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HomeMy WebLinkAbout008-1011-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538727 0 GENERALJNFORMATION (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: Docken, John Eau Galle, Town of 008 - 1011 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: R / Section/Town /Range /Map No: 1 � 1 .U , U i J _J�- Otilil.� ,t 4-t.. - 04.28.16.61A TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY ST ATION BS HI FS ELEV. 3 iv -3 Septic Benchmark I - /�- / Da /0/3 lw- o Dosing �� � k�Uf �" �p Alt�3- 7fl o� T, C Aeration _ g ! p Byer -5G S d % � 3 Holding D S St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet Septic I t 1 Dt Bottom n 7ry ' % m 2• �g- Dosing 4v� �-> Head /Ma // Aeration` bS 3a Dist. Pipe Holding Bo . Sy tea ry . 3 1��b F PUMP/ FORMATION A5( St Cina� d►n IL Manufact er Demand ow GPM Model Number C TDH Li Friction Loss System Head- TDH Ft I T5 3.2-5 21. 4 _ 3 / tri r�. Forcemain Length Dia. / Dist. to Well i S 2 > ST - 3 SOIL ABSORPTION SYSTEM EM BED /TRENCH Width ` jength No. Of Trenches PIT DIMENS NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I P/ BID WELL LAKE /STREAM LEACVK Manufacturer: INFORMATION CH OR Type f System: / r/ / f /0 S NIT Model Number: / DISTRIBUTION SYSTEM g Header anifold Distribution _ x Hole Size x Hole Spacing Vent to Length Dia L ngth�_ Dia � ' Spacing 3 7 _3 J/ 17 / � A SOIL COVER x Pressure Systems Only xx Mound At - Grade Systems Only Depth Over Depth Over xx De xx Seeded /Sodded xx Mulched B dlrrench Center Bed/Trench Edges o soil p Yes ®No ®Y COMMENTS: (Inc u i de code cr a ie , r ns present, etc.) .tom In ection #1:�Yx / Z Inspection #2: Location: 548 Cty Rd BB Woodville, WI 54028 (NE 1/4 SE 1/4 4 T28N R16W) dte�s & bounds Lot G� Parcel Igo: 04.28.16.61A 1.) Alt BM Description = Ike lioau� �ax- � _a� 2.) Bldg sewer length = 7 �`1 �� (� "f�( / - LDD - amount of cover �p 76�'tlle 400 Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signatu a Cent. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538727 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: Docken, John I Eau Galle, Town of 008 - 1011 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 04.28.16.61A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TD Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution T77 x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ® Yes ❑ No I FEE Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 548 Cty Rd BB Woodville, WI 54028 (NE 1/4 SE 1/4 4 T28N R16W) metes & bounds Lot Parcel No: 04.28.16.61A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? F01 Yes R] No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. commerce.wi.gov Safety and Buildings Division County 0 201 W. Washington Ave., P.O. Box 7162 ST. CROIX i sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 53 g `,z 7 Sanitary Permit Application �, .4 State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to riate / 4P 3Z governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owne Project Address (if different than mail' address) POWTS are submitted to the Department of Commerce. Personal information you provide may be used for C ^ [ - second purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. `� P� I. Application Information - Please Print All Informati Property Owner's Name - ame r ,, A Parcel # 008 - 1011 -70 -0 CATHY LINDQUIST R��i ' " • L�� Property Owner's Mailing Address Property Location 548 CTH BB N a Y 1 2 Z 0 1 Q Govt. Lot NA City, State Zip Code Pho er , NE '/,,SE %, Section 4 I.�lA ��I /a WOODVILLE, WI 54028 p1NING �,C�rail OFFICE (circle one) II. Type of Building (check all that apply) Lot # T 28 N; R 16 W ®1 or 2 Family Dwelling - Number of Bedroot �' Subdivision Name �ac¢�wtf ❑ Public /Commercial - Describe Use Block # NA NA ❑ City of ❑ State Owned - Describe Use c CSM Number ❑ Village of G � 7✓ ma-;J C It 144-rG ® Town of EAU GALLE III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ® Replacement ❑ Treatment /Holding Tank Replacement Only ❑ Other Modification to Existing System System — ' (explain) B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration IV. Type of POWTS System/Component/Device: (Check all that apply) 6 A ❑ 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/Treatment Area Information: Design Flow ) Design Soil Application Rate f) Dispersal Area Required Dispersal Area Proposed t) System Elevation / 450 r � /� �5' ��� S 99. ✓ VI. Tank Info Capacity in Total # of Manufacturer F z a Gallons Gallons Units o n �. New Tanks Existing Tanks 1,-,�Jh ,,,�/ G,./ c Z H f a 9L U Septic or Holding Tank 1000 0 1000 1 WIES t��ww T ® ❑ ❑ ❑ ❑ Dosing Chamber 600 0 600 1 WIESER I ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb i ture MP /MPRS Number Business Phone Number BRADY DAHMS 220355 715.235.0651 Plumber's Address (Street, City, State, Zip Code) HALVERSON BROS., INC. - 1020 NORTH BROADWAY - MENOMONIE, WI 54751 If VIII. Count Department Use Only pproved Permit Fee ssue Date �j Issuing nt Signature Owner ' n Reaso 'al $ / 71 pp 1/117 IX. Condit' n of A rovaUReasons for Disapproval A 5��6 TEM gG/NER. ,,3) ��� 1. Septic tank,. effluent - filter and / dispersal cell must all be services / r - grtaingg GG as per management plan provided by plumber. �( � 2 . An st�back requiremelft mtlst. maintained t� A W t 0 cap l d W Attach to complete plans for the system and submit to the County only on pi#er not less than 8 in x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 r z � f CTH BB) �- o --- - - ---- - - - - -- _ ------------- - - - - -- - - 0o p w ca p Go Y F- LU :, r J >< m- L!1 ! L1J .` V r O z O v c ' o >- � UJ cr, Eke LL Lli J ►- �:: to R � VJO� czO Q U! \`_`` to W �� z Q�ma 0,-w JJ �s Nr z w 3 U w Z 0 cj) 0 JJJJJ o p r w� wz Y�Opw JJJJJ o z v �0 o awZZ�wz= JJ. + zc� o� mo0oamo JJ.cnJJ x xw�� w JJJJJJ.�1J ='`- a� za�C¢U)vz JJJJJJ.�JJ //� m O mmooz0OJv JJJJJJ. JJ -� JJJJJJ.mJJ � a v -k ® ®© JJJJJJ. JJJ JJJ w JJ ° o z Q w ' Q o W U) O - C] aD 1 1 in � > 1 U p N w I— Q CL d � '\\ w W w n 0 IL � "' z U W U F- � Z L) W CO V - - z JJJ U n. �shoke _mJ E / C - ) , JJJ 0$ > Y 1 U + O N C l) , a W / 0 0 i & � , ir> E U 1 Q W Z e ; O 00 V + � J W ' Q W + coo to 00 1 a� i '�, wa LU 1` 0 O ; rn QO W �>rn \ O = O 1 i 3dQ� �J U J Q (D O Z N LL SY K N LU W J + 1 1 Z W m p w w 0 U Q + ' 0 0 Z (1� a -1 C) i L� Z a a. / w w Q w �'�wF- co Z z �ZpCl) U \ / w i i I (FE,NCELINE) .— C:) C 6 I ; co n ]COPY � PAGE 3 OF 9 f Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 Contact Through Relay isconsin www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Aar O Secretary October 28, 2010 CUST ID No. 227819 ATTN. POWTS Inspector WILLIAM J BERGH ZONING OFFICE GEO TECH SOIL & SITE EVALUATION ST CROIX COUNTY SPIA 11091 30TH AVE 1101 CARMICHAEL RD CHIPPEWA FALLS WI 54729 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/28/2012 Identification Numbers Transaction ID No. 1863274 SITE: Site ID No. 760842 Cathy Linquist Please refer to both identification numbers, 548 CTH BB above, in all correspondence with the agenc Town of Eau Galle, 54028 St Croix County NE1 /4, SE1 /4, S4, T28N, R16W FOR: Description: Three Bedroom Mound System / 6% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1283671 Maintenance required; Replacement system; 450 GPD Flow rate; 18 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders P.O. • A sanitary permit must be obtained from the county where this project is located in accordance with the C011Chi 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 APPF the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. DEPARTMEK • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank DIVISION OF SAF explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. SEE CORR • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. Please specify an alternative product prior to applying for a sanitary permit. • 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. WILLIAM J BERGH Page 2 10/28/2010 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 jerty.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Brady Dahms , Halverson Brothers Inc (Plans Mailed To) I w WILLIAM J BERGH Page 2 10/28/2010 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 7fi3 jerty.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Brady Dahms , Halverson Brothers Inc (Plans Mailed To) Y OUR U T a sec D Elffm 0 9 Proudly Serving the Chippewa Volley Since 1994 2 ech (888) 834=PERC Client: CATHY LINDQUIST ,q i 548 CTH BB — Woodville, WI 54028 0 0 '*4 rosz FO MOUND COMPONENT- USING AGGREGA TE 0� O Reference Component Manuals: ✓ r ✓� Pressure Distribution Component Manual SBD- 10706 -P (N.01101) - version 2.0 Mound Component Manual SBD- 10691 -P (N.01101) 0 version — 2.0 Job Site Location: 548 CTH BB Legal Description: NE %, SE Sec. 04 T 28 N, 16 W Town: EAU GALLE County: ST.CROIX Designer's name and license #: William J. Bergh (License No. 1577 -007) 1 the undersigned state that these plans were designed : �.u���..•. • and submitted under my . ly. • ••' 6 Gy14 //y�••�, Designer's signature: / W�Z, / � w• � c o . •�,�,,�� ner Desi 9 's mailing address: 11091 30"' Avenue C�► Chippewa Falls, WI 54729 Designer's contact information 715 - 723 -5555 voice '4 �'' �, ••� 888 - 466 -8573 fax �'�o;,$S�O 715 - 577 -6838 cellular email: billy wastewaterpros.com Contents Page 1 cover sheet 'Y Page 2 system calculations , � !, Page 3- site plan Page 4 cross section of mound component E cor, "t. Page 5 plan view of mound component & distribution lateral schematics AN BUILD E E Page 6 pump chamber x- section schematic Page 7 pump performance curve Page 8 maintenance & contingency plan ONDENICF_ Page 9 maintenance & contingency plan Page 1 of 9 11091 30th Aveave • Chippewa Falls, WI 54729 LOCAL: (715) 723 -5555 FAX: (715) 723 -7535 www. wastewaterpros. com SYSTEM CALCULATIONS USING WIESER TANKS residential dwelling with total of 3 bdrm calculated at 450 gpd design wastewater flow LLR (linear loadin rg ate) 6.0 g al /clay /ff DLR ( des ign loading rate) 0_4 gal /sgff /clay 1125.0 minimum basal area depth to limitin factor 18 inch system area cross slope - percent forcemain lenath 165 feet _u�ina_ 2 inch - SCH 40 PVC manifold and /or header length 3 feet using 2 inch - SCH 40 PVC forcemain volume 27.1 lag Ions length of each lateral 37.00 feet using_ 1 1/2 inch - SCH 40 PVC total number of laterals 4 invert elevation 99.50' (bottom of lateral) orifice diameter 0.1875 tenths /inches 99.00' system elevation distance between orifices 24 inches or 2_0 feet total orifices per lateral 19 total orifices all laterals 76 lateral volume each lateral) 3_4 Iga Ions 12.54 lateral discharge rate system discharge rate 50.2 gallons calculated at 3.25 distal pressure x 1.3 ff. vertical liff $_0 feet friction loss in the forcemain 8.3 feet calculated at 50.2 gal /min discharge rate TDH (total dynamic head) 19.5 feet minimum pump discharge 50.2 gl2m Qt 19.5 TDH (total dynamic he bump manufacturer ZOELLER model number 140 5 x lateral vol. + forcemain vol. 95.1 lag Ions 73.5 actual doaQ (total forcemain) pump tank model 60 actual tank size 653.64 ga llons septic tank model 1000 actual tank size 1087.32 g allons manufacturer of tank /s IW ESER pump float on /off measurement 6 in che alarm float from bottom of tank 16.0 inch gallons /orifice /dose 027 inch orifice density 5.92 Page 2 of 9 a. U o ACTH BB) C >: � « w N 0 o w Y ~ m 1, r ¢ z o 111 J O liJ mil. U J OO < o LU IL u w A h o LL V w ,`I y na �� °v to w ni z d F- m a � o F- U) Z Q(n Gc M J� > QJ J_G H =w Z ?gy �v u'wI�F -�O� O O �.`� JJJJJ op U)g uz Y�OOw00w JJJJJ v -� o OO awzz�ulzz JJ. ' S z�' zo3 �000ammo� JJ.u)JJ m Ei x m � p v wm00 WOOw JJJJJJ. = JJ m o m J J Z D J C) JJJJJJ. 1J -' JJJJJJ.mJJ a 0 4c JJJJJJ. W J co Q \, Q c w Cf.) o a O - a LC) > U U LLI a- Q CL co LIJ 10 w I! > > 0 O J LU r�rl I.V CIL _ w z J O w w C-) F— z z w - - -_ ----- _ z ® LCD ! \ JJJ re E i / QJ / shokE - mJ o a / ! Cl) I v $ a u I +l I U Y I L) C) i i U / p 0 ± i I in E Q wZ i LLe F � U' O W U ' S`� W Z W wo ' �z ' UO i �� # O w O w \ Q a_ z 1 1 3d07 ot_ C7 U = o c� co \ w J r I' C7 = J o m w p \ 1 _ QQ QO z �v ON0 J r r co ¢wz� :D 1 I r I 0 \ r 1 �Z z �?p� / X= O� zWU ; o U) o \ (FEN CELINE) r *k C 6 r / PAGE 3OF9 MOUND COMPONENT CROSS SECTION (typical) (DRAWING NOT TO SCALE) 4" OBSERVATION PIPE >12" SOIL TO PROMOTE SUITABLE PLANT GROWTH DISTRIBUTION CELL DISTRIBUTION LATERAL(S) SYNTHETIC MATERIAL INVERT ELEVATION = 99.50' 1 / >12" UNDISTURBED SOIL & VEGITATION O ,O 10" 0 0 0 0 0 0 FORCEMAIN 18" ELEVATION = 97.50' 22.3" ASTM C -33 6" fill material PLOWED /TILLED AREA 1.3' 5.6' 6.0' 9.9' 1.8' 6.9' 11.T 24.6' 4" OBSERVATION PIPE (TYPICAL - NOT TO SCALE) MIN. (2) PER TRENCH @ ,0'FROM EITHER END CUBIC YARDS OF AGGREGATE (minimum) 15 THREADED OR SLIP CUBIC YARDS OF SAND (minimum) 105 TYPE APPROVED CAP 4 "SCH40PVC SYSTEM AREA SLOPE "'6% PIPE EXTENDED TO FINISH GRADE SYSTEM AREA LONGITUDINAL (long axis) SLOPE NA F—+O— (4)q ^X4 " LONG SLOTS CUT EFFECTIVE BASAL AREA (SQFT) 1327 INTO PIPE @ 90 DEG. APART 4" TOILET RING DISTRIBUTION CELL 0.5" - 2.5" washed hard aggregate, 6" below & 2" above distribution lateral(s) ALL MATERIAL & PIPING SPECIFICATIONS AS PER THE MOUND & PRESSURE DISTRIBUTION COMPONENT MANUALS PAGE 4OF9 PLAN VIEW OF MOUND COMPONENT (typical) * All piping & material specifications per the Mound & Pressure Component Manuals 6.9' AG GREGATE DISTRIBUTION CEL L 1.5' 3 �' 1> DISTRIBUTION 6 t( LATERAL(S) 1.5' 24.6' OBSERVATION PIPE(S) 11.7' 10.5' — 75.0' I 10.5' 96.0' Distribution laterals terminate 6" from the end of the distribution cell © Access box covering threaded plug at the end of each distirbution lateral / EFFECTIVE BASAL AREA DISTRIBUTION CELL DISTRIBUTION LATERAL (typical) All discharge orifices are located on the center bottom line of the distribution lateral <6" final grade final grade <6" threaded cap 11/2" DISTRIBUTION LATERAL threaded cap 3 access box access box I 3.0' OF 2" SCH 40 MANIFOLD I 37.00' I- 24 " 1- 12" Xi2 X � Y -- I last orifice located I 74.00' @ end of lateral 1st orifice Discharge orifice diameter 3/16" = 0.1875 X spacing 24" Number of orifices per lateral 19 Y spacing 24" Total number of orifices (all laterals) 76 X/2 spacing 12" (DRAWING IS NOT TO SCALE) PAGE 5 OF 9 r— COMBINATION SEPTIC TANK /PUMP CHAMBER X- SECTION (DRAWING NOT TO SCALE) FINAL GRADE MANHOLE RISER & COVER (slope ground surface away from {per COMM 84.25 (7) & (8)} manhole(s) for proper drainage) ELECTRICAL & ALARM SUPPLY (electric & alarm wiring must be BUILDING SEWER installed on separate circuits) (per COMM 82.30 (1 1)j 4" VENT PIPE ULAPPROVED ELECTRICAL JUNCTION BOX FORCEMAIN \u MANHOLE MANHOLE MANHOLE 18" min. BOTTOM OF INLET (Invert elevation) whe properly sealed 3 �� en not u sed ........................................................ ............................... _ (wastewater level) - - - -- - -- IN / / / / i RESERVE / / / / / // /CAPACITY / / / /// i ALARM FLOAT C ON FLOAT 4" INLET PIPE FILTERED B ' OFF FLOAT (tee or be APPROVED EFFLUENT FILTER EFFLUENT elev = REQUIRED ON OUTLET A 91.50' MINIMUM OF 3" OF SUITABLE BEDDING BENEATH TANK PUMP PAD EFFLUENT FILTER POLYLOK ** ** OR EQUIVALENT COMPONENT Tank Manufacturer WIESER DWF (daily wastewater flow) 450 GPD Se tic /Pum tank model WLP 10001600 -MR Number of daily doses —6.1 Septic/Pump p C Y (DWF / actual dose volume) G` Alarm manufacturer S.J. ELECTRO Alarm model number ** � Forcemaln volume 27.1 Type of float switch MERCURY Actual dose volume (gallons) 73.5 (total dose volume - volume of forcemain Effluent pump manufacturer ZOELLER ** PUMP TANK CAPACITIES Effluent pump model number 140 Reserve above alarm 18 inches = 301.68 gallons Alarm float above on float 2 inches = 33.52 gallons (C) Minimum pump discharge rate (GPM) 50.2 On /Off float measurement 6 inches = 100.56 gallons (B) Off above bottom of tank 10 inches = 167.60 gallons (A) Vertical lift (pump off to distribution lateral) 8.0' system head (distal pressure X 1.3 feet) 3.25 PUMP CHAMBER DIMENSIONS Friction loss in the forcemain 8.3 / Length 150.0" Width 84.0" Total dynamic head (TDH) 19.5 ,/ Liquid depth 36.0" Gallons per inch 16.76 PAGE 6 OF 9 TOTAL DYNAMIC HEAD /FLOW `y L 1 LL PUMP PERFORMANCE CURVE PER MINUTE MODEL 140A140 EFFLUENT AND DEWATERING 55 MODEL 14014140 16 50 Feet Meters Gel. Chefs r" -- 5 1.5 66 326 _ 14 45 10 3.1 80 303 15 4.6 73 2761 f a6 20 E -1 66 25U 7 J- 12 { 25 7.6 59 223 140, 4140 - 0 30 9.1 44 165 35 �'": = v — , ,; _ - n i,n, w•i = 10 35 103 44 38 1 30 40 12.2 1 26 106 i z 45 13.7 1 17 64 0 6 25 Shut -off Head: 50fi.(15.2m) � O 010940B s so I h l 4 \.` I' 4 5/32 J_ —t.. SK1524A 2 5 o - 10 20 30 40 50 60 70 60 90 _ E GALLONS LITERS 0 80 160 240 320 FLOW PER NIINUTE 010940A CONSULT FACTORY FOR SPECIAL APPLICATIONS - 4 31z �.. • i Electrical alternators, for duplex systems, are available and supplied with an ,2 alarm. ` Q • Mechanical alternators, for duplex systems, are available with or without'' •- 1 112 - '1 lit Ei °i alarms. • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level ,E ; 6 i long cycle controls. I • Sealed Qwik -Box available for outdoor installations. See FM1420. • Refer to FM0806 for applications above 1307 (54 °C). SK15245 140 Series - 43 lbs. 4140 Series - 63 lbs. SELECTION GUIDE 14014140 MODELS Control Selection 1. For automatic use single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. PN140 Model Volts -Ph Mode Amps Simplex Duplex 2. See FM1228 for correct model of simplex control panel. N4140 115 1 Non 12.0 1 or 2 3 3. See FM0712 for correct model of duplex control panel. E4140 230 1 Non 6.0 1 or 2 3 BN4140 115 1 Non 12.0 --- All installation of controls, protection devices and wiring should be done by a qualified BE140 BE4140 230 1 Non 6.0 licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). '`Single piggyback switch included. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 70: P.O. BOX 16347 �r I Louisville, KY 40256 -0347 1, i I ` r 25#' Manufacturersof.. / i� SN1P ; 0: 3649 Cane Run Road �, pp q ' Louisville, KY 40211 -1961 QU!!L /TY / UMPS �/iHCE �/d ' %PUMP !O_ (502) 778-2731 .1(800) 928 -PUMP http : / /www.zoeller.com (502) 774 -3624 0 Copyright 2002 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: Owner: CATHY LINDQUIST POWTS Maintainer: Geo Tech Soil & Site Evaluation — Chippewa Falls, WI 715 - 723 -5555 Local Regulatory Authority: St. Croix County Zoning Department — Hudson, WI 715.386.4674 POINTS Installer: Halverson Bros., Inc. — Menomonie, WI 715- 235.0651 Septage Servicing Operator DESIGN PARAMETERS InfluenVEffluent quality (values typical for domestic (non- commercial wastewater and septic tank effluent) Fats, Oil and greases (FOG) <30 mg /L, Biochemical Oxygen Demand (BOD) <220 mg /L, Total Suspended Solids (TSS) <150 mg /L Soil loading rate (SLR) = 0.4 BASAL SYSTEM SPECIFICATIONS The components of this septic system are intended to serve a three - bedroom (450 -GPD) single - family residence. The components include: a Wieser model WLP1000 /600 -MR septic /dose tank (with an approved outlet filter and Zoeller 140 effluent pump, alarm & controls and a 75.0' x 6.0' distribution cell within a mound POWTS component. All components must comply with WI Adm. Code COMM 84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIAL o SBD — 10572 -P (R.6/99) "Mound Component Manual" ✓ SBD — 10691 -P (N.01 /01) "Mound Component Manual" Version 2.0 o SBD — 10570 -P (R.6/99) "At -Grade Component Manual Using Pressure Distribution" o SBD — 10567 -P (R.6/99) "In Ground Absorption Component Manual" o SBD — 10705 -P (N.01/01) "in Ground soil Absorption Component Manual" Version 2.0 o SBD — 10573 -P (R.6/99) "Pressure Distribution Component Manual" ✓ SBD — 10706 -P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 MAINTENANCE & MANAGEMENT Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years. The septic tank contents must be removed in accordance with Chapter NR 113, WI Adm. Code when the combined sludge and scum equals one -third (1/3) the tank volume. The effluent filter(s), effluent pump, controls & alarm and distribution lateral(s) should be inspected annually to ensure maximum performance. Lateral inspection /maintenance should include flushing of the laterals and pressure testing. START UP For new construction prior to use of the POWTS check treatment tank(s) for presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage - servicing operator prior to use, OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of wastewater will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water softeners, iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. The system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins, condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics (medications), solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain regular steady flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to freeze up. o Valves Valves should be operated in the following manner ✓ Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve POWTS. There is normally a one day reserve capacity under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surface discharge. Page 8 of 9 \ R INSPECTIONS Inspections shall be made by a person carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule) ✓ Septic Tank Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or surface discharge of effluent. Access openings used for service of assessment shall be sealed and /or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(effluent) filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank during cleaning. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating properly. ✓ Pump Chamber Treatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. ✓ Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. - The contents of all tanks and pits shall be removed and properly disposed of be a Septage Servicing Operator, - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure(s), lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • 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. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ✓ Mound and At -Grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. Page 9 of 9 W isconsin SOIL EVALUATION REPORT #2522 Department of Commerce in accordance with Comm 85, Wis. Adm. Code 3 Division of Safety and Buildings Geo Tech Soil e a of LLC Attach complete site plan on paper not less than 8 1 /2x 11 inches in size. Plan must County 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 road. Parcel I.D. 008 - 1011 -70 -000 Please print all information. Revie By Date Personal information you provide may be used for sec cy Law, s. 15.04 (1) (m)). Property Owner Property Location LINDQUIST, CATHY Govt. Lot NE1/ , SE1 /4, S4, T28N, R16W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 548 CTH BB i Nov 1 ZQ1Q NA NA City St tt to Zip Codd ber Cit Villa e T WOODVILLE I ST.cetZIZ N1IC6 ❑ y ❑ g ® own Nearest Road Eau Galle CTH BB ❑ New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or commercial - Describe NA Parent material LOESS OVER FLACIAL FLUVIAL Flood plain elevation, if applicable NA ft. General comments Site requires a mound septic system. Maximum basal SLR = 0.4 (eff #1). Abandon all existing treatment tanks. and recommendations: 1 Boring # ❑ Boring ® Pit Ground surface elev. 98.20 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff #2 1 0 -11 7.5YR 3/2 NONE SIL 2 M SBK MVFR AS 2F,1M 0.6 0.8 2 11 -18 10YR 4-5/3 NONE SIL 1 M SBK MVFR GS 1F -M 0.4 0.6 3 18 -30 7.5YR 4/4 F21) 10YR 5/3 SL 1 C SBK MVFR -FR -- 1F 0.4 0.7 7.5YR 5/8 2 Boring # ❑ Boring 96.20 facto ❑ Pit Ground surface elev. ft. Depth to limiting acto 36 in. Soil Application PP lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 1 0 -7 10YR 2/2 NONE SIL 1 F SBK MVFR CS 2F,1M 0.4 0.6 2 7 -16 10YR 4/3 NONE SIL 1 M SBK DS GS 1F-M 0.4 0.6 3 16 -24 10YR 3/4 -6 NONE GRLFS 0 SG MVFR GS 1F 0.5 1.0 4 24 -36 10YR 4/4 NONE GRLFS 0 SG MVFR CW iF 0.5 1.0 5 36 -43 7.5YR 4/4 F2F 5/3 GRSL 0 M 7.5 YYR R 5 /8 MFR -- -- 0.2 0.6 5 " Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD s30 mg /L and TSS S30 mg /L CST Name (Please Print) Signature: CST Number William J. Bergh 227819 Address Geo Tech Soil & Site Evaluation, LLC Date Evaluation Conducted Telephone Number 4255 N Prairie View Road, Suite 2 Chippewa Falls, W 154729 9/24/2010 715- 723 -5555 SBD -8330 (R.07 100) Property Owner LINDQUIST, CATHY Parcel ID # 008 - 1011 -70 -000 Page 2 of 3 F3 ] ❑ Boring Boring # Pit Ground surface elev. 97.20 ft. Depth to limiting factor 20 in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff #2 1 0 -7 7.5YR 3/2 NONE SIL 2 M SBK MVFR AS 3F -C 0.6 0.8 2 7 -20 10YR 4 -5/3 NONE SIL 1 M SBK MVFR GS 2F -C 0.4 0.6 3 20 -30 7.5YR 4/4 FLD 5/3 7.5 YYR R 5 /8 SL 1 C SBK MVFR -FR -- 1F-M 0.4 0.7 5 ❑ Boring F-1 Boring # Pit Ground surface elev. ft. Depth to limiting factor in. E] Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F-1 ❑ Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f1 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 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) Geo Tech Soil & Site Evaluation, LLC s y .JO LIM sk poo / IV j O r r r l ' r / � i+ I r � 1 \ -fts \ m rD ro�sxs- �Z A m n C m n n m m r z o m X�777 Y9 0 C O W mZ -EO C A z d� O .02 V :R m �_ n al 2 = 0 > (A Z mom m Z�j G3 m vF� = � m �m rr F-Fw n r p Z r r� o �, rr =rrrrrr Z0c pOODZ n C rr rr - rrr - r - nc� >nn�c� -� � � o rr rrr - rr - r m�x x = rr co rr ;R Zm >zzo * Z n G rrm rr :`�`,` ,z ppmpptn� Z� 3CA rrr O ` m m= -1K0F=> N r- c �;` D (/� 171 �OZ cn0 � D tn .: - m C Z m �Owcn Z *Z --4 �� :�v;� r n Rl CD p n W n O D Co � O r m X� 9m ;a m 3 'a y ; `m.` m O r W Z o N n !C r o m - r p m n x < m CD �" OD C Z (88 HiO) to i i > ST. C'ROIX COUNTY RECEIVED SFFFIC "DANK MAINTENANCI; AGREINI F AND NOV 12 2010 OW'Nl RS1- 111'('1101FICATION FORM ST. fLROI)( COUNTY FICE Chvner Buver Mailing Address Property Address -- (verification required from Planning & /oning Dcparuncnt Iirr new construction.) City/State / Parcel Identification Number C � t Il v , ' LEGAL DESCRIPTION Property Location /� /�` _ '' ..� - ' %� , Sec. Lj _ • T _ N R_ _W, Town of ^ //t Subdivision Plat: Lot ## Certified Survey Map # -- - Volume Nwc ## Warranty Deed # 2U ®�7�— (bel 2007)Volume Page it - -- -- - �s � Spec house ycs no I_ot lines identifiable ves no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance ol'your septic systcrit 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 it trcauncnt stage in rile xaastc disposal system. Owricr maintenance reslumsibilities are specified in �,Comni. 83.52(1 ) and in (Impter 1 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & /oning Deparltncnt it certification firrm, signed by the s t i •r or : licensed punt rcr verifying g that I e owner and by a master plumber, journeyman plumber, rc. tnrtcd l !send c r I I 1 Y t, ( ) the on -sit wastewater disposal system is in proper operating condition and1w (2) after inspection and pumtping (if necessary), the septic tank is less than 1 1 full of' sludge. Vwc, the undersigned have read the above requirements and agree to maintain the prixate sewage disposal system with the standards set firth, herein, as set by the Department of Commerce and the I)epanment of Natural Resources, State of W isconsin. ('enification stating that your septic system has been maintained must he completed and returned to the St. ('roix County Planning & /oning I)cpanmem within 3O clays of the three year expiration date. Uwc certify that all statements om this Ii,nn are true to the hest of my %our knowle(jge. live anvare the ownerls) ol'the property described above, by virtue ofa warranty decd recorded in Register ol'l)ceds Office. Num of bedrooms Ki APPH 'ANT(S) DATE ** *Any infirrimmon that is misrepresented nrav result in the sanitary permit heing revoked by the Planning & Zoning Department. * ** Include with this application it recorded warranty deed from the Register of Deeds (Mice and a copy of the cc•rtif ied survey map if reference is made in the warranty decd. (REV. 09/07) U, 2 8 8 5 P 0 6 2 805939 f KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Document Number Document Name 09/09/2095 10 : 30A?! WARRANTY DEED THIS DEED, made between Clifford Solstad, a single person EXEMPT # REC FEE: 11.00 TRANS FEE: 450.00 COPY FEE: ( "Grantor," whether one or more), and John Docken and Cathy Lindquist, husband CC FEE: and wife PAGES: 1 ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in S Croix County, State of Wisconsin ( "Property") (if more Name and Retwm Address space is needed, please attach addendum): Thomas A. McCormack The North Quarter of Northeast Quarter and Southeast Quarter (N 114 of NE 114 PO Box 2120 of SE 1/4), and North Quarter of East Half of Northwest. Quarter of Southeast Baldwin WI 54002 Quarter (N 1/4 of E 1/2 of NW 1/4 of SE 1/4), All in Section Four (4), Township Twenty -eight (28) North, Range Sixteen (16) West. 008 - 1011 -70- 000,008 -1011 - 90-000 Parcel Identification Number (PIN) This is homestead property. (is) Osmot) Exceptions to warranties: Easements and restrictions of record. Dated �� 6t4 �y,_ _ a� 1 (SEAL) # * Clifford Solstad _(SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN _ ) ) ss. authenticated on ST. CROIX COUNTY) Personally came before me on &/ d► ! (� * the above -named Clifford Solstad TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the perso h0',.egaalli{ed ft! fore E u authorized by Wis. Stat. § 706.06) instrument and acknowledge e s e. J%J : i ; n THIS INSTRUMENT DRAFTED BY: „ �� ! •�., „ :. a � Tho A. McCormack Notary Public, State of WISCONSIN _ �•,.n.. - . B aldwin WI 54002 _ My commission (is permanent) (expires: - ^ ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED STATE BAR OF WISCONSIN FORM NO. 2-2003 *Type name below signatures. 0 State gar of Wisconsin 2003 INFO -P RO' Legal Forms • (800)855 -2021 • infopoforms.com