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HomeMy WebLinkAbout016-1062-10-000.consin Department of Commerce PRIVATE SEWAGE SYSTEM etfety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: City Village X Township Olson, David E. Glenwood, Town of :ST BM Elev: Insp. ~ Elev: BM Description 'TANK INFORMATION /~ TYPE MANUFACTURER ~~ CAPACITY Septic e(~i~ ~b~.s,.~, S,~z~O Dosing ~~~ ~ ~ ~ ~ (~ o,e~s~ d la ~ S25 Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic `> /60 ~ ,~ /G~) ~ q i _ Dosing 7 ~bO / /3Z ~ c~ ~ I _ Aeration Holding PUMPISIPHON INFORMATION I . Manufacturer ~^ 6v~ 3 Demand GP M Model ^I! ,E P D 5 Q •~~' TDr, Lift'. ~ ~ `~ Friction Lo~~ i System H d ~ TD ~5 • / 7 7 Forcemain Len Yh Q Dia. ~ 'Z. Dist. to Well q 1 SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 515024 0 State Plan ID No: Parcel Tax No: 016-1062-10-000 Section/Town/Range/Map No: 29.30.15.432 STATION B 2•'~~ HI /6L•~i FS ELEV. /ad Benchmark 3, a ~~2 J J~ Alt. BM c l.r•. Go ~ , (~ 9,(~, Z Bldg. Sewer `!, r~ r ~~ ~ y SUHt Inlet 1Z.0 9a. ~ SUHt Outiet ,z• ~ ~1G • ~ Dt Inlet /3 ~ /3 ~~ . ~L Dt Bottom /~• ~ Q ~ S Header/Man. ~, ~ ~ 4 ~ y Dist. Pipe ~• ~L J q ~ ~ Z I Bot. System ' ~j5. Final Grade r y 1 St Cover F I ~ 4. (~-7 c~4 ~ Z j ~ r 8, 0 95 BED/TRENCH Width Lengthp No. Of T,(enc s PIT DIMENSIONS No. OF P` Inside Dia. ~- Liquid Depth DIMENSIONS ~ , ~~ /3 /~ `_. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ~ Type Of S m: ~,~~- q /~ ~ 5 a I ,/~ / 'v UNIT Model Number: OJ DISTRIBUTION SYSTEM Cad-G~) Header/Manifold ) i S ~ ?' ~ Distribution L ~ 7 ~~' YL /~ 2 ~ x Hole SizS j / x Hole Spacing ( 3 ~ ~ Vent t r Intake u~ Length + Dia ' Length Dia J Spacing J' •~ 3 ~j ' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Svstems Onlv ... Depth Over Bed/Trench Center Depth Over Bed/Trench Edges \ xx Depth of Topsoil (~ xx Seeded/Sodded xx Mulched ' ~ ~ ~ ~ 1 ~ ~ 6 V ~es ~ No +~Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1373 280th Street lenwood City, WI 54013 (SW 1/4 NW 1/4 29 T30N R15W) 80 acres of ~ Parcel No: 29.30.15.432 1.) Alt BM Description = ( SG~C.~IS G. ~ O't.. ~O C /~,, S 2.) Bldg sewer length = /$' v~ ~ ~4~~^-~- 1"'6 ~, ~' ~~ r - amount of cover = ~ ~ coy _ _ _ _ ~ _- __ - __ _- - Plan revision Required? ^ Yes ~ No i f + II~f ~j I ~ S( I - -. _ -- - ____ - - _.____ __ -- --_ _ (/ p ~~ ~ )~_~I Use other side for additional information. i l f~ v ~ SBD-6710 (R.3/97) Date Insepctor' Signature Cert. No. +~eQ~ciee~rer~ Safety and Buildings Division 201 W W hi County ,,_ ~ ~ ` ~ ~ . as ngton Ave., P.O. Box 7162 1 J iseons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co ) Department of Commerce (608) 266-3151 ~ ~ Z Sanitary Permit Applieati State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informs ou Q / ~ (~ may be used for secondary purposes Privacy Law, s15. Project Address (if different th an m ailing address) 1. Application Information - Please P ' All Information / y ~ g ~ ~3 7 3 L VV ~ ~r RE . Property Owner's Name Parcel # Lot # Block # D Is~l n~~v-~afoz - ~r~ - oao Property Owner's Mailing Address l ~h s/ Property Location ~ Q S`r. ~ROIX ~ ~~ o 2~ Ciry, State l ~ Zip Code Pgf~llNfbrt~~ICE v., /.. Secti n ` ~"l!r KK"" llii~~ l3 7i5- - ~(ctrcle T ~ N R ~ J f~W~ [I T f B ildi h k II h ; ~ oi . ype o u ng (c ec t at apply) I or 2 Family Dwelling -Number of Bedrooms 'q~~ Subdivis io n Name CSM Number ^ PublidCommercial -Describe Use ~ 2 ~f Q / ! • ~ /tT~1i5 ^ State Owned -Describe Use ~~_ ~ p/ /~ ^Ciry_^Villagc `T'ownship of 6tt°~'lGJ~ lI[. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ^ New System ~ Replacement System ^ Trcatmcnt/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permi[ Rrnewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / IV. T e of POW'TS S stem: Check all that a 1 ^ Non -Pressurized In-Ground ~ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Construc[ed Wetland ^ Pressuriztd In-Ground Holding Tank ^ Peat Filter ^ Aerobic Treat ment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) r ~~ V, Dis enaVTreatment Area Information: t Design Flow (gpd) l Design Soil Application R gpdsf) ~ Dispersal Arca Required (sf) ~ Dispersal Arca Propos (~ System Elevation ' pc~ r2.~. 16 ~Z ~~ S.7Jt y Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Conswctcd Glass New Existing D / ~ MC Tanks Tanks ~ ~ /"~ ~J(~ J Septic or Holding Tank / ~~ ' Aerobic Treatment Unit DosingChamber ~ OO / ~-GQit ~I 1~- K VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu bcr's Namc (Print) "~' Plumber's Signatu~ ~ MP/MPRS Number Business Phone Number C/ 2 ~ v rj'1 Z ~ ~Z (~ -?72 -1 ~T Plumbs' Address (Street, Ciry, State, Zip Codc ~ l Z~ ~ fh 2 7/S' 3a$ ~' bZ $ ~ ~ ~ ~0 ? VIII. Coun /De artment Use Onl Approved ^ tsappro Sanitary Permit Fcc (includes Groundwater Dat Issu Issuing cnt Signatur (N m ^ n Reason for ial Surcharge Ftx) ~ ~~ a~ ~~ 7 ~~ ' IX. Conditions of ApprovaVReasons for Disapproval 3~ _ n , G,a~ ~0~ ~~ - ~J~^ ~^~- ~tanS I't SYSTEM UWNE~t: - 1. Septic tank, eftlUent filter and ~, ~ ^ ~ ~,~ ~ / ~ ~ . ^ e~tµ ~ ,~„_ 1 dispersal cell must all be servlces7 maintained l J~ as per management plan provided by plumber. i 2. All setback cequiremerrts must be rnslintained as per appliCabk code / otd~tartce:. .v~uy.c.a y.+ns tw tn«ounry omp for me rystem on paper not Iqs than a1R s I 1 inches in siu a SBD-6398 (R. 01/03) ~~. . t _ . , ~; d b son y1~cv/fit/ u~ SZ ~( T 3v ~, ~ ~ r,J PLOT PLAN SCALE 1 "= yp .~., = T?~t~j ~, r N f nn~ 1 ~I ~ 0 ~~ O I1 J I J n I~ ~. 1 ~r~ T ~ ,. ~ ~ ~I J fL~,~ 6 ~z~s o L'*1- l U p o Ntg6° s.3 s.y ~, /" ~- 96 ~ E~ 95 °' ~~~84r \ ~~ ~ j h`7 -~- ''----_ _~~~' _ ~` .Y v O~ 5~~~ o 0~~~ ~~ 5~ 3.Z~ ap~~ OF -.vuuD S~p11vG ., R-8o~ ~. G ~(1 t.vv0 . S ~ i~-gp~ C 7a~-~ of ca~.,c~.~~ ',v~LL 1 s Lu E Fo~Z LU C~pr~, ~-~-~> > l p 0' ~~s r or Q~JCOPY r ,. - . ' Vii; ~ b ~3Dn h/ccJ~nl ~ Sz ~( T 3v ~ ~ ~ r,J PLOT PLAN SCALE 1 "= yp .~, f~ s~ ~ ~ ~~~ ~ ~~ loo ~. c~ 6 ° 8.3 ~ a.y 4 ~ 46 ~ o°l ~ 5 C L ~,~, Ri o.__ ~.z ~ ~G Cj ! ~ ~ 1~ . (GP1R (`~ r ~\ 8~9 cJ~IGS ~--- ~ iio O ~ ~ ~' ~'~~ y a~ R M > . ~~f ~4-~~'1 Q~ ~ I ~O U S ~ ~ /'i I q L 2 ~ `/ ~ T ,~,SCJ7 ~ ~ X ~ ~ Q~, // . ~ - ~/lSt~.~~~~/ ~~ c - r---~_ ~ v ~ ~ ~~ ., ' ~ ~J e ~~ ~ ~~~ rS o ~~ a 0~ ~ ~ 0 ~~ `J I Ui` n ~ v 3. Z ~ R-Bo~~ 62ot.vvD . wuup S S' DI~v G C 7a}~ of ca"Ciz.~~ ~ -~'BOUE F otZ Lu hr i 1 { commerce.wi.gov isconsin Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay www.com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary October 30, 2008 OUST ID No. 226524 ROGER L TIMM TIMM EXCAVATING 3128 20TH AVE WILSON WI 54027 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/30/2010 SITE: David Olson 1373 280TH Street Town of Glenwood St Croix County SW1/4, NW1/4, S29, T30N, R15E Identification Numbers Transaction ID No. 1605589 Site ID No. 743990 Please refer o both identification numbers, `above, in all corres ondence with thew enc FOR: Description: Four Bedroom Mound System / 10% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1206917 Maintenance required; 600 GPD Flow rate; 27 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) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. P.a.V~I.T:S. • A copy of the approved plans, specifications and this letter shall be on-site during construction and or~t>Alr~ZtlO)?Cd~~17 ac .~~ PROF DEPARTMENT OF COMMERCE ROGER L TIMM Page 2 10/30/2008 inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • 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. • 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). • 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 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. Since`rely~ ~3~~/~ Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wisc onsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. 4 i G `~ TM~'!'E11~C4~4ND PRESSURE DISTRIBUTION COMPONENT DESIGN ~,,~~>_.~.b~ ~, ~ Residential Application - - - . INDEX AND TITLE PAGE Project Name: Owner's Name: David Olson Owner's Address: 1373 280th st. Glenwood City Wi. 54013 Legal Description: SSW/NW S29 T30 R15 E Township: Glenwood County: St. Croix Subdivision Name: 39.5 Acres Lot Number: NA Block Number: NA Parcel I.D. Number: 016-1062-10 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 Designer: Roger Timm License Number: 226524 Date: 10/24!08 Phone Number: 715-772-3214 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101) Version 5.1 (R. 06/06) L~~,,~~,.~.8,ag~~,gfH,7~ LUIL~Iii~UJ SEE GURr =SPOi'~DENCE Mound and Pressure Distribution Component Design Design Worksheet ~0 Site Information (R or C) R Residential or Commercial Design 400.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) _ _ 10.0_0 Site Slope (%) ~~ 95.00; Contour Line Elevation (ft) ~~- 27.00 Depth to Limiting Factor (in) 0.50 ~ In-situ Soil Application Rate (gpd/ft2) D_istributio_ n Cell Information 93.00 Dispersal Cell 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) C Center or End Manifold 3.23 Lateral Spacing (ft) 4 Number of Laterals _ ___0.156 Orifice Diameter(in) ~__ _i3.00 Estimated Orifice Spacing (ft) _ ___2.0_0 Forcemain Diameter (in) i _ . 110.00 Forcemain Length (ft) ~ 87.00'. Pump lank Elevation (ft) 4.55 System Head (ft) x 1.3 J~`~ 8.42 Vertical Lift (ft) 2 2.45 Friction Loss (ft) 0.00 In-line Filter Loss (ft) 1 ~ ~ 15.41 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 --~--- 1.00 i 1.25 x ; ~ _ ------ - 1.50 x ~ x 2.0o x `~ 3.00 _. _ -----1 x ' _ _.___...___,_..., Note: Sand fill (D) calculations assume a Table 83-443 in-situ soil treatment for fecal col'rform of <= 36 inches. 6.46 Cell Width (ft) Are the laterals the highest point _^ in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point, (- 1, 10.01 ft2/orifice Does the forcemain drain back? Y Enter Y or N 17.94 Forcemain Drainback (gal) 84.08 5x Void Volume (gal) 102.03 Minimum Dose Volume (gal) 32.31 System Demand (gpm) Manifold Diameter Selection in. dia. options choice 1.Z5 x t 1.50 x ~x 2.00 ----1 3.00 Gallons/Inch Calculator (optional) _ _ _ ___ Treatment Tank Information Total Tank Capacity (gal) ---- --~ 1260.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weeks Concrete Prod Manufacturer (__J gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 800.00! Dose Tank Capacity (gal) 'Poly Lock Filter Manufacturer __ 21.74' Dose Tank Volume (gal/in) PL 525 Filter Model Number Weeks Concrete Prods Manufacturer Project: Page 2 of 7 Mound Plan and Cross Section Views 1- 1 Mound Cross Section View Aggregate Dispersal Area Finished Grade 97.54 (ft) -- .,,,,. ,,,,,,.. • H .,,,,,.....,.....,,,,,,,.. G 1 I F .~:::~' ................. 96.25 (ft) L Dispersal Cell atera 95.75 (ft) -- - Invert Dispersal Cell ~ ~~:•:~:.:.:~:~..•:.:.:~:~:•:~ :.:.:.:.:.:.:::::::::::::::::::::::: Elevation : ~ : ~ D ::::::::::::::: :~ ~~~~ 10.0 % Site Slope Shading Key [] ~~_ Topsoil Cap []2 Subsoil Cap e ASTM C33 Sand ® Tilled Layer © Aggregate a 1 o 1 5 ft ao ~* o 0.5 ft ~""_ A .................................................... ... ... •:~ 1/10 B ::::::::::::::::::::::::::::::::::::•'•'•'•'•'•'•'•'•'•'•'•••:•:::::;:::::::::©~:•:•. .... .... .... .................. bservation Pipe :.. .. . K ~ ::•r;•;•;•;•;::•:• :• tiff •!i . :•: :• .. I: -r -f _f -1 Mound Component Dimensions A 6.46 ft E 16.75 in H 1.00 ft K 8.59 ft B 93.00 ft F 9.50 in z 11.52 ft L 110.19 ft D 9.00 in G 0.50 ft J 4.71 ft W 22.69 ft 600.78 (ftz) Dispersal Cell Area 1672.01 (ftz) Basal Area Available 6.45 (gpd/ft) Linear Loading Rate 9.30 (ft) 1/10 B Obs. Pipe Placement 00 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Page 3 of 7 Center Connection Lateral Layout Diagram Force rt-ain eone-eceion via tee a cross to marafoW st ary point. Laterals are identic al ~ p S •= Turn-up wft»II vshro or IF x--)~Ed2 I xl2~I Laterak & force rtuin oI PVC Sch ~0 oloanouipluy per CONwt Table 54.30.5 Holes Crd1eA on the bottom of the later. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.16 ft Lateral Length (P) 45.82 ft Orifices per Lateral 15 Lateral Spacing (S) 3.23 ft Orifice Density 10.01 ft2/orifice Lateral Flow Rate 8.08 gpm Manifold Length 3.23 ft System Flow Rate 32.31 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.41 ft Forcemain Velocity 3.30 ft/sec Dose Tank Information Electrical as per NEC 300 and -~ Comm 16.28 WAC Disconnect ~` Tank component is properly vented Weeks Concrete Prod Ca aci 800.00 Volume 21.74 Manufacturer Gallons gal/inch ~- A B C D Dimension Inches Gallons A 20.11 437.09 B 2.00 43.48 C 4.6 9 102.03 D __ ___ _ _ _ 10.001 217.40 Total _ 36.80 800.00 Locking cover with warning label and locking device and sealed watertight i 4 in. min. ~- AMPmatP nntlPt location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~ ump off elevation (ft) 87.83 D~ tank elevation (ft) 87.00 Alarm Manuafacturer '~-~- ~- ~-_- --_- Septronics _ -- _ _- Alarm Model Number 2501 Pump Manufacturer :Gould Pump Model Number i EPO511 Pump Must Deliver 32.31 gpm at 15.41 ft TDH Project: Page 4 of 7 Mound System Maintenance and Operation Specifications _ __ _ _. _ Service Provider's Name r Roger Timm ~~~' Phone 715-772-3214 '~ _ _ __ POWTS Regulator's Name ! St. Croix ': Phone', 715-386-4680 __ .__ System Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1260 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.78 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 Ins ct and/or service once eve 3 ears Should ins ct 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 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. ~. an gravity and pressure piping materials conform to the requirements in Comm t34, 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 Di ib ti str u on Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Page 5 of 7 Mound System Management Plan ' Pursuant to Comm 83.54, Wis. Adm. Code en rel 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), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01 /01)] 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 fitter shall be assessed at least once every 3 years by inspection. The outlet finer 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 slough off the fitter when removed from its enGosure. If the filter is equipped wlth an alarm, the fitter shall be servicedrf 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 performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. PUmD Tank The pump (dosing) tank shall t>e 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 lt shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should lie 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 surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound lie heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODs, 150 mglL TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 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 performed lt should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice deaning 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 monltoring. Contfnsaencv 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 performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area 'rf toe leakage occurs or by removing biologically Dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 7 f Goulds ' Submersible ., Effluent Pump C~7 3871 EP05 `- ~ ~"~ ~" 4~esigned for the ~.~fauovrl ";, .~ ... ~` ° ~ 'sump ~~~~`', Water~transfer ~; r• ;rump. irnw~;. "~ • Solids handling capability: Y, , :~~ '/~ rtiazimum. ~. Capadti8s::up to 55 GPM. ~' ~,t:Total' ids:~up to 24 feet. •:[)is~ch~Fp~size: l'/z' NPT. ~Mec~flcal seal: carbon- BUNA=N; elastomers. - _ .t.. :z~~:~ 104°F:(40°C) continuous ~~=;=?140~(60,~C) intermittent. .. ~•`Fasteners:300 series - <;. stainless steel. r!;Capabie of running dry without damage to componerrts. Pump: EP0.ri • Solids handling capability: '/~ maximum. • Capacities:: up to 60 GPM. ~! Total pads: up to 31 feet. s~a.~ ',Discharge size: 1'fz' NPT. • Mechanical seal: carbon- ~- :rotary/ce[amic-stationary, :104°~ ~0°C) continuous ~140°Fy 60°C) intermittent. 4 ,: 4-. ~..,,,1,,,. 'v a~ } .:~~ •,FastenerS: 300 series • FuEly submerged in high `; stainless steel. ' grade turbine oil for • Capable of running lubrication and efficient dry without damage to heat transfer. components. -- Motor: Aval!8ble for automatic and .. • EP04'Single phase: 0.4 HP, ~ marwal operation. Automatic models include Mechanical 115 or 230 V, 60 Hz, 1550 --RRM, built in overload with Float Switch assembled and automatic reset. preset at the factory. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, FEAIi'URES built in overload wfth ^ EP04 Impeller: Thermo- automatic reset. plastic Semi-open design • Power cord: l0 foot with pump out vanes for standard length,16/3 SJTO mec:lanical seal protection. with three prong grounding plug. Optional 20 foot ^ EPtl5 Impeller. Thermo- length,16/3 S:JTW with plastic enclosed design for three prong grounding plug improved performance. (standard on EP05). ^ Casing and Base: Rugged thermoplastic design provides supe!ior strength and corrosion resistance. METERS-FEET ,o sr 8 ~ ~ s U 6 > 5 O 1 < 4 O ~" 3 1 2 1 ~- ~ ~~ `i t' o T't` i '. ,r ,. 1 ~ ~ \_ ~y 01895 (3oulde Pumps, Inc. y ~.I..c Y,, .. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Sbndards Association (CSA listed model numbers end in "P' or "AC".) i r---T-----~ 0 -- ---~----~-~-- -~ SGIPM -- ~ 2S FT ___ _. I i 5 -- I 0 ~ I ' - _ I I -- I i • ---- - ---- ~----- ---_.. _ _ E .--- 0 i _ _. ~ 5 - __.Et .... - --___ ------ 0. . _ 3 2 2 .. Iv / cv uv gV JU GPM 1 1 1 C 2 1 6 8 10 12 m~/h caanciTv Effective May, 1995 1Y~sconsin Department ofilndustry, - - - S O i L AND SITE EVALUATION = - T - Page- ~ of _ 3 Labor and Human Relattans nilii~nn of Safety 8 $trildinas - .. ~ -_. - -. ~ - ~=a ._ ~11 I -- -- _.. _., :. .. .~ ~~~~~~!-....aL 1!-1.l A. ~~ n~ .1111. - _.. ..._... ~- ~ ~,, s~-. e.~ZV ~x Attach complete site plan on paper not less than 81/2 x 11 inches in size PI u inch . ~~~ # PAR ' l not limited to vertical and horizontal reference point (BM), direction and 9'0 of I ,scale ~ . "'~ 6 ~' dimensioned, north arrow, and location and distance to nearest road. ` - '~~~~ ~ 1y i~ IE Y DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: TY "~. / '~ ~~ ~~'~' ~~ 14,x` T 3 ,N,R 1 S E (or W~ WNER':S MAZLIN G ADD~ P LOT B ~~ - ~18p~N R CSM # _ ~ , 3 3 9 Q $ T 1' CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLA OWN NEAREST ROAD G~~w~o~~ ~'t'`t buJ S of 3 0115? Z6S _ ~~ ~y ~ ~~wo~U Z 8 0 '~} STI [ ] N "on Use [,)Q Residential / Number of bedrooms ~ [ ]Addition to existing buil ing Replacement ~ [ ] Public or commeraal desaibe Code derived daily flow 60~ gpd Recommended design loading r e o • y bed, gpd/ft2 - trench, gpd/ft~ Absorption area required Suo bed, ft2 Soo trench, ft2 Maximum design loading rate o . 5 bed, gpd/ft2 0. (o trench, gpdnt2 Recommended infiltration surface elevation(s). ~ ~ - O ~ ft (as referred to site plan benchmark) Additional design /site considerations ~~~~ Itill~'K- 6 3' BL~I , t"'1 tti, l r D 1= S1°f'M~ Fi ~L. Parentmateria{ r v~~ ov~u. Sr'twla`~1 ou~,tc9t} ~ Yr ~~ Flood pain elevation, if applicable tv - ~- ft S =Suitable for system U =Unsuitable for s stem CONVENTIONAL ^ S ~J U MOUND ' [~' S ^ U IN-GROUND PRESSURE ^ S f~' U AT-GRADE ^ S ®U SYSTEM IN FILL ^ S (~ U HOLDING TANK ^ S (~ U L SOIL DESCRIPTION REPORT Boring # \:~i n... n~'r 4r r.... Ground elev. q.ZIZft. Depth to limiting factor y Boring # ~~.~::.:.;,z >n.: "~= ~~ >;-.: Z r< Ground elev. °t6•bft. Depth to limiting factor Z 5.1' ri H Depth Dominant Color Mottles Texture Structure Consistence Bandar Roots GPD/ft o zon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. y Bed rer>ch o- ~ LO" l~Z. z- ~ 2 - s i. Z 'F-s b1T m `Ft- c~.s - o. s o. b Z ~-3y Zl~`21Z ~!!3 ~ st 1 Z`Fsbk ~,'~t- GS ~. S o. ~ 3 3~-~9 l.p`2tZ 316 ~~5 ~ttz s1~ s ~ o~ irnv~h CS - - ~9 -85 LO `t R 4//6 - `~g 0 w\ ~ v 'f 1- ~ G ~ v -,~ R-~ ~ ~ S " Remarks: ~ 0-7 I,p ~ \i z 12 -' s 1. ~ Z`E' g l~k ~ 'F~- a- 5 o . S o. ~ Z ~-ZS 10~11Z312 - S>> 2~'~ek vn'~1~ CS - o•S o-b 3 zs v 1u~.>z.311a ~~~ s~Q s~$ d ~4 "t 6 si 1 1 rr, s~k ~ ~-~ c S - 1l~`1.2 yl b F1 ~~ ~~ my L- ~-~ tV~ \~ 31b ~~ s l ~ ~ m h ~ '- Remarks: ~~ Name:-Please Print Phone: ' ~~ Arthur_ L.___t~~egerer __ _ 715-425-0165 gerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 sture: ~ ~ S. _2 6 n Date. ~T ~ 1 ~4 ~ CST Num 0 O 5 ~ 6 PROPERTY OWNER ~~ SNP l'f'ZI SOIL DESCRIPTION REPORT Page ~~~ol 3 PARCELLD.~ cal(, -l~61-95 ~ ~ ~ w ~ Boring # Ground elev. X40. b ft. Depth to limiting factor Z-1 " Boring # Ground elev. -eft. i- Depth to limiting 'factor ~Z~" Boring # .4 .<. ~1~ ti}i4>~~$ Ground elev. ft. Depth to limiting factor ~3oring # ~•' ~; ~i: ~~~' Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence eourx~ry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Bed Trends ~ b-B 1.0`22 31 Z ~ s ~ Z 'gJbk ~'Ft. aS _ 0.5 orb Z 82'7 10`1231` -~ G--ail. Zmsdk ~~t- cs - o.s o.6 3 Z~-6y ~-S~2 31y c s`~2 y! sl-~cl c~.ti, 1M.~h Remarks: ~ o_q 1p`t~Z z-1Z sL1 Z ~sdk m~~ ~-S - o, s o- ~ Z 9-Z7 1l~`2R 312 si) Z '~sbh ».~~~ C s - o-S 6- 3 Z~-S3 Lp~>Z s!y C S `'lCt yly. si ~ o`er k~.`~t- c S y S3-b~ ~•S `71Z 3~y ~~ sl-3c1 Caw. y,,, ~, -- - Remarks: Remarks: 5BD-8330(R.05/92) Remarks: PROPERTY OWNER ~~ S1"'i lT'11 SOIL DESCRIPTION REPORT Page?- of ' PARCELLD.fi Old- ~~6I- q5 B'oring # .~~>.~4x ~'.'~~ 3 Ground elev. ~00~ tt. Depth to limiting factor Z~1 " .. Boring # :~ ~~~ v i;:;:S Z~ A ~F¢i .«~ti$ -~ Ground el~ev °~_~ it, i; Depth to Ijmiting 'factor ~z~ Boring # ., x~~ :> :r~<<r> Ground elev, ft. Depth to timiting factor i goring # ~.4,~.,w,~.l.Lr: ;~Y .4i:.jj;~ Y} ~~~ i -. 'Ground elev. tt. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Barry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench' ~ ~-f~ LO`1,2 31 Z ~ S, Z '~-Jb1T ~ (, a.S _ 0.5 o.>b Z $ 2,`l 1~~tiz 3l` -' 6,-,l) Z~sbk ~„~~-- cS o.s o.b 3 Z~-6`f ~-S`~Q Sly c s ~ tz yt sl-~c1 c~ ~.,.~'h Remarks: ~ o_R ~o~~Z zl2 ~ st,1 z `~sbk >n~~. ~S o, s o- L Z 9-2`l 1`1,2 X12 - St) Z 'Fsbk ~~~. C S _ o-S s- `' 3 Z~-S3 Lo~ctz sly c ... s H R y ~y .. s~ i o`er Yvt.`f ~- ~ s _ ` ~ S3-~~ ~• S `~ IL 3~~/ ~i S ~_g c.1 C~w~ ha }. - - - Remarks: Remarks: Remarks: SBD-8330(8.05/92) w~sconsin Deparerrent of Industry. SOIL AND SITE EVALUATION R E-PORT - Page 1 of 3 ,L.aiiorar>v Human Negations - - - - - - - Division of Safety & Buil~ngs in ~nnn~fi-~~rifFf -1- I.J R A9 nI. -lore. AA.,. r...d..- . .._ .- ___ _._._ _... _._ ... _----- ------ --- -- - ----• . _.__ .._.... ,._-_ COUNTY S~• ~-~~ ~x p p paper not less than 81/2 x 11 inches in size. Plan must include but Attach com lete site Ian on , not limited to vertical and horizontal reference point (BM), direction and % of sbpe, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O t b - I 0 6 I - q S APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY / ~~"" ~7 DATE PROPERTY OWNER: PROPE OCATION (,(~ C`c~'1P~Z. L~ b~ S>/1 ITN Nw v4 N W v4,S T ,N,R 1 S E for W~ PROPERTY OWNER':S MAILING ADDRESS LOT # BL ME OR CSM # 13-f 3 Z. e o -y-t} S ~-, - - - CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE MOWN NEAREST ROAD G~~woa~~ ~1'lk~l S ol3 t~IS? Z6S-~~~Y ~~.~wo~b Z80 7~} ST. [ ]New Construction Use (,)Q Residential / Number of bedrooms - ~ y [ ]Addition to existing building (~" Replacement [ J Public or commerftial describe Code derived dairy flow b00 gpd Recommended design loading rate o • y bed, gpolft2 - trench, gpolft2 Absorption area required Soo bed, ft2 Soo trench, ft2 Maximum design loading rate o . 5 bed, gpd/ft2 0. ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ ~- ~ ~ ft (as referred to site plan benchmark) Additional design /site wnsiderations ~~~~ w/ ~' X 6 3 ~ B L~ , 1^'1 tru, 1 ~ 01= S1~~ Ft t..L. Parent material r L ~Yy ov~R. Sr~y o~l~wk~t4 ~ ?7 t,t_ Flood plain elevation, if applicable N - ~- ft S =Suitable for system U =Unsuitable fors stem CDNVENiIONAI ^ S ~ U MOUND (~ S ^ U IN-GROUND PRESSURE ^ S l~'U AT-GRADE ^ S ®U SYSTEM W FILL ^ S [~ U HOLDING TANK ^ S ~U SOIL DESCRIPTION REPORT Boring # ...~. Ground elev. gZ.Zft. Depth to limiting factor y ~_ Boring # ~n: ~A{v .i{~n i~e~4 k~ ~~ Z ~::~:"~ Ground elev. °16..6 tL Depth ro limiting factor 2 5-r' Horizon Depth Dominant Color ~~~ Texture Structure Consistence Botx>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends 0-9 Lb`'t\Z z-~Z -- s~~ Z'Fsbh m.~lr ~.s - o•s o.b Z ~-3~f lu`t1Z Y!3 ~ st ~ Z~9bk h,'~t- CS ~• S o_ ~ 3 3~-~9 1.0`1.2316 ~~s ~[R s/~b s~ or„~ wtv~h CS C~ R.. V h/ T~s ~ ~ 4 Remarks: o-~? I.p `11Z z!2 _ Sti~ Z'F-g~k 5v<~1-. aS ~ o.S o.~ Z 7-ZS l0`1ti312 - S1~ 2`~J~k vn'F1~ CS -` o•S ~o-b 3 25;.4 )~l`1231L cz.~ S~¢ s/t3 d~ to ~ 6 SL ~ ~ ~ s~k ~ ~4• C g - - 1l~"L2 y1b F1 .t 'F~ rn~ H t{ uZ 7 tt3y ~~- 31b ~~ s I ~~"~ m h ~ - -` Remarks: CST Name:-Please Print Phone: t 9rthur_L. [de~erer___ _ ___ _ 7I5-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: /` C(S -2 6 9 Date:S~T ~ t ~q ~ CST Num 00 5 7 6 PLOT PLAN .' SCALE 1"= up ' ~I ~ 0 ~ i ~~ ~. quo °_ G ~~S g 8.3 46 °_ to°1 Page 3 of 3 L ~w+v ° .~ CA~1vv~L tTt.. ~1 S . O ~ ~ ~ ~ / E*C. 96_0' ~ 1}o~SE 0 s ~ s.1 i ~ ~~.,~ ~o ~`'oT cA~.PI~-c..1- o~Z ~zs' ~~qZZ zs'~ ~-. ~~81UZ3 ~'LS A~l'~q --i.-~- ~ ~ XZ- s~~n e 1 _ --------------- I m*'k r----- .._.----- - r____-~ _ - - - O ~`~ ~~ ° 0 .y 0 y I~ _ ~ ~.- LSL, 100 ~' o/.~ a~`['TU~1 Ui` wuu'D S ~ plly G C Yop ot= c.av~rc.~) 3.Z' R-SovN .GtZ1ltuvfl . S~_ -~rsovE Fo~Z Loea'f1u~~ wttL ~s ~-u care > 1 ~ ~' ~~sT o~= r-~ovr~ S 1`}~, . J Ci~~~~ ~~AT : ~ 1 L`t ~ S (715 ) 4 2. s -n ~ h qs-Z69 5 T~00 5 7 6 CST Signature Date Signed Telephone No. CST # ST. CROIX CO~CJNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~ ~~ ~ ~ d jam, y-? Mailing Address J ~ ~~~ ~~ fit' ~~ ~ 4 Property Address c~~G~~ (Verification required from Planning & Zoning Department for new construction.} City/State LEGAL DESCRIPTION Parcel Identification Number ~/6 ` /O~Z /4 Property Location ~ lt1 '/4 , ~~ '/4 ,Sec. Z l , T 30 N R~W, Town of ~ ~~°rIlUO~ Subdivision ,3~ ~j ~rrp5 ,Lot # Certified Survey Map # /y~f ,Volume ,Page # Warranty Deed # ~~~ ,Volume ~j ,Page # 7~~ Spec house yes no Lot lines identifiable 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 into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are 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) 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms "7 SIGNATURE OF 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 map if reference is made in the warranty deed. (REV. 08/05) ' .s'~'.a~i~l'.~ ST1\TE IIAf: Of' W1~COf`L~[N FCNtPI _' - l9t32 ~- lAFai.i f cntS ~7FFiCc r> - -.--' ~i Char 1 es .T. De:-:f7 _ ;.t..--and J~,r3n-1,.,.__ f~e5mi th,1-.-- --- _. ~ ~~. LHCiIX i,il1(.t ~E ! ltus:band at~d w•iF~~ _.____ Rlx'dtaRecad ---- ----------- - ----- --- - --- ---- --- _ _. J l1 N 2 6 7.996 1: 4 cur. ys ,111! a.lrram to __~a~, n_L•'._ UL on and _An~~e t:te C ~1_5r~n ,_ ~t 1L:00 A.~ 1 ' 1iu.l.'a s.i_~nal_ _wtLc. __a s_ urviv~tr.sl7~ mariLal~~~~,LFr+~~-- `~~.~1-W...-. °T} ;ir~afr.k. '. !~IIS gPACC Rrti ERVC:D 1=(Jfi RI:GORDING Dnil. ; F~- .- _._ -. __ - _. .. _ ... .. _. -__ .. _.. ._..___ .. NPf./E At:D F/L 1'Dr(w ALJHE.SS ' ^ Ot> ~..~t d!c 11.111aa•inh ctu'llx d u•:Ii l ~l.ll. ul __ __.- St-' _ Cr! 1X _--`----- -___ Cuunly, //C/// _y~.~L- ' PARCEL IDE NTIF (CATION NUMBER -- W 1/2 of NAI 1/9 of ;3ection 29, Township 30 North, Range 15 West, St. CYOix County, w~_sconsi n L'XCEP?' the South .l rod triereof . ~ T ~~~~R FE - This `_ i= homestrtd property. - (lti) (l5 flnl) L-rception to warranties: Subject to easements, reservations. and restrictions o:f record. Dated this _- ~~~' -- - day of _- :Tune _. __-_--. --. A.1~.. 19-~~-. -- - -- ~~~p ~Jry~j/"fig .~ (5[AL) C-""°o-.'6+-~y'c.Y-~ ~__ (SL•AL) CH RL);S J;DeSMIT~i __ - -- ) ~2 t ~ 5` al ) -- _1 ~+*~~• LC- . --- (SEAL) -- - -~4 t . .. _ _,_ __, l-1N L_ UeSMITIi ,___ -_ AL1TI-i[N1'li:Al'~UN ACKNOWI.E:llGMEN:r State of w'iscansin, i Signature(s) ___ ___- ' -- - - -- --- St. Croix -- -----Gl+.lnq•. ! aathenucateci thls -_ clay of _. _ __, t')___ Ncrsonaih- camp brturc• nle this __!~ ~- day r,f - -__JUne --_--._. tl)tt~t.-. dlc ah~.c n.,cn,;; - ---.----_ _ - -- -- Chax ies J . De Smith ~~~a _____ __.-._.._-.- o-------- ----- --- ---__ --.-- -_-_7_u_an L_ [3eSmi_tJT~.---.. _..--- f1TL[ MCTs1131:R 51"Al G U.aR (lF WlSCI?NtiiN __.- _ .__~--_-----_-._--- __--- ---------- _.. __ -__..._ .. r , .lallill.l l.: <'U i.), yr(~(, l•(?. ~~"I~ .~!.11. >.i 1)lltt I:nll\,11 i:l (, <' ltl.: l,iI ~I.1 _ _--.-. t'11t1 :\t'a'rl (l is Ills I,ri L', 11'~~~ ' eB~ ~ • 4~,1 Ap ~. '~"~ S•PS yy 9~~~>>yee - ill :?li Ili Y ::'{: n.lyC'1 <I ~•- lIl :'i lt' C1 ~~~ ~,a i)~. Y ~d~. / ILI:~i IrISt nllnnE rlr Vt~A:i r,nnF+Et~ ttv ; ~ ", + '. tr' ra_,lr .r ~ ~ _. l ~~~ ~~ SiL.L'IiED: I JUNL.t\^ _ _ ~~',llgF ~r Vt>riSC.C:NSiEy _ _._ a / C ~,l~t~~_b" _ .__ _ - Iillcis_:r.il, 4J.is~oll~:i.n ~:lr,.uvt'•u!,11.-.. .`~t.. '_:t-ni..:;._ _. _ l~a.:u,lq~+.l. a. i t Ill1'~.'. 11..t Iii ..tlll..`ill ll.ll.. C: .i: - 1':..I .\a li ll )',i 11 f+.`111 :11i ni.l ~..{,////{{tit,,((//~Jtjjl~l/!?~1i..,~•~t:J! 1. ~.'I.!I.Ir(r':li '1! ., .... ~i l~• .',i~•t.11 . )If(~,~t l~/.l i.' /~ '.\,!i1: 1~1, 1111: l.~l nl .~. _ 1-'.•_ ...'..,