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HomeMy WebLinkAbout040-1083-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 567270 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Schneider, Andrew& Pamela I Troy, Town of 040-1083-40-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: / M t (=�T 21.28.19.327E TANK INFORMATION ELEVATION DATA /, �c} /d/.44`1 /pn TYPE MANUFACTURER k CAPACITY STATION BS HI FS ELEV. . .^-fS 6 . 166 Septic / Benchmark 4�6 O /6 / Dosing Q S t0 T Alt.B i C.oJ !�-A C-?(r,` L GJ Bldg.Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet X �'i l• Z5 TANK TO /L WELL BLDG. ent it Intake ROAD Dt Inlet f, /� 17a 5 LS,Septic 46 3 Dt Bottom T 56 / W. S L I B Dosing S� Header/Man. �1S 7 3 43 * 3. 1 Aeration Dist. Pipe 3 Holding ; Bot.System * 3.71 95. 1 Final Grade PUMP/SIPHON INFORMATION 2 7(v-77 Manufacturer 'Demand St Cover) I� GPM u" �► ` `� Model Number 1 721 / v ' s'3 TDH Lift • ( Friction Loss System F{eas T DH Et Forcemain Length / 1 DiaZ I Dist.to Well SOIL ABSORPTION SYSTEM J BED/TRENCH Width Length No./�Trenc s PIT DIME Sh IONS No.Of PitJOR Inside Dia. Liquid Depth DIMENSIONS 1b L 4[ 0 /-{� SETBACK SYSTEM TO PP P/L /V BLDG WELL LAKE/STREAM LEACManufacturer: INFORMATION T e stem: CHAMByp,R Q J� UNModel Number: �\ DISTRIBUTION SYSTEM Header/Manifold / J Distribution �Dia 3 J/ x Hole Siz x Hole Spacing I Ve Air In e Length �'�DiaZ Leng h i J 1.47 Spacing �� . ' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only c, ,,,r„ Depth Over Depth Over xx Depth of xx Seeded/ odded GC xx 14,ulched Bed/Trench Center \ Bed/Trench Edges Topsoil Yes No Yes No ' ❑ ❑ COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: /Z-(,,!'/ ✓7 Inspection#2: / / frosF '4-oc,t Location: 549 Chinnock Lane Riv r Falls,WI 54022(SE 1/4 NW 1/4 21 T28N R19W) metes&bounds Lot l. e Parcel No: 21.28.19.327E .� � _ t J 1. Alt BM Description- � � Q-', 2.)Bldg sewer length= 6;7v -amount of cover= I Plan revision Required? [E Yes o 27 Use other side for additional information. J Lv� _j_ SBO-6710(R.3/97) Date Insepctor's Sig na re Cert.No. Mann for Me and roil Epaluation Pars 8 of9 Property Owner j4A3b, .1. L + j:,Z I" = 40ft. Legal Description TRT or- T"c- --,;-='/:4 ©F-tee jv (except where noted)- s1Ec 2?,—rZf tJ, 'Z3qW T'D wA Qf-- �fzfJ a ; eR tx L•I=Backhoe Pit. Cov�N-r�f, wtsco.t.�stnl • ! ACRE North NoRTft ply � R bwNE'E` Z4.8 C�oua� P�� EES !i 1 r r � W � v RI OS 2 a PL "--iL, d� U`. � � S .}tssu.nrt�cs �r�o.da• � 21 CElWO6cT• r i •Sc_PTtiC 'CA1U K—TO AC * p� <�D sp 4►! � Z q�t3F Oy SQAvo D3� VV F, OQII ,Lr t 0r F Site L canon: 7 71 � Sou-r-r•t- p/t � . t3R� 0 ^BA'',o� T County °'S Safety and Buildings Division 5% C e C7 14 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) yMadison,WI 53707-7162 °, ;L, 5C7z 70 Sanit. r Permit Application State Transaction Number . . ` ' In accordance with SPS 383.21( � :ioy Code,submission of this form to the appropriate governmental unit 2 3 Z 6 zT is required prior to obtain' s. 1 it Note:Application forms for state-owned POWTSfare submitted to Project Address(if different than mailing address) the Department of Saf- Tonal es. Personal information you provide may be use °r,secondary purposes in accordam . i e Priv w,s. 15.04(1)(m),Stats. , ;� PAP i r� 5? di; �.k. A I. Application Inf i ::a • -Please Print All Informati' : ��j / d 'K. Property Owner's Name /'� 040 Parcel# aye). /S"3. . 6 _ 6046 4 n .r`e t- Po,v . tc, c i )1 +ct to ti;.,,x 0, , as, !(d,�3 00 ill Property Owner's Mailing Address . Property Location ocation � D G S,/J C h i►t&t o j L a t e tiTy Govt.Lot City,State Zip Code Phone Number 5 E y,, tY(t) 1/<, Section a/ k v er, Fa us ox Sqd ::,Q, 7/5 X2,2 ` T N; R 1- y,,.(circle or l&' II.Type of Buildink(check all that apply) Lot# X1 or 2 Family Dwelling-Number of Bedrooms Subdivision Name I e, Block# 44 4-g ❑Public/Commercial-Describe Use .---- ❑ City of ❑State Owned-Describe Use i / CSM Number ❑ Village of 4 p J,4 ❑ Town of r'� III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑New System X Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner W.Type of POWTS System/Component/Device: (Check all that apply) 6,4,4„,r * 6S ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) i V.Dispersal/Treat ent Area Information: a 14 tP4-' 6'J C Design Flow(gpdDesign Soil Application Rate(gp Dispersal Area Re fired(sf) Dispersal Area Pro osed(sf) System Elevation 1/5-8 i 6 1/3o 750 y sv 783 q9, S'6 VI.Tank Info Capacity in Total 4 of Manufacturer d Gallons Gallons Units 4 o 'O New Tanks Existing Tanks // f � ', o y Septic or Holding Tank Il (( M O )/at a (!1 Q e-I`lr-/J K Dosing Chamber / 6 s 0 a v-..0 ce SLR UJ) I Q 5 �+t^ '\ r VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) inber's Sign e MP/MPRS Number Business Phone Number / &r s the -i.t i• 4., t& 1eLk :W/>y? 6.7 %- .50-- rif5.4.1. Plumber's Address(Street,Citty,State,Zip Code) 1 4) VIII.County/Department Use Only �/ ` / ( Approved ❑ Permit Fee Date sued Issuin/Si . e / " $ 6,25 . 00 // /z /3 er Given Reason for enial /-� IX.Condit$V5VAMPIONBeasons for Disapproval A 1:' Septic tank,effluent filter and 3) Lar►.0:d-i e.ns /A 5 ,� /!4-p/)oaf, I-%e..4411/4..., �r dispersal cell must all be services Imaintalneg A_ � �� I 1 VL-4,; 1�U erm,I.d-1 . as per management plan provided by plumber. �/ 2. .*setback requirements must be.maintalfied as per applical fie code/ordinances 7 4-w 6 i-.1/1 qJ 421-.A.1C.. 11.dub 6 Geil,'J-.'e.1 Attach to complete plans for the system and submit to the County w y on pape not less than 8 1/2 a 11 inches in size otv. o.�..- a...b t a.'L f (ot., re o sa. SBD-6398(R. 11/11) • 9,yAR,r \ �P�/ DIVISION OF INDUSTRY SERVICES y4' �o,, 01001 S �" PO BOX 62 dot „ . MADISON WI 53707-7162 -I Contact Through Relay 1' ,-4 9 Y www.dsps.wi.gov/sb/ �y�\ 9w www.wisconsin.gov SSIONAV Scott Walker,Governor Dave Ross,Secretary October 11,2013 CUST ID No. 224832 ATTN:POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING&DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/11/2015 Identification Numbers Transaction ID No.2320248 SITE• Site D)No. 796637 Andrew J&Pamela J Schneider Please refer to both identification numbers, 549 Chinnock Lane above,in all correspondence with the agency. Town of Troy St Croix County SE1/4 NW1/4,S21,T28N,R19W FOR: Object Type:POWTS Component Manual Regulated Object ID No.: 1454019 Maintenance required; Replacement system; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter 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 • The existing POWTS shall be properly abandoned per SPS 383.33,Wis.Adm.Code. • The area within 15' down slope of the dispersal cell shall remain undisturbed.Vehicular traffic,excavation or soil compaction is prohibited in this area. • Prior to construction of the dispersal area,check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil.Proper soil moisture content can be determined by rolling a soil sample between the hands.If it rolls into a 1/4-inch wire,the site is too wet to prepare.If it crumbles,site preparation can proceed.If the site is too wet to prepare,do not proceed until it dries. CONDIT • Building sewers shall be insulated beyond 30 feet per SPS 382.30(11)(c). APPF • The tall grasses,shrubs and leaves need to be cut short and removed prior to plowing the surface for DEPT OF S installation of the dispersal component(drainfield)to prevent matting under the dispersal area. PROFESSION DIVISION OF INDI 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. SE if ORRE; ' w I MARY JO HUPPERT Page 2 10/11/2013 • 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. SPS 383.54(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. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerel , Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Sally Sh er Please Include a Copy With Your E.I.T.,En/ eering Consultant,Integrated Services Payment Submittal. (608)264-7782,Monday-Friday 7:45 am-4:30 pm WiSMART code: 7633 sally.shurnaker@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am to 4:30 pm MARY JO HUPPERT Page 2 10/11/2013 • 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.SPS 383.54(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. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerel , Fee Required$ 250.00 / // This Amount Will Be Invoiced. When You Receive That Invoice, Sally Sh u a er Please Include a Copy With Your E.I.T.,En/l eering Consultant,Integrated Services Payment Submittal. (608)264-7782,Monday-Friday 7:45 am-4:30 pm WiSMART code: 7633 sally.shumaker @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am to 4:30 pm MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE RECEIVED OCT 7 2013 Project Name: ANDREW J. &PAMELA J.SCHNEIDER INDUSTRY SERVICES Owner's Name: (same) Owner's Address: 549 Chinnock Lane River Falls, WI 54022 Legal Description: SE 1/4 OF THE NW 1/4, S 21, T28N, R19W Township: Troy County: St. Croix Subdivision Name: NA Lot Number NA Block Number: NA Parcel I.D. Number. 040-1083-40-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry ,t�1EEttit+.ltttt:t/ts•,, Page 3 Mound drawings \`' 0 Af� � Page 4 Lateral and dose tank .t. ....... o. �r Page 5 System maintenance specifications A.a Page 6 Management and contingency plan = MARY JO - Page 7 Pump curve and specifications HUPPE41T z Page 8 Plot plan m' D'ir,59 ; t ;AVER FALLS�: WI ifi'/4U:igli6r: Mary Jo Huppert License Number. 1859-007 Date: 10/01/13 Phone Number. 715-426-1775 Signature: TONALLY LOVED Designed Pursuant to the AFETY AND Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N.01/01),and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and AL SERVICES Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) JSTRY SERVICES Version 7.0(R. 03/2012) Page 1 of 8 4411.4%A. 3PONDENCE 1 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5= 150%) fecal coliform of<=36 inches. 450.00 Design Flow(gpd) 4.00 Site Slope(%) 94.08 Contour Line Elevation (ft) 30.00 Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 45.00 Dispersal Cell Length Along Contour(ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest <oint in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) e Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 3 Number of Laterals of the highest point. 1 1 0.156 Orifice Diameter(in) 3.00 Estimated Orifice Spacing (ft) = 10.00 ft2/orifice 2.00 Forcemain Diameter(in) 20.00 Forcemain Length (ft) Does the forcemain drain back? Y 85.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft)x 1.3 3.26 Forcemain Drainback(gal) 9.17 Vertical Lift(ft) 41.61 5x Void Volume(gal) 0.26 Friction Loss(ft) 44.88 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 24.23 System Demand (gpm) 13.98 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1000.001 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Wieser I Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity(gal) PolyLok Filter Manufacturer 17.00 Dose Tank Volume(gal/in) 525 Filter Model Number Weiser 'Manufacturer Project: ANDREW J. & PAMELA J. SCHNEIDER Page 2 of 8 I Mound Plan and Cross Section Views 1/10 B .. . . . . . . . . . . . . . . . . Observation Pipe :til J K ��. : L L 1 L L L L 1 L 14: L•L•L•L•"*.1 '.•L•L•L•'••L 1 J.'•L L. S L L•L•L•L•L•L• Y•f•f•f•NJ•J•fY J J r J JY•r f•r•J•r•f•f•J•r•r•r•f•f•J•J•r•fY•fM•f r f J•J• r•J•rY •L•L•L•L•L•L•L•L•L•L•L•L•'4•ti•L•L•1• L•L•L•L•L•L•L•L•L•L•L•L•L•L•L•L•L•h•L•L•L• {•L•L•L••• • •AJY•r•r•r•r•f •r•r•r•r•r•l•r•f•r•r•r•f•f•.••r•f•f•r•r• Y•r•r•r •rY•r• •r•f•r . . . . . • • . . . . .L•L•L• •L•L•L•L•L L L L L L L L L L L•' L•L•L•L• L L L L L L L L L L L 5 L L•L•L•L A r•r•f•J J r•rY J r•r r•r•r f•f•f•r•r•r•rY••.••r•r•r•l f J r r r r•r•f•r•r�• • .L.L.L• '..1.L•L• .41••.1.L.L.�L•L•L•L•L•L•L•L•LLL•ti•ti•ti•'�"•••.•ti•ti•L "•'L L•L`L' . . . .f.1:5i •f•f• •J•J•r•f•f•f•J•J•f•J•f f f r J f f J r r•r•r•r•f•f•J•f •J r r r•r•r•r•f•J•r•f r . . . . . . • . . .L• •L• •L• .L•L•L•L•L•L•L•L•L•L•L•'.•1•ti•'.•L•ti S 5 L L L L•L•L L L L L L L L•L•L•L •L•L•L L L L L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • L • Mound Component Dimensions A 10.00 ft E 10.80 in H 1.00 ft K 7.41 ft B 45.00 ft F 9.25 in i 7.40 ft L 59.83 ft D 6.00 in G 0.50 ft J 4.74 ft W 22.14 ft 450.00 (ft2) Dispersal Cell Area 783.03 (ft2) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 96.35 (ft) —* .,J..rr........ ♦ H iF Dispersal cell 4 95.08 (ft) Lateral 94.58 (ft)_.÷I — Invert Dispersal Cell � :::::: ::. Elevation : : ::;: D: : : : �: : : : :•. VolpIrWONVPVVIr a 94.08 (ft)Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover 1 Shading Key d a n Dispersal Cell See lateral details on 0 Topsoil Cap = E. 1.5 ft Page 4 for number,size, •r„„..:.f:f:r:;.*::•:r:r:r:r:r p p Q L•L•L•L•L•L•L•L L•L•L•L•L•L• 0 Subsoil Cap c ;.r.f.r.r.`r•r•r•r•r•r•J•r•r and spacing of laterals. L ti.L:L L•L•L• M � r•} r•r ;•r•r•J MN L ti L•L• ;•L 4.{•L • .•.. Laterals are equally 2 ' r r•r•r• r• r•f•r• r•r•r•r ASTM C33 Sand •••..L•L•L•L•L` L•ti•ti•ti•L•L•L•L L• v r.r•r_rrpr;r r,r_r.r_r_rpr•r•r•r ti•L•5 L"•'•• r.r. ;.r.f.r spaced from the 111i L.L.,Typical Lateral L'L'L. ▪r.r. vaJ•r.r.r distribution cell's �,. Tilled Layer c 0T ,j~f:f:f:r L .L.L.L.L.L.L�} r• r•r`J•r•r•r-'�J•f-j(C.r © Aggregate L•L`L•L•L•L•L`L•L•L•L•L•L•L•L d C r•f•f•r•r•r•r•f•r•f•f.r•r•r• centerline in the {•L•L•L• •L•L•L•L•L•LK• •L•L •r•f•r•r•f•J•r•r•r•f•r•r•J•r•r•r•f 0—A _ 0 distribution cell(AxB). Project: ANDREW J. & PAMELA J. SCHNEIDER Page 3 of 8 , 1 End Connection Lateral Layout Diagram Csearetlw°.eart7s eves**A&eta •=Thorn-wp wad bog veI• a orc".3 want piss { P '� AQratasdsaseEdat+ a+ K-)-2l Koes on**bow:motOwIowae -.=-1) t T � Laaeraim a fmm rKer6 SC:ft 40 PVC par SPS Tcl-" 386.30.6 g • Force amain commotion was lovar woes Mora �_'. .st,sr DOW. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 125 in Orifice Spacing(X) 3:11 ft Lateral Length(P) 43.54 ft Orifices per Lateral 15 Lateral Spacing(S) 3.33 ft Orifice Density 10:00 ft2/orifice Lateral Flow Rate 8.08 gpm Manifold Length 6.67 ft System Flow Rate 24.23 gpm Manifold Diameter 1.'25 in Total Dynamic Head 13.98 ft Forcemain Velocity 247 ft/sec Dose Tank Information Lodcing cover with roaming label and locking device and sealed watertight Electrical as r NEC 300 and —'► SPS 316.300 WAC i,1 t 1 4 in.min. ------ Disconnect Tank component is properly vented [ fl f-1 L *--- Alternate outlet location Forcemain diameter Weiser Manufacturer r 2 in. Capacity 650.00 Gallons �- Volume 17.00 gal/inch A Weep hole or anti- Dimension Inches ! Gallons i B siphon device A 22.70: 385.82 B 2.00' 34.00 G d i Pump off elevation(ft) C 2.64 44.88 85.911 D 10.90 185.30 D Total E 38.24 650.00 1 ink elevation(ft) J 3"Bedding uFl er tank. 1 85.001 Alarm Manuafacturer SJE Rhombus Alarm Model Number Tank Alert AB • Pump Manufacturer Gould Pump Model Number PE31 Pump Must Deliver 24.23 gpm at I 13.98IftTDH Project ANDREW J. &PAMELA J.SGHNEIDER Page 4Iof 8 i Mound System Maintenance and Operation Specifications Service Provider's Name Tri County Sanitation Phone (715)386-2130 POWTS Regulator's Name St. Croix County Zoning Office Phone (715) 386-4680 System 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 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, 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 �► Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: ANDREW J. & PAMELA J. SCHNEIDER Page 5 of 8 p • mvunu aysurun I!vldndyW l!UM rum Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 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 SPS 383.33,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,Stets. 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 cleaned 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 filter when removed from its enclosure. If the filter 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 performed to maintain less than maximum scum and sludge accumulation in the tank. additives enhance septic tank performance is generally not required. However,if such products The addition of biological or chemical ad es to sep perfo 9 Y req tank by the Department of Commerce. are used they shall be approved for septic to use y Depa 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 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 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 be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5,30 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 n 18 months. When a pressure test is performed it should be compared to the initial test flushed of accumulated solids at least once every p t� 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 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 if 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: 4NbREV�IJ �r �Aw � �. SCNAEf pEtc Page 6of 8 , '1 RAGOULDS PUMPS Submersible ' _ Effluent Pump III m1DEL � __ PE • • ................................. liQp3 - SPECIFICATIONS MOTOR . FEATUNES Pmnp_General: al Corrosion resistant :,.-, . • Discharge:1S41'NPT • gm*Phase construction. • Tend 104f(40°C) ' 60 Hertz •Cast lion body. maximum,ccmthwous when • 115 and 230 voks . - •Theimoplastk impeller and , *submerged. • 8t hr T y� overload pro- awer. • Solids handling:w teaion with a t ma c wet •Uppr sleeve and lower maximum sphere. •Class B insulatimr. heavy duty baN bearing •Automatic models include a •Oiled design. con on. APVUCATIONS float switch. • High strength carbon steel a Motor is perinanendy SpeciaAy designed for the • Manual models available. shaft. !debated for attended following rte:see P131 Motor: service life. . • Mound Systems performance dart or curve. • 33 HP,3000 RPM is Powered for centimes • EffluentMosing Systems P131 Pump• low Pressure Maxi capacity:53 GPM • 11 Pole •�me within the • Basement Draining • Maximum head:25'TDH PE41 Motor towlthv limits of the motor • Heavy Duty Sump/ PE41 Pulp • .40 HP.3400 RPM • do De+watedng • Maxim=capadty 61 6PM • 115 and 230 volts heavy duty 1(13 SIMI wi t th • Maxdnxxn head:29'TDH • PSC design 115 or 230 volt growling PES1 Pump: PE51 Motor: •• Maldmum capacity:70 GPM • .35 and 230 volts 0 a unit is - . _ head:h 37'TON • METERS FEET • design a Mechanical SEd Is ao r--1 - i'1. •.._" =-1 •i.• • 1.-• -a..,s =mime■ mg MOOas: MINA and stainless s.r m»:taa Mule am m r, .P641,PESt 35 "�+-' �.Ir m J r ao so •Stainless steel fasteners. �s+.�+nisa-•Ilia I�..Mr1<l[1 I� I �SSswi.lw liff pii 10 a at. am z � ill,,„=„ si �pir AGlCY L 6 Kira taota lu imtsE>E>rsatm iniimiaam zkirwila Ail Inning MI if s "'EIt Mk... -a IRMt10∎111M-illUllUmI#R- •nrlir a *._ I ��aasta _.— ilrlrn1Migirat�r V �fi�l s,,- JR�ilfifi�fllAltlA 1- -•--1 alrt s��: nt� C US w -. ». ,.-rw.o.■r.:l'v �.v..a*a a-; Toted toUL778atd ,411111111111m1 NM R-mow nsitir-- lt�rA- su_ _s.�IIH i i��r ,1� "�—'i•.-�a>.rrw��ia '��s_ t3A 22.2108 Standards d s �rrw— . ir.�iM=ta a!<Urtaltrt sorryxxD1l�rert�lfext F >r�sarr:mot darg.!..1ll10,��hV�ipi \a i♦up . • as 0 . r� I • rt V�isa.�t►fri IF t^ / i✓tt -j -i- '-fit i ��rff tt{��I��i"! ilt 1 T;-i 10 AIM mill : �flt5�5= `iita� R ���OI�tO , 4-1--!, : - -'t .. "1.,• tip r aarearataa wr�n.rAr�tr • 1 .=T1...7,...4... w -1, - -1-- ■.L1- '` _. 4-ii::: — -1. • -s •- ..-..:..7. _4._ ' "t-: . . -1-t--. r.1,..- ro f R AN REW ZO m 3o rPM '7of g o 5 10 15 ` Plot Plan for Site and Soil Evaluation Page 8 of8 Property Owner ANDREVJ:.f. 4 L-A ,T c5 c44,..re t ns R 1" = 40 ft. Legal Description 17Kr. or ,, sue' 0E-'The Al h (except where noted) sec. 21,12g A1. lz vor vw1 "i6 wg 0F -rRoy, -s c-Rol x ._ Q=Backhoe pat cot&,r-r'f, vvtsc.omstn1 • 1 14cRE North .._ cL ... { ItJr}1?f'f. LAN's 'L ,‘Nov... t pie- 1.. QER bwt,ER 2.1; I (Fotrn PE) L cf,Cs H 1 1 -- - ' 1• 1. W eli 4`v t --- - I 10 ' 1* 1 ao' , V'a's G I 13Ro ®W E u) °� _ 9f`� � S a 7i � iii ? CEAvour I vsc -TANK-TO D 444- Q I x 98.83' Pt*t 4 k 4 )9 ' ti ;!: I 4e— it t k;i1 I xV r., 2i. w,t d -4 17 o 114' 1. `' f N •z 4 40,2,,10 Prov boa ,y,5.o✓ ►a or o0 - vo �Wit_ �' 43.43 t3 i. z6NN— - - Site Li ation: c v....)ao..._s 1-TIKE'e s:-) Sou-rrt pit l srtE ,oLLIN4 Q• c it Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County , ST.CROIX• Attach comp s I papa than 81/2 x 11 inches in size.Plan must Yz:. induce,but to:v and horizontal reference point(BM),direction and Parcel I.D. 1083-40-000�3 t7 percent slope, nsions,north arrow,and location and distance to nearest road. Please print all Information. Re , Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). $7 l �))!/l t,r. (0/I c/r3 J qv�X Property Owner Property Location ,,�M p� 0 ■ ANDREW J.&PAMELA J.SCHNEIDER Govt.Lot ----SE 1/4 NW 1/4 S 2P T 28 N R 19 E(or)W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 549 Chinnock Lane -- -- -- City State Zip Code Phone Number OCity 0Vllage OTown Nearest Road River Falls, 1 WI i 54022 I ( 715) 222-9606 Troy I Chinnock Lane 450 0 New : ction Use° Residential/Number of bedrooms 3 Code derived design flow rate GPD a Replacement 0 Public or commercial-Describe: sandstone Flood Plain elevation if applicable PIA ft. General comments Mound System--0.50 ft.sand fill--0.6 loading rate oie__, and recommendations: A o At C- vC Ol-r4t 5y.4 Yi'i 0 Boring 1 Boring# Pit Ground surface elev. 93.93 ft. Depth to limiting factor 30 in. (Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 "Eff#2 1 0-9 10YR3/3 sil 2fa&sbk ds as 2vf-co 0.6 0.8 2 9-15 7.5YR3/4 — s1 2fabk mfr cs lvf-m 0.6 1.0 3 15-30 7.5YR3/4 -- sl lf-mabk mfr as lvf-m 0.4 0.7 4 30-35 7.5YR3/4 t2d 7.5YR4/6 sl Om mfi _ -- 0.2 0.6 0 Bori 2. Boring Boring# 93.63 32 Li Pit Ground surface elev. ft. Depth to limiting factor in. (Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots , GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *EMI *Eff#2 1 0-7 10YR3/2 — 1 3fabk ds cs 2vf-m 0.6 0.8 2 7-16 10YR3/3 -- sl 3fabk ds cs 2vf-f 0.6 1.0 3 16-32 7.5YR3/4 -- sl lfabk dsh aw lvf-f 0.4 0.7 4 3240 7.5YR3/4 f2f 7.5YR4/4 sl Om dsh -- -- 0.2 0.6 Horizon 2 has some gr. *E f t l u e n t#1=B O D$>30<220 mg/L and TSS>30<150 mg/i_ *Effluent#2=BODD<30 mg/l-and TSS_<30 mg/L CST Name(Please Print) Sign d� CST Number MARY JO HUPPERT,Hollister's Soil Testing&Design 224832 Address Date Eval Conducted Telephone Number W9875 690th Avenue, River Falls,WI 54022 09-19-03 715-426-1775 nrr min mnn wv� 1 1 Property owner SCHNEIDER,Andrew&Pamela Parcel ID# 040'1083-40-000 Page 2 of 3 3 Boring# 13 Blxing 91.23 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Ett#1 *Eff#2 • 1 0-7 10YR2/2 -- 1 2f-msbk mvfr aw 3vf-co 0.6 0.8 2 7-13 10YR3/2 -- 1 2fabk mvfr cw 2vf-co 0.6 0.8 3 13-30 7.5YR3/4 -- sl 2fabk mfr cw 2vf-f 0.6 1.0 1 Om dh -- lvf-f 0.2 0.7 30-36 7.SYR3/4 f2f 7.SYR4/6 4 , s 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 GPO/ft' tF#2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. Boring# E 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 GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. , *Effluent#1=SOD,>30<220 mg/L and TSS>30 S 150 mg/t. *Effluent#2=BODS<30 mglL and TSS<30 mg/I_ 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-83307at(8.07/00) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner ANDi v,►1 d 4 .ELA 1 ' ' 1 ,5c+,4s1 pe IR, 1" = 40 f. Legal Description Kr: of TAE stgq oF-THE N4:4 (except where noted) 5eC. 2i,-rzg n1, Rwq W Tb wiii Op 1-12,6y, c-R,tx 0=Backhoe pit COt& -r I, it ONSttt • / liege North __ _ e - Gf ll�/J ( LANE " . . ,(N01 it Pk- y PER. bwgER Ztg' (FOUN°�°°) E�5/_�uSH_'—"--- l'_.1 i 1 1153 t- I I4 t (,) ct I 641 ^ v y . I 3 S �s. G F' I ►3el>Ro aM ®W et-L C. 1 I I Q I Q I - 36,M#1 tr.$orr°M or 10 �,oWCv .50'AgoV GRouND TS: S I - E .RsSUnnso to,o.00, k ase -tisAiK t x 98.03' 3 d • 12 1 � 43 1 hI 4 w iis as.Z s-Iv? o 1s o0 oa, 1145.0 3 (2 Li`v)• E1c3' 1e4 o i- pool_ _ , 43.93 ;VjiojEt ti / Site Location: (VJOoDS I'MS 1 Sou-rt-F ph NOC �� CM K . "l .stt gotu Viper)a �C:. DR. ZI ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERII ICATION FORM Owner/Buyer /f re cA,i>t t.I G. c hit Mailing Address 5-1// ch l nAac k A.i-A t e 2 ye,/ Fctf15 id/, 51 yo n Property Address S c.S ��b ✓E (Verification required from Planning&Zoning Department for new construction.) City/State Z.v ✓` Parcel Identification Number xi, ` 14 r .17 Li ,`'Gc•A5 +1N LEGAL DESCRIPTION Property Location 5 E 1/4, N k) 1/4 , Sec. / ,T N R 19 W, Town of -rrdy Subdivision Plat: (4'l12 ,Lot# Certified Survey Map # ,Volume , Page# 1 p Warranty Deed# —7 -7 / (before 2007)Volume 7 D , Page# 3 Spec house❑yes Kno Lot lines identifiable❑yes❑no SYSTEM MAINTENANCE AND OWNER CER INCATION 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 form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a anty deed recorded in Register of Deeds Office. Number f bedrooms 3 SIGNA I1RE 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.09/07) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK this is to certify that I have inspected the septic tank presently serving the /1idv;04,i PQ,n�4l 54 1 Q,der residence located at: � t� I l � e. 1/4, N 1/4, Section 1/ , Town X N, Range 1 q W, Town of Trot/ St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 2/l/a.e Did flow back occur from absorption system? Yes No k (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: it can Construction: Prefab Concrete X Steel Other Manufacturer (if known): Age of Tank (if known): 4 virile 0 t 41;-0116A. Mar k SLIT d gdur (Licensed Plumber Signature) (Print Name) I" t, Or 29. 9170 (Title) (License Number) MP/MPRS ?D 3 ( ate) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) -----,--f..,, 3.2137,-.-7-------77----73-7----------,7z,-::::--a-L _ -' ,. ,,, __ .-------,__„ _ I --r.- ' * - _ f STATE BAR OF WISCO,, NSI,N : itemsreas opium" 1 4 1.4- -tiTgA-1-* 8- pAst. sr.t-De.tr,„ co. wts. t I •••-.---'." • It - - vs. reer nos -_—,....... . . . ! I • ...'; 1 ;••--.V -,I ii tt Cernohos [I a single person day of AD 1987 Aug. ..... . . at - • 11 -1;15 Pg ijw 3- _Schllf14-4gN 41:4,.... . _ u.. ...e_____________ ___ 1....-Nizt1. IL _e __-_,--__... :.--.__., r=-7-i.7.4..r.ng hhcrotta4.4.......Qz:k. I-- :flantfta.a._0.....,..5CATIV.IPLO.r.a.--DUS49-4ACI---'4.0P- .W '' "'-':'''- Deputy _ - hip Inarita], prOperty in ReTLI N PI TO --- il li 11 Ifil;2-..-,:••'--- - I! li ...-........- t.,., .Q-1- . r Ystel Se firuswen I! i I Tax Parcel No: 11 I 1..:.....L --The--.:-Ea4;t_.--218,- feet of the North 200 feet of the Southeast_Quar: ?7 ir-7-- -----: f -ih k iiiyae- st. Quarter (SEI of NW*) of Section Twenty.-One ....1.4...-1.2 , II -1,---;-_-.--_-- _!Pc-wn--sh1.-p----Twenty- ae,fri-t (28--) North, Range Nitit.. it (19) Wet, Ton +4 1 S I Wisconsin. W' - - 4------,-- -.--of-Troy,--- t. Croix County, MAXON/ I FEE ---- '-= -.!---7.---.,----,--,--.-4...---,_ . .3-, - -----.--,-----,--;-----------------------i--- 1 '-'s -&-1'-'•:•," ,..: This .........Z..?..; ____......_______ homestead property. .. •..- ..-s,,,;-'-'-:.,°=''-'---1-,'",--',,-'-`----'-(ito 'eid_Acrty• • ,,,•' ,,-,2; '---_-_...: '•.Exception to warranties: easements, restrictions and rights-of-way of record, f any I ..v.-.-"-7-.------------ ,----:------.=---2--- 1-5-ki-E--- day of Jul y , 19...../... I ------ I:i,,, , --,:1 s . , - (SEAL) X.. 7:14_.c.e...-.1-: .....C. 1.4...z.4..-44,4%.4....z,..4SEAL) « Mari)a e Cernohous ...,..... ;i7-- ' ` - (SEAL) (SEAL) 11 ... - - 11 • :••••'•.= : I Atrar.itENTIcATION A•CKNOWLED0111110FT,C= s .. I z• •F ' • i -! * Signature(s) STATE OF WISCONSIN i : s r,._-. • t , a • . cl, I ..,-, . . ll -.. .. ....je .`,... ik... . I! - St. Croix County. 11:- intlienticiba this day of ... , 19 Personally came befoee me thii-,-.,. .e,-r„..t,. ,day:Ist...• ---_--r-7----- _ July 4Le4_._`,Lam.....ii II II 1 Max_ii.an.a_ C_•?X_XIQb.Q.1.1,5 2 i , .. .... _-__11 _ ..=___„-_ ___ _ -- ----Trri,v: IVIDDIBRIL STATE BAR OF WISCONSIN II 11 II - - III not. , >: 11 - authorized by § '108.06, Wis. Stats.) to me known to be the person who executed the II -- fore . • i■ trument an. _ ' - - .:.„ __-■: ------ ' I I ------- - - I i. THIS INSTRUMENT WAS DRAFTED BY <... • ----- - I I 11 k Leo A. Beskar, Attorney RODLI, BESKAR & BOLES, S.C. *_____MicAlacl__K,__Qismald ' i II 24._9___Ilox_- _ _ .11..a.in Street Notary Public_S_t-....._..co_ix_. .... ou . ............... nty wig. 54022 I,- (sliihmres Kl*tlibduititlIticateu or acKnowledged. Both My Co is mmsion is permanent.(If rot. state expiration are not necessary.) date: June 24 . le .90.) •Names of parsons signing in any capacity should be typed or printed below their signatures. _ STATE BAR.ORM No.tvg WISCONSIN Stock No. 13002 ,..-ess!....rwwwwwFan F 2— nogg ww....... Vinseses1W.alia .4