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HomeMy WebLinkAbout014-1020-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bdilding Division INSPECTION REPORT Sanitary Permit No: 483975 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: Nelson Trust, Robert P. Nelson Forest, Town of 014 - 1020 -60 -000 CST BM Elev: Insp. BM Elev: BM De cription: / Section/Town /Range /Map No: / 00 - 0 /OD.. d _ -t6 c< Zvh 09.31.15.134 TANK INFORMATION ELEVATION DATA ,/fit, 5 /65,_5 /6' TYPE ' CAPACITY STATION BS HI FS ELEV. +s ,, cry. Septic T 7 �+ J r(g d ` ) /Z � Benchmark � /1)(0.6 M /1)(0.6 Dosing M. B dini 60,A..,to a 756 Mg et � of di aj. s 5" / /• 0 Aeration /���.� /a Bldg. Sewer ' / Holding 1=p 11 St/Ht Inlet St/Ht Outlet �� TANK SE '' -ACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` 'C.,.... Septic > �� / 17'/ 57 Dt Bottom - /3+ 1/+ O 0 Dosing > AS / / 7 7 57 57 / Heade an.' f i ,• 9Z 65 cc i] Aeration Dist. e /, /o S .0 a' Holding -- Bot. Sy m( /ay3) 2- I /0 PUMP /SIPHON INFORMATION / 0 /U7ii /V Final Grade 6e_ /' flAtt-0-12, 6.42- 4.A Manufacturer / Demand St Cgy�r , / +L � /6 �. / Zo e( GPM ? T Model Number /V / ,/ /3 T5 / /� _ ,* r 3.95mz. ss TDH 11 ze b Frictio Loss System He TDH t , W /f/ / , , , // /� . 2 i t Forcemain Length Di . // (Dist. to Well 67 , z /20 SOIL ABSORPTION SYSTEM BED/TRENCH Width /_ MO / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. (Liquid Depth & DIMENSIONS Q ■` .` "-...._ SETBACK SYSTEM TO P/L c $LD) WELL LAKE /STREAM LEACHIN Manufacturer: INFORMATION f S stem:p M O T y y y / / NIT / Model odel Number: i V I )too > > /a0 /���-' DISTRIBUTION SYSTEM 0 IcG ?(5,e. tr - ixiee_e4 � Headp�fl6Aanifol Distribution / SGhf ({p / x Hole Size 'k Hole Spacing V t to Air I take /,„, VI Length 3 Dia I-S 1/ L nPI e gth s B / l'. Dia / '� Spacing 3 D !TG 1 -z-h/ , ��, ` � 1 SOIL COVER x Pressure Systems Only xx Mound At - Grade Systems Only �� Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Ceetei- Bed/Trench Edge Topsoil Yes w No Yes 0 No EI COMMENTS: (Include code discrepencies, persons present, etc.) I nspection #1: / / (o / Its Inspection #2: / 6 / 7 / ( 0 Location: 2291 Cty. Roh Q ear,Lalce, W1_54005 (NW 1 /4 � Nvy 1/4 9 T31N R15 40 acres Lot � ,d - ( � , e o Par : 1 ..15.134 1.) Alt BM Description = Kr 1 (� w )��kg f' U a /J IJSe.� - C �s� 4, 2.) Bldg sewer length = / UG' J ' s tf 5 �""` t p. amount of cover = � 3� / Clay v...6 a hp C5 tn. 1 � 4— it Plan revision Required? Yes No I ) Use other side for additional information. /� I I / _ r r. ��3 'i2'5 SBD -6710 (R.3/97) Date / Insepcto Signat Cert. No. • ReptaLmifil commerce.wi.gov Safety and Buildings Division County 201 W. W o ; Box 7162 S /. tii sco n s in Ma S -716 Sanitary Permit Number (to filled in by Co.) �rt b„et,t of Conumeroe : -,�:. ► g i3 9 75 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 1107/51 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address EsubrrUtted to the Department of Commerce. Personal information you provide may be used for secondary s'w purpos � es in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 2 1 I. Application Informati Please ' ' t • l r matio � Prope er's N e ' F ' ECEIVED Parcel # Property Owner's Mailing Addr ss J � [ t o y r� n Property Location • ,2,g , 't / For M' 1 t 1 1 1 Govt. Lot C* /3� / City, State _ /� L/ Zip Code STP I EtNTY NW y ,, W y., Section eik i il k ( V ffo IANNl #1 It` / 3 trcle one) T N; R/ Eor� II. Type of Building (check all that apply) Lot # IKI or 2 Family Dwelling - Number of Bedrooms Subdivision Name 1 pr(jj�111�G Block # ❑ Public/Commercial - Describe Use _ { ❑ City of ❑ State Owned - Describe Us / ! CSM Number ❑ Village of y eerudt odd / ` ) l /]/� Ia.Town of III. Type of Permit: (Check only one box on line A. Complete line lin B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List P vious Permit Number and Date Issued / Before Expiration Owner IV. Type of POWTS System/Component /Device: (Check all that apply) ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil %Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) • V. Dispersal/Tre ment Area Information: 4 Design Flow (gpd) Design Soil s(] Application e(gpdsf) Dispersal Arca Require t) Dispersal Area Propose ? System Elevation 6p00 • 0 vs ' 4000 c (,o t 1 /o3_33 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ^ o u u New Tanks Existing Tanks W �{ /, / o v u — CD or I lolding Tank / „1- -. /2 t Ef ��P/ O{. 75 1 —^ 7S-0 1ISI� Dosing Chamber I ( Q VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI r s gnaturc MP /MPRS Numbcr Business Phone Number DEnn i s ..° 114 Zz /'7 / 7'r2 T- 6637 Plumber's Address (Strecity, State, Zip de) 3s /VO C sT "ti .e el y Lk./ .4 SSioo I VIII. County /Department Use OnIY_ _,__--- _------ _-___._ —_ -_ - .. - - - /ft Approved El { Permit Fee Date I lied Issuin ent Signa re ❑ ven Reason o nial L 62.5. • / /D _ IX. Condit' easons for Disapproval 1..e.. �'..u_ • 1. Septic tank, efftulilit Air' algid , `r►. P�Cet.�" .✓1 a a�,( r . • dispersal cell must all be service!/ mal ta111ed I as per management plan provided by plumber. Z. Alt Setback requifementes must.be maintained 4) 6 t j 1 2e••• — k �e ov o 11 �� ac o comp ete p ans or 'e system and submit to the County only on i ape/t�not lesf 8 1/2 x 11 Inches In size 1 (404. SBD -6398 (R. 01/07) Valid thru 01/09 r : /41 , : ! , : , . — r! 0 1 1Q 1 it) 3:773 N k% 72,1 1 , „/ /j Q . c B vri Imo z /oo. & - 2? 9 / r E Is'ii # c J1 eb / r I , 444-4Q-4-- g.1 -e.r1 _ -. CI U n � G f"N - v 1 (N ° ' — 11 I - ` - I ; I I I I I r } y , . , 1 i r gm dA 1 I ! h( I / ' ' ( ! j i Ciryt + I F �� 6 i 1 t A 1 �Q t (1 j -,.. @ et . Safety and Buildings commerce.wi.gov 10541N RANCH ROAD • g HAYWARD W1 54843 Contact Through Relay 's co n s' n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary August 19, 2010 CUST ID No. 221471 ATTN: POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SPIA 352 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 -2840 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/19/2012 Identification Numbers Transaction ID No. 1807151 SITE: Site ID No. 757625 Robert Nelson Please refer to both identification numbers, 2291 CTH Q above, in all correspondence with the agency. Town of Forest St Croix County NW1 /4, NW1 /4, S9, T31N, R15W FOR: Description: Mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1270353 p.0 ,.1 Maintenance required; Replacement system; 600 GPD Flow rate; 14 in Soil minimum depth to limiting factor n ditiO original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressue Distribu9 (� Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01), SSWMP Pub. 9.6; Effluent Filter ENt The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes ° SAFE 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 aboa, The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code , s. CO 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: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The revised soil test/ additional boring(s) on which this approval is based shall be recorded with the original soil test. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour er COMM 83.44(6)(a)2. p DENNIS J GILLE Page 2 8/19/2010 • • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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 Ieft 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 $ 175.00 , _ Invoiced Amt $ 75.00 Patricia handorf ti This Amount Will Be Invoiced. POWTS Plan Reviewer , Integrated Services When You Receive That Invoice, (715) 634 - 781'0, Flak: (715) 634 -5150 , M -fr 8:00 - 4:45 Please Include a Copy With Your pat.shandorf @wisconsin.gov Payment Submittal. WiSMART code: 7633 i s t +'r cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5902 , Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in „.,„, Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business” means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. gov /SB /SB- BuildingContractorProgram.html DENNIS J GILLE Page 2 8/19/2010 • • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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 / Re q Fee Received $ 175.00 1 Invoiced Amt $ 75.00 Patna handorf 7 This Amount Will Be Invoiced. POWTS Plan (Reviewer , Integrated Services When You Receive That Invoice, (715) 634- 781 Fak: (715) 634 -5150 , M -fr 8:00 - 4:45 Please Include a Copy With Your pat.shandorf @wisconsin.gov Payment Submittal. WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5902 , Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. gov/ SB/ SB- BuildingContractorProgram.html • MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Commercial Application INDEX AND TITLE PAGE Project Name: ROBERT NELSON Owner's Name: ROBERT NELSON Owner's Address: 2291 CTY RD Q CLEAR LAKE WI 54005 Legal Description: NW NW S 9 T 31 N R 15 W Township: FOREST County: ST. CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: natty P cel .D. Plan Transaction No.: COMM WO' Page 1 Index and title Page 2 Data entry Page 3 Mound drawings ;pONp Page 4 Lateral and dose tank Page 5 System maintenance specifications r Page 6 Management and contingency plan 1, 1.., Page Pu curve d specifications C/ -/D J/ S Designer: DENNIa GILLE License Number: 221471 Date: 06 10 Phone Number: 1715 - 268 -6637 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 6.0 (R. 04/08) Page 1 of 7 • • MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Commercial Application INDEX AND TITLE PAGE Project Name: ROBERT NELSON Owner's Name: ROBERT NELSON Owner's Address: 2291 CTY RD Q CLEAR LAKE WI 54005 Legal Description: NW NW S 9 T 31 N R 15 W Township: FOREST County: ST. CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 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 Pu curve and specifications fIo o/Q 9- /O. / -sL S - i e Designer: DENNIS GILLE License Number. 221471 Date: 06/08/10 Phone Number: 1715 - 268 -6637 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 6.0 (R. 04/08) Page 1 of 7 Mound and Pressure Distribution Component Design Desian Worksheet Site Information (R or C) C Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <= 36 inches. 600.00 Design Flow (gpd) 4.00 Site Slope ( %) 101.50 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = I 6.00ICell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Fnter Y nr N (C or E) C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = ( 6.00Ift /orifice 2.00 Forcemain Diameter (in) 150.00 Forcemain Length (ft) Does the forcemain drain back? 1 Y 91.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 24.47 Forcemain Drainback (gal) 12.00 Vertical Lift (ft) 90.37 5x Void Volume (gal) 8.58 Friction Loss (ft) 114.84 Minimum Dose Volume (gal) (' 0.00 In -line Filter Loss (ft) 53.85 System Demand (gpm) Q . 6 ° 25.13 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection Q (, in. dia. options choice in. dia. options choice V. D 0.75 1.25 1.00 1.50 x 1.25 x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 750.00 Total Tank Capacity (gal) 1250.001 Septic Tank Capacity (gal) 48.00 Total Working Liquid Depth (in) IHUFFCUTT (Manufacturer 15.63 gal /in (enter result in cell B49) Filter Dose Tank Information Effluent Fl to Information 750.00 Dose Tank Capacity (gal) BEST Filter Manufacturer 15.63 Dose Tank Volume (gal /in) 10 " Filter Model Number HUFFCUTT Manufacturer Project: ROBERT NELSON Page 2 of 7 Mound Plan and Cross Section Views t — 1/10 B •: :- :•:- :•:•:•: : : Pipe •:•:• ::::::::::: -. -' -'- t :{.t•t•L•t y L y .•L•4.4•L• \•4•L•4.1•t• 4 L t.t•4•t•• t•.. L.4•t.4.•.•4•L•..•, •.•t•..... •t•t •� : t . •4•t•L•4• L•L•4 \••'� G {. t.•,. L. L. .•.. L•... .•..L•...4.L.t.t.t.L.t.4. {:7 , A • ,J,..: { { J r . J J. p t ....' { { {• J • { { �ti: : : { {{•: :y;:•1 { .. . ** : ::,t : •: r. r•... : ":•.•.i.r..•.J .r ••• e : : : : J.J.f. J..••J..,,,,, p •::,,,,,,:.: :i..•: :: ::: S�{ y{ yt� { y4y4:{•4• \• \• . t4yL•4y ytyLyL•L:LyL :L ,4 ,ty4 ,t•t y t y tyty • W / { iLi : i S{: +: }•. e)•4:7e{i; e{; {ri {:Ly y L y L ; ..4 y L y 4 : L y {ti y; . ti { : { i ti \, { i { {' {.. ti,. {i {i {i. , - . - . ...................... . B ................ •- .- . -. -. -. • I • • L • Mound Component Dimensions A 6.00 ft E 24.88 in H 1.00 ft K 11.24 ft B 100.00 ft F 9.50 in z 11.47 ft L 122.47 ft D 22.00 in G 0.50 ft J 8.37 ft W 25.84 ft 600.00 (ft Dispersal Cell Area 1747.16 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 105.13 (ft) - -- b•, . *u -'""'W;;;;;;;•,..;;,..,,,,.... . * H G • j 1 ,5 � � • 0 4-. F Dispersal Ceii • -,•7. 103.83 (ft) Lateral • 3 (ft) — .,' , Invert Di ersal Cell ---..::::::::::111::::::::::::::::: : : : : : : : ; Elevation –4. E D p EL . ; .• :::::: : : : :::: . v »>;11111111111111 „„, ..11 „7„„ 111111111111111111111111 `1111 1 ;111111 111111' 111111} • 111111111111111111111111111111111111111111111A1ittag11y1Or 4twoy► 1111111111110 ► 1111111111111111111111111111111111111111111 11.1111111... 111111111 IN im 111111111111111111111111111 n. 0 , • : .50 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key 'a & 1 1–r— Dispersal Cell See lateral details on 0 Topsoil Cap a 1.5 ft • . : .a : •.;t: ;y . y; .: Page 4 for number, size, © " ""J" Subsoil Cap o li' '' and spacing of laterals. MEM ASTM C33 Sand w 1° "` "� "` { . {y Laterals are equally { ) Tilled Layer m 0.5 ft :? TYPicai Lateral spaced from the :: {: {;::Lt•.;{:.y. {: distribution cell's © [ -:� Aggregate v centerline in the 0 �{: {: {: {:.... •• ... L. :, ' •' ' ` "' _ ___ _ }• A 1 distribution cell (AxB). Project: ROBERT NELSON Page 3 of 7 • . Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at ang point. Laterals are identical • L_J • ( Pr s e1 •= Turn -up wf ball valve or IE X-- *lx12+x/251 Laterals & force main of PVC Soh 40 oleanoutplug per COMM Table 84.305 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 6.00 ft /orifice Lateral Flow Rate 13.46 gpm Manifold Length 3.00 ft System Flow Rate 53.85 gpm Manifold Diameter 1.50 in Total Dynamic Head 25.13 ft Forcemain Velocity 5.50 ft/sec Dose Tank Information Locking cover with waming 7 , label and locking device and sealed watertight Electrical as per NEC 300 and ---110- Comm 16.300 WAC 1 4 in. min. J . connect • Di ---____ Tank component is properly vented E11 ❑ E ( Alternate outlet location 1 I — Forcemain diameter HUFFCUTT Manufacturer --I)— ;— d 2 in. Capacity 750.00 Gallons Volume 15.63 gal /inch A Weep hole or anti - Dimension Inches Gallons i B siphon device A 28.64 447.60 B 2.00 31.26 C d Pump off elevation (ft) _ C 7.35 114.84 1 91.831 D 10.00 156.30 D Total 47.98 750.00 Dose se tank elevation (ft) 3" Bedding un er tank. ( 91.001 Alarm Manuafacturer LEVEL ALARM Alarm Model Number DVL I Pump Manufacturer ZOELLER 7 Pump Model Number N 140 Pump Must Deliver 1 53.851gpm at ( 25.131ft TDH Project: ROBERT NELSON Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name DENNIS GILLE Phone 268 -6637 POWTS Regulator's Name ST .CROIX CTY Phon 386 -4680 System 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 1250 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other 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 Detail Finished . Grade / 6-8" Diameter Lawn Threaded Cleanout Pl or Ball Valve Sprinkler Valve Box u g Distribution ••••• •• •••• ••• • • • •• Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: ROBERT NELSON Page 5 of 7 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), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)j 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, Stets. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System 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 surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/l. BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10 cfu /100 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 within 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. Contlnaencv 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 with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment dolts The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 7 r • . i C . TOTAL DYNAMIC HEAD/FLOW Single Scat UCSign C PUMP PERFORMANCE CURVE PER MINUTE Weisillt 43 lbs. M0O8_140/4140 EFFLUENT AND DEWATERING - 77• HMS RI MODEL 140/4140 4L 1 e - 60.- Fed Aletere Gel lIare ' 3 7101 , 1 : 3 8 3 303 26 +a 4.e 77 6 276 s . o !r ! .1� 12 - 40 I I .. 20 _ 6 1 0e 250 \ I _ 110,4140 25 76 59 43 227 165 0 11O 11 V) lit 75 Sri B1 o to— 75 10.7 30 144 = 70 - 40 122 29 106 j Y I 45 - ,a7 17 64 s: P • o,oe4a Smko Ifeed 50 6.(15.2m) iI!!J! e- 20 " - 17101 1 4- Lain ,a i1�_► • �• ^- Ir 2- 1 Try '1 I sxtez4n s a r - . !0 20 30 10 50 e0 70 e0 16 .Double SealD ©sign °ALLONS ;Weight 63 tbs• -::;::>. thou t i 1 1 0 20 ,ea 240 !20 ' FLAY PER MINUTE - 770 11111 CONSULT FACTORY FOR SPECIAL APPLICATIONS 420 .sue" saw • Electrical alternators, for duplex systems, are available and supplied with an l a 0 - , g ' �. % 1 alarm. � /.{, • Mechanical alternators, for duplex systems, ere available with or without � alarms. "° • °'°"" • Control alarm systems are available for 1 phase pumps used In simplex system. See FM0732. �.,:._ • Variable level control switches are available for contoling single phase sys- � tems. 111 l • DoUble piggyback variable level float switches are available for variable level v 1 long cycle controls. ri1* • Sealed C�wik -Box available for outdoor installations. See FM1420. ' • Refer to FM0806 for applications above 130 °F (54 °C). . � 'I' - --F limn• - - I 97(1724* SELECTION GUIDE 140/4140 MODELS Control Selection 1. For automatic use single piggyoack variable level float switch or Model Model Volts -Ph Mode Amps Simplex Duplex double piggyback variable level float switch. Refer to FM0477. N140 N4140 115 1 Non 12.0 1 or 2 3 2. See FM1228 for correct model of model control panel. _ 3. See FM0712 for correct model of duplex control panel. E140 E4140 230 1 Non 6.0 1 or 3 BN140 BN4140 115 1 Auto 12.0 _. re ca rrfoN I NI Installation of controls, protection devle es and wiring should to dune try a quaflfiad 8E140 BE4140 230 1 Auto 6.0 ._ acenaed electrician. MI'loctrlcal and safetl codes should bo followed Indlp th eibe mos: recent Nat1onol Electric Code (NEC) and do Occupational Safety and Health Act (OSHA). 'Single piggyback switch included. RESERVE POWERED DESIGN __ _ - For unusual conditiors a reserve safety factor is engineered into the design of every Zoisller pump. MAX 7U P.O BOX 167(7 -- -- O �T ; . t r ,. > i3 402564347 R Le rnfedusrs d.. ,, : ,., : ; : SF AS T O: 964D Cans Run !i>»d �.. r r • r: - `" r ' ` • �� !(Y If)22r1 11161 `r www.rooac.com '= ' '' Ptah !O. (522) T712731.1 �q �PLI,AP 4 rPG s SAlC1F /9S9" -- -- — Zoeller 7744624 QT4 - -- 0 Copyright 2003 Zoeller Co. NI rights reserved. — '--- i I I , I i , W l ' .�' /.Y'w Z 7'1 c& - p yo' . x .t e B m /e 0' ' o: 8 I -z.. /o 67 1 (7 ( 229/ , r glry 44lgeb/ Y _ r I-- — N c rraAll 1 1 — ` , ' i Y -.. -t -* r .__ -_ ! to `l-et7 koun a (A ' r * , 1 II' ' r i F -- t 1 7f ‘S\1 ' ` ' l' I i •r j_ kp � � , r ( pC b: f , II ' ,, • _ _ e) , ,,,.... ,.„,, r..._ T l r r rt.)) p p /� ' i . t S=:' 0 I Oz, PAID Wisconsin Department of Commerce —^.IL EVALUATION REPORT Page 1 of 1 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �� w ba /_„ J �l�, l percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0/ L(/ Please pri , ,. r r -,,,. , pp ' eviewe• • Date Personal information you provide may be us for se.: sesr vary Law, 5.04 (1) (m)). ` j (jyy�\.. 17/16 Property Owner • roperty Location ROBERT NE .ON q j 1 r� lo NW NW 9 31 15 4- . -ovt. Lot 1/4 1/4 S T N R E (or) W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 2291 CO. RD. ' ST. CROIX COUNT`/ ,� �Q Q" P • NNIAIG R ZQNINt3 OFFICE City State Zip Code , ity Village Town Nearest Road CLEAR LAKE I WI 54005 I ( 71 5- 263 -2391 FOREST CTH "Q" 0 New Construction Use Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement D Public or commercial - Describe: Parent material Glacial drift & loess Flood Plain elevation if applicable NA ft. General comments This is an additional hand boring requested by St. Croix Co Zoning and Dept of Comm plan reviewer to ve and recommendations: soils and confirm adequate area. St. Croix Co Zoning was present at the time the boring was dug. a) As a result of this additional boring, the mound center could now be located anywhere between the 101.0' and 102.0' contours. 4 Boring # Boring 14 ® pit Ground surface elev. 102.0 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/fie in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 7.5YR 3/2 sil 2fgr mfr gw 2vf .6 .8 2 6 -10 10YR 5/4 sil 2fabk mfr gw if . 6 .8 3 10 -14 7.5YR 4/4 cl 2fsbk mfr dw if .4 .6 4 14 -20 7.5YR 4/4 cld 7.5YR 5/8 & el 2fsbk mfr -- ,4 .6 c2d 7.5YR5/3 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth l Dominant Color Redox Description 1 Texture Structure 1 Consistence Boundary Roots GPD /ft 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 /L and TSS < 30 mg /L CST Name (Please Print) Signature , _ ~ CST Number CHRIS FREDERICKS c� � ` 71618 Address S ate Evaluation Conducted Telephone Number 499 - 4 1/2 AVE CLAYTON, WI 54004 7/15/10 1n 419_ 4 .._ SBD -8330 (R07 /00) 4 1 $jam SOIL EVALUATION REP 1 Pa e 1 of r7 Departm a Commerce in accordance with Comm 85, Wis. Ak1 g Division of Safety and Buildings Fredericks Pere Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest tom, Wei I.D O, `7 L /D z D /v „ o , oc Please print all information. Reviewed By 1 o ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) ( m )) . 7 / t S n x,50' Property Owner Property Location / , � NELSON, ROBERT Govt. Lot NW1 /4, NW1 /4, S9, T31N, R15W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2291 CO. RD. "Q" City State Zip Code Phone Number I 1 City LJ Village Z Town Nearest Road CLEAR LAKE 1 WI 1 54005 1 715 263 - 2391 Forest 1 CTH "Q" New Construction Use: Z Residential / Number of bedrooms =ES 4 Code derived design flow rate 600 GPD ® Replacement El Public or commercial - Describe: Parent material Glacial drift & loess Flood plain elevation, if applicable na ft. General comments Recommend a mound, having a centerline located on, or near, the 101.0' contour and recommendations: ,---e-t- YVA ,,tiebt ,‘, pt. - 7 / / 04 1 Boring # .1 Boring ® Pit Ground surface elev. 101.0 ft. Depth to limiting factor 17 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 1 0 -10 7.5YR 4/3 1 2fgr mfr gw 2f .6 .8 2 10-17 7.5YR 4/4 1 2fsbk mfr gw if .6 .8 3 17 -26 7.5YR 4/4 old 7 5/8 & I 2fsbk mfr di if .6 .8 c2d 7.5YR 5/3 4 26 - 68 7.5YR 4/6 cid 7.5YR 5/8 & sl lfabk mfr - - -- - - -- .4 .7 / c2d 7.5YR 5/4 N F 2 Boring # Ell Boring ® Pit Ground surface elev. 101.4 ft. Depth to limiting factor •1 oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence a .. GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 e • 1 0 -10 7.5YR 3/2 sir 2fgr mfr g -4010601.^- , `2f .6 .8 • 2 10 -16 10YR 5/4 sil 2fabk mfr gw im .6 .8 3 16 -19 10YR 5/4 cid 7.5YR 5/6 & sil 2fabk mfr dw im .6 .8 c2d 7.5YR 6/3 i - 4 19 - 35 7.5YR 4/4 cid 7 5/8 & d 2fabk mfr dw if .4 .6 c2d 7.5YR 5/3 5 35 - 7.5YR 4/6 cid .5Y R 5/4 55/ & 7 c2d .SY sl lfabk mfi - - -- - - -- .4 .7 1 , * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < mg/L and TSS <30 mg/L CST Name (Please Print) Signature: „,� CST Number Chris Fredericks L` '" ;r <�7��y�a 71618 Address Fredericks Perc Testing Date Evalua'Ban,Conducted Telephone Number 2017 6# Street Cumberland, WI 54829 8/16/2006 715 -419 -0127 SBD -8330 (R.07 /00) Pro'Owner NELSON, ROBERT Parcel ID# Page 2 4i1_ 3 7 ❑ Boring Boring* Pit Ground surface elev. 100 .9 ft. Depth toil' -i r in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ;'r► P Mary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh *VW *Ef#2 fir-... -s. 1 0-9 7.5YR 3/2 - - -- sil 2fgr fnfr gw 2f .6 .8 - y . ..- 7 2 9 -14 10YR 5/4 sil 2fabk mfr gw lco .6 .8 3 14 10YR 5/4 cid .5Y R 6 5/6 6/ / 3 & 7 c2d 7.5YR sil 2fabk mfr dw im .6 .8 4 16 -23 7.5YR 4/4 cid 7 5/8 & d 2fabk mfr dw if .4 .6 c2d 7.5YR 5/3 cid 7.5YR 5/8 & 5 23 -60 7.5YR 4/6 c2d 7.5YR 5/4 sl lfabk mfi - --- - - -- .4 .7 , , 1 t , * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD 5 < 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) Fiederkks Perc Testing Jill 4 4'rn El Li 014 0 20 qo w/ P,SeMfti6 to Fte4b. Et V. = faZ.s BubEt. 51at fRaIL *go v%St BL. (�og ftT JJt t.SdrJ i�� Y of T k I J K , etf45, ere-- oEAa, fievo y PA-P-r rJw -new.. 5 Fo -r 'rowt451-1 P O 5vke° { 5-r. G2o) X c'outriT r 7 Ili CI a O� y SCtart4AR`� 8 I�.S t 0 Lo 1$Z C Hou 5E Bo- ,�, of 5,.,a5 ..- o ,r �I A 5nw.vJ� car'+' I1 oic 01SL towse, Q''' t Ilk P2tmAR� 6tk- IOO,a l - r of pottReh .P ndo + ;oA o AA" r1a54- nod'+Itura51'PX1y Conner o F {?arn f f Z r .r. , oz.3 ,a. , ( 4 r ti _ . 4 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer R' b , e rt Ye/co-7n. Mailing Address 2 2 l Cp u R Property Address 229/ p �.c n g (Verii`ication required from Planning & Zoning Department for new construction.) City /State GL e R /Ai / Parcel Identification Number O /'1 /OZ O` (04" °°O LEGAL DESCRIPTION /01.64---' Property Location?t/ 1/ , Nbv 1 /a , Sec. , T3 / N R it W, Town of Subdivision , Lot # Certified Survey Map # , Volume . , Page # Warranty Deed # ``3 / 1 , Volume //3c , Page # SW 2— Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is 'in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the ' standards set forth, herein, as set by the Department of Commerce and the Department of Natural 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. N r of bedrooms `t /15' /v SIGNATURE OF APPLICANT(S) DATE ***My 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. 0$/05) . I i 1 I ! , ___, ___;__________1____ I -- is-• . I 1 1 i i rot ... ..,, .___ 04_____ MI I . owl ,, , + ' 1 r 1 , ■-• . [ I i 1 7 ' ■ . I I . 1 1 1 , , 4--' ' .; ,,- -I- ' • - 6 ... 0 ( ,,-- _ , „.. le ! I -..__ h f ' . . . ;• '-'',_ 1 , . 1- , ' , ' k ,... , \ .'fe- , 1 ! 1 ,, , 60 tr" , 1 . 0 , ag,i\ t - ,, __,_„,,fi_. . . - -_____ 1 VI 1 7_ , .. I , - - - . 1- _ 1 __ f......i..._.4..................47.0_...._ 7 1 I -*--- - 7 I .7 I ■ ,• . ..-- i ---- ' 4 [_ I I ----- 1- 4 ---4-- --'----. -'- - --- ■ c r° 1 6 , ■ r- lri ,----...-i-- - „_______. ,_ _ T -,- , -,---- ; ____ _ 4 ___4_ --- ,..--- , H , - ; ■ ..-- ______,___ ,_______ 1 i I 1 , —i-- i ■.- I-- - 7 7-- k_i_ I ,--- 4-- ----- - --,--- -i-- -------- -4-- -1--- ■ -t • ; I ; 1 ,), ; 1 ; ;-- -4- .-- 3 r ---- , J _; i _. i f I ; 1----- , ! i I 1 1 1 1 1 i i t i 1 , 1 r-- 1 1 i 1 i ! I ! 1 L 1 i f t f- 1--- , I. . I I 1 1 I i f •.— ---- i 1 , 1 I 1 1 1 , I . , . I 1 IL 1 I 1 1 I I ` L 1 a — { _ 1 a : . . • . - I 4 , . A 6 , P e ifc, 2 . , c,..'. ■ I >_ I � . } I 1 , 1 I —. w —__ I — - .1 •" i 531318 r. k 0 :.. 1.1:0PMY: ter 1 • QUIT CLAIM DEED �UL 1 T 1 9� ROBERT PETER NELSON and LAUREL H. NELSON, husband and wife as joint tenants hereb uit claim to ROBERT P. t 9:30 A... NELSON or LAUREL H. NELSON, trustees, or successor )1`'` trustees) of the NELSON TRUST DATED JULY I3, 1995, - V -- , --�d (hereinafter referred to as "Assignees "), the following described real / n estate in St. Croix County, State of Wisconsin: The NW 1/4 of NW 1/4 of Section 9 all in 31 -15, St. Croix County, Wisconsin. FEE This homestead property. ' Dated this 13th day of July, 1995. ' �1 g))- 7 ROBERT PETER NELSON LAUREL H. NELSON STATE OF WISCONSIN ) ) SS: COUNTY OF EAU CLAIRE ) ACKNOWLEDGEMENT Personally came before me this 13th day of July. 1995, the above name AV' !' a PETER NELSON and LAUREL H. NELSON, to me known to be the perso r' "executed e the foregoing instrument and acknowledge the same. / // ogARY * Karlyn ' . Etheridge, No rn�v ' blitUBL Eau Claire County, Wiscosins` �,. � Ss My Commission expires 12 /i v . OF W \ el• • t. ' 1a\•'•" ' / `M This instrument was drafted by / Colleen A. Cowles, Attorney -at -Law 1324 W. Clairemont Avenue, Eau Claire, Wisconsin 54701