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018-2001-15-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATl`ACH 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 Richards, Lester Hammond Townshi :ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Q.ise./ ion 1ZOo Dosing mbo Boa Aeration Holding TANK SETBACK INFORMATION ~a'~"'~' ~ (OD F!{et~ TANK TO Pft WELL BLDG. vent to Air Intake ROAD Septic > ~ Yl.~jt- y'y( r ~ / i Z~ ~ (p ~ - lV Dosing Aeration Holding PUMP/SIPHON INFORMATION ~~, ~ /I I Manufacturer errand GPM Model Number W E~ ~ r ' ~ t . TDH Li riction Loss System Hea TDH Ft ~.3 .s rSb 2~ ~~ Forcemain Length ~ Dia. ~ if Dist. to Well /D d Ylo f 1 n SOIL ABSORPTION SYSTEM v County: St. Croix Sanitary Permit No: 453127 0 State Plan ID No: Parcel Tax No: 018-2001-15-000 Section/Town/Range/Map No: 14.29.17.879 ELEVATION DATA STATION BS HI FS ELEV. Benchmark (3-'-'-( 3•bo 103.60 _'_' /oo• O Alt. BM Bldg. ewer .Z,s 8 7. 35 St/Ht Inlet I~-sS g7• os SUHt Outlet Dt Inlet ~, Dt Bottom q,8n g3 • g Hea er/Man. ~ _ . ~,S l oZ.-~ Dist. Pipe I . $b 162, I O Bot. System Z. a /a ! - 6 b Final Grade ~. l' l.b 102.6 b t Cover r VYt.urt,~'LBQ.2 Ih SeJv fr,pU 9S. 6 D C~ 3 .tao Jvb • b BED/TRENCH Width ~ Length ~ No. Of Trenches PIT DIMENSI o. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ / 7 ' ~O C C SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING cturer: INFORMATION CHA ER OR Type Of~ ~ 25 ~ '7 ~ 1' 1 /t~'r- flt l/,QJ~" MIN Model Number: DISTRIBUTION SYSTEM ~"~'6°' `'Zc, Header/Manifold '~°~ rr Length Dia ~ Distribution Pipe(s) 2 ~ ' r~ ~ / length •~ ~ Dia Spacing x Hole Size I/ ~ u, x Hole Spacing ~ 4 !/ Vent to Airnlntake ~/'b SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of ~ xx Seeded/Sodded xx Mulched / Bed/Trench Center f~~ Bed/Trench Edges Topsoil Yes No X~ ~~:~ / ~ Yes No IS `fi J T~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ 8 /~_~.L• Inspection #2:_~/~/ Q~_~Z Location: 1948 94th Ave Unknow,n.,~(NE 1/4 SW 1/4 14 T29N R17W) Forest Ridge Estates Lot 15 Parcel No: 14.29.17.879 1.) Alt BM Description = (' `^r' ~~~ ~~ ~"~'~~~ = D'` 2.) Bldg sewer length = ~~~ bld ~~ ~5~ Pl ~J f O~ - amount of cover = $ ~ C Q~, ~ ~ (,~,.,,,,.bvi ~~ ~ Svc--61 Li ~f g-K. nn~~o~ = ('• 6 6 ~r (6 ~G) C3) Q-~a~t~td ion - ---- _``'""-fir. _ ~7} ~ ~~ _ _ Plan revision Required? Yes No ~~ ~ O~ - ~ ~~~~ U~ ~,•; ~' Use other side for additional information. _ _ _ L_____ b `~ SBD-6710 (R.3/97) Date nsepctor s Signature Cert. No. Safety and Buildings Division County ~ 201 W. Washington Ave., P.O. Box 7162 ~T C~A (,~ S\r-O~SII ~ Madison, WI 5~7 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (~8) 266-3 51 • ~ 1 Sanitary Permit Application Pl I.D umber In accord with Comm 83.21, Wis. Adm. Code, personal information y provi~~~ ~ p ,t~ ,tL -/ ~Z~O '- ~L~s • ~u:ff" may be used for secondary ur oses Privac Law ~ 2 s15 04(1)( ) if diff t d h ili dd p p y , . jec an ma s ( erent t ng a ress) I. Application Information -Please Print All Information ZONING OFFIC Ty' ~ ~ ~~ 9~~ f~,IE Proper Owner's Na me p ve Lot # -- S~ ~ S ~- Property Owner's M ailing Address ' ~ Property ovation u e r 61 ~ i r- e ~~ S d t ~ ' '~ City, fate ; Zip Code Phone Number ec on ~ ' `' " y~ 1 lS t ~ ~ ~,p~ (circle e) T~ ~ ~ II. Type of Building (check all that apply) ~ ~~ ~ N; R E o s, 1 or 2 Family Dwelling -Number of edroolms Subdivision -N}a-me CSM Number ~ ~ ^ Public/Commercial -Describe U e C$t~llsN' ° (oU.~ Z°~ U 1 e ~ ~ ^ State Owned -Describe Use ^City`^Village ~TO hip o%~~ p, /~ ~yJ~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Q ~Z,~ - -Otrp ~ ~f'•~g A. New System ^ Replacement System ^ TreatmenUHolding 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 lV. Type of POWTS System: (Check all that ap 1 ) ^ 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 Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design F ow (gpd) Design Soil Application Ra e( sf) Dispersal Area R uired sf) Dispersal rea Proposed (sf) System E ation (j"~~ 1 D D (y~~3 ~ l f y VI. Tank Info Capacity in Gallons Total Gallons Number of Units ~' anufacturer V,r~~,~,~Q ~q„~~-~~) Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Existing Tanks Tanks Septic or Holding Tank ~ r eS p ~, 1, Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for install a POWTS shown on the attached plans. Plum is Na me (Print) ~ P is Si gnature M MPRS Numbe Business Phone Number S ~ ~ ~ ~ ~~ Plumber's Addre ss (Street, City State, Zi Code) VIII. ount /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater h S F Date Issued Iss ' g Agent Signature o Stamps) ^ Owner Given Reason for Denial urc arge ee) ~~ ~- / r/~P ~y IX. Conditions of Approval/Reasons for Disapproval 3) vR~' ~ ~ ~ f y SYSTEM OWNER: ~ p.u~.. "N sa I 1 Septic tank, effluent Nlter and t ~~ ~ dispersal cell must ail tie serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. SBD-6398 (R. 01/03) w[[acn complete plans (to the County only) For we system on paper not less than 81/2 x 11 inches in size ~vo 3~ ar~~i S 6/0 . j ~,~~ ~3 ~~ -2~= _ ~- - - ~_ PLOT PLA.~~i Seale 1 ~~- y ~ - goo Face ~ G. i Page 3 of ~ 1_ i g., ~ ~ ., ~l-\ - S ql_ ~Srv~y~'Pv C _ ~v ~v~' CO?~P~r O\Z 1~\S~1~E3 I G~ ~Z I I ~+° ~, k SuGG~7.~ ~ ~~Z~ ~~ -; JI _ G~P~ _~ J O ~ Spp'~ ~ ~. OF _~_q3 ~~ ST. 1• Elevations shown are 2• Install 4" observationxisting ground elevations unless 3• septic tank to be ~ pipes with a otherwise noted. Zp /8 ~ PProved caps. ( Z w~E ~G -~-~ y gallon capacity manufacturedrbqulred) . • $ench mark ~~ ~\-P 1z-c1o ~£~ab -r-irZ w / 'R- ~~ op Z y goo. ' or, o.gs' ~~Z. Fi~l~. • Divert surface water around `~ 1 /! ~~~ C \~~ ~~~ w~L system to prevent pondin g at the uphill side. RECE!' isconsiin Department of Commerce .JAN 1 ~ '00~ ST. CROIX GOUM~Y ZONING OFFICE Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary January 08, 2004 CUST ID No.267341 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1 101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/08/2006 SITE: Lester Richard 94TH Ave Town of Hammond St Croix County NE1/4, SW1/4, S14, T29N, R17W ~-Identification Numbers Transaction ID No. 958126 Site ID No. 669862 Please refer to both identification numbers, above, in aii comes ondence with the a enc . FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 937867 Maintenance required; 600 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual, SBD-10572-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (8.6/99); r pJi Biofilter ~~~ The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes DEFARTMI and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in ON S 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 by the department pers.145.06, stats. SEE COR The following conditions shall be met during construction or installation and prior to occupancy or use: tTenerai Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (8.6/99). • 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. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. • 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 ARTHUR L WEGERER Page 2 I/8/04 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on site durinv construction and Open to inspection by authorized representatives of the Department which may include local inspectors 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/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, C~~; Pte? Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@c ommerce. state. w i. u s Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 . , ~~C ~AA J,(/ ~~~ TITLE • SHEETVIq~` N 0 ~ P~~ ~ of ~ Fj~ 2op~ IJOUND SYSTEM ~~jo FOR `` Vs I' A ~ BEDROOrI RESIDENCE V O,Y This plan has been prepared in accordance with the Mound•Component P~anual SBD-10572-P and the Pressure Distribution P•Ianual.SBD-10573-P CCZ._ blgq~ Ciz. ~1~a~ LOCATED I~t THE ~~ 1 /4 OF THE SW 1 /4 OF SECTION 1~ , T Zq ~y ~ R ~~ ra TOWid OF l~t-~ptiv~ ~ ~`~~ °~~ lid COUi1TY, tdISCONSIN. DoT ` S v ~- ~ ~Z.`. ST R-t D 5 ~ - ~'~ ~ ~ INDEX PAGE 1 of 7 TITLE SI-IE,ET PAGE 2 Of 7 SYSTEM I~IAi~tAGEMENT~ P'LAid PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUi~~iPING CHAP~IBER CROSS SECTIOd PAGE 7 of 7 PUriP PERFO~i~1ANCE CURVE PREPARED FOR 1 _ ~T~ .- 1z1::C1~R-_~~7 -~..~, ~' Y COlyM~RC~ UIL[1fNGS PREPARED BY ~PpNp WEGEFcER SL7 I L .TESTING AND . DES = GN SERV S CE P. 0. Box 7 4 4 21 id . l a i n S t. ~0gt~am®~,~~~ River. Falls, G]I 54022 ~~~ ,~ ,~ ~ Phone 715-425-0165 ti,,m ,»"~~• ' ,~'~ Fax 715-425-6864 ~~ ; ••"~ "•~ ~`' .~- 1~ t.;4i'n;~~,~ ~~~~~, ~. ~- ti.' ~ /-U6-u~ JOB N0. 03-ZZ6 Mound System Management Plan page Z of `7 Pursuant to Comm 83.54, Wis. Adm. Code - Septic Tank The septic tank shall be maintained by an individual certtified 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 filter 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 filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank; If the 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, Safety and Buildings Division. PumQ 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 S stem 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 majntenance) on the mound is not recommended since soil compaction may hinder aeraticn 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 heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is prov(ded 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 testis 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 shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Genera! - This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and steal( maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)] arid local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in 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 water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon tre completion of service. Any opening deemed unsound, defective, or subject tv 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. 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 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 adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or ~-aintenance of this system should be directed to: The County Zoning Office at , ~1S-~`~`j _ ~~j~p ST'_ ~R111 X The systea installer at '_ The tank manufacturer at ~ lS - I~ZS ~ USG $~t)O = 3 Z~S - $ ~(S~ Vy l~"3 The effluent filter manufacturer at ~Ul~ ` Z~L _ S'?l(,Z Z,p~3Crh The pump manufacturer at {~ 3t3 - $?~ _ ~ $ Ll~ GduLdS PLOT Pi.A~; Scale 1 "= y p ~. page ~ of ~ .. _~ J ~-- O 1 NOTES: ~- l. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be 12p_ OlBoc~ gallon capacity manufactured by w t Ems" CLyy G?~~. UL\' 1z.uo IF~~ -w~ rZ~ w / 'R-1.43 c~ Z.t~~Lf 1~1~2, 4. trench mark ~t.lpo,p' Ory o~85'T~.~, 1 ~/ u > >~. SI ~ ~ A P~ C ~ ! 1 w / L-~-~1-} 5. Divert surface water around system to prevent ponding at the uphill side. P_np, o ~ e^ S;r._thetic Co-rE_nc aSTi~ C33 ' Medium Sand I'CQSOii J - ~ T `'----~--- 3 ~ ~ ~-- • Face ~ Of istricutien Pipe jG ,r - Elev. 1~1. 6 o - ~ e S. °alope Distribution CeII of - Force Main Flowed i" to 22" aQ^regate From Fump Layer 0 1.6 Ft. • E Z~t~SFi. - CROSS SECTIO~i OM ~? MOliVD SYSTEM F o.S F~. • C D.S F4. A q Ft. ~ H ~.O F~. Linear Loadirc Rz ~`_ ~ .0 G?D/Iav FT 6 (~-7 Ft. Desicn Lozcinc kz~e='D .y G?D/SQ FT ~ ~. • - - i ~_ r ~ . J `~ F~. - x 11 Ft. - ...,....~ ~.. " n b ~ q FL -a7=-~ `' • ~ ~ -Observation Pipe- - E ~ K a--~---/6B- ----- ------ ---- -----Force Main -- ~.- g~~ ~Oistribution - , „ ~~~ • Pipe Ce11 of z to 2 z ( ag ;regate • Observation. Pipe --- ~- {•1ac~or sezurely) PLAi~i oIE?~ OF A MOliND SYSTE;:4 Distribution Pipe Layout Page S of ~ Place the holes at the bottom of the distribution pipes at equal spacing, Remove all burrs from the pipe and holes. Extend the end of each lateal up with the use of long turn or 4~ ° fitting to a point within six inches of the final grade. Terminate the ends of the latezals with a valve;~threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threader ply, i `-t P 1 Ct~ L. ~,~S S S~~Q i~j Manifold Lat ral ~ ~ FV y ,-- La eral I x x!Z ,F -- ~ - ~ M t''SJ 1 F~ ~: ~}CC~c SOX - -o a-- -- __-0 pvc ~-o~cr ~,~ a-- - ~a P 33 Ft. ~ ~ Hole Diameter ~~ i3 Inch ~ -~ S 3 Ft, ~ ~ Lateral ) ~ InchEes) X Zy Inches Manifold 1 ~~zInches Force Main " Z Inches ~ of holes/pipe 11 ~ - ~~ Invert Elevation of.Laterais ~oZ:~ Ft. _ ~ ~ Combination Sept~.c~ Tank and PUMP CHAMBER CRO55 SECTIOIJ A~10 SPECIFICATIOIJS ' PACE .~ OF 7 -.. - -VEU7 CAP ~ WEATHER PROOF JUlJCTIOIJ 80X . '1•C.Z. VE1JT PIPC ~ APPROVED LOCKIAJG ~ IO' FROM DOOR., ~MAIJIiOLE COVER ivC11i u`'QP~i1DU ('lP~ :J~AIDOW OR FRCSH ~ wA(ttJIS.1G l.f+~6EL. w/PrttZr6q~ ~p ' Fl N 1Slf© ~ ~~E 16'!'llfl. 1 it`1LET AP rov / P ed joint w/ PVC pipe ~~=t~`~~ ~3'E' -v0 LD-k7L~fZ - CoraDutT -_ ~~~;. L ~ \~ PROVIDE I • ~ AIRTIGHT SEAL I ~~t I Ob ~ ~ I 6 ~ I ~ I ~ 'I g~,~? FT. I I PUMP -~ --~ D CouCRETE ~ " 3 , ~ BLOCK Y Y~ HI!<1. f ~' 18' MI I!. -1---------- ih I~-•---~- - _ _ I` I ~I Approved ~I joint w/ T~ ou ALAR?1 PVC pipe oF~ RISER EXIT PERMIT(ED O+JLy IF TAt.JK MA3rLFACTURER HAS SUCH APPROVAL~3LAA~~~~" B>=00 c N 4 SEPTIC E SPEC.IFICATIOt~1S DOSE TI.-JKS MAt~UFACTUiZCR: -~~`~~Z CU1ti~~Z-~ jJ~gER OF DOSES: S ~ ~ PER DAB TAtJK SIZC: 1Z~U ~~aO GALLO+JS DOSE VOLUME r ' ALARA'1 MA>SUFACTURCA: s.~ ~~~-~~71Z.G ~`'tS Iti1CLU0;lJG 6ACKfLOW: X33 '~ GAltOl15. MC)Di`L -,,-UMBER: 1 ~ ~ Nw CAPACITIES: A- ~ ~ IuCHCS OR ~I~~' 3 sWlTCH TyPt: ~LZ-C-°UZ-~ I I CALLOUS 8 = _ ~ IUCHES'OR `~ `'t '~~1LLOU5 F'UMP MA}JUFACTURCA: GUU`-flS ~ IUCHES OR ~3~'y (,ALLpUs C= MODEL- -JUMBER: wCOS N D = 1 ~ INCHES OR Z ~Z ~ ~GALLOAIS SWITCH~TyPE: -_ML1Zeya~ DOTE: PUxP AAl A6ARM A~ 0-DC°~ 6 MlAlIMUM DISCHARGE RATE ~~•~Z Gpn INSTgLLEO OA1 SEPARATE C{RCUITS VERTICtiL DiFFEREIJCE DETWCEU PUMP OFF A-JO..D157RIBUTIO-J PIPE..~~•Z~ FEET + M-U1tMUM XIETWORK SUPPLY PRESSURE . , , ~' SQ FEET i -'-~X ~• 3, 'I' ~ 'S FEET OF FORCE MAIA1 X 3 "SQ' F~c F~FKrCTIOU FAC7oR..z_~ ( FEET ~v ~ ~ _ 1b~ TOTAL OyAJAMIC HEAD = Z~ •y~? ---_ FEET ~As per manufacturer 22_Z-~ , gal/in. Liquid depth 3 6'' . ALK IIJTAKE s ~ 6~,~ua, '.I ~ -- ~ ~ z>~8~. ~1_\~ CLEY. ~.; . ,, •R~ ~~~~ • Overload protection must be provided in starter unit. • Shaft: threaded, 400 series stainless steel. • Bearings: ball bearings upper and lower. • Power cord: 20 foot standard length (optional lengths available). Single phase: •'/ and''/2 HP -16/3 SJTO with 115 V or 230 V three prong plug. • 3/4-1'/z HP -14/3 STO with bare leads. Three phase: •'/z-1'/i HP -14/4 STO with bare leads. On CSA listed models - 20 foot length SJTW and STW are standard. 3885 APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump _~ • Solids handling capabilities: 3/4" maximum. -- • Discharge size: 2" NPT. • Capacities: up to 128 GPM. • Total heads: up to 123 feet TDH. • Mechanical seal: silicon carbide-rotary seat/silicon carbide-stationary seat, 300 series stainless steel metal parts, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel • Capable of running dry without damage to components. Motor Single phase: • % HP,115 V, 200 V, 230 V, 60 Hz, 1750 RPM; %z HP, 115 V, 60 Hz;'3500 RPfVI; 'lz HP.=.1%z HP, 230 V, 60 Hz, 3500RPM. • Buiftn pverloatl with automatic reset T FEATURES ^ Impeller: Cast iron, semi- open, non-clog with pump- outvanes for mechanical seal protection. Balanced for METERS FEET s~ - I _ ~ 2s ao , . -- 20 0 a W U a 15 Z 0 J H o to ~a sa 50 40 30 20 '• Glass B tnsulafion __~ ,~fhrte'phase ~~t~ `, ;• Yi HP_-1'/z.HP:200/2301 ' ~K~460.V,~60 Hz~3500 RPM Class B tnsulation~ ~''' r>F - ~ .. 01995 Goulds Pumps, fnc. ' 10 smooth operation. Silicon bronze impeller available as an option. ^ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge adaptable for slide rail systems. ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. ^ Shaft: Corrosion-resistant stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. ^ Motor: Fully submerged in high-grade turbine oil for lubrication and efficient heat transfer. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage. _- ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS SP Canadian Standards Association ()~ Underwriters Laboratories SERIES: 3885 SIZE:'/<' SOLIDS RPM: VARIOUS ,-. ucuias - -- . ~~~~~S~~~E ~~~~~~~1~ ~~~~ ~~ v w cu 3u vu ou ou /U tf0 90 100 110 120 130GPM ' ,~ ~ ~ ~; 0 10 20 30 m3/h CAPACITY t1 Effective May, 1995 7^cRS 4 .' , ~ ~ ~ ~~ (LX~-•6 'T~t' 1"~~~4EiY-f~l'lfjci RECEIVED ~~~ ~`'~ TI N DEPORT Page __ ~ of ~'-~' 1 2 2003so1 EvA~.uA Q W4aoonsinpepacVnentofCo ercen~f~ Division o1 Safety and Buifdln U lln accordance with C m 85, Wis. Adm. Code DWny ~~,• C~` x RO X C ~ T 11 inch s In size. Ptan must Attach complete site piano papeS7 ~gM), diredVon and Paroel I.D. FJt1plA{ ~~- Include, but not limited to: v Date pefcent slope, scale or dimensions, north arrow, and location end distance to nearest road. ~ evlewed P Please print all lnforntation. ~ ~ Penonel tnlormstion you provide meY bo ueetl for aecondery purposee (PrWecy Lew, s. 15.CA (tl 1n~1)~ __ o.,...o.h, I nrAllOn (~ Boring ~p ~ Boring # 6 Ground surface alev. _ ,n , ~~ n Pit ~(--~~~".''~~~ ~ Boring I I/11 S -rt., ~ f '~ L!-~ Boring # ~rounc~ SUr!2ce elev. ~ Z tt. Pli ,~~---------~_"r - _.-r-- Oeplh Ic ;inviting factor .,__.1-- in. y,nrvtn (/- J rr uM e ~ I Depth io IIm1Ung factor _.___L7 __ in, ''_~ ~.... __„ ....,a Tcs >'~0 < 150 mgfl- __ _. __w TCC < ~n •, ~C Property Owner _~H f'~~Gt]__` l ~.5~~.te. F3©rcel {O k .--_i_C_~l~vrr___1 - -- i Page Z of Boring t1 ~--~ Boring p}t Ground 5uN.ace elev. _~Q~Y.JS ft. Depth to Umiling tailor __ x S ~ ln. Solt ~ icatlon Rate t T Structure Consistence Boundary Roots GPD/ff Horizon Depth in. Dominant Color MunseP Redox DesGiption Qu. Sz. Cont. Color. ~ ex ure Gr. Sz. Sh. 'Ett#1 'Etfk2 l Q- ~ ~2 ~-' StI - Ab VTY -CO 0,~' O.Y ~ -8 0 L "'' ~ -mQbK ~ r -to .~ 3 -4"1 0 `l 3) `" Sr 3~ m bIC d ~_, 2 - ~ ~ . _Q ~ 8 i 4 -20 ~OYtC~~ -- SrI Z{-mr3-.W ~%5 - 0. 5 20--25 IoV ~ s5 d A,5 -m 0 3 ~_-____ ~ -1 ---- Boring ~ ^ Boring I 1 `1 0~~ Ground surface elev. __J.-,___- n. Depth to limlUng factor _ -_.._-Y In. Soil ,4oolltation Rate Horizon Depth I in. ~ Dominant Colw MunseU Redox Description Texture Qu. Sz. Cont. Color I Stn.rcture Gr. Sz. 5h. Consistence ~ Boundary Roots v__ GPDtff T 'EffNt EK~2 -----t- - I Boring Boring p i ^ Pfl Ground surtace elev. _- „____ ft. Depth to limiting lector ,_. ~__ n. SoN Application Rata Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color ioxture 5iructure Gr. Sz. Sh. Consistence Boundary Roots v^PDlif ~~ffgt 'Et~2 ~ 1 ~ ' Effluent pt = BOOS ~ 30 _220 mg/L and 7SS >30 < 150 mgt ' ERluenl #2 = SODS < 30 mglL and TSS < 30 mg+t. 'Chc llepartment of Commerce is an equal opponuni;y service provider and employer. if you need assistance to access services or need material in an attcmate format, please contact the department at 6t)8.2b6-3151 ur T'1-Y b08-2b4-8777, soo-ruo to aroo> t t I'I,(~1' PLAN CJF~3 ~ . ---- Io0,0t _ U~ _ qR.o Q ~ Di p~_.~ 3 I, N17: /r~o' C3 ~ ~TOp OF PVC PIPE . $5 vfi U/1~4- sSUMED LOO, ~ Z- PiIG~ IN T oV£s cdc0uva- ~i9.3~' ^- 50~. ~21NG W/ 8 NO COMM 83 5~1>3ACK pIZODI,EMS Q ^t4'Ar0 BoRt~6 ~L'CGL~(~VL~ L ~ U `~ n~ ~ Sc1 ~2~~ ~~l e ~ ~J c.~- i ~~ > _"---~ i ~~ >` .I J[~ -h~c~ .~" ~~ ~f ~f •r`- #~ ,. j t R1 ~_ d ;ToP of WC p-PE . ifs ~6DV~ _~~:t °__ C~RO1An~L~-f'\t,SUMLO /OO.Q~~ 74u1A1 OF ~ L-- SP+K~: rnl -t ~~~' .4,~ ttlSoJ~_ RD{ ~ STRTE. ~+cDUND- l0 ~- SOft. 6C~21NG W/ 13AGKJ-IOE ~" NO COMM 8~ ~1C3ACK f'~ODLlrMS (Q .tt~+rc~ 8oa~~ ti (i 1 (~' P-13S"L ~ 56 ~ ORTt-; Pt1 ~`~ ~ -- --- --- --- Y~3 _ ~ __-+oO.Qa ~-' a 1 ~ ~ L--------- ----- ----- GV~?~ ___-~__~___ . _..~ ~ - _._ ~- r ~ ~~2 ____.~--,.~.___------- RS.oa ~. ~ ~ ~_r s .~ ~~ ~°l~~ ~ ~, d ~oZ,y ~ ~ ~ ~ `~ -~' c~;E~ ~s ~ .~ .k l Y ~o,- ~s r. ~ ,- ~C wlsoonsfn peparvnant of Commst+ce SOIL EVALUATION REPORT Pega __(_ a 3 Ofvlaton of Safety and BuUdlnQe W NMNfrAn rw u.lll. rr.n r~ LLF. .All. A.1... /`.--.~ _ _ _ AttaUt compote site plan ort paper not less than 8 t12 x 1 t Inches In stza. Pten must County r. Include, but not Umhed to: verttCal and horizontal reference point (8M), dlredlon end p~ 10 percent slope, scale or dimensions, north avow, and location and distance to nearest road ~ PGJVC~itY Please print all Information. Revlewao by oete P enonei In(onn.lbn yov provb. mey D. uutl IDr eetontl~ry purpv.e>t (PNvay L•w, ~. tSAt (1) frtlp, ~ PropsrtyOwna Propertylocatlon /{ Q t._l_R ~ E t/4,Sy~ 1/a S I <'f T Z~ N R I ~r W Property Owner's Mal(Ing Addreca Lot k Block k Subd. Name or CSMk ~~~~ w, D~JtSto~ sc, -- o~a~sr R~~ ~.s-r.~,-ss _ Clry State Tip Coda Phone Number ^ Gly Q village $J Town Nearest Road R~~e~t FAUS wz Syo2. i7~5 ~tzb-48o H,t M,o ) e.rrF. E New Constrvctlon Use~~- Reetdantlal / Number of bedrooms -__~_,__ Code derived daslpn flow rate _ 041) _____ GPp ^ Replacement ^ Public or commsrtiel -Describe: ._~ ... ~. Parent material _~' r t [) ~-(~ u- ti _ ~~~,~ hood Pteln e)evatton it eppNWblb „~e,... _ General comments ~ ~ _ .... ~ ~- andrecommandatlons N10~.lNt~ S~(S7-EM I~~t-{r S~,yp F~~.l., ~.Z LoAOtNG. ~f~Tf, n (,~ ` to ~ 2UJZ ~ ~ ~ ~- g g _ Bonn k ~ P tin Ground surface elev. ~~. y Z___ n, Depth to limiting factor ~`~ i~ ~- f ~ Soil liwtion Rao Hafzon Depth Dominant Colo r Redox Oescfiptiai Toxturo Structure Consistence Boundary Roots GP D in. MunseN du. Sz. Cont. Color Gr. Sz. Sh. •Eftkt 'EBk2 i I ~-3 ~e - __ si ~ s!~ r-tV-F~r __ J~- 0.5 ~ ~t ~ - s!~ mfr ab . S p, ~ 3 - y 31z -- I ~- m ~ cs o. z o. 3 - ~• Y 3 N 0 5 1 - _m ~ . ~ a goring q ^ t3oring Pit Ground 6vAeoe elev. -,__~~ ry, Depth to Mmitlng fedor,___~.__ )n. 509 catbn Rata ~ Horizon Depth Dominant t:olor Redox Oespfptton 7axture Structure Consistence Boundary Roots GPDlK ln. htunseli Qu. Sz. Cont. Caton Gr. Sz. 5h. •Etfkt 'ERk2 -~~ ~ w - ~ ~~w~ °lw r~~ ,,>u ~ tau mgrs ' Etttuan k2 • OOD < 30 mgJL and TSS < 30 rrtg/l CST Name (Please Prtnq Signature CST Number mA ~a Ho~t_ts~-E~ zz .~- Adaeu oats Eveluatlon Condudad Tebphone Numbs W9875 64o~``a>! ,~~~ FAu-s, WT S'4o2Z Q$-0?~OZ. (_~~5 Nib-1'175 ____ IZ~lt~ : o9-I~-oz ~^ !~ LET ~ ~ ~ ~ ~Y Owrrw ,,.~[t~~,x,3~S~ _ Parval ro r _ C P ~N DI..I,~G~_._.. _ Pop• , ~or 1~ ~~ ^ 9a+In9 e ch ~ ar'l Sod A ~cat~on Ral. Halza+ tAo~h Oaninanl Cda _ Ratio, (3aa oh Toat~ra _ 5truclun Corwtat a Bouneary Rook ,S'P m. Munces Oa. Sc. Cont. C Gr. Sc. Sn. 'EBrt 'ERi-Y ~ 0_ -- _ 5th T~: ab o.s Y z ~ ~ '~ s ,~ c~ s a ti -Z D 5 S t z Q '~ 4 x - z -' s 0,? Z- 5 -SZ .3f _" ~ _ .~f 0 L 7 v,c3 ~ a 5 S lt~J -- . -- 0. r ^ ' -SZ (~ K (~ 13ortrg pEt Ground wr-ece elev. ~ OQ,3Z n. peeth ro tlmrtirp tetra _ . ~_, h. son tlon Rate +korizon Ooplh Dominant Cda Radox Deacrtptian Texture Struture Conilalance 8oundery Roots GPOrtt M. Muneelt Qu. Sz. Cont. Cda Gr. Sr, Sh, 'EM11 '@Rr2 ~ -t 0 ~Z -' L 4s -to , 3 -y -at y ~r - s11 a~.M ~ c s ~-t- ~, o. S _ 3 7, 5` S Cy1 vf-m L V 7,a ~+ ~ s t awJ I~f• ~+ o, ~ z ri l 7.5 Raj c 15 1 w,sb1C mfr 0.+a - D,'1 1, `~ .... .~,..ti.f G• .. ,..R . ~ ~ N r r 1 R ~01ir+Q ~~ ^ Ptt Ona1M~ strhoe eMv. =11~`rv R. OpM to IlrnHkq boson _ ZS lr~ soN R.s. t-brizon Dapfh Domksenl Cal Redox Oeaarlptlon Taxttxe Structure Corutetsnca 6ourrdary Roofs G1> DR! In. Mtuusl Ou. 9z. Cont. Cola Or. Sz. Sh. 'EMA~1 'E!(M2 1 -iy io ~t L -1.0.10 rr.~1 3 -t o ,5 p.8 Z }~'-Z5 ~ St t t~- sb Q -ea .2 ~.~ ra z ! ' Efnva~t * t - 9Qt], ~ 30 ~ 220 mdl end TSS >>4 ~ 150 mpA. ' Ef11uaM st! • BODE ! JO myL and TSS _< JO rnpR. The Uepanmem of Commerce is an equal opponumty service provider and employer. tf you need aalarance to access services or need matcriat in an alternate format, pleae eontsct the department at 608-2dG-3131 or TTY 608.1N1-8177. sso•u>.ta.~+eal ~t ~ , i ~~ ~~ ~~ .' ., 1 ,~ , ~ V ,~: ~~ ,~ _. CI7< ;. ,, --!'~3zST_~~ ~STj4T~ - LO'`~ I S' r 9o r» sr. ~' ~r P ~z,~ ~ ~~ S~ ~ ~ ~ ~ ~~ ~ s ~ ~~ W L ~ ~- - - - - :- 1- CD gs 2o0T" ST. ~ 5, s- ~EV ~ ~ ro - ~ ~~, p~~ -'ktANo orc~AG ~, ~ ~ _ _ _ __ • J, •r 3 i ` ~ ~ N ~, ~ ~7' C7 Oo ~ ~CI ,~~, , , X ~ C O ~~ s~ g ~ Oo ~ ~, i r ~, ,(n C © ~' 'f .. a ~ ~ -- ~ C~ ~ , 1 ~,~ ~~, r, ~ ~ , ~,~ ~ ~, ~ ~~ t~, ~ ~ ~~~ ~ --~ ~ ~ ' ~ ~ ~ . 1 ~ ~, ~ ~ ~, - , CJ~ _~ ~ ~- _..._ ___._ u , ~\ ~, \ ~~ /r~~ ~ i' /"mar-. ~~ \~ ''`~ ~ \~ / "~' ~ ~^~ ~ ~ I ~~ ~ ~1 ~ ~ ~ ~ 1 ~ \~ v } yam/ ~° /~~~"~ ~.~~. ~ \\~~ \~ ~~ ,~ l~ ~---_O ~ \ ~~ ~ \ \ ~ ~-~. ~ ~ 1 zl z ~ I ~l (I frn // z /1 \~~ \~~ i ~ax9\ ~~ ~\ `- -_. m o ~ ~ ~ ~. / / \\ 4 ~~rn ( { + )~ w ~ ~ ~-/can ~ I ~ X ~~~5 ~ ~ \ -~ , r ~~ \ ~~ ~, ~ _ t\ ~ I I ~ / ~ \ \ l l ~> \ 11 \\\ ~ ~\ \ 1 1 I I II 1 I ~ _ ~` ~ \~ \\ \\ 1 1 ` ~~3 V \ \ .~ I 1 I 11 ~ ~~ 1~ I ~I ~ ~N~ ~,~ T ~ ~~ ~ ~~~ ~i. 1 ~ w ~ ~ \ 11 11 11 I~ ( ~ D` ~ \\~ ~\ ~ti ~~\\ i ~~ \ h .~\ 11 1 ~ ~~ \ \ ~ n ~ I R~ ~~ I~'`~ I l ~ ~ ~ ~ D rn~lnm ~ 4 1 x rn o \ \ ~®~ 11 ~ ~1 f (1 i' ~ /~co \ \ ~ I 1 ( ~ ~ D \ ~~ N ~~ \ \\ ~ ~ I I / N N \ \ \ 1 ~ m Im 1 / ~~-~ mod. ~ ~1 ~~ \ ~ ~~ N /1 1 ~ cl / ~ v' 1 / / to ~ cr; ~ v I 1 ~ I \ ~ ` f / : ~' / / cn ~ ~ 1 -P of I I ~ may, I 1 ~ / ~ / ~ / / ,8 'l~l ~ZI'8~l I ~ I~ ~~`C~Z T- , ` ~ I 1~ 1 1 ~ ~~~'06 { f ~1 1 I I x I i I ~ \ l I I II i { I I I 1 1) ~ 1~ - -J- r 11 _. 1 I 1\ 1 \ \ 1 1 1 I \ I I I ~ I { ~~ i f i f/ ~8 ~bN2i 8 1 I ~ \ \ \ ~ \ 1 II 1 1 1 1 ~, 1 1 l i f ~ f l sr caoix covNTv S~PT(C TANK MAINT'LNANCG' AGRL~M~NT . AND OwNeRS(iIP CBRTIFICATION FO[tM Owncc/IIuycr Mailing Address Property Address 8 ' 9Y ~~ (Ycrifica(ioa rcquicrd from Piinaing Department for new coasciuctioa) -~5~ oNc / lv ul y Panccl Idcat,tficatton Nlunba G LEGAL DESCk~P'z'XON 0 /~- ZQO (- / S -otTp ~, ~) Property Locafion ~ %, sue'/<, Scc. ~~. T~N-R~W, Town of / ~1V ^~ ~-l Subdivision Lot # - ~~ ~-- ~--- Certified S arvep Map # ~ Volcmac . . Page # wa:z anty Deed ## ' ~ ~ ~"P ~ Vohmie Page # Spec douse ~ yes ^ no Lot Iincs idcatifiable yes ^. no ~YS'1'EM-~dAIl~1'~IANCE . ~pcrtucu~dutamt~aaocofyourrcPti~csYstcmooald~It"mils ooasists of pumpiag oat ~ . ~ .. tro handic ~astcs. Pcopcr anct can. a$ect ~e .f of ~ tank every tip Y~ or ' ~ ~cded ~ ~ Y1iD~ What yva ptrt.into tfic rystr_m . uP~ ~''~.a tmatuxmt ttag~c is the t~astc disposalcystcm, ~ p~ o~ agrees Irv tabmnt~to St. Quiz Zoaing a you form, signed by the ownct and ~y a ~~P7Ptrs~ictodplumbaatiP~~y~$~at(Ijtheoa~itca~fi~osaltpstcm tn~ opa~ng condition aadlor (7,) after inspocfion and pumping.C~ry), ~ scptictank is icss than 113 full of slaci<~. . ~ ~ hav~e.tria the about and agruc co ~ the P~ sewage ~ aril ~t~u standai~is ~~ fO~ ~~ ~ ~Y ~ of and the Dcpu~ of Atatraxl statrag that yoar tcptic ~ ~ bocu State of Wisconsin.. QYtificvzhon days of thrrc mai~incd~ be oompl~cUcd and ictcnaed to the St. C~viz.(:ocmty Zoning Office witiun 30 year expiration daft. lt~o OP APPLI DATE O~~IER. G"ER'~T~CA.'XTON I (~xc) certify that aII ttatcmcnts oa this form an ttwe to the best of my (our) lnowicdgc. I (wc) am (arc) the owncr{s) of ~ dcsar'bed about, by virtue of a flood ivoordcd in ~ .' ~ cgistcr of Docds Office. GNATURB OF APPI:;I Q % l ~y/ D DATE ""~• Aay infom~ation that LS mis ~I'~~~ may tcsult in the tanitary Pmt being (evoked by the Zoning pcpactmcnt. s a•... • • Iadudc trtth (tits appticaQon: a ttnmpod warranty flood firm the Register of Dcods otlicc a copy of the ccrti(iod nuvey mep if trfeocncc is rnadc iri the wacrnnty decd U 2~.28P 030° STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number 'WARRANTY DEED This Deed, made between E. W. Homes, Inc., a Wisconsin Corporation, Grantor, and Richard Construction, Inc. 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): Lots 8, 10 and~5~, Forest Ridge Estates, Town of Hammond, St. Croix County, Wisconsin. Recording Area 77925 KATHLEEN H. WALSH REGISTER OF DEEDS sT. cxolx co. , wI RECEIVED FOR RECORD 02/03/2003 09:35A?1 EXEIPT t REC FEE: 11.00 TRANS FEE: 43$,00 COPY FEE: CERT COPY FEE: PAGES: 1 Name ur~pETTE VAN HEl First National Bank PO Boz 166 ~ River Falls, W4 54022 Part of 018-1030-50-U00 & 0l 8-1030-40-000 Parcel identification Number (P{N) This is not homestead property. ~l (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. -~ Dated this ~,~~ day of January 2003 E. W. Homes, (nc. + + By, Mark B. Sylla, P sident _ `_ ___, AUTHENTICATION Signature(s) E. W. Homes, Inc., a Wisconsin Corporation, by Mark B. Sylla, President, r~~ au[henticatedthi '~ day of ,January _ - 2003 + Kristine Ogland TITLE; MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 54016 ACKNOWLEDGMENT. STATE OF WISCONSIN ) ss. _ - --- ---- -~- County ) Personally came before me this ____ day oi' the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. + Notary Public, State of Wisconsin My Commission is permanent. (!f not, state expiration date (Signatures may be authenticated or acknowledged. Both are not necessary.) ~ > _ ) + Names ot'persons signing in any eapaeity must be typed or printed below their signature. [ntorma~lon Fro[easlona[s comva~y, Fono ou Lac, v~n STATE BAR OF WISCONSIN eoo~ss-1o2~ WARRANTY DEED FORM No. 2 - 1999 TfiT~ - ~'.~ 15 ~ eta rn ~T. • ~ {~ ~$~. ~ ~` J"n `.~ n t11 O ~ r?? a ~ '~6. ~ caf ~ 1 ~ ~ ', ~ ', , , ', W L ~(ANT.~ 01~.~ilG , 1 1 y•r ~.. ~... ~:t. .~ ....J '. 1 ~ ~~,~ ~,,,! , .11 , ~ p tot ~ .~~ 1 '~ ~ t~`1 ',C C~ ~ ', '' r ~~ ~ i ,` 1 i 1 11 ~~ ~ ,1 ~~ ~.r~\•1 ~ `~ i '1 .N , 1 .! ~ '~~ ~ I~Q~,~ :U ~ ~ ~ ~ ,~ , ~'~ a~~~ ~ ~ ~~ ~, ~, ' i ~~ c,n ; ~..lti 1 1 j ~ ~ ', ---+.. b ,, ~ I ~ ~ ~ 1 ~V'{~ l 1~ I ~ v 1f ~y ~ ~ 11 ~ i ~ ~r % ~ 1 I 1 ~ ~ ~ ~I I ~ ~ ~C\ ~ 1 1 I 1 ~-ya~.,. ~ 1 ~ , /~ 1 11© ~ ~ \ f ~ , 1 f 11 v ~ ~~ 1 ~ I ~~ 4 ~~ ~~~ 1 1 V ~• ~. • 11 _' j47 r , ~ ~ .~ 1~ ,~ ~~ 11 , ` ~ ~. 1 , , , ~ ~ , r i .. ... _ ,..~~ .~tG Jf7C_C I I ~ I i ~ I-- - --- a r]9'+E"5~' ,_eeQo6' - - - -- ~ I ~ - -= I I ~ I _- -- - -- - -- _' -- ~ y -- -- i~ I I I ~ I ~ ~~, ~ SEE SHEET t I -_ I.; - ~ Im LOT 22 ~v Z ~ ~ U O I O o ul I ~ I u ' U v o n ~I V > I 2.49 nC. p ~ a o.~ 309?7.3 S F I I ~, '. c I '.11 4C. 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