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HomeMy WebLinkAbout008-1008-20-025Wisccr>~in Department of Commerce PRIVATE SEWAGE SYSTEM Safeiy~nd Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, x.15.04 (i)(m)J, 'ermit Holder's Name: City Village X Township Gou h, Jason & Anna Eau Galle, Town of :ST BM Elev: Insp.' BM Elev: BM Description: /ou-a Br~~ 'ANK INFORMATION $`yJ ?~ 0 ~ ATION DATA TYPE MANUFACTURER CAPACITY Septic / i / ~~ Dosing G~ ~~ ~~ Aeration /1n _ 1 f'~. G 7 /~ Holding TANK SEZB~CK INFORMATION TANK TO ~ WELL G~DG. Vent to Air Intake ROAD Septic ~ L QO ~ ~ ~~ r„ n/1piyW'. Dosing ~~~ ~ Aeration Holding PUMPISIPHON fNFORMATION (f~ L~ GPM Model Number ~~~ ~~ TDH Lift Friction Loss System Head TDH X2.23 1.x(0 ~f'S~ i~'.v Forcemain Lenyili5 Di~ i, Dist. `o ~el~ , Cnll AQCnDDTInAI CVCTGM County: St. Croix Sanitary Permit No: 506206 0 State Plan ID No: Parcel Tax No: 008-1008-20-025 Section/Town/Range/Map No. 03.28.16.37A STATION BS HI FS ELEV. Benchmark ~~ 2.0 /02•d /DO o F,It. BM ~~ , ~ ~~• /D~ 9 3.3 Bld . Se er~~~ .~ t In ;,y „, ~~ v C.(J L ~{ ~ ~~ v , s st/Ht o seG~ 0 S 4s OD . Z S" Dt Inlet SGT-/ ~f6 r~rla ~ . ;3 ' p ~O , 6 g ~. 7 Dt Bott m y r ~~ l'7 .~ a 1.9 ~ .3. 3 ~ Head r/Man. p ~_ u G, ~f0 G /S- ~ Dist. Pipe G /' r7 i i~ d' ~• ~~ p~,?`_ frJ+~ Bot. System ~ 0 /S~O Final ade ~ }' ,S ~ q ~ ~ / St ~o~vle~r ~ ~ t / •OS /b , 2 ~/uc ~.0 9 ~f- 6 (.,(~~ GC 1 ~ / 3. (a ~/- 7d BEDITRENCH Width 1 Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~~li'~ Uv / ~ v ~-- SETBACK SYSTEM TO P/L BLDG WELL L KE/STR M EACHING Manufacturer: CH B OR INFORMATION Type Of ystem: ~ Q ' ~ ~~ i / Model Number 1 WI C' ~ ~ -'v nICTR,4Rt1-TJ(1N SYSTEM V/OA ~, //~ __ ~, Head /Manifold n ~ Distributio x Hole Size x Hole Spacing Vent to Air Intak 1 ~ D (, 7 Q ~ Pipe(s) / O'~ I •Sii ~. 8 acin S th Di L / Q. ~5 10 3. d ~. 7 Q I ia . Length g p a eng cnn /`nVGD . n....__....,. c....a....... n...i., .L., ne.,~~.,Al n,- ef_r_raria Cvc4amc only Depth Over Depth Over ~ f~ ~~~ x D xx Seeded/ dded ~ xx Bed/Trench Center Bed/Trench Edges ~ Topsoil ~ Yes No Yes No ~, _ ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~/ __/~_/~ Inspection #2:_ ~ r~/v /- Location: 2445 60th A~ nue Woodv'ill'e, nW~I,,54028 NE 1/4 NW 1/4 3 T28N R16W) >35 acres Lot ~Q~~~"~' arcel No: 03.28.16.37A~ 1.) Alt BM Description =''"1 d~ ~"' ' ~r~`'"""'~ Y (;f7 2.) Bldg sewer length = ~rj - amount of cover = 3 3 1 . Plan revision Required? :Yes y/t~lO ~ )/~'~J G~YV~^,- ~ w/Q Use other side for additional information. ~_ r~ _J - J Date Insepctor's Sig ature Cert. No. SBD-6710 (R.3/97) ~'~- ~Zr+`/ d Mulched comrn~rcewi.gov Safety and Buildings Division Cotmty +. ' S~ ~ ~ 201 W. Washington Ave., P.O. Box ?162 U„Z ~ ^ ^ ~ Madison, WT 5370'7162 $arritary p~ttt ,anber (to be, lkd in by Co.) Coaut er D ~ C/`,~J, lO Sanitary Permit App ca CEIVED "umber s ~eTra n sa aion J In accordance with s. Comm. 8321(2), Wis. Adm. Code, submission of is form to the approprime go J /~ ~ / / ~f l ~ ,7 unit is required fining a sanitary permit Notc Appl' fo fqr ;pte,;Qw~j,1'O Project Address (if different rhea tmrliug address) ~ ~ o submitted to the t of Commerce. Pets»nal iaforntation jnay{~~I~ in accordance with the Pri law, s. I5. 1 m Stars. 1. A l[cation Information -Please Print All 1[aformation Property Oumr's Name Parcel # Property Owner's Mailing Address Property Location ~37A ~ L~ ~~sr ~ ~ x ~ ,~ ~~ b Govt Lot - City, State i Ztp Code ~ ~ ~ (if ,ti (.c.l~, ~ c:~t,~ , ~ ~~ ~.1 S ~l o Z,~ ~ `~i ~ "- j ~l'tY ~~ /7 ~j ) `~ oae) T •C d N; R ! ~ l~or W II. Type of Builtiiag (cheek all that apply) Lot # Subdivision Name LQr2 Farraly~~Ilmg _ wu.ah~ nf.Bedmomt ~ r ~ ~ - ~ .~~ct tea- ~~-i~i~ l k r ~ ~ ^ PubtirJComnretcial -Describe Use 35 ~~~ ^ City of ©StateOwned -Describe Use CSM Number ^ Village of ~/"_ ~ L 'e. Town of G /a lL ~' l7- I[i. T ype of Permit: (Check onl Complete line 8 if applicable) A" ^ New System Replacerirent System Treamratthlotdirrg Tank RepLsoarAent Only ^ Othtx Modifiratiwa to Existing Systtan (atphin) B. ^ Permit Renewal ^ Change of Plumber ^ Permit Transfer to New Pre{~vtot~ Permrt ~~ L~ )~ " WYt !~/( ~ Before Expiration ,. ~ . M K/ IY. T of POW'1'S S m/Com nmt/Devlce: Check aB that a I ~~f/ ~Z ^ Non-Pressurized in-Ground ^ Pressuaiud In-Graund ^ At~',rade wrd > 24 in. ofsuitabk m o sa /,/ (` ~ ^ Hohling Tank ^ Other Dispersal Component (explain) ^ Pretrceurrent rx % 7 V. ersa[!I'reattnentAnea Llformatlea: Qi' D Desi Fbw (gpd) ~ ~ Design Soil Appi' Rate(gpdst) 1 ~ Dispersal uved ( -z~ ~ D Area (sfj Ll ~ System Elevation r l ~"" ~ ' ' . U r ~ ~ ia_s i3~O7 s VI. Tank l[nfo 'ty,n Tots # of Man , Galhms Gal Unks f, o U' '~ = . New Trots Exiuing Tads ~ `~ /1 ,~ ~~~a ` " ~ o ~ '~l g .~ ~ ~ fi ~ l v ~ 4 G~ VJ So V! S f4 L Or Septic or [{aldma Tank I ~ (!J .' L, s t'. t/ DOSiag Ctareber - _ _ ~~~ J G ~ 1 - YII. ttsibBity Sbtement I, the eadersigacd, rrss txspons butallatiea of the POW1S show. oa the attached pleas. Plumber's Name (Print) PI s Signature RS Number Brumess Phone Nwnba ~~ e ~~~~-~c ~a`~ - ~ l~ G~i~ ~~~` Plumber's Address {Street, City, Zip Code) l~ ~/ l 3~ s~ ~L3 Lcf ~ ~ S Cl~ C~c y ~ ~~ , ~ . , ~ ; rJ ~ ~ YI nn /De at Use O Approved ^ Disapproved Permit /Feed U„ s ~ `~ Date ~25~ ~ Issuing Ages ~i~~' G~~/ ~y ^ OwnerGiven RmSOn 6orDenial l/LJ ~D7')1/!'y. IX. Conditions of ApprovaJVRtmsons for D[sapproval /S h e, ~~ 3. -?, ~~"~7~ •~ ~Q~ it OWNER: ~ - - r U SYSTEM 1 Septic tank, effluent filter and ~ r dispersal cell must all be serviced ! m n d / i I ~,~~~~~ ...P_,~~~~p-y~G~ ~.Gn plumber. ~ 0 /' ided b Q~~~J y as per management plan prov ~'z ~ 7` l fined Q 4. r~u Jc wa..~.. ~-~-.. _.. e6 for the system aed sabmit to Coeaty Daly on pater eat Ir•Saba a 1Q : 1 i - a as per applicable co e or~i~~l' ~` m~ SBD-6398 (R. 01107) Valid thtn 01/09 ZY v ~ ~ o -~`~,q-ve ~~ ~}Cn~~ Sc~~~ ~ - to tio~ U~' ~ ~ ~ ~ ~;~ .s ~ -." '~ ~ ~ ~ ~ ~ ~~~' I ~a ~ ~ ~ ~ ~~'~ - x ~. ,~ ~~~~ ,~ ~~~ r' ~ ~, r ~ ~~~ ~~ ~s`~ ~~~ 14 ~ o~ ~~~ ~P~~~ ~. 8 w~ tU~ ~~~ - ~ ~~ 3 ~ ~-1 9Nf~:5.. ~ ~ ~ ~' ~~- 2 -~ ~~F`~~ ~- ~~ - a -~ ,~ ~ ~ M. • ~ ~ ~~ ~ ~~~ ~ ~ 0 SUS v Jam, ~~i 'l ~ ~~`~ a ,% ~, o ~ 3 '~ 6• _.~ ~, ~ r i ...i ~® °~ ~ ~ y 2 - ~ / ~~,, ~` L (z0 ~, c, . S, ~ ~~~ ~ ,a ~ ~ ~...~..~.~__._~ __y._._. ,...._..~....,.vr..~:~ ___ ~~~~ ~ ~~ ~ l~~ `v (r ~~ ~ commerce.wi.gov i ^ ~sconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. co m me rce.wi. g ov/s b/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 16, 2007, CUST ID No. 223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVTLLE WI 54028 CONDITIONAL APPROVAL PLAN APPROVAL EXPIItES: 05/16/2009 SITE: ATTN. POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1394977 Site 1D No. 725264 Jason & Anna Gough Pleaae refer to both identification numbers, rx above, in all corres ondence with -the a enc . 60 Avenue Town of Eau Galle St Croix Coun ~; NEl/4, N~/ , S,B; T 8N, R16W FOR: Description:. Mound /Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object 1D No.: 1130878 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth~to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The. owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. L'Oit ~~ The following conditions shall be met during construction or installation and prior to occupancy or use: ~(,~~i Reminders pE MENTC N OF ~ • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. SEE CORRE~ • 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. • 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 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat JOE STANG Page 2 5/16/2007 • Comm 83 22(71 A coEy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • 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 conunencement 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 maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, G~e~~ ~~ ~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. ~,a ~ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN G~ 1„~r < , .~, ' S Residential Application ~ ~ INDEX AND TITLE PAGE FLU ~ ° `a w ~ ~s ~ Q ~ Project Name: Gough Replacement Mound Owner's Name: Jason A. & Anna Gough Owner's Address: 2445 60th Ave. Woodville, Wisc. 54028 Legal Description: NE 1/4, NW 1/4, S 8', T 28 N, R 16 W Township: Eau Gatle County: St. Croix Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 008-1008-20-25 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan J~~lty Page 7 Pump curve and specifications .,~ Page 8 Plot Plan ~~~ Page 9 Soil Evaluation Report ~ COMMA ~a~~s ~PONDENCE Designer. Joe Stan License Number: 223475 Date: 05/ /07 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 4.01 (R. 09/04) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 7.00 Site Slope (%) 94.00 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 80.00 Dispersal Celi Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c or e) Center or End Manifold 2.82 ateral Spacing (ft) Number of Laterals 0.156 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) _ ,., 2.00 Forcemain Diameter (in) Sd 70.00 Forcemain Length (ft) 83.00 Pump Tank Elevation (ft) v 4.55 System Head (ft) x 1.3 23 11.75 Vertical Lift (ft) l ~ ~ I ,,~ y 1.28 Friction Loss (ft) 17.58 Total Dynamic Head (ft) 1~, Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000.00 Se tic Tank Capacity (gal) Wieser Manufacturer Dose Tank Information 750.00 Dose Tank Capacity (gal) 20.27 Dose Tank Volume (gal/in) Wieser Manufacturer Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliforrn of <= 36 inches. 5.63 Cell Width (ft) Are the laterals the highest oint in the distribution Y network? Enter Y or N If N above, enter the elevation ft) of the highest point. 8.34 ft2/orifice Does the forcemain drain back? Y Enter Y or N 11.42 Forcemain Drainback (gal) 72.04 5x Void Volume (gal) 83.46 Minimum Dose Volume (gal) 29.08 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) 750.00 Total Tank Capacity (gat) 37.00 Total Working Liquid Depth (in) 20.27 gat/in (enter result in cell 1349) Effluent Filter Information Zabel Filter Manufacturer A100 Filter Model Number Project: Gough Replacement Mound Page 2 of 9 Mound Plan View i- 1_ 1/10 B • 'Observation Pipe '~' :~. K .5. ~. :R B "'~ " Lt. Mound Component Dimensions -T -} -~ -i A 5.63 ft E 16.73 in H 1.00 ft K 8.97 ft B 80.00 ft F 9.50 in z 10.20 ft L 97.93 ft D 12.00 in G 0.50 ft J 5.68 ft W 21.51 ft 450.40 (ft2) Dispersal Cell Area 1266.33 (ftZ) Basal Area Available 5.63 (gpd/ft) Linear Loading Rate 8.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 96.79 (ft) .,,,,.. F 95.00 (ft) -- - Dispersal Cell 3~ Elevation ~ ~I H Dispersal Cell ~ 95.50 (ft) Lateral Invert :D ~ t ~:..-- 94.00 (ft) Contour Elevation 7.0 % Site Slope /~ Geotextile Fabric Cover Shading Key _ Topsoil Cap ~"~'~ Subsoil Cap © • ~ : ~ • ASTM C33 Sand ® `~~~"~~~"-~` Tilled Layer ^5 '~~ Aggregate '° a • ~ Dispersal Cell ~ ~ R R 1.5 ft 5 ~~~~~ ...... ..e .' '. . . ' ' m 0.5 ft '~ ~ ~ ' ~ F :~ 7YPical Lateral ; °. :' a~ ~ I *--- A ~ See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Gough Replacement Mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered otrer the A & B dimension i =Turn-up wwrball valve or cleanoutplug P All laterals are identical IE X~I Holes dryled on the bottom of the lateral S equally spaced ~ Force main connection tria tee or cross to manifold ~ any pant. Laterals & force main of PvC Sch 40 [per COMM Table 84.30-5j Number of Laterals 2 Orifice Diameter Lateral Diameter 1.50 in Orifice Spacing (X) Lateral Length (P) 78.52 ft Orifices per Lateral Lateral Spacing (S) 2.82 ft Orifice Density Lateral Flow Rate 14.54 gpm Manifold Length System Flow Rate 29.08 gpm Manifold Diameter Total Dynamic Head 17.58 ft Forcemain Velocity Dose Tank Information Electrical as per NEC 300 and --- ~~~'''LLL,,, Comm 16.28 WAC I I Disconnect II ~_ Tank component is properly vented Wieser Ca aci 750.00 Volume 20.27 Manufacturer Gallons gal/inch Dimension Inches Gallons A 21.88 443.57 B 2.00 40.54 C 4.12 83.46 D 9.00 182.43 Total 37.00 750.00 A B C D tank. Alarm Manuafacturer SJE-Rhombus Controls Alarm Model Number Tank Alert 1 Pump Manufacturer Goulds Pump Model Number 3871 EPOS Pump Must Deliver 29.08 gpm at 17.58 ft TDH 0.156 in 3.02 ft 27 8.34 ftz/orifice 2.82 ft 1.50 in 2.97 ftlsec Locking cover with warning label and locking device and sealed watertight i ~4 in. min. 1~ ~- ARemate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~ ump off elevation (ft) 83.75 Do~tank elevation (ft) 83.00 Project: Gough Replacement Mound Page 4 of 9 Mound Svstem Maintenance and Oaeration Saecifications Service Provider's Name Joe Stang ~ Phone 1-715-684-5166 POWTS Regulator's Name St. Croix Coun Zonin Phone 1-715-386680 Svstem Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450.4 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauencv Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears 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: Gough Replacement Mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in akx:ordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS componerrts. Septic or pump tank manhole risers, akx:ess risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-induas in diameter shall be secured by an effective locking device to prevent accdental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be leaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may sough off the filter when removed from its enclosure. N the filter is equ~ped with an alarm, the filter shall be serviced if the alarm ~ activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contenrts removed when the volume of sludge and skxun in the tank exceeds 1/3 the liquid volume of the tank. ff 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 akx:umulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, ff 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 switdres, alarms, and pumps shall be bested to warily proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pnsssuns Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and muk:hed as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mamd is not rekxxnmended since soft compaction may hinder aeration of the ir-fdtrative surface within the mound and snow compaction in the wirrter will promote frost penetration. Cold weather installations (October-i=ebruary) dk~ate that the mound be heaviy muldurd as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mglL TSS, and 30 mglL FOG for septa tank effluent or 30 mg/L GODS, 30 mg/L TSS, 10 mglL FOG, and 104 k~u/100 mL for highly treated effluent. Influent fbw may not exceed maxknum design flow specified in the permit for this instaNation. The pressure distribution system is provided with a flushing point at the end of each lateral, and R is recanmer~ed that eadt lateral be flushed of akxumulated solids at fast once every 18 months. When a pressure test is performed it shoukt be compared to the initial test when the system was ~statied to determine if orifice clogging has occurred and ff orifice leaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent pondirrg. Ponding levels shall be reported to the owner, and any levels above 8 ind~es considered as an impending hydrauUc failure requiring addkional, more frequent monfloring. Contlns~encv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump. pump cpntro~, alarm or related wiring becomes defective the defective component(s) shah 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 wa~ewaffir to the ground surface, k wiN be repaired or replaced in its' present location by increasing basal area if toe leakage oxurs or by removing biologicaly dogged absorptan and dispersal media, and related piping, and repladng said corrrponerns as deemed necessary to bring tare system into proper operating condition. See Page 5 of this plan for the name and telephone number of your kx~l POWTS regulator and service provider. Project: Gough Replacement Mound Page 6 of 9 Zy v 5' ~ o ~`~/a-ve NW ~y, M~ ~y, S_$'~ T zdnl ~ R i~'^~ ~~ ~~ReS Z( .,v~ Sc~~~ ~"'to '40~ v ~, ~ ~, ~~ -.~. ~~ -b '~ _'~ ~- ~ ~~ ~~`~~ ?`~ ~" 0 ~.a ~~ t v ~~ w~ ~~~ 0 ~~ `> I tG~e~~sX L ~~d=~3'3 ~'~ ~' ~3- 2 • f3,~ ~~~`1~ ~~~ ~ g,G~ ~ Yv a ~'~' ~~b m s ~ sU~ ~\ V a 3-3 ~., \ ~ V a 3,- ~~ a~ k~ v ~ ~~~ ~ ~ i ,,1, g~~ _ _ .. ~ av I ~_._.._._._._ ..._...___W.. ..__~..~-..._..~. _~__...._...~_._....._._~ ~..... _ ._v._ ___ .__~ P~~Q ~ o-f~ ~ ~ ~ ~~ . GOULDS PUMPS Wastewater ratai 11~d ~ ~,~- ' 6aiioia ~ 1'04 EPOS 5 53 - 10 46 62 i5 36 55 20 21 46 25 0 33 30 - 1i METERS FEET 10 9 31 8 2' TQl-}~ 17.S~ ~ s 2. z d 5 7'. 4 O 3 11 1 co~o~Nrs 2 Base 3 pir~ Casing 4 Mechanital5e~ 5 Bab Beatvais 6 0-Rings 7 Pourer Cad 8 OR Filled Motor s Stator Assembly 10 Motor Cotner ~. __ ~~ q 7 t --~-___ .~ to 8 6 9 5 4 3 t 2 ~~~ ~ ~a~ q 3 C,~- h Wisconsin Deparbnent of Comrrreroe ALUATION REPORT Division of Safety and Buildings p~ 1 ~ 4 to accoroan~ce~{py~se, vvis. ream. was ~^"""""" County St. Croix Plan must n er not less than 81/2 x 11 inches in size om lete ite l n a Att h p . p p o p ac c s a indude, but not limited to: vertical and horizontal reference point (BM), direction and p~ l•p_ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all i-Norn-ation. Date , Re Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)), ~> l,G( /~ i"Yli/(~ ~~O ~/ Property Owner RECEIVED rty Location 28 6 Jason A. & Anna Go gh ~ Lot 1vE 1/4 rlw f/4 S N R 1 T Property Owner's Mailing Address 2007 Lot Block # Subd. Name or ~ ~b 2446 both Ave. MAY 1 5 City State Zip Code hone Number ity ~vllage own Nearest Road Woodville Wi 54028 ( 1~$~~ 60th Ave. New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD " ,.~ , ~ Public or commercial -Describe: Parent material Glacial Drift Flood Plain elevation ff applicable ~ i n it. and recommendations: 12" mound contour at 94 a Boring # ~ Boring Q pit Ground surface elev. 94.25 ft. Depth to limiting factor 30 in. Soil lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f1? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0-7 10YR4/2 ---- sil lfsbk mfr as 2f 0.4c 0.6 2 7-16 10YR6/3 --- sil lfsbk mfr cam, lvf 0.4c 0.6 3 16-30 10YR6/4 ---- sl 2msbk mfr cw -- 0.6 1.0 4 30-36 10YR3/4 c2d7.5yr5/S Bands sl 2fbk mf cw -- 0.6 1.0 2 Boring # U Boring 94.6 24 pit Ground surface elev. ft. Depth to limfing factor ~^• Soil lication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/flz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10YR4/2 -°- sil lfsbk mfr as 2f 0.4c 0.6 2 7-15 10YR6/3 --- sil lfsbk mfr cw lvf 0.4c 0.6 3 15-24 10YR6/4 --- sl 2msbk mfr cw ___ 0.6 1.0 4 24-36 10YR3/4 c2d7.5yr5/8 Bands sl 2fbk ~ cw --- 0.6 1.0 * Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Name (Please Print) Signatuf CST Number Thomas W. Gedatus !~/~ 962178 Address Date va nation Conducxed Telephone Number Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 4/27/2007 1/715/684/5166 Property Owner Jason A. & Anna Gough parcel ID # 008-1008-20-025 Page 2 of 4 3 Burin # U Boring g 0 pit Ground surface elev. 94.25 ft Depth to limiting factor 24 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Effft1 *Eff#2 1 0-8 10YR4/2 --- sil lfsbk mfr as 2f 0.4c 0.6 2 8-14 10YR6/3 ---- sil lfsbk mfr cw lvf 0.4c 0.6 3 14-26 10YR6/4 ---- sl 2msbk mfr cw _-- 0.6 1.0 4 26-36 l0Ylt3/4 c2d7.SyrS/8 Bands sl 2fbk mf cw --- 0.6 1.0 ^ Boring # ~ Boring pit Ground surtace elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fy in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Ong # ~ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description TeMure Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODg > 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODg < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. SBD-8330Test (R.07/00) 2yY ~ 60 +-~~ve N ~ ~Y, rtl~ ~y ~ S T .Z S nl ~ R - k- +..., Taw.. o~ ~~c,~ Ga1'tc~ -~-ov~- toag -Zc~ - ©Z-S"~ ~~ ~~~` s~4 ~ ,~ !'' to ,yp. tG~ ®j^ ~, ~ ~- ~ f ®~ ~ ~,~,~,~ ~. ~~e ~ g ~~ ~u~ v ~ ~ 2 q ~. V ( ~ ~3- ~ c~ 41 ~~ ~ + ~3' ~ n ~~~ ~ A ~'~ ~7~ ~~ 3 ~ v ~ ~g' ,, a ~S ,e -,~ o-ntGkR p ~ C ~`~ / / ~ / ~- / ~1 92 ~ 6 ~ - ~ ~' ~1/ ~ ~ ~~~}- _ ~ .,e'1 ~ ~ P~ ~ Q ~ ©~ y ~ ~ ~ ~U~ . St. Croix County Land Information Online Page 1 of 1 Parcel Computer Number: N/A County Home Search Search Results Search Results -1 Matci-ing Property N Return To Search Methods N ~"- -' Generate Mailin Labels Grid 008-1008-20-025 TOWN OF EAU GALLE JASON ARTHUR ~ ANNA GOUGH 2445 60l'hl AVE, ~~~~ Prhnary Owner: N/A Tax Recard Documents Map Too s... 0 - }J - ~ - ~~ ~~ ~~ Tools... ~' ~ o '~ ~ f~ Curnent Toots ~~~ ., ... 1 http://72.21.230.178/website/LRPortaUmain.asp 4/26/2007 Parcel #: ~~$-'~ UU8~2U-U25 05/18/2007 11:31 AM PAGE 1 OF 1 Alt. Parcel #: 03.28.16.37A 008 -TOWN OF EAU GALLE Current X ST, CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/14/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - GOUGH, JASON ARTHUR & ANNA CATHERINE JASON ARTHUR & ANNA CATHERINE GOUGH 2445 60TH AVE WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 2445 60TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 58.851 Plat: N/A-NOT AVAILABLE SEC 3 T28N R16W PT NE NW & PT NW NE BEG Block/Condo Bldg: ' ' E 655.78 FT; TH S00 W N1/4 COR; TH S86 1353.50 FT; TH N86' W 654.94 FT; TH N87' ~ Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4} W 1248.65 FT; TH N00' E 1337.68 FT; TH 03-28N-16W S8T E 1248.02 FT TO POB (PARCEL A) /J Notes: Parcel History: Date Doc # Vol/Page Type 12/14/2006 840671 QC 12/14/2006 840670 EZ 07/23/1997 1041 /497 QC 7Af17 CI IMMARY Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 0 Valuations: ° ~ Last Changed: 01!25/2007 Description Class Acres Lan Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: o Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 Parcel #: 008-1008-20-000 05/18/2007 11:41 AM PAGE 1 OF 1 Alt. Parcel #: 3.28.16.37 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISGONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/14/2006 00 6 Tax Address: Owner(s): O =Current Owner, C = Current Co-Owner O - RODEL, RETIRED RETIRED RODEL Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 3 T28N R16W 40A NE NW (NKA Block/Condo Bldg: 008-1008-20-025 37A) Tracts}: (Sec-Twn-Rng 401/4 1601/4) 03-28N-16W Notes: Parcel History: Date Doc # VollPage Type 07/23/1997 1041 /497 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Last Changed: 01/25/2007 Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Total 0.00 Special Charges Delinquent Charges 0.00 0.00 Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT page 1 of 4 m acwrvance wrtn ~.vmm av, vws. rwm. ~.we ~uMY St. Croix Plan must Attach com lete site lan on a er not less than 8 1!2 x 11 inches in size p p p p . inctude, but not limited to: vertical and horizontal reference point (BM), direction and paw I.p, 00$-1008-20-025 percent slope, scale or dirr~nsions, north arrow, and location and distance to nearest road. Please print all information. Revie by r Date ~ Personal information you provide may be used for secondary pu ses Pri m)}. /c~.~~ ~ ~~,. Property Owner 0 XI02i P.r rty p~ cation ^ ~ Jason A. & Anna Gou I.1Nf10 Govt. Lot 1~iE 1/4 NW 1/4 28 16 r T N R ( ) Property Owner's Mailing Address L O O Z ~ ~ ~~ lock # Subd. Name ~ CSMIt 2445 60th Ave. City State Zip Code Pho Number 3 ity ~vllage • own Nearest Road Woodville Wi 54028 ( 1 15/6 60th Ave. New Construction Replacement Parent material General comments and recommendations Use Residential / Number of bedrooms Public or commercial -Describe: , Glacial Drift _ Flood Plain elevation if applicable ~ e ft. 12" mound contour at 94 ~ , ~~ ,, ` ~ I ~''t~ 1^ Boring # ~ Boring pit Ground surface elev. 94.25 ft. Depth to limiting factor 30 ~. Soil IiCatlon Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eft#2 1 0-7 10YR4/2 ---- sil lfsbk mfr as 2f 0.4c 0.6 2 7-16 lOYR6/3 ---- sil lfsbk ~' cw 1vf 0.4c 0.6 3 16-30 10YR6/4 ---- sl 2msbk mfr cw _- 0.6 1.0 4 30-36 10YR3/4 c2d7.5yr5/8 sands sl 21bk rnf cw - 0.6 1.0 2 Boring # U Boring 94.6 24 a pit Ground surface elev. ft. Depth to limiting factor in. Soil iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 "Eff#2 1 0-7 10YR4/2 --- sil 1 fsbk mfr as 2f 0.4c 0.6 2 7-15 10YR6/3 ---- sil lfsbk mfr cW' lvf 0.4c 0.6 3 15-24 10YR6/4 ---- sl 2msbk mfr cw __ 0.6 L0 4 24-36 10YR3/4 c2d7syr5/8 sands sl 21bk ~ cw --- 0.6 1.0 "Effluent #1 = 60D > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Thomas W. Gedatus 962178 Address Date Evaluation Conducted Telephone Number Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 4/2'7/2007 1/715/684/5166 Code derived design flow rate GPD Property Owner Jason A. & Anna Gough parcel ID # 008-1008-20-025 Page 2 ~ 4 3 u Boring ' (~ Burin # ~~ g ~ pit Ground surface elev. 94.25 ft peps ~ limiting factor 24 in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. MunseA Qu. Sz. Cont. Cobr Gr. Sz. Sh. `Eff#1 *Eff#2 1 0-8 10YR4/2 ---- sil lfsbk mfr as 2f 0.4c 0.6 2 8-14 l 0YR6/3 ---- sil 1 fsbk mfr cw l of 0.4c 0.6 3 1 -26 10YR6/4 --- sl 2msbk mfr cw --- 0.6 1.0 4 26- l0Y1t3/4 c2d7.5yr5/8 Bands sl 2fbk rnf cw -- 0.6 1.0 ^ Boring # 1__J Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/I>? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfF#i 'Effft2 ^ Boring # ~ ~~ Pit Ground surface elev. ft. Depth to limiting factor in. Soi! ication Rate Horizon Depth Dominant Color Redox Description TeMure Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = RODS > 30 < 220 mglL and TSS >30 < 150 mglL " Effluent #2 = BODS < 30 mglL and TSS < 30 mgA. The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ss~sssar~ (x.o~ioo> Z~r 5~ 5' 6 0 ~'``,4v~ J W OOde.\\,e~ W sic. ~`iQZa N !,v ~Y, ,(~~ ~y , S ~~' T z 8 nt ~ R ~ ~ w ~~ ~ SST - ~bz 1'7~ SG~~L E ~ to ~y o 1 ~ J . i eP~.~ ~c. v ~ ~ ~, ,. ~ a ~- 2 ~ r~ ~ 5 ~. 3 ._ t Cam-, ,1 lt, ~, ~,~~ ~ O I p ~~ ~ a~ ~. ~~e. s .~ 1~- s ~ 1~ , ;3 ~ \ a o ~ V g,3 ~~ ~ v ~ ~~ ~s i 0 ~ C ph„_ `~ / ~ ~ i ' s ' 2 EL 9 - ~ r 6 ~ - ~' 4 ~ ~~ip .a v t ._i ._._.s_,~=__..~.~. Q~ ~ ~ ~ ~ ~ y ~ .~ ~__ ._--~ ~ ~ ~~~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~a 7 ~ 5 - ~ ~. -39,~~~ Mailing Address Z ~~ ~~ ~o U ~ ~U~, U ~it~DD~U,., ~~'e ~. ~ r ~~ya Property Address Sit- iyl ~ (Verification required from Planning & Zoning Department for new construction.) City/State W U D C~ U ~ ~~~ ~~ parcel Identification Number ~~ ~ ~' - /G U ~' - ,~ ~' -~ ~S LEGAL DESCRIPTION j~ ~~~~ Properly Location Nom'/4 , ~ l~ '/a ,Sec. .~ , T ~ s N R (~W, Town of ~ ..-- Subdivision- _ _ _- - - _ ------ =- - _ - _ - _. _--~ -.<? ~1 U~C~~_ -_ -- ~,ot # _ __ --- Certified Survey Ma(p~# ,Volume ,Page # Warranty Deed # d ~U e ? ~ (.,.1' l~t~~ ~~ ,Volume ,Page # Spec house yes no Lot lines ide~rtifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 a licensed pumper. What you put i~o the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities aze specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) ~ o~site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix Coumy Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statemerns on this form are true to the best of my/our lmowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number f bedrooms SIGNA APPLICANT(S) ~ /~/ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey ~p if reference is made in the warranty deed. (xEV. osios) Parcel #: 008-1008-20-025 Alt. Parcel #: 03.28.16.37A 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/14/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - GOUGH, JASON ARTHUR & ANNA CATHERINE JASON ARTHUR & ANNA CATHERINE GOUGH 2445 60TH AVE WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 2445 60TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 58.851 Plat: N/A-NOT AVAILABLE SEC 3 T28N R16W PT NE NW & PT NW NE BEG Block/Condo Bldg: ' ' N1/4 COR; TH S86 E 655.78 FT; TH S00 W 1353.50 FT; TH N86' W 654.94 FT; TH N87' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) W 1248.65 FT; TH N00' E 1337.68 FT; TH 03-28N-16W S87' E 1248.02 FT TO POB (PARCEL A) Notes: Parcel History: Date Doc # Vol/Page Type 12/14/2006 840671 QC 12/14/2006 840670 EZ 07/23/ 1997 1041 /497 OC 7nn7 CI InAMeI?v Bill #: Fair Market Value: Assessed with: 0 05/25!2007 12:08 PM PAGE 1 OF 1 Valuations: Description Class Acres Land Improve Last Changed: 01/25/2007 Total State Reason Totals for 2007: General Property 0.000 Woodland 0.000 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 0 0 0 0 0 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 008-1008-20-000 05/25/2007 12:11 PM PAGE 1 OF 1 Alt. Parce! #: 3.28.16.37 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/14/2006 00 6 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - RODEL, RETIRED RETIRED RODEL Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 3 T28N R16W 40A NE NW (NKA Block/Condo Bldg: 008-1008-20-025 37A) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1041 /497 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 ~/alUatIO11S: Last Changed: 01/25/2007 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Number ~~ Document Name THIS DEED, made between Donald R. Rodel and Judith A. Rodel, husband and wife ("Grantor," whether one or more), and Jason Arthur Gough and Anna Catherine Gough, husband and wife ("Grantee," whether one or more). I Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum}: Parcel A attached hereto and made a part hereof. SUBJECT TO AND INCLUDING the terms and conditions of that certain Declaration of Easement for Road and Public Utilities of even date. ~jQn ~ ~e.C!n ~~. Dated %Np ~~ r, ~cR 1 ~ , ~d b Signature(s) authenticated on AUTHENTICATION KATHLEEN H. XALSH REGISTER OF DEEDS 5T. CROIX CD., MI RECEIVED FDR RECORD 12/14/2005 10:30A1I QUIT CLAI!! DEED EXEMPT il8 REC FEE • 13.0Q- TRANS FEE: COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Retum Address Thomas A McCormack PO Box 2120 Baldwin WI 54002 008-1007-60, 00&1008-20 Parcel Identification Number (P[N) This is homestead property. (is) (ismot) (SEAL) h_ ~ ~ _,f ~ _(SEAL) * Dona R. Rodei (SEAL) '~- -~~~~. U (SEAL) # Judit A. Rodel ACKNOWLEDGMENT STATE OF (.tl~S C~J/ts! ~ ) ss. ~~/~~~., COUNTY) .> Personally came before me on N Dt)E the above-named Donald R Rodel and TITLE: MEMBER STATE BAR OF WISCONSIN •" ~ ~` ':~: - " b~" (If not, to me known to be the perso w~ tt~d'fjt'e:` authorized by Wis. Stat. § 706.06) instrument and a, owledge a same= ~" 2 ~~°` f "'~i ~~ THIS INSTRUMENT DRAFTED BY: * ~~ ~ ~ T~ 1 Thomas A. McCormack Notary Public, State of L.l~1~GnJ11S/! Baldwin WI 54002 My commission (is permanent) (: _ ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY n)ENT[FIED, QUIT CLAIM DEED STATE BAR OF WISCONSM FORM NO.3-2003 'Type name below signatures. ®State Bar of VYisconsin 2003 INFO-PROTM Legal Forme • (800)85$-2021 • inroprororms.com 1 of 2 PARtrEL "A" DESCRII''fION That oertaia pored of land located V the Northeast U4 of the Northwest 1/4 aad the Northwest 1/4 of the Northeast U4 of Section 3, T 2S N, R 16 W, Town of Fate Gabe, SL Croix Casty, Wiscoadn, more hilly described as toUowa: Be~nniag at the North quorter Corner of said Salon 3; thatee 386°47'50" E (assumed bearhlg oo the North Use of the Northeost U4 of raid Sation 3), a diatanu of 655.78' to the Northeast corner of the West l/Z of said Northwest U4 of the Northeast 1/4; thgtu, aloa8 the Fast line of said War lil of the Northwest 1/4 ottee Northeast U4, S 00'D4S'Z9" W,1353.50' to the Southeast comer of said Wat 1R of the Northwest U4 of the NorWeaat 1/4; them, along the Sonth lice of saW Northwest 1/4 of the Northast U4, N 86°39'14" W, 654.94' to the Southwest corner of sohl Northwest 1/4 of flee Northeost U4; thence, aloa8 the Sonth Uae of soid Northeast U4 of the Northwest 1l4, N 87°09'48" W,1?48.65 ; thence N 00°43'41" $,1337.68' to a point on the North of said Northeast 1/4 of the Northwest U4; thentx, abag said North Uae, 387°48'56" 8,1248.OT' to the Plot of BeeinoiaY, eonWnhq<?,,563,544 square tat or x.851 acres, beio8 mbjeet to sa easement for 60th Avenue over Northerly portions thereof, and to nay other easwseab, eovenoab and read3elioas of record. This pared iadodea the beaeSt of an easement for ia8reas aad egress over the Westerly 66.00' of said Northeast 114 of the Northwest I/4. 2of2 St. Croix County Land Information Online Page 1 of 1 Parcel Computer Number: N/A Prfunary owner: NiA ', County Roane Search Tax Record Documents Map a~} ~ ~ . MaP ~ -.. ~-~ ._J' ~.~ ~ ~ Tools... ~ . Sea1'Ch ReSl11tS Tools... ~ . Search ResuRs -1 Matdtin9 ~P~Y N Return Tt) search N Genera#e Maitin Labels Grid 008-1008-20-025 TOWN OF EAU GALLE JASON ARTHUR R ANNA GOUGW 2445 601N AVf, ~~~e ~ o -~ ~~ Saalea'= I""' ft. CurreatTool: tv~ E http://72.21.230.178/website/LRPortaUmain.asp 4/26/2007