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018-2001-24-000
n ~ ~' N ~ N < m c7 ~ ~ ~ n i~ p ~ ~ ~ a cn rn ~ ~ ~ ~ 3 N s' ~ 7 Q N O ~ ~ tD C C~ W ~ O O c ~ o W ~ ° _ ~ i -a m Z O Z7 y ~ C (D a O ~ o c ~ ~ a _~ O ro C CD CD N ~~ D o- o°o a m o m ~ _ ~ ~ Z b ~_ n ~ O O O N a 0 N d 0 rn X v O CD 1fl 0 O ~ O ~ ntnp' c m f, ~ A m '; ~ ~^. m ~ 3 ^~ o ~ m ''. w 3 '' W y ' rn ~ O' N 7 ' 7 ~ ' ~ C ~ m ~ w ', fl. J a ~D '' w, a' o°\o ° ~ ~' N ~p ', ~ N ~p O O 2 ~ ~ ~ ', '' Q O Q d I ~ ~ ~ ~ '',, fA f/1 N ~ ~ v v A M d '6 ~ '' ~ •• N N .. D D o c a cu N N N 7 I N A C d _Q (/1 W ~ a 0 3 O •'•' f/I Z fD ! W ~ T C 3 a 3 d o m v c m ~ A ~I = o_ p~ A 3 °D t0 N ~ V O ~ W N O ~ A O ~ O 0 fA'~'.' Q .. ~ d ;-• ~ o m N_ a f~ CD m d m ,p Z ~ J 'Ia .P Z .. ~ 3 m ~ A Z A ~ VCC ~ < A '.d ~~ m .c r"S O "S O Z y a 4 ba 0 w ti O O A N A ~i trp A O ~" V ~, y 'r ~i ~~~~ ~- STA-RI?E' _ -- N 'I ~ _.1..--.._.... ,1 __' conn~-osiT~ cuRVE .r~.. __ - -~ CANACiTY LiTHES NER MINUTE 55U 0 5U 100 150 'lUU 250 300 350 400 450 I 5V '7 ~----, ''' ~t <~a it ~` ~ Qa~ W ~. . w a i ' i o c~ ~ ~ ~ y HA ~ C~-~ ~ , y~ ~~ ~y~ ~, ` fJ~(.~ ~~~ / I 2, ~x ; , ~ kYi .. . ~ JQ ~' r ~ 4y ~ ~ 2U i ~.'.~~. N \ r ~~ ~°;ks~ . i _ T _._ _. ~3-- J I I `~~tiA . ;, ~~ tVU e' ~~aP/,GITY GALLONS PE1i MINUTE r NOrk; 1'~eesa see Mahe i ~ ror 5'I:f.N rn~s° 5'anes periorrnance curves. ~~Jv Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division '~ INSPECTION REPORT GENERAL INFORMATION ~ (ATTACH TO PERMfT) 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 rdman, Dennis Hammond, Town of ST BM Efev: ~ In~ BM EIe~ BM D~crip~~on: • ~ ^ ~~ 'ANK INFORMATION ELEVATION DATA M c TYPE MANUFACTURER CAPACITY Septic ~~ Dosing U Aeration Holding ~} TANK SETBACK INFORMATION ~ ~"' ~ TANK TO P L I~ s WELL '" BLDG. Vent to 'Intake ROAD Septic ~ ~~ / 17~ ~~~. i ~ Dosing ~ ~-. i Aeration Holding PUMP/SIPHON INFORMATION Citti~-• ~~ • ~~~F' Manufacturer /~ Demand („~ GPM Model Number W ~-~yl ~ ~/ , Forcemain Len th ~ Dia.2 ~~ SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length DIMENSIONS /. .~1 ., 1 - t• to Well ~~ No. Of Trenches INFORMATION 1)ISTRIRUTICIN SYSTEM county: St. Croix Sanitary Permit No; 479336 0 State Plan ID No: Parcel Tax No: 018-2001-24-000 Section/Town/Range/Map No: 14.29.17.888 W /~- eLJL nn n J.Gd x STAT ~ .BS .q HI l FS ELEV. vad Be~~ (rk _n n - J GtR-c.~tlus ~ . o .~ q ~ ~ o Aft. BM • ~ I~kt. Id er ~~•{ ~ p1 H nl ~ ~' c, d St/ utle ~ 2 ~• . Dt Inlet S cl'L ~ot hr • Q r+ Dt Bottom z1. i~ g`f• 7 Head an. t !~ ~-/ T l I Ql , ~~ Dist. Pipe --.--- Lr, s. ~ ( `D f, ~ Bot. System /. ~ s ~ ~ ~ . 2 4i4 f Final Grade ~~f ~o Z- StOyer /_K.~/h-~ ~ .~ L ~ 7. ~ ~ ~a~ Z ~ ~ - . r s _ q~ - V r •'~ ~7 • - ~-,ti- . Q/t n1 f-: ____ ~ Ctn... 0 AiS gel .k Dia. Nu/mb~er: Y a~ ~~ (~ p Heade anifold ~ / ~ Distribution ~ Pipe(s) 3 Di ~~ ~ /~ / ~ S i ' 2 J V x Hole Size J ~7 / x Hole Spacing / ~ dfo Vent to Air Intake ~j~ Length Dia ! • a Length 7 pac ng . Sell COVER v Drncm~rn Qu~4ome only YY Mnunrl nr O}_(;ra flP_ SVS}BmS Only ~ `~~~ ~~~ wow Depth Over Depth Over xx Depth of xx Seeded/Sodded /"~ /~ ed BedlTrench Center Bed/Trench Edges Topsoil ~, JI Yes (~ No ~ ,'] Yes ~.~ No COMMENTS: (Include code discrepancies, persons present, etc.) p~tiorNfl: ~ /~/ , Inspection #2:~/[~/ Location: 973 193rd Street Ham ond, WI 54()15 (SE 1/4 NW 1/4 14 T29N R Fore i state L t ~ ~~P cal No: 14.29.17.888 1.) Alt BM Description = (0 0 ~~ ~' 2.) Bldg sewer length = ~$ ~ / n /~ , • - - n n, f,C l~lC~Y - mount of cover = ?Af / ~ 1 -- Plan revision Re aired? ~ '] Yes [ __ No ~GZy~ c ~J f a ~~j~~~Os~ ~ ~O Use other side for additional information. ~__. ~-___ ~ `._ __--_ _~~^~ --- -- Date Ins ctor's Signature Cert. No. SBD-6710 (R.3197) .Safety and Buildings Division Coun~ • 201 W. Washington Ave., P .Box 7162 ~ ~ ` ,~ ~ ~O~~ . Madison, WI 5370,7 2 Sanitary Permit Num et (to be filled in by Co.) I~ (GUS) 2GG31t~f ~ 33 De artment of Commerce ~ . ~ Sanitary Permit Application 0 State Alan 1 D. Number ~~~~~~- s ~.~,,~;s: a personal information you provido Wis. Adm. Code 21 In accprd with Comm 83 . , , . may be used for secondary purposes Privacy Law, x15.04(1 xm ~ roject Address (if different than mailing address) I. Application Information -Please Print All Information ~ 9~ ~ ? ~ / Property Owner's Name JUL ~, 2 2D~ Lot # Block # Parcel # --~ O/8-Z~1- 2`{- tr~ Property 0 ~~'s Mat in Address S ZpNING OFFICE ~~ Location ~'/~, Section ~ ~, ~ %., Ci ,State Zip Code Phone Number ~ , , (circle ZE or~ '~~ N; R ~ l ) (check all that a ildin f B II S T ., .. y pp u g . ype o n ao Subdivision Nama pxcrvtS 1 or 2 Family Dwelling - Number of Bedrooms ~ `: rib U i i il D ^ P b / a `'~ e se Commerc t - esc u c l D Skate Owned - Doscribo Use ^City_^Villa ip of . o of Permit: (Check only one box on lice A. Complete line B if applicablo) Ill.'1'y p ~" ~ t 1,naNew System ^ Replacement System ^ TreatmenUl iolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Ltst Previous Permit Number and'Dato Issued , Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I (o X = 22 •© 3 ^ Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ~ Mound r 24 in. of suitable soil ^ At-Grade ^ Singlo Pass Sand Filter ^ . Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leachin Chamber ^ Drip Line ^ Gravel-less Pi ^ Other (explain) / V. Dis ersaVl'reatm ent Arca Information: :_ • ~ .Design Flow (gpd) } plieation Rate(g pdsl Design Soil Ap Dispersal Aroa Requirod (sf) Dispersal Area Proposed ( System EJovation L ~ nn \ / ,, /_ (~. d Sam 1 / VI. Tank Info Capacity in Total umber N Manufacttuer Prefab Site Steel Fiber Plastic Gallons Gallons ofUni w (~¢Q ~./~ ~ Concrete . ConsUvcted Glass New Foisting Tanks Tanker Septic or Holding Tank _ Aorobic Ttroatmont Unit Doering Chutrber VII. Res onsibility Statement- I, the uodersi rd, a e respoa 'bility for installation of fhe PONTS shown oo the attached plans. Plu bet' N e ( ' t)• Plum s S' a MP/N1PRS Number Businesa•Phone Number, P umber s Address (Street, City, State, 'Lip e) +C~~ s VIII: Couto /De artment Use Onl Approved ^ Di lun ed Sanitary Permit Fee eludes Groundwater Dato Yssued Issuing t Signature (No, Stamps) ^ ' Stucharge Fes) ~~~ ' ~ u axon enial er G IX. Conditions o pprova val SYSTEM OWNER: a c~T 1 Septic tank, effluent fllt®r »nd t ell must all be serviced / maintained ~ ~Ccay- ! ~0.~ u-~- ~ ersal di sp c ~~"-'"'""'~ ~ 1 • _ =~- as per management plan provided by plumber. ~,~ ~-X` - `~ / ~"`'''''''t ' ~~ } /L --- -~ ` v ~ ~ 2. All setback requirements must be maintained ,t•~r.. o.~o. as era livable code!ordinances ~~i~ ~ S 1 p ~ . ~ . P p V~t1- o+v~ e Ataep coroptete prang Ito tw t=aunty ootyl ter en 6tCf0 p0 tMpEr YO as urea m~~ : ~ iacou ru sw~ ~_~ ~ ~t~ SBD-6398 (R. Ol/03) ~. I :^w. "1 \C~` Y ~~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608} 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 12, 2005 CUST ID No.224263 KIM A O CONNELL K.O. CONSTRUCTION 504 3RD AVE OSCEOLA WI 54020 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/12/2007 SITE: Dennis Erdman 193RD St Town of $ammpnd St Croix County SE1/4, NW1/4, S14, T29N, R17W Identification Numbers Transaction ID No. 1151215 Site ID No. 700957 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: New mound, 3bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1026514 Maintenance required; 450 GPD Flow rate; 14 in Soil minimum depth to }inviting. factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.OI/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes C(~ l and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in ~-.y , chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. :.~. ;'a No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ~ ~ stats. ~ N The following conditions shall be met during construction or installation and prior to occupancy or use: ~~ General Approval Conditions: SF4= • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover.. Note • Provide a legible maintenance/owners' manual to the owner and to the sanitary permit issuing agency. The maintenance/owners' manual included with the plans is not legible. • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 22". The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. KIM A O CONNELL Page 2 7/12/2005 ~ Reminder • The orientation of the mound system. must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. A copy of the approved plans, specifications and this letter shall be .on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. -All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence 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 ma' an of the POWTS. Sincerely, POWTS Plan Reviewer , Integ ted Se ices (715) 634-7810, Fax: (715) 634- , M-f 7:45 am - 4:30 pm pshandorf@commerce. state. wi.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 a , ~i~fQ A[~~ PRESSURE QISTRtBUT[QN CQMPONE[~tT ~ES1GN Residential Application 11~X /41~tEf TiTlE PI4GE Project Name: aENNIS ERtAN f~vrtec's Name: E~ENNtS EFtt3MAN ()timer`s mess. 55tt PARK LANE C3RCIN~ I~fN 55356 Lega4l~scr Sl=--4t=-S~~14-T2~~[--R~47V~~ ~aw~sl~~: 1=1Al~fl~ND Casty: ST CR~IX Subd"itr~~ct Narrte 1=QREST RI©GE ESTATES lot Numl~r: 24 Bku~c I~mEier: Pin Transaction No. ~ R. , Page 'I ItfdeX arlEf fide `~ ~ OF 0 ~ IIDiD Page 2 f7ata entry ;AFE~`{ ~/ Page ~ II~Und dramas Page 4 Lateral and dose tank ~ -N/~ Pam 5 Systeet rnafntenance speciFtcafkins ,RRESPn Page 6 I&lanagernerft and. co~ncy p~ Pam 7 PEtmp cetrve and speeificat'~ns I I S ~ Z ~ ~ Page 8 PCQT PLpN l a coca p~~L L ter: ~4 E3ate: ~t Ply Nurrrber: 7'15-75~3~~5 sue: ~~~~ bract cu~pos~ca ~ ter PE)VYTS verses 2.€l s~-~€ast#1-P (t~: ~1fD1~, aflri SS~P ~ 9.6 of Pressexe ~ lks for ST-SASS (E~tIBt) ifers~n 3:Q (o3/otrot~ Pam 4 of 8 Design Worksheet i.~ i_t1D ` , Celt Desk ~ Rafe giant . _. (c or e) ~ IE~ ~ ~,. ~. 1; _ [~ ,. nn 1~ Y Enter Y or N €>~ d aw ~ ~. ,tee. ~q .~~-`}' "-t"': Estimated ~ - ~~~ ~ ~ ~~ ~ t~~ ~ ~ t1 _ Y 9'S_00 Pump Talk Ele~valfi~n (fl) Enter Y or N ~. ~~z~.~ ~_ t'~ t_r~ss {) 16.55 _ Total Dynamic I-ieatt (ft) ~ _ ~' ~a ~R ~~ ~~ ~~e ,gat) 73_~~ tt~ ~ Vow ~;~t3 20,60 . System 13emand (t~ptn) 1.~ ~aeeia~r ._ ~ -~ ). a_75 ~:~ _ ~_~ ~~ x ~~ ~ x ~. I~ - =..~ a x e ~~~_ __t r+ru. ~~i ~ ~, •. . 't.25 x X _~:_~ .~. e~ (optional) ~ _ cTa> '.~ll~ T ~ wEl~cS ~x~ 19~ 9~-"ua t+~ ~ cell649) ~e Yanilr IMarr~ivr~ lefll~uaant ~e+rrr eowet evea~ ea Taw ea na a_~_eE ~.ww~"-".,mr vs ~ '°",r~`.. ~ a"-...Tw'~•~.r~'.- _-.mow. --.i.- - F,~. cgs- "~E~' 'l~'kr~ sa aa_._...~_ project: DEMt~FIS ERDl4fAN Page 2 of 8 i , bound Plan View • s ~~ ~ ... ~ ~ ~ ~ ~~ k Y~ _ y ~ z -. .. .. - q ,_ __ _. .- jfr ~ . _ . ~ ~~ ~~ T ~ Mound Component Dimensions ,~ s.~ ~ ~ z~.~3 ~~ ~#5#}. tom} ~ ~l ~is~ Cep ~xrea N r.~ ~ ~,.~~ ~ ~ ~_~#,r~ +C ? g. P8 ft ~~: ~ ~~~~,~ ~~~. ~~ ~~ ~ ~~ ~~c .~, tttf Z.t~~t -~ C~-s..P~~ _p~r_~~t Mound Cross Section View v e ~.Tr Any e~~~-~ W~ ~ ~: li1Q.$3 fit}~ .~~'.= ~* ~~ ~~ 3.4 '~ Siie Slope S~3tar~ieg Key ~ ~, ~~- . ,. ~ ~ ~~~ .~.--- ~~ 1 ,,- a; ,~ .. t See i'a~ aie an ,~_ see ~ - ;,~~~. ;: .~ _ ~._ ,~ e distribution cel! {AxS). Prc~~eet_ £1~~R't-11S ~RDA~J"Atr1 ,Pam 3 a' 8 Crari 1'`nmss+nnFinra ! .zdvas+n! 3 .s>.aeaast~ 1~annaam L8C#i #!3 G#iH#iE~ 4Y#i Rk!# R ti ~ tl3iiigFlStGn ~ ~ -'....,_..r....tt-.stt..st..a ,.. a.saa..,•...i ~.e..,. t~t ...... - ......... _....... ,....~..........._. _ _ _ Ai# latecats ase iden:~3! !~ 1r -=r! #?+~1 ¢.e +33ifS#,7 n; i}'s3 bcs;x =.tTs _•# t4tt IBt2f bl YSf.3y3H~ }j; yv2V P lit L`L fitdtTT L't3TiT tf~L`tTt3Ti VTd IIN tJt ttT ttSS tt3 TiidTtTt`t111t dt dTEt~~UiT. 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X113 ~3lCYC31t ;yU€~3'1175€UI€ ~~;;~ ; €ei re~uce trasi pet~~:t~ai#c~r~. ! ataral Tesrtl-lln 1letaei ~ir~c!°t~r4 .-...mom... ~ ~iE1l 41G-.F 'F....c~,...... i/14.31M fyl,~iMWIG/Ni BF ~GZ~ ~ti _~ T { l ~ l`_____...___ _.._'' _`''_ l'.'_'_'_'. _' "_"_'_'_'_'I 3'_'_'_'_'. _'_ _"_"'~"~~ _ ~.__ N _' ' '_ _ _ _ _ '_'_ R __ __ _.._ ...__ ~ _'_'~'_'_' _. _`_'_'_'_'_'_'_' f [Lft~~[1Rpp[~E~~[~~-[l[7E H YF~r ~~ _ ~tY~C i~ia€nPi~r ~s i aiPrai Pm:grs- rl~ts€h€€C ~Rrlll:EflA! Bann ~ of R M©und System lVlana~ement Plan to ~ ,s~ ~. atis~nra, c~erat system ~ see ogeraalect a::ssssrsuce ~ornraa F,~%r"t~' °inris. r's:<s~. ice, a sI ab~zt ~a a wi~a ` axpnt rr3$riraalS ~.si~l~-~~~' .~}~~ i ~ aFX~ ~~ 3.~i ~~~}~~~j ~tE~ t9r 3~~ fta~S ~r~lr7d~ tfT Sy'3~Tit 7T73~t~3`~fSG~ ar.f~ ma~tenance reporting. `~o ores shun ever a seas or ~ t s " gases maybe preserre iaai card ease geaih. ~~ ~ ~.lc3'.3d`.~~2~~ . k3t-' ~: {tsiL''L i'!'e~fi. ~r''311'9. ~..33, ~S~u. ~c{~'ii. t"aC#d~t' ~# ~tf; ~3i~€S ~T8'.~tl rit9T#y~T 3S POWTS components. 3epi~ or p~r~n3c _ sagas, aos.-ess asers era a-,saveas sty tie ~ " water -, .. a~3 '_ trsesi s~~rice a€n# a~t€d sa"~3~ ~ se-a~ ww~€ t t#te ~p~' es# sere. r't~y ~~ ~ ~ ~~'~., or sta€€ ~ tatiure must be replaced. Exposed access openings greater than 8-incises En ~ameter sFsati be secured by an eftectlve lockaxt device to prevent acr~tiei ~ txsaiathariaed, a ar -- Septic Tank T septic. tares .3~ -= - ~ aaa_ t8 ~ ~ s-talaks, s. 2ti~., S_ Tt~ of- s~dic. tam rhall be wed of in afxxxdanre w~Tt- .i5ti# t i ~, vir~ Arun fide. Ttie n~e~rafvx~ rrxx- ni die c~fir fanir and m~ef Iffier s~~ aszet~sed of least once every 3_years by irespecfian. '€tge as ~€ . Tf ~~'~ ~,.av2 ~ s-~ st~r~~~~*', t~;'~G't6'~.s;°2rf ~:~`~ ~'~ ~ •at'tL:'~ 58TNY:Jt2 r..~io^ii~ ~ ~r'„r~sx. 5', 4E`ta!~#r~ ire ~~~'..•oiPE, ant 2}~m,'~~' sly: b~ saw ~.ttm. a!~nt-~: ~+'-'a4r~d. ..,F-W,k ~: ?t~s_. ~~~a~; .k:~ ~_ .oz .:rn;~ac,~:ca~A~,un~.?Iar~_ Tlae s~8c tam stra'~ have i$s semi aab€r, tai skadv~ asu4 scam iia die #aaatc eat t~ !5caaaid o€ the tatrk,. EYfdae confenis of fie tent; are not removea` of d`te time of a uienruaf assessment, mainfenance personnel shad aain'se dye owner ofwften dye nexf °~ t~ F~ perfnral !a : 4'~; #e~ ~, ~"r~^x~~ '~; aP ~ ac..~„~P'~,^°~.„ ~; ~~."~c _ srf xx{ ~ e~ sic tanlx ~~' is rxjt;~_ ~: ~surh ~ 3ie used they shah be approved for septic tank use by die Department of Commerce. ~ Tat'f£i The pump {dosing) tank shall be inspected at least once every 3 years. AN switches; alarms, and pumps shay be tested to verify proper c~a€xa it aa~r ~ ~ itas~ed tae taidc it si• tae a~spected sores servia<ea as necessary. Mound ared Pressure Distribution System its trees or stansbs sitiat ~ psi zua rnoaarut. ryas ~ ate Deeds a~ mnfs , arui yne raua siibi"t' be 56eE$tu att#€ rta:~.'heif 3s t~~ it> prL'it eFtssit*#t 8t9#f ~ tZ~ 5~€rr~ sTfer'~iafr €Ftrt:t ash #~~€€:l. eta {a$!er 3or v~ maintenance} on the mound is not recommended since soli compaction may hinder aeration of the in€dtratisre sestets within the moearrd and snow corr~ra~iora irs ure w ream ix orru~ ..~. %€~d uxeatreeF , ," ".• tc"~E~aber~y~ tt~tuae m ~ ~ rraACfted as Arm ~ try. Inflraent quality into the moeasd system may not exceed 220 mgtL 80D5, t 50 mg1L TSS; and 3t3 mglL FOG for septa tank ef~aent or 3f! tail: ~ aaagtl< TAY ?~ aal= Ems; #f34 t~ r~ #pr tr.~~ ate trot e s,~ ~ ire ~e~tTtr! fcr E!tisl:. The.pressure distril'ion.systern.is,~osa,€ttedan~-a ~:p4irat.at.the-end of-each.lateraE,.and:~.~ rerara[tmQrrded.tt:at each.lateral.be:tle~ed sr:~t rye evettr t~ a ~e is ~tF ~ tre bce taest tt~taen ttte sytslt;rn-,~+-as`trbldhe8ir, t,~terrriarrefi raflfii~ raur3g'tng'rras rttemtif, <ir~t5~t rnfiir~ re>=eriaeg~l31B~e7itb$lutridRd`dttr e~rda fl~rt~Cadt"rtate'vVtftlire'~eE ~•_. Qlaservatiotr tit tree sly #ae ~Eed nor e~ ~ Po€~ s Fre tep~ 1~ , at~a above 6 encfses considdered as an impendirsg tsy~au(ic farieue requfnrsg adctiliona(, more frequent momtonisg. If the septic tank or any of iLs components become defective the tank or component shati be repaired or rep~ced to keep the system `ss proper opera Y the dosing ~fai, pr~~i, pearl 6~r~t51s, air or €efatea: ~_, '€r,~es a3ee~e.~e aie?ea.-t"vsre c~~~l ~ he - - repaired or replaced with a companent of the same or equal performance. if a motrrzd c:orrrponerri i ao aceept ce aet riEa doge wastewatEr as t grrnmia sca~a€~< ti viiiti ise re~e:d c~ xce:a ai ~ tocaticxt by i3-x~-~ ba- area ~ Leakage ~s csr tsy r~~~ ~' [~irtt e~ a ttaes-~-a, aa~tl related piping, and replacing said comporserris as deemed necessary to bring the system into proper operating condition. S=ee ~ ~ Hof tags piara f~ asan~ aa~ - ` s of your k~si i-`I:~i""a ~` { _ , awl seavic+e provx~x. Pr~;ect: DENNlS ERf?!+~lAN Pegs 6 Qf ~ ~GOULDS PUMPS ^ Shaft: Corrosion-resistant, stainless steel. Threaded design. Locknut on all models to guard against component damage on accidental reverse rotation. ^ Fasteners: 300 series stainless steel. ^ Capable of running dry without damage to components, ^ Designed for continuous operation when fully submerged. PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS Specifically designed for the following uses; • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: j/~" maximum, • Discharge size: 2" NPT. • Capacities: up to 140 GPM. • Total heads; up to 128 feet TDH. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent, • See order numbers on feverse side for specific HP, voiaye, phase and RPM'S available: FEATURES ^ Impeller: Cast iron, semi- ~peil, run-clog with pump-out vanes for mechanical seal protection. Balanced for 5,nooth operation. Silicon I~ronze impeller available as ~In GptI0r1~ ^ Casiny: past Iron volute type for maximum efficiency. 2"NPT discharge, ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. -- stainless steel metal parts, i3uNk-iv elastomers, J 2003 Goulds Pumps EffecYi/e July, 2003 B3tid5 MOTORS ^ Fully submerged in hiyh- grade turbine oil for lubrication and efficient heat transfer. ^ Class B insulation on '/s-1'/i HP models. ^ Class F insulation on 2 HP models. METERS FEE: ao~- 13u ~ 2l) 35~ ~ 110 30~_ 10U yo zs eo V 70 a zo } '. ao o a 15 ~- 50 ~- O ~i ll)I 3U 5I ZU .o 0~ 0 7of,~ Submersible Effluent Pump WE Series Single phase (60 Hz): • Capacitor start motors for maximum starting torque. • Built-in overload with automatic reset. • SJTOW or STOW severe duty oil and water resistant power cords, •'/sand'/z HP models have NEMA three prong grounding plugs. • s/a HP and larger units have bare lead cord ends. Three phase (60 Hz): • Class 10 overload protection must be provided in separately ordered starter unit. • STOW power cords all have bare lead cord ends. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage when fully submerged. ^ 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. Standard cord is 20' Optional lengths are available. ^ 0-ring: Assures positive sealing against contaminants and oil leakaye. AGENCY LISTINGS ® Tested to UL 778 and csAZZ.z toBStanda~d: By Canadian Standards C US ~~ti0tl File ;t~Ut38549 Goulds Pumps is I50 9001 Registered. - ~ ' ~ SERIE S: ~~~ WE ._ .,.._ ...._.. .. SIZE /a SOLID S ~ ~ ~ p ~ ~ RPM: 35 00 & I _ r _ t .._ . -- -I ~._. . E2 ,.. H I _ .. ' ~ ~ --~ f-5 GPM ~ ~- c ' r-- - r , r r t- ' L I ~ t , I . ..... , _ -- - - -- - - - ~. .. _ . a -- _ - _ _ -_ _- EO H _ .. _.. _. _ -- -- _. . i ~ - - . --- - -, ~ . - _ -. - - _. 0 H.I ~ ~ _' ... ... - .... ... _. - _ - - .._ ~ i i - . ;.._ _ i i, .. ~ _ - ` I _ . . • t _ wE0 M.J. _. ,....,. _ -t'- -.,.-.. ._ _~ __ ... ,, _; .. . , _.. 1 .. ..._.. __. .... _ i.vvf -. ~ _ _. , .._..._ - -- -- -- -. . _ _ - - m rr ___.l__. __ .__ _~, .- -- --- - -- - --_ _ _ .-. __ . t. -- -- - - - - - 10 2 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM `? ~ 10 15 20 25 30 35 m3/hr CAPACITY Goulds pumps ~yvvw.youias.com C~~T ITT Industries ~, i r i ~ ~ ~ ~ ~ _ ~ ~ ,... _~ { ,....~1,. . ~ i I ~ ~ i J ~,. ~~ ac ylfisoonsinDeparbnentof REC~t~ESO{ EVALUAT{ON REPORT Division of safety and Build' n accordance wUft B5, Wis. ndm. code MAID c«rny s?. ~RAi X Attach oompiete site plan paper rat less tna^ X111 i es 1n size. Plan must include, but not limited to: ~ r~ererlce (f3M)~ ~~ and Parcel I.D. L~,~.+~~ percent slope. scale or di ttsi F+'~BL~~n distance to nearest road. C F Ct"'~ 1 NIIAIn ~.-r...- Rnuiw~rl~TT1v _.~~ ~~ 0~~ a~~. Date crease, pr, •--•-•• me be used for secondary D~P~~ t~~Y ~"'~ s. 15.04 l~1 tml)• persond inlormebion you provide Y Properly Location ~~ mod.-L.et ~ 1/4 JJ~ 1/4 S ~ y T Z9 rf ~ R f7 /Vl ~ 5 ~"Lfl Lot # • Biodc u slrbd. Name or CStu~- Property owners Mailing Address ~ - O (ZES i Oros ~ /tTi ti,J , ~ ~ ~ ~ 516tJ 5T wnage Tom, Nearest oad ~ State Zip Code Phone Number ^ City ~ fit ozz f t5) ~fZf~-~fflOZ D 1 e.T.~l-, ~ ~~ ~ Fi4,u5 wI ~' New Construction Use: ~Residerttial / Ntartber of bedrooms ~ Coda derived design flow rate ~ Replacement ^ Public or oorrlmercial - Desuibe: Parent material .~ '(~f f-~ O` ~,~/°FSM' Flood Plain elevatia~l it appNcaloi-e_ - /_ ~~~~' s: /YlOU~Ib SISTENt 1.g4~ S+~D Ftu- ~ ~ . Zoo K CA ~ C,~u%~~~ ^ Bonng ® Borfn9 # ~ Plt Ground surface elev. 47.8$- ft. Horizon Depth Dominar-t Color Redox Description Text) in. Munseu ou. Sz Cont. Color { o-2 o ZI- - ~ ~ Z O1CrZd~ t 3 ~,IN o ,~ 3 '~- g ~"'" Si{ 4 I -17 a tc.K 3 ~ w I ® Boring # p~~ Boring t~l Plt Ground suri2ce elev. ~. ~8~ ft. Depth to gmidng factor ~~ M. re Structure Gortsistelrlce Bound Gr. Sz Sh _ ~ ~' ~/~ GPD ft. Roots 1 GPDRC` Z d S QS -GD O Ur' Z 0.b ~s Q.5 _ o.S ©• b d -- Z-vf-ta . S ~-_ `1 i pepth to IimHklg.fador ___~~___ fn. ~p~ppgcaGori ~ upD~T~- ~~ ~6-OSi Lot ~~ z ~, 3 property Ovmer ~K sy ~ _ Parcel ID # l.~~l~~~ Page -~..._ Pit Ground surface elev. f 00. ~_ ft. Depth to smiting factor / b in. ~ R~ ~~ # ~E BSS Horizon Depth t)omirrarrt Redox Description Texture Structure Consistence Boundary Roots GPD/If •Eft#1 •EBiY2 in. MtimseN Qu. Sz. Cont. Color Gr. Sz. Sh. ~ p- tb vfe.zl[ 'r" 51 ` _ as oS 0.8 z -- ib ~ ~ --' '' ~t ~ - - 0 - 3 -! K`~ a rv_~: ~.,.rr~ ^ Boring n 8orirvg # ^ Pii Ground surface elev. ft. Depth to lhnitmg factor in. Soil Ra Ficrizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' Gr. Sz. Sh. •Eff#1 •Effff2 in. MunseU Qu. Sz. Cont. Color Ground surface elev. _~ ft. Depth to Uniting factor in. Boring # ^ ~~ ^ Pit Soil ~ ~ Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots G Gr. Sz Sh. •Eff#1 •Et1#2 in. MunseU Qu. Sz. Cont. Color > < and TSS >30 < 150 mgll • Efliuent #2 = BOD, < 30 rngA_ and TSS < 30 mgll • Effluent #1 = BOOS 30 _220 mgll The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 ar TTY 608-264-8777. saau~ota.trao) N ` ~ ~ ~ ~, rw i r~rw p~3 s Neu 0 `MID (~O~M19~-9~IIU: P~L~S ~ ~- cov' , -l-~ p ~ ~ ~G~. LoT Z~} . J ~ ~ ~'~' w ~ ~ ~ ~q9 ~ ~ ~'7,~X1 99,x, . ~ioo.'1$' . SpLLTN' ~~ v ~ ~Q~ 081 April 25, 2005 ,~.~ Ms. Mary Jo Hollister, CST #224832 Hollister's Soil Testing W9875 690"' Ave. River Falls, WI 54022 ST. CROIX COUNTY WISCONSIN PLANNING & ZONING DEPT. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 FAX (715) 386-4684 Re: Revisions for Soil Evaluation Reports -Forest Ridge Estates, Hammond Twp. Dear Ms. Hollister: On April 21~ I performed on-site verifications of data reported for lots 27, 28, 29 and 30 to determine the cause of discrepancies between the engineer's preliminary plat elevations and those on the soil reports. There was an error in your method for calculating the benchmark elevations in relation to mean sea level contours, which resulted in the contours not matching the elevations described for soil borings and test pits. While on the site, I walked all four lots and found that some of the distances between test pits and hand borings did not match measurements represented the scale used for their associated plot plans. In order for mound systems to be designed, corrections need to be made. To summarize my findings: All lots whose reports used mean sea level elevations need to be revised so that the benchmarks are based on an assumed 100.0 ft elevation. This will require using your field notes and, starting with every BM #1, add the back-sight rod reading to 100'to give a new height of instrument. Then re-calculate (subtract from HI) all the foresight rod readings to obtain test pit and/or boring elevations related to the BM #1 and draw up new plot plans to correspond ith the new contours. Lots reported using mean sea level were 1, 2, 3, 4, 6, 8, 10, 17, 21 4, 6, 27, 28, and 29. 2. Do not exclude any previously reported test pits. They must be included in revised evaluations and shown on the plot plans. This will help avoid confusion when locations for mound contours are being established. The distances between test pits within tested areas need to be updated from the original 2002 plot plans. 3. Original signed and dated revised reports must be submitted to our office so that they can be attached to the previous submittals to track changes made. 4. I evaluated a hand boring on lot 28 that was next to a test pit that had been marked with a lathe labeled " 29A" (from the original lot numbering). It was approx. 95' southwest of the corner benchmarks and 20 ft. west of the test pit you now show as "A". The original site was an excavated pit, not a hand boring, as evidenced by backfill. Regardless, both test pits were _~ -~""" Hollister -Page 2 described as having redox features within 3 inches of the A-horizon. I found mottling in the sample I examined just below the A-horizon boundary, so am requiring that any mound design be restricted to the northerly test pits B, C, and E. 5. Based on the soil evaluation for lot 28, all four lots fronting on Cty. Rd. E appear to have serious limitations for POWTS installation other than the tested areas already documented. This means that ate[ damage to existing tested areas may eliminate the possibility of POWTS installation, unless an A+0" mound design is approved by the Dept. of Commerce after the requisite on-site evaluation by Leroy Jansky. I will send a copy of this letter to the current owner of the lot to forewarn him of this situation. Would you please re-establish the marking tape to indicate the locations of these areas, since you are more familiar with the terrain? Sanitary permits cannot be issued for the lots referenced above until the soil reports in question have been corrected and/or completed. If you have any questions regarding the above requested changes and/or additions to the soil reports, please feel free to contact me at the Zoning office number and schedule a meeting to discuss the soil data for Forest Ridge Estates. Sin ~ c Pamela Quinn, CST 665054 Zoning Specialist Cc: Mark Sylla, Developer Kernon Bast, Edina Realty Leroy Jansky, Dept. of Commerce POWTS Wastewater Specialist Subdivision file _~ , i a- $ `'f ~~ ~~ VNaoonsln Department of Commeru SOlL EVALUATION REPORT k l Pee _,..~__.of, Dlvlston of asrory ago ~~~~ ~, in soctxdanu with Comm A5, Wis. Adm. Code County S7 ~t2A( X Attech complete she plan on paper not less than 8 112 x 11 iru:tlea in size. Plan must t Umked to: vertical and horizontal releronu point (8M), dlrodlort end t Perrei I.D. ~ ~ ~~ 6 PE Q~~- 2G~~'- no include, bu and location end dlstenu to nearest road. north arrow i n , ons, percanl dope, scale or dimens Date Please pent aN Information. R owed by ~ Personal Inlarmalbn YW provide rosy Ga used fa seeondiry purpwa (~wkY Law, s. ta.a t+1(mt1• Property Location ~~ pwner ~ va ~ ~ 114 s ~ 4 s Zq ~ R 17 E'~iQrf'w M 5 ~ L~ 1 {ock p Strbd. Name or t,.SMtI Lot Property tJwmeNs MaHing Address r i - r ORES t O~~ E sT - ftT~S • ~, D~v~sidnl umber [! [) Village Town Nearest oad State p a e,T. ~y ~ FALLS wI 4oL~- ( a5 _480Z a ~ y Code derived desl n I{ow rate _~ ~ ~' New Constructlon Use: ~ Reaident4el !Number of bedrooms 0 _.,. GPD Replaumont ^ Pufltic a commercial - Deacaibe: - a. ,,._. _ ood Plain olevatlon 11 appliceoie .r, ~ S ~ F~ terial ~ t<l~ ~ • - _.___ ~.,.- _. R• ~` Perent ma p -- /'«t:-O'»L~^a'~'!d ~ f f y AD ftt h 6 t S tl ~'~ . .G~n_,,, ~, ~ / Q,~ 1. 4 TEJ a+a: /vt.tltAeyO S~ S end recommsnde 'fie"" ~~ ~. ~. w , I^ 1 ~ ~ L - O S t~ Ail i0 ~ Rk~~ csT ~!A ~ ~- ~~~~m~s .~ S!e by ~ ~} f ~-r9 ~ ~ G~~ surface elev. ~(r A• th to HmltVrtfl factor ~ fn~ iii rrr "' sss Pit mil ltc ation Rate Texture $truduro Consistence Boundary Roots Horizon DePlh pominant Color Redox Desaiption •EffiJ1 'Ettp2 in. Munsetl Qu. Sz. ConL Color Gr Sh. 5 O.fS I Q.2 o z~ l ^ 0. , ~ ~ 2 ds a5 -cm 0 Or Z Z- N --- sl t z ds as _ I o.5 0.8 3 _~,~ n ~ ~ d -- Z~~~ S O 4 I -17 ~4 ~ l Y C ^ B~~ B011n~ ~ -- - ~ ~. Z.(O A. P{t Ground svrizce elev. Depth to I{rrlitinfl fador _ ~.~- i^• ~~ __~ C~ ~~ ~~ ~k c~oT ~~ 1pro^pert'y owner r *~~ S~- 4 w 1 n_J-_ Y Parcel ID # ~Q~D~J~I(~_.l_._,_ Papa Z of 3 - ~J w.-~ .• ~ PII Ground surfau elev. _1 i-f3 '~j„k ft. Depth to nmlung raccw ~.L_ ~n• SoN tcatbn Rete l C Rsdox Descriptlon Texture Structure Consiatence Boundary Roots GPO/K ortznn Depth in. or o t)orNnant MtxtseN t]u. Sz. Cont. Cdw Gr. Sz. Sh. 'E~1 'E~ 1 - o ylL~l r" •1 ti r 0.5 0.~ .. ~b ~ g.Z y y~3 --- o Z ~z ~t t t ato -m --' - - 0,5 2 o 0. D~3 lr n ^ Borinp ^ plc Ground surface elev. ^ h. Depth to Rmltinp factor I^• Sal Icatlon Role Horizon Oepth Dominant Cdw Redox Descllplbn Texture Structure Consistence Boundary Roots -E~GPOJffEM#Z In. MunseN t?u. Sz. Cont. Color Gr. Sz. Sh. ~~ # ^ 8odnq ^ Plt Ground surface elev. _„_-,~ h. Depth to limiting factor In' Soil RA Horizon Depth Domtnant Cobr Redox Desulption Texture Structure Consistence Boundary Roots •E~GPD •Etf#2 fn. Munselt Du. Sz. Cont. Cdw Gr. 5z. Sh. • ENtuent #1 = BOO, ~ 30;220 melt. and TSS >30 <_ 150 mgll 'Effluent #2 a BoD~ _< 30 mg4. and TSS < 30 mgll, '(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 formal, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. faD•Uf01x.~'00I -_~ .' Boring P y~ Boring p ~~T Z~) ~ pit Ground surface elev. ~.,rn~ Parcel ID # ~_ -~NQ~-~-~--- - Page __!_![ of Tlrc Ucpartmcnt oCCommcrce 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 608-26G-J 151 or TTY 608-264-8777. StlU•~}}0 (R.N001 ' Effluent #1 = BOD, > 30 _< 220 mgJL and TSS >30 < t50 mglL ' Efiuent #2 = BOD, ~ 30 mglL and TSS w 30 rng~t. r `. h s ~~, t4 T24o ~ K f'1 r1 ~,p SST ~ ~~~~ _ t~rrr.~'ZY /'~ 'y4 ~ P~. ~-~ 3 $- Z~#~4 , 8 ~ G ~~ ~ ~! { ~ PVC P~PF ! Z- a+c~ ~$ ~M~L.- tZi'~dov~ ~ N 4rCOt~N D - _ - - _ u,~t-cs ~, RE,V~S~o : OQ-1sC- 02 . ~_ ~ _ ~ ~-~- i 6~~ ,' r~ ( P B47 I 1 1 I `~ ~ 1- f ~~ ~ -- ~ ~ ~ .~ ~ ~ ~Q-z~A ~ ,~ ~~ ,,~~.o~ ,.~ 4- ~ A c ~. - . ~- .__ ~ ~ ~ ~~ ~ ~ ~~ y> o, `,, ,.~ ,~~Z ~ 9 38.5 7 E 4 ~ ~ ~~ ...___. ~ V l ` i • _....5 ~ 1 ~ , ' ~ .y .. '.l , i , r~ ' ~ ' , - ~ ,~ ~~ ~ ,~ ~. ~ ~ ~ --- ~~ G I t7yllbf1t7t917 Ln.4t~ Il~t4/JU30 +"-tea'"''- '-"""' sT cRax covNTY S[~1''TIC ~{'ANK MAINTENANCE AGREEMENT AND OWNf_RSHIP CERTIFICATION FORM OwnerBtryer ,vr S o.N a-yt.~ S-sv ~.~a~ ~~v~ ~2o,tla M~~ S`S3 5--.6 Mailing Address ~„~~ ~~ Property Address (Verification required from Manning Department for new construction) City/State 7 '~'~ ~'J ,~ ~", ~ PArcel Idcntificetion Numbet- ~t~:a.1 DESCRI~"TIQN Property Location 5E '!., ~ '~•, Sec, ~, T~N-R~W. Town of ~ d~ ,~-'d,~'~s > ~D~ ~Si-'-~~ 5 - . Lot ~ ~. Suhdivision ----~ ~-- ,Volume ;page 1# Certil3ed Survey Mtlp q Warranty Dced N ~~ ~ `~ ~ _ , ~olumc Z ~~ . Page q Z 9 Spec house~es O no Lot lines identifiable yes ^ na SYSTEM MAIN7'F.NANGF Improper use and maintenance of pour septic system toufd resort in its prerrtatwc failure to handle wastes. Froper maintenance consists of puttnptrtE out the septic tank e~•ery three yeah or spotter, if needed by a leeenst:d pumper What you Pus into the system can affect the function of the scpnc sank as s treatment stage in the waste disposal system. The property owner agrees io submrt to St. Croix Zoning Departittent a certtftcetion form, signed by the owner and b~ ~ master plumber, jouracyman ptunthcr, ressrictcdplumher or a iitensed pumper Yerifyipg that (!) ttte pn-t-ite wastewaterdisposal system is in proper operating ctmdttion anttiar (2) afirr tnspectton and pumping (if necessary). the septic tattle is Less titan 313 full o[ sludge. I/wc, the undtrsigncd have read the above requirements and agrte to maintain the private sewage disposal system with the standards sit fonh, herein, as set by the Department of Commerce and the Department of Natural Resources, State o[ Wisconsin. Ctmfcauoo ng that your scpttc system c been nsaint:u~+cd trust he comptcted and retumcd to the St. t"roi>< County Zoning Office +~nhin 30 clays f the three ye t trot a dote. _ 7 1~~ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION (we) cettif ail S euten+s nn this form ^rc true to the best o[ my (our} knowtcdgc ! (we) am (are) the awncr(s} o[ the pr pony describ d abov , vtnuc of ~ ti~.vraniy deed recorded in Register o[ Deeds Of{ice. ~ . - ~~~ SI ATt1RE OF APPLICANl~ DATE ...... •••••• Any information that is m+s-represcnicd may rtsult in the san+tary permit being revoked by the Zonmg Department •• Include with this application: a startipcd .varrsnty dctd from the Register or Deeds office a copy of the cMitied survey map i[ reference is made in the warranty deed U 2778P y29 State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number ll Document Name THIS DEED, made between E.W. Homes, Inc., a Wisconsin coloration ("Gr a or more), or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Cr ix County, State of W isconsin ("Property") (if more space is needed, please attach addendum): Lots 18, 22, 24, 25, 27, 28, 29 and 30, Forest Ridge Estates, St. Croix County, Wisconsin 7~3 3. 4~ KATHLEEN R. ViALSH REGISTER t:1F DEEDS ST. CROIX CO.. WI kECEIVED FOR RECORD 04/0b/2005 09:95A?! MARRANTY DEEI- t:KEMPT a REC FEE : 11.00 TRANS FEE: 1245.60 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address P.C1. ~ ~;: ~:~3 F~11L3~i.~~v, Vii 54~i.7 018-2001-18-000;018-2001-22-000:018-2001-24-000 O18-2001-25-000;018-2001-27-000;018-2001-28-000 018-2001-29-000:018-200130-000 Pazcei identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and reservations, if any, of record. Dated April 5~ , ~96~4- 2005 E.W. s, lnc. SEAL)By: .~ (SEAL) * Mark Sylla, i resident (SEAL) (SEAL) * * AUTHENTICATION Signature(s) E.W. Homes. Inc., a Wisconsin coraoration by Mark Svlla. its president authenticated on A rril T~ ~At14 5 *Kristina Orland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: ACKNOWLEDGMENT STATE OF ) ) SS. COUNTY ) Personally came before me on , the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Kristina Orland. Estreen & Orland Notary Public, State of 304 Locust Street, Hudson. WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORDO. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO.1-2003 i~ * Type name below signatures. iNFO-PROTM' Legal Forms B00-655-2021 www.infoprotorms.com ~~ ~~ ~ ~ f'v, ~? ~ ti r? ~ ~ _-_ ~ ~~ ~- i ~ ~ ~+ ~ ~ ~ ~ ~ ~ t ~.: ~ ~ i C~ ~ ,. ~ ~ ~ ~~ .~ f ~ r ~, ~ ~ ~ ~ ~ ex. ~ of ~ f4• ~. 4 9 A~. ~ r, ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~ . ~ ~ ~ ~ r" ~~~ ~~ ~ ~ a ~ ~ 7 ~84~~i S.F. i ~ ~ ~ say . ~ f ~ f ~ ~ ~