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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 430222 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:
Coleman, Roger I Springfield Townshi 034 - 1064 - 70-000
CST 7 Elev: Insp. BM Elev: BM Description: C Section/Town /Range/Map No:
29.29.15.
TANK INFORMATION ELEVATION DATA Z' to' /
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchma ...cam
/CX3v (oSU � /•)O.UC.,
Dosing 7 SU Alt. BM
LAJ
c
Aeration �_ ��� Bldg. Sewer
Holding
SUHt Inlet
TANK SETBACK, INFORMATION % �� +� C _ Sl . 4et T 10,3 7 y j
TANK TO WELL BLDG. ent to Air Intake ROAD Dt Inlet
c,'f l" ,
Septic 1 �1J . / _ Dt Bottom
�.
Dosing f , Header /Man. 2 E3 )Z_
Aeration �... -^__— C2 Disf. �; 8 `� 1\ 1 (J
Holding Pot. System 3 ,✓ 3 i o: - �' / t} t • I
C Ur -�, Q/r
Fin I grade •h
PUMP /SIPHON INFORMATION z o S }t
Manufacturer G Demand O St Cover
e.._.\ a - GPM M t fk l
Model Number W E n `3 t \ .ZS ( 'J
Pr cn 1UU• �� 5
TDH Lift C Friction Loss System He TDH G ` 4
ll 2 - � T
Forcemain Len th Dia. Dist. to Well . - -V s
G 7 IVU� 1 /t`� C_-,4 wI%i
Ir
.,
SOIL ABSORPTION SYSTEM aE. F A."
BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS L7 't
SETBACK SYSTE TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufactur r:
INFORMATION CHAMBER OR
Type Of ystem: 0 c'T UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Length � ' Dia C.— Length / / 7✓ Dia z— Spacing bb 1 —3 (O
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Se /Sodded xx Mulch
Bed/Trench Center !,1 Bed/ trench Edges , �J �t Topsoil �t �� —
s I No 1 Ye No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 10 / 3 / 0 3 Inspection #2: �o / 3 /_�Z
Location: Unknown (SW 1/4 SW 1/4 29 T29N R15W) NA Lot 1 ' `� 7 Parcel No: 29.29.15.
1.) Alt BM Description = S-t =b ��
2.) Bldg sewer length = 35
- amount of cover
p-� ¢' ( ► u_�:,.� ,� l�� er, r'Y�-r
pl ae other i s de for additionalnformatibn. No ✓�_ `'
5710 (R.3/97) _
bate Insepctor's Signature Cert. No.
.� C
1 t V La
` Safety and BliildinA Division County
an an 20. Washington Ave., P.O. Box 7 82 /� t
1 W Sf - C r - O ;�
iscon in Madison, WI 53707-7082 Sari Permit Number (to be filled in by Co.)
Department of Commerce (608) 261 -6546 � ?7 -
Sanitary Permit Application State Plan I.D. N
In accord with Comm 83.21, Wis. Adm. Code, personal,�nfotmation you provide S 5 G7
L� �
may be used for secondary purposes Privacy Lfw, s15.04(1 Project Address (if different than mailing address)
I. Application Information — Please Print All Information'
Property Owner's Name Parcel # t # Block #
Property er's Mailing Address ope / rty ation
!rte U , S�t/ %, Section (�
/
City, State Zip Code Phone Number �1ec
Lil f SGGi^- �,t /� v � sy��L � — 1/ /
�G ' /s T N RE le
II. of Builds g (check all that apply) Qy
/{�� �� � /" 4w Subdivision Name CSM Number
�
1 or 2 Family Dwelling — Number of BgdfbO'lJ�"� s • �5 � (t
❑ Public/Commercial — Describe Use ` ' J�
❑ State Owned — Describe Use t!2. .� ity ❑Village R'ownship o
r.r•
III. Type of Permit: (Check only one box on line A. Complete line B if applicable
A
CZ
. New Sy ❑ Replacement System yn ep ys ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
l3 • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. T of POWTS System: Check all that apply) OR.EnKO 1='f Mi
❑ Non — Pressurized In -Ground ErMound > 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 Cl
Recirculating Synthetic Media Filter ❑ L.eaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design So' placation Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
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 1 6 00
Aerobic Tremment Unit
Dosing Chamber
J
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
A 14 f4d sa �,� 7r�- 07 -337
Plumber's Address (Street, City, State, Zip Code)
VIII. Coun /De artment Use Onl
Approved ❑ Disapproved Fanitary Permit Fee (includes Groundwater Date Issued Is uin Agent Signature o Stamps)
urcharge Fee) 350
❑ Owner Given Reason for Denial 2
IX. Conditions of ApprovaUReasons for D
;Q�
Attach pkte plans (to the County only) for the tem ea paper not less than gl/Z z 11 1 best slze
SBD -6398 (R. 08102)
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Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TD
#: (608) 264 -8777
isconsin www.wisconsin
.wisc . on sinssb
Department of Commerce .wiscsin.gov
Jim Doyle, Governor
Cory L. Nettles, Secretary
July 16 2003
CUST ID No.222774 ATTN: Rod Eslinger
HENRY F GROTE ZONING OFFICE
CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA
E4366 353RD AVE 1101 CARMICHAEL RD
MENOMONIE WI 54751 HUDSON WI 54016
CONDITIONAL APPROVAL
Id Io. 6 Numbers
PLAN APPROVAL EXPIRES: 07/16/2005
Transaction ID No. 886632
SITE: Site ID No. 661947
Roger Coleman Please refer to both identification numbers,
USH 12 above, in all correspondence with the agency.
Town of Springfield
St Croix County
SW1 /4, SW1 /4, S29, T29N, R15W
FOR:
Description: New 3BR Mound
Object Type: POWT System Regulated Object ID No.: 911896
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:
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.
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 ry4y�
review shall relieve the designer of the responsibility for designing a safe building, structure, or component. �f
p O tt
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��
�Q
Fee Received $ 175.00
Balance Due $ 0.00.;:
Dennts R orensonrC
Wastewater Specialist, Field Operations
(608)785-9336, Mondays 7:OOAM- 3:45PM WiMART code: 7633
dsorenson@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Henry F Grote , Certified Soil Testing
Roger Coleman - Mound
Transaction # � t" t" '. `—
Construction Materials and Techniques
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manuals:
Mound, SBD - 10691 -P (01 /01)
Pressure Distribution, SBD - 10706 -P (O1 /O1)
Location: SW 1/4, SW 1/4, Sec. 29, T 29 N, R 15 W
Town: Springfield
County: St. Croix
Date: July 15, 2003
Owner: Roger Coleman
Address: 684 CTHW NN
Wilson, WI 54027
Designer: Henry Grot
Signature: = �
` y — � GO�o�o��� •
: ����\
License # WI - D 1 -007 i�i'',I' DE \
Attachments: 6748 -Plan Approval Application
SBD -8330 JAGE SYSTEM
page 1: cover
di®nally
2: design criteria & calculations
3: plot plan ROVED
4: system cross section f SAFETY AND BUILDINGS
5: plan view, lateral detail (�
6: pump tank exit detail �1 -- ,X41
7: pump curve CORRESPONDEN
8: system management
RECEIVED page 1 of 8
J U L - 1 2003
SAFETY & BLOGS 01V
Design Criteria
Residential Wastewater Contaminant Load: 30 mg /L < BOD < 220 mg /L
Anticipated septic tank effluent 30 mg /L < TSS < 150mg /L
f Fecal Coliform> 10,000 cfu/100 mL
Fats, oils, grease < 30 mg/L
Bedrooms x 100 gal/bedroom/day x 1.5 gallons /day hydraulic load
Design Calculations
In situ designed loading rate (D.1 I gallons /sq. ft. per day
Depth to estimated high ground water 2 9 in.
Depth to bedrock 4 r b in.
Cross slope at system --!� %
Force main length 2.0 ft. of Z in.
Manifold /header length or ft. of in.
Drain -back • Z to gallons
Lateral length @ SS�� ft. of \`IZ- in.
1. Lateral elevation I b ft. @ bottom of lateral
Lateral hole size -1 /16 in. @ 16 .0 in. ( 1 - 0 ft.) Spacing
\ C� holes /lateral 3 g holes total
Lateral volume ° • Zti 't - gallons
Total lateral discharge rate — 2 S� n gallons /minute @ ft. head
Network pressure compensation losses . - +e ft
Elevation difference 4, k ft.
Friction loss 0 1 7-% ft. @ 7 gallons /minute
Total dynamic head k o•b 3 ft.
Pump /si*n 2 ,9 gpm @ t Z ft. of head
r Manufacturer Model #
Dose volume gallons
Lift/sipkhon tank (A.LQ 6 'b gallons
Septic tank \ '�� gallons
Effluent filter c9 -t43A
Measurement pump on and off 5" O in.
Height alarm from tank bottom e' o in.
Reserve capacity gallons
s p ecs.calcs.res
v.
Z
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WEATHERPROOF
LOCKING GOV1zR JLNCTICt,
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5EP7iG E SPEC.IFI'CATI0Q$ c�
DO $ E I ( �b �
Tn� /v�AQUFACTURCR: j-} (J UMBER OF DOSES; �"� PEK Cam=
TA►JK 51Z E ; QUO - (P
Clio GALl.01J S
DOSE VOLUME .
ALAKr /W
1 P'IUFACTURCR: S ��� O K-�v IMCLUOINC, OACKFLOW:
MODEL QWAbER; ° k �'} 1 `�' CAPACITIES A = ZI ''� WcHCS OK
SWITCH TyPC:
IWCHEs OR Z �' g
AIJUFACTURCR : / y
C a �.Q uCnES CH^�
OR raA
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�w'ITCH TYPE: V^Q'b 0 ' INCHES ._ _.
_ 1JOTE' PUMP AW ALARM ARC TO 6C
t"I"JIMUf'\ DISCHARGE RATC ZS`� G., IN57ALLE0 OIJ SEPARATE
VIKTICAL DIFFEK[WCE BETWCCU PUMP OFF A&10 OISTKIbUT101J PIPE„ 1
FEET
* M,IUIMUM �JCTWORK SUPPLY PRE;suKE . . 7-.!r 75
lo FT
+ � ECET OF FORCE MAIW X ..= FX CC
onFRICTIOU�FACTOR. ��� FEET
TOTAL DyIWAMIC. HEAD ti O't.S FEET
IIJTERKIA�, DIME1J610AJC ' 0I TAQK: l_E►,1G7H
;W DTH
LIQUID pe PT H _
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Pump Characteristics Performance Data
► Meter Udt Se>�eoesEile t
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MI L40d bw t.0 e . so _. _ _�....
04 for Sleor♦ed P� 14 )
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leraper�twe 12" Amttt (yrch�lS N,tl 1 to to w to St
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DiuMor She 1 - /2e N►T 136stted Total 11 ( foot) 4 i 12 16 20
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50114 wwwh" 3/4 I14tts� 0'M (U.S.) 1 . 44 36 21 ZS 12
0
UAIT wolglot 30 6s•
hwet Cord 16/3, SJ'IW, zo' s►r. Dimensional Data
Materials of Construction r;; ' � wx
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Nedle Sbieleee Stud r ., a my: 111 nd
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Web Site: ww.Penldr► oM
SALES OFFK15 IN All NUJON CITIES AND COUNTMIIS
ilem u: W- 02.0350 1206 5M �" "�
� f 1
System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems
develop with the adsorption system or any other system components, the installing plumber or the St. Croix County Zoning Office, 715-
386 -4680, should be contacted for assistance.
General
Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain
greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment
to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to
protect ground water quality and public health.
I . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence
to contaminant load design criteria.
2 Install water - saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5. Garbage disposals are not recommended; if you must have one, use it sparingly.
6. No paper products other than tissue should go into the system.
7. No chemicals should go into the system.
8. Avoid surge flows of water; try to spread laundry throughout the week.
9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans.
10. If septic or pump tanks are no longer used, they must be properly abandoned.
11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching
may be required to maintain a functional system at start-up.
Maintenance
1. The septic tank must be inspected every three years by a properly licensed person.
2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume.
3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into
the septic tank to remove accumulated material.
4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump.
If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve
capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
two days should pass before any necessary repairs can be made.
7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system.
8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area.
11, Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient
oxygen.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing .
and /or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
-
ORIGINAL
• 1641
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing
Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
CSM Pending
.Dy 3 �0 67`1 Please print all information. viewed By A Dat , e .
Personal information you provide may be used for second s. 15.0 (1) (m)). W& Z 2
Property Owner Proilerty Location
Coleman, Roger Govt. of SW 1/ SW 1/4 S 29 T 29 N R 15 W
Property Owner's Mailing Address o 1 Lot Block # Subd. Name or CSM#
3133 Shores BI'vd I CSM Pending
City State Zip C de PhreCYtidie� i City f Village 1I Town Nearest Road
Wayzata MN 5539 N Springfield I USHW 12
✓ New Construction Use: i Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement _.a Public or commercial - Describe
Parent material till Flood plain elevation, if applicable NA
General comments
and recommendations: install 4'x 112.5' rock cell mound on 100.5 contour as upslope edge of rock w/ 0.6' sand fill
FT] Boring # .�` Boring
Pit Ground Surface elev. 100.4 ft. Depth to limiting factor Wi n. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDA
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
1 0 -10 10YR 2.5/2 sl 2 f sbk mvfr cs 1f /m .5 .9
T 10 -17 10YR 4/3 s1 1 m sbk mvfr cw I 1 m .4 .6
3 17 -30 7.5YR 4/4 Is 1 m sbk mvfr cs 1 1 m .7 1.2
4 30 -36 10YR 4/6 s 0 sg ml cs 1m .7 1.2
5 360 10YR 4/6 f2d 7.5YR 5/8 s 0 sg _ ml aw .7 1.2
6 4 -46 7.5YR 3/4 c2p 7.5YR 5/8,5/3 scl 0 m mfr - 0 0
F2 ] i
Boring # .. Boring
e Pit Ground Surface elev. 101.5 ft. Depth to limiting factor 32 in Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 1 0 -9 10YR 2.5/2 sl 2 f sbk mvfr cs 1f /m .5 .9
2 j 9 -25 10YR 4/3 - sl 1 m sbk mvfr cw 1 m .4 .6
-- – - --------- ---- ----- - ----- - -- - -- — - --
3 25 - 32 10YR 4/6 1 Is 0 sg 1 dl cs 1m .7 1.2
4 32 -44 7.5YR 3/4 f2d 7.5YR 5/8,5/3 scl 0 m mfr - 0 j 0
I � i
horizon 4 has considerable gr & cob
' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mgr
CST Name (Please Print) Signature: - CST Number
Henry F. Grote 222774
Address Certified Soil Testing Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave., Menomonie, WI 54751 4/27/2002 715 233 - 0398
Property Owner Coleman, Roger Parcel ID # CSM Pending _ Page 2 of 3
❑ Boring # ..j Boring
✓' Pit Ground Surface elev. 101.5 ft. Depth to limiting factor 29 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -9 10YR 2.5/2 - sl 2 f sbk mvfr cs 1f /m .5 .9
2 9 -29 10YR 4/3 - sl 1 f -m sbk mvfr cs IM .4 .6
3 29 -34 10YR 4/4 f2d 7.5YR 5/8,5/3 scl 0 m mfr - 1 m 0 0
i
I
Boring # Boring
i Pit Ground Surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I I
I I
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 QPDKF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I �
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) Certified Soil Testing
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SEPTIC TANK MAINIENMIX L AGREEMENT
AND "
- OWNERSHIP CERT[FICATION FORM
Owner/Buyer &6 a t-- �o
/C rn a
Mailing Address ZZAZ ff�XP 7
Property Address
(Verification required from Planning Dipartmetit for construction)
City/State lam. " / t o ►�- , tug Parcel Identification Number
LEGAL DESCRIPTION
Property Location Ste) V(, J y Sec. ma T-ZYN -R / W, Town of-5 r;
Subdivision Lot #
Certified Survey Map # '7�� ((>� Volume Page #
Warranty Deed # 2 Volume ZZ °! Z . Page # 1
Spec house ❑ yes L7 no Lot lines idea6fiable S Y es ❑ no
.
SYSZFM- AfA.INTENANCE
Improperuseand mamicoanecofyoursqticsystemcouldresultisrtsprematz ¢icfa Uretohandlewastes.PropormaMt= nee
consists of pammping out the septic tank every three yc= or sooner if neodod by a iiccnsed pumper. What you put into the system
can affoet&e - futon of the septic to &as. a trestmcat stage is ire wrste ."stem.
Tb& by owner a8xnes to submit to St (krone Zoning Department i .eatificatioa foam, signed by the -owner amd by a
P I P nstacbodplumberori pumperraifymg that (1) the on-sd6 w d=vtcr&posal system
n in proper operating condition and/or (2) after won and pmmping.(if necessary). fire septic.tank-is less bran I/3 full of sludge.
Ywc. the undersigned have read the above rogak=cnts and agrvo to maintain tine private sewage disposal system with fire standards
set forth, hemin. as set by tine Department of Commeme and the Department of Natual
Rcsourrcx; State of Wisconsin.. Certification
stating that your septic system has been maintained mast be oanpkW and rctumed to the St. (rote. County Zm ng Office wi81m 30
tiro throe year expiration date,
of
SIGNATURE OF APPLICANT
DATE
OWNER- CERZMCATION
I (we) certify that all statcmcnts on this form are true to the best of my (our) knowledge. I (we) am (arc) the owncr(s) of
the- property des= - W above, by virtue of a warranty dad roeordod in Register of Deeds OfI "ice.
SIGNATURE OF APPLICANT /O
DATE
« « « « ««
Any mfwxiatioa that is mis-rcpreseatod may result in the sanitary permit being revoked by the Zoning Department. ««« «««
«• Include with this application: a stamped wacramty docd from the Regina of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
05!01/03 12:09P P.002
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STATE BAR OF WISCONSIN FC 61 1 2209 f 0 ®� KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Norman L. Nelson and Arlene Nelson,
husband and wife Grantor, and Roger A. Coleman and Diane M. Coleman, 136/27/2003 09:30AM
husband and wife, as survivorship marital property Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT #
described real estate in St. Croix County, State of Wiscons a "Property") REG FEE: 11.00
(if more space is needed, please attach addendum 'r TRANS FEE: 15.00
COPY FEE:
Lot One of Certified Surve Map No. 454 , s recorded in Volume 17 CC FEE:
urvey Maps, page 45e 454_ Loca a Southwest Quarter (SW PAGES: 1
114) of the Southwest Quarter (SW 114) of Section Twenty -nine (29),
Township Twenty-nine (29) North, Range Fifteen (15) West, Town of
Springfield, St. Croix County, Wisconsin.
TOGETHER WITH and S ingress and egress Recording Area
easement as show aid Certified Survey a 4546, as recorded in
Volume 1 urvey Maps, page 4546. Name and Return Address
Erin M. Heck
Z �? (0 Q Z BAKKE NORMAN, S.C.
C� L P.O. Box 280
Menomonie, WI 54751
e er with all appurtenant rights, title and interests. 034 - 1064 -70 -000 (Dart on
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, highways, utility rights and reservations of record, and will warrant and defend the same.
Dated this day of - -- 2003
* orman L. Nelson * Arlene Nelson
* *
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF WISCONSIN )
) ss.
ST. CROIX Countv )
authenticated this day of
Perso 511v came before me this �CY day of
c Lt,r1 ti 2003 the above named
Norman L. Nelson and ,,tl►tltt "'����'
* Arlene Nelson .`� • • . ,
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the verson(s) who execlged tha reeoin
authorized by $706.06, Wis. Stats.) ins nt and acknowledged the ate.
THIS INSTRUMENT WAS DRAFTED BY / 97 J' G
Erin M. Heck • M .7. r W, '
BAKKE NORMAN, S.C. Notary Pub ' ,State of �+-� 11 1T 1 1 11111M. �``��
My CommissN' n q ve ent. (If not, state expiration dale:
(Signatures may be authenticated or acknowledged. Both are not necessary.) �� tt�f �0 7
Names of persons signing in any capacity must be typed or printed below their signature. INFO -PRO ( 800) 655 -2021 www.infoprofonns.com4TATE BAR OF WISCO
WARRANTY DEED FORM No. I - 2000
FORM NO. 985 -A
.,
Stock No. 26473
CERTIFIED SURVEY MAP NO
VOLUME 17 PAGE 4546
PART OF THE SOUTHWEST QUARTER OF THE
SOUTHWEST 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 Southwest Quarter of the Southwest Quarter of Section 29, Township 19 North, Range 15
West, Town of Springfield, St. Croix County, Wisconsin, more particularly described as follows:
Commencing at the Southwest corner of Section 29, Township 29 North, Range 15 West:
Thence N00 °05'39 "W, along the west line of said Southwest Quarter, a distance of 33.00 feet, to the
north Right of Way of U.S. Highway 11, and to the point of beginning of the parcel herein described:
Thence N00 °05'39 "W, along the said west line of said Southwest Quarter, a distance of 282.29 feet ;
Thence N89 °45'36"E, a distance of 538.75 feet;
Thence S03 °44'21 "E, a distance of 282.82 feet;
Thence S89 °45'36 "W, a distance of 556.73 feet to the point of beginning.
Said parcel contains 154,622 square feet (3.55 acres).
Together with and subject to the following 66 foot wide ingress- egress easement, the centerline
being more particularly described as:
Commencing at the Southwest Corner of Section 19, Township 29 North, Range 15 West,
Thence N00 °05'39 "W, a distance of 33.00 feet to the north right -of -way of U.S.H. 12;
Thence N89 °45'36 "E, a distance of 523.67 feet to the beginning and centerline of said 66
foot wide easement
Thence NO3 °44'21"W, along said centerline, a distance of 182.81 feet, therein terminating.
That I have made such survey, land division, and map at the direction of Norman Nelson, Owner, 2812
Highway 12, Wilson, Wisconsin, 54027. 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 136.34 of the Wisconsin State Statutes and the subdivision regulations of St.
Croix County in surveying, dividing and mapping the same. Said survey is subject to easements of
record and as shown.
Access Restriction Note: All lots and blocks are hereby restricted so that no owner, possessor,
user, licensee or other person may have any right of direct vehicular ingress from or egress to any
highway lying within the right -of -way of U.S.H. 12; it is expressly intended that this restriction
constitute a restriction for the benefit of the public as provided in s.236.293,Stats., and shall be
enforceable by the Department or its assigns. Any access shall be allowed only by special exception.
Any access allowed by special exception shall be confirmed and granted only through the driveway
permitting process and all permits are revocable.
The Wisconsin Department of Transportation has granted a Special Exception to Trans 233 for the
existing driveway access located on the easement through Lot 1 to serve as a shared access with the
remaining unplatted lands. Future highway project(s), additional land divisions or change in land use of
Lot 1 or the remaining unplatted lands may require a public road intersection or relocation of the
driveway to an alternative public road at the discretion of the department.
Highway Setback Restriction Note: Highway setback line is 15 feet from right -of -way line.
No improvements or structures are allowed between the right -of -way line and the highway setback
line. Improvements and structures include, but are not limited to, signs, parking areas, driveways,
wells, septic systems, drainage facilities, buildings and retaining walls. It is expressly intended that
this restriction is for the benefit of the public as provided in section 236.193, Wisconsin Statutes,
and shalt be enforceable by the Department of Transportation or its assigns. Contact the Wisconsin
Department of Transportation for more information. The phone number may be obtained by contacting
the County Highway Department.
Dated this 1 day of J tkn E 2003.
MA
• Am rt
s�seos
Joel A. andt, R.L.S. #2603 a ' D b
Page 2 of 2
Vol. 17 Page 4546
Ra 4 DI anm Co ler� any
FORM NO. 985-A G� R d. N
ld( .lV�ier 7 2 6 6 0 a
Stock No. 26273 VOL 17 PAGE 4546
REGISTER OF DEEDS
CERTIFIED SURVEY MAP NO. 4 ECEIV 2003 OR 10E30AM
VOLUME 17 PAGE 4546 CERTIFIED SURVEY MAP
REC FEE: 13.00
�V�O COPY FEE: 3.00
pP R ;�-O BART OF THE SOUTHWEST QUARTER OF THf
ST ? 60.6 3 SOUTHWEST QUARTER,
2 aa 0
p ,,,,1a 300 L 0 S�gJJON 29, TOWNSHIP 29 NORTH, RANGE 15 WEST,
0 ' SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN
ooh �o�_�
6Pp West 1/4 Corner
29 -29 -15
I'd Alum.Monument NOTE The entrance to Lot 1 may be required to be moved to comply with
the county driveway separation ordinance if future dedication occurs
�^ over the shared 66 foot easement.
I'R UNPLATTED LANDS
N
�N
QI N 89'45'36 "E
ZI 538.75'
of 33' 133' MI
i
W c r
.. <° r. .....1...._. •ter
51 � ; ........ 133'' zi
LOT 1 NEE �I
�i rn ai r m1 N
'42 Ln Wi
M O> rn� O )~
N , N 154,622 Square feet ; NIA co r 0.
d I
s o 3.55 a , ; W;a al
i
O N
' --- - -- r -� m
Z budding setback line ' ; ai m
rn
c_
r _ -NO ACCESS---- 15 ;
__
t
P.O. O.B, �'f Highway setback Line �`! M1 _` - _ -� - -- ' � \ ; 6
-- --- *----- -- - - - -- - - - --: i
g Aces:Reshicled
C)
1 556.73' W ee Note on Page
Southwest Corner Q0 US HIGHWAY "12" n
Section 29- 29- 15- ------- ---- - - - - -- - - - - - - - - -----------------------------------
Found Bernisen Nor?
N VV , , / / N W UNPLA7TED LANDS
I
" CAUTION - HIGHWAY SETBACK RESTRICTIONS PROHIBIT IMPROVEMENTS. SEE PAGE 2 "
WISCONSIN D.O.T APPROVAL # 55 -12- 3724 -2003
The parcel shown on this map is subject to State, County and Township
laws, rules and regulations(i.e. wetlands, minumum lot size, access to a
parcel etc.). Before purchasing or developing any parcel, contact the
St. Croix County Zoning Office and the appropriate Town Board for advice.
LEGEND PREPARED FOR:
N .........Government Corner (as noted) 2812 HI WAY
2812 1 12 2 , JIC,A.
o .......... Set 3/4" x, 24" rebar weighing WILSON. WI 54027
1.502 lbs. /lineal ft.
PREPARED BY: ` M
JOEL A. BRANDY
DRAFTED BY:
JOEL A. BRANDT
North is referenced the &/I ,
West Line of the Sou 1/4 of SCALE: 1" = 100' U�
Sec. 29- 29 -15, which bears n n
N00 °05'39 "W ('7111
(St. Croix County Grid System) 0' 100' 200'
Page 1 of 2
Vol. 17 Page 4546