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HomeMy WebLinkAbout020-1162-00-000JVisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Bu~~ing Divi~on INSPECTION REPORT GENERAL INFORMATION (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 Gelein, H Michael Hudson Townshi CST BM Elev: Insp. BM Elev: BM Des~~ption: le... ~ O / v v . wry ~ `' V ~ ~ dL~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~~ Dosi1n_g _ ~~ CJ (e a ------,. Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL .... BLDG. Vent to Air y~take (,( ROAD Septic ~Q / I I 'N (' t Dosing_ > I ' ~ ![fib lyt' , Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~~`~'/I ~ _ , i ICJ~~[/~f Demand GPM Model Number a / TDH Lift Friction Loss System Head TDH Ft Forcemain Lenoir r CC `~ Dia. 2 ,~ Dist. to Well ~r~1 -r , ~J SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix sanitary Permit No: 430089 0 State Plan ID No: GG 2 q. D ~ l 1,. Parcel Tax No: 020-1162-00-000 Section(Town/RangelMap No: 23.29.19. STATION BS HI FS ELEV. vo.a Benchmark fS,u~ IIS.v !c`c,cC, Alt. BM ST ~ /1Z- 93 Bldg. Sewer ~ (~~ f ~ 2 ~ 7 SUHt Inlet Z &~ ~f! ~ Z SUHt Outlet 3 Zti // ' o ! o Dt Inlet ~~>0 9q ~ Dt Bottom i- S 9s-o Header an. ~ ~~3~1 /~~ !/ Dist. Pipe ~ p o~p ~ / ~, 3 z l ~~ Bot. System r ~ ~~ Final Grade ..~- st~ . l s . g3 Con ~e urS t.J )7. G 3 g7. `t S-" LV Y7TO AYE /.'. ~ . I? ~,G3 /~.L..3 BED/TRENCH DIMENSIONS W idth ~ ~ Length ~, No. Of Trend i PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LE CHIN CHAM OR Manufacturer: Type Of System: ~/I ,,.~, f ~ ~ / ~' ~ ` ~ D Model Number. DISTRIBUTION SYSTEM ~. Y~;_~.. 1 /h.~d~n,,/• nL,n Header/Mani~old" Length Dia Distribution Length Dia I ~ Spacing x Hole Size x Hole Spacing{ Vent to Air to SOIL COVER z Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over pepth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ ] Yes ~._] No Yes ~' No ; COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/y /~/l~~~ Inspection #2:~/~/~ Location: 836 Kit Lane Hudson, WI 54016 (NW 1/4 SE 1/4 23 T29N R19W) Fox V Iley Farm Addn. Lot 28 ~~ Parcel No: 23.29.19 1.) Alt BM Description = cST • (~~(/'~.~ ~~ P,-~ p --.-~-~ (1- ~ -~ ~d ~~ b~ Pl ~ "11 2.) Bldg sewer length = ~ (' ~, w ~ `t ~ ~-~ ~~' ~' ~ {~o~ {j - 11 m ,.~ I,~t~ d5 - amount of cover = t...) '~, `~ • pQu,u ; „ ~ a •c to is d r~ Plan revision Required? Yes °J No ///~~ h ~ Use other side for additional information. I ___ Lv!1__ ~ ~ v ~ I ' G~~~2,~Q_ ~~~(/d~~t- SBD-6710 (R.3/97) Date Insepcto i a re Cert. No. 3 Safety & Buildings Division ' Sanitary Permit Application 201 W. Washington Ave. `~StiOi/>S~/1 In accord with Cornet 83.21, Wis. Adm. Code Po sox 7302 Madison, WI 53707-7302 Department of commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Lew, s. 15.04(1)(m)] state owned. Attach com late tans to the count co onl for the s stem on a r not less than 8-1/2 x 1 I inches in size. County ~ ~ State Sanitary Permit Nu bar Check if revision to previous application State Plan 1. D. N mbar ~ ~ n/S. 873 ~ I. A lication Information -Please Print [ormation Location: !~ Property Owner Name I ~ - + ~~G~~~~~ Pr o pe rty Location . ~ ~ ~ • ', / p ~ / -/ /UW I/4~j' 1/4 S ,~ T N K /E o W Property Owner's Mailing Address Lot Number Block Number ~ .V{~J ?2?.00.3 City, Stale ~ ' Zip Code ~'~ Pone N~nl~" ~ ~ ~; ~ , . ~ ~~; ~ Subdivision Name or CSM Number St ' . ~ /,~ .. ~~~ _ ~ ~ ~1 adds . II Type of Building: (check one) ~/ 1 or 2 Famil Dw lli - N f B d ~ ^ City ^ Villa e B y e ng o. o e rooms: _ ~ ~/~(~ ^ PublidC i l d ib "~ 'own of ommerc e use): ~~ a ( escr ^ State-owned ~. ~ ~ ~ muds III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road ~ ~ ~~ A) 1. New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem y $) Permit Number Date Issued O A Sanita Permit was reviousl issued IV. Type of POWT System: (Check all that apply) _ ~~ ~ ] S,n ~ ^ Non-}5ressurized ln-ground ound Z ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground o ding'Tank ^ Single Pass ^ Drip Line O At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dis ersallTreatment Area Information: 2 I. Design Flow (gpd) 2. Dispersal 3. Dispersal Are 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade (~ ~ Required/~ ~ ~~ ~ Proposed ~~~ Ra}~( Is./day/sq. (i. ~ 1i7~ ~tl (Min./inch) ~~ /` /\ ~ 9 Elevati/o n ~7 v V ~ ~ .V ~7 w ~V. 1 VI Tank Capaci y in Total # o Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks i~ Con- Con- glass New Existing / i~~`'~~~~ ~ crate structed Tanks Tanks / / ~' ' --- -1 a -~ - 5 --- ~e _ ^ ^ ^ ^ ~ _ _ --- ~G/~S - - ,~ - ^ ^ ^ ^ VII Responsibility Statement. I the undersi ned ass e r sibilit for installation of the POW7'S shown on the attached tans. Plumber's Name ' t) 7i ~ PI er's Sigru ,,;.(no ap-mps): MP/MPRS No. Business Phone N umber 't`- // a '~~~U' Plumber s Address (Street, City, State, Zip Code i~ ~-r- VIII ountylDepart nt Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing eqR Sign stamps) Approved O Owner Given Initial Adverse Surcharge. Fea) ~ J ~ . Determination 3~s a d D 3 X. Conditions of Approval /Reasons for Disapprov'alt~' ~Gt/~5~,~~~QL~ Co~1~t~~C.~ l-flvt,a c~1,i S--fir~ ~~~~ ~0/3~03 GHQ t~~,~~~ ~ v~u-~-°,-f ~2~c de._ Du~,~,~ c~~Ge~- ~ ~.~~~ ~ ~.- ~llvvt.~Aili+'r Gt.~i2~liTi~c-e- ~~ti~c~ !tiL L.p~tim, d'3. ~3 ~/ ~~~3f-~~,c~~~~~20~, L~ uc~ w v r~ vwwcyt~ ~~.~c. ~ ~.r/~YC~.~ Gci~a I !~6! Lti I 0 g O A E ~D rte o A ~ '1 ~ ~~ B ri ~ ~ o ~ Q ~ u• o ~~~~ A ~~~ ~,~,~ ~ ?~ wow ~ ~ w ~ °~ k ~~c~O ~~ ~\ 6 .a ~' mo ~~~~ „~~. z `C h ~ .. ~ ~~ ~ .. ~ ~;. a /, A ~ ~' 0 a ~j ~o p c O O ,~ a a 0 0 a~ Q ~~ p,`o ~~~ ~ n ~~ ~~ ~o ~~ U ~~ u~ ~~ ~~ ~£ ~L A-oPoSec~ ~t/'~t ~ y/6~rviom ~ /'cS~dance ~~ V ~ .~ Of~ ~ Q~~ve~q y C N `.c~ 0 u 0 ~~ l N 0 8 ~ ~ ~o cb ~ !4 ~ ~ A ~° g~ O "~ J ~ A J (~ ~y ~~ ~~ ~~ z~ „~ ~a 4 ,8 ~~o b loo A~~ ~`~ h ~ U ~y ~ ~ ~,~' Sm~' i J ~ N ~- -. isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.state.wi. uslsb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary June 03, 2003 CUST ID No.222904 JAMES W BOUMEESTER 1070 HWY 3S N HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/03/2005 SITE: H Michael Gelein Kit Lane Town of Hudson St Croix County NW1/4, SE1/4, S23, T29N, R19W Subdivision: Fox Valley -lot 28 FOR: ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 ~~~~ Identific s Transaction ID N .873499 Site ID No. 659720 Please refer to both identification numbers, above, in all correspondence with the agency. Description: Proposed Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 905282 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: Conditions of Approval: This system is to be constructed and located in accordance with the enclosed approved plans, the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • 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. • 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 provided per Comm 84 product approval conditions. • 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 83.22(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. JAMES W BOUMEESTER Owner Responsibilities: Page 2 613/03 Comm 83.52(I)(a) -The owner of a POWTS sha_ 11 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). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Cornm 83.54(4) shall be considered a human health hazard. 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 per Comm 83.55, that is 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. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 f MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: H. Michael Gelein 4 bedroom residential mound Owner's Name: H. Michael Gelein Owner's Address: 209 12th Street South Hudson, WI 54016 Parcel address: XXX Kit Lane Legal Description: NW1/4SE1/4, Sec. 23, T.29N., R.19W. Township: Hudson County: St. Croix Subdivision Name: 1st addition of Fox Valley Lot Number: 28 Block Number: na Parcel I.D. Number: 020-1162-00-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evlauation Report RECEIVED MAY 2 2 2003 SAFETY & BLDGS i3~V~s Designer: Jim- meester License Number: 222904 Date: 05/06/03 Phone Number: 715-386-1794 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.0 03/01/01 ~ -" `~°'~ Page 1 of 9 ( ) t?taa~rrnE~sT or c.r~,~r;;r~cr DgVf5i0IT ~1f SAfETY ANli Bt1iLi;ii~~S SFE GURRES NDE:NCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) j _ R Residential or Commercial Design _ ' 400.00 Estimated Wastewater Flow (gpd) _ _ 1.50 Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Ftow (gpd) 19.00 Site Slope (%) _ 98.00 Contour Line Elevation (ft) _ 24.00 Depth to Limiting Factor (in) f__.. 0.50 In-situ Soil Application Rate (gpolftz) D_ i_s_ tribution Cell Information _ 100.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) ----- 1 Influent Wastewater Quality (1 or 2) Press__ure Disribution Information (c or e) ~ Center or End Manifold 3.00 Lateral Spacing (ft) 4 Number of Laterals _ _ 0.125 Orifice Diameter (in) (e.g. 0.25) _ 2.50 Estimated Orifice Spacing (ft) _ ___ ___ 2.00 Forcemain Diameter (in) ___ 30.00 Forcemain Length (ft) 92.50 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 6.00 Vertical Lift (ft) 0.69 Friction Loss (ft) 13.19 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice .. --.._ 0.75 _ _ 1.00 1.25 1.50 x ~ x ~ x , x , -~~- ~_----- ___-._-- 2.00 x ; _---. _ _ 3.00 x Treatment Tank Information 1260.00 Septic Tank Capacity (gal) '.Weeks concrete_~JManufacturer Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 6.00 Cell Width (ft) Are the laterals the highest point _ in the distribution Y L-_______~_ __: network? Enter Y or N If N above, enter the elevation (ft) of the highest point. __ 7.50 ftz/orifice Does the forcemain drain back? ~_ _-Y~ _T_ Enter Y or N 4.89 Forcemain Drainback (gal) 62.87 5x Void Volume (gal) 67.76 Minimum Dose Volume (gal) 32.95 System Demand (gpm) Manifold Diameter Selection in. dia. 1.25 o tions c _ x _ _ x 1.50 x ~ 2.00 ~ ! 3.00 _ _--- -; Gallons/Inch Calculator (optional) 1066.24 Total Tank Capacity (gal) --- j 49 00 Total Working Liquid Depth (in) 21.76 gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information - 1066.241 Dose Tank Capacity (gal) (Zabel __ _~ .{Filter Manufacturer 21.76 Dose Tank Volume (gal/in) ~A100 ;Filter Model Number 'Weeks concrete __J Manufacturer Project: H. Michael Gelein 4 bedroom residential mound Page 2 of 9 Mound Plan View 1 Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.77 (ft) - ..rri ri.... G • H ~ ,rrrrrrrir 2 rrrrii~r... •j rrriir rir. ft) Lateral I F ..:: ~ : ' f Dispersal Cell 99.50 99.00 (ft) --- - ~ : ~ Invert Dispersal Cell ~: ~ ~ ~' ~ ~ ~ Elevation E ~ ~ D ' : ~: Shading Key '~ c. Q Topsoil Cap o a c Q 'r"r Subsoil Cap ©~ ASTM C33 Sand ~ Z Q ~~,:"-," Tilled Layer ~ H ^5 ~ Aggregate v o ' 1 /1 10 B : • Observation Pipe • 0 ' • • .~ . L~f.. . -~ ~ L Mound Component Dimensions _---_ A 6.00 ft 25.68 ' H 1.00 ft B 100.00 ft F 9.25 in z 23.80 ft D 12.OOin G 0.50ft J 4.34ft K 10.02 ft L 120.05 ft W 34.14 ft 600.00 (ft2) Dispersal Cell Area 2979.65 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement 19.0 % Site Slope ~- Dispersal Cell 1.5 ft .~ ; ;.: ' 0.5 ft Typical Lateral ~ ~- A --~ .00 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). -T _} _~ -I Project: H. Michael Gelein 4 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. I P •=Turn-upwi'ball valve or IFX cleanoutplug Holes drilled on the bottom of the lateral. Laterals & force main of PVC Sch 40 per COMM Table 84.30-5 S ~k Number of Laterals 4 Lateral Diameter 1.25 in Lateral Length (P) 49.34 ft Lateral Spacing (S) 3.00 ft Lateral Flow Rate 8.24 gpm System Flow Rate 32.95 gpm Total Dynamic Head 13.19 ft Orifice Diameter Orifice Spacing (~ Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity Laterals are identic al Dose Tank Information Electrical as per NEC 300 and -- (((LLL,,, Comm 16.28 WAC I I Disconnect II ~_ Tank component is properly vented Weeks concrete Ca acit 1066.24 Volume 21.76 Manufacturer Gallons gal/inch A B C D Dimension Inches Gallons A 29.44 640.62 B 2.00 43.52 C 5_.56 120.98 D ~ _ 12.0_0: 261.12 Total 49.00 1066.24 3" Bedding -__. _. Alarm Manuafacturer LevelAr__m_ _ _ _ _... --- -- Alarm Model Number's DLV = Pump Manufacturer jZoeller , Pump Model Number;98 i Pump Must Deliver 32.95 gpm at 13.19 ft TDH 0.125 in 2.53 ft 20 7.50 ft2/orifice 3.00 ft 1.25 in 3.37 ft/sec Locking cover with warning label and locking device and sealed watertight 4 in. min. E--- Attemate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P, ump off elevation (ft) ~'-- 93.50 D~ ose tank elevation (ft) 92.50 Project: H. Michael Gelein 4 bedroom residential mound Page 4 of 9 Mound Svstem Maintenance and Operation Specifications - -- Service Provider's Name J. Thompson, POWTS Maint'r #30021 Phone 715-248-7767 POWTS Regulator's Name I_____St. Croix County Zoning Dep't__ _~ Phone _ 715-386_4680 Svstem Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1260 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Ins ect andlor service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears _______Inspect for ponding and seepage.once every 3 years __ --- Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code, 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ••............ ............... Grade ~ . 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: H. Michael Gelein 4 bedroom residential mound ~ Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet 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 fitter 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 addltion of biological or chemical additives to enhance septic tank pertormance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. 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 finer is installed within the tank lt 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 soil compaction may hinder aeration of the infiltrative surtace wthin the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10° cful100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed 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 wthin the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced wtth a component of the same or equal pertormance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surtace, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: H. Michael Gelein 4 bedroom residential mound Page 6 of 9 .. HEAD/CAPACITY CURVE ~~ /3. ' T. d. h! GALL J LL F ,,,~ __ ! ,-,- „ ,, ~ HEAD CAPACITY CURVE EFFLUENT MODELS TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING arch , SERIES 6739 97 9B 1)7.1 Ja 191 10.1 i66 166 l84 I~ I IB9 y- FT. M GaL Ltr1 ON Lta Gal Lt G l 1 6 ' ~ . . a a . I.trt 6 . Ltrs Gal. Las Gv. Lt s. Gal Lts. Oal ltl. Gal Lts. Ga ~.trl v. _ ~ 5 1.62.. N 1BJ 50 212 72 277 101 791 100 wl- 0I ?71 01 2J1 68 220 156 507 156 507 'i _ 10 7,00 >• 129 46 171 81 271 79 700 100 .'778 8i 201': 01 261 68 220 IN 600 15 5i~7'1 '~ ~. ~ 15 4.57 10 72 >6 IJJ 16 170. 01 212 9i J11- 60 227 ~ 00 ?37 58 220 Ia2 577 Ia5 SW _ _ T 20 0.10'. 16 b7 2b % 76 t70 92 010': 59 220 00 ?27 68 222 170 610 1 W 5~j0 ~ Os 267.02 9 J4 71260' 67 710 6o Y21 6B Y20 129 181 ~ 13) 661 - -T°-~- 70 AI• 06 '7M- 66 .2?0 50 7Ap, 90 "710 59 y0 121 {a0 127 1aI _ w .1219 10 .171 18 .172 66 200 16 283 68 2ZA 106 186 6D .16,21 21 BO 77 .125 61 191'. . ba 219. 68 220 797 90 311 II1 uI I 1C0 )79 !. '~. J - ~ 1iZ0. 15 -67 u 101... 70.170 ba ?20 71 209 95 722! - - ?o~ 70 21.31 >D 1i1 10 7d 62 197 61 197 7C 206''' o ' - 165 W 2{,70 11 (>J 15 170 2B 100 5.1 20+ ., 90 27.1J )2 IZ1 2 9 )7 110' - -- 1 -1-- 100 70.18 1e e9 21 79 -. - ~~- _J___ _- IbJ 110 7 200. 7 Ze 1 301 Lxk Y wa: 19. 26' 2376' 2T Zd' ad' 80' 0T 77 115' 91' 1,7 ___ _ EFFLUENT &DEWATERING ,_ _ 165 Warning: Model 185 should not be subjected to less Ts._ ~ ~ than 30 feet TDH. - ~~- I IB9 --- Note: For Head Capacity on Model 112, industrial column-ex losio f F I 16t p n proo pump, see M 219. 166 - '- - ~ 98 _ Y 5 , 5, 7 ,59 IJ IJ9 SEWAGE &DEWATERING oNS ,0 20 Jo 1o so 60 70 60 90 100 Il o 1 2o IJ O 11 0 1 50 16 - o WARNING: Model 293 should not be subiecteci LITERS BO 160 210 J20 600 180 560 610 W 32.956. P . /-'J;•71: S / a-Ec. r •rGo/ 1 24 B 7 22 7 20 .-_ 6 18 .~ 60 55 16 50 li i 1S 12 r 10 75 10 :- 30 6-- 25 6 - 20 16 / -- 10 2 __ 5 C GALLONS to less than 15 feet TDH. K~ - -- TOTAL DYNAMIC MEAD/CAPACITY PER MINUTE SEWAGE AND DEWATERING l SERIES 202 200 207 280 282 2H 292 297 291 I 295 -~ _~ FT M Gal. Llrs Gal Llrs. Gal. Llrs. Gal. Llrs. Gal. Llrs. Gal. Llrs. Gal LVS Gel Lus. ___ Gal Lvs _ _ Gal 'ws S 1.52 90 J41 128 181 128 181 128 161 170 192 180 681 110 570 196 712 _I 225 dS2 l 10 J OS 60 227 B9 777 B9 J77 89 777 95 J60 158 598 121 169 ldl 685 _ _ 205 !7c 1 IS 1 57 22.5 BS 50 IB9 50 789 50 188 6J 238 135 511 t06 001 130 692 165 625 tB5 700 ?0 6 IO IO 38 10 38 10 18 37 125 106 101 68 7J7 119 650 150 568 16b 566 1~, 25 7 62 76 288 68 257 t06 101 IJ6 515 15J ii 30 9 17 17 163 17 ll8 90 NO 121 158 110 530 10 1279 5 19 50 189 91 J56 1,. +Jo-~ ~ 50 15.26 _ -' - 58 220 ---- -- B9 JJ7 60 IB.29 13 19 _ SS Z27~_~ 70 21.31 25 9 lock Va1va 1B' 21 5' 21 5' 21 5' 2 ' ' ' . . . 6 75 IT 50 67 77 ~1 i 293 __ ~ I I 282 I 292 ~ ~ ~ - T i 262 266, 267, 268 284 294 295 ;_-_~~ 10 20 30 40 f ~ 0 60 0 BO I -- 4 0 5 0 5 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 I I I I I I .-1 -t -7-._.___. _ LlTEAS 0 BO 160 240 320 40U 48u 560 640 720 800 880 ~~.7a~9 ~\ 8 m o "' ~ ~ ~~ ~, ~~ ~, . z ~b~ .. N ~ B a /` .. ~ ~ r ~ o ~ e ~ A \ ~ ~ ,a~ A ~ ,~- ~ o ~ o , ~ Q~ G' 0 ~ ryry k ~ ~ Q. t~ ~ ~ ~ ' n N A ~ w t ~ ;k, O ~ i ~ ~ \ ~o o ~ o .~ o °o ~~ Q ~n Q,`o ~~~ ~' .~ ~3 ~w J O ~~ N ~~ .~ ~a ~F o ~L ~~ A-oaose~ ~~s~ d a„Ce ~°~o ~ s~ ~ ~ Q ive~Q y N 0 N 0 ~~ N 0 8 Z -~~ U - ^ ~ ~ o ~ ~° ~ cb ~ t ~ A ~ i, , Q` A O ~ n ~ A J 3I~ ~y ~~ ~~ ~~ z~ „~ i oa 8 ° n ~' 8~ O ~~o A^Q ~~~ U ~y J ~ (~ Wisconsin Departrnent of Commerce Division of Safely and Buildings SOIL EVALUATION REPORT nrrl~n..n u~ilM r:nmm AS Wi¢ Otim ['.rv1a 1626 Page 1 of 3 A.C.E. Soil & Site Evaluations County Attach com fete site an on r not less than 8Y: x 11 inches in size. Plan must p pl pope St. Crooc include, but not limited to: vertical and horizontal reference pant (BM), direction and and location and distance to nearest road. north arrow scale or dimemsions percenl slope Parcel I.D. , , , 020-1162-00-000 Please print all information. Date Personal irdormetion you provide may be used rposes (Privacy Law, s. 15.04 (t} (mj}. ~ ~} d 3 Property Owner ~ (~ Pr Location H. Michael Gelein Govt.~ot NW 1/4 SE 1!4 S 23 T 29 N R 19 W Properly Owners Mailing Address r~a~ ~ ~ z ~ ~ ~ Lot Block # Subd. Name ~ CSM# V ll 209 12th Street South ~8 ey a 1st Add. To Fox City State Zip a .~.r.~~~~U --~ City -j Village rf Town N~r~est Road UN i ~ Hudson ~ WI 54 ~t1i~B~~p Hudson Kit Lane New Construction Use: 1/ Residential /Number of bedrooms 4 Code derived design fknnr rate 600 GPD _Jf Replacement J Public or commercial -Describe: Parent material Glacial drift over weathered limestone bedrock. Flood plain elevation, if applicable na General cxxnments and recommendations: I~t II mound system at elev. 99.00' at 12" above 98.00' contour. Boring # ~ Boring 24N i R Y' Pft Ground Surtace elev. 95.12 ft• n• Depth to limiting factor ate Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP 'Eff#1 DIft' *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-14 10yr3/2 none sil 2fcr mvfr a 2f,1m 0.5 0.8 2 14-24 10yr4/4 none sl 2fsbk mfr cw 1fm 0.5 0.9 3 24-49 10yr5/8 none L.S.B.R. na na - - 0.0 0.0 H#3 consists of limestone cobbles & plates constituting bedrock by definition, >50% by volume. Voids between limestone fragemerrts filled with 10yr5/8 sl. Boring # -~ Boring i/' Pit Ground Surface elev. 95.23 ft. Depth to limiting factor ~4s" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cori. Color Texture Stricture Gr. Sz. Sh. Consistence Boundary Roots GP *Eff#1 D/ft= 'Eff#2 1 0-7 10yr32 none sil 2fcr mvfr rs 2f,1m 0.5 0.8 2 7-16 10yr4/4 none sl 2fsbk mfr gs 1fm 0.5 0.9 3 16-25 7.5yr4/6 none Is 1 msbk mvfr - 1fm 0.7 1.2 4 25-46 7.5yr4/6 none s/Is/sl na na - - 0.4 0.6 Higf4 consists of approx. 40% limestone~e~8s 'pl~tes with an unsorted mixture of s, Is, & sl between limestone fragemerrts. ' Effluent #1 = BOD ~ 30 < 220 mg/L and TSS 30 < 150 mg/L #2 = BOD <_30 mg/L and TSS <-,30 mg/L CST Name (Please Print) Sig ure: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 4292003 715-248-7767 p~,~y owner H. Michael Gelein Parcel ID # 020-1162-00-000 Page 2 of 3 ~~ # J eonng Pit Ground Surface elev. 99.50 ft. Depth to limiting factor 27" in. Soil Application Rate Horizon Depth in. Dominant Cdor Munsell Redox Description Qu. Sz. Cont. Cdor Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 'Eff#2 1 0-7 10yr3/2 none sil Zfcr mvfr a 2f,1 m 0.5 0.8 2 7-19 10yr4/4 none sl 2msbk mfr gs 1fm 0.5 0.9 3 19-27 7.5yr4/6 none sl 1 msbk mvfr - 1f 0.4 0.6 4 27-48 7.5yr4/6 none ~ slls/sl na na - - 0.0 0.0 H#4 consists of limestone cobbles & plates constituting bedrock by definition, >50% by volume. Voids between limestone fragemeMs filled with 10yr5/8 sl. ^ Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 'Eff#2 ^ Boring # ~ Boring J pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description C;u. Sz. Cont. Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 'Eff#2 • Effluent #1 BOD ~ 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. ,o g mo ~ ~~~m ~~ ~' ~ a .. ~ ~ Qf . t~ -~ ,~ ~ y~4 /~~e'~ ~ ~ J~ ~/~, c~ / .~ ^ j ,~ -8 a ~o 2•' ~ p ~ o 0 0 ~ N o c_ N 3 ~~ ~y ~~ ~~ A 0 S ~ „ ~ oa o~ 8. N 0 a Z~ U - ^ o ~ ~° ~ ce cb ~ U A ~D ~` ~ g~ ~" J A J -'~. 3 of Pe~~/6 t~ ~ - -~-- S'i' C1tU1X C:t)tIN'1'Y S13i'"i'iC 'T'ANK MAIN'fL+NANCi~ AC,itNi?MIsN'I' ANU /~~ UWNi?RSiilf' CP_KTtCICA'f/i,O,N 1~1)!tM Owttier/Buy~ .,~Ll~_ J~~ ~1/u --_ _ _~1- ---- --~~-1.~ ~~~ Msitittg Address ~ c~~ ~ __ ~v2 ~ ~ c~ Property Address .y, (Verit'ication required frox~ I'Isnnieg Uepsrt~ fix i T ~Li CitylStete ~ (~-/ /____ t'arcet IdetltiGcatian Nuntl/er ,¢~ - ~ - nni Property Loattilm ' ~ %•, ____~_ %, Sec. ~, •i~ Sabdivisian I /~.~~ /~~` ON T~ f-C CertHkd Sirrv~r M~Ip # Vohune _ _~. Page # w.rnuat~r DKd # -1%~~j~L~ ------^-_r VOlUllie ~ ~U ~ --L-~.,.~..r I age N o-c~~ Spce house ^ yea ®no Lo! lines idesltifiat/k~l yes p Iw 1 . s~!Is islpe fnlc uas aild of Your septic rysteas could ~ri ~ its premstaue tailaae to haadk wastes. Psoper ~atsasaoe ~ atYect file ~~ ~ hd~ overy flues yesu! a aoouas, it seeded ey * !{ceosed pumper. What You put ~ the s~eul septk taste a a Ifitatrnenl wee ie the rvalle ~osai srsteul. . ~ ~. c~ ~t a certilicsllou fiuul, ~l- dis orsets..a y . d 111 pltlper opaatllt# asdror P or a reei[Yiag t1w,t (tj tl~a on-site wastewalar~~ ~ ~ - ~} ~ h ""d '~ (1! ). +~ twpek stmt b htss ti~t~it3;,i~~~t.111~!„ ~ ~ oogat~ed -ave nag t1,e sod a*res b mimaLl the prireN '- =~~0~~~ ~ at set by the Dew and the Depasttneet o[ Nattut-i Ae q~ ~ syaten ~ 6aea o~ ~ at*id8oatle1l drr °t; ttra ~ ~ data. ~;:. Meted told tetnrued:o the St. Crsl>< ConatY Tom Ot~oe.rithi.70 DJ1T8 ~° . 6y vlltee of a, ~ sne lnla to the teat o[ uiY {ow) kaowkt~a. i (we) a~a {anj Ike e~rnel(t) of rre~tltu>Zji died recorded fa Resf~tes vt heeds Office. ,~.~ , . ~_ UATB ~;.,-,. !!NN ~ ~ ~ M ~ ,. ; '1'°~!~~,taewk la ike stutittuy pellldt behlB teYOked by the Zotgtlr Dsparltltetli. •N•N " lusteda w!t!1 t6ts app~eattau; a •~" -!k"". . ~lpagr dead fsoea the Resister of Uesrfa oifi<;e a retry ~ l~s ae/tflfad ri:rrer map if reibre~e b made in the wannty deed ~.. Private Onsite Wastewater Treatment System Management Pian Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment . System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county. zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Desi n Flow -Peak (gpd) (~ ~~ ~> Estimated Flow -Average (gpd) ~ d Septic Tank Capacity ( al) ~ U Soli Absorption .Component Size (ftZ) (,~ v O Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Com onent Desi n Flow -Peak (gpd) ~~ ~ (~ U U Maximum Influent Particle Size (in) ' $ 1/8 Maximum BODE (m /L) dal`, 220 Maximum TSS (mg/L) 1 Sly 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once eve 3 ears Soil Absorption Component Inspect once every 3 years 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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). 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 Management Plan for a Septic Tank and Soil Absorption Component 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 scum and sludge 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 an 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. 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 the tank. . No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for enterfng a confined space. The atmosphere within the septic or other. treatment of holding Tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossfb/e. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by ail occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 b • ~ Management Plan fora Septic Tank and Soil Absorption Component Plantings ofdeep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 Document Numher STATE DAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED This Deed, made between Dwayne D. Couillard and Michelle L. Couillard, aJk/a Michele L. Couillard, husband and wife, _ __ Grantor, and Harold Gelein and Wendy Fritz Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, $tete.of y%iscaogin (if more space is needed, please attach addendum): Lot'?8, First Addit' n to Fox Valley, according to the Plat thereof filed March 9, 1982, i Vol. 4 of Plats, Page 98, Doc. No. 376101, St. Croix 656490 ~;i,-ILEEN N. WRLSH RLtiISTEk OF DEEDS ,. L'ROIX CD., WI F,ECEiVED FOR RECORD ~?-is-204: 8:25 AM i;AkkAh?Y DEED ExE!1P? CER? CDF'Y FEE: i;a t --- ?kANSFEk~fEE: 180.04 :iEE0RDI4G FEE: 11.00 rAGE~: 1 Recording Area Name and Return A tl11~t ~p~9tM ''9lts4Ul:~q~ oza I l6z-oo _ Parcel Identification Number (PIN) This is homestead properly. (is) ilk~t>Q Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this '~ ,day of September 2001 AUTHENTICATION Signature(s) _ _ __.~ authenticated this _day of . ~ Aq i 'lz :/ w yne DY Co `- +Michelle L. Couillard, a/Wa Michele L. Couillard!_`_ . ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) l t^1 Personally came before me this >I ^ day of ,Se tember 2001 the above named Wayne D Couillard and Michelle L. Couillard, a!k/a Michele L. = ~ -- Vuillard husband and wife _ • Q ~( c TITLE: MEMBER STATE BAR OF WISC~~r~N 7c'": ~G ~»e known to be the person(s) who executed the foregoing (I t' not, _ Ar r R~. , • ,2y~Cstrument ~ckn led c{the dame.. authorized by § 706.06, Wis. Stats.) %~~~,9 ~ • . , , . ' GO~~~ ~ ~ ~ ~' j i% l --- - _ ''~ TF OF W~5 ~.~`~ ' THIS INSTRUMENT WAS DRAFTED BYr~gprnntttas • ~ c ' r v ` ~~ '~ ~" ' Attorney Kristine Ogland Notary Public, State of W isconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both arc not necessary.) • ti amts of rsons s( nin in an • ca acit must bet d or rioted below theirs( nature. Id«mauan ara..uonan comp.ny. Fora w lac, vw Pe F 8 Y P Y YPe P g eoobss-zo2~ STATE BAR OF W ISCONSIN WARRANTY DEED FORh1No.2-1999 541~~1' • r , _ . _ ~ ~ ~ ~ `~~• ~ t ~~ Ja ~ ;, ~ ~ ~ o ' ~- ~ •~. . 9 $ ~ , 9 ~ ` g N f ~, r~ ~ ~s~ .~~ ~ ~ ,~ ~~ ~~ • • ~"L~~ • ~„`~ ~`~ , t°''+r I • w • •,5~,'tst ~ „xS .02 ao s .. ..:`?• . a. s1, ~ ~ ~ . - - .~•• / l I '.'r ~ 0 ~' j ~ Y o~ 0 I~ wo ~ ~ ~Uo f o N gi ~~r s`~ f ~rN ~~ ~ ~~~ ~N ~~, ~ ~ ~ ~ ,1 ~ ~ l ~ ~ I -• .~ ~ of ~ ~`, ~ s 1 ~ ~ ~~ ~ ~ \ \ = , ~~ ........ ....... ,~~.•~^t.-, 1~ ~~ ;~ti :tole........ ' ,. ~ ,, ,,,- I :~ ~ ~' :~ r ~ $ ~ : ~ :'' :,~