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018-1020-80-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety 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) TANK SETBACK INFORMATION PUMP/SIPHON INFORMATION Manufacturer Dema d GPM Model Numb TDH Lift iEfion Loss System Head T Ft FofsemSin Length Di Dist. to W SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches DIMENSIONS --' -- -- _ - - INFORMATION ~_ DISTRIBUTION SYSTEM LL County: St. Croix Sanitary Permit No: 404982 0 State Plan ID No: Parcel Tax No: 018-1020-80-000 STATION BS HI FS ELEV. Benchmark SE + ,r Alt. B !~, ~. C.0 'r. ~ ~~ Qldg. Se~S~+P.~Gt.~~i / C . (c • ~ ~~• 5 Ht nlet ~,o(, , L St/ t utl t Dt Inlet ~~ Dt Bottom Header/Man. ~. Dist. Pipe ~ Bot. System ~ Final Grade X153 i h ~~ 7" a QYE'r ui (d ~ ~ ~- St over Z.~ Gf -~~ Z.~~1 r'~~_ ~? ~ nside LAKE/STREAM LEACHI nt. cturer: CHAMBER OR UNIT Model Number: HeaderlManifold Disiribut' n x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No 0 Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ! D / py Inspection #2: / / Location: 1828 Cnty Hwy E Hammond, WI 54015 (SE 1/4 SW 1/4 10 T29N R17W) NA Lot ~ ~_ Parcel No: 10.29.17.1566 1.) Alt BM Description = ~ ~~ ~~ ~~'~~+'~"~~ ~~ 2.) Bldg sewer length = 4 ~ I~ NO(/~ ~o ~ o~°'~- -{'~ ~ tJ~-S-Q-d ~ t ~ cfitL/~ ~ S C'(,L-'~ ~ ~OC0.~¢~ -amount of cover = >, o2,f -3'~`~ (~uT I.( ~tjtitJ 57,g-~iyr~ -}~ ~ l Y4~~ ~ Plan revision Required? [~ Yes No ,r-1 h ~ / /' Use other side for additional information. ~p ~ ~/ v ~ ~ ~~,1i7/(/t.-- lOtp Date Insepctor's gnature Cert. No. SBD-6710 (R.3/97) 'ermit Holder's Name: City Village X Township Johnson, Kenneth Hammond Townshi :ST BM Elev: Insp. BM Elev~ BM Description: l ~ !0~ ~ ~~ of - S~~t~ -ANK INFORMATION EL ATI~N DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration -~ Holding ~, V'~ i~~-~,J~/ ~ ~?(~~ TANK TO P/L WELL BLDG. Ve t to A' Intake 0 ROAD Septic Dosing Aeration Holding ` ~6l ~~~ / / / / !~(~ ~-fi~ ru ~rQ ~~a~ 3N H ~,~ ,~ ,~t° ~- Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division s INSPECTION REPORT GENERAL {NFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village x Township Johnson, Kenneth Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: C INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION PUMP/SIPHON INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well EVATION DATA county: St. Croix Sanitary Permit No: 404982 0 State Plan ID No: [Parcel Tax No: L 018-1020-80-000 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover SOIL ABSORPTION SYSTEM BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ! Inspection #2: / / Location: 1828 Cnty Hwy E Hammond, WI 54015 (SE 1i4 SW 1/4 10 T29N R17W) NA Lot Parcel No: 10.29.17.1566 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = ----- - I - ~ --r -~ Plan revision Re uired. I ~ Yes ICI No ` I --- - --- --- ~ i i ~I Use other side for additional information. I __ ~ _ i_ _ _ _ _ _,___ ___ ; _.,. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlrrench Center Bed/Trench Edges Topsoil I,;, Yes I No I I Yes ! No Il Safety and Buildings Division County ~, ~ 201 W. Washington Ave., P.O. Box 7162 ,~J= ` C>9Z' lseons~n adison, WI 53707 - 7162 Site Address De artment of Commerce ~. Jl E Sanitary Permit A plieation Sanitary Permit Number ~ ~ ~~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ~ ^ Check if evision ma be used for seco ses Privac Law, s15. 1 m I. Application Information -Please Print All Informatio RECEIVED Stag Plan I.D. Number rtr+~ . I D Property Owner's Name arse Number ~~~ ,~ . /,! /~/-~ 1~D ~ APR 0 -- -. roperty Owner's Mailing Address Property lion ST. CROIX COUNTY ~k;S ~ T N,R City, State Zip Code Lot Number Block Number ------ ~- Subdivision Name CSM Number /I/' ©/~ ~^ O J 7 7 /y~, ~i~p~y/ / /~~ / f ~ O (/~ I r~_ II. Type of Bttil g (check all that apply) ^Ciry ~ 1 or 2 Family Dwelling -Number of Bedrooms ^Village ^ Public/Commercial -Describe Use Township ~l~~, ^ State Owned ~ Nearest Road w III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complet line B app 'cable) A" 1~C New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Onl Exis ' S stem B. B Check if Sanitary Permit Previously Issued permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ^ Non -Pressurized In-Groube 21^ Mound 47 ^ Satxi Filter 50 ^ Constructed Wetland 22 ^ Pressurised In-Ground 41 ~ Holding Tank 48 ^ Single Pass Sl ^ Drip Line - 45 ^ At-Grade 4ti ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis rsaUTreatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Ele ado Final Grade Required Proposed Rate(Gals./DaysJSq.Ft.) (Min.JInch) ~ Elevation / VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel •Fiber ' Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks -9epeie~er Holding Tank , Dosing Chamber VII. Responsibility Statement- I, the undersigted, assume respo 'ty for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature it~RaIPRS Number Business Phone Number -- .d ~ ~i~~PO ~i~ =61~ r6~ Plumber's Address (Street, City, Sta ,Zip Code ~'~C 6~'1 '~~ Y~~ -~ pia ~ c ~F ~~ VIII. Count /De at'tment Use Onl ' ~gpproved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Owner Given Initial Adverse Surcharge Fee) ~ _ ~ Determination ,3~ ~' ` l_Y~ IX. Conditions of A rovaUReasons fo fr ~trapprov (` ~ -t- ~~ ~ ._p_ s~l~Lw9~- l'"'i c~ /W-61~t..1~ 'tuST~~-~a-G'~vt a-C ~ ~^' ~-- ci ~ _ .., ~. ~oi~S r D t.~ ~.v.~-` v,N~. ~n. ~ ~O fu^- po,~:~. ~ ~'o-`"'`.t"'Q'`.tsz_ ~i;.e.~C c cod-QO~ Attach complete plfw (to the Comte only) for the rystem oa paper aot less then alts s u inches m stu SBD-6398 (R. OS/Ol) • PLOT PLAN Scale 1"= ~ ~' L`gp~ g.3 Page ~ of ~ ~QLG1hJ~t, \~\'zUQuS~S? ~g~ ws;~. s P~.~tfit- irT t3. 1 ~. z L RwtJ 1~3oT~ 1'~ S ~?L''~2 ST. ~Q-~~Y- L°.oU1ti1M Z(w 1 n~G ~ ~p t`RU~ mil- NUWc~-ufi'~ ~ s ~'`~N"t?~ ~~ $`t ~~`CY'1LS 1? S~ ~ .. ~ C~-~`T~. N~ `3 0« `t"~5`f~- t~$ S012-~Y1 UrJ S'-1 StL~''? ~ _ -- 6 ~' or- ~ k P~,c -~ MT_ W~L.L ~ _ 3 ~W~1 l~1~1~, -' 1 LPrwN J ~ ~ _Q ~ N coNc. ~ Gi~z s u~3 Fr~~p ~ ~~ 1 ~ n ~~J f~ ~=~ezt~ f 'TU ~~. ~c1~1~oi~ R3 P~2_ CoD~ of e-cyv e~-~ SUiB ~~N ~pDCL~SS = Department of Commerce INSPECTION REPORT SAFETY AND BUILDINGS DIVISION Field Operations Bureau 13 East Spruce Street Chippewa Falls, WI 54729 www. commerce.state.wi. us Scott McCallum, Governor Brenda J. Blanchard, Secretary Date of Inspection: October 3, 2001 Project Name: Johnson Use: Replacement Residential Legal Descript ion: SE-SW-10-29-17W Site Number: 635322 Subdivision: NA Municipality: Town of Hammond County: St. Croix Plan Transaction Number: 671587 Sanitary Permit Number: Wastewater Ftow: 450 gpd Persons Present: J. Thompson, D. Fogerty, K. Grabau, K. Johnson Plumber Name and Address: Dave Fogerty, MPRS 221180 ~'~"~ '~ , i` PO Box 130 ` ~,'~ Roberts W 154023 i`! ,~^ ~ Certified Soil Tester Name and dress: '" ~ ~F7 James Thompson, CST 3~~'I1 340 Paulson Lake Ln '~ ~ sT~ ~, `'~ ~'~ Osceola W 154020 ~, ,~,,, , Owner Name and Address: Kenneth & Geri Johnson 1828 CTH E Hammond W 154015 „ , - ~ -r', i ~~ .. ,- , Onsite soils verification at the request of the installer and county to determine if soil conditions are suitable for mound system installation. This site was reported to be too wet to plow by the installer and a curtain drain was installed to help drain the site. The wetness problem prompted the installer to request an onsite by the county who reported redox features to be present in the A horizon. One soil pit located near CST B-3 was reviewed in detail and can be described as: 00-07" 10YR 2/1 sil, 2fsbk, mfr, cw. 07-16" 10YR 211 cl, 2m-cabk, mfr, gw. 16-20" 10YR 3/2 scl, 1msbk, mfr, gw, w/c1f 10YR 4/4 redox concentration. 20-42" 10YR 4/4 sl, 1 csbk, mfr, w/m2&3d 7.5YR 5/8 and 6/3 redox concentrations and depletions. Initially, in the soil's moist condition, no redoximorphic features were observed in the upper 16 inches of the soil profile. However, the moist black (10YR 2/1) matrix color could easily obscure iron concentrations and depletions, and may actually indicate wet conditions based on an accumulation of organic matter. It was noted that an air-dried sample (10YR 5/2 matrix) of this same material revealed c1 d 10YR 4/6 redox concentrations. Eased on the morphology of the soli and the requirements of Comm 85.30(2)(b) the estimate highest level of soil saturation is the ground surface. This determination effectively eliminates the site for mound system use. It is recommended that another area be evaluated for possible use. Until this issue is completely resolved and to prevent operational problems with the system the owner will need to use a holding tank after obtaining approvals and permits for such an installation. If there are any questions regarding this report, please contact me. er G. J sky Wastewate Specialis Ljansky@commerce.state.wi.us E-mail 715/726-2549 Fax 715/726-2544 Voice cc: [County ~ Plumber ®CST ©Owner ^ Other ,f .. ,r ~ ~ ~sconsin 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 Scott McCallum, Governor Philip Edw,.Albert, Acting Secretary a~' ,. December 26, 2001 _ r; f,,Fh i ~~~ CUST ID No.691727 ATTN: POWTS lnspect~r ~ '?" ~ 'ARTHUR L WEGERER '~ ~ ZONING OFFICE P >'~~,t;.-K'~F~ ~ WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY S IA ,~~?~U PO BOX 74 1101 CARMICHAEL RD` ~~ ~ RIVER FALLS WI 54022 HUDSON WI 54016 ` '~ CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/26/2003 SITE: Kenneth & Geri Johnson - 1828 CTH E St. Croix County, Town of Hammond SE1/4, SW1/4, S10, T29N, R17W FOR: Description: Three Bedroom Holding Tank Object Type: POWT System Regulated Object ID No.: 825011 Idenf. ca n N ers Transaction I_R .698 Site ID No. 639879 Please refer to both identification numbers, above, in all cones ondence with the a enc . 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99). • A meter, with remote reading device, shall be installed by a properly licensed plumber, on the water system, that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • 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. • Comm 83.52(3), Wis. Adm. Code -The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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/instal lation/operation. t Owner Responsibilities: ARTHUR L WEGERER Page 2 12126101 • A copy of this letter including instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • In the event this holding tank 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, 7:15 AM - 4:00 PM j swim@commerce. state.wi.us Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 WiSMART code: 7633 ~ ~ ~scons~n 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 -~cott ~IAeCaIlum, Governor December 26, 2001 CUST ID No.691727 'ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 CONDITIONAL APPROVAL PLAN APPIiOV.~L EkPiIi~;S: i2/2G/?003 SITE: Kenneth & Geri Johnson - 1828 CTH E St. Croix County, Town of Hammond SE1/4, SW1/4, S10, T29N, R17W FOR: Description: Three Bedroom Holding Tank Object Type: POWT System Regulated Object ID No.: 825011 Ide~~tification Nambers Transaction 1D No. 698941 Site ID No. 639879 Please refer to both identification numbers, above, in all comes ondence with the a enc . 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99). • A meter, with remote reading device, shall be installed by a properly licensed plumber, on the water system, that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145. l35 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. • Comm 83.52(3), Wis. Adm. Code -The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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. `; • nn~~ u_. A7TN: POWTS Inspector ; r~<~" r` r ~ ,1 ~/ f ,..t, its ° ~" ~-~f" ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD _. HUDSON WI 54016 ARTHUR L WEGERER Owner Responsibilities: Page 2 (2/26!01 • A copy of this letter including instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • In the event this holding tank 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 - [ntegrated Services (608)789-7892 ,Mon -Fri, 7: I S AM - 4:00 PM j swim@commerce.state.wi.us Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 WiSMART code: 7633 TITLE SiiEET ' fiolding Tank for This plan has been prepared in accordance raith the Holding Tank Component Manual SBD-10571-P(n.b/99). Page ~ of Located in the SE 1/4 of the SW 1/4 of Section l0 , T~~N, R ~1 W Totan of } ~-1~yv~p~~ , ST'• C1ZO1X , County, ~•Wisconsin. RECEIVED DEC 2 1 2001 Page Page 1 2 of of 8 8 TITLE SHEET MANAGEMENT PLAN SpFET~(& gLpGS D ~'~~ Page 3 of 8 USER'S MANUAL a;~ Page 4 of 8 AGREEMENT Page S of 8 SERVICEING CONTRACT Page 6 of 8 INSPECTION REPORT- LEROY JANSKY .Page 7 of 8 PLOT PLAN Page 8 of 8 HOLDING TANK CROSS SECTION. PREPARED FOR w,TS• - ~ _l~ ~n l~onalty Rav~v L~E3_r_~1_~0 ~..,o , w_~_ _ -s_~ta ~RTMEI~'[ OF COMMERCE pEP g11-LW pIV1S~ON • . SEE CORR~ PREPARED BY ~''`jEG~RER SL7I L . TEST = NG n~~~~~e2a~ TT~ TT ^ s~ f ~ x ~ .. t1~ L~S i GPI S~ . ,.,..~... ~, <g'~'lr ?tC RV~CE P.O. Box 74 421 I1.~fain St. ~,k ` 7"'~_,, ~~~ River Falls, WI .54022 ~; u ,~~~,,. ' . Phone 715-425-0165=i` ,~:•. ..~~`"`y `~ Fax 7I5-425-6864 G~O~• , . , ~,' ~~ I ;~ ._ ~~~ . _ - - - tZ- Job :~o. O~-ZO$ Holding Tank tianagement Plan " Pursuant to COtli~i 83.54 T~7is. Adm. Code Page Z of g GENERAL The system owner is responsible for the operation and maintenance"of.ahe system, locking device, alarm, water meter, and access for tank servicing. No vehicular traffic is allowed over the tank.. The tank must be serviced by a licensed pumper and the contents to be disposed of properly, Do not enter the tank as dangerous gases may be present. ' CONTINGENCY PLAN Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at _ -1 ~S - 38 6 - y ~j~Q S`T"- C20 LX The system installer at _ X1.5 - 635-~160Q F-C~G~Z'~-/ " The tank manufacturer at $pQ_ 32,S-B~S~ ~l~~lZ " If the tank or any of its components became defective the defective tank or"component shall be repaired or replaced to keep the system in proper operating condition. Abandonment. If the tank is no longer used as a POWTS component, it shall be abandoned as per COMM 83.33. PSG ~ 3 o F 8 Holding Tank Users Manual A copy of these plans are to be given to the owner, and this information reviewed with the owner. Meter installation. A water meter, ~P~20~®model is installed on the water supply discharging to the holding tank. All exterior hydrants are excluded from the metered flow. The meter is installed downstream of all point-of--entry treatment devices. A control valve is installed on each side of the meter. The meter may clod with sediment and be in need of service on a regular basis. The capacity of this systems holding tank is ZSDO gallons. Under full estimated daily flow of ~1 S 0 gallons /day, the tank will be full every 5 : ~S days. Water conservation measures including the use of low flow water fixtures will extend this time frame and are recommended. If this tank is no longer used as a POWTS component it shall be abandoned by complying with COMM 83.33. Alarm installation. The alarm float is set to turn on the alarm when liquid volume is at 12" below tank invert or at 90% of the liquid capacity of the tank below the tank inlet invert. Alarm wiring is installed in accordance with NEC 300 and ILHR 16.23, Wis. Adm. Code. The float may become fouled in floating scum rendering it inoperable. This float assembly should be inspected at each plumping. The owner agrees to hire a pumper, licensed under Ch. NR 113, Wis. Amd. Code, who shall submit to the governmental unit and the county on a semiannual basis, for the servicing of the holding tank. The owner or owners agent is required to submit reports as required by s.Comm 83.55(1), Wisc. Adm. Code to the county or other appropriate jurisdiction and /or the department. The owner is responsible for the operation and maintenance of the system, locking device, alarm and access. Names and phone numbers of local health authority, component manufacture or POWTS service provider to be contacted in the event of component failure or malfunction. POWTS INSTALLER Name; ~_L3 • ~ G ~1Z'r'`'1 Phone Number: ~ t S _ 635- °16 0~ POWTS MAINTAINER Name: Phone Number: PUMPER Name; b'Ac'~Z2~LL. ~~t`y.~ Phone: 1 l 5- ~l 2.~ _ 1 u ZS LOCAL REGULATORY AUTHORITY Agency S1= C~Z.q ~K- C.oU N1'y Phone: -11 S- 3 C3 6- y 6 8 C~ ~, Agreement Date HOLDING TANK AGREEMENT rn;s spice ~~s~rvea ray recora;ng e,~, 1 ,L -~.~ -O1 ~ VII. ~ (80PAG[ ~0 ~~~ ~ Of-~' County or Local Government Unit Holding Tank Owner(s) G~Z.~ G • ~L~'")IJSOIV Return to: ~~j ~~~-X1S HIV (Referred to as municipality below) ti$Z~ Q~ ~~ ~ w S 6 5 We acknowledge that application is being made for the installation of a holding tank(s) on the following property, (provide legal description): vp~„ ,'lq$ PS ~-~'S SOC. ~ ~13-Z43 lam' war ~. s o ~e~r aF '~ ~rw 4$ ~ ~f o-= ~` SE <<~o - 5'w ~~y 3~0-~ 10, T Zpi N ~ R l`lw, 1~wrv c7-- ~~p>v~t S1": r¢,e~Uc ~Y~t, i.,~ls ~S1N . As an inducement to the County of S-j' , CE? 0 t)C to issue a sanitary permit for the above-described property,, "e agree to t!:e fo!!o~~:. '~b• 1. Owner agrees to conform to all applicable requirements of Ch. Cotnm 83, Wis. Adm. Code, relating to holding tanks. If the owner fails to have the holding tank properly serviced in accordance with s. Comm 83.54 (3)(c), Wis. Adm. Code, or in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14 Slats., the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Slats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assessment for the abatement of a nuisance, acid the tax shall be collected as provided by law. 3. The owner, except as provided by s. 146.20 (3)(d), Slats., agrees to contract with a person who is licensed under Chs. NR 113 and NR 114, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contractor the owner's registration with the municipality and with the county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Chs. NR 113 and NR 114, Wis. Adm. Code, who shall submit to the municipality and to the county a report in accordance with s. Cornm 83.55, Wis. Adm. Code. In the case of registration under s. 146.20 (3)(d), Slats., the owner shall submit the report to the municipality and the co~nry. ~. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) (Print) ~-~~N~~ S, ~7t ttkl SO Owner(s) Sig re s) 1~ ~y r ~~'~~~ Subscribed and sworn to before me o is date: ~(~ 2 ~~ G G . x`2-1 ~U mvSoly ~, ~~,_ Gt,~'Si~~~ ~ Municipal Official Name and Title (Print) Municipal Offic' I ignature (Notary Public) My commission expires: den ~ ~ ~~ ~`~c f c rS o n ~~~ ~wri ~ ~ ~ ~~ ~/o C~.~-rmQh a~~awn~'~-~th Aar R 9/00 1-~r~j~o 1N G ~1-c i~-Gt~~.~-vT_ •~ _ Doeumatt Tide . Y~1.1788~ ~~ ); . _' 664'94 ~~,y • I',A~THLEEhI H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12-12-2001 4:30 Rtt HOLDING TANK AGREEMENT E?(E~iPT # CERT COPY FEE: COPY FEE: 3.04 TRANSFER FEE: RECORDING FEE: 13.00 RAGES: 2 RecotdiagAra Name aad Rehtro Address 1$ Z $ ~.ou N `rt ~~ L `` l`~1~1-ti!U>y~,1,y I S X101 S d~a` 1uZ0 - X30- 000 Parse[ IdentitIcatioa Number (PIIh This infbrntition must be t:ompleted by submitteri doeumeni title: name A return addrrss. and per{ (if required). Other information such u the =ratttin` clauses. legal description, etc. may be pieced on this Oat page of the document or may be placed on additional pages of the document. -~; Use of this cover page adds one page to your document snd 12.00 to the reeordint fee. Wisconsin Statutes. S9.<3(2m) WRDA ?J9~ { ~ HOLDING TANK SERVICING CONTRACT ~~G~ S Q~ ~ Contract Date /a - ~ ©~ This contract is made between the _ _ _ _ _ _ _ _ - - - and i Pumpers Name Holding Tank Owner(s) Name(s) We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) ~~e ~ 43l ~y-~ ~, L . -l aS ~ ~ ~ ~ '~ ~S --------------------------- ~ ,~ s si ned tl~e umpir~g &~reeiilcilt 1. The owner agrees to file a r_of+y of this contract with the lecal geverrm..n. I unit that I;u g P' S'T" ~ CCU 1X a9 , as :and with the County of er to have access and 2. The owns>r agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pump to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding oldka )t nk(s) as mutually agreed upon by the ownehand pumpe~ Pay the pumper for all charges incurred in servicing the h 9 3. The pumper agrees to submit to the loca- governmental unit which has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis.... The pumper further agrees to include the following in the semiannual report: , a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; _. c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume i sites to which the contents from therhold ng tanks werendeliveredh servicing; g. The drsposa 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service cont: act or a copy of a new service contract with the local ovemmental unit and rti~e County named above within ten (10) business days from the date of change to this service contract. 9 Ovm~er(s~),N\ame(s) (Print) t Owners Signature(s) SOS S~)v i ~~'~~ I I G ~~ G . ~-CG t~ S OtV j I Pumpers Name (Print) I ' °""~" '" r .;_ r i Pumper's Registration Number ~a ~~ Subscribed and sworn to me on this date: ~~ ~ ~ ~. Todat/s Date 1 Notary Public Signature oAV~o w+u.~a+s Notary Public Pierce Co. WI SN1y Commission Expires 7.3.2005 Comm.'tssion Expiration Drafted by ~-~U~~" L ~ w~ ~Z~~ 11i15i2001 09tS3 FROM F~9erty P1b9.iP.T. Inc. T0. 17:54256864 INSPECTION REPORT .~ Dapsrtment of Comore •cs Date of {napection: Oc ober 3, 2001 Project Name: Johnson Use; Replacement Resic entist t.syal Dascrlption: SE SW-10-29-17W Sltn Number. 835322 Subdivision: NA M+sniclpaltty: Town of Nf mmond County: St. Croix P.01 PPrG C '6 0 ~ E SnFSrr aaD suaatHas olvlslot~t Field Operatrons 6u-eaU 73 East Spruce Street CtupoeMra Falb, WI Qd729 • www.canmerca.stats.'~ri.us 5oaB NkCalirn, Garerncr Brenda J. stanchaM, Sccntary Plumber Name and Address: Dave Fogerty, MPI~5 221180 PO t3ox 130 Roberts Wl 64023 Certified 8oit Tester t+tarrte and Address: James Thompson, CST 38021 340 Paulson Lake Ln Osceola VNl 54020 Plan Transaction Number 871387 Sanitary FNlmtit Number: Owner Name and Address: .~•,-- _-., ___;..____- _ Kenneth & Geri Johnson ... -- Wastewater t=1ow: ~45t gpd - f828 CTH E . . . ~ ~ ~~stong Praso»~ J. i hornpson; D: Hammond. WI 5401'3 ~ ~ ~ ~" ~~ . f~c9erty, K: Gra~beu, tC. Johr son Ons~e sots verii3catton at tt a request of the installer. and county to: determine rf sot conditions are suitable for mound system i >,.tallation. This site was reported to be too wet to plow by the installer and a c~riairr dram was installed t+ ~ tleip drain the site. The wetness problem prompted the installer to request stn onsita by the county whc reported redox features to be present in the A horizon. One soil prt located near CET &3 was reviewed in detail and can be described as: 00-07" 101!8 2/f si€, 2fsbk, mfr. crv. 07-1 fi" 1 QY.R 211 d, 2m-ca! ~k, rnfr, gyy. 1t3-ZO" ~ 10YR 3/2 sd, lmsb r, mfr, gw, w/C1f 10YR 4J4 redox c~ncertration. 24-42" 10YR 4/4 s1, 1 csbk, mfr, w/rrr2&3d 7.5Y1~ 5!S and 813 redox concentrations ar-d depletions. InitiaJiy in the soil's moist a edition, no redoximorphic features were observed in the upper 1 & ktches of the sn~ proles. However, th ~ moist black (10YR Z1) matrix color could easily obscure Iron ooncentratlons alit deptet{ons, and may aC uatly indicate wet conditions based on an accumulation of organic matter. It was noted that an a~-dried :ample (10YR 5/2 maMx) of this same material revealed ci d 10Yfi Mt3 redax concentrations. ... Based on She morphology o: ~e soil snd'3te requirements of Comm $5.30(2)(b) the estimate highest level of soil saturation is the Ground surface. This detertnklation etfiective{y efimirlatos ~e site for mound system use. tt is recommer fed that another area be evaluated fix passible use. Clntli this issue is completely resolved and to ! prevent operational problems with the system the owner wilt need to use a holding tank after obtaining rpprowals and permits for such an installation. !f there are any questions re 3arding this report, please contact me. r c. J sky .~ 1A1 SpeCi~llS !_}ansky~commerce.state.w :.us E-mail 7151726-2545 Fax 7151T26-2544 Voice Cc: 15aCvunty ®1 ~lurrtber ®C$T ©Owner [] Other TOTP.L P.01 --=---~OL~11~TG-_T'~?jJ~rc.-CP:a-SS-= s-e~o~ -----T'prs~-~g -or=--$- t:over with warning label box /and lock if access opening 1s greater tban 8 inch die. d" min. above surrounding grade or 2 n aboa/e tstabllslted regional Aaod elevation, unless access pori is water aad gas tight I---i ~~ 5~, . Vent ~ti~Stt~~ 6~~~~ 8 inch rnin. d rower source Building sewer Maximum alarm on level sat at t2" below tank inlet imrert Alarm Ooat orgOX oithe liquid capacity of ffie tank below the tank inlet lmrett ~i~e~:r'IIJ,i_;3" S~~C7vG .U~L~_'n'~'T~tt•{ --_._- I. Be installed is the water suPPIY system so as to ex- clude the supply to those water outlets, such as exterior hose bibhs and wall hydrants, which do not discharge to the sanitary drain system: and Z Include an accesdble remote reader device located on the exterior of the building or structure. TANKS New X Existing Menu a~er:_W~ ~~~"jZ ~.01~1C(Zk'~~ Tank Size: Z S O 0 allons ALARM Manufacturer: S :S. ~L~,L'~t-p SkS`r>~9 Model Number - W Switch Type n~~-~,~~-LY NUMBER OF BEDROOMS: 3 GALLONS PER DAY: ~I. SD . . '' ., • PLOT PLAN Scale 1"=4~' ~1, S p ~ Page ~ of _. $.3 ~- ~Q-LGLNIn. \~~~cipuS~D r'lWr~ ~c' t~ ~E~(L~1w1LsD L~~! S,~ws4z`t - / ~-3`I~ WR`TL'R S Pt~.lt'rt- lST ~3. 1 r6 $_z ~ Rwt~l ~o ~~~ .$`~ '1,L.S l'1..4~ Ste, _ . _ _C~1Z`T1 ~1~._ 3 oL. `Z~`fLS)Z. b o' or ~- ti Pve WEt ~ 0 C O '~ N ~~L~ ~` ~i ~~ ~~~-~1~ !~~L~ 'Tb L~ ~lvDOt~ R~ P~ CoD~ of °L(~t1 ~~~ Sl.t~$ LAN ~pD1Z~,SS ._ .............. ,, ~. e-7~4 - -~----- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownerff~npcr Mailing Address ,~ p~ ~ Ceti ~lv r Property Address S~3ml~ (Verification required from Planning Department for new construction) City/State /~ihdtdif//' u2' Parcel Identification Number ~/~ ~f~~ Sao ~ ~~ LEGAL DESCRIPTION Property Location S~ '/,, ~ '/,, Sec. <O , T_~N-R~~~~, Town of /J~YO~~. Subdivision ____ ,Lot # ~'- Certified Survey Map # ,Volume '~- ,Page # `- Warranty Deed # y3~7y3 ,Volume 19,5- ,Page # ~~S^ Spec house O yes ~J no . Lot lines identifiable ~ yes O no SYSTEM MAINTENANCE 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 Bumper. 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 of 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 Resource, State of Wisconsin. Certification stating that your septic system bas been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days.~f the three v~ar Pyr~Mti~~ a-•- ~ '. _ ,,, - 9 ~ /g ~ ~~ SIGN OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. the pro erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT I (we) am (are} the owner(s) of / / 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 • ~ Safety and Buildings Division Washington Ave., P.O. Box 7162 201 W Cry .- ,~ ~ ~ ~ . S,~ Madison, WI 53707 - 7162 Site Address ,S~~~ ;~, De artment of Commerce ~ Sanitary Permit Number ~. Salutary Permit Applic ._ In accord with Comm 83.21, Wis. Adm. Code, personal ' o ou provide ` Q Check if RevisioK~ ma be used for seco ses Privac 1 i ~ I. Application Information -Please Print All Informati ~~F State Plan I.1)!Ntunber 7. /~/ ~ /1 C'r ~7 , p~ ~,~. 's Name Property / r Parcel ~ / / / ` `;, 2,~ k `` Property 's Address ;~~;;` ~ petty Location r ,~ ~ ~, 4~d yt 54: S T N, R .. City, State Zip Code . ~ ~P,hono Number , ~ ~, Lot Number Block Number ~ •~ • , / ~ Subdivisiod Name CSM Number -=~::__..~--~ ~~~ ~ ~s ~ ~ G- ~~d -- II. Type of Bull ' (check it a ly) ^City , 1 or 2 Family Dwelling -Number o~'~litiroo ^Village ^ public/Commercial -Describe Use ~~ ^ State Owned ,f _ r , , III. Type of Permit: (Check only one box on ~& A umbel'irlg,,schelne for internal use ~ ~Gnt ~ ( if ~/ ~O" A' I ^ New 2 ~ Replacement System 3 ^ >: lace fi# 6 ^ Addition to F' ~ ~ ~ t J~ ' S stem i M E r s S stem Tank O ^ Check if Sanitary Permit Previously Issued Pe ~~~', ~ B ~ ~C ( ~ . I ~ ~ r l~ i ~ IIV. Type oP Permit: (Check all that apply)(number~ig scll~tge is ter internal »se) . - 44 ^ Non -Pressturized In-Ground 2~Mound ;, 47 ~' Sand Filar - 50 ~ Coastruc Wetland 22 ^ Pressurized In-Ground 41 ^ Holdiyfg Tank Ag ^ S' " e Pass Sl ^ Drip Line .. 30 ^ O r ` y 45 ^ At-Grade 4ti ^ Aerobic Treatment Unit 49 fl Rec• sing V. D' rsal/Treatment Area Information: ~ P Sy leva6on / Final Grade Resign Flow (gpd) Dispersal Area tspersal Area it A tioA ('l ~ Elevation Required ;proposed ./Da t. /P~ ~ ~ ~ ,.,, ~ ; YI. Tank Info pacity • Total Number Manufac r Prefab Site Steel Fiber Plastic crete Cottsuuctcd Glass C ~ Gallo Gallons of Tanks ~ . New ' tiaY Tanks Tanks Septic or Holding Tank ,~~ ~~' x f Y IbaioS Clamber ~ ~J VII. Responsibility tement- I, the undersigned, assume respo ility for installation of the POVVTS sho~4,on the a ed plans. Plumber's Name (P ' Plumber's Signature 'lvfPFIvIPRS Number Busines horse Number ,: Dl'~,t s i ~d - i.; -63~ =960 Plumber's Add ss~YStreet, Ciry, State, Zip e VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater ^ Approved ^ Disapproved Surcharge Fee) ^ Owner Given Initial Adverse Determination 1X. Conditions of Approval/Reasons for Disapproval Attach oompdde plena (to the Date Issued Issuing Age for the ayatem oo paper not leu thee 51/2 :11 lachea fn dze +dignature (No Stamps) SBD-6398 (R. OS/Ol) .. ~ ~- 5.2-2_ ~.-~-~ ~ 1315 ~~ . S~ -- ~ SOIL EVALUATION REPOR ~~+Ri~ ' Page of 3 Wisconsin Department of Commerce Division of Safety and Buildings ,,,,.,,,.a~,,,,e,,,;~h r.,.,~,.,, n~ ~nr~ nor„ rrvlEa A.C.E. Sal & Site Evaluations - ---- - -- - County Attach complete site plan on paper not less than 8'/: x 1,1 inches in size. Plan must St. Croix include, but not limited to: vertical and horizogtattasfe~en~~ pOinE(@M), direction and Parcel LD percent slope, scale or dimemsions, norttx ~n~locatioh ndrdistance to nearest road. ~°~°~ ~ . 17 1566 29 00 ID#10 80 020 ~ . ~ ~ ~, . . . - - 018-1 Please pri-iti'~i~iormaiy n. ' ~; ,' , `, ~ Reviewed By Date ~ rlvacy 5w ~ 15.04 (1} (m}). Personal information you provide ma~/tiibseb for secor~ i ~.' Property Owner f •-. ~, ~:_. Property Location Kenneth J. & Geri G, Johnson ~ ; ,Y ~.1 ~~' :~ i`r ~ ovt. Lot SE 1/4 SW 1/4 S 10 T 29 N R 17 W Property Owner's Mailing Address t --? S T ,.~Crx 1~~ ~ of # Block # Subd. Name or CSM# 1828 Co. Hwy. E : ~ C.ourv ,' `` City State%Zip•C ~ City .,~{ Village Town Nearest Road Hammond ~' WI ~ - Hammond Coun H . E r ~ r~ ti ~ ~ T New Construction .'Use: r' Residenti of bedrooms Code derived deli n flow rate 3 9 600 GPD Replacement ~ Public or commercial -Describe: Parent material loess over glaCi~. outwash Flood plain elevation, if applicable na General comments and recommendations: System elev. = 96.37' at 26" above 94.17' contour. Additional sand fill needed to compensate for 4" contour irregularity at center of proposed mound contour. a Boring # -~ Boring Pit 10" i Ground Surface elev. 95.77 ft. n. Depth to limitir~ factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' 1 0-5 10yr3/2 none sil 2fsbk ds as 2f 0.5 0.8 2 5-10 10yr3/3 none sil ithinpl ds as 2f 0.2 0.3 3 10-17 10yr4/4 mif7.5yr5/8 sicl imsbk dsh cs if 0.2 0.3 4 17-22 10yr5/4 m2d7.5 y r5/8 scf Om dh cs if 0.0 0.0 5 22-26 7.5yr4/6 5~ yyrr m2d10yr6/ 2 sl & gr. Om dh tw if 0.3 0.5 6 26-41 7.5yr4/6 mm d10yr6/ ~ Is lcsbk ds - - 0.7 1.2 Boring # --~ Boring ~ Pit Ground Surface elev. 93.62 ft. Depth to limiting factor - 16" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 1 0-10 10yr3/3 none sil 2fsbk ds as 2f 0.5 0.8 2 10-16 10yr4/4 none sil 2fsbk ds as 2f 0.5 3 16-22 7.Syr4/4 c1d7.5yr5/8 sl 2fsbk dsh cs 1f 0.5 0.9 4 22-40 10yr6/1 m3p7 5yr518 & m-2d10yr6/2 scl Om dh cs if 0.0 0.0 5 40-52 7.5yi^4/6 m2dlbyr6/2 sc Om dh cw 1f 0.0 * Effluent #1 = BOD ~ 30 < 220 mg/L and TS >30 < 150 L * Effluent #2 = BODS< 30 mglL and TSS < 30 mg/L CST Narrte (Pl~se Print) S nature: CST Number James K. Thom son 3602 Address A.C.E. Soil 8c Site Eva-uatior>s Date Evaluation Conducted Tel~hone Number Osceola, WI 54020 9/26/00 715-248-7767 f property Owner' Kenneth J. & Geri G. Johnson ____ Parcel ID # 018-1020-80-00, ID# Page 2 of 3 Boring # Boring { Pit Ground Surface elev. __ 93.45 ft. Depth to limiting facto 13" in. Sq7 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E~IGPDIf E 1 0-8 10yr2/1 none sil 2fsbk ds as 2f 0.5 0.8 2 8-13 10yr4J2 none sil ithinpl ds as 2f 0.2 0.3 3 13-14 10yr4/2 mid7.5yr5/8 sil imsbk dsh cs 1f 0.2 0.3 4 19-24 7.5yr4/4 m2d7.5yr5/8 scl icsbk dh cs if 0.0 0.0 5 24-36 7.5 r4/6 Y m2f7.Syr5/6 & _ m2d10yr6/2___ Is & gr. ___^ imsbk ds cw - 0.3 0.5 Boring # ~ Boring - ~ Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 ^ Boring # -:-~ Boring h to limitin factor _ in. ~ Pit Ground Surface elev. ft• ~ g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD ~ 30 < 220 mglL and TSS >30 < 150 mgJL * Effluent #2 = BODS < 30 mgll. 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. i , } ~~ ~,. 3aF3 ~ a3 ~iry ~ Ge./"i ~~.+Son p~o~4. SELy S~yy Sec. ~a, T, o f /-/arnrnond~ S~-~'~1oiXC'a.~t.J~. -dal ~ou~ .~; eld ~a w n I~ ^ So,% 465a~'tk~v~ P: t ~ ( • ~ledafiOr~ ~1 SCa~~,: / s S,(D , o ~o' yo' ~~--- iio g2 A/d • 6.wt.: Togo o,C' 3/b' `,` Q Qpp~aX. /ocaibar, of Ll.~ bk~~; ed ~/~c. /~.cc a.,r~~~ ~~~ ,._---. ~ ° Cone. Po,.'~:o ~ / ` \~ cp~ i ~~~ t 2Xi36:n ~ ~ lencrv~C 3 6.cd~~,~, ~ ~aro9~ S In6 rcSidertc¢ ~ a 6 3 w .~ ~d ~- ¢„CiS~i+~q ~o;/ ab so~~ot:or, ceGL _aa.nchivlar'~: ToPoFC'on¢• AsSc~,Ked elegy; = iuc~.~. ~.?a ~`- yS0 33' ,E ., ~. NwY Qe~ #i.~is CT TOWN OF HAMMOND ST CROIX COUNTY SEI/4, SW t/4, S10, T29N, Rl7W FOR: DESCRIPTION: FOUR BEDROOM Mf~UND SYSTEM OBJECT TYPE: POWT SYSTEM REC314ILATED OBJECT ID NO.: 809847 Safety and Buildings • - 4003 N KINNEY COULEE RD „ n i to CROSSE WI 54801-1831 ,~~0~~~~ ~~ ~t~' ~ TDD #: (608) 284-8777 ~' ~~nnnrw.commercestate.wi.us/sb Department of Commerce .~ ~ ~/ www•wisconsin.gov Scott McCallum, Governor p Philip Edw. Albe Acting Secretary ^~ ~~ ~ ~ September 10, 2001 ~ t ~ ~ ~ ~ ' /` ~ -~-.~.. CUST ID No.691727 `~~ ~~ A7TN.• POWTS Inspect ~ ~ ~~~~ ~©0~ 1:- ~ ~ ~ ~ ~. ~ _ Q ~ ARTHUR L WF~GERER ~J'~ ` ZONING OFFICE ..-~ ~ ~~~t~' , WEGERER SOIESTING & DESIGN SERVICE ST CROIX COUNTY S ~ ~:~' 6 PO BOX 74 ~S~ 1101 CARMICHAEL '' '~ RIVER FALLS WI j22 HUDSON WI 54016 6~-j.., ~~ ,, `• ~/ ,, r ~- , CONDITIONAL APPRC~yAL ~ i? ~ ;' 4~ PLAN APPROVAL EXPOS: 09/10/2003 Identification Numbers Transaction ID No. 67IS87 SITE: ~ Site ID No. 635322 KENNETH & GERI JOHNSpN Please refer to both identification numbers, H E above, in all corresaondence with the agency. The submittal described above has been reviewed conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has beemC01'I~JITIONALLY APPROVED. The following conditions shall be met during constructioA or installation and prior to occupancy or use: • This system is to be constructed.and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-1069(-P (N.01/Oi) and the "Pressure Distribution Component Manual for Private bnsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P(N.01/0l). 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and section V 1 of the pressure distribution component manual ate complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. - • Access to the filter for cleaning must be provided per Comm 84 product approval condititiirs. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The mound area must be deep chisel plowed to help break up the platy soil structure that was reported at the site. The county may, at their discretion, request verification of the plowing prior to continuation of system construction. 1 r ARTHUR L WEGERER Page 2 9/l0/01 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, 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. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Cotnm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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. Slats. • inspection of the private sewage system installation is reouired. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2xd), Wis. Slats. 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/instal lation/operation. [n 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 slats 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. Sincerely, ~~ Charles L Bratz POWTS Plan reviewer II- Integrated Services (608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM cbratz@commerce.state.wi.us FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: KENNETH JOHNSON isconsin Department of Commerce ~• u y +< s ~l !_. ~' S~Q 5~ ,,~~`~~G'~ ~ September 10, 2001 CUST ID No.691727 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN PO BOX 74 RIVER FALLS WI 540 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: SITE: ~ KENNETH & GERIJOHNSON CTH E TOWN OF HAMMOND ST CROIX COUNTY SE1/4, SW1/4, S10, T29N, R17W ~, FOR: DESCRIPTION: FOUR BEDROOM OBJECT TYPE: POWT SYSTEM 8~f~ ~~ 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 Scott McCallum, Governor Philip Edw. Albert, Acting Secretary A7TN.• POWTS Inspector -- -- ZONING OFFICE ~E E ST CROIX,000NTY~PIA 1101 CARMICHAE RD ~ UDSON WI 540'6. „\ i03 ,~pr' ,~~ Identifi , l7 _ Transaction ID No. 'Site ID No. 635322 Please refer to both ~, ~ above, in all comes ' ~~ 4~' ~. MOUND SlxSTE~ /' BJECT ID NO.: Numbers 587 identification numbers, ~ndence with the aQenc~ The submittal described above has been reviewed for confo ce.,~vitltappl ble Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been COND[T[ON~LY APPROVED. 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 erl losed approved plans and with the "Mound Component Manytil for Private Onsite Wastewater Systems V~~tSION 2.0" SBD-10691-P (N.OI/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N<b 1101). ,~ • In the event this it absorption system or any of its component parts malfunctioris,so as to create a health hazard, the pro erty owner must follow the contingency plan as described in the ap oved plans. In addition, the owner must ' sure that the operation, maintenance and monitoring duties as described'' section V[II of the Mound m ual, and section V[ of the pressure distribution component manual are comp ' d with. A copy of this letter in ding instructions and information relating to proper use and maintenance of the stem must be given to the caner and each subsequent owner upon completion of the project. • T existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. - • Access to the filter for cleaning rnust be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the .filter is required • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The mound area must be deep chisel plowed to help break up the platy soil structure that was reported at the site. The county may, at their discretion, request verification of the plowing prior to continuation of system construction. ARTHUR L WEGERER Page 2 9/10/01 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, 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. • Comm 83.52(2) A PO WTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer.. • 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 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 instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state slats l O 1.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. [nquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Charles L Bratz POWTS Plan reviewer I1- Integrated Services (608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM cbratz@conunei-ce. state. w i. us FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: KENNETH JOHNSON TITLE SHEET ROUND SYSTEi~i FOR A ~ BEDROOr1 RESIDENCE This plan has been pre Manual SBD-10691-P and (N.O1/O1) LOCATED Ii~1 THE SE 1 /4 TOWi1 OF ~WIWlp1V~1 Page \ of -] pared in accordance with the Mound Component the Pressure Distribution rlanual SBD-10706-P (N.O1/O1) OF THE Sk.1 1 /4 OF SECTION !p , T ~ N, R !7 [+1, ST-CQ.p `X COUNTY, WISCONSIId. INDEX RECEIVED AUG 2 4 2UU1 SAFETY & BLDGS DIV. PREPARED BY PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTE%I I-IA~IAGEi~1EVT PLAiv' PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAiv VIEtl-CROSS SECTIOIZ PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUr•1PING CHAl1BER CROSS SECTION PAGE 7 of 7 PUMP PERFORI.4Ai~1CE CURVE PREPARED FOR WEG ERER SOIL .TEST = N G AND . • DES ~ GN S~RV = CE P.O. Box 74 421 id.ilain St. River Falls, [dI 54022 Phone 715-425-0165 Fax 715-425-6864 ~•y •'~ .4RTr!.,1M ~ ~"k: iiE:Pi;H t Ollig f• ^r-_t.i~wiu~n.. wrs. . $ ' ZZ''A ~ _- ,roB rro . 4 t -ZA8 Mound System Management Plan page Z, of Pursuant fo Comm 83.54, Wis. Adm. Code • 7 Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be 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. 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, Safety and Buildings Division. 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 sail 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 far frost protection. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG. 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 it 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm.-Code, and shall maintained in accordance with its' component manual arid local or state rules pertaining to system maintenance and maintenance reporting. 5$D _1~6R1_P CNOI.~oI~ No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed ' unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continoencv Plan . If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump,. pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it wilt be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at _ ~, LS _ 3 g-Io _ ~ (~$O ~T- e-~,~ LX The system installer at -1.1.5 - 63$- ~b0 ~_ F'p G ts`iZT'~-1 The tank manufacturer at 800~3ZS-S~E.S6 !.V(,~~ The effluent ,filter manufacturer at $-Op_Z.Zj.S-1~.Z Z/'~'~CsZ The pump manufacturer at - `630 -~~-- ~[$~~ tj0~1~-DS • PLOT PLAN 7 • •Page 3 of , Scale 1"=L~~' ~~ Lp•r- L.1 N~ ~l SO ' EL °L3 s ~'~ q5 ~ DO IJ~T Cll-'~'P+~T \ ~~ ~ ~~ o~ D~S~i~ 1~ S ' PrvztTA ~uT_C.~._ __ ,~o h PLg1~1 h~1 ourvn s t`i-~, ~ ~ ~3u b~,p `tU E3 R-~~-Vc- l~P fjrJ~l , tn.q,sy -~ ~ s~ J t_ A wYv . C~p'..~ o~~LS'Pr.IG y'~~u~CD7jvG S~1ti1L~. - 2~P~tT' w t`fN --~k [wC . t-X1.12, t-IYV~~ ~ \ \ ° pe~.'r't0 ,' ,~~ 3 @~ ~ , e~.,e _ -~+•.,w-~ I Gtm s~ ~"~ A • \ .- ,a,~-1 •~°"~ U ~ v I o~5 ~~ g. Z,"--110~~ --s a ~ 9.y, -z' r ~. , ~, ~A~T_. 0 O' `7 ~ ~ 1 -1'i-i ~'SC.~.S~N 6 ~ I O\Z.PrtN FI~zLO ' i L \~ ~C`NAU-J~1D -~$' `~~ ~ccs ~;~,~~} ~~ ,: ~~ L~ t=-t~-~ o-3Mi~ l ~ CT1~n ~ ~, 'ar'1- tsL, l00•p' ON °vOn1C`.1~$ Sl.P~3 _ >• ~_ J ~;.;. 0 J Page ~ Of 7 P_pproved Synthetic Covering QSTi:~1 C33 Mediun. Sand ' ~ Topsoil ~ • ~;.: ~/_. II i "' ~ 3 E %• Slape ' Distribution Cell of .. 2" to 2 Z" La;reoate Undisturbed _ Soil Distribution Pi .~ H -~' - ~~ D' • ~~ ~ 'r " ~ i 1 i G ;~ Elev',~ (~, ftZ Force Main ~ Plowed From Pump Loyer D Z-11 Ft. E 2.$q Ft. Cross-section of a mound system using F O_~i Ft. . 2 cells for the absorption area ~ C y _ S Ft. ~v_ p-T •,. 'Ova lb > _Z' _O l= .SA.1~__Fl_~.1-~ `-j~S- A ~ Ft. H l-O Ft. _~IGN lg_ B~P,~3~ ON ~}TE ~APA'D1:-v.G B ~ S Ft. - --- _ -- ~-~E C O.3. 6t>D.~ Sal _~T> ____ __- _ ---- C ~ Ft. Linear Loading Rate='~•0 GPD/LN FT I l ~ Ft. . Design Loading Rate= --~ GPD/SQ FT J ~ O Ft. v4S W? L ~1.Z: b . Z.~ -t 1~ o w7., s ~o P ~ e.:`.'i-~ - o• Z I ,, K l 3 F t. . _ _ ... Force Main ~ L lp~ Ft, w y,3 Ft . I~ ~ ,i >3-~ ~ 9 F- K - -_- __ ~ ~tr,s3cc~-Ss A ~ - - = - - -l-- - - - --- -- - -- _ .SZ --~ _ - =-- - - ~x-. bservation ~ _ C Pipes ~ ~-- (Anchor securely) l~~ ~ - -~--- w ~ ~ ~ . Distribution - CeII of ~" ta' 2'~" Pipe .. - ~ aggregaCe . 1 . • Plan view of a mound system usir~s~ • - 2 cells for the. absorption area ~ . PUMP CHAMBER CKO55 SECTi01d AA)D SPECIFICATIOfJS ' PAGE ~ OF .._ ~~ ~ r; VE~.IT CAP ~• WEATHER PjtOOF ~/ ~~oi--' E= ~~ ~ ~ P ~dw ~~ ~'.~ ~(~ ~ • r-, /- .ltluCTlOU 90X . ~- ~~ ~cys.-..~4~' _~4~ ~{iiry~_aus z''c..„~4 .7et4J~`.vA~~=4 ~t._.~C~c. ~~4a'+..6~~"-Wi~JT~II~ N . . ~~ ~ l U(J<;UMt-N; fvU I y ~ ~yARRAt~}TY DEED i ::1':1'CI: !}.ilt II(•' ~1'(it'U\~1\ b'l)K~I 2--19821 431'73 _ i~ ~ _'"9~ ROBERT E. ROODELL AND LOLA J. ROODELL, - husband and wife as ,joint tenants ~ i! } roncv~s am n..rr:ults bl ,~ KENNETH J. JOHNSON AND GERI G. it DANIEhSON .. .. SINGLE PERSONS I _ .. _ the io!lue•In;; described r _. I~ u _.. .. 1 :'al estate ul ~t..CL'O~.X .- ........ _t.•>unty, hate of Ri~consin: .. : •i'A C Hf.'.L(1Y lb F(1R RCCORp~N6 DATA y I~~s~~'s o~€~C~ ~!L'~ ~t Nuv. 2, 1987 ~ 2:45 PM /~~. ~~ Tax I'arcc) vo :.............................. West 450 feet of South 484 feet of Southeast Quarter of Southwest Quarter of Section 10, Township 29 North, Rang 17 West. T~,L ~ ~_~ 0 FEE T i. i.; ~. 5 . . (is) (is not) F:xcepti.~n t.. n:cr.antics Uatcd thi.; -- C~~~'C.~ Rob~r E. Roodell . easements, restrictions and rights-cf-way of record, if any. 2nd (i;l~• „! November ~ 19.8 ( ~ ,. ~<~ (~~:1L) ~~~•' /Ca.o ~~C~-- (SEAL) Lola Roodell y~F..1l.1 AUTHENTICATION Signature(s) authenticated this ...-_._.day of ........................... 13.....- TITLE: 3fE;IBER 3TaTE BAR OF ~CI~CUX3[\ (If not. -••-•-•--•----...---•------•--............... authorized by ~ 70d.G6, ~Yis. Stats.) 7415 INSTRUMENT WAS DRAFTED BV Kristina Ogland Lundeen ---Attorney at haw ----------- ------ --- - (SEAL- ACKNOWLEDGMENT ST.~TE OF ~:16Ct)~SIN St . Croix ss. -....-..... _..----• - -•- --County. )'er~onally came before me t}us .... zT}S~-_....day of Novmebe;----------------- 19-.-8-.lL.. the almve name) . Rotiext--E~ ~Rooi3ell~ hi3T~--J-:----•---------- bo e to n~c }:no•.~•n tn,he the pcr~on . S-........ who executed the ,`u ins instrun tad 6 n•kdge le same. • P.lice J. F1 ischauer -.-.---_.._ -•- \n+••: t'u'~!ic St .-..Cr'O~X __-- -.County. Wig.