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HomeMy WebLinkAbout004-1013-40-200/ - Wisconsin Department of Commercd` PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Coo er, Eric Cad ,Town of CST BM Elev: Insp. BM Elev: ~ BM Description: t ale~~- ' ~ t' Y1 I G ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ r G P~ /~Da Dosing So ~~~ ~/C~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ` ~~ ~ J ,y ~~ ~ ~d/ ~ --~ Dosing `5T ~ / 75~ ~ 50~ ,'- Aeration Holding U PUMP/SIPHON INFORMATION T GPM Model Number ~ n~~ n ~ . TDH Lift/3 fiction os~ ~ Syste He TD~ . 5~ ~p • G/ 1 Forcemain Lengt~~/ Dia.Z! Dist. to Well SOIL ~46SORPTION SYSTEM 7 county: St. Croix Sanitary Permit No 463420 0 State Plan ID No: Parcel T x No' Section/Town/Range/Map No: 06.28.15. ELEVATION DATA STATION BS HI FS ELEV. Benchmark /~ Alt. BM d~ ~. B9 • Z Bldg. Sewer SUHt Inlet ICI '~ Q~ ,~ ono SUHt Outlet ~ Dt 1n1et ~ ~~ Dt Bottom Header/Man. , ~ ~G ~ i5 Dist. Pipe , I `T ~i . 1 S Bot. System ~.~ ~s.s Final Grade 3 '~ ~. / C St Cover ~` ~ . p ~ 1 CanT~v !" S, `~~ ~,,I 1~ • 5 BED(TRENCH DIMENSIONS Width G / J Length ~ No. Of Trenche PIT DIMENSIONS ~ No. Of Pits -~. Inside Dia. \ Liquid Depth ~ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. ~ Type Of S tem: ~/ ~ ~ ~~ / t , /~ UNIT Model Number. ` ~ I)ISTRIRIIITION SYSTEM /_ b.~L~ Header/Manifold t~ Distribution ~ ~7, , r ~~ P,pe(s) o~Q I ~ ~ x Hole Size ~~ 1 x Hole Spacing iI Ven~ Air Intake Length Dia ~ Z.. Dia I Z Spacing 3b Length o D ~ ~ ~ SOIL COVER v Dru~m~ro Rvc4amc Only YY Mnnnd nr At-Grade Systems Only ~ G ~~~~. Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / r ~ ~ Bed/Trench Edges Topsoil t es ' No es No 1 /. ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Z5 / OS Inspection #2: / / Location: 2714 50th Aven(ue~W.i~ls n, WI~`40,2 (SW 1/4 SW 1/4 6 T28N R15W) NA Lot 1 ~~~~ _~~` t Par el No: 06.28.15. 1.) Alt BM Description = -'-"~ VV ~' ~ ~~Y ~' ~- ~0'~TI ~ J`r~f'1V`_ V 2.) Bldg sewer length = ~D ~ -amount of cover = 7 yZ ~/ ~ ~ V \ / - Plan revision Required? ', Yes No ~ ~~ ~(~ r„~{ ,~/[ `]~ Use other side for additional information. (JJ w v~,J~ / Date Insepctor's Signe Cert. No SBD-6710 (R.3/97) , Safety and ~ s Division County ` ~~ - 201 W. Washin . (3ox 71G2 c~o~ m ` ~~~~~,~ Madtst~ ~ 71~ ( ) Sanitary Permit Number (to be filled in by Co.) ~3 ~ZO De artment of Commerce Sanitary Permit Applica on RECE Plan LD. Number ~"a ~ ou provide l inforrna on d i d C ~ 3 _ ~ ~ p y e, persona s. A m. o !n accord with Comm 83.21, W may be used for secondary purposes Privacy Law, sl 5. (1 xm) 20d ~r,- Address (if different than mailing address) ~ 1. Application Information -Please Print All Infot~rntttios COUNT 1 ~ ~~ Pro rty owner's Name ZONING OFF! P # Lot g Block 8 ~~ ~ c ~- S~-,e~ C g Address - Prop/e~t~y orlon w li n Property Owner's Mai ~ / ~ ! l ? t~ 'v / 1.2. ~ ~ ~`~ y+, S ~ y., Section - one Number City, State Zip Code Ph h G /J /~ ~~/~- /~G,J r (-(~.r ~ ~!O Z ' ! l S ~~ ~ ~ / T .C d N; R~or W) h ti. Type of Building (cheek All that apply) ~ ~ ~S CSM Number ~' ~° ~. or 2 Family Dwelling -Number of Bedrooms ^ public/Commercial -Describe Use S w ~ ~ ity ^Vitlage ~ownship of -- ^ State Owned -Describe Use ~ ~ III. Type of Permit: (Check Doty one box on iiae A. Complete line B if applicable} A' New S~~stem ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Foisting System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Plumber weer ~ t 1 ~ IY, T of POWTS S C ap that a ~ ^ ^ Non -Pressurized (n-Ground Mowtd ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Rxirculating Sand Filter ^ Rxircttlatin Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pi ^ Other (ex sin V. Dis rsallfreatment Ages Infot'mation: Design Flow(gpd) Design Soil App!' ion gpdsf) Dispersal Area Required (sf) Dis 1 Area Proposed (sf) System Elevation / ~ ~ o ~ ~ s.33 YI. ank Info Capacity in oral Number Manufacturer Prefab Site Stoel Fiber Plastic Gallons Gallons of Unit 1 ~~ ~ ~t~ Concrete Constructed Glass Nov Existing C " ~!". Tanks Tanks Septic or Harding rank I V U L/ ~`@. S ~~ Aerobic Treatment Unit Dosing Chamber ~/ ~ 3 U ( ~/ t o, $ G/C VII. Responsibili Statement- I, the ande assame asibitity for lastallatioa of the POWTS shows on the attached plans. iness Phone Number B us Plumber's Name (Print} Plum Signaturo PRS Number ~ 2/5~-G~`l-S-~G G ~ j~~ v~ s~r~-h t~ 2~ 3 PlumJmber's Anddress (Street/, iry, State, Zip C e)/ / /~ / / S Vtll. Coon /De rtment Use On Approved ^ Di cd Sanitary Permit Fee ' eludes Groundwater Dale lssttal 1 suing nt Signatu No Stamps) ) F S h ee ~ ~ urc arge - ^ n R Denial ' ~ IX. C:onditions of pprovs Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must alt be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. _- y Atatdt eoatpkee t>Ws (w the Ceaaty Doty) for rle syster as paper' a« teas tdan stn :1 t feeds in size "r~C SBD-6398 (R. 01!03) ~-~a 11 a~ ~rop~e~'~y 0 ~ ~ s = T o~ 3/6 .. • E/eda~~ ~`, ~ ' ~e.b ter: ~ lava = 89. G/.' `y 1 ~Oropv~ /:~ e . ~ f/pr,~ai'd ~ /dcr.Sor+ ~Oro~O. (o%S(opQ~c/ncc~.f si..~sw, 5cc.4, Cady ~ ~ syste,narea ~i-opo~ed t.Jtescr Vona . e~C e~ ~vr, Prbpos~~•~ ~, ~ 9~.Sm C_nf.o,.~~ - ~ ' `- - - ~ r.JL~l~~,1p/(o5'D-w(Q e. ~,, E!'~C.~,S~.'a ('.ooh!' ~ ~ P~ 6 ~[e-o' ~ ~ so ~ Ys ,, ca'ga bc/ .4-~~0 ~~L/u~,~ ~ ~OG~- /0/3 - 4~0 - A~ , _ - - - c~ \ ,. .~ v . ~`~ ~ ~ ~ ~~ ~ ~` ~ ~ a ~ yi . c bcu,b~;~ e.~aer 9S/.so'__-_ _ ~ T `~~ ~'o~cem ^ ` ' 36ec~rc~m ~ ~, P~oPostd mound at .2o.3/X /o7GS ~`~ 8~ C ~es~dancc J w/s'X 9o'c/,S,oa~sa/ce.~/, Twos;) d,'Sfi/bu,E.~ /o-fer~(S ~/~X88.ss, •.. • W M X J W¢II o M (1 W o 0 \ 3 \ d ~ ~ ~ ~ 1 a ~ ~ ~~~~_ O G - - Y.. EX/S ~i nq So ~ /o ~ /i:+Q $e arK: Too o ~ ~e I~pl~o r~Q ~0~.d. I ~ ss k e ~ = ioo . on; 50~ Ave . a8o~9 1~• commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 21, 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: 03/21/2007 Identification Numbers Transaction ID No. 1116732 SITE: Site ID No. 695784 Eric & Sarah Cooper Please refer to both identification numbers, 50th Ave above, in all. corres ondence with the a enc. . Town of Cady St Croix County SW1/4, SW1/4, S6, T26N, R15W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1008249 Maintenance required; 450 GPD Flow rate; 24 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 private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • l;nmm 83_LL171 - inspectors. ~..viiuidreviitstty ~~~~~Y~~ DEPARTMENT OF COMMERCE JOE STANG Owner Responsibilities: Page 2 3/21/2005 The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the a ddress 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, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commercestate.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 03!15!'2005 74: A8 6087859330 SAFETY AND 13LDGS PAGE 6 ~~C~~~~D ~~~ MAR r 8 ?00~; ~~'~I ~~~~1~ MP~CINEIV~ ~c~ ~~~as Mt7UND AND PRESSURE piSTRtBUT1C~Qn Ct~ ~~Gs ~~~` Residenbai App! INDEX,fl-nliD TITLE PAC3E f~~,~ Project Name: Eric 8- Sara Coo t 3 -Bedroom Resldentiel Mound cavner's Narne: Eric & Sara Coo r Owner's Address: 1170 Ma le St. Baldwin WI 54002 Parcel Address: Psndin • XX)OC 30th Ave. Legal pescxiption: SW1l4 SVY114, Sec. 6 T28N., R. 15 W. Township: Cady County: St.Croix Subdivision Name: Pending CSM -Vol Pg. Lot Number. Pendin _„ Block Number: ,~________r Qarcet t.0. Number: Pendin from 004-1013.40-t)~ Plan Trar-sactivn No:: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System mairrterrance specifications Page 8 Managemerrt and cantingerlay pin Page 7 Pump curve and specifications Page 8 Site Plan Page g Soil Evaluation R R Designer: .be Sta 1_icen~ Number_ 223475 Phone Number: ~T15j 684-a1~6 pate: 03f1 103 Signature: D~ ao~,®d >~ez~~ Mound Component Manual for POWTS decsian 20 SD&1068'1-r' (N. 01 f©1), end SSWMP Publication 9 .6 Design of Pressure Distribution Netw~q~ks for ST SAu (01/81) A D BUILDIN pIVIS10 7 ` Page 1 of 9 Version 4.131 (R. 09104] SEE CORRES NDENCE ..•. 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) 6.00' Site Slope (%) 94.33! Contour Line Elevation (ft) 24.00': Depth to Limiting Factor (in) _ _.: 0.60 In-situ Soil Application Rate (gpd/ft2) Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. Distribution Cell Information .. 90.00! Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00!. Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N __ _ (c ore) a Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 2' Number of Laterals of the highest point. ___ _ _ _. ___ _. 0.125'- Orifice Diameter (in) (e.g. 0.25) __._.._ _ 2.50', Estimated Orifice Spacing (ft) = 6.25 ft2/orifice 2.00 Forcemain Diameter (in) __ 175.00 Forcemain Length (ft) Does the forcemain drain back? Y _.___. 80.50, Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 14.41 Vertical Lift (ft) 3.32 Friction Loss (ft) 24.23 Total Dynamic Head (ft) 28.55 Forcemain Drainback (gal) 81.25 5x Void Volume (gal) 109.79 Minimum Dose Volume (gal) 29.66 System Demand (gpm) Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Manifold Diameter Selection in. dia. o tions choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) ____ __ Treatment Tank Information 646.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 38 00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 17.00 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 646.00 ~ Dose Tank Capacity (gal) Zabel .Filter Manufacturer 17.00'. Dose Tank Volume (gal/in) !A100 ,Filter Model Number _ . _._ Wieser Concrete Manufacturer Project: Eric & Sara Cooper 3 -Bedroom Residential Mound Page 2 of 9 Mound Plan View i- 1_ '• 1/10 B •••'•'•'•'•••'•'•'••••••••••ObservationPipe ~'~•~ K ' ;Q .n, . ,.. .. ,.,J~ .. .. .....~ . . . B . L H 1.OOft K 8.83ft I 9.48 ft L 107.65 ft J 5.83 ft W 20.31 ft 1303.35 (ft2) Basal Area Available 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 97.12 (ft) --~ ,.}~ ..,.. G • H ,~ ,~~~~~~ii~ 2 frfrfifr,. l . .~.--. . . . . ~f F .. ; : ; :: f 95.83 (ft) Lateral Dispersal Cell 95.33 (ft)-~~- ..::::::::::::::~ Invert Dispersal Cell :~:::::: :~:~:::; :::::~:;:;:;:• ~ Elevation ~: E ~:~:~:~:~:~:~:~: D ~:~:~:~:~~: 3 :~:~:~:~:•:•. . ~ . . . . . Shading Key 1~ Topsoil Cap © "~~~ Subsoil Cap ©~ ASTM C33 Sand ® `~i':~'` Tilled Layer ^5 ~ Aggregate Mound Component Dimensions -, -+ _fi -1 A 5.00 ft E 15.60 in B 90.00 ft F 9.50 in D 12.00 in G 0.50 ft 450.00 (ftz) Dispersal Cell Area 5.00 (gpd/ft) Linear Loading Rate 6.0 % Site Slope ~ a c 1.5 ft c N O R N 0.5 ft 0 ~ ~ Dispersal Cell .. F Typical Lateral :° ; °° -- A 33 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Eric & Sara Cooper 3 -Bedroom Residential Mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A & B dimension ~ =Turn-up m'ba II va Ive or cleanout plug E P 'I All laterals are identical ~~ X ~ I Holes drilled on the bottom of the lateral S equally spaced I Force main connection via tee yr cross to manifold a[ any point. Laterals & force main of PVC Sch 40 (per COMM Table 84.30.5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 88.55 ft Orifices per Lateral 36 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft2/orifice Lateral Flow Rate 14.83 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 24.23 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Lockin cover withwamin Electrical as per NEC 300 and -~ Comm 16.28 WAC 9 9 label and locking device and sealed watertight 4 in. min. Disconnect __,____~ Tank component is properly vented Wieser Concrete Ca acit 646.00 Volume 17.00 Manufacturer Gallons gal/inch A B C D Dimension Inches Gallons A 18.54 315.21 B 2.00 34.00 C D Total 6.46 11.00 38.00 109.79 187.00 646.00 3 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds Pump Model Number 3887 EP05 er to Pump Must Deliver 29.66 gpm at 24.23 ft TDH ~ Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P• ump off elevation (ft) 81.42 Dom se tank elevation (ft) 80.50 Project: Eric & Sara Cooper 3 -Bedroom Residential Mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Joe Stang Phone 715-684-5166 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted. and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ...~~......... ............... Grade \ , " " ".'." 6-8" Diameter Lawn ~/_ ~ • . Threaded Cleanout Sprinkler Valve Box • . • ' • : • ~ . :. ~ . Plug or Ball Valve Distribution ~ ~ ~ ~ • Lateral ~y- Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Eric & Sara Cooper 3 -Bedroom Residential Mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shalt be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped wtth an alarm, the lifter shaft be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical addttives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. 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 filter is installed within the tank tt shall ~ inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and 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 recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L GODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is pertormed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monttoring. 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 condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surtace, R will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Eric & Sara Cooper 3 -Bedroom Residential Mound Page 6 of 9 ;~~ GOULDS PUMPS ,~ . ., -. • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. APPLICATIONS ~:,ec.f~~cally designed for the ~o'~~~~o~.ving uses. • ~ff~uent systems • tiomes ~arm~S • 'heavy duty sump • :rater transfer • ~~ervatering SPECIFICATIONS • Soi~ds handlrng capability, maximum. • C~paut~es up to 60 GPM, • Total Heads: up to 31 feet • C~~scnarge size. 1 ~/." NPT. • ~.lechanicai seal: carbon- ~otary.ceramic-stationary, 3~~JN~ N e~astomers. • 'emperature. ''J4 F ~40 Cj continuous '~-10 F ~60 C> intermittent. • Fasteners 300 series sta~,;~ess steel. • Capable o! running _ ;~;'thout damage to ,,~rponents Motor: • ~~?04 Single phase: 0.4 HP, ' '. ~ or 230 V, 60 Hz, 1550 RPM. built in overload with automatic reset. • EPOS Single phase: 0.5 HP, "5'/ or 230V, 60 Hz, 1550 R?^.1 Quilt in overload with automatic reset. • ?oover cord- 10 foot aanoard length, 1613 ~~TOW with three prong oround~ny plug. Optional 20 soot !ength, 1613 SJTW with tnre prong grounding plug stanoara on EP05). Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory, FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with niimn Hilt vanac fnr morh ~nira~ Submersible Effluent Pump 3871 EP05 ^ EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and ion^:e~ heavy duty ball bearing construction. AGENCY LISTING SP Canadian Standards Association. Goulds Pumps is ISO 9001 Reyisterec ti o ~ iu~e~ d ~„ ~_ ~~~ ~~ .Z-9 ~~ ~.P~~, rrr.-ni mu cAPACfTYy Goulds Pumps __-- ~~..:,s ~~.,,,,us ~' ~/ ITT Industries ~:~ ~o~,;. w ~5. ~0~9 =~ 4 o~ a c ti ~T ~J J v " ~a l~a~ ~praP.e~'by ~ ~ off' 3/B ., • E/e d~i~ . (`~ ~; ~ lei = 89, bl.~ ~- FXiS~~ f~~Ce%tf/ /oropv~ /:~ e ,~c~d ~/ /v~crso-, ~rdp. (o%S(oPe Lrclbcc~ SwSW, Scc.4, Cady sys~~ area froPo~td ~.J;es.~ C'o„¢ . ert e~ fir, Proposed ~,lA /r- 9~.s~~c~r_co~. ~ _ _ _ _ ~ r,JL/~/,UW/~s0-~'+-(Q Cvh,b,i~vE~~ s,r./oe. E/'iG¢-~'r'Q ~~ P h-6~~ ~ 1` ,, 9s,sa'_--- -- ?o' ~ ~ ~'~.b~/.4-.~~~F/~~ ~~~-/0/3-0-ate .~ ----- _ `~ F''/~~aE S.T. out/~6•'-'~ ` c~ ~, ~ 6Q ~, • o ~ ~. ~`. az. ^ ~~. ~" ~, y, ~~ ~ ~~\~ ~ 9S~,TO'---- _ 1~~~ 8~ -F'o~ctmR%n. ~~opostcl mounda~` .Zo.3JX /o7GS ~~. w/s'X 90'~/,SPt~sa/Ce.//, TWo~z~ d; s~ii 6 u~f.~ /o-~e.~a-CS ~ /y1;Y 88. ss , • `. ~/ /,~ "o~~ F'ce S Spy to c~ ~ .2.5.3 bcuk~:~y 5~~..~err P~aPaa~d s ; 3 be~/rwm ~ ~es~d~nac o or ~ropa scr~ well. `~ h a 3 d 7 .` V O O n a.t"f<': Too o •~ ~e lepl~,o nQ ~o~.d. SS cc ~ ¢ ~ _ /OO.OD; 50~ Ave . ~. 8 ~.~ 9 Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance wfth Comm 85, Wis. Adm. Code 1769 Page 1 of _ j A.C.E. Soil 8 Site Evaluations County Attach complete site plan on paper not less than 8'/~ x 11 inches in size. Plan must St. CroiX include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road . Parcel I.D. Part of 004-1013-40-000 Please print all information. Reviewed By Date Personal information you provide mey be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location Harold Halverson Govt. Lot SW 1/4 SW 1/4 S 6 T 28 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 569 Co. Hwy. NN proposed Proposed CSM City State Zip Code Phone Number _~ City __J Village / Town Nearest Road Wilson ~ WI 54027 715-698-2791 Cady 50Th Ave. New Construction Use: /J Residential /Number of bedrooms 3 Code derived design flow rate Replacement __.I Public or commercial -Describe: Parent material Glacial daft over weathered limestone bedrock. Flood plain elevation, if applicable General comments and recommendations: Install mound system at elev. 95.33' at 12" above 94.33' contour. 450 GPD na ^ Boring # _' Boring /~ Pit Ground Surtace elev. 94.55 fl . Depth to limiting factor 24' in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ffz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/2 none sil 2fsbk mvfr as 2fm 0.6 0.8 2 9-20 10yr4/4 none sl 2msbk mvfr cs 1fm 0.6 1.0 3 20-24 7.5yr4/6 none sl 1msbk mfr cw 1vf 0.4 0.7 4 X24-30 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk mfr cw 1vf 0.6 1.0 5 30-38 7.5yr5/6 _ f2d 7.5yr5l8 scl 1 csbk mfr cw 1 of 0.2 0.3 6 38-46 10yr8/3 na L. S.B.R na fragmente - - 0.0 0.0 Boring # ~ Boring /i Pit Ground Surtace elev. 94.53 ft. Depth to limiting factor 27~~ in• Soil Application Rate Horizon ~ Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10yr3/2 none sil 2fsbk mvfr as 2fm 0.6 0.8 2 ' 10-21 10yr4/6 none sl 2msbk mvfr cs 1fm 0.6 1.0 3 21-27 10yr4/6 none sl lmsbk mfr cw 1vf 0.4 0.7 4 ~ 27-36 7.5yr4/6 f2f7.5yr5/8 sl 2msbk mfr cw 1vf 0.6 1.0 5 ; 36-52 10yr3/4 f2d 7.5yr5/8 scl 1 csbk mfr cw 1 of 0.2 , 0.3 6 52-58 10yr8/3 L.S.B.R na fragmente - - 0.0 0.0 ' Effluent #1 = BOD ~ 30 <_ 220 mg/L rid TSS >30 < 1 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson =~------ 3602 Address A.C.E. Soil 8 Sfte Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceo 154020 3/18/2004 715-248-7767 Property Ow~rier Harold Halverson Parcel ID # Part of 004-1013-40-000 Page 2 of 3 __ Boring # ~ Boring /f Pit Ground Surface elev. 92.54 ft. Depth to limiting factor 35" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 ~ 0-10 10yr3/2 none sil 2fsbk mvfr as 2fm 0.6 0.8 2 1 10-21 10yr4/6 none sl 2msbk mvfr cs 1fm i 0.6 ~ 1.0 3 21-29 10yr4/6 none sl 1msbk mfr cw 1vf,f 0.4 ~ 0.7 4 1 29-35 7.5yr4/6 none sl 2msbk mfr cw 1vf 0.6 1.0 5 35-40 10yr3/4 f2f 7.5yr5/8 scl 1 csbk mfi cw - 0.2 0.3 6 40-45 10yr8/3 na L.S.B.R na fragmente - - 0.0 I 0.0 I a Boring # -4 Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P / ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 -~ ^ Boring # ~ Boring ~ Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots / ~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh `Eff#1 'Eff#2 i i i ' Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ' -~rc / f ou7 ~orapv'£y ~~ P: C~ l~xo.~ ~'c !d l~ °,b Stope ~u~ 5ys~,r, ~eQ ^ Sor'/ a/a~ua~'o•~ P-~ ' ~ E/ed~,br, --~ FXiStl~ J f~~te%f/ ~o~opv y /%~c P~ 1 Cu./ ~ /= s<0' i ~a.~-rd !,/ lv'~s~v~+,o•-oho. $wSW, Scc.G, ,fCady ~7pOS~ ~il ~rC e4/!~ i~i^, E/'rC.~~'a ~D~!' ~~- /0/3 - ~0 - ~ - ~--- 9C~33'Sys~m ~._ ~~ 9f/.33' ~~'tif \~ 9~.SUCon~~ (S2 9fl,3,~° ~ ',. ~~ _ _ _ 9~~, ,2 y0 __- ~ . __ _ _,,_ _, lei ~~ ~~ 9S~~C°r~fy~,~~ W ,209' s~~ /~/Q . ~_ 3 0-~' 3 1769 SOIL EVALUATION REPORT Wisconsin Department of Commerce Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Courrty Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must St. Croix include, but not limited to: vertigl and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Part of 004-1013-40-000 P/use rint all information. B D Personal information ycw prcnn Property Owner Harold Halverson Property Owner's Mailing Addr 569 Co. Hwy. NN City -- ~,/ aY c-- r ~_ ~,-r~ tote ; ~~umber R sewed y Law, s. 15.04 (1) (m)). ~ ,~ O Property Location Govt. Lot SW 1/4 SW 1/4 S 6 T 28 N R 15 W Lot # Block # Subd. Name or CSM# proposed Proposed CSM City village / Town Nearest Road Wilson ~ WI 54027 715-698-2791 Cady 50Th Ave. / New Construction Use: / Residential /Number of bedrooms 3 Code derived design flow rate Replacement Public or commercial -Describe: Parent material Glacial drift over weathered limestone bedrock. Flood plain elevation, if applicable General comments and recommendations: Install mound system at elev. 95.33' at 12" above 94.33' contour. 450 GPD na ^ Boring # Boring / Pit Ground Surface elev. 94.55 ft . Depth to limiting factor 24~~ in. oil Applicat ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr32 none sil 2fsbk mvfr as 2f ~,~ Q , Q 2 9-20 10yr4l4 none sl 2msbk mvfr a 1f p , lp ~ . o 3 20-24 7.5yr4/6 none sl wmsbk mfr cw 1 p .~( ©, ~- 4 24-30 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk mfr cvv 1 ~ , fP ) . ~ 5 30-38 7.5yr5/6 f2d 7.5yr5/8 scl 1 csbk mfr cw 1 of ~ , 2 Q , 6 38-46 10yr8/3 na L.S.B.R na fragmente - - Q, O 0- ~ Boring # Boring / Pit Ground Surface elev. 94.53 ft. Depth to limiting factor 27~~ in• oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#2 1 0-10 10yr32 none sil 2isbk mvfr as 2fm 2 10-21 10yr4/6 none sl 2msbk mvfr cs 1fm 3 21-27 10yr4/6 none sl wmsbk mfr cw 1vf 4 27-36 7.5yr4/6 f2f7.5yr5l8 sl 2msbk mfr aro 1vf 5 36-52 10yr3/4 f2d 7.5yr5/8 scl 1 csbk mfi cw 1 of 6 52-58 10yr8/3 na L.S.B.R na fragmente - - Effluent #1 = BOD ~ 30 <_ mg/L and TS5 >30 < 150 mg/L * Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L :ST Name (Please Print) '~Signatu,~'-°° ~- ~ CST Number 9' James K. Thompson ~ C~y~cQ ~. "J• ~` ~_ 3602 Address A.C.E. Soil & Site Evaluns Date Evaluation Conducted Telephone Number 340 Paulson Lake t~(ie, Osceola, WI 54020 3/182004 715-248-7767 Property owner Harold Halverson Parcel ID # Part of 004-1013-40-000 Page 2 of 3 ` $ ~ Boring # Boring / Pit Ground Surface elev. 92.54 ft. Depth to limiting factor 35" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sit 2fsbk mvfr as 2fm ~~ ~ p, p 2 10-21 10yr4/6 none sl 2msbk mvfr cs 1fm ~ , ( O 3 21-29 10yr4/6 none sl wmsbk mfr cvv 1vf,f © ~ ~ ~ 4 29-35 7.5yr4/6 none sl 2msbk mfr cw 1vf . ~ ~, p 5 35-40 10yr3/4 f2f 7.5yr5/8 scl 1 csbk mfi cw - p •'Z- c7. 3 6 40-45 10yr8/3 na L.S.B.R na fragmente - - 0 • o O. ~ ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ffz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # Boring pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS ~ 30 mg/L and TSS ~ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ' -~ra //ate ~oroP.u'~y T,e o{' 3/d •. deb ~,: ~~~ = aq ~~' Co °,b 5(ope ~»a~ s y stc„~ a.r eQ Q3 ^ ~~ / e/a/ua~'o~ P'~ ~ ~ E/edax~,~i» Q/ ~jE- fXiS'~i~ J f~~ce.~:Kl /oropy y /:~c p~ 1 ca/ /_ ~0' ~ $wSW, Scc.4, Cody ~M(JoSpd yl i/ CI'C e~/ri i~v,-, Er~c.~Sa.•a ~~!" ~OGq~- /0/3 - ~0 . an 9~ 33'Sys tLe,,., \ (32, f 9d. 33'- - - - ~~' a Zro4^ \ 9~. SO Conte i ~~ ~ ~ %3, SO ~Con~P'-°~' _ _ ~y~~, ~~_ ~ lei p5 Sa' Cogfyu-,~ `4J h W ,s ,209' X11 s~~ ~Qde . .~ 1 ~• 3 °~ 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ 2`~~ ~- -~''~ 2 /~ ~ C ~~ ~ ~ 2 Mailing Address , ~ ~U ~f9-~ le- ~~ Property Address ~~ U ~~ ~~ (Verification required from Planning Department for new City/State `ti Parcel Identification Number LEGAL DESCRIPTION ~„~,ar~~~-- ~~~ ~ Property Location S~ '/., ~ `~'/a, Sec. ~ , T 2 ~N-R ~ S W, Town of ~_. Subdivision _ ,Lot # Certified Survey Ma # ~ l ~ ~l ~ 3 ,Volume ~ ~ ~ ~ ,Page # 3 Z 4° Warranty Deed # ~~ ~ ~ S~ Volume ~ Page # ~ 1~~ ~: ~. Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification statin that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 daysM f~he three ye r ex tion date. X SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the r~p99erty~~??descri above, by virtue of a warranty deed recorded in Register of Deeds Office. I SIGNATURE OF APPL CANT DATE : ««: «« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. * * * * * * " Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed A Product of Wick Building Systems, int. ' P.O. Box 530 - Marstsfield, ~~ili 54449 • (715) 387-2551 HOME System - RPT SalesOrder.rpt :ttat~t Prtiht on this Page ,~ r 4 b 0 '~ 0 ~~ o ~~ ~~ r 0 O 0 i , ~-.~ tq G ~ ~ 10 ~~ -1 0 I , i ~ ' . ~' ' ~ 11 1 1 ,. 1 1/1 i' 1 /1 1 a © 1,r 1 , 1 /1 1 1 1 1 1111 ~~ ~, {~ 1 a j, ~ ~ ~ 2 ~i ~ ~1 1 1 1 ~` 1 1 i _ _ ` 1 1 1'? ~ ~ i 1111. , `. ~I 11 1 / 1 1 11,1,111 ~ i t 1 1 1 1 1 O 1 IJ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ~~ r i~~ ~~ i~ 1 1 1 1 1 1 1 I I i 1 1 ~ >- ~ 1 1 1 1 1 1 1 1 1 1 ~ 1 1 1 1 1 ~ iZ I ~~1 1 1 1 i 1= I 1 1 1 1 I 1 1 1 1 1.1 1 II 1 1 1 1 1 1 1 1 1 1 1 1 ~~ 1 I.1 1 i 1 rl 1. 1 I I 1 1 1 1 T'}? I I i 1 1 1 1 1 1 1 1 1 1 1 1 1 i l l l l l l l l l I.t 1 1 1 1 w I t l l i i l l l l l l t i 1 1 1 1 1 1 1 I 1 1~ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I J I t 1 1 1 1 I/ 1 1 1/ 1 •1 ~'~ 1 1 1 t~ i t 1 1 1 1 1 1/ t 1 1 1 1 Q 1 1 1 1 1 v 1 1 1 1 1 1 1 1 1 1 1.1 1 1 1 1 1 1: 1 1 11 , 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 i l 1 1 1' 1 r 1 I 1 1 1/~~) 1 1 1 1 1 1 1 it 1 1 1 1 1 ~ V' 1 1 1 1 1 1 1 1 1 1 1 1 1 1 f'- 1 1/ 1 1 1 1~1 i 1 i 1 1 i 1 1111111,1+1~•.111 ~~ ~.I 1~, , / 1 1 1, 1, 1 ~1 t l 1 1 1 1 1 1 1 I> 1 1.(1}, 1 1 1 1 i I'1 1 1 1 11 1 1 1 1 1 1 1 1 1, 1 1 1 ITI 1 1 1 1 I t/ 1 I/ }}~~1 , 1!, t 1 1 1/ 1 1 1,/, < 1 1 1 1 7/ 1 1 1 1 1 1 IYI 1 ~, I 1 1 1 1 1 1 t ',, ~i 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 . 1 1 , 1 , t , ~. ~ -~ v~ 0 .~-,~ 0 0 - ~. ~'~ - - 1 ~ I ~o 1 of I 1 1 1 ,~ I~ 1 1 I I Q~ r I .~ O i D c rrl n~ ~++ d rt ~' o s :~ ~~~ ~ ~~~ o H `~ ~P ~ 0 t~ U 2775 P 326 " STATE BAR OF WISCONSIN FORM 1 - 1998 - WARRANTY DEED Document Number I This Deed, made between Harold H. Halve_rs_on and Arlene J. _ , Halverson, husband and wife, Grantor, and Eric C. Cooper and Sarah J. Cooper, husband and wife, as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): Part of the Southwest Quarter (S W l /4) of the Southwest Quarter (SW 1/4) of Section Six (S6), Township Twenty-Eight North (T28N), Range Fifteen West (RISW), To ady, St. Croix County, Wisconsin; more particularly describe as: Lo of Certified Survey Map recorded on February 22, 2005 in Vole 1~ age 4929 as Document No.: 788065. 79 1 ti7J43 KATHLEEN H. 11ALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 04/01/2005 10:00AlI IiIARRANTY DEED EXEIPT ~ REC FEE: 11.00 TRANS FEE: 12.00 COPY FEE: CC FEE: PAGES: 1 Name and Return Address James H. Krave Attorney at Law P.O. Box 304 Glenwood City, Wisconsin 54013f 004-1013-40-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements and encumbrances of record. Dated this ~ day of March , 2005 ~ (' * Harold H. Halverson ~- s Arlene J. Ha verson AUTHENTICATION Signature(s) Harold H. Halverson and Arlene J. 2005 * James H. Krave, Att~rney st Law _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY James H. Krave, Attorney at Law Glenwood City, Wisconsin 54013 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. _._ County. ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. * Notary Public, State of Wisconsin My Commission is permanent. (if not, state expiration date: •) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DECD STATE BAR OF W18CONSIN PORM Yo. 1 - Ifft INFORMATION PRUFESSIONAlS COMPANY FOND Dll LAC, WI te0-655-2041 •3~ e ~ESbm~s VO1.lA PAGE 4929 NATRL~E;A H. YiiL~N RRGLSTER OF DfifiDS CERTIFIED SURVEY MAF RECEIVED FOR RELORD 92/72!2005 83c~SPM GfiRTIFIfiD SURVEY AAP LOC ATED ]N PART OF'fHE SW il4 OF THE SW i/4 OF REC FSE: 13. A0 SF.c'.TiC/N b, T28N, RiSW, TgvvN CiF CADY, ST. CROIX COPY FEE: 3.00 P,Ap6S c 2 CUUIYTY. WISCONSL~I. °?~ SURVEYOR: W ~j O 7pUGLA.S J. ZJIHLER Q~ W/s C 9 Q N LAND SURVEYwG, INC. R T ~~ O 2920 ENLOE ST EE i ~ y ~~ DOUGI ~ HUDSON. WI 61016 ~ ~ `~ ~ .A$ J. ~ y rAMlEit PR.EP'ARED FOR: 77~~ 9-2145 ggRAk 6 ERtC COOPER Q FIU~ 110 MAVLE ST. a BALDWIN, WI. SWOT ~ V ;~ + ~ ~ • ~'~ ~ ~ AND HARQLD MAL\~ERSON ~'J ~ `~'+ ~ -.,~ ~ 369 CO tiN WILSON,'NI. ~._ `~ ~ 1 ~• ~~ ~ ~cEN:.ELiNE 7~.5't M~7N G'~ ~dhi4ly ~` ' C+(a F'R^~EA1'Y CORNER \ k ~ --~ ----- -----.L_.~ 589°33'4"W 417.x' ~6 -»....1~ s~cy,, ° ~1~ ~. •4Ck ' ~_ ~ rc V(:E (xMiNER ~tJT 1 t 2f. EAE.T Of bROPeR*Y LINE ~~ aneA INauanl~ RIa1,raF-xAr ~ ~; Qj 4.oC ACIiE$ (t7a,16? Fia. f.Tl ^ ~Jf I ~ B3 _ s ~ ~i i ~ B2 ARa4 eXOLUe~NG RI(:FiT-0F•WAY 7A ~ al + ~ w 3.7! 41:siE5 (1®1.a08 ti0. s.T) S '~ I ~ ~ ' ; ~ ~ ,~ .... 0.i "il ae'aACK ..... ...... . .................... ... .. ... .. ..... ...... ...... g I~r ~^f d ~ ~ F - t r--~ ~I L FENCELINe 7a.9't eA3T l Of •ROPERtY LINE 9W COR. ~_ _..... ,moo ....~. N89'2~'U^ 9~'EE ~/T.SB' _~. 1...- _~ _~~ ~..~ SUU'ri 7K COR. 62C 8 sEC:. a C NSG 01"~ . 27.7p' ~; SOUTt•t llNII CIF' 9w OF ew 29.ar ~~ .~r ~ ~ TR _ ~ 1~Z~ ~i ~ j,~`~~ ' -~^ N 1/~YY r~.1v~ ~ AVELED GEN ` TERLfNE Y NtW'39'Q4'E 1463.96' JV l Ll ^ ~ _ _V__. 1_~1 L, N89.33ti4'e 15BT.t9' UP~PLAT'I'ED LANDS LEGEND OMWhi ORDINARY HIGH WATER I.l4RK ;~ SOIL BGRINCS fCUNP CI( NAIL (MASONRY NAF~i FOGNO t• Be RNT$eN 7R;R'rEY lAARKER 0 SET t• WTSIOE DIAMETER BV 7C LONG IRON PIPE. WEiCdFiWD t.13 L&9. PER t,INEAR FOC' . ......... $ETBACIC ......- • • . 73' BETWOK ;NA~I~6ABL='HATER IYAY} ?CAIE: t'v 100' o (w n-o SHEET 1 OF 2 SHEETS DRAFTED er: wss.~.absRSON PROJlCT0641t'-Ct DATE: 4itl04 REV19ED: d2dC6 1701 19 Page 4929