Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
004-1037-60-000
� � o -0 °o I o O) °i c a c 0 � I N I N i I I � I I �^ I I � I 0 c Z LL c 0 a I I I N Z 3�,! £ U') O v !', o Z `m CO h Z a m o o_ z v c Z E ' cr- � M I 3 •� C O I C 0 z z O 4 N _ Z y _0 I N C ` N d w ++ O C 0 O c0 N ` O O a O a E c _� O O N N O O O Z o o • N ;� °� a a a a LO g co c o w D N J O O 0 C4 w o N ° o O 3 � U m "T d F N , ti ^ • � a } O O M N C O'0 C E M O O N O 0 Q d O O O O d C N N M N N C . . O C 7 N . C O7 co � N W QS N - a F- C N r o0 1—I �.' � O N — 0 E L r • ° o U M O z N Z: U) O r a L a r • R CL N E w C c c 7 O m O 3 w O �1 A U a 2 0 N U Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page L of _3 Libor and Human Relations . Division of safety & 6uildngs in accord with ILHR 83.05, S. Adm. Code COUNTY 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 point (BM), direction and % of slope, scale or PARCEL I.D. # 04tensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION DATE. PROPERTY OWNER: PROPERTY LOCATION g0QE) 'E:1SS GOtPr.t'@T MW 1 /4SVV1 /4,S % T ,N,R S E {or PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # _ 3� 9 z -to rf ST. CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE (MOWN NEAREST ROAD wLQOr" Aj ( - )!S) Z - 31 °1 S Z r3 0 T It ST, Pq New Construction Use [,X] Residential / Number of bedrooms Z [ J AddifiQn to e xisfing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate — bed, gpd/ft ' 3 trench, gPd Absorption area required ZSO bed, ft _ Z T trench, 111 Mattimum design loading rate • S bed, gpd$ trench, gpd/ft Recommended infiltration surface elevation(s) 1 OS - 0 1 I It (as referred to site plan benchmark) Additional design / site considerations " -jr\AJ w /S 'X 5 0' `Menu &M . Mwt )wv y \Z" (SY- SA-kb RL . Parent material �..o I;r.0 3 QQ t_NL G t-A Rt T►L-L Flood plain elevation, if applicable N A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM qJ FlLL HOLDING TANK U= Unsuitable for s stem D S [� U ®S ❑ U ❑ S ® U El S ®U O S IRU O S ICI U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell pu. Sz, Cont. Color Texture Gr. Sz. Sh. Consistence Bwxkvy Bed rerldi 0 -q 1p`ttZ3lZ sLI 2`FS� w1`�4- e5 Z�� .S .� •S .� �l sl Ground 3 Z7 - -S`IIL 31y t.s -m5lb lei w j C��, - Z- -3 elev. ti io'1�GC3 �+ �s `s► o, )m Ujit cs Depth tD S ql -S t u`1 R- yl L �; .S fzS1 a C 1 Caw, Yn `�,' _ I.� . Z limiting fac tor Z Remarks: Boring # - Z Ground l oo.b fL ~ Depth to firrdfing factor ,. Remarks: " CS T Name.---Please Print Arthur L. We erer - Pine 715- 425 -0165 g rer Soi Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 ' Sgnadue: ! 48 -6 �_ be Date: - CSTNumr. 1 y� _q M OO 576, PROPERTY OWNER C:!:AQSS SOIL DESCRIPTION REPORT Page — o f , PARCEL I.D.# 60 L)-- 1037 -61D Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD 9L, . Consistence Baxxiary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed 3 Z — sl l Z`� wt 0--s zu� , 5 Z F-Z .. loK2 3/� S Z`Fsbk 1M 'Fl� eS �u� • 5 Ground 3 a '19 S tp -' S'bk Yvt -S' elev. ti oC:S ft. Lf 3�-4L S \-1 31 y s L2 S,/& Depth to limiting factor Remaft: Boring # )u`tiz 31 Z s t I Z`�bh ��� �S 21)1� Z $ -3o LO`�t tZ. 31 � — sL 1 Z�bk >•n'F- e w 1 �� . S :Ground S `t %z 3 1 Y �`. RS sl - l s ov„ wig►. C S elev. l W n --116 - t ft. Depth to limiting factor t . Remarks: Boring # 'F>^ 0-S Zvi s . S �� Z $ -z� ti� �1.1z 31 � — s �'1 Z.M, s � k ri, `� �. � 1 u� • s s 3 z S`lk Slg 1-S4R-3 `Ps -v s cam, m v+ ' _ • U , •S. Ground elev. 1 oS•o ft. Depth to limiting factor Remarks: Boring # i +c* ^ Ground :eiev. ft. Depth to limiting factor, Remarks: SBD- 9330(R.05/92) I PLOT PLAN Page 3 of 3 SCALE 1 "= t4'0 tn-- w s � r r ab`►`R1M� OF �Z� k So' tto�s� �ti i F-- ms s - C �� �► �� �o Mar e % 101MT Ok �'Snxz,� iris . Q � a N � J oa Ez.►u MdTem fix'► L - ND LAO'p o 8` 416!{, w�t� 3 ►`H" So, Pty M ovtuA , - - - (715 ) 4?q- 14 00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry .S O l L AND SITE EVALUATION REPORT Page of Labor and Human Relations Dni sibn of safety s euildings in accord with ILHR 83 05, Wi Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 497' not limited to vertical and horizontal reference point (BK, direction and % of s Dpe, scale or PARCEL I.D. # 4ii1ensioned, north arrow, and location and distance to nearest road.: . 004 --1 by . -6U APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION Q BY DAT s Ir 4 8 PROPERTY OWNER: PROPERTY LOCATION gOQt �1SS GOV'r-t6T MW 1/4 SW1 /4,S % T ,N,R S E(or PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 3l9 ?--to `f f ST. —. — CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OrOWN NEAREST ROAD LvLISo�� k h)S) 319 S Lt b 2 s", PQ New Construction Use [A Residential / Number of bedrooms Addition to ebsbng building I] Replacement [ ] Public or commercial describe Code derived daffy flow 3� gpd Recommended design baling rate — bed, gpcW ' 3 trench, gpdHt Absorption area required ZStJ bed, ft trench, ft Mabmum design bailing rate • S bed, gpd$ trench, gpd/ft Recommended infiltration surface elevation(s) VO 5.0 It (as referred to site plan benchmark) Additional design/ site considerations `N1buKA w /S `X 5 O ` { tZf�l.,ey . Mw)h.,vm �Z" o� SAhJp FiLL . Parent material oy L*fC G LA e_r. M- — 1 - ILL Flood plain elevation, if applicable N q ft S -= Suitable for system cONVMONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem EIS CRJU ® S El El ® U ❑ S ®U ❑ S (RU ❑ S tau SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell qu. Sz, Cont Color Texture Gr. Sz. Sh. Consistence Bottxiary Roots Bed rrkixh h LO'ilZ:t` - sL Z`fsbk yr,�►. c� lv� • g ;� Ground 3 Z -1,s41I_3A( 1 S 4c 1 �asblz m`�i C►ti � - Z- -3 elev. CS q S Depth to S q� - t u - 12y /L �� - w R sla C 1 p�., tin `�t' _ ►.gyp 2 limiting factor Remarks: Boring # Z Ground elev. l AO.b fL Depth to limiting factor FT _j Remarks: CST Name. —Flaw Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soik Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 ' Date: -CST Number. . y_.P�_gc M0057(r I PROPERTY OWNER `'' �Q1SS SOIL DESCRIPTION REPORT Page Z of .` ARCELI.D.# - iD3�1_60 g �O Boring # Horizon. Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tiendi 3 l C) Nv z — sl l Z `F s b wt `fit-- CS Zug' . 5 •6 tza `-L1Z 3/� s .iJ Z`Fs�k Y►a �'�- eS �U�` -S Ground m u j elev. V .pl . . s ft: S'�2 S/s s � O wr `F1- - •3 Y Depth to limiting factor 3.q s Remarks: Boring # - WL CS Zug Z � - Lo`•t.tZ 3 — Z �p lb s f L b ly1'�t -- �° • `Fs k 1 s r 'V V T T -1 fzs 1 sl - l s o „,� Ground 13 �^'1 'Fl- C S — • 3 elev. �l8 Sb l o� i� -4/l6 e 1 0►-►� ►►, �' - N � . z 1 0.0 ft. 1 Depth to i limiting I "factor ' I . 3�• Remarks: Boring # i o C Z — s� l z`Fs b k w► 'F>^ �S z.U s S Z g -Z, tio� �z316 — T e �k »o'F►- 3 z)- S 2 S /g �LS`� - � `Ps- ti's cam, m • y .S Ground — elev. :. 1 bS•0 ft. Depth to limiting . factor Remarks: :.Boring # r;. -Gtound 1 ':r,elev. ft. Depth to limiting factor, Remarks: SBD- 8330(8.05/92) TT - PLOT P l�-y Page 3 of 3 SCALE 1 "= 40 ' I s e -5 Z �ov�Z pt, 104 p' : � OF �L�1vCt4 p I�OVSt` �ti I � i i (/3 C X10r L` "OkCT cz N o iJ a a J s3 N Nl 1p 1 S B.,Z - t @r1#A Z t2.lpp 1\105 •. -, am W1 _ fz-. LW, p� oi-� 8`1n6N, 3 �v v D1�4• Qvc pt►� wlL� , � j- ' ri d, t �1 ( ) 14 00576 715 4 .5 -ni �5 CST Signature Date Signed Telephone No. CST # ST. CROIX COUNTY ZONING DEPARTMENT,`. � ' AS BUILT SANITARY REPORT � �Fc��vE� Owner f .e Property Address ,,� 19 2 `' sr —� sr co City /State I.i I s w , f ' 20NI NGOPRCE Legal Description: Lot Block Subdivision/CSM # %4 S �✓ % 4, Sec. f�, TLN -R_W, Town of �: PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION I Tank manufacturer Size ST/PC I C ) ()U /l- U Setback from: House 33 'Well P/L Pump manufacturer _ 2. I o c Q Model 53 Alarm location ,Q ! z cz i36 k (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: m & I , O Width Length S U Number of Trenches Setback from: House 4 1-3_ Well 1 —_ � P/L Vent to fresh air intake ELEVATIONS Description of benchmark j � ,� �� r'' e_ 12 e / Elevation U Description,of alternate benchmark 4 st-ti h c 1_3 o v Elevation 2 Ste„ Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom q�, G S� Header/Manifold / �� r ' Top of ST/PC Manhole Cover y y Distribution Lines () G ? () ( ) Bottom of System ( ) �►, S t� ( ) ( ) Final Grade Date of installation `L //2/ crmit number State plan number 2 4 3 q Plumber's ture c -4, License number L j Date/ Inspector Complete plot plan a t 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. m PLAN VIEW 4 l V Lt > 0 yt INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: ❑ C DEISS, ROBERT ❑ Village Town of: State Plan ID No.: CA1�Y CST BM Elev ; Insp. BM Elev.: BM Description Parcel T N �'bT- 1037 -60 -000 TANK INFORMATION ELEVATION DATA A9800221 // z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sept �`'I,' fi ° rcxc'`; 't':r' �/�C�i 't GJJ of Benchmark Dosing 7 Aera _.. Bldg. Sewer l 65 St / inlet Holding -�', TANK SETBACK INFORMATION St/ I Outlet w TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic �r �id` f °€ NA Dt Bottom Dosing " NA Header.:. Aeration "'" NA Dist. Pipe Holding_` Bot. System PUMP /-SOWN INFORMATION Final Grade Manufacturer �eman p6, Model Number tk , 3 U± P TDH Lift V Friction �� S stem ,� L , 4, TDH ,� Ft Head -cl Forcemain Length 2 /. 1 Dia. '' Dist. To Well }� Q SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia- Liquid Depth DIMEN I N r � _ .. •IVtanufac ._.. SETBACK SYSTEM TO P/L BLDG I WELL LAKE /STREAM LEACHING f ief INFORMATION Type Of 1�g_ .�l6G, i r CHAMBER Model Number: System: /�v ?��<,.�< > `�`' /O� OR UNIT' DISTRIBUTION SYSTEM Header / Mani old Distribution Pipe(s) , y �, x Hole Size x Hole Spacing Vent To Air Intake Length _ Dia - a Length �3 7 5� Dia. Spacing — I 30 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth A. Over xx Depth Of xx Seeded/ Sodded xx Mulched i Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: CADY 16.28.15.252A,NW,SW �37 290TH STREET Plan revision required? ❑ Yes [9-No Use other side for additional information. �--- SBD -6710 (R.3/97) Date Inspector's Signat re Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e f i E , , f z p i ° E } ( t , E , , r , f ,p e 3 � , a s 3 a., a i e t .... e , a , SANITARY PERMIT APPLICATION 2 01 e E.WashingtonAve 'sion % scons i n . I n accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County cc than 8 v2 x 11 inches in size. S+ c o d I • See reverse side for instructions for completing this application State sanitary Permit Number 15732 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Numb r I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION O�� 1 Prop rty Owner Name I Property Location ''/ B IQ� e r j/4.S�W 1/4, S /!v T 2 , N, R / 5 _ klor) W Property Owner's Mailing Address Lot Number Block Number i 2 U C'% SC City, State Zip Code Phone Number Subdivision Name or CSM Number II. YPE OF BUILDING: (check one) ❑ State Owned o cit arest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF Ce ee ' 2 4 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) 1 ❑ Apartment/ Condo 00 4 - 103 9 - , sia", 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 [5j New 2. ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an System System - _____ ____- ____ ____________ Tank Only______________ Existing System _________ExistlnaSystem 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 2110 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc_ Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 30 0 2 5 S !> Feet `U ), 0 Feet VII. TANK i Cap aat Site Fiber- n ltos Total # of Prefab. Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Se tic Ta orFFaldmgT�STfk I/ f G b �� ( oi,'�( �, a S t e,-e 1:1 11 El El 11 Lift Pump Tank ber ✓ 4 I ( ' El ❑ C1 ❑ El 1. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility jor installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum s Signatur Stamps) PRSW No.: Business Phone Number: Ge sc,4,t ?/S Plumber's Ac dress (Street State, Zip Code) IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Iss in g nt Signature (No Stamps) Surcharge fee) Approved ❑ Owner Given Initial o o Q Adverse Determination ��� 16 0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-8M (R 11/96) - DISTRIBUTION: Original to county, One copy To: Safety & 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 lumber requires a Sanitary Permit Transfer / Renewal Form (SBD- 6399) to be submitted to the 9 p or p q Y county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: 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. 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 into 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; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications 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. Safety and Buildings Division 15837 USH 63 s 1 - Hayward WI 54843 ,sco si ■ /'� Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary May 22, 1998 WEGERER SOIL TESTING & DESIGN CUST ID No. 267341 421 N MAIN ST a PO BOX 74 g RIVER FALLS WI 54022 A. RE: CONDITIONAL APPROVAL iV;� !` APPROVAL EXPIRES: 05/22/2000 TRANSACTION ID NO. 81523 ` ST cROIX -. COUNTY .. ' SITE: SITE ID: 8470 Z ONINGOFFICE ST CROIX COUNTY, TOWN OF CADY NW 1/4, SW 1/4, S16, T28N, R15W f ROBERT DEISS FOR: Description: MOUND Object Type: POWTS Regulated Object ID No.: 21101 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. 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, or operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. When making an inquiry or submitting additional information, please refer to Transaction ID No. 81523. Sincerely, DATE RECEIVED 05/19/1998 ' V FEE REQUIRED $ 180.00 roy G. J ky, W Jter �S e c' st FEE RECEIVED $ 180.00 Field Operations Bureau BALANCE DUE $ 0.00 (715)726 -2544 Voice (715)726 -2549 Fax Ijansky@commerce.state. wi.us f Page of 6 MOUND SYSTEM FOR A Z BEDROOM RESIDENCE LOCATED IN THE NU3 /4 OF THE SUJ 1/4 OF SECTION l6 ,T ZB N, R lS W, TOWN OF � �`-� S�'. �lx COUNTY, WISCONSIN. INDEX PAGE 1 "of 6 TITLE SHEET I I PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR P.O.W.T.S. Conditionally APPROVED Bz T © 1 S S DEPARTMENT OF COMMERCE 3 1 - L9 3 `TN ST . DIV SON OF SAFETY AND BUILDINGS tiJ1u�� w 1 EE RRE LADEN x``81523 PREPARED BY WECCEE�EF2 SO I L TEST I NC AND 0,e`03tfN@V%1 DES IC (3U4 SI�RV I CE 0 �c olys O tis ' F.D. BOX 74 421 K. KAIK ST. ,�• .�,.. « « «..���.. RIVES? FALLS. 111 54022 t 715 -42`5- 0165 $ AR GFR 1 ' ii S W n ELLS W H .�4 W� 1� �' JOB NO_ PLOT PLAN Page Z, of /6 Scale 1 "= LR) I 1 � ,� B•5 Z c o �L , tip p m �•Lo5 -0' z�_ zBO a I i >, ELlob' Bw�Nh l D, �n 1A�1' �D h1[31' COr 1teT Ot� - NJ s ov N ' nil o rJ / � 1 �3N11(- !n_ lOU.p o►� 8`►t1GN,3[y'Dtrq, pv� 1>t'� w L Vv Z- r w W�tL �0 3C 14T C 1VTr SO' F MO UX3 vyw fPT �`r�T Z S' t=SLv�1 1'Kh1rZ . NOTES - -l. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4.-Septic tank to be\ fb5n gallon capacity manufactured by 1Z�c -�t I 1N C, 5. Bench Marks 5� �UU� h - 6. Divert surface water around system to prevent.ponding at the upill side. I Page Of Approved thetic Covering S Yn 4 t9sTN► c 3'3 Distribution Pipe Medium Sand H i�G Topsoil F Eled. 3 E b % Slope Force Main Plowed Trench of k"-2k" From Pump Layer Aggregate Undisturbed D \•O Ft. �I Soil F MS Ft. Cross Section Of A Mound System Using F o_a Ft. I Trench For The Absorption Area G o Ft. A S Ft. H t• S Ft. B SQ_ Ft. I \ S Ft. Linear Loading Rate= b.o GPD /LN FT J _7 Ft. Design Loading Rate= o• 3 GPD /SQ FT K 1 Ft. L , Z Ft. L —te,_ Position of Force Main W 2. Ft. L F J are -Q B Kirr stribution Trench Of 2 - 2 2 Pipe Aggregate Permanent ,/ ation Markers es r securely) Mound Using I Trench For Absorption Area Page L4 Of Perforated Pipe Detail 0 End View )Perforated __,� End Cop. �``�` PVC Pipe Install permanent marker at end of each lateral Holes Located On Bottom, Are Equally Spaced 4 End Cap I PVC Force Main Distnoution Pipe Last Hole Should 8e Next To End Cap i Dist P ip e Layou P - S Ft. X 30 Inches Y 3 D Inches Hole Diameter � Inch Lateral 1 1 IL/ Inch(es) Manifold Inches Force Main Z Inches of holes /pipe 13 Invert Elevation of Laterals i0 S.S Ft. LC) x t - 11 \ 1 - x Z= 23 . Y G S' h I N Place 1st hole \S from tee with succeeding holes at 30 'intervals. Last hole to be next to the end cap. Combination Septic-* Tank and PUMP CHAMBER CROSS SECTION, ARID SPECIFICATIONS''°•, PAGE S' F'pF Io VEIJT CAP WCATI4ER PKOO1r JUNCTIOIJ BOX 'i'C.I. VEAIT PIPE APPROVED LOCKING 10 ' FROM DOOR, MAWHOLE COVER wt'Ri .iIMDOW OR FRESH wARIJIsJG L - A6EC.. AtP, IUTAKE S cos�Dv�r fj LL. � o b Da I PROVIDE I IA1LE T - � AIRTIGHT SEAL APPROVED JOIIJT A I ( APPROVED JOINT: W /C.T. PIPCOR Tank construction I III w /C.I. �IPE�p'� I II ALARM shall comply with ILHR (83.15 and 33.20 b j i I I ou C I I ag.�o A LLEV. FT. PUMP -OFF CONCRE �Z LSl1. ?• q0' BLOCK 3" APPRo+cD RISER EXIT PERMITTED OIJLU IF TAIJK MAWUFACTURLR HAS SUCH APPROVAL �INr. SEPTIC f SPEGIFICATIC)US Dos>` w�IM!1 PI,e 5 3. TA1.JK MAUUFACTUfCCR: "1D T UUMbER OF DOSCS: � PER DAB TAW SIZC: ! 65U GALLOIJS D05C VOLUME I ALARM MAUUFACTUR,ER: ,� `C�(� � _LTY I S INCLUDING BACKIFLOW: GALLONS 1�1 Nw l�3 30� � MODEL IJUh18ER: C A= IiJLHE�OR CALLOUS SWITCH TyPC: '`� ` B = / Z IUCitCS OR _J_ G�LL01JS HUMP MANUFACTURCK: z�� ` C. b INCHES OR Z - CALLOUS MODEL UUMBER: S� D= \ IAICHE5OR 2U GALLONS b U 5WITCH TYPE: ��1�u�`� WTC: PUMP AND ALARM ARC TO OE MIWIMUM DISCHARGE RATE Z'3 "y GPM INSTALLED OW 5EPXRATE CIRCUITS VERTICAL DIFFEKEIJCC CETWCEIJ PUMP Off AUD 1315TRIBUTION PIPE.. -Sv FEET + ►•SINiMUM MCTWORK SUPPLY PRESSURE , , 2 FCET O T- �S • ! -{- 3p FEET OF FORCE 1"IAIU X 1 '\S F /OfLFRICT101.1 FACTOR_. FEET TOTAL OyIJAMIC HEAD FEET Pump chamber DIAMETER IAITERAIAL DIMEWSIOWJ OF TAWK: LEWGTH — ;WIDTH — ;LIQUID DEPTH BOTTOM AREA `` - 231= GAL /INCH AS PER MANUFACTURER GAL /INCH r w w 3 15/166 5/32 �G O W W �HEAb CAPACITY CURVE "53 - 57" - "55 - 59" SERIES 4 5 1 1/2 —11 1/2 NPT 25 TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLUENT AND DEWATERING 3 15/16 6 _ y - 0 50 SERIES — Ft. Meters C01. Ltrs. 4 1 /16 C _ T ..0 15 5 1.52 43 163 i 4 10 3.05 34 129 0 15 4.57 19 72 10 fact VW 19.25' O 0 2 5 Z3.�t 10 1/16 1 o 1 1 U.S. GALLONS to 20 30 40 50 1 3 3132 LITERS 80 160 0 FLOW PER MINUTE S.2% S"M CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level Float Switches available. • Available with special cord lengths of • Variable level long cycle systems available. 15', 25', 35' and 50'. • Alarm systems available. • Duplex systems available. SELECTION GUIDE Stand ?rd cord length - automatic 9 ft. 1. Integral float operated mechanical switch, no external control required. Standard cord length - non - automatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float M53155 and 57159 Series control Selection switch. Refer to FMO447. 3. Mechanical aftemator "M -Pak" 10 -0072 or 10 -0075. Model Voles Ph Mode Am s Simplex Duplex 4. See FM0712 for correct model of Electrical Alternator, E - Pak. N53155 N57/59 9 53155 & M5 115 1 Auto 8.0 1 or 1 & 7 5. Variable level control switch 10 - 0225 used as a control activator, with E - Pak (3) or 11 1 Non or & 6 or 4 8 5 0 53155 & D57/59 230 1 Auto 4.0 1 or 1 3 7 (4) float system. E53155 & E57159 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 6. Four (4) hole J -Pak, junction box, for watertight connection or wired - simplex or 2 pump operation, PM 10 -0002. 53 Series - Wt. 22 1bs. 57 Series - Wt. 27 lbs. 7. Two (2) hole J -Pak, junction box for watertight connection or splice, 55 Series - Wt. 24 lbs. 59 Series - Wt 30 lbs. PM 10.0003. CAUTION For information on additional Zoeller products refer to catalog on Combination starter, FMO514; All installation of controls, protection devices and wiring should b_ done by a qualified Piggyback Variable Level Float Switches, FMO477; Electrical Alternator, FMO486 Mechanical licensed electrician. All electrical and safety codes should be followed including the most Alternator, FMO495; Sump/Sewage Basins, FM0487, and Single Phase Simplex Pump ControllAlarm recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). Systems, FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 OEL R OBJ3, KY C ane Run Manuradurers o/. . SHIP IP T T0: 3649 Carne Run Road _ p Lorasvi5e, KY 40211 -1961 Qgw"7 PUMPS (501) 778 - 2731.1(800) 928 -PUMP FAX(502) 774 -3614 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, W Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 0'M Ix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 103_ APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R BY DATE f� PROPERTY OWNER: PROPERTY LOCATION a�RT' be1S - &WFt 'Nw 1/4 SIQ 1 /4,S lc, T Z-8 ,N,R IS E PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY EIVILLAGE ®TOWN 1 � z REST ROAD LV�LS , �vl SuoZ (CIS) 1�2_3t°tS e 0 1Q `- t) ST. [ J New Construction Use [XJ Residential / Number of bedrooms 7S [ J AdditiQn to existing building Gd Replacement [ ] Public or commercial describe Code derived daily flow 4 SO gpd Recommended design loading rate _ bed, gpd/ft - trench, gpdttt Absorption area required 3_1 S bed, ft 31S trench, ft Maximum design loading rate • S bed, gpd/ft -6 trench, gpd/ft Recommended infiltration surface elevation(s) cl 6 • S ' It (as referred to site Elan benchmark) Additional design / site considerations r*loyr.� w/ 8' x- q-)` g Y"1 NI ri y M 1Z o F S" Ru-. Parent material 1. o eS S o v� G , rt - t n t_ - T - ) t. L Flood plain elevation, if applicable N - Pr - ft S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE I AT - GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem [IS IOU I 2S ❑ U I EIS Q U El S ®U cis o U ❑ S 03 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. gam( Trench Ground - 2 ► elev. q t r `� R 6 [� S I J O �,•, h-t '� 1 - VP Depth to limiting factor Remarks: Boring # `" °°? [ 0 -9 Yp� 1Z 3L 2 St Z �5 1,� w1'F►- Cl,,, �� S L .� Z 0 1- 3i IL M�►— 3 - 6 2 - S3 S tZ 31 �) • Sc O y 'F - N�� • Z Ground �` , ` Q s)b l elev. ,� i F q ` Depth to limiting F �� factor Remarks: A �� �i N, k CST Name . Please Print Phone: %' '* c Arthur L. We erer 7 • '7 � -- ,0165 egerer Soil Testing & Design Service -P.O. Box 74 River F04s`,WI..5- 22 ' Signature: / q 8 _62_ Date: CST Number: C �s� n� �- - = 1 M0057.6 PROPERTY OWNER b�SS SOIL DESCRIPTION REPORT Page L _ PARCEL I.D.# OOy -- 1037 -6 O Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench , a —`b 1p`11Z 2 -1 - Z- S 1 Wh C 7 L\)IT •S • 6 I1 v1 s, I S b t m Ground 3 -YD t oti IZ 3l6 St I 1 Csb1 h,� elev. 'y, S `i Q S! c ', ft. U yD —S 0 l U `t R 3 / L elt c rz 6 !� si) �'� Yn `l�l. N1� ; • 'L Depth to limiting factor ' L) ^, 3 Remarks: Boring # 13 i Ground elev. ft. Depth to limiting factor i Remarks: Boring # , DUN Ground elev. ft. Depth to limiting factor Remarks: Boring # 1, Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05192) PLOT PLAN Pa 3 of 3 SCALE 1 "= 1 4D `. eoN�ov3Z a, Ct s.S ' �.�. -• q 6 .s ' 31� LS J � / { � seP �� y I I o• ! x �bo NAT pn�r tzL b TI tI s pm"' t � I 1iOv OLOR- S Am if 2 N k %m � A l — LPL, 1L)O CNJ SP�1ZL 18 "\wJE (szov►vt� i►v 99 -bz- 7 715 ) 425 M00576 CSTSignature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of safety a Builclings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 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 point (BNI), direction'and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O 0 4 — 10�� _6 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION IEVf DBY DATE PROPERTY OWNER: PROPERTY LOCATION �oa�T bEIS - 60ftt - OT Nw 1/4 SW 1/4,S 16 T ' ,N,R IS E PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # 3 t °I . zo. (3 'rd S'r. — — CITY, STATE ZIP CODE PHONE NUMBER )]CITY []VILLAGE )MOWN NEAREST ROAD W-j k).) IAJI Su 0Z.7 (�lS) '1�2_31g3 c`- 1 'CO`f Z.°t0`Tti S7. [ ] New Construction Use [X] Residential / Number of bedrooms [ ] AdditiQn to existing building j>d Replacement [ J Public or commercial describe Code derived daily flow 4 M gpd Recommended design loading rate _ bed, gpd/ft - trench, gpd/ft Absorption area required 31. S bed, ft 31S trench, ft Mabmum design loading rate • S bed, gpd/ft - � trench, gpolft Recommended infiltration surface elevation(s) C - 6 - S ft (as referred to site an benchmark) Additional design / site considerations 1 -lovtw w/ a' x_ q�' g I ru 1 114 t Z o F U_ Parent material L,o F?5 S ovr1a. - T1 �-L Flood plain elevation, if applicable 1t - ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 0 S R U I3 S O U ❑ S IOU I] S IO U ❑ S LOU EIS Q U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bourxiary Roots Bed Plerich :.. Lw :t ><: Z. $ Z.9 t�`t 3 si I Zmsbk 1��1- eS �u� -S Ground 1, Z°I S I t 0j Ll R— 1 � 1_2S It r `'1R 6C3 elev. 9Y.3 ft Depth to limiting factor y ?_ ° i Remarks: Boring # St 1 Z'�sb�C wl'Fy- cw 1� s '} Z Z q -32 1O`-1 k'.-- 31 L — S 1) Z�Sb> '�1- �� • S 3 32_s3 1 •S 71Z 3 / �).S `I Q S1$ Sc j ON', Ground elev. 4 z_5 ft Depth to limiting factor 3 Zy Remarks: CS T Name:- PleasePrint P hone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service —P.O. Box 74 River Fa11s,WI 54022' Signature: C, _ p / 9 8` 6 � Z Date: t ,_ — a CST Numb 00 5 76 PROPERTY OWNER b�SS SOIL DESCRIPTION REPORT Page?- of PARCELI.D.# Cd q - 1 V3 3 6b Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch 3 a -`b vb'-� 2 Z -Z 1 1 �� a. ��y � s► I � S b1T � ��. c.S 1 �� , S �. Ground elev. q6,�( ft. L{a -S o l 0`t R 3 / 6 zt c rz 6 1- sly ��, `Fl- - fv�� ; • Z Depth to t limiting I factor ti Lj i i Remarks: _ Boring # [3 i i Ground = elev. ft. Depth to limiting i factor i Remarks: Boring # 13 1 Ground elev. ft. Depth to limiting factor _ Remarks: Boring # Da") 3 Ground ' elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PLOT PLA Pa 3 of SCALE 1 "= 1 40 co►.�tov� � , g s.s ' B OYl'OM1 OF 8 � � a14 3�• ' ZS _ r 0, �~ -R-bo rvOT C�-0wl x b�� ! 1 11 D v s E VrLOLZ- S Bra # 'Z. O 6' N x M ( - tzL. wo.p' Cri1 SP1" \a" "\)\JE C,"V z /1v 48 - -bZ- Z 715 47.5 -m 65 _ 1400576 CST Signature Date Signed Telephone No. CST # i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer J?y e /? - e 1' 5 S Mailing Address 3 �_ � � q 0' S (�I f 5 c `t Property Address .3 3 ? � gG (Verification required from Planning Department for new construction g P ) City /State L' A SG Parcel Identification Number LEGAL DESCRIPTION Property Location d A/ y,, 51V y4, Sec. T N -R > W, Town of 4 d Subdivision Lot # Certified Survey Map # Volume . Page # n Warranty Deed # eD ( ; Volume S , Page # u Spec house ❑ yes 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 masterplumber, journeyman plumber, restrictedplumber or a licensedpumper 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. 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 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 pMe three year exp' ti n date. r .,. f / / 6 SlbNATUME O APP CANT DATE OWNER CERTIFICATION I (we) certify that all s tements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s).of the p rty described above, virtue of a warranty deed recorded in Register of Deeds Office. / 1;5� 1 Z� - W / / I S1 1 bNATURE 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 DOCUMENT NO. WARRANTY DEED STATE OF WISCONSIN —FORM I 31 U P 0 6 7 THIS SPACE RESERVED FOR RECORDING DATA THIS INDENTURE, Made this C) Y � of ST. i9_73., betwi,,. .-RicharcL G.- Ifippauf, Sr. and Patricia M. A. D A - RiIiPaixf ...... husband --- and wife.—and - each -in their-, own right . Rz!c'd for Kt; ( fl 21S_t - 13 --- --- -------- --- --------- ..... ..... ------ - --- ---- ------------ part iC S of the first part and -- --- - Ria-bext L. Reiss ------------------- . .... .. 1 - -- ------ part ---- y of the second part, RETURN TO Witnes s e t h, That the said part --- ieS of the first part for and in consideration ofthesuniof -,.- Twenty__ Thousand _ and no/100 _ Dollars . .............. ...... --- - --- ----- t . _ them hand paid by the said Parties of the second part, the receipt whereof is hereby confessed and acknowledged, ha VP given, granted, bargained, sold, r•mi,vd, released, aliened, conveyed and confirmed, and by these presents do__.__ give, grant, bargain, sell, remise, release,alivil, convey and confirm unto the said part_Y _. of the second part, Ili heirs and assigns forever, the following described real estate situated in the Count o f St. cro an d St o f NN'i scojjs i ll' t w it : The West One—half of Southwest Quarter W. of SWD of Section 16, Town 28, Range 15, excepting therefrom the North 7'. acres and the South 12. 1 acres. TPA.'NSFER S-4-ax 0 PER." (If. NECESSARY, CONTINUE DUSCRIPTION ON Rff- Together with all and singular the liereditanients mid apInlovit.til't" 111'.1 belonging or in anN wise appertaining; alld all flit- estate 1 right, title, interest, claim ordemand whatsoever, of the said part of, in and to the above bargained premises, and their hereditament, and appurtenances. To Have and To Hold the said premises as above flu'(1il,ed 16111 11)" b"Jedil'imentsand appurtenances, unto ill(• said part 3' of the second part, and to. .hl y_ ...-heirs and assigns FORI-AT'k. And the said_. . Riclijard Q. Ilippalif and Pa tricia M. Ilippauf, husbantl and, wi fe, tHfid each, ------- in their own right for- their ..... heirs, executors and administrators, do covenant, grant, bargain, and agree to and with the said part... Y of the second part,. .- his llcir'arld a—igil" that at the time of the ensealing and ( 4 , lix ti - y o f fit( prc,ents .._. . .-they axe__ ... well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all inctimbiances whatever ...... .. .. and that the above bargained premises in the quiet and pearcable possession of the said part ..... y.. -of the second part,his heir, and as against all a �� person or persons lawfully claiming the whole or anN- part thereof, they ... will forever WARRANT AN 1) DFFI-;N D. I . s Whereof, the said part_ iesof the first part ha._ Ve..liereunto set,. -their band s . and seal s this day - -- --- --- -- . 1)., 19.73 L E E LED IN PRESENCE OF (SEAL) Mnf!L I Richard G. IlipX111f, Sr. /oP ( (SEAL) Robert It. Gavic Patrici4 fl. 11'f)bauf ----- ------ -- - - _ _(SEAL) ............ J3_a)rharA s i I I ................ ----------------------- ------- (SEAL) STATE OF WISCONSIN, ................ .................. S S. Pi e rr e . - - - - -. _ ..... ..... County Personally came before me, this . .............. b --- ---------- lay of ...... .. ....... ------ --------- ....... .... .. A. D., 19.---73. the above named_.... - -- .....•. ------- Ai.c hall d ... Cy. JJ i pp.a P I ' .r . aund.. . c _ .._.HiPP4u1 ................... ................. -------- _ .................... ................. ................................. ............ ............ ............ .......... .. .... ... ....... ............... ....... ---------- ... . ...... to me known to be the person.-S. who executed the foregoing instrument and a d d t sa • ...... Robe R . .................................... This instrument drafted by 'A0 Y Public ...... N.......... ... ............. Wis. Gavic, Richardson and Skow ........................... . ....................................................... . .................... ion (Wirs) (Is) ....... P.!�XV4P!PA� .................... ..P U B -* comm ' ss (Section 59.51(1) of the Wiso6iiiiodn Statutee provides that ded ;i hale PI-Inlir printed or typewritten thereon the names of he Grantors, grantees, witnesem and notary)• !►IIM /NIINN I WARRANTY DEED•STATE OF WISCONSIN, FORM NO. 1 Fl. C. MiLL98 CO.. witllAult!