HomeMy WebLinkAbout034-1033-20-350 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
453198 0
(ATTACH TO PERMIT)
GENERAL INFORMATION C , . State Plan ID No: a �D
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. L y2
Permit Holder's Name: City Village X Township Parcel Tax No:
Schilling, Wayne & Teresa Springfield 034 - 1033 -20 -350
CST BM Elev: Insp. BM Elev: BM Des ription: k Section/Town /Range /Map No:
6 R 7, D r I'� �� 15.29.15.228F50
TANK INFORMATION ELEVATION DATA Ali
TYPE MANUFACTURER CAPACITY STATK , � FS ( E,��V.�
r4 T
Septic Benchmark U .0
L44-1 / t
Dosing W Alt. BM of ��
Aeration w Bldg. Sewer
Holding S t/Ht In let 0 SC j-f qo VkPtL a 01
St/Ht Outlet
TANK SETBACK INFORMATION -�
TANK TO P/ WELL LDG. Ven to Air Int ake ROAD Dt Inlet
Septic 1 D Bottom
f� > 20 g, 3,
Dosing Head an.
Zr I -7� /o0• S
Aeration st. Pie , �1 IM I 6o yy
Holding Sot. S 1 em S g 3i 2 ` Cr G/, Z
PUMP /SIPHON INFORMATION Final e / f �+ /a 9
Manufacturer 2, T / GPImNand St Cover ; , 21 d
Model Number 9 e , 31 : qg Zq
TDH Lift Friction Loss System Head TDH Ft I
I
Forcemain Lengt Dia. 2 ti D ist. to W - / J
SOIL ABSORPTION SYSTEM l vv N
BED/TRENCH Width `f✓ Length r No. Of Trenches PIT DIME ONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS �
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM tUN NG Manufacturer:
INFORMATION C
Typ�,Qf System \ ( } 7 Model Number:
DISTRIBUTION SYSTEM "' S.r
Header /Manifold Distribu on 1x Hole ize x Hole Spacing Vent to it Intake
21 Pipe(s) C ci ! I lr � d C
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound r At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
]Yes -- Y
No es No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ID / J/ Inspection #2: / �3 /d
Location: 3074 96th Ave Unknown SW 114 NE 114 15 T29N RI 5W) NA Lot 10 Pao: 15.29.15.228F5D-
1.) Alt BM Description= ST - CAVG)E--
2.) Bldg sewer length =20
- amount of cover =� a
`� — -- — - -
Use othes de for additional information. No r23
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SBD -6710 (R.3/97) Date Insepctor's Sig ature Cert. No
Safety and Buildings Division County
W 201 W. Washington Ave., P.O. Box 7162 C j
vsconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -315:• T53
Sanitary Permit Applic " "��` State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, perso1W inftri�� 3lyA,rk 4 7 , 7y/ Z Z = TP!}rU
may be used for secondary purposes Privacy Uw, s15.041),(m) 4 Protect Address (if different than mailing address)
I. Application Information - Please Print All Informatio 3 96 t ' A ve '
3
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Property Owner's Na me I Parcel rY Lot rY Block X
ct
Property Owneri M ailing Address Property Location
S t'LJ '4,Section
City, State j' � � Zip Code Phone Number
G t lJ� ill f s 13 circle )
II. Type of Building (check all at apply) i� S
+ty, ,^" T N; Rl _E
l or 2 Family Dwelling - Number of edrooms -9 a,„ - 0 " _A ow SM Number
- El Public /Commercial - Describe U e _ • ZZ r V, /� / *7
❑ State Owned - Describe Use ❑City _ ❑Village Towns of
rcr.SDI III. Type of Permit: (Chec only o ne box on line A. Complete line B if applicable) O . Jb33 ' - 350 22,9 D'
A ' 16 New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System
B. ❑Permit Renewal El Permit Revision El Change of El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply)
❑ Non - Pressurized In- Ground 81 Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) esign Soil pplication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
y 7Z
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units {� Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank b
rr
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement I, the undersigned, assume responsibility for ' llation of the POWTS shown on the attached plans.
Plumber's Na me (Print)P, S' gnatu PRS Number Business Phone Number
� - Z2 SZZ
Plu is Addre ss (Scree , City, State, ip )
VIII. Count /De artment Use Onl
Approved ❑Disapproved Sanitary Permit Fee includes Groundwater Date Issued Is uin Agent Sig a (No Stamps)
Surcharge Fee)
❑ Owner Given Reason for Dettial
IX. Conditions o Apprr f
SYSTEM OWNER:
nk effluent filter and - 3
1 Se tic to ,
p nay -ll'
dispersal cell must all bs serviced I ma
intained
as per management plan provided by plumber.
2. All setback requirements must be maintained c�{
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
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Safety and Buildings
commerce.wi. OV 141 NW BARSTOW ST FL 4TH
g WAUKESHA WI 53188 -3789
TDD #: (608) 264 -8777
isconsin www.commerce.state.wi . us /sb
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Cory L. Nettles, Secretary
May 03, 2004
CUST ID No.224617 ATTN.• POWTS Inspector
LYLE J MYERS ZONING OFFICE
NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA
E 1556 STATE ROAD 64 1101 CARMICHAEL RD
BOYCEVILLE WI 54725 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/03/2006 Identification Numbers
Transaction ID No. 994122
SITE: Site ID No. 682654
Wayne Schilling Please refer to both identification numbers,
96TH Avenue above, in all correspondence with the agency,
Town of Springfield, 54013
St Croix County
FOR:
Description: Mound, 3 Bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 955403
Maintenance required; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01)
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.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
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
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD -
10706 -P (N.01101).
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
comply with the operation, maintenance and monitoring duties as described in section VIII of mound component
manual. A copy of this information must be given to the owner upon completion of the project.
Maintenance information must be given to the owner of the tank explaining that periodic cleanin , e I e J
required. Access to the filter for cleaning must be provided per Comm 84 product approval d;���
�g'ti.. .�.. y fJ
p
A Sanitary Permit must be obtained from the county where this project is located in ace 91W,t� tl
requirements of Sec. 145.135 and 145.19, Wis. Stats.
Inspection of the private sewage system installation is required. Arrangements for ins pte 11 b
designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. StatsCO
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Mound System Cover Page pg 1 of 6
W"'IENER
Project Name: SCHILLING -MOUND
Owner's Name Wayne & Teresa Schilling
Owners Address 958 Rustic Road 3
Glenwood City, WI 54013
Legal Description Sw7] ' / 4, FNE '/4 Sec 15 T 29 N, R 15 w
Township Springfield
County Saint C row
Subdivision
Lot# 10
ParcelID# Pending
Table of Contents AQK v b tM
p9-
1 Cover page BL136S, DIV.
2 Mound Sizing Calculations SAFETY
3 Pressure Distribution Layout and Dynamics
4 Dose Tank
5 Management and Contingency Plan
6 Plot Map
total # of pages: 6
Designer Name: Lyle J. Myers
MP /License #: I. DI 224617
Date: 4/22/04
Ph. #: 7156432520
Signature: 1"
Mound System Design Methods Used `4ha ��;fF�C
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01/01)
per " Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N 01�'� C '`r
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715- 643 -6068 email: 3ba@3badvisement. ,
t
Mound System Page 2 of 6
Mound Sizing Calculations
Project Name: SCHILLING -MOUND
Site Cond ___ Design of Entire Fill
Project Type: or 2 Famil Dwellin Cell depth at upslope edge (D): 18.0 in.
% Slope: P % Cell depth at downslope edge (E): 25.2 in.
# of Bedrooms: Distribution cell depth (F): 9.5 in.
Depth to limiting factor: in. Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: 1 gal /ft /day Cover thickness over center (H): 12 in.
Absorbtion rate of in -situ soil: /ft /day End slope width (K): 10.8 ft.
Effluent quality Eff #1 Fill length (L): 96.6 ft.
Max BOD effluent value: 220 mg /I Upslope width (J): 6.5 ft.
Max TSS effluent value: 150 mg /I Downslope width (Toe) (1): 14.6 ft.
Fill Width (W): 27.1 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 450.0 gal /day Basal area required: 750 ft
Distribution cell width (A): 6.00 ft Basal area available: 1545 ft
Distribution cell length (B): F 7 - 01 ft
Area of Distribution Cell: 450.0 ft Observation Pipes
Contour Elevation of Mound: 98.22 ft Location from end of cell (Z): 12.5 ft
System Elevation of Mound: 99.72 ft
Final Grade of Mound: 101.51 ft
Mound Plan View
Observation Pipes
Z --�I
K A
T B k—K
I Tilled ArealFill Material
I L
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric G
Distribution Cell A %"
System Elevation tr , ;, 4g•
Cover Material Lateral
, 'kN
Fill Material
Tilled Area
z b�
S
LJ
lope ' �Forcemain System
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(8)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System Page 3 of s
Pressure Distribution Calculations
Project Name: SCHILLING -MOUND
Lateral Layout Lateral/Manifold Design
Lateral elevation: 100.2 ft Lateral diameter: I Y IIV In.
Rows of Laterals: =2 I ' I Lateral spacing (S): ft
Manifold type: �nter 'w Lateral to cell edge: 1.5 ft
Orifice diameter: C 12s • In. Lateral discharge rate: 7.83 gpm
# of Laterals: 4 System discharge rate: 31.31 gpm
Distal Pressure: 5 ft Manifold diameter: L`_ � In.
Lateral Length: 37 ft Manifold length: 3 ft
Orifice Spacing /Distribution Forcemain Friction Loss
Orifice spacing (X): 24.00 Inches Forcemain length: 60 ft
Orifices per lateral: 19 Forcemain diameter: 2 In.
Avg. ft /Orifice: ( (.) 5.92 ft Friction loss in forcemain: 1.259 ft
Lateral Side View
Manifold
Lateral Lateral
x x x 71 x x t x x x x x t x x
Al 2 2
Lateral Length Lateral Length
Lateral Plan View
I Lateral Length Turn -up w /ball valve or cleanout plug
o a T
c n i
Orifices on bottom of
lateral equally spaced PVC laterals and Forcemain to comply with
specifications per Comm 84.30(2)(e)
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean -out plug
Final Grade or ball valve
Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Collar
6" Minimum may be used in
Long Sweep 90 I place of 3/8" bar
or two 45's L 3/8" Bar
Lateral
it
Mound System Page 4 of 6
Septic, Pump and Dose Tank
Project: SCHILLING -MOUND
Tank Information Dosage Volume
Pump tank manufacturer: Wieser Conc Forcemain drains back to tank? OQ Yes O No
Pump tank size /model: W1000 /650 - MR Lateral void volume: 15.6 gal
Pump tank gal /inch: 17 Dosage to absorbtion Cell: 78.2 gal
Actual Pump Tank Volume: 646 gal Forcemain volume: 10.5 gal
Tank bottom elevation (inside): 84 ft Total dosage: 88.7 gal
Septic tank size /model L - _ •
Pump and Filter Total Dynamic Head
Pump Manufacturer: Little Giant Are laterals highest point? y
Pump Model: 9EH if not, enter highest elevation: 0 ft
Effluent Filter: Zabel A100 System head (distal x 1.3) 6.50 ft
Vertical Lift ( "D" to lateral) 15.55 ft
Note: Access opening of sufficient size to be provided to allow
removal of filter Opening to terminate at or above grade. Friction loss in forcemain: 1.26 ft
Pressure loss from filter: �ft
Total dynamic head (TDH): 23.31 ft
Pump Tank Diagram Dose Tank Levels
Watertight Locking Cover In. Gal
4Inch With Warning Label
Minimum Finished A Reserve 22.8 387.3
Grade B Pump off to Alarm 2.0 34.0
Alternate C Total Dosage 5.2 88.7
Outlet
Location Elect. per Comm D Effluent depth for pump 8.0 136.0
16.28 and Total Capacit 38.0 646.0
NEC 300 p ry'
Weep Hole A
or Anti -
Siphon 8
Device FLOW- LITERS /HOUR
C 0 1000 2000 3000
D 30 10
N
w 7.5
20 w
I
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F7 5 '
W Q
Pump must be capable of: U23AFeet = 10
2.5
and head pressure of:
0 0 TVTT
TTIT
0 20 40 60 60
Little Giant FLOW- GALLONS /MINUTE
9EH PUMP PERFORMANCE CURVE
115V 60HZ
Mound System Management Plan pursuant to,comm 83.54 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and /or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical /biological "treatments" is not required or
recommended. if such additives are used, make sure they are approved by Department of Commerce,
Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep
solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied
by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be
emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved
individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified
of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely
inspected to be watertight and of good repair.
Pump /Dose Tank
If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pump /dose tank should be routinely inspected to be watertight and of good repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4
inches or more water level is detected in the observation pipes, the owner must be notified of possible
problems /failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the installation or at the time
of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc)
become defective, the defective tank or component must be replaced immediately to ensure that the system
can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the
surface, the component must be repaired or replaced in it's current location by either: extending basal toe to
provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in order to return system to proper working order as
required.
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
,n accordance - .:iL`1 Comm 85, Ms. Adm. Coda i
Attach complete site plan on paper not less than 8 112 x 11 inches In size. Plan must County -.T7. 6401"x'
I nc!, trio nM fmited !c: veft!cal and horizontal reference pint (BM) direr'!ion. and
Parini i.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Re iewed by Date
Personal information you provtle a berms — ed fo seoondary �ur . pses (Privacy Law, S. 15.04 (1) (m)). r
Proper Owner �. �, ,.,. ., Property Lxation
6t, YAJ T TEK SS .Se,/ /G. 1A41- ! GoA Lot S GU 114 N6 1/4 S /j T 2 �? N R / 5 f•tefG>
pr opeT y ^:: "!^i!ing Address A N p 2004 lot # Block # Subd. Name or CSPJF#
C`� >` I
X58 ` /e
City State Zip Code Number ❑city ❑Village WTown Nearest Road
6:ZZA1 vood Gr Lv l _ q , 4 Ax-
1 �j0
New Construction Use: I� Residential /Number of bedrooms � Code derived desig flow rate GPD
❑ Replacement ❑ Public or commercial • Describe:
Parent material - SA Aj&5 , - Flood Plain elevation if applicable _ h.
General comments
I and rgrnm mandali9n5 I, J.1'( /
—ring illy 4 v�3
L pi Ground surface elev. G / ft. Depth to limi ng factor 2 in.
=Soil Application Rate
I lonzor Cepth Dominant Cbor' RC ri X DISC 1piivn I Texture SW ure Consistence Boundary Roots GPD/fP
n. Munsell Qu. Sz. Cont. Color Gr. 9,Sh. I 'Eff#1 'Eff#2
C 5
/o 79- si / 3s6 k /!� �f'�^ C S
2 sbK ✓ C,7 ern . 4 • 4
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(1 Bong
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L � ® pit Ground surface elev 8. L_ ft. Depth to limiting factor ?� „mi n. Soil Application Rate
1 Hnn7nn I t)antn I UQmknan, ("Nor l kemx Up-motion I I RXb)(e I StnJrture Consistence Boundary Rook GNUltt I
n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
ye _ , s / 3 6 �r ✓fir c s 3�'
r :Z 4'25 /6xx /,3 .�s�6 /n✓ r
Sh s c / Sv/ k /h rf'r
1 I I I
Effluent H1 = BOD > 30 < 220 mg(L and TSS >30-< 150 mg/L Effluent #2 = BOD < 30 mgtL and TSS < 30 nvt
CST
.a me P a Prr Si nature CST N xnber
AI �.1. . l) .ets •zlr � JAS
Address Date Evaluation Conducted Telephone Number
2-2f3 646y Weviii 6 w 54613 - 1. a
Pruperly Owner S /G� Pa"I ID # _ Page ?! of
❑ Boring
Storing # p
I .� 1 pit Ground surface elev. O 3 ft. Depth to Limiting factor in.
Soil A cation Rale
Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
'Eff#1 'Eff#2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
!S - 8 /b `�/L Z '�/ 5t' ?S4 K n 44 V- r C5 .�/►ti . 6 '
Z 8- +13 S -ak M VP r- 5 2-n1 . 1 64
3 / - 3 072 j.syjf F e &, ; Cs 2
i
F Boring # ❑ Boring
E] it Ground surface elev. __ ft. Depth to limiting factor _ in.
I
P Soil A IiCalion Rate
Horizon i Depth Dominant Color Redox Description Texture Structure Consistence Boundary l Roots GPD/fF
in. Munsell Qu. Sz_ Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
i l
�; ❑ Boring
g .frig # ❑ ft. Depth to limiting factor
pit Ground surface elev. _
Soil A ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consislenne Boundary Roots GPD./ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff #1 'Eff#2
Effluent #1 = BUD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BUD < 30 mgrL and f SS < 30 rrig2
T ht: Dupal'tlllent Of CUlllillel'Ge IS all equal UPPGrtUlll ty Service proVldCl' and CII1 pIUy C1. If you need assistance LU access SCIti'ICCS UI
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
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Wisconsin Department of Commerce SOIL EVALUATION RE ORT Page If
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County Y
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ✓�
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest ro d.
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1 (m)).
Property Owner Prope Location
IV A a/ 1/4 A/� /,6 1/4 S � T� N R ��') W
Property Owner's Mailing Address of lock # for CSM#
R G1 7`/ c. R c/ .3
City State Zip Code Phone Number ❑ ❑ Village WTown Nearest Road
GLeM iu�oo� t - �` 0/3
CO New Construction Use: Residential /Number of bedrooms �_ 06de derived di6grp w rate ��!? GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material C / J / �. Flo4d Plain elevation if appli qj ft.
r
General comments
and recommendations:
cs,,,,, te% - �P 1•
4efs � 1 , 10,
Boring #
Boring
J °•..:,:_a „':�, < -,<'
❑
® Pit Ground surface elev. / � 0,,7 ft. Depth to limiting factor o / I
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/lf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
v -// /0 Yf 3 , P- — /- aM s6111 M V R
-7- /o AV3 l s «l. A M 1+,6 M 1:
/o R �P svf S
S e d S s6 k M v
St e� s
U-1 Boring # El Boring q'
Pit Ground surface elev. / y ft. Depth to limiting factor c in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
9-'� 3 /0 3 A S
c d M vY_
e �'S
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg /L
CST Name (Please Print) Signatur CST Number
Address Date Evaluation Conducted Telephone Number
Gri /rlo G� eiyG��a�d �%f Lv1� /a -
Property Owner LIJ� yN ��%� /` N� Parcel ID # Page C; of
F-7-1 Boring # ❑ Boring
Pit Ground surface elev. 9� 9� ft. Depth to limiting factor .9_ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
-s j M A-6r - �l S l� ,
E S
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F 1:1 pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
i
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.07/00)
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ST CROIX COUN ly
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer i L)� )G
Mailing Address
Property Address --
(Verification required from Planning Department for new construction
City/State
G, z c� 010e3 ig C 1 i Parcel Identification Number
03�- /033 20 - ,x!22 F -sa)
�EGAL DESCRIPTION
Property Location '/., A t `�•, S ec. . T, ' N - R1
s' W, Town of
Subdivision Lot # _ l0
Certified Survey Map # 0:5 _ . Volume .__7 Page # 51 /.�
Warranty Deed # f Da _� Volume 1 Page # to o Z
Spec house ❑ yes 91 no Lot lines identifiable 9Q yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in iti 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 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 roturned to the St. Croix County Zoning Office within 30
days of the three year expirati
SIGNA �OFAPPLICAINT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (am the owner(s) of
the property desscn— ab Cs,- by virtue warranty deed recorded in Register of Deeds Office.
SIGNNATURE OF APPLICANT DATE
An information - represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
«• Include with thi application: a copy of the wa rnified survey p iif�reference is made in the warranty deed
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DOCUMENT NO. I 633593
KATHLEEN H_ WALSH
I II REGISTER OF DEEDS
Frank T. Kirabbeiner �, ST.. CROIX CO., WI
RECEIVED FOR RECORD
fI quit claims Co Wa E. S chi n a n d Te D. Sehi!U } 11 -13 -2000 10 :00 AN
1 husband and wife, - e� n � � I QUIT CLAIN DEED
EXEMPT # 3
CERT COPY FEE:
COPY FEE: 3.00.
TRANSFER FEE:
the following described real estate in St. Croix County, RECORDING FEE: 12.00
I� State of lvisconsin: I PAGES: 2
THIS SPACE RESrRVED FOR RECORDING DATA
NAM! AND RETURN ADORESS
duo r. la j
i c %d 7i, c-,fj.T poi
D 3pl '(a 33 -in
� PARCEL IDENTIFICATION NUMBER
IIJ1 !
i�
I I! (See Attached Exhibit "A
I I I
!I
�� I
jl
This homestead property.
I�
Dated this A l -- day of June 19- 9z
(SEAL) ��N [ �.�r�d}.J�U (SEAL)
• Frank T. Kirchheit.nCr
_. (SEAL) (SEAL)
II r
�+ AUTHENTICATION ACKNOWLEDGMENT 1I
State of 4Vksvv1Min, C3 L+ t d +
Signature(51 i
_/
f T� A, % , � � `U County.
authenticated this day of , 14 Personally tame before me this LS day of
St]T3e 19 the above named
I I _Fr T_ Kir_rj3heinear
TITLE: MEMBER STPiCE BAR O WISCONSIN
(If nut,
authorized by ¢706.06, Wis. Stats.) to me known to be the pe o executed the fomyoing
I instrumennAA0,xt;knowl get same.
f THIS INSTRUMENT WAS DIAFT,o 8Y
t Attorney L{1-; . t, Ogle^
I� Hudson, WI 54016 Counry, vuia.
it (.Signatures may be authenticated or acknowledged. Both are not + Iv}y' anancm. (If not, state expiration date:
necessnry.) i 2 —
�I • Names of perunl signing In any opacity should by typed or pnnted Wow thdr .ignntnrr:• 4 H :1 � ' •• }
1 srATH is AR OF WISCONSIN ".. . Wlscont-A L.6081 216'& Co.. Inc. f {
II QUIT CLAIM UELED Form No, 3 — 1981 Mk sukea, Wis. II
.i
. ............................... I ........... .............
VOL 1559PAGE247
EXHIBIT "A"
I a nd d 2 of rt Cc rv. i icd Su t Flap, Dor%%imen t N% .%m i
rd ed IL VoA um 4 V,49f- 1.1 4 af. ua id M,-.Apo . in L he ne-g.i _.r t- C'
Croi c7c1un6.y, Wis --t i n n ti o n 1.'i. Towns
2 N t I I rt q it rj f ± 15 We r4 t-. i n S r j. Il 0 ra I d , ti o i x Cc k I v-
Y3 r-' 01 it 11
A nT Lot' 1 of a C et r t i f i ed s i i ry tz y Ma p Doo Xxitse. n t. N urn be r 3351)5
v o - - c t,) re I e 0 1 1 1 V cp 1 u m c I g a g a 2 o f 3 a i a ma r -13 i. t . 1-1, R f- g i 34 1, f- r I., f D eecl ti
off: j r:: c i Ft: C r o i x Ct,I u n ft y , W j. cc, o n P i n , 1 oc a 1-. ed i i a pa of U 1) e S o tj t I i
t1A It of thn Northeast Quarter in Seot j.-j-1 15, Tnwj-%FtiI i p 29 Novtli , Ran
1.5 Wes t, Town a F r i n c i f i e 1,.q , S t . C r n i X V ci 1i tl t y , Wi 0 4-- o n F j i ti de S t-. r j I e d 'a s
at the Qu. Corner rif. nAi.d Sr 1.51 thence., C-1111 ;A
t-..ht- f--;xnt line. of the South 11al f of Lite
C!uarter of P;Aid Sect 15, referenced tc.-) the hearingrs eliows on -a
c"ertifit-'d r'1jr%rey map, Dr.:Icumctit Number -175065, in Volume 4
page 1.149 in said County, North 0 dOcireaD 00 rnilltlt-e-3 50 0%r.nrc>ndR Wept
a dimtanc:#:. of 263.00 feet.; thenc.7.--, along the south linf- of 2 of
1saj(j MAX:? anti part. of IL-Ase north lirki- of Lot I' of a
Mop, Documcnt: Numlzicv 343373, reci:srrled i.#-. vni.iime 2 page 463 in said
CounLy. North 89 c1c.9rccr. 14 (14 no--nnr%cim Wt-.rd F1 aietLance 0:1
397.50 feet to the nouthwest corner of Lot 2 of said Map, thi-s I
t.1- point of he ginni.ng of the p,?rcel to be del3orillf'-d; thence,
C-0 n t. i 11 U i. I's C
. 1 a I cAng the north l ine of Lot I ()I' PtA i d map recorded Vol ume 2
page 4653, North 09 dr-9rcca 14 mi-nutecs 04 rjeconr3ry Weed:* '] disfhance of
161 .50 fnc-it: to Uh- ricriAtweirit of s%aj jvt 11 ther)c3e, aloricj
1-11e. we-Fit. I ille of IaAl' said f,ot I , si:'ut-11 00 de -green 00 millutf.-.g 50
3#.-.cond" E"RL a ditataiv. of 263.00 feet to t ROI)thwe.E corner of last
Ps T.ot' 3 , I.Alin alt3v being colt thc- south line. of T01- I of a certifi'".0
3t.3t-vey map. Dot -mnat%t tlumbtar 335055, Vn -. I -
.i ir, . I timc pAg< . 290 in
naid cc.-lutity; thence, along the 8"111t.11 I.Alle- of Lot I of nail Map
recorded it, 1. pigr- 2 N,->j-tjj 69 degrees 14 minvites 04 Fqc-!r%r)nc3
West a dintart<. (If 3.1.0.39 feet; then%ze North 00 degrepr— fit) minutc-R 58
-s r- t:- C a v t: (3 reeo I
. - ond.sc 1 a dJsLanac of 742-12 feet; then S u h d eS, 4
mi rmt.,? n 0 4 a -c-ondn F-1 F& t. a d st t vice of 4 79. 0 9 fee t- to the northwest
c:ornar of said MaL- in Volume 4 rng J-149; 4 it ei n c n ong the want line
r'1 1 ,1p Caro:
,t p;a j�d M ap, S 00 a-gve-v-A t
_ ao minu tes 50 sec�evndn a
dioLancp at 479-1.2 t-.o t pc,;ivlt of beginning. ct.vntain3ncj 313,632
txqua reet-, ( 1. 2 ac r•eFsl acres Sk 1 ,k . 1 01 I easenlent* P3, re3pt r ictiorks and
cove llants or record.
WOL 1414 P AcE 60? .�
y - 600*31 -a s
STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH
Decumen t Number WA Y DEED REGISrER" OF DEEDS -
ST. CROIX CO., WI
This Deed, made between Mary Pryor Moon a /k /a Mary Moon RECEIVED FOR RECORD
a /k/a Mary P Moon a /k /a Mary Rose Moon by h Attorney in Fact 03 -31 -1999 9130 AN
Charlotte O. Kirchheiner, under Power of Attorney recorded In Vol. 1248,
Page 370 as Doc No 561631 Grantor, and Wayne E. Schilling and WARRANTY DEED
Teresa D Schillina EXEMPT M 17
antee. CERT COPY FEE:
COPY FEE:
Grantor, for a valuable consideration, conveys and warrants to Grantee TRANSFER FEE:
the following described real estate in St. Croix County, State of Wisconsin (The RECORDING FEE: 12.00
"Property"):
Recording Area
Name and RRe-ttuurn Address
l l.)6e tTna4 • {.:_114 S L-- C- -Wil
1 ,3
03 — �—
o a — Ind
Parcel Identification Number (PIN)
This is no homestead property.
(See Attached Exhibit "A ")
This deed is given in fulfillment of that certain Land Contract between the parties hereto dated August 5, 1998, and recorded
October 27, 1998, in Vol. 1370, Page 071, as Doc. No. 589989.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of February, 1999.
* *Charlotte O. Kirchheiner, as Attorney -in -Fact for Mary Pryor
Moon, a /k /a Mary Moon, a /k /a Mary P. Moon, a /k /a Mary Rose
Pryor, under Power of Attorney recorded in Vol. 1248, page 370,
* Doc. No. 561631
AUTIIENTICATION ACKNOWLEDGMENT
Ofh /V
Signature(s) STATE OF V94SCOW&W )
SS.
NA m / c- TDIJ County )
authenticated this _ day of ry� t; Personally came before me this <J " o day of
Fer3r, 1999, the above named Charlotte O. Kirchheiner, as
Attorney -in -Fact for Mary Pryor Moon a/k/a Mary Moon
a /k/a Mary P Moon a/k/a Mary Rose Pryor to me
* known to be the person(s) who executed the foregoing instrument
TITLE: MEMBER STATE BAR OF WISCONSIN and ackn ledge the same.
(If not, fj /l lj
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Public, State of– Wi&Goussa
Hudson, WI 54026 My Commission is permanent. (If not, state exylratt0
(Signatures may he authenticated or acknowledged. Both are not - 3 7
necessary.)
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATF.B.AR OF. WISCONSIN
FORM No. 2 - 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, Wl 800.856 -2021
VOL 1414YAc -6f) 3_
EXHIBIT "A"
Legal Description (Moon to Schilling):
A Part r. f. Lot 5 0€ a CPrti.fle5d Survey Map, Dooument Number 567617.
record0d in Volume 12 page 3375 of said Maps in the Resgiater of Deeds
Office in St. Croix Coo.snty, wisconsin, located in pw rt of the South
Half of the Nartheamt Quarter of Section 15, Township 29 North, Range
15 West, Town of Springfield, St. Croix County, Wisconsin described as
follows;
Commencing at th" Cast Quarter Corner of said Section 15; thence,
along the cast/west Quarter line of said Section 15, refereenc cad to the:
bearings shown can maid Certified Survey Map, North A9 degrees SO
minutes 30 0 "'"cle West a distance of 1307.99 feet to the point of
beginning of thca parcel to be described; the =nee, conr_i.nzaing along last
said Quarter line and the exterior boundary of said Lot 5, North 89
degrees 50 minutes 30 seconds West a distance of 658 -13 feet;
continuing along the exterior boundary of said Lot 5, North 00 degrees
46 minutes 16 x-conds West a distance of 984.91 feet; thenc o,
continuing along last said cxtcrior, South 89 de-grees Se mi.nuterc Ol.
seccartds East a distance of 659.25 fact; thence South 00 degrees 40
n.i"Utea 10 mecondm East a distance of 246.55 feseat; thanes, continuing
along the exterior boundary of said Lot 5, South 00 desrQla 42 tni.nutes
57 $ =conk " Ea$t a distance of 739.80 fret to tha prsi.nt of beginning.
ConLaini.ng 649,060 square feet (14.90 acres). Sabj~7Z to all
easements, restrictions and covenants of record.
t r
7205�b7
VOL` 17 PAGE 4513
�5 KATHLEEN H. WALS1fL --
REGISTER OF DEEDS
ST. CROIX CO., WI
0 RECEIVED FOR RECORD
CERTIFIED
SURVEY MAP N O3112117120 03
•
03 12.00 PM
VOLUME 77 , PAGE - mu c ERTIFI ED SURVEY x AP
REC FEE: 13-00
COPY FEE: 3.00
PART OF THE SOUTHEAST QUARTER OF THE NORTHER S: 2
QUARTER, AND PART OF THE SOUTHWEST QUARTER OF
THE NOR__ THEA_S_T QUARTER.
SECTION 15, TOWNSHIP 2 9 NORTH, RANGE 15 WEST, APPRCyV[�
ST . CROlxCOU
TOWN OF SPRINGFIELD, ST.CROIX COUNTY,WISCONSIN;
Plannfno 2oninn .�,,,+ p.,.,,.....,, r._:--
BEING LOT 8 OF CERTIFIED SURVEY MAP, MAY 0 7 2003
VOLUME 16, PAGE 4289.
If not recoroecf within 3u uays ui
approval date approval shad be
UNPLATTED LANDS null gnd,/nr,+
3/4" iron rod, found
3/4" iron rod, found N89'58'43 "E 660.00 5.58'. 547 °57'23 "E �oa•E a �
• from set 3/4" rebar tc,,h
x.08'. $44 "E 1 S89 °00'38 "E 659 25' I Reoh1' PAR OF LOT 5_C_S.M.
from set 3/4" rebar
330.00' 330.00 VOL. 12 PG. 3375
o N�o S�.se
co O � o i rC
o LOT 11 ° f S00'07 25 "E
0o
to f° 0 11 S88 °59'04 "E 357 88' )
171466 s.f. — — — — 7
d M 1
z 96th_ Ave.
UNP — 3.94 acres 1
Z 315 36'
LANDS f 0 330.00' 579.32 50`N I
,P ip S89'58'43 "W
0 o
Ct LOT 10 0 o E5. ° _L . L6
1 o P LOT 9 0
PG. 4 289
Z cn 0
0
62 223 s.f. o
t W w P A 174260 s.f.
14,31 ocres z I z °D- • N f
N 4.00 ocres t to
N
31N m o
W. 1/4 CORNER N 1 r E.1/4 CORNER
Section 15 -29 -15 Section 15 -29 -15
Found Berntsen Noil _ _ _ — 779.63'- _ _ _ I 0_ Found P.K. Noil
%` 3261,03' r 660.00 40cor 119.63 322.50' Q� 871.29' %` !
_____________J
r r i
1" iron pipe, found --- -- - - -- - .iron pipe, found
7.01', N89 °58'43 "E - $89'58 43 "W 1102.13 0.73', 522'15 49 "W
fr om set 3/4" rebar ( S88 °53'07 "W 1 1094.82' I from 'set 3/4" rebar
tn
UNP ` — S89'58'43 "W � 5234.45' — I W UNPLATTED
_ 3 _ — _ —
LANDS l s88 °5307 11W z 1 Z 5234 31') _LANDS
• �����'� LEGEND I
im .........Government Corner (as noted) OWNER /PREPARED FOR:
T 0 .......... Set 3/4" x 24" iron rebar weighing Wayne &Teresa Schilling
ocoev000cfry 1.502 lbs. /lineal ft. 958 Rustic Rd 3
< (..........Recorded Dimensioning Glenwood City, WI 54013
Note: Each parcel on this map is subject to State and County laws, rules and regulations
(i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing
any parcel, contact the 5T. Croix County Zoning Office for advice.
-� Note: " Future road extension west of 96th Avenue may not be possible wi
0 th the creation
of this map and may preclude future subdivision of Lot 1. "
CURVE DATA TABLE
CURVE RADIUS ARC CHORD CHORD CENTRAL TANGENTIN TANGENT OU
N0. LENGTH LENGTH BEARING ANGLE BEARING BEARING
N 1- 2 80.00' 93.12' 87.95' S33 °28'08"E 66 ° 41'26" S00 6 07'25 "E S66o48'511
• 2- 3 80.00' 34.44' 34.18' S79 °08'55 "E 24 ° 40'08" S66 ° 48'51"E N88 0 31'01 "E
1- 3 1 80.00' 1 127.56' 114.47' 1 S45 °48'12 "E 91 °21'34" S00 °07'251 N88 °31'01"E
North is referenced to the SCALE: 1 " = 300' DRAFTED BY:
East - West Quarter line Joel A. Brandt
of Sec. 15- 29 -15, which
bears S89 °58'43 "W 0' 300' 600' Page 1 of 2
(St. Croix County Grid System)
Vo1.17 Page 4513
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