Loading...
HomeMy WebLinkAbout018-1083-15-000 n y o c °.: 3 ~ ~ ~ ~ A W I 3 ~ ~'•' I n d ~ ai O O A S I ~ _ 01 C ~ ~ ~ ~ ~ y ~ yO W ~ 7 ~ a I ~ ~ N C C ~ I ~ ~ y H ~ ~ o ~ ~ ~ A N ~ ~ ~ ~ W fD I ~ I ~ _C O ~ '~" O1 ~ D I ~ ~ a w m o ° I o =~ o I d N N 3 a o o Z ~ .~ ~ ~ ~ ~ ~ N ~ N N N 411 I o ~~ ~~co 7 ~ ~ ~ W CJ1 0~1 d N 3 .. ~- w Z •• O ~ = Z A 7C ~ 7 S ~: O O ~ ~ ~ ~ O ~ ~ 3 ~ ~ G1 (~q n C C tD N C Z n ~ ~ ~ I o ~ y o . s g -- ~; I ~ < , a ~ m v eo a I o ~ I ,~ +, z I I ~ w ~ Q 7 ~ ( A ( D d <. ~ C' i+ . y L I o °' °' m' ~ ~ - c I ~ ~ ~ ~ z a N ~j N N 0 . N < .. 7 ~ ~ I C1 .N. ~ao I y v rn O O •~ (~D ~ to ~ < tD ~ ~ -w ~ O 7 N ~ I a O~ I m ~ ~ ~ I o N o I 7 I m I 69 ~ O O ~ 3 d o ~' ~ ~ c d ~ ~ J 0 d ~ 3`° ~ Q ~ a ~, S5~ ~ J Q °o v' y~~ 3 ~ C71 ~ 0 N 01 7 x y ~+ -i N p Z ~ ~~~ A ~ ~ J m~rni z z ~ ~ ~ .P d ~_ A'+ A~ Q w~ 0 C ~~ ~• O C ~~ "V i ~a A C 0 0 g ti ~a OQ W 10 N ti ~ Wisconsin Department of Commerce ~ 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)]. Permit Holder's Name: City Village X Township Johnson, Larr L. Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 404903 0 State Plan ID No: Parcel Tax No: 018-1083-15-000 Section/Town/RangelMap No: 16.29.17.587 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER Y Pressure Svstams Only YY Mrn~nd Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil - Yes No 'Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /_ Location: 1730 96th Ave Hammond, WI 54015 (SE 1/4 NW 1/4 16 T29N R17W) Pheasant Hills Lot 15 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = ~ - -- Plan revision Required? Yes ~I No I Use other side for additional information. __-_~-__ --- - ' - - _ _ ---- 9. SBD-6710 (R.3/97) Date Insepctor's Si nature Inspection #2: / /_ Parcel No: 16.29.17.587 1 Cert. No. ' Safety and Buildings Division Cam' ` 201 W. Washington Ave., P.O. Box 7162 T . ~ isennsin Madison, WI 53707 - 7162 Site Address q ~ ~~ n ~ ~ Department of Commerce ~~y re~i~umber 1t Sanitary Permit Application y D y 9' 0 3 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Chcek if Revision ma be used for sew ses Privy Law, s15. 1 m I. Application Information -Please Print All Information ~ State Plan I.D. Number Parcel Number properlty Owner's Name /' property Owner's Mailing Address Property Location ~ 1 3a 4~+-h Ave ~ 5~ 'RI~W!4;S T N,R I~1 City, State Zip Code Phone Number Lot Number Block Number .s Nl~m-~on.el Subdivision Name CSM Number ~he.Asr~N~' u~ ~5 II. of Buittling (check all that apply) ^ciry 1 or 2 Family Dwelling -Number of Bedrooms ^Village ^ pablic/Cotnmercial - Describe U ownship l'1'1 ^ State Owned ~ ~ ~ ~ ~Q 0. rest Road 't: ( only one bo on line i ~ ermg sche a for internal use omplete line B if applicable) III, A. For County use 1 New 2 ^ Repiacemem System 3 ^ Replacemem of 6 ^ Addition to Tank Oni Exis ' stem Permit Number L Date Issued B. k if Sanitary Permit Previously Issued C..' ~ -1 4 ~ ~ ~~, b 13 aQ t~ ~- IV. of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non -Pressurized In-Grotmd 21^ Mound 47 ^ Sam Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Gratin 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' rsal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Sod Application Percolation Rate System Elevation Final Grade R~~ proposed Raoe(Gals./Days/Sq.Ft.) (Min./Inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Consuvcted Glass New Existing , 1 Tanlrs Tanks 1"~ Septic or Holding Tank 1 ~ - t OOD O ~G }'~ Dosing Chamber / ,,,~ ~ ~" VII, Responsibility Statement- I, the un 'bility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl is S' Mp/MPRS Number Business Phone Number ~Toc.~d Sl`N~z w 34`ti ~~. 1~ - a3s-r~6~-f~~ Plumber's Address (Street, Ciry, State, e) t S~~ ~1~+h A~ YYI ~ ~~-~ ~~~~ ~ ~ ~ VIIl. Cotmt /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ^ Disapproved Surcharge Fee) ^ Owner Given Initial Adverse ~ ~ (}~ ~ 0 Determination _ lX. Conditions of Approval/ReaBons for Disappr ^ , n _ ~ R - C~ t~ ~ ~~ eo ~~, f ~~. S,d,~, . °^RA` Attach rnmplete plans (to the County ody) [or the system on paper not less than SIJZ x 11 Inchea In size cRn~~9R t'R OS/Oil Li ~/ . n S ~ U"` ,% v~ N54N A~~~ i ~~ ~~ ~~~~ ' ~„i ,5.~ !~ v ,~~,~b ~ coo -~ 7p~ N~Glrow,s~ SN E F 3v ~, w.~ ,l. ~J ~,~ . Oy ~'°"~~ I Ko~..~ pB2/ ~'~~~ maw 5~ 9~'g Og3 .?~s~'/ d'' ~ ~ X 118. ~S~c~// IfrK `(3M~#rZ ~0~~ ... ...._.......,,~..rwv~....w 1~ ` .. WtATJiEKPRt~t^ 10CKtNC3 COMER `~'~4Tt°~` ~rivy~~vpcd~G t.48E'~ . 8C~ QL:cK Waca•t,t~G~'~ Cr ~~-c. 6.. -ate ~ ,,,, -, ~--~ . y TT P1 P6 3" , v PQ ND1STtJRB~EU .,. S~lL 24" x.U. 11 a'' 40 MA-iuGtB ~,. ~• ' ~ Y fs t•1T /~K,s r wGC.v A .. Kota e}"~P~ ~ cW Kavt.a ~ 4 p (~T 3barrS ~FI..ES ~aL 3' ono Pt./'F p , N E G.T 10 K.S ~`- '"'`/(~ tai, b ~, ~ ~(~`~"l'~ ~ OH " (~7 ~ fir: ~ 'Y~r : ~ b w'Y l a~~ ~~" L~~• atF Pu~iF' b b ., ~ toMtrR~Tt _ gv . 4tO C+C StPTIG E ~ _ SPEGII~!'GATJ~I'..f5 005 t ti ~-~ ~~.`~'~ 'rA1J.•5 MA~JLfF,-CTt3ft~R: _ IJLlM6cR pP DOSES: v P£.fc pia 7'AIJK SlzC : l tr~ - Vcr~, fiAt..l.0A1S • ,DOSC VOf`cJME AL.AR/% r~AUU~~cruRca: 5 `1 1~'~ti~vs tA1CLltD11.IC' SJIL1c~LDW: ~~~~ GALLONS /'~QOC L 1.1t-)~tX; . 1 e t Wr ~ CAPACITIES: A: ~ WCHCS OR ~ 93 sWtTCN 'T'yPt; ~';'~"~` "~<<o Wt_UO>,;S // A $ m_ L t1JLxE5 OR ~'a g Cr.~.LLpS.;S SUMP /1~,AlU~'ACTISRCR: __.~irD`Y) 1iG -.~~~."~~"`~'"~..~~~-.-~ C^~ I UL H C 6 G K ~`~ Gw L L O >r 5 • MPDEL -JUMDLR: S ~~ O p. ~ laa<;KES GR ~a~GAILpH, ~W1TGN TbPlE: V"~Q~-~v •~ ^~ ~t7T PUMP AlVO ALARM ARC 70 8G MI-.IIh11SM D1SC~4Ayl(rC RAT --~~.ra-M rNST~~~FO pu sEPAa~TC CSKCusr; 1fRT1tAL RrrF[Rfut£ 0£TW[tu PUMtr 0« Ay0 DfSI'R1~1JTiO1J PlPC.. ~ , FEC1' + rtit>JlttiurK ~1ET~/oFtK 5UPP4.y J•R~L~uR~ .. ... .. = FECT + - `/O FE;E7 os Foacc rv-IN x ~9 f~ ~ --6 FEET t pP IL ~R! CT t0-J MACTOit. -- i ' ~ ~~ +_.....~..~ y~ ~ +~~r~~ . o TCTAL L1y1JAMtC NEAO ~ ~'~ fTLCT 1 .~ „ 2 ., ,1rcR-~AL, DIMEIJ6tOiS4 ~or TAAtK: LENGTH---~~ .`~W~pTH ~'~ ; ~.,qulo oePT N 4 Pa~ti ~ ~~ ~ Zd Wdti0:60 ti00Z ~Z 'h'~W 860 ~SZ STL •ON Xdd JNIlSSl BIOS QSIdI12iS~ WCJ2id Pump runs but delivers only small amount of ~Nater. 1. Pump muy'be air locked. Start and stop several times by plugging and unplugging cord. Check vent hole in pump case for plugging. 2. Pump head may be too high. Pump cannot deliver water over 24' vertical lift. Horizontal distance does not affect pumping, except loss due to friction through discharge pipe. 3. Inlet in pump base may be clogged. Remove pump and clean out openings. 4. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. 5. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. Fuse blows or circuit breaker trips when pump starts. 1. Inlet in pump base may be clogged. Remove pump and clean out openings. 2. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. 3. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. 4. Fuse size or circuit breaker is too small. 5. Defective motor stator: return to Authorized HYDROMATIC Service Center for verification. 4 Motor runs for short time then stops. Then after short period starts again. Indicates tripping overload caused by symptom shown. 1. Inlet in pump base may be clogged. Remove pump and clean out openings. 2. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. ~~, 3. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. 4. Defective motor stator: return to Authorized HYDROMATIC Service Center. 9 30 s ~ 20 s 3 ~ 10 0 0 (apotityU.S. G.P.M. 0 10 ~ 20 30 40 50 i ~ ;- liten/Se~ond 0 1 2 3 ,--.~ SHEF30 Performance Curve PAGE 3 OF ~ ~~~~ h KSO ~'1 LOT#/~ LEGAL DFCru Twrrnt~t S F ~ tiw14 ,S I ~ T L9 N R_ ~ E(or~ SCALE:1"= y~ BM 1 ELEVATION /00 ~ d BM 1 DESCRIPTION ,60~,~ // Ai c BM 2 ELEVATION ~1. Sn BM 2 DESCRIPTION a~ %v G SYSTEM ELEVATION l^~, ~y SYSTEM TYPE ~'o n yen,~~n. ~ CONTOUR ELEVATION /Jo 5~~~ N - -t- ~ 6- Z T~ ~~ 51~ ~- a-~ g.r Z 8~' ~ ~~~ r 3 .~ l Q TE l l 5 - ~ .~~- ~" wisoonsln oepartrnent of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85,111fis. Adm. Code County , .~, Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan rrttrst include, but not Graded to: vertical and horizontal reference point (BM), d'dection and Parcel l.D. percent slope. scale a' dimensions. north arrow, and bcation and distance to nearest road. Please print liti~OpRtttt3>CLQjji- Reviewed by Personal inrorrnation You Provide may be used secoi4~e~~i 'ei~y Law• 15.04 t~) (m))• ~ ~ ~~ r0 ~ Date Property Owner Laation r~,,~ ~ J U N Q Govt. Cot .~ vaN~/ va s /<v T~ 9 N R /~ E (ak5~ Property Owne s Mailing Address _ Lot # Biodc # Subd. Name or CSM# ~ ~~~ O / ~ t~~ Vie; ~ ST. CROIX COUNTY ~S ~.e$.P~ f ~j~' ~f 7 (0 ^ Cdy n ~~e (~ Town Nearest Road ~I~rhpv~n~ - ic,~( ,~y615 i c7C3" )7¢a-//Zl~-` l ~Q>fh>~~o( '~ ~.r,. © New Construction Use: [$ Residential / Number of bedrooms 3 - ~' Code derived design flow rate r~ ~~ G oQ GPD ^ Rephaoentent ^ Public or conunercial -Describe: Parent material ~, ~~/ Flood Plain elevation if applicable ~/~ ft. General oornments ,S y~,n~ 2~C V • 9,7. ~a ~ and r+eoornrrlendatiais: 1 1 ~9 # ^ Bori ~ ~ F'II v.wiw aunow c.cr. . v- -.~.. .~, vcNu. w w.rwgr .oa.,v. .. - n,. Soft Application Rate Horizon Depth Dominant Color Redax Descxiption Texture Strucxure Consistence Boundary Roots GPOIft= ar. Mansell Otr. Sz. Cont. Color Gr. Sz. Sh. •Eff#'1 'Eff#2 ~ alb b i,~L - ~/ Z~ar-~,~ -- ~~ /i , S B" 3 ~t x ~/~ - SG zi~s~ m~~ - - „~ , y i ~~ # ~ rt.. 2n -7 G ~i ~~ ~ Yrf v~w~w aw~ertc c.a~...~--v- .~. vcyu~ w w.uw.y ~a~.w. . u u~. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fiz in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 / ~ /Z 1o ij Z - S,'/ ~.s-rib~ /j1 ~ CS lad , S 8' 3 '~ -~ /~ - S~ z~s'b - ~ . s 9 • Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mg/L and TSS < 30 nxyl CST Name (Please Print) S' re ~ CST Number , S~ ~- 5-.330 Address Date Evaluation Conducted Telephone Number ~G/3 ~s0 ~ ~~• Sa~,u~~..~, w~ s s'o~ ~~ ~ _ o L -pis- r~'~-1~~8' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of C ~ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County , ~. C r0 ~ X Attach complete site plan on paper not less than 81/2 x 11 inches in sue. Plan must include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel l.D. percent slope, scale or dimenswns, north arrow, and bcation and distance to nearest road. P/e~Se p17I1t - R 'ewed by Date Personal information you provide may be useda~P"' ~01~` Law, 15.04 (1) (m)). /k~~~~M. r~~ I ~ •~~ , 2 r o. ,~,^ JUN 0 Govt. Lot .~ 1/4~(1{/ 114 S j(p T Z q N R ~~ E Property Owne~"s Mail lot # Block # Subd. Name or CSM# ~~~ _7 / ~ ,~j,.J-J- ST. CROIX COUNTY ~S ~.e5.~~ f - l~•/~f City 7 (0 Sta-ate `!~-Zp Code ^ City [~ ~Ilage (~] Town Nearest Road I~t~w~h ~ ~c~ r ;~y~ l5 ~ (7r.S j7~o-!/ZOO' I 1~4w~-+~r-ol ~ ~'G ~,~~ © New Construction Use: [~ Residential /Number of bedrooms 3 - `~ Code derived design flow rate y.~"o~ G OG GPD ^ Replacement ^ Public or oommeraal -Describe: Parent material ~~ ~~~ Flood Plain elevation if applipble ~/~ ft. General comments sy,~ e/tv• y~ as and recommendations: ~~ Burin # ^ Boring , • I I 9 r-. _ ice. ~ „ - - - - - - 7 ~ -_I t_I' Plt v~~uuu aunacc c~cv. a v- •.~.~ n. vcNu~ av ~u~uuny ro..w. - w.. Sal Appligtion Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GPO/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 z ,~-y~ ,yry - ,~/ z~.~ ~ ~s - , ~ . G ss' z9.~ ~s. ~~ ^ Boring / I Boring # ...~ ~., -~ ~ ~~ ~J tj°J Pit vrcwrw ~ruracz ~v. a.~--•v~- ia, vcNur r~ ~u~wwiy rawv. u ur. $al Application Rate Hatton Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#i 'EfF#2 3 `~ ~ /~ -- S~ z .S 2°t . Y 6 S. 'Effluent #1 = BODE > 30 < 220 mg1L and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL CST Name (Please Print) S' re ~ CST Number Address Date Evaluation Conducted Telephone Number ~G13 ~sD ~ ~~• Sa.,ur~-/, wi s yob ~~_~ ~ o L -pis- zy~-ya~8- Property Owner t~p ~ ~l.Sp ~ Parcel ID # Page ~ ~ L U Boring 3 Bon°g # ~ ~ ~d Surface elev.1 f~_ ~. Depth to Nmite~g factor ~_ in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz in. Mansell Qu. Sz. Con4. Cobr Gr. Sz Sh. 'Eff#1 `Eff#2 3 3-sa - d , y 0 ry~r% .S, ~./ SL ~~ ~ ~~ m~~ c s i - .~ ~ - r c~ . GQ . / 2R•~ 4~• s~ # ^ ~s pit Ground surface elev. fL Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Descxiption Texture Struchrre Consistence Boundary Roots GPD/ft~ in. Mansell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 Pit Ground surface elev. fL Oepth to limiting factor in• Soil Application Rate ~~ # ~ ~9 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsep fhr. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mgll. ' Effluent #2 = BODS < 30 mg1L 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. ssn-asw pe.o~rao~ PAGE 3 OF ~ ~TA_1~AE ~~ h v~So n TOT#~~ T EGAL DESCRIPTION S F ~ tiwt4 ,S ~~° T L9 ,N,R, / ~- E(or~ SCALE: 1"= y~ BM 1 ELEVATION /00 ~ d BM 1 DESCRIPTION ,6~ o.~' / FV c BM 2 ELEVATION ~1 S~ BM 2 DESCRIPTION~yo a.~ %v G SYSTEM ELEVATION I`~`~. ~y SYSTEM TYPE ('o n ysn,~-n~, ~ CONTOUR ELEVATION do s/o~~ . ~ ~ 6- Z ~~ S1~ ~ B-~ Z B~~ w ~" ~ ~ SIGNATURE DATE ~~v~ 1 .~ -« ~~ ~ ~---- Wisconsin Department of Commerce ~ 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 Johnson, Lar L. Hammond Townshi ;ST BM Elev: Insp. BM Elev: BMpDescription: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~,~~~- (axe /66n Dosing ~ ~~ • Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,~ `Z ~ `~ ~ ~Y ~ ~ Dosing 6I t, l .t .,, ~ a i Aeration Holding PUMP/SIPHON INFORMATION Manufacturer /~ ~ Demand Q~+~BN~~-tL GPM "~ Model Number / ~e~ ~ ~~ ~~C TDH ~'0 Friction Los~~` System Head TD ~~~ F 0' ) ^~ Force n Lengt ~ Dia. Dist, to well -.. O 2 u, SOIL ABSORPTION SYSTEM 9 ~ ~~,,,~~ NC Width ~ Length ( No. Of Trenches DIMENS ONS 3 i'Q•$ ~ /Z ELEVATION DATA County: St. Croix Sanitary Permit No: 404903 0 State Plan ID No: Parcel Tax No: 018-1083-15-000 STATION BS HI FS ELEV. Benchmark ~~ `F ~ (o~{ ~ op„a, Alt. BM ~q 1 O, L ~~ `(' Bldg. Sewer ~-~ ~ qr.~s St/Ht Inlet ~~,90 q3• `tS SUHt Outlet Dt Inlet Dt Bottom '~•qS -~~ r Header/Man. Dist. Pipe j ~ i~ - •r~1 Bot. System • 2 O ~•~~ S ,~~ Final Grade St Cover i PIT DIMENSIONS [No. Of Pits ceptn SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING nnanuractur e INFORMATION ' CHAMBER OR • ~~, Ji • ~= Type Of System: S ~ N C~ . ~ ~ ~S ~ UNIT M d I Number: ~'~ ~~ I~ISTRIRIITInN SYSTEM Header Manifold ~ Lengt ~' Dia ~ Distributi n Pipe(s) Length Dia Spacing _ x Hole Size x Hole Spacing Vent to Air Intake (~ ~ ~ Roll C(]VFR „ o>e~~~~~e c.,~ro..,~ nni.. Y4 Mnnnrl nr At-Grade Systems Onlv Depth Over Dept'n Over xx. Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges To, soil Yes No ~I Yes ~ ~; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1'~Z Inspection #2: ~~Lo~atjpnh: 1~ 30 ~+ ~Ig~Hat~imond, WI 54015 (SE 1/4 NW 1/4 16 T29N R17 y ~Pheasan Hills Lot 15 ~ P~cel No: 16. 9.17.5 7~ ~~JL v17 G>~(, {? `Kr/J p,~r~ ~ , fj~,~J\ t~wf~0. 1.) Alt BM Description = ~~~~~ hp~vr-S~l owl.f~ 2.) Bldg sewer length = ~ ~ ~, ~ ~ r 1.A ~4 ' _ r ~ - amount of cover = ~ $'eK,1(`~Lts><fl +' ~ Q~l~ ~ Plan revision Required? ~ Y aJ No Use other side for additions i ormation. `~-, Insepctor~s Si nature I _` (~ Cert Date t. _ _/• 9 No. SBD-6710 (R.3/97) ~(+~~ 3 •~~''~ Pte` r~~, ~) ~`(.~ ~ • - ~ `~ ~~ ~,~ v ..---- ~c.~ ~_ ~~zy ti ~°~~~ ~°"'~ ,, -~ //''~~ ~~ W N !<. i> ~ ~D'~ ~ ~~ N Safety and Buildings Division County • ~ 201 W. Washington Ave., P.O. Box 7162 C7 R- / ~ j> jSC~ns~~ Madison, WI 53707 - 7162 ~s ,~ De ~rtment of Commerce ~~ ~ Sanitary Permit Application oza9Y3 SanitaryPe~N In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ,/ a3 ^ Check if R ion ma be used for seco ses Privac Law s15.04 1 m ~7' ~ I. Application Information -Please Print All Information State Plan .Number Property Owner's Name 9 Parceh , her L ~o`IyVS,dY/ ~ ,l? ~ /~4 ~~ /083- /S- oDa Property Owner's ~ing Address perty Location g / L'U~ L~ ~~Ji~IL ~n F a ~ ~ i4 /U!(~ ik; S /I~ To~7. N, R /7 City, State Zip Code Phone r ~~ ~• y- t Number Block Number ~ L~~- S " -~ ~N't1' ~''•` ~~~" ~ '~ _ Subdivision Name ~ CSM Number os~ ~J~z 5~a/e is "~ "' ` ~~s,~vT II. Type of Building (check all that apply) ~ ^City ~ ~1 or 2 Family Dwelling -Number oP Bedrooms ^Villa e ^ Public/Commercial -Describe Use ~~' g (~'fownshi ^ State Owned ~ Nearest Road III. Type of Permit: (Check my one box on line A (numbering sche 'for inter use). Complete line B if ap A' 1 'New ^ Replacement System 3 ^ Replacement of Additio County us S stem Tank ON ~ is ' S s B • ^ Check, if Sanitary Pe viously Issued Fermit Number Da ssued i;V. Type of Permit: {Check all tha )(numbering sc a is for intern use) , 44 ~ Non -Pressurized In-Ground 21 47 ^ San Filter Construe (`_ -„Q~t 22 ^ Pressurized In~Ground 41 ^ Iiol ' 48 ^ Single Pas 1 ^ Drip ~ VVV~~~"'"""~~- 1• I 45 ^ At-Grade 46 ^ Aerobic nit 49 ^ Recirculating 30 ^ 0 V. Dis ersaUTreatment Area Informat ion: Design Flow (gpd) Dispersal Area ired R ~3~ Disper ea So' 'cation P d~ Percolation Ra stem Elevation Final Grade equ 6 m ~ dj) atc(G Sq.Ft.) (Min./Inch) Elevation / VI. Tank Info Capacity in " orll Number Manufactur Prefa Site Steel Fiber Plastic Gallons allons of Tanks Concrete Constntcted Glass New Existing Tanks Tanks septic - u-^.',~~ TODD /OOU / Ga'GtJ`T Dosing Chamber VII. Res onsibility Stateme I, the anti ed, esponslbWty for installation oP the POWTS sho n the attached plans. Plumbers ame (Print) / Si Plum r' Signs re MP/MFRS Number Business Phone Number ~~ arm L m z ~39~6 Z. S z3S- ~ Plumber's Address (Street, City, State, Zip VIII. Count /De artment Use Onl ~; Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Si tNo Stamps) ^ Owner Given Initial Adverse . Surcharge Fee) ~ ~- ~. ~ (~ ~ .Conditions of A p ov _ _d_- •- ' ~S i~` 1 _~--~ 1. .~t",`.v Ce' ~ ~ w~.t' , (2 /~ N ~ ~ Gnus Uc>~~~ •~~I-~ (/ ~~ ,W~,`~'~D w~+c.L. 1 ^'-~..~~ ~ }/.1~ ~ti~ ~ AAl~~ t~ •~t,0.1,a~,~'t, ~ lS IAI~~ ~- ~-R~ • ~-- ~`~'~``~~ MZL~id~ ~ . ~~-~ WVe ``- ""~ com ere p to a ounty o y) for the system on not less than 8112 x 11 inches in size SBD-6398 (R. OS/Ol) T.L. Sinz Plumbing Inc. E5609 708th Ave. Menomonie, WI 54751 ~.. ` 5or++~5~ ~~/oZ v ~ L~ ~~ I rt- IQ- ~73o q~~`'~E j.vr n~rH,fO (,~ls- S~t715 / ~D V L cl ~ ~s ~! ~ (,J Phone: (715) 235-2644 Fax: (715) 235-2592 www.tlsinzplumbing.com T.L. Sinz Plumbing Inc. E5609 708th Ave. Menomonie, WI 54751 / L° ZD Ifo ~a `/ I"=6o' ~.~s. i~p ~V L S~,~S~ -},v(~/off V~ ~ ~ I ~ I -4- ~- Diu ~73o qG`~~E 1.oT ~S ~ ~~a w~- s~+n~s SE'l~+ Nub'/'f s Ib rz9 ~« W Pr~E~~T ~~u s s~ b~ ~va-wt w~ o rv D Tb ~ n~sv~-~ ~? Phone: (715) 235-2644 Fax: ('715) 235-2592 www.tlsinzplumbing.com wit,~nsin Department of.Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and BuiI~R'~~L in accord with Comm 83.05, Wis. Adm. Code ' Certified Soil Testing Anacn complete site plan on paper not less than B%: x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Coun ty St Croix percent slope scale or dimemsions Wort tow and 1`on and distance to nearest road . , , , . ^ - Parcel LD.# APPLICANT INFORMATIO - lease punt all lnfdipnation. Personal information you provide may for sElcondaijf p~r~ses (Pnva Law, s. t s.oa (1) (m)). 1 iewe~ By Date Property Owner ,` Property Location Bonte, Ron .-_ ; - , ~ Govt. Lot SE 1/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Addre '""- - ~ Lot # Block # Subd. Name or CSM# 1011 170th St. r'"~.' ~'' ~ ~ ~~` 'Y 15 Pheasant Hills City ate Zi 'C~~~~RTioKi~um H d 50 ' ~ City (-] Village ®Town Nearest Road ammon 15 715-796 - ammond 170Th St. New Construction ~ Residential l Nu"tuber of bedrooms 3 ^Addition to existing building Use: ~ Replacement ~ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ft2 •4 trench, gpd/ft2 Absorption area required 1 S00 bed, ft' 1125 trench, ft' Maximum design loading rate •5 bed, gpd/ft2 •6 trench, gpolft2 Recommended infiltration .surface elevation(s) 24" below contours ft (as referred to site plan benchmar Additional design /site considerations 'nstatl 2 - 5' x 112.5' shallow trenches along contours for 3 br Parent material till Flood lain elevation, if a licable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ® ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ® U Boring# 11 Ground elev 101.1 ft Depth to limiting factor > ~" Ground etev 101.1 ft Depth to limiting factor > 60" Horizon Depth Dominant Color Texture Conslsten Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ~ Trench 1 0-11 7.SYR 3/2 - sl 2 f-m sbk dsh cs lf/m .5 .6 2 11-23 lOYR 4/4 - sl 2 m sbk mfr cs if .5 .6 3 23-32 l OYR 4/4 - sl 2 m sbk dsh cs 1 f .5 .6 4 32-46 lOYR 4/4 - Is 0 sg dl cs - .7 .8 5 46-57 SYR 4/4 - sl 0 m mfr cs - .3 .4 6 57-84 7.SYR 4/4 - sl 0 m mfr - - .3 .4 Remarks: 1 0-4 7.SYR 3/2 - sl 2 f-m sbk mvfr cs lm .5 .6 2 4-10 7.SYR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 3 10-23 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 23-30 7.SYR 4/6 - is 0 sg dl cw lm .7 .8 5 30-40 SYR 4/4 - sl 2 f sbk mvfr gs if .5 .6 6 40-60 SYR 4/4 - sl 0 m mfr - - .3 .4 Remarks: CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715-665-2681 Address ertt to of eettng D t CST Number Ref # P.O Box 57, Knapp, WI 54749 4~1~/2000 222774 1042 •7VIL L/G~7VRIr I IV1~1 RGrVRI 1~ 1~~ ~ ~ 1 -7„~ `\. Mottles Structure ~~" PD/ft2 .~ .5 .~ .~ C ., .. PROPERTY OWNER: Bonte, Ron PARCEL I.D.# Ground elev 100.5 ft Depth to limiting factor ~. SOIL DESCRIPTION REPORT Pa a of+•3 L--~.~-1 C9 ~fa~ cn~l TP~,~.,a Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft2 Bed Trench 1 0-5 7.SYR 3/2 - sl 2 f-m sbk mvfr cs lm .5 .6 2 5-17 7.SYR 3/2 - sl 2 f sbk mvfr gs lm .5 .6 3 17-54 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 54-6~2 7.SYR 4/6 - is 0 sg dl cw lm .7 .8 5 62-64 7.SYR 5/4 - mcos 0 sg dl - - .7 .8 i RS•sa 2~ (oo I\GI I IQI ICJ. 4 Ground elev 101.1 ft Depth to limiting factor > 66' 1 0-3 7.SYR 3/2 - sl 2 f-m sbk mvfr cs im .5 .6 2 3-9 7.SYR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 3 9-29 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 29-53 _-- 7.SYR 4/6 - Is 0 sg dl cw lm .7 .8 5 53-66 SYR 4/4 - sl 1 m sbk mvfr - - .4 .5 31.Z ~•2 n_~_~__ . nn~nn ac or rn nr a 5 "~ 1 0-4 7.SYR 3/2 - sl 2 f-m sbk mvfr cs Im .5 .6 ""~ 2 4-9 7.SYR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 Ground elev 3 9-24 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 99.4 ft 4 24-38 7.SYR 4/6 - is 0 sg dl cs if 7 8 . . Depth to limiting 5 38-60 SYR 4/4 - sl 1 m sbk mvfr - - .4 .5 factor y~ L Remarks ' orizon as me unions s; consi a e gr co w occ s Ground elev Depth to limiting factor Remarks: ,~ t ~O"~~ ~O~;TQ `~~o~ ~l~l4M' ~~ ;~ ~o tiTS+ zzt ~a4 3'Ib.bl~' - L +4.3 -3~- C ~,-s~ Ski-Nw -~~•.2.4-1'}•a zis, ~~ Tot.-~ a• -,.w~ ~~ tt -~~ z ~ C q4 ~ L~~ o 4 ~'qS 299.$ ' ~ ~K eau eM le+ ~w~ :nor. ~~o•c.o~ 1'brt ~l ao . 0 3 ,~ s ~~ ~~, sFILE INFORMATION Owner L ~!'~LS/Yj ~ Q AJ ~ ,~ Permit # 0 3 DESIGN PARAMETERS Number of Bedrooms 3 O NA, Number of Commerdal Units A Estimated flow (average) Sa Ms ~a 3~ gal/day Design flow (peak), (Estimated x 1.5) ~(SD gal/day Soil Application Rate O ~ ~- , ~C gal/day/ft2 Influent/Effluent Quality ~~~ Monthly average* Fats, Oii at Grease (FOG) s30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) s 150 mg/L Pretreated Effluent Quality ' ^ NA Monthly average* Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) s30 mg/L Fecal Coliform (geometric mean) s 10' cfu/ l OOmI Maximum Effluent Particle Size >~ inch diameter POWTS OWNER'S MANl1AL 8t MANAGEMEtV7 PLAN SYSTEM SPECIFICATIONS rage 1_ pf _Z Septic Tank Capacity /ODb al ^ 1`J~ Septic Tank Manufacturer ~ jr ^ ~ Effluent Filter Manufacturer L/ O N~ Effluent Filter Model f~•/Da ^ ~ Pump Tank Capacity gal ^ Pump Tank Manufacturer ^ N~ Pump Manufacturer N~ Pump Model ^ N~ Pretreatment Unit L ~Kl? ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) f~'in-ground (gravity) - ^ In-ground (pressurize d) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and septl~ tank effluent. * * Values typical for preveated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 3 ^ months l~ar( (Maximum 3 yrs. Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) o tan c vo u --~ Inspect dispersal cell(s) At least once every ^ months mar (Maximam 3 yrs.) Clean effluent filter At least once every 3 ^ months ^ year(s) Inspect pump, pump controls 8t:alarm At least once every ~ O months ^ year(s) A Flush laterals and pressure test At least once every ^ months ^ year(s) A Oder: At least once every ^ months ^ year(s) A other: At least once every ^ months ^ year(s) ~IA MAINTENANCE 1NSTRlICTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Mast Plumber; Master Plumber Resuicted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank irupectior must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure tF volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third (Ys) 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 ch. NR 113, Wiscons Adminisvative Code. The servicing of effluent filters, mechanfcal or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START VP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting produce or other chemic that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the comer n/ rha ranlr(s'E ramovad by z tentaKe ServidnR opersor prior to use. P~c~ 2af. z System start up shall not occur when Boll conditions are (roan at t?mt Inflltratlve surface. during power ouuEcs pump tanks may ill! above nomul hlghwater keels. When power is restored the exceu wastewater will be discharged co the dlspenal cell(s) In one large dose, overloadlrmc the cell(s) and may result In the backup or wrface discharge sir effluent. To avoid this situatJon have the contents of the pump tank removed by a Septa¢t Servkinc Operator.prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operatlrmg the pump controls to restore ncrmal levels within the pump unk. Do not drive or park vehicles over sinks and dispersal cells. Do not drive or park over, or otherwise dlswrb or compact, the area within 15 feet down slope of any mound or at•grade sell absorptkn area. Reduction or ellminatlon of the following from the wastewater ttnarn may Improve the performance and prolong the lik of the POWTS: antlblotlcs; baoy wipes; cigarette butts; condoms; cottotm swabs; degreasers; dental Ross; diapers; dlslnkctarsu; fat; foundation drain (sump pump) water; fruit and vegetable peelin¢s; euoNne; crease; herbiddes; moat scups; medications; oil; palntlnR crodttcts: pesticides: sanitan napkins: tampons; and water softener brine. AgANpONEMENT When the POWTS fails and/or Is permanently taken out of service the followlnQ steps shall be taken to insure that the system is properly and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Adminlstratlvs Code: • All piping to tanks and plu shill b~ disconnQCted and the abandoned pipe optnings sealed. • The contenu of all tanks and pits shall be removed and properly disposed of by a Septage ServiCinc Operator. Aher pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls an<s cannot be repaired the lollowln~ measures have been, or must be uken, tv provide a code compliant replacement system; A salable replacement area has been evaluated and may be utl(txed for the location of a replacement soil absorption system. The replacement area should be protecte4 from disturbance and compaction and should not be Infringed upon by required setbacks from exl:dug and proposed structure, lot {Cues and wells. Failure to protect the replacement area will 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 tlrne. O A suitable replacement area is not available due W setback and/or soli Ilmltatiorts. 6arrtn>~ advances in POW75 technulogY a holding unk may be installed u a Last resort to replay the failed POWTS. O The site tus not been evaluated to Identify a suttabk replacement area. Upon falture of the POWTS a soli and site evaluation must be performed to locate a salable rcplacefa~ent area, if no roplacerrsent area Is available a holding unk mad be Installed as a last resort W replace thr failed POWTS. O Mound and at•gradr soil absorption systems may be retonstructed In place following removal of the biomat ac the InflluaQve surface. ReconstrUCtlons of such rystems musi.compiy with the ruks In effect at that tlme. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASS»S AND/OR INSUFFICIENT OXYGEN. PO NOT ENTER A SEPTIC, PUMP OR OTHER TRFA'fMENT TANK UNDER ANY CIRCUMSTANCES. OEATN MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY 6E DIFFICULT OR IMpl1CtIR1 i. . ADD1714NAL COMMENTS POW75 tNSTALLER Name ~L SiN?i ~Lrirt~~rJ /NL Phone f s~ ~~ ~. SEPTAGE SERVICING OPERATOR (PUMPER Name Phnn~ POWTS MAINTAINER tACAL REQLILATORY AUTHORITY Agency ~~'~ /yl ZOh1iN hen S% 3810- ~Pv ST CRQTx COU1`ITY SBPTIC TANK MA]Q~ITBNANCB AaP;E3l~NIDNI' . ,.AND OWNERSHIP CgRT~ICATION FORM ~VYIICS/1 iaiLng mpotty r~ 0 1.o r (Verification required from Planning DePariment for new A M iM e n~ Parcel identification Number _ O I A- l OQ 3- l 5- 0 0 0 .EG ~~:xcir a ivi. ~ ~ Ib T N-R~w. Town of Nal'1'tllrl_OYIA ,ropy 'oa 5 E . /~, ~V`~ /s, Sec. _ ~_ Pheasanf 4~I~ GIs I.ot#_ 15 n ^_ Certifi Survey Map # , ~- . Vohune ~ ,Page # Warren Deed # (02'0 `~ ~ ~ .Volume ~ 50 1 _ .Page # 3 72 Spca ho e D yes no Lot lines identifiable yes ~ no use and Hof your optic system could result iu its prematum failure to beadle wastes. Proper maintenance out the septic teak every threw years or sooner, if auecded by a licensed pumper. What you put into the system O0°~ ° ~~ m the waste disposal ~~' can the function of the sepdc task as a ireatmont stage ' _ a ceriificatton form. by ~ owner and by a pr+oputy owner agrees to submit to S't. Croix v~fyiagthat(1) thsoo-sitawasbawaterdtq~al mas0a jo~Y~PI~ ~ the septic tank. is loss than I/3 full of sludge. is is operating condition and/or (2) a8er inspection and pumpin8 ( )' m maintain the private sewage disposal system with the standards ifs ~ have read the above r~ and agree of Nadnal Re~ourooa, State of wisoonsin' t~ectificxfion ~ ~,, as set by the Departineat of Commerce and the ~~ ~ the St. Croix Coaaty Zoning Office within 30 ~g your septic system has boon maintained must be completed and tr~1ed of threeryear expiration data DA' ~ 4 OF APPLICANT U 'R R ~C our knowledge. I (we) am (are) the owner(s) of I (we) ccstify that all statements on this foam are true to the best of my ( ) ~ described above, by v of a warranty deed ed in Register of Deeds Office. DATE X SIt3NA OF APPLICANT Any information that is mis-represented may result in the sanitary pumit bcin8 evoked by tiro Zoning Dapartruent- ««««« «««««« «« indkide vrith this application: a clamped warranty deed from the Register of Deeds office a copy of the certified survey asap if rcfcaonv° ~ made is the warranty deed 01/18/2002 16:58 FA% 715 684 2624 FNB OF BALDWIN f~j002/002 ~ i730P~~~ 535 • ~ +ol ~ ~ . ' ~ a.,..tTE BAR OF WISCONSIN FORM I - 1998 U 65S09S WARRANTY DEED KATHLEEN H. WALSH •kEGISTEk OF DEED5• ' Doc+nw+l Ntmhar '^ "' ' ~ '" 5T. CkOIX CO. ! :WI - •• , RECEIVED FOR RECORD.- ,-• - •._. -"'-'-' • °-- Ronald C. Borate and This Deed made beiween , iris M. one 14-OB-E001 10:00 AM - ...--- ' YARRAHTY DEED .. tor. ExEnPT Y and ~T~arr o s CERT (bPY FEE: COPY fEE: TRANSFER FEES - 81.00 • RECORDING FEES 11.40 , Grantee. PAGES: 1 Grantor, for a valuable conslderatlon, conveys to Grantee the following described real estate In St , Cr01.X County. State of WlseonSln (the 'Property ): Racadlnq Atea Part of the SE ~ of •the NW '-, of Section 16, NemaandReltmAdbeae - '---~-TZ~wnshi•p 2Yf-lvortFi; ~tarige~'17-~ West, in the Township of Hammond, St. Croix County, F1p110NAL8ANKOFBAIDWIN Wisconsin, described as follows: ~pgT 990 Main Stfeel h Nn 54002 9aldvnn , of 15 f Pheasant Hills filed May 5t ~ + in Volume age 6, Document ` #622544 ) / 018-1083-15-000 • -- . - . .. • Pend IdenIMcYlas NumDfr F0.+) ... ~ . This i s . not_ homenead prvpsny. •I ToPether with all appurtenant rights, Utle and Interasu. Grantor wamna that the uUe to the Property Is good. Indefeeslble In fee simple and free end clear of encumbrances except Easements, licenses, zoning ordinances, and restrictions of record September 21 st th is da y of Dated 2001 ~j ~, ,, (~ ~ ~- ~~ ' `c"' ~- " "" US (SEAL) ~' ~~ y . ~ . .. yu L - {SEAL). Ronald C. Borate ~ Dine M, Borate (SEAu (SEAL) •• • ' •' - -AUTHEN'TICA'TION ~ ---- -- ~ '- ""'-" ~ "•ACKNOWLEDGktENT ' "~ " - $Ignawre(s) State of Wisconsin, l } ss, "" _ - St. Croix County. authenticated this day of Personally ame beforo me this ~ 1 s day of ' September , 200"1 ,the above named Rona d. orate Dine M. Borate TITLE: MEMBER STATE BAR OF WISCONSIN to (Ir not, ma known to be the persons. who executed the ftxagoing • ~:,--auihorlsed by §706.06, Wis. $tats.) " " ' ~;'• . Instru and uknowle e.-_ _ „• THIS INuTRUMENT WA$ ORAFTEO BY -• - - ~.c ~ • ' • .... Ronald:..- $t2nte-_ .1011 17Q`th St ~ ~ ~ J ~?-02rR.57~i~J Hammond, WI 5401.5 (71 5) -?~f~~*~d0 s ~ .~ ' Noury Pub11C. Sute of Wisconsin ~.,jta2 •- .. _._- -.__-. .. __..._ ..:._..._.. _._..-....._. : My commisslom Is permanent;-(If--not-,-sptr expiration dau; (Slgnatura may be authentlated or acknowledge ~.. :~f4.Aot-;' ,:' ,r. ' ~, ~ - •) i necessary.) .... .. ' .. ~ :r '.' . ' ' Hay (;phyryy~ort Expires alarcn 17.2002' . "Wm,u o! peiso,u ,u,+lry In aq upkNll mur oe lyp.d or Drlmd blow STATE aAR OP 1YISCONSIN YVkoar+eh LAY 9e,M W.. K. wA0.RANTY DEEb ' ' ' PORM No. I - lass wwnws,wu. ----- 2a 1. oo / " . ~; ' 3 75. 00' r F- O i0 : ' o ° I 1 N W ~ \ n ~ v ~ FA ' t TO NEI C OR. Ot)TLOT I 1 o ~ Q y \°; ~ "~ '^ '"~ ~)~ 2121. 96 F-- i O ti n N ~ p~ "' W I 3 ~ ,'' 7 1- N t. En1I ~ , 'p N v N . W I Z ~ n N n rn ~ N N r, ~ ~ W ~ V ~ r e e ~ ' ~ o, ; r r `Z ti ,fl '99f M.fb .02.105 ~ H I 2 r , 1- ~ ~ ~ iy ~ p F,,,, /~ Q) O Y'1 V' ~ ~ ' ~o ~ .n y r ,n ~ 4 i I O ~ O ~ ~ r+l ~ n /- ~ ~ 6 ~ b O c N ~ r ~ ~ 1- ` a ~ W to ~ I ~ ~O I D G. ; _ Q II ~J O V ~ I rl 'a I r M Q t M b ^O1 •Z\ ~ 4 2 ~ ~ C) 'ct ~ ! ^ ~ ~~ ; N ~ N I Q O , V,~ 1 I N ~ i~ ~ '~ ~ 2 25 h ~n ~ , m (.a . i r r- I z M ~ i' ' 4~ n ' it^/ ~ i , ' v~ ~ ~. i ~ I r Q' .[b '99t' ~ ,M I r r I > I o- r r T i ~ ~, o ~(o M ~~ r , ~ N W tli J ~ ~ , 'r J' JJ' .[('h v • °~ ~ p . 1 ,.. ~ ~ ~ Q ~ ~ A ~ y ~, ~, N ~ ~y ~ ~0 ~" - v ~~ b O O~ ; O Y ' ~ o ~~ \ ;~ ~ / _ o l U ~ v~ Q ~ N n ^~ M ~ N ~ ~ ti ~ o- V ~ F- N~ ~ b b O ~ I M , ~ i , GL•BOS I f \ I ~ . ~ © ~ I , V ~ r r ~ \ d m r N O / n ^'~ ~ O\ ~~d S~ \ d e2 -~~ ri d / r N Y ~ W 0 r e d cY N nc ~ O e I v O r ~ OG / I ~O~I\ s ~O ~f I N d Q i[l ~ ~ I W 2 r / I \ O J ~ m ~.) / M N I \ \`~` j1 E, 6 . ~~ 99'90 0 A' J, F ~ r ~ ' ~ ~ q i \ \ ~ ~ ° s r ~ j < ~ (l ~I J / y \ \ l ti 1 be ~~ W ~ \ y \ \ I \ 3~ I ~"~ 33 ~ \ C 1 ~ ~ ~ a ~ \ ~ \ \~ \ ~ ~ ~ ~ >r~, i~ \ I- C!)I \ C O \ \ ' 1 ~r3 z yr , /, / , ~ \ \ , \ / .rte /•/ /; ~ \ ~ ',~.~5~ = ~ .. -~ -: I _---- __ _ _- -` I ~j _.__. ~ ~~ \~ -~ r © I l~t"~ I --- I I `° °' I LL o~~° -- ~ ~' ~ I J ~ 3 ¢ ~~ ~ I ~ M I v ~ I r ~ fl! ~ ~ Z = C ~ ~ z .- m m I m ~ uWi a m o .' y g I O Z ~ C ~' U ~ r 7 ` t ~= ~ ' m Z ~ ~ ~ ~ ~~ O fq F- r ~ N ~ .o Z v ~ x M I .~ ~ I N N N ~ d' ~ ~ ~ N w ~Opp C ~' C L Y L C U Z = ~ z I y C I ~ ~ E N ~q ~ °' I c o ~ '~ ~ ~° c a~ ~~~~ ~~ hh ~~ a ~n o `r+U Z a a a ~ H I a •~ 7 0 fA ~ N N N fn J V X 0 0 ~7 Z _ ~ ~ ~ 'O O ;">o ~~ N t o ~ ~ g ° ~ ml ~ ~ a ~ ~a ~ w I ~ N ~ ~ I ~j ,~ °o ~ J u~ c ~ [O ~ ~ ~ v ~ ~ c ~ N l FAi ° N E c rn ~ a~i c & y co I R •O ~, o m= ~~ o z ~ Y g~ I ~ r I V a ~ ~ =€ ~ vs `m ~ € a ~ ~ a m ~` t'~i +~+ a ~ 'c c ~ c t A t°~a~ Ov~iv ~ ~ , ~~ Q `~