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002-1091-40-100
W iscvnsin Department of Commerce PRIVATE SEWAGE SYSTEM Safetyand Building Division ' INSPECTII~N REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1 }(m}I. Permit Holder's Name: City Village X Township Hel eson, Geor a Baldwin, Town of CST BM Elev: 6v ~ 0 Insp. BM Elev: a BM De~ption: / / ~ 1 vn. j / ~ t TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic -~L~-P/L J - ~yC/ Dosing /~ ~ b i~ "Yy ~UQ Aerationsn ///n /. ' Holding TANK SETBACK INFORMATION TANK TO P/L WEL BLDG. ven~ Air Inta a ROAD Septic } ~ ( y ~~' Dosing ~ ~, ,_ J /, , ~ / Aeration Holding PUMP/SIPHON INFORMATION /_ I/ \ Manufacturer Demand GPM Model Number f~ ~ S i / [ / , TDH Li ~ ~3 FrictionFriction Loss Systet~ H~a~ TDH r Ft Forcem 'n Lengt d Dia. h Z Dist. to Well ~ / ~ (,l1 vb Snll_' ABSt')RPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 487927 0 State Plan ID No: Parcel Tax No: 002-1091-40-100 Section/Town/Range/Map No: 36.29.16.519A STAT NI'i I' (~BZS (Ob• ~S ODVU Benchmark'"'"-"~"- Z, ~~ /~ /~ Alt. BM ~'' x.7,0 /03~ Bld~~ ,~ o->h ??~~ 5-• D /o/ - 2 SUHt Inlet SUHt Outlet ~ '" t Inlet ~ ~ Dt Bottom 9y-ys- eader/Man. 7 3.n / o3,/~ Dis= ipe ~ r ~ 3 /0 ~ ~~ Bot. System Fin de ~' ~O co r~ ~ 3.2(~ / 0 3.6 S ~' ~.9~ /o(v- ~ ~ ~ ~ to l' B ~ ~•~~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~S"" i ~")1 ~ !~ " j SETBACK SYSTE TO P/L BLDG WELL LAKE/STREAM L CH G Manufacturer. INFORMATION CHA R OR T O stem: Yip Y ~ ~ ' M d l N b ~ ~ ~6U ^^~~ ~/6j ~ Z ~ _/ um er. o e ~ ,, r11CTRIRI.ITInN SYSTEM /I'/JA .,//n Header/ ifold Distribution x Hole Size x Hole Spacng Vent t Air Intake . ~7 2 l/ i '?' -7 `` pipe(s) Q ri Z J/ acin ~ ' th ~ 0 ' Dia /' • 2 ~ S L ~ ~ 3 ~ ~, ~ ~ ~ D a Length G p g eng ,ne,w - i cnn r_nvGR ., o............. c..~ss...~ nnl.. .... Mnnnrl nr ef.(:rarla Svctc2m5 AnIV ~ ~~~ ---- -- Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulc d Bed/Trench Center ~~ Bed/Trench Edges Topsoil i ~ Yes f ;'i No Yes I ! No COMMENTS: t(Include code discrepencies, persons present, etc.) Inspection #1:10/ Z-/l Cif Inspection #2:~~/~~} Location: 2610 60th Avenue Woodville, WI 54028 (SW 1/4 SW 1/4 36 T29N R16W) NA Lot 1 ~~~~- `~_ '• Parcel No: 36.29.16.519A C.I~ 1.) Alt BM Description = ~r .ST,w. c~rt~ 2'- ~t ~ ~~ ~~ ~ tl~~ ~~ ~ ~ ~~ ~~ 2.) Bldg sewer length = ~~ ~ (j~ _ ~~ ~-~~a.~~~~,..~j~yy, ~~~ ~.`i•tr ~~ ~ -amount of cover = I (fl'~ ~,~ ~~p(~ ,(~~q,Jc Use other s de for additional in Yes ~ o ~ (~ ^ y ~ ~~ I _ -- - ~ ~ ~v ' formation. ot0 ~ - 1-_~ Date Insepctor's Signature Cert. o. SBD-6710 (R.3/97) s U . _ ~~.eJ ~~ ' Safety and Buildings Division Count ~~Q (,/'~ J~ ` ~ - 201 W. Washington Ave., P.O. Box 7162 I~~ , Madison, WI ~ ~ ~~. 4 (608) 26 3151 '~ nitary rmit Nu ber (to be filled in by Co.) ~ Department of Comm ~9 Z ~,. ~ Sanitary mit Application Plan I.D. Number `.~ g , , ~ ~~ _ ~~ In accord with Comm 83.21, Wis. Adm. Code, personal information yo provide may be used for secondary purposes Privacy Law, s15.04(Ixm , pct Ad ess (if different than mailing address) ICc I. Application Information -Please Print All Information Lr%'"~,~.:.~, 1,~,,,,,,~a .,~'.. "`" Property wner's Name t / /' Parcel # JLot # BfnC,fk71 Property wner's ing Address Property Location l 5-'~~ ~~ ~ U ~ {¢f/Ef • s ~ S w/4 Section ~ ~/< Cit~y~, Stfate j, J VL/ ~J t// d / Y • ~ ~ ~f.. '~/ ~ Zip C//ode (~ ~ Z~ ~ d Pnhone Number / ~~ ~ ~~ , , T ~ N; R~Eco~ _ II. Type of Building (check all that apply) . N f B d ~ F il D lli b Subdivis1on N e CSM Number ng - um er o rooms or 2 am y we e +~ 23`f ^ Public/Commercial -Describe Use V ^ State Owned -Describe Use ^City_^Village Township of ~ r III. T ype of Permit: (Check only ne box on line A. Complete line B if applicable) A. ^ New System eplacement System ^ TreatmenUHolding Tank Replacement Only ^ 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 Plumbe Owner t I 11 ~~ 1 IV. T e of POWTS S stem: Check all that a 1 X ,D - ~• 2• ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable s ound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber Dr' Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: .i- Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation G.' U ~, O A '-~ ~ ~ Z. 5 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units wt~ L~ a~/plr~ ~ -~' Concrete Constructed Glass New Existing ( ~~. Tanks Tanks Septic or Holding Tank tl VU ( / r W ~'C-' .SC ~L Aerobic Treatment Unit Dosing Chamber /' ` Gv ~./ t,GS~2 VII. Responsibility Statement- I, the undetsi ned, assume res onsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb s Signature RS Number Business Phone Number ~` J to ~'~~ S~~h ~ ~ 2~3K?} Try-~~~(-5 Plumber~'sf Adyd~rress (Street, Ci ate, Zip C /,et) /0 / J / VIII. Coun /De artment Use Onl Approved ^ D ed t~cJ Sanitary Permit Fee (i udes Groundwater d ~ Date Issued Issuing Agent Signature (No Stamps) ^ en Re for Denial Surcharge Fee) ,7J T7 j ~~~/ J ~ .D(p ~ 1X. Conditions of A r /R~ val ~ 1 ' ~ ~ a~ ^ n, ~ / ~/ SYSTEM OWNER: 1 Septic tank, effluent filter and t~~~''~ ~ ~b"`^'t d~ ~' ` ~ dispersal cell must al! be serviced /maintained Q U ~ n . _ 8s per management plan provided by plumber. ~`-`""'~ ~P~I t ~~ ' 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the Comity only) for the system on paper not tens tnan aril x tt mcnes m stze 4~ ~C LCl~ SBD-6398 (R. 01/03) I/ i ,! ~ ~. C~k~~~ ~~ ~ ~~' 1~ ~ =~ N f ~~ gk ~, ~ _ ~. S~ ~ ~'~_ M ~\ ~l~ G`~ ~~~ lI ~' ,p i 5G .a t ,. r ~Jlt' e w n /~GI ~~ ~ ~f ~h ~~~~ ~ Q O „ " --"--_ ~. b~'~~n~~~ii . Y ~~ ~ ~ ~c~.,. G ~ ~ - /~-.~ 2 f3~ 1~'//1, d•~• ~ V~~ C~ ~~ t ~ ~ ~ t k` ~ ~~ ~ ~ ~ ~ ,~ ~ -~~ ~ ` ~ ~ ~~ ' ~, v J a 8 ~ ~ ~ 1 3 t - -- > ~~ . ti ~ ` ! t t ,~ ~ ~ ' ~e ~ ~ i / I e~ ,s ` ~i~ ~U ~ t ~) / ~ / ~. ~ 3 ~ i . ~ ~~,j ~ ~~~ sra ,~~ 1 G.c~ ~ ~ a -~ ~ ~ ~ ~~ 5~ ~~ ~ F `' ~} ~ 8- r~ -1 t G.P ` i ` commerce.wi.gov isconsin Qepartment 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 ovls b/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 30, 2005 CUST ID No. 223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/30/2007 SITE: George Helgeson 2610 60th Avenue Town of Baldwin St Croix County SW1/4, SW1/4, S36, T29N, R16W '.Identification Numbers Transaction ID No. 1199778 Site ID No. 703846 Please refer to both identification numbers, above,"in all corres ondence with the a enc . FOR: Description: Three Bedroom Replacement Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1042487 Maintenance required; Replacement system; 450 GPD Flow rate; 7 in Soil minimum depth to limiting factor from original grade; System(s): 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); 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.O1/O1). • 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 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. 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 conditions. • Due to the presence of season soil saturation so near the surface where the tank will be installed, the tank shall be anchored securely per Comm 83.43(8)(8), Wis. Adm. ~.~ 1` $~ Co~Zditionaldy ~PP~®~~n JOE STANG Page 2 9/30/2005 • 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 may 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 maybe 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, ~v~----~ Gerard M. Swim POWTS Pian Reviewer- Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 MOUND ANO PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Helgeson Replacement Mound Owner's Name: George Helgeson Owner's Address: 2610 60th Ave. Woodville, Wisc. 54028 Legal Description: SW 1/4, SW 1/4, S 38, T29N, R18W Township: Baldwin County: St. Croix Subdivision Name: Lot Number: 1 Block Number: Parcel I.D. Number: Plan Transaction No,: a'~GE~v~D SEP ~ 6 Zoos •- _. y ~8~~1.p1NGS 5~~~~ 002-1091-40-100 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evaluation Report Designer: Joe Stand License Number: 223475 Date: 09/2 ~ 5 Phone Number: 5715) 684-5166 Signature: ~L Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81 } DEPARTMENT OF COMMERCE Version 4.01 (R. 09/04) DIVISION ~ SAFE Y AND BUILDINGS Page 1 of 9 SEE GORR PONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 4.00 Site Slope (°~} 100.00 Contour Line Elevation (ft) 6.00 Depth to Limiting Factor (in) 0.30 In-situ Soil Application Rate (gpd/ft2) Note: Sand fill (D) q~ulations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. Distribution Cell Information 4.50 Cell Width (ft) 100.00 Dispersal Cell Length Along Contour (ft) _ ~~ 1.00 Dispersal Cell Design Loading Rate (gPd/ft2) Are the {ateralS the highest point 1 Influent Wastewater Quality (1 or 2) Y in the distribution network? Enter Y or N Pressure Disribution Information (c ore) c Center or End Manifold If N above, enter the elevation (ft 2.25 Lateral Spacing (ft) of the highest point. f L terals 4 Number o a 0.188 Orifice Diameter (in) (e.g. 0.25} 3.00 Estimated Orifice Spacing (ft) = 7.03 ft2/orifice 2.00 Forcemain Diameter (in) 60.00 Forcemain Length (ft) Does the forcemain drain back? ~~ Enter Y or N 90.00 Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 12.25 Vertical Lift (ft) 2.16 Friction Loss (ft) 17.66 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o ions choice 0.75 1.00 125 x x 1.50 x 2.00 x 3.00 x Treatment Tank Information 1000A0 Se tic Tank Capacity (gal) Wieser Manufacturer 9.79 Forcemain Drainback (gal) 62.81 5x Void Volume (gat) 72.60 Minimum Dose Volume (gal) 41.94 System Demand (gpm) Gallons/Inch Calculator (optional) 600.00 Totaf Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) 16.67 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) Zabel ~. Filter Manufacturer 16.67 Dose Tank Volume (gal/in) A100 Filter Model Number Wieser Manufacturer .~ Project: Helgeson Replacement Mound Page 2 of 9 Center Connection Lat®ral Layout Daigram Farce mai n connection Mia tee or cross to rnanirold at any point Laterals ~e 6dent~al 1 P •=Turn-up+rel'ballualvecr ~-X-}IFxYL xf2~ Laterals~forcem~ofPVCSch40 cleanaitplu9 per COMM Table 84.30-5 holes driNed a~ the bottom of the lateral. S Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head Orifice Diameter 0.188 in Orifice Spacing pC) 3.18 ft Orifices per Lateral 16 Orifice Density 7.03 ft~lorif Manifold Length 2.25 ft Manifold Diameter 2.00 in Forcemain Velocity 4.28 ft/sec Dose Tank information ~ocbng with warning label and ktt~dng device and sealed watertight Electrical as per NEC 300and --~ Comm 16.28 WAC Disconnect ~ 4 in. min. ~1 -1- ~- 7ank componer>t is properly vented ~ ': 'E- Alternate outlet kx:atiort Wieser Ca aci 600.00 Volume 16.67 Manufacturer Gallons gaVinch Dimension Inches Gallons A 20.64 344.03 B 2.00 33.34 C 4.36 72.60 D 9.00 150.03 Total 35.99 600.00 ~- A B C D Forcerrlain diameter ~ 2 in. weep twle ~ at>ti- siphon device ~-~-elevaton (tt) 90.75 . Dose tank elevation (ft) 90.00 Project: Alarm Manuafacturer SJE-Rhombus Controls Alarm Model Number Tank Alert 1 Pump Manufacturer Goulds Pump Model Number 3885 WE05H Pump Must Deliver 41.94 gpm at 17.66 ft TDH ~Helgeson Replacement Mound Page 4 of 9 Mound Svstem Maintenance and Oaeration Specifications Service Provider's Name ~- Joe Stang _ Phone 1-715-684-5166 POWTS Regulator's Name St. Croix Count 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 Capaaty 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Colifomt >10E4 cfu/100 mL Service Freauencv Septic and Pump Tank Effluent Fitter Pump and Controls Alarm Pressure System Mound Other Ins ct and/or service once eve 3 ears Should ins and clean at least once eve 3 ears Test once eve 3 ears Should test months Laterals should be flushed and ressure tested eve 1.5 ears Ins for ondin 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 (8)(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 chile! plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished •~~~~~~~~~~~~• •~~~~~~~~~~~~~• Grade \ 6-8" Diameter ~ ~/_ Threaded Cieanout Sprinkler Valve Box Plug or Bail Valve Distribution Lateral ~y- Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Helgeson Replacement Mound Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code en rat This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in axordance 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 presets that could cause dceth. Septic and pump tank abandonment shall be in acxordance 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 shook! be inspected for water tightness and soundness. Access openings used for service and assessment shall lie sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry itrto a tank or component. ~c 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 finer shalt be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless proviskxis are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent faker 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 stodge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally nat required. However, if such products are used they shah be approved for septic tank use by the Department of Commerce. Puma 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 lt shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings maybe made around the mound's perimeter, and the mound shalt be seeded and muk;hed as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommehded since soil compaction may hinder aeration of the infiltrative surface within the mourxf and snow compaction in the winter will promote frost penetration. Cold weather installations (October-Febnmry} dictate that the mound be heavity mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mglL BOD3, 150 mg/L TSS, and 30 mgtL FOG for septic tank effluent or 30 mg/L BODg, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highty treated effluent. Influent tkna may not exceed maximum design fbw speafied in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and lt is recommended that each lateral be flushed of acx;umulated solids at least once every 18 months. When a pressure test is performed lt should be compared to the initiaal test when the system was installed to determine if orifice clogging has occurred arm if orifice cloning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Porxting levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monltoring. Continaencv 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 conditron. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective cwmponent(s) shall be immediatety 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, lt will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by rerrwving biologicaity ckgged 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 fa the name and telephone number of your local POWTS regulator and service provider. Project: Helgeson Replacement Mound Page 6 of 9 ~[~~ou~us PuMPs Submersible Effluent Pump EP04 & EP05 Series .....~ ~~~ ~: • .~ ~d • 9 SPE~FICA'IKINS Sorids halidCaig capability: ~/1' m~dmlari. • Capadlies: up m 60 GPM. • TOIL heads: uP~ 31 fleet. • Disdlarge size:l'/4' 14P'[ • tlAediaa~ seal: ~rboo- ~- Bl1NA-N elastariers. • ~: 104• F {40° q continuous 140• F (60° q i~rlw0ent. • FaSte11e1S 300 SeneS Sr Steel. • `~1°'~ O1 f Wily dry MIIOIOirt damage t0 Mob: • EP04 Single phase: 0.4 HP, 115 or 230 V, ti0 Hr, 1550 RPM, bait in OYelload wish automatic reset. •EP05 Single phase: 0.5 HP, 115 dor 230V, 60 Ht,1550 RPM, bie1t it Overload whti ailjomatic resEt. • Power aord:l0 foot statidand letigtli, iti13 SJTW wih three prong groi~ng plug. Optional 20 ~ ferlgtll,16~13 SJTYV with three P~9 9~9 Pw9 (stmrdand on EP05). • ~ ~' Ilrhrication and eR~nt ~~ rradels include Madlarial ADatSyYi~d1 asaertrbled artd presets at the factor3C FEATINIES ^ EP04 61rpeNer: Themw- with poi niedssldcal seal projection. Marais .l~r = 6 V_ 5 0 a 4 O t ~~~ superior streli~i and aorro~oli resistance. ^ Mo1or ilousin¢ Cast fires for eificknt Beat transk~G strength, and dirrabi~ ^ Mob' Gables: Thenriop~tic covervhdl l handle and float sw~ch attachmait pants. ^ Pbwe~ Cabin Severe duty weed viand vra~ef resi~tarrt. ^ Bearilgs: Upperand bwer ~~ • Assoaebe. u: fie ~ u3i5~ 6o~idcll~s tc6Dl6Gt Neg'sfnad o coos m vwse. in< EsieaMe ~ Loos B~, 20 __._-- GPM GODS Pul'Y7~76 ITT Industries ~Q q ~ ~ 6 U 0 2 4 6 8 ~ ! ~y 1Q ~ D1~ m~/h ca-Paarr ' "l, J . , ~ U t: ti ~ r,,~ . _ ~.__~_.»:_ . _,~ _ _ .. _~~~._~__w.~...._ ~ ~~.. _.~ _ . ~/ ~ s~ ~~~~~~ ~ ~,~~ l ~~ ~ ~r Lx -~ ~ ~" ~~ ~ . ~ ~~ `~ ~~ ~ ~~„°" - m -1 t mil' ~ ~ l `' ~ ~ Q-1- ~ o ~ ~_~ ;. t 3 ~~~~ ~ U ~ . . ~ ~ ~ try ~ \ $ ~ a, tq `\~ o ~ `'~ _fr~ ~ ~ 1 1 ~'~ 1~i5,L~ ~ ~~~~, ~~ ~ ~ ~ X83 i '"'' ~l t { i 1 i S~~G ~ ~ ~ ~d ~ ~ ' ~ / ~ `' / I , ~ ~3> r ~ rf L er ~ ~ / vN i ~ 1 ,< ~~ yv~ ~ ~ ~ Gf ? ~~ f ` f FR"f C~. ~ ~ a --~ ~ ~ a ~ ~~ ~~} ~Q ~ cw,nty St Croix Attach complete site plan ~ paper not less than 8 Y, x I I inches in size. Ptah must . Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 002-1091-40-100 Percent slope scale or dimensions north arrow and BM referenced to nearest road. , , , Please print all information Reviewed by Date Personal information you provide maybe aced for secondary purposes (Privacy Law, s. 15.04 (1) (m)) properly Owner Property Location Geor a Het eson Govt. Lot SW y. SW i, s 36 T 29 N R 16 w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2610 60~' Avenue 1 Ciry State Zip Code Phone 0 City ~ Village ®TOWn Nearest Road,,,, Woodville WI 54028 715-698-2664 Baldwin 60a' Ave. ^ New Construction Use: ®Residential ! Number of Bednooms~_ Code derived design flow rate 4~0 GPD 0 Replacement ^ Public or Commercial -Describe: Parern Material Loess Flood Plain elevation if applicable NA ft. General comments and recommendations: ** Redox features includes spots and Redoximorphic masses. The features identified as spot are lmm or less in size. Boring # ClBoring EI Pit Ground Surface Elevation 100A ft. Depth to Limiting factor $ in. Cnil Anni'~r~tinn r2ata Horizon Depth Dominant Color Redox Descxiption Texture Structure Consistence Boundary Roots G D in. MunseN u. 5z. C nt. Color Gr. 5z. Sh. •Eff#1 *Eft#2 1 0-3 10YR2i2 None F SIL 1-co-sbk dh cs 3f 0.4 0.6 2 3-8 10YR2/2. None SIL 3-m-sbk dh as 1f 0.6 0.8 3 8-12 10YR5/3 ;;; S{L 2-vftom-pi ds gs 1f 0.0 0.2 4 12-20+ 10YR4/4 f-1-f 10YR5/6 CL 2-f-sbk dsh - 1f 0.4 0.6 Boring # ~ Boring ®Pit Ground Surface Elevation 100.2 ft. Depth to Limiting factor 7 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P D/ft2 tn. unseN Q . Sz. Cont. Cobr Gr. z. Sh. 'EtT#1 *Eff#2 1 0-7 10YR3/2 None SIL 1-f--sbk dsh cs 3f 0.4 0.6 2 7-11 10YR3/2 f-1-d 7.5YR4i4 SiL 2-m-sbk dsh as 1f 0.6 0.8 3 11-12 10YR5/3 f-1 f 10YR5/4 SIL 1-f-pt ds cs 1f 0.4 0.6 4 12-18 10YR5/4 r-"~ a SICL 1-m-sbk dsh - 1f 0.2 0.3 r;IrtlkYlr 8 r = rfUl)s > SU ~ llV mg(L BtIU 1JJ > 3U ~ t ~V mg(L ' brriUent rfL =13Vi15 ~ SU m$/L and 1 JJ ~ 3U m$/L CST Name (Please Print) CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 August 16, 2005 715-796-5664 ~~~L ~~~~ Site Loc~on Section 36 X i ~. House '$s. 70~• m B-2 to B-1 at agrees NNE nth of the 100' rr from B-1 to proximately 120' South property boundary >50 south of B-2 Q =Well Location -- - -' - =Estimated contours to show general slope B~E~p~'-~ =Bench Mark ~' =Boring Location & Elevation House and well location to be determined Owner. George Helgeson Site Information: Compieted By: Mark Iverson, PSS #197 261060th Ave SW 1/4, SW 1/4, S36, T29N, R16W 680 Larcom Street Woodville, WI 54013 Town of Baldwin Hammond, WI 54015 St. Croix County 715-796-5664 0 ft. 30 ft. 50 ft. 100 ft. place system page 3 on the 100' of 3 contour .. . _-~ '~ DOCUMENT NO. ~'' STATE BAR OF WISCONSIN FORM I-lYef•~ Tres s~ac^ RESERVED reR REeoROiNO osta ~: WARRANTY DEED ' f, _. ~ _. -_ dog S~__ Pa~t_ . U REGISTER S GFFICr _ __ This Deed, made between .. Ge.arga.. W....H.@l9esO.n...dA.d . ~~ `~• ~ROIX CQ.~ WI , ~ ' Lucille .Helgeson, husband and.. wl.>~.el.. as . jciri.t......... , Rec d for Record '~ tenants __ .. _..................., ............. i APR241~91 ........ Grantor. ~~ ~ 8:30 A. M ~' and Paul A_ Helgeson..and.Judy-.R...Helgeson...-- " - ~~ ~~ husband and wife as sur.vivorshi marital. ~' ~ C'°~""~X. ''~ p.. ....... .. i ~ a. RegisMr of Deeds ~ . property _._ . _....... _.:__.......... .. _....... .. _ ----....... .. ., Grantee, 1,~ritnesseth, That the said Grantor, [or a valuable consideration-..... __ --- One dollar and. other valuable.. consi.der.a.tion--:-.. ; ~ _ -_--- -_- ~- - RETURN TO ~' conve s to Grantee the following described real estate in .. $t.,. -Cr-OiX- -- •-~- County, State o[ ~ isconsin: ~', - _ ------------------~1 The Southwest Quarter (SW 1/4) of the Southwest Quarter (SW 1/4) of Section Thirty-six (36) i Taz Parcel No :.................................. Township Twenty-nine (29)~ Range Sixteen (16). I EXCEPT Lot One (1), of Certified Survey Map No. 2344, volume 8, page 234-~~; of Certified Survey Maps Docum`nt No. 468073. ~t s ~ S (~ f F,E T^is is- nOt-~~ - -homestead property. lis) (is not) Together with all and singular the hereditamenta and appurtenances thereunto belonging; And Grantor........._- __ ............. ... . ........._. ..- ._ ._..........- -..... ..._ -...- -............... warrants that the tale is good, indefeasible in iee simple and free and clear of encumbrances except and kill warrant and defend the same./ Uated this .. _.... -._ . ~~ Nc~... .-. day of . . _ - _ - --tsEAL> ~~.ei~ -..., s..91.. x~i~:~~Crcz/ .ski. c- L~'~~.a~~-~..t S EAL ) George W. Helgeson ~~-~t~a/ ..... ~.~4</~.~-ec:~!z/. (SEAL ) Lucille Helgeson AIITHENTICATION ACKNOWLEDGMENT Signature(s) ----------------- -------•---.•---------•---......----...... STATE OF WISCONSIN St. Croix gg• ----•---•-•----------------• •---......County. authenticated this ...._-.-day of .........................., 19.-.... Personally came before me this lc:.lt!s~ .day of ---------------/~~r'.1~-.........., 19..9,1.. the above named •---------------------------------_...-........--------•--•----•-----•-------- -----Geor-ge..y,1_--Helgeson..and-------•-~----------- TITLE: )fE)IBER STATE BAR OF NISCONSIN -.•--LL3G-ills---HelgBSari--•-••---••-••--•-----••••-~------- (If not. -•- --- - --- --- -----------------•--- -------•----.. authorized by ~ 706.06, Nis. Stets.) to me known to he the persong.....-..... who executed the foregoin instrument and acknowledge the same. 7M15 ~NSTRU MENT WAS CR4 F7ED BY ---------- - BAKKE r NORMAN i SCH_UMACHER r t ~~~~ ~ ~~~~~~ _ --- --- -------•- - -- -Diane B. Willett ~' SKINNER 3t WALTER S.C. - - - ----- -- --•----- -- -- ---• ---- -- - - ---- _...--•--••-------••----- -- -• ............... Notary Public -- St-.-- CraiX -.... --.Counh•, Nis. ~; (Si;naturPS may he authenticated or acknowledged. Both 31~• Commission is permanent. (lf not, state expiration I _ i ; are not necessary.) date: `"! .::~...._, 19.l~ ~ J ji j: •Namea or perwn~ .~Rnin` in any capaci!y ~hou!A be type.t nr prin~e.l brlow their eiQnatures. ~lf 8• ~~~ Nadroy Pt,aiC t ~ .~ d We>cwlein ~IIGfl1~f STATFURN Ns. 1 1981 SIN StOCI( NO. ~ $~~ FORM N0.9BSA ~IlG.R1Wro Stock No. 26273 480'73 CERTIF/E'D SURVEYMAP NO. 2344 VOLUME s PAGE 2344 PART OF THE SW. 1/4 OF THE , , SW.1/4, SEC. 36, T29N, R l6 W, TOWN OF BALDWlN, ST. CR OlX C WISCONSIN APPROVED 9 FILED APR 7 2 5991 ' S APR 0 91991~- ~ ST. CROIX CCiJ!vr'r t- WEST fp CORNER S£C. 36• r29N• alsw G~O1ViPAfH[:IJSIVE PAfti(5 RI.NrN~FY;. JAAAES O'GONNEI.i. ZOA1JlK:Gt~A+MtT7=(; FND. 7.V70 " Rf -BAR ~ SCALE ~ !J' = 200' ~ ` h 3 ~ O~ 30' 100' 200' 300' 500' N ~ e e o g n w i z ~ W N J'= ~ N C 3 awo "~ LEGENDJ FW ri n o ' ry 0 x 0 - GOYS RNNENT CORNER (AS NOTEO) ~ O •- 0 ry ~ •' o- S£T 3/4" a 24" RE-BAR 1.302 LBS. PER LJNfA1 WffGNlNG FOOT u b W ~ 3 W 3 ~ W - ry O 10 ) W ~ ry ti o O N = b a UNPLATTED wW 3'~ LANDS ~ H _+ ~ ABANDONED C. Sf. P. N, 8 O RR f I ~I q ~•y~~s G O N S: j •.~ l o ~ ,,........ . Z •. LOT / ~~ ~ c~A~x " ~ M __ s-~sso = - b EXCL4DING R/w w R/W 4la,33J so.Fr. 2l 8 ;. s MENOMONIE,•=~, ~ O TOTAL , J7 SO. FT, (0.3 AC.J ,p ~' ~p V +•• v N x36,348 SO. FT. I (0.02 AGSJ O ~ ~ •' • ~ _~1M W I cV 4J ~~ Q, N O OWNERS GEORGE NELGESON N 41 w J O 26 ~ ! , QI O i 10 60 TN AYE. WOODYiLLE, Wf 34702 Np, ° ° Fes, F+, ~~~~ ~ 9~ z. ~~ e o a. --~1 wi ^~ u 0 y 4 f n N.86o34'36"W 661.13' ~ ~i 6~ Tl'I JavE.J SOLTN LJNE OF $W. I/4 SEC. 38 661. l 3 SOUTHWEST CORNER SEC.3B• T29N, R16W FND. RR SPIKE '~~ ~ f9B3.87' N.88054'36"~ 2647.10' SOIJTM 3 EC. 38.. T29 N~RR 6W UNPLATT~p FND. 3/9"RE-B4R _LAIVOS eo w~isolvPOVRii4vutQN VOLUME 8 PAGE 2344 ME`) 2~ N~IEi Wl 54757 A4GE ! OF Z sT. cROrx covNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ mac, 2~ ~ Mailing Address ~~ -~~~~~ Sam Property Address ~ ~~ -~ (Verification required from Planning & Zoning Department for new construction.) rr ~ s City/State ~~U dv~ ~ ~~ ~i FarcelldentificationNumber - ooZ-/aq/-~o-1~ (.SI9A~ LEGAL DESCRIPTION Property Location S~ %4 , ~ ~ 1/4 ,Sec. ~ ~ , T ~ ~ N R~W, Town of l~ ~ l ~ ~ ~ `~ _ _ _- _ ._ _____ __ _ __ _ _ _- _ ____ ,Lot # ~_ ._ Subdivision_ p Certified Survey Map # ~~8~d ~ 3 ,Volume 0 ,Page # Z 3~. Warranty Deed # ,Volume ~~l c ,Page # ~~ Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION I~roper use and rnaintenar~e of your septic system could result in its premature failure to handle wastes. Froper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted phmiber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Depardnent of Natural Resources, State of Wisconsin. t.eriification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed ra;orded in Register of Deeds Office. Number of bedrooms SIGMA F APPLICANT(S) DATE *'"*.Any information that is misrepresented may result in the sanitary permit being revoked by the.Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/O5~ ,,<,;.. f* !, P.o. t~ ass: Han,mona, tnn sao~s {~`~°~ ~ ®~' .~~?' : amass-~. ~ ~nsase-was August 31, 2005 George Helgeson 2610 60"' Street Woodville, WI 54028 RE: Interpretive Site and Soil Evaluation Dear Mr. Helgeson: '~~.~' ~~ 2 200a ST. CRO(X COUNTY ZONING OFFICE Enclosed is a copy of the Interpretive Determination Report and Wisconsin Department of Commerce approval letter for the Interpretive Determination Report completed at the your property. Copies of the report and approval letter have been submitted to St. Croix County and Stang Plumbing. If you have any questions or comments please feel free to contact me via a-mail at evergreenetc~a,baldwin telecom.net or telephone at 1-715-796-5664. Sincerely, Evergreen Irrigation Inc. Mark Iverson Professional Soil Scientist Enc. cc. St. Croix County Zoning Department Stang Plumbing 0 Parcel #: 002-1091-40-100 10/06/2005 04:20 PM PAGE 1 OF 1 Alt. Parcel #: 36.29.16.519A 002 -TOWN OF BALDWIN Current X' ST. CROiX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current CaOwner O - HELGESON, GEORGE W &LUCILLE GEORGE W &LUCILLE HELGESON 2610 60TH AVE WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description * 2610 60TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 10.020 Plat: N/A-NOT AVAILABLE SEC 36 T29N R16W PT SW SW LOT 1 CSM BlocklCondo Bldg: 8/2344 Tract(s): (Sec-Twn-Rng 401/4 1601/4) C ,~ ~ I 1 f a C~ ' , (1 36-29N-16W CC ,, ~~ss» SS11 Notes: ~ Parcel History: Date Doc # Vol/Page Type 9f1A~ CI IMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations' Last Changed: 06/29/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 6,000 80,800 86,800 NO AGRICULTURAL G4 9.020 500 0 500 NO Totals for 2005: General Property 10.020 6,500 80,800 87,300 Woodland 0.000 0 0 Totals for 2004: General Property 10.020 6,500 80,800 87,300 Woodland 0.000 0 0 Lottery Credit: Glaim Count: 1 Certification Date: 04/17/2001 Batch #: 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r commerce.wi.gov • isconsin Department of Commerce Sl . CROIX COUiVTY Safety and Buildings 10541 N RANCH ROAD t-IAYWARD Wt 54843 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 30, 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 PLAN APPROVAL EXPIRES: 08/30/2007 SITE: George Helgeson 2610 60TH Ave Town of Baldwin, St Croix County SW 1/4, SW 1/4, 536, T29N, R16W Identification Numbers Transaction ID No. 1190302 Site ID No. 703846 Please' refer to both identification numbers,- above, in, all corres ondence with the a enc . FOR: Object Type: Soil Saturation Determination Regulated Object ID No.: 1037111 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. Approval is hereby granted pursuant to s. Comm 85.60(2), Wis. Adm. Code, to estimate the depth to seasonal soil saturation based on an interpretive determination process. Approval of the interpretive determination negates the requirement in s. Comm 85.30(2)(b), Wis. Adm. Code to designate the ground surface as the 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 seven (7) inches below grade. At least 30 inches of sand lift on top of six (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 < 4.0 gpd/ft. 4. Chisel plowing to a depth of 12-14 inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. Three to four inches of sand fill may be placed on the basal area prior to plowing and then chisel plowed in to improve sand to soil contact area. 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 8/30/2005 A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives ofthe-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 construction installation/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. Sincerely, /d Leroy G. J ky, PSS, astewat Specialist Integrated Services Bureau (715) 726-2544 Voice (715) 726-2549 Fax lj ansky@commerce. state. wi. us Fee Required $ 100.00 Fee Received $ 100.00 Balance Due $ 0.00 WiSMART code: 7633 INTERPRETIVE DETERMINATION REPORT Property Owner: George Helgeson 2610 60th Ave. Woodville, WI 54028 1190302 Site Location: SW 1/4 of the SW '/4, Sec. 36, Town 29N, Range 16W Town of Baldwin St. Croix County P.O.W.T.S. Conditionally ~PRROVED DEPARTMENT OF COMMERCE DIVIS~O OF SAFETY AND BUIiDING3 Prepared by: S E COR SPOND CE a Mazk Iverson, PSS #197, CST #46672 August I9, 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. Additional Data ............................................................................................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 I. INTRODUCTION On August 16, 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 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 acceptable soil is present). The onsite evaluation was completed through the observation of the soil profiles at four hand dug test pit locations. This report has been prepared to present the results of an interpretive determination completed to determine site suitability for installation of a POWYS. The evaluation was completed at the request of the homeowner, George Helgeson. The evaluation was completed to identify a location to site a replacement POWYS for the Helgeson residence. The current system includes a septic tank with surface discharge. The location of the current system is identified on the figure included in Attachment A. The property is located east of Woodville on the north side of 60~' Avenue. Bennie Helgeson of Helgeson Plumbing and Excavating completed a preliminary soil evaluation. The preliminary evaluation included the entire property (10 acres) and concluded that A+4 soils were not present on the site. Mr. Helgeson identified the location the interpretive determination was completed as the most suitable location on the site for installation of a POWYS. No data from the preliminary assessment has been included. II. PROJECT INFORMATION The following is site-specific background information, which has been collected: Property Owner: George Helgeson 2610 60`" Avenue Woodville, WI 54028 715-698-2664 Site Location: SW '/4 of the SW '/4, Sec. 36, Town 29N, Range 16W Parcel ID # 002-1091-40-100 Town of Baldwin St. Croix County Historic Land Use: Agriculture Crop Production /Pasture Current Land Use: Pasture Vegetation: The site is currently vegetated with miscellaneous grasses and thistle. 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. Small depressions are present on the downslope side of the proposed system area. These depressions are 4 to 8 feet in diameter, b to 18 inches deep, and are downslope of the 99' contour identified on the site map included in Appendix A. 2. Subsurface Water Drainage -Limited compaction was present within the upper 3 inches of the surface horizon over portions of the proposed POWTS location. The compaction is most likely due to continued use of the property for grazing purposes. The compaction may slightly limits the infiltration of surface water. Areas with less compaction offer good infiltration for the typical rain event. During frozen conditions and following heavy precipitation events, runoff will be much greater. The moderate structure of that Ap does allow for 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 18 to 22 inches. 6. Surface Water Elevations- Surface water within 1/4 mile of the site has been identified on Figure 1. The nearest surface water feature is an intermittent steam located approximately 200 feet northwest of the site. B. Geomorphology 1. Parent Material -The parent material is loess over dense glacial till. 2. Landform Type -The proposed system area is positioned on the foot slope of a till plain just above an intermittent drainage way. The till plain extends up to the east for approximately '/4 mile. The general slope shape in the vicinity of the proposed system area is linear convex. 3. Slope Aspect -The slope aspect with in the proposed system area ranges from WSW at 240 degrees to NW at 310 degrees. 4. Surface Elevation -The surface elevation is between 1160 and 1180 feet msl. C. Soil Disturbance and Hydraulic Modifications The proposed system location is in a pasture. According to the owner the pasture had been farmed previously, prior to that a homestead had been present west of the proposed system area. The proposed system location has not been severely disturbed by cutting or filling, although some filling has occurred in the vicinity of B-3. No hydraulic modifications, such as drain the or ditches, were observed at the time of the assessment. No additional surface water is received from impervious surfaces. 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 - northwest as shown on the map. The ground surface elevation is between 1160 to 1180 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. E. Soil Series and Mapping Units The Soil Survey of St. Croix County maps the soils on the Helgeson property as Floyd (FdA), Skyberg (SrA), and Vlasaty (VaB). The location of each soil type is identified on Figure 2. The primary soil characteristics as described 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 - NRCS Technical Guide - Hydric Soil Interpretations and in US Army Corp of Engineers (USACOE) hydric soils list. FIGURE 1- USGS TOPOGRAPHIC MAP TABLE 1-SOIL SERIES CHARACTERISTICS Texture Parent Material Permeability Soil A E or B Surface Subsurf. Surface Subsurf. Drainage Series Horizon Horizon Class FdA 1 scUsl/1 Till M M SP Sed. SrA sil siUsicl Loess Till MS or S MS or S SP VaB sil siUcl Loess Till MS MS MW Abbreviations Permeability IM =Impermeable VS =Very Slow S =Slow Draina eg Class VP =Very Poorly P =Poorly MS =Moderately Slow RA =Rapid M =Moderate VR =Very Rapid MR =Moderately Rapid W =Well SE =Somewhat Excessively SP =Somewhat Poorly E =Excessively MW =Moderately Well Table 2 - H dric Soil Classifications NRCS -USDA Soil Series Com onent Inclusions USACOE FdA No Clyde No SrA No Auburndale No VaB No None 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. 4 FIGURE 2 -SOIL MAP F. Field Observations The soil identified during the completion of the test pits closely resembles the Skyberg series except that higher chroma colors are present in the E and B horizons. Skyberg typically has dominant low chroma matrix colors in the E & B horizons such as 10YR4/2 or 2.SY5/2. Compaction is an issue on this site as the site has been used for many years for cattle grazing. Significant compaction was observed within the upper three inches at B-1. Structure was present at this location however it was coarse blocky versus fine blocky or granular as is typically observed in the surface horizon. At the time of the evaluation the consistence was dry hard (dh). The same level of compaction was not observed in all of the test pits. Redoximorphic features were observed as Fe concentrations and occasionally as iron depletions in the E and B horizons. Redoximorphic features were observed in the A as f-1-d features at 7 inches below surface in Boring #2. The redox features observed in or just below the A horizon can most likely be attributed to short term seasonal saturation. The redox features are also a result of low permeability due to, the platy structure identified beginning at 7 to 11 inches below surface. The platy structure is most likely a result of previous tillage completed on the site. 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 boring (B-4) was completed down slope 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 down slope is similar to the soil upslope. 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 7 inches of the soil profile. 2.) Hydric soils are not present within the proposed system area. 3.) There are no features that concentrate surface water flow toward the proposed location of the system. 4.) The slope at the proposed system location is 3 to 5%. The slope is uniform with no dips or valleys. 5.) Although compaction is present within the upper three inches of the surface horizon at certain locations on the site, it does not appear to have increased the retention of water within that layer or caused a total loss of structure within that horizon. Annual root growth has reduced the effects of compaction sufficiently. 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 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/ft2 for EFF#1. 5.) The system shall be designed to have a linear loading rate of 4.5 GPD/ft or less. 6.) The system will follow the 100 foot contour and have a concave 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). VI. REFERENCES l .) 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 Surve~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 : //terraserver. micro soft. coral 6.) St. Croix County. St. Croix County Land Information System. http://72.21.23 0.178/website/pasystem/gisportal.htm 7.) United States. United States Department of Agriculture -Natural Resources Conservation Service. Hydric Soil List for St. Croix County, Wisconsin. ftp://ftp-fc.sc.egov.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. 7 APPENDIX A SOIL EVALUATION REPORT Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings In accordance with Comdr 85, Wis. Adm. Code Page 1 of 3 County CTOIX St lete site plan on paper not less than 8'h x I 1 inches in size. Plan must Attach com . p Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 002-1091-40-100 and BM referenced to nearest road north arrow scale or dimensions Percent slo e . , , p , Reviewed by Date Please print all information Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location Geor a Hel eson Govt. Lot 5W 'i< SW 'r< s 36 T 29 N R 16 w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2610 60th Avenue 1 City State Zip Code Phone ^ Cjty ^ Vil lage 0 Town Nearest Road Woodville WI 54028 715-698-2664 Baldwin 60th Ave. ^ New Construction Use: aResidential /Number of Bedrooms___~_ Code derived design flow rate 450 GPD f?J Replacement ^ Public or Commercial -Describe: Parent Material Loess Flood Plain elevation if applicable NA ft. General comments and recommendations: ** Redox features includes spots and Redoximorphic masses. The features identified as spot are lmm or less in size. Boring # OBoring D Pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor 8 in. Qnil Annlirafinn Rata '. H rizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft~ o p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-3 10YR2/2 None SIL 1-co-sbk dh cs 3f 0.4 0.6 2 3-8 10YR2/2 None SIL 3-m-sbk dh as 1f 0.6 0.8 3 8-12 10YR5/3 f-1-f t0YR5/6 f-1 -d 10YR3/4 SIL 2-vf to m- I P ds s 9 1 f 0.0 0.2 4 12-20+ 10YR4/4 f-1-f 10YR5/6 CL 2-f-sbk dsh - 1f 0.4 0.6 ^ Boring 2 Boring # ppit Ground Surface Elevation 100.2 ft. Depth to Limiting factor 7 in. Soil A lication Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP O/ftZ p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 *Eff#2 1 0-7 10YR3/2 None SIL 1-f-sbk dsh cs 3f 0.4 0.6 2 7-11 10YR3/2 f-1-d 7.5YR4/4 SIL 2-m-sbk dsh as 1f 0.6 0.8 3 11-12 10YR5/3 f-1-f 10YR5/4 SIL 1-f-pl ds cs 1f 0.4 0.6 4 12-18 10YR5/4 f-1<it0YR5/28 t OYR4/6 SlCL 1-m-sbk dsh - 1f 0.2 0.3 . Ff'Fl~~P~r at = Rnn,> ~tn <?~n mon .and TCC > ~n < t 5n mo/t. • F.ftluent #2 = BOD. < 30 m¢A. and TSS 5 30 mg/I. CST Name (Please Print) ~-__Nature CST Number Mark Iverson °~"'~ 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 August 16, 2005 715-796-5664 Property Owner Geor e Helgeson Parcel ID# 002-1091-40-100 Page 2 of 3 Boring # ~ Boring aPit Ground Surface Elevation 99.0 ft. Depth to Limiting factor 10 in, Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P /ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EtI#2 1 0-6 10YR3/2 None SIL 2-f to m-sbk dsh As 2f 0.6 0.8 2 6-10 Same as above wJ burnt material, glass, 8 metal As 1f 0.6 0.8 3 10-13 10YR5J3 f-1-d 10YR6/2* SIL 2-vf to m-pl Ds Cs 1f 0.0 0.2 4 13-17 10YR5/4 f-1-f 10YR5/6 SIL 2-m-sbk Dsh Cs 1f 0.6 0.8 5 17-22+ 10YR4l4 None CL 3-m-sbk Dh - 1f 0.4 0.6 ' 10YR5/4 redox is visible when dry Boring # ~ Boring OPit Ground Surface Elevation 96.3 ft. Depth to Limiting factor 7 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efl#1 *Eff#2 1 0-7 10YR3/2 None SIL 2-f-sbk dsh Gs 2f 0.6 0.8 2 7-11 10YR5l3 10YR4/6 f-1-d SIL 2-f to m-pl Ds Cs 1f 0.0 0.2 3 11-14 10YR5J3 10YR5/6 f-1-f SIL 2-m-sbk Dsh - 1f 0.6 0.8 ^ Boring Boring # ppit Ground Surface Elevation ft. Depth to Limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Efl#1 *Ett#2 * Effluent # 1 = BODS> 30 5 220 mg/L and TSS > 30 S 150 mg/L * Effluent #2 = BODS <_ 30 mg(L and TSS <_ 30 mglL 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. Site Location 0 ft. 30 R. 50 ft. 100 ft. Section 36 N place system page 3 on the 100' of 3 contour X 60th Ave eM~`e °~`o ~i ° f~~ s yr eM~T` T TO~~ e~ `Y °p°p1+ esfs~a Shed pVC e °fb T A~ ~''~d' urre n ~o• o~scr,a~9e ~e oca6o s~,~,. a M ~ CO B- / ~ o S/o .a F / ~ i o / a~ n/ .' ~ ,~ c o e i ~ B-4 B 3 ~ n ~ ~ 96.3' 0 '~ ~ >~ ~ ST ~ ~ '~ ~ Q ~ `'~5~1~ ToT,\ \ ~ ~ \ House a ~ o x ~ ~~ v 2 \ ~ ~ 1 '1~1, ~ 108' from B-2 to B-1 at 2 degrees NNE 7p~, The tenth of the 100' 99, contour from B-1 to B-2 is approximately 120' s~ South property boundary >50 south of B-2 Q =Well Location - - - - =Estimated contours to show general slope i3tui# & Description =Bench Mark &' =Boring Location & Elevation House and well location to be Elevation ~~' determined Owner: George Helgeson Site Information: Completed By: Mark Iverson, PSS #197 2610 60th Ave SW 1/4, SW 1/4, S36, T29N, R16W 680 Larcom Street Woodville, WI 54013 Town of Baldwin Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-698-2664 CST# 46672 commerce.wi.gov isconsin Department of Commen:e INSPECTION REPORT SAFETY AND BUILDINGS DIVISION Integrated Services Bureau 13 East Spruce Street Chippewa Fatls, VVI 54729 www.cornmerce.wi.gov/sb (715)726-2544 Date of Inspection: August 24, 2005 Project Name: Helgeson Use: Residential Legal Description: SW, SW, 36, 29, 16W Site Number: 703846 Subdivision: CSM Lot 1 Municipality: Town of Baldwin County: St. Croix Plan Transaction Number: 1190302 Sanitary Permit Number: NA Wastewater Flow: 450 gpd Persons Present: M. Iverson Owner Name and Address: George Helgeson 2610 60th Ave Woodville,lNl 54028 (715) 698-2664 Certified Soil Tester Name and Address: Mark W. Iverson, CST 46672 PO Box 155 Hammond, WI 54015 Plumber Name and Address: NA An onsite soils verification was conducted at the above referenced site as per district policy for all sites with less than four inches of unsaturated soil below the bottom of the A horizon. The intent of this investigation is to confirm initial observations by the certified soil tester (CST) relating to the presence or absence of redoximorphic features in the A horizon and/or subsoil. In-situ soil texture, structure, and consistence factors were also reviewed as they relate to wastewater application rates. Other site conditions such as percent and direction of slope, landscape position, land surface contour length, and surtace water hydrology may also be noted and their effects are factors considered in the recommendations and conclusions portion of this report. A typical soil profile at T-1 could be described as follows: The soils verification conducted on this date is generally in agreement with the report filed by the CST dated August 16, 2005. No redox features were observed in the A horizon. If a mound system is designed to overcome limitations of a high level of seasonal soil saturation and slow permeability, the linear loading rate should not exceed 4.5 gpd/ft and the basal wastewater application rated should not exceed 0.2 gpd/ftz. The additional basal area will partially compensate for the gentle land slope and prevent wastewater leakage at the mound toe. At least 30 inches of sand lift is recommended when applying septic tank effluent to the distribution cell of the mound to ensure proper .treatment. The Longest portion of the mound must be orientated along the contour. The mound shall be constructed to divert surface water around the mound structure as much- as possible. In addition, an up slope drainage ditch should be considered if it is determined that surtace or subsurface hydrology is improved by intercepting water and diverting it away from the mound site. If there are any questions regarding this report, please contact me. eroy G ansky, stewat pecialist cc: ~ County ^ Plumber Ljansky commerce.state. ~. s E-mail ($ CST ^ Owner 715/726-2544 Voice 715/726-2549 Fax ^ Other ~~ ~~~~ ~~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY ~ BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: SW a , SW a , S e C . 3 6 , T 2 9 - R16 ~ CONVENTIONAL ^ ALTERATIVE Of assigned) Town of Baldwin 3.5 ^ Holding Tank ^ In-Ground Pressure Mound a3 93 -emu '~ ,b F OLDER: ADDRESS OF PERMIT HOL ER' ~ INSP I Np T ~~ ~ 8S BE RK Permanent r rence porn C I c~~Cr'ti ~ S ~~a `~_ tJ ~._ I DIFF R FR . R T. L .. CST REF. PT. ELEV.: ~ Name of Plum er: MP/MPRSW No.: County: • Sanitary Permit Number: 128879 SEPTIC fiANK/HOLDING TAN . s, e/': , ~ /i o MANUFACTURER: ~ LIOUID CAPACITY: TANK INLET EL ANK OUTLET ELEV.: ,/ WARNING LABEL PROVIDED: - LOCKING COVER PROVIDED: ,~ ~N / ,> '~ , r .~ ~~ rt ~/nom ~ ~ ~,2 ~~ ~ ~ / ~'S . 0~5 l'f ^ NO C~'PES ^ YES BEDDING: IA.: \~f MATL. ~ ` HIGH WATE C1aUMBER OF ROAD: PROPERTY L E ~ LL: BUILDING: ~ VENT T F ESH AIR INLE : U C . s ALARM; FEET FROM ~. ~ ^~ d ~ ~~ ^ YES 0 ^ YES ^ NO NEAREST -~ DASINGCHAMBER• ~./7Sl' ..~",l. r.~~-~i.,~ = SI,D7 _ Wl G~ ^ YES O ~S ~cG ~~ LJ~`U~ ~ DES ^ NO ~^ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING; VENT TO FRESH It LINE: ~'~q~ AIR INLET: (DIFFERENCE BETWEEN ~~~ GpC~c • FEET FROM ~, J / PUMP ON AND OFF I ~ d ES ^ NO NEAREST --~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: ~ DIAMETER: MATERIAL A,N/D MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN ~/~ ~ ~~ ~ ~!~ P, ~ C., the soil is dry enough to continue.) n~-nir~~T~nu w ~ cveTr~~. - - ENGTH: NO OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIOUID BE . ENCHES: MATERIAL: PIT ~ DEPTH: IMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MAT DISTR. NUMBER OF PROPERTY WELL: BUILDING: R SH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: FROM LINE: IR INLET: NEA MVVIYU.7i.71CM" ¢,7°> c-~~ 171.d- Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ES ^ NO ~ meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERV~AT(ION WELLS; d~,~'C ~ ljl S, ~ YES ^ NO ,251 YES ^ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: i/ EDGES: ~ 2. ~~` /~ ~ ~ to ' YES ^ O YES ^ NO YES ^ NO I~ •~G^C%~ ~/ ~ !/ r t J (/t_~r' }^ J!" 7 ~~')/~it,~~.G C.7_,..' .~.' ~.'~-C ~i9.X N,'~4.;!:~'~.~~..~ x'T<C; ~< ._~t.~ ~/ ,1 ~a. ~U /i~/ ~ Sketch System on Reverse Side. SBD-6710 (R. 06/88) . ..___-^•--- BED/TRENCH -"-""°- WIDTH: LENGTH: ) NO. OF TRENCHES: ~~ LATERAL SPACING: GRAVEL DEPTH gEL / FILL DEPTH ABOVE C /~ DIMENSIONS I ~ ~ ~ MANIFOLD 1 PUMP aCl MANI OLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV. 1 ELEV. ~~ DIA.:~ r/ ELEV.: ~ O1V~ PIPES^ DIA.:^r/ ^[ ~~ ~ ~~^ '_1 I , DISTRIBUTION INFORMATION HOLE SIZE: !~ HOLE SPACING: ~/ DRILLED CORRECTLY: COVER MATER AL: J ~ VERTICAL LIFT CORRESP DS TO APPROVED PLANS C~ W~~+~ ~ r u~ ~ Y ~~~' ES ^NO G ~ ES ^NO ,~A COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF F OM PROPERTY uNE WEL4: / , \ BUILDING: / YES ^ NO YES ^ NO FEET R NEAREST~~ U(~ '` ~ ( ~ ^-~7S - ~D'ILHR SANITARY PERMIT APPLICATION _~,,,,,,,.,~v In accord with ILHR 83.05, Wis. Adm. Code .e....,....v....,..,...,e,. -Attach complete plans (to the county copy only) for the system, on paper not less than 8'r4 x 11 inches in size. -See reverse side for instructions for completing this application. I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER ~ PROPERTY LOCATION r ~ :.~L.. ~O/1 '~(_,tJ '/ate W '/a, S PROPERTY OWNER'S MAILING A DRESS LOT # _ ~~~C.~v~ STATE1SANITAR~(Y~P7ERM T # ^ C~idic if~iM§ion to~ vious application STATE N 1.0. NUMBER T,~~~, N, R BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 1!. TYPE OF BUILDING: (Check one) CITY ~ NEAREST ROAD ^ State Owned VILLAGE ~ ~ i ~ ~ , ^ Public ~ 1 or 2 Fam. Dwelling-~ of bedrooms ~ A L u B ) 111. BUILDING USE: (If building type is public, check all that apply) / ~ ~ ~ _ ~~y ~~~~ S! 1 ^ Apt/Condo 2 ^ Assembly Hall 8 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church/School 8 ^ Mobile Home Park 12 ^ Service Station/Car Wash 5 ^ Hotel/Motel 9 ^ Office/Factory 13 ^ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an System System Tank Only Existing System Existing System B) ^ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21 ~ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground 42 ^ Pit Privy 13 ^ Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ,~"~'..~~. '"`'1 ° Feet C' - Feet VII. TANK CAPACITY in allons Total # of Manufacturer's Name Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncret structed glass App Tanks Tanks !~ I L'y .~ .C S .IF /L S VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) ~ MP/MPRSW No.: Business Phone Number. ~ ~/ ~' IX. C NTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a e ssu Issuing Ag t Signat a (No amps) Surcharge Fee) Approved ^ Owner Given Initial .... X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Satety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your -local code administrator or the State of Wisconsin, Safety 8~ Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and. complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a!! septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILNR. VIII, Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. , Complete plans and specifications not smaller than 8h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies ccilected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 {R.11l88) APPLICATION FOR SANITARY PERMIT STC- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec hause"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property . f~ Q~~q ~ ~~~` L ~~ ~ ~ :~ Location of Property r' ~~ '~ ~ c~J '~, Section ~ ~ , T~~ N-R~ W Township ,u ,,r~~r~•=.~ i ~-. Mailing Address ~j ~ LD ~® -~ ~, Address of Site 2(p 20 (p fj y~~4~.L Subdivision Name ___ ~~~//~ Lot Number /~/~~ Previous Owner of P. roperty ~~~~ ~;., ~,~ ~--~ ~ ~~s~ -g e ~~ R ~•~~ Total Size of Parcel ~O ~ct~ / Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes ~~ No Volume ~~ ~ and Page Number .~~d as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and pale number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) cenxi,~y zhcLt a.Q,~ d~atemer~ta on zhi,a ~anm ane ~Jcue .to ~h.e bead a~ my (owc) k.now.Q.edge; ghat I (we) am (ane) the awnen(~) ob the pnopenty de.~chi.bed ~.n xhi,a ~.n~onmati,on ~anm, b y v.chtue o ~ a wa~vravrty deed neconded .tn .the U ~ .ice a ~ the County Reg~xen o~ Veedb ab Documev~t Na. 07 ~~ ` ; and ~hcLt I (We) pneQen~Cy awn ~h.e pnopoe ed e.ixe ion the ~ ewag a dib pad b y~ 'em (an I f we) have ob~ai.ned an easement, ~o nun w.cth. the abave,de~seh.i.bed pnopenty, fan the eonb~cuan ob scu.d .system, and the .same has been du.C neconded .%n the U~~.~ce a~ the Ca y Reg.cd•ten o~ Ueedd, as ~aeument No. ~x7~ as ) , ,> SIGNAT O1~ OWNER SIGNATURE OF CO-OWNER ( APPLICABLE) ~~a~~~ ~ ,.~~ ~ ~ ~ :.DATE SIGNED ~" DATE SIGNED ~~;~. ., , ~ 3D. .• ...) EP,;,[ second part, t}tei.r heirs and assigns, against all and every person or persons, lawfully claiming the whole or any part thereof, shc; will forever WARRANT and DEFEND. 7tn ~.~ftnP~~ Il~li~e~ea~, the said part v of the first part has hereunto set her hand and seal this 1_l~th dap of September , A. D., 19 62 Signe a led in Presence of ~ __.-t-''1.1 _ ~obcrt r . Gavic /~'~ .: `~.L~-1 d -LOLL F+-~ :..w.f ,.~'~. ~~:• z' t t~/ Barbara Rudesill. Matt at itIIittftons~cin, ss. .~..._.._._.._.._..~._ ~'~' ~~i•c? County. Personally came before me, this :1t~th the above named ;ilrna }:.hut son to me known to be the person who ~..~.!~~~' ! L.!f'~, +-ti~1~ '~'f L (Seal) 9lrrla hnui; san °--~---°~-•. (Seal) -°-~-°---• (Seal) -'-~-~~---~ (Seal) day of Scptclilb~r. , A. D.,19 6?. , and acknowledged the same. t ' • ~'. - , ! S1 ~ Notary Public, ._.._.._.....P~.___„_ Ceuntp, •Wisconsin ~ ,y .. ~f My commission espires• _ _7.0-2~',:, A. D., 19 ~i2~ •• Drafted b r-. ~ '' t.] "" (N.il.---Ch. 68 Wts. Bt~b, }reridn that ali lwtromaab 8u be recorded p4sL Neva plsinly printed or gpewrfttea theraoD the eases o[ the ~naton, arenteee. ~rltneseee ant notary.) 1 L~. ;; 1. 1~nrrnul)' IkvJ -Uouuouu Munn ($TATB VF WI$CON$1H) Sec. E8G.16, W ~, $tntutee. Fotm Pi0.1 PobUshed to 6aa CLl» IIaok k 84tloo~tl fb, 2'7~2~9 This Indenter@~ Made this ll~ tl"t day of September A. D., 19 b2 . between ' , ~~,?.~,~ 1~.mz+,son, a t'rortan, . part y of the 1Srst part, and • Gco.r~;e ~.:'. IinJ_;;eson anti T,uc9_:l.l.e Iie].~eson, husband and ~~.ie and • • part ies of the second part. ~nittriC~~fCty: That the said part y of the first part, for and in consideratio» of the sum of 'i'crn "~'ho~_tsctnl am-1 no/l~ ?o • ----------------------------•--Dollars to her in hand paid by the said partiE~s of the second part, the receipt whereof is hereby confesseri and acknowledged, ha ve given, granted, bargained, sold, remised, released, aliened, conveyed and eon&rmed, and by these presents do es give, grant, bargain, sell, remise, release, alien, convey and con£lrm unto the said part -~.c:s of the secand part, -i,heir beirsand assigns forever, the following described real estate, situated in the County of ~, . C;r'oi,c and State of Wisconsin, to-wit: ;~ttt.l~r-r~; l-. -,n~u~L-~:r. oC ;;nu~L'1ttJest cJ~~attE:r (,",'~.~.~, o~ S!•1;`:) of Section ~G, Tairr_ ?.y, I?an~-r. a-~:~ a ~;.-~~ c... - u ~~f ` ``~3 `. .~ ~g ~ ~ 1 t~'"~ ,~. ` ;* ~~jj77 ~~jj]] P C~7 47 _ ~__.._.__.-~ Z~OgttJCC with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said part ;j of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises and their hereditaments and appurtenances. coo babe crib tq ~Olb, the said premises as above described with the hereditaments and appurtenances, unto the said part ies of the second part, and to their heirs and assi ns FOREVER. ~nb t'~t sib ~1~'-ma 3;:nut son g for hersel (' and her heirs, executors and administrators, do e~ covenant, grant, bargain and agree to and with the said part ies of the second part, their heirs and assigns, that at the time of the ensealing and delivery of these presents stic is well seized of the premises above described, .;s of a good, sure, perfect, absolute and indefeasible estate of inheritance in the Jaw, in fee simple, and that the same are free and clear from all incumbrances whatever, no e;:ceprions, and that the above bargained premises in the quiet and peaceable possession of the said part 1 cs of the vr.i •rM~ ~. ~.,.~ STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER- ~_~Qy~q~)~~i ~G ~r ~•~;;,,V ,~ -~.fA ROUTE/BOX NUMBER ,[(p~'~ (~,Q Arc Fire Number~~ CITY/STATE~,~~~,ti,~~,(,(,~ 1~/,~ 7.IP C~t~'~j~~_ PROPERTY LOCATION: t'J %, .S'~'~ ~L, Section, T.C ~ N, R~W, Town of f,'p~_..~..~ ~,~. St. Croix County, Subdivision- /~/lJ~ Lot number~/~ . Improper use and maintenance of your septic system coulc result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_Y a maximum of 60% of the cost of which was in operation prior to accepted this ,program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above. requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be cz-mpleted and returned to the St. Croix County 7,oning Offitce within 30 days of the three year expiration date. St. Croix County Zoning Office P.O. Box 98~ Hammond, WI 54015 715-796-2239 or 715-425-8363 1 SIGNED DATE_~~Zf ~y~ M N H a r r H r+ 0 z t7 a H Cs7 H O E z x H b ~+ Sign, date and return to above address. STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER~~ ~ ~s ~-~h% ~' t'r...ti .{h ROUTE/BOX NUMBER ~,~~ (~~ ~l~e Fire Number~c~ CITY/STATE ~n.v~t~rL,L'~e~ 1a~,~ ZIP ~~~j~ PROPERTY LOCATION:~'L! ~, ~~!-/ 3L, Section~_, T~N, R~W, Town of~',f/~~~~' /~ _ St . Croix County, Subdivision /~/~~ Lot numbers Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_~ a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County 7.oning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary),-the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 7.oning Office within 30 days of the three year expiration date. St. Croix County Zoning Office P.O. Box 98` SIGNED D A T E // ~~ f~ Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. H z H 9 r r a H W 0 z d a r~ H 0 E z x N ro ~~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ._IND-L1S'TR~, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: sw'/ sw'/ SECTION: 36 /Tzq N/R 16E ca OWNSHI UNICIPALITY: ~L.Dtv1~J OT NO.: - BLK. NO.: SUBDIVISION NAME: - -- COUNTY: MAILINGADDRESS: ~~S G~RGLCS ~1V1zT S-r.cCZ,o~x 1~kvL t~~-LGFS`Oly woot~ucLL.~ w 54'~Zg .Residence ~ --• ~ -~-- I _...._.._.~ `'~~.._ _~-.I New ^Replace RATING: S= Site suitable for system U= Site ~nsuitahle for system ~~ S I ~ ~ 1 ~ ~ 1 /TU~ {~ .S DATES OBSERVATIONS MADE I A S: 1L ~o-3)-qo 11-1- 9~ ONVENTIONAL: ^ S ®U MOUND: ®S ^U IN-GROUND-PRESSURE: ^ S ~U SYSTEM-IN-FILL OLOING TANK: ^ S ~ ^ S ®U RECOMMENDED SYSTEM:(optional) 'Nlov>uD - ~{IGH GROu>y11w~"~X If Percolation Tests are NOT re wired DESIGN RATE: 9 If any portion of the tested area is in the A' •~ ' under s. ILHR 83.0915)Ib), indicate: N • A. Floodplain, indicate Floodplain elevation: ' V PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH IN, ELEVATION PTH TO R UN OBSERVED DWATER-INCHES H S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~ 3{o q S . ~ SON Cry Z S 5 ~E 1~hGE z OF Z B- Z Flo q S.~ '` Z S •, B- 3 y1 x}9.3 `t Z$ ~r B- B- B- PERCOLATION TESTS DEPTH , WATER IN HOLE TEST TIME D O I WATER L V L-IN HES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p RI D 1 P RI D 2 P PER INCH P- 1 ZA U 30 !'/8 1 '/,~ 1116 Z8 P- Z Zu 1L1 'Sb 1 1~6 ~ I~lb ~ tlE, Z7 P- 3 ZO )UO 34 l'~s 1 I/g 1'/I1, Z8 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas, Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 30Tt'OI1 OF'`RQ~C,N-~)8,g ~G@' ~' S1'IiuTllal60 S~' SYSTEM ELEVATION ~ "~ I'~ ~ ~' o F SRND - _ - - "~.,~.-.- - _ ~ . _ ~_ -~ -_-~--°~-° ~~-~- -I- ---~--- _ _... _ _ . ~ _, ~_-_ .~ . 8,Z ~ ~ >~ ~MvS~"' R>ls~ h.J~..L ~ ~Rta tS~tt~ __ . '~N sc~t,~ 1 =So' ~z~c~r hs St}owN ._ __ ~__~ ~ __,_ __. ~.~ Sic 36 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. AND RIVER FALLS; WI 54022 715-425--0165 11-1- °10 ERTIFICATION NUMBER: PHONE NUMBERfoptionall cSTt,oy S7 6 ~)S- UZS- 0165 ST SIGNA URE: 9~, zlo DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD~395 IR, 10/83) -OVER - 7~GL ~ OF Z J r INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. IS this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY if ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing M@ plot plan; 7. MAKE A LEGIBLE diagram accurately locating your teat locations. Drawing scale is prefered. Aaeparate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Solt Separates and Textures Other Srttlbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - .SfBngatOHS gr - Gravel (under 3") LS - - L.itttea~flB 's - Sand HGw - - MiOh C~rour-dtltrater ca - Coarse Sand Perc - orecotat+on Aate made - Medium Sand W - Welt fs - Fine Sand Bldg - Building is- loamy Sand > - Greater Than 'sl - Loamy Sand ~ - Less Than '1 - Loam Bn - Brown 'ail - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sict - Silty Clay Loam mot - Mottles sc - Sandy Clay w1 - with sic - Silty Clay fff - few, tine, faint 'c -- Clay cc - common, coarse pt - Peat m m - Many. Albdiunn m - Muck d - distinct P - ptorninen4 - '~ MWL - Wiph wt>ffor'Ie1~iN, surface wasst '~ Six general soil textures BM - BenCft •Matik for IK}vid waste disposal Vf1P - Yi~tittttl ,~e'teftts4 Point TO THE OWMER: This soil test report is the first step in securing a sanitary permit. The county or ttfe t?epartM@rit"may request verification otthittto(tte5t in the field prior to permit issuance. A complete set of plansi~tVteprivat@sewage system and a permit epplic8tion must be submitted to the appropriate local authority in Order tOQbtatina Pennft. The sanitary permit must be obtained and posted prior to the start of any Construction. ... "•a.: r .. a. SOIL DESCRIPTTON FORM Attach Soil ProTslo location Map On • Supu'ate Sheetf ~~~ ~ f'CU L ~1 ~"L, G ~ SCAN LINEAR LOADING RATE • D E`er l G~1 _~ 1- b • C7 PURPOSE: E\1 AC ~-{U~ ~~ ~~~ ~~ S~2•u C DN SLO ~ o ~d D[~CR1PTlON BY !TR-~t"t'UR L- ~EG~Z'~~ ASPECT' wL'S'~R~•'y OATC : O +LT. •3 ~ ~ 9 9 ~ CURRENT ANO U ~ ~ L-D COUNTY/STATE: ~• C~lX CpUl1.)•['Lf lt,! ~ VEGE TIV COVE C>iZ- S S LOT DESCRT TIONr swJ~ - sw~i sec.36,T24-J, R 16w DRAINAGE cus t-..~L-z-~ U2AtAJ~ WT~.1 ~~ BA~~LV IN GALLONS•PER S FT. PER OAYs UES16~1 I}T 0.3~ LOCATION: ARENT MATERIAL s / EPT I: SO L SERIE5t S }~1`1Tt ~ GO $ t FKN2110N $p ~ Z 3 OEP1N in. 1N 6 d - i 0 to-is ZS -~~ MATRIX COLORS mo st t~j~-tR 313 ~o~-1R, y 13 1~1ti iZ y! MOiitES - - C 3 p TEXTURE S ! I s ~ 1 S ~ ~ STRUCTURE Gr. Sz. Sh ~'F-3~k Z ms bk ~ tiVT Sb CONSISTENCE ~''- ~~^ h1'F -- v-z CLATSNGSS/ PORES ROOTS Ptl •80UNOARY C S CS REMARKS o~rtz s/ r~ie limo 1 JtuG 0-8 _ toH~ 31.3 - s1 1 1 Sbk `r h'lTY' "`"5 3 ZS'_ Z'7 l~`-i R y13 Z S1• ~ Zrn Set~c -'''~'F'h C S ~~ >~ i7_ y ~.S`iR. 3)yc C 3 P s 1 1.msbk. rn f-- '~ -- ~°c 1 ~ 3 0-9 1~`-t~-~1 - sll 1~sbk ~ -- cs Z 9-zs to~r~. y~ - sJ. Zms~~ m`F~ _css 3 Z-&-y! l~`C R 3l6 e 3 P s i t Z>» sbk rn ~- " ntucn cTTP FFaTIfIES/NOTES: • LIMITING fACTORS/OEPTN: Sfynature Date CST X i ~' -- ' - T I I I I ~ I I I I I I I F- FTrTT .e.~•» r ..<. I State of Wisconsin Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION PRIVATE .SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 WEGERER SOIL TESTING & DESIGN Owner: P.O. BOX 74 RIVER FALLS, WI 54022 RE: Plan Number: S90-40669 Gallons Per Day: 450 Project Name: HELGESON, PAUL RESIDENCE Town of BALDWIN PAUL HELGESON 408 GEORGES COURT WOODVILLE, WI 54028 Date Approved: November 5, 1990 Date Received: November 2, 1990 Location: SW,SW,36,29,i6W County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW MOUND Inquiries concerning this approval may be made by calling (608) 785-9348. Sinc rely, ~~ RD M. SWIM Section of Private Sewage Division of Safety and Buildings 4PP039/0009n/20 cc: PAUL HELGESON X Private Sewage Consultant SBD-6423 (R. 08/88) MOUND SYSTEM -FOR A 3 BEDROOM RESIDENCE Page 1 of • 6 LOCATED IN THE SW~/y OF THE sw ~~v OF SECTION 3~ , T ~9 N, R ~ ~ W, TOWN OF BALOw 1 N , ST• C42.0 t X COUNTY, WISCONSIN . INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR aavl- N E L G c s ON ~o ~ G E OR ;L 'S ~u~-T' L~3~~~,UiI.LE , ~ 1 5~t0 ~~ PREPARED BY WEC- ~>FcE~tr.~- Q I 1. TEST I IVY AIVD L?E~ I RCN SEFc~ I GE t'.0. BOk 74 421 N. 1lAIN 5T. RItit:k FALLS, YI 54(lii 715-425-OibS ti~ ARTHUR L WE^_,EAER '- D-915 P = ;~~. .. ELLSWOP.TH, WIS. • ~ s ~.. 's~i~~'s i G ~ F'4.~ [E-1-g0 Job # ~10~ Z10 PLOT PLAN Page 'Z of ~ Scale 1 "= y0 ' No-~.: w~l-1.1b B~ 5'~T L~1Sl" S0 ?vw ~o~SE CsF MO Ul~.~p Pyvp 1~T L ~Sfi ZS ~=tZOY~ S~'hC 1'n~uh~PuMp CN~-~8b"R 65 ~oF y"pVC S \q5~ OF Z~ A ~vRC.L ht~ i nr -- Q 2- z-7 r- I I I 1 I 1 1 S no ti or cori pn~r ~~ o4a ~A ~~ur2t3 ', `Ri ~ S A 1~.~ ' ~ SY~tiE~ i SEAN AGE r ~ e'ZS - - ~,;,,. C,~SS1T~ ~~~ to Z ~ ~ Corc~{.UE2G~. ~~~ a~ z (- a~ ~ y G d5 7 °~o i I I B3 1~ ~ I 4' I1 I z~ ~-oti~rovct ,-L~,. a~.8 v ~ ~ ~~ !.lit~,~A( REI.~~S, ~ ~ ,, ~, . ^~~~, -~ .J ,~~ Y, ~n ISJ~ - ~~,J~~~ ~~ I` ~ ~~ ~ ~ D~~~~-~Mrt1t ~ . j~v ~ ~ ~ .~:~l4 z -J 7 a ~ U F- 1 ti ~..i 2 ..~ ~~ r , • N 2 NOTL ~ PPC1Z CEO CO+J~Lt1 %rJS ~ ~~ ~~~ ~~~~~~~~~ v '~-10 ACRE 5 J~ ~~ _ ~` sou ~} _s ~ o~ b21UE ~ _ C vo'r-+ ~u~~ --- --- - ------- I NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( z. required) 4. Septic tank to be zoo/-lgp gallon capacity manufactured by W l L S~'R CA~C.RET'~ 1~RuU~ cTS ~~~-`~131~MI~U/V Tn~-k1 . 5 . Bench Mark ~te~. 10~, oo' o~ Ton oP S' hi ~ G1~} y''~c 4" h1ooD iwsT MRRI~c~U~~~CN HAR1c" 6. Divert surface water around mound to prevent.ponding at the uphill side. 5~t O~ lint COwt PAC..TL'fl SZRAW OR HARSN 1~A'1 '6\ SARI $VZ]l)1.) T~ 1 P 1= L L , q q - 3 ~ ~ (~'PROU~O S`'t N fH~T\ C Co V ER I tJ G mot l.. E + i=.L.-- :v~pllo~-TiW f-IEL11oH SFi+vD _. __ :~-1 G loPSo~~ ~ _ ~~ ~' O ~ ~ F'. ~ 8~ ~L. ~1Q. ~~ ---~~ t '~ % SLOpE L pV C FORGE h fa I .N_ _ TAE,NGK of i~z"-.Z~/Z"~~FL~sATe ~;~1'1 hvl'~ P 6~' BEW~v PIPE - '2" oVEZ PIPE D ~•Q ~=7". E x.35 ~-. ~ o • q FT. p ~ ~-~*-- L°,R,OS.S S~C~V1v~ ~ ~' d FT, H ' ~ S irr. '~ 17ESlGly 1J1 [~ATE~i~ ~ -~ GP'D/S©. FT~_ ` . ~_ y2~'~tdl ~'LGt i~ E~ . ~ ~. '~4G!~ At~Q 1 ~~ iiF1#vtlt~+1S pFpARTMtNT F -rJCl;S1ZY. i., NGS I~'UN 0¢ AF Y D A S ~ 1~ S I l5 J ~ X ll L °l -1 W Z-l FZ- FT. Fr• FT '~. FT. ,~ ~ ..> S ~ ~\sltZ\aullor~ P~"R-aA1a9~T HARtcER i Fo 1r'1P~LN A ~-------'s-- - - ---- ~--------- ------- ~# w 4 oess~Rwtro~ PIPE ~quc•H'OR P\PE SEGUR~-Y~ B K T(Z61JCl1 of ~/2,u - 2 ~~Z~-- -- I 1~GG\ZEGATE L PL~4~ V1~,VJ PERFoRATf=b pt PE DE~'A 1 L PE[~.FORAT EO Svc, t>> a E ENO CRP ~r`~<gt " G -o`S.. ~( a-1FJSTALL PC[Z.rIAIJOVT HRR.\t.lr-'R RT EUD OF EI1CN LATt"'StA~. ~- Ts-.~D CA f' 1~ VAS W C A7L~D O!J 801"fp h OF P!-P~. PNJD J~it4~ ~~~1pLl.Y SPAetr'A . pvc FORGE N A ! IJ FRpN L~f ~''f P PLRCC UtST ltUt~. t~ExT To E1,x~ CAP ~V C \-RTERA LS ~J1STR.~B~T]Dit PIPE ti+}4oUT .~ r ~~ ' ~ ~ ~ p~~Li~Tia~1S UR ANh t ~^~~,u~~~v. ~.a~ eu~ G5 ~%+~A~iYM~~1'f ~ OF ~ S~~ flagf}~'' tt0~~-r~ P 35.75 FT. ~ ~0 ~ "~ x z. ~ ~N, s 9 Y ? b 1N. ISLE 'DIF~YIET@f~ ~~Y 1*t . 1.-1`cT~'.A 1, ` ~ ~- I N , )=0i2.C~, ri R ~u ~~ ~ Iw , ~ OF 1~ULE$/!~ I PE ~, IUV. ELEV. O~ lftT~J11.S °~Q•30 ~, p~r~c~, ! s7r /fU~ 13, FRo~-~ T~ w1?N S~ c~~-DAN G HOLES /`}T Z 6" 11J1'~RU~I.S . - - I_AcST l-bLE 1'p ~E IUEX 1' TO T1t E' E'7u D C1E P- . - ~ Co11 g 11J f~"j'1 ~ N S~~ C Tf'~I~ tt. A J~ D -'' PUMP CNAMf;ER CROSS .SECTIOIJ AL]D SPECIFICATlOIJS ' ~Jpc~ S pF ~ .~ - ~ ~ ~ ~_ , ti"c. i. VENT PIPC . ~ 25~ FROM DOOR, '.JItJDOW OR FRESH AIR IuT~IKE -_ ~LQ 28 1,r3' n I N. ItJLE T . G~~",. t° A P`P}IP<`~~rp J O 1 W~r..Z. PI ~~ EXTENDI ~ ' O1,.IT0 601.1D.~1~ .~~~ ~~,~ .~.~ ,.~1 ~~~. 4FF~~S - 1' r `~' ~~~P11~~~ ,<`S ,.a PZ~~~~G~ - LLCM. BZ..C~'1 FT L. SI.SO VEIJT C^P Iz•Mlu. Cot..,p~-1T f 1 i `__ WEATHER PROOF JuucTlou BOx .IPPROVED LOLKI-.1G MIIIJHOLE COVER ~I~ wRRt.~IIJG L.IagEC. ~s' MIk1. ~ ~~ ~\~ Y PROVIDE I AIRTIGHT SEAL I A I I e I I ~ ~I I PUMP -~ -_J' D CoWCRCT[ BLOCK ~ ~ j IB• Mlu. ICI III I APPROVED JpIAiT III W/C.I. PIPE~PY I EXTC-JOIUG 3' II ALARM ,~ OWTO soLID troll I b °N I OFF L - ' 3 ' AVPxt~ ~- RISER EXIT PERI'111TED OAJLy IF TAIJK MAIJUFAGTURER HAS SUCH APPROVAL gr<DOIr~; SPEGIFICATiC)L]S SEPTIC f 005E ~~~~, C,~C~Ls pRADtKTS TAUK MA~JUFACTURCR: AJUMBER OF DOSCS: Z'7g PER DAB . TAIJK SIZE: ~~~~ 7S0 GALLOAIS DOSE VOLUME INCI uDItJG 6AC ow: ~a3'~O GA S,s• ELFC'[R4 SYSTt?~ ALI~R!'1 MAIJUFACTURER: . Kr~ LLONS MODEL -,IUM>jCR: ~~, lbw CAPACiTIES~ A= `9_II,1CHfS OR 306.5 GALLpyg SWITCH TyPC' ~~~~R'Y B = Z 1-JCHCS OR 3~" ~ G(.LIOA,-5 E'uMP MAIJUFALTURCR: Cx~~~-~S l~-~~"-pS. 1~.IC. C= ~~ •tUCHESOR ~°i3~6 CALLOUS MODEL AJUMBER: ~~EO 5 ~ D< <~INICHES OR 2Z'S'g GALLOIJS SWITCH TYPE: ~" I~~¢y° IJOTE: PU/'tP AUD ALARM ARE TO bC MIAltMUM DISCHARGE RATE 39'18 GPWI INSTALLED OAl SEPARATE CIRCWT$ VERTICAL DIFFEREfJCE DETWCEU PUMP OfF AUD..DISTRIf3UTIOIJ PIPE.. 16-63 FEET ~- MIA1lMUM XJETWORK SUPPLE PRESSURE .. 2.5~ FE.~ {~ ~ .. (~O ~ ~~ d + 1~S FEET OF FORCE MAI-J X ~"Sq F~orr.FRICTIOU FACTOR. S•OS FEET _ TOTAL Oy1JAMIC HEAD = ~4' l8 FEET ' ~ r1 P GttR1'18~R DlR~1ETr`'R _ - - 1.17 ~1 ItJTERUAL DIMEIJSIOE.I~i Of TAIJK: LEAlGTH - ;WIDTH ~' ;t1QLS10 DCQTMi goT~TUYt AQ~q _ = ~3! _ - 6RL / i+.~cN ot: .4s P~ M'c~.l,.~vt=AcTv~LL1Z = 16.3 ~n~ / ~Nc}i t ~ ~+ Su ~mer5i bie Effl uen~ Performance _ Curves Pum S '~G~ 6 ~~ ~ p ~ METERS FEET 90 25 ~ 70 = 20 J F F- ~ 15 40 10 ~ 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i ~ t i 0 10 20 30 ~m CAPACITY ~GOULDS PUMPS.INC. ~- F+41,5 ~w,~xac oae PETERS SET 120 35 110 100 30 90 ~ 80 70 = 20 J 1~ 15 ~ 40 10 ~ 5 10 a~ 0 0 O ~ ~~ 0 t0 20 30 40 50 60 70 80 90 100 110 120 GPM i i i i 0 10 20 so m°m CAPACITY 01985 Goulds Pumps, IBC. Effective July, 1985 ST. CROIX COUNTY WISCONSfN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 3.86-4680 Nov. 1, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Paul Helgeson property located at the SW 1/4 of the SW 1/4 of Section 36, T29N-R16W, Town of Baldwin, St. Croix County revealed suitable soils at a depth of 25" below which seasonable high ground water was noted. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerely, `'`" _ ~, amen K. Thompson Assistant Zoning Administrator cj Nu. ti-1. NacranlY llced--Uomnxu' l~urm (6TAT$ OF WI6CONBIN) $ec. E8G.16, Wle. 3tntutm. Form No. l Publlahed M loan Clam Book ~ Btatlo~ Oo, r 2'7l~ 2'S 9 ~~ Z`ill~ Tllt~@IItUre~ Made this ll.i.th day of September A. D., 19 62 . between ' • Alva Knutson, a woman, ' ' part y of the Srst part, and George i•:r, Helgeson and T,uca_7.1e Iiel.geson, husband and wife and • as joint tenants, part ies of the second part. ~ttliP##tt~: That the said part y of the first part, for and in consideration of the sum of Taro Thousanc] and no/lr)0 • ----------------------------•--Dollars to hc>r in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, ha ve given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do es give, grant, bargain, sell, remise, release, alien, convey and con£rrm unto the said part ies of the second part, •tl~eir heirs and assigns forever, the following described real estate, situated in the County of ;;~-, , C;roi;; and State of Wisconsin, to-wit: Sout?iz,rest '~u.~rt<::r o.f Sou-tJ.ltJest (quarter (~;.r,` of ,SL°d:.`:) of Section 3b, Tot~rn ?9, ~ogtt~et with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and al! the estate, right, title, interest, claim, or demand whatsoever, of the said part y of the first part, either in law or equity, either in possession or expectancy af, in and to the above bargained premises and their hereditaments and appurtenances. ~o babe an0 to ~ulD, the said premises as above described with the hereditaments and appurtenances, unto the said part ies of the second part, and to their heirs and assigns FOREVER. ~t.ttD tit ~ai0 A7_ma Lnut, son for herself and her heirs, executors and administrators, do es covenant, grant, bargain and agree to and with the said part ies of the second part, their heirs and assigns, that at the time of the ensealing and delivery of these presents she is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, no e;:cep•rions, and that the above bargained premises in the quiet and peaceable possession of the said part ies of the VG+.. •_~~~~ rf^E lei ._..~• . second part, their heirs and assigns, against all and every person or persons, lawfully claiming the whole or any part thereof, she will forever WARRANT and DEFEND. 3ftt ~ftttt~£f ~~tYtOf, the said part y of the first part has hereunto set her hand and seal this 1l~th day of September , A. D., 19 62 . Signe led in Presence of ~ ~ --~tti _ Robert .~. Gavic '"' .~ Barbara Rudesill Matt of a~i~con~cttt, ss. ,,,,,,._.....,,~..,,,_.,,,,,Pi erce County. Personally came before me, this .l~~th the above named ~;ln1a :riut son to me known to be the person who _. ~.~%Y~C3~M / ti~_ .+-~~~. ~e'~•' (Sea!) Alrna Knutson ....~...._~..~.~... ~ (seal) •-•--• (Seal) day of September , A. D., 19 62 , and acknowledged the same. -~, ;,~s ~+ Notary Public, .~._.._..~.x'.~..~.~..,.,.,: ~s"unty, •Wiscbnsin #~ t.~ .. •, . My commission espires___ 1.0-21;- A..D,, 19 ... ~2;~ .~ ___.~_.. ~-..42 __. (f Drafted by......_,... ' i.~ f .. (N.B.--Ch. 68 WL. Btats. 1re~hlea that all laatrumenta b 6e r~ordea a6at! have plainly printed or typewritten thareoa tLe ns-wa of the srawton. anntese, wltneuea and aotaq.) 11"~ r h s: i r! 'C) e; rl r-i ~U t- AW W A F z w ...i..., W w w '~ 0 y ~~ O ~ ~ ~ •~ ~ ~ V a ~' 1 O •~ b ~ b O ~ Q ~ ~ ti N w b F-i a ~ ~ 1 ~ .~ O .U ~ G v R L Q ~1 ,~: ~~