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HomeMy WebLinkAbout026-1149-00-004 b 1, UKu u AAA _; � -___ - PLANN & Z ONING +Pw...,. ..>+'ds..,Xw a1- •xS;:°- fr.' ".sr - ...._'...Y.'5.-:�r.a ...K..e•�... -..'. FAX 5 Z£ '' 23 DATE: I .;ode Administrati T a • wb�� o 715 - 386 -4680 °y FAX NUMBER: 7/5 - 381 7-57 � Land Information & ma y. Planning FROM: 715- 386- 4674 FAX NUMBER Real P erty 7 -4677 PHONE NUMBER: 7/5 R cling -386 -4675 Number of pages including cover sheet: Z 4, �- �" 1 4�oa� a oo c o a�� Le- A ecam CLi � 4� 4-L,+ L - N O ESL a.d1c�1: d o„�SL is M� - tj e G c. .ti_ G �� � �S 011E < � /� �` ✓� C u i f O� t�tv0 Si CfL_ ! 1 o �� < l s 57 CR01X COUP✓`Y Go vERrnat n A i CE �✓ rER 1; 0 ' CARJN1C.HAEL .g0AD. HODS")/v. W1 54016 7 386 - 464c� . =-=7X - I NTCT? � 1 � a u I I� a{ i vy y� e_ - �� Cap° V CP 01X COUNTY 0 PLANNING &. ZONING December 15, 2006 William Schumaker 1070 Scott Rd. Hudson, WI 54016 ` RE: Non - Compliant POWTS, Town of Richmond CodeAdminis=ra Lot 4 of Cherry Knolls 715 - 386 -4680 Parcel #026 - 1149 -00 -004 (Computer# 15.30.18.1109) Land Information & Dear Mr. Schumaker: Planning 715- 386 -4674 The purpose of this letter is to notify you that the above mentioned Private On -site Real Property Wastewater Treatment System (POWTS) is in Violation of St. Croix County 715 -386 -4677 Ordinance Chapter 12.1 F4(g) and State of WI Comm 83.43(8), which requires ' POWTS treatment, holding, and dispersal components to be located so as to Recycling provide minimum horizontal setback distances from the nearest property line(s). 715- 386 4675 The system as installed extends across the property line onto Lot 5. The minimum setback from the distribution cells is 5 feet off any property boundary. A sanitary easement is not an option so the system must be moved to achieve code compliance. A new state sanitary permit will be required prior to any work being completed on the system. The new state sanitary permit must be submitted to the St. Croix County Zoning Office by January 31, 2007. Please be advised that fines and /or forfeitures of not less than $100.00 and more than $500.00 per day everyday the violation exists will be assessed if plans have not been submitted by the above stated deadline. Sincerely, R, Ry n Y rington Zoning Technician rt CC. Glen Johnson, P.O. Box 809 Hudson, Wl 54016 " n Scott Pettee, 1263 152 Ave. New Richmond, WI 540 17 a. ST. CRO /X COUNTY GOVERNMENT CENTER 110 1 CARM/CHAEL ROAD, HUDSON, Wi 54016 71-5-386-4686 FAX PZO- CO.SAINT- CROIX.WLUS WWW.CO.SAINT-CROIX.WI.US l _ County: W;sconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix t Safety and Building Division INSPECTION REPORT Sanitary Permit No: M 479349 � 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal informatibn 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: Glen Johnson Construction I Richmond, Town of 026- 1149 -00 -004 CST BM Elev: llnsp. BM Elev: BM Description: Sectionlrown /Range /Map No: •4f0 a— Z CS ( 15.30.18.1109 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark l� ems_ Q. s l doo '5, O 163 . 'b 9B . ssp n Alt. B c� 9 9 Z Aeration Bldg. Sewer Holding St/Ht Inlet $. (P ITS .- s TANK SETBACK INFORMATION St/Ht Outlet TANK TO , / P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet _ Septic �s / S� �� + _ Dt Bottom Dosing — _ Header /Man. 4/ Aeration Dist. Pipe I , 39 7 # Holding Bot. System I q ° f q3 9 Final Grade . 645 ° I�- 3 5 PUMP /SIPHON INFORMATION Manufacturer Demand St Cover q7 , Model Numb TDH Lift Friction Loss System d TDH Ft Forcemain Le Di Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 ll i� () SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer��.l INFORMATION CHAMBER OR A TypC_ Of O � ` ✓ - � I UNIT Model Number. �/�. J, JQ.�� W n DISTRIBUTION SYSTEM l.,le,� 4-2, = 6 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake �j �Ir Pipe(s) loci s Length O Dia Length \ Dia Spacing Z.wx ��QN- e SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over + Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 41,416 Bed/Trench Edges \ Topsoil \ Yes [ No I Yes `° _' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1261 152nd Avenue New Richmond, WI 54017 (SW 1/4 SE 1/4 15 T30N R1 8W) Cherry Knolls Lot 4 Parcel No: 15.30.18.1109 1.) Alt BM Description= �` ` °J�- C: 1, %--, `~ �<_� _ 5 -\ 2.) Bldg sewer length = // Q ce - amount of cover .�l b«�✓< -�r �� o-�P�� i �'q- rT 6a l . - -- -- - — -- r -- Plan revision Required Yes Use other side for additional . information ° 1-I I Z- ; - -I y '. - - -1 Date In pctor' nature t� Cert. No. SBD 6710 (R.3/97) � 1 l l 666CCC �� Safe and Buildings Division County rt a 2U 1 W. Vh' ingfan Ave., P.O. Box 7162 1tTG !. rson, I) 7 - Permit Number (to be filled in by Co.) Cie artment of Commerce 8} 66- 31�ECEIVE � 7 � � Sanitary Permit I1Cat1 State Ian I.D. Number In accord with Comm 83.2 1, Wis. Adn . e, personal informatio you prQi6 . }_ ZO may be used for secondary pvqoses Privacy Law, s 15.04( )trn} Proje Address (if different than mailing add I. Application Information - Please Print All Information ZONING OFFICE .>� I � � 152 Pro pe Owner's Name / / u e . �,v e- �d�l (/ Parcel # [ t> Block # e•s ,vs� Property �-- Owner's Mailing Address Pm a Lo p rty cation oa �O City, State Zip Code Phone Number "- �> =� 4, Section l_ e II. Type of Building (check all that apply) �p� oaf _ nom- T29 N. R `E lrcf or Ial or 2 Family Dwelling - Number of Bedrooms ' Subdivision Name CSM Number ❑ Public /Commercial - Describe Use _ G ._I4�ve /45 ❑ State Owned - Describe Use ❑Ci 17 Villa e ownshi o - - -- g P III. Type of Permit: (Check only —one on line A. Complete line B If applicable) ( _ 66 _ A. :� ewSystem ❑ Replacement System T P y ❑ Treatment/Holding Tank Replacement g Unl ❑Other Modification �— Y to Existing System g } B. ❑ Permit Renewal Permit Revision ❑Change of I 11 Permit Transfer to New List Previous Permit Number and pate Issued Before Expiration _ Plumber i Owner IV. T ype ol'POWTS S stem: Check all that a 1 - —� ✓ / / — 4 Non - Pressurized In- Ground ❑ Mound _> 24 in. of suitable soil -! Mound < 24 in. of suitable soil Lj At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter d Aerobic Treatment Unit ❑ Recirculating Sand Filter S Recirculating Synthetic Media F ilter 44eaching Chamber CJ Drip Lin Gravel -i s Pipe ❑Other (explain ll✓ ' V. Dis rsalff'reatmeat Area Information: L o Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal equrred (sf) Dispersal Area Proposed ( System Elevation ✓/ �t!o ✓ > e°�4 e S `fit w mar VI. Tank Info Capacity in Total Number _ 0i` I Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Vii/ �1 Tanks Tanks vi C (J t Septic or Holding lank Aerobic Trtetettent Unit - Dosing Cha M r VI 1, Responsi Statement - I, the under signed, assume responsibility for I Nation of the POWTS shown on the attached plans, Plumber's Name (Print) Plumber's Signaturl MP RS Number Business Phone Number �r./•'f /��H1 ��jK H' > � �•7 7T 7 0 7l �..� ".� 2 Plumber's Address (Street, City, State, Zi Code) G, VIII. *van Use Ont Approved approved Sanitary Permit Fee (includes Groundwater Date Iss Issuing nt Signatur (N , tamps) Surcharge Fee) eys ❑ Own _ e R eason fo Denial _ • C� # / A I IX Conditions of Approval/Reasons for Disapproval 3l �o rert SYSTEM OWNER: / 1. Septic tank, effluent filter and dispersal cell must all be s ervices / maintained L I n C 1 \ b as per management plan provided by plumber. ] l/ 'rem " I AN "back requirements must be maintained are pw SPPNCIW Lade / ordWw1m. �� ( J-✓l5 C � �"� Attach complete plaw (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01/03) Aj o y ri�ed,Y d ls' c�1 o.�d r e ` 6 q h k, v p r� y � o s , r� _,�� Sao. 6 ® /�.�GG � � �� ` 0 �► !� �` � ,� � � � �' b�� � � �� ti � h r � �y ;,f� s � � i U 1 I o V"' `� `J� S ` �� r� �rl ���� �-- Mtl4 T, �I r • FCF��IFf?� , Wi sconsin Department o tpaW S IL EVALUATION REPORT P of Division of safety and 8u O C F Nwith 85, Wls. Adm. Code NI FFICE mi Attach complete site plot less than x In site. Plan must - r include, but not limited lo: vertical and horizontal reference point (BM), direction and Perosl LO Peru* slope, stale or dln>arrsions, north arrow, and location and distance to nearest road. 6 � P/oi80 print tall ! »fiormation. by on. POMW W Ydormsdon YOU provide M be used for teconfty purposes (Pdvscy Law. s. 1 5.04 (1) (m)). /D 3Il e ) S Properb Owner Property Location v n n Govt. Lot V 114 S/- 114 S kt N R I g E (orW Properly Owners Mailing Address Lot # I Block # Subd. or AAN o C) i CR Phone ` O City O (Town Nearest Road gut 5-C/0,6 , a New Construction Use: / Number of bedrooms Code derived deign flow rate y 2Xj(9 0 CJ GPD Rutplacernard Public ux oommerclal •Describe: Parent material — -j �> L,) t w ` 5 !.� Flood Plain elevation N applicable General corttrr(errtt Y s� r and noorrimmidalions: c•� i 0 4 1 L!._ I [ ' pi Ground surface alev 7j t paw+ to lim&q tactor // S in. Sol Application Rate Horizon Depth Dm*mtcoior Redox Description Texture St'uctire Consistence ftwWary Roots GPDAY in. Mu nsell Ou. Sz. Cont. Color Gr. Si. Sh. •EfWl •011102 o l toZ — r C: - C 0 5q Pit Ground surface elev. 0 R. Depth to liimiting factor �U Soft Rate Hotixon Depth Domb>ant Radax Description Texture Strum Consistence Boundary Roots OPD/f! In. Munsem Qu. Szz Cont. Color Or. ex Sh. •001 '0111112 S ! - .5 3 1 Z- yn U , S z S — 3H O • E%m t 01= 800 > 30 220 mq& and TSS 3-30 < 150 n%OL • 802 and M = 30 mplL CST Nerve (Please P // rht) taro C CST Nrrber ply Owner _ Parcel 10 # 6c /S Page d FN 800 0 ❑ Boring Pit Ground surface afev.� d R. Depth to Iirtftg Isuor W A Rate Motlzan Depth Dominant Color Redox Description Texture Stuck" Consistence Boundary Roots GPDIff' In. Mks" Ou. SL Cont. Color Gr, Sz. Sh. i TWI TIfaK2 3� Z S— 2— S— � 3L _ c yn Boring ff ❑ f3orir>g p Ground sutfaoe alsv. ft. Depth to limitir>Q factor In. Soy Application Rata Horizon Depth ppmInant Color Redox Dworlplion Terre Structure ConsIdence Boundary Roots GPM in. Munsell Ou. SL Coat. Color Gr. SL Sh. *!111112 N 1 011 all - sL c /a ❑ Cl Boring In. — Ground surface afev. n. Depth to kmi9ng faelo _ Cl Pit Rate HMM NO Do *wvt Redox Destxlpdon. Texture Structure comma" Boundary Roots IM Mundell Ou. SL Cont. color Gr. Sz. Sh. 'Ef #i 'Efftl2 ' EftW $1 - SOD, > 30 _< 220 n yl and TSS >30 _` 1 S0 mgk ' Edluent #2 • BOD, 130 myL and TSS <_ 30 mgli. 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. sw+r�o ply ormer Parcel to u �i flR 1 S Ps" —41Ld _ r ❑ a eonna ES tlod►�D [@ Pit Ground surface Nov. is Oepih to *wwv fotor in. Rate Hodxon Depth Dominant Cow Redox Description Texrirte SUumnxe Consistence Boundary Roots GIMON In. Munw Ou. SL Cont. Color Gr. Sz. Sh. INI •EIlAt2 31 Z ,' Cf U . S _Z4 16V r W14 r pZ — 5 �le, a sorIng a ° ❑pit Grand suAaoe Nov. R. Depth to limiting Cacao h• � Rob Horizon Depth Dominant Cow Redox Desalption Texture Structure Consistence Boundary Roots GPOIN In. Munsd flu. Sz. Cad. Color Gr. SL Sh. 'EW1 *012 a &Aa d ° ❑ Pit Groun ataiao. Nev. R. Depe, to Nrrnitlng factor _ i^• so MOCS Reds Hotixon Depth Dowd cow Reft Description. - rw*" Stnlon Consistencs Boundary Roots in. Muaad Qtr. SL Cont. Color Gr, Sz. Sh. -EfGM1 'ERIM2 • >:fAusra #1 is BDD > 30;S 220 mall, arc! TSS 401 130 nVk • E*.W t 112 ■ HOD, 130 mplL and TSS 1 30 ffQ& The DM&Ment of Comareree is tut equal opportunity service provider sad employer. Jf you need assistance to access services or Goad nucOMW in en altercate format. please contect the deim went at 608- 266 -3151 or TTY 608. 264 -8777. swasrotaaae� PAGE OF NAME �� 5 ` r LOT# LEGAL DESCRIPTIONS 1 /a- j / —Ya,S j5 T3U,N / � E(Ot SCALE I" _ Y,/rj' BM 1 ELEVATION �W, C! BM 1 DESCRIPTION BM 2 ELEVATION BM 2 DESCRIPTION c� / SYSTEM ELEVATION C� ! r � SYSTEM TYPE ( U 4t l/� r1 ,u evu _\ 1 �� yy SIGNATURE DATE r — ty and Buildin Division Couny 201 ashington AV P , .0 tV CY� u _ i N *isConi n lyla , Washington dison, W1 47 - rotary Permit Number (to be filled in by Co ) D epartment of Co (648)266= 1 i, Sanitary Permit Application �� Pl n 1.D. Number - -- + In accord with Comm 83.21, Wis. Adm. Code, personal information y pro" CROIX COU 14 /" ` may be used for secondary purposes Privacy Law, s13 (AO)( ZONING OFFI EProleet ddress (tfdtffNrnnt than mailing address) 'r I. A pplication Information - Please Print All Information Proppe / ry , Owner's Na me Parcel N -- Lot - -T Block k I PrI Pr peo - M - Owner 'q M ailing Address -'� Praperty.Localion o �6 �1V9_ 06 A ,/mod �: � � , City, State Zip Code one Number ,Section ^ l5 - (circle o I ! 0 �ly or T �d N; R � y Building (check all at apply) 2 Family Dwelling - Number o edroo - � J i Subdivision Name CSM Number Public!Commerciat - Describe Use -- (M - �-- r; tr YYy FF,, / L Smote Owned - Describe Use _ — - ° ❑Crty_CV[Ilage fluTo nstti of 11 Type of Permit ( Check only o& box line A. C(a npiete line B if ap cable) j 1._1 Replacement System TreamenbHolding Tarli(Replacernent Only ❑ Other Modification to Existing System T � �B. L� Permit Renewal Permit Revision 'hange of Permit Transfer to New 'List Previous Permit Number and Date Issued I Before Expiration r Owner 1V Ty of POWT System: ( Z Che ck all that apply) �,t/ a t — Y INon - PressurizrA in- Ground '' Mound > 24 in. of swtabte soil ❑ Mound < 24 in of suitable soil At -Grade Single Pass Sand Filter Constructed Wetland ❑ Arssur[zed In Ground 1y, " ng 7i�arJc E_� Peat Filter �.J Aerobic Treatment Unit L� Recirculating Sand Filter }, 0 Recirculating Synthetic Media Filt Leaoun�Chamber a larip L ❑ Gravel - less Pi r_ Other (explain) ^ V. rs Bispe /Treatment A rea Info ma tio- _ .� -�— Design Flow (.gpd) De: Soil Applt�ation Rate(gpds ispersa Area Requi (sf} T pispersal Area Pr sed (sf) i System Elevation V1. Tank Info apacity in Total h ber Manufacture Prefab Site Steel Fiber i Plastic Gallons Gallons Units Concrete Constructed Glass _ New T@xisting ! L_ _ Ts Tanks Septic or Holding Tank r i j o , 1?L� _.._ Aerobic Treatrnera Unit Dosing Chamber VIi. Resp Statement- 1, the and si ed, a ssume r f or u iUatior, of the POW'T'S shown on a attached plans, Plumber's Va hie (Print) - Plum is Si gnature i . P PRS Number mass Phone v'umber f ' Cr� 'l<, ar rc ,a�a Ll Plumber's Addre ss (Street, City, State, Zi ode) VIII ount /Department Use Oul Sarutar Permit Fee includes Groutulwater Da lssutd uin Age nt Si n ill t am p s) j Approved C1 Disapproved y� U g p Surcharge Fee) - -- -- t :)wner G iven Reason for Dental g _ �3od' ✓d I M. Conditions of Approval/Reasons for Disapproval � 3 � - 5 1dispersal TEM OWNER: / � / v r Septictank,effluentfilterand � cell must all be serviced / maintained t� as per management plan provided by plumber. `� �a� J X// 2. 1PGU�f%t 7 as per applicable code /ordinances. / Attach complete pleas (to the County onlY) ror the system on paper not less than gilt x 11 inches In size L � r �o a Q - - � S_ � f -` l �s�" .�'�rd ,�/J may- `� •- � ��� �� T� �� �` �-� dy _ e k lzz a 2° `0 �i 4 4 i o � r i i � 0 I ' �1 Q Coen ty Road »G,» x 7 77 1 1 02 ' 431 ' w X \..... X 00 4. bD J V� I 6 \ - IA � CD (l� z to O co X ?� Fn CO D �I :U _ n n ( . LA i cQ u I , N,) i O m Z ao o X n / D O N W Q N� In CC) oX O I ° / n rr (� crl a _ m i X o; i 371 to V -0 o n W O n 00 O \ o 1 t O X 6 way 29 �1 i D ,v ° o �j YE' o I e rn nnA !`� XI/ i % a ~ Wisconsin •DoloWtMentofCommerce' SOIL EVALUATION REPORT p age I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code C St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. R ew ze Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 15 Property Owner Property Location I Steve Derrick Govt of SW 1/4 SE 114 S 15 T 30 N R 18 tE. (or) W Property Owner's Maitirtg Address - Bloek # Subd Name or CSlbl# 1438 County Road G 4 - Cherry Knolls city State Zip Code Phone Number ity [IMIlage R owrr Nearest Road New Richmond I Wl 1 54017 1 ( 715 246 - 3120 County Road G Q New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement Public or commercial = Describe Parent material 1 .0ess aver till Flood Plain elevation if applicable w. °` f"1 ft. Generatcornmants Site suitable for a conventional below grade system and recommendations: * residual fragments of rock at 7.5yr5/8 and 5yr5/8 t, 2 2002 srW rrMrMt -rbff or tsz. Made sysW,ff Utbw MUTOtrvO ra eir Boring # 0 Boring ' c Ft-;CF Ptt Grounf# starlare elev. 1 02,30 ft. Depot W lifnitirig factor >98 in: Soil Application Rate Horizon Depth Dominant Coior Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2 1 0 -5 10yr3 /3 sil 2msbk mfr cs 2f .5 .8 2 5 -12 1 7.5 4/4 scl lmsbk mfi cs if .3 3 12 -98 7.5yr4/6 *sl Om mfi - - .3 .5 2� F 2 Boring* 107.35 50 -57 El Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3 /3 sil 2msbk mfr cs 2f .5 .8 2 10 -50 7.5 4/4 scl Imsbk mfi cs if .2 .3 3 50 -57 7.5yr4/4 Yr5 / scl Om mvf cs - 0 0 4 57 -110 7.5yr4/6 "� sl Om mfi - - .3 .5 b KA t oe -Sa+ -. Or C Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = OD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Thomas C Nelson — 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, Wl 9 -25 -02 715 -246 -2454 nne. n +ten mnn,nn. Properly Owner Steve Derrick Parcel ID # Page 2 of 3 F # Boring it Ground surface elev. 102.60 ft. Depth to limiting factor >102 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr3/3 - A 2msbk mfr cs 2f .5 .8 2 6-22 1 4/4 - s i;,L— ---bugbk, mfi cs if 2 .3 3 22 -36 7.5yr4/4 - sl Om mfi cs - .5 4 36 -50 7.5yr5/6 - is msbk mvfr cs - .7 1.2 5 50 -102 7.5yr5/6 - s Osg ml - - .7 1.2 F Ong # goring pit Ground surface elev. ft. Depth to limiting factor in. it Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IFz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 E Boring # Boring ® pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOO, > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg& 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. SM- 8330rest OL07 /00) s Pate www.eh y: :otiMrcti tA�6y�csisti.coM 715- 246 -2454 CHERRY KNOLLS o: ]LOW 4 1 0 t u 4 ID �07s 63 AU ,60 i 1 0 4 U ✓o Z Thomas Nelson Scale V = 3o 227387 T P CHAMBER CROSS SEC;TIUN AND sPiCIFICATIONS SEPTIC .ANK PUM 44 CI PIPE 12" MIN-. ABOVE GRADE E WEATHERPROOF > 25' FROM DOOR, W�SND�JW - JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK & FINISHED GRAD £ WARNING LABEL " Cl R ? S ER ---- -- _.�...� 4" MIN . 18" IN. 6" MAX. NLET ' t WATER TIGHT SEALS S. TIGHT' ' APPROVED A SEAL JOINTS WITH PPROVED B ` f ALM APPROVED PIPE 3' ONTO IPE 3' �'" s ON SOLID SOIL NTO SOLID C + OIL PUMP OFF ELEV . FT. --f— OFF P RISER EXIT PERMITTED ONLY D P IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE ' TANK MANUFACTURER: NUMBER E dSES PER DAY: TANK SIZES: SEPTIC (3AL. DOSE VOLUME INCLUDING DOSE GAL. �5'!j GAL FLO W BACK: rem ALARM MANUFACTURER: peP CAPACITIES: A = INCHES = MODEL NUMBER: a v _ GAL. � I N CHES = 3;2 SWITCH TYPE: B 2 zNc PUMP MANUFACTURER: �ovti C = S INCHES = _GAL. MODEL NUMBER: o ITCH TYPE: g = GAL. D _ INCHES _ .^. .+��erG � -- ---' REQUIRED DISCHARGE RATE _� GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . ,,�_•___. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . • • • . • • 4MOV FEET + _G M �_ FEET FORCEMAIN X 2. FT /100 FT. FRICTION FACTOR . FEET TOTAL DYNAMIC HEAD INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID A4 DATE: SIGNED: LICENSE NUMBER: 'i /BB Y 1 HGOULDS PUMPS Submersible Effluent Pump 3871 EP EP05 APPLICATIONS • Fuiiy submerged in high 0 EPOS Impeller. Thermoplas- • Bearings: Upper and lower Specifically designed for the g turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. heat transfer. • Effluent systems ■ Casing nd Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion • Heav sum rllOMni w C&vdianStandodsAssodation vY 11 tY P ntatic modals include • Water transfer Medtanical Float Switch 0 Motor Mousing: Cast iron (C5A listed model numbers end • Dewatering assembled and preset at the for Oftlent heat transfer, in "F" or "C ".) factory. strength, and durability. SP ECIFICATIONS ■ MoW Cover. Thermoplastic GWA* Pumps M no goat AegisWred. Solids handling capability: FEATURES cover with integral handle and •S ' of maximum. Moat switch attachment points. ■ EPO4 Impeller: Thermo*$' O Powor CaWe: were duty • Capacities: up to 60 GPM. tic Semi -open design with rated og and water resistant. • Total heads: up to 31 feet pump out vanes for mechanical • Discharge size: 1'h" NPT, seal protection. • Mechanical seal: carbon - rotary /ceramic- stationary, BUNA -N elastomers. • Temperature: 104 (40 continuous 140°F (60 intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel, e • Capable of running f 5GPM l . dry without damage to a 2srT components. ' Motor: _ • EPO4 Sing phase: 0.4 HP, zo 115 or 230 V, 60 Hz, 1550 1 RPM, built in overload with s ' automatic reset. • EP05 Single phase: 0.5 HP, Eros 115 V, 60 H2, 1550 RPM, - built in overload with EPO4 automatic reset. z • Power cord: 10 foot g. standard length, 1613 S1TOW with three prong grounding plug. Optional 20 aL 0 0 1 20 30 40 50 GPM foot length, 16/3 S1TW with three prong grounding plug -`-� (standard on EP05). 0 2 4 6 e 10 12 mvh cAwaclry Gould Pumps V 2tl00 Goulds Pumps ITT I ndustries ENectWO February, 2000 B3671 l STANDARD CHAMBER Quick4 Standard Chamber - -- -- - -- 48 " -- — _ (EFFEC'riVE LENGTH) el I 1 1 12° \ i 1 SIDE VIEW SECTION VIEW MultiPort End Cap 2" 1 ( � �� � 16" - -- - -- — -- SIDE VIEW TOP VIEW FRONT VIEW `y' r x.. .my �: S ' "• ���' ;Y' i 4 .t. F - ���w y � ' C QuiCk4 Standard Chamber Morainal S pe�itications 4 a MultiPrt :end Ca'tVamnat Secitications y 34 "x i6 "x 12" fffec Length ` ' 48 ' invest Height 8" or 1.25° Invert Height 8 LNEILTRA-7Q "STEM INO. TAN L IMLT_ l2 ARR (at I c SI J ^�urar rri{ 01 each cha end prate, wedge and nlher a Ge B30ry mar .1U!evtid b'y''r ('U: a`I, wiu"t itlStaflad anti P(Wi'alad rn a n+acn cold of ;r I P- n SyLlen: rl accofda:,(>E, wqn Intulrakx s utstr I'cxrs, Is .va IanteC to n,n ortp nal w: ohasu ( "IitNdar) ;cMinsr nsieccros vr, I as u i wo k , sI I:. IFr n r. year Irr]rn the : Ja!e Ihai the sr:p'ic pennil a krusd t0! soptK: system. r ryrtainrng Ine U uts, prourlgd. hrnvr Il la 1 a 'Aplif ly I S n'x rH':,.rle0 h� app'"anlB 12 w', IhP Wdrl'anly' perkxJ w1lf b--q,,, h • tla -P 'het IlitalatNNl IA the •fi[ s i"rn v frPnfM(k3$, TJ % SP 1 h ;Y rh3, Pic !oust �OlEy 1 SliRfr`r in wT! Ily w Its C Haar141 _xle�s AI :JeJ $e1yTY.JN C/•n'lecl¢!f..7"I1 Wteen . •lay I IJ,e I tYwc k n t. In NN Ir' rot supph r.pauomenl Una3 kJr VNIb uetaln,inrxi t,v Infidu. hi he cew rrad by this i rr'�red lk'm,arvl'i rr w w s aalV ay sµ.c" c-ly e,c!uoes Ine owt ul rlr: ival artWor ns a! %i (.t • of the units It I in" f.r] WA ll {AN1Y AN , nFMF OICS IN L;;F'ARAGRAf'H -.]: A'iF EXCLUSIVE rk 7 'I riE Af I II C WARRAPr 11C$ NNTI I RESPECT SYSTEMS 14 V n :ter I uN. r�., INC I! 71r F3 PJp IMf! WAHRANI :ES JF MERGNAfdTAft LirI OH FII P(n; :1 FART. JLAR Pi.NPC] L-. 'I n "h tcd W IF 7 y hnll r wr.] d any part of ha rhaflber Sys;ent S 1 Ir .a0L,IF(, try Lyons ctf v 'n.ln "'tilt otor, Tha Limited W Jrslnty boas -t z to ]d In Ill idnIal c,xr: e uw I, specral or oche t;l ci,mages lrllihral hall n ,j be lace. for pr, tale ; Or ly,;idated dar wq> 7cWCiry !r ss cd EnVIMnMental Onsite Wastewater Sdutlolle w pdurllon and p ut5 Goy d id na a ial , overYSatl craAS or olhar +psse., r, exy.srses :nrurrsd by Pie HJidai or any Irerd pary "ir"..IGeally, Ilho Unit W' ren;y c[rvi' - Ue are damage IC the Ungs dlra io U IinarV Wbaf of (1 I - a! ]IlerJtlo't a�ddare mi5115d, as P O' nfY:j6 Ct of °.a Ur .ts, Iho Uu"; tJwr.i ,ulynrled to ehkae kale o other "di it which are' parnuttexl hY the va �tailaliorr iIISI liCtiOnfi; lalure O marital" IY,a 6 Business Park Road " P.O. Box 768 rrem ground rovyrs sat fodr, ' the .,talla6en ins,rucl ens the Paoarhert of ,mDrcpe naler''a:: into the by &isrrr eOntalnirtg the u t its, lauun d o r t u n Unns a the seFU y^;Iem dire IO improp�r:l.Lng or rnprgre: si�ny, BxcesJeyi ware Js g 1 T,ix(y�er mass erspnsa1, or an O!d Saybrook, C 0647b any r!Ixrr evalt , u -u„ed by InkNralex. This umileC Waharty t# az be void d tt>d Holder tails to contpN with ;dl of {na terms sei o n ; o n ; o r 'Varerlly 860- 577 -7000 " FAX 860- 577 -7001 'Oh' in ' avant wit Ir Iiltalor bo respor;sd�le'or arty los • or damage to I e N xr. Its U..i ,)I arly Ihlyd party last Itiny'rom In 18 W*r or &q.; q me o - Iran arty f lue.i I-Ad?'/ claims Of Holdar OI any Ihir(1 (,any. For I ns I� drlrl Warr & try .o apray, the Units mrrsl be rrsla:k)v o aao'uai 8���2� �jy 1 �44J� Nnh a, [aydH V1..'erJn.red by "late and iocat codes; a!i OV'Rr apiolicahle lams: qn0 t1 : -Im'c oxtalat— tns•"l;one, Ia;)!-rpldatrNe'CntaliVe ,ri knahalOr nae the aUl.'+Ontr' !O a'llerk3f :.]r L'xtan[7 Ih9 Iji nileV Wanaray 1,1' -i"—ty appli. Ih Few party :.Jtw 9i ur. It'. o'igr ?iX+ b m3 reprers Ns Ire - tareilari a. ati(ed ri ma :yly oRwsr7 hY nliltr'tof A Ilm +tat ❑unlbsr '.r ;tales to co'.uaiss have dilic+era v rea�rira met I. airy pw:1» rx .I In Jts ;h utld eallacl irdlNralor's Gaxporate HCaetlual lets in Old SayL -wk, fpnllecllw6 poor to s�c�� pwenase, to oLlaln a co;]y of the apt�eable wan'anty, anC should i arelury mad J':at warranty tx�+r to t. a plmhase of i,mds. U S. Patents: nts: 4,7 9 oat 5,01!,'.81; 5,156, 488: 5.336,017; 5,401,116; :i,4 {:1,459 5,511 0 03; 5,716,163; 5,588,779; 5,839,844 Cann;] Patents 1, A .16A 2,1)04,564 Othor patents pending Inhilra+nr, Equalizer art S jaVJlndar are registered trademarks Uf Infiltrator System l Irc. I_fiihator Is a f8(j Stofed Vadontlik it) France. Infltrator Syslarne Inc. IS .a rcgiSterect hadafnark II' PAb .ico, Contour, Contour Swivel Con action, kl,u Jt_eac ling, Pgly,Tuff, ;mapi_a Chao' erSracer, Posit,ock, Quk:krul, QulckPtay aeercEeo rAPew and Qu'ek4 we trades of lHiltrator Syslen',s Inc, C 2003 Infil ralor Sys6ams Iris,. Printed In S.A. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Divisionrof Srdety and Buildings in accordance with Comm 85, Wis. Adm. Code County s { . Cy�O 1 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. oo Please print all information. Revie b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 'Y� Property Owner Property Location Q 0-4 ie'4-- Govt. Lot 5 w 1 /4SL 1/4 S T 3 o N R L p E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3 C. U 1-4 Che.r,- o l l City State Zip Code Phone Number ❑ City ❑ Village [B Town Nearest Road Z I (1 ) 2 - 31 Zp I Ch ci I El & -New Construction Use:8 Residential / Number of bedrooms 3 ` Code derived design flow rate c fS6 v b GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material —j 1 Flood Plain elevation if app ft. General comments $ d RE CEIVED and recommendations: 5 Lls 4-1 C -hour -e lt.r. q 7 .50 MAR 1 3 2002 F T] COUNTY Boring # Boring ZONING OFFICE © pit Ground surface elev. D , \ ft. Depth to limiting factor ZJo_ in. __j Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I 0 -8 I 312 50 ZrrqJbk c v . L -! 1b 4 C qL3 Si Z k C-S — 3 l l — 5 L Z I C2P 1.5 .5L m v-4'; i F7--1 Boring # E] Boring ( ► Pit Ground surface elev. `I_ 1 -�(� ft. Depth to limiting factor Z� in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i *Eff#1 I - EE ff#2 -tp 16 12 5'1 2n p c-5 l d• S • O 3 Z4' Ip 3 c.2, -- urs, l r 41q 5 L. Zrinsbk YrXy — ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg /L CST Name (Please Print) gnature CST Number m chum - -- -- -- 23 -3.309 Address c_ Date Evaluation Conducted Telephone Number Ztl Rots 54• -56 mesaeL Cvl D L 12 -15--61 C 7 /S)2`f 7- -e-14o 9 PAGE 3 OF_f�_ NAME 01" fFc,k LOT# `� LEGAL DESCRIPTION 5w YSX AS T 30, N,R, fi R E(Or�W� SCALE: 1 "= y� f BM 1 ELEVATION X00. O f " BM 1 DESCRIPTION doe a BM 2 ELEVATION q 9. 3 0 BM 2 DESCRIPTION DoT /J � r/c_ - SYSTEM ELEVATION S'a 1 ALTERNATE ELEVATION ti /A CONTOUR. ELEVATION `l ,?. S` o J . N- 3 V4 e r g�l • �/ a $0 SIGNATURE --� DATE / Z Property Owner errt c- Parcel ID # Page 2 of � �- Boring # ❑ Boring Z O �]C pit Ground surface elev. 9(0 • I () ft. Depth to limiting factor in. Soil Applicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -ZO l I -- 5' 1 Z b k, - 3 l 1 -I F—I Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F - I ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 100) • ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -e Mailing Addressa a Property Address / Z 4 (verification required from Panning Department for new construction) City /State _� �� �Id � Parcel Identification Number j�F.. DES _RIPTION Property Location L /. SL= L (, 11 0�► , /., Sec. /� , T -Fd N -R w w, Towffi ) of Subdivision Lot Certified Survey Map # , Volume , Page # Warranty Deed # 70 :2�rY/ , Volume - a !f r� ,page # /mod Spec louse p yes j"no Lot lines identifiableKyes 0 no SYSTEM MAINTF NCE 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 systcm can afrect 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 b a master plumber, joumeymar, plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal sysic,m: is in proper operating condition ancVor (2) aficr inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standarc:s set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Centficat:on stating ilia ur systcm s been n);J1W nncd must be crimpleted and returned to the St. Croix County Zoning Office within 3;; days of tee car "P 'I n date. SIGNATURE 0 PLICANT .7 LeLl r-- DATE OWNER CERTIFICATION 1 (we) ce tha 11 statements un this form are in-c to the best of my (our) knowledge. 1 (we) am (are) the o wn ers) of the pro desc ibe ab c, by v;rtuc of a warranty deed recorded in Register of Deeds Office, SIGNATURE 0 PPLiCANT DATE Any information that is mis rcprescn cd Wray 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 aced POWTS OWNER'S M UAL & MANAGEMENT PLAN Page of FILE INFORMATION �ZN �' SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Q ®Q a l E3 NA Permit # q -31 Septic Tank Manufacturer �`c ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 4 a l ❑ NA Estimated flow (average) g al/day pump Tank Manufacturer Se ❑ NA Design flow (peak), (Estimated x 1.5) g al/day . Pump Manufacturer � j64 ❑ NA Soil Application Rate al /da /f t2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cells) ❑ 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) 510 cfu /100m1 ❑ Drip - Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other. ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 months (Maximum 3 years) ❑ NA ear(sl Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cellls) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 w ear(s) monthls) O NA Clean effluent filter P At least once every: A year(s) —� O month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: •— E] year(s) ' O nth(s) ❑ NA Flush laterals and pressure test At least once every: ❑ earls) Other: At (east once every 13 month(s) ❑ NA O year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carry ing one of the following licenses or certifications: ; Septage Servicing Operator. Tank Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer 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 cellls) 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 shalt 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, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. i •9p eA!1eJis!U!wpV u!suoos!M'1£!'A (Z) . (1)4g'ES PUe (I)V(p)(L)(g)(Z)ZZ'¢B wwo:) Jaideyo 41!M ooue!ldwoo u! peueip sem J,!JJewJJOOp+s!yl 5 ,? �) m 9uoyd A ! 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Derrick a married man Grantor, and G1ei1J01(1S4,l p1�'SF t1C770�1 '1 C- 12/19/2002 09:30AM Grantor, for a valuable consideration, conveys and warrants to Grantee �XthiF the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): REC FEE: 11.00 TRANS FEE: 302.40 COPY FEE: CERT COPY FEE: PAGES: 1 oWisconsi. d 9, Cherry Knolls, St. Croix County, Recording Area Name and Return Address Attorney David J. Estreen 304 Locust Street Hudson, WI 54016 026 - 1045 -90 -000 Parcel Identitication Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 1 day of D 2002 * * Steven J. De rrick * * AUTHENTICATION ACKNOWLEDGINIEN'[ Sienature(s) _ STATE OF Wisconsin ) - - -- - - - - --- ) ss. St. Croix County ) authenticated this day of Personally came before me 18t day of Decemb 2 002the above named Steven J. Derrick a married man * - - - - -- - -- ----------------- TIT LL 'MEMBER STATE BAR OF WISCONSIN (If not, to me kn to be the erson(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrura d aeknowv,led�ed the same. THIS INSTRUMENT WAS DRAFTED BY -attorney D avid J. Es _ _ * avid �. Estreen 304 Locust stre Notary Pq lic; =State of [� sconsin Hudson, WI 54016 My C0rti3,nrssion is permanent. (It not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) . * Names of persons signing in any capacity must be typed or printed below their signature. " ; % "in forn, anon Professionals Co. Fond du La:. \\ STATE BAR OF WISCONSIN \ \ARRA.N'TY DEED FORM No. 2- 1999 f� f i Ge ' C r� y ► f � 1 / 'I ♦ r Pi Ol varr r i r i r qg UNRtAnm_ AAVS Km . 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