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032-2046--70-066
Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 574367 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Croes, Troy & Heather Somerset, Town of 032-2046-70-066 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: nj 05T 13.30.19.667A26 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Ems;t4--' We�ek6 /hod S. 33 105. 3 Ana 9esirr w` G Z O —i Alt. BM 3'?� �•` Z .a /�3.3/ Bldg.Sewer Holding ]' (G �J St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet -2•I A3. aZ TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet G i 3 Z U 'q-74/6a • ST Septic ✓7 Z7 / DtBottom 46 x{•83 /e0 ,� Header/Man. 9.Z 9 V• Z �A' a 4i.•iit Aeration Dist. Pipe .� 4�} 9q Holding Bot. System /d.33 4 1140.-7V '7 V- S5 Final Grade PUMP/SIPHON INFORMATION ,LS 9v, c Manufacturer Demand St Cover GPM ' Z.t /a 3 •3� Model Numb /D TDH ift Friction Loss System T Ft C• Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No.Of Trenches PIT DIME SIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 /� 3 SETBACK SYSTEM TO CJ P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR G Z IF/e T&Of System:, � rL _ ! UNIT Model Number: 1 ��t �O 3� /t/� SQ�w.�► o.I DISTRIBUTION SYSTEM 3 k Header/Manifold L J Distribute x Hole Siz x Hole Sp ing Vent to AiAtake X / �f Pipe(s) Length �WO**�' Dia Length Dia Spacing 1 1110 SOIL COVER x Pressure Systems Only xxNtound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/S dded xx Mulched Bed/Trench Center 3- S3 Bedrrrench Edges �_ Topsoil ` e es 1 No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 819 160th Avenue New Richmond,WI 54017(SW 1/4 NW 1/4 13 T30N R19W) NA hof 2 Parcel No: 13.30.19.667A26 3za �•11•�.. Gc�.u` at�1 1.)Alt BM Description= 2.)Bldg sewer length= �X�S `✓� GJ✓� n -amount of cover -1J it Plan revision Required? Yes . No ___- - Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Sign ure Cert.No. P v RECEIVED Coun _ Safety and Buildings Division , l X 201 W.Washington Ave.,P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.) ;1 p$ It ST CROIX COUNTY Madison,WI 53707-7162 � 1q &V �OMMIJNITY DEVELO MENT 7 Y Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit M is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Addr ss(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. I. Application Information—Please Print All Information 1 im Property Owner's Name r Parcel# v o )t 6A i t46w C,2 c,c S 03 Z - Z io iv 6 - 4 '0466 Property Owner's Mailing Address /� Property Location l%/ p 7 N /T ✓ Govt.Lot City,State Zip Code Phone Number Af 1(>,�AI 1 y� ..��1 I,�j // -�_/<, /,, Section ~w iL ftfYil0!V'l k 1^ 7f� 0 2 cucleone T 3 O N; R Eorb II.Type of Building(check all that apply) Lot# I or 2 Family Dwelling—Number of Bedrooms Subdivision Name-- Block# ❑Public/Commercial—Describe Use —'' ❑ City of ❑State Owned—Describe Use CSM Number 1/ 15 'T ❑Village of �i I 1 Y� Gu �Town of �0 J'"G Ir-5/L T III.Type of Permit: (Check ne b on line A. Complete line B if applicable) A' ❑New System a lacement System � ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑ Change of Plumber ❑Permit Transfer to New List Previous Permit Number Date ssued Before Expiration Owner 3 ' 06 / Z(� 1V.T O stem/Component/Device: Check all that apply) Non-Pressurized Ian-Ground/❑Pressurized In-Ground ❑At-Grade , ❑`44ound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Ho tf 6tite>'Dispersal Component(explain) ❑Pretre4t7pent Device ex lain) V.Dispersal/Treatment Area Information: ` L ' ` Design Flow d) Design Soil Application Rate(gpds Dispersal Area Required(sf) Dispersal Area roposed(s System Elevation y1 V 0. �- �r 900 9c�o VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units / /� >g/ /G a 9 c New Tanks Existing Tanks j'1 Gt y /� q Y ro 52s— �7�7c Y w" U° •v"� rn w C7 a Septic or Holding Tank 320 V 0 1320 L 7 Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for installation the POWTS shown on the attached plans. Plum-l='s-Name(Print) Plumb ig re MP/MPRS Number Business Phone Number J C9 y /.J Sc 4 tu 1 /7 all t2_3 76 0 760 0 M Plumber's Address(Street,City State,Zip Code) D T N E 7 tV / ,S' VO 2 �1 VII 'Coun /De artment Use Onl Permit Fee Date ssued Issuing Agent gnatu ) Approved ❑Disapproved Ci/i� � ❑ Owner Given Reason for Denial / 12_40 f IX pf N PP roval/Reasons for Disapproval ,"„� I '' :� Y j ' j� ' � E�`"� I 13S Vl�t-/��vliC 1.Septic tank,effluent filter and dispersal cell must toeervi�ed/main"ained 1 as per management plan provided by plumber, 2.All setback requirements must be maintained as Pel applicable plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Croes Replacement Septic System Owners Name: Troy& Heather Croes Owner's Address 819 160th Avenue New Richmond, WI 54016 Legal Description: NW1/4, NW1/4, S13, T30N, R19W Township Somerset County: St. Croix Subdivision Name: CSM 15/4207 Lot Number: 2 Block Number Parcel I.D. Number 032-2046-80-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross Section Page 4 Septic Tank Specifications Page 5 Filter Information Page 6 EZ Flow Instructions Page 7&8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 9/3/2014 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) I Page 1 of 11 PLOT PLAN N Project Name: Croes Replacement Septic System Legal Description: NW1 14,NW1 14,S13 T30N,R19W P.I.D: 032-2046-80-000 Subdivision Name: NA Lot#: 2 SCALE-I"=4. Township: SOMERSET Parcel Size: 5.96 Acres County: ST.CROIX System Elevation: T1=95.0' Proposed 60'EZ Flow Trench Slope: 12% T2=94.2' Proposed 60'EZ Flow Trench A BM1 Elevation: 100.00 Top of 2'PVC pipe T3=93.4' Proposed 60'EZ Flow Trench A BM2 Elevation: 106.84 Top of Septic Tank manhole cover TA=100.46' Existing 56.25'Inf.High Cap.Trench 0 Backhoe Pits: TB=99.16' Existing 56.25'Inf.High Cap.Trench NOTE:See page 11 for a complete plot of the parcel. a inch Sch ao ASTM D2665 4 inch 3034 - ASTM D3034 " A N 3 W LE L!_ I f � GAp-AGE Ac k. - a 3 H DNS Goo©Or 1 1 K 6q1 I T'l ft —13 y ' y Page 2 SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Project Name: Troy& Heather Croes Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 System Sizing Flow Rate 5—s-0 g p d EISA Rating per Foot of EZ Flow 57 ft2 Soil Application Rate 0.5 gpd/ft2 450.0 gpd Design Flow_ 0.5 Soil Application Rate_ � EISA= 180.0 Feet of EZ Flow trenches 60 feet long each 3 No. of Cells 6 Per Cell 3 ft Cell Width 18 Total No of 1203H 60 ft Cell Length 300 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Typical Cross Section Finished Grade 98.50 ft Observation Pipe with approved cap or vent Soil Backfill ■ 36 inch Geotextile Fabric • >3 ft • - 12 inch ° If r>3ft: �� and Anchored Vent/Observation Pipe with Cap 95.00 ft / O / 93.40 ft Infiltrative Surface >36 inch 94.20 ft .■®■..�.'-`� r■ 89.30 ft Limiting Factor rrr■rsrrr■rrrrrrrrrr*7T'g"rerrrrerraarrrrr■rsrrr■rrrrr■rrrrrar■ Plumber/Designer Si nature: 9 g License#: MPRS 223760 Date: September 3, 2014 Page 3 aM-MM :3113 99-ve—SZ2-008 ZLOZ 'Mdf a3SVG8 o \ 09Lb9 IM 'NOOa N301VW OL AMH sn 9LLFM Z 8nod-1SOd Zl O £ 31V0 ZLOZ laVnNVP c�y0 31 801100 J3531M ldflNb'W OIld3S W o\ F n38 Nvq-ozcm :anOd-38d „0-,L=„b L -3"IVOS 3ws :A8 NMVaO m(n 0 LLI (n w J k Z o mO W W J O ^ U v ¢ a = (n d w CL co z H �p �o� Q z a m F.-LLJ °w Q ° O m Q a ..� !- Z fY W o a O U o 1- z_ a 2 w� 3 LL � cV OW w1�,�FU \ Z d mj O a t �c Q d \ min JWW Q O \ O� U ¢ o O m <Q W°N U ` (;i 0 I ZV) V¢-) Li- - ° ! WI mW(n O O Q Z Y O - F 06 OIQ 00 Q )'NQ U W O F cn ¢ a z .. �==�U' �O°-= °Uiinn °vF a. o °° a °w° Qj Y o�K ' zc�Zo i z. Q zcn Q c� a vWi ” wv Qo OQw <,* Q$° U z N Z Z3m U2=��m� F ° �- 20 Q J J = Q Y �Y OIL 0 Z Z OJ H OQ O U!- U J Q W U) I Q ~ W ¢ W U d- W ce H W N � N o "9- a rl SV0 ,- Q 3 „g-V do 3 ° t— — II 5 « 0I £ W 0 �� „�� svo ,.V o , _ � wg� do w Li W ¢ 2 m o W J Z_ QW W "og 9t, j Q U U- V) 0038 gg z U sy < W Q N Y z F- Q Page 4 Wisconsin Department of Commerce,Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow (GPD) and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84,Wisconsin Admin.Code,and Chapters 145 and 160,Wisconsin sizing can be used in Wisconsin, resulting in a 40%smaller Statutes. All sites must meet the Site&Soil Conditions&Locations Isolation distances as noted in local regulations. drainfield. The approved products are 1203H (3-12" bundles with pipe in cen- 6. Place EZflow bundle(s)in the EZflow configuration approved ter bundle in 5'or 10'lengths)and 1203HP(3-12"bundles with pipe by system design permit specified for the particular site.The in each bundle in 5'or 10'lengths. top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler.Any additional aggregate ed by EPS aggregate and is held together with polyehtylene net- only bundles that may be required,should be butted against ting.A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filter fabric pre-manu- • EZflow®Bundles factured in between the netting and aggregate. The fabric • EZflow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZflow Internal Pipe Couplers sure the the GEO is positiioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation Instructions 8. The EZflow Drainfield Systems should be installed in a level The instructions for installation of EZflow® products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom)and should follow the contour of the ground surface defined in chapters Comm 82 through 84,Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code,and Chapters 145 and 160,Wisconsin Statutes,as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing,con- figuration,and layout for the EZflow systems,stake or mark 9. The trench top shall be graded such that water will not pond. with paint the location of trenches and lines.Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe, header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10.EZflow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZflow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed EZflow assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown, however,that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6"of soil cover as bottom of product. recommended by manufacturer. 4. When installed in a trench, the trench should be dug to a 1203H-GEO width of 36 inches. This not only saves labor in excavation, -- Geotextile but also provides better load-bearing capacity after backfill- Barrier Material ing is complete. ts" JOINCIIJ'IFAt BUNDLES WI'I}! IN]ERNAL P�ECWPLPIO 36" ...:... Top View ..... _. ... 9w Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. Ez DOES IT.® F: 1-866-279-9203 1044-101008 Oakland,TN 38060 Ringlndustrial.com ©2006 Ring Industrial Group,LP Page 6 paL koX Inc. Innovations in Precast Drainage Zabel" PL-525 Effluent Filter &Wastewater Products A Division of Poyok Inc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day)making it one of the largest filters in its class. It has 525 linear feet of 1/16"filtration slots. Like the Polylok PL-122,the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning,the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: e 1/16'r Filtration Slots Alarm Switch • Rated for 10,000 GPD(gallons per day). 1 Ox (Optional) • 525 linear feet of 1/16"filtration. • Accepts 4"and 6"SCHD 40 pipe. Accepts 1"PVC Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for 10,000 GPD • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. of 1/16" 10,000 gallons per day(GPD). Filtration slots 1.Locate the outlet of the septic tank. 2.Remove the tank cover and pump tank if necessary. t Accepts 4"&6" 3.Glue the filter housing to the 4" or 6" outlet pipe.If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend&Lok or piece of pipe to center filter. - 4.Insert the PL-525 filter into its housing. r 5.Replace and secure the septic tank cover. Certified to NSF/ANSI Standard 46 PL-525 Maintenance: I The PL-525 Effluent Filters will operate efficiently for z a several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped,or at least every three years.If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing.Servicing should be done by a certified - Gas Deflector septic tank pumper or installer. Automatic 1.Locate the outlet of the septic tank. Shut-Off Ball 2.Remove tank cover and pump tank if necessary. ? . 3.Do not use plumbing when filter is removed. 4.Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all 411 solids fall back into septic tank. 6.Insert the filter cartridge back into the housing making Outdoor SmartFilter@ Alarm Extend&LokTm sure the filter is properly aligned and completely inserted. Polylok,Zabel&Best filters accept Easily installs 7.Replace and secure septic tank cover. E the SmartFilter®switch and alarm. into existing tanks. Polylok,Inc. 3 Fairfield Blvd. Wallingford,CT 06492 Toll Free:877.765.9565 Fax:203.284.8514 www.polylok.com Page 5 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Troy&Heather Croes Tank Manufacturer: Week's C. P.oncrete r NA Permit# 5 -7 Septic C� Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: r NA Number of Bedrooms: 3 F— NA Septic Ir Dose r Holding Volume: 320_ I Number of Public Facility Units: NA Vertical Distance Tank Bottom(s)to Service Pad ft Estimated(average)Flow: 300 gal/day Horizontal Distance Tank(s)to Serivce Pad: ft Design(peak)Flow=estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.5 gaVda /ft2 horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok r NA Fats,Oils&Grease(FOG) 530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand(BODS) 5220mg/L r NA Pump Manufacturer: r NA Total Suspended Solids(TSS) 5150mg/L Pump Model: High Strength InfluentlEffluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L TINA I— Mechanical Aeration r Peat Filter Fr'NA Total Suspended Solids(TSS) 5150mg/L r Disinfection r Weiland Petreated Effluent Monthly average r Sand/Gravel Fitter r other: Biochemical Oxygen Demand(BOD5) 530mg/L Soil Absorption System Total Suspended Solids(TSS) 530mg/L f P-"N A r In-Ground(gravity) r In-Ground(pressure) (` NA Fecal Coliform(geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: %in dia. r r Drip-Line r other. Other: r I Other: r NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third(%)of tank volume Pump out contents of tank(s) When the high water alarm is activated Inspect condition of tank(s) At least once every: 3 r-rr Y-V(s) (Maximum 3 r8) r NA r inoraxs) Inspect dispersal cell(s) At least once every: 1.5 r✓ y-V(s) (Maximum 3 r$) r NA Clean effluent filter At least once every: 1.5 frr Year(s) r NA Inspect pump, pump controls&alarm At least once every: r y-1r(s) r NA Flush laterals and pressure test At least once every: r- yea(s) r NA Other:Cap trenches TA&TB Use T1,T2&T3 for 5 IF/ yews)) r NA Other:Alternate Trenches Alternate Trenches every 1.5 years MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:Master Plumber;Master Plumber Restricted Sewer;POWTS Insepector;POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface.The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third(%)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,Wisconsin Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page 7 START UP AND OPERATION Page of For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels.When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells.Do not drive or park over,or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTS: antibiotics;baby wipes;cigarette butts;condoms;cotton swabs;degreasers;dental floss;diapers;disinfectants;fat;foundation drain (sump pump)discharge;fruit and vegetable peelings;gasoline;grease;herbicides;meat scraps;medications;oil;painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: •All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. •The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. •After pumping,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been,or must be taken,to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations.If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. L� The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name:Owners Choice Name:St Croix County Zoning Phone: Phone:715-386-4680 This document is intended to meet minimum requirements of Ch.Comm 8322(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. Pne A5) s 'v Department of #1764 p SOIL EVALUATION REPORT f,. } •.,, !� � Safety and in actor h m 8 is.Adm.CodeJC•�'� �4 ���� Page 1 of 4 Professional Services _ R Schmitt Soil Testing,Inc.COUNTY h�o Obidl�lcSNITY"Vfr6�7P�UlENT Attach complete site plan on paper not less than 8%:x 11 inches in size�fan musf rolx 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. Parcel I.D. 2-2046-70-066 Please print all information. Personal information you provide may be used for seconds a, Reviewed Date Y P Y secondary Purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location Croes,Troy&Heather Govt.Lot NW1/4, NW1/4,S13,T30N, R19W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 819 160th Ave. 2 CSM 15/4207 City State Zip Code Phone Number ❑ City ❑Village E Town Nearest Road New Richmond WI 1 54016 1 715-246-5487 Somerset 160Th Ave. ❑New Construction Use: ❑ Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial-Describe: Parent material Outwash Sand Flood plain elevation,if applicable NA ft. General comments Area is su' a conventional cv tem with a 0.5 gpd/sgft rate. Possible system elevation for replacement area is(3 Step and recommendations: Trench )T1=95.0',T2=94.2',T3=93.4' Slope of area is 12%. L2 / � -� F-11 Boring# ❑Boring Pit Ground surface elev. 99.80 ft. Depth to limiting factor 29 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#f *Eff#2 1 0-9 10yr3/3 none sil 2mgr mvfr Cs lvf 0.6 0.8 I 2 9-23 10yr4/4 none A 2fsbk mfr gw 1vf 0.6 0.8 3 23-29 7.5yr4/6 none sd 2fsbk mfr gw ------ 0.4 0.6 4 _ 29-38 7.5yr5/6 m2d 6 10yr6/2 SO lmsbk mfr gw ------ 0.2 0.3 6/2 5 38-66 10yr5/3 m2d 10yr6/8 sil lmsbk mfr ---- ------ 0.4 0.6 10yr6/2 a Boring# ❑Boring ❑Pit Ground surface elev. 99.80 ft. Depth to limiting factor 35 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Ef1#1 *002 1 0-7 10yr3/4 none sl 2fsbk mvfr Cs 2vf 0.6 1.0 2 7-15 10yr5/3 none sl 2msbk mfr gw lvf 0.6 1.0 3 15-35 10yr4/6 none grsl 2msbk mvfr gw 1vf 0.6 1.0 4 35-74 5yr4/4 c2d 7.5yr6/6 7.5yr6/2 grsl Om mf ---- ------ 0.2 0.6 *Effluent#1 =BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<_30 mg/L CST Name(Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond,WI 54017 8/8/2014 715-760-1978 SBD-8330(8.07/00) Property Owner Croes,Troy&Heather Parcel ID# 032-2046-70-066 Page 2 of 4 Boring F 3 Boring# Pit Ground surface elev. 97.30 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Ef1#1 *Eff#2 1 0-10 10yr3/4 none grsl 2mgr mvfr Cs 1vf 0.6 1.0 2 10-31 10yr4/4 none sl 2fsbk mfr gw 2vf 0.6 1.0 3 31-38 10yr4/6 none Is icsbk mvfr gw 1vf 0.7 1.6 4 38-9 10yr5/6 none fs OS9 ml ---- ------ 0.5 1.0 4] Boring# Boring [�Pit Ground surface elev. 97.30 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-7 10yr3/3 none sl 2mgr mvfr cs 2vf 0.6 1.0 2 7-16 10yr4/4 none sl 2msbk mfr gw lvf 0.6 1.0 3 16-26 10yr4/6 none grsl 2msbk mvfr gw 1vf 0.6 1.0 4 26-40 10yr5/6 none grls Osg ml gw ------ 0.7 1.6 5 1 40-96 10yr5/4 none fs Osg ml ---- ------ 0.5 1.0 Boring 5 Boring# ❑Pit Ground surface elev. 100.40 ft. Depth to limiting factor 72+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-7 10yr3/3 none sl 2mgr mvfr a 2vf 0.6 1.0 2 7-15 10yr4/4 none sl 2msbk mfr gw lvf 0.6 1.0 3 15-24 10yr5/6 none fs Osg mi gw 1vf 0.5z) 1.0 4 24-72 10yr6/4 none cos Osg ml ---- ------ 0.7 4.6 *Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R07/00) Schmid SON T2sft,Inc. y Conducted by: Conducted For: Page 3 of Schmitt Soil Testing, Inc. Name: Troy&Heather Croes Thomas J. Schmitt, CST 227429 Address: 819160th Ave. 1595 72nd St. City, State, Zip: New Richmond,WI 54017 New Richmond, WI 54017 Phone: 715-7 0-1978 Subdivision: CSM 15/4207 Signature Lot No. : 2 Date & Legal Description: NW1/4 NW1/4 S13 T30N R19W Backhoe Pit i 14,4AI0 AuGtR 8o2/MG Township, County: Somerset Township,St.Croix County ,►Bench Mark 1 El. 100.00'Top of 2'PVC pipe. Bench Mark 2 El. 106.84'Top of Setic Tank manhole cover Slope- 12% Scale 1"=40' Alt 601-3 1aso, a wtcL v w Sr'7l3gcr I l G t _ _I Imo`' S�K to/Jo 7c) Loc6i 7i o•v -- ��A ®aye E-a-i 5't rJ G- 1 (3 vn I T�43 -rRewc,14,d �0 a ' ' yy s � .&w ..t"" •t!r t c n x g x _ t l ': TV I X-M. C-1 41 a I 177 N i 4+n v a 4 ^fit L r ; +� y ra R ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Troy & Heather Croes Mailing Address 819 160th Street Property Address Same (Verification required from Planning&Zoning Department for new construction.) ` City/State New RICh111011d, WI Parcel Identification Number 032-2046 /p LEGAL DESCRIPTION Property Location NW '/4, NW '/4, Sec. 13 T 30 N R 19 W,Town of Somerset Subdivision Plat: Lot# 2 Certified Survey Map# Volume ,Page# Y20 Warranty Deed# lo(�3 (before 2007)Volume I Page# 3% Spec house Q_vesElao Lot lines identifiable❑yes[]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. Itwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin_ Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 & 'I /3 /14 SIGNATURE OF APPLICANTS) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) Page 9 Vol . )7-7Lj Nl e• 3V5' 6C�:239420 STATE BAR OF WISCONSIN FORM 2-1999 i/,ATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS f i'. o-RoiX CO., WI This Deed,made between Gregory R.Boardman and Renee RECEIVED FOR RECORD Boardman,husband and wife 11-2?-200: 10:30 AM WARRANTY DEED Grantor, and Troy R.Croes and Heather M.Croes,husband and wife EXE:IPT it CER; CORY FEE: COP, FEE TRANSFER FEE: 615.00 RECORDING FEE: 11.00 PAGES: 1 Grantee. Grantor,for a valuable consideration,conveys to Grantee the following described real estate in St.Croix County, State of Wisconsin(if more space is needed,please attach addendum): Recording Area Part of SW'/,of NW'/,and part of NW'/.of NW'/.of Section 13, Name and Return Address,,✓1 �- �j� ��,./3� Township 30 North,Range 19 West,St.Croix County, Wisconsin described as follows: Lot 2 of Certified Survey Map filed November 13,2001 in Vol. 15,Doc.No.661982. 032-2046-70,032-2046-80 Parcel Identification Number(PIN) This is homestead property. (is) i�saiii0 Exceptions to warranties: Easements,restrictions and rights-of-way of record,if any. Dated this day of November 2001 * y 4....rB.I.dman R.Bos man v�' ■ ■ ' AUTHEN TICATION ACKNOWLEDGMENT Signature(s) Gregory R.Boardman and Renee Boardman, STATE OF WISCONSIN ) husband and wife )ss. t0, County ) authenticated this 2"15 day of November 2001 Personally came before me this day of L/ the above named * Kristine Ogland 11� TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s)who executed the foregoing authorized by §706.06,W is. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson,WI 54016 My Commission is permanent.(If not,state expiration date: (Signatures may be authenticated or acknowledged.Both are not necessary.) , ) Names of persons signing in any capacity must be typed or printed below their signature. fnrormadon Pror�ionais camper+,.Fond du Lae.wi 9M-e95-2021 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-1999 ooDCe S-a LA1cE, _ r \ 661982 �� q KATHLEEN H. HALSH l REGISTER OF DEEDS SL CROIX COUNTY Ey ST. IXX C&III RGIM FM RVEYOR'S RECORD /y4j"' ,an,rauaa` CERTIFIED SURVEY MAP 11-LI-M 436111 Located In port of the Southwest Quarter of the Northwest Quarter and port of the C6DY FED 3.66 Northwest Quarter of the Northwest Quarter of Section 13. Township 30 North, S eMI N FEES L'SO Range 18 west. Town of Somerset, St Croix County, It Mansin. r A Z Prepared for and of the request of: tr'OR �O owNER: LESdQ �%g� L Greg dk Renee Boardman $ Section Comer Monument �' �G °�cOf�� 819 160TH AVENUE New Richmond, N 54017 of Record og �� 1 +'11,21. • Set 1' x 24' Iron Pipe rrefgtnin �,Yi,, u� Draftee yn Jre►ion„ 1.13 pounds per linear foot a�v O Found 3/4' Rerod Haoki ��J I Q c O Z R- Recorded As 9 m ..........Building Setback Line (100' for pouNk s,town rood) ba. g g?r SEE SHEET 2 OF 2 FOR MAM DATA TABLE °e N89 W58'E 2639.50' ' ~v21 7N LW klr 7W NW 114 S895W02'E -------- s� ,.—..—..—. lhlA_I�BK�E _32 -- Y �age / '� i OF=WAY —1 -T- a o 7 NA47NNEST COAW R 'oil,o „ ,°.u t SEC7AGW 1 TO-19 101 1 I w Ncwnr//4 L�iQNt�iv ^i o@ n 3 I I (/raU1n 1-NPLNr 1 0,I ' I o 1 �2 a o I I£ I I com7r MaWA A 9 sisal a I jL� o 11 u N rn @ 3 N Y L O_T--1 I "3- a a W g I s , C£RT/F/£D SURIi£_Y MAP I I ^+ cup S p VOL__ 10_PAGE 2949 1 I i 14 o 3 g + 151 I CL $va , � a =a 1 Is e A I I %If L tAa 1 I---- v 1 I � 4 iC z I I `"" °I IZ [3; and col to ms la fl Im 11 z�= Qa I� �� R9R x°a a 9Wx o 1 In � z •� or'a c S87 58 59"w O"' 0 LOT 2 o \°� ® ".o0' 1 , TOTAL AREA: •• •��SS "�r ' 259.585 So. FT; 5.96 ACRES + N NEU © a I Z r R N NW%4Qr7WNW114 F w Q>;b 44, ? UNPLATTfO...LANDS OF OWNER 1 4 1 NEST I/4 caa1E7P 400 0 loo N TH ' s�5 1r l r-w-1g ralalr n ' GRAPHIC SCALE else � SCALE IN FEET: t inch - 200 feet BEARINGS ARE REFERENCED TO THE NEST LINE OF T►ii�age 11 Sheet 1 of 2 NW 1/4 OF SECTION 1A TOWNSHIP 30 N., RANGE 19 V"CH IS ASSUMED TO BEAR No1'S6'47'E. ^ ��� ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e» e, E II ..<_. '"moo--. ....�.� ......8. ... M_ ., _Y... ( _..... .... _._ .... ......_ .... .. <..� .... _. ..W.p........ ` _ _ ...... SSt[ { S E g I _.�». a rc �mw . a s m..» ... :.w v.�. �t i n >. «......w .��>, ..... ,.,..,y 3 3 ....... >>... E 3.. e s... . y .. ........d �... de .ve ....... €®e�m. . E E LM. 77� € .. ,.r.. » m mm v.... ....... ..„. .» ...5.. . . t L i II 3 r , e II E ( g II � II a � � a ..».,.. .p®» ..... ..................7 ,r _. ._ .» _. & S .. s..._ ....... a ,... .... a t I f � t E II..a..,.. II _ �^^ E E II ¢ f t W e e E 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. 353106 Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.: Boardman- Greg I Town of Somerset CST BM Elev.:- Insp.BM Elev.: BM Description: Parcel T of O /0 v� 0 032-2046-80-000 Z-D-ZL TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 5 ���jC7 Benchmark 6A3 D� Alt.BM Aeration Bldg.Sewer Z./S /0 • Z'/2 Holding Ht Inlet TANK SETBACK INFORMATION 6t1 Ht Outlet TANKTO P/L WELL BLDG. Air to i ntake ROAD Air Septic I ±Z r 3�'�/ NA NA Header/Man. t,•6 3 /% IL 7,-/,/ 3 (4)T/ Aer NA Dist. Pipe (Q)TZ Holding Bot.System (�)7� z/ c PUMP/SIPHON INFORMATION Final Grade Ma er _ Demand St cover Model Number GPM TDH L' Friction stem TDH t Loss e Forcemain Length Dia. Dist.To SOIL ABSORPTION SYSTEM BED/T C Width Length No.Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth DIMEN 3 sG-Z� Z DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA G Mapuf cturer: INFORMATION Type_0T__ �r AM Model Num er: System: �Z(9br 3 �0 7 ppr O UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s)/ x Hole Size x Hole Spacing Vent To Air Intake Length /b -/ Dia. Length �G ZJ Dia. Spacing �r 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 E] Yes E] No ❑ Yes El COMMENTS: (Include code discrepancies, persons present,etc.) Inspection#1: /2//Do Inspection#2: Location: 819 160th Avenue,New Richmond,WI (SW1/4,NW1/4, Section 13 T30N-R19W)- 13.30.19.668 -0 Ldell �.) L�(�� S�wN lcw9✓� ��D�,/� .�� —,-� �srsf �' D`�Sk-4ee Plan revision required? ❑ Yes No Use other side for additional information. Z 3 IJ SBD-6710(R.3/97) Date Inspector's ignature Cert.No. Safety and Buildings Division � SANITARY PERMIT APPLICATION 201 B Washington Avenue `•/$C0/1S%11 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. _ -^o O • See reverse side for instructions for completing this application State Sanitary P Personal information you provide may be used for secondary purposes * n El Check if r i2nS ievlo} supplication [Privacy Law, s. 15.04 (1) (m)]. O I q 1 6 U i 1� • State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATI N Property Owner N ropert cation ®a nc ma. 42 1 A 1/4jr 3 N, 1/4j R f E Property Owner's Mailin ddress Lot Number mber /Ko >'� / .,-c_ Ci ate r Zip Code Phone Number Subdivision Name or CSM Number e>t e I. TYPE OF BUILDING: (check one) ❑ State Owned 't� Nearest Road Vil '� p age O/1lCr' yL Public 1 or 2 Famil DwelIin - No. of bedrooms Town OF O III BUILDING USE (If building type is public, check all that applyyS Parcel Tax Number(s) (�, 3o , . (• lO$ 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. 1�4 New 2 E] Replacement 3. E] Replacementof 4_ F] Reconnection of 5_ E] Repair of an ystem ____ - __ __________ _ __ ______________ System only Existing System Existing - 7-- ---- -- 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 Q Specify Type 41 ❑ Holding Tank 12 M Seepage Trench 22 E] In-Ground Pressure r S ' 42 ❑ Pit Privy 1 Seepage Pit w ,�-, X43 Q Vault Privy 14 ❑ System -In -Fill �8 �Cc ac G/ f �jy� / Off► 4a VI. ABSORPTION SYSTE INFOR ATION: 1. Gallons Per Day 12.Absorp.Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (GaIs/day /s . ft.) (Min. /inch) Elevation � —3 Fee O.7- -;,' Feet VII. TANK Capacity Total # Of Prefab. Site Fiber- plastic Exper. INFORMATION G in gallons Tanks Manufacturers Name Concrete Con- steel glass App. New Existing structed T nks Tanks Septic Tan Rrg Tank BTiw ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. F Plumber's Name: (Print) Plumb gnature: (No Sta s) MP /MPRSW No.: Business Phone Number: �— �•� i^O / car © /�� �l Plu is Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY Q Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing ent Signature (No Stamps) Surcharge Fee) [ pproved []Owner Given Initial ¢ / D /et Adverse De termination ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety 6 Buildings Division, Owner, Plumber INSTRUCTIONS , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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 S. 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 9 and Buildings Division 608 - 266 - 3151.' To be complete and accurate this sanitary permit application must include: I. 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. III. 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. t 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 8 1/2 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; pumpor 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 for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump 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) for a 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. ! PLOT PLAN J I� PROJECT 1171' %r Ty lea � I /4 1 14S /T N W 'TOWN a✓stdr C0UNTN' MPRS Byron Bird Jr. 220527 DATE _ BEDROOM CONVENTIONAL X)OC IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING 'TANK I E DOSE TANK SIZE MOUND SEPTIC 'TANK SIZE L �p -�-c� b"I TANK SIZE HOLDING 'TANK SIZE LOAD RATE ABSORPTION AREA _$'� # of chambers IL BENCHMARK V.R.P. ASSUME ELEVATION 100' ❑ BOREHOLE 0 WELL *H.R.P. Vent SYSTEM ELEVATION 1 �,, Sidewinder High of Cover Capacity Leaching Chamber with 31.8 ftA2 per chamber 6' Long 16" 34 „ Grade at System Elevation '0 4) LY64 � low 1 N ... / �o Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bwreau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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. Parcel I. D. # APPLICANT INFORMATION - Please print all information. Rev' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4/W/4,S T ,N,R E Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City r State 7 Zip Code Phone Number ❑City El village ,�' Town Nearest Road New Construction Use: � Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate _Zbed, gpd /fi trench, gpd /ft Absorption area required O�JV_e* b ed, ft trench, ft2 Maximum design loading rate bed, d /ft g g gp trench, gpd /ft Recommended infiltration surface elevation(s) A ft (as referred to site plan benchmark) Additional design /site considerations < Parent material G /tom [e Flood plain elevation, if applicable _ ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ U ,�S El aS ❑ U 1 54 , -s ❑ U I ❑ S JaU ❑ S lZ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench e Ground elev. 10, Depth to limiting factor in. Remarks: Zring # Ground elev. Depth to limiting kAddrs emarks: ease Print) Signat a Telephone No. / or Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed .Trench Ground 4/1 / ele / Q7 Depth to limiting 3 factor Remarks: Boring # f Ground elev. Depth to limiting factor in. Remarks: / Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. Bed Trench Boring # O % , Ground elev. Depth to limiting fa to in. Remarks: Boring # Ground elev. ft. Depth to limiting factor 'n. Remarks: SBD -8330 (R. 07/96) Parcel #: 032 - 2046 -70 -066 07/21/2005 09:03 AM PAGE 1 OF 1 Alt. Parcel #: 13.30.19.667A -26 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * CROES, TROY R & HEATHER M TROY R & HEATHER M CROES 819 160TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): *=Pr ary Type Dist # Description * 819 160TH AVE SC 3962 NEW RICHMOND �j SP 1700 WITC " (q Legal Description: Acres: 5.960 Plat: 1389 -CSM 15/4207 SEC 13 T30N R19W NW NW SW NW LOT 2 CSM Block/Condo Bldg: LOT 2 15/4207 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13- 30N -19W NW NW Notes: Parcel History: Date Doc # Vol /Page Type 11/29/2001 663420 1774/345 WD 11/08/2001 661558 1758/216 EZ 07/26/2001 652196 1688/69 EZ -IE 12/07/2000 634828 1565/225 LC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.960 62,800 114,100 176,900 NO Totals for 2005: General Property 5.960 62,800 114,100 176,900 Woodland 0.000 0 0 Totals for 2004: General Property 5.960 62,800 114,100 176,900 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Soil Te t Plot Plan Project Name / yP ®eL r Bir c B r0 B Jr ' � Address �/ Y �6 /br o t/r CS pzoZ v ,5 Lot -- Subdivision -- 1/ T �,p N/R W -,_ Date 1 /4 AV !� Township ❑ Boring O Well PL' Property Line County foo BM or VRP Assume Elevation 100 'ft ' ®,4::� System Elevation *HRP tt �fi In >- �, 3 V � 1 �3 Scale 1/4" = 10 1~t. When Dimensions aren't stated ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address Property Address ROO Aig . (Verification required from Planning Department for new construction) City /State �P�e; �/G L Parcel Identification Number LE GAL DESCRIPTION Property Location,` _�,_) -L A1,, Sec. /,�, T Z,D N -R W, Town of ✓� / ° e.'S -e � Subdivision , Lot # Certified Survey Map # , Volume , Page Warranty Deed # ,Volume Page #_. Spec house ❑ yesA no Lot lines identifiable] yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o e thre r expiration date. SI ATURE OF APPLICANT DATE OWNER CERTIFICATION (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p p Fded above, by virtue of a warranty deed recorded in Register of Deeds Office. SI ATU PLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r • V COCUMENT NO. WARRANTY DEED THIS s ►ACt MCSERY[D •011 IIECORpIN DATA STATE BP_R OF WISCONSIN FORS% 2 - 1985 -- ._.... sr. CROIX cJ., V3 Reed fog F.sc;,, d E1�aine ••G*..Boardman,.- a_9ingle- woman ...................._....._. _ .... MAY 11 1995 at . ........................... .... 35 F ................ • �,. conveys ..nd warrants to Gr -R.. Zaardman .......... ....................... egary Regi.•.. t of M..r-311 ...... ............ . ........................... ............................... _......_......... -- ....... ........................ . ........ 4 ...._ - - - -- . - -- , = _ - -- L cTUnH To _.. I St...l;roix........ - -•-. ....... County, - - -- — -- -- - - - --- 1� the following described real estate in ; State of Wisconsin: Tax Parcel No:.�- ��• -''�� �! The Southwest Quarter of the Northwest Quarter (SW of NW}) of Section Thirteen (13), Township Thirty (30) North, Range N{neteen (19) West s i l I This .._. i:s - not _......_. -• homestead property. (is) (is not) Exception to warranties: 11th . ..... ............ .• -• -.. day of 95 X . �s. . 1' Oates; this Ii (SEAL) .... ......................••- _...__ Ela ine. G.._SQerdman. .... (SEAL) . .... ..... -- ...... ........... ......... .------ .--------- .. i . !V AUVIRNTICATION AC1KN0WLBDGMR NT l f Elaine G. Boardman STATE OF WISCONSIN ` Stgna::ure , , a) sse. .. ...................C Ka enti 19 ... Personally came before me this ............... day of auth Y r ------- V -- --- ------ ----- -- --- -- ---- -•- -•- ..... 19 the above named �M .. - �� . Hendrik..W_.: Van Dyk ......... .... i TITLE: MEMBER STATE BAR OF WISCONSIN --• .......... ..............................- -• (I1 no ....... ....... .... °-- ..................•. - -•-- --• -- ......•.. - •- - -.. ......... ........... ............. .... i. authorized by i `.-08.06, Wis. State.) to me known to be the person ----------- wh: executer the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY j .................. ...... --- -- - -.... REINSTRA & V DYK, S.C....._..... 11 .......... 201 Sou. n les venue Know Wis. a Nest__Iti�hiaQrisly -- i - -- �� !017 ... .............. ... . ..... ... Not-, -y Public -. .. IS I[v Commisslca is permanent. (If not, state expiration II (Signatures may be authenticated or acknowledged. Both ) 1 are not necessary.) date: la I I - — �Naa•o of ;.,tseona s(fntsa is any eaD�'�'• should be typed or printed IAow tl,rir sWaaWrm. l I Wisconsin Legal Blank l grpgh,;.:J?T STATE FAI OT WISrON'TIY MIMau ssonsin DEED FOR N O. a — 1 s n § o ■ M � �M7i / M , t a { _ z 0 ■ & s ¥ E $§ S n ,« o CO , 3 Z4 " - 2} 0 * E 3 2" k / / § § i $ & \ t X820 E G) -4 ` ch ■ 0 0( 2 f I ¢ ¥ U 2 a \ \ $ C / ® ( k CD « @ § o r @ $ § .0 82 CD CO) � i k o o o =Or � 2{ o 0 0 = � 2 g cn cn (A = �)/ 73 ■ ■ ■L \ § BCD f/ J am \ a �° K' t 7 g 8 . { .. $ > % 0 9 $ / E §. � & , CD I @ $f e \' m / 7 CD \ / - 4 § CL j $ 9 D _ w � $ / 06 Z \ 2 Z % k 0 >�> m CD 3 0 . k E2_gKk CD Z A \ \I E ƒ � g�� ��Es / CD =E l CD CD \co k C:. $ 90 2 00 \ 0 � \ � /\ �2 §E �\ Parcel #: 032 - 2046 -70 -066 06/16/2005 08:37 AM PAGE IOF1 Alt. Parcel #: 13.30.19.667A -26 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner TROY R & HEATHER M CROES CROES, TROY R & HEATHER M 819 160TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 819 160TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 5.960 Plat: 1389 -CSM 1514207 SEC 13 T30N R19W NW NW SW NW LOT 2 CSM Block/Condo Bldg: LOT 2 15/4207 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13- 30N -19W NW NW Notes: Parcel History: Date Doc # Vol /Page Type 11/29/2001 663420 1774/345 WD 11/08/2001 661558 1758/216 EZ 07/26/2001 652196 1688/69 EZ -I E 12/07/2000 634828 1565/225 LC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.960 62,800 114,100 176,900 NO Totals for 2005: General Property 5.960 62,800 114,100 176,900 Woodland 0.000 0 0 Totals for 2004: General Property 5.960 62,800 114,100 176,900 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 I TY R. g DODGE AN k ? S•2484 JAN CLEAR LAKE, : i I -o l KATHLEEN H. WALSH WI kEGISTEk OF DEEDS SL CROIX COUNTY %lq�p- .. -.... �iO ST. CkOIX CO. WI SURVEYOR'S REC '``�.�, SURD 0IN RECEIVED FOR RECORD CERTIFIED SURVEY MAP 11-13 - 20014:30 PH Located in part of the Southwest Quarter of the Northwest Quarter and part of the COPY FEE: 3.00 Northwest Quarter of the Northwest Quarter of Section 13, Township 30 North, , RECORD FEE: 13.00 Range 19 West. Town of Somerset, St. Croix County, Wisconsin. ��n P � i0 Z Prepared for and at the request of: <;, OWNER: p ' , '��Oi,.y Greg do Renee Boardman Section Corner Monument i �G ' •; t'n,��` 819 160TH AVENUE of Record O New Richmond, WI 54017 • Set 1" x 24" Iron Pipe weigNn§'wP Drafted by. Jim Hahn 1.13 pounds per linear foot pr o N ov �Q� O Found 3/4" Rerod :,, / R= Recorded As y 0 —{ o - • • • • • • • - - Building Setback Line (100' for possible fi -town road) X :3 (1r <. . o y ba On 3 1 SEE SHEET 2 OF 2 FOR CURVE DATA TABLE ' zl- al co N89'55'58 "E 2639.50' Nz NORTH LINE OF THE NW 114 S89'58'02 "E 0 0 / -- - - - - -- 66.32' -- \ m .. — — — — -�-� RLINE ,� — -- TH A VENUE 0 C 0 _ _ - �� �� 1 h3 RICH OF -WAY - - - - -- mc�a % I W� { i W 1D { 66' 1 cn Q o `c - NORTHNEST CORNER p cs) o _ I SEC710N 13-30 { �►; � NORTH 114 CORNER (FOUND 1 " IRON PIPE) I J` 1 `� S£C710N 13 -30 -19 3 1 (FOUND ALUMINUM y �v I 91 I ' m COUNTY MONUMENT) I C v m f I I oZ I Q W G) • O to o { � D co m 5'0 n I { wl I l00 �N I N N I rn N rn � N �Z LOT 1 m� I ° C_E_RT/Fl_E_D_ S_U_R M__A_P_ { I o k I � � N 0 o 0 � ' a VOL. 10 PA GE 2949 { "a � i -1 O m " -------------- - - - - -- { 1 I 2� 11 1 m N n �3o { V nIm 02 j �= I 2I I 6`Z < 0 N o j '4 o ro / [� j t` n ^ 0 :3 1 Cy Cy / " 02 -c I I 7 A V U) c I { 1 1 �� 0 1 Ia I� IC Z { Npl 6', I� M = =r - 1 O Z O c0 O_ I :E (Do N CO 1� toa to to �MM (1) �I ( Im �� = o pa 1 1 N B� �o ICI s IW I� ` y I N j + 664.3 I o a s Tt c X a o 1 O I CA \�`�`� S87- 58'59 "W o � a 16 LOT 2 \� © N ss.00' m I TOTAL AREA: •` , o X w 1 259.585 SQ. FT. � �' a'_ w� N 5.96 ACRES to � v WELL O (� w C jz O N?6 ''� � m D 1 �SOUIH LINE OF THE 33 4- • � 38 w 69 v ti� NW 114 OF THE NW 114 0 1 ' v .v . 44 �Cb 4m v Cb ---- TT ED LANDS F • -------------- - - - - -- O OWNER - O WEST 114 CORNER 200 0 200 N 0 T 1 SE_C770N 13 -30 -19 i (2 IRON PIPE, 4 HIGH) GRAPHIC SCALE SCALE IN FEET. 1 inch = 200 feet BEARINGS ARE REFERENCED TO THE WEST LINE OF THE Sheet 1 of 2 NW 1/4 OF SECTION 13, TOWNSHIP 30 N.. RANGE 19 W. WHICH IS ASSUMED TO BEAR N01 "E. Vol. 15 Page 4207 4" ZONING ACT s .a Property ID #: - - o - OD Parcel #: P> -3o Municipality: � ►')1 eX� Property Address: s ►'t'tir s e Owner Name: 1 Other Interest: Other Interest: _ Activity: Special Exception Variance ezonemen Request Date: Acres: - 7 Zoning District: A2 - AG (FR3 RES COM IND Past Zoning: A2 ��G A/R RES COM IND Overlay District: SHORELAND WETLAND FLOODPLAIN RIVERWAY NONE Type of Variance /Special Exception: Ordinance Citation: Ordinance: ZONING SANITARY SUBDIVISION Conditions: Decision: D ° DENIED WITHDRAWN Date of Decision: Notes: _Support Linked to Rezoning _Objections _Hardship _ Conditions 2DINANCE AMENDING CHAPTER 1 ST. CROIX COUNTY LAND USE ORDINANCE REZONING LAND FROM AGRICULTURE TO A�- RESIDENTIAL ORDINANCE NO. WHEREAS, the Statutes of the State of Wisconsin provide for a Planning and Development Committee to act in all matters pertaining to county planning and zoning; and WHEREAS, the St. Croix County Board has established the St. Croix County Planning, Zoning and Parks Committee; and WHEREAS, at the request of the County Board this Committee is to review petitions, hold public hearings, and present its recommendations for rezoning requests to the County Board for action; and WHEREAS, the St. Croix County Planning, Zoning and Parks Committee held a public hearing on the rezoning request of Gregory Boardman on September 20, 2000 in the St. Croix Government Center in Hudson, Wisconsin; and WHEREAS, the St. Croix County Planning, Zoning and Parks Committee having considered all written information and verbal testimony presented at the hearing, and finding that the request meets the requirements of Wis. Statute 91.77, voted to approve a rezoning of the following described land: A parcel of land located in the Northwest Quarter of the Northwest Quarter and the Southwest 1 /4 of the Northwest '/4 (EXCEPT Lot 1 of Certified Survey Map recorded in vol. 10, page 2949 of Certified Survey Maps) located in Section 13, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin, described as follows: Beginning at the West %4 Corner of said Section 13, Thence N01 °56'03 "E 1930.70 feet; Thence N89 0 55'08 "E 629.76 feet; Thence NO2 1 01'49 "W 720.53 feet; Thence N89 °56'01 "E 739.80 feet; Thence SO1 °01'34 "W 2635.99 feet; Thence S89 °19'58 "W 1362.08 feet to the point of beginning. This parcel contains 3,108,577 square feet, being 71.36 acres, more or less. Based on the following findings: 1) The Town of Somerset supports the rezoning. 2) Rezoning of the parcel would have no adverse effect on surrounding landowners. 3) The land is in the rural planning area and is an appropriate use. 4) This parcel is not suitable land for Agricultural production. 5) The Town and County confirmed that the request is compliant with §91.77. THEREFORE, BE IT NOW ORDAINED by the St. Croix County Board of Supervisors, meeting in regular session, that the parcel is now rezoned from Agriculture to Ag.- Residential. Dated this o'� (, of �� -� - 2000. ST. CROIX COUNTY PLANNING, ZONING AND PARKS COMMITTEE RECOMMENDS DENIAL: RECOMMENDS PROVAL: Ronald Raymond Rona ymond Linda Luckey Linda ckey IM e C.W. Malick CT. Malick Gerald Larson Gerald Larson 0*0,!Fe eF "seeNSIN (V Art OF 8T. CROIX Artlensen 1. Out E. Nelson, St Crobt County Clerk. 00 HEREBY CERTIFY that I m otnp Is a true and correcl..c opy °'1 adopted by the County and o superviso at M* meolnp hod