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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division '
INSPECTION REPORT sanitary Permit No:
479442 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:
Nichols Jim I Springfield Town of
CST BM Elev: Insp. BM Elev: BM Description: G 5 / Section/Town!Range/Map No:
29.29.15.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
/O
Septic r Be chmark
Dosing Al.
�f ( Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLD Vent to 'r take ROAD Dt Inlet
RR 4
W
Septic ! i I _ Dt Bottom 3 7J.
Dosing 7 Z S' b / h a Header /Man. 97, �[
Aeration Dist. Pipe q 7 �S
Holding Bot. System G1 -75
7h
Final Grade
a
S
a�
Od
PUMP/SIPHON INFORMATION � Z•coo 99 ,
Manufacturer �, Dem and St Cover r ��
Model Number 15b, 1
C,6r.�_a�r S•S•C�
TDH Lifi Friction os System Head TDH w
, J ".�
Forcemain Len DiA. I Dist. to well /
SOIL ABSORPTION SYSTEM
BED /TRENCH Width � Length / No. O nche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
�
DIMENSIONS 7 �_- i
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR
Type Xtem: L7 1 M / �/ UNIT Model Number:
/ / 16 c)
DISTRIBUTION SYSTEM
rLengtder /Manifold Distribution it / ;: Hole Size it x Hole Spacing Vent to Air Inta ke
h_3L Pipe(s) t(
Dia Length �� Dia / Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulch
Bed/Trench Center / C Bed/Trench Edges Topsoil ` s ` No s No
J q
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: I / I / O 5 Inspection #2:
Location: 2899 80th Avenue Wilson, WI 54027 (NE 1/4 NE 1/4 29 T29N R15W NA Lot 2 C Ow Parcel No: 29.29.15.
1.) Alt BM Description = �rL1Ll�- 1p C11 0. :,I�.S
2.) Bldg sewer length = 31 I
- amount of cover � 9—a-. /` e �,.J co V J?"
� _' Q; � P �
- -- -- ,��
Plan revision Required? f Yes N o r q 20 J5 __ _ _____ — _._ -- - -- �q3?
Use other side for additional information.
Date Insepcto Signal Cart. No.
SBD -6710 (R.3/97)
09/19/2005 15:06 17156581344 TOM GUSTUM PAGE 01
K KJ uJ PL) VIA P
L l - 7 7 qy2-
grrA -RITE'
cast iron submersible eftent pump
OUTLINE DIMENSIONS SECTIO
I '
_ - & . 13.50
000 000
)
Dimensions (in inches) are for estimating purposes only.
ORDERING INFORMATION PUMP PERFORMANCE
Max, In Cal
Catalog Load phase/ Cord Switch CAPACITY UTlap6 PER MINUTE
Number HP Amps volts. Cycles Length ,1° e ° 50 10o 150 2DO 250 am a8 4 450
EC650120T 1/ 12.0 11 S 1 60 20' Tethered
-EC650120M 1112 12,0 115 1/60 20' Manual
EC650220T 1 /2 5.6 230 1 60 2D' Tethered _.._. _.......... -. -! __--- ...... 1 ....__. ____... - .------- - ..... . ........__. za
EC650220M 1/2 5,6 230 160 20' Manual a I i
EC650320M 1/2 5.5 208.230 3 60 20' Manual 24
EC650420M 12 2.7 460 3 6D 20' Manual
EC750120T J12 13.0 115 1/60 20' Tethered 7O EC750120M 1 2 13.0 115 1 /60 20' Manual _.�..._ '....._ ...........................
........ _
EC750220T 1 6.4 230 1/60 20' Tethered
e°
EC750220M 1/2 6.4 230 1/60 20' Manual , F - 14 0
EC750320M 1 2 6,0 208 230 — 3 Z60 20' Manual W ..........�_._
EC750420M 1 2 3.0 460 3 60 20' Manual
EC7100220T 1 6.6 230 1/60 20' Tethered `
EC7100220M 1 6,6 230 1 60 20' Manual
EC7100320M 1 5.8 230 3 60 20' Manual 40 i ,2
EC7100420M 1 3.0 460 3/60 20' Manual a
HIGH HEAD MODELS ,o
aD
EH750120T 112 12.0 115 I60 1 20' Tethered I ! '
EH75OIZOM 1/2 12.0 115 160 20' Manual
EH750220T 1/2 6.5 230 1/60 20' Tethere
EH750220M 1 2 6.5 230 1 60 20' Manual
EH750320M 12 5.2
230 3/60 20' Manual r 4
EH750420M 12 2.7 460 3/60 20' Manual i0
E117100220T 1 8.7 230 1 /60 1 20' 1 Tethered ---- ...,._.__ .......,;......._ 2
EH 71DD220M 1 8.7 230 1/60 20' Manual
EH7100320M 1 6,0 230 1 3/60 20' Manual 0 E 40 90 no +00
EH71 0 D42oM 1 3.1 460 3/60 20' Manual CAPACITY GALLONS PER MINUTE
-All E06 /EC7 /EH7 5erles Pumps have 3/4" solids handling
capablllry and 2" NPT discharge. C
C
A/ " �a
u,romer service (88.782 -7483 • Fix Orden: (400) 4269444 s I stRfRepUmOs.cam sta•Rlh I4dustrks, Inc. • Delnwn, w s3i 15 usq
5395355E (4 l01)
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 St. Croix
isconsin WI 53707-7162 Site Address
Department of Commerce (/ d 80 Ave. t
Sanitary Permit App Sanitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal informatio ou
may be used for secondary purposes Privacy Law ❑ Check if Revision
I. Application Information - Please Print All Information State Plan I.D. Nu r
Property Owner's Nam _ Parcel Number
Jim Nichols 3 M �l
Property Owner's g A s ING OFFICE Property Locaffion
2887-8 0 Ave. L� NE %4; S29; T 29N, R15
City, State Zip Code Phone Number Lot N her Block Number
Woodville, WI 54028 (715)698 -2486
Subdivision a CSM Number
s l
SD
�
II. Type of Building (check all that apply) p
❑ City_
X 1 or 2 Family Dwelling -Number of Bedrooms 3 _.(�/c �K��
El Village__
❑ Public /Commercial - Describe Use 1 — o? $1 ��� �i X Town Springfield
❑ State Owned Nearest Road
80" Ave.
III. Ty r 't: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A. I New 2 Replacement System For County use
System X 3 ❑Replacement of Tl� ❑Addition to
Tank Only xi stin System
B. Sanitary Permit Previously Issued Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44 [1 Non -Pressurized In- Ground 21 X Mound 'GZ N 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aeroljic Treatment Unit A9 Recircu)ating, / 3011 er
V. Dispersal/Treatment Area Infor mation:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Pe olation System Elevation Final Grade
Required -7 Propose Rate( Sq t.) Rate Elevation
/ •O f j (Min. /Inch) 96.58' 98.38'
450 450.0ft2 450.0ft2 .6 /. N/A �— ✓
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing `W #-A Tanks Tanks
Septic 1000 1000 1 Skaw Precast X
Pump 642 642 1 1 Skaw Precast X
VII. Responsibility Statement- 1, the undersi , assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) er's Signat MP/MPRS Number Business Phone Number
Thomas D. Gustum Pn; 227618 715 658 -1344
Plumber's Address (Street, City, State, Zip ode)
N13450 937 St New Auburn, WI 54757
VIII ount /De artment Use Onl
19/ Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued O suing Ag t Signature o tamps)
Surcharge Fee)
�
El Owner Given Initial Adverse 6
Determination
ndispersal W�tiproval/Beasons for Disapproval 3
el: tank, effluent filter and
cell must all be serviced / mai J T Sex_ 1'eV1e&WA�Ii
a ntalned �jvl /per G
as per management plan provided by plumber.
2. All setback requirements must be maintained I, 4z,Yvi 1
as per a licable c ode/ordinance- -
Attach complete plans (to the County only) for the sy em on paper not le s than 81/2 x 11 indlubi size \
SBD -6398 R. 05101
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Safety and Buildings
1340 E GREEN BAY ST STE 300
comnlerce.Wi.gov SHAWANO WI 54166
TDD #: (608) 264 -8777
It isconsin www.commer govsb,
www.wisco isconsin.gov
Department of Commerce
Jim Doyle, Governor
Cory L. Nettles, Secretary
November 18, 2004
CUST ID No.227618 ATTN: POWTS Inspector
THOMAS GUSTUM ZONING OFFICE
GUSTUM SEPTIC SERVICE ST CROIX COUNTY SPIA
N 13450 937TH ST 1101 CARMICHAEL RD
NEW AUBURN WI 54757 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 11/18/2006 Identification Numbers
Transaction II? No. 1080813
SITE: Site ID No. 692317
Jim Nichols Please refer to both identification numbers,
80TH Ave above, in all correspondence with the agency.
Town of Springfield
St Croix County
NE1 /4, NE1 /4, S29, T29N, R15W
FOR:
Description: Mound System for Jim Nichols
Object Type: POWTS Component Manual, Regulated Object ID No.: 992434
Maintenance required; 450 GPD Flow rate; 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 approved plans,
and the "Mound :'omporient Manual for Private Onsite Wastewater Systems Version
2.0" SBD- 10691 -P (N.01 /01).
• The pressure network is to be constructed in accordance with publications SBD- 10706-
P (N01 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater
Treatment Systems - Version 2.0" and /or the sizing methods of publication "SSWMP
Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) ".
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation /operation.
THOMAS GUSTUM Page 2 11/18/2004
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making hem necessary for code compliance. As per state stats 101.12(2), nothin
g rY P P g in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Keith A Wilkinson
POWTS Plan Reviewer, Integrated Services WiSMART code: 7633
(715) 524 -3630, Fax: (715) 524 -3633 , M -f 6:00 am 2:45 pm
kwilkinson @commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist (715) 726 -2544
Mound System pg 1 of 6
Cover Page
�CE�
N O V r
Project Name: Nichols 450 GPD Mound SqF 7 200 4
D
Owner's Name Jim Nichols
Owners Address 2887 - 80th Ave.
Woodville, WI. 54028
715 -455 -1799
Legal Description * w %4, FE %4 Sec 29 T 29 N, R 15 W
Township Springfield
County I aWt Croix
r7
Subdivision" € ' �' ` ` "�" `✓��
Lot#
C{ ... -E
;:-1,;1 01 51 1-1Y %� bJIi.D{ti GS
Parcel I D#
CO'J LSPONEENCE
Table of Contents / 02,00 rr M/ pg- 01
'S 1 Cover page
Q' O 2 Mound Sizing Calculations
8140M D. s 3 Pressure Distribution Layout and Dynamics
GUSTS
4 Dose Tank/ Pum p Curve
�
1201 ;� 5 Management and Contingency Plan
O 6 Plot Map
total # of pages: 6
Designer Name: Tom Gustum
License #: D1201
Date: 11/15/2004
Ph. #: 715 - 658 -1344
Signature:
Mound System Design Methods Used
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 01101)
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715 - 643 -6068 email: 3ba @3badvisement.com
��,. a ,.
`� �'`� �.
Mound System Page 2 of 6
Mound Sizing Calculations
Project Name: Nichols 450 GPD Mound
Site Co nditions Design of Entire Fill
Project Type: [I or 2 Fami Dwelli Cell depth at upslope edge (D): 19.0 in.
% Slope: P17 % Cell depth at downslope edge (E): 23.4 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: 0.6 gal /ft /day End slope width (K): 10.7 ft.
Effluent quality FE #1 Fill length (L): 96.4 ft.
Max BOD effluent value: 220 mg /I Upslope width (J): 7.4 ft.
Max TSS effluent value: 150 mg /I Downslope width (Toe) (1): 11.9 ft.
Fill Width (W): 25.3 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: 1343 ft
Distribution cell length (B): F - 7 - 5 - . - Ol ft
Area of Distribution Cell: 450.0 ft Observation Pipes
Contour Elevation of Mound: F 95.00 ft Location from end of cell (Z): 12.5 ft
System Elevation of Mound: 96.58 ft
Final Grade of Mound: 98.38 ft
Mound Plan View
Observation Pipes Z
w y
B K
Tilled Area/Fill Material
L
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric G
Distribution Cell
System Elevation a, F
Cover M ate nal Lateral p 3
Invert
Fill Material Tilled Area
Slope FDrcemain 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)(g)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System Page 3 of 6
Pressure Distribution Calculations
Project Name: Nichols 450 GPD Mound
Lateral Layout Lateral /Manifold Design
Lateral elevation: 97.1 ft Lateral diameter: 1'i2 'w In.
Rows of Laterals: L2 ' Lateral spacing (S): L ft
Manifold type: yp C enter 'w] Lateral to cell edge: 1.5 ft
Orifice diameter: 0.188 In. Lateral discharge rate: 12.52 gpm
# of Laterals: 4 System discharge rate: 50.07 gpm
Distal Pressure: 2.5 ft Manifold diameter: 2 In.
Lateral Length: 37 ft Manifold length: 3 ft
Orifice Spacing /Distribution Forcemain Friction Loss
Orifice spacing (X): 24.00 Inches Forcemain length: gg ft
Orifices per lateral: 19 Forcemain diameter: 2 vJIn.
Avg. ft2 /Orifice: ,sue ft 2 Friction loss in forcemain: 4.4011
Lateral Side View
Manifold
Lateral � Lateral
x x x x x x x x x x x x
2 2
Lateral Length Lateral Length
Lateral Plan View
Lateral Lan th
Turn -up w ball valve — c4—a ut plug
:J F PVC laterals, forcemain and manifold to imply with
pecifications per Comm 84.30[2]
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Glean -cut 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 45'8 L 3/8" Bar
Late
Mound System Page 4 of 6
Septic, Pump and Dose Tank
Project: Nichols 450 GPD Mound
Tank Information Dosage Volume
Pump tank manufacturer: Skaw Precast Does forcemain drain
Pump tank size /model: 642 back to tank?
Pump tank gal /inch: Lateral void volume: �*.I gaI
Tank bottom elevation (inside): g2 ft Dosage to absorbtion Cell: ;* - fgal
Septic tank manufacturer: Skaw Precast Forcemain volume: 15j37gal
Septic tank size /model: 1000 Total dosage: 93.6 gal
Pump and Filter Total Dynamic Head
Pump Manufacturer: Little Giant Are laterals highest point?
Pump Model: 9EH if not, enter highest elevation: 0 ft
Effluent Filter: simtec STF 110 System head (distal x 1.3) 3.25 ft
Vertical Lift ( "D" to lateral) 4.08 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: 4.
Pressure loss from filter: ft
Total dynamic head (TDH): U.73 ft
Pump Tank Diagram ,r�
Watertight Locking Cover ' ` C
4 Inch With Warning Label
Finished
Minimum Grade Dose Tank Levels
In. Gal
Alternate Z
A Reserve l Z
4e 321.2
Location Elect. per Comm B Pump off to Alarm 2.0 32.5
_J 16.28 and
Forcemain NEC 300 C Total Dosage 5.8 93.6
Weep Hole A D Effluent depth for pump 12.0 194.8
or Anti- Total Capacity: ra9-6 642.0
Siphon B
Device 311.
C
Pump Curve: 9EH
D FLOW- LITERS /HOUR
0 1000 2000 3000
30 10
f N
w 7.5
W
20 W
Pump must be capable of: 50.1 GPM A s
and head pressure of: 11.8 Feet =
2.s
10 s
0
0 20 40 60 80
Little Giant FLOW- GALLONS /MINUTE
9EH PUMP PERFORMANCE CURVE
11sv 60Hz
i
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 113 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 RT Page 1 of 3
Division of Safety and Buildings in accordance with Com t35, Wis. Adm.�6d� Gustum Septic Service
Attach complete site plan on paper not less than 8% x 11 inches in size Plan Coun
/; ,a r St. Croix
include, but not limited to: vertical and horizontal reference point (BM), rection� r of Z bi4,
percent slope, scale or dimensions, north arrow, and location and dis ce to nearest road Parc I.D. n —/
Please pint all information. ;?1_ ;o�)th u1 ? . V
Z(�p11fE( Revi' ed B Da fo
Personal information you provide maybe used for secondary pmpow-s Low. s. -
Property Owner Property Location
Nichols, Jim Govt Lot n/a NE 1/4 NE 1/4 S 29 T 29 N R 15 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3Y6
2887 80th Ave n n/a 'ap
City State Zip Code Phone Number _f City J Village _J✓ Town N est Road
Woodville WI 1 54028 1 715 - 698 - 2486 Springfield 1 80Th Ave.
✓J New Construction Use: ✓l Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
I Replacement _j Public or commercial - Describe:
Parent material glacial til Flood plain elevation, if applicable n/a
General comments
and recommendations: Part of 10 acres. Recommend mound system along 95.0' contour.
Boring # I Boring
1/ Pit Ground Surface elev. 93.65 ft. Depth to limiting factor 29 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
*Eff#1 *Eff#2
1 0 -5 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8
2 5 -15 10yr3/4 none sl 2msbk mvfr cw 2m,1co 0.6 1.0
3 15 -21 10yr4/4 none sl 2msbk mvfr cw 1 m,1 co 0.6 1.0
4 21 -29 10 r4/6 none gr. sl 2msbk mfr cw - 0.6 1.0
c2 -3p 10�•r7 2
5 29-40 10yr4/6 7 5vr5 8 gr. sl 2msbk mfi - - 0.6 1.0
Boring # Boring
I/ Pit Ground Surface elev. 93.5 ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence undary Roots GPD /1`1
*Ef1#1 *Eff#2
1 0 -5 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8
2 5 -12 10yr3/4 none sil 2msbk mvfr cw 2m,1 co 0.6 0.8
3 12 - 17 10yr4/4 none sill 2msbk mfr cw 1 m,1 co 0.6 0.8
7.5-,T5 T
4 17 10 Y r5/6 c2 -3p 8 sil 1 msbk mfr - - 0.4 0.6
8
* Effluent #1 = BOD s> 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD 30 mg/L and TSS <30 mg/L
CST Name (Please Print) Signature: CST Number
Tom Gustum 227618
Address Gustum Septic Service Date Evaluation C ducted Telephone Number
N13450 937th St., New Auburn, WI 54757 9/16/2004 715 -658 -1344
1
r �
Nichols Jim Pa
Property Owner = Parcel ID # e 2 of 3 9
3] Boring # —J Boring
1/ Pit Ground Surface elev. 95.5 ft. Depth to limiting factor 18 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : GPD
*Eff #1 *Eff#2
1 0 -7 10yr2/2 none sil 2msbk mvfr as 21',1m 0.6 0.8
2 7 -14 10yr3 /4 none sil 2msbk mvfr cw 2m,1co 0.6 0.8
3 14 -18 10yr4/4 none sil 2msbk mfr cw 1 m,1 co 0.6 0.8
c2 -3p 10}T7 2
4 18 - 35 10yr5/6 7 5AT5 8 stoney si 1 msbk mfr - - 0.4 0.6
4 Boring # Boring
Ground Surface elev. 96.5 ft. Depth to limiting factor 24 in.
or] Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAVI
*Eff#1 *Eff#2
1 0 -7 10yr2/2 none SO 2msbk mvfr as 2f,1m 0.6 0.8
2 7 -12 10yr3/2 none sl 2msbk mvfr cw 2m,1co 0.6 1.0
3 12 -17 10yr4/4 none sl 2msbk mvfr cw 1 m 0.6 1.0
4 17 -24 10yr5/6 none stoney sl 2msbk mfr cw - 0.6 1.0
5 24 -35 10yr4/6 c2-7. T5 r 2 gr. sl 2msbk mfi - - 0.6 1.0
F—I Boring # _ Boring
_ f Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
* Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg/L and TSS <-30 mg/L
The Department of Commerce is an equal ual opportunity service provider and employer. If yon need assistance to access services or
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�� 1574 FIAG E343 K 6366.39 H
STATF WISCONSIN FORM I - 1998 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
pocument Number
01 -11 -2001 9:30 AN
This Deed, made between Michael J. Shimek and WARRANTY DEED
Kathle R. Shimek, husband and wife EXEMPT 0
CERT COPY FEE:
Grantor, COPY FEE:
TRAWFER FEE: 585.00
an a d Jmes O. NicholS . and See H Nichols as RECORDING FEE: 10.00
sux - v j v orshlp marital ro rt PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of
Wisconsin (the "Property "):
The East 820.7 feet of the Northeast Quarto= Recording Area
(NE1 /4 of NE1 /4) , Section 29, Township 29 North, NameandReturnAddress
Range 15 West, Town of Springfield. RETURN TO TITLE ONE
706 19TH STREET SOUTH
HUDSON, WI 54016
034 - 1063 -20 - 000
Parcel Identification Number (PIN)
This is homestead property.
(is) (is not)
i
together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Road-ays, Easements and Restrictions of Record.
a`]
Dated this day of ^
1
*Michael J. Sh
*
thleen R. me
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
) ss.
Signature(s) ?); _poz-b County. )
Personally came before me this 2 _day of
t`L'I C - , X a the above named
authenticated this day of
Kath
' to me kno to be the person $ who executed
TIl i,L: MEMBER STATE BAR OF WISCONSIN the fore i instru nt
(If not, WAYNE
C
C. LUCE
authorized by § 706.06, Wis. Stats.) My COMMISSIONNCC 796a�
THIS INSTRUMENT WAS DRAFTED BY 1- two- 3.WMARY Fla N01try senneee 3 OCT!!
* �u A•,Ne r i,, er
Notary Public, State of W reeensttt" f < • d h
I�ichaa H. Forecki . Attor_ ev My Commission is permanent. (If not, state expiration date:
Eau CIA W*sco s )
(Signatures may be authenticated or acknowledged. Both are
not necessary.)
*N.,mcs or persons signing in any capacity must be typed or printed below their signature.
STATE ORM No. I W I SCO NSIN
"S
W DEED 0l77a4E6.UFD
Produc*tl with 2ipFtlrm by V*rtiadt Inc. 19025 Fifteen Mile Rob, CliMOn T Mi 71,S) 35 302 9• (�) � 935 112
Ant ney nii<hacl F4 F—.ki 1930 Bracken Ave, Eau Claire WI 54701 -4627
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer J P t'Y1
Mailing Address Z � J Ck�) oc&y\
Property Address a-' c l
/ (Verification required from Planning Department for new construction.)
City /State aJ pA 11e Parcel Identification Number
LEGAL DESCRIPTION
Property Location &L '/4 ,'/4 , Sec., T N R1f�V, Town of I I�
Subdivision , Lot # .
Certified Survey Map # OUY Volume Page # 50S
Warranty Deed # C ev'9 /1 1 )Volume 5 ,Page # 3
Spec house ii yes i� no Lot lines identifiable / Lj 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 County 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 s t forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certificati stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning
Departure ithin 30 ays of th+e thr ye r expiration
IG date.
SNA URE OF APPLICANT DATE
OWNER CER TIFICATION
e 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 escribed above by virtue of w rranty deed recorded in Register of Deeds Office.
7 //s /
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if
reference is made in the warranty deed.
9:30 AM
'f his Deed, made between Micheal J. Shimek and WfakRhNTY DEED
f Kathleen R. Sh imak, husband and wif EXEMPT Y
CERT CONY FEE:
— _ Grantor, COPY FEE:
and James - O. Nichols - and Sae H. Nicho as — _ T ECORD IN FEE: 565.04
RECORDING FEE: 10_00
su rvivorship marital property PAGES: 1
� — C;rantee.
Grantor, for valuable consideration, conveys to Gran tee the following
in St. Croix County, State of
j� described real estate _
} Wisconsin (the "Property "):
The East 820_7 feet of the Northeast Quarter -- - - - -- iZ -
CCnrding Arca
If (NE1 /4 of NEl /4), Section 29, Township 29 North,
Range 15 West, Town of Springfield. Name anct Return Address
RETURN TO: TITLE ONE
!I 706 19TH STREET SOUTH
Ij HUDSON, WI 54016
k ,
� ff 034- 1053 -20 -000
4
Parcel ldentificalion Number (P1N)
�I This is homestead property.
(is) (is not)
Ef
I!
I�
Together with all appurtenant rights, title and interests.
I1 `` Grantor warrants that the title to the property is good, indefeasible. in fee simple and free and clear of encumbrances except
Roadways, Easements and Restrictions of Record_
Glared this '� � � day of
M J. Sh c - --
thleen R . uke - - - - - --
It
AUTHIEN'FICATION AC'KNOWLEi (;MENT
S"I'ATF OF WISCONSIN )
Si matures ) ss.
6 ( )-- - - ---- _ Count
-- personally came before me this 2� day of
F authenticated this day Of -- _ - -- _ *� c CLvti �[� . Z o°: the above named
-" Michael J. Shi.me�
Kathleen R Shimak
to n1c kno to he the persons who executed
I'll MEMBER S7'A "fE BAR OP WISCOhISSN
t}te tore a instrunIrrit ' _ WLCUg-
WAYNF C. I_UCF_ I
{{ authorized by § 706.06, Wis. StaIs.) � -- MY commg [Io±u
MCC'796bt"' .
. :-
t 'I ILIS INtiTR CIMI -Nr WAS DIZA11ED 6ti' � 1- vuo- 't- tvOTARY Fi. N«.y5m+cs& meei�C
* j
Notary eC _
Mich H. Fo • Attor _.____ -._
Notary public, State of W+seerttrStT►
Eau Clais � W isconsin My Commission is permanent. (!f not, state expiration date:
St gnature% may be authenticated or ackffowledged. Roth are
! not necessary.)
�` •1�arne+ oC perxfns sit:nmg in aoy capacity must be typed or primed below their signature.
j3
STATE BAR Of WISCONSIN
WARRANTV I)EVI) FORM Nc 1-19"
Fr .mo _ Zip( try Yernec%f Irtc 18Q25 f Men M le "o d. G I. Taw w Mlt an 4IIC35, t8 MJ -OW5
' r4s's+�xy A.4VChact tr Fegrclj Iu�D
V.71.46 1SG Ul
B- B- A E—C I-- W7 K3G:J -JRn_7 Tiarc. (71`•/ 635.11'24 Fsa. (71 �7 a)� -411' I)
� � -1 -A
i
FORM NO. 985 -A
8 KZ14
Stock No. 26273 6
VQL. PAGE 5051
REGISTER OF DEEDS
RECEIVED FOR ECORD
08/24/2005 02.36PH
CERTIFIED SURVEY MAP NO . CE RT IF IE D r SURVEY MAP
---- -� . 13.
VOLUME 20 5051 COPY FEE 3.00
PAGE .PAGES. 2
PART OF THE NORTHEAST QUARTER
OF THE NORTHEAST QUARTER,
SECTION 29, TOWNSHIP 29 NORTH, RANGE 15 WEST,
TOWN OF SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN
UNP
North 114 LANDS 2655.77' exis Ong NE comer
Section 29 -29 =15 centerline existing driveway Section 29_29 -15
Found 1.25" Iron Pipe driveway N89'45'02 "E 820.70' Found uA - m - Vo
0 J _ _183_5._07' _ - _ — — 340.70' — — — — — — — 480. —OOT — —
j N$9'45'02 "E _ T 9_45 02 E _� — — — — —
3q . ' — — — 1 480.00' 33.O0T
33.00' a 33.00' g
well building setback line
° shed
PREPARED FOR: soil tests
Da
James and See Nichols
2887 80th Ave.
Woodville, Wt 54028 LOT 2
2 � o
at 01 a 435,600 sq.ft. A is
`O to o c 10.00 acres it N
f incl. r -o -w 9
am
419,760 s ft. `
UNPLATTED q rn
LANDS 9.64 acres
- - -- �„ not incl. r -o -w
N
N �
V .p
� A
CL
480.00' w
DRAFTED BY: s89 "W v
J6 SURVEYING LLC "
0
966 Rustic Rd 3 LOT I
Glenwood City, WI UNPI.ATTED
653,884 sq.ft. 642,640 sq. ft. .o LANDS
15.01 acres 14.75 acres o_ - - --
incl. r -o -w not incl. r -o -w
SE corner
NE /NE
S89'44'08 "W 820.70'
UNPLATTED LANDS
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 St. Croix County Zoning Office for advice.
SCALE: 1" = 250'
i swot :
o' 250' Soo' .-son
Me"Oe oo MY
LEGEND <-q m
y 0.......... Government Corner (as noted) �S
North is referenced to the o .......... Set 3/4" X 18 " iron rebar
North Line of the Northeast weighing 1.502 tbs./lineal ft.
Quarter of Sec. 29- 29 -15,
which bears N89 °45'02"E • ........ Found 1" iron pipe
(St. Croix County Grid System)
Vol 20 Page 5051 Page 1 of 2
L
FORM NO. 98yA
Stock No. 26273
CERTIFIED SURVEY MAP NO. 5051
VOLUME 20 PAGE 5051
PART OF THE NORTHEAST QUARTER
OF THE NORTHEAST QUARTER,
SECTION 29, TOWNSHIP 29 NORTH, RANGE 15 WEST,
TOWN OF SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN
SURVEYOR'S CERTIFICATE
I, Joel A. Brandt, Registered Land Surveyor, hereby certify that I have surveyed,
divided, and mapped part of the Northeast Quarter of the Northeast Quarter of
Section 29, Township 29 North, Range 15 West, Town of Springfield, St. Croix
County, Wisconsin, more particularly described as follows=
Commencing at the Northeast corner of said Section 29, as the point of beginning
of the parcel herein described
Thence S00 ° 16'19 "E, along the east line of the Northeast Quarter of said Section
29, a distance of 1327.40 feet, to the south line and southeast corner of the
Northeast Quarter of said Northeast Quarter,
Thence S89 ° 44'08 "W along said south line, a distance of 820.70 feet
Thence N00 ° 16'19"W, a distance of 1327.61
feet, to the north line of said Northeast
Quarter
Thence N89 ° 45'02 "E, along said north line, a distance of 820.70 feet, to the point
of beginning.
Said parcel contains 1,089,484 square feet (25.01 acres). Said parcel is subject to
the right-of-way f 80th Avenue and d to the easements of record and as shown.
That I have made such survey, land division, and map at the direction of James and
See Nichols, Owners, 2887 80th Avenue, Woodvile, Wisconsin, 54028. That such
map is a correct representation of the exterior boundaries of the land surveyed,
and the subdivision thereof made. That I fully complied with the provisions of
Chapter 236.34 of the Wisconsin State Statutes and the subdivision regulations of
St. Croix County in surveying, dividing and mapping the same.
V'r
Dated this day of Aul V ST 2005. x.
�` tiwor
�->
I A A
2 °uM► *000 atr�
wi
Joel A. ndt, R.L.S. #2603 �q pQ`
� suRV�
Approved this )- 'f - day of do S 2005. APPROVED
f �! / ✓"1
ST. C1lOpc COUNTY
/,�, G 7,KrtAtitq i ZetRMg CawtstMise
St. Croix County Zoning AdrM tis+ratc& AUG 2 4 2005
If not raooroed within 30 days of
approval d a t OPMOVvold 1 shah ba
Page 2 of 2
Vol 20 Page 5051
a
ub
dsa ^ ` rah
Ala -J
Z 1""j ° s �
Wh
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c.t
. .. Y
yUN.ffi
Parcel #: • 034 - 1063 -20 -000 07/18/2005 12:36 PM
PAGE 1 OF 1
Alt. Parcel #: 29.29.15.434A 034 - TOWN OF SPRINGFIELD
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): ' = Current Owner
JAMES O & SEE H NICHOLS ' NICHOLS, JAMES O & SEE H
2887 80TH AVE
WOODVILLE WI 54028
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 2887 80TH AVE
SC 0231 BALDWIN- WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 25.000 Plat: N/A -NOT AVAILABLE
SEC 29 T29N R15W 25A IN NE NE E 820.7 FT Block/Condo Bldg:
OF NE NE
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
29- 29N -15W
Notes: �/> Parcel History:
n (� /_ �' 01) Date Doc # Vol /Page Type
(f
Y �t l d" 07/23/1997 636639 1574 WD
Zs: \° 14
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations Last Changed: 06/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 12,950 157,800 170,750 NO
ENTERED BEFORE'05 CLO W8 23.000 41,400 0 41,400 NO
Totals for 2005:
General Property 2.000 12,950 157,800 170,750
Woodland 23.000 41,400 41,400
Totals for 2004:
General Property 2.000 12,950 157,800 170,750
Woodland 23.000 41,400 41,400
Lottery Credit Claim Count: 1 Certification Date: Batch #: 310
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
St. Croix County Map Output Page Page 1 of 1
St. Croix Count Ma in
Leamrvd
i
St. Croix County Planning Department`�'��
1101 Carmichael Road q C*tV1AW4 � x
Hudson, WI 54016 #r"Wc"r
Phone: (715) 386 -4674 RIO44
L�`aririarl�
DISCLAIMER : The information contained on this map is advisory. Map s
accuracy is limited by the quality of the public records from which it was Wawa
prepared. It is not intended as a substitute for an accurate field survey. cw*laaw
ON*" M two" XzW*A ^
AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist
presently in the County may not be present in the photos.
http: / /72.21.230.178 /servlet/com. esri. esrimap.Esrimap ?S erviceName= StCroixOV &Client... 7/18/2005
I � I�
SPRINGFIELD PL R.29N- 'R.15W 3 �
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SEE PAGE 23 ,9 >Cro/ie Couniy,Wio ••"`
STEINER SALES & SERVICE, INC.
SURGE
THE WORD THAT MEANS SERVICE IN DAIRY EQUIPMENT
& WATER SOFTENING
YOU'RE A STEP AHEAD WITH SURGE
PHONE: 684 -3261 or 684 -3041 BALDWIN, WISCONSIN
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