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HomeMy WebLinkAbout018-1094-26-0004 0 V°~ ~ or Q 0., 0 N tvj ti m O C O •~ O N ,~" d O [ l CC V ~ tx, w • N ~' r~ ~ V ~ t`~i t A n Z Z ~ W W H Z c C7 o z g H~IV ~ r v/ ~"' t c a~ :_ a N R a ~ J V a L O N O m CO ~ ~ v o o E ~ N E o ~ 2 ac a ad:~ ` C 7 ciao ~~ ~~ C 7 LL 3 w N ~° °o m v c C Q C ~" 7 v y E ~ ~ 3 m 0 v c o ~° c Z N ~ .'.: c m R ~ ~ ~ ~ d '• a ,~ > ~+ m :.' . rrc rrc rra O 3~ o °o m c 0 3 m c a~i c a~ 0 ~ VJ t0'6 ~ ~ _N N ~ aE ai c ?3 O - N Z O ~ f0 C ~ ~ O :~ ~ ~ aim C O O E y 3 a~ y ~ ~ C E m a~ .~. a 7 'y d ~ N N ~' N C t ~ ~ ~ m E Y ~ c E 7 a O • M O ~ N . ~ Z ~~ ~ m d oo ¢ ~ z in > ~ > Iq C f0 M O o v o € a a ~ C ad+ ~ Q H V c c ~ C7 d z° ~ a i I I I I I I I I I I I I C I ~ 3 I I 3 ~ I a~ Z h `~ O ~. m I I c O` I ~ N 'C 7 ~ C ~ 3 I a ~ Z z I _ I ~ m ~ ~ ~ R I ~ a ~ l oc c a` c 5 o O O o I E a a a E = M N N I t ao °p o ~~ 0 I ~ ~ m yyy ~ `.4 U fA C .Z I °' I ~' I o rn rn I ~ v o I ~ d a d a ~ C ad+ ~ I N V ~ °o O ~ d c 0 y d O i6 O a .N. C E .? N r O E a~ m EI ~ L a in O Z •~ a 00 ¢z~n a~i c o ~ y N 9 z° ~ Z Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM S9fety and Boilding Division INSPECTION REPORT GENERAL INFORMATION I;xTTACH 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 Millionaire Services Inc Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: >C~C. ~ ~GC'i-c~'j Qoo~'~'.~\ wattto ~ 2c~St 5:0.1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,.,r ~~i r .~CC~-S eF zffj, ~ 25 ~--~... ..~_. Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer __ Demand GPM Model Num DH Lift Frictior]'Losg. System Head T H Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ r ~ ~ ~ ~-- -- ~._, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ INFORMATION CHAMBER OR ~'YS ~ ,~ ~. 1'{ / ~ Type Of System: ~) ~ c ' J' ~,-. s~l t ~ a~ 1 v O~ T ~ ~ Model Number: S' ~ \u-~r v L r ~ ~ r DISTRIBUTION SYSTEM ~ 13 e~~-v ~ Header/Manifold Length 1 ~f ~ Dia `~ ~ Distribution /7y ~ Pipe(s) r., qv.i ( Length ~~ ~ ~ Dia Spacing'' ~ x Hole Size r- x Hofe Spacing '-------. to\Air Icn~tak~je / /CJ~ SOIL COVER x Pressure Systems Only xz Mound Or At-Grade Systems Only ,( Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mu Bed/Trench Center .,.- L/ r Bed/Trench Edges Topsoil ` _ ~ Yes ~ No V~~ ~~ ~~ Iched ~ Yes L No Ch COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1l~ / ~ / ~ ~' Inspection #2: / / Location: 985 168th St Hammond, WI 54415 (NE 1/4 NE 1/4 17 T29N R17W) Pj~airie Run Lot 261 Parcel No: 17.29.17.766 1.) Alt BM Description = ..{a ~ °~ SQ.p ~ ; C ~w ~ /e lC- ~,-~, ,~ ~, ~ n ~ L~ t ~ ~CS~G ~-~ 2.) Bldg sewer length = ~t3° ~ ~ (~ ~ ~~ ~ f ~~ ~Ll/v`'.~' -amount of cover = 2, 5 ~ -+ ~~ ~` Plan revision Required? Yes ~ No ~ ', Use other side for additional information. ~ _ __ ~ ~_~ ___ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ELEVATION DATA county: St. Croix Sanitary Permit No: 430343 0 State Plan ID No: Parcel Tax No: 018-1094-26-000 Section/Town/Range/Map No: 17.29.17.766 STATION BS HI FS ELEV. Benchmark ,~, .28 /v4~.~ / ao . c.G Alt. BM Bldg. Sewer q t/Ht Inlet $. 1 ~7 X7`7- I~ SUHt Outlet ~ Z~ g~. v~ Dt Inlet Dt Bottom Header/Man. ~ ,~ S q~. • ?3 Dist. Pipe Bot. System ~ ~ G 4 : y~ 9 . ~I U q s; vv S• Final Grade S , 17 / aa_ i3 St Cener /~O. V 5.35 99.3 "~x-!~ SGic C.' ~b L.-~C~i~'CR ~/ ~Y.."~'tr~ S Iy '~p ~3- Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 SCO SIO Madison, WI 53707 - 7162 Sancta Permit Num to b filled in by Co.) 1 / De artment of Commerce (608) 266-3151 3 Sanitary Permit Application State Ian I.D. Number --_____ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide _ may be used for secondary purposes Privacy Law, s15.1>4(1)(m) roject Address (if different than mailing address) lication Information -Please Print All Information I A / . pp ~ Property Ow is Na me Parcel k Lot p ~ Block N ,, ~' 1 operty Owner's M ailing Address Property Location / _ / y ~ ST. CROIX COUNTY ~~li Section ~ t,4 ~ ~ City, State ~ Zip Code , _ , . . ~'~' S, (circle R~_E o~ T N ~-~ ; II. Type of ding (check all that apply) 1 or 2 Family Dwelling -Number of Bedrooms -E Subdivision Natae C-S~-NumlSer ^ Public/Commercial -Describe Use ) tt,, ^ State Owned -Describe Use ~?j~ 3. X !oS•~ T - - ~'7 ~ City_^Villa .Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ New System ^ Replacement System (~Treatment/Htilding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal Permit Revision Change of ' ^ Permit Transfer to New List Previous Permit N rand Da Issued Before Expiration Plumber Owner ~~~ (~r? s/~O ~ «~ "~ IV. T e of POWTS S stem: (Check all that a 1) ~ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Pilter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sar-d Filter ^ Recirculating Synthetic Media Filter ^ Leachin Chamber ^ Dri 'ne ^ Gravel-less Pi ^ ex sin) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) 'spcrsal Area Required (sQ Dispersal Area Proposed 0 System Elevation VI. Tank Info Capacity in .Total Number ~ Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Urtits Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank „~ -. -~ Aerobic Treatment Unit Dosing Chamber 'VII. Responsibility Statement- I, the undersigned, ass a responsibility for installation of the POWTS shown on the attached plans. Plumber's a me (Pric>,t) Plumber's i g e ~ MP/MPRS Number Business Phone Ntanber - -~ - ~ Plu ber' Addre ss (Street, City State, Zip ode l a J ~ _s ~ ~ , ~ VIII. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee 'dudes Groundwater F S h Date Issued su' Agent Signaler No Stamps) ^ Owner iven Reason for Denial ar a ee urc g ) ~ ~_ ((-- .'v IX. Conditions o pprov Reasons for Disapproval `}-~ , S tl l,~, „ ~,,~Q ~ ~q„~~'~te~ P~, ,~,0~ ~ SYSTEM WNER: 9 Septic tank, effluent filter and ~ 1 '`~` ~ l~"'°"'~" C "~ ~Q ~~ o.~Q -}p ~ dispersal cell must all rv' as per management plan provided by ~ s~ ,, ,q J ` 2. All setback requirements must be mac ~? ~ as per applicable code/ordinances. ,f'~'~.~, t y~ ~ ~ ~~~ Attach complete plate (to the County otily) for the system oa paper not less than 81/2 x 11 Ituhars to >~ ntair lumt laine SBD-6398 (R. 01/03) ~~~ ~.' ~ ~ ,_ ~{ _S"~ ~/ _~ '~ .- !tiY T-".t'1/1aI~,~.Cwf9,/ 1-~-~- F- ~- ~-- _ r-. _ s _ i- _.~ . _- .- _ ~_ __ _ _ _-_ Y- _ --r l--f ... _ _.~_- J ' /~//y /~ '~ ~ ~ I I ~ _ .~-.~t...~.~._ }-__~- Y_ ~ -3- -.Y~-t-- -4---~--1-T--~-- ~. ~ ~i I I I ~ ~ _._.... __-_i._._._t 1._.__....L__._- i -_.__r____...r___ i t__r-_ r__. "/y-~~/y- -~ ' /?- T~'r/ ~/I rel. L. J~/ r '/~N1~1'C ~'1 ~./.~q U`L'~~ .h 7{/l~ .. ~~~'/'A/m~/'0 n ~ / ZL)®a~,~3~r,~ ~i~~ SS/off 5 ~3 3vr, - ~ 1~Jks at // ~~ ~~ "'~- _ . ,~_ ,,[~~,;c.~ fr/~~rd ~,4,0,~t /G~'-l~~C ;,~, 928 - /~ -~ _ /5 s,~ ~i1cK F _ - - ----- -_. __ _ - --- _ -----_.. ------ I: "L \ i ~) txJ.~„;aj _ _ -aJz.l/ o ~i'~ase __ _ ~$, ,~_ S~_a?ra? ~i.~c~ius.;l_ ~ I _~ ~c~/ _ ,~ ,3/Yl ,E __ _.._ ----~ [J" _ ~ I ~ ~ _._~ -- i_. __ ~S ~ _ ys' ~ ~° ~ ~~ ~ _ x.48 _ / _ , F / ~ /` ~~~~` yt,~'K ~'~'~ yep GL~,c,~~s' _ (1 ', J11~~''S ~.~~~~~~ ^_ S7 s/>x.4o.~C~ JJr:C; ~/~r~s -- Pl1MP C AM6Ei~ CROSS_SECTIO-~ ANO SPCCIFIC/lTfOh1S V E AJt CAP y~ VENT PIPE ~ 2S' FROM DOOR, WINpOWOK fRCSN AIR IIJTAKE WEATHERPROOF' JUA1CTIOAJ Box It~MIU. i,RADC le•MIr~. I! r_-_ I I ~ ~ --~ _ COIJDUIT-~ .__i PAGE Of /-PPAOVC D LOCKING MA-JHOLE CovLR YJITN WARNING Lnt3rCl y" MIAJ. ~ - ^ r ` IeYnlu. ~`: l-~ \~. 11~ IAILCT l~PPROVED JOIIJT .ti!/ P 1 P E CXTCIJDIIJ6 3~ ~-JTO SOLID SOIL ;_! Cv. FT A D C 0 PaOV,DC ._~J I AtR,1~7C.lt 7 SCAI_ I I I ( I I I PU~'1P -`r _1 fT~ CO-JCRCTC GLOLK ~ ~ ~ l II III J~PPROVCD J01~:" ;I w/ ~ ~IPC I II ALARM CXTCUDI~:L 3' II I 0-JTO SOLID SO' 'rVOU. I b oFr RISfR EXIT PCRMiTfED 01JLy IF TAUK MA-JUFAGTURCR HAS SUCH APPROVAL ~ 3+~ ~PPrRovEl, DcDCING u+~dcr T~r.ll~ SPE~CIFIG.ATIOIJS scrTlc t oostL ^ ' ' T A U KS M A -J U F A C T U R C: R: `Z•. ~, ~-=------ U O S C S. ~~ P C R DAy t: K O i I.1 U.M. L GALLOWS TAA1K SIZC: UOSC VOLUMC _ r ~ ~ f IUCLUDIUG DACKFLOW: ~-~~.5 G GAttON~ ALARM MAUUFACTURfR: h IN L/ ~ ~... .s,y ~•~ MCDC:L UUM6CR: ~ ~~~~/~J CAPACITIES: A=.~1._..IIJCNCS OR ~GALLOAlS S~.,IITGH TyP[; .~ A ~ e .s-~.f; _ ~~' ~ ~~ ~' GALLO~J~ 8 =~ IIJCHCS OR ~ 5: ~ ~ ~ ~ ~ ~ L0~15 IAILNC$ OR ~~ GAl C =~ PUMP /'~AUUFAGTURCR: ' ~ . ___. MOOEL 1JUMDCR: ~~ L !~L y~- D ~ ~ INCHES OR,e~L~..tt-~-- GALLO-J SWITCH TYPE: / / ~~ l ~,yi~~La--.~f(+1U~L~ Il~_T~~ f'UNP AUD ALARM ARC TO DC INSTALLED 01J SE PARATC CIRCUITS r11A11MUM DISCNAI~GE RATe~~:PM VORTICAL DIFFERCFJCE OETWCCIJ PUMP OFF AUO OISTRIF,lJ710~J PIPC.. --~~.C~ FECT htIWIMUM -JCTWORK SUPPLY PKCSSUR,E~/, ~~ EE.C7 -~ _~~,,,,,,, FEET OF i'ORCC MA11J X ~F~oa rr.FRICTIU~I ~I~~TOx...,~~o+ S FECT TOTAL Dy1JAMIC. HEAD - /.~>~2~ FEET // ~~ ~y ,~;y.. IIJTCRWI-~V 111MLIJ510 or 1A1JK: LGWG'1'11 ._._..._.._.._..__jWiD'('II ___--_r_~~L,ICJUID oEP'(H _..~..~ _.__ '=1G-JED. c ~ LICE-JSE NUMUER:~~`X~~~ ~ -GATE: - Performance Curves METERS FEET 25 8 70 20 60 N ~ 15 40 10 ~ 2 5 10 0 '~ C Submersible Effluent Pumps - j- ~ ~ ~ MODEL 3885 SIZE 3/," Solids WE15H ~-' - I i __ . _ •WH07H - ~ }~ - _ WEOSH - - --~ - WEO~M -_1 -, . y ~ ~ E031. _ _ , _ _ ~. - - i ~_~ -1- $ y- f ~ 0 ~0 20 s0 ~0 50 60 70 80 90 100 t10 120 GPM t..____._... ~_..-.......__,.-..~_ _._ .. ~ i 0 10 20 30 m~ih CAPACITY ~GOULDS PUMPS, INC, sash ~ ~ >ax ~~. ~ METERS FEET ,2 35 11 30 F t i 25 7 20 O 15 ~ 40 10 ~ 20 5 t0 0 0 ~-f- - -~----;--±-- ~ ~ M 0 D E L 3885 " 3 p WE15HH I ~ /4 SIZE So~~dS 0 ,_ ~.. C ~ ..... - _ .~..._ •~- '~ ' ~" W E 06 H H ._..,_.._.. . _ .j.__.. ~ ~.._. j. _ _}.~.. --~- ._._~.._.. . ~ --r- ~ ~ r'- ._,_ -. 1 ~ i -r -~ ~ i 0 9G rap 0 0 r0 20 30 40 ~) o ... _ -- - --...'O _ ._. •198b Goulds Pump, Ina ov ~v tw w tpp llp 120 OPM 20 30 m~/h CAPACITY Ef1~ONW Jury. X985 '° CJ885 POWTS OWNER'S MANUAL & MANAGEMENT PLAN.. Page ~ of ~ FILE INFORMATIO Owner f s Permit ~ ©3 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~ NA Estimated flow (average) -~ al/da Design flow (peak(, (Estimated x 1.5) ~+ al/da Soil Application Rate al/da /ftz Standard Influent/Effluent Ouality Monthly average * Fats, Oil & Grease IFOG) 530 mg/L Biochemical Oxygen Demand IBODa1 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ye in die. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTFNANr_F Cr`HFr)lll F SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer E ^ NA Effluent Filter Model ^ NA Pump Tank Capacity ~ al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model - ~~ ~ O NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration O Disinfection ^ Peat Flltar ^ Wetland ^ Other: ~ NA Dispersal CeII1s) ~In-Ground (gravity) O At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other; Other: ^ NA Other: ^ NA Other. ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) ~ earls( ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY,1 of tank volume ^ NA Inspect dispersal ce(lls) At least once ovary: l^d` earls11s) (Maximum S yeah) ^ NA Clean effluent filter At least once every: ^ month(s) _~ ~ yearlsl ^ NA inspect pump, pump controls & alarm At least once every: ~ ^ month(s) ,~ `~ earls) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^yearlsl ,t~ NA Other: At least once every: 0 y88f~s~ls~. 1zl`NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined .sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal ce(lls) 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 snd requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,1 or more of the tank volume, the entire contents of-the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wlsoanaln Administrative Code, All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. OMW 14/01) Papo of START UP AND OPERATION ' For new construction, prior to use of the POWTS ch~rck treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or dama~ae the dispersal ceII1s1. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the ceII1s) and may resuk in the backup or surface discharge of effluent. To avoid this situation have the contents c-f the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber iar POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersF-I cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken Gaut of service the following steps shall tie taken to insure that the system is properly and safely abandoned in compliance with ch~zpter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconne~:ted and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement 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 time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as; a last resort to replace the failed POWTS.-- - ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available, a holding tank may be installed as a last resort to replace thi9 failed POWTS. .. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such rrystams must comply with the rules in effect at that. time. < <WARNING> > ... SEPTIC, PUMP AND OTHER TREATMENT TANKS MItY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLE ~ Name Phone POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Phone Name 1 Phone -~ This document was drafted in compliance with chapter Comm k33.22121(b11t11d1&If) and 83.54(11, (2) & (31, Wisconsin Administrative Code. } Wispbnsin 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)j. Permit Holder's Name: Millionaire Services Inc City Village X Township 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: $t. CrOiX Sanitary Permit No: 429953 0 State Plan ID No: Parcel Tax No: 018-1094-26-000 SectionlrowNRange/Map No: 17.29.17. [~o B BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom I Dist. I Final Grade ISt Cover BED/TRENCH 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 z Pressure Systems Onlv xz Mound Or At-Grade Svstems Onlv 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: / / Inspection #2: / / Location: 985 168th St Hammond, WI 54015 (NE 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 26 Parcel No: 17.29.17. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = -- ~- -, Plan revision Required? Yes ~': No ~i Use other side for additional information. _ _____ '~____ ~ I~__ - _ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Q~ ~~~ -~ i Saft;ty and Buildings Division~ ~ 201 W. Washington Ave., P.Q. Box 7162 '~uitY I _ ~j ~_ ~ ~i'o ~`~^.~.J ' Madison, WI 53707 - 71b2 ~ ~~ ~ S ~ ~ I Sanitary Permit Number (to be filled in l=y Co.) I t a > t i (608)266-3151 De Z9 ~ I Sanitary Permit Application Stag Plan I.D. I~u er In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ' may be used for secondary purposes Privacy Law, s15.04(1)(m) j Project Addres (if different than mailing address) ! I. Application Information -Please Print All Informs RECEIVED ~ ~ ~~~~ i operty Owner's Na me 2003 Parcel iY O ~ , /d-.E~ _~ 6 ~ yh, ~f! • r~Y S~rv%~ ~ APR ~ 0 ~ ~--- Property Owner's M ailing Address CROIX COUNTY T Property Location . S 3~d l sx- , • eJ ZONING OFFICE ~ ~ yt Secaan / 7 City, State Zip Cale Phone Number , ~ I ~DO1 11~ ~ ~ ~ ~ ~ -~^ ~ f ' ~~`~ ~-~ -"- ! (circle one) E or W T N; R ~ 7 ,I~~I//~~Type oP BWldin eck all that apply) L // crD Lwb ~ j 2 Famil Dwellin b f B d ! , ,_ ~ -!~ ivision Name CS umber I y g er o rooms % ~ 1~5.d or e Fublic/Commercial - Descri se r~~ - ~ ~ ' ~_~ ^ State Owned -Describe Use - ~ ~ ^City_^Viilage~ownship oi' - ,,,r/ i III. Type of Permit: (Check only box on Une A. Complete lime l; if applicable A' ~ New System ~ ^ Replacem stem I ^ TreatmentiHolding Tank Repla ent Gnly Other Modification to ixistin -~ ~ 1 B. ^ Permit Renews! ^ Permit Revision ^ Change of ^ Per ransfer t ist Previous Perr' Date sued ~ Before Expiration Pluartber~ Ow IV. T of PUWTS S stem; (Check all that a Non -Pressurizai In-Ground ^ Mound > 24 in: of su le soil ^ ound < 24 in. of s so ra ^ as Filter ! ^ Constructed Wetland ^ Pressurized In-Ground ^ Hol Tank ^ Peat Filter Aero nit 1 and Filter j ~ ^ Recirculating Sytuhetic Media Filter eachin Chamber i Line D Gravel-leas Pte they (expl ' ~ ! V. Dis rsallTreatment Area Information: ~'a.v - 'Y ~ Design Plow fgpd) Design Soit Application Rata D' rsal Required (sfa Dispersal Area Pr ystem Elevation - ---- VI. Tank Info Capacity in ~ Total Nu r facturer ' r S1te i Steel ~ Fiber ~ Plastic fab Glass ct f C st d t C Gallons ~ Gallons ~ o nits I e on ru e i oncre ' New Existing \ i ( ~ -~IJtJ ~ I ~ Tanks Tanks ~ , I Septlc or Holding Tank \/' _~ ~~- ~ / J ifs ~ y I~ ~~ Aerobic Treatmetu Uttit + ~ t3nsing Chamber I ~~ ~~ ~ v, VII.' Respon~ibillty Statement- I, ttie u ersigned, assume responsibility for ' Ration of the PO shown on the attached plans. Plumber's Na me (Print) P tier's Si gnature P/ PRS Number Easiness Phone Number 1 J ~~ ~ ' ~al a ~qd ~~ , ~ 3~~~ . s ~ ~~ ~ Plumber's Addre ss (Street, City, Sts ip Code) 9~ ~ I ~/ VIII. ount /De artment U Onl ' Approved ^ Disappro Sanitary Permit P (includes Groundwater f D Is ed I uing~ re o tamps) Surcharge Fee) ~ 2 2 ~ . dZ7 ~ ~ ~ 3 d Owner ven Reason fer Denial '-' d ,_,_ IX._ Co~lnd~i-tio"ns oP A~pp~r-ovaUReasons for Disapproval ~~ ~ .~6~CX CA rt ~~~ ~~/,tl n° ~cc~Q~ c~(~,t2~ ~ ~ ~'° G!/,t,-2~ ~~~L~~S./`~;~~ ~~~ ~~'~~ ~ l ~~~ ~,~t~-- p-~ ~e~~.~-, . S 3• s - - - - L// ~'v«~~~vt~- ~ n co plate ptans (t We County only?; for tde 1 u on p less cngq stye x~3zC SBD-639$ tR. dl/03) / <Ir~-- //Q~_ ~- Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ~~ ~~ Page / of ,,. v...,.,,..~,,.,., ..,.,, .,.,,,.,,. ~.,, ..~~. ~,,.~~~. .,.,..~ County ~ ' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ~ [/ ' ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~j/ ~l} ~ (o 7 ~p PI@aS@ pf%f1t 811111fOClfl8tl0I1. Personal information rovide ma be used for seconda ou ur oses (Privac Law 15 04 (1) (m)) s Reviewed~,b/yL~~,,, ~~ " ~ -" ~//, ~~ Date ~~/d3 y p y ry p p , . . y . ~ Property Owner Property Location ~~`1 ~ Govt. Lot ti~ 1/4~F 1/4 S ~~-. T Zrj' N R ~y'z E (or~ Property Owner's Mailing Address ~ ~ Lot # Block # S d. Name or CS # ~ ~ ,S ~~~ /7~ Zoo un rf-c City State Zip Code Phone Number ^ City ^ Village [~} Town Nearest Road r-~t ~,td w~ ~y~~s (~/S) 7SG -z~9 3 ~ ~--t wLo etc! ~~~i~r'`e . [~ New Construction Use: ~ Residential /Number of bedrooms ^ Replacement ^ Public or commercial -Describe: Parent material T~ ~ ~ General comments SY 7l-P`n P/ ~ v. Y ~?2 ~ and recommendations: ~`~~ ~'t f/'~ r/ ~ Z a ~~~!!I ~ ~~/ Code derived design flow rate `~.S'D'~G ~ ° GPD Flood Plain elevation if ap-pli,cable /G/!~~- ft. ~'~~ r~ f i )*Jr-a^~ ... r (~,%~,~ ,10 Boring # ^ Boring / Pit Ground surface elev. <~~'~~ ft. ~ a J , ~ ~ ~~'~"; Depth to h tit~g'factor- ~~~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structur Consis en d dary ~bots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. s *Eff#1 *Eff#2 Z ` S 1 3 ---~ S' I rn m r ~5 - !o 3 ~ ~~ ylm ms ~ m1 -- •-~ .Z oE-g4• ~($ uro - Boring # ^ Boring Q~ ~ O ~I Pit Ground surface elev. ft. Depth to limiting factor ~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0-' f0 ( - SiI Zn ~ ~S Ivy' •5 .8 Z _0 3 -- .~ 2 k ~ - .~ Icy -- ~ Cis ~-- ~ - - . -, i.z ~-a~t-~ 2. * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Ple a Print) Signature CST Number Address ~~ Date Evaluation Conducted Telephone Number 2113 gGZh ~ . ~me~a l~~ 5~l'~ l/-2 ~- o - C~lS)Z~f 7-y~g SBD-8330 (R07/00) Property Owner ~VIIAJ~n~ ParcellD# Page ~ of 3 ^ Boring Boring # Q~ $~ Pit Ground surface elev. ._ ft. Depth to limiting factor ~(~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ O- Z i(~ ~ ~ 5i ~ ~Y1-~'r ~- v~ . 5 • 8 Z 12- I ~3 -- ~'cl Z c5 3 ~ ~ m ~n I -- - z 4 ~ 33. 9.` 6 z. Y ^ Boring # ^ Boring - ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit ~- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L 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, pleases contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) a PAGE~OF~ 1~T A AdF ~ , ~ ~ T OT# 2 ~ T FGAL DESCRIPTION ..vE ~.GE ~ aS / ~ T Z`T ,L~I,R,/ ~ Elor~ SCALE: 1"= y~ ~ BM 1 ELEVATION /(~ . y BM 1 DESCRIPTION -~~ a~ /~ "~J~L P ~~ BM 2 ELEVATION `~~ 8'y BM 2 DESCRIPTION ~ o•~ ~1 ~y~ ,O, PP SYSTEM ELEVATION ~ ~ • Z ~ ALTERNATE ELEVATION `~ ~ • 2 CJ CONTOUR ELEVATION ~liy S~~o e. ~"- C v ~ ~Q. 0~~ g-3 ^ 5(oPL ~o a• SIGNATURE X j PG . ~ 7" ~ ~ bw.~ B , • ~,,„ z ATE / z-/--~/ .~ Ga ~- - /.;wc. FRI ltf:ltl FAIT 71tf~885232 C'E~ 8i'RNET HfDSt?;ti $'T CEtOIaC CUUN')r'Y SEPTIC TANK. MAINI'BNANCB AGRL'L'NIItNI' ' ~ ANi7~ OttvNEI:SI~IP G'Li;TIFEt:,ATIUN ~'OitM I/ ' / }Wi'lfit'~QA)~tr ~ ~ ~/d ludi~'~ JIC~U ~"~G ~GC Railing Ad'3ress ~ ~~p®~~prrt a..G/-~yr`v-G GJc~d~,(~<m/ ~/ f~~Slle~ -- 'rnpotiy Address ..© `~___._~t~.CL~-- ~/ -_._..._ - (Vclificatsoa rcyttircd fro»+ I'tanoiug Doparaucut Ior vcw construCiiw),_ ~ity/State ~ I,'arcGl ):dcntifi:,ation N+unJCI' ~~~~~ _o d~ ~.F~AI, nL+'St'~P'Cit3N ~r c,u Z i'mpetty Location ~_.'1.,,~ t/., Su:. ~ T'.a9 N- R f~_W. Tov~m of ~ ~i m- ac/i9~ . Subdivision ~,~~~,' ~ ~~~ -- -~_ .Lot # ~~ ./ CertSied Survey Map # .._ .,~- ---------~ Valune ,_,....~.. _. -, Page ~ Warranty Decd # fz ly ~'~ _-_, ~r'ott+me a1~2____., Pagc # "~ .~ Spot house f~'_}+es C] na I,ot 1ialss identi~iable~ yes d no ~~~T~~~~ANCL+ Imnsopetttso sad ruaintaaaaccoiytx~r septic aystcrr. uaui~ tcrictt i~. ifs prcxaatttrc failare to IIandlawaates. Propet maialettauer eorrsists of pnmp'tnr obt ttte aet>tIo tank every tbrcc peatyf of aoouer, it acodect tay s tieetsscd pumper. vVltst you put iota tha tysteat am a~'ed the 19taetion of the ssplic tank as a iteatntafi steEe in ttte waste dlspasat systea:r 'Y'ba pc+operiy oxaer sgrea to aubrnit to St Croix T,oai,+~ 23eprtisiltreui a rcrtit'wtiots fattu, tined by the oanrer sad by a ntaaeergttaubar, jauuueyt~ara @hambcr, rrstticted t-IuaiGar or a tictrarcd ry>cpcr vezifyiap, timt (I) dte ea-site waalevtrstettdiispawl tystam is iu proper anentiinp condition aadr'ar (2) n Iltr icsspectfon and puuipin~ (if necosaaryj, We septic tact is tcss than 1/3 flt1E of stadgo. Uwe, ttte vndatsianed have read ttu s!-ovs requirtsaeats end agrra to msirrtaia tLe iarivate seaa~e dirpesat eystera ~t-ith the at>tnduds cct t"ottlt, bttsia, sst eet by We Depututeru pf Ccntmcrc~e and ttu llcpartu:ent ofNatttsai Rerparees, State of Witscoasin. CertiCte~tioa etatin$ that your eegstic ttystera has bees main:aincd roast be cant~teted and rctutited to tfas SL Croix County ZasflunY Ottice wlt~ara ~ (3a)"a O to Q1r~0e yas[ c7t ~ t' dale. i~' i~t~ ,~~ __.......... J~ f O~ SdGNATURE OI Ai't'[.iGANT A~ UWI~Y:R Cl[~s`RTT[rICA'~~ON i (we) catlL'y ittst alt atattutcnts on ibis fcuirr a:c tn~c w fire best of city (oac) Istowtedgt. I (A~c) ant (ste) the ocrpcc(s) of fife pr rty d+'sex~ed above. by vutuc af` warraufy docd recorded in Register of Uecds t3fficc. ! J ~ StGNANItE Ot: ATPLICAN'1' DA1'~ ••"•• AnY h~foa~naiion +Itat is mis-rerneserttei tazay' 1csti.l i1. ,F,c tanitsr~• pcrmlt b~rn$ revokad by Qte ~tS 17eparit°attt' ""`" •• Ynclude with dais applitatioa: w siarrpcd wa11>Aaty cteod frutu iLa Ceaist<.r of iJeods otTice a copy of ttre eertit:ed Yttz1•ay nwt~ if refet'utce is made in ttu vrarrsOty daed y~, ~m ~ c ~4 ° ~fi,~I,y~,r~~ 9_ P~ ,~ cJ a- ~a~ s~ ~v~ s-' ~~ s ~F Q,~-. `V"'/ ~ 1~d ~G ~,b a ~e D~~~w ,a~ ~~~ a +Am~ . Bm~ Mt~N 1~;:~~ FAI 7':~ :~4 d3isa ST v}'+.'~ f:~- Zt~±~~I,tiG 'w . ._ A'4WT$ OVI~iV~"Rr~ r4A1~IVtIAl: & MAIVAt~M~IVPy° 11f ~ _,_.,,. et ,,,~, AN snhnr ser~rq~agG, N~efl~iding but r-nti lii~i~eesd to the seev~Oinp pf atfk: *nt ttluta. ieael+ankrd or prewurlasct ~rrSp01'tsALa, ;xercreatrrtsnt units, snd pny ~ at fr'rt~rveli ~ ic1~ montihe; o1~ei1 bs patforma~ by s osrtliisd POWTffi Meirfalnsr. A ~ report attadt bw prA~7dl0 'i~ till ia0isi tspuil~torY autt~ortty wlittirt 10 sf~Ayi of ~ootnph~o-~ Of stty ~iow wer9l. tNltt~ tee rnei a4atNrw~Rioe vP ilud~+ snd •arrrt fn any tertk ~uelo ons•tbYd fy~} ar enpr~ al the soak vpk~me, tits sntir,r llOltfiN9ta q! the faRk erwei W rsfnilMd fiY a ssptep~e ~ServicEr-~ npiretor and disMossd ~ in MOOPAMIO« w~ M ~ f f ~~ 1Nhoonuein JRdMln}~ . Q."1,~•~lrtla ~Oit 1:25 ~':~ "iS X88 449 S7 ~'RT C,'C~ ZC:1:1G .. .~ '_ r lt7AAT tff AlNti< Q~t+~11ATtOt4- ~ t1eltlM f:Igl9~- tk~t' ttl t~ 4f dM !"01y1'3 dtt~fik ttidtlMnt ~1+eta1 tar TtN Pa'ei~lrwti Qf ~ pr~u4tt ear OtAer at~am3aauc t!!at n~ a'~« tlilwit i'x'«~- a~dlor dan+aa« the +!ti•pera+el aN4t;?. If hipl- octnoontrattorn «rs dsteateA h«v« th« ac.ttant9 of the +dwd~rl nrRawed 1h- « wq~aKt« s~odtp cw-stor t~++' to ~~. uM/t ~I they riot C%hxur when t01! wnt~litlia aye treeNl ht the infkaethn~ ewfaoe, t?~rMp trlos~r Crdt~AO >A t«{ti;>t ~a4 fiN Mlpi-A t-CrRt«t n~wut«r Mwtt. Whn~ ~~+ ~- T*froraa d;s a~w waeew«ar wiSl h. dlsghfnlyect ~a ~« 'w~ csattt ~ one tstos Qatt. ovtrt0~p tM aeiNsl anc ~-~- raeutt ih ~-~ haokuq or saHsce d~*harq+r of Ate. t0 swodd this s~huasion h«vs th« oenta+ttu of the p4nsp tank removed aY a She fiervtctr+q Operator prier to raat«rtnp ptrwer w tk~s irk lwrnp- or os~nsaat s Rumbor ar lOWTR f~tsa+tairsdr to aeeNt h m«ieusty ap+rretinq the pip Qontroia to nerrnst !«vor rytkhin tht tsalw t~ not drtvs ar perk tart+w'o~a owre• t«alae arMO dl«payN arNir~ Rya nar dr;va or pa+'k owr, a- otha~rwlN di«surb ~ awnp«et, the a-+a v~'-tw+ i# l+pe! dexm of sny Around n! at-prae. ~oit sbeorRtipl+ kre«. te' sdrntnadan of thsr foMow~ lr~ss tl~s waetoewe'or' thin tnay improve the p«efcra:«nw and (aroi~p th« lift 4) the t~Cl : +~«+-: t,aby w~ae; etparrttt bstttt; aor~danztr co0on ttirtbtc dedreatira; dente! fbw; dtapr'e~ dtsrr+laetatrea: tat, few drsin ttat-'np pWtfpt wst«r; fruit erstl vsp«ttbM ps«itnpa; gsea,in~ prsttr, hp+'biaidta; +t+~rirl' wraps; medtoatipns; a~ t ; partleidtt; asnltery napkins; taertpenr end wattr wf't!A'Nr brM+e. r W!-sA lf111 _._ fade arrrt,~ar ie peMaente~tiy tsksn eat of aarvica tt~a tpl4ovrlnd sttAt 11~d1 be eakrn to Mlwnr shot iha aratertti !s pr~-esfy art+d ssf ar-ad in aampttsnoe 1~vi'th ahspt«r Comm fk3.3:4, W~antk+.ndmjn~etreri~+s Cam; ar to ar-d pit. the be tltecanrteat~aQ and tt+« tFsar+darttd etAt aKeninp swMd. • TM1t wrrttsta ~' +~ t ss~t t~ s±tsil ba rsmov«d and arap~h- dte~x+ssd a4 by a Saevtat+-p 4 vr. +~ Ahtr ~ eft tanks per than bt eera+rated end reMaved ar ~sw aavsts r«rnaved arts! epeae failed vwith aoN, p'wM ar snet+her tnsrt trles«riet. CCtifl7Wi1!' tst~IM i! th« t~NV't~ 'Iat1e srtd aexv-es be -«P M« feitowtnp rrreaa:erea hrve bean, or mu«t bet , roc provide a cads corr+tsksr-t Q A au~bts rsetestrnsnt snw hsa Jeuen Maai~ and rtiay ba utitesd iar tM of a caideoansnt sou abcoroti0n system. Thu r°tMMNOe't+ M+k« irrsuid be fron7 QiRturWnoe end snd Nwovid hat a 1nMnq.6 Espa~+ by r«gwihd aum«ak+R horn eMdtt~ end Prop furs, bt Hnee Brad w+tNtt. ra to preact the ntpteaareht er8t vrill reach to the teed for a RA~w sa# east sht av ca attslell«t+ s wk#bt aa~ment arcs. ttspita~n-tnt ty~t«ena rnuat «sAtply+ with tl» tutee ih N'ln4t et M1at tints, y~ ~ A su~btr ~t ane 1s Rat awiteb;e ovo osatt;adc toN iimitatlons. Bq~relnp «dvsrtaie In i•QWTS s holdiryp etn>< leNh be intta~d at « test tR rspi the failed IgWli. tank ~~ ~ ~ fl MeuM eat aadrsrSs sop alsetrptttex+ sYstsMt mqr be oh in pteoe fr+llowihpl rtmarsl 0! the t>~mat n the infttre e>`rfsos. tReaAntpsetttrts 0'f •1i4h ~yaef'M OpRlply th« ntlsa ih sftsat st thst T~e• ~ 4~~'.F ~ tncfm~. t A~ ostfa Tt~ATfft' xwalres cur ,-u~ ~'ti~ A~~r~ nwtu~' axYfi~t. do bo~r w tr~r~c, tN,NiIN- ~a vet Tt4~4'fAtli~iT TANK ~ AidY Otl!{~1AMiT toe! iDtEATH MJ4Y AltdtJLT. t~1iKCUK f~R a Pal ~iM TII~ t1~TflEtlIb1R ~ A TANK NiAY IER !.TOR 41AM~uCl. f, Pi#oralR ~/j 7#+Et ~FOtMNeflt wee drwK«d ks • MANIT 3%~ rhona '+lJMt pllilR ~~ ~ttt:A RY ~ llfi`Y Naar ...... thOn~ ql whh ahep~ta- Camn~ t3.p,4{~;Ibit'.Jt~llt «hd ri,9.i4t~ i. tZl a, t~l, w-iaa~Mn adr+tiedetratiw Code• v DOCUM$N^t NUMBER ~~ z~~z~ zzy w~~aa..~rr~ ~ss~ M;.dhest Equities, LLu, Granter, ~ r.~ s.-:! -z_ •;~s .,~ l.l:~-;:,_ c~ ~ es, Inc. , Grantee, the f ~~wi ~ .,,, „-~? __ .'a-.~ Craix Coun~y, State of o%i~..~n _. ^ Lot Twenty S ,26; , P ,._ ~.v ' , ;i .:1 ..: -.. _ . %' 1 4 489 REGISTER OF DEEDS S~'• CROIX GO., 1iI RECEIVEb FQR RECQRD 03/25/2003 12:00PM WARRANTY DEED EXEt4~T # REC FEF; 11.00 TRANS ~'t:. ; 101.70 CQPY , :..: 2. 00 CC FEE : PAGES: 1 T_~ , ~ krTk?:: ~7RESS ~.-. r c_; ~ i~~ .j . 1 "~ (r J ~~~r- ~ ~ yap. ,.. , U :, _ This is ncc r _-~,a Excec>tion to ~.:~arra..r_ ! =~ ~~~'~ x,11 easemer.- _.. Dat- - ~ f ~_ (~~~ r,.1 ,, `_" -- M w ,_ G;~ .. _. _ Signature(s) authenticated _ TITLE: MEMBER 5,?•.- ' iIf not, ~ '~ autharized by §'~~ ~ . THIS INSTRUME;7T ~~:_: Lec A. Besic~.r ~odi~, 3eskar ..._ ..-.C~. _ox 138 ~ y~r~r ~,~~~s, ,~r~ - r~ ti. ~ rC.,~ .. ~....1 ` C ~ , y 3 ~ -:~.r. ,r,,. l _ ___ ___ ._ ._ _ ,.._.._,._._________ ~ S ^ AL __ _...__ __.._ ._ ___..__._--_~~_ (SEAL) t ~_ ~, Y... ~ ~ day of March, 2003 .. 3 ., _- ` a~ho executed the - - u... ~ -- .J'a~~ ~t:~ Sd7ne. _._,_. _....r._._____ ;Slanaenret ~ ~ T ~~'~, ''~ _:'°~"~'~""~~Xarre :':arced or ^ivedr t.. _~~`~~!_~ Caurty, wig. - - ~ T`_T -.,., expiration date:; <, ,: _, _ __ a---- y a. _ _ ,, v'. .'~ ~_. T 32 s ACRES $ `~s so. Fr. - I .1 ...................... N89° 04' 14" t ~ ~n• ~~ a T V g .. LOT 33 1.69 ACRES 73, 598 S0. FT. a o- Vo O LOT 34 1.69 ACRES 73, 598 S0. FT. 1034.00 MVE 1038 LFE N00° 39' 03' W b0. 00' N88° 04' 14" E 184.00' r-__-_-____-_ -------------------- ........ ® DRAINAGE AREA ' 245 33' z 8 e W W W S g LOT 2.25 A 9T, 889 ; 1034.00 1036 L ......o ............. ------------ 326.3C ~ ------- ---------;-----p 33'---------- -------• 245.34'--- 61.33'-`- N89° 04' I4" E 142 I. 60' PURL ~ 1 C o - - ~ W w - - - - - ~ °' - _. _ _ S~ _ ~ °04' 14" $89 W 507.95' - ' e' e w _ '---------- ______ 263.35 ~' ' ------ i3. 98' --------- ------ _____ ---253.97 - U - ~ Z l ~ ® 488.35 i y Q ® ................ ....... ® ° - ......: .................................. . o ~ S IC O ........ ................ ..... ~o :......... o . . ............ Z ... 1 g _ ~ ~ ~ O ~ tV ~ • C7~ ° ° I ro ~ ~ r- ~ ~° )T 21 W `° ° LOT 22 .~ ° °' ° ~-' m '~°~ LOT 2s m W ° • w ~ n ; 72 ACRES 1 ~ i I ACRES ~ 1.55 ACRES ~ 33' 33' . ~ 50' )09 S0. FT. 67, 531 S0. FT. ' i ®! ~ ~~ • FT. w ro % ; I ~ ~ ` 8 8 ~, ~ © r-- - I ~, p i 53.98' 208.31' ~ ( ~ ~ 218.68' ° I N89 04' 14" E 462.29' ~ ®~ ~ ~ N89° 04' 14' ~ E , 443, i r I )T 20 t5 ACRES 348 .i 0. F T. I ~. ~ LOT 23 _p 1.77 ACRES ti;l; 77, 119 SO. Fr. Z;~ ................ 1062. 30' NS 1 ° 55' 44' E-••- 38.24' NI W 0 a ~I N e wi S =~ ~ '•~ ~ ~ ` 44. S9' ~ ~ , ~ ~. ~~ 3•. ` ® O m ~,~~"~ • y °~ LOT 24 ,~~ 1.92 ACRES p 83, 544 S0. FT. ti ti ' ;' °ti~: . ; ~. ,tip tip' ~~%m~ I , 1 Ss~ ,fie BB 3~ alp•% ~ ' ~ ~ ~~, f , ~4q Tj. I I L 0 T I ,, ? _ - ~° ~r~k ~ -- -- --- ~0 ~ - - ~-f>rri n~~,~ LOT 25 1.74 ACRES 75, 944 S0. F7. 6 ----- ~~ -