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HomeMy WebLinkAbout004-1061-95-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574326 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Schultz, Francis A. c/o Jim Cady, Town of 004-1061-95-000 CST BM Elev: Insp.BM Elev: BM Description: Sectionlrown/Range/Map No: (LID` a ,� -t-b a.4' L Fit 26.28.15.417A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic c �• Bennc`hmar� I �1� IOU Dosing Alt.BM jo o F -Fi I}t Ambe. ion Bldg.Sewer 4 1, �a731 St/Ht Inlet ") TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD net �>•i Septic f f)O° >fin' l�" ° � 501 Dt Bottom ' .Q Sol .Lf Dosing ,Ji / 7 t� Header/Man. vl� (9 bq g � tl)b` �5U` > 5 Aereli Dist. Pipe I I C1 8° 0th Me+eiing Bot.System 1 qlq. qq Final Grade w X11 1„e }, c° �Ivyv� 1 PUMP/SIPHON INFORMATION \ �1 t� Manufacturer ,,.jj Demand St Cover (O "11 '019 b' (gyp WS GPM Model Number LP b TDH Lift-I.� Friction Loss System Head TT F�, yh` Ft Forcemain Le f Dia. 11 Dist.to Well IL ABSORPTION SYSTEM Qv / NEW 6t A H. IOR.yb y ,9 1 BE RENCH Width Length t No.Of Trenches rl'F DtMeti9f8N6 N .' f Pits FModel Li epth ENSIONS O SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM HAM EIR OR er: INFORMATION Type Of System: `rsi�' ° 1 ` t�ti Lt- tW 'V ' ` ber: tO N� DIS TRIBUTION SYSTEM Header/Manifold Distribution x x Hole S acing Vent to Air Intake Pipe, �i It 1 n i j, L Length_Dia 1. Length�� Dia _ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center I) Bed/Trench Edges `2 1 s Yes - I No 'it �t i Yes No 712 Top���+► b� COMMENTS: (Include code discrepencies,persons present,etc.) Ins ectio 1: /�/ i' Inspection#2: Location: 3170 HWY 29 Wilson,WI 54027(SW 1/4 SE 1/4 26 T28N R1 5W) >35 acres Lot Parcel No: 26.28.15.417A / 1 f1 U4- M R A t)11Ct( 'L r l A q'S —a 6f I OW q if D� 1.)Alt BM Description='fy p b"t �» ����� V��n� � ��'��I )) vv 2.)Bldg sewer length= `�-i V046ci J2- J ' j j� Me,(\LOVe-r LA, Y+n s � �ye Air -amount of cover= ►° � k.� 7Vw��owsk\ ( ' 2d ► Plan revision Required? nal information. No 7 S�JI.D J I Use other side for additio - -- - Date L + Actor s Signat a Cert.No. SBD-6710(R.3/97) ��` 1i, .Sod) V!tStf�WL CTlry• Soh l+Z� St.C�ci `l ow v\ a'c C Sim e 5 -y Sec, �b coFUL Lp �C- �1 Gn aw. a� 6 ( I �KCc�f As M fr�l� a 7S—O Gad PLIC- to �7a .M loc�,oc� /q3 ' PVCcire�'t �t- per, 3170 7 �� 5 J Y � l PA I ID �v .® t s Division Coun! Indus 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) Olt P.O.Box 7162 Madison,VN 53707-7162 State Transaction Number �( �R ' ermit Application In accordance witAl 1 ),Wis.Adm.Code,submission of this form to the appropriate governmental unit Z• is required p' mmg a sanitary permit Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary /7t7 o^ l purposes in accordance with the Privacy Law,s.15.04 1 m,State. I. Application Information-Please Print All Information —owyl. d>1c C Property Owner's Name j 1L_ Parcel# r ( , f �lA- S�hw �* Off- id(o/ 9s - Property Owner's Mailing Address` ,,�- Property Location / #17k) ,J� �D W I-" 13� Govt Lot I • City,State ' �j Zip Code Phone Number j W i/y y4 Section �3 E./ ' /). `J_�2—;>C) ,o]D °+'� -'�7g7 (circle one J T2,N; R Eo b IL Type of Building(check all that apply) Lot# 1°l'or 2 Family Dwelling-Number of Bedrooms Subdivision Name El Public/Commercial-Describe Use Block ❑ City of ❑State Owned-Describe Use CSM/�Nummb'err El Village of V /O '� �O✓ti C� �% ,O/60 AA-Town of IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) ^A— I A. ❑New stem S y Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B• El Permit Renewal ❑ Permit Revision El Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS System/Component/Device: Check all that apply) D^ J ❑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 4 V.DispersaLlTreatip6t Area Information: A r Design Flow(gpd) Design Soil Application Rate(gpds Dispersal Area Required(sf) Dispersal Area Proposed sf) System Elevation (COQ /aoo 97, V� VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units c'li o s o New Tanks Existing Tanks / / n I� u q `l SZ ° i U rn � ai w C7 a Septic or Holding Tank h S o /aSv l e -,-- Dosing Chamber .7 7 O I / VII.Responsibility Statement- I,the undersigned,assume responsibility for installation ofthe POWTS shown on the attached plans. Plumber's Name(Print Plumber' nature MP/MPRS Number Businev Phone Number If 71 )7 7 Plumber's Address(Street,City,Iftite,Zip Code) X7(ok9 -o VIII. un /De artment U e Only Approved d Permit Fee Date Is ued Issuing t Signature Own en Reaso enial s t�2 6. IX.CondiGNSTENtWbA Measons for Disapproval / , 1. Septic tank,effluent ffter and` 3 (p 1 n,A-5 A '� ro a,-re. dispersal cellmust all be services/maintarrled `rte �� J '� eVA,%4 �-- as per management plan provided by plumber. ` f 2. SS IIIpplicibM code 7 must ordktsrtas ntaie►e f /� 5 J t _ �i aA Attach to complete plans for the system and submit to the County only n poper�not less than 812 x 11 inches in size 1 SBD-6398(R0313) r BENNIE W HELGESON Page 2 7/22/2014 • SPS 383.22(7)A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. Owner Responsibilities: • SPS 383.52 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. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to 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. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II,Integrated Services WiSMART code:7633 (608)789-7893 ,7:45 am-4:30 pm Monday-Friday charles.bratz@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm YMZar' <c,s A► y tiYaxr�gv� DIVISION OF INDUSTRY SERVICES o� 3824 N CREEKSIDE LA °off f 9� HOLMEN WI 54636 3 d Contact Through Relay �1 www.dsps.wi.gov/sb/ www.wisconsin.gov �O ss10TV w Scott Walker,Governor Dave Ross,Secretary July 22,2014 CUST ID No. 220292 ATTN:POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON ENTERPRISES ST CROIX COUNTY SPIA N7649 STATE ROAD 128 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/22/2016 Identification Numbers Transaction ID No.2435721 SITE: Site ID No. 804298 Francis Schultz Please refer to both identification numbers, 3170 St Hwy 29 L above,in all correspondence with the agency. Town of Cady, 54027 St Croix County SWIA,SE1/4,S26,T28N,R15W FOR: Description:Mound/Four Bedroom/Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1494554 Maintenance required; Replacement system; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual-Ver.2.0, SBD-10691-P(N.01 101,R. 10/12), Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01 101,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. The owner,as defined in chapter 101.01(10),Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above,limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation,vehicular traffic and other similar activities that impact the treatment and CONDI dispersal are prohibited. API • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption DEPT OF area. chs.NR 811 &812c PROFESSH DIVISION OF 1b • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis.Stats. • Inspection of the POWTS installation is required.Arrangements for inspection shall be made with the designat SSE GDS county official in accordance with the provisions of Sec. 145.20(2)(d),Wis. Stat BENNIE W HELGESON Page 2 7/2212014 • SPS 383.22(7)A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department;which may include local inspectors. Owner Responsibilities: • SPS 383.52 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. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to 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. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer H,Integrated Services WiSMART code: 7633 (608)789-7893 ,7:45 am-4:30 pm Monday-Friday charles.bratz @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm INDEX SHEET PROPERTY OWNER: FRANCIS SCHULTZ (JIlVI SCHULTZ) 18140 ZANE ST. NW#139 ELK RIVER MN 55330 PROJECT NAME: FRANCIS SCHULTZ PROJECT LOCATION: SW 1/4 , SE '/a , S 26, T 28 N, R 15W MUNICIPALITY: TOWN OF CADY COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL VERSION 2.0" SBD-106706-(N.01/01) MOUND COMPONENT MANUAL VERSION 2.0" SBD- 10691-P (N.01/O1) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank and Pump Chamber Cross Section and Specification Page 5: W1250/750 Tank Specifications Page 6: Pump Specifications Page 7: Observation Pipe Detail Page 8: POWTS Owner's Manual &Management Plan-Pg 1 Page 9: POWTS Owner's Manual &Management Plan-Pg 2 e� oNqL` Name: Bennie Helgeson Signed: p gFE7yAND Address: N7649 Hwy 128 )NAB SERVICE, Spring Valley, WI 54767 IDUSTRY SiMVICES Credential Number: 220292 Date: 07-10-2014 Pi z��ONOEN� e � ra�.us S�. tZ ice. srh�.lfz� l ---_-- � ST,C Xis r✓t Sc' [c Toutk T0wv\ o C CcL� Su-)� d-C S y Sec, WELL TZ s' Ai R q BA 03,00 2t Qo�Owl 147 ( 1 ou!A /ea n octil KC�(- AS S� a M a By sv/ 76-0 p,,t ,na17 la k �jp4 CFCL Nl- ra ja M o0.06 I) a � _ Ua `rod d l RUC y ��� (R,`lo�o h iv3 X ca-r es I Proper k.f✓x�-� 3��D ��ty,ueiZ: t r nC_r5 ra►►.wl-tz irh ;L 0Sr-9 Synthetic Covering ASTM C 33 Distribution Pipe El Medium Sand "' `u G 9,y3 __! r E o 3 . b C car bleu. 4� .I %. Slope• C E U 0 f 2.— 2 1-2" Force Main Plowed Aggregate From Pump Layer D /33 Ft. E /. 93 Ft. Cross Section Of A Mound F Aa Ft. G ,6- Ft. A /D Ft. H / Ft. Signed: g Ft. License Number: K « Ft. LO.SFt. Date: j (o, d Ft. Ft. All PJt y W ( Ft. w• �v-w• Observation Pipe K W p, -- -f-- _ ___._.—.�_— J Distribution 6LL-O f 2 ` 2 '2 Pipe Aggregate i I Observation Pipe �S :� 131q N.. I Plan View Of Mound PC Perforated Pipe Detail Cleanout Access ' Threaded End V 16 Cleanout Perloroi<u f PVC Pipt o�\an�o��, f End Manifold Holes Located on Bottom / R Are Equally Spaced �- Force Main From Pump First Hole Next to Manifold e / Cleanouts Distribution Pipe Layout P ,9 Iff R S X Y _ Hole Diameter Inch Lateral" Inch(es) Manifold" Inches Signed: Force Main" Inches License Number: Date: Invert Elevation 2Z 9� Holes Per Lateral Number of Laterals Total Holes �� ewtr^_yL` ' cry .►-, 1 �TiV*l U. Page 4 Of SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4 " fVC.VENT PIPE 12" MIN . ABOVE GRADE E WEATHERPROOF 25 ' FROM DOOR , WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK & �►-oc��^cQ _ WARNING LABEL �___,__411 MIN. 18" IN. r.a. I N LET I , 90 WATER TIGHT SEALS GAS- TIGHT :: �1 \/APPROVED FILTER A SEAL JOINTS WITH APPROVED f°k --�— ALM APPROVED RIPJE PIPE 3' �S - ON 3' ONTO ONTO SOLID C I SOLID SOIL SOIL PUMP OFF ELEV . ��FT. - -- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS _ 1 cj s S-� L tl ri SEPTIC DOSE Pa t a t l X TANK MANUFACTURER: bjl �S-eli p h TANK SIZES: SEPTIC ,QS_v GAL. DOSE VOLUME INCLUDING DOSE '-75-c) 1 GAL. S 7 FLOWBACK: qL!5-. 7 GAL. ALARM MANUFACTURER: �� � hc�v►��+.�5 CAPACITIES: A = a.S INCHES = u03 GAL. -MODEL NUMBER: �=2 INCHES �, GAL. SWITCH TYPE: Jz±��v�rcc�� JD B = Y . PUMP MANUFACTURER: (+0 C� S C = _ INCHES = // ��tAL. MODEL NUMBER : SWITCH TYPE: lDa� D = /L INCHES = GAL. REQUIRED DISCHARGE RATE GPM PUMP 6 ALARM WIRING AS PER I LHR 16.23 WAC r VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIP£ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . FEET + 3 FEET FORCEMAIN X 3 _FT/100 FT. FRICTION FACTOR . /, FEET TOTAL DYNAMIC HEAD = L FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTH Cam, P T k-- Spec 7 SIGNED: LICENSE NUMBER : DATE: 1/88 C o ° LO Z [�a N, n O WQ �� U N @,, N W p (o d Ali Z tW-L � �8 q* Np i O F0 U.. cV) a: 00 �Ud Y� aM wp = o � �{ Fv) Q 000 O H V)Q- f" � N LO W U 0, wm �Q ZZ w �RMc ��Q- O YJ p OQ QU JJ Q u p NdN N W �V o m o N w o v``'i o 0 I((rLrL�nl rn 3 n o r w ppOpindm BFI QwN rnN O Oco W Q af o a. N dOs 0 .. ..0, �(n m(n< Ind n p Z LO Z r Q Q� g ' O Z m OU F <z J � � O O n o w OQwpJ ps Q p N O Q O3Om01SJ -M-21 Q�� Q�" U O_ Z J J = Q p Z Z Cl J OJ S9 W Z s _ �KV N 1 � I I W = i 3 ii I 5 � I I N ( V N H °9 It I is L5 f� H W „99 „09 „99 Gl.> ra f EL 3871 x ' PO4 Submersible Effluent Pump r I ' 1 t-5 .kJ �t I 'Sa i METERS FEET �p e 30 — t__ ---- MOOR:3871 25 .o. - - _F. U5 6 -- -- - EP05 o - 4 3 10 2 S 1 r 0 00 -10 20 00"' 40 � so USGPM I 0 2 4 S 8 10 12 CAPACITY Pump:Specifications. Features and Benefits rho and'/:HP •EP04 impeller-semi-open design Up•to 60 GPM . with-pump out varles.to protect Maximum head to 32' ,mechanical.seal. , Discharge size 11/2"NPT •'EP05 impeller-.enclosed design Solids:2/4'maximum for improved performance. Motor *Rugged glass-filled.thermoplastic All motors feature ball casing and base design provides bearing construction, superior strength and corrosion Single phase: 115V resistance. J Materials of Construction -Cast iron motor housing for Cast iron efficient heat transfer,strength, Thermoplastic and'durabil4. Stainless steel •Corrosion resistant threaded ' stainless steel shaft. *Available for automatic and manual operation. •CSA listed models available. operation and feature stainless steel hardware, �Li�a�1�' �Y�GI� �.i.�'�Z �✓ «'1'4 c.�-h.k.�"f'Z. 1 0� 7 Water tight cap 4" min, dia. T Piping material can be ASTM D2665,D1785 or D3034 Slot 6.� 6`" min. min. Infiltrative surface Water Closet Collar Bar(3/8" min. dia.) Observation pipes must: • be located such that there are a minimum of two Installed in each dispersal cell at opposite ends from one another • be located near the dispersal cell ends • be at least 6 inches from the end wall and sidewall • be installed at an elevation to view the horizontal or level Infiltrative surface within the dispersal cell Observation pipes may be located less than 6 Inches from end walls or side walls if specified in state approved manufacturers installation instructions. POWTS OWNER'S MANUAL &..MANAGEMENT PLAN Page FILE:INFORMATION Ownar SYSTEM:3P,E.DIF.ICATiONS. Permit# Tankltilanufacturer: DNA . 19 Septic 0 Dose p Holding Volume; p WESIGN.PARAAAErltRS D (gal) Tank Manufalurer C�.l r Seer N Number.. © A ffNumber edrooms:. NA 'Septic I Dose 0 Holding, t/olumw. ?5a (gal) of Public Facility Unitsr g9 NA Vertical Distance Tank Bottoms)to Service 1I.stimated,(average)Flow; . • � (n) µoo (gal/day) Horizontal Distance tank(s)to Service Pad: H D (h) Design(peak)Flow=(estimated x 1.5): Specific ser vicing m echap e (gal/day) nics must be Provided K verges(Is>i5'feet or f ais>15feet. Specific instructions to beprovided on back. In Situ Soil Application Rate: • (gaUday/ff) Effluent Filter Manufacturer: o ly(o Standard(Ddmest1c)7inffuent/Effluent Monthly average Effluent Filter Model: o l t7 NA Fats,Oil&Grease (FOG) s3oamg/t_ Biochemical O en Demand (BODs) s220 mg/L• • 0 NA Pump Manufacturer: Coaujc(5, -roar 7DCSl;;}us : d6;to11ds:(T gS.. ;s10 m/L'. . , .. :. paryt�Medal,.---- �c3_r,a High Strength Influent/Effluont 7, l NA Monthly average Pretreatment Uhit (FOG) >36 mg/L`' Manufacturer: (B.ODs) >2$0 mg/L 13 NA NA SS) >150 m /L 0 Mechanical Aeration �)Peat•FiltO A l Pretreated'Effiuent: Monthly average ❑Disinfection L7 Wetland (BOOS) s30 mg/L 0 San Gravel Filter 0 Other. (TSS) 06 mgll. NA Soil Absorption System Fecal Coliform.(2eometric mean) s10o ' ❑ In-Ground(gravity) 13 In:Ground(pressure). 0 NA [MEa .um Ef fluent Particle Size 36 in dia. 0 NA 0 At-Grade ®Mound: Drip-Line.' 0 Other. 0 NA Other: 0 NA MAINTENA N.0 .SGHEDt1LE Service Event Service Frequency q Y .. Pump out contents of tank(s) JS When combined sludge and scum equals one third.(;)of tank volume 0 When the high water alarm is activated Inspect condition of tank(s) -At least once every: ❑month(s) .Z 1 year(s)' (Maximum 3 years) 0 NA lnspeet dispersal ceil(s) At least once every: 0 months) v`Z ffi year(s). (Maximum:3.years) 0 NA Clean effluent filter At least once every: ®month(s) 1 3 0 year(s) O NA Inspect pump,pump controls&alarm At least once'every: months) t� R'year(s) 0 NA Flush laterals and.pressure test '.At least once every;• ❑month(sj D NA At ldhS once every: Ej months) Other: r 1 yesr s) "NA O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soli absorption systemsshall be made by a.n Individual carrying one-of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, Tank inspections must include a-visual inspection of the tanks)t identify aOny/m missing iboken harrdwaee3erviang Operator(pumper). measure the volume of combined.sludge and scum and a check for any'back up or ponding of effluent on the ground surface.. The soil . absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent 1 on the ground surface. The ponding of effluent on•the;:giound surface may'indicate a failing condition and requires.the immediate notification:of the-local regulatory authority. When the.combhed accumulation of-sludge and:scum In any treatmerit tank equals one-third contents of the tank shall be removed by a Septage Servicing: Wisconsin Administrative Code: Operator(pumper)and disposed of in accordanceawlth chapter-NR 113, Ali.other services,Including but not..limited 1d'.the servicing:of sffluent filters,mechanical bf i0 es§urized:-components,:pretreatmrent units, and any servicing at Intervals of 512 months,shall be performed:by a certified POWTS Malntainer. A service,report shall be provided to the local regulatory authority within 30 days of completion of any service event' GMW005(02105) q Page / of START UP AND OPERATION For new construction,..prior to use of.the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process'.and/or damage-the soil absorption,system. if high concentrations are detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater-will bedischarged to the soil absorptbn system in one large dose causing an overload that may result In the backup or surface'discharge of effluent.and..dama'geI6 the.system. :.To avoid.this situation have-the contents of the pump tank removed by a Septage Servicing Operator(pumper)-prior to•restoring:power to--the pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil.conditions are frozen.atthe Infiltrative surface. Do not drive or park vehicles over tanks or the soll'absorption system. Do not.drive or park over,or otherwlse disturb or compact, the area-within.15 feet down slope of any mound or at-grade soil absorption,area. Reduction or elimination of the follov;!ing from the we stream may improve the performance and prolong:the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts,, condoms, cotton swabs,.degreasers, dental floss, diapers, disinfectants, fats, foundation dralih (sump_,pump)discharge, fruit and vegetable peelings, gasoline, greases, herbietdes, meat scraps,medications,oils,painting products, pesticides,sanitary napkins,solvents,tempons,'and water softener brine discharge. ...ABANOANMEMT When the POWTS fails and/or Is permanently taken out of service the following steps shall be taken tolnsure that.the system'ls.propedy and safely abandoned In compliance with s. Comm 83133,Wisconsin AdmirilstratlVe.Code:'' • All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents:of all tanks and pits shall'be'rerioved and properly disposed of by a Septage Servicing Operator:(pumper.). • After pumping, all tanks and pits shall be excavated and removed or theircovers.removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and.cannot be repaired the following measures have been, or must be taken,,to provide-a code compliant replacemment system: ❑ A suitable replacement area has been evaluated and may be`utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance-and compaction and should not bew•inf.dnged:upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and'site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules in effect at the time of their pemtit issuance. ❑ A suitable replacement area is not.available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort: ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site•.evaluotion must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. .0 Mound and at-grade soil absorption systems may be reconstructed In place following removal of the btomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GAS' OR.LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE.. NEVER ENTER,ANY TANK.UNDER ANY CIRCLQWSTANCE. DEATH,MAY RESULT: MAM OR AtSCUE FROM THEINTERIOR OF{t TANK'MAY NOT BE.POSSIBLE: - ADDITIONAL INSTRUCTIONS: r ROWTS INSTALLER PO.WTS:MAINTAINER Name ,do plgi y Name So�hS o Phone l5= `Z7a-3 Phone SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY , Name �d tL ' Name Phone Phone � 1 G This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Property Owner t avQ C iS SI�L t` z— Parcel ID# ODD//D6/f�Do v 7 Page c=) of 3 _ [Y Boring# Bo—ring �y pit Ground surface elev. 9y 7 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. *Eff#1 I *Eff#2 a -�o /0K -3 IoVP, 10" C L Qcss I cc.J -S l0 yK s 7 5 C. I UL 4., of MaSSi v� Boring# ❑� Boring Ly"Pit Ground surface elev.9g1 9 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. *Eff#1 *Eff#2 b-- Ic)\l L b6c a u✓ �z�F —�D C�2 D 7,5 y Q im3W 7.s 0 1n�sSiva F] 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 GPD/ft? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD,<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.07/00) Wisconsin Department of CommeRECEIVEOSOIL EVALUATION R�PORT Page / of -3 Division of Safety and Buildings J� in icft ttr with Comm 85,Wis. Adm. Code County U LU I Coun • Attach complete site plan on paper no ess than 81/2 x 11 inches in size.Plan must include,but not limited to:vertic �trtt KOVAroftifgT"ce point(BM),direction and Parcel I.D. percent slope,scale or dini4t 'Nlq-q)WL:@LrigpDMLbgtand distance to nearest road. Please print all information. viewed y _ Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). C�(�t/Y`" i1v Property Owner Property Location E�-euc i s S f V 1 t�h Sc l u-\ Z Govt.Lot s (,t) 1/4,5 JE 1/4 S.?/,:. T a g N R 15 E(or WD Property Owner's Mailing Address c Lot# Block# Subd. �e or /� 19 y D �IrvE 5r N I 3 3� /w / City State Zip Code Phone Number ❑City ❑Village RTown Nearest Road Elk (ur- S532 (o)-�) ,�6 -9787 ��b 3�'7 �4w a ❑ New Construction Use:A Residential/Number of bedrooms _ Code derived design flow rate—,;goo GPD eplaceme ❑ Public or commercial-Describe: , 1 t Par material // ��5 O U�!� �� Flood Plain elevation if applicable /y A ft General comments 6Z55,' 33 " Lcyp�QPl� e�y e� and recommendations: Boring M Boring# n/ l� Pit Ground surface elev. �7 o ft. Depth to limiting factor A_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. *Eff#1 *Eff#2 o-g royn — sr� C ii w �o /O'vfz b 11 !v 3 IO`l2 31)75"lR k/0 Ye 7CL Cs �^ Uj u� q P 757YR +16)Vk v-F s s 1 < o ❑ Boring# %ring L'� /� �J 'pit Ground surface elev. % , o ft. Depth to limiting factor�_in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 o l0`l� 3 L I- C� ?u �D�(L 4 ­0 o C L C ��i Cc.J 10 0 2 c P _2 t *Effluent#1 =BODS>30:5 220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD6<30 mg/L and TSS<30 mg/L CST Name (Pigg§e Print) Si ature CST Number Address UOL e Evaluation Conducted Telephone Number �"y 67 � l Property Owner �1 �S �CI Parcel ID# ��y�D6/9�'D� 7 Page g=) of 3_ ❑ Boring# F] Boring Nk'pit Ground surface elev. 9y 7 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. *Eff#1 *Eff#2 I b- I vjk 3 S 1 -a to y -F C L Q c s tl c -50 0 k s . N. D -7 5C_ l UL 4- Vnvfi O MaSSI vQ F�] Boring# 0 j ring �( �) - L�J'Pit' Ground surface elev.�'O a _ft. Depth to limiting factor in. ' Soil Application Rate Horizon Depths.'Dominant Color Redox Description Texture Structure Consistence Boundary 'Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 S1L ais r a..W 0C- _ 6 , R -20 0 VIZ C�D �5 y fZ s + S 6 k o k- ',�C_�� C) �h13P7.5 + p tylaS$7Uv 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 GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.07/00) S�fr ��ss Qwn.e t Frek is _ u'lfz) 3170 015o o,�ff W/,�1 ?� Y �y 57-c,e,nlk CeaW ry 7OUIti OF 64 y .j U)� of sE s Sc r c. Ex%sr n LA t r . Ar R i w oo d �cc�e�-� �s Shoc..n� • ; Woes 0 Fl d d 3.t-A. 9'q. 7 Toe PUC.._ R(bboh Wno�s� a c�i 44 -7 �. To cr{�Pu L PI�.e %�• R�bbo� �r t�/3 3l7 D L_ �,L,--�,y 9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/ uyer Lta n S Sc i J t2_ Mailing Address Z,^' V w :lt-/3!7 1 k V'- }-/`'"V _?o Property Address 317 0 Wr 5"/0-17 (Verification req ired from Planning&Zoning Department for new construction.) City/State Parcel Identification Number 009/0-(/7S00 O LEGAL DESCRIPTION Property Location,5 UJ 1/4 , ,S 1/ , Sec. ,T a N R 15 W,Town of Ca&, Subdivision , Lot# Certified Survey Map# 7 0 C7 , Volume Page# Warranty Deed# S 3 )d G ,Volume ,Page# Spec house❑yes❑no Lot lines identifiable❑yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§Comm. 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,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 retwned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on thi form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a w ty deed recorded in Register of Deeds Office. Number of bedrooms Af SIGNATURE OF LICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) 996 BE T REGISTER OF DEEDS ST. CROIX CO., WI CERTIFIED SURVEY MAP RECEIVED FOR RECORD 06/03/2014 2:37 PM , EXEMPT *: PART OF THE SOUTHWEST QUARTER OF THE SOUTHEAST REC FEE: 30.00 QUARTER, SECTION 26, TOWNSHIP 28 NORTH, RANGE 15 WEST, COPY FEE: 3.00 TOWN OF CADY. ST_ CROIX COUNTY,WISCONSIN. PAGES: 2 UNPLATTED ° �o LANDS g 5- PREPARED FOR_ M;M Francis A Schultz N89'47'47"E 621.91' 2825 Calumet Rd Eau Claire, WI N 90 machinery 0 q CO sheds �'('''��I � UNPLATTED `O well a M— — — — house LANDS UNPLATTED SOT p tic ' - - se ! � LANDS 435,735 sq.ft. �' N z 10.00 acres South 1/4 Corner 100.00' N89'36'12"W Section 26-28-15 �3 Ns2 w go 2"W L2 Aluminum Cap ssss gg44 518.92' I—--5.--f——°—�-y------------- 2107—.07' / �-- 7' —'E N_89'47'37"E S.T.H.o "2 N89'4 - -2625.99 � -� — — — — _ Southeast Corner Section 26-28-15 Line Data UNPLATTED 1" Steel Nail L1 N00'1 2'23"W 91.03' LANDS L2 I N89'18'54"W 54.41• L L3 �-S71'06'24"W _41.92' t Note: Each parcel on this map is subject to State and County laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and Town Board for advice. OlVa Drafted by: JOKA, Joel A. Brandt * BRANDT c /►}/ JB SURVEYING LLC S�Of UNPLATTED R �o i LANDS in I - - - m'5. PREPARED FOR: , Francis A. Schultz N89'47'47"E 621.91' 2825 Calumet Rd Eau Claire, WI q CO machinery CO sheds d: N UNPLATTED �O well G' M; LANDS house UNPLATTED - - - .� LOT � , t - - - - LANDS septic .v 435,735 sq.ft. �.' 0 a 10.00 ocres OD South 1/4 Corner 100.00' N8.9'36'12"W Section 26-28-15 302.04' 302.04' — Aluminum Cap �� N82.55'56" L2 ,- w sa3'44 32"w _518.92' I �� ___ ¢�__21_07.07'] J1 J----- 0 mac'-- V-N89'47'37"E 2625.99' S.T.H_—'29———��°' N89'47'37"E — — — — — — — — — � — — _ — — Southeast Corner Section 26-28-15 Line Data UNPLATTED 1" Steel Nail L1 N00'1 2'23"W 91.03' LANDS L2 I N89'18'54"W 54.41, L3 S71'06'24"W Note Each parcel on this map is subject to State and County laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel, contact the St_ Croix County Zoning Office and Town Board for advice. Drafted by: Joel A. Brandt JB SURVEYING LLC S�0! ur. ': Cf►Y,; S SCALE: 1" = 200' 0' 200' 400' �` 0 ti LEGEND North is referenced to the ?!........_Found Government Corner South line of the Southeast o..........Set 3/4" x 18" Iron Rebar quarter of Section 26-28-11S weighing 1.52 lbs. per lineal foot which bears N89°47'37"E Sheet 1 of 2 (St. Croix County Crid System) St.Croix County 996700 Page 1 of 2 Vol 26 Page 6020 I I i UhNT1r'1h1) �!iUNVEY 1 AJff PART OF THE SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER, SECTION 26, TOWNSHIP 28 NORTH, RANGE 15 WEST, TOWN OF CADY. ST. CROIX COUNTY,WISCONSIN. DESCRIPTION A parcel of land being part of the Southwest quarter of the Southeast quarter of Section 26, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, more particularly described as follows: Commencing at the South Quarter Corner of said Section 26, thence N89°47'37"E, along the south line of said Southeast quarter, a distance of 518.92 feet; thence N00°12'23"W, a distance of 91.03 feet, to the point of beginning; thence N15°31'53"E, a distance of 634.88 feet; thence N89°47'47"E, a distance of 621.91 feet, to the east line of the Southwest quarter of said Southeast quarter; thence S00°12'13"E, a distance of 605.83 feet, to the north line of State Highway 29; thence N89°18'54"W, along said north line, a distance of 54.41 feet; thence S83°44'32"W, a distance of 302.04 feet, thence N82°56'56"W, a distance of 302.04 feet; thence N89°36'12"W, a distance of 100.00 feet; thence S71°06'24"W, a distance of 4192 feet" to the point of beginning. The described parcel contains 435,735 square feet (10.00 acres), and is subject to easements of record. SURVEYOR'S CERTIFICATE I, Joel A. Brandt, Registered Land Surveyor, hereby certify That I have Surveyed. Divided, and Mapped the above described parcel of land in full compliance with the provisions of Chapter 236.34 of the Wisconsin State Statutes, along with the provisions of St. Croix County and the Town of Cady in surveying, dividing and mapping the same. That such map is a correct representation of the exterior boundaries of the land surveyed and the subdivision thereof made, and was done by the direction of Francis A Schultz, owner Dated this a Zo 2014. ���GolvB% maw Joel A. randt, R.L.S. S-2603 s ' JB SURVEYING LLC � CERTIFICATE OF COUNTY TREASURER E STATE OF WISCONSIN ) COUNTY OF ST. CROIX ) SS 1. k ar;eA•L)We the duty-elected, qualified and acting treasurer of the county of St. Croix" do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of ft�r�e �� lel affecting the lands of this Certified Survey Map. W03114 G}�0•�Jot Date Treasurer APPROVED JUN 0 3'2014$'I,GKUTA I;UUN J Y Sheet 2 of 2 PLANNING&ZONING OFFICE I 1 j �01_ Is n Ui ! b �co• 4 e d (•6IIn3ou pun eoeeau)[m'eaa3uuaa .IIO3uo:e eq3 to eamnu eq3 uoeaeg3 uemis,944 to Pe3alaa 6ry)e)a aseq nugn pepsoa"eq o3"MMUII3euf llu 7x43"PWIIn'97878 MAN 69'RD—f[-K) ,....rh8rrsvTTV L"7... ........... Sq Pa;;eaQ g5`i6F`'a b+•- — gZ��7T---sasrdxa uorssrunuoo fPF ursuoosr�"el�utioq••«._.a.Ja.T.a_....»- •orlgnd.f.ra;oLV ` 9t e 3 a� a.x os a ;uaurnr; ur offalo oil; a;noaxa o ni S uosrad a ;a o;umou aru o; g P P 1 bFial Pu d q P q R R X zZ tngoS eselD pue z�jngoS xueag Paureu aaoge aq; 86 61"Q'b'' Aaenuer ;o A-P gZ srg;lour arolaq aureo Sllauoszad aOlOTd `ujOU030}2114 30 JID30 �Iea5)........ .....»».«_.._ .._«.__..»._....«...».....»......_............. ..«......«..... _.»._...._........... .... ...... ... z} (leas .._..._.... ;o aauasaad ur paleaS pus auBrS 89 61°"Q5'' Axenuer ;o Sep 8Z srq; oleos PUB s pueq 'I-Eag1 ;as o;una.raq an eq;red;sag aq; ;o Sat ;aed pies air; I;onaQ244 ggaUJIM uy[ 'a N93,Q PUB J NVZI;YVA4 sanaao;Ilrm AaT44 '{oaaaq;;red Aue ao alogam aq; 8uruo Slln3Awl'suosrad ro uosrad d raea pue Ile;sue8e'su8rsse pue saraq S?q red puoas 8—236.16,Wis.statute. Form No.1 -- 253216 (0? leis 3nbrn#ure Made this 28 day of January ,A.D.,19 58 , between Frank Schultz and Clara Schultz, his wife and as joint tenants and each in their own right part i e s of the first part,and Francis Schultz part y of the second part. Mitntoottb: That the said part ies of the first part, for and in consideration of the sum of Three Thousand and no/100 -------------------------------------dollars to them in hand paid by the said part y of the second part, the receipt whereof is hereby confessed and acknowledged,ha ve given,granted,bargained,sold,remised,released,aliened, conveyed and confirmed,and by these presents do give,grant,bargain, sell,remise,release,alien, convey and confirm unto the said part y of the second part, his heirs and assigns forever,the following described real estate,situated in the County of St. Croix and State of Wisconsin,to-wit: An undivided two-thirds (2/3) interest in West One half (WWI,-) of the Southeast Quarter (SE -) of Section 26, Township 28, North Range 15 West. Southeast Quarter (SE-4w) of Northeast Quarter (NE-) of Section 26, Township 28 North Range 15, West. A tract of land commencing in the Southeast Corner of Southwest Quarter (SW41) of the Northeast Quarter (NF-41) of Section 26, Township 28 North Range 15 West; thence North one (1) rod; thence in a southwesterly direction to a point one rod West from place of beginning; thence East along South line of the above forty acre tract one rod to place of beginning Grantors reserve the right to live on premises for rest of their lives. I i-I t I I a i i Cogetba with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining;and all the estate,right,title,interest,claim,or demand whatsoever,of the said part of the first part,either in law or equity,either in possession or expectancy of,in and to the above bargained premises and their hereditaments and appurtenances. Cc I?abt snb to I?Olb,'the said premises as above described with the hereditaments and appurtenances, unto the said part y of the second part,and to his heirs and assigns FOREVER. RLnb tbt%atb Frank Schultz and Clara Schultz for thier heirs,executors and administrators, do covenant, grant, bargain and agree to and with the said part y of the second part, his heirs and assigns,that at the time of the ensealing and delivery of these presents they are well seized of the premises above described, as of a good,sure, perfect, absolute and indefeasible estate of inheritance in the law,in fee simple,and that the same are free and clear from all incumbrances whatever, No encumbrances and that the above bargained premises in the quiet and peaceable possession of the said part y of the 0 : in CD 0:0 tl:F- rA 0 0 cn ti:cr PA 0 ts �C+ 01 N F-b: Mi. ac y . PD CD ti C-j.;CO o rri �j H.:c+ ;7i@ O;vl :Fl (D ct:r3 (D C+ C+;o C+G II ii t3 CD F4 U. r3 C+ OD N C+ ii ': _ ii Ii f ii li it it •• I This Indenture Made this ........... of ..._...May..-.. .._ .. ...... .....__,A.D.,195Q.._., between ..Frank Schultz and Mara Schultz: husband and wife,...as joint tenants,!; p - - �j _.._._..._......_.._._......................._...._...................__..___....._... part..ie.S... of the first part, and_....Eran.ci in common and...not...a.s...j-oint...tenant.,............ .......... h s i! ....._....................._...-.._.........-.........._...................:: .......................................... part..!.... ..-of the second part. �f �y WITNESSETH,That the said part.leSof the first part,for and in consideration of the sum of..._.one...d.ol.lar if _......_............. wx to.....them ...- i; ..._.. - ...__........... .._...................................._..._................................................... in hand paid by the said part.y_.....of the second part,the receipt whereof is hereby confessed and acknowledged,ha.v-e.... it given,granted,bargained,sold,remised,released and quit-claimed,and by these presents do............give,grant,bargain,sell, 4 if C remise,release and quit-claim unto the said part..y.__of the second part,and to.. h.is. .......heirs and assigns P forever,the following described real estate,situated in the County of.._...`.t......Cr.Oix...................State of Wisconsin,to An undivided 1/3 interest in the West Half (W2) of the Southeast , t Qunrter (SEA) of Section Twenty-six (26) , Township Twenty-eight (28) North of Range Fifteen (15) West. 1 r �i I Grantors make this conveyance for the express purpose of creating a tenanc3 in common between themselves and the grantee herein, who is their son, and at the same time maintaining their mutual relationship as joint tenants to each other, n the undivided 2/3 interest which they retain in the above i 1 I described premises. r i TO HAVE AND TO HOLD the same,together with all and singular the appurtenances and privileges thereunto belonging or in anywise thereunto appertaining,and all the estate,right,title,interest and claim whatsoever of the said part..ie8.of the k first part,either in law or equity,either in possession or expectancy of,to the only proper use,benefit and behoof of the said j ........................................heirs and assigns forever. part.y........of the second part,..........h�,.S. `a ±? %j IN WITNESS WHEREOF,the said part.�.E':nq...of the first part haY..£......hereunto set their ......................hand..5_and i . . .................................daYof.................MAy.......... ..... .--------- ...._..:_........._.�A:D...19.5... ........---........(SEAL) I' sea_B-this.................22nd...... I , I ?i Signed and Sealed ffi Presence of ran `chin Z ...............(SEAL) yC lU1tZ our f j M... _ .........................(SEAL) .iI76 seorge ! �! �yy� , ............ h.ar _a._t.�/.. /.... b ............. - -.............................................. bd eS d_ .......... ------- --- _ ........................... .......(SEAL) +� �( STATE OF WISCO i IN, l { }as. Pierce.......................County.J it '! J Personally came before me,this..........22n.d............. - ................day of.... ..............................................A.D.,1950 1 I. the above named......r'rank._Sc.hu.ttz and...Clara..,-SChultz.,..._hus.ba,n.d and_._wife....................................... jI I! t to me known to be the person_5....who executed the foregoing instrument and acknowledged the same. It ii _..... ..... eOr._e... . .. '.----.. ....---. -- j ;; g lYi�bee Notary Public,. ......County,Wis, if P.iexc.e......................... My Commission expires October 5, A D 1052 ii