The URL can be used to link to this page

Home My WebLink About026-1126-39-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division r + INSPECTION REPORT Sanitary Permit No: 405140 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Brushy Mound Partnership Richmond Township 02e'-1 126-39 CST BM Elev: I Insp. BM Elev: BM Description: /(T / TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark fiU,t- ,�,achJ ast� p Dosing a �rb� Alt. BM Aeration fJ Bldg. Sewer s o � 173 1 Holding SVHt Inlet Z G TANK SETBACK INFORMATION St/Ht Outlet - 3 Z TANK TO c P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic x / / D / ZQ ' Dt Bottom (J / Dosing Header /Man. sf 0 Aeration Dist. Pipe /oP • p -b y Cj 0 Holding Bot. System t . (p 3 91 3 PUMP /SIPHON INFORMATION Final Grade 3(, �- 3 Manufacturer Demand GPM - St Cover � z 9 Model Numbe TDH Lift Fn 'orZLoss System Head T)H ` Ft Forcemain Length' Dia. ist. to well SOIL AB ORPTION SYSTEM BED/TRENCH Width Len th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREA LEACHING Manufacturer: INFORMATION CHAMBER OR Type System: UNIT Model Number: ,v � / s' D ) bb "� DISTRIBUTION SYSTEM ai r1/ Header /Manifold Distribution x Hole Size x Hole Spacing an to Air Inta e 3 t n Pipe(s) /� ! /i �✓► CL Length_ Dia Length / / Dia Spacing SOIL COVER nd Or At -Grade Systems Onl x Pressure Systems Only xx Mound Y Y Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center j� Bed/Trench Edges Topsoil Z1 Yes No Yes [F No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / d Inspection #2: / / Location: 1440 166thAvenue New Richmond, WI 54017 (SE 1/4 Nip( 1/4 12 T30N R1 8W) Wait(efs Edge Lot 39 Parcel No: 12..30.18.800 1.) Alt BM Description = S�' CQlN1/1 ' Q "„'1� " j ✓ .�P ,,j4_� Gi h am' { ✓ ts / � 2.) Bldg sewer length = d W - b` Id wti �� ( �-- - amount of cover = S2 r — V h � � �' 0T-G Plan revision Required? ❑Yes No -7 Use other side for additional information. Date Insepctor's Sig ture Cert. No. SBD -6710 (R.3/97) s ` �� ^ �� _ \� /h P �� Safety and lkvia M FV < Ave.. P.O. Box 7162 �• � � 2131 W. W 7162 SW Ad*m Department of Commerce -'D 0 Z .0A4 P+drasit Number Sanitary Permit Application /� m a w l Comun 83.21. virts. Adm. Code. > :. 1 �1V E D o `� / O be used for Stain Pbtm I.D. Number c Pend Number propel owores Name F i X Cu u N l Y Da (D -- 1 ( d �0 — oo C� n propem Local a MaAw Ad&M P - 6-6 0 s 5' N w�tCky, � ptpae Number Lot Iv N Name rr \\ CSM Number r '!E; O C 7C5 II. Typo of Bull ( an than appw f � P,S,J Ocky 7_ or 2 Nn* DwOft - Number of N&OO N� / 7 ms 0 PibIicJGomseerciat Describe vac - ilkwas Road 0 Stage Owned LAO M. Type of Permit+ (« ► aae is�aoc m free A saes for 1>ra� line a it apptitable) A 3 0 RapUaemmt of 6 ❑ Addition m Fur Camlj =in New 2� Tsok 001, Date Issued s. 0 Ckeek if Sanitary Puri Ptevimnsly trammed Persmt Number IV. Type of permit: (Check ag *At ap*)(nmdwing adalemile is fbr ktwNsf =a) /5 �,{ b.G ound 21❑ Mound 47 0 Sand Pier so 0 Co. WcdanlA 3 ��T ? 441 t4On Pre�od 0 D� Li Ste• S/� � �'�i-�� r 0 22 0 p h G and 410 Holder s1 me Tarok 48 ❑ Single Pass 8!O Chi S 45 0 As -Grade 46 0 Aerobic TMIUoeac UM 10 ❑ 30 0 Omer V. A Ara► I>;sPecsai Alva Sod ApP Elevation. RmrahW proposed m 0° Rate Elevation Oracle DWp PAW WO R (1 Jincb) Ram(QabJDaydS9 ) VL Tank Info C m ?oiat Number Prefab Sift Sled Pier Phil t3allaatt Caocnere CA OWkm *(Tuft NOW >3 Tads Tads - la� c � DodatC C'Inmber musew VD. Wit, Our bmanwim ar ew POW'f S tdna�m m We Plumber's Name (ptitit) 's MP/MPRS Number > Pbooe Number S-:1 t (0 's Address (Street. City. StIft. Cade) 5�`` fi ZiP I t L Dam Issued Sign u Stumps) 0 ,,,d 0 Disapproved Fe` (iocieda firom�dw+ser / surch ❑ awua Given briod Adverse � �• S- l !�D wns � � /2D "• 13U�C.v - ro f 24 ✓tD E fpm t�O c Fa A) S N? Ateae► /� tle ere C�4.a�y s�sur. �'� QTtTs -AgQ%t !R (15/(311 -P 107 -P6,,- 1.7r u.s�,� ,moLend NO f-51hi 4'c- �a4 S�e„ ��.� S Y A) S !a - r-30 A) w Po So& N� �c.�n,ond.,w� Syot7 K�c.�vrnorl� �s T �'�o, ✓- �lCo- ll a -3q' _ oo v CJ a ll r rc s , ? 5 - #� )Laas3 Bit =gy S . ra 9�_,' — a Better W g /} nn + 8_�p� « Units: 34 z 716* .x + open bo:ftm 1 + L oner - P"nect +; Sorf aft and + y�,�� Pft*wman Ma�xirrt,�� u Of The at Provides the si �e s effective lea objective i ching s °Pum amount unmasked t° provide an mace. lts desi side wall to allow Open boctom and �P111ary action in all directions. efflue thieved flow SPEC! !��; by combining the tra ditional Th is has been 0"9hw � otto C A'l""�S: nt to with a se ' ditionai Muent nes of louve •Open L ...........76" f - Low Aroma Untt oil inside the ber al side L ' �� f lows g t he s idth....._.... _.34" 9th .....76" e alo ng the full length of a to unCOmpact Height. ... alo ....... I Width ..... ....3 " ¢ 4 fined to allow effluent ach side. The lo uvers I nvert .......... H eight......... I co mpacted en t to 9 " backf 11 while Pass into the 6f oDIryW iR+►eft ...........6.5 SeMT" �ahrt8 into the chamber Preventing it from of ddsd and of elthe size, wt insta �r 17", withstand H. I per' to d o Ver �`y -201 factors 3l. � Wisconsin Dgartment of Industry, SOIL AND SITE E V A L U AT I 7Code T Page 1 of 3 Labgnnd Hufnan Relations t Division of Safe & Buil �' n9 in accord with ILHR 83.05, ►�. Adm ,� ti U NTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size mus1�1,4iGt � St. Croix not limited to vertical and horizontal reference point (BM), direction and b lope, scale or p EL I.D. # dimensioned, north arrow, and location and distance to nearest road. l L 2�� pending APPLICANT INFORMATION PLEASE PRINT ALL INFORMATI rw ST C .9 DATE PROPERTY OWNER: RTY N Derrick Const. , Inc. SE J '�1 /4,S 12 T 30 ,N,R 18 (or) W PROPERTY OWNERS MAILING ADDRESS LOT C S11BD. NAME OR CSM # 1505 Hwy #65 39 1 na I Brush Mound Lake CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD New Richmond WI. 54017 (715)246-2320 Ri [x] New Construction Use [:A Residential / Number of bedrooms 4 [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _.7 ed, gpd /0 gpd 1ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate _ .7 bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 94.10 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem KI S❑ U i] S❑ U CAS El U F1 S❑ U S❑ U ❑ S 1 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .................. ................. .................. ................. .................. ......,1 .. 1 0 -9 10 r 2/2 none 1 2msbk mfr rR if -6 2 9 -20 10 r 4/4 none sicl 2msbk mfr crw if .4 .5 Ground 3 20 -26 7-5 r 4 elev. _ 9 8.7 ft. 4 26 -96 7.5 r 4 Depth to = a limiting i factor -67 + 9611 2 7 4a- Remarks: /VZR-0L 710 jaL jlea� P, Boring # 1 0- 10 10yr 212 none 2M Mfr cc- if 6 2 10 -21 10 r 4/4 none sicl 2msbk mfr Ground 3 1 -33 yr 4/4 none scl 2msbk mvfr ctw na .4 .5 1 elev. 4 3 -96 .5 r 4 9 8.7 ft. Depth to limiting factor +96" Remarks: 4yt 8 3. -3 CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. v New Richmond WI 54017 Signature: Da 6 -21 -2000 CST Number: m02298 PROPERTYOWNER Derrick const.. TNc SOIL DESCRIPTION REPORT Page -_ PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour%by Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -11 10 r 2/2 none 1 2msbk mfr cs if .5 .6 2 11 -19 10 r 4/4 none sicl 2msbk mfr gy if .4 .5 Ground 3 19 -33 7.5 r 4/4 none scl 2msbk mvfr crw na .4 .5 elev. 9 8.1 ft. 4 33 -90 .5 r 4/6 none cos 0sq ml na na .7 ..8 Depth to limiting factor +90" Remarks: Boring # 1 Q-19 10yr 919 none 1 2msbk mfr if -9 i .6 4 2 15 -27 10 r 4/4 none sicl 2msbk mfr aw if .4 .5 Ground 3 27 -35 7.5 r 4/4 none scl 2msbk my r crw na .4 .5 elev. 4 35 -90 7.5 r 4/6 none Cos osa M1 na na .7 .8 9 7.8 ft. Depth to limiting factor +90 Remarks: ak kn s a,, ' q D I Boring # >- > -> 1 0 -10 10 r 2 none 1 2m mfr cs if .5 .6 5 2 10 10yr 4 none sirl 2esbk mfr CM if .4 .5 Ground 3 - na na .7 ' .8 elev. 97.8 ft. Depth to limiting factor +90 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SE4NWq S12- T30N -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #39- Brushy Mound Lake This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shorn as permanent lot lines were not established at the time the test was conducted. N 1 " =40' BM.= top of 1" pvc pipe Cel. 100.00 Alt. BM.= top of 1 pvc pipe C el. 97.70' AD i ° Gary L. Steel 6 -21 -2000 4 -25 -1996 2 -00PM FROM P.1 r vian Rela entorindusny, SOIL AND SITE EVALUATION REPORT rand Human ttotW P�Qf:. 1 of - �ticn of 5adety 8 >3uildngs in accord with ILHR 83.05, Wis. Adm. Code NTY Attach complete site plan on Paper not less than a la x 11 inches in size. Plan must include, but St. erniv not limited to vertiaa,l and horizontal reference Point (BM), drection and % of slope, scale or PARCEL W. 9 dimensioned, north arrow, and location and dstance to nearest road. APPLICANT IINFORMATION- PLEASE ALL INFORMATION in REVt Q BY DA PROPERTY MWER; PROP6RIY LOCATION TY Derrick C WS . GOVT. LOT SE t/4 NW 114,812 T 30 .NR 18 � (a) !N P OWNER 1505 R MAILING ADDRESS LOTS BLOCK N SUED. NA PHONE NUM9ER ME OR CSM e 39 tm h CITY, STATE ZIP CODE SCI II:LAGE ®TOWN NEAREST ROAD New Richmond wI. 54017 (Z15) 6- kc� New ConstrWW 1,1991A Hes�denlfal / Number of bedrooms a (j Addition to existitg Wilding l 1 Replao�ment (� Public or wmmerCW desaibe Cade derived defy lbw god go Recommended design leWing rats _ i L_ bed, gptllft &_ trench, gpolltg Abrpdon area required 450 - bed, 0 59 trench, 4 Maximum design loading rWa _ i Z_ btd, 2 _ jL- , gpd j * tiecomrttended iMitration surface elevations) _ 94 R (as referred to sib plan benchmark) Additional design / sib mWidereti na Parent material aubvash f=lood Pin elevation, daPP�b ria R S _ SuLble for system WrNNaVTiOWAL MOtNVD W_ GROUND PRESSURE AT-GRADE fl TEM IN .uu, O S pM� TMK U= Unsuitabb for ic7 S 0 U fl s 111.1 [as ❑ U 0S D u ❑ SOIL DESCRIPTION REPORT Boring #r Horizon Depth Dominant Color in. Munsell p Sz. Conn Color Texture Gr. SZ uSati. Consistence gx� Roots GPD /ft e BBd Ill 1 1 0-9 1 r 2 2 Ground 0- 2 9 -20 10 r 4 4 none el", sie� � ' 1 8.7 fL 4 5 6 inn Depth to _ limiting -7 r U bow' +96.. i Remarks: 3oring S 2 2 10 -21 r 4/4 n cl around 3 1 -33 .5 r 4/4 none srl Zma mvfr rta .4 ��' 4 3 -96 5 r nth to siting � '— _ cbr 1, Remarks: CST Name :_ - Please IPtint Gatry L. Steel phone: 715- 246- 6200 Address: 1.554 200th. v N ew Pic d WY 54017 Signature: i /J ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �t S /�`�cj cr�l� 1- 1�'►LS /L'1 /t Ac �. ST�V rtS Mailing Address _ �� ✓�' 1� `� /��r �Ze t�, s`rd 7 Property Address (Verification required from Planning Department for new construction) City /Stat ` " C " (4/ J- - Parcel Identification Number 01 !o LEGAL DESCRIPTION Property Location 5 '/., / 4 ' 4 J '/,, Sec. 1— , T -j N -R l'� W, Town of �\` `'`f ° A C) Subdivision -' Lot # Certified Survey Map # , Volume . Page # Warranty Deed # q - '1 , Volume � `� 3 . Page # J � Spec house Kyes ❑ no Lot lines identifiableXyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and' by a master plumber, joumeymanplymber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o e thr a ear exp!7te,� SltNATURE OF APPLICAT DATE OWNER CERTIFICATION I e) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the propp descri above, b of a warranty deed recorded in Register of Deeds Office. y L SI TURE OF APPLICANT T DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ? � FILE INFORMATION SYSTEM SPECIFICATIONS Owne l O 2r r S� Septic Tank Capacity So al ❑ NA Permit # Septic Tank Manufacturer �S Q rs ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer • �b� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ZV14A Pump Tank Capacity gal ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) p C7 g al/day Pump Manufacturer ❑ NA Soil Application Rate - al/day/ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average • Pretreatment Unit ❑ NA Fats, Oil &Grease (FOG) 530 m 9 /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cel1(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L �(In-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 51 W cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: E3 NA Other. ❑ NA Other: ❑ NA Other: ❑ NA * values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Frequency Service Event ❑ mo is _ Inspect condition of tank(s) At least once every: 3 earls) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y of tarok volume ❑ NA ❑ m th(s) (Maximum 3 years) [3 NA Inspect dispersal cell(s) At least once every: earls) ❑� mynth(s) p NA Clean effluent filter At least once every: - yearls) ❑ month(s) Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ monthls) Flush laterals and pressure test At least once every: p years) 13 month(s) 944 Other At least once every: ❑ yearls) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y 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 filters, mechanical or pressurized components, pretreatment limited to the servicing of effluent certified POWTS Maintainer. units, and any servicing at intervals of 512 months, sha ll be P erformed by a A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) ? � S P a g e ? - o f For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater win 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. To avoid this situation have the contents of the pump tank 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. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area Within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Cale: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removal and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the treed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name c Name Phone ( S a Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S_T_ C- ` Zp c Phone Phone 7 S This document was drafted in compliance with chapter Comm 83.22(2)1bl0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 1 31 A�� 169 " P 1S C> -42!►? .� STATE BAR OF WISCONSIN FORM 2 -1998 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between David L. Naser, Grantor, and Brushy RECEIVED FOR RECORD Mound Partners, LLP, a Wisconsin limited liability partnership, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee 06- 03-1999 9:30 AM the following described real estate in St. Croix County, State of Wisconsin (The WARRANTY DEED EXEMPT # " Property"): CERT COPY FEE. COPY FEE: See attached Exhibit "A" TRANSFER FEE: 1047.60 RECORDING FEE: 12.00 PAGES: 2 Recordinz Area Name and Return Address Hendrick W. Van Dyk VAN DYK, O'BOYLE & SILER, S.C. Post Office BOX 127 New Richmond, WI 54017 Pmr of 026. 1037 -30 -000: 026 - 1037 -95 -000 and 026 ; Y 038. 10.000 Parcel Identification Number (PIN) This is not homestead property. P . I Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated.this 28th day of May , 1999. i *David L. Naser * AUTHENTICATION ACKNOWLEDGMENT Signatures) David L. Naser STATE OP WISCONSIN. ) ss. County ) authenticat d this 28 hday of May , 1999 • Personally came before me this day of I'' 19_ the above named to me known to be the persons) who executed the foregoing * Hendrik W. Van Dyk instrument and acknowledge the same, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis, Smts) THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin Hendrik W. Van Dyk My Commission is permanent. VAN DYK, O'BOYLE & SILER, S.C. (If not, state expiration date: Post Office Box 127 --)' New Richmond, WI 54017 (Signatures may be authenticated or acknowledged. Both are not necessary,) r a as c 480J 44M L NO 0 as ND bA O F tz bjo O o o � p p G o W_ p vy W b0 v vii 1 ca v � f � C a�i L� v v ci 60 i