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HomeMy WebLinkAbout24-50S Lee Shoon Trust5{ <s»-' f;i^'Vp» kj %>^- ^.<^/ Department of Safety & Professional Services, Industry Services Division County Bayfield Sanitary Permit Nuyber (to be filled in by Co.) Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondaiy purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. State Transaction Number I. Application Information - Please Print All Information Project Address (if different than mailing address) 49655 Pease Road Property Owner's Name Lee Shoon Rucker 2020 IRREV Trust 2.0 Parcel# 1955 Property Owner's Mailing Address 15236 Boulder Point Road Property Location Govt. Lot 1 &2 City, State Eden Prairie, MN Zip Code 55347 U. Type of Building (check all that apply) B 1 or2 Family Dwelling—Number ofBedrooms D Public/Commercial - Describe Use a State Owned - Describe Use. Phone Number 612-619-0517 Lot # ;E/SW./<. NW/NE ./,. section 15 T 44 N R 09 EorW Subdivision Name Block # CSM Number D City of _ a Village of 0 Town of Barnes m. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A.8 New System d Replacement System a Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.a Holding Tank In-Ground (conventional) D At-Grade Mound Individual Site Design D Other Type (explain) c.D Renewal Before Expiration Revision D Change of Plumber Transfer to New Owner List Previous Permit Number and Date Issued IV. DispersaI/Treatment Area and Tank Information: Design Flow (gpd)450 Design Soil Application Rate(gpd/sf) 0.7 Dispersal Area Required (sf) 642.9 Dispersal Area Proposed (sf) 664 System Elevation 93.45 Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer •s §S 5a: 0 ^1s '"s S£ _SE U Septic or Holding Tank 1000 1000 Wieser Concrete x Dosmg Chamber AOP (aOo V. Responsibility Statement- I, the undersigned, a^iuri|p responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Douglas Manthey /rk^l MP/MPRS Number MP 230722 Business Phone Number 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196 Drummond, Wl 54832 VI. County/Department Use Only^•roved D Disapproved \D Owner Given Reason for Denial Permit Fee$Date Issued I ^^] 3 5/^A^ Conditions ofApproval/Reasons for Disapproval ^•-t^e- 'O^Ad ^ Attach to complete plans for the system and submit to Ac County only on paper not less than 8 1/2x11 inches in size SBD-6398 (R. 03/22) 'yi?l ,^21^y?^' '^•yt 's,'psj^ ?A•Ips i/ Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT '7'". firr)i^-/i^'y Page /_of_ 'S'^W;!?In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 81/2x11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1 )(m)). County^./^./J Parcel f.D.w ^ t^^^ Reviewed by Date [Property Owner \/^>^T ^ ^ <^^AfScS^f ^.-^'^ Property Location Govt. Lot % "DW y< s /^~T ^ N R GJ E (or) W Property Owner's Mailing Address \^3C A^rJ^ ^7- ^.Site Address or CSM and Lot #^J&-S~S~ /^3^<2. W te^'}t ^r/-^ • 5'^/^^-t^ <si*^s/Ky e> ^ai^fis-j^A. af- !f ^/'<" 7'-*c£M-^<p^/<-r^^,^3-i^lCity &M- /^sl/>'/e£ State /^A/ Zip Code ^3~!</^ Phone Number ( ) D City D Village ^^<£_T E Town Nearest Road /^c,.s^ ^ New Construction Replacement Parent materiaL General comments and Use: El ResidentiaUtilumberof bedrooms. D Public or commercial - Describe: ^.c/t/ OvCT'ifJ^t^/. recommendations: ^Y^ITV--€^ aS-^, 3. ^.¥s~ 4 Code derived designflow rate tiSC> Flood Plan elevation if applicable. 2.7 _GPD _ft. Boring #D Boring12 Pit Ground surface etev/^-'^ft.Depth to limiting factor^S" m. / elev.9^- <<^'~ Horizon / _-L 1^ J_ Depth In. ^-? 3-^ ^'^ i€-^ Dominant ColorMunsell ^^ ^ 7.^)^ Vt> >^^E? ^Z.W ^ Redox Description Qu. Az. Cont. Color Texture i 5 i <. 5 _^_ Structure Gr. Sz. Sh. /^^ ^^r s6^~ <D-S^- £>~^6> Consistence M.y^ /^^/^ -^- (- «< Boundary ^l^-> £. (-<-> (yC^J Roots ^0^ &o vf /<^E Soil Application Rate GPD/Ft2 *Ef»1 .? .7 _!_ _^_ *Effiff2 /'c A4^ J^_ J-^- A Boring #QBoring^pjt Ground surface elev,$^ft.Depth to limiting factor /£>?? in. / elevt^Q. Hon'zon 1_ _^_ ^_ ti_ Depth In. £>-6>^/(.-Y3 V3 -/^ Dominant Color Munsell ~2.s~y^ ^ 7^< y/5 z^^v/^ 7.s-^ y/^- Redox Description Qu. Az. Cont. Color Texture t. S ^5 5 /- Structure Gr. Sz. Sh. /^.^-^ /^*, f^A-- <^>-^<i- ^>-_f<^ Consistence ^/-^f /^i^/^e f^tC- ^, ^ Boundary ^>^>-/ <$A^ 6'- t^ Roots -<2re»<-y ^v fA^ Soil Application Rate GPD/Ft2 *EfW1 =-^- -2- .7~3L *Eff#2 1.6. _^L -A^- A^_ CST Name (Please Print) './y^a.i^af. ^.^Ut <-/ Signature CST Number •%7^7 Address II ^^ /3^^e^&-^ ^ ^ ^^/<> ^7 ^-«y^f Date Evaluation Conducted///^/^s Telephone Number 7/^~-^Syf-He?f ' Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 £ 150 mg/L Effluent #2 = BOD, e 30 mg/L and TSS s 30 mg/L SBD-8330(R04/21) Boring # D BoringI Pit Ground surface elev.^'s"<"ft. Page ^? of ^ Depth to limiting factor^0^ in. / e\ev.^§^~ Horizon jL _^_3 y Depth In. 0-6 (f-^f ?C?-J^? r<? *-/<;'? Dominant Color Munsetl ^yy^Vs. 7.^-^^' 7.5-^^ ^ ^s-Yi€ ^/y Redox Description Qu. Az. Cont. Color Texture ^- s. < 5 J- s» Structure Gr. Sz. Sh. ^.^ Ayf /*. 5^/C c-^<^ 0- 5^- Consistence ^*f^-< H4. ^^ A ^ f^c Boundary 6- IAJ ^UJ 6- u? Roots7PP 2e-ft^ ^0 ^ 1^ Soil Application Rate GPD/Ft2 /*ewiiZ4 p_4_~T .7~^~ *Ef»2T^ f.^^/.^ Boring #D BoringD Pit Ground surface elev._-ft.Depth to limiting factor._in. / elev._-ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/R2 *Ef»1 *Eff#2 Boring #D BoringD Pit Ground surface elev..Depth to limiting factor._in. / elev.._ft. Horizon Depth In. Dominant ColorMunsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sb. Consistence Boundary Roots Soil Application Rate GPD/R2 "Eff#1 *Ef»2 • Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L ^r /€/^AO^ ^^t ^ (^o- ^ ^^ ^>?^r $ QS>^s Os tjt^t ^A T^ <3>Ul^^-^».?^^^5<s ^Oo \^•o ^^j>?;1^ .^ ^ '^ -lrl^ ^?'.^^^.Ss? <•s,^<?'0^p \nIf^ 0^ ^^ ^I- •^ R-SI?N2*~s; r I ^ ^ ^ ?^y 'f^h s^ -jy^ ^W 7^ T^^ ^ ^?^ ^ Js?A" ^ s- J,^^ PAGE 1 OF 5 In-Ground Dosed-Gravity Plan Index & Cover Sheet Component Manual Design References: In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) AP° 2 - J/4 Pg1of5 Pg 2 of 5 Pg 3 of 5 Pg4of5 Pg 5 of 5 Index & Cover Sheet Plot Plan Dispersal Area Cross-Section & Plan View Pump Tank Specifications Management Plan Attachments: Pump Curve Manufacturer Tank Specs Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Rucker Conventional W/Lift Owner Name(s): Lee Shoon Rucker 2020 IRREV Trust 2.0 phone: 612 .619 .0517 Owner Address: 15236 Boulder Pt Rd Eden Prairie, MN _ Zip: 55347 Project Address: 49655 Pease Rd Barnes, Wl 54873 Govt. Lot: _ SE Township: Barnes .1/4 of NW_1/4^ section^_, T 44 N-R09 . County: Bayfield or wl/ Project Parcel ID #: 1955 Designer Information Designer Name: Douglas Manthey _ Phone: 715 .739 -6868_ Designer Address: PO Box 196 Drummond, Wl E-mail: norpines@cheqnet.net ^ Zip:. 54832"\-V License Number: MP230722 Remarks: Fhis space-reserved for approval s^amp. r:'" i..'\ \ ,< ^ Signature:Date: 04/25/24 Original signature required ^f^ach submitted copy t^^?/ 3? ^^}J ^^-! ^ cat^ -Ct\^1 f^l -^ ft%?ii?°o ^^ ^tp ^ Q1 ^I^^,S~ ^' ^'?"f^ ?^ ^ g ?; ^ I j^fr^' 1^wi^ A?.^j^ (*^^^ ^ "1 It ^ >^ ^ ^ ^ ^^ ^ rf^ ^^ ^^ f^ ^ ' ^ Aj^j I'^"~gc 5 rr)^ d.<s ^? ^fft VA0*n^ IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) SOIL COVER -.6 :<, 12" mln. trench depth(typical) Quick4 Standard-W w/ End Cap (typical) '!glBiiilSJIl!il!B[3iB)giH!nJ^ System Elevation = 93.45 ^ (typical) (Show location of inlet / outlet pipe connection on plan view.) TYPICAL TRENCHCROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. -//- ——————— -//- — — — —,am&Ma Observation Pipe •ns.allpJSao^ TYPICAL TR_ENCH Instructions. PLAN VIEW (No Scale) A = 3.0ft (typical) (typical) INSTALL PER TRENCH: -Quick4 Standard-W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions.Quick4 Std-W @ 20 ff EISA/chamber = 320 ff Pairs of end caps @ 6 ft2 EISA/pair = 12 ft2 = Proposed EISA per trench = 332 ft2 Required Infiltration Area = 642.9 y x 3_ trenches = Proposed Total EISA = 664 ft2 n>0mcoQ-n en Distribution Method: -^ !^.branched manifold cr PAGE 4 OF 5 GRAVITY-DOSED SEPTIC / PUMP TANK SPECIFICATIONS APC(No Scale) b.'-L< IMPORTANT: Anchor tank(s) as necessary 4"0 Vent Pipe >10 ft from Building 12"Min. or 2.0 ft aboveEstablished Flood Elevation (typical)Approved Vent Cap Electrical must comply withSPS 316 and NEC 300ID! pursuant to SPS 383.43(8)(g) \1/ \i/ Finished Grade Weatherproof •Junction Box Quick Disconnect CAPACITIES @ 16.76 gal/in A B [C] D Depth (in) 18 2.0 6 10 Volume (gal) 301.7 33.5 100.6 167.6 in in * Pump Tank Liquid Level = 36 Force Main Diameter = ^ Force Main Length = '^ ft Force Main Void Volume = 20.4 gal [C] Total Dose Volume (TDV) = 100.6 gal/dose Extend manhole riser as necessary. Approved Locking Manhole with Warning Label Attached(typical) 4" Min. or 2.0 ft aboveEstablished Flood Elevation (typical) \t/ \1/ 18" Min. (typical) Approved Joints with Approved Pipe 3 ft ontoSolid Ground (typical) PUMP-OFF ELEVATION =80.6 ft INSIDE BOTTOMELEVATION = 79-6 3" Approved Bedding Material Beneath Tank u<(^ 0.2X design flow + force (n'ain void Vsjlume) 13.8Vertical Lift =ft ft Volume = PUMP TANK: 603.4 gal Manufacturer:Wieser Concrete SEPTIC TANK(S): Total Volume = 1000 gal Manufacturers):Wieser Concrete Pump Manufacturer: Pump Model: EP0411 Goulds (See attached pump curve.) Install approved effluent filter at the septic tank outlet immediately upstream of the pump tank inlet. Controls/Alarm Manufacturer: SJE Rhombus Controls/Alarm Model: SJE1025830 Float switches containingjsercurv are prohibited. Filter Manufacturer: Filter Model: Orenco 14B PAGE5 OPS In-ground Dosed-Gravity Management Plan IMPORTANT: " ;^ The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wise. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 45° apd: BODsS220 mgL1; TSS $ 150 mgL-1; FOGS 30 mgL1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/.e. odors, user complaints, etc.) o mechanical malfunction (/.e., pumps, valves, switches, floats, etc.) o material fatigue (;".e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (/'.©., exceeding design capacities, prohibited activities, ete.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (/.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (/.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure laterat distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage sen/icing operator licensed under s. 281.48 Wis. Stats, when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wise. Admin. Code. o Effluent filterfs) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wise. Admin. Code. Report any component failure or malfunction to: Name of individual or company: HK SeptJC _ phone: 715-798-3494 Local government unit: Bayfidct County Zoning _ phone: 715-373-6138 Local government unit address: PO BOX 58 Washbum, Wl _ ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wise. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code. GouldsWate^^ Wastewater -_—___.,_^^o^, 6 8 CAPACITY 10 12 m3/h MODEL INFORMATION Order Number EP0411 EP0411A EP0411F EP0411AC EP0412 EP0412F EP0511F EP0511AC EP0512F HP .4 .5 Volts 115 230 115 230 Amps 12 6 13 6.5 Minimum Circuit Breaker 20 10 20 10 Phase 1 Float Switch Style Plug/ No Switch Piggyback/Wide-Angle Plug/ No Switch Piggyback/Wide-Angle Plug/ No Switch Plug/ No Switch Plug/No Switch Piggyback/ Wide-Angle Plug/No Switch Cord Length 10' 10' 20' 20' 10' 20' 20' 20' 20' Discharge Connection 1 1/2" Minimum On Level Manual 12" Manual 12" Manual Manual Manual 12" Manual Minimum Off Level Manual 6" Manual 6" Manual Manual Manual 6" Manual Minimum Basin Diameter 15" Maximum Solids Size 3/4" ShippingWeight Ibs.kg 20/9.1 21/9.5 20/9.1 21/9.5 20/9.1 20/9.1 22/10 23/10.4 22/10 PAGE 3 4" CAST-A-SEAL i~£. 4" CAST-A-SEAL TOP VIEW VENT PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP1000/600-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 51" LENGTH: 12'-6" WIDTH: 7'-0" BELOW INLET: 42" LIQUID LEVEL: 36" WEIGHT; BOTTOM 9,500 LBS.COVER 5,470 LBS. INLET AND OUTLET: 4" CAST-A-SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN, SEE DETAIL #}0(OTHER STATES SEE CHART) LIQUID CAPACITY: 27.88 GAL/IN (SEPTIC) 16.76 GAL/IN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP, OR SEPTIC/SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN jjdO (STRUCTURAL FIBER) CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: s ec2IQ0(0IQ0d <=) 0p a-u(7) SHEET NO. 1 OF 1 Private Sewage System Maintenance Agreement Owner(s) Name LEE SHOON RUCKER 2020 IRREV TRUST 2.0 Owner(s) Mailing Address 15236 BOULDER PT RD EDEN PRAIRIE, MN 55347 Site Address 49655 PEASE RD BARNES, Wl 54873 Tax ID # ^55 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the Wl Adm. Code, as from time to time amended. (COMPLETE Legal is required) 1/4 of_1/4 Section 15 Township 44 N. Range 09 W. Additional Legal Description: SEE ATTACHED DEED Town of BARN ES _ (Acreage) 22.5 Gov'tLot. Lot __ Block_ Subdivision Lot _ CSM # _ Vol. _ Page _ CSM Doc #. DOCUMENT NUMBER2024R-603064 DANIEL- J. HEF-FNER REGISTER OF DEEDS BAYFIELD COUNTS, WI RECORDED04/26/2024 AT 1 0:45 AM RECORDING FEE: $30.00 PAGES: 3 Recording Area Return To: ^ and Zoning DepartmentAPKTO'JiT^"^'""^' 'yly D In-ground gravity Mound [X| In-ground dosed L] At-grade Sewage System In-ground pressure distribution Sewage System: Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank affluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At-arade, and In-around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) - Please Print ^ 3^o^ Q^cUd^l^~^f Subscribed and sworn to before me on this date:. y\\" ".' 'J'////"^^."p;^^ w°^s^' ' ' /yf^/^Notarized Owner(s) - Signature(s) J-Q^(^k^c^'c^^UB^-rMy Corffmission Expire^ ' ' ^<%-... uur ..••^o&hti/^<r ^^•^^ Drafted by: Douglas Manthey Date: 04/25/24 '////nnn^' Proofed by: u/forms/sanitary/septicmaintenceagreement Revised July 2020 Document Number QUTT CLAIM DEED Document Name THIS DEED, made between Lee Shoon Rucker, a married individual, ("Grantor," whether one or more) and Cresset Trust Company, LLC, as Trustee of the Lee Shoon Rucker 2020 Lrevocable Tmst 2.0 under agreement dated October 10, 2022, ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Bayfield County, State of Wisconsin (the Property"): SEE ATTACHED EXHIBIT A [)j '-' !- :-• il APR :< DOCUMENT NUMBER 2024R-602254 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, Wl RECORDED 02,16/2024 AT 8:00 AM RECORDING FEE: $30.00 TF EXEMPT #; 16 PAGES:2 ELECTRONICALLY RECORDED RECORDING AREA"NAMK AND RETURN ADDRESS Fox Rothschild LLP Attn: Jacob D. Hoflman 33 S. Sixth Street, Suite 3600 Minneapolis, MN 55402 Dated December ^3,202^. Lee Shoon Rucker, Grantor _(SEAL) 04-604-2-44-69-15.1 03^00-10000 (Parcel Identification Number) This is not homestead property JiSEAL) AUTHENTICATION Robert A. Rucker, Grantor's Spouse ACKNOWLEDGEMENT Signatures) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN STATE OF HAWAII <iL COUNTY OF VUW ^ Personally came before me this ) )ss.)zi\day of (If not,, autauthorized by Wis. Stat. § 706.06) ^- ,\\\ ••a '[?.sc~l^^/~^:^^ \THIS INSTRUMENT DRAFTED BY:.?, ~/^ ' \ '\ Jacob D. Hofifaum, Attorney s ^/', . „ *,Fox RothschUd LLP ' =^; 16-460 '; 33 S. Sixtii Street, Suite 3600 ^ V \ Minneapolis, MN 55402 '•:: \ /-, fp.L'*0.''.^^'v^::^^y December, 2023, Robert A. Rucker and Lee Shoon Rucker, husband and wife, to me known to be the person who executed the foregoing instrument and acknowledged the same. VinOi.^t'^\^\ TA^M^ Printed Name Notary Public, State of Hawaii „ „ .„, 2.o24 My commission (is permanent) (expires: _______) I (Signatures may be fluthenHciit^flr.nettotmledged. Both are not necessary.)0 2003 STATE BAR OF WISCONSINQUIT CLAIM DEED *Type name below signatures. Form No. 3.2003 p.,^,. \2 -^°\ V^_^ "•aces: ^-» ,,„.,,CNSw^^'-Src?» Doc; Description: J^^— "Notary SignattNOT/^Y CERTIFICATION ^'""""".,^/^^^\/ ^-^^ ^ 16-460 '; t ( \ ^^Q^''^.fs^^'i^^y'"f/-^ (:)F ^ty '•'-';"<m..»>^*kv' Bayfield County Register of Deeds Document #2024R-602254 Page I of 2 \ui •' '! ! " !^: 1.111 APR '- '.M [y Exhibit A Legal Description A parcel of land located in Government Lots 1 and 2, the Southeast 1/4 of the Northwest 1/4, and the Southwest 1/4 of the Northeast 1/4, Section 15, Township 44 North, Range 9 West, located in the Town of Bames, Bayfield County, Wisconsin, more particularly described as follows: Commencing at the Southwest comer (3" square cedar stake) of aforesaid Government Lot 1; thence N. 85° 15' E., along the South line of said Government Lot 1, a distance of 76 feet to an iron stake which is the point of beginning. Thence N. 85° 15' E., along the South line of said Government Lot 1 and fence line a distance of 2274.61 feet to an iron stake lying on the Northwesteriy right of way line of Pease Road in the aforesaid SW 1/4 - NE 1/4; thence S. 44° 09.5' W. along the Northwesterly right of way line ofPease Road, 1143.49 feet to an iron stake in the SW 1/4 - NE 1/4; thence N. 69° 44' W., 1780.42 feet to an iron stake in aforesaid Government Lot 2; thence N. 45° 38' W., 303.76 feet to an iron stake on the meander line of Upper Eau Claire Lake, said iron stake lies 90 feet, more or less, from the water's edge, thence N. 48° 59' E., along said meander line, 492.30 feet to an iron stake lying 58 feet South of the water's edge in Government Lot 1; thence S. 05° 09' E., 521.14 feet to the iron stake which is the point of beginning. Said parcel of land is to include the land lying between the meander line and the water's edge of Upper Eau CIaire Lake between the parcel lines extended. Bayfield County Register of Deeds Document #2024R-602254 Page 2 of 2 ^ fyn?! RAvpiFi n r-niiMTv ,^15S7!C| CVPW./^] '-iv,yJ7 i BAYFIELD COUNTS ——^^]_ ^'[CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-l-10(e)) Lf/y, ^, ,, , ^ E'fOieckList ^ ;J / D/- B^riginai Sanitary Application (Submitted in Deed Holders Name - not prospective buyers) (383.21(1)1.) a^fndex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Original Plot Plan (383.22(2)2. 3. & 4.a) :ross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer )ump Tank Diagram, Alarm and Pump Curve (when applicable) efcTontingency Plan / Management Plan (383.22-3(2)(b)l.f.) laintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) O^idding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) D Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) D ATU Servicing Agreement (Recorded at Reg. of Deeds) -0"Fe^(Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 0<( Complete Sets of Plans (383.22(2)(2.) CNote: Sanitar/ Application and Maintenance Agreements are to be attached to all copies) B^oil and Site Evaluation Report (383.22-3(2)(b)l.e.) a State Plan Review (when applicable) D Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) Application Information must include: D 23 diait Parcel ID# - (do not use 12 digits anymore-obsolete) Address or Road Name where driveway is/will come off of) D (Owners Phone Number) Type of Building B'Tfl Type of Permit Type of POWTS System V Dispersal / Treatment Area Information /I Tank Information B^/ll Responsibility Statement (Plumber's Information) ^/^ :f:Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information 0'Address Number and Road Surface Elevation of Body of Water Q^North Arrow )irection and Percent Land Slope EC Contour Lines lank and Filter Information and Location Q^Structures and Driveways Navigable Bodies of Water 0'Boring Locations Area (Proposed and Existing) ^Property Lines ^Bench Mark (Location, Elevation and Description) D Well Locations "iomponent Manual Version OCegal Descriptions q^Plpfng Material information (conveyance line, building sewer line, material type and diameter) Turn Over > Cross-Section and Over-Head Profile of the System: Q'Surface and System Elevation I1 Position of Observation and Vent Pipes APR 2 62024 Dimensions and Depths Make, Model & Number of Chamber Units in each Cell Property Information How many systems will there be on this parcel of land? 1 B'ffas this property been split? ^vr (Property Statement shows Property History) Fees: &1$nvate Sewage System (Septic Tanks) $ 400.00 D Private Sewage System (Holding Tanks) $ 400.00 a Mounds or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions $ 25.00 D Private Sewage System Reconnection $ 50.00 and Private Interceptor D Return Inspection $ 50.00 D Maintenance Agreements ^ $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: BAYFIELD COUNTS SANITARY PERMIT (#04}-24r50S STATE SANITARY PERMIT OWNER: LEE SHOON RUCKER (2020 IRREV TRUST 20) GOVTLOT:GL1 LOT: BLK: SE 1/4 NW 1/4 SEC:15,T44N,R9W TOWNSHIP: Barnes SOIL TEST: 45-24 NEW SYSTEM SYSTEM TYPE: Non-Pressurized In-Ground PLUMBER: Douglas Manthey Tracy Pooler DATE: 5/16/2024 Authorized Issuing Officer CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. b. The approval of the sanitary permit is based on regulations in force on the date of approval. c. The sanitary permit is valid and may be renewed for specified period. d. Changed regulations will not impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. f. The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 C. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: # MP 230722 Condition: System to meet all setbacks. Management plan to owner. Properly maintain system per recorded agreement. THIS PERMIT EXPIRES 5/16/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION