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002-1051-20-000
W iscorisin department of Commerce Safety and Building Division GENhRAL ~'NFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) ~ersonai ~nrormanon you prowoe may oe used for seconoary purposes tNnvacy Law, s.15.04 (i)(m)J 'ermit Holder's Name: City Village X Township Udder Lee Uair Inc. Baldwin, Tow f :ST BM Elev: Insp. BM Elev: BM Description: /d d ~ ~ /off. /1/~ r~-t` ~'I-ee-- ~^-~ TANK li'lFORMATION TYPE MANUFACTURER CAPACITY Septic ~, ~ U i Dosing ~~ ~~\\ ~~v Aeration _----_ Holding TANK SETBACK INFORMATION TANK TO P/~L WELL BLDG. Vent Airlntake ROAD Septic / ~ .~~j ~ ~ y osing r Aeration Holding PUMPlSIPHON INFORMATION ,, Manufacturer Demand GPM ? Model Number ~~~~ ~ , ~ Z TDH Lift ~~ / ~j Friction oss System Head / (o S T'~ I ~ r=t Forcemain L `' Dia. 2 ,~ Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrDIX Sanitary Permit No: 506312 0 State Plan ID No: Parcel Tax No: 002-1051-20-000 SectionlTown/Range/Map No: 21.29.16.317 STATION BS HI FS ELEV. Benchmark ~- 3 ~a ion ~ D Alt. BM Bldg ewer / SU lnle - /a -s 9i• S.~ SUHt Outlet Dt Inlet i Dt Bottom / t~/ • p O ~; Header/ an. ~ L S ~Q3 • ~ S Dist. Pipe ~~ z5 e~3• o Bot. System ~2 ~~ /~ A - , ~S ~ /D Z ' y Final Grade ~2tF ~° ~ ~ z st c ~ ~ / s 5 • ~ 9b'. (b ~ y3 /~~a / /~~~ BEDlTRENCH DIMENSIONS Width / ~ S - Length No. Of Trenches PIT DIME IONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM L ING BER OR Manufacturer: TypeQf-System= , /I,L)i~ ~~[/On~',~,~•,1.tr/ j`~ ~~~~! ~ ~ ~ ~~ ~ U Model Number: SYSTEM ~ >~{(,eLCii.~/ Bader anif Distribution x Hole Size x Hole Spacing rv/ ~ r ,Length 2 0 Dia ~ Z~ Pipe(s) ~ ~ Length Dia /• Spacing ' 2 ~ ~ /i /~ Y~• SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv /~ ~' a -~ 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 discrepencies, persons present, etc.) Inspection #1:~/ 0 I ~~ Inspection #2: `t / Location: 2352 80th A~ve~Baldwin, WI 54002~~N~WQ~1/4 SE 1/4 21 T29N R16W) 40 acres Lot ,~ A ,,, ~ ~P~a/rcet No: 21.29.16.317 1.) Alt BM Description = / e/' ~ ~ Z' ~~' "~""" ~~ G ~ ~ ~'~~ ~'~~~,,~~~~~---/~'y~Gr(/~.~c-r+E 2.) Bldg sewer length = C~ '"`~lX~ /~~t-~ ~~ y~ ~~ - amount of cover = ~ O t% r ~~ r --- - _ __ _ .. -- -- ~ --_ Plan revision Required? ~ Yes - No q i I~j - ~ /~/,~~- Use other side for additional information. ~ ( _ ~_-- _ f-/ ~ i' - _ _-- -~~%~-~ .._- '!~ SCE ~? ~ SBD-67'!0 (R.3/97) Date Insepctor's Si ature G 0$/27/07 18ON 15:28 FA% 715 3$8 4688 fool. C~v1f~.gC1v Safety at-d Buildings Division County ~r% ~ ~° i 1~ 201 W. Washingtrm Ave., P.O. Box 7162 ~~~-,/~'~~~~ ~ Madison, WI 53707 7162 Sanitary permitNurnbet{tA be filled in by Co.) Bapergrle~ o?t Colmrreu+as Sanitary Permit Application State Trarasaction Number ~ ~ 3 ' In accotdartce with s. Comm 8321(2) Wis. Adm. Cade, sldxnission of this fottn to the appro vernrtfefltal 2 ~ ~ ~ _ ~ ~ ~ ~ c( Z unit is required prior to obtainiftg a sanitary ptxt)fit. Noce: Appliatioa forms for state-o WTS are Project Address (if different than mailing addnss} submitted to the Deparhrtent of Corameroe_ lrersonal information you pfovic~ may De secondary in accattlattce with the Priv Law, s. 15.04(1 ~ ~~ ~`-~'~ j f(„ , I. A ieation Llfat•alatioa-P A8 olnl ~ ~ ll/ Property a~ ~ Parcel # ~ ~, ~2- /05 /~ 20 - aoo Property 's Mailing Address Location /' '? ~ ~ ~~o ~ z ~- ~ CJ . 3 / s Get. ~ City, State ` ' r ~ 1 p Code ne Number / ~I /_ ~ y~ ~ ~, y Seelio o ~ - l ~7 L~ 41 t w~ ... ~ ,t3'~ C' (c g ~ T ~ rte, R 1 L irclFl N W It. T of Bui3diag (ebeclx s!1 that apply) ~~ tot it or ; -~-- M ZFamily Duvciting - Number of Bedr~n ~ ~ Subdivision Name ~ ~~ ~~ ~ ~ ^ Pt~liclComrrlttcial - Describe Use ~ ^ City of ^ State Owned - Destxdre Use ~ ~ ~ CSM Nttlnber ^ Village of ~ _ ~~ a J Ili. Type of Permit: (Cbedt only one hex or line A_ Compb:te line B if applicable) A, ~Iew System ^ Replacement Syskm ^ Tteatrttent/Holding Tank Replacement Only ^ Other Modification to Existing System (explain} B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Trarufer to New List Previous Permit Number and Date Issued Before Fa:piration Owner i IV. T at POWT5 S stefnlCo tlDevice: Cbcek a~ that a ^ Non-Pressurized tn-Oraund ^ Pressurized In-(around ^ At-Grade ~ Mound >_ 24 'sr. of suimbte soft ^ Mound < 24 in, of suitable soil ^ [-loldirtg Tan{: ^ Oder Dispersal Component (explain) ^ Pretreatment Device (explain V. Din alfTtrata/ent Area Inforta'tioa: ' Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) ~ System Elevation i d• Zd 2 /b Z• S o VI. Tank Info Capacity in Total # of Manufacttner Gallons Gallons (3nits ~ ~ U Atew Tanta Existing Tanks B ~ + r ~- o ~ _, s~ 7 ~ ~ ~ : U ~ A ~/ ~ ~ t V r y ta . Septic or Holding Tank 1 ~ G ~' 6 K Ik~ng~h8/1~Idr I / Vll. Re onsibility Statement- I, the undersigned, responsi for iafstallation of toe POWTS shown on the atached 1~. Plumber's Name (Print Plumber' Signature PIL$ N um er b sines S Phone Number B u ` ~ ] / ~/ L Plumber's Address (Street, City, State, iP Code) VIII. Cozen •/De nt Use Onl Approved ^ D. ~+ttt Fee D at e Issuing t Sigrtattm; a ~ • •~ Q Q ~ D ~ _I O~ ^ tven Reag4n Denim 1%. condltiapyy!sonsiorDisap{ttavsl `3, G /~ J _ n lL ~eU t•"~' K j- ' ~ oobt a. .- a ~ . .x,15 1. l~pllctlW~Mllu~l~ pNKand ) J cM rnrprtsN ~In~ras (mrtnb~ ~ ~~. E~~. L~.J 1 tt~,,,S QG!`uw. •~-; f * ° #~swr~ v~+a~w•o e„wtlllna. I z ~ Eck nos trrust bs tt>fittWtnd .C(taeh ~ car•ylldc pliws ~f~~stm aid se6rnif M dte Comfy Daly es paper war ku Ihaw 6 th a 11 apetKa in sae SBD-6398 (R. QI107) Valid thrt101/09 ,4U"~{~ 08-27-@? 17:35 TO: FR{7M:715 386 4686 P@i r t C7~ W y+J ~ p ~ ~ ~ /~ c... ~ --~ ~{~ ~~x~S ~ j ,. raa ~ L f~ -~ q ~~q ~ ~~ ,~c~ ~ ~-~~` q7,s~' ~ ~ ~'~ 2- ~ ~ r~.~~ 1'~ ~ ~ \ ~, ~ ~„ ~ ~~~ i ~ ~~ * , f ~~ ~~~J 5 ~' ~~~ ~' .-- ~~L+~1.S'f~ o ~~ r~~~ __ / r 1 '+~ ~{ V ('j~• r~ ~ i ~~ ~`a~ /''w ~~ f j, ~' •`i p~ C / ~~ ~,~ ~~~ .., ~' ~ 1 1 ~, ~ ~ f ~l q~~ ! e~~p. r f ® t Q If ! ~ f r r ` ~ 1 b j 1 1 ~. r@a =ar ~T:B@ L@-~~-8h` g 7 ~ ~ ~fo~'`~ ~t~ (~~. ~c~ wig ~>5.~_ ~ ~lCI4 z... r -~- ~ ~ r ~ ~ ~ ~. ~~ ~~x~~ ~_~ ~_ ~ ra~.G ~_~ ~~~~ ~-s~' q'7, ~~ ~`'' `• i. ,~ ~. ~. 3 1 T@ ~~ ~, ~ ~ ~~ ,~~ o /~ ~ ~ !~ '~ s~. ~~. ~ / ~~~•. W ~~ r~~~ ~ ~ ~ ~,~ ~ b e~ ~~ s ( ..~., ___ - ...-_-__~ f =az o~ .,~ ,~ ', ~- G E ~ ~' ~ ix E ~~ r ~ `~~'c ~ ~ $,~ ~ ~• ~ i :~ , ~' 1 ~e f ~ .~ ~ ~, $~~ ~ ~ , ~ ~ , ~ , ~ . 1' 4~ .~ / ~ ,~ ~~ ~\ ~ ~ ~ (~ / 1 ~ ~ ~ ~ ~ ~~ r ~a r•' r I ~ ''~ ~d ~' ~ ~ +~ ~~ i ~ r ~ ~ l.7 ~ ~° d ~ k 1v~ ,~~~ i ~T :80 Lf~-ZZ-B(~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. co m m e rce. w i. g ov/s b/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 23, 2007 CUST ID No. 223475 ATTN: POWTS Inspector JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/23/2009 ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1432766 Site 1D No. 707542 SITE: - Please refer to both identification numbers, Udder Lee Dairy above, in all corres ondence with the a~enc . 80TH Ave Town of Baldwin St Croix County NW1/4, SE1/4, 521, T29N, R16W FOR: Description: Mound /Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1148215 Maintenance required; 450 GPD Flow rate; 6 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) 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. COttG No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. ~~ The following conditions shall be met during construction or installation and prior to occupancy or use: A1EI OF Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CURL component manuals listed above. • This plan has an approved Soil Saturation and Determination (Transaction I.D. # 1217104) associated with the design. All of the condition for the construction of this system shall be upheld. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83 22(71 A coov 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve. the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who' are responsible for the installation, operation or maintenance of the POWTS. Sincerely, <~~ f~~i" Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633. cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. i. M~-unti anti Rressure Distribution Coirnponent Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Vii; 3'fv~ Estimated Wastewater Flpw {gpd) 1.50 Peaking Factor (e,g. 1.S =150%) -j~~ A•~"50 Design Flaw (gpd} 3.00 SitE Sfape (%>) 100.00 Cantpur Line Elevation (ft) 6.00 Depth to Limiting Factor (in) 0,2p In-situ Soii Application Rate (bpd/ftz) (c o leis tl CeH InTarmatian 105.0 Qispersaf Cell Length Along Centaur (ft) _ '1.00 Oispersai Geii design Loading Rate (gpd~ft~) 1 Influent Wastewater Quality {1 art) Pressure Disributian infonnatian Center or End Manifold Lateral Spacing (ft) Number of Laterals Orifice Diameter (in) (e.g. 0.25) Estimated Orifice Spacing (ft) = Farcemain Diameter (in) t=arcemain Length (ft) Purnp Tank Elevation (ft) Wrote: Sand fill (D) calculations assume a Table 83-a4-S in fitu salt treatment for fQCal coliform of ~s 36 inches. 4.50 11 Width (ft} Are the laterals the high~est -a~int--~ in the distribution L.~.~..J network? Enter Y ar N If N above, enter the elevation ft of the highest point 9.08 fC~/orifrce Dais the forcemain drain back? Y Enter Y ar N 6.50 System Head (ft) x 1.3 ~y,~ f7.25 Vertical Lift (ft) 125 Friction Loss (ft) 25A0 Total Dynamic Head (ft) Lateral Diameter uelection in. dia. o bons choice 0.75 1.00 1.25 x x 1.60 x 2.00 x 3.00 x 18.57 Forcemain Drainback (gal) $5.95 5x Void Volume (gal) 85.52 Minimum Dose Valttme (gal) 21.42 System t]emand (gem) Manifpld Diameter Selection in. dia. o bans ice 1.25 x 1.50 2.00 3.00 Gallons/Inch Catcula#4r (optional) Treatment Tank Information 650.00 Total Tank Capacity (gal) 10p0.00 Se tic Tank Gapacity (gal) 38,00 Total Working Liquid Depth (in} Wieser Manufacturer 17.11 gal/in (enter result in cell [349) Dose Tank Information 650.00 Dose Tank Capacity (gal) 17.00 Dpse Tank Volume (gallin) Wieser Manufacturer Project: Lee Mound T@d =at f;ffluent Filter Information Best Filter Manufacturer GF10,$ 10x18 Filter Model Nc~rr,-,a,- Page 2 of 1 p Mound Plan Yi~w _ ......-- .~: J 1/~ 10 B ~ObservationPipe _;.;.; ;:;: 3 . ti;: ~: =~= r:r~r r r 'ti ti.r ~ ~r=r ;'a•-r-r•r;r•}-f:: 's'r' ti {?. f:,f~f:l:frl.:.l~-•:•::J'.1'.J'.f~1:: ~1~J'~: ~J..l~.R:^.,.r 1~.;.r~l~l;r f.: - W .~T~ .0. _ ~~., _ ~ ~ ~ S .~-:f ' -- L Maund Catnpanent Dimensionz;< down slo a tae extension made. 13.02 ft _.,q 4.50 ft E 31-$2 ir1 H 1.00 ft K B 105.00 ft F 9.25 in i 18.00 ft L 131.03 ft D 30-00 in G 0.50 ft J 10.38 ft W 32-$$ ft 472.50 {ftz) Dispersal Cekl Area 2382.60 (~) gaaal Area Available 4.50 (gpd/ft) Linear Loading Rate 10.50 (ft) 1110 B Obs. Pipe Placement Maund Grow Section View Aggregate Dispersal Area Finished-Grade 104.27 (ft) ----~- ~- H .. rrr ... rrrrtr 2 rririfi 1 , rrrrirr rlrt 103 00 ( T1 ~' Dispersal Cell ft} Lateral 102.50 (ft} --M~* ---- - - invert faispersalGell -:,,3~,i~~~~~=~~' ; .: -3... . Elevation = - - - _ _ ~:ti - - ~~~ - ~ 4 4 . ~ - ~ ~~ ~ ~` - 1 Q .Od (ft) Contour Elevation 3.0 °la Slte Slope Shading KeY w Topsoil Cap c ~ 1.5 ft ® trrrr gubsoil Cap ~ y-c ~ ASTM C33 Sand :~ ~ $ ft 0 4 TiNed Layer ~ ~ - 0 r~; ~:: Aggregate ~ o Project: Lee Mound z©a =at Lateral A page 3 of 10 End Cann~lction Cetera! L.ayvut Diagram) Lateraltoenteredoeertht}A dil'n4nson ~eTrlm-~p+udhallvalvevfFiesrt4utpluy P Alt laterals are (dentinal main i4 ~..,..-}I Hot es d-dYad on the bottom of the latetai equally spaded vid Si~q 4r GroSri CQ maniFOld ,7t any pOlnt t,peerals & fpree main 4F P5{C Soh 40 (pee L'[JMAA Table $4.30-'~] Numk>er of Laterals 2 Lateral piarrleter 1.25 in Lateral Length {P) 103.5Q ft Laterak Spacing (5) 2.25 ft Lateral I`1Qw Rate 10.71 gpm System Fiow Rate 21.42 gpm Total Dynamic Head 25.00 ft prifice piameter Orifice Spac'ing (X} Ur~ces per Latest Qrifice pensity Manifold Length Manifold f~iameter Farcemain Velocity Dose Tank .Information Electrical as per NEC 80D and ---~- Comm 96.2$ WAC Tank component Vs properly vented Wieser Ca aei 850.00 Volume 17.00 Manufacturer Gallons galrnch Dimension inches Gallons A 22.20 377.48 f3 2.00 34,40 C 5.03 85.52 EJ 9.00 153.00 Total 38-24 85x.00 ~- A f3 C D 3" Pra ject: Alarm Manuafacturer S,J~-Rhombus Controls Alarm Model Number Tank Alert 1 Pump Manufacturer Goulds Pump Model Number 3871 >=pQS ~-~ Pump Must IJeliver 21.42 gpm at 26A0 ft TDB! Lee Maund Tod =QI Geatextile Fabric Cover Cell Sea lateral details an Page 4 far number, si~6, Lr{r ; ~ ~ 2nd spacing of laterals. '=~~~;' .~ F Laterals are equally ;-'~ .; s ' ~~ ~ ~ . ,, ~ spaced from the distribution cell's f r t~nterline in the --~"`~ distribution cell (Axl3). `~y'. S %. 26 9.09 frzlorifice z.25 ft 1.25 in 2.19 fUsec hacking cover with warning label and locking device and sealed watertight 4 in. min. ~~~ ~-- Alternate outlet location Forcemain diameter 2 in. Weep-hole or anti- siphon device P~off elevation (ft) 85.75 Do~se_tankelevation R 85.00 page 4 of Mound Svstem Maintenance and Oaeration Saecifications Service Provider's Name Joe Stan Phone 1-715-684-5166 POWTS Regulator's Name St. Croix Coun Zonin Phone 1-715-386-4680 Svstem Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ct for ndin and see a e once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished .~~~~ ~........ ............... Grade ~~ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Lee Mound Page 5 of 10 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code neral This system shall be operated in akx:ordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to faiure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent akxidentai or unauthorized entry into a tank or component Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The kbntents of the septic tank shall be disposed of in akx;ordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be Leaned as necessary to ensure proper operation. The finer cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its encosure. If the filter is equipped with an alarm, the filter shall be serviced ff the alarm is activated continuously. Intermittent fitter ala-ms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. !f the contents of the tank are not removed at the tkne of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank pertortnance is generally not required. However, ff such products are used they shalt be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shah be inspected at once every 3 years. All switch, alam~s, arxi pumps ahaN be tested to verify proper operation. ff an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perirreter, and the rr~nd shah be seeded and mulched as necessary to prevent erosion and to provide sane protection from frost penetration. Treffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter wNl promote frost penetration. Cold weather installations (Ok~ober-February) dik~ate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/l. FOG for septic tank effluent or 30 mg/L BODg, 30 mgJL TSS, 10 mglL FOG, and 104 du/100 mL for highly treat+sd effluent IMIceM flow may not exceed maximum design flow speafied in the permit for this installation. The pressure distribution system is provided witi~ a flushing point at the end of ead- lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is perfom~l it should be compared to the initial test when the system was inataUed to determine ff orifx~e dogging has oocuned and ff orifice leaning ~ required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shah be dx3dked for effluent pooling. Pondurg levels shah be reported ie the owner, and any levels above 6 inches kxxrsidered as an mpending hydraul~ failure requiring additional, more frequent monitoring. Corhinsrencv Plan If the septic tank or any of its components become defective the tank or k~mponent shah be repaired or replaced to keep the system in proper operating condition. ff the dosing tank, pump, pump control, alarm or related wiring becomes defective the defective component(s) shall be knmediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewnter or begins to discharge wastewater to the ground surface, d wiN be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biokgically dogged absorption and dispersal media, and related piping, and replaksng said oomponerts as deemed necessary to bring the system into proper operating candition. See Page 5 of this plan for the name and tebphone number of your local POWTS regulator and servk~e provider. Project Lee Mound Page 6 of 10 ITT PERFQtZMANCE R~-i`lNGS Tat,~l Head (ft of water} ~t8n' ~ Minute i:POd E~5 5 53 ?0 46 62 15 36 55 ia a? as 25 0 33 30 - tt G~U~~'iS PUMPS Vl/astevva~er COMI~NENTS Desaipnian i impeller 2 Base 3 Pump Casing 4 Mechanical Seal 5 Ba11 Bearings fi ¢Rings 7 Power Cord $ Oil FlEteki A+{ator ~ MotarHousing/ Stator Assembly 10 Motor Cover METERS 10 a .~ 2z ~ FEET . _...... ...., . _..-- --~---~ 1 . _.. , _..._ ~...... ;~ - ---------~•-- ~ 7 `~ i ~ ~ ' i ~ .._.-.. -... ........ c s , _ _.__-T .. . ~s -- ----~- t . ' t J $j'--'-----~ --- "~ -- ~- ? t d z a ?0 8 6 4 5 a 3 s z ±_ I ~"'--' +~-S GPM ...--: --•- • '~ ..-~---Y-.~ i_...~ -,. ~- - _ S .... -_ ~_ . ~ ~ { ~ ~ ~ ---_---~ EP04 ~. .v~`...~. v.. - i ,......~.y ~ ~ 7 } _ _ __ --- '---.....-i 30 40 ~~SO C,PM 5 8 ? 0 ? 2 m~lh CIAFACITY ~ t. ~~ ~ 1-~~~a~ ~~d =at 7 ~~ 8T:80 LO-~~-80 ~' oTCamaaoe SOIL EVALUATION REPORT P,~ _~ ~ 3 ~~O° °'~~' asd is seardaace vrith Caas~ ><3, vets. Adoa. Cane Attsd~ ~ t~ ~ pspa~ not less mere 8 !4 x 1 l iad~rs ®sde. Plan ~ Cosay $t Croix Ia!dade bat aot Gmiled to: rerlical sad~oriaoatd n~eooe pout (BM); d"sedioa and Psnxt LD. _ gaoas slope, sale err doss, sror~ amawr, aad 13M rrdaeaoed ~ nearest goad. 002-1051 20-000 Pkalte prat ttfl i~fun ~' °i~ Persao~ man you Provide ma9 Ge road for soaondty psatposea (ptivay I.aw, s. 13.04 (I) (~) >'~9~' Property Laation Udder Lee tout tat IVW w SE ~ s 22 r 29 rl R 16 w owa~ s lot a Block d subd. t~Iaase err Csl-~t 878 240m St ' '""` `''r"~O°e ''~ t7 City O Vil~ge H Town Nea~rat ltosd Baldwin WI 54002 715-684-2580 Baldwin 80'~ Ave H New Lion Use: ®R1 / Number ofBedmoms~_ Code derived design flow tame 450 GPD ^ Replaceeae~ ^ P~lic or Cammencial - Desa~e: Patent M~xisi G~ial tt71 Flood Piam elevation if ~plicable NA R " Gam! caaa~ts toad reoo~e>t~datioes: 1----1$`x7Og ~ H~~g G~nd Sv~Ce Btevation 100.6 fl. fiorimo n ~ f)ortdnant Color Redwc Description Sz. Te~xhae 1 0-7 1oYR3/3 None StL 2 7-8 10YR313 None ~L 3 8-12 10YR4/4 None SyL 4 12-17 101fR4/4 1:1~ 7.5YR4/6 spots SIL 5 1726+ 5YR4/4 cs-2-d 5YR5J8 & SJ3 SL Z ~g ~ ~ ~ SZ>t1aoe tbriaon ~ Dorrri~ cover tiedaoc ir. 1 0.3 10YR3/2 N~ 2 3-10 10YR312 Norm 3 10-13 10YR4/4 f-1~ i0YR52 4 13 21 10YR414 c-1~ 7 5 21.36 7.5YR5/4 f-~2.f 7 ' F-i~r~l~1=BtN?s> 30 <~0 ~, sad El 99 evation .6 g, Teattrre StL SIL &7.5YR~ SIL .5YR4J6 SL •~~ LS Mark Iverson P.fl. Box i55 Hammond, WI 54015 Depth m Limiting factor 12 in. Shrrcdrre t~ Sir. Cie Boundary Roots 'Eflbi "E>fle2 1-rn sett mfr gs 2f o.4 o.s 1-m-pi mfr as 1f 0.4 0.6 1-m-pl mfr a 1fi 0.4 0.6 2-n~-sbk mfr a 1f 0.8 0.8 1-co sbk rnvbr - 1f 0.4 0.7 to Limiting facmr 10 in, Stye 4 ~- Comae !f Roots 2-rn sbk mir cs 2f 1' ~' 2s 2f 2-f bo m-pl mfr cs 2f 2-to-sblc mfr gs 1f ~ rrn4r - 1f - --- ---o-- - cmum[sL =ids 530 i n~ caa~ea Sepfemb~ 19, 2005 0.6 0.8 0-4 0.6 Q-0 02 0.6 1.0 0.7 1.t3 715-796-5664 Y_UtiderLeeD aay Parr:elIDdf 002-I05~ 20-00 0 P~e.~_of~_ C7 Bormg t _ i $Or1Dg # ®Pit Grand surface Elevation 9$.9 ft. Depth tv Limiting facc bor 9 in. Morino Depth Dominant Cob r Redox Desexiption Texlure Strucdrre Corroe Boundary Roots 'Et~'1 'Etf~1 1 0-3 10YR3/2 Notre SIL 2~ sdc rMr cs 2f 0.6 0.8 2 3-9 10YR3/2 None SIL 1-coo-sbk mfi as 2f 0.4 0.6 3 9-12 10YR4l4 ~1~ 10YR5~ 88/3 SL 2-m-pl mfr a 1f 0.0 0.2 4 12 24 10YR4/4 f-2 fi 7.5YR5/2 L 2-rn-pl mfr cs 1f 0.0 0.2 5 24-32 7.5YR5/4 f-2-d 7.5YR4J8 &513 LS 2-oo-sbk mvfr - 1f 0.7 1.6 4 ~ # I$Pit Grand Surface Elevation 101.3 $ Depth to Limiting 11 ID, Horinorr Depth Dominant Color Redox Descripfipn Texture Structure Caenoe Boundary Roots 1 0-3 2 3-9 3 9-11 4 11-14+ 10YR32 10YR3/2 10YR4J4 t0YR4/4 None Norte None f-1~# 7.5YR4J6 spots SIL SIL SIL L 2 f-sbic 1-vo-sbk 2-m-pl 2-m-pl mfr mfi mfr mfr a ~ as a - 2f 2f 1f 1f 'Et~i 0.6 0.4 0.0 0.0 'E1t82 0.8 0.6 0.2 0.2 t+3Pit Ground Surface Elevation 97.5 g. ~ Limiting i>~ 9 ~ horizon Qepth Dominant Cola Redox Sirue~ne Cerroe B, Roars ~. IYktnseN n.. c~ .•, Texture 1 0-4 10YR3/3 "` '~. sn. 'E4~i 'Eif# None SIL 2~-~c mfr ~ 2f 0.6 0.8 2 49 10YR3J3 None S1L 2-m-sblc mfr as 2f 0.6 0.8 3 9-13+ 10YR4/4 ~1-d 10YR52 & 5YR4l6 SIL 2-f-pl rnfi' - 1f 0.0 0.2 `I~IaBODs>30<Ylpl~i,aedTSS>30<15p~, s~~ HODS<30 ~ asd T3S <30 mg/L T~ of Cede: is ~ squat opprat„mi0- service provider and employer. gyce nexxl e ~ arxxss services or Need matted in an alter p exs~ct the ~ 608-266-3151 ex'I'I'Y 60ii-264-8777. ' . ~ Page 3 of 3 Site LocaBon System On the 100.0' oont~ur s.~ 97.. B-a ~- The ProPerhi are greater than 200 feet from aN boring locations ~--"~ The system area is located in a vacant farm field `-~" + Bench Mai ar = Location & Elevation Howe ~ Leif bcaGorr to be d~rrnrned Owner. Udder Lee [~, 878 240th Street B~dwirt, Wt 54002 Phone: 7i5-G84-258Q OR 24R 40R Bo S, N Site Ind: ~ ~. NW i/4, SE i14, S29, T~1, R16W Town of Baldw~ St Crobc Couniy . talN~lc hr~t, PSS #997 680 Laroom Sbeat Hammond, W154015 715-796.6GGq CST#4$672 Ave Safety and Buildings • ~ 1t>S<41N RANCH ROAD r - COD1f1<f~.1AI~.~V . HAYWARD iM 54843 TDD ~: (608) 284-87T! , ... .... _~ - ~~~~~~~~ . wwrw oomtneroe wi.govlsb/ www.wiscwnsm_gov of Cotmn~tie Jim Doyle, Governor Mary P. Burke, Secretary December O1, 2005 OUST ID No. 46672 MARK W IVERSON PO BOX 153 HAMMOND WI 54015 A77N: Pt?il'7S Inspedvr zoNn~rG o~ICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54416 CONDITIONAL APPROVAL ~ _, _ , ~~~ _ _ PLAN APPROVAL EXPIRES: NA Transaction ID No.1217104 Site ID No. 70?542 SITE: Udder Lee Dairy ~ -'. ~ ~+tean -.- Town of Baldwin, St Croix Coimiy ,~ t~~~~ '~.`~~ ~ ~,~~: -.~ NW 1/4, SE 1/4, 521, T29N, R16W FOR Object Type: Soil Saturation Deterinination Regulated Object ID No.: 1051621 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 nespons~ble for compliance with all code require~nerrts. . The following conditions shall be met during construction or installation and prior W occupancy or use: I . Approval is hereby granted pursuant to s. Comm 85.60(2), Wis. Adm. Code, to estnmate the depth to seasonal soil sotto often based on an i~erpretive determination process. Approve} of the interp~ve determination negates the requirement in s. Comm 8530(2xb}, Wis. Adm. Code mdesignate -die ground surface as the highest level of soil saturation when redoximonphic 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 6 inches below grade. At least 30 inches of sand lift on top of 6 inches of unsaturated, iu-situ soil is required for adequate treatment and dispersal 3. The basal soil application rate for the mound shall be 0.20 gpols~ and the linear loading rate 4.5 gpolft. 4. Chisel plowing to a depth of 12-16 inches immediately prior to sand placement is required to improve vertical water movement i~o the soil sohma. 5. Landscaping up slope of the mound shall be incorporated imo the POWTS. design to prevent surface water from concentrating along the up slope edge of the mound and to divert surface watea drainage away from tlu system. 6. This approval shall remain valid unless the site is altered in such a way that the depth m 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 distnbntion componeant. 7. 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. 8. A copq 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. • ~ Mt1RK w1VERSON pa~2 12/1(2005 w A copy of the approved plans, specifications and this letter shall be on-site during constcvdion andopen inspection by authorized rcpreseatatives of the fit, which may include local inspectors.: If plan index sheets were submitted in lien of additional full plansets, a copy of this approval letter and iadez sheet shall be-attached to plans tbat correspond with the copy oa file with the Department. All pernrits required by the. state. ar the local municipality shall be obtained prior to commencement of constructionlinstailationloperation. if this constrocaon Prof will disturb ane ar tt~re acres of land, an Eaosion Control Notice of I~at (NOI? shall be filed with the department 14 days prior to any earth disturbing acxivities. In Smn~g this approval the Division of Safety Bc Buildings reserves the right to requi:; changes or additions should conditions arise making them necessary ~ ode compliance. Asper state stets 1 Ql _ 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, shucture, or cornponent. ~~~ Ong this ~ t~3' be made to me at the telephone number listed below, or at the address on-this lexterhead. Sincerely, ,. _ _ _ ~> Leroy G. J , PSS, W s ist ~ .~ Bureau (715)726-2544 Voice 1J~skYC~ommence.state.wi.us •Wisconsin Department of Commerce Division of Safety and Buildings Attach complete site plan on p r no Include but not limited to: vert d hoi Percent slope, state or dimensions, Please print Persnnal information you provide may be used for SOIL EVALUATI In accordance with omm 11 inches ' size. Plan must 205 point M), diar~ eren to nearest road. ~a ion ST. CROIX COUNTY rouses (Priv v Law, s. 15.04 (1~ t+++,_,...~~ Page 1 of 3 St. Croix '~ 002-1051-20-000 ~yr~',~~.-.. D I13~~ Property Owner Udder Lee Dai ation Govt. Lot NW ~i, SE ~i. s 21 T 29 N R 16 w Property Ownet's Mailing Address Lot # Block # Subd. Name or CSM# 878 240' St. City State Zip Code Phone ^ City ^ Village 0 TOWn Nearest Road Baldwin WI 54002 715-684-2580 Baldwin 80~' Ave. 0 New Construction Use: 0Residential /Number of Bedrooms^~_ Code derived design flow rate 450 GPD ^ Replacement ^ Public or Commercial -Describe: Parent Material Glacial till Flood Plain elevation if applicable NA ft. General comments and recommendations: ~e ~~ ~~ a Boring # Boring 0 Pit Ground Surface Elevation 100.6 ft. Depth to Limiting factor 12 in. ~" 3 Boring # ~ Boring I~~~..~~~III OPit Ground Surface Elevation 99.6 ft. Depth to Limiting factor 10 in. Soil li ion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munself Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eft#2 1 0-3 10YR3/2 None SIL 2-m-sbk mfr cs 2f 0.6 0.8 2 3-10 10YR3/2 None SIL 1-m-sbk mfr as 2f 0.4 0.6 3 10-13 10YR4/4 f-1-d 10YR512 8~7.5YR5/6 SIL 2-f to m-pl mfr cs 2f 0.0 0.2 4 13-21 10YR4/4 c-1-f 7.5YR4/6 SL 2-m-sbk mfr gs 1f 0.6 1.0 5 21-36 7.5YR5/4 f-2-f 7.5YR4/6 LS 0-sg mvfr - 1f 0.7 1.6 • l;tnuent # 1 = tiUlls y .SU <_ llU mg/L ana 1JJ > JU ~ 1 JU mg/L - bmuenr s~ = tsvLS ~ ~v rngrt. ana i ~~ ~ ~v w~i. CST Name (Please Print) Sign CST Number Mazk Iverson m--'-~ 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 September 19, 2005 715-796-5664 Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. `Etl#1 *1r1f#2 1 0-7 10YR3/3 None StL 1-m-sbk mfr gs 2f 0.4 0.6 2 7-9 10YR3/3 None SIL 1-m-pt mfr as 1f 0.4 0.6 3 9-12 10YR4/4 None SIL 1-m-pl mfr cs 1f 0.4 0.6 4 12-17 10YR4/4 f-1-f 7.5YR4/6 spots SIL 2-m-sbk mfr cs 1f 0.6 0.8 5 17-26+ 5YR4/4 c-2-d 5YR5/8 8~ 5/3 SL 1-co-sbk mvfr - 1 f 0.4 0.7 Property Owner Udder Lee Dairy Parcel ID# 002-1051-20-000 Page 2 of 3 Boring # ~ Boring E1Pit Ground Surface Elevation 98.9 ft. Depth to Limiting factor 9 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EtT#1 'Eff#2 1 0-3 10YR3/2 None SIL 2-f-sbk mfr cs 2f 0.6 0.8 2 3-9 10YR3/2 None SIL 1-co-sbk mfi as 2f 0.4 0.6 3 9-12 10YR4/4 f-1-f 10YR5/6 & 5/3 SL ~-m- I mfr cs 1f 0.0 0.2 4 12-24 10YR4/4 f-2-f 7.5YR5/2 L -m-p mfr cs 1 f 0.0 0.2 5 24-32 7.5YR5/4 f-2-d 7.5YR4/6 ~ 5/3 LS 2-co-sbk mvfr - 1f 0.7 1.6 1- Boring # ~ Boring OPit Ground Surface Elevation 101.3 ft. Depth to Limiting factor 11 in. S it licat' n R to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. "Etf#1 *Eft#2 1 0-3 10YR3I2 None SIL 2-f--sbk mfr cs 2f 0.6 0.8 2 3-9 10YR3/2 None SIL 1-co-sbk mfi as 2f 0.4 0.6 3 9-11 10YR4/4 None SIL I mfr cs 1f 0.0 0.2 4 11-14+ 10YR4/4 f-1-f 7.5YR4/6 spots L - - I mfr - 1 f 0.0 0.2 Boring # ~ Boring ®Pit Ground Surface Elevation 97.5 ft. Depth to Limiting factor 9 in. Soii A li tion R Horizon Depth Dominant Color Redox Description Texture Strudun3 Consistence Boundary Roots GP D/ttZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Efl#1 'Etr#2 1 0-4 10YR3/3 None SIL 2-f-sbk mfr gs 2f 0.6 0.8 2 4-9 10YR3/3 None SIL 2-m-sbk mfr as 2f 0.6 0.8 3 9-13+ 10YR4/4 f-1-d 10YR5/2 & 5YR416 SIL 2-f-pl mfr - 1f 0.0 0.2 * EIDuent # 1 = BODs> 30 5 220 mg/L and TSS > 30 <_ 150 mgJL " Etlluent #2 = BODs <_ 30 mg/L and T5S <_ 30 mg/L T'he 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. Page 3 of 3 0 I ~ ~. a~~ ft. N Site Location 90th Ave m Sect n 21 a~ m ~ ~ L = M N X ~ N 80th Ave place system on the 100.0' contour B-5 97.5 100' B-4 101.3 )1' The property lines are greater than 200 feet from aA boring locations The proposed system area is located in a vacant farm field BM# ~ Description =Bench Mark s'1 Elevation 1~, =Boring Location & Elevation House and well location to be determined Owner: Udder Lee Dairy Site Information: Completed By: Mark Iverson, PSS #197 878 240th Street NW 1/4, SE 1/4, S21, T29N, R16W 680 Larcom Street Baldwin, WI 54002 Town of Baldwin Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-684-2580 CST# 46672 APPENDIX B SOIL SURVEY LEGEND AND MAP UNIT SUMMARY SOIL SURVEY OF ST. CROIX COUNTY, WISCONSIN MAP LEGEND MAP INFORMATION Soil Map Units Source of Map: Natural Resources Conservation Service ~ Cities Web Soil Survey URL: http:/lwebsoilsurvey.nres.usda.gov 0 Detailed Counties Coordinate System: UTM Zone 15 Interstate Highways Roads Soil Survey Area: St. Croix County, Wisconsin Spatial Version of Data: 1 -i--~- Rails Soil Map Compilation Scale: 1:15840 Water Hydrography Oceans The orthophoto or other base map on which the soil lines were compiled and digitized probably differs from the background imagery displayed on these m As a result, some minor shifting of map unit boundaries may be evident. 1 Nmr.~ EeaoBecs 11/10/2005 Ce~rnUo. Service Page 2 of 3 i` Soil Survey of St. Croix County, Wisconsin Map Unit Legend Summary St. Croix County, Wisconsin Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI AdA Adolph silt loam, 0 to 2 percent 8.1 3.4 slopes AuA Auburndale silt loam, 0 to 3 percent 0.5 0.2 slopes FdA Floyd silt loam, 0 to 3 percent 2.1 0.9 slopes FnB Freeon silt loam, 2 to 6 percent 180.3 75.2 slopes FoB Freeon. silt Loam, heavy substratum, 12.5 5.2 2 to 6 percent slopes FoC2 Freeon silt loam, heavy substrattun, 0.0 0.0 6 to 12 percent slopes, eroded MaB Magnor silt loam, 1 to 6 percent 20.8 8J slopes Sa$ Santiago silt loam, 2 to 6 percent 1.4 0.6 slopes SIB Sattre silt loam, 2 to 6 percent 13.0 5.4 slopes SrA Skyberg silt loam, 0 to 3 percent 1.0 0.4 slopes USDA N.anu 8a,ourcea Web Soil Survey 1.0 11/10/2005 ~ CoaoerraHon Service National Cooperative Soil Survey Page 3 of 3 . P.o: t~ ws: ~. wt ~to~ ~'~'t ~~ ~. : ~s-TSe-sse~ ~ ~-TSe-sQae December b, 2005 Doug Lee 878 240' Street Baldwin, WI 54002 RE: Interpretive Site and Soil Evaluation Dear Mr. Lee: Enclosed two copies of the Interpretive Determination Report and Wisconsin Department of Commerce approval letter for the Interpretive Determination Report completed at the your property. A copy of the report and approval letter has been submitted to St. Croix County. If you have any questions or comments please feel &ee to contact me via a-mail at everyeenetc(a~balciwin-telecflm,net or telephone at 1-715-796-5664. Sincerely, Evergreen Irrigation Inc. Mark Iverson Professional Soil Scientist Enc. cc. St. Croix County Zoning Department commerce.wi.gov ^ isconsan Department of. Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary December O1, 2005 CUST ID No. 46672 MARK W IVERSON PO BOX 155 HAMMOND WI 54015 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: NA Transaction ID No. 1217104 SITE: Udder Lee Dairy. Site ID No. 707542 Town of Baldwin, St Croix County Please refer to both identificatian numbers, NW 1/4, SE 1/4, 521, T29N, R16W above, in all comes ondence with the a enc . FOR: Object Type: Soil Saturation Determination Regulated Object ID No.: 1051621 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 8530(2)(b), Wis. Adm. Code to designate the ground surface as the highest 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 6 inches below grade. At least 30 inches of sand lift on top of 6 inches of unsaturated, in-situ soil is required for adequate treatment and dispersal. 3. The basal soil application rate for the mound shall be 0.20 gpd/sf, and the linear loading rate 4.5 gpd/ft. 4. Chisel plowing to a depth of 12-16 inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. 5. 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. 6. 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. 7. 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. 8. 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. MARK W IVERSON Page 2 12/1/2005 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. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior to commencement of constructionlinstallation/operation. If this construction project will disturb one or more acres of land, an Erosion Control Notice of Intent (NOI) shall be filed with the department 14 days prior to any earth disturbing activities. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ~ v~. , Leroy G. Jan y, PSS, W ewater Sp 'list Integrated Se ices Bureau (715)726-2544 Voice lj ansky@commerce. state.wi.us Fee Required $ 100.00 Fee Received $ 100.00 Balance Due $ 0.00 WiSMART code: 7633 INTERPRETIVE DETERNIINATION REPORT Property Owner: Udder Lee Dairy 878 240' Street Baldwin, WI 54002 Site Location: NW'/4 of the SE'/4, Sec. 21, Town 29N, Range 16W Town of Baldwin St. Croix County 1~1~~U~~ Prepared by: P.O.W.T.S. Cnnditiorially ~' P ~~0~ ~ DEPARTMENT Of COMMERCE DIVIS N Of SAFETY AND BUILDINGS 5EE GO ESPO NCE Mazk I erson, PSS #197, CST #46672 November 10, 2005 Date Evergreen Irrigation Inc. Mark Iverson, Professional Soil Scientist P.O. Box 155 Hammond, WI 54015 Phone: 715-796-5664 Fax: 715-796-5246 TABLE OF CONTENTS I. Introduction .............................................................................................................1 II. Project Information ..................................................................................................1 III. Method .....................................................................................................................1 IV. Discussion of Results ...............................................................................................2 A. Local Hydrology ..........................................................................................2 B. Geomorphology ...........................................................................................2 C. Soil Disturbance and Hydraulic Modifications ............................................2 D. Landscape Position and Local Topography .................................................3 E. Soil Series and Mapping Units ....................................................................3 F. Field Observations .......................................................................................5 G. Comparative Analysis ..................................................................................5 H. Government Reports and Comments ...........................................................5 V. Conclusions and Recommendations ........................................................................6 VI. References ................................................................................................................7 TABLES Table 1 - Soil Series Characteristics Table 2 - Hydric Soil Classification FIGURES Figure 1 - USGS Topographic Map Figure 2 - Soil Map APPENDICES Appendix A - Soil Evaluation Report Appendix B - Soil Survey Legend and Map Unit Summary I. INTRODUCTION On September 19, 2005 Mark Iverson, Professional Soil Scientist #197 and Certified Soil Tester #46672, completed an Interpretive Onsite Soils Evaluation. An interpretive evaluation is required because the soil on site does not meet the requirements to install a new private on-site waste treatment system (POWYS) through completion of a conventional onsite soils evaluation (<A+4 inches of soil suitable for treatment of eflluent is present). The onsite evaluation was completed through the observation of the soil profiles at three excavated (B-1, B-2, and B-3) and two hand dug (B-4 and B-5) test pit locations. This report has been prepared to present the results of an interpretive determination. The evaluation was completed at the request of the property owner, Doug Lee. The evaluation was completed to identify a location to site a new POWYS for Mr. Lee's proposed new home. The property is located east of Baldwin on the north side of 80th Avenue. Shawn Bird of Bird Plumbing completed a preliminary soil evaluation. The preliminary evaluation included the property in question and concluded that A+4 soils were not present within a reasonable distance of the proposed building site. Mr. Bird identified the location the interpretive determination was completed as the most suitable location on the site for installation of a POWYS. Test pits B-1, B-2, and B-3 from Mr. Bird's evaluation were utilized during the evaluation. II. PROJECT INFORMATION The following is site-specific background information, which has been collected: Property Owner: Udder Lee Dairy 878 240th Street Baldwin, WI 54002 715-684-2580 Site Location: NW '/4 of the SE '/4, Sec. 21, Town 29N, Range 16W Parcel ID # 002-1051-20-000 Town of Baldwin St. Croix County Historic Land Use: Agriculture Crop Production Current Land Use: Agricultural Crop production Vegetation: The site is currently vegetated with alfalfa and miscellaneous grasses. III. METHOD This interpretive evaluation and report was completed following the guidelines set forth in Comm 85.60(2) of the Wisconsin Administrative Code and in the summary provided by Leroy Jansky titled, "Preparing the Interpretive Determination Report" (March 13, 2002). IV. DISCUSSION OF RESULTS A. Local Hydrology 1. Surface Water Drainage Patterns -Surface water drainage is uniform over the majority of the proposed system area. No areas of concentrated flow were identified. 2. Subsurface Water Drainage -The silt loam texture and moderate to weak soil structure offer good to fair infiltration for the typical rain event. During frozen conditions and following heavy precipitation events, runoff will likely be much greater. The weak to moderate structure of that Ap does allow for fair lateral movement within the surface horizon. 3. Artificial Drainage Devices - No artificial drainage devices were observed during the completion of the evaluation. 4. Contributing Drainage Area -There is minimal area. upslope that contributes surface water to the system area. 5. Soil Saturation -Saturated soil was not encountered during completion of the test pits identified on the figure included as Attachment A. The depth of the test pits within the system area was 26 to 36 inches. 6. Surface Water Elevations- Surface water within 1/2 mile of the site has been identified on Figure 1. The nearest surface water features include two intermittent streams, one northwest and one southeast of the proposed system location. B. Geomorphology 1. Parent Material -The parent material is loess over glacial till. 2. Landform Type -The proposed system area is positioned on the backslope. The general slope shape in the vicinity of the proposed system area is linear linear. 3. Slope Aspect -The slope aspect with in the proposed system is westerly and ranges from 268 degrees to 278 degrees. 4. Surface Elevation -The surface elevation is between 1240 and 1260 feet msl. C. Soil Disturbance and Hydraulic Modifications The proposed system location is in a farmed field. The proposed system location has not been severely disturbed by cutting or filling. No hydraulic modifications, such as drain the or ditches, were observed at the tune of the assessment. No additional surface water is received from impervious surfaces. 2 D. Landscape Position and Local Topography The regional topography is shown on figure 1. The general direction of slope within the proposed system area is to the west as shown on the map. The ground surface elevation is between 1240 to 1260 feet mean sea level (msl) within the vicinity of the proposed system. The topography within the proposed system area is shown on the site map included in Attachment A. ~j FIGURE 1- USG±~S TOPOGRAPHIC MAP ~~ ~~ ~ -- yr; I G '~, ~ Tawnha~N ~--~1 ~' "t ~ - ` : •~ ~ ~ r 'k i; r ~ ,. ~ ~ _ ~~ v. ~' ~~ 1~ ~ ~ • t Y ~ .e..C `,5 ~ `~ _,240d'I Street . . '~ I .' F - _-- Proposed ~' --.~ • r a ~'r / ~~ System ~ --___~-- ~~'~~ _~ - Location ' , J ~.} . _ ° ~~ ~ V ^ ~. ~ 1 . , ~: .--. ~. ~r t r .`~ .. .~ .. ~ ©© _ ~ r. ~\ I ~ ~ ~ ~t ~ ~~ ~~~~ ~ ~ ~-~ - f 2,,r ~ ~-'~----7s`Z~ ~'~- --~~ f x.24 ' • ~" ~' I ~ ~ _...~ , r ~ ,' ~ $dth Avenue r---- St '~ E. Soil Series and Mapping Units The Soil Survey of St. Croix County maps the soils on the Udder Lee Dairy property near the proposed system area as Freeon (FnB) and Magnor (MaB). The location of each soil type is identified on Figure 2. The primary soil characteristics asdescribed in the series description are identified on the Table 1. Table 2 identifies the wetland indicator status of all soil identified on the property as identified in the USDA -MRCS Technical Guide - Hydric Soil Interpretations and in US Army Corp of Engineers (USACOE) hydric soils list. FIGURE 2 -SOIL MAP TABLE 1-SOIL SERIES CHARACTERISTICS Texture Parent Material Permeabili Soil A E or B Surface Subsurf. Surface Subsurf. Drainage Series Horizon Horizon Class Fn SIL SIL Loess Till M MS to S MW Ma SIL SIL Loess Till M MS to S SP Abbreviations Permeability IM =Impermeable MS =Moderately Slow VS =Very Slow M =Moderate S =Slow MR =Moderately Rapid Draina eg Class VP =Very Poorly P =Poorly SP =Somewhat Poorly MW =Moderately Well RA =Rapid VR =Very Rapid W=Well SE =Somewhat Excessively E =Excessively 4 ` i Table 2 - H dric Soil Classifications NRCS -USDA Soil Series Com onent Inclusions USACOE Fn No None No Ma No Adolph No Component soils are soils that are most likely hydric. If inclusions are identified, small pockets of hydric soils listed may be present within the soil series. F. Field Observations The soil identified during the completion of the test pits closely resembles the Freeon series. The major difference was that the E horizon is not present and redoximorphic features were observed higher in the soil profile. Redoximorphic features were observed as Fe concentrations and occasionally as iron depletions in the B-horizon. These features were observed 0 to 3 inches below the A-horizon. Redoximorphic features were not observed in the A- horizon. The redox features observed can be attributed to short-term seasonal saturation within the subsoil. The soil on site does not meet the hydric soil criteria. The lack of hydric soils indicates that the soil is likely not saturated for greater than 5% of the growing season (approximately 7 consecutive days}. The lack of these features does not precluded the possibility that the soil is saturated to or near the surface prior to the growing season or for shorter periods of time during the growing season. G. Comparative Analysis Soil borings B-4 and B-5 were completed upslope and downslope respectively to determine if the soil conditions were uniform throughout the site and if additional surface water received down slope had any impact on the soil characteristics. The results of the soil evaluation indicate that the soil upslope and downslope is similar to the soil within the proposed system area. H. Government Reports and Comments No government reports or comments have been identified or received for this site. V. Conclusions and Recommendations The site is suitable for installation of a POWTS (mound system) for the following reasons: 1.) Redoximorphic features were not observed in the upper 9 inches of the soil profile. 2.) Redoximorphic features were not observed in the upper portion of the B- horizon in some test pits within and around the system area. 3.) Hydric soils are not present within the proposed system area. 4.) There are no features that concentrate surface water flow toward the proposed location of the system. 5.) The slope at the proposed system location is 2.5 to 3.5%. The slope is uniform with no dips or valleys. The following recommendations should be considered during installation of the proposed system: 1.) The system should be installed on the 100' contour to stay within the tested area. The approximate length of the contour within the tested area is 120 feet. 2.) Sand fill shall consist of 2.5' of material meeting ASTM C-33 specifications. 3.) Four to six inches of sand should be placed on the system area immediately prior to chisel plowing. 4.) The basal loading rate shall not exceed 0.2 GPD/ftz for EFF#l. 5.) The system shall be designed to have a linear loading rate of 4.5 GPD/ft or less. b.) The system will follow the 100' contour and have a linear to slightly concave upslope shape. 7.) Due to the concave shape of the system and the potential to receive surface water from upslope, the topography upslope must be modified to limit surface flow toward the system area. The final approval of this site must be made by the Wisconsin Department of Commerce and the St. Croix County Zoning Department. This report represents the observations and professional opinion of Mark Iverson, Professional Soil Scientist (#197) and Certified Soil Tester (#46672). 6 VI. REFERENCES 1.) United States. United States Department of Agriculture Soil Conservation Service, in cooperation with Research division of the College of Agriculture and Life Sciences University of Wisconsin. Soil Survey of St. Croix County, Wisconsin. 1978. 2.) State of Wisconsin. Department of Commerce Code, Chapters 83 and 85. 3.) US Department of Agriculture, Natural Resources Conservation Service. 1996. Field Indicators of Hydric Soils in the United States. G.W Hurt, Whited, P.M., and Pringle, R.F. (eds,). USDA, NRCS, Fort Worth, TX. 4.) Schoeneberger, P.J., Wysocki, D.A., Benham, E.C., and Broderson, W.D. (editors), 2002. Field book for describing and sampling soils, Version 2.0. Natural Resources Conservation Service, National Soil Survey Center, Lincoln, NE. 5.) United States. Us Geological Survey. Topographical downloaded from http:J/terraserver. microsoft.com/ 6.) St. Croix County. St. Croix County Land Information System. http://72.21.230.178/website/pas stem/ isftortal.htm 7.) United States. United States Department ofAgriculture -Natural Resources Conservation Service. Hydric Soil List for St. Croix County, Wisconsin. ft~//ftp-fc.sc.e~ov.usda.gov/WI/Soil/hyd/hyd109.htm 8.) United States. Us Army Corps of Engineers. 1987. Corp of Engineers Wetland Delineation Manual, Technical Report Y-87-1. USAEWES Environmental Laboratory, Vicksburg, MS. 9.) United States. United States Department of Agriculture -Natural Resources Conservation Service. Web Soil Survey. http: //webso it survey. nres. usda. gov/app/ 7 ~ .. APPENDIX A SOIL EVALUATION REPORT r• ST. t~ G~OIIN!'Y SBPTiC TANK r~~~~~b ~AN~D ~7 w ~/g~ ~1` O~~~i~ii~-1~LC 4~.LJrj~AilVl~ ~VA~ _____~. ... ~ ~ c~ w • ~,,, t~ ° . S G Pan~ei ~t1t~Sctrtio~n Namo~r O o Z / oS l -~ o - o c~ U 31~ Properly Low ~/~/ 'Ys, S~ %4, SoG. d'Z 1 , T ~ R / b W, Tcown o~ ~ q I ~ w; -~ 3ubtiiviei~on _ __„____ . Lo~t#~,_~,,~ ~' ~ ~ ~ ! ~ ~~ ~ , Vow G . P~+ # _r~,~ r ~,~- W Deed ~ ~ ~ ~ ~ ~ ~ ,,,., _ , vo~taee ~ 1. 3 ~ . ps~a # ~ 5~~ ~ ~ ~ LotY~as i3set~iisble yes a~ Innpt+aper tree snd Baca afy~oear septic systeon could n~ in its psm~d~oe fi~ene eD hss+dia wras~s. IMoper Dossiers ofpusopi>ag cut tsra septic t~ ~ ~ yeas or sooaez, if~aeedul, bar s Taceesed pu®pe~ W~ ~raaput Leo flMa sy~tem~ ~afimctiosi afffie septic ts+~itas a sts~a a Wa ~a d~spoeai syalam. Owaarasisseesooa respoosiilities sea ~ 83.5~(I)asditi C'~spler 12 - St ~ Oo^etq ~s^ilaTq~oe~ TLs p~o~ratrneityitoesia etdratitts 8t t~eeitt Plss~aie~ dt7~lents csoa~ siaeed bY~ ~rw~rsc ss~db~ratassrecpirsabay jossArymsapirsi~sy reslrialsdpLtiisr®r:lietsrsdpetepet ~ (i) 8re tior~iie aaseewarse diposid sy+Ntanis inpst~pacapser~o~t+oadllfo~etadKor ~Zj s*tc ieepesWataadpaatpin~{~[swetM^tn.4~ stye ttsttie lasdrar-lf3 dtYatsi^Ale~ T/wR 1bs ~ gene toted is orb o~t~ >~iigas~+t~b and aaM b ao~it ie pdwMt Ntr~ dilposd AM~ttt wl~t ~a C~Barfioasoed~t~retyetrseplb syelnttys~r'bs~taesittsieisdseoettie esetdislsd slttsl^oNii1-fr &. C~roitl~r~r!lee~lr~ ~ ZnaiAiD~wrl0ia3@iq~td~r~rseywr+tapiMfendrls. uw~sa~r~rEs~~trlsaa#iiss~wostrrta~sitMtdag~tlooe~~4i~j~ jhredYtstr~s)sEtba peeltetl~-derxMd s~e~ 1gr qtr eta wetrgrdeed sttaoeid is gs~Mtr aiDasdt t'ldtoa. Nee>eVet~[Mi~ewr .~~ ~°~ ~~ `fiD~ DATB ~An~rii~isaii^titt^ieet~wsraledag'~1tia~sse^ilt~~r~bsitt~t'~ti7'~p'r^~L~?~^yi"'°R . Igeiaae wiBi ~ as a »oeitdsd wetrrq- deed fbeae ~ r alllsed~ ~ atl a ~!- atb aet~lei antwpr ~ ~ reibseea i aosdsittir~rdasi. (~-~? ii ppC~tMFNT NO. sl~ ~ ~+ /y STATE BAR OF WISCONSIN FOli Nt `s-iao~ jj T^r~,,.-^..~ °E~~••'===F='° RECORDING !BATA Qgsl1{rTc},CLAIM i3E~0 ~{ . '. ~ .i ~ i _~P yy~~ 1 ft L4C tL V~'1 II r~-=, v quit-claims to P r- - ~ ,~ ~ - tt,a tOllOwing described re81 e9talb State of Wisconsin: L _:;~ i~-----~ -: tly-T~ Y. Fi~•d'Botr• R~~ APR 5 1994 D.t 12:30 - ~ P ~ar~~ RETURN TO Tax Parcel IJO:__ No>:-th~:.tst Quarter of the Southwest Quacter (NG'-n of SSJ%,) of Section Twenty-~ne(21), Township Tt.•enty-nine North (29), Range Sixteen tJCS.. (lE). 1 PAR(~L NO. 1: :rhe South Half of ttue Northeast t~uarter { o ~Ytfi~ t; .;tuu.: per (S~ of "~~ of N~3;) ; ='•d the { Southeast t.lt7arrer or the c±arcnP.ast ~:ari.ci (.~.::a a:. :•:%I:i 11 aIL in Section Tt,~estty-one (22) Township 2tar~tty-nine (29) North Range Sixtec-n (16) West. PARCEL NO. 2: The North Half of the Southeast Quarter (N~ of SF3•J F.X(~P'CZT`IG the East eet o C e North 473.47 feet Chereof; AlI in Section Ttaenty-one Township j Ttsenty-nine (29) North Range Sixrteen (16) 4lest. , PAI:~L NO. 3: The South Half of the Southeast Ouznrter (S~ of SEA) of Section Ttaenty-one } .. , ..ow:...~p '~.~ ~-y-_^_ine (29) Nor*_h Rffit~e Si-xt~t (16) t•?est F.~CGE'P~IiyC~ `l~'tta::r~ttf~'r^" t;te ! followinK described parcel: The Sot.7th 300 feet of the East 860 Feet of the St•7~ of the SF~ of 21-29-16. EXCEPT: ' Lot Qne (1) of v^ertifi~d Surv9y Map Nuatber 1685, recorded in Voluma ~ of CSM at page 1595, as Document Number 415805, being apart of the Southwest (luarter of the Southeast Quarter (SW} of SE}) and the Southeast Quar*.er of the Southeast Quarter (SH,( of SE}) of Section Twenty one (21) , Township Twenty nine (28) No rth, Range Sixteen (15) West. This tIO/Y7eet9atl property. (Is) (is mot) Dated Phis r' ~~day c? ~^ rr•~ ~ -.. 19~.L- Lee Farm Tnc. (SEAL) Doug Lee, President - ~ (SEAL) AUTHENTICATION Signature aulhenficated this_ day ol~ .-_--, 19 TITLE' MEMBERSTAI'E BAR OF WISCONSIN Ilf not, authorized by § 7U6.Oti, Wis. State.) TN1$ INSTRUMENT W0.$ DRAFT EC pY tglgnaluras may be aulhenticaled or acknowledged. Both are not necessary EAL) ACKNOWLEDGMENT STATE OF WISCONSIN St. Croix . L ss. County. S Personally came before me this _.~ h"` •>••.. ~ _day b! April _, to^\ ~•, t~te~bi3,v~•t}sTetl );o•.le Lee ~;~: ., -~;. ~ _ • ~.. to m,,PP known to bs the perso~'• ~ '• J~h~{~Q$e6utedrthe tor¢gbingwnstrumentapip~c' vtt)e e.lh~s$r/~$. r,' v Jar*ies O' Connell Notary Public St-• Cr'O].X County• Wis. My CiOmmlSSlOn is permanent (11 not, state expiration date:. April. ..__20, t9`~~ .- Nd~r.c5 O' :.Cr SO'+S Srg~rns rr 3nY C301C r:Y S~OC•':1 bB tY0°O Or D•rnln6 DCIOW thCrr SrAnBIt,~C3 NTF 002] OU1T CIAtM OEEO eTAT F_ eAR OF W IeCONSIN FOAM No. 7- 19112 Nelco Tax Forms, f' ~. P.ox 10208. 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