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008-1063-20-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERA!., INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Ciry Village X Township Theisen, Gar & Sheltie Eau Galle Townshi CST BM Elev: Insp. BM Elev: BM Description: . ~ ~" ~,(' TANK INFORMATION ELEVATION D TA TYPE MANUFACTURER CAPACITY Septic I W, P~- f~d~ Dosing p / b5~ Aeration ~~, /~ ~ye~J Holding TANK SETBACK INFORMATION TANK TO P/L 'WELL BLDG. Vent to Air Intake ROAD Septic f ~ t /Q~ i ~ , r `D ___. Dosing ' ~ ~ f 6~ ~ t f ~ '\D~o Aeration Holding PUMP/SIPHON INFORMATION ~~ ~1 Manufacturer Demand p Q GPM ode! Number ~ I v ~ ~~ `1L1 H Lift ~ .c~ Friction Loss '-~. `~ System Head TDH Ft .4 Forcemain Length/~ / Dia. /> Dist. to Well ~ ~ ~ ~ Z SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 453160 0 State Plan ID No: Parcel Tax No: 008-1063-20-100 Section/TownlRange/Map No: _/_ __ _. /_ 22.28.16.3210 STATION BS HI FS ELEV. Benchmark [~ ~ Fc,,,~ a 6 Z.G.S X61 Z /ds /.5 Alt. BM ~--- Bldg. Sewer J ~ /~ // St/Htlnlet /~ p•ZZ q4.9~ r St/Ht Outlet Dt Inlet Dt Bottom ~~ !3.50 3.~9~ Header/Man. 5 .Z~ ~6 ~ ,~j(P Dist. Pipe 5~•3 s.3 5.3 aI.9 Bot. System G Final Grade ~• z~ ~ a Z ~ el St Cover Uv~ A 2 •~ T ~ ®S ~ BED/TRENCH Width 1 Length ~ No. Of ench PIT DIMENSIONS No. Of Pits Inside Dia. 'quid Depth DIMENSIONS ~ 1~ j~ ~_ ~ ~~ SETBACK INFORMATION SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~~ Type Of System: r., /~ 5~ ! J 1`, / ~5~, ~~ UNIT Model Number: ~ / f I a \ DISTRIBUTION SYSTEM 1..07 Lei Y-tiGl,~" b.¢.- ~ S - o-I~ Olh~ •Ct?~ Header/Manifold Length ~ Dia Zjl Distribution / Pipe(s) GGr Length~•J y~ Dia ~''~ Spacing ~ x Hole Siz ~ ~ x Hole Spacing / --77 ~ '~ U Vent to Air Intake (a w SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over ~ Bed/Trench Center Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/ dded xx Mulched I ~ r \ I .Yes No Yes No ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~7/• ~~, Inspection #2:~/ 3 // ~ y Location: 2483 30th Ave Unknown (NE 1/4 NE 1/4 22 T28N R16W) NA Lot 1 ~~~•~- Parcel No: 22.28.16.3210 1. Alt BM Description =tf...hM,~..'S ~•- l,,,o ~,,~ ~,~, 2.) Bldg sewer length = 0 -amount of cover = L~ ~ / /~ Plan revision Required? Yes o Use other side for additional information. SBD-6710 (R_3/97) - - --- ___ ~ ' 3~ oa' __ , -- _ _ Date I ~g3~7S ~~ ~ e~ -- _ ~ ---Safety and B(y~~~[~ 201 \V. Wa tngto (]3dR`7T62 Co(mty~^ n S~• C~~IX seons~n Madi on, W 707 - 7162 Sanitary Permit Numb(r (to be filled in by Co.) ~ Qe artment of Commerce 608) 266-3151 op4 TJ ~~Q Sanitary Permit Applic do TY to Plan LD. Number ~ couN Ln accord with Comm 83.21, Wis. Adm Code, personal info anon ~t P}{3G1](X E G OFFIC ~ /1o Q = e.MN'S • ~. ess ili dd th f diff d rr~ON]{~ may be used For secondary purposes Privacy Law, sl .tM(1 } ng a an ma r erent ress (i ject Ad y8'3 3 0~•.4~'• ~ 1. Application lnfonnation -Please Print All Information . n Property wner's Name Parcel # l.~t ~ 32~L ~ ~ Z~f ~ /e ~.~t~ _ ~ bog- o`3-2aI~ Zo _ Property Owner's Mailing ddress Property Location ~ C~e~~/"'r t J/- ~ . SS/ zd` Section 2.2- ~'~+ ~~ City, State Zip Ccx1c Phone Number , , (cinae one) T ~ N; R~'C>a_W (check all that apply) 'T e of Buildin ll yp g ~ ~ ,. , 2 F il D lli N b f B LVJ'1 CSM Number am y we um er o _ or ng - blic/C tercial -Describe Use ~ ~ I'r~Ql ^ P ~l1 _ _ _ , u onw ~• ^ State Owned -Describe Ilse aQ [[ = ~S [• ~ ~• ?S ` ^City_^Village ovvnshi of _ Permit: (Check only one box on the 111. Ty pe o f `~' ,~ / ' lL1't~ ew System ^ Replacement System ^ "1'; eatmc:nt/Holdin Tank Re tacement Onl g p y ^ Other Modification to Existin S stem g Y B. ^ Permit Kenewal ^ Nermit Revision ^ C;ratrge of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V. 'T • of YO WTS S stem: Check all that a 1 _ __ ~~~~// ^ Non --Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ItlMouud < 24 ur. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Conshuctt;d Wetland ^ Pressurized In-Ground ^ liolding Tarrk ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filt('r ^ Leaching C'harnber ^ Ihip Line ^ Gravel-less Pipe ^ Other (exp ) V. Dis rsal/Treatment Area Information- ~ ~ S. ~ Designr Flow (gpd) Design Soil Application Rate gpdsf) Dispersal Area Required (sfj is 1 Area Proposed (sf) Syst •rn Elevation ~ Vl. Tank n o Capacity Total Nun;t:er Man(tfacturer Prefab Site Steel Fiber plastic Gallons Gallons of Units Concrete Constructed Glass `Jew Existing ~ 'looks Tanks _ Sc;ptic or Holdinb Tank ~ ~ / .r7[J~ Vw _ /a _ - ~I ~s~~r+ ~TI~ ~ _ Acatbic T[catmcnt Unit - w~..p ~6ID 6so Daving Chamber _ y- m Vli. Responsibilit} Statement- 1, the un sigued, ss r rc responsibility fur installation of the POWYS shown on the attached plans. Plumber's Name (Print) PI tier's Si a Ml'/i14~'iZ9 Number e Number Business P hon ~23 ~ 7S ~/ , p 7/s to07' ~ s~~ Plumber's Address ( e t, City, State, Zi ode - c~ced~%//? cc~ 1. s y0 ?..~' P ~ ~ ZG 3 , Vlll. County/Department Use Only ' ~ g Agent Sign ore (No Stamps) ' Sarutay Permit Fee (' icludes Groundwater Date Issued ss Approved ^ Disapproved Surcharrge Fee) 0 ~ ~ ~ ~ ~ ^ Owner Giverr Reason for Denial LX. Conditions of ApprovallReasons for Disapproval 31 ) ~ l?2tit 2~C / ~~A/~~~ .~ ~ SYSTEM OWNER: 1 Septic tank, effluent filter and ~ • dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) fbr the system nn paper no[ less [non xua x t [ mcnes io sac SBD-6398 (R. 01/03) So,% e~/a/ua f'on P-'E ConfCx..r c le ~/a~z 'S~"Su~•~D,a/.C.bu!'/din~~ Scwar rriScJa6C 4S ~Ocr- Comm. 82.3oCTi)(a~,Z. ~/ea 1 ~ ~ , ~~, , p~oh;e~k i-' = ~" ~~~ 7'70 ~ ~ ~ ~ s /OPT ' ~,~n,6ou• Sao - ~--~' ~~ /~ i i~ Aropos~d ~..~;cse~ C~.,c. ~.a~A~,c¢t~~Gson~R Co>„b,~ S:r. ~iO.C. w/ ~abt//~-iLb eFF/ccen E. F','/{eru-t vu-cict (3chcb, yv~a~~i' : G ~adc a E b a sc off' (Iq~S e,~/ SEecl Sba~e,f}ssumc.~ele~' _ /UD.cZ7.' ~ Y~ote : f3. r-1. -tic bC J'e - c.5~ L3 I• ed a ~y ~ ~'o w. Cave 5•tn~ ctroh ?pant Phi or' 'ta S~S~e~.,~ Constl'kction. Prp~1p5G.d /YIDu-n o~ 4'E..2C9.~~' /.3/.57 a(,-Sfr; bv.#r•or~ /aE~i'a/s a,f ~~~! 1'SS.SS~ ~oQv P1.8 ~9 isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory l_. Nettles, Secretary February 19, 2004 CUST ID No.223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/19/2006 Identification Numbers Transaction ID No. 969407 SITE; Site ID No. 670828 Gary & Shellie Theisen Please refer to both identification numbers, 2483 30TH Ave above, in all corres ondence with the a enc . Town of Eau Galle St Croix County NE1/4, NE1/4, 522, T28N, R16W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 942949 Maintenance required; 450 GPD Flow rate; 21 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, the "Mound Component Manual for Private Onsite Wastewater Systems Version 2" SBD-10691-P(N.O1lO1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for POWTS -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The area within 15 feet horizontally below the mound system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Comm 83 22(7) - A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department. which may include local inspectors. P ®.~~~.~ v. Ca~c~~~`~oi~a~~,)J JOE STANG Owner Responsibilities: Page 2 2/19/04 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the 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, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 Cc:Leroy G Jansky, Wastewater Specialist, (715) 726-2544 `j'9 MOUND AND PRESSURE DISTRIBUTION COMPONENT DES ~~ ~~~ ~~~ V' ~OG~, 1~ GF ~~~ Aso ~~ INDEX AND TITLE PAGE Project Name: Gary &Shellie Theisen 3 bedroom residential mound Owner's Name: Gary &Shellie Theisen Owner's Address: 2863 Hadley Ave. North Oak Dale, MN 55128 Parcel Address: 2483 30th Ave. Legal Description: NE1/4NE1/4, Sec. 22, T.28N. R16W Township: Eau Galle County: St. Croix Subdivision Name: Lot Number: Block Number: NA Parcel I.D. Number: 008-1063-20-100 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 Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Joe Stang License Number: 223475 Date: 02/12/04 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) W h Vgr ~ W^S 4..3'if Version 3.0 (03/01/01) DLt'ARTMENTOFCOMMfR!'E Page 1 of 9 UiYt5tAN t1F SAFETY ANG i3llltDl"tGS SEE CORRESP DENCE Mound and Pressure Distribution Component Design Site Information _ ___ 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 (%) __ _ 1 00.00 Contour Line Elevation (ft) __ _ 21.00 Depth to Limiting Factor (in) _ - _~ 0.50 In-situ Soil Application Rate (gpd/ftz) Distribution Celt Information _-~_ 112_50 Dispersal Cell Length Along Contour (ft) _ ______ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) Influent Wastewater Quality (1 or 2) ~__.-- Pressure Disribution Information , c Center or End Manifold 2.00 Lateral Spacing (ft) _ 4 Number of Laterals _ ___ _ 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 _ :Orifice Spacing (ft) _ ___ _ __ _ 2.00 Forcemain Diameter (in) 85.00 Forcemain Length (ft) 93.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 7.75 Vertical Lift (ft) 3.65 Friction Loss (ft) 17.90 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 .__-_._---__-_-- ' ~ --_ ---..~_-~ 1.00 i i 1.25 ------ ; x L. ----- z 1.50 x I ~ 2.00 ------- - x i - 3.00 x Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 4.00 Cell Width (ft) Are the laterals the highest point - __ _.. in the distribution ~ Y network? - --- _._---. __. If N above, enter the elevation ft of the highest point. ~________ ', 4.02 ft2/orifice Does the forcemain drain back? j _-____ _ Y__ _ _ 13.86 Forcemain Drainback (gal) 70.79 5x Void Volume (gal) 3 . ~ ~ 84.66 Minimum Dose Volume (gal) ~ I /~ 46.14 System Demand (gpm) ~ ~j Manifold Diameter Selection in. dia. o tions choice ..__....---------- 1.25 x ~ _ 1.50 - --X-----~ - x 2.00 x I ; 3.00 _ __ I -_ __ ___--~ Gallons/Inch Calculator .:, Treatment Tank Information ! 646.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 38.001 Total Working Liquid Depth (in) r ---- -~ ----- iWieser Concrete ~ Manufacturer 17.00 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Infonoration _- - -- -- _ 646.00 Dose Tank Capacity (gal) ;Zabel__ _ _ ~ Filter Manufacturer F 17.00 Dose Tank Volume (gat/in) A100 ~ Filter Model Number ',Wieser Concrete ;Manufacturer Project: Gary & Sheltie Theisen 3 bedroom residential mound Page 2 of 9 Mound Plan View •• •• 1/1 0 B •.•.•.•.•.•.....•.•.•.•.,... . ..•. . . 3 . . Observation Pipe •••~ ~• K •'• B i L Mound Component Dimensions A 4.OOft E 18.36 in B 112.50 ft F 9.25 in D 15.00 in G 0.50 ft 450.00 (ft2) Dispersal Cell Area 4.00 (gpd/ft) Linear Loading Rate -f _I -1 H 1.00 ft K 9.48 ft z 10.64 ft L 131.47 ft J 6.25 ft W 20.89 ft 1646.56 (ft2) Basal Area Available 11.25 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.02 (ft) ... ,.. ~I H teral F . • : ~ : ~ : ~ ~ Dispersal Cell 101.75 (ft) La 101.25 (ft)-~ - Invert Dispersal Cell ~~:~:':'~':~:~ ~~~~~~~~'~~~~~~~~~ '~'~'~'~'~'~~~~~~~'~~~ ~ Elevation ~: E ~:~:~:~:~:~:~:~:D~:~:~:~::::~:::;:;:;:;:;., ....... ......~~..... a ..... .. " ~ 4 4 100.00 (ft) Contour Elevation 7.0 % Site Slope Shading Key ~ a ~- 10 0 Topsoil Cap o ~ 1.5 ft © ~~~~~ Subsoil Cap H c ©0 ASTM C33 Sand `-° [~ Tilled Layer ~ ~ 0.5 ft Q5 [~ Aggregate v c Dispersal Cell ~- O ~ F Typical Lateral a A ---~ Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Gary & Shellie Theisen 3 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. ~E P I! •=Turn-upim'ball valve or IEX~ cleanoutplug Holes drilled on the bottom of the lateral. S Number of Laterals 4 Lateral Diameter 1.25 in Lateral Length (P) 55.55 ft Lateral Spacing (S) 2.00 ft Lateral Flow Rate 11.53 gpm System Flow Rate 46.14 gpm Total Dynamic Head 17.90 ft Dose Tank Information Electrical as per NEC 300 and -~ rrrLLL,,, Comm 16.28 WAC I I Disconnect II ~- Laterals are identic al x12->I Laterals & force main of PVC Sch 40 per COMM Table 84.30-5 Orifice Diameter Orifice Spacing (~ Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity Tank component is properly vented Wieser Concrete Capacit 646.00 Volume 17.00 Manufacturer Gallons gal/inch A B C D Dimension Inches Gallons A 18.54 315.23 B 2.00 34.00 C 5.46 92.77 D ' 12.00 204.00 Total ___ _ 38.00 646.00 3" Bedding under tan __ _ _ _ __ Alarm Manuafacturer LevelArm Alarm Model Number DLV __._ Pump Manufacturer Goulds _ ___ __ Pump Model Number EP05 0.125 in 2.02 ft 28 4.02 ft2/orifice 2.00 ft 1.25 in 4.71 ft/sec Locking cover with warning label and locking device and sealed watertight 4 in. min. F- Alternate outlet location Forcemain diameter ~I 2 in. Weep hole or anti- siphon device P~ ump off elevation (ft) 94.00 D• ose tank elevation (ft) 93.00 Pump Must Deliver 46.14 gpm at 17.90 ft TDH Project: Gary & Sheltie Theisen 3 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name J. Thompson, POWTS#4819 j Phone(715) 248-7767',. POWTS Regulator's Name ~ St. Croix County Zoning _ Phoney (715) 386-4680; stem Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 years Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Inspect for ponding_and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ... ......•.. ............... Grade \ ;~ ~:~.~ ~ ~: 6-8" Diameter Lawn ~/` ~ . ~ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Gary & Sheltie Theisen 3 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N,01/01) and SSWMP Publication 9.6 (01!81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced, Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be pertormed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank pertormance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem 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 mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surtace within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10° cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is pertormed tt should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and If orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal pertormance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surtace, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Gary & Sheltie Theisen 3 bedroom residential mound Page 6 of 9 Pump Specifications i r~1l ltN) ItLI ~ 7~~ U'f I'JI ' I~~ 1 "'-' ~i ~ ~. ~ Jf' ., _il"gz SRe 1'/~ NPT ~~~ ~o -- ~ f(~ o I D.- ~! ~~ "~`~ + fvlotor 'S ' ~ ff ~ 90 /7 ~~I ~~ I`ila ierials of Const action . .~~ U_ 5 Features and Benefits o ~~ _._ __.~.._~", eiimuiates ~ 4 '~ '° ~lu~ging =>~'~ ~~ e~IS[anI .j L1 _ I o I __ AP CITY ~ ~ ~ ~ j-irp~ _ ~ Pump Specifications Features and Benet i~s ~~ wiooE~ ovNUS ~'~I~ and ';r HP • EP0=1 In~pr!le ~-_ Up (o GO GPM °n[!~. ;nn~ll; ~...._, .._ _ ~. _ i~~1XIIllUf11 11~;id (U J% I'~ic'Cl~;illll;l'~ Sc.l " Discn~lrge size 1'' IUPT •EP05 n ,~~'~~i~ ~~_ _ _. _ ._ . SOIdS~''I Il11X111,111, 101 illl~)'l,'c"~.! I)? ~~, Motor • n~:~g~~~ r:;~~ :... _ All moors lecture I)~lll c~~~ing u~~i o~1s~ ,~~~~_~. _ )eallllg COnSIrIiCIIUI! Sili)e i01 ~~.,~rl~~ . ,.~ .. ..~ ------ _~ __ ;0 3s au uscl°rn ~ Single phase 115`.- ic'SIS'..III~_ a CA ~ a ,01111 „ PACITY Materials of Construction • CaS' - ~ - _ Cast iron - I c ~ln ~~~.~' 1 Ti~Zn11~3p~1s!iL ;IIIC! Ci~,,rall~,l.. S!a~nless stee~~ • Cc;rr~~s,ul~ r~ ~ ~.,. ~ ~~ -__ _. s~::m~e~5 ~~-~~ :~ _, nl~~l~rr,:~l ~~,;:,;,,,, •CS;~ i~~~~c . ~~.._ _ .._ lire ~ ~ its,gne., for contu~uo~;~ ~~~e r,-tno~~ <~nclleatwe ~r-tn~;es~ reef ,,,11~ .:;r ~~, 7gF9 ~ - 30 -/.eve . a AiE.~B.wt.: Tp of Serve y X01.0' f'arttc ~iN.4• p~aPoS~ weal -~. 0 p~opos~d 3 b~.d~oo,~• r`c s ~ dcncc . SO.%~(/4/uQGOn a P~'E L a ~ \_y"Sc~(. s~o,~r.c. bu,/din5~~ Scw¢/ .rnSc/aEt Q S ~Otr Comm. f~1,. 30(i'i~(c~,Z , -- - - ~~ propo5cd u~;esei ~'c„c. ,,a~Al,cet~/Gso„~,~ Co~» 6,-.,~ti~~ ~ ~ S.r. /RC. ,..>/ Abe/%}-iu~ eFF~aen E ~,'/{e/~.t oc..cict. ,its ~~ ~ achc,,L.rKarK: G~adc aE base o~ ~~a59 b;k~ ~~ Pc,h-~~i~ stet( Sta+C~e.,~ssume_dele/: = ~UV•~.' ~~ ~' ~--'~ ~ ~s~apc ~Y\ote: ~.wi. -bc bCfe-e5~1r3~.eda~y ~' ~ ~~' ~~ ` - - ~ r'o n~ C.ari StrLt C.trGh ~,~ ~p/'i ar ~v ~~ --' ~ SASE-e,.,., Constl'kct~on. r i i i ~ ~ ~ Pao 5c-d ou-n d a.f ,20. w/ S~ ~X//1.S~d,S~r'Sa/ CeiY, F'cr (..,~ d,s~r; bc~i•av~ /aE~ra/s a.f ~~i/ XSSSS' p1. 8 0~ Wisconsin Department of Commerce SOIL EV~ 'i`-- Division of Safety and Buildings in anrnrrianrp with C:nmm AS Wic Arun Cndr± 1865 Page I of 3 Certified Soil Testing ' ~ ` 2 ~n~ ` Attach complete site plan on paper not less than B /: x 11 inches in size. Plan ust ~ ), F ~ Ull St. Croix ------- include, but nol limited to: vertical and horizontal reference point (BM), dlrectio and Parcel I Di percent slope, scale ordimemsions, north arrow, and location and distance to Barest road. . 321 C 28 16 22 ;' ` ""''' ~'` . . . " ' Please rint al! information. P ; ~NiNG ~~~ ~ ~iewed-~y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. m ). Property Owner Property Location Gedatus, Brian & Sheila Govt. Lot NE 1/4 NE 1/4 S 22 T 28 N R 16 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2475 30th Ave. ----- - City State Zip Code Phone Number ~ City _~ Village yj Town Nearest Road Woodville ~ WI 54028 715-265-4817 Eau Galle 30Th Ave. New Construction Use: Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ~f Public or commercial -Describe: Parent material l oess over till Flood plain elevation, if applicable NA ___ General comments and recommendati ons: install 4' x 112.5' rock cell mound on 100.0 contour as upslope edge of rock w/ 1.25' sand fill for 3 br residence Boring # _~ Boring 21 f!J Pit G in. round Surface elev. 97.3 ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft ' _ in. Munsell Qu. Sz. Conl. Color Gr. Sz. Sh. i 'Eff#1 'Eff#2 1 i 0-3 10YR 3/3 - sil 2 m gr ds cs i 1 f/mi 5 8 2 3-9 10YR 3/3 - ~ sil 2 f sbk dsh ~ cs '~ 1 m 5 8 3 9-21 I -- 10YR 4/4 sil 3 f-m sbk dh cs I 1 m ~ 5 ~ 8 --- -- 4 ~; 21-26 10YR 4/4 f2d 7.SYR 4/6 lOYR 6/2 scl 2 m sbk dvh cs 1m ~ 4 6 _ 5 ~'I 26-36 - 10YR 4/4 c2PP 7.SYR 4/6 lOYR 6/2 scl 0 m dvh i - i - ! 0 __ 0 ~ ~ -- - - common gy si coats on peds 9-26" Boring # 1 Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon ~ Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary ~ Roots GPD!ft' _ ! 'Eff#1 I ~Eff#Z 1 0-4 10YR 3/3 - sil 2 m gr ds cs 1f/m ', 5 8 2 4-10 10YR 3/3 - sil 2 f sbk dsh cs 1m ~! 5 8 -- - 3 10-22 10YR 4/4 - sil 2 m sbk dh cs ; i r 8 1 m 5 4 22-43 10YR 4/4 I OYR 6/2 scl 2 m sbk dvh j - I - 4 6 i - i --- - - - ~ _ ___ i 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mgC CST Name (Please Print) Sig at e: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 9/15/2003 715-233-0398 Property Owner Gedatus, Brian & Sheila Parcel ID # 22.28.16.3210 Page 2 of _ 3 _ Boring # J Boring ~/. Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ____ `Eff#1 `Eff#2 1 ~ 0-4 10YR 3/3 - sit 2 m gr ds cs 1 f/m 5 8 2 i 4-12 10YR 3/3 - sit 2 f sbk dsh cs 1 m -- . .5 ~ 8 3 ~ 12-25 10YR 4/4 - sl 2 m sbk dh cs 1 m .5 9 4 25-32 10YR 3/4 ~P 7•SYR 5/8,5/3 l OYR 6/2 sl 0 m dvh - - .3 ~ 5 ^ 6oring # ~ Boring __~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ _ i 'Eff#1 'Eff#2 I --- I -- - i ~ ---- - I ^ Boring # _..I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ~ Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. __ 'Eff#1 `Eff#2 I I ---- i ------ - I I 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. tf 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. S6 D~8370 (R 07/00) Certified r01~ Testing Z~ U ~ ~; ----_- ~ ~- s w°~ ~ =:= ~ ~ ~ ~ ~° ~ ~ ____= r ~ ~-'P _. ~ g _ __ _- ~ ~ o ~i-~ f F ~ ~ ~ ~~ FJ m o F ~ ~ . f '~ ~ f~ '~ 0 Yl (~ 4 ~, ~ ~ r f ~' ~4 ~~ -t~ .F~ v t ~~ 1 9 Q r? 6' ~$~ a ; 6 ~v t lJ tJ ~- t ~f r r~ s w 1'~ ~ 1 ~ r ~ ~ I F 1 y e ~_ ~- ~ I~ ~, S t ,~ ~ o ~ N ~ ~ ~ f o ~1 O ~/° 0 ~ i ; ---~ ~ ~- 'O ~r N N N Os r d --, ~ ~ ~~ ~ ~~ ~ +~ ~ ~ ~f f % ,f^ / ~ ~ r G ,I ~ N r ~ i S ~ ~ ~ ~ ~~ o ~.~_/ S r 0 '~ ~1 S i 0 y f ~ f '' N N P ~ j ~ Y ~-. , ' . • ~ r Wisconsin Department of Commerce Division of Safety and Buildings ,fl~l~~G~~~~.~~ SOIL EV~f~~' in ~rrnrrhnro wi+h (:nmm 5 Wic Arlm (:rota 1865 Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan ust ~ ~ D ~, 2, ppn ~J ~ St. Croix include, but not limited to: vertical and horizontal reference point (BM), directio and l I D P rc percent slope, scale or dimemsions, north arrow, and location and distance to Barest road. ~~' C,~;~Ix ~' . e a `~~ 22.28.16.3210 Please rintall information. P LUNWG OF y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. m ), Property Owner Property Location Gedatus, Brian & Sheila Govt. Lot NE 1/4 NE 1/4 S 22 T 28 N R 16 W Property Owner's Mailing Addre~ Lot # 131ock # Subd. Name or CSM# 2475 30th Ave. City State Zip Code Phone Number .City ~ Village i ~ Town Nearest Road Woodville ~ WI 54028 715-265-4817 Eau Galle 30Th Ave. New Construction Use: /' Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement _. Public or commercial -Describe: Parent material l oess over till Flood plain elevation, if a~cable NA General comments and recommendati ons: install 4' x 1 12.5' rock cell mound on 100.0 contour as upslope edge of rock w/ 1.25' sand fill for 3 br residence '- Boring # :Boring 97 3 21 Pit G round Surface elev. . ft. Depth to limiting factor in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence oundary Roots GP DIft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-3 10YR 3/3 - sil 2 m gr ds cs 1f/m .5 .8 2 3-9 10YR 3/3 - sil 2 f sbk dsh cs 1 m .5 I 8 3 9-21 1 OYR 4/4 - sil 3 f-m sbk dh cs 1 m .5 .8 4 21-26 10YR 4/4 f2d 7.SY6/4/6 scl 2 m sbk dvh cs 1m .4 .6 5 26-36 10YR 4/4 c2pj OYR 612 /6 scl 0 m dvh - - 0 0 common gy si coats on peds 9-26" Boring # !Boring /' Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 22 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIR' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 10YR 3/3 - sil 2 m gr ds cs 1f/m .5 .8 2 4-10 10YR 3/3 - sil 2 f sbk dsh cs 1 m .5 .8 3 10-22 10YR 4/4 - sil Z m sbk dh cs 1m .5 ; .8 4 ~ 22-43 10YR 4/4 f2d 7.SYR 4/6 l OYR 6/2 scl 2 m sbk dvh - - .4 .6 ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mgL CST Name (Please Print) Sig at e: CST Number Henry F. Grote 222774 Address Certified Soii Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 9!15/2003 715-233-0398 ~, ~~ Property Owner Gedatus, Brian 8t Sheila Parcel ID # 22.28.16.3210 Page 2 of" 3 Boring #~i Boring , /i Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 10YR 3/3 - sil 2 m gr ds cs 1f/m .5 .8 2 4-12 10YR 3/3 - sil 2 f sbk dsh cs 1 m .5 .8 3 12-25 10YR 4/4 - sl 2 m sbk dh cs 1 m .5 ~ .9 4 2 - 2 10YR 3/4 ~p 7.5YR 5/8,5/3 l OYR 6/2 sl 0 m dvh - - .3 .5 a boring # 'Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 I II Boring # ~ Boring ,_J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i I I ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified Soil Testing ~ ~ ~ \ ~ i v r~ N ~ (~d~ I' ~ ~ f Q /~ ~ o s i 1 i -~ ~ ; ,.~ 8 ~~ ~ ~ ` t ~ ~ ~~ ~ E ~ P S ~~ 3 ~g ~~ J z~: a a B0 ~i,,, N ~~ 1.~1 0 ~' c~ Y~ J _~ ~^ ~' Q a i ~ v N ~ ~ ~ ~ ~ ~~ ~ o ~ /~ . ~ ` ~ J ~ ~ ~ `~ ~ -- ~ ' --3 H ~ ~ J t _ ~ a ~ ~ ~~ ~ ~ / D ~ c ~ ~ ~ ~ ' r1 ~j ~-~ , p ~ 3 /` I ^ ~ ~ I~ ~ ~ S V l 9 , ~ ~ I `j n ~ ~ ~, ~ t,,~ d =N tiN~u `~~~_ r ? 3 pp ,~.. b ~ ~8~=_x., ms~,,:g ''~~r.' =' ~ .i d , ~nmN,T. ~ ~' ...r /~ ~ .~~ 9 ~,, b ? ~b`rTr ~£"' J ~ ; v ~. :n v ~ Z ..J ~ ~`~~' s ~ r;,V,,~~~ s~ . _, s. ~o~~~ , O J ~ ~ r ~ - ~~~~~~ DDD>T> T._, m . ~ ~ o ~~ N , ~~ g ~ ~ ~ ~ z ,, s~ 1 "'J / Q ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownetf~er ~' ai y Q J``wu%~ ~t%Sc.-~ Mailing Address 2863 !,/ad/e y .4d[ . /1~-~ ~.~('~~ ~~t, ss/,zd Property Address Z ~~3 3 0 ~ fide • `~ (Verification required from Planning Department for new construction) -~ City/State Parcel Identification Number Oo $'- /063-2v-/~ Property Location ~.'/<, .L~'/e, Sec. ,~, TAN-R_l~W, Town of Ca ~ ~~e- Subdivision 11 ~ -- ,Lot # -- Certified Survey Map # n ~ ,Volume _ ,Page # Warranty Deed # ~~2 G p9 , Volume z 2 ~ ,Page # Spec house ~ yes ~o .3Q3 SVCTF,M MAiNTFNANf'F. 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 into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-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 County Zoning Office within 30 days of the three year expiration date. SIG RE OF APPLICANT DATE (1W1VF.R (''F.RTiFiC'ATinN I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prop~rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * * * Any information that is mis -represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** * * Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 02-24-04 14:20 ID= P01 t , , ~ijL (i. II ~` ~~_~ illl~~ .~. I ~ ` ._ , r._ '_ ,I. ' I ~ I ~ f~7 _ ~I i t i i i f ~ ~ ;. ': l± -- ., _. - - --- - 1 . 77 ' 7 I~ ~, ,:. I i I i .j 1. ~ , I ~ _ PP . ...,u~l..~_ .... _~. _I..~. _.f i I I f ~ ~ _ ..i._ .3.. ,. - -- - - ~.. . ' 9 i 1 .. jI r~ ' 1, ~. i ' ~II1 . .__ ,....~ i !. i I. ......~ r........~ ~ _ .r.._ fi _ ~ _ _ l s • ,.: ~ I "~`li ..L.. .. f . L. .f..... ;. .. _. .... . CF !. ~.. s-- --j, u ! { :, I 1 '~ i ..,. • ' t :.:~. ' d I . ; ,, . ,, ;. , ,, .. .. . ... ~.. -.. ... ..;...4 ..i.~.. _.!__;_. ,~ ..~. .._ , i ..~.... !, ...i ....,. _ i ..{..~ ! ~ i ~ ~ .~. ~ I I •I ~ .,. I ~ •a T ',4 I ~._. ,. ., _ , .... .. _ _ .. ~ ~ - ` I ~.. ~' _ .. _ .. . . ~ ~ I ~... I. ~ ; .~ ..~ ~ .t-- - : ~:......~ _ _ ~ ~ ..API. I.~. _ ; ' • -~ .... i i l + ~ c...~ r - L I .~... __i. . ~.~. ~L,. _ _ ... .~ _~... ; _.'. ., .,;,,. , I , .. f. ., _ , ~ , ~ j~ ; L ~ ~:,._~ , : ....E „~ < ; .... ~,. ( -h-•f' r" , ~ ~ , .._ .._ _ r -- - ..1. 1 ._ ~ , i 4 -- I ~.~ :. i,; .: . , f ~ ..... ~s ~ _ ~ ~ i • I I 1 j _ , ~ ~ ~ r_, ~ ~ I i i. ~ ~... f ~. ~ ~ ~ ~ ~ r r ~ II;; ;11t ;.. ~:;. ~j. jF~ ~. ~ ~ ,, ..: ;:. ~ t •1 ~ .j f ~ .,.... ; ._ I ~,. . ~ _ ' .. __ ' !...~....~ ~~ i ' i..... ~~.I ( I i ' WF. • ,~ f I ~ I ~"' ~ f I ~ j ..~ ~ ~ ~ ! f t ' ~ i _ i i fJ ~ ~ I. .{ . ~~ ~I ~ ' ~~ _ .f_ ._~.-~....v-....... ,... ~..... , I , i , ~ f j . I ~I II ~ ~ i I ~ ~ { ~~ . I 1 j ! y~N ~ , ~ i _j ~ c ~ ~ i ~ . ! ~ I-• ay:~r- ~^r-t- . { ~ I ' f } I ~ ~ ' t I ~ ~ ! f ~.! ' i ' ..I•~.f.L f... ~ i ~ j ~ I i ; ~ i '..i j I It`~~ ~ ~ ~ ~ ' '. . I , ,. :~, ,I~,;. ;. :; . ,_ ; ~1. ~;, 02-24-84 14:21 "`- i S i i 1 4 I I t I ~Y 1 f ~ ~ ~, ~ 1 i! - .. ~ ~ ~ i 3 i ~ - ___ ~'C .~ l -• I t j "I . ~ ~,:~: 1 ' ~ h1~ ... ........ .1 `i.' i . ~ ~ i I ' ~ ~ ..~ .. i ~ i~ t s i 7"I i I I ;, ( .. ' i ~ . .,-•- .... I ~ ~- ~ ~ i ' ; i I ~ I '' ,. ' t ... ~ t .1.. - - I- ~ , ~ ~ - - ._ . .. ., . o f ... .,. ~ ~ ~ ~.J~~ ~.~ ~ ..~- - - ~ ~ ~ ~ 1 f _~ ,:~ f{ . ~ ,_~ ... .~ j ~...-- ;,,, :, ,I ,~ ~ ~ .~ ,t i .~ ~~~~~~ t_ _ • -. f 4 { ~' _ .: - •- - - '~ __r t, .._ • ! - _. ~, _~~ ...... .. I t : t I ~ ,.~ ~ 1, --- ( I ~ ~ .t..~..f ! i ' t ~. , . i , .- 1 1. i ~ - - - : _ 1.. _ .f .I. . ~. , ~ . ,., i, 1 i ~ ;. ., - f ~~ . .. ,~ -3 . I i ... _ :- II 4 ~~ ~ ~ j f t t ~,.~ 1 ~ ~ ~ f ~ i I ( ~ 1 ' ` t.. ~... 1..f ~~ ; ~ s~~,l _I 4..-f i 4 ~.~, + ....i I. t I I I s ~ . t... i.~~ 1 i ~ ~ i i i} t 1 ,fl . ,~ _ ~~ t---; . t f ~ f i~ t ..~.~ t ~ :I. ~ ~...i..I i~{~ I t i I i _ ~ i i U 2y29P 303 STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Brian Gedatus a/k/a Brian J. Gedatus and Sheila Gedatus a/k/a Sheila G. Gedatus, husband and wife, Grantor, and Gary Theisen and Sheltie Theisen, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A 14ietro Legal Services EDIRET 409787 A 308562 WD 236569 Exceptions to warranti°s: Easements, restrictions and rights-of--way of record, if any. 742599 ~~ XATHLEEH H. MALSH REGISTER OF DEEDS ST. CROIX CD.. MI RECEIVED FOR RECORD 10/06!2003 02:00PM MARRANTY DEED EKEl~T # REC FEE: 13.00 TRANS FEE: 1S7.S0 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Addres • ^"~ r nv ~avna..~en~rvrv.v ~;,,~„~. $1FIE FIRST NATIONAL ~-Nlc ew~lNQ ao - I I s ~ MINNESOTA STREET, SUITE N-t OS S~+~iS '" ~ 8T. PAUI~ MN 55101 . 008-1063-20-100 Parcel Identification Number (PII~ This i not homestead property. Dated this 23rd day of September, 2003. k * Brian Gedatus a/k/a Brian J. Gedatus X * Sheila Gedatus a Sheila G. Gedatus M. HENDRI~KSON AUTHENTICATI Signature(s) authenticated this 23rd day of September, 2003 * T1TLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) * ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this September 23, 2003 the above named Brian Gedatus a/k/a Brian ]. Gedatus and Sheila Gedatus a/k/a Sheila G. Gedatus, husband and wife to me known to be the person(s) who executed the foregoing instru ~ an acknowledged the,same. ~ THIS INSTRUMENT WAS DRAF"fED QY Edina Realty Title -Doug Berk ~ Notary P ic, State o Wi onsin 400 South Second Street # 1 15, Hudson, W 1 540 16 My co lssion is permanent. (If not, state expiration date: (Signatures may be authenticated or ackno~~ledged. Both arc not necessary,) 'Names of persons signing in any opacity must be typod or printed below their signature WARRANTY 1)EEn S"fA'!'E liAli OF \1'lSCONSIN FORM No.2-2000 Il 2y29P 3fl`i Exhibit A . The certain parcel of land located in the Northeast Quarter of the Northeast Quarter (NE'/. of NE'/.) of Section Twenty-Two (22), Township Twenty-eight (28) North, Range Sixteen (16) West, Town of Eau Galle, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Northeast corner of said Section 22, thence N 87 degrees 22' 44" W (recorded bearing on Section Twenty-two) a distance of 545. t0' to the POINT OF BEGINNING, of the parcel to be herein described; thence continue N 87 degrees 22' 44" W 504.26' on said line; thence S 00 degrees 17' 44" 200.26'; thence N 87 degrees 22'44" W 285.22'; thence S 00 degrees 12'51" E 912.00'; thence N 54 degrees 59' 16"E 748.79'; thence N 14 degrees 48' 16"E 668.94' to the POINT OF BEGINNING, containing 12.466 acres, being subject to easement over Northerly portions of said parcel for town road purposes, as now laid and traveled and also being subject to easements of record. LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF EAU GALLE COMPUTER NUMBER 008-1063-20-100 Parcel Number 22.28.16.3210 OWNER NAME: First GARY & SHELLIE Last THEISEN PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment SECTION 22 TOWN 28N RANGE 16W'/<160 '/.40 Line Description Line Description, TOTAL ACREAGE 14.600 PLAT LOT BLK 01 SEC 22 T28N R16W NE NE 15 02 COM NE COR SEC 22 N 87 DEG 16 03 W 545.10'-POB, N 87 DEG W 17 04 504.26', S 200.26', N 87 18 05 DEG W 285.22', S 912.20', 19 06 N 54 DEG E 748.79', N 14 20 07 DEG E 668.94'-POB 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit 76092 1 VOL 18 PAGE 4734 KATRLEE~f K. REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 04/28/2004 09:45AM CERTIFIED SURVEY MAP Gary and Shellie Theisen Located in part of the Northeast %. of the Northeast %+ of Section 22, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin. AI'pRC)VtD ST. CROIX COUNTY Planning Zonir±q ar+d Parks Committee APR 2 g 2004 If not recorded within 30 days of approval date approval shall tie nnN and vnlr! NORTH 1/~ CORNER sECnoN 2z, T 28 N, R 18 W UNPLATTED LANDS A~ MINUM MONUME~~N - N ar22'44' w 1s1s.22~- • m • _- - • - - oT,' `~ ~~ ,,, -- - • I NN ~ ',?4~ S ~I~LPX1.l11.Q l fJUJ11s2 g ° °~o _ N 87°22'44" W 285.2 ' ~ 0 0 0 - N 87°22'44' W 2668.58' - - ~DTtJ Al/~N__4l_E ~8L°~~~"w T---.-- LOT 1 CONTAINS 543,013 SQ. FT. OR 12.466 AC. °ry (532,965 SQ. FT. OR 12.235 AC. ~~ ~ OCCLUDING TOWN ROAD RIGHT OF WAIF 0, °' Z~ ~~ " ~, ° W o g' a, .. ~~ °~ 2 - - - - 504.26 - - N 86°44'04" W 498.48' - $ '~''~'. - - - 5----~_ - - - CERTIFIED SURVEY MAP REC FEE : 13.80 COPY FEE: 3.00 PAGES: 2 Q' ~~ >-; ~-, W~ ~I ~I ~ a ~~ ate'' ~ o; w; ~ ~~ F-, ~; I ~1 a U1 ~: `1/4 --71~ NORTHEAST CORNER SECTION 22, T 28 N, R 16 W (FOUND 3/4' IRON ROD) OWNERS ADDRESS 2863 HADLEY AVENUE NORTH OAKDALE, MN 55128 N ~QS BEARINGS ARE REFERENCED .= ~ TO THE NORTH UNE OF THE Q •' NORTHEAST 1/4 OF SECTION 22, .~~%'' T 28 N, R 16 W, ASSUMED AS %~ N 87.2244" W. ~~Q SCALE IN FEET 1 " ^ 200' 100 1 0 2 ~/