Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
018-1087-77-000
Wisconsin Department of Commerce Safety and Building Division ~ PF~IVATE SEWAGE SYSTEM INSPECTION REPORT ATTA TO PER T GENERAL INFORMATION ( CH MI ) 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 Jorgenson, Scott Hammond Townsh CST BM Elev: I Insp. BM Elev: ~ 93•ro g~•/o TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic H S6a- o. ?$U Dosing ~ u i Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL ~. BLDG. Vent to Air Intake ROAD Septic ,t. S I ~ t ~r Dosing $ ~ ~, .k ~ t .~, gar Aeration Holding PUMP/SIPHON INFORMATION ~~~ rD/ Manufacturer ,, n C ~ Demand 7o~•S D GPM Model Number ,11~Z " ~PoS 1 TDH Lift Friction Loss System Head ~ TDH ~t Forcemain Length ~ Dia. Dist, to well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark {„4 Z .6Z ~o~.(, 93•fo Alt. BM I•~s` 94.9}I Bldg. Sewer 3• ~5' ~ } SUHt Inlet ~•o °~`f-~Z.~ SUHt Outlet Dt Inlet Dt Bottom I Header/Man. Cp~ ~ or 19 . ~ ~ Dist. Pipe ~p~ 3.o S 3.~o 99.0' P•9s Bot. System ~ 3.e~ 98'./9, Final Grade w ~ ll lo¢ o>~- i 2 ~~- ~ Cwe~ - a•o St Cover z . ~~ 98.9 ` INA~ Z ~'~~ ~•9S lozos 9~• I~ BE ~iENAM IMENSIONS Width r 9' Length I ~ '~ No. Of Trenches ~~\ I ~. (1_ PiT DIMENSIONS No. Of Pits Inside Dia. Li uid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/ST EAM LEACH IG anufacturer: INFORMATION CHAMBE ~ r Type Of System: g / ,~ 9 I ' ~3 -~+ S Q. ~ umber: DISTRIBUTION SYSTEM r s`O"~°` ~( "K' ~--tio`~.l Header/Manifold Distribution f `~ , x Hole Size x Hole Spacing Vent to Air Intake r 2 1~ Length ro • o Dia pipe(s) 3 Length 3 Dia ~ • ~ Spacing ~ • ~ (/~„ 2 ~ u SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes ~ No ~, Yes ®No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~r / ° 1 Inspection #2:~ / // /0 / Location: 859 164th Street Hammond, WI 54015 (SE 1/4 NW 1/4 20 T29N R17W) Hammond Oaks 1s Addition Lot 7 Parcel o: 20.29.17.697 1.) Alt BM Description =`'~ ~ ~ ,(' „~e,~irr. 's~ ~'~s '~ tf'n~ew t"~ ~ ~l ~+` vCw'°~tt~ ~ ~..,~ S`~C.' e 4tw~ 2.) Bldg sewer length = }S' n -amount of cover = > yz, ~ 3.) Contour = y. q } ~ `~6 •~ • P an revision equir ? Yes ~ No O ~ ~/ ~ '7~ SZ Use other side for additional information. ~ 3 7' SBD-6710 (R.3/97) ~ ~ se ctor's Signa r< Cert. No. Wiscronsin 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 Jor enson, Scott Hammond Townshi SST BM Elev: Insp. BM Elev: BM Description: -- ~'"".~ SANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~(`~G S P I Z ~U Dosing Aeration Holding - TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , ;- ~= S : ~.. - -1 t7 ~ Dosing ~ ~ , ~ ~ ~ , ~. n ~, , d' anon 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 DISTRIBUTION SYSTEM County: $t. CrOIX Sanitary Permit No: 395189 0 State Plan ID No: Parcel Tax No: 018-1087-77-000 STATION BS HI FS ELEV. Benchmark ,_ , ~ ~~ Alt. BM .Z _ ,J ;;~ ~ ?- Bldg. Sewer -, SUHt Inlet -; ~ . ~ ^, ~ SUHt Outlet.. r,..... ,. ~.... ....: ,_ Dt Inlet Dt Bottom J ~ 9 ; ~ Header/Man. Dist. Pipe Bot. System Final Grade St Cover _~ ~ i~ ~ a - Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake „ Pipe(s) r Length Dia Length Dia Spacing SOIL COVER x Pruccuru Rve4amc Clnly xu Mnundl Or Af.Grade SVStemS 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: / / ' Inspection #2: / / Location: 859 164th Street Hammond, WI 54015 (SE 1/4~NW~1~/4~20 T29N R17W) Hammond Oaks 1s Parcel No: 20.29.17.697 1.) Alt BM Description = ~ ~~ '^ , ."' ~ 1 :, dtli~ ' ~ ' ` 2.) Bldg sewer length = _ ~ -r. - amount of cover = = ~ ~S 1 ~ ~ eN" ~ 3.) Contour = ~ ~ ~~~ , Plan revision Required? ^ Yes ~ No Use other side for additional information. ~ Date Insepctor's Signature SBD-6710 (R.3/97) ~„~ Cert. No. , Safety and Buildings Division County . j 201 W Box 7162 O ~S~~~S,~ i M~ ~WI 53707 _ Site Address l De artment of Commerce , `~ ~~ ~ ~ "- Sanitary P@rlYllt ~PPI1C~lUri b Sanitary Permit Number ~ 3~s1~9 In accord with Comm 83.21, Wis. Adm. Code, personal info y ro ~ ! ~ Check if Revision --~ ma be used for seco ses Priva Law I. Application Information -Please Pr?nt All Information ~-' ~ •~ State Plan I.D. Number ~ Property Owner's Nam e ~ _ 1 ~~'~ Parcel Number - ~~ ~ / ~ ~q ~'~(i ~~6 V v~~ ~~`i j~d~ lift " F`~ ',. % ti--~'i Property Owner's Mailing Address j'~~?~ Property Location . 2~. 1 ~UJy ~ Sf idi; S.^~ (. T~/ N, R / ~ $ City, State Zip Code ~ j Lot Numberil .~ flock N~ J - Subdivision Name CSM Number F,~:,, ~ s /sr II. Type oP Building (check aII that apply) /.rs P/'~"" ""'' P ""`s • ~Ciry ~ ~ 1 or 2 Family Dwelling -Number of Bedrooms []Village ^ Public/Commercia( De ribe Use ~ D o~~ ~ 17~ /!?~i7 . C ^ State Owned ° ' t x (Q~ ~ ~ rem .,gyp ~~ f (.p ~lZdt Q~ Nearest Road III. Type of P 't: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) `~' i ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ~ Addition to For County use S stem Tank Orel Exis ' S stem $. ^ Check if Sanitary Permit Previously Issued Permit Nwnber Dace Issued _ 1'V. Type of Permit: (Check all that apply)(nnmbering scheme is for internal use) ~E- ~i.a.l~-- I &~ 44 ~ Non -Pressurized In-Ground 21~ Mound 47 ~ Sand Pilter 50 ^ Conswcted Wetland 22 ~ Pressurized In-Ground 41 ~ Holding Tank 48 ^ Single Pass 51 ~ Drip Line 45 ~ At-Grade 46 ~ Aerobic Treatment Unit 49 0 Recirculating 30 ~ Other V. D eatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Ga1s./Days/Sq.FtJ (Min./Inch) Elevation j / VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel -Fiber plc Gallons Gallons of Tanks Concrete Constructed Glass New Existing ~1 /~ Tattlts Taokt i J v Septic or Holding Tattle _ ~~:, x Dosing Chamber VII. R onsibility Statement- I, the tmderBigaed, s~.~. responsibiAity for the POWTS shown on the attached plans. Plumber's Natne (Print) `~ ignaaue RS Numbe Business Phone Number ~ o ~ ~ a~ ~ ~as -9~~~ Plumber's Address (Street. City, S to Z' Code) VIII. C /De ent Use t7nl Approved ^ Disapproved Sanitary Permit Fee (inahtdes Gramdwater Date Issued Issuing Agent Signatare (No Stumps) ^ Owner Given Initial Adverse . ~~ ~) rt ' Determination `~ ~r~ 5 _ • " ~ . ~3 F~ r i ~., . ~ L Y ~ ~.y~:,r._.. IX. ConLditions o!, ApprovaUReasons for Disauppro~l ~ ~ ~ G S~fS~-+^^- .~w.tb'~- ~t~ 5~~ 9a-~-,fcs ~S•t-~"`^- d',~-u..~_. -E.R.~.c~.~7~ ;~ ~M,~,_ atfca `a~imtir~-~ 6.ti.. `~-<,+~-r~..£ ~ ; , - ( 'Q-.~ ~~~~~( ~jp y~ / /' ~ • i~ ~~ - " _~.P d C"~ ~ ' li ' ,Q~i(Jti-~.. '1 i~lb+1.~.~s1 fi+'L 'Li 4ta~.k ~~ ~ ~ j LLVL•~' ~{.bt.. ~41~ ~ _ _ ~'S~ ' ~ L^ ` f \"S~ `, .Q.~ " 'J bill-~ i ~ ~ CK,C.. ~ t.l. ~... ~ .r,,t,l Q ' .lr.. ~ ~ j ~ ~ i _ 1 1. 1M.t.W ~~ i~ C_ ~ d.'1~Ad. y1 as d'~1itut-'}tr-f. ~,1E. _'~i Y't Cbt.u.d.tt~.4 t(~,d` waacn ~P~e l~ tw tree a:oenry ono) rot me s7aoaoa on paper not wa man sus s u mchea In size ~.~ . c. ' jd SBD-6398 (R. OS/Ol) 3 ••~tt D~ ~~ i O N -D N e~ _.., ~. . - PLOT PLAN ~U ~ 'Page 3 of 7 Scale 1 "_ - D~~ ~6E ~~1 ~T ~1z~ ~n -voT CO-~l.Pge~ orz qb - ,------ ----- -- - 8S , ~, I - -~- - - ~ 30, t3r11~-I ~ B~• 05~ ~ 3°10 15~ OF ~ ~a ~~' zK pv e F. ~ . 3 M ~ J a ~~' ~.~ .9 ,- ~ ~ r`~ ,~~\ N N (/1 ~ N ~~ ~~~ S u 66 @:g-R~p L~.~~ a ~ 1~C~~.`1- C.'_-QNS,~.oUivD__~'sT_=_`t~1:it~i~Z'1dzC ___ __ _ NOTES • ~ ~- 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank. to be~Z$0 ~8 0 o gallon capacity manufactured by ~vt~L'tZ. C0~1 e.~~E p~,~~ ~ w~A loo Z~~, ~t~~ 4. bench marks:. g~~- ~pVE ~. Divert surface water around system to prevent ponding at the uphill side. ~-.tTpt,nz ~.1.. °t~.0 ~... 9.8.01 _ ~~Z"1,U ~'- yv <. - ~ f . sconsin rJepartment of Commerce ATTN.• POWTS Inspector July 13, 2001 CUST ID No.691727 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/13/2003 SITE: SCOTTJORGENSEN 859 164TH ST TOWN OF HAMMOND, 54015 ST CROIX COUNTY SE1/4, NW1/4, 520, T29N, R17W LOT: 77, SUBDIVISION: HAMMOND OAKS 1 ST ADD. Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188-2439 TDD #: (608) 264-8777 www. comme rce. state. wi. us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. B~acharc~Secretary ~C~ ;, ~ .~-. R~~n~~ /~ ~T ~ P,btJN?~' ZON1NCi tE ~'~ ZONING OFFICE ~ 1 ST CROIX COUNTY SP ' 1101 CARMICHAEL HUDSON WI 54016 .~ Identification Num ~'-"' Transaction ID No. 661767 Site ID No. 633105 Please refer to both- identification numbers, above, in all correspondence with the aeencv. OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 802584 DISCRIPTION: 600 GPD MOUND SYSTEM. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10572-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • 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 mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning. of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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 ARTHUR L WEGERER Page 2 7/13/01 required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/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. Sinc ely, FEE REQUIRED $ 175.00 ~ FEE RECEIVED $ 175,00 I ~aa/yy~ BALANCE DUE $ 0.00 THOMAS J PERKINS POWTS PLAN REVIEWER ,INTEGRATED SERVICES WiSMART code: 7633 (262)521-5064 , 7:30-4:00 TPERKINS@COMMERCE. STATE. WLUS ~ ~ ~ J. isconsin ~^ Department of Commerce /.,. ~;~ :-,^ ~ / ~" ' , . +,. `~^ ..eet-1 ~ ~µ~, . July 13, 2001 - ,~11~' g ~"~ CUST ID No.691727 k ;' u ARTHUR L WEGERER ~ ~ ~ tee' ~.. .,~ .,~ WEGERER SOIL TESTING & DESIGN SER PO BOX 74 RIVER FALLS WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIItES: 07/13/2003 ' 1.. t; `~ iI ~7'N Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188-2439 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: SCOTTJORGENSEN 859 164TH ST TOWN OF HAMMOND, 54015 ST CROIX COUNTY SE1/4, NWl/4, S20, T29N, R17W LOT: 77, SUBDIVISION: HAMMOND OAKS 1 ST ADD. Identification. Numbers Transaction ID No. 661767 Site ID No. 63310.5 -Please refer to both identification numbers, above, in ail correspondence with the agency. OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 802584 DISCRIPTION: 600 GPD MOUND SYSTEM. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10572-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • 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 mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Maintenance information must be given to the owner of the tank explaining that periodio~h f the filter is required. Access to the filter for cleaning must be provided per Comm 84 product~Ir~rq~a~r-d' ~is. C?r ~'s~~~~ ~f • A Sanitary Permit must be obtained from the county where this project,~s locaf~d;' 'd~ with the '! ~ requirements of Sec. 145.135 and 145.19, Wis. Stats. ~"'~,:'~iFj • Inspection of the private sewage system installation is required. Arrangements £q~r~Cpection shall be made with the designated county official in accordance with the provisions of Sec. 145.20c2), Wis. Stats. 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 ARTHUR L WEGERER Page 2 7/13/01 c . . required by the state or the local municipality shall be obtained prior to commencement of construction instal lation/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. Sinc~eiy, FEE REQUIRED $ 175.00 //' /'~~ ` FEE RECEIVED $ 175.00 ~a~l ' ' BALANCE DUE $ 0.00 THOMAS J PERKINS POWTS PLAN REVIEWER ,INTEGRATED SERVICES WiSMART code: 7633 (262)521-5064 , 7:30-4:00 TPERKINS@COMMERCE.STATE. WLUS TITLE SHEET Page ~ of ~ This plan has been i4anual SBD-1057 P CCZ. 6lgq~ LOCATED IN THE S~, TOWi1 OF ~,pry~ ._1 FOUND SYSTEM RECEIVED FO~t A ~ BEDROOM RESIDENCE c~~`.I" CI ~fi~,3 prepared in accordance with the Mound ~P~fi4~~~GS.DIV. and the Pressure Distribution Manual SBD-10573=P Ctz. b14q~ 1 /4 OF THE NW 1 /4 OF SECTION Z~ , T 2-°L N, R !~7 W, h'lOh.~~ ST`. CCc2)UC COUNTY, WISCONSIN. INDEX PAGE 1 of .7 TITLE SHEET PAGE 2 Of 7 SYSTEM riANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUI•TPING CHAt1BER GROSS SECTION PAGE 7 of 7 PUriP PERFORI.IANCE CURVE PREPARED FOR ----~::~:~3 -: T:6 ~~::`rr1- ::: s r -:: -___- PREPARED BY WEGEE~ER SQ = L .TESTING AND . . DES = GN SERVICE P.0. Box 74 421 Id.~lain St. River Falls, WI 54022 Phone 715-425-0165 Fax 715-425-6$64 7~r' .r ~ ~ ARTK!Fl ~ Y vv,`-~~ ~~%~ , c~ JOB N0. L11-~(7Z Mound System Management Plan page ~Z of 7 Pursuant to Comm 83.54, Wis. Adm. Code Mound System Management Plan Page Z of 1 Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if _ the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank; If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce,Safety and Buildings Division. • Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS,and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis.Adm.Code,and shall maintained in accordance with its' component manual[SBD-10572-P(R.6/99)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning -Office at -1.15 — 3$6- Y680 CC Lx The system installer at 1 [S _4/4S8 I'JfV'JG The tank manufacturer at 3,L)0 S 6 W ! QSeZ The effluent filter manufacturer at S-2CLZ 2..pcgt1 The pump manufacturer at 630— LaciR GouVpS PLOT PLAN Scale 1"_L4U ' • -Page 3 of 7 MTh• i ; -Do N JOT CO)-IPFj - 0'2 1-3k_s43 `n1-ts , . As' , Z A \Sr '6 4�S , :11 3p' ____ — 301 1. 3 ,a,i11 — 3e awt Z SS, 1 CO pt.,cz tt.. C i.pit?' 10 30 `'VVe't CIF- c�-�.L. F EL. 9.8.o, 1S'o F i21 G 2.4.pveF.v.i. ,,.<z) 6 0 J' ri)\ (� i``��.�� ii NW _ �R.\U 1 g ij 1 3114 E 41 5l66t5`R'P . O ��e.As-c ,3 — x N 0 $M 1 =TL too-i' akl_'r OFG1ZQ sTh}-z(. �w Z--__= Cal • ein.1' ON G_2oVtiD P T `i E-cclw__STtrkC. NOTES : 1 . Elevations shown are existing ground elevations unless otherwise noted. 2 . Install 4" observation pipes with approved caps . ( Z required) . 3 . Septic tank to be \2.80 /80o gallon capacity manufactured by ‘1v1-LL Z CO,J 0-41C P iv w/fy_ teoo ZPcla -L F.c- 4 . Bench marks : se" -- prove 5 . Divert surface water around system to prevent ponding at the uphill side. , Page y- Of 7 • Approved Synthetic Covering _ ASTM C33 - Distribution Pipe Medium Sand - Topsoil - , Flee. 9.6,. 0 1 b Z. % Slope Distribution Cell of - Force Main Flowed 2" to 2 2" Aggregate From Pump Layer D \•') Ft. E \-z7 Ft. CROSS SECTION OF A MOUND SYSTEM F 0.8 Ft. . G 0• S Ft. A 9 Ft. • H 1- OFt. Linear Loading Rate=9.0 GPD/LN FT B 67 Ft. . . . Design Loading Rate=0.31 GPD/SQ FT I I Ft. J 7 Ft. K A Ft. A-Fberftete Position L 'as Ft. of Force Main w 3 O Ft. L I -Observation Pipe 1 Wi - . 4*---C____ "7 _ 4-0 1760460,4; . Distribution t o 2 I I . z aggregate Pipe Observation Pipe (A . achbr securely) Cell of z . J PLAN VIEW OF A MOUND SYSTEM . • , • Distribution Pipe Layout Page S of 7 • Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes . Extend the end of each lateral up with the use of Iong turn or 45°fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve,.threaded cap or . threaded plug. Provide access from final grade for the valve,threaded cap or threaded plug. CC`s �0 _ II) [ PVC 4c. Ji?VC. Lateral� Manifold �Lateral x •x x I x 1� � 1 x x x x Lateral Length— Lateral Length — P ii Distribution Line L'FYt V\C..) - 14 . 7 t}Cr•ES bpX P a- — ,-t ,_ I -o S v - o-- — �a it— ti?uC 1-0z4E 'In PnN P 3 3 Ft. Hole Diameter //v Inch S -3 Ft. Lateral I - Inchces) X 2-y Inches - Manifold " Z - Inches Force Main " Z Inches - I of holes/pipe Vi • - Invert Elevation of Laterals qg• S Ft. fxo.4il = 6-4-2xb = ut_ $Z �wj • . - Combination Sept,,.c:Tank and . • PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE b OF 7 VE►JT CAP - WEHER F JUJJCTATIO►J ljOXPKOO. 4"E.I. VENT PIPE i APPROVED LOCKING 110 FROM DOOR, • MAJJHOLE COVER wt'IK :ltuDOW OR FRESH 2 wA(ZNIJJG LIN%EL. w I � �attr A 1 IJJTAKE S' caaeu�T . , ; j„,, 14_ . .. ,....,.... . 6i 4t . _ I0 / • F1ivtS�^ . T2-S f I • �i. HIL1. I G�oE IT: L_- Ib'MII1. 'I--� \ \.`k -- -, .1- .- . \;frar:-:6_[--1 - It INLET L.: PROVIDE 1----- � `-..‘,--,7 AIRTIGHT SEAL Iii l V .^,styLC •, r.: 1Approved 1zf8� ski ..A lAPProved joint w/ �-_�ppI joint w/ PVC pipe ALARM PVC pipe i Is II ► I c ► 0� CLEV.°IZ•3 FT.--^'-' __J PUMP-� OFF D . CouCRETEI V V• °LO.00 I I. n BLOCK—{ I t RISER. EXIT PERP I1TED 0J.1Ly IF TA►JK MAJJUFAGTURICR HAS SUCH APPROVAL 3"APP120••n 8ED0 I>v 4 SEPTIC E 5PECIFICATIOUS . DOSE ' 1 ` TAWKS MA►JUFACTURCR: w` �Z rh CtJ�C-Z-Q'a uU bER OF DOSES: 4-ES PERQA:1 TAMK SIZE : \Z-aO '/ 8OD GALLOUS DOSE VOLUME z ALARM MAUUFACTURCR: S'J• `w�{`�Zp S' i1 - Z IIJCLUDILIG bACKTLOW: l� - GALLONS MODEL ►DUMBER: 1 O I Hw CAPACITIES: A- ZO IJJCHES OR 1'1\1 •° GALLOrJS SWITCH TPE: �CS`4a-Cl, g= Z ILICHES'oR ("it' Z G G(�LLOUS OVL PUMP MAJJUFACTURCR: DS C= 6 INCHES OR 1� - ? CALLOUS MODEL NUMHER: g�1 ' ePO S . D= I0 INCHES OR 2-D6"0 GALLOAJS SWITCH TPE: e Z-L IJOTE: PUMP AUD ALARM AR TO 6E2 S • MINIMUM DISCHARGE RATE 1 . Z GPM INSTALLED OAJ SEPARATE CIRCUITS VERTICAL DIFFERENCE HETWEELI PUMP OFF AIJO.DISTRIBUTIOiJ PIPE.. -1- 67 F• EET + MINIMUM 1JETWORK SUPPLY PRESSURE S. SO FCET CS-OX.L- 3) + S FEET OF FORCE MAIM X .. 9 FJ0 fLFRICTIOLI FACTOR_. CI' Ski F• EET TOTAL D JAMIC HEAD = ly.--11 FEET • As per manufacturer ZO. btu gal/in. Liquid depth 3 8 9 Y'1? '? -zFOR- cG. a' ..v�. . 7 0 7 . ' . • • Gou ds !� i . Submersible . ,,..,,r,, -, Effluent Pump MODEL -0 3871EP04r` - EP05 APPLICATIONS • Fasteners:300 series • Fully submerged in high ■Motor Housing:Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength,and durability. •Effluent systems dry without damage to heat transfer. •Motor Cover:Thermoplas- •Homes components. Available for automatic and tic cover with integral handle Motor: and float switch attachment •Farms . manual operation.Automatic •Heavy duty sump • EPO4 Single phase:0.4 HP, models include Mechanical points. •Water transfer 115 or 230 V,60 Hz, Float Switch assembled and ■Power Cable:Severe duty •Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. •Bearings: Upper and lower SPECIFICATIONS • EPO5 Single phase:0.5 HP, FEATURES heavy duty ball bearing 115 V,60 Hz, 1550 RPM, construction. Pump:EPO4 built in overload with ■EPO4 Impeller:Thermo • Solids handling capability: automatic reset. plastic Semi-open design 3/4"maximum. • Power cord:10 foot with pump out vanes for AGENCY LISTING • Capacities:u to 55 GPM. standard length, 16/3 SJTO mechanical sealprotection. P PEl- Canadian Standards Association otal heads:up to 24 feet. with three prong grounding •EPO5 Impeller:Thermo- - , Discharge size:11/2"NPT. plug. Optional 20 foot (GSA listed model numbers • Mechanical seal:carbon- length, 16/3 SJTW with plastic enclosed design for end in"F"or"AC".) rotary/ceramic-stationary, three prong grounding plug improved performance. BUNA-N elastomers. (standard on EPOS). ■Casing and Base: Rugged • Temperature: thermoplastic design provides 104°F(40°C)continuous superior strength and 140°F(60°C) intermittent. corrosion resistance. • Fasteners:300 series METERS FEET stainless steel. 1 o- j , • Capable of running { ' dry without damage to 9- 30 — *. .'"4 components. ', ; P . Pum :EPO5 8_ 5FT • Solids handling capability: 25 c 7_ I I • I " 3/4"maximum. w • Capacities:up to 60 GPM. = -o • Total. heads:up to 31 feet. 620 ! I • Discharge size:1t/2"NPT. Z 5_ j • Mechanical seal:carbon- } rotary/ceramic-stationary, -1 4- 15 ' I tc-11 BUNA-N elastomers. o EP •Temperature: 1- 3 10 r . 104°F(40°C)continuous { 4341 -____I a 140°F(60°C)intermittent. 2- i 1 b•7 ' ," 47 1 5 • ICirettie 41.$Z 0- oo 10 20 30 ( ) 40 50 GPM I , 1 1 1 1 1 0 2 4 6 8 10 12 m3/h CAPACITY ©1995 Goulds Pumps.Inc. Effective May.1995 07''75;•O1 TH?r 08:47 F:tY 7I5 3~ + 4686 ST C.1LY CO ZU:~ING C~UU1 '+vismnt~pt>apaRm~motC~+r,~,erce SQL AND SITS ~VA,LUATMON _ .~fsi~N+ at!'^~'3(eiY and 6uiiding3 a/ i^ sccprd with Comm 83,b5, Wis, Adrn, Code F~ ~ ~ ~ Cesium Sdptic 5wict t~p~ 9ite P~ ~ P~• not lass than t3! ; x 11 inches in size. Plan must Counfj ~~`~"~"-"~~' mdida••but not wed to: vortical and hcrizant~ ne a-ence point {CifU!), din~ctian antl percarlt stops, scale ~ d~r++rtreiiorsd, ,ot'th arrow, a ~ to nearest n72C, _ ~~• Cro;x ~.~cAnT ~F®~ala ,~ . a t~ ; -~ ~ ~, Parcel LQ.# -- TNOP1- Weas~r ~~iitt a!t ir~rrq~8'~cn. _ _ Penonat intw,rat:an Y~+ Provide may De used fsx'isscon gull rpos~y (Prt ~/' Reviewed t3 --- - - i?v tract' Gay ,sat 5.Ga i~) (mq)' l9 Y Date Prol~ty+Jmwr ' , ~.. '_ _ Pbt~eerty LoGatart • . -- - Elumbird L;3nd~rati~rt ~'b.~G.~'~S ~-N ' ~~a c/a 9r SJ4 ;vW 114 S 20 T 29 ' N,R 17 w •, ~ _ 'nperty C+vner's btaYlnq Address ~ - ~~ ' ~~; L~ ~ 7 ;Stork # -. Subd. Name-or CSAdA! 332 Nlinnasata SrteetL East I ~0~ ::. ~;.: , ; 7 ~Sf' -- ~;~, ~ n!a . ? xammond oaks•31i9 .addltiun State •~uq,~de pttand r City ' Cj V(Ilaga f I,~C-,'twvn Nearest Roan ..- Swint Pau! h2N S~~T(}.fi ~ 6'~ 1'-~'1~~' ;; ` Hammond I 160Th 5ttxxt ~y Now C0176'~Ut~1917 l,; ~ - Use: !~: Rem • `• l ~ ~ rooms 3 i_ IAdttltkn Ep e~ds+tlng t)tatldhg ;-, Replacert7ealt ; ~ PutzGO t r comrnerclel die - Code Otetiveci darn/ flow-- -- 450 '~'-- 9ix Recommended design ioSdirtg r8tz -5 bed, 9i)d~' •6 ~ , 9Ad1tl~ ort area requ~rEd _. 904 bed, f~ 75~ tre~neh. A= Ma~dmum design load'mg rats •~ b~, gPd/f~ .~ fir~ctt, 9P~ Rt~omrnended }ntlltrstion SUrfaC° ~eVatl~'i(S) _ -- non 9°+.0` wntour ft {2S r@F6fne(i t0 SitB plan benchmark} Additional design 1 sibs u-onsideratlons ~~ z = ' ~. r Par~llt material ela~tmd mnrateoe S= 5uilab(e ~Or 5ystem Com~yntions! U=Unstit&bfe for system I f ~ S~ U ~rttg# Groued alw+ 97.1''t iD} ~~ tailor _ 24' 2 Grour-d elev ~.r a ~ to limiting !actor 2S Narizvn ; Depth I DorNrtarrt C , in. MunseM Mcumd i In~tound pressure I AT ~s;u _,st~u ^ Mottles ! Texture ~ Strocture ~,. Sz. Coat Cdor ~ Q'. Sz. Sh. •Grade ~ System h FiU ~ Ndding Tank st~;u cs ~;u I us~u Boundary Roots +-- ~ ~.. Trench 1 ~ 0-14 ! 10yr372 ; none -- ~ sil ~ --j--• 2msbk j mvfr as ~ ~f,lm ~ 0.5 0.6 2- i 14-f8 ~ ~~ . 7.Syr4l•1 `~ ~ none - ~ sil ---- 2msbk f _ •-I ~ rnvfi• ~ ---,-----! ! cw I f I OS - 0.6 3 118-2+1 J _ I - i 7.Syr4/6 ! none i i f sit --1- _ 2msbk - .r j ncvfr ~ ~. ._ cw ]f ~ 0.5 ~ ._ 0.6 4 44-33 ~ . -..~.. c 416 --7'r ~ c2 3d ]0}a';tr2 , SyrS/8 ~ fir. s}1 • •- - zmybk - mti I --.~ . _ ._ _~ -- ~ - , ~ -- __f- ; - ---- --r-- - .. .. -i-- -- ~ _r_ . ...~ ~. i -- ~ I ~ r- ~. -~-- I . _ __. I~narks: __ 1 I 0.6 ~- l0yr?l2 Z 3 a 6-16 ~ 7..5yr4/4 ! . _~ n~c ~.. ~. •16-25 ~ 7.5yr4J6 ~ none 25-34 ' 7.Syr4/6 ~ .. - - _ ~ 7.Syr5B7/'.1 - .. ~ _ ~ ~_ -~- Sil l -_~_ gr. sit gr. s}l gr. sil i ~..-_ . l Remarks: _ - _ _ CST t+-arne (Pteasa Print} Signatu ~ ~~ _ Tom Qustum Address vw,ium Septic Sc:tvic:c ~~ nTJ_ -- . N13450 937th St, Tfew Auburn, WI 547 7 na--c ! -_. .. .~. zmsbk mvfr as ~_-. 1 fl m ~ 0.5 0.6 2msbk rttvfr i cw • -~--~ •---1•-.• • - i if _F O.~S ;- 0.6 2msbk - ~ mfr ~ 4-w - ~ - 0•S - 0.6 . 2ms~+k r rnfi - I - ~.3 0.6 -~- _.. f- ..- ,~ ~_. - _. i ---~- -- 1- i I ! ~ _ 715$Sti-1344 U31e CST NURlbar RBfn - 3r1/00 227618 1Y43 Wiscon=i'DepartmentofCommerc2 SOIL AND SITE EVALUATION t~iuuion ot5~fety and Buildings in accord with Comm 83.05, Wis. Adm. Code Page 1 of 3 Gustum Septic Service Attach canplete site plan on paper not less than 8%2 x 11 inches in size. Plan must County inGude, but not limited to: vertical and horizontal reference point (BM), direction and " St. CroiX percent slope, scale or dimernsions, north arrow, ana ~Ri~dctance to rarest rced. ~ \ a ~~ Parcel I.D.# APPLICANT INFORMATION - P/ ~? ~ r~I1if all informat / 1 ~dn, Personal information you provide maybe used s'sCOnBary ~urpos~s (Privacy law s':,15.04 (1) (m)). ~~ , e ewed By to L ~ ~ L1b f Property Owner ~ ~ - ~ Property Location Humbird Land Corporation Govt. Lot n/a SE 114 NW 1/4 S 20 T 29 N,R 17 W Properly Owner's Mailing Address ~ -> ~~.; ' _t~ot# .7 r Block # Subd. Name or CSM# /S i`- 332 M_ innesota Street, East 1444 , _ ~ ~' _ ' n/a Hammond Oaks~B Addition _ City State ip,Cgde P r ,''~~ ~ " ` ~ City ^Village ^Town Nearest Road Saint Paul MN FQ.1 ~51 - JSS '•, ` Hammond ~ 160Th S treet ^ New Construction ^ Resi ~ `I I t~uml~ o rooms 3 ^Addition to existing building Use: ^ Replacement ^ Public or commergal describe Gode Derived daily flow 450 gpd Recommended design loading rate •5 tom, gP~ .6 trench, gpolftz AbsorQtion area required 900 bed, ft2 750 trench, ftz Maximum design loading rate .5 bed, gpd/ftz .6 trench, gpd/ftz Recommended infiltration surface elevation(s) along 97.0' contour ft (as referred to site plan benchmark) Additional design /site considerations 13M 2 = 97.1' Parent material ground moraines Fkxxt lain elevation, if a livable n/a ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ^ S ®U ®S ^ U ^ S ®u ^ S ®u ^ S ®U ^ S ® U Boring# 1 Ground elev 97.1' ft Depth to limiting factor 24" 2 Ground elev 96.2' ft Depth to limiting factor 25" Horizon Depth Dominant Color in. Munsell Qu. Bed Trench 1 0-14 10yr3/2 none sil 2msbk mvfr as 2f,lm 0.5 0.6 2 14-18 7.Syr4/4 none sil 2msbk mv$ cw if 0.5 0.6 3 18-24 7.Syr4/6 none sil 2msbk mvfr cw if 0.5 ~ 0.6 4 24-33 7.Syr4/6 c27S10yr7/2 gr.sil 2msbk mfr - - 0.5 0.6 Remarks: 1 0-6 10yr2/2 none sil 2msbk mvfr as lf,lm 0.5 0.6 2 6-16 7.Syr4/4 none gr. sil 2msbk mvfr cw if 0.5 0.6 3 16-25 7.Syr4/6 none gr. sil 2msbk mfr cw - 0.5 0.6 4 25-34 7.Syr4/6 c2 7 S 10yr7/2 gr. sil 2msbk mfi - - 0.5 0.6 .~ Remarks: ;ST Name (Please Print) Signature: Telephone No. Tom Gustum ~s! ~r-,is!L~% 715-658-1344 lddress Gustum Septic Service Date CST Number Ref # N13450 937th St., New Auburn, WI 54757 3/1/00 227618 1193 SOIL DESCRIPTION REPORT ~, ~ ; S (7,~ -~ Mottles Texture Structure Consisten Boundary Roots GPD/ftz Sz. Cont. Color Gr. Sz. Sh. .~ .~ •5 .., .~ PROPERTY OWNER: xumbud land Corporation _ SOIL DESCRIPTION REPORT PARCEL LD.# _____ 3 Ground elev 97.1' ft DepUi to limiting factor 26' l 1193 •Page 2 .- ~ 3_ , (:ucM1im Crntir Crruin* Horizon Depth Dominant Color Mottles Texture Structure sistence Bounda Roots GPD/ftz in. Munsell Qu. Sz. Cont Color ~ ~ ~ ry Bed ~ Trench 1 2 3 0-8 8-12 12-19 10yr2/2 7.Syr4/4 7.Syr4/6 none none none sil gr. sil gr. sil 2msbk 2msbk 2msbk mvfr mvfr mfr as cw cw if,lm if - 0.5 0.6 0.5 0.6 0.5 j 0.6 4 19-26 7.Syr4/6 none gr. sl 2msbk mfr cw - 0.5 0.6 5 26-33 7.Syr4/6 c27 SyrS~~ gr. sl 2msbk mfi - - 0.5 0.6 Remarks: ~1 Ground elev ~~,~~ W rlimiting factor Ground elev Depth to limiting factor Ground elev ~or~~ ... limiting factor ~5 .y .y .5 . ~c-• rn m orb Oaks o~# ~4dr~' ~"f- ~'dn ~~' st N~ .S'tc.2o T~~'N RI'7w~ %owr- o ~ ~k w,rx 0 '~ I~ ~° ,N ~~oPoS~~ ~Ah ~dl j~/J Par of P~'e~os~~ l-~+ ,~ ~7 ~~ s~~.~ _ +gv --~ f//~~ 7i t,pr~'~DVv L~~~~~/ ~ $M f ~ ~L ~~~, ~, TP O~ C7r c G+1 S+ak~. B3 ~7 ~e~ tour' q~' }l~~~ow .S~~.k-~ ~ So ;1 ge: ~ ~9 ~13~~ k~o~ cc~ I ~. ~ ; y d S 9` z ~~~~ B~'I ~a~~ ~0~3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSti[P CERTIFICATION FORM Owncclt3uyc~ _ ~Cb ~ ~ O v` ~ ~® Mailing Address Propctty Address 0 ~ ~ ~~ y -1.6slf~is~ _ d~ (Vuification rcgciicrd from Plu~aing Dcputmat for new ooastntctioa) , - - (~itylStaLc ~.- /~cB ~ c c Para1 Idcnftftcation Ntunbcr ~~1 ~ ~d ~ /' ~/ ° W`~ X..n:GAL. D~fiCRXP_ Pmpu[y Locatioa ~~%, ~ Y~, Soc. a D. T ~~ N R~W, Town of ~ Subdivision 8 ~ ioc # ~erfifed Satvep Map ~ Volume . i'agc # Waciaatp Deed # ~ ~ ~~~ Volmne ' 2aSe ~ ~~ Speti.boase O yes ^ no Lot lines idc:~Sabic~l yes (~- no ~~!S"~141'A'tH"~'N'AfiI(~ aasesnd~y~s~aoaid~tmrts eonsistsaf'paggriogeatQrc~cc~a~yt5roc~ayooar„~ifiroo,dod ~`t0band7,cv~te's.Proper~saoe eaa:ttS~iod~re,bro~oatofhie ~:. P~P~ ~~P.at.~o$ye~ . ~C~a°°lcss-=Loatarcntst:ge~inII~evrutesysOcm, .. • ~ P.~P~' ownar aseoes to sabntnt'to St (k+ooc T~ Dgi signed by ~eoa?oec sad i~:: -~~q°`~rodpl~dbaoe:irxas~d ~t(1~~ Gc:risaeWaterdz~OSatsysbcm ProPaop~ageondis~aaaad/oc(~ "'~`i0n'~P_C¢,~esni~is kxs~dnn I13~aIIofld~adgG . ~ ~ i:nne,aad fire sbora aada,~ox ~ mai~int~re pdrite sevrrage disQa~t ~ Qie sbRed~ds ~~~•~~~'1'~D~tmemeofQoascac~+oermd~reDco{g,esStat~eofFrrsoansur.. '~~sS'~.bas'6ocnmaim4aoeda~tbeoonq~Sctodmdre6urroodtp t~ St;t~uucQoomtyZ~i~gg~O~eoe~ai~ia 30 dayz•of the Quue y~r dam ~ F ~~ C~ DATE OVA ~7.A~CA.~ON . I (vrc) vufiifY that all oa taus foon ace tnre to the bat of mY (onr) hoowl~odgG, I (wee) aax (are) the owocx{s) of ~ ProE~y dod abo~ by vicarc of a wamu~y flood tcoocdod ~ ~~. of Doody Offioc. /, _ ~~~~ ~ DATE sss«~s ~, iafoimatioQ -tgmxcatodmay t+csvlt is the suut~ty pcamit being t~cvolcod by the 2aairtg Dcpar6m~t- "`"s • ss [ndadc ~rtth this appiicattoa: a ttampod waawty flood trots ~ ~S~«' of Dodds oiI'~ a dopy of the aetifiod eutvcy rnap if rrfcxcnoe is asede is the watrnnty dcod V'f. 1~1?3PA~E4sz f0 r ~ STATE DAR OF WISCONSIN FORM 2 - 1998 650142 WARRANTY DEED I;ATHLEEN H. WALSH kEGISTEk OF DEEDS Document Number GT. CkOIX CO. , WI This Deed, made between Humbird Land Corporation, a _ kECEIVED FOk RECOkD Minnesota Corporation _ .. 07-03-2001 1:20 PM - ~ YAkRANTY DEED _ Grantor, and Scott E. Jorgensen and Margaret A. Jorgensen, husband and EXEMPT 8 CEkT COPY FEE: wife as surviorshi marital ro ert p p p ~! _ _ CGF'Y FEE: - - TRANSFEk FEE: D3.70 --- ---- -- kECORDING FEE: 10.00 - _ PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin' Recordin Area •^"ifarne ~ d~dr''~~ccTt ~ Lot Hammond Oaks_First Addition Subdivision, Town Of Hammond, St. 1 1 1 L.C .SV~ 200 rotx County, Wisconsin. 1900 SILVER LAKE ROAD NEVy~~ ON, MN 561 1 2 - 7 Q ~~r 20.29.17.697 ~d¢~ ~~~"'~~/ C~'L~ Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to easements,restrictions,covenants and rights of way of record, if any. T}re warranties of this deed, either expressed or implied are limited by the grantor to the gntntee, or anyone in the chain of title, to the consideration expressed herein, that being the sum of $ 27,900A0. Dated this 18th day of June 2001 Humbird Land Corporation ,, by ~_~,7;,,;t :~ President AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) .Austin J. Baillon ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. Ramsey county. > Personally came before me this 18th day of June , 2001 the above named Austin J. Baillon , >sresl en__t of _Humbird_ an orpor~i on to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. D~,a..~~..~f . . THIS 1NSTRUMF.NT WAS DRAFTED BY -~ NrUL A. gAILLVrv Paul A. Baillon ^,~~ NOTARY FUOUGMwNESOTA Paul A. Bai 11 on. Attorn A aw _ . oN-~wRES-,~at-: Notary Public, State of Wiscon C' ~ l C't~l 'rlLhfrc~~~t ~ 1=..~.~' K ~ ~ My Commission is permanent. (Signatures may be authenticated or acknpwledged. Both aze not 2005 ) Sf~°- t Januury3l necessary.).~,3 ~_ I'~t ~"t f^se fc•- «. („ -- - -~ - "Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OP W ISCONSIN WARRANTY DEED FOAM No. 2 ~ t998 fNFORMA7ION PROFESSIONALS COMPANY FOND DU LAC, wl BOD-655-2021 ,• _ _ _._ ,.. _: _ ~ : ~~~~ © ~ ~ ` ® 56_13' ` _ 160.00' - ~ ~ 152_00' _ 152.00' - ~ I -- ~ 589'45'08"W 216.13' - - ~ r- ~ _ ______ _ 8 7TH AVE. w s89.4s'o8' I - --- - ~ I 589'45'08"W 216.29' ~'' I v: ® _ _ _ _ _ 589'45'08' 19 54.29' 162.00' - - ~~ - -' -- -- 227 .38 ~- ~ \ a ~ _ _ -- ~ c;. w 18.54' O~iT~ ~ _ -~ ~ ~ o° I ' ~ ' `~iA HIGH WATER ~ cFv ~ ~ <" `, LOT 65 w LOT 64 I ° ~gsc'~~LEVATION '~~+ ~\ ~~ 4i N '' 66 ~ 439118 As re ft ~' 1.03 Acre ~ ~ 6 ~ ~ \ ~ 152.58' tss,07. \ ~ ri q 45017 s ft ~ ~' - -- - 95.16' gyres - - - - _ _ N q• I I ( I ;q, ft N v I N88'23'16 - 247.74' ~ 1~6; ~ I f ~ O I ~ Vj w ~ I LOT 77 ~ N I r fJ I ... I , ~ ~ ~ 12.33 Acres w •7' 165.20' 162.00' JO NT ' ~ 01317 sq, ft ~ 30' DRAINA 47.00' N89'45'08"E 327.20' $ o ~ EASEMENT LOT 63 ~ ~° ~' ~ ° ~ ~ LOT 78 can ,i z ~?~ . 1.03 Acres ~ ~ ~ w I ~ ao 44923 sq. ft o l I I "' ° I I `~ 1.92 Acres `~ ~ 83873 sq. ft o i 33' 33' ~T 61 ~ N89'45'08"E 326.20' I ' I 0 ~ N Acres m ~+ sq. ft rv g 16 ~' 16.61 w LOT 62 O 5 ',~ ~ ~ 1.19 Acres 16.61 ~ ; © ~ 1D'~6 19 W 0 51896 sq. ft N'I'o'SS'1g ~ O 0 _, \ g\9~ ~~ - ~, ~ t0 > 2e 8, / 7.01' 115.43' / g6~6~~ ____ O S>? ~w ~~93>.14 ~ _ ~~~~- - - - - _ `~ ~6~,1" _-=-- ' 765?"~\ \%~ 413.14' w O ~y6 ' ~ ~ ~9 3j. ` 11 ~ _ w 86TH AVENUE - ~ ~\ ~ W - _ $~0 a12.97' "- ~-~ 2 ~ 12 0 ~~~, ~ ~ _ _ ~__/~ / ~~ 120.97' ~ `~ .,, . _ ~ LOT 81 ~ ~~r.~ .t .. > .y ` `" l , ~'C Cu r t ~ ~. r ~ ,^ dy , ~ _ .rf„~! v v. 4.~ij`~v'M1Gy r ~ ~~w'td^J~a ~41 r G J .. w _ 7