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DEP4RTMEfq OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
❑CONVENTIONAL ❑ALTERNATIVE State Plan I D. Number:
(If a.egnedl
❑ Holding Tank In-Ground Pressure ❑ Mound a
zet
N ME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
A Ad
L£ -
EN,( TF ~A {K~IPermanen reference point) ESCRIBE IF IF ERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV..
V W '
Name of Plumber: IMPIMPRSW No.: Count Sanitary rmit NumUR
O
'
3 l
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ONO
BEDDING: VENT DIA.: VENT MATL.: f IGNUMBER OF ROAD: PERTY WELL: UILDING: V NT TO FRESH
LARM: FEET FROM LINE: AIR INLET:
DYES ONO OYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL, PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
r_ PROVIDED: PROVIDED:
[DYES ONO WP 1.5 V o2 DYES ONO OYES ONO.
GALLONS PER CYCLE: vuM AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. V N TO H
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) DYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING,
or excavation. (If soil can be rolled into a wire, constructio shall cease until FORCE
the soil is dry enough to continue.) MAIN
C NVENTIONAL SYSTEM:
/ INO TREN ES DI . PIPE SPACING: MCOVER ATERIAL' PIT INSIDE DIA #PITS DEPTH
BED/TRENCH WIDTH, LENG
DIMENSIONS
GRAVEL DEPTH FILL DEPT DIST4Y IP DISTR, E MATERIAL: No. DISTR. UMBER OF WELL' BUILDING: V NT TO FRESH
BELOW PIPES: ABOVE COVER. EL . INL T ELEV. ND: PIPES FEET FROM LINE: AIR INLET.
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Ch the texture o he fi terial for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: m nd systems mak n that it ON REVERSE SIDE. SHOW ELEVA-
m is the criter' for ium and. TIONS MEASURED.
DYES NO IL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS
DYES ONO [DYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER Tfl EN H D /HO OPSOIL: S 4DE SEEDED: MULCHED:
CENTER: EDGES:
OYES ONO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHESNO. LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER:
DIMENSIONS 3 & f I C)
MANIFOLD PUMP MANIF LD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DIST PIPE DISTRIBUTION PIPE MATERIAL & MARKING r.
ELEV. CC ELEV.. DIA ELEV PIPES DIA.:
ELEVATION AN Of -7
DISTRIBUTION D I 4 t
INFORMATION HOLE SIZE HOLE SPACING DHIl LED COHHECI LV COVFR MATERIAL VERTICAL LIFT ORRESPONDS TO APPRCIVEO
t
1,4 r+.. PLANS
V YES L DYES ONO
COMMENTS: PERMANENT OBSERVV11011 LLS: '-NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE
YES I__1 NO S ONO NEAREST
t q~aS I S, ~i~~
4
Sketch System on Retain in county file for audit.
Reverse Side.
/SIGNATURE TITLE
DILHR SBD 6710 (R. 01/82)
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY,. FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/s x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: ailing Address
To :
Property Location: City, Village or Township: County:
SW '/a i/aS J30 N/ R r) W 5$7r. C h s I
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
A (lime ' )
T E OF BUILDING
Number of
Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
❑ 1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: `
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New ;9* Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
1-5 3 37-5 ';Wl Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint _E] Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: MP/MPRSW No.: Phone Number:
Pa w e 4'S /569 1 (71S~a~l
Plumber's Address: r Name of Designer-
COUNTY/DEPARTMENT USE ONLY
Signa re of Issui g en Fee Date: Sanitar Permit Number: , toe) APPROVED y
s - ` El DISAPPROVED D60
eason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted_ to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81)
DEPARTMENT OF REPORT ON SOIL BORINGS A9; 0 Y 4W-5 & B DI LDINGS
INDUSTRY, s ON
LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISOP.O. B N WI 53707
LOCATION: SECTI N: TOW IP/MCRlTCTPAttTY: LOT O. BLK. O.: SUBDIVIS N NAME:
/T N/ (or) W
COUNTY W ER'S BUYER'S AM : MAILING ADDRESS:
USE DATES OBSERVATIONS MkDL'r
NO. B RMS.: COMMERCIAL DES Ri TION: ~r~rr PRO ILE DES RIPTION S: PERCOLATION TESTS:
❑Residenc ❑New l~Replace 'y ~ - ~
RATING: S= Site suitable for system U= Site unsuitable for system % 7
JC MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING T K: EC MM NDED SYSTEM:(o nal
S au s ❑u s ❑u a s u a s u.
If Percolation Tests are NOT required DESIG RATE: YSTE I If any portion of the lot is in the
under s.H63.09(5)(b), indicate: I` Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-
B- / r
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 PERIOD 2 PER PER INCH
P- 37 A~2& A/0
i i ~
P-
42,
P-
P_
P-
P=-
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slop. 10 / a I`,
SYSTEM ELEVATION r-.7
~ca/~aJ /hEkt /j;0'(.4rG Q r
. 4V a,
10
D
44, 96
E
e
ew o
•
o Re
C D,
EI
,E
•
MAY j 1 LUV e3U«>a. ~ t
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME print : TESTS WERE COMPLETED ON:
ADD CERTIFICATION NUMBER: PHON NUMBER optional):
-7
4)f L-14aZZ
T GNAT E:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 IN. 03/81)
rl ~ ~i~?J•'1C~ ~ `~J
8 2 0 1 4 8 5
;S (c r, v 7~ -y RECEIVED j
MAY 11 1982, I
PLUMBING BUREAU
low---~►
` i\ I I l i :r,~
lop
Q ~n,p, ~ ~~~~NS 1 '
SZN~ ti~ G~
p F N
1
$2® 485
ECEIVED
MAY 11 1
982
z,
PLUMBING BUREAU
J
i !
b1 Y
17
C&U
RE~,~,pNg 3, +E-'fr N i
$'tR~ ' 8 R 1L S ~ ~
N a
h
<Z) 6>~- ~0 w
t~
' T"PG~ 3 ~F ~ r
f,
~2fkilv& 85
MAY 11 1982
3
PLUMBING BUREAU
o E.?et! APE
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AE~p~10NS
_ p uMA
I GOV.=.,C . i~~~ `"T :~'t~t.*..e.... , ~ ~ R•~ ; B \1S~
? Z Op
CE
S
~AG
' RECEIVE
M 82~ 01485
MAY 1 1 1982
"W" EAU
f
{
'Edo CHAP
~ ~ P,~PfoRfrf~O
s
faa 11low
94,E5 )DOWILD OA)
j It,QE ~~clA~/may S'~°r~,o
~95T f7o~E SMFxi/0 B~ 1 /
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SEti ~
Plb. # 60 REC02 011-46
PROJECT DETAIL DATA SHEET MAY 11 1982
NAME OF BUSINESS Q_q ayN PLUMBI.NG BUREAU
LEGAL DESCRIPTION
OWNER eorw ~~Q A,.~ - MAILING ADDRESS N 9kL\AYYM
ZIP 5y0/7
ARCHITECT, ENGINEER, ot V%
pc,~ 2 Y`S ADDRESS c- w z-Y\A
PLUMBER OR DESIGNER
~~Sc zip 5Y60
TELEPHONE NUMBER c;) /
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed. Please consult Section H 62.20.
Existing building New building Addition
( ) Apartments and condominiums . . . . Number of bedrooms
( } Assembly hall . . . . . . . . . . . Seating capacity
( ) Bar . . . . . . . . . . . . . . . . Seating capacity # of meals served
( ) Bowling alley . . . . . . . . . . . Number of lanes ( ) With bar
( ) Campground and camping resorts . . . Number of sewered sites
Number of unsewered sites
Total number of sites
( ) Camps . • . . . . . . . . . . . . . ( ) Day use only Number of persons
( ) Day and night Number of persons
( ) Catchbasin . . . . . . . . . . . . . Number
( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons
( ) With kitchen Number of persons
( ) Dance hall . . . . . . . . . . . . . Number of persons
( } Dining hall . . . . . . . . . . . . Number of meals served daily
( ) Dog kennels . . . . . . . . . . . . Number of enclosures
( ) Drive-in restaurant . . . . . . . . Inside seating capacity
Car-service Number of car spaces
( ) Dump station . . . . . . . . . . Number of dump stations
( ) Employees ( total of all shifts) Number of employees
( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit
Number of units-with 4 persons per unit
( ) Medical and.dental office bldgs. Number of doctors, nurses, medical staff
Number of office personnel
Number of patients
( Mobile'home parks Number of sites 12
( ) Nursing homes . . . . . . Number of beds
( ) Parks Number of persons ( ) Toilets ( ) Showers
( ) Restaurant . . . . . . Seating capacity
( ) Dishwasher and/or disposal? +
f
24-Hour service
Retail store . . . . . . . Total number of customers
( ) Schools . . . . . . . . . . Number of classrooms Meals Showers
Self service laundry
( ) Total number of
machines
( ) Service station . . . . . . . . Number of cars served daily
( ) Swimming pool bathhouse . . . . Number of persons
( ) OTHER . . . (Specify) . . . . . . .
COMPLETE OTHER SIDE
I
2. Indicate whether the following facilities are present.
Floor drain. yes no _ Number of drains x
Food waste grinder yes no
Dishwasher yes no _
Automatic clothes washer yes no _ Number of clothes washers c_L
3. Septic tank capacity aC a csaa + /0b0-PC.(> 0.9 v
Holding tank capacity
Septic or holding. tank manufacturer J _n 1
4. SEEPAGE TRENCHES: total square feet width of trenches
length of trenches depth
number of trenches
SEEPAGE BEDS: total square feet 3 7 }per width d
length of bed q depth ~/t)
SEEPAGE PITS: total square feet outside diameter
depth below inlet
total depth from top to bottom of pit
Signature of perso mpleting form: FOR DEPARTMENTAL USE ONLY
Address
Z i p
Telephone Number olS
Date d ' Qv •U+"
d~
i
~~SL'f,~
WORKSHEET - PRESSURE DISTRIBUTION NETWORK DESIGN
PROBLEM t i 1 (pUV%it lyiCZ31 IR8w.t ~b201485
14
Design a prAssure distribution network for a _ bedican
..hnmr?. The site
characterisitics are: '
RECEIVED
Depth of groundwater or bedrock 7 in.
• MAY 11 1982
Landslope_ %
Percolation rate n./in.
Distance from dose chamber to distribution system ft.
Elevation difference between pump and distribution system ft.
Step 1. ESTIMATE WASTEWATER LOAD
i
L;vrt,,.#,o X
Step 2 SIZE THE ABSORPTION AREA
A) Area required
i
B) Select length
C) Width is 36 'I
f
D) I wi1T use a manifold.
Step 3. SIZE DISTRIBUTION PIPES
A) Hole size I will use is in. i
B) Hole spacing I will use is in.
s
C) Lateral length is ft.
D) Lateral size l- in.
Step 4. DISTRIBUTION PIPE DISCHARGE RATE
7.2
Step 5. SIZE MANIFOLD;
A) Manifold length ft.
B) Number of distribution pipes =
C) Manifold diameter in. '
i
Step 6. SIZE THE FORCE MAIN
A) System discharge rate rr
B) Force main diameter
C) Friction loss will be . ft./100 ft.
Step 7. TOTAL DYNAMIC HEAD
A) Vertical lift 15, ft.
B) Friction loss ft•
C) TDH = ft.
i 8.3
Step R. SELECT A PUMP
Step 9. DOSE CHAMBER SIZE
/ate C." y- I bopd ta.o o a
Step 10. DOSE VOLUME
V
C
.~jr h1 1S6
P A✓, W 44-1 nnnn 4 6a s
5-5- 9
A
Z
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 5X, 5. C+"-\
r
7 V
Vent Cap Weather Proof 820148A
Junction Box ApprovLock
T Manhole Cover g
12" Min RECEIVED
4" C.I. '
Vent Pipe Final 4MA~jkl 1982
• Grade ,
t~LU I~I~C ~~:A
Conduit
18" Min 18" Min II
Inlet
zxNa
„
V
Approved Approved
Joint w/ N N A Joints w/
C. I. Pipe C. I. Pipe
Extending Extending
3' Onto 005 F~ ~G ; arm 3' Onto
Solid 0 pC10 C/" N On B Solid
Ground ME Ground
10-9 C
S Pump ® Off
Concrete Block D
SPECIFICATIONS
TANK PUMP
I tt -
Manufacturer Sr sr Manufacturer: P~ ((I
Tank Material: C'ar, `c. Model Number- tk S` S S f
Tank Size: Gallons Switch Type PT L
Total Dynamic Head: FT
CAPACITIES Pump Discharge Rate:-. GPM
Total Daily Effluent: a llons
A = or Rai?.CGallons Number of Doses: 41 Per Day
B = or 1 Gallons Dose Volume: 6,7S
C or /jNng Gallons Notes: 1. See pump curve for
D = or Ool. Gallons additional performance
Total Tank information.
Capacity Required s }Q~7 Gallons 2. Pump and alarm are to be
installed on separate circuits
ALARM as per ILHR 16.19 WAC.
Manufacturer: ,~►n~ ` SIGNED: f
Model Number:- LICENSE NUMBER: Switch Type r `i DATE:
- - _S -
DIEPARTr kNT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
VCONVENTION) ❑ALTERNATIVE State Plan I.D. Number:
(If assigned
❑ Holding Tank In-Ground Pressure ❑ Mound SS
r
[BENCH F PERMIT HO DER: DRE S OF PERMIT H DER: INSPECTION DATE:
MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: t' REF. PT. EL V.: CST REF. PT. ELEV.:
Z C7 P 67 ® SW
Name of Plumber. JMPIMPHSW No.: County: Sanitary Permit Number:
- 5~ c C'
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
DYES ONO DYES ONO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM FEET FROM LINE. AIR INLET.
OYES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ONO DYES ONO
GALLONS PER CYCLE: r7ND CONTROLS OPERATIONAL. NUMBER OF 'ROPERTV WELL BUILDING: JVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM INE AIR INLET
PUMP ON AND OFF) DYES ONO INEAREST-~
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I,NG I H uIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM: _
WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING. COVER JINSIDE CIA. #PITS LIQUID
BED/TRENCH TRENCHES MATERIAL: PIT DEPTH
DIMENSIONS T -
Glc.a. ~~i,d ;,l FILL DEPTH DISTR. PIP' DISTR. PIPE DISTR. PIPE MATERIAL: N. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END. PIOPES. FEET FROM LINE AIR INLET:
(NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ONO
SOIL .`OVER. TEXTURE PERMANENT MARKERS: OBSERVATION WELLS.
DYES ONO DYES ONO
DEPTH OVER TRENCH; BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED.
CENTER EDGES.
DYES ONO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
.yDTH. LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL: N0. DISTR. IS R. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
-LEV.. ELEV. DIA. ELEV. PIPES. DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS
DYES ONO _ DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ONO DYES NO NEAREST
r
Sketch System on Retain in county file for audit.
Reverse Side.
ITTLE:
S
DiLHR SBD 6710 (R. 01182)
4EPARTMENTOF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/a x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mang Address:
DQIIM~ ,
r Property Location: j7,""&or Township: County:
5W '/a W %4S 11 iT 30 N/ R JZ or) W C"_<
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
n ) Q, 8.
N*- I A AIX GS (If assig~/Z
TYPE OF BUILDING
Number of
Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required. NA
TOTAL !NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
'HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New a Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
fC Alternative (specify) ^ J klQ❑ Seepage Trench
00 jSS
Water Supply: Owner's Name as Listed on Soil Tes Report (If other than present owner):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Nam of Plumber. Signa e: MP/MPRSW No.: Phone Number:
(7is ► a¢G -50
Lkk
Plumber's Address: Name of Desi r:
COUNTY/DEPARTMENT USE ONLY
igna re of Issuin Age Fee: Date: APPROVED Sanitary Permit Number-
01 1 Qtp ~~7 v ` ❑ DISAPPROVED
Wfor Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
LABOR UMAN N
DLATIONS PERCOLATION TESTS (115) I MADISOP.O. BOX 76
N WI 53707
H
RE 'I r,
LOCATION: SECT ON: TOWNSHIP/MlifditTPALITY: 11.1\10.: BLK. O.: SUBDIVI ION NAME:
114 d/ I:X / N/R (or) W
Alb 1,0
COUNTY: O NER'S B YER'S AME: 110-11-166 ADDRESS:
USE ATES OBSERVATI N MADE
NO. B DRMS.: 12OMMER AL DESCRIPTION: DESCR
IPTIONS
I 1PERCOLATION STS:
❑New gRepiace e
❑Reside
RATING: S= Site suitable for system U= Site unsuitable for system O`
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SI E] YSTEcM-IN-FILL 1011111 TANK: RECOMMENDED S EM: optional
S El J ou S J S
If Percolation Tests are NOT required DESIG RATE: SYSTE ELEV. If any portion of the lot is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
M_ ~JAd,
B-
B-
6-
I
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH
P_ .2 Ig
P S J
P- I
P-
P-
P-
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slop. ' Sx ~
SYSTEM ELEVATION 9s 9
~A 40eO
A
X
I
I ~ ~o
,
• 4 ~ ~ i ~--E.cioca o -
/moo
_ t N
,
,
x
t
E
I, the undersigned, hereby certify that the soil tests reported on this form were rr de by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAM print : TESTS WERE COMPLETED ON:
5 / V.
A CERTIFICATION NUMBER: PHONE NUMBER optional):
CS GNATU E:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
1HR-SBD-6395 (N. 03/81)
r
12
i
e+N~` 1
~\ON
D REU I '
BEN F 0~ a
i
i
i
Agcewm
MAY 11 1982
\ PLUMBING BUREAU
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olk"
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N N
- ~ 6 01
SZ
OEQPA N R~ RECEIVED
f MAY 1
1 1982
~j 61 ' r . ,LUKIBING BUREAU
cy
~.7
t-z~ ,08201484
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:
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1
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~U~ ,Dts rRiBUT/D~ rr'ES
Ii
n P Aa
~`ONS
i ~N C~u `7u ► c N u~ S R EIVED
- of MAY 11 198
DEp ¢E5 PLUMBING BUREAU
~G
8201484
~ErP~ORR f6D ~`".~Pc ~Er•9«
~,JD L: AP
&oEs )oe,,f LD old &7,"Cm
POE ~,g J/FO/D 1"1,44
~~95T Ho.~E S//{xlnnlD ,8~. J
&5,1,pIB0714AJ / 1J94S ,i
P
ry\
gp h 8~\4
~O~Ry RECEIVED
~4rM N G MAY 11 199
PLUMB
82014 84
PI b. 60
1/78
PROJECT DETAIL DATA SHEET
NAME OF BUSINESS
LEGAL DESCRIPTION _-t
OWNER eo Q o.~ MAILING ADDRESS li~~ NQ 9~"Y II~Y
ZIP Sy0/7
ARCHITECT, ENGINEER, 0,0 t cat v~ 1Uc~ e rs ADDRESS rv,m1a
PLUMBER OR DESIGNER ` .1
WtSG ZIP S yal7
k
TELEPHONE NUMBER S' - ~ yr6-Jr/3S i
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed. Please consult Section H 62.20.
Existing building New building Addition
( ) Apartments and condominiums . . . . Number of bedrooms
( ) Assembly hall . . . . . . . . . . . Seating capacity
( ) Bar . . . . . . . . . . . . . . . . Seating capacity # of meals served
( ) Bowling alley . . . . Number of lanes ( ) With bar
( ) Campground and camping resorts Number of sewered sites
Number of unsewered sites
Total number of sites
( ) Camps . • • • • . . . . • • • • • • ( ) Day use only Number of persons
( ) Day and night Number of persons
( ) Catchbas i n . . . . . . . . . . . . . Number
( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons
( ) With kitchen Number of persons
( ) Dance hall . . . . . . . . . . . . . Number of persons
( ) Dining hall . . . . . . . . . . . . Number of meals served daily
( ) Dog kennels . . . . . . . . . . . . Number of enclosures
( ) Drive-in restaurant . . . . . . . . Inside seating capacity
Car-service Number of car spaces
( ) Dump station . . . . . . . . . . . . Number of dump stations
( ) Employees ( total of all shifts) Number of employees
( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit
Number of units..with 4 persons per unit
( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff
I Number of office personnel
' Number of patients
(>C~ Mobile home' par`kt . . . Number of sites"
( ) Nursing homes t . . Number of beds
( ) Parks Number of persons ( ) Toilets ( ) Showers
Seating capacity
Restaurant .
v
( ) Dishwasher and/or disposal?
( ) 24-Hour service
( ) Retail store Total number of customers _
( ) Schools . . . Number of classrooms TT McWf-VP) Showers
Self service laundry ' -.._Total number of machines
$2
9
1
1
( ) Service station Nurttber of cars served daily
Swimming pool bathhouse Number of persons
E
R
U
B
( ) OTHER (Specify)
COMPLETE OTHER SIDE
8201484
f
2. Indicate whetherthe_.following facilities are present. ,
_ I
Floor drainl yes no Number of drains X {
Food waste grinder yes no
Dishwasher - yes no
Automatic clothes washer yes no Number of clothes washers X
3. Septic tank capacity 3CCCOD a cS~fl + gz o-Pe.P
Holding tank capacity
Septic or holding.tank manufacturer
4. SEEPAGE TRENCHES: total square feet width of trenches
length of trenches depth
number of trenches i.
1
SEEPAGE BEDS: total square feet 3 7~~ width
length of bed 97 depth
SEEPAGE PITS: total square feet outside diameter j
depth below inlet
total depth from top to bottom of pit
form. FOR DEPARTMENTAL USE ONLY
- Signature of perso mpletin
A i
1,
Address s: f~" cJ ~.~.4~►-~
f~ Zip
Telephone Number
Date
wow*
ONS
1
Ate''
ice`
w
WORKSHEET - PRESSURE DISTRIBUTION NETWORK,DESIGN ~
PROBLEM
A ~I c 1h.Q W. s c~ (,IJru ob ~'~aw~c. ~~r•
Design a presk ure distribution network for a e. The site
characterisitics are:
Depth of groundwater or bedrock. in
Landslope %
Percolation rate min./in.
Distance Jrom dose chamber to distribution system o~ ft.
Elevation difference between pump and distribution system ft.
Step 1. ESTIMATE WASTEWATER LOAD
X 3~ = 1 `a 0~
Step 2. SIZE THE ABSORPTION AREA
i
A) Area required
o
B) Select length 9ff
36' ;
C) Width is
D) I will" use a 6wptj manifold.
y
i
Step 3. SIZE DISTRIBUTION PIPES
A) Hole size I will use is in. 9
R) Hole spacing I will use is in.
C) Lateral length is W-W ft. -q co
D) Lateral size in.
Step 4. DISTRIBUTION PIPE DISCHARGE RATE
yy,\,
Step S. SIZE MANIFOLD
RECEIVED
A) Manifold length 3 ~ ft.
MAY 11 1982
B) Number of distribution pipes = 1
PLUMBING BUREAU
C) Manifold diameter in, •
8201484
Step 6. SIZE THE FORCE MAIN
A) System discharge rate P rn
B) Force main diameter
C) Friction loss will be .z.9 ft./100 ft.
Step 7. TOTAL DYNAMIC HEAD
A) Vertical lift ft.
B) Friction loss b ft. Do,L ~X 0?-a
a -_5
C) TDH ft.
Step B. SELECT A PUMP
D cal S W Q 3 Era 3 w~ l- h
G td
Step 9. DOSE CHAMBER SIZE-
/0n4 elecuk t ! too Or 0 a E74,-k
Step 10. DOSE VOLUME
a
I (0
Cam;
~i1f t1 'b We , , ti r
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS St `L 101~I ~I
7 0
Vent Cap Weather Proof I
Junction Box Approved Locking
Manhole Cover
12" Min '
I
4" C.I. '
Vent Pipe Final ' 4" Min
• Grade
Conduit f
18" Min 1 18" Min
Inlet
I
C"01iO
Approved Approved
Joint w/ A Joints w/
C I . Pipe
C .
I Pipe f
Extending Extending i
F
3 Onto Iarm 3' Onto M
Solid On B Solid
Ground Ground
C
Off
Pump
Concrete Block ID
RECEIVED
MAY 11 1982
SPECIFICATIONS
TANK PUMP PLUMBING BUREAU f
I
Manufacturer Y. I > Manufacturer: ~r) 1.1 ~d
Tank Material: or~c re ~ Model Number: ~ S E: 3
Tank Size: Gallons Switch Type P L
Total Dynamic Head: FT
CAPACITIES Pump Discharge Rate: GPM
y
Total Daily Effluent: allons
A " or D a IT Gallons Number of Doses: t4 Per Day
"
B or O. Gallons Dose Volume: Gallons
C aA or M Gallons Notes: 1. See pump curve for
D = 47 o'16k, ~ r Gallons additional performance
Total Tank information.
Capacity Required Gallons 2. Pump and alarm are to be
installed on separate circuits
ALARM as per ILHR 16.19 WAC.
Manufacturer T, t-1 SIGNED
Model Number: /D 1,0 LICENSE NUMB ER
Switch Type DATE: 8' 8 2014 4
Wisconsin Department of Industry,
PL$-1 INSPECTION REPORT' Labor & Human Relations
Safety & :Buildings- Division
Bureau of Plumbing, Platting & Fire Protection b
Rime o remises Date an . No.
Street i y County Sanitary ermit
1-360lew Lw R t c UN ST -C.QDI
Master um er Firm Name AdareSS
C4LVII J -LP w AE3 "-7Z-4q V_1L
uJ ~c. MON ~ fUi
ourneyman Plumber Addres
'Twner dress
141o jAd
-2vZ~ &v,) ' tC MON S401
6
EoeA E b6Atit 2
'1_1P 414a
42dn
f
E
i
9
qp . /f/ D.I.L.H.R.
I l9 eroy ans y D.W.S.
Chippewa Falls, WI 54729
-V-T5j 723-8786
ca ins
scusse w1Th gna ure
( )See Attached.
14fAlt-1-1 _Ad - CJS-X.~
hi n
. n- 1 wnte,~Fpecia _
DILHR-SBD-6192(N.09/80) igna ure o
trite-Inspector ` Fellow-Local Inspector Pink-Plumber or Responsible-Party Green-Nr
y p
~ ~ .,t to a:'. - ~49. STS. - .
.:x..._.. _ _ .was . ....w.,~. . . _ .
s
a'
.
s
P
. ' ~ sue, ; ~ s .
n
r + ~~r
Wisconsin Department of Industry,
PLB-1 INSPECTION REPORT Labor human Relations
Safety & Buildings Division
Bureau of Plumb in , Platting & Fire Protection
Name o remises Date Cana of
rig dry Permit
Street y county
1 ~s~ tJ W o N I &4_% ui b > i . C PO I X
master um er irm ame Maress
Journeyman Plumber Address
Owner Address
-L
r _
* / = f
lelwl"
lit~"+e
(`F7f-;
f/k,c -r.-a.ii s y t ZJ i ~,ZGC r, , { ~ < ' r, %~-1 ,!t-!~ ! .~!/t.~
3
i e
iscusse w~ use
)see Attached. - \
DILHR-sBD 6192(N.09/80) Signature o 1s . Plumbing up/. n e as1,;;` pec a s
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible arty Green-&ner,-
09 j-
/
' - w t
...`r.+ ,,.t.~~.. .:la+s• ; n..,, s,-.. ~ e. r.. ~..~v. , a _ d.-.- ,o,.
1 e
4
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State of Wisconsin ` Department of Industry, Labor and Human Relations
p f" Please Reply to:
SAFETY & BUILDINGS DIVISION
--1 Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
e Plan Identification Number
L
t
i ~l
PRIVATE SEWAGE SYSTEM ONLY- c2' o `r►
i ei+
The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction- ernative private
sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by
and received for
f
approval on
The The soil and site evaluation was conducted by Z IA
~
The site meets the soil and site requirements specified in chapt rr H 63, Wisconsin Administrative Code, for the use of
The proposed system is for a~"'+a'h`~L-
Wastes from the building will discharge to a`- gallon capacity septic tank which will discharge to a ° gallon capacity
pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of - feet will
discharge through a LIC? inch diameter pipe to the soil absorption system.
It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of
approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation
of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this
approval and shall follow the directions or orders issued by the appropriate local or state authorities.
In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with
the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional
engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at
the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall
become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the
Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight,
construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions
arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the
permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void
this acceptance.
cc: OWS BY:
County
Other
Enclosures AV I'"~/
mes Sargent, B erector
DI LHR-SBD-6159 (R. 7/81)
,--^^"P'.--"--~---,~ _ me .~-..;,+'n; ,r -:,°~q,~.~ -.-R":... -~-~.m'i~eST--•9F:;: xr-+'. - -^Sr~v.:Fw~^d~ee -q"~. ^c. sw ti. -
,VD 6(b.7,M9/81) (Plb 100a)
STATE OF WISCONSIN DILHR
Detach And Return Upper DIVISION OF SAFETY & BUILDINGS
Portion Of This Form With BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 178
Any Fti'n Correspondence P.O. BOX 7969
MADISON, WI 53707
608-266-3815
DATE: PROJECT:
TVA Co.
'V-1 ~t?~C.~MC~1JO, V~1~ •v''~ C~~~ PLAN ID. #
DETACH HERE
PROJECT NAME PLAN ID. #
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $ Fee Received is
❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming.
Plan accepted for review. ❑ Plans being returned.
❑ ' No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW.
held in abeyance.
1. Plan Submission ❑ Complete data relative to anticipatog.,use of bldg.
Additional information ishall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. - ,
.less specifically noted. ❑ Deed restriction required 0,copy).
❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (f copy)
All information submitted shall be signed, dated and sealed
or stamped in accord with Section H 63.08(2)(a) WisconsinM
Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks
❑ Profile of holding tank showing vent, manhole alarm and
manufacturer if precast. Complete construction details if
II. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed.
❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and,lncal unit of
and notarized. (1 copy)
government (sample enclosed). •t
❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement
for pressurize distribution. ❑ Soil boring & percolation from county (1 copy).
test data. ❑ Plot plan showing location of holding tank with lateral dist-
❑ Cross section of system. ❑ Pipe lateral layout. antes to any building, wells, water seGirice'piping, water
❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weatheiy service road,
❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point.
III. Private Sewage Disposal Systems V. Lift Pump
❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons
tion system extending 25' on all sides. pumped per cycle.
❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main.
❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including
soil data. size, pump curves, drawdown and average flow rate GPM.
❑ Plot plan showing lot size and all lateral distances from ❑,Cross section of lift pump tank showing pump(s) or
sewage disposal system to buildings, lot lines, well, water siphon(s).
course, swimming pools, water service piping, Etc.
❑ Construction detail of septic, holding or lift pump tank if
site constructed or tank manufacturer if precast. V I. Systems In Fill (Fill must be placed prior to-plan submission)
Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench
system, before side slope begin).
❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill.
tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff.
State of Wisconsin ` Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
r- -1 Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Plan Identification Number
L J
jz~
Re:
t r0
t PRIVATE SEWAGE SYSTEM ONLY-
The Bureau of Plumbing has reviewed plans, site survey information and installation details for the const I ive private
i
sewage system to. he installed at the above-mentioned location. The plans and specifications were prepared by
i k
and received for
approval on
I y
The soil and site evaluation was conducted b
The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of
The proposed system is fora`
Wastes from the building will discharge to a. ..ttr. '-'gallon capacity septic tank which will discharge to a gallon capacity
pump chamber from which a pump having a capacity of ~ gallons per minute against a total dynamic head of ~~F•~-1 feet will
r`'
discharge through a V~ inch diameter pipe to the soil absorption system.
It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of
approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation
of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this
approval and shall follow the directions or orders issued by the appropriate local or state authorities.
In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with
the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional
engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at
the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall
become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the
Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight,
construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions
arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the
permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void
this acceptance.
cc: OWS
By:
County
Other
Enclosures -
mes Sargent, B erector
DI LHR-SBD-6159 (8. 7/81)
r
SBD 666' (9/81) (Plb 100a)
STATE OF WISCONSIN DILHR
Detach And Return Upper DIVISION OF SAFETY & BUILVINGS
`Portion Of This Form With BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 178
Any Return Correspondence P.O. BOX 7969
MADISON, WI 53707
608-266-3815
DATE: PROJECT:
Iv\ oho `e~w~,e ~w~~-`•~s~
eie5 c r(1 T P/Z.o d uc.TS ` ~t~ $ w
u11mO.t> Y\~GY~
PLAN ID. #
8a- o c-A $4
DETACH HERE
PROJECT NAME~~ja PLAN ID. #=s~1 1
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required,fee is $ ~ Fee Received is $ -A 4
❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming,
Plan accepted for review. ❑ Plans being returned.
No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW:
held in abeyance.
Y
L Plan Submission ❑ Complete data relative to anticipated„usR gf,'bldg.
❑ Additional informations--sbatl be'submitted in duplicate un- ❑ 2 copies of PLO. 60 enclosed, ,
less specifically noted: ❑ Deed restriction required (1 copy).
❑ Plans not clear, legiblegpr permanent. ❑ Condominium declaration. (1 copy)
❑ All information submitted shall be signed, dated and sealed
a, or stamped in accord with Section H 63.08(2)(a) Wisconsin
t
Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks
❑ Profile of holding tank showing vent, manhole alarm and
r manufacturer if precast. Complete construction details if
' 11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed.
k ❑ Application for use of an alternative system signed by owner
r. and notarized. (1 copy) ❑ Holding tank agreement signed by owner and local unit of
government (sample enclosed).
❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement
for pressurize distribution. ❑ Soil boring &; percolation from county (1 copy).
test data.. ❑ Plot plan showing location of holding tank with lateral dist-
❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service piping, water
❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service road,
❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point.
III. Private Sewage Disposal Systems V. Lift Pump
❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons
tion system extending 25' on all sides. pumped per cycle.
❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main.
❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including
soil data, size, pump curves, drawdown and average flow rate GPM.
❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or
sewage disposal system to buildings, lot lines, well, water siphon(s).
course, swimming pools, water service piping, Etc.
❑ Construction detail of septic, holding or lift pump tank if
site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission)
❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench
system. before side slope begin).
❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill.
tified soil tester 0 Copy). ❑ Copy of onsite report by county or district staff.
l a n 1970
~ x ru yL` Lei Ya~ ~t . lc~t ~c L I-
t,acATION
street or highway kt city yor toqw,nshipcounty
LEGAL DESCRIPTION ~Utj A L•k Ott ~~cV,'~ /
OWNER CL C~~~ Mailing address
ZIP ell.
ARCHITECT OR ENGINEER Address
n ZIP
PLUMBER 0 ILL" Address
ZIP f /
1• Check appropriate building usage(s) and fill in the information requested opposite each usage listeds
•Existing building New building Addition
If addition to existing building attach detailed memo for each.
O Drive in restaurant Car spa.cea~ /
G~
( ) Restaurant • • • • . • Seating oapacity710 sq. ft./person) ~
O Dining hall . . . . Per meal served Toilet waste Yes No
O Motel O Hotel O Cottages Number of units: 2 persona/unit 4 persons unity~vaa~
e TOTAL NUMBER OF UNITS
( ) Churches . . . • . , . . Number of persons Kitchen Yes No
O Bar or cocktail lounge . . . . Seating capacity (10 aq. ft./person)
I
Nursing or rest home • . . Number of beds
Mobile home park . • . . • Number of units - dependent (oamp~r trailer)
- nondependent (mobile home) L
Otail store . • . • • Number of employees Number of customers (10 sq. ft./person)
)'Service station . • : Number of oars served-daily)
( ) School • • Number of classrooms Meals served Yes No
i
Showers provided Yes No
O Factory or office building . • Number of persons (total all shift
O Residence Number of bedrooms
( ) Apartments . . Number of bedrooms
O Other . . Specify
2. Indicate whether or not the following facilities are aonneeteds Food waste grinder . Yea No k
Dishwasher Yes )NO
Automatic clothes washer Yea o
3• Fill in the appropriate information for ~the,f lowing as indicated: ;t C) a GA I
,
sal." IdJ .SG.e/PAS "
Septic tank capacity planned k-TOTAL Septic teak capacity required A •
Percolation test results • ATTACH PEFCOLATI N TEST flEPORT SHEET /
Seepage trench bottom area planned width ;3 linear feet depth
Seepage bed area planned ' width linear feet depth
Seepage pit planned outside diamete depth below inlet depth
Seepage trench bottom area required -oll U 6 width linear feet depth
Seepage bed area required d width_ linear feet depth r
Seepage pit required outside diameter depth below inlet
Signature of person completing fo s STATE DIVISION OF HEALTH, PLUMBING SECTION
P. 0. Box 309, Madison, Wisconsin 53701
Address e Y1-= L_ < 1 Approved: s
zip
Date $ - - Dates APR 1 197
Q
' THIS APPROVAL IS BASED ON STATE PLUMBING
THIS APPROVAL SHALL BE VOID IF REVISED CODE REQUIREMENTS AND DOES NOT EXEMPT THE
,*;-rc~~ WITHOUT THE WRITTEN APPROVAL OF THE INSTALLATION FROM CITY, VILLAGE, TOWN-
DIVISION OF HEALTH, SHIP OR COUNTY REGULATIONS OR PE;t1IT
- (OVER) REQUIREMENTS.
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NR. JOHN DEAN
RT. # 1 Nov. 3, 1969
NEW RICHMOND, WISCONSIN, 54017
Dear Mr. Dean;
In reggrds ti tNe sanitary facilities that you have on the premises
for your mobile home park. It #ight be well that you make a survey of the
whole area. You have now received three (3) vi.ilation notice from this office
in the past year. It could be that the systems that younow have are some-
what antiquated and need overhauled.
It is a suggestion Thom this office that you get in contact with
Mr. "arold Najact of the State Board of Health District #7; State Office
Building in Eau Claire. I am certain that Mr. Najacht will be glad to
assist you in any problem that you might have and give you some tips on
sewage system for mobile home parks.
Yoin- s truly,
V44'x-~
Harold C. Barber, Zoning Admin.
I ~
t ` 1N► 1M to x ei a s t t1, ;fit avo can the is maw
for yaw a Al" hom it diem be wou t a war"T *'r IWs SO 'SOU CIA nVW "WOIV*d thM (3) x,144,0 t MUOO c~tis the
*fill**
Lr ~r4t.1g!1+1~°Il itld !4 a!
``fit . of bo Sato P r ipt ~.*Aath ` tT lRtt ' mom!>a ?°1
' If!i ir. I &A +rerWITI that *4U 'o glad to
+ r pan 1^ ww obi tr t y vlbomo fetid give ym mom tips on
i
MR. JACK DEAN
DEANSMOBILE PARK
RT.#1
NEW RICHMOND, WISCONSIN 54017
Information and evidence has been received by this office that you
are in violation of Section 5.0 of the -,ANTTAEV Code,
as follows, to wit: ALL PRE'`ISES INTENDED FOR HUMAN OCCUPATION OR 0_ IIPANCY
SHALL BE PROVIDED WITH PUBLIC SEWER, PRIVY OR SEPTIC TANK AND ASORPTmN
SYSTEM OR OTHER METHOD OF SEWAGE DISPOjAL
contrary to the St. Croix County ZONING Ordinance as enacted
November 14, 1967 (as adopted by the Town of RICHMOND
You are hereby notified that failure to comply with this order on
or before the 30 day of JUNE , 19_La, may result in
prosecution in conformity with the aforesaid County (Town) ordinance.
Dated MAY 23, , 1968
You sae vi&lating the Sanitary Codes by running sewage over the top of the ground
along Highway 65. This must be corrected at once or this matter will be truned
over to the State Board of Health and District Attorney for legal action. It is
illegal to run water from drains over the top of the ground.
Harold Barber
CC: DISTRICT ATTORNEY
DONALD KINYON, STATE
PLBG. INSPECTOR
FIEF
Ze/V tO?
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MR. JOHN DEAN
RT. # 1 Nov. 3, 1969
NhV RICHMvND, WISCONSIN, 54017
Dear Mr. Dean;
In re8Vds ti the sanitary facilities that you have on the premises
for your mobile home park., It 1ji.ght be well that you make a survey of the
whole area. You have now received three (3) AAl.atien notice from this office
in the past year. It could be that the systems that younow have are some
what antiquated and need overhauled.
It is a suggestion ibom this ofti.ce that you get in contact with
Mr. `I arold Najact of the State Board of Health District #7; State Office
Building in Eau Claire. I am certain that Mr. Najacht will be glad to
assist you in any problem that you might have and give you some tips on
sewage system for mobile home parks.
6
Yozz - s truly,
' Harold C. Barber, Zoning Admin.
F PleFr~Q 1: ~ 1970
1.
LOCATION Pt t` /}(j~>a W e"6Z'C~-~ ~j
P,
street or highway city or toqwnship~/ county
LEGAL DESCRIPTION C t• .t 4i~ `L /
OWNER CL- Ck Mailing address k. k 11, ZIP C, e/ t !
ARCHITECT OR ENGINEER Address
• A ZIP
PLI"ER a `~1n Address C_4_ A L '•z 12 i ( t E
Y 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed,
'Existing building New building Addition
If addition to existing building attaoh detailed memo for each.
O Drive In restaurant • , • Car spaces
O Restaurant • • . . • • • • Seating oapae-7-57 10 sq* ft•/person)
O Dining hall . . • . • • Per meal served Toilet waste Yes No
O Motel O Hotel O Cottages • . Number of unitst 2 persons/unit < persons it
e TOTAL NUMBER OF UNITS it
( ) Churches • • • • • • • • • Number of persons Kitchen Yes NO
k O Bar or cocktail lounge Seating capacity (10 sq. ft./person)
O Nursing or rest home • Number of beds
Mobile home park . • • • • . Number of units - dependent (sampar trailer)
- nondependent (mobile home)
O lrtail store • • • Number of' employees Number of customers 10 sq. ft./parson)
O Service station • Number of oars servedTddZly)
( ) School • . • • . Number of classrooms Meals served Yes No
Showers provided Yes No
O Factory or office building . • Numtber of persons (total ail shiftsT-
O Residence . • • • . • • • Number of bedrooms
O Apartments . . Number of bedrooms
O Other Specify
2. Indicate whether or not the following facilities are oonneoteds Food waste grinder Yes No k
Dishwasher . . . . . . . . . Yes No
Automatic clothes washer . . Yes o
3. Pill In the appropriate information for that lowing as indioatedt 3 ' tl O Cs A
TK'pika ;,v SO,aIes
Septic tank capacity planned z TOTAL Septic tank capacity required 3
Percolation test results- ATTACH PEICOLAT TEST IMPORT SHEET
Seepage trenah bottom area planned width linear feet depth
Seepage bed area planned width linear fast depth
Seepage pit planned outside diamete depth below inlet depth
Seepage trench bottom area, required -70 10 ! iridth linear feet 7661 depth a3 ,
i Seepage bed area required width linear feet depth
Seepage pit required outside diameter depth below inlet
Signature of pars ponplotIng to t STATE DMSION OF HEALTH, PLIMING SECTION
( P. 0. Box 309, Madison, Wisconsin 53701
Pet X, v.r .
Addresst Ytz Approveds •.i .s
C ~
Data: ZIP Dates AER 1 _
970'
C°~`+~ti ` • THIS APPROVAL SHALL BE VOID IF REVISED THIS APPAUVAL IS BASED ON STATE PLUMBING
CODE REQUIREMENTS AND DOES NOT EXEMPT THE
WITHOUT THE WRITTEN APPROVAL OF THE INSTALLATION FROM CITY, VILLAGE, TOWN
a ¢ DIVISION OF HEALTH. SHIP OR COUNTY REGULATIONS OR PERSIT
• - (QyEg) REQUIREMENTS.
44
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no 101t?
Information and evidence as been received by this office that you
are in violation of Section „ „ of the Code.,
as follows, to wit POWA! bo" .M w IN
*%%W too
contrary tc the Gt., Cro County Ordinance as enacted
November l4, 1967 (as adapted by the Town of
You are hereby notified that failure to comply with 'this order ore
o before the . day ofk 19 may result in. prosecution
in. confor dtv vitfi the aforesaid County (Tarn) ordinance.
Datedu 1.9
y ~ yEa. rr - r girrw.Irr.~rGi irrwr.~
Harold Barber, Zones
tAministrator
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and date data, and *here
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THIS IS BASED ON -
NG CODEOREQU REMENTS ANDADOESUNOT DATE _ APR 1 1970.
EXEMPT THE FROM CITY, VIL-
LAGEETOWNSHIPTOR COUNTY REGULATIONS P~.H BI 'G SKT ON
OR PERMIT REQUIREMENTS.
THIS APPROVAL SHALL BE VOID IF REVISED WIS. DEPT. OF HEALTH & SOCIAL SERVICES
WITHOUT THE WRITTEN APPROVAL OF THEW
DIVISION Of HEALTH.
SEPTIC TANK PERMIT NO. 16616
R Z P 0 R T O N S 0 I L PtZ R C 0 L A T I O N T E S T
AND SOIL BORINGS
TO
DIVISION OF HEALTH - PLUMBING SWT1dX
P.O.Box 309, Madison, his. 53701
PMMW nt to H 62.20, Wis. Administrative Code
PERC'OLA`T`I ON TEST
Test Depth Character of Soil -Hours Mater, Test Time Dro in or Level Inches Minutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to Neat to Last To Fall
lst Wetted Overnisht in Minutes Last Period Last Period Period Ow Inch
Example
- 0 3611 To Soil 10" C 26" 25 Yee or No 30 1/2 1 2 1 2 60
SAME AS APPROVED O APRIL 1970
RECORD DATA FROM MINIMUM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L B O R I N G S- Minimum 36" Below Pro osed Abso tlon stem
Boring Total. Depth Doh to Ground Water Depth to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches
Example
B - 0 72" 72" Black To Soil 12M CL4Z IS" Sand 18p Gravel 2411
h _
S ME AS PPROV ON P RIL 1, 1970
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
PE OF OCCUPANCYs
RESIDINCEs Number of Bedrooms OTHHERs (Specify) Number of Persons
FOOD WASTE GRINDZR% Yes No Dishwashers Yes No Automatic !Clothes Washers Yes No
REQUIREMENTS A APPROVED APR 1, 1970
FFWENT DISPOSAL SYSTEMS NEW XX EXTENSION ADDITION REPLACEMENT
Tile Site No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Length Width Depth _ Tile Size No. Lines
Seepage Pitt Inside Diameter Liquid Depth
I, the undersigned, hereby certify that the percolation tests reported on this form were made by as or under my super-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and
that the data recorded and location of test holes are correct to the best of aW knowledge and belief.-
NAME Calvin Powers TITLE
Typs or Print
REGISTRATION NO. or MASTER PLUMBER LICENSE NO. MP RSW 1583
ADDRESS
DATE SIGNATURE
i
Wisconsin Department of Health and Social Services
Pib. #67 3/70 Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK
A. OMER OF PROPERTY
Name Address (street, city, zip Code)
R. R., Hwy. 65
Dean's Trailer Court New Richmond, Wisconsin 54017
B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY St. Croix
Check Ones
CITY VILLAGE LEGAL DESCRIPTION
_IM TOWNSHIP Richmond NW 1/4 of SW 1/4 of NW 1/4 of Section 14, T30N R18W
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? XX YES NO 1030 PERMIT NUMBER
D. SEPTIC TANK CAPACITY 2500 Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete XX Poured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED: One
E. TYPE OF OCCUPANCY
,Check Ones One or Two Family Residence Commercial _ XX Industrial Other
Specify
Number of Persons to be Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES` NO
Dishwasher YES NO Automatic Potato Peeler YLS NO
Other (Specify)
G. MASTER PLUMBER MAKING INSTALLATION
Name: Calvin Powers. Jr. Addreass klew Richmond License Numbers
Wisconsin 54017 MP
Signature of Applioants MP RSW 1563
Addresss
H. (To be Completed by Issuing Agent)
Date of Application 5-4-71 Fee Paid $ 1. 00
Permit Issued (date) 5-4-71 Permit Number 16616
Agent (Name) k. Fors St. Croix
Town, Village, City, COMAW, etc.
(Specify)
Notes The application cannot be considered for filing until all of the above questions are answered and the
fee paid. Agents will forward application, the fee of $1.00 for each septic tanK and the tnird copy ,
of the permit (canary) to the Division of Health. Checks and money orders should be made payable to
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETURNED
(Initials)
.(Date) See Correa.
FEE RECEIVED _ VALID. No. PERMIT N0.
es or No
REVIEWED BY APPROVED DATE
(Initials) Yes or No
COMPLETE OTHER SIDE
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.
ORDINAACE REGULATING THE P,iiiKING AND LOC.iTION OF MOBILE HONIS,
LIC' SING AND A-,GUL TING IriOBII., HUMS PtiRKS, PROVIDING FOR THE
TAXATION OF MOBILE HOMES AND PROVIDING PLi ALTY.
The Town Board of the Township of Richmond, St. Croix County, Wisconsin ,
does hereby ordain as follows, hereby revoking all other Ordinances re-
lating to Mobile Homes;
Section 1. Definitions. Whenever used in this Ordinance, unless a different
meaning appears from the context:
(a) A 111viobile Home" means any trailer, coach, cabin, or other vehicle
or structure originally constructed for and/or intended for or capable of
human dwelling or capable of being used for sleeping purposes, which is
mounted upon wheels or supports, or capable of being placed on wheels or
supports, and/or capable of being transported by another vehicle, except
thos intended and used for recreation and having dimensions of less than
8 feet by 35 feet and/or except those intended for tourism or devices used
exclusively upon stationary rails or tracks,
(b) a "Travel Trailer" means a trailer or camper intended for tourism
or recreation-use with dimensions of less than S feet by 35 feet.
(c) A I'Mobile Home Park" means any park, court, camp-site, plot, parcel,
or tract of land designed, maintained, intended or used for the purpose of
supplying a location or accommodation for more than two Mobile Homes and
shall include all buildings used or intended for use as part of the equip-
ment thereof, whether or net a charge is made for the use of the Mobile
Home and its facilities, 11114obile Home Park" shall not include automobile or
trailer sales lots on which unoccupied trailers are parked for purpose of
inspection and sale.
(d) The word "person" shall be construed to include an individual,
partnership, firm, company, corporation, whether tenant, owner, lessee,
licensee, or their agent, heir or assign.
Section 2. Location outside Mobile Home Park.
(a) Except for parking in the licensed Mobile Home Park and except as
provided in subsection (c) hereof, it shall be unlawful for any person to
park or occupy any Mobile Home on any street, alley, or highway, or other
public place, or on any tract of land within the Town of Richmond, St.
Croix County, Wisconsin.
(b) It shall be unlawful for any person to occupy, for more than ten
days in any year, any travel trailer on any tract of land within the Town
of ichmond, St. Croix County, Wisconsin.
(e) Emergency or temporary stopping or parking shall be permitted on any
street, alley or highway for not longer than four-hours subject to any other
and further prohibitions, regulations or limitations imposed by the traffic
and parking regulations or ordinances for the street, alley or highway.
i
Section ,3. Abandoned Mobile Homes.
All abandoned Mobile Homes within the Town of Richmond may be condemmed
by the Town Board and ordered removed from the premises. An abandoned mobile
Home shall be defined as being unoccupied for 12 months.
i
Section 4. Building Codes.
It shall be unlawful for any person, outside the Mobile Home Park, to
remove the wheels of a Mobile Home except for temporary purposes of repair,
or take any other action to attach a Mobile Home to the ground by means of
posts, piers, or foundation or otherwise.
/ Section 5. License for Mobile Home Park.
i
(a) It shall be unlawful for any person to establish, operate or main-
tain or permit to be established, operated or maintained upon property owned,
leased, or controlled by him, a Mobile Home Park within the limits of the
Town of Richmond without having first secured a license for such park from
the Town Board pursuant to this Ordinance. '
r
-2-
Such license shall expire one year from the date of issuance, but may be
renewed for an additional period of one year. There shall be but one Mobile
Home Park licensed in the Town of Richmond.
(b) The application for such license or the renewal thereof shall be
filed with the Town Clerk and shall be accompanied by a fee of $100.00.
A Surety Bond in the sum of Five Thousand ($5,000) dollars shall accompany
said application. This bond shall guarantee the collection by the licensee
of the monthly parking permit or tax provided for in Section 10 and the
payment of such fees or tax to the Town Treasurer, the payment by the
licensee of any fine or forfeiture including legal costs imposed upon or levied
against said licensee for a violation of the Ordinance of said Town, County
or State, pursuant to which said license is granted, and shall also be for
the use and benefit and may be prosecuted and recovery had thereon by any
persob, firm or corporation who may be injured or damaged by reason of the
licensee violating the provisions of this Ordinance. A fee of ten ($10.00)
dollars shall be paid for the transfer of such license. Any license transfer
must be approved by the Town Board in writing.
(c) The Mobile Home Park now licensed shall meet all specifications of
this Ordinance and of all Ordinances and Codes of St. Croix County within
one (1) year after this Ordinance has been adopted..
Section 6. Inspection and Enforcement,
The one Mobile Home Park license shall not be renewed and no new license
shall be issued or renewed until the premises have been inspected by the
Zoning administrator for St. Croix County and/or proper officials of the
State of Wisconsin to determine whether the applicant and the premises on which
Mobile Homes will be located comply with regulations, ordinances and laws
applicable thereto. The license shall not be renewed without are-inspection
of the premises. For the purpose of making inspections and securing enforce-
, ments such officials or their authorized agents shall have the right and are
hereby empowered to enter on said Mobile Home Park premise and to inspect
the same and all a.ceommo(l3tions connected therewith at any reasonable time.
Section 7. 114obile Home Park Plan and Specifications.
(a) All applicants for the Mobile Home Park License shall conform with
all of the Ordinances, specifications and codes of the Town of Richmond,
County of St. Croix, and the State of Wisconsin.
(b) The Mobile Home Park shall provide a plot of ground of not less than
5000 square feet for each Mobile Home located or to be located in the Mobile
Home Park. Each plot shall have a minimum width of 50 feet.
(c) Each Mobile Home shall be set back a minimum of 15 feet from each
of the boundaries of each Mobile Home plot.
(d) All drives, roadways or streets within Mobile Home Park shall be
at least thirty-six (36) feet wide and shall be hard surfaced. (asphalt or
concrete).
(e) There shall be a curb extending along all streets or roadways.
(f) There shall be a hard surfaced (asphalt or concrete) parking space
of five hunfred (500) square feet in area per lot.
(g) There shall be a hard surfaced (asphalt or concrete) area or
sidewalk four (4) feet wide leading from the parking area to the Mobile
Home entrance.
(h) There shall be only one combined entrance and exit from the Mobile
Home Park to the main highway.
(i) All Mobile Home sites shall be sodded, or seeded, and shall be
attractively maintained.
(j) There shall be a storage area of at least 5% of the total Mobile
Home Park area. This storage area shall be fenced and screened from the
balance of the Mobile Home Park.
(k) A system of collecting sewers all of which discharge to a treatment
facility of a type other than a septic tank-soil absorption system shall be
installed in the Mobile Home Park.
-3-
This sewage system shall be of the type which requires the preparation of plans
by a Wisconsin registered professional engineer and formal written approval
by the Division of Environmental Protection of the Department of Natural
Resources prior to commencement of installation.
(1) Unless ac_equately screened by existing vegetative cover, the Mobile
Home Park shall be screened by a temporary planting of fast growing material,
capable of reaching a height of fifteen (15) feet or more, such as hybrid
poplar, and a permanent evergreen planting, such as white or Norway Pine, the
individual trees to be such a number and so arranged that within ten (10)
years they will have formed a screen equivalent in capacity toa solid fence
or wall. Such permanent planting shall be grown or maintained to a height
of not less than fifteen (15) feet.
Section g. 111anagement and Mobile Home Park Maintenance.
(a) In every Mobile Home Park there shall be located the office of the
attendant or person in charge of said Park. A copy of the Mobile Home Park
license and of this Ordinance shall be posted therin and the Park register
at all times shall be kept in said office.
(b) The attendant or person in charge, together with licensee of the
Mobile Home Park shall:
(1) keep a register of all guests, to be open at all time to inspection
by State and Federal officers and the Town Board or their agents, which shall
show for all guests:
(i) Names and adresses.
(11) Number of children of school age.
(iii) State of legal residence.
(iv) Dates of entrance and departure.
(v) License numbers of all trailers and towing or other
Vehicles.
(vi) State issuing such license.
(vii) Purpose of stay in Mobile Home Park.
(viii) Place of last location and length of stay.
(ix) Place of employment of each occupant.
(2) Report promptly tot he proper authorities any violations of this
Ordinance and/or any other violations of law which come to his attention.
(3) ileport to the Town Health Officer all cases of persons or animals
affected or suspected with any communicable disease.
(4) Collect the monthly parking permit fee or tax provided for in Seem.;on.
10 of this Ordinance. A book shall be kept showing the names of the persons
paying said charges and the amount paid.
(c) The Mobile Home Park shall at all times be maintained in a clean,
orderly and sanitary condition.
(d) There shall be kept in convenient places in the Mobile Home Park,
hand fire extinguishers in the ratio of one (1) to each nine (9) units.
(e) No open fires shall be permitted at any time on the Mobile Home Park
premises. This does not include charcoal or other similar cooking fires.
(f) No parking of any automobiles on the lawn in front of any Mobile
Home shall be permitted at any time.
(g) all Mobile Homes shall be skirted from the Mobile Home to the 6rolind
with the same material or material of equal durability and appeai-'anca as that
from which the Mobile Home is made.
(h) Every Mobile Home shall be provided with a substantial fly-tight,
water-tight, rY~~lex~+-proof garbage c)o~; c;.t<ry, from which the contents shall
be removed in a sanitary manner at, least twit,],. l_y between May 1 and
October 15, and otherwis-u weekly.
(i) Cars parked in parking spaces in Mobile Home Park shall be parked
} so that the rear of the car faces the street.
-4-
Section 9.
1. Plumbing, electrical and Building Ordinances.
All plumbing, electrical, building and other work on or at the Mobile
Home Park licensed under this Ordinance shall be in accordance with all
Ordinances of the Town of Richmond and of St. Croix County, Wisconsin, and
the requirements of the State plumbing, electrical and building codes and the
regulations of the State Board of Health. The license granted under this
Ordinance is i.htended to grant no right to erect or repair any structure, to
do any plumbing work or to do any electrical work, except for normal main-
tenance.
2. Recreation Areas for Mobile Home Parks.
There shall be an open recreation area of ten per cent of the Mobile
Home Park area for recreation and play grounds for children in the Park.
Section 10.
1. Monthly Parking Fee.
There is hereby imposed on the owner of the Mobile Home Park a monthly
parking permit fee to be determined in accordance with Section 66.058,
Wisconsin Statutes as amended by Chapter 366 and Chapter 495 of the laws of
1969 may be further amended. The licensee of the Mobile Home Park shall
collect the fee on or before the 10th day of each month following the month
for which such fee is due.
Each owner of a Mobile Home located outside of the Mobile Home Park in the
Tcwn of Richmond and not subject to this Ordinance by reason of having been
located there before the adoption of this Ordinance shall pay the Town Treas-
urer a monthly permit fee as determined herein.
Section 11. Limitations of Number of Mobile Home Parks and Mobile Homes
Permitted.
(a) There will be only one (1) Mobile Home Park permitted in the Town
of Richmond.
(b) There will be no more than fifty (50) Mobile Homes permitted in the
Mobile Home Park in the Town of Richmond.
Section 12. Revocation and Suspension,
The Town Board may revoke the Mobile Home Park license in the event this
Ordinance is not being complied with.
Section 13. Penalties for Violation of Ordin: nce.
Any person violating any provision of this Ordinance, shall upon con-
viction thereof, forfeit no less than $10.00 nor more than $200.00 and the costs
of prosecution, and in default of payment of such forfeiture and costs, shall
be imprisoned in the County Jail until payment of such forfeiture and the costs
of prosecution, but not to exceed ninety (90) days for each violation. Each
day of violation shall constitute a separate offense.
Section 14. Separability and Conflict.
(a) If any section, subsection, sentence, clause, phrase or portion of
this Ordinance is for any reason held invalid or unconstitutional by any Court
of competent jurisdiction, such portion shall be deemed a separate, distinct
and independent provision, and such holding shall not affect the validity of
the remaining portions thereof.
(b) All Ordinances or parts of Ordinances inconsistent with or contrary
hereto are hereby repealed. Nothing in this Ordinance, however, shall be
interpreted so as to conflict with laws of the State of Wisconsin or Ordinances
regulating trailers, Mobile Homes, or Mobile Home Parks of St. Croix County,
Wisconsin.
Section 15. Effective Date.
This Ordinance shall take effect from and after its passage and posting.
r 6
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Parcel 026-1042-50-100 07/26/2006 12:12 PM
PAGE 1 OF 1
Alt. Parcel 14.30.18.205B 026 - TOWN OF RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - WALLRICH ESTATES INC
WALLRICH ESTATES INC
4505 WHITE BEAR PKY#2200
WHITE BEAR LAKE MN 55110
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1571 HWY 65
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 30.000 Plat: N/A-NOT AVAILABLE
SEC 14 T30N R18W PT SW SW COM NW COR SEC Block/Condo Bldg:
14 TH S 1329. 99' TO POB S 908.99' S 89
DEG E 1438.50'N 909'N 89 DEG W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
1437.64' -POB ASSESS WITH P206C 14-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/03/1999 597020 1400/552 WD
07/23/1997 945/449
07/23/1997 911/230
07/23/1997 798/622
more
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 8.000 310,000 0 310,000 NO
AGRICULTURAL G4 21.360 3,500 0 3,500 NO
UNDEVELOPED G5 0.640 100 0 100 NO
Totals for 2006:
General Property 30.000 313,600 0 313,600
Woodland 0.000 0 0
Totals for 2005:
General Property 30.000 313,600 0 313,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 026-1042-50-000 07/26/2006 12:09 PM
PAGE 1 OF 1
Alt. Parcel M 14.30.18.205A 026 - TOWN OF RICHMOND
Current I X, ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
GEORGE L & SHERYL DEAN O - DEAN, GEORGE L & SHERYL
1563 HWY 65
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1563 HWY 65
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 12.460 Plat: N/A-NOT AVAILABLE
SEC 14 T30N R18W SW NW EXC P205B Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 760/252
07/23/1997 725/553
07/23/1997 725/551
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/30/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 10.460 1,800 0 1,800 NO
OTHER G7 2.000 11,400 108,800 120,200 NO
Totals for 2006:
General Property 12.460 13,200 108,800 122,000
Woodland 0.000 0 0
Totals for 2005:
General Property 12.460 13,200 108,800 122,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 220
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ST. CROIX COUNTY ZONING DEPART
r AS BUILT SANITARY REPORT Jti
Owner
Property Address
City/State
Legal Description: Z~
Lot 1 Block Subdivision/CS # - M6~4 'A ire. o~-
5&j 1/A/4, Sec. , T 50 N-R_L&, Town of
SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION:
Tank manufacturer kp y " size ST/PC ~Setback from: House / 0 r Well,6M P/L
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Width -Length Number of Trenches
Setback from: House Well P/L Vent to fresh air intake
ELEVATIONS:
Description of benchmark Elevation
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet ST Outlet PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines ( )
Bottom of System ( )
Final Grade ( )
Date of installation / /owp number 3.53161 State plan number
Plumber's signature License number 2 :105,T7 Date
Inspector bv-
Complete plot plan a
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
J,ej g „
o ~ 1 eo.~.~
INDICATE NORTH ARROW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division
INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. 353101
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.:
NEW RICHMOND ESTATES RICHMOND
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
026-1042-50-100
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANKTO P/L WELL BLDG. A
irito ntake ROAD Dt Inlet
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction Syestem TDH Ft
Forcemain Length Dia. FFii Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
DIMENSIONS
$ TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION ype O CHAMBER Model Number:
stem: r OR UNIT
DISTRIBUTION S
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
ICHMOND 14.30.18.2056 1571 Highway 65 /
.
~wSp,(<C~ia.... Wab ihsr~l/rd ~ ~work GIQS 6urit~.1 //Ul'6re/~ jrhSveGri'oY
(et&~C of hwrayLr 07 ~alL!/f 'Irfty,
Z, P,`~c u1aS Gruske'?( ul rr- i5 /!H~- s fluiT
1~~• 11
OrD S~`S were T4e•~ 3a Z PiG~u~cS
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. q Z 7 f f
SBD-6710 (R.3/97) D to Inspector's Sig ure Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
e
£ { g
E e
a
j [
{ ~ e
g t
t
g
`s
g
s
F
= g
5S~
1 E `
4
e r
i
-
q E ~
m
3 t
x
3
g
6
S $ F
_ t
~.........W tee........ .w ,.,..o.. . ..w,: ~ ..®s_,~
e e~ a «.k~.. ww .....e.. w.~ a..... .aa ~........a .~..~....b.«~.~
Safety and Buildings Division
Visconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue
In accord with ILHR Wi P O Box 7302
Department of Commerce 8305, ~od~e
~ ~ Madison, WI 53707-7302
• Attach complete plans (to the county copy only) for the sys , ' paR' er r~t leas.., unty
than 8112 x 11 inches in size. 1''" ;
-Pr • See reverse side for instructions for completing this appy a~tibn _tatAlSanitary Permit Number
Personal information you provide may be used for secondary purposes Sr ^.y [heck if revision to pr lows application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALLINF
Pr rty Owner am M r Prope cation
' _R U,.4 6 1/4,,5 T 51 r N, R /4 Aor) W
rop@rty Owner's Mailing Address m'b*r Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
11. TYPE BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Towan of w ~FJ
i
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 2(sp (p ! _/m,
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5*Repair of an
System System Tank OnlyExisting System ____Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
Feet Feet
VII. TANK C It
in allo s Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete con- steel glass Plastic App
New Existin strutted
Tanks ks
tic an ft4eki~ M , ❑ ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑ ❑
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for in lation of the onsite sewage system shown on the attached plans.
Plumber's Name: int) PI tier's Sig ature: Stamps) J11FP/MPRSW No.: Business Phone Number:
zz o 53 7 '7 k5' 0- Q35
Plumber's Address (Street, City, State, Code):
I gleti I ~ ~1_t 1-1 V RYLKd Y)", ci C),~ nrv-o :Z
IX. COUNTY / DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater ;~:7 Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination if
. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
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SD- 6398 (R.11/97) Dls BUTTON: Ori nal to Coo s Di sion, Owner, m r
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3151.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
Ill. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII_ Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e:g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications f``o~~~' pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pAp manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) fora number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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SEC. 14
7. VOL 1400P~E52 o~~~ ~o~a-~o-goo
597020 ,2~~
/ KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Thomas A. Otteson, Grantor, and Wallrich 02-03-1999 8:00 AM
Estates, Inc., Grantee.
Witnesseth, That the said Grantor, for a valuable consideration conveys WARRANTY DEED
to Grantee the following described real estate in St. Croix County, State of EXEMPT # 15
Wisconsin: CERT COPY FEE:
rr 'I_ COPY FEE:
l~ 0 w V~ 1 ea (r kw /-c I ~ Zoo RECORDINGFFEEE:
E: 10.00
I M S~ f l U PAGES: 1
Recording Area
Name and Return Address
BANK OF NEW RICHMOND
P.O. BOX 128
NEW RICHMOND, WI 54017
026-1042-50-100
~0 S (Parcel Identification Number)
b ~9 C Part of the South Half of the Northwest Quarter (S-1 /2 of NW-1 /4) of Section 14, Township 30 North, Range 18
West described as follows: Commencing at the Northwest corner of said Section 14; thence S 00° 1 P45" W along the
West line of said Northwest Quarter 1329.99 feet to the Northwest comer of the Southwest Quarter of the Northwest
Quarter (SW-1/4 of NW-1/4), said point also being the point of beginning of this description; thence continuing S
00°11'45" W, 908.99 feet; thence S 89°31'56"E, 1438.50 feet, thence N 00°08'30" E, 909.00 feet to the North line
of said South Half of the Northwest Quarter (S-1 /2 of NW-1 /4); thence N 89°31 '56" W, along said line, 1437.64 feet
to the point of beginning. TOGETHER WITH an easement for ingress and egress for mobile home park emergencies
and for the removal and replacement of mobile homes situated on the above described property over the driveway as
presently laid and traveled lying South of the property being conveyed and being located in said Southwest Quarter of
the Northeast Quarter (SW- 1/4 of NE-1 /4).
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This is not homestead property. P Together with all and singular hereditaments and appurtenances thereunto belonging;
And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances
except easements, highways, utility rights and reservations of record, and will warrant and defend the same.
Dated this day of January, 1999.
' 'Thomas A. Otteson
AUTHENTICATION ACKNQVVLEDGMENT
Signature(s) STATE OF WISCONSIN
ST. CROIX COUNTY
Personally came before me this-Z_(g_ day of January, 1999
the above named Thomas A. Otteson to me known to be the
authenticated this day of person(s) who executed the foregoing instrument and
acknowled the ame.
signature
signatur
type or print name type or print name i
TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wisco
(If not, My ommissio is permanent. If not, state expiration date:
authorized by§706.06, Wis. Stats.) LI/t )
THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing in any capacity should be typed or
Timothy J. Scott printed below their signatures.
BAKKE NORMAN, S.C.
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
Information Professionals Company Fond du Lac, Wisconsin 8008552021
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