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STC - 104
AS BUILT SANITARY SYSTEM REPORT
'r
OWNER
/ G
i
ADDRESS 45
SUBDIVISION / CSM# LOT #
SECTION~T N- W , Town of
,
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
I
NDICA NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
1
f .
BENCHMARK : ~ 2 rL Al C ~ -6-t
-z ~
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: W Liquid Capacity: ZC-C-f
Setback from: Well-_A08_ House Other
Pump: Manufacturer 01SIO-0 M o d e 1 # 3 Size 3//.,/- ` P
Float seperation 9 Gallons/cycle: D
Alarm Location lips;,
SOIL ABSORPTION SYSTEM
Width:_ Length b< Number of trenches
Distance & Direction to nearest prop. line: _Y~-
Setback from: well: /G 7 House _25 Other
ELEVATIONS
Building Sewer ST Inlet, 8'y's ST outlet s 3
PC inlet , 9 3 PC bottom Pump Of f
Header/Manifold / ~i -30 Bottom of system
Existing Grade g, 20 Final grade
DATE OF INSTALLATION: /4
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:-
3/93 : jt
III"
Wisi*n Department of Industry, PRIVATE SEWAGE SYSTEM county:
10,abor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
~
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P
COLBETH, DICK X
WWHZEN
Parcel Tax No.: _2
CST BM Elev.: Insp. BM Elev.: BM Description:
TANK INFORMATION ELEVATION DATA
~ l l
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing ~SCS •~"~T .D~' 7 ,
Aeration Bldg. Sewer
Holding r- St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet 1377' BY. /8
TANK TO P/ L WELL BLDG. Avintake ROAD Dt Inlet OPP 07 "
Septic 7, 7 7 / NA Dt Bottom l7 ~a/ ESL
S ~ 3
Dosing NA llaafil4w/ M n1 a
r
Aeration NA Dist. Pipe=,,-7 '
Holding Bot. System.
PU IPHON INFORMATION Final Grade
Manufacturer Demand
Model Number
GPM
TDH Lift 1 Loss Friction H System TDH Ft
~
Forcemain Length O Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length / No. Of Trenches P No. Of Pits Inside Dia. Liquid Depth
DIMEN I N ~ DI EN I N
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI u acturer:
SETBACK C BER
INFORMATION TypeO r - i Moe Num er:
System: ~v ,~tiw S C. a?S L'~ OR UNIT
DISTRIBUTION SYSTEM
k2
n
-F-r /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
/ ~i ♦ ! 9
Length e2,0 Dia. Length n~ Dia. ! Spacing c ?j1 I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: WARREN.31.29. 18W, SW, SW, 93RD STREET
(9?~~~ zt?< r t 98.5 f 6
1'
Plan revlsiQn required? iYes o /y
Use other side for additional information.
__--SBD-6710(R 05/91) r Date Inspector's Signature Cert. No.
Ja~
ADDITIONAL COMMENTS AND SKETCH
ot
SANITARY PERMIT NUMBER:
/J/ 'i ~ ~ mac.- /~s~ KL✓ nQ C.Z ~?^.,-,c yr, •a~~ ~x~ ~?CZ i,G-Q
se _ _ mt
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SANITARY PERMIT APPLICATION
1 DILHR' In accord with ILHR 83.05, Wis. Adm. Code COUNTY
~ r oI \
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 2 4t Zapplication
8% x 11 inches in size. Chec ifrevslopoprevi -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. a $ D
PROPS OWNER PROPERTY LOCATION
` ~ '/4 ca~a, S 3 T a N, R ~ (or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
L. N
CI R, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
Hl~l '0 A-1 r~ S O ;),A I It -I 1 -7149 391Z 5 0, S
11. TYPE OF BUILDING: (Check one) F-1 State Owned ❑ VILLAGE : NEAREST RQAD
gi~ 400 OF: toctuc*,-, ST
❑ Public '504 1 or 2 Fam. Dwelling-# of bedrooms a PARCEL AX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply) O ; 7 -`70 - ] o20
1 ❑ Apt/Condo l
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. iK New 2.E] Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 210 Mound 30 El Specify Type 41 ❑ Holding Tank
12 1:1 Seepage.Trench 22 In-Ground 42 ❑ Pit Privy
13 ❑ SeepagePit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
Z REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
,375 3~5 0 02 Ito 90 Feet 41 Feet
VII. TANK CAPACITY
in allons Total # of Prefab. Site Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank S
Lift Pump Tank/Si hon Chamber s
Vlll. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Si at (No Stamps) MP/MPRSW No.: Business Phone Number:
Ca~ P. !5(0 L5 6 S
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I 'ng Agent Signat a (No Stamps)
Approved [3 Owner Given Initial Surcharge Fee)
Adverse Determination Ato X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R.11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be.applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
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 in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for 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 name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8'/ 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 1,15 form; and F) allsizing 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 surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards '
SBD-6398 (R.11/88)
SAFETY & BUILDINGS DIVISION
201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
State of Wisconsin
May 30, 19Department of Industry, Labor and 1-119940DEW-W9W Bav Street
SUITE 300
Shawano WI 54166
POWERS, CALVIN JR
1969 - 185 AVE
NEW RICHMOND WI 54017
RE: PLAN S95-30340 FEE RECEIVED: 180.00
COLBETH DICK
SW,SW,31,29,18W
TOWN OF WARREN 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
i
on chapter 145, Wisconsin Statutes, and chapters ILHR. 83 and 84, Wisconsin
Administrative Codeand is contingent upon compliancy 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 Cade.
- The orientation of the mound system must be such that the mound's longest
dimension is perpendicular to the direction of maximum slope. Also, the
area within 25 feet of the mound's downslo e toe must remain undisturbed b
P by
anything, including the force main.
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 w
when inspections
can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
SUDA-6928 (x. la94)
I SAFETY & BUILDINGS DIVISION
201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
State of Wisconsin
POWERS, CADepaftment of Industry, Labor and Human Relations
Page
May 30, 1995
PLAN S95-30340
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely,
Karl Schultz
Plan Reviewer
Section of Private Sewage
(414) 424-3311
SUDA-9928 (x.10/94)
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division
Labor and Human Relations Bureau of Building Water Systems
REVIEW APPLICATION
Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office
209 W 1st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C
Rt 8, Box 8072 - LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 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 have questions on what information to
submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference.
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
11171 1`71 30
2. PROJE T INFORMATION If this review is a revision or extension to your existing a
plan identification number, provide that number here r.
Project N me
❑ City ❑ Village Town Of: County
Project Location
GOVT. LOT U) 1/4 r ,1/4,5 T G N,R or W ( i
3. APPLICATION FOR 4. FE COMPUTATIONS FEE SUBMITTED
System Type (check one): System Type t (include new and existing tanks) /
Up To 1,500 gallon septic tank $110.00 1 1 • 0 v
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 N Mound 5,001 - 9,000 gallon septic tank $200.00
N Non-Pressurized In-Ground (conventional) 9,001 -15,000 gallon septic tank $ 300.00
.P ❑ Pressurized In-Ground Over 15,000 gallon septic tank $ 500.00
O ❑ Other: Up To 1,000 gallon dose chamber CO
$ 70.00
1,001 - 2,000 gallon dose chamber $ 80.00
Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00
4,001 - 8,000 gallon dose chamber $120.00
D rvr Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00
P Public Building Over 12,000 gallon dose chamber $160.00
S ❑ State-Owned Building Up To 5,000 gallon holding tank $ 60.00
5,001 -10,000 gallon holding tank $100.00
Code Derived Daily Flow gpd Over 10,000 gallon holding tank $150.00
❑ Check If Replacing Existing System Experimental System (additional one time fee) $300.00
Revisions To Approved Plan 2 $ 60.00
Petition For Variance: Setback $100.00
❑ Petition For Variance Site Evaluation $225.00
Plumbing $225.00
Revision $ 75.00
Groundwater Monitoring -Per Site $ 60 4
El Groundwater Monitoring • • • • • • • • • • • • • • • 8 .5.
(other than a proposed subdivision)
❑ Site Evaluation in Lieu of
Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00
Subtotal: 7.
Priority Review: Enter same amount as Subtotal:
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: , 1 O,~
5. SUBMITTING PARTY INFORMATION
Telephone No. (include area code & extension) C pany Name Contact Person
C'- I An %At y V: X Ot" I, v,"C' N~&St eetAddressOr .0. Box C t \ ` PO +.k' ~ S
` It Cit , Town or Vill ge, State, Zip Code
0/
I 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.
SBD-6748 (R. 03/93) OVER
Dl. I< C~ I b ~t~ / .,~o
J I I w A5 s.~ yy s 3 I 10-1
WORKSHEET.- MOUND SYSTEM DESIGN Qi- c,r
PROBLEM:
Design a mound system for a -3N C-r-~
The site characteristics are:
Depth to groundwater or bedrock gin.
Landslope __3
Percolation rate 9i•n.
Distance from dose chamber to distribution system 50_ ft.
Elevation difference between Dump and distribution system ft.
Step 1. WASTEWATER LOAD ~ .S0 gal
Step 2. SIZE 'T'HE ABSORPTION AREA
A) Area required q,50 37s' sq. ft.
B) AP.d or- length (E) a 37S :
C) or trench width (A) ft.
D) Trench spacing (C) r
=
Wastewa`er load .24 qal f!:2 day S ft.
tre;ice ~
q1 Step 3. MOUND HEIGHT
A) Fill depth (D) Q _L ft.
h 702 f t .
B) Fill depth (E) D + slope (AT6-)
C 6.3 X 4-X)
y
C) Bed or trench depth (F) _ X83 rt.
D) Cap and topsoil depth (G) _ ft.
E) Cap and topsoil depth (H) ft.
F~w
i
AV
• W asp -.a' ~ _
u%~x S y c a3
Step 4. MOUND LENGTH
A) End slope (K) _ D + E / + F + H x aft.
\ 2
B) Total mound length L) = B + 2_(K) (pct, a z 01 °Z ft.
Step 5. MOUND WIDTH
Al) Upslope correction factor
A2) Upslope width (J) (D + F + C)(3)(factor) _ WZ ft-
: nf,433tfJ~3 x,915 =772
B1) Downslope correction`` factor = b
B2) Downslope width (I) _ (E + F + G)(3)(factor) _ ft.
C117a-+;t3+9x3x 1,1 C //.72-
C1) Total mound width (W) for bed = J + A + I ft.
C2) Total mound width (W) for trenches =
J + ~ + (no. trenches -1) (c) + A + I nft. ky,
7,77+3.. + Ca ~ ao Z 2i. 57.79 6
Step 6. BASAL AREA
A) Infiltrative capacity of natural soil = gal./ft2/0ay
r
B) Basal area required = wastewater flow
natural soil infiltrative capacity = a? sq. ft.
Cl) Basal area available for bed for sloping sites =
B x (A + I) sq. ft.
C2) Bas are avail le for trench for sloping sites =
B W ~J + AA = o - r"sq. ft. )_2 5
ftat~ 15
71 5 ~
C3) Basal are available fo tref hzoi-10de or level
PJJA sq. ft.
sites = B x W = r
a ~ r'`1 ' ~O'k►rn"~
Lic:.u ISG-3 _ Dat
~3~t
RG WA sy~a3
Step 7. DISTRIBUTION SYSTEM
1A) SIZE DISTRIBUTION SYSTEM
1) Hole size = in.
2) Hole spacing =
3) Distribution pipe length
4) Distribution pipe diameter_ in.
5) Spacing between distribution pipes = in.
6) Distance from sidewall to distribution pipe _ in.
7B) DISTRIBUTION PIPE DISCHARGE RATE
1) Number of holes per pipe
2) Flow per pipe GPM
7C) SIZE MANIFOLD
1) Manifold is central/ end
2) Manifold length Q ~Q ft.
3) Number of distribution lines a
4) Manifold diameter 3 in.
7D) SIZE FORCE MAIN
r
1) Minimum dosing rate =0 GPM
2) Force main diameter = in.
3) Friction loss _ ,5.Y/av~~3~52 ,x, •~9 ft.
7E) TOTAL, DYNAMIC HEAD
1) Vertical lift = ft.
2) Friction loss = ft.
3) System head 2.5 ft. a 5 ft.
4) Total dynamic head ft.
7F) PUMP SELECTION
1) Pump selected will discharge 6 GPM at /S- ft.
total dynamic head.
2) Pump model and manufacturer
328,9- ?
7G) DOSE VOLUME
1) 10 times void volume of distribution linesgal./cycle
/IJ,( obyXt'x .i
2) Daily wastewa r volume : 4 doses/24 hrs. _ /las gal./cycle
- )S
3) Minimum dose volume z `7S / ga1./cycle
(5 e> I V00-9)"K /9 05
714) DOSE CHAMBER /~a5
36.7S-
1) Minimum capacity required = Sa-o•~~a"'~ ?So-gal. P~aw~°d
!AcunoL1 .:u: ISG _
Dace 5~ 9s
elk
R
Wiz,`
Li ash: 7~~ -1k
o. r V -Q-V-
C"°• x
~~s 3a •
3/
31
1E l'i u. `
31
C
d~
'
7a 5+J- .
C~ ou9D 03l! ~
y Cyx _aa~ c~--~~n~
_ rrt PRs~ l5 ~+_3_
9 '
340
cIfy
D ~k b PA Page 4~
t \ \ Lam? s
I I F] OF
Synthetic Covering
Distribution Pipe
wCulurn
Topsoil ' H - --c
E
3
1.
3 % Slope t t Force Main Ch15J J
Trench Of .Iu- 2 P I o w e d
-Aggregate Layer
Undisturbed D Ft.
Soil ~
E .1~L~ Ft.
Cross Section Of A Mound System Using F J3 Ft.
2.Trenches For The Absorption Area G• 1 Ft.
A 41 Ft. N Ft.
6:jl,~8y Ft. ,
Signed: A C . ~D Ft.
License Number: IS(03 K ,a7 Ft.
Date: .5 / L ~q,oZFt. 5 • 0~„
J 77 F,yV- d1 ti 4,
Alternate Position of Force Main I 7•10
~
W 7.7 Ft. A o~' \
L 0o P ~ _ .
• J t `~c o~ _ ~Gt
B
T_"
C
Force"
W Observation Permanent Main
Pipes Markers
- ____--tl
Di t
stribution
Trench
Of 2 2 2
Pipe
1 Aggregate
Mound Using 3 Trenches For Absorption Area
00 16,6
0 1D ~v ~ S ~v-f S .140 0 1
a
P4902, Qi'".,,.D
Perforated Pipe Oetoll
. End VIM,
)Petforol$d
End Cop
PVC Pipe
°~d*e~°c~• Hotara (.o6ated ;On 8ottorn~.
Are
r. c a s . Eqqally Spaced
1
W .
a
C Fore• Moift 't
PVC Force Main,
a
t
t
k~
PVC
MoNfold Pip* :4ck
Q _ r
g,JS pF5~~
~rsfrit-Ilion AlfVon Of
Pipe `Forc."a10\`
Lost Hole Should as
Next To Eqd Cop ) 5
End Cop ! Distribution Pipe Layout
P PQ Ft.
S
X ~ Inches
Y Inches
Signed: C 6th. Hole Diameter
Inch
09
u
License Number:. ►5~3 Lateral _VT_ I ~
Manifold " 3 Inches
Date: a -9 ~z Force Main Incho,
.ol
11of holes/pipe
Invert Elevation of Laterals q~ Ft,.
e .
' ~o . ~vJZ- S"I O a-~AGE OF A
PUMP CHAMBER CROSS SCCTION AND SPECIFICATIO►J_S
VENT CAP
~ 4"C-1. VENT PIPE
WCATHER PROOF APPROVED LOCKING
25' FRC(`1 DOOR, JUNCTION BOX MANHOLE COVER W/A)Q- r n
WINDOW OR FRESH 12"MIU. 5
AIR INTAKE
GRADE
I
I `i" M11J.~
COIJDUIT L-- 18"MI1J.
Alm. v
IAIL.F:1' PROVIDE
crti~a yv AIPYTWHT SEAL I
APPR.O`JED JOINT
W/ C. I. PIPE. y~
a fi I APPROVED JOI
~ ji , I i I I W
o`,
CXTCNDIAI(" 3' /C.I. PIPE
ONTO SOLID Sc!:. B ~~y~',f~ - I II EXTENDIUG
ALARM
! b v,•~ I ( ONTO SOLID S
00 P~~.. ' i . \ I I
c s~°~ ` p tits ' x- I i Ow
zls
pb,
!I i~ I" U M P ` OFF
'y~+Iyo lr', s CONCRETE BLOCK
RIS ISIS) J sA ED OULy IF TANK MAIJUFACTURC:R HAS SUCH APPROVAL
"(1 ~'qC Ry
/6~ SEPTIC AND S E C I F I CATI Of\1 S
7~ ~45E TANKS MA►JUFACTURER:
NUMBER OF OOSES: PER J)Ay
TANK :,IZC : _ -7 d GALLONS DOSE VOLUME
ALARM MAAIUFACTUK9.R: r- I / 5 ~ INCLUD!!!C C;,`!'.FLOW: ,3D~1'S
GALL ON
MODEL 1JUMBER: /d/ 4 W 'y~I I
CAPACITIES: A- - INCHES OR ' GAILOU:
SWITCH TYPE: - nQ (,tJ 0 hM
O=~INCHESOR 35'~ GALtO1J!
PUMP MAIJUFACTURCR:
• MODEL .IUMBER: C. INCHES OR /6;0,GALtO►J!
.✓1 D ' ---~L-INCHES OR L~1:--QL' PG A L L O ►J
SWITCH TYPE:
NOTE: PUMP AMD ALARM ARE TO BE
PUMP DISCHARGE RATE GP. INSTALLED ON 5EPARATE CIRCUITS
VERTICAL DIFFERCIJCC Dt-'Z~wCCAI PUMP OFF AMD DISTRIBUTIOlj PIPE_
+ MIIJIMUM NETWORK SUPPLY PRESSURE , FEET
C~ 2.5 FEET
+ FEET OF FORCE MAIN X -L• Yllorr.FRICTIOU FACTOR.. ~ FEET Z a-/IL*i\
TOTAL DYNAMIC. HEAD = x(__/.3,7/ FEET
IMTERNAL RIME.WSIGNC OF TANK: LENGTH '/amdw
L I Q U I D DEPTH /
SIGIUED:
LICE-USE QUMBFR'.-
~S
117- DATE:
40
i
i - j Pagelf
- d r cn
0 A
0
6- eA
z `n
a b •
rt
w
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a `
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rt
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y •A ® ro ~L _ ~
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a rt
t~/t 0
n
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,V C \L. l ' T`r.>ti,,l~i"nty, N V
y la~. FI I tw,v` y~e y z ' ~ ` w A :3 w - .t t
It y GOULDS 'SUBMERSIBLE
EFFLUENT PUMPS r
:SE pNp
VUAG t '
ON,
r,.~~~Mz EP0311 LLST DISC.
4 t~ ,
S
rr 9~s~. solids 256.80 172.10
~f w 1 A QW°~ Fp0311 142 EP0311 1/0 tQ' 115 V Effluent Fv+p
ilk
v71{`zb iiY
1n S p0~11 '
V LL N.
' 1n aay'i ,,1l6
~dtY~SUbm iN\/ MODEL EP0311 '
•~,lt4L[ffluent:;Pum p SIZE 3/s,, SOLIDS
x .n. ri
AG to t
UMRS FEET
~ 25 ,y
Ali. -
r d N1 •Y t
20
15
10
r tr1Y t t: 2
40,
a 7a 2e 02
0 0 _ 4 a 12. 20 2t GPM
+ 0 5.0 7.5 m'M
0 2.5
CAPACITY
V
10,
Performance 38 .5
curve` • ' U.Cm1• "`T MODEL 3885 6^M1r.'
SIZE.3/40 Solid
1
i td ti' i~ 1 00
Y ~ktrr
4'~,9r # 70
('$~...r... 20
y""k# l r t r. 16 50
.0 +J.
M 10 yr[
E, w[o>l _
20
{t S 10 _ •
70 BO 90 100 110 • 120 opm
1. 0 0 40 60 60
'10 20 30
20
CAr^C1TY LIST Dm.
S
1:•„ , Y- _ 3/4' solids '191.55 729.35
1/3 HP 115 V tow H
ir~ yv f a:K. tE0311I. 142 wV1I LL solids 491.55 ]29.]5 r# Kr
r1di1~ 'WE0311M lids HP 115 V H r
aokw6'E0311M 142 3/4' 9b704.25 /7.1.85
High N
1/2 ►T 115 v
'.•O~UP.4Pu0511I{ 142 WE0511H 3/4' lids .8.43.65 565.25 + •
071?JI 3/4 HP 230 V H3.
1 h;" +t t High
GXF IE0712►{ 142 }:E
t ~tyi 'sit'i• pEptratt.V,t= M41) SPE)C1r1cATIt~0s
Fm G 7u..
it Y5 ai y.•.g~ .FDidANIPY; PM E tr `a ~c
DFS'T 30 PA
30 lzj
t.l`: R DnTE 10/88
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division cf Safety 8 Buildings in accord with ILHR 83.05, WIS. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but PARCEL I.D. #
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. 042-1087-70-120-
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Dic% Co1beth GOVT. LOT SW 1/4SW 1/4,S31 T 29 N,R18 )6Qor) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBSD.. NAME OR CSM #
111 W Ash 2 na m 6/1662
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY CIVILLAGE MOWN NEAREST ROAD
Roberts, Wi. 54023 V15)749-3895 Warren I 93rd. St.
New Construction Use ( Residential / Number of bedrooms 2 ( ) Addition to existing building
j j Replacement ( ) Public or commercial describe
Code derived daily flow 300 gpd Recommended design loading rate nP bed. gpd/ft2 . 2 trench, gpd/ft2
Absorption area required nP bed, ft2 250 trench, ft2 Maximum design loading rate _PP bed, gpd/ft2 •2 trench, gpd/ft2
Recommended infiltration surface elevation(s) 97.30 ft (as referred to site plan benchmark)
Additional design / site considerations system el based on contour line of el. 96.30
Parent material pitted ualcial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for svstem 1:1 S (M I M❑ U 1C3 S)9 U I❑ S MCI I ❑ S M 1C3 S I:U
SOIL DESCRIPTION REPORT
Depth I Color Mottles Texture I Structure Consistence IBaixiary I Roots GPD/ft
Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed IT
1 1 -14 10 r 3/2 none 1 2msbk mfr w if .5 .6
2 4-26 l0yr 4/4 none sicl. lfsbk mfr g1v na .2 .Ground 3 .6-47 7.5yr 3/4 c2p7.5yr 5/6 sci l.msbk mfr ger na .2 1.3
elev. !
95.0- ft. 4 7-67 7.5yr 4/6 12d7.5yr 5/8 is imsbk mfr na na .4 .5
Depth to
limiting
factor
261,
Remarks:
Boring #
1 -13 10yr 3/2 none 1 2msbk mfr w if .5 .6
2 2 3-2$ l0yr 4/4 none sicl 2msbk mfr gw na .4:.5
s 3 8-55 7. Syr 4/4 none s1 lmsblc mfr aw na 4 5
Ground
elev. 4 5-75 7.5 r 4/6 none is Os mvfr na na .7 .8
95.00t.
Depth to
limiting
factor
y-,
751,
Remarks:
CST Name:-Please Print Gar L. Steel Phone:
715-246-6200
Address: 1554 200th ',re-, New Richmond, Wi. 54017
Signature: ? Date: CST Number:
4-26-95 cstm 02298
PROPERTY OWNER Richard Colbeth SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D.# 042-1087-70-1.20
Boring # Horizon I Depth i Dominant Color I Mottles Texture I Structure I Consistence lBourXbry I Roots Bed DTft2
in. Munsell Glu. Sz. Cont. Color Gr. Sz. Sh.
N3 1 b-10 10 r 3/2 none 1 2 if ra .2
' 2 10-21 10 r 4/4 w if .21 .3
Ground 3 1-41 7.5 r 4/4 none sl lmsbk mfr gw na 4i .5
;
elev. 5/2
96.6 ft. 4 1-75 7.5 r 4/6 c2 2.5 r 5 sl lmsbk mfr ria na .4 .5
Depth to
limiting
factor
41"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
R.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting 1
factor
Remarks:
5pp-g3gp(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Richard Colbeth 1554 200th Ave.
CSTM2298 sw4Sw4 S31-T29N-R18w New Richmond, WI 54017
MPRSW-3254 town of warren (715) 246-6200
1
N
1"=40'
BM.= top of NE lot stake @ el. 100'
oM
A
~o~✓-~oc~rz ~ ~
~j'~•jQ
j J~10 li
Gary L. Steels cc~~ n
4-26-95 t~ t," A ~ 1;
Wisco: sin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
.L tr i%M 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,k! x tftt ze. Plan must include, but
not limited to vertical and horizontal reference point of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and Ostance to pearest roa 042-1087-70-120-
REVIEWED BY DATE
APPLICANT INFO RMATION-PLEASI~ PRINT,,, 4,,L=1)RfbRMAT
PROPERTY OWNER: OPERTY LOCATION
! r: VT. LOT SW 1/4 Sys 1/4,S3I T 29 N,R 19 for) W
I
Dic.c Colbeth
PROPERTY OWNERS MAILING ADDRESS OT # BLOCK # SUBD. NAME OR CSM #
111 W ""Ash IJ-
2 na csm 6/1662
CITY, STATE ZIP CODE P ONE 6ER ❑CITY (:)VILLAGE )TOWN NEAREST ROAD
Roberts Wi. 54023 °)9i= ?t5 f Warren 93rd. St.
New Construction Use ( Residential / Number of bedrooms 2 ( ] Addition to existing building
j ] Replacement Public or commercial describe
Code derived daily flow 300 gpd Recommended design loading rate np bed, gpd/ft2.2 trench, gpd/ft2
Absorption area required np bed, 112 250 trench, ft2 Maximum design loading rate -2 _bed, gpd/ft2 •2 trench, gpd/ft2
Recommended infiltration surface elevation(s) 97.30 ft (as referred to site plan benchmark)
Hdditionai design r site considerations systern el. based on cone ur litie of el. 96.30
Parent material pitted galcial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for svstem O S 56 M O U I O S-IO U I O S my I O S M [Is 19U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. I Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. I Bed Trend
1 -14 10 r 3/2 none 1 2msbk mfr w if .5 .6
l
2 4-26 10yr 4/4 none sicl lfsbk mfr gw na.2 .3
Ground 3 6-47 7.5yr 3/4 c2p7.5yr 5/6 scl I-msbk mfr g1-r na .2 .3
elev.
95.0- ft. 4 7-67 7. 5yr 4/6 12617. 5yr 5/8 is lmsbk mfr na na .4 .5
Depth to
limiting
factor
26"
Remarks:
Boring #
1 -13 10yr 3/2 none 1 2msbk mfr w if .5:.6
2 3-28 10yr 4/4 none sicl 2msbk mfr gw na .4 .5
3 8-55 7.5yr 4/4 none sl lmsbk mfr aw na .4i.5
Ground
elev. 4 5-75 7.5 r 4/6 none is 10sq mvfr na na .7 ..8
95. 00t.
Depth to
limiting
factor
75"
Remarks:
CST Name:-Please Print Phone:
Gar L. Steel 71.5-246-6200 (
Address: 1554 200th Ave., New Richmond., Wi. 54017
Signature: ` Q Date: CST Number:
4-26-95 cstm 02298
PROPERTY OWNER Richard Colbeth SOIL DESCRIPTION REPORT Page J. 3
PARCEL I.D.# 042-1087-70-120
Boring # Horizon Depth DominantColor I Mottles Texture I Structure Consistence BoI GPD/ft
trxfary Roots
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed iTrench
1 -10 10 r 3/2 none 1 2c' 1f n ' .2
2 10-21 10 r 4/4 w if .21 .3
i
Ground 3 1-41 7.5 r 4/4 none sl lmsbk mfr gw na .41 .5
elev. 1
96.6 ft. 4 1-75 7.5 r 4/6 c2 2.5 r 5 sl lmsbk mfr ria na .4 .5
Depth to
limiting
factor
41"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
F-T
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Richard Colbeth 1554 200th Ave.
CSTM2298 SWgSW4 S31-T29N-R18W New Richmond, WI 54017
MPRSW 3254 town of Warren (715) 246-6200
1
N
1"=40'
BM.= top of NE lot stake C el. 100'
eM
A
~o,~our~ ►3=~ ~d~
01
Al
~ le
9 t'
~o
Z
Gary L. Steel
4-26-95
CERTIFIED SURVEY MAP
` LOCATED IN PART OF THE SW 1/4 OF THE SW 1/4 OF SECTION 31, T29N, R18W,
TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN
OWNER LEGEND
FLOYD COLBETH 19 ST. CROIX COUNTY SECTION CORNER MONUMENT
RT. 1
HUDSON, WI. 54016 • 111 IRON PIPE FOUND
O 111 x 2411 IRON PIPE WEIGHING 1.68 LBS/LINEAR FOOT, SET
AREA OF LOT 3 AREA OF LOT 2
11,667 square feet 86,751 square feet
0.27 acres 1.99 acres INCLUDING R/W
+**NOTE*** 68,570 square feet .110
LOT 3 IS TO BE DEEDED TO AN 1.57 acres EXCLUDING R/W /
ADJOINING OWNER.
unplatted lands owned by platter J
1►+
S89021' 32'1W 558.79'
yN 535.60' 1331 331
349.741 L0 185.861
9.05
1 0
342.25' 3 cv T
'N 52 E hicken coo
S88 = 1C
ro o02 11IE N I ~ 17
= found iron pipe lies t _ o a i~.
I S4703113511W, 2.431 of o ° rt
w
i~` I true corner location. C! o C4
i a
CERTIFIED SURVEY MAP LOT °-°oo
m cn w f a
Co -
volume 6, page 1571 N IN
C (C! i~
Co m
LOT 1 <v z ; a
N Q Vwi O
c N garage -i Un i °
co -,T m co
i
13
O N
" I
N "
C ° " house
as m -
eo z a I
n
o~
0 m =
~i
r o
z
T G=)
N -i
m T CENTERLINE C.T.H. 'IN"'
to m ~
m
r 2
y ° CURVE DATA LOT 2
19034'55"
o m R - 859.16' CURVE DATA LOT 2 R/W
H CB - 572051'24.511E Q = 16034'05"
01 C)
m C - 292.211 R - 892.16'
a = L - 293.64' CB - S74012'40.5"E \
C - 257.09' cn
N
L - 257.98'
TN FFFT N88054'5211E 1349.621
100 50 0 100 -SOUTH LINE OF THE SW 1/4
SW CORNER S 1/4 CORNER
SECTION 31 SECTION 31
this instrument drafted by Douglas Zahler job no. 86-11
SURVEYOR'S CERTIFICATE
I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify
that by the direction of Floyd Colbeth, I have surveyed, described and
mapped the land parcel which is represented by this Certified Survey Map;
that the exterior boundary of the land parcel surveyed and mapped is
described as follows:
A parcel of land located in part of the SW 1/4 of the SW 1/4 of Section 31,
T29N, R18W, Town of Warren, St. Croix County, Wisconsin; further described
as follows:
Commencing at the SW corner of said Section 31; thence N88054152"E, along
the south line of said SW 1/4, 1349.62 feet to the east line of said SW 1/4
of the SW 1/4; thence N00O51'28"W, along said line, 608.52 feet to the
centerline of C.T.H. "N", said point also being the point of beginning of
this description;sthence continuing N00051128"W, along said east line of
SW 1/4 of the SW 1/4, 404.65 feet; thence S89021'32"W, 558.79 feet; thence
S01O38'32"W, 25.91 feet to the NW corner of Lot 1 of Certified Survey Map
volume 6, page 1571 as recorded in the office of the St. Croix County
Register of Deeds; thence S88002152"E,along the north line of said Lot 1,
342.25 feet to the NE corner of said Lot 1; thence S11028'05"W, along the
east line of said Lot 1, 280.26 feet to the centerline of said C.T.H. "N",
said centerline being an 859.16 foot radius curve concave southwesterly
whose central angle measures 19034155" and whose chord bears S72051124.5"E
and measures 292.21 feet; thence southeasterly along the arc of said curve,
293.64 feet to the point of beginning.
Above described parcel is subject to Right-of-way for C.T.H. "N" and the
Town Road as shown on this map and all other easements of record.
that this Certified Survey Map is a correct representation of the exterior
boundary surveyed and described; that I have fully complied with the
current provisions of Chapter 236.34 Wisconsin Revised Statutes and the
Land Subdivision Ordinance of the County of St. Croix in.surveying and
mapping same.
Go IV&
ALLEN C.
C.
NYHAGEN ~
ci S-11407 l
HUDSON, ~s
Wis.
00bW .11V ~JS o'10' N.Wo flags
Allen C. Nyh en ate
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER IO e~ \
MAILING ADDRESS 3
PROPERTY ADDRESS 1.~2 S p l(o
(location of septic system Please obtain from the Planning Dept.
CITY/STATE R o)p e'A S W-C S4 ®a-3
PROPERTY LOCATION S 1/4, S w 1/4, Section 3 , T_=L~j_N-R [ g W
TOWN OF W 4 o~e, v~ ST. CROIX COUNTY, WI
SUBDIVISION C.s in^ Ca ~ 1(~ b a- , LOT NUMBER oL
CERTIFIED SURVEY MAP , VOLUME La , 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 expiration date.
SIGNED:
DATE: 6 - k
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
Location of property_&~Z 1/4 SW 1/4, Section 31 ,T_Q-L04_N-R_J_e_W
Township Maid' g address I I W A.~ L,
o ~L 3
Address of site 5-
subdivision name Lot no. a
Other homes on property? Yes X No
Previous owner of property Ford ~j
Total size of property
Total size of parcel Al 99' a~~•e-s•
Date parcel was created
Are all corners and lot lines identifiable? _X Yes No
Is this property being developed for ('spec house)?. Yes _,A_No
Volume and Page Number 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. , 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.
nature of _Applicant Co-Applicant
Date of Signature Date of Signature
~LSOCUMENT NO. STATE BAR OF WISCONSIN FORM ld- 1982, TM" '"ACE NESE",CG Fu" "EGU"GMG nAr, ~
TRUSTEE'S DEED i'
G2,70~34
..._...Thomas.......CQltae.kh.............
as Trustee of I PARR 2 8 199 "I I
E•loyd•AMyr_t];.g..CQDk.0..Eimi1•y-•, 1: u ,C
at 9:30 A.
for a valuable consideration conveys without warranty to
R•ich-r--d..F~..Co.lb~th...a.nd...~a_t1;1.~~,.a..A~
hu s ba nd-• a nd•--w•i f a. . -.~-4~ rv yo_~.- R-- m a r -t- 1•-_-.-_-.-_
-
proper.t Y It 'u.,,, 1,
C. L. Gaylord
................................................................•••--•.Grantee, Attorney at Law
the following described real •state in .___.~t,._GYA•7.X•.•-_•••••-.......... Caunty, - 1 S• M-54022- I
State of Wisconsin:
Tax Parcel No:
Lot Two (2) of Certified Survey Map in Volume
;ix (6) of Certified Survey Maps, Page 1662, as Document Number
413149, filed in St. Croix County Register of Deeds office on June it,
1986, being located in part of the Southwest Quarter of the Southwest
Quarter (SWk of SWk) of Section Thirty One (31), Township Twenty
Nine (29) North, Range Eighteen (18) West, Town of Warren.
r L
_q
I
_ 18.~~....
Dated this day of ,
~LOYD & MYRTLE COLBETH FAMILY TRUST
...............•---._._...__......_........._..._.....__...........(SEAL) -____--_-...-(SEAL)
'Thomas E. Colbeth
Trustee rust.e
1
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN
i r County. e i
l J 0 ,rr. ' I
authenticated this day of 19 Yerso..rr!ly c2n^ b°foro me +
. K}}.91ndS._.E _..Go.l e-
j
i
TITLE: MEMBER STATE BAR OF WISCONSIN . ~..2 ..-•,J•«
j' (If not........... ')'4•- I ,J~. Y.
ii authorized by § 706.06. Wis. State.) to me known t. be the erson who 14d the
i~
foregoing, instr( ent a d acknowledge t1w„g~p7~,er•'' I ~
THIS INSTRUMENT WAS DRAFTED BY
~.._..I..r...Gay-.lord, ..Attorney
( >r1.......
-
I~ River Falls t WI 54022 Notary PubLc County, Wis.
(Signatures may be authenticated ur acknowledged. Both My Commission is ermanent. tlf not, state expiration
:i are not necessary.) date: . 19.........) I~
,I II
"Name.: of persuns aiKninrt in any capacity should be typed or printed below their :agnelure..
STATE BAR OF WISCONSIN Stock No. 13016
M.GM.Ia,Cmprry~ FORM No. Is- 1922