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HomeMy WebLinkAbout030-1040-50-130 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 574397 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: Tortosa Boonacker, lva n St. Joseph, Town of 030-1040-50-130 - CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: (� CST 19.30.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER � CAPACITY STATION BS HI FS ELEV. Septic =,,� /Z5a Benchmark 5 ce 1� Dosing /0 �T �j� Alt. BM / e /Z.-5 . T� Bldg.Sewer #4 is - CCk. Y Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION S ~ TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet Septic /06 A)A- q U Dt Bottom Z Dosing 7W ,V 10\ w 1 �t 1 ✓ Header/Man. 49 Aeration Dist. Pipe 11 -.8 CI(ov `q8 t� =f Bot.System 9(,p` / Final Grade 17-PUMP/SIPHON INFORMATION 7' Manufacturer GP Rand St Cover f s 1 Z. "Y3 / Model Number i0 I U 7 � �o V.,14--t�- TDH L' Friction Loss System Head TDH F 2. 7 , Za . S Forcemain Length Dia. Z Dist.to Well SOIL ABSORPTION YSTEM 9.5 12 -to BED/TRENCH Width Length No.Of r ches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 75 d�� SETBACK SYSTEM TO P/L BLDG _ LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR /�, Type yste Z 7 � ./A UNIT Model Number. DISTRIBUTION SYSTEM ° �� �I /V Header/Manifold/ / Distribution �, x Hole Size + Ix Hole Spacing Vent it Intak Pipets) +►� ,�3L Z Length Dia 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 Bed/Trench Edges Topsoil t es [] No �s No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: Z 1 / Inspection#2: Location: 1401 33rd Stree Houlton,WI 4082(SE 1/4 SW 1/4 19 T30N R19W) NA Lot 2 � Parcel No: 19.30.19. /a L.�)- n 1.)Alt BM Description= GLwS 2.)Bldg sewer length= °16 -amount of cover= 412 Plan revision Required? Yes No 2� G — Use other side for additional information. L Date Insepctor)Sign re Cert.No. SBD-6710(R.3/97) PLOT PLAN .f PROJECT Ivan Tortosa ADDRESS 1401 33rd ST. Houlton Wi 54082 �l SE 1/4 SW 1/4S 19 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX SYSTEM ELEVATION' DATE 9/9/14 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHO O WELL *H.R.P. Same as Benchmark 405'Property Li ne Scale = 1 4" = 10' 33rd St. All piping shall be SDR 30/34, within 10' of tank,piping shall be Schedule 40. B.M.* 3' 95'M97 223' 9' Tank is to be properly bedded and B-2 provided with Iockdown covers 15 Slope with approved warning labels Grading is to be done to divert B-3 run-off away Area 15' from system. below system is to 382' Property Line remain undisturbed B- 1 98.3' Huffcutt Combo Tank Wei I is to meet all WDNR setbacks Pro 4 Bedroom House 470' coun"54-e f 1b Safety and Buildings Division f Sanitary Permit Number(to be filled in by Co P.O.Bo;70162 -w 201 W.Washington Ave., 1p Madison W 53707-7162 -7 r7 <.q P A I D S, Stine Transaction Number r t ary Permit Applicatio Z,? Z/IS the app[Wriate governmental unit In accordan 'jb�99 38321(2).Wis.Adm.Code,submission Of this form in are ubmlftd Pro ect Address(if diftercut than 'ling addrcss)� is=, e:obtaining a sanitary pemuL Note:Application forms for state-owned POWTS s to J the Department of Safety and Professional Servim Personal emulation You Provide may be used for secondary '73 ---,>'z , tl accordance with the Privacy La w• 15 134 1 1 (Iii�Stilt& s m accordance with If W `�4 — , L kpwiticktion Information Please ple Print All Information. property Owner's Name t OLI 0 I-ar?c - P a n4 (9 Property Owner's Mailing Adam S )112- /.Yo Ll 31 J Govt.Lot City State t Zip Code phone N Soctiont L circle N; R Ir 961 7\ EL pe of Banding(check 211 that Apply) Lot 4 2 Family Dwelling—Numb-Of ---- Block# ❑Public/Commercial—Describe Use d City Of CSM Number ❑Village of ❑State Owned-Describe Use 1/l/7 1-� Aown of V JR.Type.9f P (Check only one box on line A. Complete tint B if applicable) , 9 Other Modification to Existing System(explain) A� VW system ❑Replacement System ❑Treatincrit/Holdiug Tank Replacement Only Permit Transfer to New List Previous Paut N""and Data Issued R. Permit /I�V A- it owner Renewal ❑Permit Revision ❑Change of Plumber -L T Before Expiration p7n� r, ,"1B V IV.Type of POWTS System/Component/Device: (Check all that a IV) [I Mound<24 in.of suitable soil D, .4on-pressurtw,d In-Ground ❑Pressurized In-Ground ❑At-Grade 4 in of Suitable soil ❑Holding Tank ❑Odier Dispersal Compoocrft(explain) ❑preo ont Device(explain) V.Dispenali/Treatment Area Information: ri V Design Soil Appli Dispersal Area Of) D Area Proposed(st) S Elevation 7 'o" ZZOV,(Cpd) Des f Capacity in factiviEr VL Tank Info Total #of Manu Gallons Gallons units New Tacks Existing Tanks 2 Tanks Septic or Holding Tank !K/ Doising Cbamber VII,Responsibility StatelllejAr I,the undersigned,ass r ponsibdity for installation of the POWTS shown oa the attached plum Plumber' Name(TPrmll- Plum ature se7j;jM Number Business Phone ber Plumber's (2treet,city, tax,Zip Col��� on* pArtment Use ODIV Permit Foe Date Isped Issuing Agent Si atIT Approved Disapproved ❑Ow=CnvenReason for Denial zs- P P Plumber'or Plumber's pkpprovaMeasons for Disapproval -,u Septic 1.S eptic tank,effluent filter and C- C Sp pn dispersal cell must be serviced/maintained as per Management plan provided by plumber. 2.All setback requirements must be maintained as per applicab!- -Aft& co plans for the system and soumnu the C.=,Y—y oil paper not iess than sifix 11 inches in size SBD-6398(R-11/11) SHAUN R BIRD Page 2 9/24/2014 Owner Responsibilities: • The current owner,and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 This Amount Will Be Invoiced. OGrard�M Swim When You Receive That Invoice, POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code:7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm i i owY�Tv DIVISION OF INDUSTRY SERVICES To 3824 N CREEKSIDE LA o �1P HOLMEN WI 54636 3 Contact Through Relay p K http://dsps.wi.gov/programs/industry-services S r www.wisconsin.gov A:oo S101S 5� Scott Walker,Governor Dave Ross,Secretary September 24,2014 CUST ID No. 226900 ATTN.-POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/24/2016 SITE: Identification Numbers Ivan Tortosa Transaction ID No.2458266 1401 33RD S_t_, Site ID No. 806254 own of Saint Joseph Please refer to both identification numbers, St Croix County above,in all correspondence with the a enc . SE1/4,SW1/4, S19,T30N,R19W FOR: Description:Four Bedroom Mound System/ 15%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1503793 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s):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.01/01,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: COND Reminders: /!gyp • A sanitary permit must be obtained from the county where this project is located in accordance with the DEPT OF requirements of Sec. 145.135 and 145.19,Wis.Stats. nnrr PROFESSIO • Inspection of the private sewage system installation is required.Arrangements for inspection shall be madeRY431014 OF IM the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provi per SPS 384 product approval conditions. SEE CORRE • All POWTS component piping material shall be SPS 384,Wis.Adm. Code compliant. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • A coy o�f the approved plans,specifications and this letter shall be on-site during,construction and oven to ins e Mthdrized representatives of the Department -inaude-lAcal-m tors.----- -------`\ *CHANGES MADE TO PLAN WERE ACKNOWLEDGED AND APPROVED BY DESIGNER ON 9/24/14. \` i Cover Page Shaun Bird Bird Plumbing Inc. SEP 2 1432 120th St. �1 �T1! New Richmond Wi 54017 715-246-4516 Date: 9/9/14 Owner:Ivan Tortosa Location: SE1/4 SW1/4 S19 T30 N,R19W 1401 33rd St. St. Joseph Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan T/ 9-11. Soil test RO�A<<Y sgFF o 12. Filter Specifications cross s ction C S RAND STR s!�CFS Shaun Bird Signature - License number 4900 �FNCE i PLOT PLAN` PROJiCT Ivan Tortosa ADDRESS 1401 33rd ST. Houlton Wi 54082 SE 1/4,SW 1/4S 19 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX � SYSTEM ELEVATION BEDROOM 4 --� DATE 9/9/14 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHO E O WELL *H.R.P. Same as Benchmark 405'Propertyr Line Cale = 1l4" = 10' 33rd St. All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. B.M.* 93' 95' 7, 223' 9' Tank is to be properly bedded and B-2 provided with lockdown covers 15 Slope with approved warning labels Grading is to be done to divert B-3 run-off away Area 15' from system. below system is to 382' Property Line remain undisturbed B- 1 AL 98.3' Huffcutt Combo Tank We l l is to meet all WDNR setbacks Pro 4 Bed roo m House 470' Mound System Cross Section and Plan View -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i Dimension Feet i + t A B T I J _ SLf1�1JLJ LI1f�J4J !M1!f�M1fL!f1!J f Lr 1 rti••1,J1 L f f:J.r f f J J r r J r f r r J r r r fr•l f I D •LrL L J 1�rLjLf NL 1 L ti�tijLfljl h.i.LfLJM1fLJ f1r4�1 1 1 L{L L 1f1 L L. 1 L}1 f I E A + L L•{µ{1 •1 M1 L L 1 L i L•.1 1 1{.L.{.L.{{h{\{i.L.L.L•1.1•i•L L 1 L•1{M1 L 1 h Y L 1 L j4 L L �(- {r•� . .{•r.{•r.f. iirLr r W + r f ffK•f{fi.•LIf` fi•ffiN ri�i•frfLir�{irl�.{J{{ril{{rJ.rr..{f inr•�{{i{,tEr{{r{{{iiri=i{{ii{{ii f{{ii{{i S{{1i{{{i{{i{{{iLJi i{i{i{i i4 Nf {ti i{f i:r i l ri rirf l:fLi •f.L1r:iLf:i:iLf.i if f I F i•� f•l.J•J I f f•J•I•r•f f r f J f•f r f r r r•r•r r I /yVl + I G "-- +-- Z -` + H + + I J I 1{ • L - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ' W 231 K --T B Z /. —� L Slope Topsoil = ASTM C-33 L{iii = Clean aggregate = 4 in. sch. 40 pvc rir•r• _ Cap Material sand fill :%r% 1/2 to 2 1/2 in. dia. 0 observation pipe Geotextile H Fabric G -�- r•rw M1{1•L.\• F tN{1.1•L•L•L•L• ' it�.L.Ldi.1.L. f1.L. �i L•M1•M1.L• D E : r Plowed Surface Ft Contour I < <�� 1!713 t 3 r ?i"' Slope Direction y GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page_ of Pressure Lateral Layout Two Laterals — End Manifold 4-- 'Threaded Cleanout Lateral Turn-up ----► Plug Manifold M X L, - Long Force Main Sweep 9t) Bend Distribution Network S eeifieations Pressure System Construction Lateral Diameter In. Manifold Diameter _ In, Laterals are constructed of Schedule cu lar to PVC Orifice Diameter `�f 2, In. pipe. Orifices are drilled perpendicu X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) ? Ft. Lateral turn-ups terminate with a threaded �' A. cleanout plug and are enclosed in a 6.8 inch M (Manifold Length) --- diameter lawn sprinkler valve box accessible Force Main Diameter In' from finished grade. Force Main Length L/� Ft. — 9 UF I ce-5 /1,A T, v, 19 90 tAT 2 • • • • • Grade • • • • • • • .. _ : :: : 6-8 Inch Lawn Sprinkler Valve Box Page ---- 03105 lgj Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Pam Model Number Tank Model Number p Alarm Manufacturer Total Tank Capacity .- Manufacturer � T Max. Bury Depth Alarm Model Number .-- Switch Type LC Filter Manufacturer Total Dynamic Head(TDH)- Feet Filter Model Number Elevation Head'H� Distal Pressure Network Loss Minimum Pump rerformance R aired Force Main Loss GpM; Ft TDH r Total _ �-� - 1 1 ole Njin.4"Above Grade With I Manhole Min.4 Above Grade outlet Mash Ou Locking Deg ice, Inlet Manhole Securely Mounted With Locking Device <b Below Cr�ca Seal ed Watertight roof weather- P . '-----► Junction Box - Finished Grade ' •• -- --1► Vent Min. 12" Disconnect Above Grade Means • with Vent Cap Cutlet Filter ..._.♦, ----- -- _1--' Inlet nlet Bale A 1/+" Switch Sett ReserVe Capacity :" Weep Tank Volume= GPI B Hole Dimension: Inches Volume Gal. X. (reserve)A o'Z off Elevation C alarm B. 2 Ft > ( .. Bottom (dose) C D Elevation .3 , dead D --� /7i Ft Total .:;:;;•.,:..;;:;::>.::. is bedded and back filled in accordance with the tank of 'cldose a n The to rer m Th fac y TION: the menu ALLA ified T by IN S as GENERAL royal spec °f bury device (padlock) ificataons. Maximum depth have an effoctive locking manufacturer,s product alsp t fittings, and be exceeded without prior approval. Manhole covers exposed to ecxod�the tank with watertigh g, is of approved material, Conn pVC to bridge the tank d outlet Plx .40 Wet an 4 Sch installed. piping at the inl The force main is sleeved w� prevent WW'ng or fig' 1 service complies with NEC 300 and Comm 16.2'. laid on stable soil to per► t Elecuica se excavation and the sleeve is sealed watertigh • . Page of — 02105 LJ . TOTAL DYNAMIC HEAD/CA?AC 7Y PER V,INU?E � HEAD CAPACITY CURVE EFFLUENT AND DEwATERING �r 7 Ln MODEL 152/153 MODEL ! X52 ( 15J Q: ww ieters' Gal. I Liters ! Gol. Liters 1, 50 t 261 I 77 I 291 153 t 0 3.1 { p l i 031 70 265 � 12 40 152 15 4 6 � 53 1 201 1 61 231 `-`� i 67 I 52 '.97 u z 2� 5 7.6 i 34 129 42—r —15y v 30 z 33 3009.1 2 o 3 22 1 42 a 20 4v I 12 2 380 ( .6rntA40 Ft m Lc�k ` eive. . � 4-1 - -----__— 014508 10 I I 0 20 40 60 80 100 GALLONS LITERS 0 160 240 320 - 3 27/32 ---'�"' 80 FLOW PER MINUTE 1 3 -,/'2 CONSULT FACTORY FOR SPECIAL APPLICATIONS ® 27/32 •Timed dosing panels available. 6 j •Electrical alternators,for duplex systems,are available and supplied with an alarm. •Variable level control switches are available for controlling single phase systems. �� •Double piggyback variable level float switches are available for variable level long and short cycle controls. Lz — •Sealed Qwik-Box available for outdoor installations.See FM1420. ; . •Over 130°F.(54°C.)special quotation required. 2 1521153 Series 1521153 MODELS Control Selection 5 1/8 Du lex ' I Model VoItsTPh Mode Am s Simldex 2 or 3 —_L sKZOS4 N152 115 1 Non 8'5 Included I 2 or 3 —I BN152 115 1 Auto 8.5 E152 230 1 Non 4.3 1 2 9,_3 ' BE152 230 Auto 4.3 Inclined '2 or 3 10.5 t 1 or3 SELECTION GUIDE N153 115 1 Non back variable level float 8N153 115 1 Auto 10.5 Included 2 or 3 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double pggy E153 230 2 or3 BE153 230 1 Auto 5.3 Included switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. duplex 3 p CAUTION 3, Variable level control switch 10-0225 used as a control activator,specify p and wiring should be done by a qualified licensed installation ci controls,protection device`des should be followed including the most or(4)float system. licensed electrician.All electrical and safety recent National Electric Code(NEC)andthe Occupational Safety and Health Act(OSHA). RESERVE POWERED DESIGN For unusual ccnditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 70: P.O.a0X 16347 Manufacfurersof.. Louisville,KY 40256-0347 SHIP TO:3649 Cane Run Road /7 C�vcE /939 ZQ Louisville,KY 40211-1961 QLQU/TY'Cw Py ✓ ® (502)778-2731-1(600)928-PUMP `Q FAX(502)774-3624 http:11www.zoe11 er.com ©Copyright 2000 Zoeller Co.All rights reserved. SNOI1 MSV 31380NOO 1SVO38d NISNOOSIM li 1VNOIIVN 2 WoD-j�noddny-MMM ■ lilt-UL (91L) XV3 O U1 •313 V O U 0 O HNVI 3Ild3S NO dWnd N :30 838W3W �g j g 9191-626 (008) I. 9"L-E2L GIL) NOTM) O6L/OS21 C. I" SUK IM 'SIIV! VM3ddIH3 1NVld O31311833 y d N 133?J1S p�EZi bSib '133f 0?Jd Auno I I ao v :o ID n .66 •6E I I .8L in d. 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CERTIFIED PLANT CHIPPEWA FALLS,Wl 54729 ���� & 1,250/750 GALLON I MEMBER OF: (715) 723-7446 r (800) 924-1516 e N PUMP OR SEPTIC TANK C 0 A C R E T E. inc FAX (715) 723-7111 w www,huffcutt,con NATONAL k WISCONSIN PRECAST CONCRETE ASSOCIATIONS ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page o! FILE'INF0521WN SYSTEM SPECIFICATIONS I Owner { 5 Septic Tank Capacity � S ,1 ❑ NA Permit 7 Septic Tank Manufacturer ❑NA DESIGN PARAMETERS Effluent Fitter Manufacturer ,� ❑NA Number of Bedrooms ❑NA Effluent Fitter Model ❑NA Number of Commercial Units A.NA Pump Tank Capacity al ❑NA Estimated flow(average) gat/day Pump Tank Manufacturer NA Design flow(peak), (Estimated x 1.5) al/day- Uda Pump Manufacturer ❑NA Soll Application Rate /�7,(p _RazaL , 7�1 a'Vda 1W Pump Model ❑NA Influent/Effluent Quality Monthly average' Pretreatment Unit 0WA Fats,Oil&Grease (FOG) 530 mg/L. ❑Sand/Gravel Fitter ❑ Peat Filter Biodhemical Oxygen Demand (BODS) :52-20 mg/L ❑Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection ❑Other. Manufacturer Pretreated Effluent Quality A Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-ground (gravity) ❑ In-ground(pressurized) Total Suspended Solids (TSS) s30 mg/L ❑At-grade Wvound Fecal Coliform(geometric mean) 5104 cfu/100m1 ❑ Drip-line, ❑Other. Maximum Effluent Particle Size Y inch diameter Values typical for domestic(non-cornmerciaq wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every '� ❑ months ar(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,)of tank volume Inspect dispersal cell(s) At least once every months r(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑months ar(s) Inspect pump,pump controls&alarm At least once every ❑ month ar(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ears) ❑ NA otlier: At least once every ❑ months ❑year(s) ❑ NA At least once every ❑ months ❑year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer,POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual tnspec tim of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third(Y,)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113,Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatgment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page of_y_ START UP AND OPERATION f the POWTS For new construction, prior tooeess and/or damagehthe dtispe saltceil(s). If high conscen ations are detected have the rcont contents the may impede the treatment pr tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface, During power outages pump tanks may flit above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose, overloading the cell(s)and may result in the backup or surface discharge of effluent. of avoid this or col acct a Plumber or POWTS Maintainer to assist in by operat operating the Opmpoconrtrolsoto restoring restore normal levels effluent pump within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance disinfectants; fat foundation drain antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; roducils; (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting p pesticides;sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is propel y and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code' • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code complispnt replacement system: O 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 be infringed upon by requirled setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result h in the the nelen for a now soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologv a holding tank may be Installed as a last resort to replace the failed POWTS. The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 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. _>•/_aQQ.g.nd and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface, Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O�A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAIN R Name > ' Name J_e Phone SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHORITY Name J Name �T ✓�f....�- -Phone -_i " �, , c This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f)and 383.64(1),(2)&(3),Wisconsin Administrative Code. DepXtrnent of SOIL EVALUATION REPORT #1735 x r and in accordance with Comm 85,Wis.Adm.Code Pa of 4 ko nal rviceS Schmitt ling,Inc. :.ounty Attach comp pi on paper not less than 8%z x 11 inches in size. Plan must Cr ix include,b o imit to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent si or dimensions,north arrow,and location and distance to nearest road. part of 030-� C' OOO� Please print all information. Revi t Jsl Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Yvt1 /� el li G, Property Owner Property Location A Boonacker, Nina&Tortosa,Pedro Govt.Lot SE1/4, SW1/4, S19,T30141 Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# , /`i � 1431 cty Rd V 2 CSM Readiag.Approval V i City State Zip Code Phone Number City []Village ❑ Town Nearest Road Houlton I WI 1 54082 612-366-5993 St.Joseph 331Rd St. New Construction Use: Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD []Replacement ❑ Public or commercial-Describe: Parent material Glacial till (Amery Series) Flood plain elevation,if applicable NA ft. General comments Area is suitable for a mooun_ d system. System elevation is 98.33'based off a contour line established at 97.33'. Slope of area is and recommendations: 15%. F-11 Boring# ❑Boring Pit Ground surface elev. 97.63 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 none sil 2fsbk mvfr as 2vf 0.6 0.8 2 10-24 5yr4/6 none sl 2msbk mfr gw ivf 0.6 1.0 3 24-29 5yr4/4 c2d 10yr6/6 sl imsbk mfr gw ------ 0.4 0.7 10yr6/3 4 29-72 5yr4/4 c2d 10yr6/6 S1 Om mfi ---- ------ 0.2 0.6 10yr6/2 21 Boring# []Boring pit Ground surface elev. 98.63 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 -Eff#2 1 0-10 10yr3/3 none sil 2mgr mvfr as 2f 0.6 0.8 2 10-16 7.5yr4/4 none grsl 2fsbk mfr gw ivf 0.6 1.0 3 16-26 5yr4/6 none scl 2msbk mfr gw 1vf 0.4 0.6 4 26-34 7.5yr5/6 none Icos Osg mfr a lvf 0.7 1.6 5 34-71 5yr4/4 fif 10yr6/6 SI Om mfi ---- ------ 0.2 0.6 10yr6/2 *Effluent#1=BOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5 s30 mg/L and TSS<_30 mg/L CST Name(Please Print) Signature: CST Number Thomas J. Schmitt :� 227429 Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond,W154017 4/26/2014 715-760-1978 SBD-8330(R.07/00) Property Owner Boonacker, Nina&Tortosa, Parcel ID# Part of: 030-1040-50-000 Page 2 of 4 3]F ❑Boring Boring# pit Ground surface elev. 93.93 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#t *Eff#2 1 0-11 10yr3/3 none sil 2fsbk mfr as 2vf 0.6 0.8 2 11-21 10yr4/4 none sil 2msbk mfr gw 1vf 0.6 0.8 3 21-26 10yr4/6 none sicl 2fsbk mfr as lvf 0.4 0.6 4 26-55 5yr4/4 cld 7.56/6/8 7.5yr6/d sl Om mf --- ------ 0.2 0.6 F-1 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/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 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/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#t *Eff#2 I "Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L "Effluent#2=BOD5<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) Schmitt Soil Testing,Inc. _ r , Page 3 of 4 Conducted#y: _ Go ".Po educ ted . r. ;Scr mitt So�i Te�iting Ind _ N mew Nina Booga cket&Pedr4 Toftos� Thomas J. $chrcitt, CST 2-27429 Address: 1431 Cty Rd v.' 1595 72nd St. _ City,State Zip fianitan,WY 54082 Now Rie hmQn�„WI X44 7 - - . Part of'.30-1040-50-004 Plp• Phone: rl1 ` 60�-1971.. -Ldt Nei - _ Lega Ue�p�tt.ySE'�14�lY1 I114.>�' - I !4 S19 T30N Backhon Ptt gwr►sjttiP,' ty: osep6,St Crniz Coal nty - ,, Bench*ta 1 M. TbO.�'Tbp of 3`_j'1lC..Pipe A Bench Mark 2-4t.96.71.T*O of X!_PVC 01PO. Slope- 16% Contour Line EievaO, on;=97.3V Contour Line Length 8?"' j i n + , , 4V4} t i i �J { f , RRR _ { } �0 br Sc6le-f 40' Ila 43 At ra t4 It jq I f r , , -- - - r r i 3T " " ! : , " i t i 11 _ IV (�� , -- L A 1 _., ^I(y� 1 , , , 1 I w fr , x v y Anf^ w / r 4SI y k ,r /WMyk " 'I X- T • - 2 .. j 4 f rt �a t CERTIFIED SURVEY MAP LOCATED IN PART OF THE SE-1/4 OF THE SW1/4 OF SECTION 19,T30N,R19W, TOWN OF ST.JOSEPH,ST.CROIX COUNTY,WISCONSIN. z g— Bo W PREPARED FOR: NINA BOONACKER&PEDRO TORTOSA 1431 CTY.RD.V 9 x HOULTON,WI 54082 ZO a SURVEYOR: m sn DOUG ZAHLER S&N LAND SURVEYING SCALE: 1" 200' 2920 ENLOE ST.SUM 101 HUDSON,WI 54016 200 100 0 `200 _V a a A = . se of the open space area is limited to the ses prescribed in 168-18D of the Town of St. ` oseph Subdivision Ordinance.Development thin the Open Space is prohibited.The boundaries of the Open Space may be ha ed with the appro val o the town board. �o L T1 LOT 2 aR ro DRAFTED BY: DOUG ZAHLER PROJECT NO:7263.001 DATE:412412014 SHEET I OF 2 ' FILTER CART R"D" JMVrJRUCT,10jvS �trial�t'�r,( ta lwt 1 buy in kf,e Mtttsl'ca sar,watp thm Cvbtri ur+d+rr tlw WttP itf Cltu nuly�l t,ipr yr,eserMara it!u tttl l(�1f lYt�b�i1 1+1ff Jv uY vu�uvn� r tP tCli�y Qllbl!W�fryy}rry tit" 't pllla itrY'o ttwe I,ipta. artd4f LtBrit#m1 dddlttu,lrai III"4w to Elm Wurk t 'U ww am rig"ig sa m dry oil*" Wf 1t1t1 nU1�ah tape,r,lab&uru tlrav ivrtgti qP%-I th OW,rrrrsd,wl tv etrliowal'►W#aftnt""'trlrl.,v,u'e thu#Yttar#to lm ilk ua,i WWI k ut"Ift,fhe l,tul*iod ht t NIK tunu,ra Ir vtrfm AlwoJoutt t,raillbd I*trek akgliud, 1'1lr.i'a.� 1"'Wr iorkyrw,itftf7,1!'1 lrtlyWrtet 044M ills s14,•irrc 1r Pipe oeaiok��r�r r���f�1�ysi bp�t krpIwo-tt artllF.t6yir Nrtw"4 ty aieu foul: 1a.bni' 5u1Vrurt weil tires float r.aetr tlhtu the Wtrtlat:t,iue. lr,snr# tl,u a cbt't trlvw r#ato the retie,plr#tigl,t t damn,utrtit E iilrrr ut +' thu cnsu. Ntt 6lttle iockt;Ittu this 4„tttrrir W",t WAS 6,wkr4,is tft&,rJ. ilf-wrt irrfu t'br, t+�t rltrticwlee 911x, iritur?It,ri Wclr fly tUttttrtk •' ,r 1. fhra er9(ue#rt(iftur rhrsuld h� et�urrwf r,vrrry burr(#the&eptlr'NO(is srorvfautk. 1, t)glerr film uUtlet maxo a u4►r�,WarP)to Inmpvtt tire tupkk aim tithtl; 3. Ptugp ti,b atlfstic t¢,#rlr rwrr � ibv#A,tat the ha",of toraaeakY�tehlr surd to rtitrltAN thu altudyls not J",t file buUfrl tttml dtPfltuht. - n• uhw laE,a erYkprrrt Irevr,t has t Warm(Www rod u Wtttl*t Mill,"rmty pub err,'*h tw-r,Ntw'hamolle tj tars nrNyrt rr#flue cu,rOwwo#Mal Ike rutuu, diair#dlyv tNtt 5, SO&titre rrrtrmAw up:red onr or'the rtr,rrr Ior�itwiNNly 6. If is VA.%5wkct,t plthnctrsd t:u ofv tltryrtn rry+iSrrthtt#rds swid ho b n C9tihtt7iri+51ttti,e swif,r mttd dltilNtfri wick wow illw �. Whoe humin[4��the Wuo al is xirld�f:rtkp Mat�uriur.e r:rrlwp uhrwre�outw adru `+ a+Tiy, ,vaaleltly eHrrW i� rror t'NKm ON the t'�Old 't r ptargu#raatrsrtay Iv rlttatyd Bit tulljr b. If Vttb sYNtch qt Mmd tack N►Ltr tbib lard_ ?fir tur'rrt#00 doakwicv otter-. er by 11*wtj g(ttfti 1%4r'4w :?1r�,. t #, ltrsert tl#a Haar cartri+l�an t►arCk.fi>ku ttft Q" )tfe t;brl�duWn'u#,tl/ uy 1' ' the filter lac^^ �k'1 4• 4 t,p itdtq the Luttamrr err”t7l4rr,:g4;ry. f q.W,trlate and alwwry lira U#;trttitj ItCltttTNill C7tu t171y Milt„ 4' r, e> ..r.. ',a, .r,,vxl;kb»s,� •t.,. .F r,r a Fwt'61.?.,v:,Jlata,. 1 t+r��r+�.�etfu�fll�.r�v� 8E6a�'�'�'.� �,`t"� i CC,����5��•� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE t-�GREEME,NT AN'D OWNERSHIP CERTIFICATION FORM Owner/Buyer 2C4 V) Mailing Address?!!!=/%C-____ �� Au_a�— - Property Address ) o 3306 S7 7?&�T (Verification required from Planning&Zoning Department for new construction.) City/State �DU�Td�� L ,5 Yd ,arcel Identification Number LEGAL DESCRIPTION Property Locations 1/4 , '/4 , Sec./9 T ��V R/ W, Town Subdivision S-- _-_ , Lot# . Certified Survey Map # Volume_ , Page Warranty Deed# J �J I , Voitune_ , Page# Spec hoes no TT-- Lot line;, identifiabl 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, ii 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 was!-e disposal system Owner maintenance responsibilities are specified in§Comm. 83-52(1) and in Chapter 12-St. Croix Coiinty 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. Vwe,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 Departrntnt of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St, Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we arrJare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office, ber of bedrooms SIU ATURE OF APPLICANTS) 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. i (REV.08/05) I' • 0 997517 BETH PABST REGISTER OF DEEDS CERTIFIED SURVEY MAP RECEIVED FOR RECOIRD LOCATED IN PART OF THE 1 4 F W 06/20/2014 2:02 PM SE / O THE SW1/4 OF SECTION 19, T30N, R19 TOWN OF ST. JOSEPH ST. CROIX COUNTY WI SCONS I . EXEMPT #: REC FEE: 30.00 W LEGEND COPY FEE: 4.00 H Q 00 ® FOUND ALUMINUM COUNTY SECTION PAGES: 3 CORNER MONUMENT O FOUND 1-1/4"DIAMETER o O ++ u ROUND IRON BAR a PREPARED FOR: m i-- FOUND 1-1/4"OUTSIDE Z ut • "z¢ o u ✓t DIAMETER IRON PIPE �� ✓r . NINA BOONACKER&PEDRO TORTOSA Y '- ---- O 1431 CrV.RD.V 2 p SET 1"OUTSIDE DIAMETER BY 18" r'DOUGLAS J-'.%y HOULTON,WI 54082 u O LONG IRON PIPE,WEIGHING 1.13 ( ZAHLER ?� a r LBS.PER LINEAR FOOT dr; S-2145 SURVEYOR: PREVIOUSLY RECORDED AS L HUDS / DOUG ZAHLER S&N LAND SURVEYING 2920 ENLOE ST.SUITE 101 HUDSON,WI 54016 SCALE:1"=200' 200 100 0 200 �J UNPL_AT_TE_D LANDS 589°06'41"E 582.64' F_ —' • CV �Y Z b LOT 1, C.S.M. 0 - VOL. 8 PAGE 2175 x7301'1 U A LOT 3 A " 717,703 SQ.FT. 16.476 A CRES (N88°51'15"W) ao • S89°06'41"E 516.00' 171.51' 115 589'06'41"E 589'06'41"E 386.13' OPENSPACEAREA=10.746ACRES I 8 v+ IC Z N Use of the open space area is limited to the (w 1-0 uses prescribed in 168-ISD of the Town of St. ° I; Joseph Subdivision Ordinance.Development 1:4_ m within the Open Space is prohibited.The I o N m z m boundaries of the Open Space may be I OPEN SPACE ti Ip I< changed with the approval of the town board. I N Ir- I0 mo /� ) ,A, z I� c 589°06'52"E 206.56' OPEN SPACE / ��� I° a i S62.0 589°06'41"E 413.26' D a IIcw ti> m OPN SPACE � S� a' a� �'�%?6338 l .Z-_.7 U3 � LOT 2 11/QI 80 LOT 1 J T In A m w I^�+` 164,958 SQ.FT. w C1-t 4 V 201,866 SQ.FT. I"' 3.787 ACRES N 0 4.634 ACRES 52.00' v I w 52.00' °, 589°06'52"E i I w S89°06'52"E FOUND 314"REBAR /_N54'03'S0"E 1.99' SOD°53'08"W S"�- N00°53'08"E 1244.03' f 561.87' 116.00' 116.00' 470.77' N89°06'52"W 1098.64' • 210.87' TOWN ROAD RIGHT-OF-WAY SOUTHWEST CORNER — —' ' N89°06'52"W 2553.5 1 DEDICATED TO THEPUBLIC SECTION 1J (589°07'00"E) (�Ivw SEE DETAIL ON SHEET 2 SOUTH 114 CORNER SOUTH LINE OF THE SW1 14 \I iy p I / SECTION 19 DEER MEADOWS I PLAT OF BROWN WOOD ESTATES —I - - - - - - - - - - - - - - Each Parcel shown on this map is subject to State, County and Township laws, Note: Lots may be subject to future rules and regulations(i.e.,wetlands,minimum lot size, access to parcel,etc.) Before assessments for any upgrades or purchasing or developing any parcel contact the St. Croix County Zoning Office and improvements to 33rd Street. the Town of St. Joseph for advice. DRAFTED BY: DOUG ZAHLER PROJECT NO:7263-001 DATE:6/2/2014 SHEET 1 OF 3 St. Croix County 997517 Page 1 of 3 Vol 26 Page 6025 • • � - � IIII!!illlllllllllilll!ll!!il! ! State Bar of Wisconsin Form 3-2003.: 8 2 5 5 6 0 1 QUIT CLAIM DEED Tx:4208930 - 1001359 Document Number .Document Name BETH PABST REGISTER OF DEEDS THIS DEED,made between )95p' .9n �:Tp 77`D� 'eAl ' ST.:CROIX CO.,.aNI /fNTOiL/i1/fl.. .u. �ilOf>�VAcKil2 ("Grantor,"whether one or more), 09 J09J 201 4c 11 PM and /V 1/�40 TO/�TUS>f -P�O�//1 Gl7c'7� EXtMP.T#: 8 REC FEE: 30.00 - ("Grantee,"whether one or more). PAGES: 1 . Grantor quit claims to Grantee the following described real estate,together with.the rents, profits, fixtures and other appurtenant interests, in ST' alA County, State of Wisconsin:("Property") (if more space-is needed, please attach . Recording Area addendum): Name and Return Address RV .3 TD/�/ /_O.T /four i oiv wr 54�oa'Z 2 !,44 X9 5" Oil/ J7/N�`ZC7 �itL1Ta� �if/�rrL 0- 044-SO--0 u parcel Identification Number(PIN) This homestead property. (is)(is not) FELICIA BAICLAR6EON Notary Public State of Wisconsin '. Dated (SEAL)-(SEAL) Pc i)2 O a7, O R TO SA (SEAL) (SEAL) AUTHENTICATION .' ...ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. authenticated on G m t COUNTY ) Personally came before me onV4�AC�- a• a.0(� , * the above-named j�n �g roc t Jn-1°or�tsa $�nncK TITLE:MEMBER STATE BAR OF WISCONSIN pe_&6 1-0'46SoA (If not, to me known to be the person(s) who executed the foregoing authorized by Wis.Stat.§706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: C O No - ic,State.of Wisconsin 1 My Commission(is permanent)(expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTHVIDED. QUIT CLAIM DEED ®2003 STATE BAR OF WISCONSIN FORM NO.3-2003 St. Croix County 1001359 Page 1 of 1 es M m� uo no � auµPapysry saay IM' N H Oil aouapisall osopo j / liassnb IEE y y ff M.l T-mm I ff F F H 14 Hot i- 41 1 �a t � 4 f,, o j11 -b uo no - Q X11 ay+l�aAy3y IM' 11 H o� 14 M:aa eouepisaa osopol / jjessnb eo i _gg E n3 ti — \ 4 9 4 A � 8 doQ Z s @ � Eve ll-- m sill.. 11 1 �S r y j uo no on 42m."� aauaplsaa osopol / Ilassnb ; gi , a r �ga . / MS r r 44 Jill 8 �I r IWO I II L I ,;II I �7 F $ � I` L LPI p I � -QO — -- # Jlr—� �.. ;III g ._ $� a ■ Z fit & z Ili;' r H9, g II ; 9 =A �g�Q� dl��g� � aff $ a �� � �j �� �a•