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ST. CROIX COUNTY WISCO `` '"�'"`°"'""° '�..✓ """ `" k .� PLANNING & ZONING DEPARTMIC 11 i 4i1 i 2 * ■ ST. CROIX COUNTY GOVERNMENT CE 1101 Carmichael Road _.. �- Hudson, WI 540 6 -7 ��, -r,. w" ° Phone: (715) 386-4680 F : (71E� APPLICATION. FOR MINOR SUBDIVISION JAN 2 5 2005 The submittal deadline for cent f ed survey maps is the a Tuesday of the month two months prior tot month of presentation for approval by the Planning & Zoning Committee. ST. CROIX COUNTY ONING OFF CE Property owner: (W I L.A S eV6eS0Q Agent (if not owner): Sc e L Mailing address: 1 90$ 2 S'�. Wac�,�icL6 to S4OZ8 Mailing address: 9&G Rusr« Daytime phone: (� 15) '}2 �-� 2(0� Daytime phone: ( 4-45" Z(gS- H 2-0 Property location: 5w 1/4, SW 1/4, Sec. z l , T. Z N., R. 15 W., Town of 5P Rk to 6Vl ELb Number of Lots: 3 Total Acreage of Lots: 35 •`f Size of Original Parcel: 3S' • Zoning District: A& RE7 5 Computer #: 0 3 - J0 q - Zo boo Parcel #: 2 - Z9 1 S 331 A Surveyor: S6 lr 4- A. 8 9 A U a T Mailing address: ct &o Ro G n e- i 3 ( C 6A y wl Make a sketch In the box showing how the new lot(s) fit withinA Ell, I T L am. LOT 1 p & t�017M Miff 7- � LOT FEB 2 4 2005 if not recorded thin 30 days of approval date approval shall e I certify by my signature that all information presented herein is true and correct to the best of m94Mf4e. I hereby request the St. Croix CouZoning Department to pro ess this application according to Chapter 18 of the St. Croix Zoning Ordinance. Signature Date — /9 — OS r XAuthorized Agent One (1) copy of a "concept" map are to be submitted for staff review. The applicant/agent will be notified of any required revisions. Once the "concept" corrections are made, an official minor subdivision application may be submitted. NOTE: ONLY COMPLETE SUBMITTALS WILL BE ACCEPTED 5r✓Applicable Fees (Noted Below) Wylone (1) copy of the preliminary certified survey map 9 wnship Approval (A copy of the map signed by the Town Chairman or a member of the Town Board) A copy of the soil test for all proposed lots not having a residence on the lot (soil test location to be shown on individual lots) 5d General Zoning Notice Statement ❑ DOT certification letter if the proposed lot(s) abut(s) a state highway ❑ Road Plans (if new roads are proposed) &'-'Check list from County Surveyors Office WA, ope & Driveway Disclosure Statement ❑ .Conditions of Plat Approval Statement (if applicable) ❑ If required, wetland delineation is to be done by a professional and maps will be reviewed by St. Croix County staff. Applicant shall flag all property/project corners and mark flags accordingly. A final map, reflecting all requested revisions, as well as town approval and soil test if required, must be submitted 10 days prior to presentation to the Planning & Zoning Committee for approval. These deadlines are firm � "Application Fee $400 *County Surveyor Review Fee - S75 per lot or outl0 * These fees are mandatory at time of submittal Road inspection fee - $400 Erosion control inspection fee 5200 Subdivision Variance application fee $500 Re- submittal fee - $400 Subdivision re- inspection fee $200 TOTAL FEES PAID PAID Application accepted and complete: / / By: Zoning Map Number: ps,clv Nsc onset Department of Commerce MOIL EVALUATION REPORT Page I of 3 Division at Safety and Buildings in accordance with Comm 85, Wit. Adm. Code County ST. CRO1X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference poi nt ( BM ), direction and Parcd I.D. g� Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Reviewed Date Personal iMamalion you �e may be used for secondary Purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location • TWILA SEVERSON & PATRICIA HUBBARD G (. Lot -- SW 114 SW 1µ S 21 T 29 N R 15 E( )W Property Owners Malang Address 4L# Block f or CSKV 808 292nd Street . Narrle - k City State Zip Code Phone Number nVdlage own Nearest Road Woodville, WI 1 54028 1 ( 715 772 - 4262 80th Avenue Q New Construction Use(D Residential / Number of bedrooms _ 3 Code derived design flow rate 450 GPD Replacement Pubic or commendat - Describe: Parent material till Flood Plain elevation if applicable N A- R Ger>eral comments Mound System - 0.4loading rate - 2.5 R sand fill and recommendations: Additional boring required per Leroy Jansky, State Wastewater Specialist to extend area for system tklO7V- (Sec Intecpreh Report) I � E Boring # [3 Boring Q Pit Ground surface elev. 99.54 ft. Depth to limiting factor 14 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Struchme Consistence Boundary Roots GPDW in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh I I -13MI - 0102 1 0-3 l0YR3/3 - 1 31gr mvfr as 3vf-co 0.6 0.8 2 3 -10 10YR3/3 - I 2fabk mvfr as 2vf-co 0. 0.8 3 10-14 10YR4/3 - A 2fabk mvfr as 2vf-m 0.6 1.0 4 14-20 7.5YR3/4 f2f 7.5YR4/4 sl l f -mabk mfr as l vf-f 0.4 0.7 5 20-25 7.5YR3/4 e2d 7.SYR4/6 sl Om mfi - 1 vf-f 0.2 0.6 (Some gr in all horimoc; few cobbles.) 2 ❑ Borlin9 98 10 0 Pit Ground surface elev. .11 ft. Depth to limiting factor in. Sod --cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Corumstenee Boundary Roots GPD/W in. Munsel Ou. Sz. Cont. Color Gr. Sz. Sh. - Efflkl I TRW 1 0-3 10YR3/3 - 1 3fgr mvfr as 3vf-co 0.6 0.8 2 3 -10 10YR3/3 - 1 2fabk mvfr as 2vf-co 0.6 0.8 3 10-15 10YR4/3 of 10YR4/6 sl 2fabk mvfr as 2vf-f 0.6 1.0 4 15 -20 7.5YR3/4 1217 7.5YR4/4 sl l f -mabk mfr as l vf-f 0.4 0.7 5 20-23 7.5YR3/4 c2d7.5YR4/6 sl Om mfi - lvf 0.2 0.6 Efterrt #1 = BOD > 30 1 220 mg& and TSS >30 150 mg& ' Eguent 02 = BOD < 30 m9& and TSS -< 30 mg1L CST Name "m Print) 7 CST Number Mary Jo Hollister 1 1.S 1 224832 Address Dale Evaluation CondudBd Telephone Number W9875 690th Avenue, River Falls, WI 54022 11 - 18 - 04 & 12 - 17 - 04 (715) 426 - 1775 ir' Property Owner Severson/H Parcel ID fik (p ending) Page 2 of 3 01 Bo*V a � a pit Grou sur<aoe elev. 98.32 R Depth to fi W&V factor 9 in. Soil Appkation Rate Homan Depth DorriinardColor Redact Description TeAlra Structure Corviisterroe Boundary Roots GPW in. Munseli o]u. Sz. Cont. Color Gr. Sz. Sh. 'Eff*1 'Ef102 1 0-3 10YR3/3 — 1 3fgr mvfr as 3vf-co 0.6 0.8 2 3 -9 10YR3/3 — 1 2fabk mvfr as 2vf-co 0.6 0.8 3 9 -15 10YR4/3 — sl 2fabk mvfr as 2vf-m 0.6 1.0 4 15-20 7.5YR3/4 Of 7.5YR4/4 sl 1 f -mabk mfr — 1 vf-f 0.4 0.7 (Some gr in all horizons) 4] Bari F # p pit Ground surface elev. 98.52 ft. Depth to �9 factor 12 in Soil Appl icstion Rate Horizon Depth Dominant Color Redooc Description Todir+e Structure re Consistence Boundary Roots GPDW in. Mursell Ou. Sz. Cont. Color Gr. Sr- Sh. 'EfW1 •Eff#2 1 0-3 10YR3/3 — 1 3fgr mvfr as 3vf-co 0.6 0.8 2 3 -12 JQYR313 l 2fabk mvfr as 2vf-co 0.6 0.8 3 12 -15 I0YR4/3 t2f 7.5YR4/4 sl 2fabk mvfr — 2vf-m 0.6 1.0 F� Bod% Bodry Pit GrourW surf elev. iL Depth to irntiir� factor in. Soil Application Rate Horizon Depth Dominant Color Redact Description Texture Sbu*n Consistence Boundary Roots GPDff IM Muse1 tau. Sz. Cont. Color Gr. Sz Sh. 'Effflrl 'Etf#2 • Effluent #1 = BOD > 30 220 mall. and TSS >30 150 mgA. ' Eflluera !2 = BOD < 30 mg/L and TSS < 30 mg1L 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. seo4330rr (R0710) PLOf PLAN O*M. seurmSo►J k * i TKE W - Taftl A- O SPRt Krypl Coll eaumy OF 11,P M qsTl►l.- RS.58� 501. WD GOMM 84 5i:'16 a CMS �RflQOSto 3 Aoms d= HAA08ORIJ06- ZL �GNO RTt1 PRo�V l.ta�, ��� �Ih.#2 pp 'Yo SLev� s ,aE F . w tu 4 N 2 � N �A1y Feb 15 05 11:54a owner 7154264927 P.1 '► ) • Safety and Buildings CJivision 13 East Spruce Street commerce.wi,gov Chippewa Falls WI 54729 isconsin Jim Doyle, Governor Deparbnent of Commerce Cory L. Nettles, Secretary January 06, 2005 , CUST ID No. 224832 A777V: Inspector MARY JO HOLLISTER ZONING OFFICE HOLLISTERS SOIL TESTING ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 -4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/06/2007 Identification Numbers Transaction ID No. 1087527 SITE: Twila Severson and Patricia Hubbard Site I No. 692966 - Town of Springfield, St Croix County Please refer to both identification numbers, SW 1/4, SW 1/4, S21, T29N, R1 5 W above, in all comes . ondence: with the a enc .. FOR: Description: INTERPRETIVE DETERMINATION Object Type: Soil Saturation Determination Regulated Object 1D No.: 995115 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01 (10), Wisconsin Statutes, is responsible. for compliance with all code requirements: The following conditions shall be met during construction or installation and prior to occupancy or use: 1. Approval is hereby granted pursuant to s. Comm 85.60(2), Wis., Adm. Code, to estimate the depth to seasonal soil saturation based on an interpretive determination process. Approval of the interpretive determination negates the requirement in s. Comm 85.30(2)(b), Wis. Adm. Code to designate the ground surface as the higest level of soil saturation when redoximorphic features are less than 4 inches below the bottom of the A horizon. 2. The estimated highest level of prolonged soil saturation approved under this determination is 9 inches below grade. At least 27 inches of sand lift on top of 9 inches of unsaturated, in -situ soil is required for adequate treatment and dispersal. 3. The basal soil application rate for the mound shall not be greater than 0.3 gpd /sf, and the linear loading rate not more than 5.0 gpd/ft. 4. Landscaping up slope.of the mound shall be incorporated into the POWTS design to prevent surface water from concentrating along the up slope edge of the mound and to divert surface water drainage away from the system. 5. This approval shall remain valid unless the site is altered in such a way that the depth to soil saturation would change or if saturated conditions are observed for seven consecutive days at depths less than 3 feet below the infiltrative surface of the POWTS distribution component. 6. This approval in no way relinquishes the use of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. -7. A copy of this approval letter and attachments must accompany the mound system design for this site for purposes of plan approval and sanitary permit issuance. If the Interpretive Determination Report was accompanied with a plan and an expiration date is shown on this letter, the expiration date only applies to the plans for the design, not to the decision on the Interpretive Determination Report. Feb 15 05 11:54a owner 7154264827 p.2 A copy of the approved plans, specifications and this letter shall be on -site during constl is ±ion and open to inspection by authorized representatives of the Department, v, hich may include local inspectors. If plan index shuts were submitted in lieu of additional full plansets. a copy of this approv le tter and index Slleei shall be attached io plan that correspond with the cope on file with the Department. All permits required by the state or the local municipality Shall be obtained prior to colt menceunellt U'i C; }tltiTrllitlJll. IIISi'aii3fi ^r Cipci'afiDl'.. ai _ rantin^ this approval the Divis on -}* : afzt`-' tr:. RLI!'.�{ n'l` t.l S'i_{"i ro } fi "l. ?1: ,4i :ll' 71u'•d;*1io ?!S ShO!lid ..:}ri�r!tiOltc :i1'!S Ii'IFl1 •: :F re?t:er. :�e.. -- _ :�•' .. c :ill... ih m ! .. 1' for `;CLG :!':: !:� .i ..t2•: :;L�'lt` ?: !�i. ;1'� r•'I � _ _ .i.s. ° i is 'I ... !'tit "'Si_'i' }�-!• .:1 j'li'.. '..:Si'.i tii-'`r .y :l'l:{.r: a' iii ..;z •' - __. P Feb 15 05 11 _owner - 7154264827 p.3 Mar ,Jo llollister WY875 690 4 ' Avenue !1 �' River Falls, Wl 5+OZ2 +26 1 77 x: • fa+26 - +827 Interpretative Determination Report ? Z+ Novem6er 200+ Propert O wners: TWILA 5EVE AND FATKICIA r1(AE)E)AKD Location: 5W ./ + o the SW /+, Section 2 1, T2 N, K 1 5 W, P.O.W.T.S. Town of nn � s P ield, jt. Croix County, W isconsin Conditionally A P Pil, (0 V ED DEPARTMENT OF COMMERCE DI ISION OF SAFETY AND BUILDINGS INTRODUCTION: SEE 9ORRES NDEN On 18 Novem6er 200+ a site and soil evaluation was completed on the property descri6ed a6ove 6.9 th is soil tester. The test was conducted 6y t request of t6c owners to sell a 5 acre parcel from the acres that they own and have constructed a new Dome on it. The p rop osed osed acre site is located north of the original farmstead site that was alrea sectioned off the original forty.. (5ce Soil S urvey map.) f ew months ago 6 her soil tester which initiated Anot her test had been conducted a e g y another this report as it was determined then that there was no A ++ conditions at the site. Apparently no paperwork was submi Gr—OLOGICAL H15TORY- n a rea of the G laciated Ke As we know, this area in Wisconsin is a ion which occurred a G Keg ion 5,000 to 50,000 years ago. This caused erosion, deposition, stream erosion and other processes. Wisconsin is divided into five natural regions which arc related to land 6 the use of plants, animals and 6 man. Also the bounda are dete rmine d 6 so il texture and structure in the underlying rocks. jt. Croix County is located in the Western Upland which is underlain 6 Ordovician dolomites. (M artin, L. (1965). The Physical Geolo o his art of G t. Croix W isco nsin rG55 M a di son, Wisconsin.) T J C niversit of isco _ P , i M p Wisconsin. (,,l y W Feb 15 05 11:54a owner 7154264827 p.4 Page 2 = Severson and Hu66ard County was formed 6 .9 ground moraine deposits from the Wisconsin stage of glaciation. The soils at tine site indicated that the area has been affected 6, the glaciation period. They are loamy over sandy loam till. LOCAL HYDROLOGY: This land area is located within the Chippewa River E>asin which inclucles the hay, Eau Gallo Rivers and part of the Rush River and Annis, Gilbert and Cady Creeks and several smaller creeks. (St. Croix County Development Management Plan; Physical Features ,Analysis pg. 2 -1 1.) The Eau Gallo River is located approximately one and one - quarter miles southwest and flows at a southerly direction with several smaller basins located in the area. Glen Lake is located approximately two miles northeasterl Much of the groundwater in the area is recharged from rainfall. The attached topographic map from the State of Wisconsin Geological and Natural History Survey shows the land seventy feet {nigher then the two mal or drainage areas that surround the proposed area to the cast and west and flows at a southcrly direction, This site does not receive any drainage of surface waters. Therefore, the indication of seasonal saturation is apparently occurring from massive soil conditions in the sandy loam till. SOIL MAPPING: As indicated in the Soil Survey of St. Croix County, Wisconsin pu6lishcd 6 the National Cooperative Soil Survey the area tested is mapped as an Amery series that occurs withgently sloping and steep slopes, well drained soils on ground moraines, end moraines and areas of pitted drift. The order is an Alfisols and is classified as a Typic Glosso6oralf5 and the family is coar9e- loamy, mixed. E)oralfs arc the more or less freely drained Alfisols and have a cryic (cold) temperturc regime and udic (humid) moisture regime. (Keys to Soil Taxonomy (Soil Survey Staff) USDA- NRCS -) The descri6cd profile to 60 inches for the Amery series does not indicated any mottling in Feb 15 05 11:54a owner 7154264827 p.5 J C r r Page 3 - ` jeverson and Hubbard the horizons. however, described in the II133 - 24 to 3 1 inches are few strong brown (7.5YK5/ sand coatings on faces of the peels.) SOIL CONDITIONS AND SURFACE- WATE-K FLOW- The soil evaluation completed 6 this certified soil tester encountered no 0 horizon even though at one time this site was forested. An A horizon of 9 to 10 inches of loam with no redoximorphic features and with root and worn action present was observered. The color was a 1 OYR3 /3 (dark brown) which is not associated with wetness. This indicates that there would 6e enough in -situ soil to accommodate a properly functionally soil absorption system. Kedoximorphic features are observed under the A horizon and into the substratum. The g honzcsn consists of sandy loan. There is some gravel in all horizons with some co66les present. Also noted that along the 6acksicle (u of the two u pp er pits (E)'t and 53) there was no evidence of redoximorphic features in the upper 14 inches. An A +4 condition existed. According to the St. Croix County map for depths to groundwater, this area is mapped at greater than 75 feet. (Map enclosed) Some surface water flow is apparently straight down into the A horizon which may 6e perched in the I> horizon as indicated 6 the faint redoximorphic features. The drainage at the site appears to flow away from the site in all directions as it is the highest elevation in the landscape- A hand 6oring sample was taken approximately 600 feet to the southwest of the tested site and at about twenty feet lower in elevation. Kedoximorphic features were indicated in the lower part of the A horizon. This area is mapped as Freeon silt loam with saturated conditions for long p eriods during the year. L,ocatecl to the north of the property approximately 500 feet is a new honie with a mound system. This site is mapped as the some soils. i Feb 15 05 11:54a owner 7154264927 p.6 REFERENCL5 1 .) Martin, L. (1965). L Nisical Cjeol af Wisconsin. university of Wisconsin rress, Madison, Wisconsin. 2.) Soils. University of Wisconsin Education Courses. 3.)St. Croix County Development Man. Volume Two; E)ackground Studies. Physical Features Anakis. 4.) Soil Survey of 5t. Croix County (1978). United States ]-)epartment of Agriculture Soil Conservation Service and Researck Division of tke College of Agriculture and Life Sciences, University of Wisconsin. ST. CROIX COUNTY ZONING DEPART REGl1.�E0 N AS BUILT SANITARY REPORT -- i j C 1999 �f= TY �— STCROIX _• Owner Property Address 2 w zoN+n� °FFrcE� City /State Legal Description: Lot Block Subdivision/CSM # S t /4 � � /4, Sec. 2 TZ2N -R f W, Town of S PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 1 20 A Size ST/PCf900 / Setback from: House Y:�E Well ZZL P/L2aS d Pump manufacturer Model S d Alarm location (HOLDING TANKS ONLY) Setbacks: Service road VenLto fresh air ' Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width S-� Length z6 / Number of Trenches l Setback from: House Well 3XG P/L ,7,�" Vent to fresh air intake 1%20 ELEVATIONS Description of benchmark -�— A Elevation Description of alternate benchm T S Elevation 1 d. , 3 Building Sewer/ ST/HT Inlet A 7 ST Outlet /C ja PC Inlet PC Bottom i' Y / Header/Manifold v Top of ST/PC Manhole Cover ` Distribution Lines O A2L)" O ( ) Bottom of System O 1,1a O ( ) Final Grade O 10, O ( ) Date of installation 6 /6 l y P nu er 3-2 State plan number Plumber's signature License number Ifs Datt ' - ) u g Inspector �/ /-✓ i Complete plot plan or l 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 . � 1 ti INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y' Count Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitarFt.: Personal information you provice may be used for secondary purposes (Privacy La s.15.04 (1)(m)]. � F1 IinIdElS Na in7ILA E �jp i t�TOwn of: State Plan ID No.: CST BM Elev.: l W Insp. BM Elev.: BM Description: r Parcel �f�lq_1048 -20 -000 C13. A,;l _62 . am k5 0 1 TANK INFORMATION ELEVATION DATA A9900017 TYPE MANUFACTURER CAPACITY !*' X S ATION BS HI FS ELEV. Septic (�S �ZQp Benchmark �,?, 2 D , q3• Dosing V s d a,S� /O 9•�/ Aeration Bldg. Sewer .tb /off • 2. Holding & Ht Inlet 3.3 )be_ TANK SETBACK INFORMATION St Ht Outlet 3. /6 Z. If TANKTO P/L WELL BLDG. Venttake ROAD Dt Inlet 1.z8 y>r Septic >t&D 5D� �]�� NA Dt Bottom ��, f6 9� 3 Dosing 7(Bfl / l �� l��( ���� NA Header /Man. y 6r} 100-0/57' Aeration NA Dist. Pipe y 9 3 /oo• �' 7� I I V, 1 *4/ Holding Bot. System X6 / PUMP/ SIPHON INFORMATION �' Final Grade Manufacturer 640c Dem nd — Z t5 Model Number L��, �p - PM G 9,r �/� g� 6 Z IF Frictio S stem X ' TDH Lift �� $ Z ,� TDH t ��• Forcemain Length o9 Dia.,Z Dist. To Well SOIL ABSORPTION SYST M °'} D RENCH Width 3 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth I N Z DIMENSION SETBACK 'C SYSTEM TO P / L BLDG I WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION TypeO CHAMBER Mod Num er: System: dw,j Aga' > 25 ' 1 >25 0 ' OR UNIT DISTRIBUTION SYSTEM Header / Mani old r' Distribution Pipes) « x Hole Size x Hole ,pacing Vent To Air Intake Length Dia. 3 Length GOCe "kia. 2 Spacing 3 -38 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.) LOCATION: SPRINGFIELD 21.29.15.331A,SW,SW 808 292ND ST E� [` w,) L, Ce+dl .r - q 9 . o _9 \ I - P ro If17 �( f c Plan revision required? ❑ Yes ❑ No Use other side for additional information. Z3 SBD -6710 (R.3/97) Date inspecto �s Sig ridt ure Cert. No. Safety and Buildings Division "ViSCO/1S %/1 SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue 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 l � than 8 112 x 11 inches in size. �T_ / Z • See reverse side for instructions for completing this application State Sanitary Pe Personal information you provide may be used for secondary purposes [I Check if revision ion fop evi1 pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N 9 Prop Owner N e Pro pert Location p y � " / /a /a, Ta , N, R E (or Propert Owner's Mailing Address Cot umber Block Number Q 5,Z City tate �_ Zip Code Phone Number Subdivision Name or CSM Number 01 Vo O a ( ) II. WILL I . (check one) ❑ State Owned [I ity ea rest Road Public E1 or 2 Family Dwellin - No. of bedrooms ° Town oF�� III BUILDING USE: (If building type is public, check all that apply) Parcel Tax N ber(s 1 [] Apartment / Condo 0 ( 011. O`er •'/ 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 _ y - ew 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5 E] Repair of an stem System Tank Only Existing Syste Existing System ------- ------------ y- ----------------------- y------------- - - - - -- g- y----------- - - - - -- 9 -y - - -- 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 2jC94Aound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -ln -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 <"' — A211 Feet , aeet a aclt VII TANK in allons Total # Of r Prefab. Site g Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete con- steel glass Plastic App New Existing strutted T nks Tanks e ticTan or Er_ 0 ❑ ❑ 1 ❑ ❑ PumpTarik/S amber QQ 1:1 El 1:1 1:1 11 ESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name: (Print) Plumber's * n re: (No St ) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City ae „Zp d �� tt i Col IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing A nt Signature (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial Z po � /� Adverse Determination 00 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber • Safety and Buildings 15837 USH 63 HAYWARD WI 54843 -8107 Visconsin Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary Department of Commerce January 13, 1999 CUST ID No.226900 ATTN.• POWTS INSPECTOR ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY 513 55TH ST 1101 CARMICHAEL RD CLEAR LAKE WI 54005 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 01/13/2001 Identification Numbers Transaction ID No. 204957 Site ID No. 165734 SITE: Please refer to both identification numbers, Site ID: 165734 L above, in all correspondence with the agency, ST CROIX County, Town of SPRINGFIELD; 80TH AVE SWIA, SW1 /4, S21, T29N, R15W BILL JENSEN RESIDENCE SEPTIC SYSTEM 80TH AVE P Q .V FOR: Description: MOUND SYSTEM, 600 GPD Condit Object Type: POWT System Regulated Object ID No.: 444699 APPR DEPARTMENT The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes SI DN OF SAFE and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. SEE CORRI The following conditions shall be met during construction or installation and prior to occupancy or use: •1. This plan action is subject to designer comments on the plan. v2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. % ' 1 3. The area 25' below the downslope edge of the mound must remain undisturbed. -*'4. Insulate building sewer per COMM 82.30(11)(c). `'S. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). - Corrections on second page are as follows: I = 16 basal area =1500 square feet. "7. Corrections on fourth page are as follows: C =11" (220 gallons); A = 21" (420 Gallons). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 01/04/1999 l / FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 PATRICIA SHA RF , POWTS I - AN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 PLOT PLAN PROJECT Bill Jansen ADDRESS P.O. Box #2 Hammond Wi 54015 SW 1/4 SW 1/4s 21 /T 29 N i 5 wN Springfield COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/34/98 BEDROOM 4 CONVENTIONAL IN -G D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND )= SEPTIC TANK SIZE 1200 Gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 500 # of chambers none IL BENCHMARK V.R.P. Top of Nail in Basswood ASSUME ELEVATION 100' ❑ BOREHOLE WELL IH.R.P. Same as Benchmark SYSTEM ELEVATION 141.2 I.T.S. OjZIIIZy 292nd Seale = 1/4" = 15' OVED St. OF C E CE .TY A SPONDENCE a B -3 Dose Tank to be pro , ,Tided with lockdown cover with approved Bedroom Slope a O B-1 warning labels. House s DT ST tjAIt. B.M. Septic and Dose Tanks B'-2 are to be properly Area 25' Below B. M. bedded System to remain undisturbed System to be installed along the 10.20 15' Contour Line W5k to meet setbacks according to Comm. 82 and 83 1320' Pro Line 80th Ave - Designer / No Date j,, - 4" Observation Pipe Perforated Non -Woven Filter Fabric Below Filter Fabric �DistriDution pi ASTM C -33 S a n d ;' "Topsail :.H 6 % Slope Bed Of 12 Force M.oin F lo w ed Drain Rock From Pump Layer .I C Section 0 A Mound System Using A Bed For The Absorption Are o F ° Q G A O F t. . Fi 6 62.5 t . I r . Ft. J Ft. K. .8 Ft. L Ft. W t. 40bservation Pip e - 8 � K °' A j b - yy in �o -- 4 --- -_____ .-------- - - - - -- Force Main C ---- From Pump o DiSiribution bed Of %Z ° — 2 %2 Pipe Drain Rock 4 Obt►ervotion Pipe Permanent Marker Pipe or Rods Pion View 01 Mound rOng A Bed For The Absorplion Area PAGE _ OF Page Of Distribution Pipe Detail For A Lateral Network PVC Distribution Pipe PVC Force Main P PVC Manifold Pipe. S �-X x X * Last Hole Should 8e Next To End Cap Y P Ft. S Ft. X—_� LInches Signed: Y�_Inches License Number: �� Hole Diameter Inch Date: 30 — o $ Lateral Diameter � Inch Manifold Diameter I Force Main Diameter Inches N Holes Per Pipe Invert Elevation Of Laterals �� AMD --VCKJ CAP C, 1. ;�,�' ^_ 'v,/CA7 APPROVE AIJHOLE CC' E 77 AIR IfJ 7,4,KE C, R A 0 C r-oki IIUIT P ROVI 0 2: AIRTIGHT SEAL I i I I *� A I !�� I ALARM *APPROVED I I ou JOINTS WITH L L E 7 _ _ __t V. APPROVED PIPE 3' ONTO OFF c SOLID SOIL r-OUCRETE BLOCK - RISCR. EX1T PFRM OQLy IF TAWK MA)JUFACTLJRFR HAS SUCH APPROVAL sEpric E SPECIFIC.ATIoKiS DOSE u TANKS MAQUFACTILIkEP,: QUMBER OF DOSES:_ PER OAtl 7 AQK S;ZE : GALLOUS DOSE VOLUME ALARM /`1Akj J FAC U P, r,;t. ALeat, IAJCLUOIAJG 15ACKI`i.OW.V_ FALLONS /`%00EL QUMbEK: c!/- CAPACITIES: CAPACITIES.' A= )LICHIS OR :�GA L P� LOk.:5 5Wl7r-H TYPE: IMCHES OR PUMP t MODEL MUMBEK*, C, IMCHES OR ARM GALLOkTS SWITCH TYPE' GPM Ilk4CHES OR lao_ r. �JOTE: PUMP AND ALARM ARE TO 5L �� mlkj mum DISCHApt RAJ G P).\ INSTALLED OW SEPARATE CIRCUITS VERTICAL () 'F_ r EKEWCE I5Z7W[Zlj PUMP OFF AND 015TRIbLITIOM P IF E.. i!�a_ FEET 0, //, Pei + MIkJimLjm IkJETWORK SUPPLY PKESSUF(E . . . . . . . . . . . 2 . 5 FrrT Z FEET OF FORCE PoIAIIQ X %e � F p Yloo FT. FRICT IOQ FACYOK. az ll!r FEET TOTAL OyIQAMIC_ HEAD = FEET P WTERMAIL- F TA ti UCTT —;WIDTH ;LIQUID 07- PT H 51G1JE 0: /c). — LICEQSE ki U M B E R ��(/CJ DATE i Performance Data N,' R�CEEVEO JUN 2 a 199 40 x N SHEF40 30 Pump Characteristics Pump/Motor Unit Submersible 4 20 Manual Models SHEF40MI SHEF40M2 X _ Automatic Models SHEF40A1 1 SHEF40A2 10 Horsepo 4/10 Full loud Am s 12 1 6.5 Motor l` 1e - Shaded Pole (4 Pole) 0 R.P.m. 1550 10 20 30 40 50 60 70 Phase - --_ - 10 GPM Volta a ^_ t 115 1 230 Total Head (feet) 10 14 17 j 21 25 2 30 I 35 Hertz 60 (m) 3.0 4.3 5.2 b. t rt 7 6 8.5 8.8 10.7 V\ Tem erarure 120° F Max. Fluid Temp. C3 NEMA Desig A GPM (US GPM) 70 60 50 40 30 20 10 1 0 Insulation Class A (liters /sec) 4.4 3.8 3.2 2.5 1.9 1.3 .63 0 Discharge Size 1 1/2" NPT DlrnenslQnal Data t Solids Handling 3/4" Wei ht 28 lbs. 3- 7/8 " 6 -5/8" (166.27) 1. All dimensions in inches. (Metric for W V i Power Curd 18/3, SJTW, 20' std. (9e.42) 5"(127) international use). V ( (30' optional) �I — - - - -- 3 -7/8" 2. Component dimensiuns may (98.42) vary + 1/8 inch. Z Materials of Construction y - Handle Stainless Steel 3. Not for construction purpose h 3 -7/8" DISCHARGE Lubricating Oil Dielectric Oil (98.42) 1 -1/2" NPr unless certified. Motor Housing Cast Iron FLOAT SWITCH 4. Dimensions and weights are Pump (asinq Cast Iron approximate. Shaft _ Steel Mechunice+ Seal Faces: Carbon /Ceramic f'. 5. We reserve the right to make Shalt Suni Seal Body: Anodized Steel -' revisions to our product and their Spring: Stainless Steel I specifications without notice. _ Bellows: Buna•N Im ellei Engineered Thermoplastic - 11.3/8' 10 -3x16" — Up . p el bl-i iiu -- BronIe Sleeve Bearing (288.92) ^ (258.76) Lower bearing Single Row Ball Bearing_ Bottom Plate Polyester Coated Steel `� 8" Fasteners Stainless Steel 2" (50 .8) (sz.o7) Legs Engineered Thermoplastic 4 — ! � - -- — � ©1998 Hydromatic" Pum /ash cmd Ohio All Rights Reserec iHYDROMAT1C IF I bland, Ohio 44805 Tel: 419 -289 -3042 fax: 419 -281 -4087 I --- - - - - -- ----- - ---- -- J Web Site: www. entair urn .corn vsrr ) vFFICES IN ALL MAJOR CITIES AND COUNTRIES Ke r� , he yellow pages of your phone directory for your local Distributor tem #: W -02 -6680 1198 5M GOUIrd" Submersible Is.. . Effluent Pump I. 10 3871 EPO4 EP05 I APPLICATIONS • Fasteners: 304: series Fu ly suomerged in high ■ Motor Housing: Cast iron Specifically designad for the stainless steel grade turbine oil for for efficient heat transfer, • Capable of running lubrication and efficient strength, and durability. following uses: dry without damage to heat transfer. ■Motor Cover: Thermoplas- •Effluent systems • Homes Effluent components. available for automatic and tic cover with integral handle •Farms Motor: nanual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single p hase: 0.4 HP, ►oriels include Mechanical Points. • Water transfer M, built overload wi t Switch assembled and 115 or 230 V, 60 Hz, 1550 los ■ Power Cable: Severe duty • RPlt il th rated oil and water resistant. Dewaterin9 automatic reset. .reset at the factory. H ingle phase, C.5 HP, F EA T URES h ■Bearings: Upper and lower • EP05 S SPECIFICATIONS 115 V, in 60 Hz, 1550 C.5 eavy duty ball bearing Pump: EPO4 built in overio;id with construction. t r A EPO4 Impeller: Thermo - • Solids handling capability: au reset. ,iask Semi -open design 3 /4 " maxinlum. • Power cord: 10 foot wish pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection, Csk canadian standards Association • Total heads: up to 24 feet, with three prong grounding • Discharge size: 1' /i NPT. plug. Optional 20 foot ■ EF05 Impeller. Thermo- (CSA listed model numbers length, 16/3 SJTW with • Mechanical seal: carbon- lastic enclosed design for g improved performance end in "F" or "AC ".) rotary/ceralllic stationary, three prong grounding plug BUNA -N elastomers. (standard on FP05). ■ Casing and Base: Rugged • Tenlperaiuic: then ioplastic design provides. 10.1 1 -'F (4l):C, continuous Superior strength and !40 (60 "C) inlermMent, cormsimi resistance • aste vet s: 300 Series METERS FEET,. staff tt +ess steel. 7 0 • Capable of running l dry without damage to 9 30 _ .._... _ _.... _.. f ... �2 5uPMComponents I? y o 25 r Pump: EP05 8 Solids handiini ca abiliE : f.. L... ... ?/4" maximum. a • Capacities: up to 60 GPM. s zo • Total heads: up to 31 feet. • Discharge size: 1'/?" NPT, z 5 • Mechanical seal: carbon rotary/ceramic - stationary, l3UN N elastomers, o - - - -.._ ...- EPOS 4 _ .__ ..._.._.. - .. __. _. _..... _... • Temp erature , � ' 104 °F {40 °C) continuous } I { I 140 °F (60 °C) intermittent. 2 � i i ... ._ E PO 4 1 i i j _. 0 _.._._. - _.....J G 0 30 40 50 GPM CAPACITY 1995 Gouos dumps. inc. Ellijove May, 1995 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code 10-1- COUNTY Attach complete site plan on paper not less than 8 1/ trtc�tes -in size. Plan must include, but St. Croix not limited to vertical and horizontal reference t , i�ection and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and i tatxlce to near! st road. 034- 1048 -20 -000 APPLICANT INFORMATION - PLEAS 1NT A tNfsATION RRRIEWEDBY DATE PROPERTY OWNER: PROPERTY LOCATION i ELF f J R�^ OVT. LOT SW 1/4 SW 1/4,S 21 T 29 N,R 15 for) W James Mahone ; ..wp PROPERTY OWNERS MAILING ADDRESS ' ' CRCiX ]:OT # BLOCK # SUBD. NAME OR CSM # 2859 90th. Ave., `'N''` na na na CITY, STATE ZIP CODE , PHONE N '- [ ❑VILLAGE MTOWN NEAREST ROAD Woodville, WI. 54028 x,(715 698 - 214``:% Springfield 80th. Ave. [ New Construction Use [ Residential / Number oTbed - rooms 4 ( ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 600 gp d Recommended design loading rate • 4 bed, gpd /ft - 5 trench, gpd /ft Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Recommended infiltration surface elevation(s) 101.20 ft (as referred to site plan benchmark) Additional design / site considerations system el based on contour line of el 100.20' Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I ❑ S Amu ®S ❑ U ❑ S CCU EIS f:1 U EIS f: U ❑ S CCU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10yr4/2 none 1 2msbk mfr cs 2f .5 .6 `....1._`' 2 10 -22 7.5yr4/3 none sic 2msbk mfr gW if .4 .5 Ground 3 22 -39 7.5yr4/4 none sl 2msbk mfr gW if .5 .6 elev. 4 1 39-49 7.5 r4/4 c2 7.5 r5/8 scl lcsbk mfr na .2 .3 1 y p y Depth to 5 1 49-60 7.5yr4/6 c2p 7.5yt5/8 of s M na na na .4 .5 limiting factor 39" Remarks: Boring # 1 0 -11 10yr3 /3 none 1 2msbk mfr gW 2f .5 .6 2 € 2 11 -24 10yr4 /3 none sl 2msbk mfr gW if .5 .6 3 24 -48 7.5yr4/4 c2d 7.5yr5/6 sl 2msbk mfr na na .5 .6 Ground elev. 98 ft. Depth to limiting factor 24" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. New Richmoml. WI 54017 Signature: Date: 3 -6 -98 CST Number: m02298 I PROPERTY OWNER James Mahoney SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # 034- 1048 -20 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourx* Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -9 10yr4 /3 none 1 2msbk mfr 9w 2f .5 .6 2 9 -28 10yr4 /4 none sl lcsbk mfr 9w if .4 .5 Ground 3 28 -48 10yr4 /6 c2d 7.5yr5/6 sicl lmabk mfr na na .2 .3 981% ft. Depth to limiting factor 28" Remarks: Boring # ................. Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel James Mahoney 1554 200th Ave. CSTM2298 SW4SW4 S21- T29N -R15W New Richmond, WI 54017 MPRSW -3254 town of Springfield (715) 246 -6200 36 acres N 1 " =40' BM.= nail in Basswood tree C el. 100' Alt. BM. nail in Aspen tree C el. 93.40 g 100 N \ c � � r -54 ey, n!� Gary L. Steel 3 -6 -98 I - • f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer L��,d�fl1 -�� Mailing Address Property Address .S- (Verification required from Planning Department for new construction) Lp City/State -� Parcel Identification Number 6�3 7 /6 () I LEGAL DESCRIPTION ` Town of Property Location �/, Se� � W i P rtY ��: , 'I� N- Subdivision . Lot # Certified Survey Map # ' , Volume , Page # Warranty Deed # z'7Q� 3 Volume _, Page # Q� Spec house ❑ yr4%=n0- -- Lot lines identifiable ❑ 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 wastewaterdisposal 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. Uwe, 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 of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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. SIGNATURE OF APPLICANT 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 1 �� oa • �o� 7.`s� OP+�05b 5'76013 . WARRANTY DEED Document N umber Doc um.a t Title 1 � MAR 'JI 1�9$ 9:30 A. Recording Area Name and Return Address 2 ke� w 034 - 1 048 -20 Parcel Ideuti6eation Number IPIM A �SFER This information muse be completed by subs istar: document riglc, named return address. and pfN (if required). Other information such as the granting ciawes, Legal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note: Use of dhir cover page addr one page to your document and $2.00 to he reccrdine fee. Wisconsin Sgamses, 39.S/7 WMA 2196 .� z9 VOL 1`�f�1P STATE BVI -F WISCONSIN FORM 1 – 1982 ` �C- U51 ' WXRkANTY DEED DO UMENT NO. RECEIV FOR R RD This Deed made between Jam T. Mah one. an _ Keri S _ Maho husba an wife T�� MAR CLOCK_ M 1998 _ Guntur, �c Twila R_ S verson a.ld Patricia A. liubl ar d� A each an un 112 interest as tenants in con OLKCOUNT Bonnie II' erg, Re8p p eeds Y — f ` Grantee, Witnesseth That the said Grantor, for a valuable- axwdetatix _ Lrj :��rys to Grantee the followi..g descnbcd real estate in St Croix THIS SPACE RFSERVED FOR RECORDING DATA .,.a -"y; State of Y & onset: NAME AND RETURN ADDRESS '1 T.M. Abstract & Title The Souchwest Quarter of the Southwest Quarter of Services, Inc. Section 21, Township 29 North, of Range 15 West 63 South Third St. 0n the Township of Springfield), except Lot 1 of Barron, WI 54812 CSM 3 -703. 034 - 1048 -20 PARCEL IDENTIFICATION NUMBER TR s N S.FM qq� i This is not homestead property. os)( is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And .lamac T_ ahnna�_Ki-ri S MahnnPy. hllchan(d and t,rdfe _ " - that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions o` record, i ni warrant and defend the same. his day y of M '19 (SEAL) a Z. (SEAL) . James T. Ma (SEAL) �`�""`� (SEAL) Keri S. Mahoney AUTHENTICATION ACKNOWLEDGMENT x cisl State of Wisconsin, __ Barron -- -- county � F - icated this _ day of , ld Personally came before me this day of Mar e - - - - - -. 19--9j_, the ahr . nied - -- - - - -- -- - - - -- — da T _ Mah oney anti Keri- 5 -A _hG.iey, - — - - -- -- - - - - -- husband._and- wLfe__ -- - -. N1E ALAI[ B.�RoF \\'ISCG)NSIN '� -- . —. - -- n ,n• — — — - - - -- — h))n"d by 3 i 06 0(+, A is Stars) to me known to be the pers, wh executed the foregoing I nutvm. d acknowledg e me - --CIS INS7R�MENT, 'JYAS GRAF - TED 8Y - - �J���_ Mar-k-0 �.- Dobbe.rfuhULIDEN-& D-ME AIL, �1 425 1raSa -1 ie__ Ave_ > - Barron, -W-I ;d8 �.�t o r Ptibll�. - - -- -._Bar trty, Wis. _- may h or arknosled a fk)th a1c urt ° c i s nCrMancrit lif not, state expiration date. Ph #(715) 537 -5636 I B:%R UI• w IS( ONSIN W)sc~ L G-,o Bland Co. k)e a = ;:84 1 t UFPU torm Nn. 1 - I9r52 r'bh"'--''kee. Wis.