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HomeMy WebLinkAbout191-1012-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 399477 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: Hillstead, Greg Springfield Townshi 191 - 1012 -30 -000 { CST BM Elev: r Insp. BM Elev: r BM Description: Qli„ s 2 102. Cc TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r - Benchmark L r / O D O $ /DD Dosing Alt, BM 0 / ! Q 2 Aeration 1BIdg.!5ewer - 30 2 Holding St/Ht Inlet _ •$0 93- 3 St/Ht Outlet TANK SETBACK INFORMATION TANK TO t1 P/L E WELL Bn�� Vent to Air Intake ROAD Dt Inlet j, W to lm2_ Septic ( i Y ' , N k/' / Dt Bottom Herder /M n. Dosing > I / Z / > 1 r �lW d ? c�.� �h 15-0 Aeration — Dist. Pipe I 0 O Tepo•�PtP� 9 Holding Bot. System •- Final rade r, P [c>M Shcw PUMP /SIPHON INFORMATION ' l2 !o Manufacturer Demand St over l GPM °� 1 / `• Model Number 3 TDH Lift Friction Loss System Head TDH Ft S . .b g Forcemain Length Dia. rr Dist. to e[ Q � \/ � W IL ABSORPTION SYSTEM BED RENCH Width Length No. Of Trenches PIT DIMENS ONS No. Of Pits Inside Dia. Liquid Depth DIM SIONS O SETBACK SYSTEM TO P/L BL G WELL LAKE /STREAM AC G Manufacturer: INFORMATION CHA R OR Type f System: UN � ��� L3�� j I Model Number: DISTRIBUTION SYSTEM - Header /Manifol fr Ditr(b) tion , j x Hole Size ]I x Hole Spacing / ent���ke Pe s [� I. 2 r� � Dia Spacing /v 9 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center r L h Bed/Trench Edges Topsoil (] Yes [� No [III] Yes # No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:� `/ /� /� Inspection #2: Location: 1960 310th Street Willson, WI 5/402277 (SE 1/4 NE 1/4 27 T29N R15W) NA Lot NA � Parcel No: 27.29.15.97B 1.) Alt BM Description = D"t 2.) Bldg sewer length = 14 r - amount of cover = 3.) Contour Plan revision Required? U Yes No O Use other side for additional information. L- Date Insepctor's Sicjnature Cert. No. SBD -6710 (R.3/97) i T \ s �� �Cny4 loo f U VJ? v-t! i _ _�s �+zllz�z Safety and Buildings Division - County f 201 W. Washington Ave., P.O. Box 7162 ST. C ROIX sconsin Madison, WI 53707 - 7162 Site Address -- 7 1960 310TH ST., WILSON, WI Vi Department of Commerce Sanitary Permit Number Sanitary Permit App ' aai In accord with Comm 83.21, Wis. Adm. Code, perso irnation ] 'de �` \ ❑ Check if Revision lG1 ADO ► �7C1 may be used for secondary ses Privac "1v, s15. 1 ,,,.. State plan I.D. NumberSite ID #636403 I. Application Information - Please Print All Informal "•" Trans. ID # 676573 — Property Owner's Name °"" ST � ;� �° P arce l GREG HILLSTEAD % ID# 27.29.15. Property Owner's Mailing Address ,� _ f Property Location SE 1 -A NE 9; S 27 T 29 N R 15 1960 31 Zip Cod Lot N Block Nu Z e City, State N/ A N/A Subdivision Name CSM Number WILSON WI 54027 715/772 -3376 N ?A II. Type of Building (check all that apply) ❑City M I or 2 Family Dwelling - Number of Bedrooms � [Village ❑ Public /Commercial - Describe Use p�l��, �>i1�QX1CQ �+- STownship S Nearest Road ❑ State Owned 310TH STREET III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A ,,��yy For County use 1 LONew 2 IX Replacement System 3 .^ Replacement of 6 ❑Addition to S Tank OW Existin S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) �( �/, SO 44 ❑Non - Pressurized In- Ground 21(I Mound 47 [1 Sand Filter 50 ❑ Constructed Wetland 1 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line q I� ' �t7!✓6G�,S 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: - as Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation 450 '1/ 450 450 1.0 N/A 102.30 103.59 VI. Tank Info Capacity in Total Number Manufacturer Prefab site Steel Fiber P1aStIC Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks pilej 4 e+s�a ++k 1000 1 nnn i W X P� Dosing Ctuunber 600 600 1 WIESER CONCRE2E VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plate. Plumber's Name (Print) 4ode) Signature Mp/MPRS Number Business Phone Number BENNIE HELGESON 20292 715/772 -3278 Plumber's Address (Street, City, State, r W1229 7 70TH AVENUE, SPRING VALLEY WI 54767 VIII. County /De artment Use Onl ❑ Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge e) (� ❑ Owner Given Initial Adverse Determination IX. Fontito&ia3i ��slte mus e a �er requirements. 2. Effluent filter to be installed and maintained per manufacturer's recommendations. 3. Floodplain mapping = Zone "C" 4. All setbacks to system and residential structure must meet applicable code requirements. 5. Well setbacks to be maintained per NR 811 & 812. 6. Po ssibl e VV isconsm u plete plant (to the County only) for the aystem on paper not lee than 8V2 s u lnehee In size ,,.: f SBD46398 (R. 05101) ■ 5r� ;� u/a/aa.�;arl • Gle(/26ion (� 3.2.0 i pl c let d"YL X11. A ba don aS io" code • 4X /3 6 c W/ 6v be a. nc6cd a s code • � d ' s ■ Cv d�Q EX:sL' r�s � �6E R--•� wc.1.1� s y sE.�nt wv P. posed t.-e I I - pea posed resi Ms bu,IH Se f Pro p�o 4 doo %oa ya�on St u(• s( P.✓ e. Coal 6,-n a te, s. T. /P. e. W, t< 7-a e0i_E �� �/►t•' TP C- Vo.4.d,e. Fo ,-ceWa;n �.o Proposed n2ou,,,d ,23.2/ / /o.S�3 � Yy q, of 1& 1 W1 y8 • ���� o�� {,'� c.s Stu c ed a.t .2.53 \-q• � F� ,Pcs6.Assu.JAd 82 e.IeW = /oD•�. / ;:ze r Safety and Buildings 4 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iseonsin www.commerce.s i www.wiscon isconsin.gov n.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Acting Secretary October 03, 2001 CUST ID No.220292 A77N: POWTS Inspector ZONING OFFICE BENNIE W HELGESON ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/03/2003 Identification Numbers Transaction ID No. 676573 SITE• Site ID No. 636403 GREG HILLSTEAD Please refer to both identification numbers, 1960 310TH ST above, in all correspondence with the agency. TOWN OF SPRINGFIELD ST CROIX COUNTY SE 1/4, NE 1/4, S27, T29N, R 15 W FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 812979 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (0 1/8 1) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The changes made to this plan on 10 /03/01 by this reviewer were acknowledged and approved by the system designer. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. r BENNIE W HELGESON Page 2 10/3/01 • Comm 83.52 Responsibilities. 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). In addition, 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. • Comm 83.52(2) 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. . • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 Charles L Bratz POWTS Plan reviewer II- Integrated Services WiSMART code: 7633 (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM cbratz@commerce.state.wi.us cc: GREGORY W HILLSTEAD , MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Greg Hillstead 3 bedroom residential mound Owner's Name: Greg Hillstead Fp Owner 1, s Address: 1960 310th Street e0 Wilson, WI 54027 O�V �7 O/f; Legal Description: SE1 /4NE1 /4, Sec. 27, T.29N., R.15W. Township: Springfield County: St. Croix Subdivision Name: Lot Number: Block Number: Parcel I.D. Number. 191 - 1012 -30 -000, ID#27.29.15.97B Plan Transaction No.: Page 1 Index and title Page 2 Data entry ctof017Qffy Page 3 Mound drawings Pa 4 Lateral and dose tank MPROVED Page 5 System maintenance specifications C0mmERCE Page 6 Management and contingency plan J- I�S Page 7 Pump curve and specifications '� ., Page 8 Site Plan 8t CORRESPONDEN Page 9 Soil Evaluation Report Designer: Ben Helgeson License Number 220292 Date: 09/04/01 Phone Number. 715- 772 -3278 Signature: Designed Pursuant W the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03101/01) Pagel of 9 ' r' _ �. � - r _ t t - z .. ., .. .,. ,. ,,. r ' ,', , $ , , � i. s+ 3 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sant fin (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ sal fteaWxYd for fecal 1.50 Peaking Factor (e.g. 1.5 =150 %) caiform of <= 36 inches. 450.00 Design Flow (gpd) 5.50 Site Slope (%) 100.30 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd/If) Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design fading Rate (gpd/fe) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 6.25 ft /orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? Y 90.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 11.30 Vertical Lift (ft) 81.25 5x Void Volume (gal) 1.90 Friction Loss (ft) 97.56 Minimum Dose Volume (gal) 19.70 Total Dynamic Head (ft) 29.66 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options I choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information 602.82 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 51.00 Total Working Liquid Depth (in) Wieser Conc. Combo. Manufacturer 11.821 galfin (enter result in cell B49) Dose Tank information Effluent Filter Information 602.82 Dose Tank Capacity (gal) Zabel Filter Manufacturer 11.82 Dose Tank Volume (gal/in) A100 Fitter Model Number Wieser Conc. Combo. Manufacturer Pr Gr eg Hillstead room residential mound Pa 2 of 9 ro�ect• eg 3 bed ag Mound Plan View . .. K observation Pipe Q ' _ J ... T o © A W B I � • ..... ... ............................... .. ......... ............................... .......... ............................... L Mound Component Dimensions A 5.00 ft E 21.30 in H 1.00 ft K ft B 90.00 ft F 9.50 in z 11.02 ft L [aft D 18.00 i G 0.50 ft J 7.19 ft W ft 450.00 (ft Dispersal Cell Area 1441.62 (fe) Basal Area Available 5.00 (gpollt) Linear Loading Rate 9.00 (ft)1 /10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.59 (ft) - --►� -- r� r.... G H rf��ifr�f 2 flf:ttri.. �ir�tr _ / 0 2 . F Dispersal Cell 102.30 (ft) Lateral 101.80 ft� — Invert Dispersal Cell p t Elevation E . 100.30 (ft) ntour Elevation 10 0, 3 1 5.5 % Site Slope Geotexdile Fabric Cover Shading Key $ - T Dispersal Cell See lateral details on 0 Topsoil Cap 1.5 ft -( Page 4 for number, Subsoil Cap a 0 size, and spacing of ASTM C33 Sand A " ` F laterals. Laterals are Q Tilled Layer 0.5 ft TYPE 5 equally spaced from Q5 Q Aggregate �* o 9 t the distribution cell's A —} centerline in the distribution cell (AjO). Project: Greg Hilistead 3 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigrarn Force main connection efa tee or cross to manifold at ang point. Laterals are identical I P ;k i= Turn -up wiball valve or X�+rd2 W241 Laterals &force main of PVC Soh +0 deanoutplu9 per COMM Table 84.E -6 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 12 n Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 44.28 ft Orifices per Lateral 18 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 W /orifice Lateral Flow Rate 7. 1 gpm Manifold Length 2.50 ft System Flow Rate 29. gpm Manifold Diameter 1.50 in Total Dynamic Head Forcemain Velocity 3.03 ft/sec Dose Tank Information Lo&j,g cow wMtl wnN label and locking device and sealed " ght Cam as per NEC 300 and ---► Ca 16.28 WAC Disconnect 4 in. min. Tank cornponent is properly vented E—�--- Altemaeee outlet location Forces in diameter Wieser Conc. Combo. Manufacturer 2 in. Capacity 602.82 Gallons Volume 11.82 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 344 33 "7 B 2.00 23.64 C Pump off e levation (ft) C d `i 7.89 93.26 ' c' : 91.00 X36 D 12.00 141.84 D %Iv Total 51.00 602.82 Dose tank I LI 3" Bedding un r tank. L 90.00 ef Z. to � Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds 4 I I Pump Model Number 3871 EP05 V Pump Must Deliver 29.66 gpm at 19.70 ft TDH Project: Greg Hiflstead 3 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name J. Thompson, POWTS INSPA4819 Phone 715- 248 -7767 POWTS Regulator's Name St.Croix County Zoning Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Ma)dmum BOD5 220 mg/L Septic Tank Capacity 1000 gal Ma)dmum TSS 150 mg/L Soil Absorption Component Size 450 if kWmum FOG 30 mg/L Type of Wastewater Domestic Ma)dmum Fecal Coliform >10E4 cfuh00 mL Service Froauency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should Inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Nloundl Inspect for ponding and seepage once every 3 years Miscellaneous Constr gft and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum -up Detail Finished •....••........ ................ Grade ..... ` 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valle Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Greg Hdlstead 3 bedroom residential mound Page 5 of 9 i r Mound System Management Plan Pursuant to Comm 83.64, Wis. Adm. Code offal This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained In accordance with its' component manuals (SBD 108914P (N.01/01) and SSWMP Pcubgcetion 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No she should am enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Cann 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greeter than 8. inches in diameter shall be secured by an effective kxlcing druid to prevent accidental or unauthorized entry into a tarts or component. septi Tank The septic tank shall be maintained by an individual certified to service septic tanks . The contents of the septic tank shall be disposed of in 113, Wis. Adm, Code . The operating condition of the septic tank and outlet filter shall be assessed at feast once every 3 yeas ins action shat be c necessary to ensure proper operation. The filter cartridge should not be renamed unless provisions are made to retain solids in the tank that may sknrgh off the filter when removed from its enclosure. If the filer is equipped with an alarm, the filter shall be serviced if the alarm Is activated continuously Interrnittent fifer alarms may indicate surge flows or an rripending continuous alarm The septic tank shalt have its contents removed when the volume of sludge and scan In the tank exceeds 113 the liquid volume of the tank. If On contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shag advise the owner of when the nod service needs to be performed to maintain less than nu&mmh scum and sludge accumulation in the tank. The addition of biciogical or chemical additives to enhance septic tank performance a generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Puma Tank The pump ( dosing) tank shag be inspected at least once a ft 3pa s. All switches, alarms, and pumps shag be lasted to verify proper operation. if an effluent filter is installed within tank it shag be inspected and serviced as necessary. Mou" Ng Prenum Distribution System No trees or shrubs should be plated on the mound. Plantings may be made around the mound's perimeter, and the mound shag be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) an the mound is not recommended since soil compaction may hinder aeration of the imfl *Jw surface within the mound and snow comipactim in the winter will promote frost penetration. Colo weather insteitabons (October-February) dictate that the mound be heavily mulched as protection from freeting. Influent quality into the mound system may not mooed 220 nVL BODt,150 mgIL TSS, and 30 mg/L FOG for septic tank effluent or 30 ng& BOD 30 mg/L TSS,10 mg/L FOG, and 10" Cfu/100 mL fa highly trested effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated la ted solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and A orifice dewung is required to maintain equal distr ition within the dispersal cog. Observation pipes within the dispersal cell shag be checked for effluent ponding. Pondirg levels shall be reported to the owner, and any levels above 6 inches considered as an wrnpending hydraulic failure requiring additional, more frequent monitoring. Conilns>armcv Plan If the septic tank or any of its components became defective the tank or component shag be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump c ortrots, alum or raided wring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repelled or replaced in its' present location by incressirg basal area 9 toe leakage occurs or by removirg biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page �d this plan for the name and telephone number of your local POWTS requistor and service provider. 5 Project: Greg Hdistesid 3 bedroom residential mound Paige 6 of 9 M OD EL 1 1 M Vertical • Pump 0' Su bmersible Effluent Pump s y , Pump Specifications M C,tHS FEE, ',r3HP Up to 40 GPM °! MODEL: 3871 Discharge size 1 NPT 91 30 Solids: 1 /8" maximum b', Motor } 25 , Single phase: 115V 5 20 O A Materials of Construction _4 Brass,/thermoplastic z a� 15 EPOa Features and Benefits 3i •Top suction eliminates a impeller clogging. 2 �! EPO4 *Corrosion resistant j construction. 1 Go n o 40 50 sc+V •Float actuated switch. 10 - 12 Ia L CAPACIT d ,, �i M. nl:ni/NUR1 Y C �TJ j Pump Specifications ' �e�atures and Benefits MODEL DVP03 '10 �-wd ' HP • EPO4 Impeller sem -open design to 60 GPM .'JIth pump out vanes to protect IVIaxlmurn head to 32 mechanical seal. 1 Discharge size 1 NPT • EP05 impeller - enclosed design SoNds 3 (," maximum for improved perfomiance. Motor • Rugged glass - filled tlnenmu I.,;� !'0 motors feature hall casing ana base design aring construction super Ior strength and can r, 10 ,s 20 25 30 35 40 u G GPM resistance. Single phase 115V a Cast Iron motor housng for CAPACITY Materials of Construction efficient heat transfer. strength. -- Cast ilon and durability F e! "oplastc I • � 0'1 OrroS1 rP,slSt i' ` '�12�:'. ?ell „iIr eSS steel StalnlesS SiP,i'I sliilil • 1 lo! �1L110111<ill, a!1U 6 i "�l�llU<l; Cl,)erilt101? • CSN lstetl 1110dels ;i""Ilanle 5 All Models arc designed for cont11,UOL1s ups r ,t1on and teature stain!ess steel hardware. P �9 • rle door) Q -1 3-W ca I� ptc 6zne4f o�ryc� //. �, Aban don aS P- -Cock. 2X i3 E , v#- 6t be uba.ndmcd 5,&r ae „„ e ° � 4 s code • ■ d�a` EX�'sf: roeS idm 'I—D y wok sE�rK 4 ZQ c ter P�oposcd �s"'well Pao posed . 3 bets. res�dene�¢ Y Pro p� s¢.d � 000 /Goo � a.�o., � "su(•� ✓ C. 6u;,N,:�Sc�: Co,n b, „Q , S.r. /P. e. Wig 7-abP(/f /dD el'C/uen,E -� n ��•�•M Tp �'; l�r• a-•� s.T occ� /�L� , �26a� 5/e�,,._ /oz.?s d 3/0 - .2 ",5c�. 1 /0 tmcx;n i \.O P ro f�ose�! Mo,,dl " 23.2/x / /o.SB �\• yy,�. � 45 90 � �iS�Ocr�o l ee /% � u.r (�� \" a f 1Az 5/V wl Y,5 „ \ o��' {,•C S�c ceda.t 2 .53, E \- . .D� ga.ylc.� h�(o��= 1'1u in cJ c� den g� _ ■ Fc nce posh. Assu,ned B2 ;3zo Sou• -� P�o�. /.ne -� 1457 YJisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Cade A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'/: County 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 L D 191 - 1012 -30 -000, 0 #27.29.15.978 Please print all information. - -view _ -_ _ _ _ Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Greg Hillstead Govt. Lot S 1/4 NE 1/4 S 27 T 29 V R 15 W Property Owners Mailing Address Lot # 1 Block # Subd. Name or CSM# 1960 310th Street City State Zip Code Phone Number City Village ✓ Town Nearest Road Wilson WI i 54027 , 715 - 772 -3376 Springfield 310Th Street New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ✓ Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Mound system elev. = 101.80' at 18" above 100.30' contour. FTI Boring # Boring ✓ Pit Ground Surface elev. 99.19_ _ ft. Depth to limiting factor - -_- 22 in. Soil Application Rate Horizon Depth Dominant Color i Redox Description Texture Structure Consistence 'i Boundary I Roots � _ 'Eff#1 •Eff#2 1 0 -7 10yr3 /3 none sit 2fsbk ds as - 2fm,1 c 0.5 0.8 2 7 -12 10yr5/3 none sit 2msbk ds cw 1fmc 0.5 0.8 3 12 -22 10yr4/4 none sl 2msbk dsh cw 1 f 0.5 0.9 4 22 -36 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk dsh gw 1f 0.5 0.9 5 36 -51 7.5yr4A m2d 7.5yr5/8 scl 1 csbk dsh - 0.2 0.3 F il Boring # Boring u ✓ Pit Ground Surface elev. 99.78 ._ ft. Depth to limiting factor _ 23" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ . GPD /ft' - . - eP P ry '' I 'Eff#1 - Eff#2 1 0 -9 10yr3/3 none sil 2fsbk ds as 2fm,1c 0.5 0.8 2 9 -18 10yr5 /3 none sit 2msbk ds cw 1 fmc 0.5 0.8 3 18 -23 10yr4/4 none sl 2msbk dsh cw 1 f 0.5 0.9 4 23 -34 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk dsh gw - 0.5 0.9 5 34-48 7.5yr4/4 m2d 7.5yr5/8 scl 1 csbk dsh - 0.2 0.3 ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TS >30 < 150 mg/L ffl enj#�= BOD < 30 mg/L and TSS < 30 mg'L CST Name (Please Print) Sig 5urw. CST Number James K. Thompson 3602 a Eva Address A.C.E. Sal & Site Evaluations luation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 020 8/27/01 715 248 - 7767 Property Oyvw Greg Hill stead Parcel ID # .191- 1012 -30 -000, IQ # _ _ _ Page. 2 3 11, i 3 ]Boring # Boring L_J ✓ Pit Ground Surface elev. 100.88 ft Depth to limiting factor 18" in. oil App Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft� Rate 'Eff #1 `Eff#2 1 0 -9 1Oyr3 /3 none sit 2fsbk ds as 2fm,1c 0.5 0.8 - - -_ - - 2 9 -18 10yr4 /4 none sl 2msbk ds cw 1 fmc j 0.5 0.9 -- - - I -.._ -- 3 18 - 26 10yr414 f2d 7.5yr518 sl 2msbk dsh cw 1f { 0.5 0.9 4 26.40 7.5yr4/6 I m2d 7.5yr5/8 sl 2msbk dsh gw 1 f f 0.5 0.9 - - --- - -- - - -- t 5 40 -53 7.5yr4/4 m2d 7.5yr5/8 t scl 1csbk dsh 0.2 0.3 r I I Boring # Boring Pit Ground Surface elev. 100 ft. Depth to limiting factor 30" in. _ ______ _ Soil Application Rate Horizon Depth Dominant Color I Redox Description Texture Structure Consistence Boundary Roots I _ GPDJff.. - "Eff##1 'Eff#2 1 0 -8 10yr313 none sit 2fsbk ds as 2fmc 0.5 0.8 -- i- 2 8 -27 10yr5/3 sit none 2msbk I ds cw 2fm,1c 0.5 0.8 3 27 - 10yr4/4 none sl 2msbk dsh cw 1fm 0 5 0.9 - -f 4 3044 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk dsh gw 0 5 0.9 5 44 -53 7.5yr4/4 m2d 7.5yr518 scl 1csbk dsh - 0.2 0.3 - i-- - - -- - -- - - f i F7 Boring # Boring 1 Pit Ground Surface elev. _. ft. Depth to limiting factor in. -- Sol Structure Consistence Boundary Roots -- _ GPD /fP - . Application Rate Horizon I Dep th Dominant Color Redox Desc Texture I I 'Eff#1 "Eff#2 I I I f I i t Effluent #1 = BOD 5> 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. Approx. O��XiS Aban (ion a5 P�' C°de' 2xisE cv¢ ly be a. an cloned -� SwFa as code.! dise�ae razed cleo = 9.t.so' P - posed 3 bedcoo dn�ue . I£. 4. M. - roo F1'z ■ m6ar Elegy' - _ /o.2.� 4 3io - \ \g Cap 83 \ 2 BQ tA e- flail 'n Ljczden �Fe- ne.e�as�. ASSU.ir�e.d ■ F Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 \ *hscons�n www.commerce.state.wi.us/sb www.comm www.vAsconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Acting Secretary October 03, 2001 CUST ID No.220292 Y771r: POWTS Inspector _. I M 4 '-_Z NING OFFICE BENNIE W HELGESON CROIX COUNTY SPIA W1229 770TH AVE \ g� r 01 CARMICHAEL RD SPRING VALLEY WI 54767 DSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/03/2003 Identification Numbers Transaction ID No. 676573 SITE: Site ID No. 636403 GREG HILLSTEAD Please refer to both identification numbers, 1960 310TH ST above, in all correspondence with the agency. TOWN OF SPRINGFIELD ST CROIX COUNTY SE 1/4, NE 1/4, S27, T29N, R15W FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 812979 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and - prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (0 1/8 1) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The changes made to this plan on 10 /03/01 by this reviewer were acknowledged and approved by the system designer. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. BENNM W HELGESON Page 2 10/3/01 • Comm 83.52 Responsibilities. 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). In addition, 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. • Comm 83.52(2) 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. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 1700 BALANCE DUE $ 0..00 Charles L Bratz POWTS Plan reviewer 11- Integrated Services WiSMART code: 7633 (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM cbratz@commerce.state.wi.us cc: GREGORY W HILLSTEAD i ,1 1457 Wisconsin bepartment of commerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal r t (BM), direction and St Crobc percent slope, ale or dimensions, north and lance to nearest road. Parcel I.D. wale ID #27.29.15.97B Please prin I nart fon. R Date Personal W mation you provide may W,40 (Privacy La*, 15.04 (1) (m)). Property Owner Vru Property Location Greg Hilistead . Lot SE 114 NE 1/4 S 27 T 29 N R 15 W Property Owner's Mailing Address -. CEP - t - - z�o' . . L # Block # Subd. Name or CSM# 1960 310th Street ST �+x City da.� City Village of Town Nearest Road Wilson WI 715 - Springfield 310Th Street New Construction Ilse. ✓ 1RMErlw 3 Code derived design flow rate 450 GPD ✓ Replacement Public or commercial - Describe: Parent material Glacial Till _ Flood plain elevation, if applicable na General conwrients and recommendations: Mound system elev. = 101.80' at 18" above 100.30' contour. Boring # Boring ✓ Pit Ground Surface elev. 99.19 ft. Doh to limiting factor 22 " in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPD/fF - Eff#1 `E 1 0 -7 10yr3 /3 none sil 2fsbk ds as 2fm,lc 0.5 0.8 2 7 -12 10yr5/3 none sil 2msbk ds cw lfmc 0.5 0.8 3 12 -22 10yr4 14 none sl 2msbk dsh Cw 1f 0.5 0.9 4 22 -36 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk dsh gw If 0.5 0.9 5 36 -51 7.5yr4/4 m2d 7.5yr5/8 sa 1 csbk dsh - - 0.2 0.3 Boring # Boring ✓ Pit Ground Surface elev. 99.78 ft. Depth to limiting factor 23 " m• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Str Consistence Boundary Rods GPDKe 1 0 -9 10yr3/3 none sil 2f ds a 2fm,1c 0. 0.8 2 9 -18 10yr5/3 none sil 2msbk ds cw lfmc 0.5 0.8 3 18 -23 10yr4 14 none sl 2msbk dsh cw 1 f 0.5 0.9 4 23 -34 7.5yr4/6 12d 7.5yr5/8 sl 2msbk dsh gw - 0.5 0.9 5 34-48 7.5yr4/4 m2d 7.5yr5/8 scl 1csbk dsh - - 0.2 0.3 * Effluent #1 = BOD ? 30 < 220 mg/L and L >30 < 150 mglL = BOD <_30 mgll. and TSS <_30 mgll. CST Name (Please Print) Sig re: CST Number James K. Thompson - 3602 Address A.C.E. Sal & Site Evaluations Dke Evaluation Conducted Telephone Number 340 Paulson Lake lane, Osceaa, WI 8127/01 715 -248 -7767 r f property Oryrw Greg Hillstead Parcel it) # 191- 1 012 - 3 0-000, ID# Page 2 of 3 F # 3 ] Boring Boring ✓ Pit Ground Surface elev. 100.88 ft. Depth to limiting factor 18" -- in. Soil Appilc atim Rate Horizon Depth Dominant olor Redox Description Texture Structure Consistence Boundary Roots GPDW 'Eff#h 'Eff#2 1 0 -9 10yr3 /3 none sit 2fsbk ds as 2fm,1c 0.5 0.8 2 9 -18 10yr4 /4 none st 2msbk ds cw 1 fmc 0.5 0.9 3 18 -26 1 /4 f2d 7.5y r5/8 sl 2msbk dsh cw if 0.5 0.9 4 2640 7.5yr4/6 m2d 7.5yr5/8 st 2msbk dsh gw if 0.5 0.9 5 40 -53 7.5yr4/4 m2d 7.5yr5/8 sql 1 csbk dsh - - 0.2 0.3 Boring 4 � # ✓ Pit Ground Surface elev. 100.79 ft. Depth to limiting factor 30" in. Sal Application Rate Horizon Depth Dormnant Color Redox Description Texture Stnrcture Consistence Boundary Roots GPDHP 'Eff#1 'Eff#2 1 0 10yr3/3 none so 2fsbk ds a s 21mc 0.5 018 2 8 -27 10yr5/3 no sjl 2msbk ds cw 2fm,1c 0.5 0.8 3 27 - 10yr4 /4 n one sl 2msbk dsh cw 1 f 0.5 0.9 4 30-44 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk dsh gw - 0.5 0.9 5 44 -53 7.5yr4/4 m2d 7.5yr5 /8 Sol 1 csbk dsh - - 0.2 0.3 Boring # Boring F] Ground Surface elev. _ ft. Depth to limiting factor in. Sod Appliealiw Rae Horizon Depth Dominant Color Raft Description Texture Structure Consistence Boundary Roots GP 'Eff#1 'Eff#2 ' Effluent #1= BQD s' 30 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BW <_30 mg/L and TSS -..V mglL The Department of Commerce is an equal opportunity service provider and employer. if you need wsistance to access services or need material in an ahmime format, olease contact the deaartment at 608-266-3 151 or TTY 608 -264 -8777. ■ So;l utzlcc�oni?� w A Cle da. 6'0n )f Eklaelll? ca/Q = 54� IV Apprax. loC.a4b,7 Oeex.3 pfc. fYnkt di'ycve /% s+++d Aban a5 4e- 06 0 e�c ;sE wall - Ev be oban doaed � / $w� 4 s code. P ao posed 3 bed rom►� � Y - © . Wu,, 63 l� & nc. M,,re- flail in ceder, $ _ ■ km ycLi6- A ssu-me d 8 2 e.►ew = ;3.zA" Souk P�o�. /.ire . - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer H" Mailing Address 9&6 SIO St"ee--T, It) 11 J,` 7 Property Address l < aZ) (Verification required from Planning Department for new construction) City /State U)cL56�1 �� 7 Parcel Identification Number /q / — /D /a -3o dc6 l P f 7. 29.15: 97 LEGAL DESCRIPTION .lsGh Property Location S F t /4, At j5 '/4, Sec. Q7 . T 2ii N -R W, T*wa -of _ �§ 0 Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # t � �' Volume � y , Page # '7 3 Spec house ❑ yes 91 no Lot lines identifiable )g] 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 h 7been a intained must be completed and returned to the St. Croix County Zoning Office within 30 y s f the three year a 'ra i e / I A OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all sta ements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of t described abov b rtu warranty deed recorded in Register of Deeds Office. S1 AT OF APPLICANT 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 r fit ` ' • DOCumeNT No. '_ ._ �►_+.�..- f f STATE BAR OF WISCONSIN FORK it -1W rww sMCi �asovw ►oa asc000i*S wTA x . .QTR CLAIM DtEp 7W r 273 tw — - REGISTERS OFFICt ...... -.. Arlene Y. Hillscead __.... ST CR'OIX CO., Wj& r. .. ........... .... ............................... ....................... Recd. io► Record thi: �. r f dahes b - - -•• :;�iYYo't'eaa ............ .•............................. "day of s� e t' A..0. 1987 ..... .. .... -__ . .. ..................... .................................. ............................... 8:30 - ' .. ...............-............ ............................... ................ ............................... !{ - ' Moving dsicr%W rW state is .... S... C......... it state of �Yiseonsis: - County, li s[ruNN to I DOAR, DRILL 6 SXOW,S.C ' South 363 feet of the Southeast Quarter - � -- R SB -} of the Northeast Quarter (NE -1) of Section 27 -29 -15 in Tax arpi No: the Village of Wilson. Ta P " This is given pursuant to a divorce ud � gment. .I i _j i I i i This .......... Is .......... ... �� Fr'oDaty� sDated tbL ......... ............. �................. day of .......... ...... 1. 4�!... .............................., 15..87... (SEAL). �j •...... »......witlent. V. Hillstead ................. .........................(SEAL) I . ......................... ............................... ... ......................... ..... (SEAL) {I I.............. ............................... ...... (SEAL) .... ... ............... ......................................... • AVIXIIINTICATION ACSNOWLBDQUXNT . SUpetore(,) � l�ne V� >Sillstead .... .........._......._..... STATE OF WISCONSIN ---- ......... ..»_ ........................ _......... ........................... ..... -. ---- County- I 1d .'ISY Personally came before as this - -- - -day of ,r e„ -, •-_ ....:...��..._...» ........... rlene.V. Hillstead87... - sallow � ` IiV T BA�t OF I3 N ........ ...................... ............................... ...... II t4 (� ..................... ................................................ ........-- •- tats. MARSHFIELD A Product Of Wick Bugding Systems, Inc. P -0, Box 590 - Mersht;etd, WI $"49 - (71*387.2551 # 1 F .r o ° y F 0 O b N CQ v o I v J I 4- -A _ - to � $ F 1 Nl � It ld ! • . ci) iii �"� _• c.) t� : .' tl E t o, :.. qq ,S N t.. n CJ O m 05 q- QO O 0. • I , LA J O 1 LL pd w I C 8 on w N 4 J ° 0 • 2 ,