HomeMy WebLinkAbout020-1395-22-000:onsin Department of Commerce '` PRIVATE SEWAGE SYSTEM
_.,,ty and Buildirig Divisicri
INSPECTION REPORT
CENER~:L 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
Bonfe Builders, Inc. Hudson Townshi
CST BM Elev: Insp. BM Elev: BM Des ription:
p~, v U. d ~ , (,v
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic /
Dosing ~ /
l v
Aeration
Holding
TANKS INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic
71 ~
(J
I ~
~~i
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION.L I~p~,c L.t ~.
Manufacture Demand
GPM
Model Number
TDH Lift Friction Loss S ad TDH Ft
Forcemain Dia. Dist. to Wel
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
430529 0
State Plan ID No:
Parcel Tax No:
020-1395-22-000
Section/Town/Range/Map No:
25.29.19.2416
STATION BS HI FS ELEV.
Benchm rk ~ ~M
r~l
-U +(~
/U ~ fj0 • Z~
Alt. BM
B~ ~
jn~v ,~
J ~
~8~
St/Ht Inlet ~ ~ G~ p
/ ~ `O~
St/Ht Outlet
.3
9~~
Dt Inlet
/- ~~
Dt Bottom /~ ~
Header/ an. -
g. b
6
Dist. Pi
~P
N1~-
g. a
~ ~
Bot. Ste' ~W ~ ~~ ~ S
Final Grade
Mld- ~ Q S
St Cover ~ /n - trS f ~ . Q
SOIL ABSORPTION SYSTEM ~."?i-}~ ~~ (~/vu~ _ ~S
BED/TRENCH Width 1 Leh o. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 ~ ~
(Q~ d
SETBACK
SYSTEM TO
P/L
BLDG
WELL
LAKE/STREA
LEACHING
a rer•
(~
INFORMATION
'`~
CHAMBER 0 _~ 1
Ty Of System:
\ ~
~"/
] ~
~,.,~
Model Number:
DISTRIBUTION SYSTEM / (~}~2Q~-..Pi~s~ -
Header/Manifold
Len th Dia
9 ~ ~- Distribution ~/ ,,~ ~ ~
PiP9s) " J - ~~p "g~
Len th D L Dia S acin x Hole Size
~'" x Hole Spacing
c,~---- Vent to Air Intake 3
~ r
SOIL COVER
x Pressure Systems Only xx Mound Or At-Grade Systems Onlv ~ ~ ~ ~i 'l9~' ..P~Yt~S
Depth Over /J
_ Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center !~
~3 Bed/Trench Edges Topsoil
~ Yes No i
Imo; Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ 2~ / ~ Inspection #2: / /
Location: 872 Highl/~e~r,T~rail, H~dson, WI 54016 (NE 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 22 Parcel No: 25.29.19.2416
1.) Alt BM Descrip lot" n =`~0 v~.tv1/ ` ~~~Q,~a/G~.~
r ~~
2.) Bldg sewer length = 2~
-amount of cover = ~ l ~ ~~~~+ /`T"`" ' w"""e•-~x' ~ S v~c~-5 Q
Plan revision Required? ~ Yes No Q ~ I
y
Use other side for additional information. ~ ~ ~J ~~- - ---- I~~ __
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. c
/ ~; , -, ~~ , ,r,.~ ~
~ a Safety and Buildings Division County ~~ -
,~ 201 W. Washington Ave., P.O. Box 7162 ~r ~~~ ,` x
~~~jO~s,~ Madison, WI 53747 - 7162 Sanitary Permit Number to be filled in b
( Y )
Department. of Commerce (~18? 2b6-3151 ~~~ ~~~ ~~,yS
` Sanitary Permit Application ~ s~~ Plan 1.~. Number~l ~ -
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ~ /-1-
I111 may be used for secondary purposes Privacy Law, s15.04(i}(m} ProjectcA~ddress ~' d'iffe/rent t/han ~maihng~address~
I. Appircation Information -Please Print All Information ~~ °°"- °'-''°° _ l~ ~ ~ 7''l ~~~f"l ~~/NGt:~/
`~~ ~~~~~~' - ~S9S-~~.-DUCE
Property Owner's Na me 6 Y : Parcel^(/
~ / ~' ~~t ,2 J . ~-4 , lit Lo[ ~ Block q
Property Owner's M ailing Address Property Locati
p - ~. i ~i; ,,/_
City, State Zi Code y ~ `k;~'k,Section .2,5
p °Plione~itmber
~T-`l~Gf.~~~ Y ~7.I/ ij~LJ'r~~ (circle
II. Type of Builtling (check all that apply) _ T ..~~ N; R,~E or
or 2 Family Dwelling -Number of Bedrooms ~~~~ ~~tGr~ ' - ~` Subdivision Name CSM Ntunber
^ PubliclCommercial -Describe Use ~ - ~ ~~~ • ~ . ~ lls
^ State Owned -Describe Use
--- __._._____~ ~ ^City~^Village~wnship of~/~=~ls~,~
III. Type of Permit: (Check only one box on line A. Complete line I3 if applicable)
A. ~~.--
' New System ^ Replacement System ^ Treatmentlliolding'1`ank Replacement Only ^ Other Modification to Existing System
' a•~~ Permit Ren wal ~-
i
~ e ~ermit Revision ^ Change of ^ Permit Transfer to New I Ltst Previous Permit Number and Date Issued ~
} 'Before Expiration Plumber Owner '
i N. T of PdWTS System: (Check all that apply) ^~i _-T ~d ~~ ~ ~/ ~~ ~
I Non -Pressurized In-Ground ^ Mound > 24 in. of suitable sail ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter
^ Corstructed Wetland ^ Pressurized n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filler i
^ Recirculating Synthetic Media Filter caching Chambet C Dri _ ~~ h„ they (explain I
V. Dis ersal/Treatment Area Infer ation:_ ~ c.L , .~ , y ~ ---------III
Design Flow (gpd) Design Soil Application Rate(gpdsf) Disp Re aired st Di posed (sf) }System Elevation
VL 'Tank Info Capacity in Total Number Manufacturer -~~ Prefab Siie Steel fiber ~ Plastic
Gallons Gallons of U[rirs Concrete Constructed ~ lass
New Exis[ing ~ i
Tanks Tanks I II
Set tic. nr Holding Tank + --- -
~ Aerobic Treatment Unit --
I~ Dosing Chamber -i= ' ' r J
~ VII.-Responsibility Statement- I, the undersigned, assttme responsibility for lns Ration of the POWTS shaw•nfon the attached plate. _ _
Plumber's Na me (Print) ~ plurrtber's Si gnaiure P! PRS Number Business Phone A'umber
6tJ,`ll: n~ ~'G7 4zlir~ a ~~y~~~---~- ~~ ~91~ 7i 5'-3 ~~'-- 3r.~ r
rPlumbar's Addre ss (Street, City, State, Zip Code)
! aid ~'c-~ tom' ~~ ~'cy ..~,-` ,5`~~~
VIIL oust /De arttnent Use Onl ~~
pproved 0 Disapproved Sanitary Permit Fee {includes Groundwater Date ssue uing Age t Signature Stamps}
Surcharge Fee) ,(~ r--js ` Q~ -7 ~/ D j ` `
^ Owner Given Reason tirr Denial ~fJ -~ V 7 ~~~ ~'~~~i~
1X. Conditions of Approval/Reasons for Disa proval
YiA.~J yt~a~ ~2r~- l~_ '" ` G:a~z-rte .~ h~ ~ ~
~~~Z~ ~-1,~ ~~ ~'~-~' ~ ~ `~~ did ~, o
Attach complete plans (to We County only) Por the systetn on paper rwt less then 8111 x 11 inches in slze -__J
SBD-6398 (R. 01/03)
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w•rsconsin Departmer-t of Commerce SOIL EVALUATION REPORT Page ~ at
Division of Safety and BuAd'utgs
m accordance wmi t;omm aa, tors. nam. wde - ~
County
t
11 i
i
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Pl
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8
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Attach r:omplet
stee plan on paper rat
1
indude, but not limited to: vertical and horimrrtal refenmce point (BM), direction and p~ lD
~ ' 22 -f~~
--
percent sbpe, scale or dlmensbns, north anow, apolocatloaaoddismucata,ooarast~ road. 3
O
Please print all Inft~rmaf ~ ~ ~ ~ ~ eviewed Date
Pemond ivvrovmarbn yw, provide msy be used f ry puryoses (Pfiraey Lev.. s. 15.b4 (1 ~ (m)). ~ ~ 2/ (~
Property Owner
~~ ~ ~; ? ~ ~ Z ~perty ovation .
~
~ ' ~ ~ u Govt Lot f
' ~ 1/ ~ 1/4 S ZS T N R E (orJ®
Property t~vner ailing Address ` ~ l ~' '~ ' Bbdc # Subs, Name or ~SM# //~
City State Z1p Code Phone Number ~; ^ City ^ village [~ Town Nearest Road
~~
' f ~ ~
.
t~.~, d )
i uc
New Construdron Use: ® Residential i Number of bedrooms _~~ Code derived design flow rate ~ ~ ~~/ 0 a GPD
^ Replacement ^ Public or commercial -Describe:
Parent material _ ~ C~~--C.~-1Gi S [.~ _______ Fbod Plain elevation if applicable ~_,- iLU~ ft.
General wmments (ys~ P r/~ ~1 e v . 9'~/
and recommendations: ?
Boring # r~(~7 ~g p~~/
i~r pit Ground surface elev. _ l ~ 1 ~ R. Depth to limiting factor _~_~ in.
Sod A lica6on Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft=
in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Eff#1 •Eff#2
Z 2 l~ -- s ~ ,~-~'r- ~ ~ to
z- - s ~ _ P ~ lz
Boring # ~ Bonng
pit Ground surface elev. ~_~~_ ft. Depth to NmiGng factor ~z in.
Sod A ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fi=
in. Munsell Qu. Sz. ConL Cobr Gr. Sz. Sh. •Eff#1 'Eff#2
I - Z a y ~ S os ~ l - , ~-- I-
Eftluerit 1t1 = BOD > 30 <_ 220 mg/L and TSS >30 <_ 150 rnglL 'Effluent if2 = BOD < 30 mg/L and TSS < 30 mglL
CST (Please P ' t) Si re ~ CST ~~ r
cr i~ ~
Address Date Evaluation Conducted Telephone Number
~ of
e
Parcel ID # ~o ~ L Z
---- __
Pag
Property Owner ~----- - ~~
//
BO~g # ^ Boring ~ n
e eleV
rf ', ~~
,,
Deptn tD Iirniting factor _1~--~-•- in• SoB icatbn Ra
=
Ground su
Pit ac
•
Redox Description Texture
Structu-e Consistence Boundary
Rests GPDfff
~Eff#'I •Eft#2
Hor¢on Depth
in Dominant Color
M~cery
Qu. Sz. Cant Cobr
` Gr. Sz. Sh.
~
,
, ..5 F
U
I
S ~
r
1 a -i3 ~ ~ 3lz
GI
S ~
~ •
-
Z 2 ~ . _
l/ ~ ~ I ~ lip //
Boring Soif A icatlon Rat
^ Boring # :Ground surface elev. _--- ft. Depth to limi5ng factor ___~ in.
^ Pit Roots GPDIfg
th Dominant Cobr Redox pescription Texture Structure Consrstence Boundary 'Eff#1 'Eff#2
Horan DeP Gr. Sz Sh.
in Mansell Qu. Sz. Gont Cobr
^ Boring # Depth to limiting factor --f.- ~n•
^ Borin9 # Ground surface elev. Sod A icatron Rat
^ Pit GPDfff'
Horon Depth Dominant Cobr Redox Desription Texture Sttidure Consistence Boundary Rooms 'Eff#~ •Eff#2
Qu. Sz. Cont Cobr Gr. Sz Sh.
in. MunseN J
• Eii4ient fk`2 = 8OD5 <_ 30 mgl~ and TSS <_ 30 mglL
• E~uerd #1 = BODS> 30 < 220 mgll_ and TSS >30 <_ 150 mglL
The Department of Commerce is an equalo~portun~sceonta t the departmentrat 608-2166-3151 oa TI'Y 608-264-8777 services or
need material in an alternate f t, P
SBD-Hil01R.01100)
" '
PAGf.~Of~
NAIv1E: rum fir0"I"#~_LGGAL DESCRIP~'101/411/`i,~~"I~-~-•rJ,tt,~'C(~~~
SCALE: 1 "_ ~~ i
- _ - ~
~~ ELEVATION: ~4c~ ~
~ _
Bhi l DL-SCRII'"I'IOIJ:~ 3 ~.re~ Gr-S'~~
BM 2 ELEVA"I ION:
BNI 2 DESCRII''I'IOi`J:
SYS"I'Etvl ELEV~"I'I~ )~J:__~! . ~ D-
S}'S'I'ETvi '1'Y PI.: ~C'JIl 12 ~~~~ --_-
~ ~
d~
Safety and Buildings Division County ~ --,
~ 201 W. Washington Ave., P.O. Box 7162 S ~CY'o r`
~~~Ons~~ Madison, WI 53707 - 7162 Sanitary Permit Number (zo be filled in by Co.}
D~ ertment of Commerce (608) 266-3151 ~Z
Sanitary Permit Application State Plan I, D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondar
ur
oses p
iv
L
15
0
p
y p
r
acy
aw, s
.
4(1)(rn) Project Address (if different than mailing address}
I. Application Information -Please Print A!i Inform n ~ E C E I V E ~.~ ~~
l
la t~~
Praperry Owner's Na me ~,~, , .-L„y~L• ey /3 O Parcel # at # Block #
i_,NOV:,.O ~ 2Q~3 ~ ~2
Property Ow Mailing Address
iS7. GROiX CUUtV l Y Property Location
%"'
4= ? C1 ~ 7;' G d.Y` r vcQ - ~ ,4~F±i~~ ~~ ~ ~~
of ~
City
State N,Socdon
,
,Zip Code Phone Num er
5~` it x f~ r ~,5" Q ~~ ~ 9 {circle )
~ ~
II. Type of Building (check all at apply) a~
S ~,,,,~,~ N; R
B
~
or 2 Fatn!!y Dwelling - Number o rooms Subdivision Name CSM Number
^ Pubtic/Cotnntercit-l-Describe Use .,5~ ,- ~.°~c/i~(~ ,`
p.~
^ State Owned -Describe Use 2 tX O -f • ~ r-a. ~ ^City_LVillag~Towtuhip of~,~'sQ~/
III. Type of Permit: {Check only ane box line A. olnplete line B if appy p Zo - ( `1 S - ZZ - OafiO 2 /
A' New System ' ' ^ Replacement Syste ^ TreatmendHolding Tank lacement Only ^ Other Mod' c ion to Exis 'ng
$. ^ Fermat Renewal ^ Permit Revision Change of ^ ermiz Transfer to New List Previou m `Date Issued
Before Pxpiration PI lxr i
ner
i[V. T of PC3WTS S stem: (Check al[ that a I) -
~Non -Pressurized In-Ground ^ Mound > 24 in. of suitable s ~ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter
^ Constructed Wetland ^ Pressurized In-Ground ^ Holding T ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter
^ Recircula ' SynUtetie Media Palter Leachin Chamber Line ^ GraveI-less Pipe ^ Other (explain)
V. rsa]/Treatment Area Information: ,~/ ~cr
Design Fvlow (gpd} Design Soil Application Rate(gpdsf) i r I Ar Required (sf) Dispersal Aree ProQp'o~sed s0 System Elev lion
~
~,•~
'~t~r~ 0 r~ Vs"
~
~
p.
VI. Tank Info Capacity in Tote! Num r anufacturer Prefab Site Stee
Gallons Gallons of 'ts Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank ~ /~~
~`CSCj
Aerobic Treatment Unit
Dosing Chamber ~ ~`d~ ~ G~~ "e5' ~ Y
ViL"Responsibility Statement- I, th! rind ed, assume responsibility for on of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plu s Si gnature M PR Number Business Phone Number
" l `Qr~ Sc~k sr.ei!'~c~y~ ~ o~'o? ~ 4 7!~' • 3 d''G-.31.2/
Plumber's Addre ss (Street, Ciry, State, Zi ode)
ld ~ D s'a..v~, ~ ~~COI
VIII. Count 1De ent Use
Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued lssui Agent Signantre (No Stamps)
^ Owrcer Given Reason for Denial Surcharge Fee)
2 ~ . /! Zem3
1X. Conditions of Approval/Reasons for Disapproval ~ ~~ ~ ~ ~~~~ NZ ~~
1 c
SYSTEM OWNER: /
-
1 Septic tank, effluent fitter and ,~Ti,H,~ tv.~~~ ~ S u-~wk'`~ ~ S
dispersal cell must all be serviced /maintained ~ n ~~~ ~~I~ ~~ ( I
t i
S~ w-dC ~
as per management plan provided by plumber
!
.
2. All setback requirements must be maintained
'~L as per applicable code/ordinances.
Attach compfele plans (to the County only) Por the system on paper not les9 thaw 81/2 x 11 inches is size
SBD-6398 (R. O1 /03}
' 'H
. ~ ~~~,16G2P~~289
648604
DOCj"°^~ ° KATHLEEN N. WRLSN '
' °' ~° REGISTER OF DEEDS
' 1,.3o~r r+wn•~ ~cea ST• CROIX CO., WI
RECEIVED FOR RECORD
•• - ' 46-IA-2001 12:55 PM
I-_ .
YARRANiY DEED
EXEMPT M
CERT CDPY FEE:
COPY FEE:
TRANSFER FEE: 9900.00
• ~SDING FEE: 31,00•
~. Raeoediot Aaea
' Name amt Ae<am Add~st
t.~,.l T. -~ le, I r ~ .
X900 ~Dilvcr Lwke
Nt ~ a ri
~( ~ ~ MN 5~/I Z
OZo - t 064' - 70 - oo v
raKd Yas~s~m,a xamber (per
(~ZU-(06Y-~SO•-dUp -
OZ o - I O6y -yD _ o00
U 20 - 1070 ' too - Clop
020 - /070 ~ ~~ -ovp
U 20 - 10 ~b - zo -~
"PHIS PAGB IS PART OF THIS LEGAL DO(.'DNE1~ - DO
~GG
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7LG io[°mrtioa aautbe oompLed yj, Wmwec: ¢~„~ dde
t~s ~°., ktat 4rat
~+4~ ~; Ute oJd4 cvher pas ~ ~ ~ ice °•° ~ ~ ~ or Mo7 bar pt~/~ ~ ds
Pate a your dady~ent and !3.017 w dK rceo~$a et Wircaruin P.S 7 H7PDA 2/S16
~~,
~~! 1G62P~<<291
EXHIBIT A
Parcel Identification Numbers
020-1069-70-000
020-1069-80-000
020-1069-90-000
020-1070-00-000
020-1070-10-000
020-1070-20-000
r.
' DOCUMENT NO.
-_ a'AIIM.NTY DEBD
2rO~~r,-. BTAT[ OF Wt/CON/IN-FORM /
VQi. ~~~"~" "'` tNla /FACt Raa[RV6D FOR R{CORDINO DATA ,
THSS INDENTURE, Madc b .RICHARD .N... PEARSON and JEAN M. '
PEARSON, husband and t~ife, ..... ..........................
grantor_s.. of..._St. Croix ........................................................County, Wisconsin,.
hpteb conveys and wartants to..._~1~?IAGE„HOMES XXI INC. , a ,~
M1nn~sota corporation, ...._........_! ........................._.
.... ,
........
Wash~ingEon ~tMwn~tgrauree..._... of
......._:...__ .................._.._.._........................-........Count , >~pffa~7~61i( ~~``
~?ir_pollar,. and no 100 1.00... and..other ood and rvaluable fj;
• ..........-. .................... R[TYRN TO L Ll Nf. T l ~ ~ L'
CQl?.5 ~SI~F..?tl,orl...._......... .......,.
................................................................................. ..._.....:.;7Sfi~i~/Y3 /6/L`c Srl/r~ Ltcf~el~.
......_.........._.._ .............._..........._......_.................................._................---....-.........._........ , 5 f 1 v c /
the followiag tract of land ;n....S~.r...CL01)C-_,•,,,.,•.-.•_. rL'F•~' „r, Jh~"~~ y)/1./
................................Goan ss// L
Wiscoasin: .i?+l.]...C~...k1?e..N4r..Zhw~S.t--QS?ari<er,,,((~y~TsA•~ and,.,(Vor~h._Half (N~) of the Southwest
Quarter ($W~) of Section Twenty-Five (2S), Township Twenty-Nine (29) North, Range
Nineteen (19) West, st. Croix County, Wisconsin, except Lot One of Certified Survey
Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register
of Deeds, as Document No. 518449.
See Attached Exhibit A
Parcel Identification Number
This is not homestead property
ID Witness Whereof the said grantor. S_. haVe...... hereunto set.........their hands... and seals.... this
......._......_........... day of.._!~aY ........................................ A. D., YD(_2QOJ. ............
BIDNEp AND BRACED IN PAEBENCE.OF
.................................... ... .....~ -- .(SEAL)
(~~~Sp ~ ..............................................................................................(SEAL)
St~tt: of to
„ WasttingtOn __ County. Personally came before me, this.?~:.'~`. day of.. ~.`.-~ .............. A. D., ~C.,,ZQOl
the above named ._RICHARD N,. ON and JEAN M. PEARSON husband and wife
to me known to be the persoll5.... who executed the foregoing instrument and acknowledged the same.
TNI/ IN/TRUMENT WA/ D AFT,~e Y ~ a~vN-OUNTAIN
Richard J. Gabr>.e~, i~2~64
N swi T Notary Public, . w~' ,
880 Sibley Memorial Hwy., X114 ~' NOTARY PUBLIC-MINNESOTA Countq, W;s:
~R~~~s-~-ea:, s.~a°-1736 ~ My Cantu. Expires Jan. 31. 2005
lfy commission (a# ' ...._ .............._..
(SMion 79.)1 (1) d the ~iuauin RrNtp pro•idn Ihst ail inatromeMS to bn raewdiy shall have plainly printed a typerrinen thereon
the names of the pamaa, Grantee, ritnu,et and notary. Section )9.)lj aiatiluly rtxWiro that the turns of the pecan rhe, ar aoverm
WARRANTY DCED T rhuh, dratted each iiralR,ment, shall Le printed, typnrnr~, Ramped or written thereoe in a Ieaihle manner.)
STATE OF WISCONSIN wtaeonem I,eRd Blank Dom/avT
FORT( No. 1 llnwaukae. wte. (labs7art 1
~~ ry-~ -e ~a~n ~ s .~ -~c_ ,t o ~ ~2 ~'e e,..c% ` ~ ~G`~ `llS C~~,y a ~ t5'~ ~S'or./
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lllhswnsin Department of Commerce ' - SOIL EVALUATJON REPORT ~{ Page I of
t3ivision bf utifeiy and Buildings /-i ,~~~t ~a.~~~h/ _ __
m aoooroance wim wmm ~, vvis. narri. was ~~ --
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ch~co ~ oleo on paper not Iece than 8
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-~ vertical and horizontal 'P_ t ( '1(A),'dir and
indude, b
percent slops. ;,.,G.. ,.. dimensbns, north arrow n and distarrc8 ~ crest road. Parcel LD.
Q Z U - l ~ ~ ~ ~ ~" Q~ v
P-~~ ~t as ~ .~•
~~ ~,, Date
y
~tivaaY Law. s M {1) (m))..
Personal information you provide may bs used for dary ~
property Owner ~
~
-- ,,
9 ~l~i~ 7 ~! ~~iQ~ P , , Locatbn
~~~!"w
- .:1C.J ~ . ~
. , _ LgC~tX ___ `,~
Govt, IV t 1/4 N W1/4 S Z 5 T 2, 9 N R l 9 E (~>~J
Property Owner's Mai~rig Address ;"" ~- ,. ~
pFFICE Bbdc # Subd. Name or CSMl~
~
w~ Z O S-~ ~ ~ ~ wad' -`> .; S e
City State Zip Code Ph ;; . ~ City ^ Ydlage (,~ Town Nearest Road
<S~"i: I L wa.~r VYt v~.. ~'SQ ~Z ( b~i') - s ~<. ~ n -, 2d.
® New Construction lJse: ® Residential / Number of bedrooms 3 _ `{ Code derived design flow rate DSO ~(o O O GPD
^ Replaoerrient ^ PubFc or oommerGial -Describe:
Parent material DUfcr•Ja.S (~ Food Pla'}.eN~vation iF 'N ~4 _ ft
General cammerits S ~ S ~ rrt G l e V0. f.b n - °- ~ • So [~'~ /~ Yidi~,`fJ ~ vs~
and recxtmmendations: .~ J 0.J-. d -~. - . ' . ~ I n ~-'11 !~/~~h~L ~a;~~~
. ~. (..~. 1 9 2 . So ~~~-
~r-u2ctta~ w~-c.~~C --~..~,c~e_-fa .s~i~4.,~-- sys'-~~-. 0~- u~vy s~d~ ~~-c~.e~
goring `~ ys.~iw, - 2XX.U ~ .(~ ~~ cvl 7~ u ~- ~-
^Boring #
Lp Pit Ground surface elev. y • I ft Depth to lima
to
Horizon Depth.
in. Dominant Cobr
MunseU Redox Description
QU. Sz. Coot Cobr Texture Strudui
Gr. Sz.
1 c~-1 Z 10 r 31 z - L S ~ mS~
Z 12-wv I ,~41~ `- ~ mS Q~
q~•~
,L ~ - 2 ct~' `l2. DSO ~
I~•Z Z
~-- G~=~
,~'ti~z~-c~k Sys-
~~ ~- ~~ ~~
Z ~ # ®~~ Ground surface elev. 4y .9t1 ft Depth to IRn ~,'~M~ -~~/1~ '"~ ~a~ ~ ~ ~
~ ~~-2-rj ~ ~ 8 ~ I ~ '~
Horznon Depth Dominant Cob Redox Description Texture Strudu
in. Munsell Qu. Sz. Coot Cobr Gr. Sz. Sh. 'Eff#1 *Eff#2
'Effluent #1 = BOD_ > 30 < 220 moll and TSS >30 < 1 50 ma/L ' Effluent #2 = BOD< < 30 mglL and TSS < 30 mglL
CST Name (Please Print) Signs re - CST Number
~G~ ~~ ~ wok e.r~ ~ ~~~~--~ Z ~~~~09 ~
Address Date Evaluation Conducted Telephone Number
211 go~''S~ - .Sow-,e~se~, t9Jr 5~fozs ~-~-rn ~~is~2y"7-~{oDg
. r
Property owner /~.r k~ ~ ~,
Parcel ID #
,,x
Page. z ,
3 Boring # ~ Bow ~ _
®Pit Ground surface elev. ~ 3 . ~0 ft. Depth to limiting factor l ~ ~ in. Soil lication Rate
D
th ant Color
D
i Redox Description Texture Structure Consistence Boundary Roots GP D/ig
Horizon ep
in. om
n
Munsell Qu. Sz. Cont Cobs Gr. Sz Sh: "Eff#1 *Eff#2
I ~--I ~ l,-ns~ ,-~-~ -~-~ ~S I v ~ ~ f , ~
z IZ- i ~i
_.
^ Boring # [-~ Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in. Soft lir:atior- Rate
n
H
i De
th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
or
zo p
in. Munsell _
Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 *Eff#2
Boring # ^ ~~
^ Pit Ground surface elev. ft .Depth to limiting factor in.
Sal licatbn Rate
Horizon Depth Dominant Cob Redox Descriptbn Texture .Structure Consistence Boundary Roots GPD/fl?
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *EfF#1 *Eff#2
"Effluent #1 = BODS > 30 < 220 n~/l. and TSS >30 <_ 150 mglL * Effluent #2 =GODS < 30 mglL and. TSS _< ~ 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.
SBD-8330 (807/00)
r, Y •
~ • r .
. ~ !
PAGE ~ OF~_
NAME IQ• Y` K -~ ~ I LOT# Z Z LEGAL DESCRIPTIONro F'/4,Uw'/4,S zsT z a N,R I g E (or~
SCALE: 1"= yU
BM I ELEVATION_ /OU • d
~~ ~
BM 1 DESCRIl'TION na; ~ ~ •~ (~ ~~ o u'~ - ~
BM 2 ELEVATION v • ~ ~ ~ See, ~S
BM 2 DESCRIPTION nu ; l i• n R " DoPA,^~
SYSTEM ELEVATION G I ~ S O
ALTERNATE ELEVATION q Z • SO
CONTOUR ELEVATION 4N• ~ y q$ , y U
~~
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SEPTIC TANK E PUMP CHAM3ER CROSS SECT ANG sPECIFICATIONS
~~
4" CI VENT PIPE 1.2" MIN. ABOVE GRADE ~ WEATNERPROOP
JUNCTION HOX
APPROVED
>_ 25' FROM DOOR, WINDOW OR WITH CONDUIT MANFiGLE COVER
FRESH AIR INTAKE ~ W/ PADLOCK ~ ~
WARDING LABEL
FINISHED GRADE 1
~+" CT RISER i~_u~~ MIN.
~ +a
1$" IN . g" MAX . ' `: ~
NLET L t
' '
~,
WATER TIGHT SEALS
~ -~" i
TIGHT ~ 1',
APPROVED
~ SEAL ~ JOINTS WITH
_ ALM APPROVED PIPE
PPROVEO ~ B ' ON 3 ON7d
3' SOIYD SdIL
1~T0 St?lID ~ ~ ~
~
OIL
PUMP OFF ELEV. FT.
----° ...~.
OFF ~~ RISER EXIT
PERMITTED ONLY
D IF TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED.. BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
S£P`TIC / DOSE
TANK MANUFACTURER: ~~,'~5~r'
TANK S~ I ZES : SEPTIC 1D~1d' GAL
DOSE G S'6,,,,_ GAL .
ALARM MANUFACTURER:
MODEL NUMBER:
SWITCH TYPE:
PUMP MANUFACTURER
MODEL NUMBER:
SWITCH TYPE:
REQUIRED DISCHARGE
~ ~. y .-
~ri ~ s- ~
~ac~•.%~ ....,
~t'/ D '~
~ri,e ~^ c
RATE ~_ GPM
NUMBER DOSES PER DAY : ~ ,,,_„
DOSE VOLUME INCLUDING
F LOWBAC K :~_ GAL .
CAPACITIES: A = ~ INCHES = •___~Y __GAL.
B ~ 2 INCHES = -~~ GAL.
C = $ INCHES =~~GAL.
D = ~ INCHES = ,~ ~~ SAE •
PUMP E ALARM WIRING AS PER ILHR 16.23 WAC
b'ERTICAL DIFFERENCE s3ETWEEN PUMP GFF AND DISTRIBUTION PIPE _..L_., FEET
+ MINIMUM NETWORK SUPPLY PRESSURE -~ FEET
+ ~ FEET FORCEMAIN X ~.G FTI100 FT. FRICTION FACTOR ~ FEET
TOTAL DYNAMIC HEAD = l3~FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH________; DIAMETER _______
LIQUID ~EI3fiAr D „ ~G ..~ /~~c x• ~ ,.
SIGNED: ~,,.~k~--~,c~~'~~'° LICENSE M7MBER: a2~79~d DATE: 3 1~~
i/88
~~~
r~
a)
~not~
~tttody tarttn
. g ~brtae .
* F+srcrit
~~m4
• O~ews!'erNt~
~AttQlli
Ptp~p: X04
• Scat ~ gip~l~r,
}1~' rnximum.
~: up to 36 C~f'M.
• ~"oiet howl:{: ~D to 2~ te~rt,
• Ditdl~frpe else: i'h' t~'r
• Med-ru-ldei ~iai: cerbon-
ro--t~~tl~~~++/OlNr+110~tiQtq-ry,
BW~1~N elttftortNre~
i '
~tK {4ti"C) aoi~nuous
14Q'F ) l~rrrdttir-t.
• Fes; 3t~ ee~ries
~~
• dwN >a~ut d ~ to
~~r
• rrwc~ntu~~.p gpttl~{ity:
• titta: tip to 6f~ i~hAll.
• 'ir made. up to 3l.,t~eerr. .
• M~ etz~ 1~~ 1K'!.
• (4iY0fW1101i Nsfie: f;#tbaft•
~~ ~ ~~
~ 10~~ o0!#ttuJOlte
14Q'f .#~ ~ta~'t~,tent,
I! tOMI Pltll~ Sf1C.
• F~tNrt: 300 series
t ~+~.
• Cfpiblf Of NRf1irtD
~itaottlrlgt~~e #o
till~Ot;
• ipQ4 6~ pt~as~:Oro FIP,
115 or , 60 Mz,1530
RPM, built to owrbe#d with
eutomalC rent
• ~n k phase: Q.5 HP,
115t ~OG~f'tz, t550 I~PMr
b8idbodktitl!C~t~6t.
• Powsc ca~d:10 foat
rtar~dNd tert,~t+,18/3 S,i'3'C
wkh tlwre Fran4 ~roun~i!np
ie!u+ 0~, t~ w(i~r
`h~tro ~gfinp piup
tes"rs~a ~r
iQ~
~ ~
a ~
6
t6
4
3 ~0
1 r w~ r
~~.~ J U I' J v ~r'1 ~.
Submersible
Effluent Pump
16~1~~-~
3871 E
0
• Fully aabmerplcf in high
pry tu~r~ oli for
lubtti~n ux! emit
heat trtraier.
kw for •t~it~Ntc ted
muia~ apu~toa Aataa~a
m leelusle dal
fiv~t iwtMh anunbleA end
pnpt dtbe teolatt.
l~lTliAdS
r ~ lmpr,lNr fiermo-
pfaet~c Srm dat~n
with pump out wave for
maCtw~lG~! ~ protection.
~ EP06 Mlps#i~ei'; fierm4
plastic enalond deetpn for
improved pertOrtrwtCe.
• ~>!d Yee; Rtr~ed
therm~~ desrpn provides
superior strer~gi and
corroeian~ rem.
• ti~Itt l~tinQ; Cat iron
for ~ N1et tnmtter,
ebrettpgt, did ~ursb~ily.
s Mo~'Co~ia: 'C%rmapias-
tic t>ova with iii t~die
s~wttoh ~ht
f Pawwerr C=ba; Swera tluty
n>i~ oe ~ wesar ftiL
^ ; per anei i0wur
uy~~ da~yy bet! beui~q
a~etnrolion.
~a~or u~~
~r es~
(CRA made- rwmt~re
end M "F" Ot "AC'.}
_ ~
~ I ....._-•
f
.__,~._.... ~
~ i
~ .i...,._.
f
~ i ~
~
~~,
~~
~
1
... ,
i
_.._..~~
i ~
~~
iQ itP ~ w au wren
~ ~~
ir~i~t~ r "' ~.'= ::
,: ,
~. , y k'l1~lIItY, ffl83
.Q
rr
~' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of ~
Owner
1 Permit # 3 p r,-Z~ _ ~
nee~n_u awOA~ueTCQS
Vfa{~71~ rrN r+~-~r-ww
3 O NA
Number of Bedrooms
Number of Public Facility Units A
Estimated flow (average) ~f SD al/da
Design flow tpeak}, (Estimated x 1.5i Q slide
Soil Application Rate slide lft~
Standard influant/Effluent Quality Monthly average•
Fats, Oil & t3reasa {FOG} 530 mglL
{3iochemicat Oxygen Demand iBODs) 5220 mg/L O NA
Total Suspended Solids {TSS) 5150 mg/L
Pretreated Effluent Qualhy Monthly average
Biochemical Oxygen Demand (i30D6) S30 mg/L
Total Suspended Solids ITSS) 530 mg/L O NA
Fecal Coliform {geometric mean) 510` cfu/100mi
Maximum Effluent Particle Size Y, in dia. ^ NA
Other: ^ NA
"Values typical for domestic wastewater and septk tank effluent.
MAINTENANCE SCHEDULE
Service Eveat Service Frequsnay
mont s} (Maximum 3 years) ^ NA
Inspect condition of tankls} At least once every: earls)
When combined sludge and scum equals one-third {Y3! of tank volume DNA
Pump aut contents of tank(s)
st once every:
At l monthtsl (Maximum 3 yearsi
~ ~
ar(s) DNA
Inspect dispersal cell(si ea e
monthts} DNA
Clean effluent filter At Least once every: , earls}
^ monthts) ^ NA
inspect pump, pump controls & alarm At least once every: ~-- {~ yearisl
' ^ manthisl ^ NA
Flush laterals and pressure test At least once every: r-- ^ earisl
^ montfits} DNA
Other: At least once every: p years!
^ NA
8ther:
MAINTENANCE iNSTRt1CT1ONS
inspections of tanks and dispersal cells shall be made by an individual carrying ane of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servioing 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 far any back up or pending of effluent on the ground surface.
The dispersal cellis} shatl be visually inspected to check the effluent levels in the observation pipes and to check #or any pending
of a#ftuent on the ground surface. The pending 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 {Y31 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,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmen~
units, and any servicing at intervals of 512 months, shalt be performed by a certified pOWTS Maintainer.
A service report shaA be provided to the local regulatory authority within 10 days of completion of any service event.
Page ~ of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tanks! for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have i<he contents
of the tank(s) -emoved 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 cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. Ta avoid this,shuation have the contents of the pump Lank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Oo not drive or park vehicles aver tanks and dispersal calls. 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 fallowing from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dente! floes; 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 out of service the fallowing steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm $3.33, Wisconsin Administrative Cods:
• Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shaft 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 falls and cannot be repair ~he foil wing me uic@s ve been, or. must ba taken, to provide a code aampliant
replacement system: ~ l~~ ~ V-aQ ,
A suitable rs iac~,ent area has been evaluated and may be utii~zed for t e location of a replacement soi{ 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
resuh in the Head far 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.
~/p ^ 8 Site
e tank
^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNINfs > >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL DASSES 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.
ADDfTIONAL COMMENTS
POWTS_ INSTALLER
Name ~~``j,'u ~,,., yr~ ~Y
Phone 7 C - _ ~ ,- ~
POWTS MAINTAINER
Name
Phone
SEPTAG@ SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name / CCU t ~nl /-~
Phone Phone ~
Tills document was drafted in compliance with Chapter Comm 83.ZZ{Zi(bi{13{dl~{f) and 83.5411 i, (Zi & (31, Wisconsin Administrative Code.
Nov-14-03 1Z:3~P joe bonfe 651 734 9836 P.O1
FkUr1 : SChH~r1'~ER Fi_UMR ! NI i FAX N0. : 7153°~~ 1 ? 1 Nr_w. 11 '~t[~ ~ ~? : 3'.~Pr'I P 1
.;,- o .
ST CROIX COCJIV"I`Y
SPp?IC' TANK Ms71---rr;-;t4I4I; .+G~'ci+d~IvT~
A 7.TJ~
.• ....
(1WNFD Cvin ~~ `i ii it h 1 AVl11 tIIKLV!
Uwner/BUver ~l`,1n~ ~ '~'~ 6 -~ .L ~ V ~
/ t ~ s Y- S -j- /1 t ..
1 11d~i1.~~ 4 .+a. ~~ "3 ,;} / ~ ),!~
N ' y ,rncidress ~ Z . ~...~~ t 4 ~. Jl. rc ~ ~_~
(Verification reomred fmm PI,~»;,.,. n,.
'~~ !State ~ rv t ~:,,wi :dcntiftcauon Number X20 ^. I~°JS - Z'Z.-_~tJt~
[.F,w~ai. n1~SiCyrn~n~.~ Co ~~ (01
1'roperiy Location ~ ~- %, N' ~/ ~/ Sec. Z 5 ~ I Z
_ ~,
;subdivision ~ ~ ( ` 'Z.2
Certified Survey Map f!
Voluttt~ ~..--- Yage # ~.--- .
Warranty Deed # T" 3 ~ Ib ,Volume ~ pale # SoZ~ .
~~ ~.
Lot lines identifiahl~ 11 ..P~ n ...,
~X;'1',~-11~ MA7NTENA(Y_C~
Improper use and anaint~•--~eofyeur sepaic svs[em eoTalrl.r`•.+~t ~~ iry,..e-..~•..__ ~;~. ~` .~ 4 _ .,
COrlilSt6 OY ~ - ' -- r--".•-~'.. ••...•• a..++r..:-~a.ca- ~. upei•mli3TCla$IIGt
pump t~ ou! t]fe xpDC tank every thee! yeaKS or sooner, if nez+AWi by A I:~..~~P.1 ~~.~...•- ,ern-- .-.. ~ .
r.-•-~•~•- ••++~. rv.. -yui iutu iLe sysictR
cep aFieGr llle tutiCtioR O~ tt:e septic souk as s tnatltteAt STtRe itt the warts Afanneal ey.t.~.r
l~0 p<QDe1:TY ~C; a~iZ9 t0 SL~ft%[ tP St. tTAix ,Z0711n~+ nOrlitrtTTN"-Ir A r,•,*i~ir•i~nw i_~ .: .+ a..- .~.- .
~u+~aerpiumCer.Jo~a~aymanpl~b~er,resaieta:d 1 booralice o .., .•b;•c•• ~J y~ •,:r~~a .uai ur a
i. iii P tlttf tlSGdvurt~pEC vlTffYin , rhnr / Il rhP nr~ g~k...,.~~'L•:: ;.C.-a:.... .
Proper o raT copditi ~ -. way:+3fia sya~;u
Pe m$ cn t-ad/or (2) after iaspecrioy and tnrtnpine !if nae~ssarvl- tbP ee„rir -anY :.. T~~p ~r,.._ 2 ~~ c.a~ c.`;;::,:dc-
~'', ~. ~~~ ~+,e~siynen nave rcaa wt above requirettuats and agree to maintain tht private se~aRe di9va4al svsrem wir}t rtu ~rxndarAq
..., e..~ t---~..
-- .~.•y +~b,.aaa, dw aoi uy tiro i.-Cp~atttaent of C;ottuneCCe tnd tht pcparuncnt of NaRttal Itesoutzes. State of W i9tontin. rr?rtifirrrinn
~+ =`~w ••~'•t y ~~ ~~~~i~ Yyxauia iws been nr.uatzined ~usi be swttpleted and rcairaed to the 5t. Ctt>ia County Zoaiae Of'6cr. nrichin io
-~-•~ ~ ~ :fir.:: yce• c:piaatiun assts, -
UA1'L'
~-'WNER CER FY ATION
i lwtj certify tit alt statements on this form are true to the hest oftay (our) Irnowled,~t- t (tee) am (are) rite o++ner{s) of
,rc pn-Qerry aeSCntod ii)pve, by virtue of a watr8nty deed recorded in Rester of Deeds Office,
n
tl ~lti ti3
aaa... Any i»fnrrnatiop rbtt iz retie eeprcrcutsdmay rvSutt in tt1C tanitaay pcau~it being re.oi.cd ty thr. Zvniog Dop+trdrnent. *'+"'
•* include with r!s!s applieatreR: a stsntped wuraesty deed fsatre ttte Register of Deeds ot3ice
...: ~.•; ar :`e ;,e..ifs~« SL:.-.'Ly ~:xp ;~ t~:~rCrt~:..: a Cirieic ira ei~u weeraaty aced
i
U 2434P 52?
• STATE BAR OF WISCONSIN FORM 1 - 1998
Docum~t Numbs WARRANTY DEED
OZ(}-1395-22.000
Parcel Identification Nwnber (P1N)
THIS DEED, made between Classic Home Design, Inc. a Minnesota
Corporation, Grantor, and Bonfe Home Builders, Inc. a Minnesota
Corporation, Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, Stan of Wisconsin (the
"Property"):
SEE ATTACHED EXHIBTT A
This is not homestead property.
Together with at1 appttrteaant rights, title and interests.
Grantor warrants that the d@e to the Property is good, indefeasible in
fee simple and free and clear of encumbrances except
Dated this 10th day of October, 2003.
CUISSIC ESIGN, INC.
ucr (SEAL)
' Steven J. May, President
(SEAL)
AUTHENTICATION
Signanue(s)
authenticated this 10th day of October, 2003
s
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. State.)
THIS INSTRUMENT WAS DRAFTED BY
Greg Booth Attorney 1900 silver Lake Road New
Brighton Ma 55112
(Signatures may be authenticated or acknowledged. Both are
not necessary.)
'Name of pawns signing is any capacity imiat be typed or primal blow their
signature.
743~+9Q
KATHLEEN H. YALSN
REGISTER OF DEEDS
ST. CROIK CO. , WI
RECEIVED FOR RECORD
10/13/2003 12:30PN
WARRANTY DEED
EXEMGT I
REC FEE: 13.00
TRANS FEE: 297.80
COPY FEE:
CC FEE:
PAGES: 2
Rceordiag Area
Name and Return Address:
Lend Title Inc.
1900 Silver Lake Road
New Brighton Mn 55112
a-~l~C~~
•
ACKNOWLEDGMENT
STATE OF MINNESOTA
WASHINGTON COUNTY.
SS.
(SEAL)
(SEAL)
Personally came before me this 10th day of October, 2003,
the above named Steven 7 May President of Classic Homo
Design, Inc. a Minnesota Corporation to me !mown to be the
person(s) who executed the foregoing instrument and
acknowledge the same.
•
Notary Public, State f MINNESOTA
My commission is permanent. (If not, state expiration date:
~~
NANCY J. LENTZ
~,-~ NOTARY PUBUC•NIINNESOTA
MN Comm. Expires Jan. 31, 20Q5
~, -
.-.- .~ U 2't3y P 52a
LEGAL DESCRIPTION
Lot 22 Scenic Hills Subdivision, Town of Hudson, St Croix County,
sconsin, according to the recorded plat thereof
EXHIBIT "A"
FROM :SCHUMAKER'PLUMBING FAX N0. :7153863121
May- 17-64 Q4 : 49P ,ioe bonfv
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May. 20 2004 04:54PM P2
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DATE
~ ~~ ~~! Rn t~ta~ r ~ ten .n ~ a rile Dear of
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FROM :SCHUMAKER~PLUMBING FAX N0. :7153863121 May. 20 2004 04:53PM P1
Schyrr-a~'r~r Plarritb/n~
1070 SCOTT Rp
HUa$ON WI 54016
Phone K ~eoc (715} 386-31 ~ 1
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