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020-1395-68-000
wigco~isin OepartmentofCommerce PRIVATE SEWAGE SYSTEM Safety and Building Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Manchester Homes Hudson, Town of CST BM Elev: ~ Insp. BM Elev: BM Description: < ~~ ~~,~a~k.. ~ TANK INFORMATION TYPE ;5, .MANUFACTURER CAPACITY x ~ ~ •,. Septic Dosing i•._'1 Aeration Holding TANK SETBACK INFORMATION en o it n a e ep is _ osmg ~~ , ;•, . ~, . era ion o mg PUMP/SIPHON INFORMATION anu ac urer eman i GPM "-. :,f~.,.;_...~_ ~ o e um er !y l i nc ion oss ys e.~} ea ~ orc main g ia. .. tl ,t JVIL ACSJVKI" I IVIV .~TJ I GIVI ; ~r`a `. ELEVATION DATA County: St. Croix Sanitary Permit No: ~ J~ 488157 e State Plan ID No: Parcel Tax No: 020-1395-68-000 Section/Town/Range/Map No: 25.29.19.2462 STATION BS HI FS ELEV. Benchmark ? , Alt. BM Bldg. Sewer ,~~ ~3. 3d t/Ht Inlet )~.~ ~~~ t t ut et t net 0 om , f ~+'. TLS ~/ D ~Q~~ ea er an. tn.~'E ~~, ~ is . ipe 1~- o . ys em I~,'}c m~ N ~`~'l.~ q~ 7 G'Uyt, DIMENSIONS -~ i-:'~' ~•~%` ` ~ . ~.~,. i}w7, , ~,'. INFORMATION CHAMBER R _~,.5, .''_.. I UNIT {, tf, O V I I V 14 J I J I GIYI neauevi iuwiu viauwuuvi ~ ~ ~ ~~~~ ~~-~ ....-'- -r--....~ - -- - _. 2 Pipe(s) _ ~._ _ ~ .J _ -_ ength Dia Length V ~ Dia Spacing t x Pressure Systems Only xx Mound Or At-Grade Systems Only Bed/Trench enter ,~ f Bed/Trench Edges Topsoil ~~ Yes ~] No ! ]Yes ~=_~ No ~OMMENYS:~ (Include code discrepencies, persons present, etc.) Inspection #1:,,,-. •-x-f -~:e Lf~~`,,'i-+~. Inspection ~z:-- - --r i --. Location: 724 Regal Ridge Hudson, WI 54016 (NW 1/4 SW 1/4 25 T29N R19W) Scenic Hills Lot 68~' ~~ Parcel No: 25.29.19 24F+,T~ 1.) Alt BM Description = ~ J ~fi~~'•~ ,. 2.) Bldg sewer length = ~•-~ 1 .: , )_ .~,, d ; ~ t ~ ., ~ '~/ . amount of cover = ;~ z<<- `ra-~ ,wtxr«,, , ~i. c ~r n e sr_ ~ a-'`l ~,; Plan revision Required? Yes No it 2 ~~ -j i ~ ~ ~ - - ''~ Use other side for additional information. III ~ J ` _ _ J ! ~ -@a /e- `-- - - oat's-Sig tore----- ~-Cert~ SBD-6710 (R.3/97) ---~-- salary and Buildings Djvision I 201 W iVar}1)ingtan Ave , P.O. Box 7162 i ~s~O~s~~ Madison, WI S37Q7 -- 7162 Department of Commerce (bt}8)26ti-3151 Sanitary Permit Applicat~4n l In accord with Comm 83.21, Wis. Adm. Code, personal irlfoematiun y County-- _-- ------- ~~ ~T C'y ' Sanitary Permit Humber (ta he filled in by Co.) ~($$ ~5 state Plan LD. Number --~ -----------._ ____ ._.., /vr, ' may be used far secondary purposes Privacy I.aw, s13.0a(1)(tp) ~ Project Address (if diffcrt;nt than mailing address) r.._...._~.._. _~.. ~ 1. Application Irtformatlon -Please Print All inforrntation ~ ~ ~ 72~ ~ ~r~ Property owner's Na me i parcel x __ -^'-- ~ _~ ~~ Block A' i ~ 'd.,tJ G e 7`tr S ~ ~.T ~~ ~ ~Q'~i, ~o~ ~ ~ ~ I Property Owner's M ailing Address Property i.ocatia ' ST. Cf3~Vk L1t~1Jt'i:T~ 1...._ ~ .Y1L_. S/ /~~L ~+ sif~Y ~ _ ~ ~/L~, k, .S[rS6,Secrion ~ J City, State Zip Code (Circle } .~~~~.a~% _. /lam __ i ~' ~~ ti's R1-~E o~ ____~x~I~L~ 1I. Type of Huiltiing (check al! that apply) ~ o t ~, - _.._ ___-- _ _~~ Subdivision Name CS!st iSumbcr ' or Z !~att]l Dw ~ ll d b ~ y , e tng - um er of Bedrewms ~ ~ ~ ~J _. ~ V"'' ~ !_~ PubliciCommere;ial -Describe Use `_-~_~ _ _~.~ -`_ i~ ~' eBNf`G ~ ' 1~ _ .._._.__ !!~~ ~ i-.i State Owned - Ucscribe lase _~ tJ-t5 ~~~ ZZ.'~"Z3 G ~t~5 ~ L'Ctty+^Village ~'ownship of~~~a(~.~ ~ 1II 'Ty(p~e~of Permit: (Check only one box on line A. Complete line B if applicable) ~ ~ -1.35 ~$ ~_ bO~ ~i A e e T ~ ' rr y w 3ystetn i-: itrplzcenx•,~t System ~ ~~ Treaiment/Hoiding Tank Iteglacemerri C)i,ly ~ ^ Other F9odification to Existin4 System ' f y ^ B • '~_i Permit Renewal ermit Revision ~_.l Change of (.E Permit Transfer to New 'List Previous Permit Number anti Uate Issued Before Expiration ~ Plumber ~ L____...., Owner LT~~ /c~ ~ ~ _ IV._T~p~e of pOWTS S~+stem: (Check all that apply) t et'S s_. --- ---- _....._._._._.~.. - - Nun -Pressurized lu-Ground i, ~ Muurd ~ 24 tn. of sellable soil ~) Mottnct ,; 24 in of suiwblr soil L~ At-Grady ~"-.~, Single Pass Sand Filter i L_1 Constructed Wetland ^ Pressurized Tn-Ground ~; Hardin Tank f_~ Peet pipet r~ $ ~ Aerobic Treatment Unit ~ Recirculating Sant t~il[er ! L.i Recirculating Synthetic Media Filter ,~' Leaching Chamber i.,a Drip Line !] €itltvel•less Pip e ~.~ Uth tr (explain) . Dispersal/Treatment Area lnfortnatlon: ~ ~ ~ _ ,n. _ _ IJ~sign Flow (gpd) Design Soil Application Rate(gp:lsf) 1 rJispersal Area Required (st) Dispersal Area Proposed (sfl System Elevation ' _ _ ~O'd / . ~ 7 ~ ~S 7 / :L ~ 7 l '~ i 3r .2 i~3e~aa/ euc/ '~ . ._ VI. Tank info i Capacity ill Total Number '~ lvtanufacturEr Gallons Cations ~ of Units lVrw Existing , ~ ' n Tank T k ~ ' ~~ ~ Prefab Sits St~l ; FiTbar ~plasnc Concrete Cunstrttctrd ~ Glass ' , ;~ ' s an s r_._..._,_.. _ __-_ _ l \ Septic or Hoktirg lank I -` ~_~ , i a4 ~~L ese ~ .__ _t._. --- ------ --- _. ._ Arrob!c Treatment Unit - i `"'°"' ~~- _ __ Dosiny Chamber ~ ~___,_.__~. ______, 'VII. Responsibllsty Statement- I, lire tinderci ed, assume respon9tbillty fnr ' • Nation qP the POwTS shown an the attached plans. Plumber's Na nee (Print) ~~-T'Plumtazr's Si gnature P' PI2,5 rlum't+er Business Phone ivumber ~ ~~~~ C N~ ~J /~ ey~~/_ /`7 ~~N/ ~~ ./t!i ~lf./"I~~L~Y ~~ ~ ~OL. ~ ~ ~ ~ /~ x..70 `~ r J~~ . ~ ~ 1 ~ . ~ ...-.»-...._~_. . Plumber's Adder ss (Street, City, State, Zip Coda} -_._.....~~._ /~74 ~~~~~~~ ~ VI1.I. Count JDe arOnent Use Oni _ Saniutr Permit Fee tncludds Ciroundwater~ ,.Approved ~~7 I7is ved Y C SurclsarYc Fee) ~ ~~ ~ Ob _ ~~ J t3wn r n Reaaon Denial `' ~~-- l Da Issu Iss.t R g p ~ in nt Si non i tarn 17/ / q ~~ / Q i ~. 4onmttuns oa ApprovalJRe:rsons far Dismpproval SYSTEM OWNER: s 1. Septic tank, effluent filter and ~ dispersal cell must all be servines I trtaiMairted as per management plan provided by plurpber. ~. AN setback nq~rrtents must ba maintained as pat app4cabl. coda, ctdin.ttta. Attach ,Z ---- ~'b r ~J ~~ i~c,.~,.~il.~~ Ll ~L. ~' . ~a~lPdL CSt 1 p No ~(~'- t~ fin.. ~ ~ i n.. 7~~~ ~~ ~ ~ ,~ , off. ----e~,~t~,,-=-_) oi-l ~) Poe :lie tyirtem on peter not let than 81/2 x 11 inches fo six '' 1 ~` t v' ~~ w\ ~: .~ a e `~ ~ ~ S d ~ ~ ~t ~ f ~~ ~ ~ ~° I' ~ ~ ) ~ - ~ ~-~ d~ c~ .~~ c~ 4 O t ~~ i ~$~ + ~ ~~-nom ~~ COPY a Wisconsin Department of Commerce ~_,,,,r.....-801L EVALUATION REPORT Division of Safety and Buildings „~,.~~ ~ in accordance with Comm 85, Wis. Adm. Code County ~( Attac ete site plan on paper not less than 8 7 /2 x t 1 inches in size. Plan must _. ~/ ...~ include, t limited to: vertical and horizontal reference point (SM}, direction and p Lp. percent slope, sc~®or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed b Personal information you provide maybe used for secondary purposes (Privacy Law, a. 75.04 (7) (m)). ,~ Property Owner Property Location ~ ~ e ~a.. ~ ~ vV~ Govt. Lot ~(/~~/ 1!4 S~l1l4 S,~S Property Owner's Mailing Address rr - ~ Lot # Block # Subd. Name or CSM~ O S~- ( t~Ja.-t~e ~ ~ t~ fv~ s(An (,t_. City State Zlp Code Phone Number ity , f Village own VY~ ci ~ ~Urr~pi i't, v~ S ~U.~I ( ) f-~-udSo r^ ® New Construction Use Residential /Number of bedrooms 3 ° ~~ Code derived design flow rate ~~ ~, ., ~~ ~ ~t X 3 7!' q~~O ~, Replacement 1 ~ Public or commeraal - D Parent material Ov-~-w ~ ~ ~ Flood Plain elevation if applicable ~~ General comments 5 S e G~ ~ Z~ ~~a w and recommendations: / v ~ ~~ ~~ ~ ~ Boring # ~ Boring Pit 9 ti~~6 ~VL 1 o~N~v S~.~R face e • Ydft. Depth to limiting factor /~~ in. .l~'e~f';itnli~ 'ration Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dtt>z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 f o- 9 0 3 _ S ~- m ~ im~' ~ C )~ v.~ ~~ ~ Z q-z5 /a ~/ `/ ~ m m ~ ~ ~ 1 v~ ~ ~ /L 5 -ll -~ ~S /r ~- - ~ ~- - .:~. Boring # l--~ Boring ~ v ~ ®Pit Ground surface elev. ~ft. Depth to limiting factor ~~ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I - c 3~3 - S L zm -~-~ r C S U f .~ j ~ r v/~ 1 .r b /, * Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Pri t) lgnature CST Number G~ ~ VI~101, _____- - O A/ddress ~ // Date Evaluation Conducted Telephone Number l6 ~ ~ /. ~ ~G~ ~// S`l~Ll S `3CJ -D~o 7/S-7~y0 -dL ~.. . . '. ,;" ~~ ~~_ ~~- Z~.}~ ~ ~x f aw ^.. ~, . ti -'' "fifes _ Parcel ID # /e' ~ C~ ~ R ~ound surface elev. ~ft. Depth to limiting factor ~~ ~ in. Page z dF~f' Soil A lication Rate Redox Description Texture Structure Consistence Boundary Roots GP DHg C!u. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I - SL m ~ ~ ,S ~ ~~ ~,~J ^ Boring # ^ ^ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell G?u. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 :.fi .~,~ .. ^ Boring # ~ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ~cartion Rate Horizon Depth Dominant Color Redox4~cription Texture Structure Consistence Boundary Roots GP Dlflz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mgiL and TSS >30 < t 50 ntgJL * Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-2648777. SBD-8330Test (R.07I00) :~~ ~~ ,. :~'. f ., Z ~. . 3; .j Boring # ^ Boring rt _.. ~M..._a _..~___ _ Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Strucwre Consistence Boundary Roots GPD/f~ in. Munsell C±u. Sz. Cont. Color Gr. Sz. Sh. '~Eff#1 'Eff#2 =ri,. ^ Boring # ~ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil A u~tion Rate Horizon Depth Dominant Color Redox ilraiption Texwre Structure Consistence Boundary Roots GP DJft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 `Effluent #1 = BODS> 30 < 220 mg/L and TSS X30 < 150 mgJL * Effluent #2 =BODE < 30 mg/L and TSS < 30 m9ti The Department of Commerce is an equal opportunity service provider and employee. If you need assistance to access services or need material in an alternate format, please wntact the department at 608-266-3151 or TTY 608-2648777. °.;: C~ Parcel ID # /~ ~ (3 ..J .....3.... tKt• page Z ~f'~ ~;~~ Soil A ication Rate .t~ RedoxDescription Texture Strucwre Consistence Boundary Roots GPD/fg ~ Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t *Eff#2 ~ "~- ~ 10~ . I SL- m ~ T ~ ~ ~ ~ ~~ ~ t-Z.~ ,ayr" - ~~ r c -. ~~ ~ ~ = ~ _ U i~ ~ ~" - ~ ~ , . san-sssaresc ca mroo~ ~; ~ _ r^ NAME t~~fi /1(,V~ SfE' f LOT# ~/ ~ LEGAL DESCRIPTION ~/a ~/a,9~ ~ ;"!f'"~ Wiz, ~" - SCALE: 1 " = ~~ ' BM 1 ELEVATION- _l~G~ U BM ~ DESCRIPTION ~P p,~ ~q y-~u~ j-~,~,.~~Q~.-~t~.,~ BM 2 ELEVATION i1/ /~'}- BM 2 DESCRIPTION ~~~~ ~ SYSTEM ELEVATION 3 2 ~ ~(o;,,J ~'o.>~~..,/ SYSTEM TYPE LG~n.,tis-,-~ ~'e:-i •c.~ ~, ,o~~ '\ ~~, ~~ ~~ SIGNATURE ~`'"~"""-' -..~,.'""'~ ~. ~~ ~,, - g91. 5 ~aF~M -'1 ~~ DATE - ,S - C~(o l~ . ~ ~ C,v ~ • ~ ~ A `~-- ~ ~ ~ ~ ~ o ~~~~ ~ ~~~ ~ v°~ ~ ~, ~ --~ -t --~ ~~ ~ ~ ~ X49~ A 7 j ~ 3 ~.., 3 -~ .Q ~~ ~ ~ ~ ~ ~ ~~ - ~~ ~ ~- J~ 3 " 3, 1. J o~ N a ~ ,~ ~ ~ .~ ~ _ ~ ~ L ~ ~~ ~ ~: ~ - ° ~~ ~ ~ ~ ~ _~ /. /~ /. ~~ N O ~. X~ S.~. ~ ~~- '~~/11~1Ey otig - fi ~iW ( ~ ~ a~ N o i- d ~ . I ~ ~ ~ I `QI ~ . '~'~~M,vz,g~~ Jam. ~`\~ ~ 1 ~ W ~ _ ! ~ r~ ~ ~~ _\\ % j ~ ~ ~ ) r' - 1 W '~ ~ o ~ ~ ,~ ~ Q ~ w C` cgQ~ O ~ ~! N i ~ 1 f ~N ~ ~ ~ ' \ ~ ~ ~: ~ S ~!~ 1 ~ ' ,~ ~ i \ n~~~ , ~ ~ ~~~~ ~. ~ .,~~ ~ / /~ / / . ~ .. ~_X~ ~ `~~1~/ ~ ~ ~ ~ o ~°%~ j *~' ~ . . ~ ~ ~~ ' / ~ - ~, ~ _ . ~~ ~, ~ ~ . . ,b9'86~ 3.bb,L 1o00S ~w o~ ~Q ~ N ~ N ~ ,9£'4lb 3.bb,Llo00S ~.~~~ ~cn w ~bNi y~~~,~~~~\ ~ ~ rn ~ ~~ r j n o ~~~~ J 1 ~ _ ~ \~ l ,tii ~'~zti~~oc~S ~~ O~ r ~ UQ ~ ~~ ~~ ~, _ N ~z S,L ~~HS 5 ,~0 t~ ~ ~,~HS ~~S N ~te~6v5 ~ nn.vzeeeos ~ ~~ i~ m ~ a 3 ~, ~ O ..~~ ~ N "~ \~_ ~, ~~ \~ 14i• .~ ,oo~~se ~~ of ~Q $" ~~ r N ~5,~31~~ J" ~+ GtG 6,i~ ~ ~ ~ ~ ~ S~ ~ ~ p ~ 5~0 i ~ ~~~ o~~ --~ 1 d ~ ~l~ ~~ ~Q ~ ~W ;~ ~ ~ \ ~ ~~ -~ .W f U .Q ~ 1 ~v, ~ " 1 Z pmjCV i `~ z t 8 t~- / iN ~ j II S ` . . ~ _ _ _ - -- S01°16'58°E 774.65' -~- --~ _ ____---- No °»s58~w na.s5~ _ _ _ e7:_ - 3pa.8T _ ! . _ _ . r ~ \ _ - ~ r N ~cs~sba ~ce~z,~ 8 -+r v N ~W ~~ ~ cn 4 ~ N ~j N ~. ~_ ~\ . ~ ~~ \ ~ ~~~ \ ~ • ~~s ' ~ $EFTIC' TAP+K E PUMP C~:ANB£R CROSS S£OTIGN AND SFiCIFiC~iTIO!~t5 ~+" CI VENT PIPE 12" MIN. ABCVE GRACE ~~ 41EATHERPRQOF >_ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVEi} FRESH AIR INTAKE WITH CONDUIT MANHCi.E COVER W/ PADLOCK F FINISHED GRADE WARNIPIG LABEL ~+" C I RISER ~,,._._,_. 4 " MT N . ., 18" IN. 6" MAX. i~s4 ~•t7 tlvl,ET ' -~ ` l` ~` WATER TIGHT SEALS TAS- , s tGHT + , ~.IAPPR4YED A SEAL + JOINTS ~IITH APPROVED -~-- ~ ; ALM APPROVED PIPE IPE 3 INTO SALID } ~ ~ ON SOLIDTSOI! ! ~ r afllt PUMP OFF ELEV . FT. --~r-- OFF '~~ RISER PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEpAING UNI~E~ TANK CONCRETE PAD SPECIFICATION SEPTIC / DOSE TANK MANUFACTURER: ~~,.S~.R TANK SIZES: SEPTIC 1~~Q GAL. `""`_' DOSE ~r GAL. ALARM MANUFACTURER: legit _ ,~,, sr1 MODEL NUMBER : ~ ~.V SWITCH TYPE ; _ t*ctie,~,~„ PUMP MANUFACTURER MODEL NUMBER : [~ c7 SWITCH TYPE: n~e,~s, PwE~I~ IRED DI SCH.ARGE RATE y ~ GPM NtlMSER DOSS PER DAY: ~_ T~QSE VOLUME INCLUD NG F 1,OWBAC K : ~ ~ 9 GAL . CAPACITIES: A = ~_ INCHES =~,_GAL. B ~ 2 INCHES = ~a. GAL. C = 0 INCHES = -~ _GAL. D = ~ INCHES = J ~t~ GAL. PUMP ~ ALARM k'IRI NG AS PER 11LHR 16.23' WAC ',tERTLCAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE /~ FEiT + MINIMUM NETWORK SUPPLY PRESSURE 2.5 FEET + ~.~_ FEET FORCEMAIN X ~~VOFT/100 FT. FRIC~'ION FACTOR -~j~LFEET T,OTA.I~ DY~IAMIC HEAD = ~' EET INTERNAL DIMENST_ONS OF PUMP TANK: LENGTH .r ; WIDTH •--~' ; DIAMETER =__ Lz4uT~ ~- ~ g " ~ I ~~C pe.2 !" SIGNED : .~s~~.,~~""~-- LI C EN S ~ NC! M S ER : ~.e~,~ Q q l7 DATE : _.______, _ s. 1/SB (ep GOULDS PUMPS Submersible Efflueirt Pump 3871 E 05 ~; ~~ APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECiFlICA710N5 • Solids handling capability: 31." maximum. • Capacities, up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'h'° NPT. • Mechanical seal: wrbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40~ continuous 140°F {60gC) intermittent. • Fasteners: 300 series stainless steel. Capable of running dry without damage to components. Motor: • EPOd Single phase: 0.4 HP, 115 or 2~0 V, 60 Hz, 1550 RPM, buih in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, li0 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SlTOW with three prong grounding plug. OptJonat 10 foot length,16/3 S1TW with three prong grounding plug (standard on I:P05). • Fully submerged in high grade turbine nil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auta- matk models include Mechanical Fbat Switch assembled and preset at the factory. FEATURES ^ EP05 Impeller: Thermopias- tic endoseddesign for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplastic rover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' Gnedian 5tandaMs Assodadon (CSA listed model numbers end in "F" or "C".) Goulds Pumps is ISO soot neyistered. ~ 2000 Goulds Pumps Effective February, 2000 63871 ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. {TT Industries • = uick~'M STAN~AJAd CHAMBER Quicica Standard Chamber ------- aa° ---•---- (EFfEC7iVE LENGTH) SIDE VIEW MuitiPort Ertd Cap j ------- -..t ~.-- ~_ -_ `~.__~I r ~ ; ~., i I f d-~- ! ~ ~ . y~ ~ 1 -----,.J 34" ---- -• ! SIDE VIEW FRCN7 Y!EW Qvick4 Standard Chamber:Nominal`•S~pecNicatians~'- Size (W x L x H) _____~_ ~ 34" x 52' x 12" Effective length 4fs" ~nvett Height ~,~. 8" 16` ..i_ tOP VIEW ~ '_ r7, ...', +" ` Sr e~W x LAX. H~_--•- • _ ~ 3~1' x 1fi" x i2" ---"•-- Invert Height ~ 8" or 1.25'_ ~Nrl~r 52~+ ~Y~7~~~G..~.TA~A~ 4~~~ w~~~ , ,r. mut n'ner acreawirY rt,an x +Yxl t,v I rlNrat t bur r wk , sw ~ e r , "wa nva. I,~I r r.. MU Y ~r D~: I r,nt•iher, urU fJlaln. 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Ln'wan r.,tY arrorea u, env parry d~ Irvin me m)U~ war ;di sVc ca,Wt,c .. r dr NJ rP.V!BCW>f$tmr, d c I'isPator ties Ina atNh,OrNY W chonya Or Uxtentl trtis LI'nNed Wano^!Y nu thw nl atalr;^•.a+,d rAunUe3h~„yr,Iq.Bnt 'nerrnnry rtxArVO• I nal Ho0.-tor r rv such hulrhir&1. 10 obtain S t w"rr8l,ly .,reeat by InlxUatOr A Umll0ll etd_r £Arnlnxlk. Gonnn:lu',M f~ atG HeOOOurMMS , rrw: al .-tits. irn aln7•'e raGrnc,srxs !i,a St.+ndard Um+nrrt8nl Wgrlol'a G~ ~antY Pam to !tie W ,.,:~rtts Mw ,:,:r[',•A.r'r d Units sand atauw:arerdy read that ro M Ina aUphcab~e war BrtIR ~ j ~ ~ ~YST~MS iNC ~If0fllifOt/t~ wgg1RIMRtEr $otUtbT18'" 6 gu5ine,s faar>< Pond • i',O. Box "68 Oil Ssybro~k, C7 ~`t7:~ BC~J-~iT7-7000 • FAX 66i)-bi7.7Q0i X00-221-aa36 lW r 0~: t),:,Ef13.718t S Q99.PA4 AO',,518;3,4G1,a5ttS',511.90J, ,756 17. 5, k rr ~ t8t1G8, Intgbrrro• 5ydnnw lrw,. I 'JI t a 7 s'a.c•F ; , O t 7.9a r', 6. t 5G 4EP; 5.338,0 t~tl!C4iCiU1. ~a~ ,e .ts t ~b.o~~T+: 7.Ix:a,Srri orruv natente venarng r ~ I stF^t~ tr~rtof~ acct, Pcs+'..gCk, cn^°d'~' eo tradarr+ar+4 01 tnfllrBtor S)5lcn<; Int.. intatrolrr' `~' k. (;r?arfttta!5t7 ,~,~,r ,Pr>isrereJ NaAr}~nanc1m Mrexlco. Gonia~~Jr~,eContolx SwHai (;om,ecGUn, N:+.+ds,:tl;•Int9. PoWRrfl, ,,,tnplsx: ,..,. ~, s~na Irv1Yq~ror S~ssems >ate. Arirted in UB,r~. pFCrct.pp vaOEN ~1'~rh~'Z*it-•U SECTION VIEW • Parcel #: 020-1395-68-000 05/02/2006 02:33 PM PAGE 1 OF 1 Alt. Parcel #: 25.29.19.2462 020 -TOWN OF HUDSON Current ~_X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 =Current Owner, C =Current CaOwner GWEN JOHNSON, DIRECTOR OF FINANCE O -MANCHESTER HOMES INC MANCHESTER HOMES INC 760 STILLWATER RD MAHTOMEDI MN 55115 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 724 REGAL RIDGE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.270 Plat: 2438-SCENIC HILLS LTS 1/72 020/01 SEC 25 T29N R19W PT NW SW SCENIC HILLS LOT 68 2 270AC Block/Condo Bldg: LOT 068 . Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-29N-19W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 04/29/2004 760960 2559/419 WD 10/04/2001 658318 8/76 PLAT 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Totai State Reason RESIDENTIAL G1 2.270 86,100 0 86,100 NO Totals for 2006: General Property 2.270 86,100 0 86,100 Woodland 0.000 0 0 Totals for 2005: General Property 2.270 86,100 0 86,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 / / i / / / 67 i ~ ~ • ~,~ 0"~ 96,775 SQ FT ~~.. 2.222 ACRES • 1 ~ ~J' ~~o ~ ~ • . ~ / ~ ~ ~'~. 68 •~~ •. • ~ ~ ~~\ 98,886 SC • • ~ ~ ~ PGA 2.270 ACR S $ >s' 0 ~ ~ i ~ ~ ' .~ `{P.~ ~ ~ ' • ~ H.W.L. = 991.9 \ro ~ , i ~ 'Q\ ~ ~ `` ~ \ ~A~l /7----- 1.~ ~x ~ • . H.W.L~= c 1002.0 \~, ?8 ~ \ \ ' ~ \ •. v • 69 90,281 SQ FT ,~ 2,073 ACRES ~~ 13' -_.__ _ __ 586°58'14"E 336.83' -Regal Ridge- _ - N86°58'14'W 336.83' -- -- --. 19AOa a ~,/~~ • .............. z 138,651 SO FT ~~~~~~/~ 3.183 ACRES ~' ~~~~ ~~~~,~ ~ ~~ ~ _---~~~ ~~ i _~ / ~ ~ ~ ~ i~ ~ H.W.L.= I w ~ 1014.10 ~ g 95,918 SQ FT ~' i 42 ~ 2.202 ACRES i i ,~ `~„~~ 104,201 SQ FT 2.392 ACRES 2606.51' 219.32' 276.64' 236.49' ;6.30.40' SOUTH LINE OF THEN 1/2 OF THE SWi/4 Mo ~o Lao ~! ~ ~ -, 16a 44 POWTS OWNER'S MANUAL & MANAGEMENT PLAN >:~aoe .~ or FILE lNFQRMATION ~~ -yam--~ ~ ' ~.~ L-- Owner Yr1 ~`ck~i~..~,lt~~Q~.~.~ (~iL..C.. Permit ~ ~ l DESIGN PARAMETERS Number of Bedrooms ^ NA Number of public Facility Units ~ ~ G NA Estimated flow (average) ~~ +~, p O al/da Design flow Ipeakl, (Estimated x 1.5} d O a1/de Soli Application Hate elide /ft2 Standard MfluentlEffluent Quality ; Monthly average" Fats, Qil & Grease IFOGi ~ 530 mg1L Biochemical Oxygen Demand 4801©~i ~ <_220 mg/L ^ NA Total Suspended Solids (TSSI 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Qemand (BODg} 530 mg/L Total Suspended Solids (TS5} s30 m$/L ^ NA Fecal Coliform igeometric mean) 510" cfu!tOOml Maximum Effluent Particle S1ze ~.. Ys in dla. _-. ^ NA Other ^ NA "`lal~tes typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFiCATlONS Septic Tank Capacity ~~s" ~'j al ^ NA Sapt'sc Tank Manufacturer W ; ~5~.. ^ NA Effluent Filter Manufacturer ~a,,,iq ~e. ^ NA Effluent Filter Model ~ ~~'(~ ^ NA Pump Tank Capacity g Q t7 dal ^ NA Pump Tank Manufacturer W ~~ S Q- ~ ^ NA Pump Manufacturer ,~~, ©~` ~ ^ NA Pump Model ^ NA ~ Pretreatment Unit ^ Sand/U'ravel Filter ^ Mechanical Aeration ^ Rislnfection ..~ ^ Peat Filter ^ Wetland ^ Other: . _ ~ ^ NA . ~.. Dispersal Cetl(s} O in~Ground (gravity} ^ At-Grade ^ Drip-Line ~ __. _ DNA ^ !n-Ground (pressurized} ^ Mound ^ Other: Other: _.~__. ~ -__.____._ ^ NA Other;~~W ^ NA Other: .~ ^ NA Srirvica Event €ervice Frequency Inspect condition of tanks! At least once aver Y' month (s} ~ i~ Year{s) {Hlaxlrreum 3 years- C7 NA Pump out contents of tank{s} When combined sludge and scum equals one-third (i~} of tank volume ^ NA inspect dispersal cell(s) _ At least once every: ^ month(s} Tdyearlal (Maxlmut:t 3 yearsl -~ ^ NA Clean a#fluent filter ____ At least once every; _ ___ ^ month(si ~ ^ NA Inspeet pump, pump controls & alarm ~ TAt least once every: ++ ~- O monthis! ~-. ^ Y®arls} ~ __ R ^ NA Flush laterals and pressure test __ ! At least once every: ,,..,.,,, d months} ^ yearEsl ©NA Other: _ At least once every: _ ~ - ^ monihls} ~- _-~ O yearist ^ 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 tanks} to identify any missing or broken hardware, 'sdentify 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 cell{s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a taiPng condition and requires the immediate notification of the local regulatory authority. 1~Nhen the combined accumulation of sludge and scum in any tank equals one-third IY3! or more of the tank volume, the entire contents of the tank shalt be removed by a Septage Servicing Operator and disposed of in accordance with chapter Nl~ ? ? 3, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components. pretreatment units, and any serv}cing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service ceport shall be provided to the local regulatory authority within 10 days of campietion of any service event. ' 'ePa~ en~la~isiuiwpy uisuo~s+M '(El's tzi '{t>09'8B pue i#)'81p}I tllgilZlZZ'£8 wwo~ ,a~dayo ys~M a~uei~ctuao~ ui peJ{6~~ seen luewnaop s,y~ Q °IlS - °~~ ~ S/~ auoyd ~ auoyd ~ swe .. _ aweN All!lOHliltl A>dOltl'1f10~a 1tl~Ol !li9dWfid) tlQ1tJl19d0'JNIOlA!!gS 3Jtl1d3S -- -~ auoyd sweiy a~NItl1NIbW S1M©d ~: ~ ~~- ~ ~ ~ ,~ / ~ auoyd ~ ~ S b ~ ` every ii31ltl1SNl S1MOd S1N9WW00 1tlNOtlIOQtl '~181SSOdWI a0 iT,AO1~dIG S8 AVW iiNV1. b d0 liOltlglN! 3H1 WOlJd NOS>i~d d dd 3f1~S3a '11f1S3lI AtlW Hltl3a 'S~ON1d1SWfl~kll0 ~lNtl !l30Ni1 ~Ntll 1NgWltl3!!1 a3H10 kl0 dWtld 'OIld3S tl >i~1Ng .LAN q0 'N3JAX0 1N3101d3f1SNl llOlaNtl SdSStlD 1tlH13'i NItl1NOa AtlW SNNtlI 1N3Wltl3kll l13H10 aNtl dWlZd 'OI1d3S < < DMINatlM > > •awii 3ey21e laa;;a u! spina ay; yi!nn ~tidwoa isnw swaisAS yons;o suo!lanlisuooad •a~e;.ins an!le~li!;ui ayi le lewo!q ayi ;o ienowaa BuiMOiio; eoe!d w pe3analsuoae~ eq .law swsisAs uoiid~osge pos spe~8-is pue punoiry ~ 'S.LMOd P811e# ayi aaeida~ of i~osa~ ice(e s a((ei~,-~~q Aeiu ~uei Bu!pioy a aiggi!enp S+ gsae ;uaWB~e)dOJ pU ;( 'eaJa ;ueWBDBidA~ aigejins a ai8ao( of psw~o~ad aq uol;en(ene t ails pue iros e S1Mgd ayi ;o e~n(!e; uod~ •se~e lueweae!dai eigei(ns a .t;iluapi of paionivna ua loo se alie ayl 0~t t~ 'S1Mgd RalEe; ayi eaeldai of UOSaJ i8ei a se pspeisu) aq Aaw ~iuei 6uipioy a hBoiouyaai SiPAQd ua saauenpe 8uu~e9 •suo~lei~w,y cos ~o/pue ~ioegiss of enp aigei!ene loo si ease luewsaeide.r aigei!ns d 0 •aw(i leyi le laa~a u! sain~ syi yilnn Aidwoa isnw swais~ts luewaaeiday •eale luswsaeida~ ~ip~;ins a yspgaisa o; uoilan(ene elis pue iios nnau a ~o; peso ayi u4 iinsa~ i!rM ease luawsoeida~ syi ioaloid o3 s~ni)ed •ei)enn pue sau)) lo! 'a.~n;ones pasodad pue Bupsixa wa; s~ioegias ps~inbsa ~(q uodn pa6u!i;u~ aq iou pinoys pue uoiioedwoo pue saueganis!p woa; paloaloxi eq pinoys ease luewsaeide~ eyl •wais~Ss ua(id~osge ,(as luawaaeide~ a ;o uoi;eaoi eyi ~o; paz(i!in sq Aew pue peleniens uasq say es~e luawaaeidaa eigeilns d ~ weis~ls luaweoeids} iue!idwoa apps a apinoad of 'ue~iei aq isnw .~o 'ueaq aney sslnseeua Bu!naopo; ayi panade~ eq ;ouueo pue siie; S.LMgd ayi ;( Ntlld lON3DNI1N00 yei~siew piios ileui ~eyloue ~o iene~fi 'i!os ya~M pa((i# aaeds pion ayi pue penowe~ s.~enua nayi ~o panowa~ pue paieneaxa sq pays slid pus s~iuei Ile 'Buidwnd jai;y aoieaedp Buio!n~ag a6eidag a Aq ;o pesodsip Rijadad pue pencwe~ eq pays si(d pue s~iuei pe ;o slualuoa ay,~ e •psisas sBuiuedo adid psuopuege syi pue pe;aeuuoosip 3q pays siid pve s~uei of 6wd+d pb :spot en!leiisiuiwpy ulsuoos)M 'Sg•gg wwo~ isideyo yiinn ~ou~,(dwoa u! pauopuege tie;es pus Aiaadoid s. wa3sAs ayi leyi emsu( of ue~iei aq iieys sdais Bu!nnopa; syi ealnaas ;o ino us~iei A(luauewied s) io~pue si!e; S1MOd syi uayM 1N3WNOONtl@tl •e~a~q ieue#;os ~aleM pue :suodwei :sut~ideu Aiei!ues :sap!oiisad :sianpad Builuled :~~o :suoilea(psw :sdeaas ieaw :sap!o(q#sy :aseea9 :auiiose8 cs6uiiaad eigele6an pus #{na; :aalenn (dwnd dwns) u!eip uoilepuno; 'Le; :siuelaa;uis!p :saade!p :sso); )eluap :siasee~Bep :sgenns uouoo :swopuoo :siinq sile~eBia :sedtro- ~qeq :eaiioigilue ~S1MOd Bpi ;o edli eyi Buoio~d pue aauewao~ad ayi anoadwi hgtu weeais rsieMeisenn ayi wog; Bwnnopo; ayi ;o uaieutw(ie ~o uoilanpe~i •esre uoiidaosge pos ape~6-la ~o punow Aue ;o edois unnop laa; S ! u)ylinn ease ayi `lae~Juaoo ~o gmis±p es±nn~aylo ~o '~eno died ~o sntip lau ota •siiea ies~edsip pue sa)ue; nano sa)aiyan aiaed io an!~p loo op of sialuoa dwnd ayi 6u,le~adv Alienuew w ss(sse of feu elu a '~iUei dwnd syi uiylinn sisnai iewaou eioise~ ! ! W S1Mgd ao asgwn(d a loeluoa ~o dwnd loan(;;e syi o; ~ennod Eiu!aoisa~ of Loud ~oleaadp fiuiainaag aBeidas a ~tq penowa~ ~iuei dwnd ayi ;a siueluoo ayi aney uo);enils siyi pone of •;uan+;}e #o e6~eyas!p sae;ans ~o dn~iaeq syi us lines( Aew pue it)paa ayi 9u!psal~ano 'asop sale! auo u! (s)pas ies~ads)p ayi of pe6~eyas~p eq p,nn ~eieMeisenn seaaxa ayi pe~oisa~ s! ~eN,od uayM •siansi raisnnyBiy ~ew~ou anoge ii±; dew s~iuei dwnd saBeino iannod eu!~np •soe;ins sn(le~ip;ui ayi ~ uazoJ; sae suoii!puoo ilos uaynn anaoo loo pegs do iJeis weisAs •asn ai ~n!~d soleJedo Bwa!nias eBsides a ~tq psnowal !sl~iuei ayi;a slualuoa eyi aney palaalap s34 suo!ie.+iusouoo y8iy ;i •;s)pea ies~eds!p ey; a8ewep ~o/pue sseoo~d luewiee~i syi epadw) stew (ayi sieaiwayo iaylo io slonpold Bu±luled ;o aauasa~d ay; ~o; !s)~iuei luowieali ~iosyo S1MOd aw #o esn of ~o{~d •uoilan.llsuoa nnau !off --- ~ to - - s6sd NOlltla3d0 ONt/ dti lbtliS Page .__- of STARTUP AND OPERATION ~ -'--- Far new construction, prior to use of the POWTS check treatment tank(si for the presence of painting products or other chemicals that may imp$de theareatment process andlor damage the dispersal cellfs3. If high concentrations are detected have the contents of the tanklsl removed by s septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During powei outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the ceil(si and may result in the backup or surface discharge of effluent. Tv avoid this situation have the contents of the pump tank removed by a Septaga 5ervfcing Operator prior to restoring newer to the effluent pump or contact a Plumber or POWTS Maintainer to assist in mantralty operating the pump controls to restore norms! levels within the pump tank. do not drive or park vehicles over tanks and dispersal tails. Do not drive or park aver, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction ar elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT5: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable pee{ings; 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 following steps shalt be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: ~ Ali piping to tanks ar,d pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed 2nd properly disposed of by a septage Servicing Operator. ~ After pumping, all tanks and pits shall be excavated and rernaved or their covers removed and the void space filled with soil, gravel or another inert solid material. C0NTINt3ENCY PLAN tf 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 b® utilized for the location of a replacement sot! 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 weNs. 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. D A suitable replacement area is not available due to setback and(or sot! limitations. Barring advances in PgVJTS technology a holding tank may ba installed as a last resort to replace the failed FOWTS_ N~~^ The site as not en evaluated to identify a suitable replacement area. Upon failure of the POb'UTS a soil and site tV evaluation be performed to locate a suitable replacement area. !f no replacement area is available a holding tank may alle s a last resort to replace the fatted POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place fallowing removal of the biomat at the infiltrative surface. Recartstructions of such systems must comply with the rules in effect at that time. < < WARNINl3> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, Pt!lUIP OR OTHER TREATMENT TANK UNOinR ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUIs OF A PERSON FROM TFtE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~ lA ~ L u,, sL„ Phone 7 / ~' ._ 3 g --,,~ 1 ~ / PpWT3 MAINTAINER Name Phone SEPTAGE SERVICING npFanrna rotraaocQ~ Name - - - ~, - - .. Phone Th?s document was drafted in compliance with chapter Comm 83.22{21Ib1111(d)&(f) end 83.5411), {z) t3, {3l, Wisconsir, Adrninistratwe Coda. LOCAL REGULATORY AUTHORITY Name ~}'• GC'o ~ ~ l.c ,n. '~tg,~n: '(- ~n Phone ~/s - ~(o ''S((o b i;~'r ' 3 ~~Qfi ' ? °6FfY1 i,^ar~ch,est r Hr,~~es hJ~ ?3~;? P~ 1 '8 POh'1 : U~;HU^IAKtF~ NLUMt31NG FRri hNJ. ' ?? X863121 Apr„ 14 2Cb6 95: 44AM P1 $T. CR(litX CI)I3NT•Y SEPTIC TANK MAIl~'TENANCE AGREEMEI~'T A~ UW(~T~R~HIP GERTIFICAI•lON IiUKM Mailing Address ~' `7l.~ ~ c~ ' .cx..7.vc.~c~~ ~ ~.~.~ Property Address ~~~~ ~x~ t~,Q ,~ (VeriflcFitlan ued fraTn ~ Z,nntn~ Deparmtenr for new ~at]StItlGtxall.) ~ , Cityl~tat , ~ ~ _u_cx~.a.~.; ~. T .S~ i~, k'arcel Idet]ti~aatian Number ,~-~ ~"~ ~ ~~. CC_ 1 ~G'~y-rccl ~~~.~ LEGAL. D~SCY2TPTICIN Property Location ~ '_ -- ; ~, ,^'~. S~,•c, z5 , T ~ ~ N R / ~ W, Town of ~.r,~.~~or-~ Subdivision ~,~~`~.+~~._-r~~r~ ~_. _ , Lc-t # Cra ~ „ Cert~ed Survey Map # _, Yolumc _ , Fage # Warranty Deed # •a~ ~ ~1 ~ d' r ~ , Valume _ ~~, Page ~ ~ l ~' ,. 31,i~. lLause yes na I.tt Ii:us id~ntafisblc yrs na SYSTEM MAIlV'TENANCE AND OWN'~~ CIERTX~CATTON Improper use and maintenance of your septic sysrcm cautd result zn its pzrrnatwe failuro to handle wastes. Proper ~nneis]tettftnct; consists of plumping out the septic tack evezy three y4a,:s or eemixa, if needed, by a Iiooz~cd pumper, What you put ieto the system eaa a#'~ct the aCTa~notioa of r>,a Septic tank as a trc~ftTZnt stgga itr tlxa waste dispaat systc~ lJwncr tnaintenaaco responsfbi3itios ara spooiilcd in $Comi.~u. H~.52(7) and in t'tsupter i 2 - St. Croix County Saoltary Ordinance. The property owner agrees W subutit W St. 4"iYaix County Planning & Zoniu~ Department a eertifscation f4rxu, signed by the owner sad by a master plumber, jot~ymdn plumber, restYioted plumber ar a licensed puxoper ve: tfying that (l) the on-site waste~+at~:r ducpnsat system is in proper opexatimg condition and/or (2) after inspection and pumping (if t~eaA€ary), the septic taTak is less than 1!3 full of 6-udgc,. 71we, the ut]dersigned have xcac? the above 1Cequircrnant4 and ~gre,c to maintain the private sewage disposal system With the standards eyt #bx#i, t~¢rein, ac cef by the Dc~artmani ot~fanssue+rce and Torn f ]aparbrenr rrt'I~afiuz-l ~'raY~uTC:Cry St~dx of Wiswa~ai~c. Certifioatinn atating th,~t yoirt xeptir. Fycrenn. has beem uiaiutaiuad must be Cptrrnietnd uad rettuned to the St. C`x4i?c Gautlev p]attning & Zoning Department within 3c~ tia}x of the thre® year expiration date. T/we rectify that all staternezTts on Ylais form are true to the best of my/our knowledge.. T/wc ano/sre t1~e owner(s) of the property dESCrihed alu,~~., by v;fi~t nFa ~~~,ry decd recorded in Ragister of Deeds Qi~ce. Namber of bed •nr-n~c ., , .. ,. ... DAVE ***Any imfotmatian that;ia rttie•represented rn~y result in the sanitaxy pe.'ma± being revaYed by the Planning & Zoning Department_ *'"* Iueludc with this app]ication a recorded warranty decd tixtta the Register efDeeds VfificG Ahd a espy of the Certified muxvey map if rctcrertcc is made in the warttlnty deed, 4~rr. oai4fi r - Safety and Buildings Division unty ` ~ ,~ 20l W. Washington Av S~ Gov ~ f~ ~C~~s Madison, S Sa itary Permit Number (to be fii[ed in by Co.) pe artment of Comme {6 ) 266 y~ ~ ~ Sta Planl.D. Numbaz Sanitary Per it piica on MAY 0 1 ~ In accord with Comm 83.2], Wis, Adm. Code, personal informa on you provide N may be used for secondary purposes privacy Law, x15.0 (Ixm~T, CROIX COUNT proj t Address (if different than mailing address) I. Application Information -Please Print All Information ~ 7Z ~ ~~ /~ ~ Property Owner's Name ! ~ Parcel # ~( Bloc # Property Owner's Mailing Address Pro Location City, State Zip Code Phone Number ~ ~'•'S ~, Section ,~` c ~ ~~~/ ,~ p~ l ¢circle 9uerh / '7 t~ 1 Z. II. Type of Building (check all that apply) T N; R E o~WJ C r L-.-C'~O ~,l or 2 Family Dwelling -Number of Bedrooms ~'e 1e~ ° Subdivision Name CSM Number ^ Public/Commercia! -Describe Use /~ ;~ ~ ~ C ~ 1ls ^ State Owned -Describe Use Z ~ t t~ ~ (~ ZZ }- Z~ w,1p~('S ^City_^Village~ownship of~/_9e.tJ III. Type of Permit: (Check only one box on line A. mplete line B if ~ licable) DZO ,., ~ 9 - O~-X~ A. }New S stem p y ~ Y ^ Re lacement S stem ^ Trea enUHoldin ank Replacement Only ^ Other Modiftcation to Existing System i B• ^ Permit Renewal ^ permit Revision ^ Change o ^ Pemtit Transfer to New List Previous Permit Number and Data Issued Before Expiration Plumbor ~ ,' Owner IV. T e of POVVTS S stem: Check al! that a 1 ~ on -Pressurized In-Ground ^ Mound > 24 in. of suitable s ^ Moun 24 in. of suitable sail ^ At Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holdin ,ank ^ Peat Fii ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin Synthetic Media Filter aching Chamber` ^ Dri Line ^ Gra -less Pie ~ Othe (ex lain) V. Dis ersaifl'reatment Area Information: ~ 6 Design Flow (gpd} Design Soii Application Ra g Dispersal Area Required (s Dispe al Area Prop sed (sf) System Elevation ~'[. Tank Info Capacity in Totals' Number Manufacturer Prefab Site Stee! Fiber Plastic Gallons Gail `s of Units ''7 ' n Concrete Constructed Glass New Existirg ~ W GG~/~X+ f ` 1 ` Tusks Tanks f Septic or Holding Tank ~r7• LG7 '~'..~ Y' Aerobic Treanrwnt Unit Dosing Chamber OL G~ G/,' c ~ Y VII. Responsibility Statement- [, t ' undersigned, assume responsibility for is tattoo of the POWTS show on the attached pleas. Plumber's Name (Print} Plumber's Signature MP PRS Number Business Fhone Number Plumber's Address (Street, City, Sta ",Zip Cade) lv~d ~ ¢~ 6c~ d ~. ' SY C' VIII. Coun /De artment U Onl Approved ^ D' pprov Sanitary Permit Fee (includes Groundwater Date Issu Issui ent Signature S mps) Surchazge Fce) ^ enReasan ' I ~d~ , i7t~ 5 Z ~b IX. Conditions of Appro aURtasons for i7isapproval SY8TEM OWNER: 3~ ,g J~l~(" /WtJ6~" St,~,p~~ Ou+/<L' ~ : ~.~e wa,n 1. Septic tank, effluent fitter and L _ ~ l U~ VV dispersal cell must all be servfces /maintained ~~ ~ Y~,t...~ ~,pw. tv D as per management plan provided by plumber. I_ _ 2. AN setback requirements must be maintained \\ its psr appfigble cede ~ ordinartcas. ,r~J Rnn~l ~ I a. Pecx lrh,t)S~-' p cue Y~o 0~ ~atn2.. ~oc.4y"t ~ t.~/t ~~ na ~" °~ Attach compkte plans (fo t6e County only) for the system on paper sot Irss than tl/E x 11 inches in size ~ SBD-539$ (R. 01/03) ~(Q,,~,~,~,L_, {{~~;;~~ ~5~~ ~. EL '~. ~~~ 4 ~' r ,Wisconsin Department of Commerce - SOIL EVALUATION REPORT Page I of Division of Safely and Buildings m aoooroance wmr ~.orrun aa, rvss. wam. was t Pl i 81/2 1 d an mus x 1 - n res . Attach complete site plan on paper not less than indude, but not limited to: vertical and horizontal refep`ar~oe: p4irit (BAI~~ don and parcel I.D. ' percent slope, scale or dimensions, north arrow, aye lacetion and distanrxt tol+~arest road. Z O ~ 13 S Please print all f ~~,~ '~ '`',, R by Date ~. ~ Personal information You provide may be used for dary ~ y~nw. s t6:A4~1) (m)). .. ~ ~ ~ ®~ Property Owner _.. ~ .~ ,~ - ~ ~ . , r. ~~~ p ~~ Gorit.d~ ,(j c.J 114 Sc~! 1/4 S 2S" T Z ~( N R (q E (or~1 Property Owner's Maikng Address ; c; ,;. t=c~t~n~ 7y ' ` ~ L Lad•~, ~ Bbdc # Subd. Name or CSNq~ F~cr ~` .- C,7 ~ Z O S-1•. I I wa-E-e j1~~~ f S e; City Stale Zip Code Ph l~rmber. _ : , -: City ^ V~lage (,~ Town Nearest Road ® New Construction Use: ® Residential / Number of bedrooms 3~{ Code derived design flow rate ~Sd ~~ O O GPD ^ Replacement ^ Public or aommerdal - Descrbe: Parent malaria! OU fc~a.s !^ Flood Plain elevation if appfa~ble ~~ U ~ Gerreral comments S ~ S ~ t11 e, l e J0. f ~ b /~ - f~ P 99 ~ .f ca L o r..~ 2 r- 4 y . and recommendations: ~ L.,~ e. l •e.J a- •4-.`0 >~ - -}o p q ~. ga yo w ~ ii' S' ~. a v a Boring ~ ~~i Boring i:pi Pit Ground surface elev. v~ ~~ ft Depth to limiting factor I Q ~ in. Soti ic~tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GP D/f~ , in. Mansell QU. Sz. Cont. Color Gr. Sz. Sh. •Eft#1 •Eff#2 C -O 10 33 _- LS I c. Iv •~ 1.Z Z 10 -108 l~ - m S Q tn'-i 1 - - .1 I. 2 i .'~ Borng # ^ ~~ __ ®Pit Ground surface elev. ~ • G ° ft. Depth to limiting factor I I in. Soti Rafe Horizon Depth Domtirant Cobr Redox Descxq~tion Texture Stntc~ure Consistence Boundary Roots GP D/ll? in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 *Etf#2 l 0-12 I 33 _ ~ >/~ i - ~' c Ivy •Z i.Z z !z-yz ap ~ ~ I~ -:- . L5 I mS ~m~r c - .`~ 1.2 3 y Z -u 5 ~ ~ 4/~ - m S C~ S ,~-1 - . ~ 1.. Z I I (0 ' * Etfluerrt #1 = 6~D > 30 < 220 ma/L and TSS >30 < 1 50 mo/L ' FJtiuent #2 = BOD. < 30 rnglt. and TSS < 30 mglL CST Name (Please ..Print) S' ature CST Nurr~er ~cl~ Vl/L ~~ ~ti~ wtoc-k e. r ~_T ~~ 2 5 3 3d9 Addmss Dale Evaluation Conducted Telephone Number 2113 ~ ~ ~'~merSe~, c,Jl .~-10Z~5 G `~-D/ 1-5-2~t1-~loob Property Owner iQ..r k~- ~ Parcel ID # Page z of_~ Boring # ^ Boring 3 ^ Pit Ground surface elev: U ~ -S~t. Depth to limiting factor ~ O 3 in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfit in. Mansell Qu. Sz. f;,ont Color Gr. Sz. Sh: "E~ 'E~ I a, LS m5 ~' C..S _. 1 ,1:' ~ . 2 3 _b )O vr4/1o ~, ~ m S . Wis. ~ ~: .;Z [ . 2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth th limiting factor in. Soil ic~tion Rate Horizon th De Dominant Color Redox Description Textrrre Struchme Consistence Boundary Roots GP Dlft= p in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 ~~ # ^ Boring ^ Pit Ground surface ekv. ft .Depth fo limfirg factor in. Soil icatbn Rate Horizon Depth Dominant Cob Redox Descr~tion Texture Structure Consistar-oe Boundary Roots GP D/ff? in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#'I *Eff#2 " Etlfuent #1 =-GODS > 3p < 220 mglL and TSS >30 _< i 50 mglL ' Effluent #2 =GODS < 30 mgll. and. TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the departmerrt at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07Po0) Properly Owner r k~ 1 I _ Parcel ID # Page z of-~- Boring # U Bonng ® Pit Ground surface elev. U 3- SGFt. Depth to limifing factor l C~ 3 in. Soil ' n Rate t C D i l tion Redox Descri Texture Structure Consistence Boundary Roots GP DltI? Horizon Depth in. nan or om o Munsell p Qu. Sz ~ Cont Cobr Gr. Sz Sh: `~ ~ff#2 - 2 -Z I ~ ' LS I m~'r c s - ~ (. 2 ^ Boring # U Boring ~ . ^ pit Ground surface elev. ft. Depth to limifing factor in. Soil. iration Rate Horizon Depfh Dominant Cobr Redox Description Texture Struchue Consistence Boundary Roots GPDIfF in. Munsell ~ Qu. Sz. Cont Color Gr. Sz Sh. `E~ 'Eff#2 ^ Boring # U Bonng ^ Pit Ground surface elev. ft Depth m limiting factor in. Soil ication Rate rizon H De th Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP Dff~ o p in. Munsell Qu. Sz. Cont.-Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = GODS > 30 _< 220 mg/L and TSS >30 < 150 mg/t. * Effluent #2 = BODS < 30 mglL and TSS <_ 30 mglt. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altenlate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (807/00) i .y PAGE ~ OF~_ NAME 14 Y` K-e~~ + LOT# ~g LEGAL DESCRIPTION,Uc,~ '/e~,,r'/o,SZS'fzG ,N,R /qE (or)~ SCALE: 1"= yU 1 BM 1 ELEVAT~N ~~~•~ BM 1 DESCRIPTION ~P o ~ ~ ~u~- ~,'Pr_ BM 2 ELEVATION / p • O BM 2 DESCRIPTION~p a ~' ~ ~ ~oc- ~ •'P e SYSTEM ELEVATION •(aP qq.5'~ ~v~,tr qs(. So ALTERNATE ELEVATION ~a p 9 7. g y Gow e ~ 9 Z 6 a CONTOUR ELEVATION (off • ~, 10 2.0 , /03.0 ~~ J l~~ 1D .yELj ~" ` • ~~~~~ S~ S~~ ~- ,, ,-- ~~~f I~ ~ c~ • ~ • ~~~,~ `~,-~~~` ~/'UP~ SP ~ `P ~~' Sec • ZS ~C ~ - .~- I is ~~ ~~. r/~ ~ r^ ;' w ^ ~,, ~ ;, ,ti •~ _1 G~ ~ ~~~ ~,~ ~~ ~ ~, ~ ~~ ~~~ _ - ~ ~, ~ 2 D ,z C U r ~~11 ~- ~l - t i L r~ ~~ a.- ,.y l~ ' ~ ~~ s~ 1 ~ ~r ~ ~ ~~ -L- ~' ° ~ ~ ~ ° 2 Gam' lM -o i ' ~. __ _ __I ~= ~`~ 1 ~. \ X ~(:~ \ ~ 11 rn \ cn ~ v X x~ ~ r, w S£ x ` ~ ~ ~ // ~ l` ~ ~ II ~ , x ~= rl i7 ~i v~ ~~ v /~. y , ~~o 1 ~^~+r...~..~~ O `~ \ U X o Q w w t Wx o ~ -. ~ ~ ~~ X o \ v ~_ ,. \ ~~• J ~ 'i~~ • . n~i ~'' v ~ O ._ ~.___~`` _~ 0 X~ ~ ~--, 4:~ u.rz~r z>•s ~~~ 1 ~~ ~ ~ ~z ~' ~ 4, ~ }~ d7 ~ ~ {~~ ~~ f N ? p X ~~ .~ z w~ nw ~' 3~ ~~ av~ ~O 1:1 ~a ~ o~ 3N qp dN ~~ a ~V ~`~ _~ 1 . ~._ ~ t-----~. ~~~~ ~~, n. _ , ,-- ~4 ~ I ~ ,~ ~~ 1 e~ t I ~ f ~ 1 -m .~~ ~ ~ ~ ~~ ~ .~ - r ' I ... 1 ~ a~ ~ ~ + .p~ f p~ ! ~ $~ ~I ~~ P ~ r~ ~ rte- + ~ ~ ~ ''whh f "~~, '~ / 1 V r ~ r F 1 ~~ r r' 1 ~r s .., ~ ~ ~ R- 1 1 ' 1 i ~ ~ / ~ ~~ ~ 1 .- ~ ,, ~ tr Y;' ~ ~ ! `_~ I ~, ~ / y ~~r, J~ Y / / ~~/ J ~~ ` / Z /{' r ~~~~ ~~~ ~ ~~ ~~~ ~ f ;~, ~/ j ~` / ~ ~~ /~ r = u „~ f~ u~i ti / ~, M - ~' ~+i;Du lE~c:BaJU°W Wd?G l' 9~.lOL Ul '~" Ai~~r ~13~ ?OCc 11 ~28F~~1 ~'1i~cr~ater Ha~~a` ~ ,': ~ p, ,';'S OWNER'S POLICY OF TITLE INSUR~tNCE issued by Lawyers Title insurance Corporation ~~ A PdLICYNIlMSfR LandAmeriea lawyers Tie lnsurerce caryo,~tiurr ~ a mcr•~cEr of the A ~ ~ ~ ~ Q Lawyers Title LanaiAmercafamdyofrtleint;ufarceunderwrilers. , SUBJECT TO THE EJCGLUSIt}NS FROM COVERAGE. THE EXCEPTIONS FROM COVERAGE CONTAINED IN SCH~GUi_E B AND THE CONbIT1CINS AND STIPULATIONS, L4WYER$ TITLE INSURANCE CORPORATI~IN, a virginip corporation, heresn called the Campany, insures, as of Gate of Policy shown in Schadul2 A against lass or damage not exceeding the Amount of Insurance staled in Schedule A. sustained or ~currnd by the insured by raas0o cF 1. Title io the @State 0[ interest described in Soheduie A being vested other than as stated therein- 2. Any defect in cr Iren or encumbrance on Lhe kitlo 3. Unfrrarkotability of the title; 4 Lack of ~ right of access to and from the land. The Company will also pay the costs. attorneys' fans and expenses incurred in dtfaitse of the title. as insured but only to the extent provided in the Conditions and Stipulations., IN WITNESS WHEREOF, LAWYERS 71TLE INSURANCE CORPORATION hss caused its corporate name and seal to be hereunto arTixed by its duly authorized of6cnrs, the FpiiGy to become valid when eeur.tersigned by an authorized officer ar agent of the Campany. .,* ~^~w, LAWYERS TITLE INSURANCE COR~4RATION ~pSURR,y F~rrr Attest: ~~ / ~ _ . ! ~j n - - ~y: :~, 8 U ~ecreka ~ w ~ ~ ~~ y (•/rr r%~~ :., t J 2 5 ~ S PreSidEnt =af h.. ~.~..~°r::;.vFs EXCLUSIONS FROM COVERI,~GE The following matters are expressly excluded frc.rn t~s coverage of this policy and the Company will not pay loss or damage. costs, atic:neys' fees or expenses which arise by reason oY 1 (a} Any law, ordinance or governmental regulation (including but not limited to building and zoning laws, ordinances, ar reguiat+ons} restricting, regulating, prohibiting or relating to (i} the occupancy, use, or enjoyment of the land (ii) the Character; dimensions or location of any improvement now or hnr6aftpr erected on the land; (iii) d separation in ownership or a change in the dimensions ar area of the land or any parcel of which the land is or was a part; or (iv) ehvironrnontal protection, or +he effect of any violation of these laws, ordinances or governmental regulations. except to the extent that a notice of the enforcerneni thereof qr a notice cf a defect, lien or encumbrance resulting from a violation or alleged violation affecting the land has been recorded in the public records at Date of Policy. (b} Rey govarnrnantal pglita pgwgr not excluded )~y (a) ai3ove, except to the extent that a notice of the exercise thereof or a ruxice of a defect, Ian or nncumbrdnc2 re8ulting fr7m a violation or alleged violation affecting the land has been recorded in the public records at Date of Policy. 2. Rights of eminent domain unless nctioe of the exorc;$e thereof has been recorded in the public records at Date of Poiiey, but not excluding frpm Cgverage any taking which has ocarrred prier to Date of Policy which would be binding on the rights of a purchaser fqr value without knowledge, 3. Defects, Piens, encumbrances, adverse elainl5 or other matters: (a} created, suffered; assumed or agreed to by the insured claimant; (b) not known to the Company, no: recorded in the public records at Date of Policy, but known to the insured claimant and not dis:,tosed in writing tq the Company by the insured claimant grlor to the date the insured claimant became an insured under this pgliGy {C} resulting in no lass or damage ?o the-insured giaiman#.~, (d) dtidohing or created subsequent to Date of Policy; or (e) resulting in loss or damage whielr would net have been sustained if the insured Glaanant had pair value for the state or interest insured by this policy. 4 Any claim, which arises out of the transaction vesting in the Insured the estate or interest insured by this policy by reason of the operation of federal bankruptcy, state insolvency, or similar creditors rights laws, that is based on: (a) the transaction creating the estate or interest insured by this poficy beinfl deomed a fraudulent conveyance or frauduienttrarsfer, or (b) the transaction creating the estate or Interest insured by this policy being deemed a preferential transfer except where the prefereniiai transfer results from the failure; (i) tq timely retard the instrument or transfer or (ii} pt Such recordation to impart notice to a purchaser for vahJe or a judgmertt or lien creditor. NM ~ PA ~a -- - . 14LTA Owner's Policy (101'!7192) N.IRR 1-ii ~~ U 2559P y19 STATE BAR OF WISCONSIN FORM I - 2000 WARRANTY DEED THIS DEED, made between Carriage Homes XX[, inc., a Minnesota Corporation Grantor, and Manchester Homes Inc., a Minnesota Corporation Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property'"): SEE ATTACHED EXHIBIT A 760960 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , NI RECEIVED FOR RECORD 04/29/2004 08:08A![ MARRANTY DEED EXElIPT # REC FEE: 13.00 TRANS FEfi: 286.50 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Ret m Address: ~~~i5w s~ ~3Jf~~r- N Together with all appurtenant rights, title and interests. 20-1395-68-000 d~~S77 1'ttroel Identification Numlxr (P1N) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this. Carria ~ omes XXI, Inc. (/ . * Kellei St. Martin, Vice President AUTHENTICATION Signature(s) authenticated this TITLE: MEMBER STATE SAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) 'I'I IIS INS'I'RUML'N"I' WAS URAI'TI:U L1Y * * ACKNOWLEDGMENT STATE OF M(~11~~~- ) COUNTY. ivaS~/lv(1r~~ ) ss. ersonally came before me this ~ ~ day of aWy the above named Kellei St. Martin Vice President of Carriage Homes XXI, Inc. a Minnesota Corporation to me known to be the person(s) who executed the forego'ng inst ment and acknowledged the same. * Notary Public, State of Minnesota My commission is permanent. (If not, state expiration date: (~tgnatures may be authcntlcatcYl or acknowledged. Both are not necessary.) "Names ofpersons signing in arty capacity must be typed or printed below their signature ~i` ANGFUI PAARIE SPYCHALUI R Notary Nublic-Minnesot8 W Conwniniott Fxph...htt il, i00/ WARRANTY DEED STATE BAR of WISCONSIN FORM No.1-2000 U 2S59P 'i20 EXHIBIT A Lot 68, in Plat of Scenic Hills, located in the Town of Hudson, St. Croix County, Wisconsin. Lawyers Titfe Lawyers Titie insurance Corporation AGEPJ't' CASE ti0,.-04-0577 POLIC!~' ~U. A75.206274is DA'1'~ OF P6LIC:Y-i#I2~3,'2U{)4 $:UO:gt7 ~1P~'! Alviourrr or• dv5lrrxANC~ - $17U,000..UU SCHEDULE A 1. ,Name of ;gsuKer;: MANCH>r5 i r=R HQM~S„ 1NC , a Minnesota Corporation 2. The estate or interest in the land desc:-ibed herein acid which is cavezed b}~ this pcslicy is: Fee Simple 3 Tha estate or ittteregt referred to herein is at Date of Policy of record in the insured. 4 7'he land herein described is encumbered by the following nwstga~;e or trust deed, and assignments. OWNER'S "POLICY Mortgage firorn MANCHESTER HOMES, INC., a Minnesota Corparafion to JENNINGS STATE BANK in the amount of $"170,000.00 dated 4/27/2004 and recorded in the office of the Register of Deeds for St. Croix ~~'~LiiSf'y' WI X515 ~41.^~!1/^Of1~4 !1'I!1'f'f1.f1 AArR Iri ,u~e~lI.I611f nrr(} i~,d;ft4 ~.e^1-~?', t+, Ilr.~r.i.uti~~itit ~,If.trti5i~~rr 71:~ft'1r:~q and the mortgage or trust deeds„ if any, shot~~ in Sc!tedu;e ~ hereof 5 Tice lanC reterre!t to in the policy is situated in the C;aunty of St. Groi.C, State aT Wl and described as folluws• LOTS SIXTY FO1JR (64) AND SIXTY EIGHT (6$), SCENIC HILLS, TOWN OF HUDSON.. i St Croix County, Wisconsin.. '~ ~ ~~ Bye ~--~--. Authorized Officer ar Agent far Lawyers Titie Insurance Co. i i (7 gy} N ~ VNi CS tD ~_ ~ 7 ~ fE9 i ~ a ~ ~ cn N C ~ `' O ~ ~ ~ N ~ Q. 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