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HomeMy WebLinkAbout010-1044-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safe Gilding Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 4 /339s - 7 0 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. F5YO / Permit Hold Township Parcel Tax No: 6/ 0- A544/ _ Ay K OE v e_r- r 0. 6- o Irc�t 0 oc5 CST BM Elev: Ins . BM Elev: BM Description: Section/Town /Range/Map No: /e:r_ 6 /ii I csT 18. ?r) , j 6 269 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION _BS HI FS ELEV. 4 0 /0-57C /DO •- d Septic S� / Benchmark -- b00 3. /45.r /4) Dosing Alt. BM z (a o ) . Tp o f n 73TC.4146✓ Aeration N..„ 5/ i / /_ r Bldg. Sewer a/ Holding ~`fC � � St/Ht Inlet 75� /,./ _...- tlHt O , � TANK SETBACK INFORMATION /2o (La- 7 2=t--2,2 1 ., h _ y 3 �� v , TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ,�� to /41d. �yti 7 e Septic — G e-w / 77- / ii / g 8 D o P `s ✓ ! Aver _ Dt Bottom Dose , / k ' 9a �� Head ari. Z F a • 9Z q �� 3 3c / D/ _ 66' Aeration L/ytA,n, t � Dist_Pj Holding Bot. System ( 0/s/ 4 17 r _ �`�`� , / Sao . 7 PUMP /SIPHON INFORMATION 3W W/eCrif,u.f Final Grade A - C / Manufacturer D eman d A' n� Cove 1.7 A93-3 CXOr7r„►fi GPM I> T y n' t-s 0\4 3. 0 /02' o Model Number Ma 14 , y0 - Co y I Lir �.- TS, 7 TDH Lift Friction Loss System Head . p S TDH p t g 7 /.7 / -/ / , , D4 Force t en th / !D 2 ,, - 6i�t. to ell � � O J a SOIL ABSOR TION SYSTEM ",, / BED/TRENCH Width 8 !Length INo. Of Trenches PIT DIME NS No Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 SETBACK SYSTEM TO P/ BLDG BLDG WELL LAKE/ TREAM C Manufacturer: INFORMATION C ER OR Typ f System: Ste Imo / ` I �d UN Model Numbe / !! J V / / �,�°„ 7 0.7 t^2 of DISTRIBU SYSTEM �� IIK� tr Head anifol Distribution �� x Hole Siz x Hole Spacing Z� q .set to A Intake ,a - r 2 tI Pipe(s) t � 2 / 2 / ! G Length Dia Length 5 / Dia Spacing I / /& 2 k /,Q /- SOIL COVER x Pressure Systems Only xx M nd Or At - Grade S stems Only ` / ' /`n"d r� / � yy, Depth Over '�' y y J b"'` G - - ` P / Depth Over v Depth of )o< Seeded /Sod b b� xx Mulc Po (Q Bed/Trench Center / Bed/Trench Edges T opsoil v Yes ® 0 Yes m No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: lb ! E' w / AS � / ` Inspection #2: / 7 / 1 � Location: Z / F e l . 4=, /1.304 76 2 3 C ‘ , . . ; „ . . . 0 _ , Pia Parcel No: 1.) Alt BM Description = /Up U /124/” II kT t-i /� � ) . -00e--- 2.) Bldg sewer length = ` r z / 7 e ( - amount of cover = A J 1t2- `� Plan revision Required? 0 Yes No Use other side for additional information. i 7 � (___ /,,L- - -3- -,-v /G' �J SBD-6710 (R.3/97) Date Insepctor's Sig lure Cert. No IREC commerce.w i.gov S fety and Buildings if ' + Coun 201 W. ashin �.a It.1716 ' , t /' o / x scon n adison 5i'707 ((x Sanitary Permit Number (to be filled in by Co.) Department of Commerce Ss . CR O\X: N 0FPtCE T 7 39 $ 7 - Sanitary Permit Appl r_ State Transaction Number C B Sve �)) r? In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this farm to the appropriat. . v N. • mat J � unit is required prior to obtaining a sanitary permit. Note: Application forms for state -. • ed P . t S • e Project Address (if di than mailing address) submitted to the Department of Commerce. Personal information you provide ma ` w. '.r se dary Z/d .0 .oses in accordance with the Privac Law, s. 15.0' 1 in , Stats. .,,,, I. Application Information - Please Print All Information e _5"4 '' Property Owner's Narne '� Parcel # t 1. o ,4 1L 0 s44..,t.t2/t/ D /_0 /rn' D .' Property Owner's Mailing Address Property Location 2�9 c 1 0 i C fe-S G / G o vt. Lot City, State Zip Code Phone Number 7 Y, t �� / +, Section II. Type of Building (check all that apply) Lot # T�b _ N; R A) _ E W r 2 Family Dwelling - Number of Bedrooms �- Subdivision Name Block 4 ❑ Public /Commercial -Describe Use / r- ❑ City of _ ❑ State Owned - Describe Use / / ,1494#.19a CSM Number ❑ Village of jl e' 5 7 )own of �Y7 /" cc/ -r.e" III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System 74 System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Chan a of Plumber List Previous Permit Number and Date Issued g ❑Permit Transfer to New � Before Expiration Owner . IV. Type of POWTS System/Component /Device: (Check all that apply ZO,51--aor fY ' 5 ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At- Grade and > 24 in. of suitable soil ❑ Mound < 24 is of suitab soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) t if V. Dispersal/Tree nt Area Information: `f De ' n Flow (gpd Design Soil Application e( sf) Dispersal Area Require sf) Dispersal Area Propos d System Elevation �- j VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units , t _ _ o . o New Tanks Existing Tanks /4 fl/ „,,:' s 1 , a. t...) ti m w r5 a. Septic or Holding Tank ` - - Dosing Chamber A 517.11111111� VII. Responsibility Statement I, the undersigned, as /responsibility for installation of the P OWTS shown on the attached plans. Plumb is Name (Print) Plu ... ignature MP /MFRS Number Business Phone Number Sar. r. .// 2Z6 - , Plumber's Address (Street, ity, Stat Zip Co ' /�) . ' r ,∎ b e 6 r / i .: VIII ounty/Department Use Only 1 pproved ed Fee Date Iss ed Issuing • t Signature / ❑ rven Reason fo nial 6,25 ' . 9 22,,As ....„..,_ ■......Ail IX. Condi 0111(IiEReasons for Disapproval 1. Septic tank, effluent fitter and dispersal cell must all be servk:es / maintaineq • as per management plan provided by plumber. 2. All setbackrequirements must.be maintained as per apple code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 PLOT PLAN PROJECT Duane Rosauer ADDRESS 2108 Ctv Rd G Baldwin Wi 54002 SW 1/4 SW 1/4S 18 /T 30 N/R 16 W TOWN Emerald COUNTY ST. CROIX SYSTEM ELEVATION 100.5' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND >00( 1000 TANK SIZE 1000 gallon LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none • BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' Filter SimTec Inline ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark A •, SM. l pp `fo AC - PARCQ ( o 'fie l � Existing dd ' IPt NI 1000 gallon 'A� 1320' Property Line 81. septic tank S °- Existing • Inspected - din working order bedroom house ` Dverflow . :0 7 1,0 Tank is to ed properly bedded and pr ovided with lockdown Line is to be insulated covers with approved warning underdriveway labels Huffcutt 1 : 0' Dose Tank Scale is 1" = 40' -� unless otherwise 100 noted 1:1 99.5' ,� 99' 8 -2 N Grading is to be done to divert run -off away from system I n 4 Slope 0 8 -3 G Area 15' below system is to remain undisturbed I13.M.* B00. — \ J Q _A vount Road 0 Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 Contact Through Relay tisconsin www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Aaron Diver, Secretary September 16, 2010 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/16/2012 Identification Numbers Transaction ID No. 1854029 SITE: Site ID No. 760157 Duane Rosauer Please refer to both identification numbers, 2108 Cty Rd G above, in all correspondence with the agency. Town of Emerald St Croix County SW1 /4, SW1 /4, S18, T3ON, R16W FOR: Description: Three Bedroom Mound System / 4% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1280642 Maintenance required; Replacement system; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); 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, P ©•1 stars. Condit The following conditions shall be met during construction or installation and prior to occupancy or use: P R Reminders DEPARTMENT • A sanitary permit must be obtained from the county where this project is located in accordance with the DIVISI OF SAFE 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 SEE CORRE; 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 provided per Comm 84 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. SHAUN R BIRD Page 2 9/16/2010 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. Comm 83.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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 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 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 $ 250.0 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART, code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5902 , Monday, 7:00 A.M. To 3:30 P.M. SHAUN R BIRD Page 2 9/16/2010 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. Comm 83.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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 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 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 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5902 , Monday, 7:00 A.M. To 3:30 P.M. RECEIVED SEP 1 3 2010 Cover Page „rETY & 8UILDINGS Shaun Bird Bird Plumbing inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 9/ 8/10 Owner:Duane Rosauer Location:SW1 /4 SW1 /4 S 18 T30 N,R16 W 2108 Cty Rd G Emerald System type: Mound System 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 'V•7.S. �ao�i�x�ly 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout OVED OF COMMERCE 5. Pump Chamber Cross Section TYAND BUILDINGS 6. Pump Curve DEN DP CE 7 -8. Maintance and Contigency , an 9 -12. Soil test 1 Shaun Bird Signature i License number 2.190 d PLOT PLAN PROJECT Duane Rosauer ADDRESS 2108 Ctv Rd G Baldwin Wi 54002 SW 1/4 SW 1 /4S 18 /T 30 N/R 16 W TOWN Emerald COUNTY ST.CROIX SYSTEM ELEVATION 100.5' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00( 1000 TANK SIZE 1000 gallon LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of fence post ASSUME ELEVATION 100' Filter SimTec Inline ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark H el> L , r. S T. 100 `foAC_ PARce( o 'Fell Existing 1000 gallon 1320' Property Line • 3T septic tank Existing 3 • Inspected and in working order bedroom house Dyer Tank is to be properly bedded Line is to be insulated and provided with Iockdown \ covers with approved warning underdriveway labels Huffcutt 180' Dose Tank Scale is 1" = 40 O unless otherwise 100' noted 8-1 ❑ 99.5' 99' 0 -2 Grading is to be done to divert run -off away from system S 1 o pe 6 -3 Area 15' below system is to remain undisturbed 46.11•* 000' 600' vo u my Road G V . Mound System Cross Section and Plan View • ♦ ...,-.,1•..." ...■� - - - . . _ •! Dimension Feet r. I , 'wens' Fee J 1 . ..::,:::::.:::::::::::::::::::::::::::.::::::::::::':::::::::.::.:'':::::::::::::....:.:::.::::::.:::.:.:i.,•..::::...:.::::':.: \ A t - t B 5 t- D 1 }_ �.; 3 r. } ;l L r;1 . } t s ��'tlz.. { r � } } 3,`. • } r, ! t ,tr ,i3. � ' 2iY }}t }ii }r, Lcrrtr,'a} 1r rr ; . ;r �Y1. {q,r� t r., . , t Y� . : 3, 1 1 . � 4 . ,,,viclr7t. ,. S . ,. f , .rt S :. - : 1 L 1 A l rtrSr.r rr.rr ,.;t lrr. a , ; ' 4 .5 ;t r s. r �xs� i ? }!r*. tilr r t r E I, t �t `t+; LI,,•• ; , �.} �j '� }lr;� ..rt';#L.,� b .; � 7 7 1 ' r; tr ,rCt?,':c.t;;rt {7Sft ?,ti ;� I {c,r4 'r.t ,s < ?;] 1 ;tt:if , . ,x % {i <?i'S{w, ;?; 4. ?+?{:. i ..,,t F W 1 8S 1 I G I H I t. ;a !t I 1. t J F 1 t K 0 7 . W ` �. '- — . rr .. . -- r nr ,ir r = - r rr r .. :.. r ,: •r L ` ."..r .... , rw W., �Jr' v rr - "r r. . - - M K B Z 1;111 L Slope yo 1 " 71 = Topsoil = ASTM C -33 `' = Clean aggregate = 4 in. sch. 40 pvc t L } }f r.... Cap Material , sand fill FL ; nF; %2 to 2 %2 in. dia. U observation pipe ■ Geotextile G H Fabric 'L;ir rt r r rl r T L ,s r ?l it t . F t GS 4 �t S � ; Ft r ;r 3 a D :titi E ►v 1 � 1 ►t 11 11. 1 titi1rti11 b� 141r r '► 11 r11'�►ti1�' � • et o o i •lovow or••stirw��vt►li rttrll�iti�1111r1�111r `111►11rti1��1i►1ti��rtibti ►i�1`lrli►i .ti,►rti » y �.ti , '.i�►�►tii�� v �iti iiti itit144tiiitiiiiii�:ii . ;''''' �.t1. 111,. ►�i1ti iititeitiii1i.�111ti1ti1'li , 11'.... ,S,5---Ft ,. t10 Sti Plowed Su r f ace 1•�►oti ,► .. .. Contour ���a.11 �»z»�► »ti » » >titi� ti�tititi 1 111ti11111111 �ti N Slope Direction -► 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' /a inch soil wire when a sample is rolled between the palms of the hands. ASTM C -33 quality sand is pla __ ' after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand to is placed overhead by a backhoe. Special care must be used when placing sand of le thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, is seeded and mulched to promote vegetative growth, limit erosion and protect fror observation pipes are slotted in the lower 6 inches and secured in place with rebar or a cloE 10/07 lgj Page of • Pressure Lateral Layout Two Laterals — End Manifold I 1 .4-- Threaded Cleanout Lateral Turn -up -- —i Plug Manifold 1— — — k �`M . .-01 iii • \ ..___eit 1 • 1 1, X -4 L • Long Force Main / / Sweep /4 90 a l Bend A Distribution Network Specifications Pressure System Construction Lateral Diameter 2 In. Manifold Diameter 2_ In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 3/� In. pipe. Orifices are drilled perpendicular to X (Orifice Spacing) c9 In. the pipe with a sharp drill bit and face down. L (Lateral Length) Ft. Lateral turn -ups terminate with a threaded M (Manifold Length) Ft. cleanout plug and are enclosed in a 6 - inch Force Main Diameter Z. In. diameter lawn sprinkler valve box accessible Force Main Length ‘(J Ft. , from finished grade. 'ZS i+et. - S /MTTE KA L ••••• Grade ••••••• : j: ••••••• • 6 -8 Inch Lawn Sprinkler Valve Box i • . _• • I: -r Page of 03/05 lgj Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer 14-,(4eAktt Minimum Pump Performance Required Tank Model Number _ g 6 414 GPM 1 @ 1 A 4 1 Ft TDH , Total Tank Capacity 6 ' o / Total Dynamic Head (TDH) - Feet Max. Bury Depth Elevation Head /0 Pump Manufacturer ,` e, C ,a y a--- Distal Head , 3, 0 Pump Model Number 9t Network Head Loss 0 7 Alarm Manufacturer Ud-C -tK" i 9 Force Main Head Loss s Alarm Model Number L t, ,/ Filter Head Loss - o� Switch Type S/n !r, / iefe , Total j 1 f ,, Manhole Min. 4" Above Grade l I With Locking Device Vent Min. 12" Weather -proof , �� Above Grade Junction Box �� 1 With Ca p 11 l q 4.__) .. INN -- ... - - . Finished Grade -- ' ff � ..5-7 09 Disconnect - 7 -- x - c 7: 1 ; ' ` 'r! Means .. ("Cte s?'F_ l ©D • ii I t, :: Switch Settings and Reserve Capacity _ M u�r ; ;; , I _ I Inlet '; :.. > : >; Tank Volume = / / S' GPI Dimension Inches Volume Gal. A ' 07)/.. S (reserve) A P Py 6 7 ..0 ,'> -- -- Op -0 I : Weep eel (a B 2 B - ,/0, 1� :: Hole (dose) C 6.3 9 ? -s ' Off Elev. >< >< (dead) D '7 /3s i/o Ft C il :,:. 't' <; . Total ' D 1 :'r 90 . a Ft < : <` Bottom of Tank Elev. < :' L;;;;;;;;;;4;;;;;;;;;;1 ♦ . > . > . . st.t ♦t> <> .<> <i >t♦ . >t` :'t Y < <. > . > > s < >t> >t1 < >t. <> . ♦t > <a > 1 < >tl <> 1 . . > > < > . 1 < > < . . f > . > 1 > . 1 GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer' s product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical servicecomplies with NEC 300 and Comm 16.28. 10/07 lgj Page of By: HP LaaserJet 3100; 1 715 bia COW iflI ±!thnii. Yni y 9 E H S ERI ES S V l'"..w..........................,,,,j,L21EFNT PUMP 11.06 . ,... 400 - 4 r. am , 0 ) , l . .� . . ; 0 .: a ts ...4•44 a ' 4., i r a . 0 a sum .11 lit Wall 1r WW WOW IMO v W IQ " vti gg WA 10 13.1 a` i Pit v11100. s' .M1 116 et 13 IGOO 71 M 41 t41 Y11i1s{/► WOO WAN W +r'i ee a< BB 1 M0 7a a ei 1t * iu Ia 2r 1.11 c 1 qpare MAW r' 1'e x' " 1 -'.....- i�C Ieoo plow- Lrrestmeua o imo MS WO tl ° .. . �����t ! was .. _�....._ _ la 1111111 1 1 11 101 1111111111111 7 � � with carbon a 1 1111111111 11101111 1 Stainless Steel RUM IIIIIIIkll w aaa1�, !ta u n ea 60 B row- cuu. E - -, L Giant Pam , Q I ut'tVE �.. ASP' w► posse sew t manta isto Mow 4111/04111111 4116O111.11111111 4....... ft Pam M OS -•0703 • • MANAGEMENT PLAN Pa10* -o1 POWTS OWNER'S MANUAL & SYSTEM SPECIFICATIONS S eptic Tank 0 / 4� , , 0 NA RMATIOH I► ... T IYILm ![ o • 0 MA • Septa cNiptior # Muted ' M� S e 0 Ni � F ®r Mots S re- 100 4 4 �i� o NA DEMON PN�N �3 Cl NA Effluent (.2 Tank • Number of � Uflis Pump T ank M� �� . .M . - �l 0 NA Number of C.. , j Rini') . o A flew (ar rage 1.6) q- rz7 , y ..„ =. ,Pump � �„ _ .� DNA A x Rees O . _. _j Unit _ -r; NA son Application Monthly average © It 13 Peat Fitter ats,. ty Mi� fl WaWr!d • • Bledttamical Omen Demand trstissetca p8 (BOW s30 mga.. D Medl sZO rrlg►i 0 won D Other. T+OON Oucapenctoct NA WI** 8yoragg'" Dispersal Od1Ce) Q (pr+sssutias� Pretreated Effluent Dually - •-, 0 in-ground (gnarly) Demand (SOO m Q At-g a t7 . Sboiterdice Oxygen Told Suspended Sonde m stir dull OQml ❑ Dd ,,,,. wrens Fec�d ' _ XMakdiameter 6, Wow typtesi t` Of , d onesct � Maximum Pellicle S _.. Wes tank etlitsost. MAINTENANCE SCHEDULE Service Event Service Frequency - s) t8Qa7dmuaa 3�ns -) At feast ante every ❑ mo condition of cell(s) s) *1 • (4) of tank volume inspect when combined sludge and ©n ` s} (lrlaximuea 3 yes.) Pump out contents of ONO) Atlees[ once every inspect disperse aslKs) At once every 0 months rlosnefiluentf86er' 0 ,• s) 0 NA At least once every s) Q NA rat sn'peet pump, um lss alarm 0 , , . ) At least once every s DNA Flush borate old P ash 0 m :. • Cl year( s) r At sees[ once every CI mango 0 pegs) 0 NA ono: At feast once every • siA NThNAN E INSTRUCTIONS be made by an individual naming one of die licensee 01" oonf . M$ ss s Mae Restricted Sewer. POD inspector; p S Op M. ! s crust include a visual inspection of the lank(*) scum end to dock far any broken up morons. Identify any the volume of combined and b check k f r any beck p:t t leaks a dispersal minis) shall be Visually htspeoted on the The Pending Ot ankient or Parretti or � to for any por4� of effluent on the grohnd the lace new tY• s condition end requires the immedi s rte' m, mote a regLde volume, authority. tank equals one-tbkrt (X) grourid surface may Indicate e tnn the ntire contents �b be re of s moved any Servicing disposed of In a van c'• NR of rile tank shall removed ems. and tS+Y 'd 1 3, en A�amtnts or s Cods � or pressur1Zed POWTS components. pratrsa t POWTS maintainer. m' Intervals oil? m+on �s or less shall be p Bd by e event: A send* st>aft� to the total regulatory authority wi tlin 10 days of cafnplt START UP JD OPERATION For new cariebuotien, prior to ruse of the POWTS check went tanks) for the presence chemical that main !mode the ira�neni process anal*" damaged disposal [detected have the =tents of the tank(*) remoVect by a se P ta ge Ong operator Prior to cam. Page of System start up shall not occur wheel sang conditions are frozen at the infiltrative surface_ • D power ti es pump tanks may Si above normal tughwater wets_ When power is restored the eXcess wastewater wil he discharged to the dieparsal cell(s) in one large dose, overload the rush's) and may result ut the bad ersrlrfaoe dTsdmaarge of agleam To avoid this situation have the contents of the primp tank removed bye sweep servicing Openstor prf r h power to the effluent pump or canted a Plumber or POWTS Maintainer to assistift manually operating the pup' mamma to more normal levels within the pump tank Do not drive or park vehicles ovef tanks and dispersal cells. Do not drive or par1r over or ottawLse disturb orb, the area vein 15 feet down slope at any mound or at -grade soil absorption area. - edsution °terrrnination of the following from the wastewater stream may improve the performance and prolong the tole of the prl y s anf$llot# .lyapyry ;'c garette bulls; condoms, cotton swabs; degreasers; denial firms; diapers disinfectants; fat found/lien dial (sump pump) Water, fruit and vegetable peefuigs; gasoline; grease; herbicides; meat scraps medications; play iksinting products; peatiddes; sanitary napkins tampons: and water softener brine. AHANOOP MENT When the POWTS fano and/or is permanentty.taken out of service the following steps shalt be taken to insure that the system is properly and safety abandoned in compliance with ch_ Comm 83.33, W isaonsin AdmkrIstrative Code: • AU piping to tanks and pits shall be disconnected and the abandoned pipe openings seared_ The contents of air tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, tali tanks and pits shaft be excavated and removed or their covers removed-and the void space fitted with soil, gravel or another inert solid material. CONTINGENCY PLAN It the POWTS lags and cannot be repaired the following measures have been, or must be fatten, to provide a code compliant replacement system O A suitable repaoement a has been evaluated and may be utilized for the location of a replacement soil . absorption system- The nepiacaementarea should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and well_ 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 that time_ 0 A suitable replacement area is not available' due to setback and/or soil limitations_ Barring advances in POWTS ,, technology a holding tank may be installed as a last resort to replace the failed POWTS_ " -- a site has not been evaluated to identify a suitable reptacement area. Upon failure of the POWTS a soil and j° site evaluation must be perksrmed to locate a suitable replacement area if no replacement area is available a - ing lank may be installed as a last resort to replace the failed POWYS. and at -grade soli absorption systems may be reconstructed in place following removal of the biomat at the surface. Reconstructans of such systems ;must compry with the rules in effect at that time. «WARNING> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. 00 NOT ENTER A $ TIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. • RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDMONAL COMMENTS - • POWTS INSTALLER 4 POWTS MAINTAINER • Name ecijI✓ /�i Name ram,. ( p hi"--,21 �'' // j / Phone 7 f - -- a a,- � SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHOW Y Name / / / .. _ , /.J► agent • �r • C._ r, Phone ? �� = -�T h `� / er • Panne — & — 6 �'.�lMI ruis document was /mead by, rho of err Green Lake, aran7ae to and Waushan County Zoning and Sanitation agendas. This document meet' Mgt minimum "Klulawaints of dr Caress 89 _ 2 Z( 2 )(b)( 1 Xd14ff) and 8354(7) (2) dr (3), W&c arum Arhritrrtstraiive Code;. Use Wade document does not guarantee the performance of the Powys. Caw (7/Dt) J M T 3 e'v ,. � !; A Tiro Sim I''5 desirtstr and mou tin ., ittwcation, *Nows /ha fi'llcrifig `'' cnnaa'i to ba ±s'cr`ubs Wittig • ;Rn dY`cionp - pre:,viding martiffirm .. intenwj interior's R: � . p Ot lc'E capabilities. v Y { ' i -!' '° The fallt€r sae en is a 347 si rira j : ' stet, ' , J how a .hitdds 9' s and .8 inches ; 5 a 9 52 � rr a kith asst ' " h fi, p $11611116 at 1 . W+ ' f f ur We e5' Evian ' gy p. ..,. scretri tt keep the s ' €it ' ' ; Jt and ro r 1 a eri i 4 ,, This pr a d asses � €; th to TSS ititais. keeping 'lair ittre siotern danhiq at _....: - sue' and designers now t1 €' abiiity to oifer a sintsiia to litssirire sgstetrrs will' fi rnellory as ,desigrred now mild in tflit firtitre. i Thy Si YT rf�call aril crincir �,, f' , STFO -Hr F ow rate / c aii s a a? 1206' D 7i P5! STF O fto t rate +uw�l95, p 1; a €d cr €era. 1 GF 2 �5P 1 x > ! itilarthridtd 7'aatai ,head .h ssAiS - . a =1, - or .2. F5! assort-bits 11111111111111101111 ' .g s �. 999-3x sI Ec � y ru w co ry H - H . • - m rrII 1 - 70 ed d \ ■ i _. 0 D 01 (A — � \ m7C7(/) ���z H -n n -0 d t , 3 "D = H--'. XI 1 Zl D D M (/) D --I xi D (4 F --, r �- -I O -T 1 r D o -1 C. (/) co o CO SCI° I— Iru a <rv r{1H xi r 70n mmm - E1 --1 3> n P CO W- 70 7° o -P 0 D f' 3 1 1 ti Z zmm - M (/) ---I N o V) D I l P1 it m r- • II) (..0 CO R) H I --- -I n 77 I bd 1_122 , W O I i__, \ O D fTl 7D H -9 -H C C-) 70 Z7 rn x D D pi (/) D —I 73 073 z , iT1 -1 4 �, Z Q 1 xi -0 bd D 0 1_,. pi - - I -c r -I ❑ -- -1 i ? L �, r D o - i (_ (/l o CO rri b ❑ d r --I R) 1 nzrv —{ d� nnc�n - � (/) Dom w w � o --P y) D ( D d 70 < � �z n �I 7 -Hn m L ��o -rnn (/) -- I ru N o to N °, ON0 _ n 11 k J �: Pi ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer .70 (.l .. a — a- 0 s Q 1 -eV' Mailing Address v 'b 0J4 iJ d, t A ) \ -54 C Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 01 0 - - IV- LEA' 4L DESC ItIrON l -, Property Location--CL) % L) '4 (, , Sec. / 8 , T a N RI 4 W, Town of F(1.12 r � Subdivision . , Lot # Certified Survey Map # , Volume Page # Warranty Deed # / b b / , Volume `C , Page # 3Z • Spec house yes Lot lines identifiable V s no SYSTEM MAINTENANCE AND OWNER CERTIIICATION 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 staling that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all staff on this form are tare to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of b - ' ms !. /1.., / 1 /O /L) • X 741 A . iAPPLICANf(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) • ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the a ft 5 "r {` residence located at: 7 - -! 5u/ � % , Section t z T 3 7 N, R /,� W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: O) 7 GI fAd flow back occur from absorption system? P y em. Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes capacity: /1 Construction: Prefab Concrete Steel Other Manufacturer: (If known) : t tt-h(/ oca.) ,./ Age of T k (If known).: a: 2It,(',ncrtA),A,/ (S/ture) (Name) Please int (Title) (License Number) 1 Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the be' - t of my knowledge will conform to the requirements of ILHR 83, W .dm. Code (except for inspection opening over outlet baffle). / Name Signature/ MP /MPRSZZ O) o r I • 6; consin Department of Commerce ' `. / OIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordan =; • h Cy i, • Wis. Adm. Code County ,5f Cr Attach complete site plan on papa not less than 8 1 f x 11 inches i ust / _ include, but not limited to: vertical andhorizontal re -rence point (BM), :r'�-7 • Parcel I.D. percent slope, scale or dimensions, north arrow, . d IocatiQPrand distance to n -- rest ro d. / — /D 4 7V --/Z7 - 01:7)(26/ 13 1 Please print all i o ma ion. J9 2 Re"eW • I Date, �5 Personal information you provide may be used for seeon. • 4•' ,.•`e ivacy L r3Fr! sy,s.o4 c (m)). p�ej it / j am ' I 7w // 10 Property IO / H Prope Locat IJAL24 - � / �l7 5ez.,„„e / O' / t of 5G) 1/451 1/4 S /FT R /,%E )W Property Owner's Mailing Address • Block # Subd. Name or CSM# Q / 0 3 >a- C, f C,�,a � 2 1arzc -QS City /n/ ` State p Code Phone Number 0 C' ❑ �I Town Nearest Road air-Lin. IL/ .2) �y 2I ( ) ,e i-pei -c�Sl� i .' & I SIONew Construction U s X Residential / Number of bedrooms c3 Code derived design flow rate ' .) ' 7 GPD Replacement A Public or commercial - Describe: __ _ ��/ _- ___ _ Parent material t .--.. /./ Flood Plain elevation if applicable /1 / //f . ft. General and recommendations: UZ/Ytp/t/ (� � � System Type / 0f 12 te j System Elevation /8 ' ) q Boring / / Boring # pit Ground surface elev. ft. Depth to limiting factor 3 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 / 0 2- /0 3/z- s>' ;c);Y_/' c •2 - ‘ Z h -3o7 ,..c-// - - c/ ap.sj /4 9 .7 f2 /.. ' Y - 3 at i °7. 0 - - ." .vi' - ,4/ 4- - a • # Boring fffli Boring Pit Ground surface elev. /trp i . Depth to limiting factor r l', 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# 'Eff#2 d -- 7 /0 ,3 /z.- . i p 9 n e� o - -g 2 _ 7 - �- e:--- a / , w�4 / ,noc, -- fG 2 jc i .. -7s 7- S � f _ 5/ - rn - Kr").' iv44 r✓J.d , c. , 6 • Effluent #1 = BO; > 30 < 220 mg/L and TSS >30 < 150 i • Effluent #2 = BCD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) u CST Number Bird Plumbing, Inc. Shaun Bird �' 226900 Address D ate Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 G_ 4- / /7 715 - 246 -4516 f i 1 Property Owner Parcel ID # Page of cJ `� n# Boring Pit Ground surface elev ? ft. Depth to limiting factor Ov g 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 / 11 13/ I—. 5 AA a S i '• 3 a3 ? -J y rif, e ------- _37 - :r-- , , r✓l# /'/ • c9 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I 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 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth 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 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/t. 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 (8.6/00) I Property Owner Parcel ID Si Page _. of # Bori Pit Ground surface elev ° ! ft. Depth to limiting factor �. Soli Applic anon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots • GPD/ff in. Munseil Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 4; .51 a nf; Z 7 is !a s/41 ,('' 04 1 / - 1 • Boring I lam ❑ ❑ Pit Ground surface eiev. _._ ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munaed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor . in. Sod Application Rate Horizon ' lepth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/ff in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'E0#1 'Eff#2 • Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mgIL. and TSS < 30 mglL 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 or TTY 608 - 264 - 8777. sBD -5330 (R.6ro0) ,' Soil Test Plot Plan Pr ject Name Duane Rosauer Shau . A r Address 2108 Cty Rd G Baldwin Wi 54002 / � C ,� #226900 Lot Subdivision Date 9/6/10 S W 1/4 S W 1/4S 18 T 30 NCR 16 W Township Emerald El Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of fence post with bird house System Elevation 100.5 *HRpSame as Benchmark 0 Well 1320' Property Line Existing 3 I bedroom house Overflow 30' 180' Scale is 1" = 40' unless otherwise 100' noted B -1 99' B -2 II 0 4 /o Slope p ❑ B -3 B•M.* 800' 600' County Road G s.. .... .r , '' . 1 . d " • �..'. .....4". r ,,. _..' . ... . ...' „ ,tEri`" ^°.* : nr*. aa. '..,...;r """. ew�w ,; q... '" '` ,w' "t..r +*, !1.' ?'' ''''', ■ DOCUMENTNO. WARRANTY REED _ * BOOK 436 'FA E LtJY S TATE OF WISCONSIN FORM 9 , ,, r gl Qp O n n !i TIRO • SPACE RBSERYED FOR RECORDRIG DATA; t s i: ! 4 ` r l REGISTERS OFFICE .. THIS INDENTURE, Made by Albert S • Thc1mP0n F.Stp 1.1 a T1 ' hU tbard W an d 'W 'FP ST CROIX CO ., WIS ;; as joint ' i R ' and ' lth_ tPnantR � { � ' � � - Recd for Record this Z____. day of e,PIP ber A.0.19 67 • grantor _S___ of St - Cr0 i x County, Wisconsin, hereby conveys and warrants to DI1af1P F. T ISA liPY and ,Tar'cquelin F_ Rosauer, . -- • -_ M (:)- h,IShand a nd wife, as joint tenants, i ede grantee . RETRNN TO of qt- Croix County, Wisconsin, for the sum of , , TPn Thou Five Hhindre.d and no /100ths-- - - - - --. Richard PI. Rivard„ • _- nollax's Glenwood City, Wis. the following tract of land in ' St - Croix' County, State of Wisconsin SW Frac. 1/4 of Sect 18, Township 30 North, Range 16,,. except that part thereof described ``as follows: Beginning 2 rods `N and 2 rods E of SW corner of said SW Frac. 1 /4' , thence E 8 rods; thence N 5 rods; thence W 8 rods, thence S 5 rods to place of beg Subject to 50% Mineral rights reserved by the Federal Land.Bank of St. 'Paul. Also Highway easements of record DI►�1M + \, .c,00nuMeNynnv1 f I � l.'� �( 'f� If li. Q i 0 b i, ; ' a pl I ' y ti I T H ii:S U'V 57 .111 4 i( � I 1) + INIEHN.ILII1'IENIE INI TI'D 411715 ` • -�— avD I LYTERYilb it IF1I'E ++" LL11,Y,5 ; 5 I„ IL;.li,915(1 ', in DIILL.ID 11 IN WITNESS WHEREOF, the said grantor _s___ ha v hereunto set thei hand .__,;_ and seal __s__ this ` 29 th day of ! • , A. , 19 67 . G D A ` SEALE PRESE CE OF � a v i -C�J �/ �� - �J� yf (S •r I Albert S. "Thompson Richard P. R °) � '�'�'�'' 1� (SEAL) son .iP ,eY/ Ir`� 4..2l,r. (SEAL Charl rlttP c] al...v., (SEAL) STATE OF WISCONSIN, , St,. Croix County. } S9 Personally came before me, this 29th day of August , A. D., 19 6 7 . the above named G • - t' • • u • • e ...• - : . eel,. • • • - �• to me known to he the person _q who exe'nted the foregiii'ii73 and ncknpwl_edged the same — , t`� NU • . nalzid Bore ' ,t4`B ' a ' This . instrument drafted by. r '' A Notary Pub St Croix C R ivare' ,�„ • Richard P. Q • (' ' ' My' Commission(g 1 (Section 59.51 (1) of the Wisconsin Statutes provides t sU tha instrument. to be recorded shall have plainly printed or typewritten thereon the name• of the Qtantora, &ranteee, witnesses and notary). 1 WARRANTY DEED —STATE OF WISCONSIN, FORM NO. 9 • , 5. e. xuux CO., xuwAUKI(