HomeMy WebLinkAbout032-539-34-2407-SAN-2003-335 Safery and Buildings Division Counry
� �, 201 W. Washington Ave., P.O. Box 7162 t��c.z�
�scons�n Madison, WI 53707 -7162 Sice Address
Department of Commerce ST Not Re uired �`���� �
• Sanitary Permit Number
Sanitary Permit Application 428553
In accord with Comm 83.21,Wis. Adm.Code,penooal infortnation you provide ❑ Check if Revisioa
ma be used for seco� us Privac Law,s15. 1)(m
I. Application Wormation-Please Print All Information Stace Plan I.D. Number
��'ld��i�
Property Owoer's Name Cu2t1S Mark Hermanson Parcel Number
032-539-34-2407 �
Property Owner's Mailing Address�ep..� (6Z 0 S �t��" � �°' � Property Location
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City,State Zip Code Phone Number S�ob G Lot Number Block Number
O
Subdivision Name CSM Number
l CSM Vol 2 P 48
�'/�Z��T ��-.� ��� �"��?�� g
II.Type of Build g(check all that apply)
� �Ciry
�1 or 2 Family Dwelling-Number of Bedrooms ❑Village
❑Public/Commercial-Describe Use �Township �
❑State Owned Nearest Road
�/ � �'l�C �nJ
III.Type of Permit: (Check only one box on line A(numbering scheme for internal use). Complete line B if applicable)
A' 1 �New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use
S sum Tank Onl Existin S stem
B• ❑ Check if Sanitary Permit Previously Issued PO��Number Date Issued
IV.Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44 ❑ Non-Pressurized In-Ground 21❑ Mound 47❑ Sand Filter 50❑ Coaswcted Wedand
22❑ Pressurized In-Ground 41 �Holding Tank 48❑ Single Pass 51 ❑Drip Line
45❑ At-Gcade 46�Aerobic Treatment Unit 49❑Recirculating 30�Other
V. Dis ersallTreatment Area Information:
Design Flow(gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevatioa Final Grade
Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevadon
L/�� �, �� ` �-^
VI.Tank Ittfo Capaciry in Total Number Manufacmrer Prefab Site Stcel Fiber Plastic
Galloas Galloas of Tanks Concrete Construc[ed Glass
N�W Exiscine
Taiilcs Tarilcs
Sepric or Holdine Tank _ �,� t ��
DosinY Chamber
VII. Responsibility Statement- I,the undersign�d,usume rapoacibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plum r's Signature MP/MPRS Number Business Phone Number
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Plumber's Address(Strect, iry,Stau,Zip Code)
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l�l_SL' `' �L � � �� � � �cJ i 5� `1
VIII. Count e artment Use cil
" pproved ❑ Disapproved Sanitary Permit Fee(includes Groundwater Dace Issued Issuin A t Si ture 1f Sra s)
Surcharge Fee)
� ❑ Owner Given Inidal Adverse �19 0.O 0 8/2 8�� � .
Determiaadon _
IX. Conditions of Approval/Reasons for D'uapproval
Attach complete plac�(to the Couuty ody)for the rystem on paper not la�t6an SIl2 x 11 inc6a In size
SBD-6398 (R. OS/O1)
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Safety and Buildings
� 10541N RANCH ROAD
HAYWARD WI 54843
� � TDD#:(608)264-8777
�scons�n �•�mmerce.state.wi.us/sb
Department of Commerce �W�✓isconsin.gov
Jim Doyle,Governor
Cory L.Nettles,Secretary
August 22,2003
CUST ID No.221718 ATTN.•POWTS Inspector
ZONING ADMINISTRATION
DONALD C THOMPSON SAWYER COUNTY SPIA
N5089 THOMPSON RD PO BOX 668
WINTER WI 54896 HAYWARD WI 54843-0668
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/22/2005 Idenrificarion Numbers
Transaction ID No.896935
SITE: Site ID No.663299
Mark Hermanson Please refer to both identification numbers,
Ehn Rd above,in all correspondence with the agency.
Town of Winter, 54896
Sawyer County
SE1/4,NW1/4,S34, T39N,RSW
Lot: 7,
FOR:
Description: New holding tank,2 bed room residence
Object Type: POWT System Regulated Object ID No.: 915510
�V j1"���
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrarive Codes � 1
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner,as defined in �`,�#
chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. �'� �
' µC�`�
The following conditions shall be met during construction or installation and prior to occupancy or use: ���
General Approval Conditions: �
;��
• This system is to be constructed and located in accordance with the enclosed approved plans and with the ,/- -"" r
"Holding Tank Component Manual,SBD-10571-P(R.6/99)" /
• In the event this holding tank malfunctions so as to create a health hazard,the property owner must follow the
contingency plan as described in the approved plans. In addirion, the owner must insure that the operation,
maintenance and monitoring duties as described the Holding Tank Component Manual are complied with.A
copy of this information must be given to the owner upon completion of the project.
Key Item(s)
• The horizontal reference point is the top of the stake for the foundation wall.
• Manhole cover or service port to be no more than 25' from service road or drive per Holding Tank Manual,
Table 1.
Reminders
• A meter shall be installed by a properly licensed plumber on the water system that adequately measures the
amount of water used by the structure,excluding hose bibs and wall hydrants,which do not discharge into the
sanitary system.
• Anchor tank as necessary to negate buoyant forces per COMM 83.43(8)(g).
• Materials shall conform to the requirements of COMM 84.
DONALD C THOMPSON Page 2 8/22/03
• Maintain well and waterline set backs per COMM 83.43(8)(i).
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Deparhnent,which may include local inspectors. All pernuts
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Safety&Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure,or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation,o eration or maintenance of the POWTS.
Sinc�ly, Fee Required$ 60.00
� � Fee Received$ 60.00
.--._�'..,-... ,
� � , � „�._ Balance Due $ 0.00
f ,�
� � Patricia�L Shandorf
POWTS Plan Review�r tegrated Services WiSMART code: 7633
(715)634-7810, Fax: (715)634-5150,M-f 7:45 am-4:30 pm
pshandorf@commerce.state.wi.us
cc: Carl J Lippert,Wastewater Specialist,(715)634-3484
CONCRETE HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project Lake Winter
Owner Mark Hermanson
Address 5139 Lower 183rd St. W.
Farmington, Mn. 55024
Legal Description SE1/4 NW1/4 Sec-34 T-39-N R-S-W
Township Winter County Savryer
Subdivision Name Lot No. 7
Parcel ID Number
Plan Transaction ID Number 72403-2
'`����i�.
Index and title sheet Pac�e 1 ;,'�
�c�.
Holding tank specifications P�a_ye ?_ a- �« :r p� �S
Site plan Page 3 �' B�� �.
Maintenance and contingency plan Page 4 �
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Designer ponald Thom son
Signature l' Phone No. 715-266-2842
License Number 221718 Date 07/24/03
Designed pursuant to:
Holding Tank Component Manual For POWTS
SBD-10571-P(R.6/99)
version 2.0(03/01) Page 1 of 4
-�
HOLDING TANK SPECIFICATIONS
2 Number of bedrooms
Non-residential estimated flow(gpd)
2000.0 Minimum holding tank volume required (gal)
2000.0 Proposed holding tank capacity (gal)
Skaw Per Cast Tank Manufacturer
2000 Tank model number
Tank Alert Alarm manufacturer
101 Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for round tank 16100 Ibs Weight of tank and cover
47.0 Liquid depth below inlet invert (in) 1.50 Safety factor
3.0 Maximum depth of soil cover(ft) 24721 Ibs Weight of anchor required
67.0 Height (in) Outside 33.1 in Soil cover req. for anchor or
152.0 Length (in) Dimensions 6.1 yd' Concrete counter weight
74.0 Width (in) Only
HOLDING TANK CRUSS SECTIDN
manhole cover with
locking device and finished ��ent cap
junction � waming label grade
box —� �
4"min. 12"min.
24 in.
Manhole and vent locations
condun may be reversed. vent pipe 18��min.
building sewer
� ---�seMce /, 12.0 in---------------------�—------ inlet
blind plug alarm on Note: All tank joints, and
co seai joints between tank
outiet openings and pipi�g are
Electrical as per 35.0 in. sealed watertight. All
NEC 300 pipe and vent materials
and Comm 16 comply with Comm 84.
3 in.bedding under tank. Tank is anchored as necessary to negate buoyancy.
Project: Lake Winter
Transaction Number: 72403-2 Page 2 of 4
HOLDING TANK SITE PLAN
Project: Lake Winter
N Legai Description: SE1/4 NW1/4 Sec-34 �T-39-N R-S-W
Subdivision Name:
Scate: 1: 30' Parcel ID: Lot No.: 7
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Transaction I.D.: 72403-2 Page 3 of 4
HOLDING TANK MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and
maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P
6/11/1999), and the Sawyer County Sanitary OMinance.
1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd.
2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in
the attached Holding Tank Servicing Contract and Maintenance Agreements.
3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet
(at which time the alarm will activate), the pumper listed in the current Servicing Contract must be ca►led to
empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Cnde.
4. At each service event, the service provider should visually inspect the condition of the tank, risers and
manhole cover(s) and verify that the alarm system functions and manhole locking devices are present.
Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions
shall comply with ihe county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code.
5. All service events or inspections of this POWTS shall be reported to the county within 10 business days.
6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes
tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes
a failing POWTS and may result in issuance of correction orders or a citation by the county or state.
7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards
for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue
of a person from the interior of the tank may be difficult or impossible.
8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank
may be installed in the same location (a new sanitary permit is required for such a replacement). Con-
nection to municipal services would also be considered at this time if they are deemed available to the
property.
9. If this POV1rTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in
accordance with Comm 83.33 Wis. Adm. Code.
10. If there is a problem with, or question about this installation, the following persons should be contacted:
a. Installer............................Donald Thompson Exc. Phone: 715-266-2842
b. Seroice Provider................. Gene's Sanitary Service Phone: 715-943-2650
c. Co. Zoning or Health Dept. Sawyer County Zonin� Phone: 715-634-8288
11.
Project: Lake Winter
Transaction Number: 72403-2 Page 4 of 4
HOLDING TANK SERVICING CONTRACT
Contract Date
�'r� � f� zj THIS CONTRACT IS MADE BETWEEN THE
Holding Tank Owner(s) Name(s) and ; Pumper's Name
' Gene's Sanita Service
M �ir l� H-�r x.��N S o c�l ; rY
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:)
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1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality",
which has signed the pumping agreement required in Ch. ILHR 83 1�4)(b), Wis. Adm. Code and
with the County of -S�W y'-Q r
2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have
access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain
the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment.
The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed
upon by the owner and pumper.
J 5
3.The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.�
(4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The
pumper further agrees to include the following in the semiannual report:
a. The name and address of the person responsible for servicing the holding tank;
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contact. In the event of a change in this
contract the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with
the municipality and the County named above within ten(10) business days from the date of change to this service
contract.
,
Owner(s)Name(s)(Print) � Owner's Signature(s) �'
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� i /�% Subscribed and swom to be re me on this date:
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�Y �Y 5��/ ; ��� � -�'-� ��� � � ,�
Pumper's Name(Print) ; Pumper's Signature �:� � -� :T�= Notary Public
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Gene's Sanitary Service � �����n expi ' '
; ✓��v�- ��� = . •��:'
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Pumper's Registration Number
This instrument was drafted by the State of Wiscansin Departrnent of Industry,
SY 61� labor and Human Relations,Bureau of Plumbing
SBD-7574(N 11/85)
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t10LU1NG TANK AGRECMEN'1' " � ' .
Tliis Agrccmcnl is niadc bcl�vccn Ihc - •
� Govcrnmcntal unil and I►olding lank owncr(s). �
Document Number � �
Parcel Number: Agrecment batc: '
-���� -�-��v�'�G� - 5=o
(ivvanments)UniL• Ilolding'fank Owncr(s);
�U�L� G � C�/, ' -Pa' i �'� /5`��' C{�( S �i✓
We acknowledge that application is being rnade for tl�e
installation of(a) holding tank(s) on the property described on
the attached st�eet(s). �
S'E `/ . �t w�/ S c'c_ j`/ l�`l�l/?s�-c� ,� t'� l 3'
SEE ATTACHED SHLL+'T(S). Return to Sawycr County "Lonin� �
Or that continucd usc oC thc cxisting prcmises rcqaires that a holding lank bc installcd on Ihc properiy for Ihc purposc of proper
containmcnt of sc�vagc. Also, lhc properly cannot no�v bc scrvcd by a municipal scwcr, cir airy crihcr lypc uf�iri��alc sc�va�;c systcni ;ic
permiucd undcr Comm 83, Wis. Adm. Codc,or Ch. 145, Slals.
As an induccmcnl lo Sawycr County to issuc a sani4�ry pcnnil for Ihc aUovc dcscribcd properi}�., ���c agrcc to Ihc following:
l. To confonn Io all applicablc requircmcnts oC Comm 83. Wis. Adm. Codc rclating to holding I��nks. If Ihc owncr fails lo havc II►c
holding tank properly scrviccd in responsc to ordcrs issucd by Sa�vycr County to prcvcnl or abatc �� huiiian hc:illl► hazard as
dcscribcd in y254.S9. Sl:ils., Ihc govcrnmcnlal unil may cnlcr upon Ihc propert�� and scrvicc Ihc I:ink or ciusc lo h,rvc Ihc lank lo
bc scrviccd�nd chargc thc owncr by placing Ihc chargcs on thc lax bill as a spccial asscssmcnl for cutrcnl scrviccs rcndcrcd. 'I hc
chargcs�vill bc asscsscd as prescribcd by §GG.GO. Stats.
2. Purst�nt to Comm 83, Wi. Adtn. Codc, to havc a watcr mctcr installcd in thc building or slructure scrviccd b�� tlic holding lank.
Tl�c watcr mctcr shall bc inslalled by a plumbcr authorizcd by thc St�tc lo conducl such installations, wilh said inslall.�lion
complying �vilh slalc regtilations and manufacturcrs spccificalionS. Tlic ownCr agrCcs (o bc: finally responsiblc (br thc purchasc.
inslallalion. tnainlenance, and repair of the water meter. and agrees Io allo�v lhe counly or bovernment,il unil lo enter Ihe abo��e
dcxribcd property on a rcgular�asis to rcad and/or inspcct lhc�vatcr mctcr.
3. To pay all charges and cost incarred by the governmenlal unit for inspeclion, pumping, hauling, or olherwise servicing and
mainlaining Ihc holding taiilc in such a manncr as to prcvcnt or abatc airy hi�man hcallh ha�.ard causcd by Ihc holdinK lank. 'i7ic
govcrnmcnlal unil shall notify thc owncr of any costs which shall bc paid by thc owncr wilhin thirty (30) days from thc dalc ol'
nolicc. ln Ihc cvcnt Ihc owncr docs nol pay thc cosls wilhin thiriy (10) d;rys. Ihc o�vncr spccifically agrccs Ihal all Ihc cosls ;md
ch�rgcs tnay bc placcd on thc la�c roll as a spccial asscssmcnl for Ihc abalcmcnl of a hiim;in hcalll► h:►�;►rd. and Ihc lax shall bc
collcctcd as providcd by tlic law.
4, Except as provided by �281.48(3)(d) Stals.,agrees to contract wilh a person who is licensed under $281.48(3)(a), Stats. '1'o havc
thc holding lank scrviccd and lo file a copy oC thc con(ract or thc o�vncr's rcgistration wilh Ihc govcrnmcnlal uniL Thc o�vncr
fi�rther agrecs lo file a copy of any changes to the services contracl, or a copy oC a ne�v scrvice conlricl, wilh lhe governmenlal
unit within tcn(l0)busincss days from thc datc of changc to ll►c scrvicc conlract.
5. To conlr.tcl wilh a person licensed under §281.4$(3)(a), S(als., who shall submit holding tank scrvicinb reports lo the county in
accordancc with Comm 83.55 Wis. Adm. Codc. In tt�c c.�sc of cxccption undcr b281.48(3)(d). Stals., Ihc owncr shall subtnil thc
rcporls lo lhc counry. Tlic governmcntal unit or county may cnlcr upon Ihc property lo invcstigalc Ihc condition of Il�c holding
lank whcn pumping rcporls and mcicr rcadings may indicalc tlu�l thc holding lank is nol bcin�proExrly maintaincd.
G. Tliis agrccmcnl will rcmain in cffccl only o�riil Sawycr County ccrtifics that thc property is scrvcd by cilhcr a miinicipal sc�vcr or
a privalc scwagc syslem othcr than a holding tank Iha1 complics with Conun 83, Wis. ndm. Codc. ln addilion. Ihis agrccmcnl
may bc canccicd by cxcculing and recording said ccrtificalion�vilh rcfcrcncc lo Ihis:igrccnu�nl to sudi m:inncr n�hich will permil
Ihe e�cistence of the cerlification to be detennined by reference to the property.
7. Tl�is agrecmcnt sliall bc binding upon Ihc owncr, Ihc hcirs of th�owncr.and assignccs of thr, owncr. Thc o�vncr shall submil Ihc
agrccmcnt lo Ihc rcgistcr of dccds,and Ihc agrccmcnl shall bc rccordcd by Ihc rcbistcr of dccds in a manncr �vhicli �vill pern�it thc
crislcncc of thc agrccmcnt lo bc dctcnnincd by rc(crcncc�o lhc property�vl�crc�hc holding�.ink is inslallcd.
chvna'a name(s)-Please print: ACKNOWLEUCMFN'I�
s�rn�rr c�r• wiscc�NsiN >
�n u �I� l�� ��� ���� s ���.� ��;,..�,��R�ae���,,,
K ) „B �C���`o� CuuntY ).`� • S
Nutarized Ownc s S� nalur • ---- — ��� * • wt�• ` , .�� �^ �
�,� / 71ie Owners,printed belotv,ptts�llallx camebl ,�'i�Iln.��_X� d�V���
.r ' `V� �7� .-
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_ u,�� -Qz z�---n/ � — -�'-��f __ _.:_��:E�C��_ �_ _ _ . _ _ .
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Owncr Namc(s): ���`���� ` ---__ _ _--
----
Gvvernmrntal llnil U�cial Name—Please Print: � . �
r ;• C _. � �
- � � � -----�- =.�--- - ,-. ;r-- _ ___ ----- ----
Governmenlal Unit O(iiciel Title—Pleaae Print: known Io me lo he the person(s)who''�f����$ `\�q+�i g instn�m �d anJ� iowlcdgeJ,thc
n A� same. J�ii�i t�t� ,�
L.� �T��" �'/f� �:3���� S< <���2 --
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Ciovernmental Unit U(Ticiel Signewre&Dete: Notary R�blic(Print or Type) Signalure
� � State uf Wioconsin
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My Cimimiesion is pern�ancnl �L� . � )
1 (If not,expiralion dele ia:__�--------.__--------'-----_---.
ih.n�a ny: � 1� " r ����r� Names of personl signing in any capacily mm�hc 1}'�ed vr prinled hclow Ihcir signaturc.
Name of Perann com letin form-T elPrint
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2'hat par� of the Southeast :�ual�ter oi 1;he �
l�orthwest �uai�ter �;j,�4-IVW4) , Sectio�L lhirty-iour
(3�) , Township `rhil•�y-nir�e (39) 1•!ol•tn, i�anoe
�'ive (5) r�est, �o�c pa�t;icularly desc-ribed as Lot Seve�� (7) as ��ecoLded
in Volume Two (2) oi Ceriii'i�d Survey t�:a�;s, pa�;es 48-49, Survey I�do. 246.
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' DOCUMENT r10. STATE BAR OF WISCONSIN FORM 1.-1982 *H�s sP�cc PE9ERVEO Fow RECORo1NC OATA
WARRANTY UEED -
zsoo48 �
. 9is�e�5 o,fl�e •
TYus Deed, mede between .l�OR3ld _�i.... ',�'�lOt.F.�_ 211 }SS
vryer Counry �-}
`-1d.u�.t man--.. .---- .. . . ......_ eivediorrecordthia J k deyd
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_ _ __ - . __..___ _..... _
_ _ _... -__........-----�--�
__ __.. .. _
__, Grentor, M and rewrded as vd 7.2 ia -.
and. Cux'ti_S__Tiaark__.�e_imanson_, an__adult �man Racordsonpage 13
__ _..__ ...... ----....._._......___ _._.... --- - - - - - - -- Fegfster
_.... _ _
----....- --�-- ---�-�- . .... ........... ---_-....._.. - __, Grantee, Deputy
Witnesseth, That the eaid Grantoq for a valuable cone�derat�on.. ..
- _-- -___ --
_ ._ __ __.. - � --.. _ ._ _ .. _. _ __.. -
--------
Jd�J' eT' n�runn roj�,.ST'�C �OTIDSI`iS021
conveys to Grantee the followmg described reul estate in ._ ..,1r. . . . .....__-.
County, Stete of Wisconein: S�3� LOWeT' 183rd S�. w
ThO.L par�� of the Southeast ;�uac•ter of the �'armir.gton, ;�li� 57024
----- -
-- - .
� 032-539-34-2407
l�orthwest �uarter (,;�;y-1�W4) , Sectioi� lliirt;�-iour
�j�}�� `,['OWriS171� 'L'�"lll'i,y-i11Yi� (39) il0i't11� idanoe TexParcelNo:..............____...._..__....
.�'ive (5) ;;est, mo�c pa�iicularly described as Lot Seve�z ('j) �s ��eco�ded
ii: Volur,ie Two (2) o; Certii'i�d Sus�vey t�Iays, pa"es 48-49, Su�vey Pdo. 246. �
��
�i
` 'I
I This deed is �iven in iullfilirnent ot the terms and conditions ol that
certain land contract dated August 31 , 2000 a,id cecorded in Volume 715
oi Records on pages 99-10C as Document I;o. 286241 . III
�
� ��
EXEMPT
�`
This .._1S.,_ROt.._.. _ homesteed property. i
� (ia not)
il
Together with all and eingular the hereditamenta and appurtenancea thereunto betonging; �I.
And..�'?2'ca71t.02' . _. _ __..._....--- __.........-- -..... _ __.__ _._ __.. ....... �
I
warrants that the title ia good, indefeaeible in fee simple and free and clear of en�umbrances except Subjeet �
to easements, exceptions, and reservations o� record and a�iy liens or
e.ictunbrar:ces ci�eut2d by i;he act oi• de.fault cz urantee.
und will wari•ant and defend the same.
Dated this _......_. '1. day of ._..... .. _ ____. _ :_pTll__ ....... _..._..., : 2.QQ1
_..__. r. .....-
� _ ........_(SEAL)
_.....--....._......(SEAL) �.._Q?_......� .... .. _
, , Donald i�. Thorp
......... -- .................(SEAL) _ ._ _ . .. .........._._ .....-- -..... __..._ (SEAL)
. .
ADTHSNTICA'TION ACHNOWLED(iMTsNT
Sienature(s) --- ..----------•.--------------.----------------- STATE OF WISCONSIN
� ss.
---------...............-- ---'----'-"-------------.._....----.........----
Saw 2Z' ,�unty. �
- -- -y-- ._........ -'
authenticated this ........day of._...............__.._., _.__..._ Personally came before me this ����`�u,I.��'��ft1�{�of
:ipl'11.--...-,2��Q`a��`�C$bU�C���i
-----......... .......•--� -------�-----�,�Q,'��;Q.�.A'.��SO''''��
.... .............--- -----� ---- --- _.._ .----........-- D�nala x----T_ho_r � Q- �
'- - - - --- - -- ��--- - - - ..__................- - --.-.._........- _ _ ;
TITLE: MEMBER STATE BAR OF WISCONSIN - • - �
�------..._ ..__... - --- -- - - -_ - ..... ....--•
([f not,---...................�-�--�---•-�----------�------- ..._..---�---........_._-------- - -.I.
� * -- ..�.,�.. . .
-'------ ��---`- -,-�.. � ...
authorized by § 706.06,Wis. Stats.) %N � ~
to me known to be the person ...... ���fio(gXe�u�thd'`�
forego �nstrume an�d a/cknawlec'(�g'9 e ealne., , ' �. .
THIS�NSTRUM[NT WAS OFAFTEO BY ��� // /���� �(`�'GO����\ I
Donald R.._Thor --..--_.-- ���r�� ��� r r�i�ii�+;N�..
... - �---..--.......--��- - .p.._....... -�--- - . C ' � Sc�..._
........_ C�.rc_�.._�_�..Ll.s_.(�.m .---.......
� . Su w�8r _._.........Count Wis.
......... ... ... .. .. . ----- - -
--�----�--- Nota.Y Public-- --- � - Y�
(Signatures �nay be authenticated or acknowledged. Both Mp Commeasion �s Permanent.(�f not, state expiration
I are not necessnry.) date: u �.� ��J.� 3__ , _ J _
�
.
� .._ -- - .- _ - 36 -
•Name�of peream�ixnina 1n•ny c•o+�ity eho�dd be tvned�r�Nn4d beloa thetr eisneWre. �t � PG � 3 4 II
µ'ARRANTY DEED eTAT£. 6AR OF WISCONSIN Wi�c„nsin[.e¢al Olnok Co. Inc.
FORM No.1—I7At Mllwnukee.�Vu,
ADDITIONAL COMMENTS AND SKETCH
' SANITARY PERMIT NUMBER: �.3 ' �3 S
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PRIVATE ONSITE WASTE TREATMENT SYSTEMS counry
`�sconsin ( POWTS) s w �e
Department of Commerce INSPECTION REPORT A Y�� •
Safety and Buildings Division (ATTACH TO PERMIT)
Sanitary Permit No:
GENERAL INFORMATION D 3 _33 S
Personal information you provide may be used for secondary purposes(Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑ City ❑Village [�Town of: State Plan Transaction ID#:
C�c�is �a�IrC Hecw�o�v�so,� v�'��e�' 896935
CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No:
loo� �p o-��,,,k�F"j�o�, wa ( I o3a-s39-3y-ayo7 '
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark 3.a� � �03•aS� loo•� �
Dosing
Aeration Bldg. Sewer S 3� ' ,q 3 �
Holding }{,,��..�� 3opp St I Ht Inlet 6'•S ' .7 '
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Hclding oZ� NI A I Y` f I y' f ' Dist. Pipe
PUMP/SIPHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS Width Length No of ceiis Type of System Manufacturer:
SETBACK OHWM of n�av LEACHING
INFORMATION P/L Bldg wetl Waters 1 I T CHAMBER Model Number:
n
CELL TO
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia _ Length Dia Spac _ Spacing ❑Yes ❑ No
SOIL COVER
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges Topsoil ❑Yes ❑ No � ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
�i�,s�-�l�ee� o�/a8�o`{
Plan revision required?❑Yes ❑ No �� p � p� ���I� I
�-�---1---� ��� - --� 6 � s � I 6
Use other side for additional information Date POWTS Inspector's Signature Cert No
Bureau of Field Operations,PO Box 7302, Madison,WI 53701-7302
SBD-6710(R.3/01)