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020-1356-18-000 (2)
Jrriar Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix - Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538728 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: Chelstrom, Richard Hudson, Town of 020 - 1356 -18 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range /Map No: /OS • //L—_ 4/ /3 W\ 14.29.19.2080 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se tic Benchmark e• 66 /k 14/e5 s' 24asvi--- /260 D - Yq 169 Ass. ,z.. ' Alt. BM �,'1 (N; Gk IIL 6,4,, � ,Q.' 5 el 1.4. Gu✓+A. 2.3 4 /Q 7.OZ_ P Go id k_ , 26 B ld g . Sew 6.11_4_ o ` mo / Holding St/Ht Inlet ,N j ,_ TANK SETBACK INFORMATION St/Ht ou ttil . 4 (O5 16Z .7 / TANK TO /L WELL BLDG. Vent to Syr Intake ROAD .- 9kinfet- of 4rfe,A G...4,. 514"... (v .76 /G?. G41, Se tic / J / Dt Bottom rvl, . 75 � 9a / iZO -- Caw. (3•A ‘,.g'i /Az. 5z. Dosing s ' ' — Header/Man F,`l4. . 7 -�. qa ' /to /z0 7 7 /d / • 4 89 Aeration Dist. Pipe 7r 5s /a /� 7/ Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 1.56 S. 6C Manufacturer Demand Gv -L.. eand St C ver 2 , 34 /67, oz_ Mode V*, c - V"...._ G .c1 /6 38 TDH Lift Friction Loss System Hea • Ft / Forcem: 01a. Dist. to Well ✓ab t_-.. Ot1 4 — CoI J 7,de /1Z. 3(o SOIL ABSORPTION SYSTEM 2.-44 BED/TRENCH Width ' Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. ( Liquid Depth DIMENSIONS 3 G L G• -7 '/,ems/ R 1+ ` _ SETBACK SYSTEM TO P/L BLDG WELL �_ ,� LAKE /STREAM LEACHING Manufacturer: / r% , t _ INFORMATION i CHAMBER OR ,Ertl, f i � L, Type Of System: / / ff (.O AA" / , ate n / 39 ^ Biz /t/i4:7 UNIT �j �L � Model Number , I L !'C 5 r 4..../ DISTRIBUTION SYSTEM /Vera._ zz t- ZZ=- 54 d4, Header/Manifold ii Distribution \ \ x Hole Size x Hole Spacing Vent to AiiIntg Pipe(s) ` per �d Length 7 Dia Length Dia Spacing Q SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only ✓E n +' i f0�a.. E-2 Depth Over f Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center 44z Bed/Trench Edges ` Topsoil `` �....y2s 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! / Inspection #2: / J1 / Location: 708 Paul Burch D ' Huds £. J on , W I e. &. 1 54016 (NW 1/4 NW 1/4 14 T29N R19W) Grass Range 2nd Addition Lot 18 Parcel No: 14.29.19.2080 1.) Description = Alt BM Descri r L P GIA.a: ,,.5 4" JGkS 60l 2.) Bldg sewer length = - amount of cover = x � �� ", I i Plan revision Required? Yes -J No ii j ' ' /b / 4 x /75 1 Use other side for additional information. 1 �p U.�'7 Date Inse , :r'sS , re SBD -6710 (R.3/97) p g Cert. No. / ( I\ 61, commerce.Wi.gov Safety and Buildings Division County keg te-L K/ , 201 W. Washington Ave., P.O. Box 7162 St. Croix ti C0 n S' n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) i)epattrrlerit of rc® St t t 4! 5 37 72 Sanitary Permit Application State Transaction N ber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate g ental Project Address (if d ifferent than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS e submitted to the Department of Commerce. Personal informatio ' "ond Paul Burch Drive. purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. I I. Application Informatio Please Print All Information _ roperty Owner's Name Parcel # & *IQ � C ,, h � ee � 1strom NOV 1 j 2010 020 - 1356 - 18 - 000 Property Ownet"s�Vtra Address Property Location / , ,. e go) 708 Paul Burch Drive ST. CROIX COUNTY C %/ mania R 7ONING OFFICE Govt Lot e City, State Zip Code Pl.,,..., 2i.....bei , , /<, Section Hudson, WI i 54016 715- 381 -5371 NW /. , NW r l 14 (circle one) II. Type of Building (check all that apply) Lot # T 29 N; R 19 E or W ❑ 1 or 2 Family Dwelling - Number of Bedrooms 18 Subdivision Name Qepta INAe Block# Plat of Grass Range 2nd Addition ❑ Public /Commercial — Describe Use Na ❑ City of ❑ State Owned — Describe Use CSM Number ❑Village of t Na 0 Town of Hudson r 2 16;si- C P116 t.�u J zt i .. Z cL doOPS III. Type of Permit: (Check only ode box on line A. Complete line 13 if applicable) A. ❑ New System Re lacement System ❑ Treatment/Holding Tank Replacement Only ❑ O ther Modification to Existing System (explain) 61 Y ∎ P Y g P Y g Y ( P # 31438%Z. B• Change 0 Tran to New List Previo Permit m ber and Date Issued ❑ Permit 0 P ermit Revision ❑ C han e ofPlumber r,, L Before Expiration Owner I�_ Iv- -- IV. Type of POWTS System/Component /Device: (Check all that apply) O1i,'UL T Gl Z ►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 a l ain) ? ❑ Pretreatment Device ex lain) V. Dispersal/Treatment Area Information: in filtrator "Q-4" standard chambers & r. endcaps,(olvLok PL -525 effluent Design Flow 7 Design Soil Application Rate( f) Dispersal Area Required ( Dispersal Area Propose sf) System Elevation 600 d 0.70 d/s . ft. 857.15 sq. ft. 891.60 sq. ft. 101.00 gP gP q sq sq VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a o New Tanks Existing Tanks 8 .8 1 2 a .. /�.► 14'6 r .4- 4 , �wt �.0 ti w C7 a. Septic or Holding Tank Na 1,200 1,200 1 Weeks Concrete X Dosing Chamber Na Na Na Na VII. Responsibility Statement I, the and rsigned, as a me responsibility for i s on of the POWTS shown on the attached plans. Plumber's Name (Print) P lu m .: 's Signa MP/MPRS Number Business Phone Number James K. Thompson '11111 : , • / 7 "5--- MPRS 30021 (715) 248 - 7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 4020 , VIII. County/Department Use Only / / roved Permit Fee , Date/ssue Issuing t Signature / wen Reason Denial �� rr r i IX. Conditions of Approval/Reasons for Disapproval SYSTEM QWNER: 1. Septic ta effluent filter and dispersal -tell must ali be services / maintained as per management plan provided by plumber. 2. At setback.tequirements must be maintained as Per applicable code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD - 6398 (R. 02/09) Valid thru 02/11 . 3 eg(g-4 dtv% /ua ,o, E A E /ech o,- • (- otic¢ed s 6241e ke.ha/d u sa.41 CJ, 6 /s 6co Pr, / oro/aze* pik . 1 yob Au4' cl, ! . A4- i ... dso►?, c c�/, s' '6 - vo4.o . _ /!S.P -- !OX °__ la3.0' O Lot /5; AO/a 0c 6'4a sS ye's' 83' ` 19W flC)4! SlG /f 8 \\ E,ri.Sfi alis,awJa ieez /. 0 ', \\ S - Tc 7 0 (2- 6 cla a£ 3 F7s' 77.191 . ,P. /9c.). ii7. 0 • \ • /a!53 e\ \ \ /.2 f�� 4av / �4[1/+SC/1; l� [�1'. ` , \ 6: (�r /OJe/ d g c-I nfl � 1. � /jSG - B' C2 \ \ cr fi•c •, c-k. Z i ae 6e; .2 54.5 QC.cJ �`o \ -5(4-e tce ✓." - , 9X4.z ? p_ \ \ ql / oo. 00,` 5,06/7 /, 2cd 5oc.Q uJmKs oPi ■ 432 - • , e f T :s€rnc to—K. ✓ T. \4 a ' .� 0J-5 t0 os �� � No i t .r �\ ,q ✓ 0, ..�_ Pr t.a'esci d" mi t . 1031 i EX/ i tr y e!f/uan �arale ■ 4 6to/roar, Piopos /-- . ;on oP ✓t Re-side" ny 9 a.ratz oC - & -on. :1 ; b7e11= /48.9 ci utu7Ar /� /9 2 eK'// '5 i�'w�y. ,ee( ,,ZZ3S • 6,,7 eda/ua.{Mn 2/ 6 • 57e e an -lion • /- ocaiecifir'o s62.1'e 6 24d4 susa,r, C.h 0Er'am/o Du 708Azu/d re/calk • v �,,, )/ S 6 . / _ /oyo_ /D3, 0 Lo /g 0� /a cf' 6 raSS - -/ o a ,Qa.,,ge. ,�- .t &G rn-7, Cow t44",..., ♦ \ S8 j ,�� i ■ B3 \ , � 6 � � � � � EXiJt�i cl,3 fGlf'sa�Ce/% r l 1 seG / > • ', \ 7 (s. ncljsab 3;r75' ? ,P /9'4-1, 7�n' of 407/.2. ii, - P ryo adv y (1 a3 SSE C.ia c.. : ` ♦� a .� �` c- 40,, 6 e/vf �./" &o 6_/.3SG - /B- ♦ � , Lr6re•I c.4. Zln7� /�i11^ i' bel.2.S43QC.�G.s p_ • k $ i co. a.' EX/156 1, Zas y e-€ u..,,....0 :o _ . S c &-,. K. K .4 , I.e - t ss ,w Proposed c.�9; e St e" Jy ■, /z s/B• .� y / - rA..4c ca.,rs • &F /Rem blo�rooM ,g l - - lfnL - - qa�Q cY l lees1'o%ne PPopo uaP✓ . Ex 9q/$q,Q, OCIM - Q 'On. Elec) / . /ay. /2' A /6. ,d,r, : x3o Etn4 A.Z1;41. Elul = /08.9X: di: vu _3v- W &a' C4 briat 19. zeiP/i Conventional POWTS Index & Tilte Sheet Project Name: Chelstrom 4 bedroom Replacement Conventional POWTS Owners Name: Dick & Sue Chelstrom Owner's adress: 708 Paul Burch Drive, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot18, Plat of Grass Range 2nd Addition Legal Description: NW1 /4 NW1 /4, Sec. 14, T.29N., R. 19W., Town of Hudson, St. Croix Co., WI. Parcel ID #: 020-1356-18-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 Treatment & /or Filter Tank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of existing septic tank Page 11 Waranty Deed Attachments: Soil Verification Report Mater P1 er Restrict d Service: James K. Thom son, De 't. of Comm. Credential #30021 Signature ) ✓ Date: 44 Page 1 Of 11 Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01 /01) DISPERSAL CELL SIZING CALCULATIONS 1. 4 bedrooms 100 gallons estimated flow 1.5 design factor) = 600.00 Gpd design )( g )( ) p gn flow 2. Infiltrative capacity of native soil = 0.7 gpd/sq. ft. 3. Absorption area required: 857.15 sq. ft. Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.ft, EISA 857.15 sq. ft. — (2 pair endcaps)(5.80) = 845.55 sq. ft. 845.55 sq. ft. /20.00 = 42.28 chambers required 4. Absorption area as proposed: 891.96 sq. ft. (44chambers total) Number of trenches: 2 @ 22 chambers per trench (44chambers total) Trench width: 2.83' Trench length: 90.00' Trench spacing: 9.00' on center Total system area w/ 6' trench spacing: 12.00'x 90.00' � . 3 0(1/ Soil Absorption System Cross Section I ®W,75 I 1 / ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap �_ O/ ,Z V ft Leaching _÷ Chamber /0 4 66 ft ~ System Elevation 2.13 ft Qr, 0 ft , Soil Absorption System Plan View 96,o ft .z-e.,3 ft -[I - - - 1 # 6„,c ft Leaching Trench 1 Vent Or Observation Pipe r Chambers —_I f .11111) .I II,II,,,, I Mil 11 ' I .\ „ 4 Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model / t a ?o-., c%ez✓ 0 -' EISA Rating 2-0.0 sq ft per chamber Soil Application Rate 6,'7 gpd /sq ft 6 C gpd Design Flow T 0, 7 Soil Application Rate + .G.C) EISA = Chambers 2 rows of .`Z.2 chambers each. Page of a 4 0-0/ Conventional Septic System Management Plan Pursuant to Comm 83,54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705 -P (N.01 /01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October- March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation, Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two- year /1 -year schedule by use of diversion valve. Effluent to be diverted from new dispersal cell to old cell at 4 year anniversary of new system installation. Old cell to be utilized for a 1 year period. Afterwards, effluent dispersal to be alternated between cells on schedule to allow use of new cell for two years and old cell for 1 year. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248 -7767 or the St Croix County Zoning Department at (715) 386 -4680. p 5-007 EFFLUENT FILTERS PI:OLYIPACK "The PL -525 has 525 linear feet of 1/16" slots. It has an automatic shut off ball. When the filter is removed for cleaning, the ball will " "m ^ ° °• to PVC f1 eccesslbili '� -- - -_ P J � eslension handle float up and temporarily shut off the system 1 so the effluent won't leave the tank. No other 525 b feet filter on the market can make that claim!" of 1,16' . filtration slots---- _..y Rated for over 10,000 GPI/ Accepts 4" & 6' 4 "r% SCHO. 40 Pipe *, '` lo -...„3,,..„0,01,1/2 C. ,, x- ,. ,,...„, 1 i ti Gas deflector li g _ Automatic shut off 1 1 tl ball when lilts, I3 removed p "The PL -122 has over 122 linear feet of 1/16" slots. Rated for 1500 gallons per day, and .< Accet " s1 /2 PVC Handl can be manifolded together with other PL- Alarm h 122's to double or triple the GPD. It has an 122 Linear ft . automatic shut off ball that stops flow when _ of1,16Inch Fllter Slots the filter cartridge is removed for cleaning. l Comes complete with it's own housing, no Filter Housing gluing of tee or pipe and no extra parts to with 3 - &4 Pipe Adaptor buy. i ,, 0 " W " • Ges Deflector 1 -} Automatic i Shut -OH 7 �. Ball When j- I Filter Is � Removed From Tank Order # Model # Description List Price PK -525 PL -525 Effluent Filter System 203.50 PK -122 PL -122 Effluent Filter System 62.50 6 -10 / r - f - . 432„ v N 13 m nn m 73 m >> o 0 m _I, rn I D Z D N m Z ■ O 2" al x r D r N W 372 2" NJ 6.. ( ` —' "m -r a 4 V )I L D = / U) o z C3 O M - 0 MIN. 7 1J M N A m 4 0 aim/ D r p np rt._ r r _I O Z 37'' o 1 _ [ 2 2" e i m n ? D D • D - n Z V - - 1 x D N m �, w 71 �m D r n 0 77 0 Z m z - D Fri m O r � m E m m - D r m r -1- V) O F m (1-1 D D D D r r Z 1- ---I C_ U) O -H Z -< FILTER CANISTER DETAIL SCALE:3 /4" = 1' REV NO. DATE: \ ^ WIESER COIICAETE DRAWN BY:SWT 1 J \ ° z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2008 REV. JAN. 2008 800- 325 -8456 FILE:SHEET 13 a 70./'// N .::::*..1.,,....7...,.....,:::,,, LOCATION SKETCH GRAss ,.., w" 7, ' � LOCATED IA t' _ ■■ THE NE 1/4 e ■ OF HUDSOJA 111 � 8 IIII � 11! � / LO UNPLATT� NDS LA SECTION 14 ' LOT 3 T29N. R191I NW CORNER N 8 '/ 5" E 1387.25' 265.53' EL 924. �y W l 1 ` 1LM.L _ YNA US S DATUM 7 •••W ` \ S • ATER USDS DATUM 1528 � 6•x.0 STORM RA n RON Q' tu � ..� 19 "` 2 ACRE S c T. n / 1 1.M1.1. WATER RET -0 \ 2.894 ACRES \ / N / 0 �` 126,059 SO. FT. `, — EST 300 FEET OF ROAD TO BE ODNSIRUC le' TORM ETNTIRIN AU1EA ., ,, f / — EST 7 ) ' 1° : N1 ,jai i W - - UPON FUTURE ROAD MADISON. 4 / / S gt • ' G • • LEGEND (gy . N89•S2' "w 447.00' 0, • ,dgzI • • AUIMINUM COUNTY SECTOR L4U� • • /�` • 25 CORNER MONUMENT FOUND C O 589 'E 446.78' • • • ( • t' IRON Pre sum — — — — — — 3; 2875 ACRES .0 • s' IRON PIPE FOUND O 01 125,246 S0. FT. o r 2 30' IRON PIPE SET. MIMING 3.85 LDS PER LINEAR FOOT. W a NOT 20 E ALL OTHER LOT 000(895 © IG Z ' • • ' • MOMIIME14TE0 WEN 1' x s4• fu 2.220 ACRES IRON P8E SEWING 1.88 LBS.., t,1 • . PER LINEAR FOOT 96,714 SQ. FT. u (0 *3 940 �SETBAOC UNE M ® • N76'31 • t2' WOE UTUTY EASEMENT (489 "W 471.3 lel - O • ,o� -- • PROPOSED 1xDVE R= 80 24 )F--)( EXISTING FENCADE b HALL. .. 806.0 21 • MIL. - IDOLx HIGH WATER LEYEL ELEVATION O r m 2.169 ACRES .4- 95,263 SQ. 1 • NOTE A GRACING THAT WOULD D ALTER THE a 1 94,493 SQ. FT. Fv - `t • CAPACITY OF THE STORM WATER STORM WATER RETENTION AREA � �3. RETENTION AREA IS PROHIBITED h In ; • • • • • ' \ ' l n 4S' .) 3! .1 NOTE B BUILDINGS ARE PRCHENTED TIR5F1 (489'59'52 "E 394.46' o THE SEMI WATER RETENTION AREA 9'' Ai 23 22 to 2.182 ACRES 5 2.809 ACRES 95,026 SQ. FT. to ni 1 22,359 SQ. FT, y Z W 361.05' • 475.95' • o CURVE S 89'24'30" W 837 CURVE DATA LAT W W MASER NUMBER RADIUS DELTA ANGLE CHORD BEARING Z t) (V 0 233.00' 53 S27•N•18"E 4 !.4) 9 26700' 27 S40•351.6512 UT 1"---.. Ro UNPLATTED LANDS 3 8 . 43300 27'14'40" s4o •22 41 E - 0 167.00' 65'36'00" (483'57'20 "V Z 6 33300' 76•00'41'• 1489•09 "W W1/4 CORNER I7 333.00' 36 1469•22'31.5 "V t8 33300' 39'3418" S72•37'08 "W SECTION 14 0 217.00' 37 S11'28'47• V 18 217.00' 18 S61•56'38"W 19 217.00' 19 S80•3326 "V UIIJTY EASEMENTS NO POLE OR BURIED CABLES ARE TO BE PLACED SUCH THAT THE INSTALLATION WOULD DISTURB ANY SURVEY STAKE OR OBSTRUCT VISION ALONG ANY LOT UNE OR STREET UNE 0 8000' 245 N50•39165'E THE DISTURBANCE OF A SURVEY STAKE BY ANYONE tS A VIOLATION OF SECTION 238.32 2l 8000' 38'38'12" 925•0'41"E OF SBSCONSN STATUTES. MUTT EASEMENTS AS HEREIN SET FORTH ARE FUR THE USE OF 22 8000' 48'43'26" 269•31•30"E DUB UC BODIES AND PRIVATE PUBLIC MITES HAVING THE RIGHT TO SERVE THE AREA. 23 8000' 54 N58•51'34"E EACH PARCEL SHOW ON THIS MAP ( PLAT) R SUBJECT TO STATE, COUNTY, AND 1OBN9MP 24 80.00' 53 /104•39'513"E LAWS. RITES AND REGULATIONS 0.E.. WETLANDS, MINIMUM LOT SZE. ACCESS TO PARCEL. ETC.)- 25 80.00' 4973 N47'l3'08.5"V AN BEFORE PURCHASING OR DEVELOPING ANY PARCEL OF LAND CONTACT THE ST. atom COUNTY 80.00' 65'38'17" N39•20'43.5'W ZONING OFFICE AND APPROPRIATE 1OS44 BOARD FOR ADVICE 28300' 23'56'39" 861 I 26700' 76'00'41" 289'09'40.5'E l 23300' 65'36'00" S837720'E 27 23300' 44'30'36" S73•4'38'E THIS INSTRUMENT DRAFTED 87 MICHAEL ERICKSON JOB N0. 98 -38 DATE 12/7/58 28 233.00' 21'05'24" N73'47'22"E ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owlier/ er— 3c .t. S a r-) cwt C (5Z --) Mailing Address 768 { ( a Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 0 - 2 - 6 " / /8- LEGAL DESCRIPTION Property Location /7 &c) Y4 , 17cd 1/4 , Sec. /1 , T % N R /9 W, Town of tcmlSBP Subdivision Plat: `a_55 Ye i f n � f- cta t r7 , Lot # /9 . Certified Survey Map # /let ✓✓ , Volume yfc , Page # 44 Warranty Deed # (before 2007)Volume , Page # Spec house n0' o Lot lines identifiable s 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. 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. erofbedroo s SIGNATURE OF APPLICANT(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. 09/07) 6 . . 9C .c// ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: bicet of Ciie /sfre , (Street address) 7CB Pau.L s4'4-r 4V,(/e, (— ,0lxk,,) /_ svew located at: nu) '/4, raw '/4, Section // , Town ,2_9 N, Range / W, Town ofctdso r , St. Croix County Wisconsin. . Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service j/crvl 5, ;d/e') Did flow back occur from absorption system? Yes No i (if no, skip next line.) Approximate volume or length of time: 1(4 gallons minutes Tank Capacity: h yez- Construction: Prefab Concrete 1 Steel Other Manufacturer (if known): 0 > s Gr,e.re: .. A. e_of Tank (if known): /c ermit number (if known .36, 386 -'J icensed Plumber Signature) (Print Name) (Title) (License Number)MPRS � - /S /0 (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 • STATE BAR OF WISCONSIN FORM 2 -- 1982 1 6274 9S • WARRANTY DEED KATHLEEN H. WALSH DOCUMENT NO. r.. -, � c(� REGISTER OF DEEDS ="."'" — .: ..:. - • :•_ i 3 pAG! t�CT- - = =_ =_� ST. CROIX CO., WI RECEIVED FOR RECORD Kernon J. Bast and Donalda J. Speer — Bast 0B -02 -2000 10:40 AM WARRANTY DEED EXEMPT 11 conveys and warrants to Rl _c- hard - . L.Chelstrom Jr &_Susan CERT COPY FEE: M. Chelstrom COPY FEE: TRANSFER FEE: 128.70 RECORDING FEE: 10.00 PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. CrOlX County, Richard and Susan Chelstrom State of Wisconsin: 708 Paul Burch Drive Lot 18, Plat of Grass Range Second Addition Hudson, Wi 54016 in the Town of Hudson, St. Croix County, Wisconsin, Except that part to Janice M. Koval and Dale Jensen in Vol. 1466, Page 304. Doc. No. 612811 020 - 1021 -00 PARCEL IDENTIFICATION NUMBER • This is not homestead property. Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dar • is 26th day of July ,A.D ''I9' 2000 - (SEAL) 40/St- 'wa�.�LC — ��' t. ) (SEAL) • Pr .T. ast • Donalda J. Speer —Bast (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, } ss. St. Croix County. JJJ authenticated this day of , 19 Personally carne before me this 26th day of July 114 / 2 0 0 Ate above named Kennon. J. B_t and Donalda J. • Speer mast TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stars.) to me known to be the person 5 who executed the foregoing ins • en nd acknowledge the sa e (3(. THIS INSTRUMENT WAS DRAFTED BY . . _. • a . ALL. rc nor J. Hest • l�/'LQ .A Gf eQ4- -' S t i Notary Public. St. Croix County, Wis. (Signatures may be authenticated or.ackn• lodged. Borth ee ne01. My commission is Permanent. (If not. state expiration date: necessary.) • • MAUREEN f —' CD • Names or persons signing in any capacity shout , lay t d or printed bel• -[` �isir - ojgnatures. • WARRANTY DEED TATE BAR OF WI WISCONSIN NM1xonsin Lego) Blank Co_ Inc Milwaukee. W(s . 1 2235 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'/2 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 dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 0211-135. 18 -000 Please print all information. Revie�/d By / Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). io Property Owner Property Location Richard & Susan Chelstrom Govt. Lot NW 1/4 N /4 / 14 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Na e or CSM# 708 Paul Burch Dr. 18 Grass Range 2Nd Addition City State Zip Code Phone Number _J City _J Village e Town Nearest Road Hudson 1 WI 1 54016 715 - 381 - 5371 Hudson 1 Paul Burch Dr. J New Construction Use: J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD i/ Replacement J Public or commercial - Describe: Parent material Glacial Outwash , F loo plai elevation, if applicable Na 1 / General comments .�Jt, , Ct t e, V / � \+\ l��c , O '\ l' 4', _e S P :AA G� .4?,' �7z�, ( 5 W and recommendations: Site suitable for conventional POTS dispersal cell with 0.7 gpd /sq.ft. /d y loading rate. Proposed system elevation to be 101.00'. Existing trench elevs. = 99.62' & 100.00'. /9,1 ,,// J Boring .4)1 cue. ,atC_. #.1 k- 1 Boring # ►/ Depth limiting Pit Ground Surface elev. 106.73 ft. De th to limitin facto >116" 116 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. *Eff#1 *Eff#2 1 0 - 17 10yr3/2 & 4/4 none sl fill na na ci 2vf,f na na 2 17 -31 10yr5/4 none sil 2msbk mvfr cw - 0.6 0.8 3 31 -42 10yr5/4 m2d 7.5yr5/8 sil lcsbk mvfr aw - 0.4 0.6 4 42-48 7.5yr4/6 none 1 Is Osg ml cw - 0.7 1.6 5 48 -70 7.5yr4/6 none /� if Osg ml gw - 0.7 1.6 1' 6 70 -116 10yr4/6 none ( & g r Osg dl - - 0.7 1.6 Horizons #4, 5 & 6 contain approx 10% gravel, cobble & sfone. Comm. 85.30(3)3 applied to discoun redoximorphic concentrations reported in H #3. 2 Boring # J Boring 1 Pit Ground Surface elev. 104.58 ft. Depth to limiting factor >97" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -19 10yr3/2 & 4/4 none sl fill na na ci 2f,1m na na 2 19 -23 7.5yr4/6 none Is Osg ml cw 1fm 0.7 1.6 3 23 -30 10yr4/6 none s Osg ml aw 1vf,f 0.6 1.0 4 30 -37 7.5yr4/6 none s Osg ml aw - 0.7 1.6 5 37 -97 10yr4/6 none / s /i Osg dl - - 0.7 1.6 01 i q Horizon #5 ■ (Z IA a 1ox10% gravel, cobble & stone. * Effluent #1 = BOD 30 < 220 mg /L a d TSS >30 < 1 • mg/L ' * Effluent #2 = BOD <30 mg /L and TSS 5...30 mg/L CST Name (Please Print) Signatur= . CST Number James K. Thompson ��L , 5----- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11/8/2010 715 - 248 -7767 A Property Owner Richard & Susan Chelstrom Parcel ID # 020 - 1356 -18 -000 Page 2 of 3 3 Boring # -J Boring ✓f Pit Ground Surface elev. 107.00 ft. Depth to limiting factor >121" 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. *Eff#1 *Eff#2 1 0 -30 10yr3/2 & 4/4 none sl fill na na ci 2vf,f na na 2 30 -35 10yr4/4 none sil 2fsbk mvfr cw - 0.6 0.8 3 35 -39 7.5yr4/6 none 1 Is Osg ml gs - 0.7 1.6 4 39 -50 10yr4/6 none Osg ml cw - 0.7 1.6 5 50 -57 7.5yr4/6 none * s_ i bs 4 il Osg ml gw - 0.7 1.6 • 6 57 -121 10yr5/4 none P . s & gr Osg dl - - 0.7 1.6 T Horizons #4, 5 & 6 contain approx 10% gravel, cobble & stone. Boring # :J Boring J 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/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 I Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal 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 * 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) A.C.E. Soil & Site Evaluations . Sc.a/c:/ `= /G $ �.% edZ/c<0. ri ,4. E 6 E /edaon • /-oCa ied /) op. - � uSeer, Chefs bra.►, / oro / 4"-l il y 70g l u./,du•ec- -4 O �. /,�,,�r : c.a /. g �' -- /o�.o' - - --: ••, - ia3.o' O Lot /B, de /a diG , aSS • } ,` 58 3 a"9e /183' , , G ,, s cof-5e`1c�t SL /4 g3 4 �\ E,r.3 di3 scC/&/ /. ■A ' ,, \♦ T�(i 6ncids a6 3 , r75 • E ?,y ' Tr.C • w iz fir- �yoaa y / dsal; . C./,'k (, c,.;'. ;o( S3' � � &z,- i.)e 4a .n b ecr A-/, , e 7 .2.6 -435 - /6 - aG . , er 6f'eAc_k. r�7<'ie• `'e he,. 93 Q C.rc.s �o � 3u.rAce ✓.' -> = 99.az ' ` �, 4"6'' '&' E,6s6 /, ,ZccD J'.'' u.7a.ks ° sepb -c 6'" K. ∎ " i11111i g 00-9 Ilk' `� v ��a's , ,` 761.4:11r4 \ Res c%n< �w,(�: Ti - � ; 1 _ we 9q/- Ou,n -a_ 'On . E'le�> /c' /z' fl r&,d,r/ : 6466n0701 .S;,i,',7 F /u!= /u8.9 a.SPkai dnacY /' Pau/ 2U.rC-4 oc; /9.33 c ,. 3 = a 3 eD v 4D .2 D t ' '1 ° • `! c = ice` .. v 4D 'o e11 d m CD g t = " A: n . g t ai N N uNi O 0 a) W g d �Zl y , 0 4 0 i A N 1 • I 1-. p) c\ • o . 7 7 4D N ! N M > > tD y N N t N 'O N N IV f) a o N N N N 3 1 Co c7) so N N O O O 9 - ! ° ° D o ° o n m m 0 7 1 ° C3 co fD X ! * ° w oo 2 W N Co c...) C tD C C A ` Ca C 4D . 7 O I O 3 0 3 N Q , 1 3 7 7 0 7 N y' 2. oo p N N N e�. C N a Z - 4T 01 c C `° A o a s d < O A N o a • °o a N -. 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A C C C N a ' m 3 ii i 0 5 co N td v, 6 -L -4 (/) N D c c i-, xi 3 a a A 0 R 4 N 4 (I) 0. * iv A a 3 3 _. z A ;U p w O :+ 3 Z w 23 • A * A v fr) A • m • • D o =N > 3 m ° `2 5 m o -a g SD c � m c 3 o Z a 3 ` o a • N o a o g... m <!' o m o a CD _ A 4D o O p, VC you n' a N o N Pr 4,4 ( a O N 7 a o a 1 O O • D 0 t , , p O p O p a O a ti r Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 363862 Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.: • Bast, Kernon - I Hudson Township ,-_—' CST BM Elev.: Insp. BM Elev.: i - BM Description: Parcel Tax No.: lnt) . 0' cst9.O ' C5(g 2 020 - 1356 -18 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic LOA 1 200 Benchmark 042_ jo8•c,Jr ( ono •O ' Dosing Alt. BM ) 4- ( 2 (v `) )eq.1 C Aeration Bldg. Sewer /J cf. 7-p 103.1 Holding St/ Ht Inlet 6:419 10212.1 TANK SETBACK INFORMATION St / Ht Outlet J T, 0(p I o 2 - 4.6' TANK TO P / L WELL BLDG. Ae Intake ROAD Dt Inlet -- Septic >513 f C / 1 2 NA Dt Bottom Dosing NA Header / Man. , ,; D /Do -Y _. -sa6�a�a.,�:� Aeration NA Dist. Pipe 4 cf. °p - "- 6 Holding °---- Bot. System l 9 - (O 2- C .o o � PUMP / SIPHON INFORMATION Final Grade w raw- Man \\. cturer ` - . . a St cover I LEb to Co . ZZ Model n *tmb- GPM TDH • Fricti• • • System TDH Ft ' Loss Dead Foccemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM 12 RENCH Width r Len No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM . 7 7� C2), DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK t' - O `��� �- INFORMATION Type Of r r , ----. CHAMBER Model Number: System: ('�.„ t.f , '~ - OR UNIT ( T - CAPA rl` DISTRIBUTION SYSTEM Header / anifold ( N Distribution Pipe(s) ' x Hole Size x Hole Spacing Vent To Air Intake Lengt Q� Dia. Le - ---..` ..—________' SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over. N Depth Over xx Depth Of xx Seeded / Sodded xx Mulched P P Bed /Trench Center afe + Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: fill/ Cfilob Inspection #2: — / Location: 704 Paul Burch Drive, Hudson, WI 54016 (NW 1/4 NW 1/4 14 T29N R19W) - 14.29.19.2080 Grass Range Addn. II -Lot 18 uN��j 6 o - 1. Alt BM Description = I U 2.) Bldg sewer length = v 3 S a - amount of cover = 21 $-Q' cevcl ( ''0�) *7 `m tt .....A—J- 4— Plan revision required? ❑ Yes IR No Z S' ( Use other side for additional information. D4 ° "4" crt� � '[ N SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. . ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , . e.,e � _ �. i d , 1 i H a 1 ' ' 1 ' 1-- i , t 1, .----1- r i _ , £{ 2 ° F T # _ 1 PPP, . _ i Fr , , i 1 1 :;1I in i ir l J • . : i / , : . a ai ing awl i an M N . . . i : R . 01.4 : 1 C 'I . . lek "141 i . , 11111 ril i 1 al I _...___4____ ., 1 __t_ . - 1 % . MI T ---- i - ' --t iii i : am i :, I i le „.. 66. NE Nrv : „L ,i_ I I pi. ... 1 r , II . .. _ .._ f : 4 • in r __,.... 11 ,. v . , 1- 4.- I I= i iii, : ,--- -4 , •• i , . , . . -----I--' legiistavy. Imma L ...... ..,... ._t... , . ri. - 14, ._ 1 . , : 4 61111. f. ild _ > : __ r ,_. + t ._._. .1.114 I • , -4 i - m aim , 1 IIE 6 L._L_ -I: _I_ l ` � Safety and Buildings Division •/SCOWS %n SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department bf Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst - • • • a 'Jr n •! ' county than 8 1/2 x 11 inches in size. , �' r - _v. • See reverse side for instructions for completing this app * e � •L n ' ` s tate Sanitary Permit umber Personal infomiation you provide may be used for secondary purposes ' lip � © 7 heck if r revision to previous application [Privacy Law, s. 15.04 (1) (m)). 2, C° th. Stilte Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT 'tL INFO' ■ t . • Prop rtyOwnerName 61\ .♦ -' rtyLocat'. irr /4 / ,5�-s'T i A - r 14) b / V T.2. f , N, R / 9 E (o� Property // Owner'� Maili� Address ,, of Num er kt Block Number / 41. City, tats Pre- Zip Code Phone Number A amee o�M amber O Dp tt La= TV, /d am 7 77 .r 4.e. �s . -a�'e� II. TYPedrBUILDING: (check one) ❑ State Owned ❑ City Nearest Road El ag /,�D e ❑ Public � 1 or 2 Family Dwelling - No. of bedrooms .___Y_ ToTo wn OF ilSoi Lifi'''- Z. III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 D Apartment/ Condo 4 0240 - /3S1-- /r - eve 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility . 3 ❑ Campground 7 ❑ Mer ndise:Sales /Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church / School 8 ❑ M bile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. D New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 Q Repair of an System System Tank Only Existing System Existing System B) n{ A Sanitary Permit was previously issued. Permit Numbers 3 /6 L Date Issued r--- V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench f 22 ❑ In- Groun• Pressure 42 ❑Pit Privy 13 Seepage Pit C � , 2- 3X7 43 ❑ Vault Privy 14 ❑ System -In -Fill / Ly 'i yam- ®DTI T`NRTLZ' F MS VI. ABSORPTION SY 4t - hc M INFORMATION: / 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade /,., �1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Al /Dm y Elevation 40 .7s 7rd • / . L /A■16 Feet /D,,,T.D Feet Capacity site VII. INFORMATION in gallon Total # of Manufacturer's Name Prefab. Con- Steel Fiber Pl Exper. New Existing Gallons Tank Concrete strutted glass Apt). Tanks Tanks , Septic Tank orNeWierej-lank _ ,p .r- .• _ !. _ ❑ ❑ ❑ ❑ ❑ • Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatio the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: ( tamps) 1 M/MPRSW No.: Business Phone Number: v tt8o 74 3 • PI er's Address (Street, City, St te, Zip Code): lc / 3v , Zoa'i'izx ws , z3 IX. COUNTY / DEPARTMENT USE ONLY , ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) Surcharge Fee) pl Approved ❑ Owner Given Initial Adverse Determination 4- /20666 tin, X. NDITI OF CO ONS O APPROVAL / REASONS FOR DISAPPROVAL: Z� Prek. SlAa s ww — - CPS God- . SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly rnairitained." The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Building6 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and - manufacturer's name, indicate prefab or site constructed and tank material. Complete for al/ septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing,plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches rnust be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location cif holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; 8) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer;_ D) cross section of the soil absorption system if required by the col r y; E)" soil test data ona 115 form; and F)'all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. • r ' 497- # /s• Fogerty Plumbing �' #221180 E . / L 28288 McKenzie Rd. .# i = Bi, 7& j ' oP ST-14,t E , /ov.O ' Spooner, ) 35 - 96091 dj #Z = o}rT "of To? of - " p vc 1 /03. '• .,P / X = do 0 = wL {-0u v) e or ro,4.rv'yz sr-,,L.t -/ » As 0 = / mad trill cvtErAs c'.i 3 51 - Ic ^•- 1r -- '1S yr --,c `g► > I A 14~ a ft 1 A 4.7. '.#4" 1 4 2 # 9DI �. 7t $XE ShrrUS (0 • q PA SI # /moo 1 2 — T,tcrehe r 0 r `. ' r ■ 1 I { 7 QV 5 1 ` pow( Ateet4 DA. 3nijelmulci e O t' I i �rw - s , hy z � T — i c e -via (a c) + . _ i . __ 1 . _. . I i i i 1 I t , : - - I • I T j i .4 • • I t r -- _ _.. 1 II - I i . , • j i I t + .1 : , + I i ..- .-_ _- - __ -.. - _ --- - -__ . _• --__- _ _ - I- i I 1 1 I I 4 f ■ a __ -_ . _, _ { _. _ _ 1 1 { • t 1 .,_.t. ; ; • I I • I i ' I ■ I 1 i • i • I ' r . i 1 . ,, ---/fr--- Toy Pm/a- (itrzc_4( La,w6-- Safety and Buildings Division ` *s. cousin SANITARY PERMIT APPLICATION 201 P Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. Sr, • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ['Check if revision to previou . plication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Numbe I. APPLICA • N INFORMATION - PLEASE PRINT ALL INFORMATION . Pro erty Own:, , e Property Location . 1T IUArl1/4 w 1 /4,S /y )7 ,N, RAF E(orer Property Owner's Maih . Address dd Lot Num Block Number 9yy 44, . _ rte• ! , ..._.— City, State Zip Code Phone Number Subdivision Name or _ - - r l ,PFoAl �L 7 !/5'3'S►L'�- 777r 4.ms , .s.. At , II. TYPE OF heck one) ❑ State Owned o i t Nearest Road p Village ❑ Public 1 or 2 Fami Dwelling - No. of bedrooms Town OF aeso L.4,G,ret',€ /�Ci�eG1 III. BUILDIN USE: (If building . •e is public, check allthatapply) Parcel Taxi dmber(s) J .1,1,1/. n_SD 1 ❑ Apartment/ Condo y ' ' /3 — /et — We 2 ❑ Assembly Hall 6 • , edical Facility/ Nursing Ho 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ -rchandise: Sales / Repair 11 ❑ Restaurant / Bar / Dining 4 ❑ Church / School 8 ❑ Mo •a Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Offic - Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box o ine A. C ck box on line B, if applicable) A) 1 16 New 2. ❑ Replacement 3. a • • lacement of 4. ❑ Reconnection of 5- ❑ Repair of an System System ank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issue. P- mit Number Date Issued V. TYPE OF SYSTEM: (Check only one) C,�,E &) Non- Pressurized Distribution Press ized Distributi. Experimental Pther 11 ❑ Seepage BeditrfF' 21 • Mound 30 ❑ Specify ype •41 ❑ Holding Tanks 12 Seepage Seepage Trench S/StGuS ❑ In- Ground Pressure Z- 7» ' 7s' 44 ' 4 ' � � •s 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System- In -FiII0 0 //...1 Skid. 2 S r /�' 9 . '- — - -. _ — VI. ABSORPTION SYSTEM I ' • RMATION: - - • • / "' 1. Gallons Per Day 2. Abs. p. Area 3. Absorp. Area 4. Loading Ra ,- 5. Perc. Rate m Elev. 7. Final Grade Requ' -d (sq. ft) Proposed (sq. ft.) (Gals/day /sq. ft. (Min. /inch) Elevation ‘a sb 92 /. y . /4 11-Feet *a /D/;l - VII. TANK in Capacity allon Total # of Site INFORMATION Gall T an k s Manufacturer Na - Concrete Con Steel glass Plastic App. New Existin• structed Tanks Tanks Septic Tank o : . • - - /,, /. ) / _ 4,,!�`:2 // ❑ ❑ ❑ ❑ ❑ 161 ❑ ❑ ❑ ❑ ❑ VIII. RESPO • IBILITY STATEMENT I, the un • - rsigned, assume responsibility for installation of onsite sewage system sho on the attached plans. Plumber's N. e: (Print) Plum r'sSignature: (No St s) 117IP7'MPRSW No.: Business Phone Number: )A ) • Ep� I i 3 t/ d.D j ? 5,4 — . s'6 Plurer s Address (Street, City, State, Zip node): ‘O J �DJ3f1t , deft - 3'seo.33 IX. COUNTY / � / [D EPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) Owner Given Initial Approved ❑ / Surcharge Pee) �� ! . ' aaS . i =8 �► . Adverse Determinatio , � X. CONDITIONS OF APPROVAL / RE SONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety Si Buildings Division, Owner, Plumber . INSTRUCTIONS • 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be subm ted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pamper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administratox^or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. f d To be complete and accurate this sanitary permit application must include: ,r P yp I. Property owner's name and mailing address. Provide the legal description and pars) tax number(s) of where the system is to be installed. �� II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams ind lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction los pump performance curve; pump model and pump manufacturek D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE ti 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Fogerty Plumbing lor' #/7 *221180 28288 McKenzie Rd. 1/)pc0GE' / "= Yo Spooner, WI 54801 of ��� (715) 635 -960 d t#'/ = 4 4wr r t 0 ? � Grrr sap I,� Chlye -E, / C A / -'! J 4 = T• A r ?el? of .2 " '-/ r/`°° Ay Arpa , Fe. / t2 ?.m K • go /z4-iv‘ -/e) .... . e.ogeze 'uw4) 4,7 cows_ sr /io1s O = 4 sah 444 ee.e,retr s•.?; Ger • - -- - , a 4 A - , • , - ci, ' Y7,' . ,.. .,,... j , . . , , 1 -.- .... , . 1 /- 1 _ 0 /79 ~ /TI i 1 - - -" • r -sty' ■ 1 • Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 'Labor and Human Relations ,Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ,. ;:. � > ; '��•,, Attach complete site plan on paper not Tess than $42,x i.ihohes in siz , Plan must include, but St. Croix not limited to vertical and horizontal reference BY DATE mt,(�1Nf), direc on and %off slope, scale or PARCEL I.D. # ` ` 020 1021 - 00 �, dimensioned, north arrow, and location and distattio� to n�Po . 4 L i l ' ' APPLICANT INFORMATION PLEASE PRINT ALL INPott ATION..- \ RE EW ED BY,pt to 1 f 14f PROPERTY OWNER: ' A 1998 � p6 PERTY LOCATION Kernon Bast ,T �-Rorx f0 . LOT Nw 1/4 NW 1/4,S 14 T 29 ,N,R 19 f (or) W PROPERTY OWNER':S MAILING ADDRESS t,OtViN GO G oc FiCf f.� f �L # BLOCK # SUBD. NAME OR CSM # 948 LaBarge Rd. ' , ' 18 na Grass RancgP SPC Acidn _ CITY, STATE ZIP CODE PHONE NU ❑CITY DVILLAGE ®TOWN NEAREST ROAD Hudson, WI. 54016 (7t 1 _ Hudson McCutchen Rd. [x] New Construction Use [ A Residential / Number of bedrooms 4 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) 102.40 ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code 3/50' below surface el. Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT - GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system E] S❑ U 111 S El U CAS ❑ U gicS ❑ U ®S ❑ U El S Mu SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft2 Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ::: 1 :::: 1 0 -8 10yr 3/3 none _ 1 2msbk mfr cs 2f _ .5 .6 2 8 -12 10yr 4/4 none sit 2msbk mfr gw 1f . _h Ground 3 12 - 65 7.5yr 4/6 none ms osg ml gw na .7 .8 elev. 103.0ft. 4 65 -84 7.5yr 4/4 none cos osg m na na .7 .8 Depth to limiting factor +84" a- l d •12,, 36/3 - z Remarks: Boring # .. 1 0 -15 10yr 3/3 none 1 2msbk mfr gw 2f .5 .6 i:. 2 .' 2 15 -29 5yr 4/6 none is osg mvfr gw 2f .7 .8 Ground 3 29 -82 7.5yr 4/6 none ms osg ml na na .7 .8 elev. 103.0ft. / Depth to �� limiting `) / factor +82" Remarks: ' CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. ve., New ich VIII WI 4017 Signature: D ate: CST Number: m02298 g - . WW.0 8 -19 -98 PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT Page 2 of 3 , PARCELI.D.# 020- 1021 -00 Depth Dominant Color Mottles Texture Structure Consistence GPq/ft Boring # Horizon .. in. MunselI Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Roots Bed Trench 'k4' 1 0 - 10 10yr 3/3 n. 3 none 1 2msbk mfr cs 2 .5 .6 2 10 -25 l0yr 5/4 none sit 1 cshk mfr gw 1f .5 .6 Ground 3 25 -84 7.5yr 4/6 none ms osq ml na na .7 .8 elev. 104.2ft. Depth to limiting factor 84 (6,1- /co • a ix, . `{ 3c(? 0 .0 /8Y `fr 6JF/. 6 Remarks: Boring # gavnu 1 0 -8 l0yr 3/3 none 1 2msbk mfr gw 2f .5 . 6 .:. 4 2 8 - 14 l0yr 4/4 none sil 2msbk mfr qw if .5 .6 Ground 3 14 -82 7.5yr 4/6 none ms osg ml na na .7 . elev. 105.9. Depth to limitin g factor: ? 1, / 1- 2 44- /00-9 +82 (io16 ) Remarks: Boring # :i- >'': ::^ 1 I O -12 101rr 3/3 none 1 2msbk mfr gw ii 2 12 -27 l0yr 5/4 none sil lcsbk mfi qw if .2 .3 Ground 3 27 -80 7.5yr 4/4 none cos osg ml na na .7 .8 elev. 105.11. Depth to limiting 3 I, /1" factor „i- /0o +80” Remarks: Boring # Ground elev. • • ft. Depth to - — limiting factor Remarks: SBD- 8330(R.05/92) e _ . .. STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Kernon Bast New Richmond, WI 54017 MPRSW -3254 N<a4Nw4 s14- T29N -R19W (715) 246 -6200 town of Hudson lot #18 -Grass Range second Addn. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may may not be as shown as permanent lot lines were not established at the time the test was conducted. \ N 1"=40' M 1��,b BM.= top of mid lot survey stake @ el. 100' L ?/ Alt. BM.= top of 2" pvc pipe C el. 103.00' L 3 5 �{ 5 -tor a I`.% 4-(.' ?ji ... Al r 1 7. 5y5f 26‘ .11--/` IR � tf' ( ' 07 N N I -.I k 4 X61 Gary L. Steel 8 -19 -98 r it://,44 1 ° 6 - ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /ZOz/ 401,37 Mailing Address ? : .:, .. ./. , . Property Address t � . , _A 11 ' A. (Verification required from Planning Department for new construction) City /State , 24a f ,.(4/- ,S'qO/ Parcel Identification Number O .74 — /jir6 - / 1 aia LEGAL DESCRIPTION Property Location -91c' ' /,, A44/ '/4, Sec. /1/ , T 29' N -R / f W, Town of 40.40 ' • Subdivision _ „ ..2. - ...pi , Lot # /7 . Certified Survey Map # , Volume , Page # . Warranty Deed # id e, f , Volume /, t/..) , Page # S 7 . Spec house ❑ yes % no Lot lines identifiable .4 yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, 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 Zoning Office within 30 days of the three year expiration date. .4.1„ , A l_ , i . i / / SI NA' ' OF • 'c IC • " DATE OWNER CERTIFICATION I (we) 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 abov by virtue of a warranty deed recorded in Register of Deeds Office. / / SIGN TURE OF s cliCANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed •, ..,/, • • • • .. . • . ' : . „ . ..,..',..- , ,• . , MENT NO i WARRANTY DEED • , . • 'STATE BAR OF WISCONSIN FORM 2 — 1982 , ., • . % • .'::::: , . . • . .iii' .. • -....., 1 il ?vet 509 .: , ,. • _•.•_ • , : • . . . . ..,. : :,, :- . .7! lit i' Ray G,BrONn 40.E1e4nOrP Brown, husband . 40. wife, . , , • JUN 2 199T Ai il. . ii:i !! conveys and warraats to . rt 8:30 A. Kernon Bast and Jonalda Speer-Bast,a/k/a_Donalda J._ Speer- Das;t, 4.. GA husband.and wife Deki..3 4 .—e ......--•—.— . -- --. .; ■) ;! for $1.0Q and.other_vaLuable consideration .....„ 1, '' :• J I r(1 , ; I St. Croix the following described real estate in County, I Part of ! I State of Wisconsin: ,;(4,_ I Tax Parcel No: 020-1Q21-00 d ?art of NW 1/4 oe NW 1/4 and Part of NE 1/4 of NW 1/4, All in Section 14, Township 29 North, Range 19 West, St. Croix County, WiscCnsin, described as 11 follows: Beginning at the NW corner of said Section 14; thence N89°43'45"E along the North line of the NW 1/4 of said Section, 1387.25 feet; thence S00 11 910.15 feet to the Point of Beginning; thence S89 558.46 fee' • . I thence S00 105.90 feet to the NW corner of that parcel of land recorded and described in Vol. "952", Page 382 at -he St. Croix county Register of Deeds Office; thence N89 157.00 feet along the No-t ? . line of the parcel of land recorded and described in vt..1. "952", Page 382 to the NE corner of said Vol. "952", Page 382; thence S00 along the East line of said Vol. "952", Page 382, 299.48 feet; thence N89 .; 405.05 feet; thence NOO°23'09"w 405.00 feet to the Point of Beginning. il This deed is given in partial performance and satisfaction of a Land Contract • dated July e, 1992, recorded July 10, 1992, in Vol. 958, Page 577, Doc. No. 485728, : 1 in the office of the Register of Deeds for St. Croix County, Wisconsin. The above- A described parcel is to be reconveyed to an adjoining landowner, Thomas I. Wiley, to 1 , be merged into and become part of his existing contiguous parcel, and shall not i i ii thereafter be conveyed or encumbered separate from said contiguous parcel into which it is to be merged, unless subsequently subdivided pursuant to applicable state, J. i county and town laws and ordinances. ° This . nct.. ....... homestead property. The !I II' (is) (is not) real estate transfer fee was paid at :i the time of recording said Land Contract. ! 4 il Exception to warranties: Subject to to road right-of-way over the Southerly side. il 1 I' -r4— 1 1 May 97 .; il Dated this . . C ... ...... day of . „ . 19 . 'l II i■ , . • 11 6, (EAL) UeOr il • Ray_G. Brown •Fleanore Brown , 1, ! 11 ; • (SEAL) • (SEAL) i • l , ii • - •• •• . . II - 1 1 AUTHENTICATION ACKNOWLEDGMENT II ;; Signature(s) STATE OF WISCONSIN II II ..ST....CROIX ss. County a •, „ li authenticated this day of , 19 Personally came before me this day of . l " May , 19 97 the above named I ; iRay G„Brs:An1 and ., 4 TITLE: MEMBER STATE BAR OF WISCONSIN _Eleanore rown, (If not, Brenda-Pouhn busba;x1 and wife a authorized by § 706.06, Wis. Stats.) il li Notary public to me icri vn to be the per on S who vxecuted the II li 11 THIS INSTRUMENT WAS DRAFTED ay State of WisconAiregoi instrument an acknowyge the same. •I' li William J. Gilbert, Atty. 1, 1 6 206 Second St., Hudson wt 54016 • Notary Public St. Croix .. . _County, Wis. il li (Signatures may be authenticated or acknowleOged. Both My Commission is permanent. (If not, state expiration " / /O 11 are not necessary.) date: , "Names et persons sigoing in any capacity nhonlit he typed or ;printed helm,' their signalise,. tl 1 I h 1 WARRANTY DEED STATE BAR OP WISCONSIN Msgr.-Ism 0 Co, fn.- ■ FORM No. 2 — 19,42 ktolw.iuke■p. WIsronstn • -AA IL . _ _