Loading...
HomeMy WebLinkAbout004-1024-50-000St. Croix County Planning and Zoning Friday, September 21, 2007 at I1:15:43 AM Detail Sanitary Information Page 1 of 1 Computer #: 004-1024-50-000 Sub/Plat: NA Section: 11 Parcel #: 11.28.15.166 Lot: TN/RNG: T28N R15W Municipality: Cady, Town of CSM: 1/4 1/4: SE 1/4 NE 1/4 Owner: Klatt, Jeff 464 320th St Spring Valley, WI 54767 State Permit: 420721 Issued: 03/05/2003 POWTS Dispersal: Mound less than 24" suitable s Permit: New County. Permit: 0 Installed: 09/02/2003 POWTS Detail: Bed -Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Reauirements Additional Notes Monev Owed Not determined NA Stang, Joe Changed from separate septic & dose tanks to $0.00 Pam Quinn Signed Off: Yes combo tank and increased forcemain length. Upsized pump to EP05 after checking pump curve for capacity. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/2/2006 Permit Holder's Name: City Village X Township Klatt, Jeff Cad Townshi CST BM Elev: Insp. BM Elev: BM Descn on: ~p ~1>0 ~ T a~ ~t~ ~wuv ~ uwT~~~~ ~ r~/ATIA~I f1ATA Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH fi0 PERMIT) Personal iriformation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 11\f~ 11\rVR1Yl I'll IVI\ GLG YMIIVI7 LIMIA c°unty: " ~ St. Croix Sanitary Permit No: 420721 0 State PI~ ~~~ Parcel Tax No: 004-1024-50-000 SeckionlTown/Range/Map No: 11.28.15.166 S, Fy'~ION ~~' H~ FS E E Benchmark ~ 3 •q V ~~L ~ •~ ~ o/l- /\ v t. ~-- co .Lb R ~ • ~~ Bldg, wer ~~ o ~. o yd- a r, S Ht {nlet ~,~ pp ~y 47- !~ SUHt Outlet ~- ~ Dt Inlet _~ l Dt Bottom • 9, S" ~ l3 • r~~ .~s .3 Dist. Pipe 3 ~ 99 ~s Bot.~ ~st~i ~/ ~ ~ ~ Final Grade ~.. 1 St Cover 1 ~ , ~~ S pto. ~ ~ ! lb. b•zf (P.2S ~7.7 to s-f*•!i± ; ~ TYPE MA UFACTURER ~a C.dYtc~ CAP ITY S/ h Septic / ~y-- C% Dosing <~ 3 rz w bs 7J Aeration •' Holding TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ l~ Q ~ _6 I'~ts Dosing ~, ~ Aeratio Holding PUMP/SIPHON INF013MATION Model Number ~~ ~-- TDH Lift Friction Loss Syste He~ci •~ For~emain Len th Dia. /, Dist. to Well / ~ SOIL ABSORPT ON SYSTEM Demand GPM Z ~•'~ ~ . BED/TRENCH Width Length No. Of Trenches PIT DIME ONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ~D' / ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/S EAM A ING Manufacturer: INFORMATION CH ER OR Type Of System: ~~ ~~dfy ~ Model Number: UISTRIBLLT+A~N SYSTEM Head /Manifold Distributio n ~y / ~ x Hole S' x Hole Spacing h ' Q ~ ~ ~ L r . s S ~ ~ „ ~~ ~ Lengt Dia ength O Dia pacing SOIL COVER i x Pressure Systems Only xx Maund Or At-Grade Systems Only is•a~ Ve~nt~ ~ Intake~„t~ v;~"~E~' Depth Uver Depth Over xx Depth of xx Seeded/Sodded xx c I Bedlrrench Center I s'~ O/ Bed/Trench Edges Topsoil ~u°J Yes [] No j ] Yes ~~;_ o COMMENTS: (Inclu e c~ discrepencies, persons present, etc.) Inspection #1:~/ L l0 j Inspection #2:~- /~~~/ Of Location: 464 320th St Spring Valley, WI 54767 (SE 1/4 NE 1/4 11 T28N R15W) NA Lot ~Y~~ Parcel No: 11.P8 15.166 1.) Alt BM Description = r( 2.) Bldg sewer length = .~ ,d ~~ 1Q ~~~-~„ ~ _ -amount of cover = ~aa ~~% /~ ~ l'A ~"'"K- 3. Contour = ' f~ ) ~~,~ ~ / --- -- - II --- - __ _ - - ~ ~_ Plan revision Required? ~ ', Yes ~~] No I ~ ~ i ~ .l L .--- r- Use other side for additional information. ~.__~___ ~ ~ _ _ ___ ___ __ // 5 ~ ~ ' SBD-6710 (R.3/97) Date Insepcto igna~ure Cert. No. ~. a~itl( 320- Safety & Buildings Division 7 Sanita Permit A 11Cati0II rY PP ~ 201 W. Washington Ave. PO B 73 _ _ ox 02 ~se~ns~n In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707-7302 department of commerce P ersonal information you provide maybe used for secondary purposes (Submit completed form to county if not . [Privacy Law, s. 15.04(I)(m)] state owned. Attach com lete tans to the coun co onl for the s stem, on a er not less than 8-1/2 x 11 inches in size. County ~ ~ ~ State Sanitary Permit Number ^ Check if revision to previous application fate Plan I. D. Number hs+n ' i '~ •. l 2.0 2 { t ~wsar/ ID. S 820 I. A lication Information -Please Print all Informa ion Location: Property Owner Name Property Location F ~~ e "~ MAR 0 5 2003 5E 1/4 11 E1/4,S (TZB,N, W Property Owner's Mailing Address Lot Number Block Number /D //~,e~ ~ ST.C~~O!X000NTY ~ /1 ' ' ZONING OFFICE } 1 City, State Zip Code one um er Subdivision Name or CSM Number II Type of Building: (check one) w.~ g ~ ^ City 1 or 2 Family Dwelling - No. of Bedrooms:~~ ^ Vil~~l ge m f ^ Public/Commercial (describe use): own o ^ State-owned l.~ III Type of Permit: (Check only one box online A. Check box on line B if applicable) Nearest Road ~.~ LL/,~ ~3G A) 1. l~w System 2. ^ Replacement 3. ^ Replacement of 4., ^ Addition to Parcel T• x Number(s) S stem Tank Onl Existin S stem C1O - 1> S~-O~' B) Permit Number Date Issued ^ A Sariitar Permit was reviousl issued IV. Type of POWT System: (Check all that apply) ^ Non-pressurized In-ground C~'~v ound ^ Sand Filter ^ Constructed Wetland ^ Pressurize In-ground + ^ Holding Tank ^ Single Pass ^ Drip Line 4}'~~ ) ^ ^ A d ~ i i h b ^ l O t-gra e ~ rc~ t ng t er: Aero Rec ic Treatm~nt i~ it ~~ V Dis ersaV reatment Area Information: I .Design Flow (gpd) . DispersalArea .Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed ay/sq. ft.) Rate (Gals./d (Min./inch) Elevation ''// T~ ¢~ ?~ ~s~ / Q.J 94; ~ ~ p ~.0~~ VI Tank Capac yin Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks t..,j,tzo~Q ~~Ippl Con- Con- glass New Existing ~, fl^ .~}~.~.. J Crete structed Tanks Tanks / GY ^ ^ ^ ^ p T~ ~ ~~o - ~; ~ ~,~. ~ ^ ^ ^ ^ VII Responsibility Statement I, the undersi ed, assume res onsibilit f r installation o e POWTS shown on the attached laps. Plumber's Name (print) Plum is Signature ( s ps): MP/MPRS No. Business Phone Number e ~ o~ ~a23 ~7s ~' ~~ - S/~~ Plumber's Address (S e ,City, State, Zip C e) . ~, 8 a~3 cJ~~;l/ c.~l, std VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued sui Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fe ) Determination ~~ ~ O.S~ 3 IX. Cond~it~~Qqns o Approval /Reas ns for Dis pRroval: ~ n ..~.. ~l CF~e ou+~ri1 = ~~ c> D a~ _ ~~ --~-- 0. \` ~ ~ ~ ~ ~ ~ .~ ~ ~~ ~ h 0 ` ~ ', ~ ~ ~ v v ~ i b ` ~ ~ ~ ~ m ~ . 3 ~' ~ a ~ ~ ~ ~ ~~~ ~~~ ~ ~ ~ `~ ~ .~ ~' ~ ry ~~ o v ~~ v c R ~ 6 v ~3 Pro~su{ Sri vt cv ci y ~\ \ '~~' o ~ c ~~ o ~ $. ~~,~,a ~~~~s. . ~ ~~ ~ ~~ ~~~ h~~ k s ul 0 'f ~ y s ~ Q . ~ ~'O ~~~_ ~`~d~ •~ ~ ~ y` ~ C ~° I .~ ~ ~ o n ~~ Z '~ ~ti ~ ~ ~ ~; ~~~~ gas ° ,~~~ ~ a ~ o o `~ 3 o ,c \ rii oz's `_ isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary February 20, 2003 CUST ID No.223475 JOE STANG PO BOX 263 WOODVILLE WI 54028 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/20/2005 ATTN. POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 540 i 6 SITE: Jeff Klatt 320TH Street Town of Cady St Croix County SE1/4, NE1/4, S11, T28N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 892371 Identification Numbers. Transaction ID No. 838207 Site ID No. 655938 Please refer to both identification numbers, above, in all eorres ondence with the a enc . 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: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the COn) "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) APPI and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) B • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. ~ Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal ~ are prohibited. 8EE CORj • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • 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. Stat • 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. JOE STANG Page 2 2/20/03 • The changes made to this plan on 2/20/03 by this reviewer were acknowledged and approved by the system designer. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/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. 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, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 James K Thompson, Ace Soil & Site Evaluations MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Jeff Klatt 3 bedroom residential mound system -- ~;- .~ ~. ~~. Jeff Klatt ~` ~,'~,, ~~~, ~F ~~. ~ l ~' Owner's Address: 610 Hillcrest St. Baldwin, WI 54002 Legal Description: SE1/4NE1/4, Sec. 11, T.28N., R15W Township: Cady County: St. Croix Subdivision Name: NA 8 ~~~.., ~. fi""s of ~.'~ ' w s ~. ° ~,, ~4 Lot Number: NA Block Number: NA Parcel I.D. Number: 004-1024-50-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank ,l~.O~ Page 5 System maintenance specifications Page 6 Management and contingency plan ~0~~~ Page 7 Pump curve and specifications rTpfi Page 8 Site Plan ,~,.~MERf~ Page 9 Soil Evaluation Report •ESp~~ENC Designer: Joe Stang License Number: 223475 Date: 01/16/03 Phone Number: (715) 684-5166 Signature: 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) Version 3.0 (03/01 /01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Inform ation (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) 10.00 Site Slope (%) _ 97.67 Contour Line Elevation (ft) 2 0.00 Depth to Limiting Factor (in) . 0.50 In-situ Soil Application Rate (gpd/ftz) D_ is_tribution Cell Information __ 90.00 Dispersal Cell Length Along Contour (ft) _ _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) __ _~1~ Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c ore) e~ Center or End Manifold 2.50 Lateral Spacing (ft) 2' Number of Laterals ____ _ 0_.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) _ v 2.00 Forcemain Diameter (in) 2~U _ _ 180.00 Forcemain Length (ft) _ 87.00 Pump Tank Elevation (ft) ' / 6.50 f~ System Head (ft) x 1.3 ~ •~ • T 11.50 Vertical Lift (ft) 2.44 riction Loss (ft) 20.44 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 ~ 1.25 I _ 1.50 x ; x 2.00 x 3.00 x Treatment Tank Information ~ 1000 00, Septic Tank Capacity (gal) j Wieser Concrete ~ Manufacturer Dose Tank Information 750.501 Dose Tank Capacity (gal) --_ _Y._, 20_28 Dose Tank Volume (gal/in) ,__._ ~ Wieser Concrete ~ Manufacturer Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil tn3atrnent for fecal conform aF <= 3g inches. 5.00 Cell Width (ft) Are the laterals the highest int in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. 7.50 ft2/orifice Does the forcemain drain back? Y Enter Y or N 29.36 Forcemain Drainback (gal) 81.16 5x Void Volume (gal) 110.52 Minimum Dose Volume (gal) 24.72 System Demand (gpm) Manifold Diameter Selection in. dia. o tions choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) 750.50 Total Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) 20.28 gal~n (enter result in cell B49) Effluent Filter Information Zabel Filter Manufacturer A100 Filter Model Number Project: Jeff Klatt 3 bedroom residential mound system Page 2 of 9 Mound Plan View T ;.; '• 1/1 0 B •'•••'•'•••••:•:•;•;•.•.'.' Observation Pipe '. .' .:.~... . . 5~.~ •f . f: . . .•.~.•~5. . . . . . B• . . ... .. . E. '. . ~- _ ~ L Mound Component Dimensions y .} _~ _l A 5.00 ft E 22.00 in B 90.00 ft F 9.50 i n D 16.00 i n G 0.50 ft 450.00 (ftz) Dispersal Cell Area 5.00 (gpd/ft) Linear Loading Rate H 1.OOft K 10.13ft z 13.39ft L 110.25ft J 6.06 ft W 24.45 ft 1655.36 (ft2) Basal Area Available 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.80 (ft) ,.2 I~ teral F ..:::::: ' Dispersal Cell 99.50 (ft) La 99.00 (ft)-- ~ : ~ : ~ Invert Dis rsal Cell 3 :::::::::~ ~~::: ~:~::::~:~~~~~~~:~. ~ Pe :::~. . . . . '~p :::::::::~: 3 :•:•:•:• Elevation ~~ E ~~~~~~~~~~~~~~~~ ~.. .::::•. Shading Key 1~ ®Topsoil Cap © '}~" Subsoil Cap ©~ ASTM C33 Sand ® "'.~. ~. ~. Tilled Layer Q5 :0 Aggregate 10.0 % Site Slope ~ o. I o ~°• 1.5 ft M O 1 R ~ -~I •- 0.15 ft 0 ~ ~ T ~J ~r~ T al. }f~ F 67 (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 (Ax6). Project: Jeff Klatt 3 bedroom residential mound system Page 3 of 9 ~--- A End Connection Lateral Layout Diagram Laterals centered over the imension ~ =Turn-up wiball valve or clesnoutplug P All laterals are identical IE X~I Holes drilled on the bottom of the lateral ~ equally spaced Force main connection via tee or cross to manifold at any point. Laterals & Force main of PVC Sch +0 (per COPrIMI Table 84.30-5j Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S} Lateral Flow Rate System Flow Rate Total Dynamic Head 2 1.50 in ~ 7 88:45 ft 2.50 ft 12.36 gpm 24.72 gpm 20.44 ft Orifice Diameter Orifice Spacing (X) Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity 0.125 in 3 .3:85 ft 30 7.50 ft2/orifice 2.50 ft 1.50 in 2.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and seated watertight Electrical as per NEC 300 and -- Comm 16.28 WAC ~ ~ 4 in. min. ----- Disconnect ~_ Tank component is properly vented Wieser Concrete Ca aci 750.50 Volume 20.28 Manufacturer Gallons gal/inch Dimension Inches Gallons A /~ 438 5-37$:?1 B 2.00 40.56 D ~ 12.00 243.36 Total 37, 5~ 37-81 750.50 3" Beddi ~- A B C D Alarm Manuafacturer LevelArm Alarm Model Number DLV -~~ Pump Manufacturer Goulds Pump Model Number 3885 WE03L Pump Must Deliver 24.72 gpm at 20.44 ft TDH ~- Attemate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device Pump off ele~ration (ft) ~ 88.00 tank ele~ratlon (ft) 87.00 Project: Jeff Klatt 3 bedroom residential mound system Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name J. Thompson, POWTS#4819 _ Phone 715 248-3271 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 BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftZ Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins t andlor service once eve 3 ears Should ins and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins for ndin and see a e once eve 3 ears Miscellaneous Construction. and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • .............. ................ Grade \ 6-8" Diameter Lawn ~ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jeff Klatt 3 bedroom residential mound system Page 5 of 9 Mound System Management Plan . Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' canponent manuals [$BD-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 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 tie 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 lie 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 cert~ed to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall lie disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at I~st once every 3 years by inspection. The outl~ filter shall be cleaned as necessary to ensure proper operation. The finer cartridge should not be removed unless provisions are made to main sdids in the tank that may slough off the finer when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced 'rf the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid voume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. {f an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the around shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost pen ration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiRrative surface within the mound and snow compaction in the winter will promote frost penetration. Colo 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 BODS, 30 mg/L TSS, 10 mg/L FOG, and 10° cfW100 mL for highly treated effluent. Influent flow may not exceed maximum design fkwv specrfied in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked far effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered ~ an impending hydraulic failure requiring additional, more frequent monitoring. Contins~ency 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. ff the dosing tank, pump, pump controls, alarm or related wiring trecomes 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 vu~tewater to the ground surface, it 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Jeff Klatt 3 bedroom residential mound system Page 6 of 9 'Y ~~ _._ _.. ~ - , __~ .1 MODEL: 3 --- - ±--- - -- __. J~ _ C ~ Pf a~. + o o iza i~a alo U S t ro ~ m~n~~ Pump Specifications F' _, ~. ~.;~~ , 1?. 'i:= '~ ~ ".: F.. _ ~~~~ ~~ maximu~r f~lolor -~~~ ~a.ttura '~2' _,,"S"J; IIC;~ =. ~ ~a~, ~~~_ _ _ ; , ~,? ~~~_. _ ,~~n~~~ o~ st~~rt ~ Fors Materials of Construe±ion Features and Benefits All mode's feature silicon carbide mechanical sea! faces for superior abrasive resistance and extra long life. • Cast iron semi-open non-clog impeller ~,vith pump-out vanes for mechanical seal protection. • mugged cast iron volute type casing adaptable for slide rail systems. • :;orros~o~~~~ resistant threaded stainless steel shaft, Motor a 'ally submerged in high rtuaiity oi'~ !or lubrication and r f?~c~ ant heat transfer. ~pt~unal ~~ilicon bronze impeller ;vailah!e • SSA listed mooels available. ~. _ ~ _ _ ~ _ ~_ _ ._ _ _ ~ !MODEL 3872 ~_ I I I 0 2 4 6 B 10 12 '.~ f ~P4f ITV Pump Specifications 'z HP Up to 75 GPM Maximum head to 18 Discharge size 2" NPT Solids: 2" maximum Motor All motors feature ball bearing construction. Single phase: 115!/ Materials of Construction Cast iron Thermoplastic Stainless steel Features and Benefits •Glass filled, thermoplastic ~;o^e~ impeller with stainless step' mser and pump out var.e~~~_ mechanical seal protection. •Rugged glass-filled themroplasn~ casing and base design po,~ces superior strength and corros.cr resistance. •Cast iron motor ho ~~;na t~~~ efficient heat transfer. stye ~g'r and durabilir/ •Corros~on resistant threaded stainless steel shah. • Available in automatic ana ~~,an~~,, models. •CSA listed models a~ra~lab~~ ~~ Underw~~iters Lahoratories ~,10~ is are ~ies;gned for continuous operation and feature staiiUess steel hardware. r~ 7~~~ 9 ~n U o ~ s w 0 ~ ~ ~~ t, i ~~~ P ~ Qp~~ 6,~ ~ O '1~ ~~.~ ~ b~ 4oe(a ~ ~~ -3c $ ~ ~ 3 U; c., ofl So\ ~ 'Oe ~ro M an»~ ~~S~o.,d E~ (a 99 1 V ~~ ~f n ~e ~y ~~ ~I ~ ~ ~ ~/1 W 7 ~ J ~ 3~~ -~ ~ b" ~~ N~ ~ o ~ Q ~ ~ o r. ~ ~ ~ ~ O ~ E ~ o ~ ~ o\ ~ ~ A Q ~ ~ ~ ~ ~ r ~` \.+ 0 k~ v ~ O ~i. ~' S A \~ ~ ~ A ~ ~ ~~ o ~ ,, ~ ° ~ nn ~v a ~ ~ ~ ~ `, f~ ~i Z \ ~e ~ P ( ~ CF .~ ~ 3 ~ ~ ~ ~ 3 w P~ ~ ~ . t ~~ ~~^~ a~~ 4~ ~ .. 8• ~ o ~ ~ /~ ~, ~ ~~ m .,o ~c F~-~~ ~ o o ~~~ ~~~ cti ~\ ~~~ ~~ ~~ ~. ~ z r oA u ~ ~ O ,~ V ('+' .~ ~~~ ~, ~ ~ 2 0 se ~3 i .a ~ 3~D~e ~~ee~ F~.Ba~'~ ~., 1611 Wisconsin Department of Commerce SOIL EVALUATION REPORT page t- ~ _ 3 - Djvision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & 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. 004-1024-50-000 _ _ Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Jeff Klatt Govt. Lot _ SE 1/4 NE 1/4 S 11 T 28--N R__ 15_-W Property Owner's Mailing Address Lot # - -i Block # Subd. Name or CSM# 610 H illcrest St. 40 A _ _ _____ _ _ _ _ City State Zip Code Phone Number ~ City Village ~') Town Nearest Road Baldwin I W I 154002 (715) 684-4650 Cady ~ 320Th Street f/ New Construction Use: yJ Residential /Number of bedrooms - _3_ Code derived design flow rate _ 450 ___ GPD Replacement %~s" Public or commercial -Describe: ._____- Parent material Glacial drift _.__ Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 96.34' at 16" above 97.67' contour. a Boring # Boring i 24~~ /_J Pit Ground Surface elev. --_ 96.78 __ ft. -_- n. Soil Application Rate Depth to limiting factor _-_ Redox Description Horizon I Depth I Dominant Color Texture Structure Consistence Boundary Roots GPDIft'.__ _-_ ~ I *Eff#1 'Eff#2 1 ' 0-9 10yr3/2 none sl 2fsbk mvfr as 2f,1m 0.5 ~ 0.9 fi ~ --- _- - 9 24 10yr5/4 none _ I 2 _ r f2d 7 5 r5/8 3 24 32 - 7.5 r4/6 Y Y Ifs ~ sl ~ 2fsbk I lmsbk ~ mvfr i mfr cw cw 1fm - ~ ~ 0.5 0.9 , 0 4 0.6 - - _ - _ r - ----- 4 32-80 ! 7.5yr4/6 f2f 7.5yr5/8 ~ strat. s - - -~ 0 sg - -- ml - - - -_. _ . _ _-- 0.7 '~ 0.8 l -- - ---t - -_-- __ ~ ~ ~ ~ ~ I , --- -- H#4 contains 1/2 ~ - -- --- - ---- - 3/4" bands of Om 6yr4/4 Ifs at 6" - 16"inter ---- vals. Redo --------- - x concentrations a ---- re located in c oarser mate rials at up per edge of banding. Boring # Boring 29~~ i n• Sal Application Rate 1/ Pit Ground Surface elev. _ 98.94..__ ft. Depth to limiting factor - Texture Horizon Depth ! Dominant Coior ~ Redox Description Structure Consistence Boundary Roots GPDIft* _ , ; I I t Eff#1 Eff#2 1 0-9 10yr3/2 ~ none sl ---- - -- - -- - __ - ___ - - - - ~------ - 2fsbk -------- ---- mvfr ~ --- - as ~ - -- 2f,1m 0.5 0.9 2 ~ 9-19 ~ 10 r5/4 ~ none ~ Ifs Y 2fsbk mvfr -~ cw - 1fm 0.5 ~ 0.9 - - __ __ j-._ - -- ----r _. -~._~_ 3 19 29 I 10yr5/4 I none i r-- - sl -----~ 2msbk -- ds cw - 0.5 ~ 0.9 -~ -- --I - --- 7.5yr4/6 ~ m2d 7.5yr5/8 I 4 2 8 scl I 1msbk ds aw - i 0 2 0.3 .- _ _ - - , _ - -- - - - - --- - -_f r _ _---. 1 7.5yr4/6 f2f 7.5yr5/8 5 38-63 G -~ gr Is f - - - ~ Om -- --- dsh ~ --- - ~ ~---- - I 0.5 0.9 ---~---- are located m coarser matenats ar upper ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS 30 < 150 mg/L ' Effl #2 = BODS< 30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig ure: CST Number James K. Thompson ~--= 3602 - _ _ Address A.C.E. Soil & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54 0 1/9/03 - 715-248-7767 ` P(rop~ertyjOwner Jeff Klatt___ _ ___ _____ ____ _ Parcel ID # ._._004-1024-50-000 ______ _ Page _2 _of __ 3__. I 3 I Boring # J Boring -- II -- II 1/ Pit Ground Surface elev. ___ 97.59 ft. Depth to limiting factor 40" in. Soil Application Rate Horizon , Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : __ i *Eff#1 *Eff#2 0-11 10yr3/2 ; none sl 2fsbk mvfr as 2f,1m 0.5 0.9 1 i--------- ----- ------- ------ 2 11-26 ! 10yr5/4 none ~ sil 2fsbk ~ mvfr ! cw 1fm 0.5 0.8 __. -- ---- ---- - --- - --r-- ~ ------- 3 26-40 ~ 7.5yr4/6 ~ none sl 2msbk ~ ds cw - 0.5 ~ 0.9 ---- I ----- _ 4 ~ 40-68 7.5yr4/6 ~ m3p 7.5yr5/8 scl lmsbk ~ ds aw - 0.2 0.3 L ~ I- fi i __ --- - - - - - :_ _ _ _ __ ___ _ . _ - --- _------ --- -- --- i --- ---~--- -~-- ~- - ~--- --- _ H#4 contains 1/2" - 3/4" bands of Om 5yr4/4 Ifs at 6" - 16" intervals. Redox. concentrations are located in coarser materials at upper edge of banding. Boring # Boring 1/ Pit Ground Surface elev. __ 100.15___ ft. Depth to limiting factor 20" _ in. Soil Application Rate Horizon ', Depth ~ Dominant Color ~ Redox Description i Texture Structure Consistence Boundary Roots : - ~ *Eff#1 *Eft#2 1 0-10 j 10yr3/2 none sl 2fsbk mvfr as 2f,1m 0.5 ~ 0.9 2 10-20 10yr5/4 ~ none ~r.lfs 2fsbk ~ mvfr cw 1fm 0.5 ~ 0.9 - -- t -- ___. ._ - 3 20-36 10yr5/4 f2d 7 5yr5/8 ~ gr.lfs/sl 1msbk mfr cw - 0.4 ~ 0.6 4 36-51 10yr5/4 ~ f3p 7.5yr5/8 ' Ifs/sl ~ 0 sg ~ ml ~ - - 0.7 ~ 0.8 _, ~ I -- ----T- --~- ---- -__ - - __ ~ - _ -- i ,. H3# & 4 consist of an unsorted mixture of Ifs & fsl. Redox. concentrations observed within coarser materials. ^ Boring # ~ Boring Depth to limiting factor in ft __ _ Pit Ground Surface elev. ________ __. __ _ • . Soil Application Rate Horizon Depth Dominant Color ', Redox Description Texture Structure :Consistence ; Boundary Roots GPD/ftz i ______ *Eff#1 'Eff#2 i i -------------------r-- -- -- -- --- --- ~ - -- ----- - ----------I- --- i --- -- ---- --}------ I - _._ _ . _ _ ~ { ----- ___ ~ _ _ ~_ _ --- _ _- - - -- - --_ . _- ~ i _- --- - f - ___ - ~ ---_ . - _r . ------- --- -- - -- --- - 'Effluent #1 = BOD 5> 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. 1f 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. J 0 w H v 1~ xi 57~~ ~ 75a,. ~1 ^ ~~.~•rn, Top of .~ Stf~l ice ~OoS{ ~ ~ Elegy = 97.7Z' i ~~~ ~^ ~ ~~ ~ ~~ / a ~o ,~c~ s, /F /yam /y /~( a~ ~ ~an c ~. YYIa nl~~ Tc~o o~'S~Eee l ~enee~bst ,s-ianf'to~ w~.~ Of4n~e~4,~, /q~S4nrLt~ elegy _ /~•~; Socc-t~. (~~op. C;ne i ~z ~ Soy/E~Q~ua-~ion ~'E ~ E/e dam a-~ 5ca/e: p'_-fop, o~ Yy *f M ~p~` V ~ ~A ~ ~~ i ~. 3 d'3 Wisconsih pepartment of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arrnrrianra with (:nmm R.ri Wic Attm r:nriP 1611 Page 1 of 3 AC.E. Sal & 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 ta: vertical and horizontal reference point (BM), direction and percentslope, scale or dimemsions, north snow, and location and distance to nearest road. Parcel I.D. 004-1024-50-000 Pease print all information. By Date Personal informatbn you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). DF' J Property Owner ~~ Property Location ~+~ ~ Jeff Klatt Govt. t SE 1/4 NE 1/4 S i l T 28 N R 15 W ___ _ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# C1 0 HiIICreStSt._ 4 ~/ State Zip a PhoneNumt ~ ~~_ Ci ty ;; village i~+i Town Nearest Road Baldwin ~ W I 54 02 S T7~1`8~~ 0 Cady 320Th Street ~ New Construction Use: Residential !Number of r 3 Code derived design flaw rate Replacement ~ Public or commercial -Describe: Parent material Glacial drift _ ____ Flood plain elevation, if applicable General comments and recanmendations: Install mound system at elev. 96.34' at 16" above 97.67' contour. 4__5_0_ GPD na Boring # --~ Boring Pit Ground Surface elev. _ 96.78 fl. Depth to limiting factor -_ 24~_._in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 *Eff#1 *Eff#2 1 0-9 10yr3/2 none sl 2fsbk mvfr as 2f,1m 0.5 0.9 2 9-24 10yr5/4 none Ifs 2fsbk mvfr cw 1fm 0.5 0.9 3 24-32 7.5yr4/6 f2d 7.5yr5/8 sl 1 msbk mfr cw - 0.4 0.6 4_ X32-80 7.5yr4/6 f2f 7.5yr5/8 strat. s 0 sg_ ml _ - - 0.7 0.8 - H#4 contains 1/2'`- 3%4" bands of Om 5yr4/4 Ifs at 6" - 16"intervals. Redox. concentrations are located in coarser materials at upper edge of banding. Boring # ~ Boring ,d Pit Ground Surface elev. 98.94 ft. Depth to limiting factor ~~ in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' *Eff#1 *Eff#2 1 0-9 10yr3/2 none sl 2fsbk mvfr as 2f,1m 0.5 0.9 2 9-19 10yr5/4 none Ifs 2fsbk mvfr cw 1 fm 0.5 0.9 3 19-29 10yr5/4 none sl 2msbk ds cw - 0.5 0.9 4 29-38 7.5yr4/6 m2d 7.5yr5/$ scl 1 msbk ds aw - 0.2 0.3 5 38-63 7.5yr4/6 f2f 7.5yr5/8 gr.ls Om dsh - - 0.5 0.9 H#4 contains 1/Z"-314" bands of Om 5yr4/4 Ifs at 6" j.~interv~ls. Redox. concentrations are located in coarser materials at upper edge ~ banding. * Effluent #1 = BOD 5> 30 <_ 220 mglL and TSS 30 < 150 mg/L * Effl #2 = BODS <30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig ure: CST Number James K. Thompson ~~-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 540 0 1 /9/03 715-248-7767 s '3 Property Owner Jeff Ktatt Parcel ID # 004-1024-50-000 Page 2 of 3 Boring # ~ Boring ~ Pit Ground Surface elm. - 97.59 ft. Depth to limiting factor 40" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 1 0-11 10yr3/2 none sl 2fsbk mvfr as 2f,1m 0.5 0.9 2 11-26 10yr5/4 none sil 2fsbk mvfr cw 1fm 0.5 0.8 3 26-40 7.5yr4l6 none sl 2msbk ds cw - 0.5 0.9 4 40-68 7.5yr4/6 map 7.5yr5/8 scl 1 msbk ds aw - 0.2 0.3 ---- - - - -- I - H#4 contains 1/2" - 3/4" bands of Om 5yr414 Ifs at 6" -16" intervals. Redox. concentrations are located in coarser materials at upper edge of banding. Boring # '_~ Boring . t~ Pit Ground Surface elev. 100.15 ft. Depth to limting factor 20" Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 1 0-10 10yr3/2 none sl 2fsbk mvfr as 2f,im 0.5 0.9 2 10-20 10yr5/4 none gr.lfs 2fsbk mvfr cw 1fm 0.5 0.9 3 20-36 10yr5/4 f2d 7.5yr5/8 gr.lfslsl 1msbk mfr cw - 0.4 0.6 4 36-51 10yr5/4 f3p 7.5yr5/8 Ifs/sl 0 sg ml - - 0.7 0.8 H3# & 4 consist of an unsorted mixture of Ifs & fsl. Redox. concentrations observed within coarser materials. ^ Boring # ~~ Boring _, Pit Ground Surface elev. ft. Depth to limiting facts in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 rng/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. ff 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. s7o'` ~ ~. -~ ~- 750 -~.$.rrt TopoF ~ te~I ice j0o5{ ,~ ~ EIeU = 97~., ~ :' ~~ ~~~ / ~~ ,, /~. h~ , ia~ b \b / ~o ^ i~ J ~~ /y ~h~ /~ a~ ~ BRnc~, rvla 7o~o~'Sfeel O~Qn~e ~ct,'~ • .9.~s4med ._-. i /~ solo. prop. C:ne ~ ~ Soy/ EjrQ~aafiOn ~'~ ~ E/e da~'o.~ ,/ p ~ Seca/e : ~ '= flp , *~ M ~C ~c qA u~ ~-y . 3 0,<'3 ST CROIX COUNTY SEPTIC TANK MAIN'TENANCB AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownerlll~r ~e~' ~~Q-~~' Mailing Address (~ 1 O ~; I 1 e.resf 5-~ • ~a-Qal wr'rl cc~l. 5"S~44a Property Address 3010 `~ (Verification required from Planning Department for new City/State Parcel Identification Number Ooh --/~a~i~- ~'~ LEGAL DESCRIPTION property Location S ~ '/4, /1 E '/., Sec. // . T a8 N-R. /S W, Town of ~~~/ Subdivision I'1 ~- .Lot # Certified Survey Map # l~ ~- .Volume '- ..Page # -' Warranty Deed # ~ (S~ 2~ 3 ,Volume _ `~~_~ Page # I ~'s Spec house ^ yes Lot lines identifiable ~ ^ no SYSTEM MAIINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank Query three years or sooner, if needed by a licensed pumper. What you put into dre system can affect the function of the septic tank as a treatment stage is 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 mastCrPlumber, journeymanPlumber, restrictedplumber or a licensedpumper verif3ringthat (1) the on-site wastewaterci~sposal 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. I/we, 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 Resoura;s, State of Wisconsin. Certification ~,~ ~^.t ;.ou€ s°pt~. MMt~n: ~.~.~'~r.r :z:3~+_.,•_^e3 *~+•.•~r t~ co*ng?Pred and returned to the St. Croix County Zoning Office within 30 days f e expiration data .~ ~ ,~03 X SI OF APPLICANT DATE OWNER CERTIFICATION I (we) ce that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the rope d above, by virtue of a warranty deed recorded in Register of Deeds Office. ,~ 3 ~ .o SI OF APPLICANT DATE **s**« 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 ~n~~' ~~ VOL ~4~ / PAG~~,7 ~S v This Deed, made between Joseph J. Menter and Audrey L. Menter, husband. and wife, Grantor, and Jeffrey A. Klatt, a single person, Grantee. Witnesseth, That the said Grantor, for a valuable consideration One Dollar and other valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: tb y- ~o~y~ ~~~ 615233 KATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CROIX CO., WI RECEIt~D FOR RECORD 12-49-1999 9:30 AM WARRANTY DEED EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: 195.00 RECORDING FEE: 10.00 PAGES: ~1 w Zuv ~"f°OD~ Name and Return BAKKE NORMAN LAW OFFICES 2403 STOUT ROAD MENOMONIE, WI 54751 /~ ~~ s~~c Nag ,Pa S•ti+' e.i... o 0 04-1024-50-000 (Parcel Identification Number) The Southeast Quarter (SE '/.) of the Northeast Quarter (NE '/.) of Section Elev~.(1~ Township Twenty-eight (28) North, Range Fifteen (15) West. This is not homestead property. Together with all and singular hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record and will warrant and defend the same. -w Dated this ~ day of t./Q.C;2ti~c.~- , 1999. AUTHENTICATION Signature(s) ?i cntirn 4{ 4hie ~ -' `Igy of •~ ~ • signature ~ ~~ / ~~ 1~0 ~ r'YLi type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by§706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY ROBERT G. WALTER BAKKE•NORMAN LAW OFFICES (Signatures may be authenticated or acknowledged. Both are not necessary.) STATE OF WISCONSIN DUNN COUNTY Personally came before me this _ day of 1999, the above named Joseph J. Menter and Audrey L. Mnni,ar ti, ~chanrl ~nii ~gifn 4~ mn knn,~m fn F,o the nr~a,.c~n(c) who executed the foregoing instrument and acknowledge the same. signature type or print name Notary Public Dunn County, 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. Intormakon Proleasionals Company Fond du Lac, w~aconsin 80055.2021 ACKNOWLEDGMENT