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HomeMy WebLinkAbout012-1048-30-000 Q o O o 0. 0 V © N N I ti O v U) X 1 O ~ N C I w a v)) C Z M LO - c rn U U. O C 0 N ~ C d N I 3 I z _ a z m d _ O co N O z d III a w n Z Fd Z N - N C pp E a o E N N C • C O d d O gU N ~ZZ O Z c ~ I ~I N N r N w > A N O d d U W C: C) U) 24 (D 0 a D a 11 2 a~ 6 o (n U) Ei 3 _ I o N a o _o FL s It o o Z E a a a N U 7 O N a) O y U) } J U N rn rn O O O > LT1 N N 0 y Q } c ►~i O o 3 0~ w e ° E o o O O CQ H U to N O 0O C C O O N E O N r \ m M N a c - 00 Q) I V Q V B O N N 3 00 (D try~'j N_ M C O N (9 (6 c3 U N W Z N O N s (n `v ca a 3 Q' L a T Q d .2 a 0 c ; A c0 a~ 0 U) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS S ` (8) Y c-I r .l M 00 J S/ .Z J SUBDIVISION / CSM# LOT SECTION T3_N-RW, Town of raj ir ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Kv INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. a BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: wd"A.%" Liquid Capacity: _gT Setback from: WellT House C~S Other Pump: Manufacturer Model# .311k size_ . Float seperation_ Gallons/cycle:. Alarm Location, SOIL ABSORPTION SYSTEM Width: Length 7_5' Number of trenches Distance & Direction to nearest prop. line: 31Y Setback from: well: ,l~ House Other t ELEVATIONS Building Sewer ST Inlet. ! ST outlet PC inlet a PC bottom_~R;~f17 pump Off gg, Header/Manifold 960..2( Bottom of system 9 7 63 Existing Grade g Final grade lea 7 DATE OF INSTALLATION: O -9 PLUMBER ON JOB: LICENSE NUMBER: 1 Cj INSPECTOR: m 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: :aaboran,tHumanRelations INSPECTION REPORT ST. CROIX Safety:-and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI NAGEL, VERN X CST BM Elev.: Insp. BM Elev.: BM Description: Erin Prai7rie Parcel Tax No.: GJ~~ ad-~e~ cri TANK INFORMATION ELEVATION DATA ah ~y TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark°d. 1 .4 Ica s-r~T 1 Dosing '/per„i v3 Sal Aeration Bldg. Sewer Holdin St/ V Inlet a 9a 6 TANK SETBACK INFORMATION St// Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet / Air Intake Septic NA Dt Bottom (,7 Dosing tn NA Header/Man. 32 fig, Aeration NA Dist. Pipe 5; 3D ~t8 Holding - - Bot. System PUMP/ SIPHON INFORMATION Final Grade ~n - cJr v 7 ~ ~ ~ Manufacturer Demand ~_.x~ Model Number ~oGPM TDH Lift C~. '',y Friction System TDH 1-),5q Ft Forcemain Length qo' Dia. , " Dist. To Well N~ SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt►}~ , No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth DIMENSIONS /5DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER Moe Number: System: a ('Y4'~ 3a q9 /VA OR UNIT DISTRIBUTION SYSTEM I#ea~er/'Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ~L ~ Length Dia. Length 1:U~ Dia. 114-1 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over FBedtlTrench h Over 'I xx Depth Of xx Seeded xx Mulched Yes E] No Eko Bed /Trench Center JV Edges Topsoil L-1k cf yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Erin Prairie.21.30.17W, SW, SE, 140th Avenue p F 4; ~ d c LLJ ~lC:. Plan revision required? ❑ Yes [✓f No u Use other side for additional information. 'JO t1_ SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division ; SANITARY PERMIT APPLICATION Bureau of Building Water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County s i r C r o l,x than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number X49 900 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State P an I.D. Num er 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Nam Property Location N, R I7 for) W r 0. ` $W 1/455_ 1/4, S T <3D r Property Owner's Mailing Ad ress Lot Number Block Number I .5D d~ c>e N City, Stat Zip Code Phone Number Subdivision Name or CSM~ er II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ?t~ Nearest Road ❑ Vllage ~Flr~ l l`a1~/~ .(!b ..r Public 1 or 2 Family Dwelling - No. of bedrooms---? Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) o rr -7 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 E] Church/ School 8 E] Mobile Home Park 12 Service Station/ Car Wash ❑ 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. Vf New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an Sy ystem --System----------- --Tank Only-____________ Existing System ExlstingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit 43 E] 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 i~CD Reqresq. ft.) Proposed (sq. ft.) (Galslda~sq. ft.) (Min./inch) Elevation Feet , N ~'3 Feet / VII. TANK Capacity Site in gallons Total # of 's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Manufacturer Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank / /0" ~ f El 0 1:1 I Lift Pump Tank /Siphon Chamber ~ ? tj ~ ~ 11 E El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. No.: Business Phone Number: /MPRSW Plumber's Name nt) Plu~mps) e-~~ 15.3 y~5 aV6-~5/.3s Plumber's Address (Street, Cit,tate Zip Code): 6 s - o,( IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuin Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge fee) ~ f /S~ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings 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 a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. Y 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) tD 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 and Buildings Division, 608-266-3815. 4 To be complete and accurate this sanitary permit application must include: 1. 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in narne, 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 8 1/2 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 collected through these turcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Industry, Labor and Human Relations November 10, 1995 2226 Rose Street La Crosse WI 54603 CALVIN POWERS 1969 - 185 AVE NEW RICHMOND WI 54017 RE: PLAN S95-41438 FEE RECEIVED: 180.00 NAGEL, VERNON SW,SE,21,30,17W TOWN OF ERIN PRAIRIE COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. irard cere M. Sw Plan Reviewer Section of Private Sewage (608) 785-9348 3352R/ 1 SUDA-788718. 10/941 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Bureau of Building Water Systems Ldbo~ and Human Relations REVIEW APPLICATION Waukesha Office • Hayward Office La Crosse Office Madison Office Shawano Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614 Fax (715) 634-5150 Fax (608) 267-0592 Fax (715) 524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or I( regelx(onwn alnfoynaWn to submit PLEASE PRINT VERY CLEARLY A sample of a completed form is on the reverse side for your referent ttJJ f!~Jjl 1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Reviewer Name Plan Identification Number -S1996 1-ell~r=i -I s- 3 2. PROJECT INFORMATION If this review is a revisio or extension to your existing plan identification num er, provide that number here: Proj ct Name ❑ City ❑ Village by Town Of: County I Y\ Project Location tt - 1 I w GOVT. LOT W 1/4 ff 1/4,S QI T 3d N ,R 17 or W ~I r r 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type t (include new and existing tanks) //O Up To 1,500 gallon septic tank $110.00 A ❑ At-Grade 1,501 - 2,500 gallon septic tank $120.00 H ❑ Holding Tank 2,501 - 5,000 gallon septic tank $160.00 M Mound 5,001 - 9,000 gallon septic tank $ 200.00 N Non-Pressurized In-Ground (cornentionaq 9,001 -15,000 gallon septic tank $300.00 Over 15,000 gallon septic tank . ' . . $ 500.00 . . . . . . P El Pressurized In-Ground O ❑ Other: Up To 1,000 gallon dose chamber $ 70.00 1,001 - 2,000 gallon dose chamber $ 80.00 2,001 - 4,000 gallon dose chamber $100.00 Building Type (check one): 4,001 - 8,000 gallon dose chamber $120.00 D Dwelling, 1 or 2 Family 8,001 -12,000gallon dose chamber $140.00 Over 12,000 gallon dose chamber $160.00 P Public Building S ❑ State-Owned Building Up To 5,000 gallon holding tank $ 60.00 ~~//5D 5,001 -10,000 gallon holding tank $100.00 Code Derived Daily Flow '7 gpd over 10,000 gallon holding tank $150.00 Experime@~ at one time fee) $ 300.00 ❑ Check If Replacing Existing System Revisions volt uu I $ 60.00 Petition havrtanc8 SJ4k $100.00 Site Evaluation $225.00 ❑ Petition For Variance m , $ 225.00 vArc1 i dt Jis $ 75.00 Groundwater Monitoring - Per Site $ 60.00 ❑ Groundwater Monitoring (other than a proposed subdivision) ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 v Subtotal: ~4 0 Priority Review: Enter same amount as Subtotal: MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 5. SUBMITTING PARTY INFORMATION CTelephone No. (include area code & extension) Comp Name ~6 . No. & Street Address Or .O.Qox City, ToXV, llage,State, zip Code h M woe Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. The information you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1) (m)]. OVER SBDW-6748 (R. 09/94) --tvisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 j Labar and Human Relations ✓„vision of Safety a Buiwings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.O. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. 012-1048-90 APPLICANT IN PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: FG OCATION Vernon Nagel SW ua SE tia,S 21 T 30 N,R 17 fir) W PROPERTY OWNER':SMAKING ADDRESS OCK * SUBD. NAME OR CSM • 2656 Co r Cliff Trl. CCpp na 40 acres of 200+ acres CWWoodbury, MN. 5~I25DE 61 2E 735 3156 CrTy Ern Prari iee OWN NEAREST [x] New Construction Use: c Residential / Number of bedrooms 3 I J Addition to existing building J Replacement J Public or commeraal describe Code derived dairy now 450 gpd Recommended design loading rate -4 bed, gpd/ft2 .5 trench, gpdm2 Absorption area required 375 bed, h2 375 trench, ft2 Mabmum design loading rate • 4 bed, gpdm2 .5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.63 ft (as referred to site plan benchmark) Additional design I site considerations system el. based on contour line of el. 96.63 Parent material pitted glacial drift Flood plain elevation, if applicable na -It S a Suitable for system CONYENnONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK ® U U= Unsuitable for stem OS ®U K-) S O U 0S gl U O S [2 U OS ®U . 0S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boarday Roots GPD/ft in. Munsell Ou. Sz. Cons Color Gr. Sz. Sh. + Bed Trertdi 1 0-8 10yr313 none 1 2msbk mfr cs if .5 .6 2 $-20 7.5yr4/4 none sl 2msbk mfr, 9w if .5 .6 Ground 3 20-30 7.5yr4/6 none sl lmsbk mfr 9w na .4 .5 97. 3' tt 4 30-7.0 7.5yr4/4 c2p 2.5 yr 4/6 sl lmsbk mfr na na .4 .5 . Depth to limiting fac 3091 Remarks: Boring # 1 0-8' 10yr3/3 none 1 2msbk mfr 9w if .5 €.6 2 .2 18-15 7.5yr4/4 none sicl 2msbk mfr gw if .4 .5 3 15-27 7.5yr 4/4 none sl lmsbk mvfr c na .4 .5 Ground elev. 4 27-50 7.5yr4/6 c2p 5yr4/6 scl lmsbk mfr na na .2 °.3 97.2X Depth to limiting faCtDr 27" _ Remarks: T Name:-Please Print Gary L. Steel Phone. 715-246-6200 Addr 1554 200th. Ave., New Ridhmond, 54017 10-13-95 02298 PROPERTYOWNER Vernon Nagel SOIL DESCRIPTION REPORT Page 2 , or3 PARCEL I.D. / 012-1048-90 Boring# Horizon Depth Dominant Color Mottles Texture I Structure Consistence Botdary Roots GPD/ft n in. Munsell tau. Sz. Cont Color Gr. Sz. Sh. Bed tTmnch 1 0-12" 10yr3/3 none 1 2msbk mfr Lj 9w f . 5 .6 2 12-21 7.5yr4/4 none sicl 2msbk mfr gw if .4 j.5 Ground 3 21-30 7.5yr4/4 none scl 2msbk mvfr gw. na .4 1.5 elev. 95.1 3tt 4 30-50 7.5Yr4/4 c2P 5Yr4/6 sl M na na na A '.5 Depth to limiting Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Nn j '1 Ground elev. tt Depth to IMMV tacror _ Remarks: Boring # K Ground elev. ft Depth to fimiting facts STEEL'S SOIL SERVICE Gary L. Steel Vernon Nagel 1554 200th Ave. CSTM2298 SWkSEk S21-T30N-R17w New Richmond, WI 54017 MPRSW 3254 town of Erin Prarie (715) 246-6200 N 1"=40' EM-= t p of 1" steel pipe @ el. 100' Alt. bottom of..,,,steel siding of shed @ el. 97.68' rb p 53 ` 19-3 F~ 43 G°0 g9 ~r )3 3j f 81A Gary L. Steel r4-..3,, !5 T iI VR.I-Y, ~No,~-A WORKSHEET-- MOUND SYSTEM DESIGN PROBLEM: Design a mound system fora arn2 The site characteristics are: Depth to groundwater or bedrock _a in. Landslope _ (o % Z ak Percolation rate _.S ma n. Distance from dose chamber to distribution system ft. Elevation difference between sump and distribution system r,$ ft. Step 1. WASTEWATER LOAD 'Jun gal.' Step 2. SIZE THE ABSORPTION AREA A) Area required v ISO , z- 37s sq. ft. B) Bed or trench length (B) ft. C) Bed or trench width (A) ft. -0) Trench spacing .(C) R Wastewa ,er load .24 gal/ft2/day B ft. r trF~c ei s Step 3. MOUND HEIGHT A) Fill depth (D) _ ft. B) Fill depth (E) = D + slope (Aj'ff- _f 3 ft. / -t .0(' X-~ ; A-3 C) Bed or trench depth (F) _ $ 3 ft. D) Cap and topsoil depth (G) _ ft. E) Cap and topsoil depth•(H) t 115 ft. Step 4. MOUND LENGTH A) End slope (K) _ (D + E1+ F + H x3- 0I ft. \ 2 B) Total mound L e h (L) = B + 2(K) = t. 7.~ -f a~~a, Step 5. MOUND WIDTH ' Al) Upslope correction factor F A2) Upslope width (J) ^ (D + F + G)(3)(factor) = 74 ft. 4. 8340XSA,86 = 7.3D Bl) Downslope correction factor B2) Downslope width (I) _ (E + F + G)(3)(factor) ft. Cl) 0 Total mc+und width (W) for bed = J + A + I a3'~"ft• ~,~+s +11y6 ~~3,74 C2) Total mound width (W) for trenches = i + + .(no. trenches -1)(c) + A + I= ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil gal./ft2/0ay r B) Basal area required = wastewater flow natural soil infiltrative- capacity = 900 sq. ft. .qSO C1) Basal area available for bed for sloping sites = B x (A + I) _ sq. ft. C2) Bas are vail le for trench for sloping sites = B W za+J / sq. ft. 75 A C Basal area available for trench or bed for level ites - BxW= 1`t sq. ft. License "Ku:.__J.S.63-- Datz) • - Z. i. Zc) ~.rn I Step 7. DISTRIBUTION SYSTEM 1A) SIZE DISTRIBUTION SYSTEM ' J 1) Hole size = in. 2) Hole spacing a in. 3) Distribution pipe length = 3Sin. 4) Distribution pipe diameter = min. 5) Spacing between distribution pipes = D in. 6) Distance from sidewall to distribution pipe = 6 in. 7B) DISTRIBUTION PIPE DISCHARGE RATE ft. 1) Number of holes per pipe R 2) Flow per pipe ,-Z3GPM 7C) SIZE MANIFOLD 1) Manifold is, central/ end 2) Manifold length = Tex_- O ft. 3) Number of distribution lines a a 4) Manifold diameter = 3 in. 7D) SIZE FORCE MAIN yy GPM r 1) Minimum dosing rate = 2) Force main diameter -3 in. 3) Friction loss 1,A~ 7 0 ft. 7E) TOTAL DYNAMIC HEAD 1) Vertical lift =ft. 2) Friction loss = ft. 3) System head 2.5 ft. = 0?.5 ft. 4) Total dynamic head ft. biccrl ae T-: o~ o!p j t 7F) PUMP SELECTION 1) Pump selected will discharge GPM at /r5 ft. total dynamic head. 2) Pump model and manufacturer 7G) DOSE VOLUME 1) 10 times void volume of distribution lines gal./cycle 2) Daily wastewater volume . 4 doses/24 hrs. gal./cycle 3) Minimum dose volume e /I` gal./cycle 7a c&to,- x , 3 24 7H) DOSE CHAMBER 1 S a 6 1) Minimum capacity required a / 7SZ gal. Sim: S-,~fzA-~."-4p~'- Licunoc -:u: (03 Date:_ zz- ~-w c% e% c ~ 1 I ~ ~ S._~ 1'11' -5--~!' .ry;~i~.t~!+.~.~•`~ M r ~c -5 E, 16 41 MP 4' M ~ i 00 d i I i GE SY TE ~ I COn 'on y1L MAKI ~p STN , B ®v'I i~ s j ~ j 1 /D Page (a OF . ~cQ•vrti. I v 0.GG, l - - . d Straw, Marsh Hay, Or Synthetic Covering 1ASi M C-33 Distribution Pipe Medium Sand Tops T G % Slope Bed Of 2 Force Main Plowed Aggregate Layer .D f Ft. Cross Section Of A Mound System Using E ..L. Ft. 'A 'Bed For The Absorption Area F 3 Ft. G I Ft. Signed: L"Qt4-~ A .5 Ft. H 1+-S Ft. B s Ft. License Number: K 140 Ft. Date: L 95,6-ti? Ft. J 3 Ft. Alternate Position Ft. of Force Main w a3, XR, J Observation Pipe 6 K A i'-- - - I i I `Force Main w i Distribution. ed Of 2M- 2 .1 Pipe Aggregate 1 Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Pag a ,Z, 4 Perforcled Pipe Detall . End View Perforated End Cap PVC Pipe p~+\ Holes Located On Bottom, e Are Equally Spoeed _rz=y ~ rnat x + P L) e- 0,5 .4. Lott Hole Should Be Neat To End Cap Distribution Pipe Layout P Ft. R r, S Alf / x1 ~1 X a Inches ;orU-A Y /E' Inches Signed: --4 Hole Diameter Inch ~S(o~ Lateral Inch( s) License Number: Manifold " Inchc:. Date: Force Main Inclto; # of holes/pipe Invert Elevation of Laterals $,13 Ft. V Q 1r r~ 1 ' 1, i 1~ Y I ~ ~ t page of Tv m r. m 0 ~ N m - N p b t rt P. rt x 0 00, ~ N rt C tD rt N rt lb rt w 0 n O T. 1 ~ d W f.. tr• n x ~ O I x 1 IL I~ I 'j w 1;0 I PU YL IVQy PAGE OF L= MP CI.IAMBER CROSS SECTION Al SPECIFICATIOQS VCWT C,A,P H' C.I. VENT PIPE , WEATHER PROOF APPROVED LOCKING Z5' FROM DOOR, JUUCTIOM BOX MA-WHOLE COVER WIWOOW OR FRCSH 12"h11U. AIR INTAKE GRADE I `1" MIM. COWDUIT to"MIN. _ _ _ 11~ rrIL.ET PROVIDE I AIRTIGHT Si I I APPROVED JOINT ( I I A I I~ W/C.I. PIPE APPROVED JOIIJ EXTCNDIAIG 3' I III W/C.I. PIPE ONTO $01.10 SG:;. I II ALARM EXTENDING 3' f'. B i I ONTO SOLID SO: I 1 c i ON PUMP - - - t'vm'~' FF = 90`,13 0 r. OFF COIJCRETE BLOCK RISER EXIT PERMITTED ONLY IF TAWK MA1J UFACTURER HAS SUCH APPROVAL SEPTIC ANDS C. I F I C AT I OFJ S DOS_ E TAWKS MAWLIFACTURER: ~•~O I ~p r WUMBER OF DOSES: PER pAy TANK JIZC : _ 75O 6ALL0IjS DOS£ VOLUME ALARM MAUUFACT URCR: S.T fl.~ r 1 rl~Q~ INCLUC'f" C.C".FLOW: /-?R/ CR( GALLONS II, MODCL ►JUMBCR: 1 CAPACITIES: A. INCHES OR GALLONS SWITCH Tt:li ~t~i~4q,J PUMP MANUFACTURCR: ~ ~•~.lds INCHES OR 3S7 GALLO►JS MODEL NU,% tBCR: C /'a INCHES OR GALLOWS D- -V-- I 143 SWITC NCHES OR ~ GALLOWS H TYPE: NOTE. PUMP AIJO ALARM ARE TO BE PUMP DISCHARGE RATE O GPM/S INSTALLED ON SEPARATE CIRCUITS VERTICAL X46 &PM bit/ 4, D~WECAJ PU/•'IP OFF AND D15TRIBUTIOM PIPE., a FEET f M11,11 MUM N ETWo RK SUPPLy PR,~E/SSURE + 7O FEET OF FORCE MAIN X "7 ~ FEET FYorr.FRICTIOU FACTOR.. r 7 FEET TOTAL OyWAMIC. HEAD i...~ FEET INTERNAL,,` RIME}JSIGNC OF TA►JK: LEI.IGTH " I _ ;LIQUID DEPTH SIGR) E0:-c LICEWSE MUMBER: DATE:-// 2 ~95 -117- } A*4 r GOULDS SUBMERSIBLE ~Y ~1.. SEWAGE AND EFFLUENT PUMPS j~~i, • , Lv. s w EP0311 LIST DISC. y f tia~t y~;~ :1'. 03UPF4.0311 142 EP0311 1/3 MP 115 V Effluent Pulp 1/2" solids 256.80 172.10 'y;1 iMttt a Submersible MODEL EP0311 ' Effluent Pump METERS FEET SIZE W SOLIDS `.Y 25 t ~ r. 8 20 R;:y~ Sl k . 4 0 00 4 a 12 18 20 24 28 32 36 40 GPM 0 2.5 540 7.5 m'R1 CAPACITY r • Lv/ Performance Curve 3885 elclsrs .EeT , . so < - MODEL 3885 ti 25 eo SIZE 3/4" Solid ~ wEOn1• so 14 - r. 1o we aid. wEOX 10 o 0 134, 0 10 20 30 40 60 to eo e0 100 Ito 12D arm a to 20 30 -WAI CAPACM 4E f . s LIST DISC. GOU WE03111, 142 WE0311L 1/3 HP 115 V Low H 3/4' solids 491.55 329.35 GOUPWE0311M 142 WE0311M 1/3 HP 115 V Mod H 3/4" solids 491.55 329.35 ,y 3 GOCIFWE0511H 142 WE0511H .1/2 HP 115 V High N 3/4 ablids 104.25 471;85 # GC)l7PWE0112H 142 FIE0712H 3/4 HP 230 V High Hsi. 3/4" solid; $43.65 565.25 y *****SEE FCLLCWING PACE FCR PERFONANCE AND SPECInCA77ON3. Y D= 10/88 DEPT 30 PAGE D70 WiseonJn Department of Industry, SOIL AND SITE EVALUATION REPORT Pagel of 3 tabor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 X-1:1`1 e. Plan must include, but not limited to vertical and horizontal reference point (QM); dir7"116 ;f slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance.to nearc012-1048-90 REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL~INF~9RMATIOf PROPERTY OWNER: B ERTY LOCATION Vernon Nagel GOVrf. LOT SW 1J4 SE 1J4,S 21 T 30 N,R 17 for) W PROPERTY OWNERS MA!IING ADDRESS LOT # BLOCK D. NAME OR CSM # 2656 Copper Cliff Trl. Ana na "40 acres of 200+ acres CITY, STATE ZIP CODE H NE NUMBER ` CITY VILLAGE MOWN NEAREST ROAD Woodbury, M. 55125 X7735-3156 Erin Prarie 140th. Ave. [31 New Construction Use * [ Residential / Number of bedrooms 3 Addition to existing building [ ] Replacement [ [ Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpdm2 - 5 trench, gpd/ft2 Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate • 4 bed, gpd/ft2 - 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.63 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 96.63' Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN ALL HOLDING TANK U= Unsuitable fors stem ( D S ® U Z IS o u ❑ S Z U 13S 12U I ❑ S ®U [:]S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence I Boundary Roots GPD/ft in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trerch 'm1 0-8 10yr3/3 none 1 2msbk mfr cs if .5 .6 2 8-20 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 Ground 3 27.5yr4/6 none sl lmsbk mfr 9w na .4 .5 97.23 ft. 4 30-70 7.5yr4/4 c2p 2.5 yr 4/6 sl lmsbk mfr na na .4 :.5 Depth to limiting fact30 Remarks: Boring # 1 0-8 10yr3/3 none 1 2msbk mfr gw if .5 .6 '4> 2 ? 2 8-15 7.5yr4/4 none sici 2msbk mfr gw if .4 .5 3 15-27 7.5yr 4/4 none sl lmsbk mvfr gw na .4 .5 Ground elev. 4 27-50 7.5yr4/6 c2p 5yr4/6 scl lmsbk mfr na na .2 .3 97.23ft• Depth to limiting factor 27" Remarks: CST Name:-Please Print Gary L. Steel Phone' 715-246-6200 Address: 1554 200th. Ave., New Richmond, I. 54017 10-13-95 cstm 02298 Signature: Date: CST Number: PROPERTY OWNER Vernon Nagel SOIL DESCRIPTION REPORT Page 00 PARCEL I.D. # 012-1048-90 Depth i Dominant Color Mottles I Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed iTrench 1 0-12 10yr3/3 none 1 2msbk mfr 9w If .5 .6 ::3 2 12-21 7.5yr4/4 none sicl 2msbk mfr gw if .4 1.5 Ground 3 121-30 7.5yr4/4 none scl 2msbk mvfr gw na .4 1.5 95e13ft. 4 30-50 7.5yr4/4 c2p 5yr4/6 sl M na na na .4 !.5 Depth to limiting fac%,, Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # :i?:•\;Oji:iy}iii: Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. 1 ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Vernon Nagel 1554 200th Ave. CSTM2298 SWgSE4 S21-T30N-R17W New Richmond, WI 54017 MPRSW 3254 town of Erin Prarie (715) 246-6200 t N 1"=40' BM.= t p of 1" steel pipe C el. 100' Alt. bottom o"teel siding of shed C el. 97.68' 'b a 53, C-3 FN e~ Lp( 43 y, C° o'v ' l y ..r 13~ J~ Gary L. Steel b¢-13.: 95 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER `0 Iq&U 1-- 5512.5 MAILING ADDRESS G4 P 1?QZ (Ll,~ Mw PROPERTY ADDRESS I~ S® 1 4OY c t i(location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION SV~1 1/4, 5C 1/4, Section 'ZA T -3 a N-R__A I W TOWN OF~l N T~'~PI'IC ST. CROIX COUNTY, WI SUBDIVISION ~a LOT NUMBER N VA CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expi ation date. SIGNED: L' . DATE: 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 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 house), 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 yEL-NQ N HALIeL, Location of property SW 1/4 5C 1/4, Section "LT 77O N-R W Township 014" j~IrU15 Mailingaddress IWC7%6 CQPpkM1 ~r-F T~.o.«., ~Noao~~I~ M Ss i L~ Address of site 1"150 4 a t.~ tv e`,LA,4rA sL1D, W1 Subdivision name Lot no. t~ A Other homes on property? s X No Previous owner of property "f'eoyL, -Al, L'P~'g o AN1~ Total size of property 4<3 ~C'.VLc'3 Total size of parcel 4a Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? ---L~Yes X No Volume and Page Number "7 -1 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 41:'5(0(40 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. q-Z~loco O I'al L.. Signature of Applic t Co-Applicant SEP 13 '95 07:37 NATIONAL SUN MSPI.° P.4 t Y ~ i a I 'r } t q • .ERIN PRAIRIE T30N7R.17W. 45 • SEE PAGE 57 1 /loTNSEE PAGE 59 A Q w. K ~f PO 721 v ➢ Jos h R' e, s° mes IL-40 W - o s in e C/i°¢se 7`rrc.a. 43.77 ~ Vl .ee N 9~ C v F y Mi~cha °.ese/ r , EWET b av~ f sserer /'FN ✓ .f~c.f~t.ma/ /.9B e L O ~w~ v~ U r~ tl fCor/a 'B Audit n s cl",~ ra ~d /7o treth y ~ Q e// ? ~ so - ryar,eioc IVE Ida 24-0 t o a-L DIP N San Marcos 7 W/LQW norN e ti ~ ryF, t ~9 O NO ~ r` ~ tl / ~ ~yM S9 D~3iae yis h . ~ o\ U H ~ ~ r// • V /6 •0 tl~ Thornaa P ° o v Q o u 21 E,~~ • t C7rJ/ 0 >`Ord .40 to 1W Ir/1 s v v Gay Couyh/. M/chad i ~Em/net'tf hew o ti Q` i 3 0 9 oseph 11 X5-&64 f Teresa, .Dorreen Suean Ssr 7hn.7nos,Q. Qj ^ Nase~ Gr//en Carp. Hare e eta/ / r ters017 LSchm/cr7 ~k Qti / O • a 40 V t /5746 /06 GG •Geo ra3 roc ere Gy/a ~r N.PPO/dt 2gO 2e7 Y3 ynnf /moo Louse B/ Anew %4299 res., Z". s 'b Bo Wald %er- For~est ,0 3 2 Rar , Farms, ,ea aG~uetfe E/eo- 01-6 M Bruce 119 zye 2.en ;f 9srr-om NGa Snc. 2250/ 9A /sa_sr BO .Bcr- C7i//en efa,/ ber_ t roc • r to h auser y /60 rN /stad FrmJE° /60 O GK 7~ .riS • Nfrch¢erf g AM 0 ern / Te r'esa 'O'qm 0 A SMar Pe ter-SCn 40 = /berT Iar7 V1 no.67 /e v n i Ida Bc s ke~nk V C?~ C Kul/~ d 60 rr6. 94 Mi Gael :.to ~TrT \ Ter-rFae Fa~ s 17en .s F7 ~y 9/bu't ~r 17onah~.c/ 6 6✓as/ey .~tl .:2,' Stoddard buci, Far Geurk, • ` v / L / BO go Franklin M//t°n Sr Ruth r60 y sue /09 D f Doro t/~y Al zoo ,~rz Griffit/7 Peters. Buraw BO 7t70TQ5 Donahue'.s Q W e v '6 /0e ter. M rno/ Cl N a¢ir y Inc e u tiv Fr der /00 c7 T L Burow Ca~rr>,~r 'S /o• c ~y~ rockPal7/e C7eu k J Shn .aeo u W go • sPoV hfu !5846 Q e4$ Co. 9 n • 40 FllTeriM BO 5+7 G J tephen ` • • Qa6 R G 4 Cael, n ,fo C C Dennis t Ojrole PcN - N t Robe& R f ~ r s9 roc ~er C1 u ~ y 99 RS `'+merf 25~ Dorxi- N R/chard f7 . 8a Farm 17oberstein d S7o.va ld a t+ v o hue >>o a t ~2 F~r. a/on,y° n 7r~ Den Er-r7f c tG n. fa SBGKof 2B0 eras 3y a~i~ 'PO -2 Frank -too 17oro th l E f7 ,a .Mane 4 Co-'fell Ku.E.is,Ea ,r 237 84 Cdr ff th <fOro/d r Prrbnow 1/ernon /G° T n s °'e ;an 740 elal ~ C o • r'a~- Dona a n ,Ire. $ Rebecca, oof E Kaes Gerald os S /5/23 9 NO&e/ Jzo K '7 c/emus A O /I rN n 7 21 NJ ° ,•VE 0 • gM/dred v v.v -77e17171-5 • 8 z/ v Rrft erne - a Dobersrerq ne 4O • ♦ L,qm yfsn_ 7c Marvin /john C E Grace - n 40 q. n 2 Fmr77el~ R-A rd A. S _ wa ne s ~7ane //e/nbuch yicke son _ R bell y 1 y C y CC~ °°~e 9 240 liz. n 200 / 70 240 0, §>e/' V'ui;en ¢ 60 Q C„ 7R5 - tl y 40 ` 75 - Socerber, Z 0 Q Z' Alamo Joanne K cf/or<1 2oc ~v, v 'a b a i 187 % Lkvane Louis H f 4 Jud~.J/ f, ennvs l Fern xr E/lrror' J`taFsroU ``71~ evr'aCC ~ a G /eu 40 tl0 finrn r}- b a~ i CC 0 C h r /aJid9, r3 ~'//en p N F tl J ~ ~ o v a ; /ron ~G4a.oi ~ n~ n~F /20 ~O° X J" l<a.. 09 BUy u~ 0 446.ee VER cmaa,-.:/ so n / TN • .7007 'Yw t Bo Kma:/BO ♦o°~O Z~:~ wv. ' hr/d 00 a ~(f j • M • v~ /5462 -tq}e Car-/ Ri~ardti tTu~ ~8 4o Ru N sccLarrie A6/Ara, Le/and q D. . ,e. Quern; K f'i an Howard Bur; ow wa.lder7 /zO i Edna_ C N 9r/eoe V oh c 160 T S`oddard lzo Farms W¢/ken 6J so o -3oQ- /c 20B Y L. 32C') ✓ernon ll 67 eonar2 Larrre "o 0'9RerN If, r~G., W/ia•r,. J \ n /ly.s/ [eannC u T LTOhn ~T 'ef Quam v E ; 3uth Sic d j,:• a/son Q x: Sebw y q yirp F Mary 40 Walsh q qp~~ Tof = a Yd" .Landry h~ w/ram ,Q c tier tl CG EMax-nG r, ~Y' - ~l•y C rzo ~\p c nA; F~/ rthc.- vid /ao tl a ue y Joe wC ' h e;:h ~ ~ 0 ~ oy o P >r r'SOn G'a o/yn d ~ ptl C~ t (lea nden c tl rhom entie o h'^ • V e 17arson y ~7er-s.-n ,eon, 0 3~ onP O E 3 u E v zo rN ao ee.s. 41 kel c SEE PAGE 31 ~StC o.x unt,wrs N 1500 99/ Poc Efor MaP600 /s, Inc. 1700 1800 1900 2000 y 2100 DEER'S FOOD LOCKER, INC. CREATING AND PRODUCING 39 Years in Business BETTER PRODUCTS IN 1952-1991 cemstom, CONCRETE CUSTOM PROCESSING CO"CRETE READY MIX CONCRETE CURING. SMOKING, SAUSAGE MAKING SAND - GRAVEL RETAIL MEAT & CHEESE - SAUSAGE - ON FARM SLAUGHTER LOCKER RENTALS THE WAIDELICH'S * (715) 269-51 18 New Richmond Amery River Falls St. Paul Plant DEER PARK, WISCONSIN 246-4238 268-6948 425-1119 386-3922 1 . f COCIJMENT NO. WARRANTY DEED T«., „nes RtecAvae ram Rc4eROln6 CaT♦ r P. A, LTA 9 BAN OF WISCONSIN RORM i!-taax I1 • I r INK T2 PArE't I. i - KEG(STERS O I FflCE The rederal Land Bark of Saint-Paul, a federallx ST. CROIX CO., WII& I chartered eo ration. for Reopra ...s 25th ~4C d. !t I, ` it day Of,- MHU ct. A. D. r1967 I eon•ve3•e and warrants to veQTI~.7A,.. !1d.,Ro~tGC.d........ i Allt...re • !I . , M I I i aeTURR Tb ~ li ~ the fellowin described rsal pints In t• ~ Q>~14 .......................Goan I' I state of Wiseonsin: 1 Tas Pared Me:....._.......... I SWhg and Swk 3Srs, Section 21. T3oN, Rl7W 1 The above parcel contains 200 acres, more or less. Shim conveyance is exempt from state deed transfer tax pursuant to ~1I ` W.S.A. 77.25 (2) l ~I I • ~ Ii ,I I, ~i This is not bo•nesteed properer. (bi) (is not) . Exception to wrarreatiear ~ p I IA,P.~.. I I Dated this ...................4? 7yR....... day of ................._...(SEAL) a (SEAL) ...................................(SEAL) FL.... N~•,y' /.~LtSraSEA i. • ' AUTURNTICATION ACKNOWLUDGM$NT `f Signature(s) STATE OP WISCONSIN I' Polk eL county. I authenticated this __day o2.._.-----........_::, P 19th oneliy came before me ........---.__.day of ..._I°~'WTC~1 . 15.~..... the above aaal«i 6MT•T. %ss - i I TITLE! MENDER STAT>! >!AA OF WI$CONSI (+~ti Rifted by .06. Wis: States) ~ wbo 4~ EMT WAS OAAIrrxD br fore$oi `eieattto be the ument a d ..nPj lidre the samob- the A sconsin................. -001 Kristine M. Breault I• 4...................... :~'S Notary Paslio County, Win. a ~e authenticated or acknowledged. Both MY Commission is permanent(If not, state expiration ` j date: November 1 1987....) • •.IUp.M y "Iris of seAaoe aleads Is oaf empetiq Should be 4aw1 or .rieW belor their eIRnsWra wwaRAKrT assn aTAT3 All or WISCONUM Wbron.i. irpl 8160 C•. ine YC N#• e_ lost Wilw.,lkee. wlr.