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002-1070-40-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 479279 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Gilbertson, Larry & Susan I Baldwin, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: D� , O M C 1 28.29.16. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 7 Benchmark 3 5 5 1a 3.5S Dosing / j AItPM (, zt A t � Bldg. Sewe 13 7 7y Holding St/Ht Inlet -1. 9 y , 05 ,7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 75 f ,/ (03j i_ 3 i Dt Bottom i 4, U 9-7,35 Dosing -7 5> (v3 j �O 3 Header /Man. � �1 9-7 2 Aeration Dist. Pipe q 9 77 , 3 Holding Bot. System Final Grade 22 PUMP /SIPHON INFORMATION l Manufacturer Demand St Cover ,f� G f ,J JOu� 5 GPM �� ,�T �• I /037 Model Number � Pa 5 3( , q ! / 7, 6 S J I TDH Lift, ` ll Friction Los System H9d Z115 TDHi �` Forcemain Len th / Dia. i Dist. to well SOIL ABSORPTION SYSTEM � BEDITRENCH Width Length i No; Of enche PIT DIMENSIONS No. Of Pits Inside Dia. Li uid De t DIMENSIONS •`'7 T5. SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type �J : / UNIT Model Number. N DISTRIBUTION SYSTEM /j-f Header /Manifold �, Distribution ( I 1 � p x Hole Size ,1 x Hole Spacing , Veptto Air Int Pies q i1U Length I is Z Length 4 `• -1 Z Dia r Z Spacing Z 1 3, d 1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched :[]:N Bed/Trench Center 7 � Bed/Trench Edges Topsoil Yes No es o COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / ZU / Inspection #2: / / Location: 741 230th Street Baldwin, WI 54002 (NW 1/4 SW 1/4 28 T29N R16W) NA Lot 1 Cr&6 - V 6L ", arcel No: 28.29.16. 1.) Alt BM Description= V,a`PO _ U(-' �I�tx�n5 �t � P I (Jj 2.) Bldg sewer length - amount of cover = ' 4 4 Z� Plan revision Required? j ;] Yes >Q No <p Use other side for additional information. Date Insepctoe Signatur Cent. No. SBD -6710 (R.3/97) Safety and Buildings Division County /i � f Aff 201 W. Washington Ave., P.O. Box 7162 1. VIs Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 1 - / 1 7 9 0- Department of Commerce State Plan I.D. Number Sanitary Permit Appl cat RECEIVED In accord with Comm 83.21, Wis. Adm. Code, personal formation you provide may be used for secondary purposes Privacy La , sl5.04(1)(m) Project Address (if different than trailing address) L Application Information - Please Print AN Inforruwtioa 7 Z 36 &1, 51 Property Owner's Name ZON G 04 ( Parcel Lot # Block # / /f r fj e l G s c! � Property 's Mailing Address Property location .a. 3 v r s —re V., Section ' Cit State I e Zip Code Per f T V T .c N: R l�cir o) li. e Subdivision N CSM Number Temp of Building (check all that apply) / pj� Q •5 �. �� ✓ 1 or 2 Family Dwelling - Number of Bedrooms ❑ Public/Commercial - Describe Use 7�C $S on Ce..�n''r a•7 ❑City_❑ Rage ownshipof ❑ State Owned -- Describe Use � //r lll. Type of Permit: (Check only one box on sine A. Complete line B if applicabtc) A ' stew System ❑ Replacement System ❑ Twatman/Holding Taiy ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner IV. Type of POWTS S ttnt: jCbKk all that a pply) ❑ Non - Pressurized In - Ground Mound a s 24 in, of suitable soil Mound < 24 in. of su itable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Roeirculatin Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber Q Drip Li ❑ vel -less Pipe ❑ Other (explain) AA V. Di rsal/I'reattnent Area Information: a Design Fiow(gpd) Design Soil Application Ra � Dispersal Area Requi sf) Dispersal Area Pro System Elevation GU 1560 cG t� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks �� Septic or tiotdhn Tank b(f l (fir/ i a ge— Aerobic Tregment Und Dosing Chamber 1 7 4 9T O ( t VII. Responsibility Statement- 1, the und9p4med. assume responsibility for installation of the POWTS shown on the attached plans Plumber's Name (Print) Plu 's Si PRS Number Business Phone Number P S it 9 "? 31' 1 ' , ? 5 2 7 PI her ' s Address (Street, Ci State, Zi ode) ' rvr I&Ir fV3 e . /� 411 s" yo 2� Vill. ('aunty/ partawat Use Oa ppro C1 Sanitary Permit Fee (includes Groundwater Da t Issued Issu2Agen gnatur e ( o er Giv Surcharge Fee, Z , z / ❑ eason ial & IX. Conditions of Approval /Reasons for Disapproval � ` "TEM OWMER: 3 I. Septic t6rlk, effluent filter and c (`e_ eWe,c -- t J ( 4A,: g prti: �- dispw"cell must all be services / maintained 1 Q'� as per management plan provided by plumber. 2. AN sefarck requirements must be maintained as per applicable code / ordinances. Attach eompkse plans (to the Cowty o*) tar the system c0 P' awt Ims rhae Stn x It caches in sift SBD -6398 (R. 01103) Safety and Buildings conimerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www•commerce. o e of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 03, 2005 CUST ID No.223475 ATTN.• POWTS Inspector JOE STANG ZONING OFFICE STANG PLUMBING & ELECTRIC ST CROIX COUNTY SPIA PO BOX 263 1101 CARMICHAEL RD WOODVILLE WI 54028 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/03/2007 Identification Numbers Transaction ID No. 1141494 SITE: Site ID No. 699116 Larry & Susan Gilbertson Please refer to both identification numbers, 230th Street above, in all correspondence with the agenc Town of Baldwin St Croix County NW1 /4, SWIA, S28, T29N, R16W FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1020285 Maintenance required; 600 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101); Biofilter 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. 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: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • 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 private sewage system 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. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval condit' } DEPARTMENT C CO30ft CDrr t JOE STANG Page 2 6/3/2005 • Comm 83.22(7) - 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 mgy include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Gilbertson 4 Bedroom Mound Owner's Name: Lang & Susan Gilbertson_ Owner's Address: 737 230th St. Baldwin, Wise. 54002 Legal Description: NW 1/4 SW 1/4 $28 T29N R18W Township: Baldwin County: St. Criox Subdivision Name: 3 Acres Pending Lot Number. ;91 pending Block Number Parcel I.D. Number 002- 1070. 40 -M Plan Transaction No.: b y tI qj q Page 1 Index and title Page 2 Data entry . RECEIVED Page 3 Mound drawings Page 4 Lateral and dose tank JUN 2 2 005 Page 5 System maintenance specifications Page 6 Management and contingency plan SAFETY & BUILDINGS Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evauation Repart Designer Joe S ta2g License Number. 223475 Date: 05f2 3j05 Phone Number (715) 684 -5166 Signature: t ��, 4� - Cie want to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01101), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) Version 4.01 (R. 09/04) .vsoWw u E YANU BUILDINgs Page 1 Of 9 SEE CORR ONDENCE Mound and Pressure Distribution Component Design Design Worksheet site Information (r or c) R Residential or Commercial Design Nate: sand ell (D) calculations a"ume a Table 83-"3 in -eitu soil tc�nent for fecal 400.00 Estimated Wastewater Flow (gpd) caNform of <= 36 Inches. 1.50 Peaking Factor (e.g. 1.5 =160°fd) 600.00 Desig Flow (gpd) 4.00 site Slope ( 97.05 Contour Line Elevation (ft) 17.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 85.00 Dispersal Ceti Length Along Contour (fit) = 7.06 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft) 1 influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution lnformation network? Enter Y or N (o or e) c Center or End Manifold 3.53 Lateral Spacing (ft) if N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 10.72 fe /orifice 2.00 Forcemain Diameter (in) 60.00 Forcemain Length (ft) Does the foroemain drain bade? Y 89.50 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 8.63 Vertical Lift (ft) 76.55 5x Void Volume (gal) 1. 69 Friction Loss (ft) 86.34 Minimum Chose Volume (gal) 13.57 Total Dynamic Head (ft) 36.70 System Demand (gpm) Lateral Diameter Selection Manifold diameter Selection in. dia. options choice in. dia. 4 options choice 0.75 1.25 1.00 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information 800,00 Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer E :Ngal/in (enter result in cell 049) Dose Tank Information (Effluent Ater lnfomistion 800-001 Dose Tank Capacity (gal) lZabel I Filter Manufacturer 22.221 Dose Tank Volume (gal /in) JA100 IFilter Model, Number Wieser Manufacturer Project: Gilbertson 4 Bedroom Mound Page 2 of I zed =ai ze:zt se -sz -se Mound Plan View T 1/10 . ..................... J Observation Pipe ..... ...... ...... .. _ _ T .f.:. .f.: ,:. �l.. •rir•r•r� .,r. .:.:. .r.r. .,•.. w T B i -, I . . . . . . . . . . . . . - . . . . . . . . . L -- Mound Component Dimensions A 7.06 ft E 22.39 in H 1.00 ft K 10.55 ft B 85.00 ft F 9.50 in T 10.76 ft L 106.10 ft D 19.00 in G 0.50 ft J 7.70 ft w 25.52 ft 600.10 (ft Dispersal Cell Area 1 1515.03 (ft) Basal Area Available 7.06 (gpd/ft) Linear Loading Rate 1 8.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.43 (ft) --► .rri f H rirrrrri 2 rfririi G .rfirfif rirE F pal Celi 99.13 (ft) Lateral 98.63 (ft)--► — Invert Dispersal Cell E' i Elevation D ..... ..... ........ ..... 4 4 97.05 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key _� 1 Dispersal Cell See lateral details on 10 _ Topsoil Cap ° 1.5 ft - •.• - .• Page 4 for number, size, F/ 7/ - - ' 7 1 . , f•r• j •: �:• © Subsoil Cap M o •5 ti: ti :�r, 4 • ., and spacing of laterals. LL�jj ASTM C33 Sand -•' Z :; :••stir �; ti ?.;:, Laterals are equally F Tilled Layer 0.5 ft 1; ti7ypical Lateral .r spaced from the 1 r•r•r- ..r.r.. © ti , ti , ti p ; ..., {t { ;•.'• distribution cell's J•r•r• Aggregate d' p r`r':':•r•r� : -. •r %' •: . . .. A �* centerline in the distribution cell (AxB). Project: Gilbertson 4 Bedroom Mound Page 3 of 9 Center Connection Lateral Layout Daigrarn Force rr W n connection Via tee or cross to maWold at any point- Later,* are idpnHC al P 0 w Tura -up wlball valve or IE X '�! 812 xf2 9� Laterads & Woe maw of PIVC Soh 40 olNatrout Plug per COMM Table 94,6M Holrhr dried oh dw bottern of the IateraL Number of Latera 4 orifice Diameter 0.188 in Lateral Diameter 1.50 in orifice Spacing (X) 3.09 ft Lateral Length (P) 41.72 ft Orifices per Lateral 14 Lateral Spacing (S) 3.53 ft Orifice Density 10.72 ftl /oribce Lateral Flow Rate 9.18 gpm Manifold Length 3.53 ft System Flow Rate 1 36.70 gpm Manifold Diameter 1.50 in Total Dynamic Head 1 13.57 ft Forcemain Velocity 3.75 ft/sec Dose Tank Information L cow vdth warning label and loddm device and seated n�.ttertlgt>s Elt�ctrkcal a$ per NF-C 3W and --�- -► �° Comm 16.28 WAC Dlscanr 4 in, min. Tank component Is properly vented E Alternate outlet localion Forcemain diameter Wieser I Manufacturer 2 in. Ca arit 8 Gallons Volume 1 22.22 gaUinctt A Weep hole or anti - Dimension Inc Gallons 8 slow device A 18.12 402.58 B 2.00 44.44 C e te40M fl C 3.89 86.34 90.50 D 12.00 266.64 D Total 1 36.00 800.00 Dw tank efevatiWt ft) 3" Bedding un er tank. L g�• Alarm Manusfacturer [ Controls Alarm Model Number JTank Alert 1 Pump Manufacturer JGoulds Pump Model Number 13887 EPOS Pump Must Deliver 36.70 gpm at 3.57 ,TDH Project: Gilbertson 4 Bedroom Mound \ Page 4 of q 80d -0.1 €O:ZT SO -SZ -50 Mound System Maintenance and Operation Specifications Service Provider's Name Joe Stang I Phone 715-684 -5166 POWTS Regulator's Name St. Criox County Zonin Phone 715- 386 -4680 System Flow and Load Parameters Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.1 fl: Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Freauencv Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 ears Pump and Controls Test once every 3 years Alarm Should test monthl Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other 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: Gilbertson 4 Bedroom Mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance 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 failure must be replaced. Exposed access openings greater than 84nches in diameter shall be secured by an effective locking device to prevent accidental 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, Stats. The contents of the septic tank shall be disposed of in accordance 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 fitter shall be cleaned as necessary to ensure proper operation. The filter 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 enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms 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. If the contents of the tank are not removed at the time 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 performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (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 will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg/L SODS, 30 mg/L TSS, 10 mg/L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system In proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Gilbertson 4 Bedroom Mound Page 6 of 9 Tod 6TgVTE8STL:KGUJ :oL 66:LT S9- s� -t�8 GOULDS PUMPS SU1 1"S1ble W " ut Punip tr I r EPO4 0 1 EP05 APPIM1111 NS • Fully submergetf in high ■ % v0PdW.Ttteno- r BeadnW Upp¢r and tower grade turbine 011 for plask endow design X9 heavy d* bail bearing Specifically designer( forte lubrication and dficient meowed perkw a ", cortstrucction. tollomno uses hW try_ nr Caft awl Sim R ugged Efflue systms thermoptasdc design provides AGEMCV LIS'rtllG • Homes Avaliable for avlomalic and super strength and • Farms i11WAIM t1p@C ft AUNMallt CorMSion C canad[aa8Ux*arftA=Qda6W • Heavy duty sump madels Whole Mecharilcal • Wafter transfer real Switch e889mliled and ■ MOW Housing: Cast iron (CSA listed model numbers • Dw ateririg preset at the factery. for ~ heat tr8rWer, end in 'P sttteVth, and duca tyr_ SPEC I M:AT IM FEAlr IRs r U1 gm Cater. Thennoptaske cwft vow to lea 9M . Coiff With • Solids handling capability= ■ EPO4>hnpeVW Tilerrno Eva swtlo[r moment hand and W rTWdmum. plastic Sen* vpen design points. • CapaMes: up to 60 GPM, vAth pump out wares for • Total heads: up to 31 tee[_ mechanical seat pratect�. ■Fearer Cake SeverE duty • Discharge s izr 1 NP raged oil and water rESi5tarlt • Mechmical seat carbon- rotaty/beram - stationw, BUNA - N elamamrs. • Twrwwature: 104•F (40 owrdrwaz } . _` r ....... _ �.._. _.. . T40°F 6Q°C rritetmRtent. • Fa*nem- 3QQ series t0 �~ stairdess steel. , + • Capable of nrrrnirig s 90 .... _ .i -i► +H - Stet . ...... dry without damp to _.. -....: ; components. a ; ?5 Motor. 25 7 o FPO4 Single phase: 0.4 HP, us 115 or 230 V. 60 HZ, 1550 � s 20 '° RPM, built in overload with ; - autornatic reset z s EE'4S Single phase_ 0.5 HP, $ 115 V, 60 Hz, 1550 RPM. I. _ , T �'- +epos built in overload with s to ..___.. _ aukw aft reset. i • Pow card: 10 loco ` epaa ... standard lewth,16/3 2 SJT vfdth tree prong 9rWnft plug. Optiartal 20 , .. f foot length, 1613 WW with a three prong grounding plug o 10 20 3a ... _. _... 50 C INA (st J Q -2 1 6 5 t4 i2 CAPAC"Y Goulds Pumps , 0 2W GO," ft ITT lndmtries Rio". MW e 1,4 rn 15:,00 l QIE •• jq Ile ��. flea : ��'r , ,/ , 6.0 1 co 13 6Ih G rill e q 7% Sh ., pm C. <� ip0d =aI s O:zT SO -SZ -SO T I �rA\j U ,, TION REPORT #1657 Department of Commerce PP t rd n h Ef° 5, Wis. Adm. Code Page i of 3 Division of Safety and Buildi s S� CRO`G �FF�CE Steel's Soil Service, Inc. Attach complete site plan on pa not les7s \N : x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical izontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. - 1070 -40 -000 Please print all information. R iew Dat Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). 4 /U,/- Property Owner Property Location Gilbertson, Larry & Susan Govt. Lot na NW 1/4, SW1 /4, S28, T29N, R16W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 737 230th St 1 na 3 Acres Pending City State Zip Code Phone Number City ❑ Village ❑ Town Nearest Road Baldwin I WI 1 54002 715 - 684 - 2546 Baldwin 1 230Th St ❑ New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe na Parent material Low ridges and Knolls of ground moraines Flood plain elevation, if applicable na ft. General comments Mound Design, system elavation 98.64ft. based on contourline elevation 7 /,?S-' and recommendations: F -1-1 Boring # ❑ Ground surface elev. 97.55 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0 -9 10yr3 /1 none A 2msbk mfr cs if .6 .8 2 9 -17 10yr5/4 none sicl 2msbk mfr cs ivf .4 .6 3 17 -24 7.5yr4/4 none scl 2msbk mfr cs na .4 .6 4 24 -34 7.5yr4/4 c2d 7.5yr5/6 scl 2msbk mfr a na .4 .6 5 34-48 10yr7/4 c2d 7.5yr5/6 andston( Residuum mvfr na na .0 .0 [ L Boring # ❑ Ground surface elev. 97.55 ft. Depth to limiting factor 17 in. Soil ❑ 9 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 - Eff#2 1 0 -9 10yr3 /1 none A 2msbk mfr cs if .6 .8 !► 2 9 -17 10yr5/4 none sict 2msbk mfr cs ivf .4 .6 3 17 -28 7.5yr4/4 c1d 7.5yr5/6 scl 2msbk mfr cs na .4 .6 4 28-48 7.5yr4/4 c2d 7.5yr5/6 sl 2msbk mfr na na .6 1.0 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD s30 mg /L and TSS < 30 mg /L CST Name (Please Print) Si nature: CST Number David J. Steel 248956 Address Steel's Soil Service, nc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/16/2005 715 - 760 -0347 SBD -8330 (R.07 /00) Property Owner Gilbertson, Larry & Susan Parcel ID # 002 - 1070 -40 -000 Page 2 of 3 F Boring # L1 Ground surface elev. 96.05 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -12 10yr3 /1 none Sit 2msbk mfr CS if .6 .8 2 12 -22 10yr5/4 none sicl 2msbk mfr Cs lvf .4 .6 3 22 -32 10yr5 /4 c1d 7.5yr5/6 Sicl 2msbk mfr CS na .4 .6 4 32 -48 7.5yr4/4 c2d 7.5yr5/6 scl 2msbk mfr na na .4 .6 F-1 Boring t # ❑ Ground surface elev. ft. Depth to limiting factor in, ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 F-1 Boring # ❑ Ground surface elev. ft. Depth to limiting factor in. 1:1 Ground Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 I •Eff#2 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.071001 $[Eel's Soil Service, Inc. STEEL'S SOIL SERVICE INC 3 of 3 David J. Steel Larry & Susan Gilbertson 994200 th St. CST - POWTSM NWl /4,SW1/4,S28,T28N,R16W Baldwin, W154002 Lic. #248956 Town of Baldwin, St Croix Co. Cell.(715) 760 -0347 Lot, 1 Pending Fax.(715) 684 -3449 Legend N 1 = 40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" Steel pipe • = Alt Benchmark Ele. 101.00 ft Top of 3/4" Steel pipe = Borings Boring Elevations B1 = 97.55 ft B2 = 97.55 ft B3 = 96.05 ft B4 = 0.00 ft 6 ( C / /G . / � o r 1 i 10 � v- 7'988EsC VOL 19 PAGE 4999 KATMEM H. WALSH REGISTER OF DEEDS ST. CROIX CO. VI RECEIVED FOR kECORD 96/28/2886 83:39PIt CERTIFIED SURVEY MAP REC FEE: 13.98 COPY FEE- 3.98 PAGES: 2 CERTIFIED SURVEY MAP Larry W. and Susan D. Gilbertson Located in the Northwest '/, of the Southwest '/4 of Section 28, T 29 N, R 16 W, Town of Baldwin, St. Croix County, Wisconsin WENrQUARTER CORNER MONUMENT) &s'- Lleil =lYY F.AYI' QUARTER CORNER _ - -- - " 3 ND s8, a9m, R s6 W S 8 � 5219.06' - - - F NUM6IJT) (POU BSRN78 AL� NUM M E .1 o' SPu -) 4Q• Q kANQS 1 - 4667.96' 1 LOT v; 3.OIA')�IC7PE( R/•6W � FT. w 8 o„ I g i Z. TOg12Z,616 SQ. FT. 3 j aj F= ' 33 33' �q's j h =i • 61 N85•$2��W S zo' v7 I MMATTED Am D1 - SO[TTHW84rCORNER - -- -- -- - - -�?. SECTION s8, T 29 N, R 16 W (POUND "PIC" NML) N -TK E LEGEND p Indicates i "O.D. x 18" Iron Pipe Set Scale in Feet I" 100' (Min. Wt. - 1.13 Ibs./Iin. ft.) Section Corner Monument 100 50 0 100 0 (a8 noted) Bead are referenced to the t?ast -West quarter section Indicates soil Boring line of Section 28, assumed bearing 3 SS°52'34" E (R = ) Recorded as �Sa a oNSr� _ _ _ Roadway Setback line • • • • • . — (loo' from right - of - way) • i wux$ivc$ • W. r:vxr !c 13 Errvrzsx.� wi. DATED- • •••• : OWNER'SADRESS March 3�, soog • ....... • . •... 737z3oth ST. L,.Lrry Rakhvir4 WL 54002 This Instrument Drafted by Mark W. Peavey Vol 19 Page 4999 SHEET 1 OF 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM o wner /B uye r A elz d- -sos 4�1 �n f Mailing Address a P S Property Address - 7 47 �. 3 ( Verification required from Planning Department for new construction) City /State 13/� l / 0 - �` 5 T W L' Parcel Identification Number L M 2 - 16 20 - W LEGAL DESCRIPTION Property Location '/4, .s i./ ' /., Sec. 2 , TN -R 1 W, Town of l� Subdivision , Lot # Certified Survey Map # - 7 17199 (O Volume , Page # Warranty Deed # L l ° 4 , Volume ? . Page # 2 �' 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 licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the thre a r: ka Eon ate. AA#J AP 1; SIG A OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the openly d ribeff ove by virtue of a warranty deed recorded in Register of Deeds Office. / (/ I NA 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 1S'COnSin SOIL EVALUATION REPORT #1657 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 v 3 Division of Safety and Buildings Steel's Soil Service, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope; scale or dimensions, north arrow, and location and distance to nearest road. 002 - 107040 -000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Gilbertson, Larry 8 Susan Govt. Lot na NW1 /4, SWIM, S28, T29N, R16W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 737 230th St 1 na 3 Acres Pending City State Zip Code Phone Number J City ❑ village [] Town Nearest Road Baldwin WI 1 54002 1 715 - 6842546 Baldwin I 230Th St New Construction lase: f Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement f7 j Public or commercial - Describe: na Parent material Low ridges and Knolls of ground moraines Flood plain elevation, if applicable na ft. General comments Mound Design, system elevation 98.64ft. based on contourline elevation R7, as and recommendations: F 1-1 Boring # Z Ground surface elev. 97.55 ft. Depth to limiting factor 24 in. Soil Application Rate F Hodzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Etfa1 -Eff#2 0-9 10yr3 /1 none sil 2msbk mfr cs if .6 .8 9 -1 7 10yr5/4 none sid 2msbk mfr cs 1vf .4 .6 7 3 17 -24 7.5yr4/4 none sd 2msbk mfr cs na .4 .6 4 24-34 7.5yr4/4 c2d 7.5yr5/6 sd 2msbk mfr cs na .4 .6 5 34-48 10yr7 /4 c2d 7.5yr5 /6 andstonn Residuum mvfr na na .0 .0 F Boring # Ground surface slew. 97.55 ft. Depth to limiting factor 17 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz_ Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3 /1 none sil 2msbk mfr cs if .6 .8 2 9 -17 10yr5 /4 none sid 2msbk mfr cs 1vf .4 .6 3 17 -28 7.5yr4/4 cid 7.5yr5/6 sd 2msbk mfr a na .4 .6 4 7.5yr4/4 c2d 7.5yr5/6 sl 2msbk mfr na na .6 1.0 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = B00 <_30 mg/L and TSS s,30 mg /L CST Name (Please Print) Signature: ^ / CST Number David J. Steel ``--'' 248956 Address Steel's Soil Service, na Date Evaluation Conducted Telephone Number 9% 200th St. Baldwin, Wl 54002 4/16/2005 715 -760 -0347 SBD.8330 (R.07 /00) Owner Gilbertson, Larry & Susan Parcel ID # 002 -1070 -40-000 Page 2 of 3 'Boring # Ground surface elev. 96.05 ft. Depth to limiting factor 22 in. Son Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary I Roots GPD/ft in. Munsefl Ou. Sz. Coat. Color Gr. Sz. Sh. f 'FJft -E!1#2 1 0-12 10yr3 /1 none sit 2msbk mfr cs if .6 .8 2 12 -22 10yr5 /4 none sic! 2msbk mfr a ivf .4 .6 3 22 -32 10yr5 /4 cid 7.5yr5/6 Sid 2msbk mfr a na .4 .6 4 32-48 7.5yr4/4 c2d 7.5yr5/6 scl 2msbk mfr na na .4 .6 Boring # = i Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munseil Ou. Sz. Coat. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 Boring # Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *EW1 •Eff#2 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <_150 mg/L ' Effluent #2 = BOD <- 30 mg /L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777, SBD- 33301&07/00) Steers Soil Swvke. Inc. STEEL'S SOIL SERVICE INC 3 of 3 David J. Steel Lary & Susan Gilbertson 994 200` St. CST- POWTSM NWl /4,SW1 /4,S28,128N,R16W Baldwin, W154002 Lie. #248956 Town of Baldwin, St Croix Co. Cell.(715) 760 -0347 Lot, 1 Pending Fax.(715) 684 -3449 Legend 1" = 40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" Steel pipe • = Alt Benchmark Ele. 101.06 ft Top of 3/4" Steel pipe = Borings Boring Elevations B1= 97.55 ft B2 = 97.55 ft B3 = 96.05 ft • � B4 = 0.00 ft a c, i / 36 /G i 2$ 3 2 p 5 6 - 794B 93E3 KATHLEEN H. NALSH State Bar of Wisconsin Form 3 -2003 REGISTER OF DEEDS QUIT CLAIM DEED ST. CROIX CO., III RECEIVED FOR RECORD Document Number Document Name 06/29/2005 10:45AN QUIT CLAIM DEED THIS DEED, made between Larry W. Gilbertson and Susan D. Gilbertson, EXEMPT f B husband and wife REC FEE: 11.00 TRANS FEE: ( "Grantor," whether one or more), and Karla M. Gilbertson, a single person CCPFEE -. 2. PAGES: 1 ( "Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix Recording Area County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Name and Return Address Part of the Northwest Quarter of the Southwest Quarter (NW 1/4 of SW I /4) of Thomas A. McCormack Section Twenty-eight (28), Township Twenty -nine (29) North, Range Sixteen (16) 1020 loth Avenue West, more particularly described as follows: Baldwin, WI 54002 Lot One (1) of Certified Survey Maps filed June 28, 2005, in Volume 19 of Certified Survey Maps Page 4999, as Document No. 798860, office of the Register 002 - 1070 -40 of Deeds for St. Croix County, Wisconsin. Parcel Identification Number (PIN) This is not homestead property. Os) (is not) Dated (Q • 0 , 2005 (SEAL) A (SEAL) * * arty W Gilbertson (SEAL) , �v /�, X�I�L (%Lim — (SEAL) * * Susan D. Gilbertson AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF WISCONSIN ) ) ss. authenticated on ST. CROIX COUNTY) Personally came before me on (e - � D p , 2 005 , * the above -named Larry W. Gilbertson and Susan D. TITLE: MEMBER STATE BAR OF WISCONSIN Gilbertson _ (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) ins ment and acknowledged same. ye THIS INSTRUMENT DRAFTED BY: * 0., L. Thomas A. McCormack Notary Public, State of WISCONSIN Baldwin, WI 54002 My commission (is permanent) (expires: -6!a ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM NO. 3-200.3 *Type name below signatures. 0 State Bar of Wisconsin 2003 INFO -PRO Legal Fortes • (900)655 -2021 k 4bproforms.00m 79E38C6121 VOL 19 PAGE 4999 KAT9EEBA H. WALSH REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR RECORD 06/2812005 03:30PH CERTIFIED SURVEY MAP REC ME t 13.00 COPY FEE: 3.00 PAGES: 2 CERTIFIED SURVEY MAP Larry W. and Susan D. Gilbertson Located in the Northwest 1 /, of the Southwest 1 /, of Section 28, T 29 N, R 16 W, Town of Baldwin, St. Croix County, Wisconsin WFSTQUARTERCORNER SECTION 28, T 29 N, R 16 W I M . Ur BERN15EN ALUMINUM UNPLATI �Fp (AND F,A,SI' �uARTER CORNF3t NUM_ ) SECTI N 28, T z9 N, R 16W -- - SS 'E 5219.o6 MUUND B ALUMINUM U1VPI,A7T p I" - = ZZP j 5rs.o2' E U •,R N W10 I i 466796' N j tor 1 o. 3 . O IG 1 'IAe WSOR 130,680SQ. Fr. g M 8 $ 1 Z.BI5 A 4 WS yy OR1 � f 2 � 76 � 16SQ. Fr. i Of °aay Z VV c�C �I 0 p G.i ►i�� -;jl 3T 3T q'S I g ZI 61 o + N8g°52'34"W 55j•zo' UNPL,g7TEp LANDS SOUTHWEST CORNER SECTION 28, T 29 N, R 16 W (FOUND "PIC" NAIL) N E LEGEND O Indicates i "O.D. x 18" Iron Pipe Set Scale in Feet t" = loo' (Min. Wt. - 1.13 lbs./lin. ft.) t o0 50 o t o0 0 (� n C orner Monument Bearings are referenced to the Fast -West quarter section Indicates Soil fine of Section z8, assumed bearing S 85 °52'M' & Boring (R = ) Recorded as eta c oNar4 — — _ Roadway Setback Line - (loo' from right -of -way) • LAURENCE W. �• MUlZY >k � �13 • � DE�7VILLEy ^p% �' OWNER'SADRES•S DATED- �••.. ..•' �¢ 737�d1ST. March 31, 2005 r g1.TD 9 Baldwin, WI. 54002 This Instrument Drafted by Mark W. Peavey Vol 19 Page 4999 SHEET 1 OF 2 i .1 D ocu m EN r rlo. STATE BAR OF WISCONSIN FORM 1 - 19Ag THIS vwca RuaRVao roR RacOROIaO owrw WARRANTY DEED _ per � 6GG� i t1 (P��t 2t ( REGM 0FRCE SST. C1 rA co., Wis. This Dead made between Durand- Fe- deral. Savings.&..Loan.• f Aee'd for Record Mm 28th �i PSQ�Ia�iQI 1 .:.... .. ............ ...... . . ..... Jan 87 .... of A.D. 19 . ................ ....•--• ....-....._..-..----.-.-.-....-...-..-- ---•---................_.... -.. Grantor, � :55 and..- Larr.y. W_.&, Susan..D_ Gtibertson,..survivor .mar.i a1. -. -. __. .1 Fr- opLer ... ............. ,- __ .- .� ...... ........ .... .... ..... ..... ...._.......... .......... ........ Grantee, Witnesseth, That the said Grantor, for a valuable consideration of. Thirty- .F-ive.- Thousand.Dolla,s and. N_O /100. .... (35,000.00)... -__._ ... ij RaYURt. TO Durand •re erai Savings conveys to Grantee the following described real estate in . ...... and Loan Association � County, State o! Wisconsin: 890 main, Baldwin, WI 54002 Commencing at the NW corner of the SC of Section 28- 29 -161 thence S 676.5 feet; thence E 550 feet; thence N 676.5 feet; Tax Parcel No: .4z5._5 ......: :__._.._. thence W 550 feet. 'i .F This ...... is ....... ............ homestead property. (la) Ok " Together with all and singular the hereditaments and appurtenances thereunto belor ^ing; Aid .- - -- 4ur.and .Feder.aL Says.n s..� .L.oarA. Association ._ .. - ........ ....... ................. ............... warrants that the title is good, indefeasible in iee simple and free and clear of encumbrances except Easements and restrictions of record. } and will warrant and defend the game. sts Dated this 15th ..... . .............. . .•... ......... day of ........ Januar . ..... 19...$.7... DURAND FEDERAL SAVINGS L A SS , ION - .......... ............... _(SEAL) 'Z............. ........ (SEAL) By: Ronald Hemmy, Presi nt ...... . ... ... . ... ............... ...._.. - .. ...... - .. ......... •....... r ........(SEAL)' ..- ..- ......<<S.! _, i n.- .. .•. - .:... .... .. - - .......... (SEAL) . _ By: Linda L. Weber, V ice President _• - -- •• -- 193 - _ ... � Ar11 S'i+tICATI0N ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN • ............................. ...•-- •-- -•-._..._..._.- .. - - --- •- --- ----- .._.... as. ......... 1?e p.i -Q .................. County. authenticated this ..... —day of— ........................ 19._.... Personally came before we this ..... 15th .... day of ...... Jaguar- y ...... . ..... .......... 19..82.. the above named ___..-_• .............. ..................... ....... . .. -- -Rona d_lie.mmy,..Pses-irient ..and ............. .. ... . . ..... • Linda - L. Weber. Vice _President_ .......... .. ......... ....... - TITLE: MEMBER STATE BAR OF WISCONSIN Durand Federal Savings .. ....... .... Loan__ -• _ - __•______••_ ;. (If not, --- -- - ....._ ..... Association .... -:. .. ..................................... authorized by 1 Wip, Scats.) °-..-.....--.....- to me known to be the person ... (.$-) .... who executed the " foreAng instrument and cknowledg the same. THIS INSTRUxtEr!r'"d DRAFTED SY 11 " .Durand.Fedexal S n s[_.LodA.- Pssociatinn- • Patricia M Radle s .. - --- ._ ...... ......... ..................... ...... r (�e .. �4 ------------- r Ca. - -.. Notary P❑blic �'epin- . - -- . County, Wis. I (Si matures may be authenticaki d 6r acknowledged. Both 'Icy Commission is permanent. (If not, state expiration are not necessary.) ^T t' date: Se - temb P......- .e5 - -34 .. ................. ...... -Names of persons alanine in any ups -i!Y .novld a type'1 or printed Arlon their s(anature.. I STATE 84R OP WISCONSIN wr u•�a. �,�........,,. C 1� 1,1� .1'Zr1111 _ s r7 p - - - -- /! — — — — — — — — — — — — — — — — — — t -- - - - - — —(` ; I aw 11 i t If I I I 1 ......... • d ' � • ar b It I It +� I/ i It I ' / a ..R a J ri. pp 1: R r +' o _ z 4 � � J S ig N b O_ a � Y -0• m z � y � u ��•1X X �,• ll lit• a --- rig t m 3 � i { t