~ , Cert. No. `~~ if~ip,~"r%/~ SOIL EVALUATION REPORT # Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Steel's Soil Service, Inc. County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Pending Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Cutting Edge Four, LLC Govt. Lot n/a SE1/4,.SE1/4, S4, T29N, R17W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# E976 170 TH Street ; n/a Hillside Heights City State Zip Code Phone Number ~ City ^ Village ®Town Nearest Road Hammond ~ Wi 54015 715-796-2793 Hammond Cty Rd T New Construction Use: ~ Residential /Number of bedrooms _ 4 Code derived design flow rate 600 GPD ^ Replacement ^ Public or commercial -Describe: n/a Parent material Ground and end moraines, pitted giaical drift Flood plain elevation, if applicable n/a ft. General comments Conventional system, system elevation 104.30 ft. Trenches spaced and depth to code 3.50ft below and recommendations: grade. ^ Boring # ~ ® Ground surface elev. 107.80 ft. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominanl Color Redox Description Texture Structure Consistenc Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3i1 none sil 2msbk mfr cs 1f .6 .8 2 12-29 10yr4/4 none sicl 2msbk mfr cs n/a .4 .6 3 29-110 10yr6/4 none grcos osg mvfr n/a n/a .7 1.6 -- --- ~ - ---- , ^ Boring # ~ ® Ground surface elev. 107.80 ft. Depth to limiting factor 120 in. Soil Appli Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots Gi in. Munsell Qu. Sz. Cont. Color ~ Gr. Sz. Sh. *Eff#1 ' 1 0-10 10yr3/1 none sil 2msbk mfr cs if .6 2 10-31 10yr4/4 none sicl 2msbk mfr cs n/a ~ 3 31-120 10yr6/4 none Is osg ml n/a n; a i /~ * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L CST Name (Please Print) David J. Steel , Address Steel's Soil Service, Inc. ~ 994 200th St. Baldwin, WI 54002 * Effluent #2 = BODS < 30 mg/L and re: Date Evaluation Conducted 5/19/2005 IL T abet d56 urttbet 7eP1~Q 0 ~~ o~ROlioo1 ~ Fj- S0p.833 Property Owner Cutting Edge Four, LLC Parcel ID # Pendi Page Boring # ® Ground surface elev. 104.70 ft. Depth to limiting factor 120 in. Soil A pF Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots C in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#t 1 0-12 10yr3/3 none I 2msbk mfr cs 1f .6 _ 2 12-24 7.5yr4/4 none sl 2msbk mfr cs n/a .6 1.0 3 24-48 10yr6/4 none cos osg ml cs n/a .7 1.6 4 48-120 10yr6/4 none ms osg ml n/a n/a .7 1.6 a Boring # ^ Ground surface elev. 105.50 ft. Depth to limiting factor 120 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#t tEff#2 1 0-12 10yr3/3 none I 2msbk mfr cs 1f .6 .8 2 12-24 7.5yr4/4 none sl 2msbk mfr cs n/a .6 1.0 3 24-120 10yr6/4 none cos osg ml cs n/a .7 1.6 ~- --- i I _ - _ _ ^ Boring # ^ Ground surface elev. ft. Depth to limiting factor in. ^ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2 I "Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L ~ Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/ tices oY The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access need material in an alternate format, please contact the department at 60$-266-3151 or TTY 608-264-87775<eetssDO ~N~ce~ ~~`~ SBD-8330 (R.07/00) STEEL'S SOLE. SERVICE INC. Page 3 of 3 ~.vid J. Steel 994 20Qu' St ST POWTSM Cutting Edge Faur, LLC Baldwin, WI 542 C. #248956 SEi/4,SE1/4,S4,T29N,R11W Bus.(715) 684-568U Town of Hammond, St t:rnix to. Fax.(715) 684.3449 Hillside Heights, Lot 3 Tlti~~ 'on ~. , was conducted >p satisfy a coning requirement; it may or may not be suitable for your Legend I" = 40' • = Benchmark E~.1t?O.t><1Ft Top of 3/4" P~ P~ • = Alt B~chmarkEle.100.30Ft ,, Top of 3/4" P~ P~ ^ =Borings _ BOiltlQ ~~t8tionS B1 ~tc~~Y~Ft 82=p1.$vFt - B3 =/oY ~Ft • ~y DY y~~! ~/l' L /a ~,s~ /ay~;b ~ C' ' J~' it ~$ ~ ` \ / ~`~-- ~f$~p/~$jjt SOIL EVALUATION REPORT #1528 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 ""°'"-~ Steel's Soil Service, Inc. Division of Safety and Buildings ~°d~~~ ,` I~ County ~ Attach complete site plan on paper not Irrt m size. Ian must St. Croix inGude, but not limited to: vertical and rizon nce point (BM), dir ion and stan o nearest road Wort arrow and location an scale or dimensions ercent slo e Parcel LD. L%/ ~ ~ DO 9~U~~ . , ~ , p , p a ~ en in Please print l infoioil: j ~ y ~ r . Reviewed By Date pu s~eLa(F~V' a~i'Law, X15.04 (1) (m)). n Personal information you provide may be used seco da ry s ~ as N,N~, Property Owner S Z roperty Location C Cutting Edge Four, LLC Govt. Lot n/a SE1/4, S 1/4, S4, T29N, R17W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# E976 170 TH Street 3 n/a Hillside Heights City State Zip Code Phone Number ~ City ^ Village ~ Town Nearest Road Hammond WI 54015 715-796-2793 Hammond C Rd T New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ^ Public or commercial -Describe: Na Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable n/a ft. General comments Conventional stem, system elevation 104.30 ft. Trenches spaced and depth to code 3.50ft below and recommendations: gra e. Boring # ^ Boring ® pit Ground surface elev. 107.80 ft. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/1 none sil 2msbk mfr cs if .6 .8 2 12-29 10yr4/4 none sicl 2msbk mfr a n/a .4 .6 3 29-110 10yr6/4 none grcos osg mvfr n/a n/a .7 1.6 Boring # ^ Boring pi} Ground surface elev. 107.80 ft. Depth to limiting factor 120 m• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk .mfr cs if .6 .8 2 10-31 10yr4/4 none sicl 2msbk mfr cs n/a .4 .6 3 31-120 10yr6/4 none Is osg ml n/a n/a .7 1.6 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) S' nature: ~ CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 5/19/2005 715-760-0347 SBD-8330 (KU7/W ) Property Owner Cutting Edge Four, LLC Parcel ID # Pending Page 2 of 3 Boring # ~ Boring p~ Ground surface elev. 104.70 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EtT#1 `Eff/KI 1 0-12 10yr3/3 none I 2msbk mfr cs if .6 .8 2 12-24 7.5yr4/4 none sl 2msbk mfr cs n/a .6 1.0 3 24-48 10yr6/4 none cos osg ml cs n/a .7 1.6 4 48-120 10yr6/4 none ms osg ml n/a n/a .7 1.6 Boring # ~ Boring ® pit Ground surface elev. 105.50 ft. Depth to limting factor 120 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 'Eft#2 1 0-12 10yr3/3 none I 2msbk mfr cs 1f .6 .8 2 12-24 7.5yr4/4 none sl 2msbk mfr cs n/a .6 1.0 3 24-120 10yr6/4 none cos osg ml cs n/a .7 1.6 ^ 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Et~#1 'Etf#2 `Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mglL " Effluent #2 = BODS < 30 mg/Land TSS <30 mg/L T'he 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 T"I'Y 608-264-8777. SBD-8330 (R.07f00) ~~5 ~ • ~• ' ~. Page 3 of 3 STEEL'S SUIL SERVICE INC. David J. Steel 994 200`" St. CST PoQVTSM Cutting Edge Four, LLC Baldwin, WI 54002 Lic. #248956 SEl/4,SE1/4,S4,T29N,R1~VV Bits.(715) 684-5680 Town of Hammond, St. Croix Co. Fax.(715) 684-3449 Hillside Heights, Lot 3 This~rsoil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. I,egead 1" = 40' • =Benchmark E1e.100.00Ft Top of 3/4" pvc pipe • =Alt Benchmark Ele. 10030Ft Top of 3/4" P~ PiPe ~ =Borings _ ., Boring B{~vaxioas B1=la7~Y~Ft B2 = ~°~$v Ft __ B3 =taY ~t B4 =io~~3Ft ~a' a~, ~r3' ~3 ~`~ ~,; l Q l ~ i ~~~ g~5~~ ~~ - r~ I c`~~J r lb Wis. ~o ~~~ ££'~` ~o ~ '~. ~~~=:~,- Safety and Buildings Division County ' 201 W. Washington A 7162 m ~s~ow~~,n Madison, WI 5 707 -~ ~C'1 ~ am Permit Number to be filled in by Co.) Department of Commerce ( ) ~ 608 26 3151 C V I Sanitary Permit App MqY ~ State lan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal in ~n r 'de ~ Z~ 5 ~t.2 may be used for secondary purposes Privacy Law, s15. 4(1) SIX COUN yProje Address (if different than mailing address) I. Application Information -Please Frint All Information (~ ~ I ~~ ~~ Property Owner's Names J c~- / Parcel # L.ot # Block # RX- e. -~- V e ~ Property Owner's Mailing ddress Property Location ~L ' City rate Zi C d /<, ~ ~ ~~`~ Section , p o e Phone Number ' L 1 ~1/ l~ ~ ~~~~ ~ ~EcI II T e of Buildin (check ll th t l T N. R . yp g a a app y) s r V ~-L or 2 Family Dwelling -Number of Bedrooms ~ ~ yv~ dµ5 Subdivision Name CSM Number ^ Public/Cpmmercial -Describe Use ^ State Owned -Describe Use ^City_^Villag ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p _ _ p _ O'l7D `~• ew System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner N. T e of POWTS S s tem: Check all that a 1 on -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 Chamber ^ Drip Line Gravel-less Pipe Other (e lain) V. Dis ersal/Treatment Area Information: ,p Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dr ersal Area Pr osed (sf) System Elevation D - 7 " ~ ~ /80 ~ ^Z F~~ 3. ~7 VI. Tank Info Capacity in Total Number Manufacturer ite i er Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~~~ J~- Aerobic Treatment Unit ` Dosing Chamber /yam . ~rSS ( ,~?- VII. Responsibility Statement- I, the undersigned, assume res r installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Si MP/MPRS Number Business Phone Number ire ~ o ` - 35-//3 Flumber's Address eet, City, State, Zip Code) ~ _ ~ ~ 3" ~ ~ ~to-~ ~ CAL ~"~ 7s/ VIII. Coun /De artment nl Approved ^ Disa Sanitary Pemrit Fee (in des Groundwater S Date Issued Issuing ent Signature Stamps) ^ O eason enia] urcharge Fee) 3~ - 3 ~ IX. Conditions pprov 1 SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. ~,.-~~ v,upro,c p,aus tw me a.ounry onty) ror [ne system on paper not less than 81/Z x 11 inches in size SBD-6398 (R. 01/03) 1" = 40' Benchmark Ele. 100.00Ft of 3/4" pvc pipe ~- •'~ Alt Benchmark Ele. 100.30Ft p of 3/4".pvc pipe ~- ^ =Borings Boring Elevations B 1 = 97.70Ft B2 = 97.70Ft B3 = 94.20Ft B4 = OO.OOFt 1 N ~~~f~ Ss,~ ~~g7 ~~?['r- 7y~ i ~a~°9~ oQ~ c " - z~'l g'c'O ' _ zo~ll~u,-gS3 ~""`~ Ada- A-ioo F (~~- o ~ "pve 9~•~ ~ r/ 32` iz' fc/r -~5,< prc ~oSE~ ~~t~is 1" = 40' ~-~- Benchmark Ele. 100.00Ft of 3/4" pvc pipe ~- Alt Benchmark Ele. 100.30Ft p of 3/4" pvc pipe ~- ^ =Borings Boring Elevations B 1 = 97.70Ft B2 = 97.70Ft B3 = 94.20Ft B4 = OO.OOFt ~ ~,~~~ . - ~~e ll~r g5.3 ~""~ zada- /~-boo F l,~a- ' ~ "pie `,~' N \\~~~f~ '~. ps5s,~ ~~ . 47 \' ~°~"- ~~ - ~~~;/" aa5°y`/ 9~•~ p© ~ ~Gt .~,~ ~ S~t ~ z ~~~+cv f~i~ 5 S~~ ~~~ow_ ~~~°s~~s~ar~ Wisconsin Department of Commerce Division of Safety and Buildings ,~~Ia~UATION REPORT in ~~t~ fh`"r:nmm Rai Wic Aclm r:nrlP 1528 Page 1 of 3 Steel's Soil Service, Inc. ' County Attach complete site plan on paper not less than 8'/: x 11 inches in, ~~ Ian m St. Croix indude, but not limited to: vertical and h nzontal reference~oifit (B percent slope, scale or dimemsions, no~ arrow, acid Ibcation and distanc on a e ton road. parcel LD. P din ~ ' g en Please print 11 inforrrtq~. \ ~~Ct~ e ~ wed By Date Personal information you provide may be u for secon~a@ .04 (1) (m?)• ~ ~~,,`_ ~ 3 ?.coo Property Owner Property Location Cutting Edge Four, LLC Govt. Lot n/a E 1/4 SE 1/4 g 4 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# E976 170 TH Street 3 n/a Hillside Heights City State Zip Code Phone Number ~ City ~ Village ~ Town Nearest Road Hammond ~ WI 54015 715-796-2793 Hammond Cty Rd T New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe:n/a Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable n/a General comments and recommendations: Conventional system, system elevation 94.20 ft. Trenches spaced and depth to code 3.50ft below grade. Boring # ~ Boring ~J Pit Ground Surface elev. 97.70 ff. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 1 0-12 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 12-29 10yr4/4 none sicl 2msbk mfr cs Na .4 .6 3 29-110 10yr6/4 none grcos osg mvfr Na n/a .7 1.6 ~j 3 ~D/ Boring # ~ Boring ~f Pit Ground Surtace elev. 97.70 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 10-31 10yr4/4 none sicl 2msbk mfr cs n/a .4 .6 3 31-120 10yr6/4 none Is osg ml n/a n/a .7 1.6 r,~` ~3. ~ * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) ignature: CST Number David J. Steel ~ 248956 Address Steel's Soil Service, tnc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 9/10/2004 715-684-5680 Property Owner Cutting Edge Four, LLC Parcel ID # Pending Page 2 of 3 Boring # ~ Boring ~/ Pit Ground Surface elev. 94.20 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Stnicture Consistence Boundary Roots p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr'3/3 none I 2msbk mfr cs 1f .6 .8 2 12-24 7.5yr4/4 none sl 2msbk mfr cs n/a .6 1.0 3 24-48 10yr6/4 none cos osg ml cs n/a .7 1.6 4 48-120 10yr6/4 none ms osg m! n/a n/a .7 1.6 ^ 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 D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # --~ Boring Jj Pit Ground Surface elev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P 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 mgR and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ~. David J. Steel 994 200th St. CST-POWTSM Cutting Edge Four, LLC Baldwin, WI 54002 Lic. #248956 SE1/4,SE1/4,S4,T29N,R17W Bus.(715) 684-5680 Town of Hammond, St. Croix Co. Fax.(715) 684-3449 Hillside Heights, Lot 3 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend 1" = 40' • = Benchmazk Ele. 100.00Ft Top of 3/4" pvc pipe • =Alt Benchmark Ele. 100.30Ft Top of 3/4" pvc pipe ^ =Borings Boring Elevations B 1 = 97.70Ft B2 = 97.70Ft B3 = 94.20Ft B4 = OO.OOFt Page 3 of 3 STEEL'S SOIL SERVICE INC. <<~ ` / 13i 32` 5 ~~ lZ-' / ~5 i /CI" ~ 57 7~,1 ~~~~' l-~ ~- ~~ ~~ ~, ~~f~ ~s5sc~ ~~ • 4 7 \ ' ~°~`,~ ~~',~ ~ Co ~~~ ~~ ~ ~o ~ ~1 ~ `~ 'tij ~ ~ ~ ~ `' _ x ~ ~ 'N.& 67844 S`~F. _. ` - - ~~ - ~- - ~ 1. ~ N.B. 1.56~c-- - - - ~,~j p, _ ~ , x x x .~ -, y~. x-fix - - /~-`~- ~ - ~3`o~&1'X S' ,F~ ~ ~ ~ - - - _ _~ ~ -~ _, _ x _ _ ,~' - . - ~, \~~9, A~ / ~ sue, ~ ' - 6~7 7$ ~~F ~ ~ ~~ _- /~ - -~ 80- ~~ ~ r1-.B-66o9s s.F: ~• ' - _ _ 1.51 A~~ ~ ~ ~ : 1 ~ ~ / N.B~ 46 ~Ac. ~ ~ ~ ~ C8 1 1~7.~5 ~ / / / 3 • ~ \ \~ 3 / / ~ \ \ 3p •~ / 1 1 y ' ~-- ~~ ~~ r _ ~ ~ ,~ / \ ~1~ ~ --- f~-A~--, `~ -- E ~\ ~ ~ 45599 S.F'~ -~ \ ~-' ~ v ~ ~ ~ _ ~ - ~ -~ _ _ r 1 LBO = X78.5' ~ ~ t \ \ \ \~ ,1 / ~ L-Pa- 8 ~~4' ~5" 1R~-1--~ ~ Bch \ ~,I,\ \ \ \ \ \ ~~ , i P ~ \ ~ \\ \ ~ I SEE,PTIC 7.7~\ ~C. \ \ ~ \ \ ~ 1 AEA \\\ \ \ \ 65341 S.F. ~ ~ ~ ~ ~ ~ \N.B~ ~~5670, s.~~ ~ ~ ~ \ 1 ~ 1.50 Ac. I ~ - r ~ ~ N.B~ \~~7 A~` ~ ~ ~ \ ~ ~ \ I N.B. 65341 S.F. I ~ _~... -~ \ N.B. 1.50 Ac. ~ 1 , ) , ~ (~1~~ I \. n ~ ~ ~ Private On-Site Wastewater Treatment System (POWYS) Index & Title Sheet Owner: Project Na Location: Street Address ~ ~y Contents: Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWYS Owner's Manual Management Plan Page 8: POWYS Owner's Manual Management Plan Page 9: POWYS Owner's Manual Management Plan Page 10: Certified Surve~p Page 11: Co of House Plans Attachments: Plumber/Designer: Mike Ro ers Signed: Credential Number: 225094 Date: Page 1: Sanitary Permit Application TDH Calculations TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems lot 3 Owner's Name 5/10/05 _ Review Date X g Gravity Dosed, or gpd Design Wastewater Flow X Pressure Dosed ft Total Combined Lateral Length Y or N y Forcemain Drainback in Lateral Diameter 20 ft Forcemain Length 2 in Forcemain Diameter 20 gpm System Flow Rate 0.00 ft Minimum Design Head 10.00 ft Vertical Lift 0.18 ft Forcemain Friction Loss ~ 10.18 ft Total Dynamic Head 2.04 ft/sec Forcemain Effluent Velocity Choose Pump That Discharges At Least: 20.00 gpm at 10.18 feet TDH Maximum dose volume is >20% of design wastewater flow gal Maximum Dose 0.0 gal 3.26 gal Forcemain Drainback 3.26 gal #VALUE! gal Maximum Dose Volume 3.3 gal 5x Lateral Void Volume Forcemain Drainback Minimum Dose Volume Version 4.1 (07/03) Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems lot 3 Owner's Name n _ Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System ~ 12 in Chamber/Unit Height 2 8 ft Maximum Bury Depth s 600 gpd Estimated Daily Peak Flow 0.70 gpd/ft` In-situ Wastewater Infiltration Rate 93.70 ft Proposed SAS Elevation 5/10/05 Review Date Ezflow EZ1203HP & EZ102H ~ 857.14 ft1 Chamber/Unit Area 50.00 EISA ft2 /Unit 18 # of Chambers/Units 26.50 Bottom Area ft` /Unit Soil Surface Acceptable Finished Grade EL a (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 95.70 102.70 1 97.70 120 90.70 96.70 Yes 2 97.70 120 90.70 96.70 Yes 3 94.20 120 87.20 93.20 No Fill required 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 W PUMP PERFORMANCE CURVE MODELS 53/55/57/59 a 6 -~ 20 w s ~ 15 4~ 0 Q 10 0 I- 2 5 0 10 20 30 40 50 GALLONS LITERS 0 80 160 FLOW PER MINUTE c~NSULT Ir,~croRY FAR SpEC1~4L APPLICATi~r~ • Variable level float switches available. • Variable level long cycle systems available. • Available vuith special cord lengths of 15', 25', 35' and 50' • Alarm systems available. • Duplex systems available. Sin le Seal Co ntrol Selection Listin s Model Volts Phase Mode Am s Sim lex Du lex CSA UL M53/55 & M57159 115 1 Auto 9.7 1 ----- Y Y N53155 & N57/59 115 1 Non 9.7 2 3 or 4& 5 Y Y * BN53 115 1 Auto 9.7 * Y Y * BN57 11.5 1 Auto 9.7 -- N Y * BE53/57 230 1 Auto 4.8 Y Y D53/55 & D57/59 230 1 Auto 4.8 1 Y Y E53155 & E57159 230 1 Non 4.8 2 3 or 4& 5 Y Y TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 53/55/57/59 Feet Meters Gal. Liters 5 1.5 43 163 10 3.0 34 129 15 4.6 19 72 Shut-off Head: 19.25 ft.(5.9m) 009897 10 1/16 11 112 NPT SK858 SELECTION GUIDE 1. Integral float operated mechanical switch, no external control required. 2. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. 4. See FM0712 for correct model of Electrical Alternator. 5. Variable level control switch 10-0225 used as a control activator, with Electrical Alternator (3) or (4) float system. 'Single piggyback switch. included. D CAUTION forinformationonadditionalZnellerproductsrefertocatalogon PiggybackVariableLevel FloatSwitches, FM0477; All installation of controls, protection devices and wiring should be done by a qualified Electrical Alternator, FM0486; MechanicalAlternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump ControVAla~m Systems, FM0732. must recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESEI~~'E P€~'~Ii~RECy DE~iGnl For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 l7/7 ~~'C ~~" Louisville, KY 40256-0347 Manufacturers of.. ~~ ~~~ SHIP T0: 3649 Cane Run Road ~~ ~~~r..a~~~ Louisville, KY 40211-1961 Q~~/ryPu%yPS S,vcE 19~J.. (502) 778-2731 • 1 (800) 928-PUMP hftp://www.zoellercom P~MP ~O FAX /5021 774-3624 © Copyright 2004 Zoeller Co. All rights reserved. P0~4VTS OWNER'S MANUAL MANAGEMENT PLAN I±ILE INFORMATION Owner u ~ ~ N ~ Permit # 3 ~~ i)i+`.S><[~N PARA]V1E RS Number of Bedrooms 100gpd/bedroom ^ NA Number of Commercial Units NA Estimated flow (aerage)* 2~ gaUday Design flaw (peak), estimated x 1.5* Q p gaUday Soil Application Rate gaUday Influent/Eftluent Quality (NA^) Monthly Average** -Fats. Oil & Grease (FOG) < 30 mg/L ..Biochemical Oxygen Demand (BODs) 5 220 mg/L Total Suspended Solids {TSS) <_ 250 mg/L Pretreated Effluent Quality ^ Monthly Average*** Biochemical Oxygen Demand (BODs) < 30 mg/L Total Suspended Solids (TSS) 5 30 mg/L . Fecal Coliforin (geometric mean) <10+cfu/100m1 Maximum Effluent Particle Size 1/8 inch diameter *Wastewater Flow Verification on and calculations: (Other than bedroom based) ** Values typical for domestic (non-commercial wastewater and septic tank effluent. ***Values typical for pretreated wastewater. SYSTEM SPECIFICATIONS Septic Tank Capacity peg gal ^ NA Septic Tank Manufacturer ~ 15~P.~- ^ NA Effluent Filter Manufacturer DNA Effluent Filter Model - ~v ^ NA Pump Tank Capacity od gal DNA Pump Tank Manufacturer ~,-- ^ NA Pump Manufacturer e ,~- ^ NA Pump Model ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) -ground (gravity) ^ In-ground (pressurized) ^ At-grade D Mound ^ Drip-line ^ Other: ~I,eaching Chamber Manufacturer --z pproval Stipulatio A Model f`~ ~ ~ n ~ ~ p 7'~ d/ft Area Re q .~~ Soil Application Rate , ~,r ~1 7h7 ~ ~ ~ Absorption Area Credit per unit ~V `-L Minimum Number of Chambers ^ Aggregate Design Flow/Loading Rate= min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and approval letters. nF.SiGN C'RiTERIA ^ "WISCOIlSm At-grade 5011 AUSOrpLIOn Jystem, .ljung, LCSj~u «. ~.uu~uu~~jvia av.aa.,.a. ~~..+....._~........--•.~~..~ ^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ^ ."Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ~`I?esign of Conventional Soil Absorption Trenches and Beds". RJ. Otis - ASAE Publications 5-?7 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 ^ SBD -10570-F (R.6/99) "At Grade Component Manual Using Pressure Distribution" ^SBD -10567-P (8.6/99) "In Ground Absorption Component Manual" ^SBD -10705=P (N.01/Ol) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD -10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" D SBD -10656-P (N.6/99) "Split Bed Recirculating. Sand Filter System Component Manual" ^ $BD -10572 P (86/99) "Mound Component Manual" ^ SBD -10691 P (N.O1/Ol) "Mound Component Manual" Version 2.0 ^ SBD - l O5y5-P (8.6199) "Single Pass Saud Filter Component Manual" ^ SBD - 10657 P (8.6/99) "Drip-line Effluent Disposal Component Manual" ^ SBD - 10573-P (R 6/99) "Pressure Distribution Component Manual" ^ SBD - 10706-F (N.O1/O1) "Pressure Distribution Component Manual" Version 2.0 ^ Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units e1ltTTTT1T7T T.l j\'j{;jj~jJ'./j\t11\l~L` 111L1~i1 Vi>u•v •+vaa~.~.v Service Event ~~.. Service Frequency Inspect condition of tank(s) At least once every ~ D months wear(s) (Maximum 3 yrs.) out contents of tank(s) Pump When combined sludge and scum equals one-third (1/3) of tank volume . inspect dispersal cell(s) At least once every ^ months ear(s) (Maximum 3 yrs.) Clean effluentfilter Atleast once every ^ months [®'~ear(s) inspect pump, pump controls & alarm At least once every D months ear(s) ^ NA Flush. laterals and pressure test At least once every ^ months wear(s) ^ NA Valves At least once every ^ months ^ year(s) ^ NA Other: At least once every ^ months ~ ^ year(s) ~ ^ NA D.. of :..b- -- START ITP For new construction, prior to use of the I'OWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process. and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a segtage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be dischazged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit .peels and. seeds, bones, and food solids such as those produced by a gazbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow aver the dispersal unit may cause it to freeze up. O Valves Valves shall be operated in the following manner: L~.Aearms Alarms: should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 dayreserve under regular operating conditions, however water should be conserved until any .problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance ScheduIe). .;Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1!3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufachuer's specifications. Provisions are to be made to retain solids in the tank. Fitter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardwaze and the condition of the filter. Any service needs or repairs shall be promptly taken care of. ~7""~ Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. page of p Mound, At-Grade, ln-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or dischazge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloadin or im endin h draulic failure g P g Y necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) yeazs. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution ofeffluentis occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails. and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks andpits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with ' soil, gravel or other inert solid material. CONTINGENCY PLAN If the PQWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. Thexeplacement 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 azea will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement areawill result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. D A suitable. replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank maybe installed as a last resort to replace the failed POWTS. p The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement azea.) f no replacement area is available a holding tank maybe installed as a last resort to replace the failed POWTS. ~ Mound and at grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative .surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN: DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIItCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THF. INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS "SEPTAGE SERV.' Name Phone /„ POWTS AINER i~ o Name ~~ Phone BATOR (Pumper) LOCAL REGULATORY AUTHORITY Agency T_ Q~Dt ~ ~ N Phone K:\WPDATAtEH1POWTS OWNER'S MANUAL.doc POWTS STAL; Nanne c :Phone D~ ~~ Page of ST CROIX COUN'T'Y SEPTIC TANK MAINTENANC$ AG~EMBNT •-AND OVf/NL~RSHIP CLRTIgICATION FO1tM owner/Buyer //~ Kaiiing Address ~ Address ~ ~ ~~---~ ~ ~ c a~ent for new construction) p~~~y iced from Planning D P _ ~~.~-, (Verification requ' Parcel Identification Number ° ` City/State p/8- 2c~q - 0 3 - ors < 9 g~ LEGAL DT+;SCRIPTION ~/~aA. ,..,,,~1~" . L~ . T~N-R /? W, Town of Pro erty Location S ~ .'/•, 5 '/,, Sec. p - // ~ Lot# 3 Subdivision ~/, ~l s~ a~ M'~ ~ ° ~ Volume '` ..Page # Certified Survey Map # ~ ,Volume 2 `~ ~ Page # Warranty Deed # ~-~3 ~~ a Lot lines identifiable ^ yes ~ no Spec house ^ yes ~ no ~SySTEM rlIAINTL' NA-NCI; remature faiiure to handlewastes- proper mai ntenanm Lnproper use and matntenauceof yoia septic system could result in its p ttm r Wbat you put into tt ., sy ~~~ of pumping out the septic tank every three years or a ~a~e waste disposal sys e-eud P ~ . can affect the function of the septic tank as a treatment stag ed by the owner and by a to subnut to St. Croix Zoni~-g Deponent a certification form, sign :.al ~~ The property owner agrees ~, r verifying that (1) the on-site wastewaterdisp° sY mast~rptumber, Jou~yulanPlumber, nstrictedplumber or a uce~isodmp tf necessary), the septic tank is less than 1/3 full e f sledge. is ~ proper operating conditionand/or (2) a fter inspection and p P g C ee to maintain We private sewage disposal system with the standards State of Wisconsin. Ce ctification Uwe, the undersigned have read the above requirements and agr Zotmxg OiI'ce ~~ 30 set forth, heroin, as set by the De~pz~n nmatntaA ~ must be comp e d na T ~ntaed to th CStuC oix County stating that your septic system days of three year c lion date. ~ ~ ~ ® ~ v~ ~~g,--~ DATE 5I AT(JRE OF APPL ANT - OR-NER Ci;RTIFICATLON our knowledge. I (we) am (are) the ~:wner(s) of I (we) ccctify that sll statements on this fo ~ are true to the best of er of Deeds Office. the prop rly describ above, by virtue of a warrant deed recorded iu Reg // o / ~S a ~~ ~~~/ DATE. GNATUItLt OF LICA ;nt. «««**s SI Any information that is mis-represarted may result in the sanitary permit being revoked by the Zoning DeparW *•4~M«t ++ Include vrith ll~ts applieat~on: a corny of the certified sucvcy map fRf geferea Uis made n the warranty deed r . U: 2~95P 119 N STATE BAR OF WISCONSIN FORM 1 - 1998 II WARRANTY DEED Document Number II This Deed, made between Cutting Edoe Four. LLC.. a Corporation, Grantor, and Si"OTT PAYNE t~ND 70DT PAYNE HUSBAND AND WIFE , Grantee. ----• Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): 7513` 1 0 KATHLEEi~I H. MALSH REGISTER OF DEEDS ST. CROIK CO. , MI RECEIVED FOR RECORD 05/03/2005 10:20AM MARRANTY DEED EXERT # R&C FEB: 11.00 TRANS FEE: 116.70 COPY FEE: CC FEE: PAGES: 1 Area EAGLE VALLEY BANK, N.A. PO BOX 70 2501 HANLEY ROAD HUDSON, WI 54016 O1 S- /DDS-so- po d Parcel Identification Number (PIN) This is not homestead property. (is) (is not) of Hillside Heights in the Town of Hammond, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 28th day of April, 2005. (SEAL) David Dalton, Organizer Cutting Edge Four, LLC. (SEAL) AUTHENTICATION Signature(s) authenticated this day of , TITLE: MEMBER STATE 8AR OF WISC (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, WI 54016 5-31104 (Signatures may be authenticated or.ackr Both are not necessary.) WARRANTY DEED ACKNOWLEDGMENT State of Wisconsin, (SEAL) (SEAL) } ss. St. Croix County Personally came before me this 28th day of April, 2005 the above named David Dalton as Organizer of Cutting Edoe Four. LLC.. a Corvoration to me known to be the person who executed the foregoing instrument and acknowledge the it t ~~ ~ ,•; N~~' PV{tuC~ y Publi fate of Wisconsin '9~~."•••••C•---• G ommission is permanent. (If not, stake expiration date: Op yy~5 _ p IPe~lnP~ ~- ~ ~ ~UD 1 .) STATE BAR OF WISCONSIN FORM No. 1 -1998 Wisconsin Legal Blank Co, Inc. Milwaukee, Wis. l~ \ \ ~ V ~ ' ' ~ \ ~ ~ ~ . _ _ ~ `~ 'N.& 67844 5'~. ~ _ ~ / ~ '' x ~ - ~ !~ ~~ ~ ~ N.B. 1.56~c- ~ g~ \ __ -__ ~ 7 \ ~ ~` ,- '` - ~ ---_ ~` -~ ~~ ~_ _ ~ / \ X X ~ X X ~//~ ~, /r',1 C y _ • ~ ~ ~ _ T ' _ ~ / ~ _ ~ - ~ 8 _ \ ~ \ rT.a-sso9s s. \ ~~ _ ~ - - 1.51 A~ ~ ~ ~ ~_ ~ _ L.@01-~~78. - i~:6~6~44R S.F` ~ ~ ~ \ / ~- _ - ~ CB ~ / / ~-4 3 \ \, ~ ~ ~ \ \ 3 ~ \ ~ \ 3~ \ 1 ~, ,~ ~ I ! ~ yip i ~---- I . . ) w r~ E ~ ~- l ~ ~3 _ ~ ~. Y ~-~~\ ~ -. ' ~1~ ~ / - ' ~ f ~9` A~ ~` ~~ ~~-- 4 599 S.~: -- \ -- _~ ~ ~ ~- ~_ ~ / - - r / ~ ~ ~ ~ ~ \ ~ I ~ I ~ \ \ \ 1 ., ~-?..58:x-6' -7~ ~ \ ~ ~ \\ \ \ ~` \ l S PTIC 7.7V \ C. \ \ ~ ~j Q ~ \ AREA \ '\' \ i w , 65341 S.F. ~i ~ ~ ~ , ~ N.\B\\'~~5670~ S.F~ \~ ~ I ~ ~ \ ~~ ` ~ f ) \ / \ ~ ~ ~ ' - N.B. 65341 S.F. E------- W ~ ~ \ ~- ~ `. ~j \ N.B. 1.50 Ac. 1 1 ,' I , ~ (/)- ~ / \ ~-~ \~ ~ ~ ~ ~~ n N 89'17'00" 1N X94.84' __ ~ ~ ,~ af., C~~,, ~ j~'1 f,, ~ ~ . ~ ~'` . _. __._. __ _._ .. t t~j N 47 26'59" E ~ ~`~ ~ ~`~'` •f ~ ~ `L ~ ~ 17.80'... ~ i ~ ~ ~ f ~ ~ / ~ I ~ 68868 ~. F. 1 f j ~` ` ~ ~-- - _ ass ~ 1.58 Ac. ~ C,rf ~~ // ~~'/~ /. ~ ~ ~/ ~~~~ 61.45' ~ ~`~" --.... ~ t ~! j ~ ~ ~~ 23038 S _ _ _ / ~a3~ ~~ ~ ,`' 5.29 Ac ~3 J /~ ~ ~. ` t5~a .! ~~ '~'~ ~~ 1~J ~~'''r... 4'~ t.- ~~ /~ 5~ !y HWE = 1 X76.5` f ~ 1..... ~ ~ r ~- t f ~ t,~ ~ / ~ HWE ~ 1076.5' ~~ 1.71 Ac. ~ f o I '~.. I `~ ` N (~ ~ ~~ ~~„ ~ 342.16' `~~ ~ ~ ~~ -~''~ ~ ~ ~ __ _._. ~... v.. ~ 104054 S.F. ~. ~ ~~.~va~noru = 1t~77.97 ~ ~ . ~ ~ ~g2.39 Ac. ~ `r~ tS s~ V ~ t::' ... .... ... .~ ~...~.-w~ {~ f U~ ~ • r w X28 S. F. ~ ~ u-y ,~ ~. -~ ~, m tf? g?' I C7~ ~ ~ + ~ ~ ~a~6Q~ -t 78.5' I 332~32~ ~ ~ ~ ~ N 89 24'35" ~ 258.10'1 -~•~ ~ ~ ~ ~ ~w ~ ~ ' p :~ { ~ ~ ~ cn ~ ~ t ° rGa ~ 65341 S.F. ~o ~ o ~ ~ - E ~ r`: 1.50 Ac. ~ i~'i ct'OV ~ 5593 S.F. ~ ~ ~ ~ Irv ! ~-- ~~ 1.51 A c. ci I ~ ~-- -~--~- "~ ~' I ~ ~ ~~