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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION
Pe tll-~1,dst W, eDON ❑ City ❑ Village R Town of: state Plan o.:
CST BM Elev.: Insp. BM Elev.: BM De scription: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS H S ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P / L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss Head
Forcemain Length Dia. Dist. Towel I
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM
INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length 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 Mulched
Bed /Trench Center Bed /Trench Edges Topsoil -1 Yes ❑ No ❑ Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SPRINGFIELD.21.29.15W, SW, SW, 292ND ST
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert- No
Safety and Buildings Division
v.=`riR SANITARY PERMIT APPLICATION Bureau of Building Water System,
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit NumbeYl The information you provide may be used by other government agency programs
❑ Check II r~v(n`fo pievi /u. tion
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Pr pert y Lo ation
~ i4$ Zj 1i4, S T , N, R ?5 (or
Property ner's Mailing Address Lot Number Block Number
!
City, tate „ ZIP C de Phone Number Subdivision ame or CSM Nu e
(W t; )772 - y7Z iwl 0 3 ? a3
II. TYPE OF BUILDING: (check one) ❑ State Owned yy el Nee re t Road
Z N Village 2 f ~ aL+ pt 4J
E] Public 1 or 2 Family Dwelling - No. of bedrooms Town of
III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Num er(s)
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4..M Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number /4 /Zy Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11)0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:,
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) V6 Elevation
a 5~ ~'~a 3 Feet Feet TANK Capacit Site
VII. in galio s Total # of Prefab. Fiber- Plastic Exper
FORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existing strutted
Tanks Tanks /
Septic Tank or Holding Tank S / /J
Lift Pump Tank /Siphon Chamber ❑ ❑ ~ El ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plu er's Name: (Print) Plumb 's Signature: (No amps) MP No.: Business Phone Number:
1112-V -FJOn*-
Plum is Address (Street, City, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing ent Signature(No a S)
Approved ❑ Surcharge fee)
Owner Given Initial ~ ~ fJ
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SHO-6398 (R. 0' 5/94) _ DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS r
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority-
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The- septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax nurrber(s) of where the
system is to be installed.
Il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dvvelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, r,-.connection, or repair.
V. Type of system. Check appropriate box depending on system type.
Vl. Absorption system information Provide all information requested for numbers ! throug,i 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, num >>r of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all optic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experiment I product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriat ? prefix (e.g. MP, etc.),
address and phone number Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
7!ete plans and specifications not smaller than 8 1/2 x 11 inches must be subrr,itted tc t` e cunty. The plans must
include the following: A) plot plan, drawn to scale or with complete dimension;, location of (ilding tank(s), septic
~ankes) er other treatniew tanks; burlr`fng sewers; well.; water mains/wa,.erso ce; strt:~<i< ~d lakes; pump or siphon
tangs, distribution boxer.; soil UL):,orption systems; replacement system the IocZ:.:")r- ; f the building served;
B) horizonia,l and vertical elevation reference points; C) complete specification; for pump,..3r (.ontrols; dose volume;
elevation differences; friction •oss' pump performance :urve; pump model and, ,~:ump rna,)u llc user; D) cross section
of the soil absorption system if required by the county, soil test data o , a 115 °orm; an:': ; ll sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practic s which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamwabo , investigations
and establishment of standards.
. ~Aee
TIMM EXCAVATING JOB 1667r7
Route Z BOX 192 SHEET NO. I OF
WILSON, WISCONSIN 54027 CALCULATED BY e'r DATE J L6
(715) 772-3214 (715) 386-5443
DATE
MPRS #3224 WI MPCA #696 MN CHECKED BY
SCALE
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PRODUCT 205-1 Inc,Groton, Mass . 01471. To Order PHONE TOLL FREE 1.800-215-6380
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT ? of 3
Labor and Human Relations '
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
C St .oix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
EL 5L
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R€UIEW D BYD
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT 1/4 1 Y N,R,; W
Dan & Sharnn Spielman 0161 qW 99
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME C
816 292nd St.
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
Woodville, WI 54028 (715) 772-4721 Springfield 292nd St.
[ J New Construction Use kx] Residential / Number of bedrooms 2 [ ] Addition to existing building
Jx] Replacement [ ] Public or commercial describe
Code derived daily flow 300 gpd Recommended design loading rate .4 bed, gpd/ft2 .5 trench, gpd/ft2
Absorption area required 750 bed, ft2 600 trench, ft2 Maximum design loading rate .4 bed, gpd/ft2 5 trench, gpd1ft2
Recommended infiltration surface elevation(s) existing 97.4 It (as referred to site plan benchmark)
Additional design / site considerations if necessary a mound (5' x 501) rock bed can be installed on 96.8 contour
Parent material till Flood plain elevation, if applicable NA It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem EIS ❑U OS ❑U as ❑U ❑S ~ic7U ❑S E ❑S UU1
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
Existing system is installed in marginally code-co liant soil existing stem i over ized b
<•`current loading rate standards: the weak 'y struct red sandy tom soils at system levat on have
Ground a nominal bed loading ate of 0.4 gpd/sq t and 30 gpd/900 sq t = 0.33 g d/sq ft Thi avers zing
elev.
ft. combined with the regular (yearly) tank p roping ha resulted in a system w ich appears t still: be
Depth to functi ing effectivel in spite of the heavier (sandy clay loan) soils at depth. No water was:
limiting
factor evident in the ends of the lateral pipes and there is no eviden e of hydra lic failure. imiteb are
is avai able to replac this system if ne essary i the future put a suits le mound repl cementsite 's
Remarks~ocated downslope and east of the existing system.
Boring #
1 0-9 10YR 2/2 - sil 2 f sbk mvfr cs 1f/m .5 .6
1" « 2 9-26 10YR 4/4 - sl 1 m sbk mvfr cs 1m .4 .5
3 26-49 5YR 4/4 - sl 2 m abk mfr gs 1m .5 .6
Ground
elev. 4 49-66 5YR 4/4 - scl 1 c abk mfi gs 1m .2 .3
99-4 ft 5R46
Depth to 5 66-70 5YR 4/4 f2p 5YR 6/2 scl 0 m mfi - 1m NP .2
limiting belo 26 there are common g si coats on the pads and the deep root enetration through horizon 5 is
factor accom anined y 7.5YR 613 - R 4/6 vertically riented oat mottling w/ classic dark ce ter st ins
mfi"
Remarks: estimated system elevation of 96.95 marginally satisfies footnote A of TI HE 83.09 (am) Tahla n
CST Name:-Please Print Phone:
Henry F. Grote 715-665-2681
Address:
PO Box 57, Knapp, WI 54749-0057
Signature: Date: CST Number:
c
PROPERTY OWNER Don/Sharon Spielman SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
......2.....'. 1 0-11 7.5YR 3/2 - sil 2 f sbk mvfr cs 1f/m .5 .6
k8
2 11-36 10YR 5/4 - sl 2 m sbk mfr gs 1m .5 .6
Ground 3 36-53 5YR 4/4 - sl 0 m mfi - 1m .3 .4
elev. horizon 3 is occasionally 1 c a k mfi
96.8 ft.
Depth to sidewa 1 seep @ 36 and below (frost going out stil
limiting
factor
3b '
Remarks:
Boring #
1 0-12 7.5YR 3/2 - sil 2 f sbk mvfr cs 1 f/m .5 .6
2 12-32 10YR 5/4 - sl 2 m sbk mfr gs 1m .5 .6
3
3 32-48 7.5YR 4/4 - sl 1 m sbk mvfr - 1m .4 .5
Ground sidewall see below 32
elev.
94.3 ft.
Depth to
limiting
factor
~2!
Remarks:
Boring # 1 0-11 7.5YR 3/2 - sil 2 f sbk mvfr cs 1m .5 .6
4 2 11-34 10YR 5/4 - sl 2 m sbk mfr cw 1m .5 .6
3 34-47 7.5YR 4/4 - sl 1 m sbk mfr - 1m .4 .5
Ground
elev. no sidewall seep this pit
96.8 ft.
Depth to
limiting
factor
> 47"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS bad /PS
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATIONS 1/4, Sk~ 1/4, Section T _2F N-R./S W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVLSION LOT NUMBER
CERTIFIEDSURVEY MAP 36 LU, VOLUME - , PAGE ?o LOT NUMBER
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 licensed septic tank pumper._WhA-t--you put into the system can affect the function of the septic tank
as a treatment stage in the waste dispo ' system.
(St. Croix; County residents may be eligible to receive a grant for a maximum of 60% of the cost
of rep cement f a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted is program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE: 5- 2\ - C lG
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, Wl 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property &W
Location of propertyyLL_l/4 1/4, Section L,21 N-R /S W
Township ~i. 12 -J Mailing address
6 d92-
Address of site/n2
Subdivision name cs/'11 3'6aw ~W' Lot no.
Other homes on property? Yes ~C No
Previous owner of property k'n h'1a.~o;~uy
Total size of property
Total size of parcel's
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes A No
Volume 3 and Page Number 70 3 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Appli ant Co-Applicant
5- 2~--5("
Date of Signature Date of Signature
3 5 2 0 6 CERTIFIED SURVEY MAP 703
Part of the Southwest 1/4 of the Southwest 1/4 of Section 21, Town 29 North,
Range 15 West, Town of Springfield, County of St. Croix, State of Wisconsin,
described in Volume__I_of Certified Survey Maps, page 703 as Certified
Survey No. 703
3
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UNPLATTED LANDS -
F M
q
i W O M1
J
U N 89° 24 20" E I W z
1. w
1
9 1l 9jO~ 415.61 p 66' Z °w
.v
' 230 . dlA Q h N
F ED ~3a
SEP 2998 LOT
A4ft OfCO~yN~` 144,910 sq.ft 3.33 ACRES
±
CC"* 00441• OU LEGEND
~tls [x O 3/4" X 30" ROUND IRON ROD
O: WEIGHING 1.502 LOS/L.F.
U? WELL ~I
Q: 3 Q:
J: O N F= Z• J:
N
in C):
W: N M M N m' . W:
° 1-:
0 BARNJ
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``,~IIIIIIIIIp~, 92 394. 5 vp 33. 33.00
S 89°24 20 W
G 0 Ns. "04540
UNPLATTED LANDS t
LEON R `
HERRICK
• i g\ 4
j. MENOMONIE, KALKRI:jNR \ ROAD SCALE
r~ .S.W.Cb AE ;2i. I"= 100'
/0
WlB. `er . RtiR: iSP1~~r
O 150 80 40 0 100 200
U
I, LEON R. HERRICK, Registered Land Surveyor, hereby certify that I have surveyed,
divided and mapped a part of the SW4 of the SW-1, of Section 21, T29N, R15W, Town of
Springfield, County of St. Croix, State of Wisconsin, more particularly described as
follows:
Commencing at the Southwest corner of Section 21; MAN APPROVAL FOR
BUILDING SITE OR SEPTIC SYSTEM.
Thence N. 610 18' 00" E. , 1 ,491 .40 feet; REFER TO H62.20.
Thence S. 890 24' 20" W., 33.00 feet to the point of beginning;
Thence continuing S. 890 24' 20" W., 394.45 feet; APP ROVE
Thence N. 030 23' 10" W., 358.20 feet;
2 01978
S EP
Thanra N RQ0 ?a' ?n,, F - 415 (;l fact
i.
DOCUMENT NO. I WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
2G STATE BAR OF,_WISCONSIN FORM 2-1982,
44
_8~_rs«t1.5 ~i REGISTER'S OFFICE
BOOK
' ST. CROIX CO., W!
Rosella A. Mahoney, a single person Recd for Record
CC; 31198
a~
8:00 AMA
conveys and warrants to -Donald E. Spielman and Sharon
_Sp elman,...husband and .w fe, as marital-- ro ert 1, Regiu~raioee~
..with. ridhts_.of... urvivorship p p~
~I RETURN TO
II
~ the following described res. estate in S.t-. ]CO].}h coil rty,
State of Wisconsin:
I Tax Parcel No---------------------•-°------
I
t
Lot One ("I") of Certified Survey Map recorded in Volume "3i` of Certified Survey Maps,
page 703, as Document No. 352066, being a part of the Southwest Quarter of the Southwest
Quarter (SW} of SW}), Section Twenty-one (21), Township Twenty-nine (29) North, Range
Fifteen (15) West.
This deed is exc:uted solely for the purpose of fulfilling that certain land contract
between the parties hereof dated April 30, 1981, recorded May 4, 1981, in Volume "628",
page 479, as Document No. 370626.
R' Si- `R
F, E_ F
This is_.-not----- homestead p'
(is) (is not) G
Exception to warranties:
Dated this ..25th.................... 19 88
p
- -Q~h- -...(SEAL)
Rosella A. Mahoney
- - .
(SEAL)
. -
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
$_t.... rOIX----------.County.
authenticated this ........day of 19 Personally came before me this -_-Z5........ day of
Octo-ber 19_88. the above nammi
.....Rosella_-A..-Mahoney------. -
TITLE: MEMBER STATE BAR OF WISCONSIN
If not, f
authorized by 706.06, Wis. Stats.) to me known to he the person uC(+o e. --uted Che `
fore nR instrument and ackn w1"1 ;p vi swile. r
THIS INSTRUMENT WAS DRAFTED BY \ /L A~~~ 3- ~ _^V _ +
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Parcel 034-1048-30-000 01/09/2006 12:22 PM
PAGE 1 OF 1
Alt. Parcel 21.29.15.331 B 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): O = Current Owner, C = Current Co-Owner
O - SPIELMAN, DONALD E & SHARON K
DONALD E & SHARON K SPIELMAN
816 292ND ST
WOODVILLE WI 54028
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 816 292ND ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 3.330 Plat: N/A-NOT AVAILABLE
SEC 21 T29N R15W 3.33A IN SW SW LOT 1 OF Block/Condo Bldg:
CSM VOL III P703
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-29N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 826/154
2005 SUMMARY Bill Fair Market Value: Assessed with:
82240 139,400
Valuations: Last Changed: 06/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.330 21,100 99,300 120,400 NO
Totals for 2005:
General Property 3.330 21,100 99,300 120,400
Woodland 0.000 0 0
Totals for 2004:
General Property 3.330 21,100 99,300 120,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 212
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
•
•
35205fp CERTIFIED SURVEY MAP 703
Part of the Southwest 1/4 of the Southwest 1/4 of Section 21, Town 29 North,
Range 15 West, Town of Springfield, County of St. Croix, State of Wisconsin,
described in Vol ume___J___of Certified Survey Maps, page 703 as Certified
Survey No. 703 .
3
w O
UNPLATTED LANDS a N
W O M
LL -1 0
'n N 890 24'20° E ' I W WW Z
9 iV s_ 415.61 z
(l Bj O 66' O ~ O
0
b c 30y 0~ Q W N
I'1 D W3a
A 29 197 LOT i
C 144,910 sq.ft 3.33 ACRES-
9°E~Dia LEGEND
Wy sh ~yi Zj a Q 3/4" X 30" ROUND IRON ROD
WEIGHING 1.502 LOS/L.F.
a .
WELL
Z'
Q:
_ N .
J : o L5 IS U
O o
OD to
in in co: ; W:
W: N ,n
F-: O F':
:
• F-F" O
BARN Q'
J. Z'
Z:
a' ST CROIX COUNTY
Z ` SURVEYOR'S RECORD
hp 3
92 q 394. 5 ''0 33. 33.00 :
S 89° 24' 20' W
G0 NrUNPLATTED LANDS
• LEON R
HERRICK. \q9~' 'o
g it S•1303 0
ALKR~F~JyNR ROAD SCALE
~f MENIOh
WIS. RONIE. 0 ` g, Cb A 21' 1":100'
150 so 40 0 100 • 200
Iy~s U ~N1~
I, LEON R. HERRICK, Registered Land Surveyor, hereby certify that I have surveyed,
divided and mapped a part of the SW-1, of the SW4 of Section 21, T29N, R15W, Town of
Springfield, County of St. Croix, State of Wisconsin, more particularly described as
follows: r• .,.......•~:~,r.~~,1~
Commencing at the Southwest corner of Section 21; 004 MEAN APPROVAL FOR
BUILDING SITE OR SEPTIC SYSTEM.
Thence N. 610 18' 00" E., 1,491.40 feet; REFER TO H62.2Q.
Thence S. 890 24' 20" W., 33.00 feet to the point of beginning;
Thence continuing S. 890 24' 20" W., 394.45 feet; APPROVED
Thence N. 030 23' 10" W., 358.20 feet; SEP 2 01978
^^0 ^A t nn" r AI C Gl -C--4-.
AS BUILT SANITARY SYSTEM REPORT
OWNER DO#ALh _ 5M j%AAI TOWNSHIP SPR)~~^0 SECaAf N-RjfW
ADDRESS Q~ T~L•~KL ST. CROIX COUNTY, WISCONSIN.
J,Q- LOT LOT Si - "
AIM ;r
SUBDIVISION
PLAN VIEW
Distances and dimensions to meet requirements of H63
THING WITHIN 100 FEET OF SYSTEM
1 r
5F Pe 1V
464
r
I di ate o th Arrow
T"`" I
• SC L ~ _
BENCHMARK: (Permanent reference Point) Describe: Al 754/1' WE//
Elevation of vertical reference point: WAF11 Slope at site
SEPTIC TANK: Manufacturer: SA )TM Liquid Capacity: /000 &Al.
Number of rings on cover : NbAl TaW7-manhole cover elevation:
Tank Inlet Elevation: q Tank Outlet Elevation:
r
PUMP CHAMBER
Manufacturer: Number of gallons
yc e gallons; tots capacity o
Number of gal. pump set or a cycle-
distribution lines gallon: size of pump head;
gallon per minute horsepower ran name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
S' . is~ ~ ~ f° it
• a
faou
.
*6 It
'r
REPORT OF INSPECTION - INDIVIDUAL SC.GIAGL SySTLM / ff
~
S a vi .t. "t a h. it P e it rn,i t _
Sta.tc. septt~
NAM(: ' Township s 0 ~ ~St. Cn.o.i.x Couvntil AdLd& Lrrcat~on Secttiov Lot # Sub divis4-on
SI PTIC TANK
S.< e gateons Numbers o4 eamra4.tmen,t6
U±-tit(4nce Piom: GIeE1 Buitding__ f 120 ~5ka~e.
Highwaten 7~
PUMPING CHAMBER
gad ;ciZ Pfi p Manu{actunen ModeE Numbejc-- -
HOLDING TANK "
. / V
S.i zo. gattons Numbe,~106 Cam~arctmen t~
P u mpe. n.~ k a S m
n 1
V"(.A '"n IL V Iff "YMuiA:Nlbar J .,,av'a'A41p1 ~.U G1-c
g----dre
Highwa,te t
A1)'ti0KPT1ON SITE
-
Tn.e-nch
Ut .ti tane~ 6~iom: We. X Buitding_~. 1296 S Bore.
Ili h.waten
A6SOKI'7ION SITE DIMENSIONS
W.('dth o6 tne.neh /11(-j' _6t Re.quiAed area
Lenyth o6 each tine 6t Depth o6 koch beeow ti&. ~ to
f
Number o6- 1-ines Death o(y koeh oven. -t4fv .in
Totaf tengt-h oA tineb 6:t Death oh t to be.,eow yn.a.de_-/f ---i.n
Di,Stunee between ~Ine~s Z At Store (-)6 tne.nch .cn. ren 100 ht
Totae ab~son.rption a It e a.
• --"-----fit Tyre. (JA Co vch-: I>arc n 0 01 ~ ~ it_
PIT DIMENSIONS
rVumbeh o
h p.i-t,5 tca arr.ound T,~,ts eA no
Outs~de di ame.ten. D .rth bekow inket ht _6 I~ Totaf ab~so&ptt.on ane.a.
.
t~
t ~
IT T,
f~
DEPARTMENT OF ~s APPLICATION
SAFETY & BUILDINGS
IICfUSTRY, FOR SANITARY DIVISION
`LABOR.AND' PERMIT P.O. Box 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address: o
Property Location: City, Village or Towonshiig County:
Ntj '/a 50/aS $ J NCR E (or lo IrlW) ST- GROI X
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
FAR 0 1! (If assigned)
TYPE OF BUILDING V /7
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
ftm
~ZL 1 or 2 Family *State Approval Required. C
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: Cw
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
/ OD ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: L
Owner's Name as Listed on Soil Test Report (If other than present owner):
;4 Private ❑ Joint ❑Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: MP/MPRSW No.: Phone Number:
13-) cs QR
lumber's Address: Name f Designer:
• l A D r
COUNTY/DEPARTMENT USE ONLY
Sig re of Issuing A nt• Fee: Date: APPROVED Sanitary Permit Number:
❑ DISAPPROVED
Reason for Disapproval:
Alternate course(s) of Action Available: ,
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
I°~ Sra~•/ L'am'(
-
E; ~15Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
• WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATIONA-aY4,5.91%a, SectionA~q_,Tqd.A_N,R1rE (ord Town shi or Municipality SAfW&AIZeD
Lot No. ,Block No. A Go County
i sio me
Owner's/Buyers Name: L sr 0)
Mailing Address: E X71 I
TYPE OF OCCUPANCY: Residence X No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT_ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS _1 NE 1 PERCOLATION TESTS jV)N,F l/. 9J
SOIL MAP SHEET 72 NAME OF SOIL MAP UNIT Al*viFR y
Obi/ G 130 )?F h/ r/oft S PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHEI RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE BOLE AFTE INTERVAL MINA N
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
Cr' rE D D -1-k 421 -1-1 77
P- 0 r~ rr o? D Q
YR.
?0 -27
PUP _L*ZLf,0._
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- 72 t' ANOON 10" "
L"M
_0 44
B- 16
B- 79,W 40 'et A#
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of. suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy Indicate_ scale or distances.
Give horizontal and vertical reference points. Indicate slope.
0-1-4V At I-
70k
ScAl r
J10 Al a
k
a
v ~ m £
e
A
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8 k ,
{
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Aility Business Co. a
A ' B ' C compiete sewer services
KNAPP, WISCONSIN 54749 Phone: 665-2112
p ~XiSI iNC- t.JEL ~
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hnQ BILE
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