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Parcel #: 014 - 1032 -50 -000 07/14/2008 10:18 AM PAGE 1 OF 1 Alt. Parcel #: 15.31.15.228B 014 - TOWN OF FOREST 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 DAVID A & DORIS D SCHMIDT O - SCHMIDT, DAVID A & DORIS D 2168 CTY RD P CLEAR LAKE WI 54005 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 2168 CTY RD P SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 12.400 Plat: N/A -NOT AVAILABLE SEC 15 T31N R15W 12.4A IN SE NE COM NE Block/Condo Bldg: COR, TH W 960' TH SLY 54570 A PT 1030' W OF E LN SE NE TH E 1030' TO E LN, TH N Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 545' TO POB 15-31N-15W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 907/441 07/23/1997 457/143 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/05/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 9.900 1,500 0 1,500 NO UNDEVELOPED G5 0.500 100 0 100 NO OTHER G7 2.000 10,000 131,000 141,000 NO Totals for 2008: General Property 12.400 11,600 131,000 142,600 Woodland 0.000 0 0 Totals for 2007: General Property 12.400 11,600 131,000 142,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 214 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 014 - 1033 -80 -000 07/14/2008 10:17 AM PAGE 1 OF 1 Alt. Parcel M 15.31.15.240A 014 - TOWN OF FOREST 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 DORIS D & DAVID A SCHMIDT O - SCHMIDT, DORIS D & DAVID A 2168 CTY RD P CLEAR LAKE WI 54005 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 13.800 Plat: N/A -NOT AVAILABLE SEC 15 T31 N R1 5W SE SE EXC RR ROW & EXC Block/Condo Bldg: W 38RDS E 66RDS OF S 35RDS & EXC CSM 12/3406 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15 -31 N-1 5W Notes: Parcel History: Date Doc # Vol /Page Type 09/21/2006 835005 WD 02/27/1998 573982 1300/532 WD 07/23/1997 1107/479 WD 07/23/1997 713/319 LC more... 2008 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 13.800 2,100 0 2,100 NO Totals for 2008: General Property 13.800 2,100 0 2,100 Woodland 0.000 0 0 Totals for 2007: General Property 13.800 2,100 0 2,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 014 - 1033 -50 -000 07/14/2008 10:17 AM PAGE 1 OF 1 Alt. Parcel #: 15.31.15.237 014 - TOWN OF FOREST 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 DORIS D & DAVID A SCHMIDT O - SCHMIDT, DORIS D & DAVID A 2168 CTY RD P CLEAR LAKE WI 54005 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 2132 CTY RD P SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 33.850 Plat: N/A -NOT AVAILABLE SEC 15 T31 N R1 5W NE SE EXC S 375FT OF E Block/Condo Bldg: 715FT Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15 -31 N-1 5W Notes: Parcel History: Date Doc # Vol /Page Type 09/21/2006 835005 WD 02/27/1998 573982 1300/532 CWD 12/06/1997 569651 1281/512 WD 07/23/1997 1107/479 WD more... 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 32.850 6,200 0 6,200 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2008: General Property 33.850 6,300 0 6,300 Woodland 0.000 0 0 Totals for 2007: General Property 33.850 6,300 0 6,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 T 0 0 10 © 0 0 sm T n a � X co - v x F z C:- U) -n 0 a) CD dn 0 CO o =r 3 =r 0 CD :3 CD 3 c ° C W-ft CJ (D to el CL = a tn CD C) OD c,o a 0 0 co F.-P. M 'A I CD co z o CD (a > (n CL 0 CD CL Z 3 OD �o a C, 0 CL OD i CL - Cb C) C:5 0 r CO) CA 0 c CA CD (D o cr 0 0 0 Q O C: 0 CO) CA (0) C CT M a a 0 3 0 3 3 CD CL z kj 0 z z > > 0 CD 0 a CD z :3 r 0 S: z m 0 z 0 G) cn --I ca m z 0 0 z § . (D /E /) Z k CD CD $ &, / i0 9 = 3 c- "n 3 0 c o CD c ( D z < r 0 =r c o l \C 0 0 � E� —_, k CD 0 COL C. 5 0 CD a o : =1 N 3 0 =r 3 C (n (D 0 C, 2 / § / \ 3 M 5 . 0@ 0 qb ON Q 0 z CD t-4 < 0 a, CL n N p 3 fl n d � o m O Z CD U Z O ra n <• C C= y 0 3 � o O N R CO 0 C n= c O O CL 4 d I O 7 t (D A O cn zD a co D a o c Q p � z r%) a p O n r C N 3 w O O O �. � °7 t►1 CD z a4 c I- (n ti D M v v A CA 3 I N D D o O o co (D N C D) N = c A Z n CD N W m cn CD - ' z o' 3 +' O : Z Wv CD I a � o — I a c o z a CD I m 0 I � a , I I I y N ti N O a A 0 00 CD o ti .9 O C) ti ov P. O. B n commercem. 53701 g Madison, Wisconsin 53701 (608) 267 -7113 i m Doyle, Governor � � O � �' � Jim #: (608) 264 -8777 4 t 1 of Commerce . Mary Burke, Secretary MEMORANDUM DATE: June 1, 2007 TO: Wisconsin Fund Authori ed Representatives FROM: n Joyce �i Grant Specialist, Wisconsin Fund SUBJECT: Fiscal 2008 Wisconsin Fund Applications Enclosed is a printout listing the applications that you submitted for funding in the next fiscal year. Please look it over and verify that all of the applications that you submitted are listed, the spelling is accurate, the category of failure is correct, and that you agree with the amount pending. If there are any changes that need to be made, please contact me. The proration on the category one applications should be around 6% and there won't be sufficient funds to cover the category two applications this year. A letter will be sent to the category two applicants explaining this to them. The letter will be sent on the same date as the grant awards are sent to you and a copy will be in your envelope. Appeals on category two applications are made to the Department of Commerce. The small commercial establishment applications will also be prorated by around 25% this year. If it would be to the applicant's advantage to have any of the applications that you submitted changed from . a small commercial establishment to a principal residence, please let me know. I hope that they've been entered as whatever is to their advantage already but please double check. All small commercial establishment applications will have "SCE Proration in the comments column. If you have any applications on hold, please try to get that information in as soon as possible. The same for any outstanding awards from the last fiscal year, please submit the payment request as soon as possible if that system has been installed. This helps us to award the most possible to the approved applicants this fiscal year. Grant awards should be sent out to you the second week in August. Any questions or corrections needed, please let me know. Thanks. Page 1 of 1 Pam Quinn From: Joyce, Jean Ujoyce @commerce.state.wi.us] Sent: Wednesday, May 02, 2007 9:45 AM To: Pam Quinn Subject: Fiscal 2008 Wis Fund Apps Section 145.245(5m)(b), Wis. Stats., requires that we verify each applicant isn't delinquent in child support or maintenance payments. If they are, their grant award is held until they can show proof that they have an established payment agreement on file with the county. I use Wisconsin's Child Support Lien Docket website and check for the names of all Wisconsin Fun applicants. This listing is alphabetical and sometimes the name of an applicant will appear on their list but may not be the same person. Please email back the social security number for the applicant listed below so that I can verify if the applicant is the person listed or just someone with the same name. Thanks. Please email the social security number for: C-I-y, 2o! David Schmidt (There were several on the list because of the common name.) CO2Gt v L4A--,— lii/.� Thanks 5/2/2007 r o commercemi.gov Wisconsin Fund — Owners Private Onsite Wastewater isconsin Treatment System Department of Commerce Application Replacement or Rehabilitation Safety and Buildings Division Financial Assistance Program Instructions For Property Owners: TO BE C MMERCE You may apply for a grant award for up to three years after you have received a determination of failure and after you have obtained a sanitary permit. Complete Part A of this form, attach evidence of your annual income explained in Section #7, and return those items to the sanitation or health department office in the county where the property is O6 located. PART A. TO BE COMPLETED BY THE PROPERTY OWNER Please rin s turY Owner* Owner Owner Owner Owner Owner art s �. mcG' Address f �_ City, State, Zip Co e Telephone Number El ea r �a. (,c) I . 6gob5 Gear " '5400s 1 � (?/5 ) 0 -do !a 5 *Grant awards will be issued in the name and address of this If there are additional owners, attach documentation listing all owner. owners. 1. Is this application for a principal residence or a small commercial establishment? =stablishmentrc (Complete both if applicable. If applying as a principal residence, do you occupy this residence 51% of the year? Yes. No If applying as a small commercial establishment, do you own and occupy the small 11 commercial establishment? I I. Yes No NA x 2. If applying as a small commercial establishment, what is the name of the small commercial establishment? Description of Small Commercial Establishment (farm, restaurant, etc.): Fa rm 3. Has there been a change in ownership of the principal residence or small commercial establishment served by the failing system within the last three years? Yes No If yes, please explain: 4. As the owner, are you a licensed plumber or contractor engaged in the business of installing private onsite wastewater treatment systems? Yes No 5. Will a portion of the replacement system be funded by another program? Yes o If yes, explain: 6. How did you hear about the Wisconsin Fund - Private Onsite Wastewater Treatment System Replacement or Rehabilitation Program? Fro rn ke ra n s-K �, r u - GtJi Ze 01-- C6rrm mc�2c� 7. Evidence of income. If you are applying as a principal residence, attach a copy of your federal income tax return for the year of or prior to the determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of income for each owner and for each owner's spquse. If you are applying as a small commercial establishment, submit a copy of your federal profit and loss form for the year of or prior to the order or determination of failure. If you or any owner listed above did not file an income tax return, contact your governmental unit for further instructions. Evidence of income will be kept on file at the governmental unit and is subject to verification by the Department of Commerce. Property Owner's Certification. I certify that, to the best of my knowledge and belief, the information I have provided on this form and all attachments are true and correct. Owner's Signature Date Signed Co- wner's Signatur Date Signed 16 o Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)]. SBD -9163 (R. 02/2005) PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT 1. VERIFICATION OF OWNERSHIP On the document used to verify ownership, do the names match those on Part A of this application? If no, please attach additional documentation explaining. Yes No If the applicant answered yes to question 3 on Part A of this application, did the applicants) own the property when the order or verification of failure was issued or the system installed Yes No and incur the cost of replacement? s7-- P� �y� 1/OL • y Document or Pa Document used to verify ownership: gy71 �L�� �� G I �6 9 Number: � 2. Is a public sewer available to this property? Yes N 3. Has a previous grant been awarded for this property under this program? Yes No 4. Principal Residence evidence of income. Please indicate applicable annual family income: $ / '73 `l ?O Federal income tax form D G Q , Line , Year 7,0 OR Affidavit of Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross revenue: $_ Profit & loss form used: F ' Pro �D� rM yI Line « Year ZOd S 5. Date of the Order or Determination of Failure: _ Ap -o, 2 b0 When was the existing failing system installed? Prior to 1 2-1 -1 12 -1 -1969 to 7 -1 -1978 Vertical distance from the bottom of the existing infiltrative surface to a limiting condition: 0 to Less than 24° 0 4 sys -ei lS i V% qk ^64iX4 sp{,�C/� St` Equal o ka <4;(T 24 to Less than 36" S.R 4 t r greater than 36" (sQ r� 1 — 6. Private onsite wastewater treatment system failure caused by discharge of sewage to (check all that apply): Surface water or groundwater ........... ....� . ............................... i ate gory 1 A zone of saturation....,I ..... ....... J >T.'"^� • ••• ......... Adrain tile or zone of bedrock ............................................................................... ............................... Category2 The surface of the ground ...................................................................................... ............................... Category 3 Back -up of sewage into the structure served ........................................................ ............................... At -grade 7. This request is for what type of replacement system: Conventional If this request is for a system not listed at the right, please explain: Experimental Holding Tank In round Pressure 64- u . ,g2 A o 8. Uniform Sanitary Permit Number - 7 11 � r� � Date Issued — 4 0' a 6 Plan Approval Number I Z g 0 D U Date Approved 7 Experiment Approval Number Date Approved 9. After reviewing this application, I have determined the applicant to be: Eligible Ineligible If ineligible, reason ineligible: 10. Governmental Unit Representative's Certification. I certify that I have reviewed and verged all information provided on this form and atta hments and that they are true and correct to the best of m knowledge and belief. Signature of A orized Governmen I Unit Representative Titl � Date Signed . 2,7 ?.aft commerce.wi.gov Wisconsin Fund - Private Onsite Wastewater i sco ns i n Grant Treatment System Department of Commerce Worksheet Replacement or Rehabilitation Safety and Building Division Financial Assistance Program Owner's Name: Governmental Unit: 3ch n id f U PART 1. GRANT FUNDING TABLES In Sections B -F, the number of bedrooms determines the grant award. To use the grant funding tables for small commercial establishments, divide the estimated daily wastewater flow rate in gallons per day by 150, round off to the next highest whole number, and use the result for the number of bedrooms. A. Site evaluation and soil testing. Grant amount $250. $ B. Installation of a replacement anaerobic treatment component. Number of Bedrooms Grant Amount 1 or 2 ................................................................... ............................... ...........................$500 3 ................. ............................... ............................550 4 ................................................................................................ ............................... 650 5 ....................................................... ........................:...... * ............. ....... * ....... * ...... 725 6 ... ............................... .................................. ............................... ............................ 750 C7-- lJ 7 ..................................................................... ............................... ............................875 J 8 or more ................................................................. ............................... ............................950 $ C. Installation of a dosing component, lift pump or siphon: Number of Bedrooms Grant Amount .......... 1 or2 ................................................................................... ............................... $1,100 ao� ..........1,200 I 5 or more .......... ................................................ ................. 1,250 $ D. Installation of a non - pressurized and in- ground pressure POWTS treatment or dispersal component. Percolation Rate Design Loading When Properly Filed Rate in Gallons with the Governmental Per Square Each Additional Unit Before 7 -2 -94 Foot Per Day 1 2 3 4 5 Bedroom: Minutes Per Inch 0 to less than 10 0.7 or more $ 925 $1,200 $1,400 $1,450 $2,100 $250 10 to less than 30 0.60 to 0.69 925 1,200 1,400 1,800 2,175 250 30 to less than 45 0.50 to 0.59 1,375 1,550 1,650 2,000 2,225 300 45 to less than 60 0.49 or less 1,375 1,900 2,200 2,250 2,275 300 $ E. Installation of an at -grade or mound POWTS treatment or dispersal component. Each Additional Type of Design 1 2 3 4 5 Bedroom: At -Grade $1,975 $2,350 $2,350 $2,925 $3,025 $275 High Groundwater Mound 2,600 3,150 3,525 4,250 4,775 300 High Bedrock Mound 3,300 3,850 3,975 4,500 4,725 350 * Slowly Permeable Mound 3,250 3,600 3,600 3,975 4,775 375 $ i I DID Mound with less than 24° of suitable j Soil or greater than 12% slope. 3,050 3,450 4,000 4,550 4,550 375 * A slowly permeable mound may be designed using percolation test results property filed with the county before 7/2194. A slowly permeable mound is defined in s. Comm 83.23(1)(b) as having a percolations rate of greater than 60 minutes per inch and less than or equal to 120 minutes per inch, or having a soil loading rate of 0.3 or less. F. Installation of a POWTS Holding Component. Each Additional 1, 2 or 3 4 5 6 7 8 Bedroom: Grant Amount: $2,500 3,150 3,225 3,625 4,200 4,750 $400 $ Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)]. SBD -9167 (R. 02/2005) PART 1. GRANT FUNDING TABLES continued G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity. Gallons: Up to 1,249 1250 -1,499 1,500 -1,749 1,750 -1,999 2,000 or more Grant Amount: $550 $650 $750 $800 $900 $ Amount Requested H. Installation of an Experimental System. For Installation: If you are requesting funding for an experimental system, please submit a copy of the Wisconsin Fund $ pre - approval letter along with a copy of the plan approval letter and experimental approval letter containing corresponding identification numbers. Amount Requested For Monitoring: List the total cost of the experimental system and monitoring that is being requested separately at the $ right. Copies of paid invoices must be submitted with this request. 1. Installations not Covered by the Grant Funding Tables. The Department on a case -by -case basis reviews installations not covered by the Grant Funding Tables. If you are requesting funding for an installation not covered by the grant funding tables or listed in Sections A -H, please explain your request here, attach a copy of. the paid invoice showing the cost of the item, and request 60% of the cost of the installation at the right. TOTAL PART 1. $ V PART 2. GRANT AMOUNT CALCULATIONS A Enter the total from Part 1. $ lLJ Q v B. Is the applicant a licensed plumber or contractor who installs private onsite wastewater treatment systems? If yes, enter 2/3 of the amount from section A or $4,667, whichever amount is less. If the applicant is not a licensed installer, carry the amount forward from Section A $ C. If this application is for a small commercial establishment and the annual gross income of the business that owns the small commercial establishment is less than $362,500, this is the total grant award. Carry the amount in Section B forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is less than $32,001, this is the total grant award. Carry the amount in Section B forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is between $32,001 and $44,999, list the amount in Section B here and go on to section D. If this application is for an experimental system, carry the amount in Section B forward to section F. $ D. Enter 30% of the amount by which the applicant's annual family income exceeds $32,000. Annual Family Income Subtract -$32,000 Subtotal X .30 = $ E. Subtract section D from section C. This is the maximum grant amount for this applicant. Carry this amount forward to section F. (The amount in sections E & F must be at least -- $100 to be eligible for any grant award. If the amount calculated is less than $100, enter $0.00 in section F. ) $ F. Total grant award requested for this applicant up to the maximum of $7,000. $ QQ D Wisconsin Department of Industry, PLB -1 INSPECTION REPORT Labor & Human Relations Safot4 & Ruildingc� Divi Name of remises Bureau of Plumbing Date an . . o. S+°ee�t !l -1 6 -e3 as er um County Sanitary Permit 3i�� �t i�c' i Si -tQp1 er i rm ame dr ss Journeyman Plumber ress Owner ress �� V i� $ �eQtg SC-4m iD l R C��aR LAKE WL S`fao5 ol f _ �+ -may' txp L - - l e Leroy Jan G. (7 723- 8 - 86 Discusse with igna ure ( )See Attached. DILHR -SBD -6192 (8.10/82) Signature o is n- a a a pe a S. Inspector Local Inspector Plumber or Responsible arty er NO CWIX co UNTY PLANNING &. ZONING v, NOTICE OF VIOLATION April 20, 2006 f'x DAVID AND DORIS SCHMIDT 2168 CTY. RD. P CLEAR LAKE, WI 54005 CodeAdministrad RE: Failing POWTS at 2168 Cty. Rd. P 715 - 386 -4680 Town of Forest - St. Croix County, WI Planning Landnformaaon & % Computer # 014 - 1032 -50 -000 Parcel # 15.31.15.228 -B <{ 715 - 386 -4674 Dear Mr. & Mrs. Schmidt: A Real Pro,Arty As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in 715-3$6'-4677 violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Re4r, Article 12.1.F.4.d of the St. Croix County Zoning Ordinance. This Private Onsite Wastewater #r g Treatment System ( POWTS) has failed under the definition in § 145.245(4)(b) Wisconsin Statutes 7,5 -386 -4675 1 , (Category 1). This violation was first noted on April 20, 2006. AN The violation noted is septic effluent discharging to zones of saturation. An on -site inspection conducted April 20, 2006 verified that septic effluent was discharging to zones of saturation. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed from April 20, 2006 in accordance with Chapter 145.12(4) Wisconsin Statutes. ;r THE FAILING POINTS ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTIONI REQUIRED ACTION: A sanitary permit must be issued through this office. You have already ' contracted with a certified soil tester (Tom Gustum) to have a soil evaluation conducted. The soil evaluation determines the type of on -site wastewater treatment system necessary, the required sizing, 0 and its location. You must then contract with a licensed plumber who will design the replacement POWTS and apply for the sanitary permit. The POINTS must be replaced by October 1, 2006. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. Your cooperation in abating this violation is appreciated. S , .. Pamela Quinn Zoning Specialist cc: file ST. CRO /X COUNTY GOVERNMENT CENTER 110 1 CARM/CHAEL ROAD, HUDSON, W/ 54016 71x386 FAx PZC 0 C0.SA 1NT-CR01X. W1. US WWW.CO.SAINT- CROIX, WI, US ' Safety and Buildings commerce.Wi.gov 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 27, 2006 CUST ID No. 227618 ATTN.• POWTS Inspector THOMAS GUSTUM ZONING OFFICE GUSTUM SEPTIC SERVICE ST CROIX COUNTY SPIA N13450 937TH ST 1101 CARMICHAEL RD NEW AUBURN WI 54757 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/27/2008 Identification Numbers Transaction ID No. 1288479 SITE: David Schmidt Site ID No. 715294 2168 CTH P, Clear Lake, WI 54005 Please refer to both identification Town of Forest, St Croix County numbers, above, in all SE 1/4, NE 1/4, S15, T3 1N, RI 5W correspondence with the agency. FOR: Object Type: Soil Saturation Determination Regulated Object ID No.: 1085481 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: 1. Approval is hereby granted pursuant to s. Comm 85.60(2), Wis. Adm. Code, to estimate the depth to seasonal soil saturation based on an interpretive determination process. Approval of the interpretive determination negates the requirement in s. Comm 85.30(2)(b), Wis. Adm. Code to designate the ground surface as the highest level of soil saturation when redoximorphic features are less than 4 inches below the bottom of the A horizon. 2. The estimated highest level of prolonged soil saturation approved under this determination is six inches below grade. At least 30inches of sand lift on top of six inches of unsaturated, in -situ soil is required for adequate treatment and dispersal. 3. The basal soil application rate for the mound shall be <_0.20 gpd/sf, and the linear loading rate <_4.5 gpd/ft. 4. Chisel plowing to a depth of >_16 inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. 5. Landscaping up slope of the mound shall be incorporated into the POWTS design to prevent surface water from concentrating along the up slope edge of the mound and to divert surface water drainage away from the system. • THOMAS GUSTUM Page 2 7/27/2006 6. This approval shall remain valid unless the site is altered in such a way that the depth to soil saturation would change or if saturated conditions are observed for seven consecutive days at depths less than 3 feet below the infiltrative surface of the POWTS distribution component. 7. This approval in no way relinquishes the use of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. 8. A copy of this approval letter and attachments must accompany the mound system design for this site for purposes of plan approval and sanitary permit issuance. If the Interpretive Determination Report was accompanied with a plan and an expiration date is shown on this letter, the expiration date only applies to the plans for the design, not to the decision on the Interpretive Determination Report. 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. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. If this construction project will disturb one or more acres of land, an Erosion Control Notice of Intent (NOI) shall be filed with the department 14 days prior to any earth disturbing activities. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 100.00 Fee Received $ 100.00 Balance Due $ 0.00 I Leroy G. Jansky, PSS, Wastewater Specialist Integrated Services Bureau WiSMART code: 7633 (715)726 -2544 Office Ijansky@commerce.state.wi.us Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Di�kion i s INSPECTION REPORT Sanitar Permit No: 499105 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: Schmidt, David I Forest, Town of 014- 1032 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /00 . D `QV Si a2� S Lo!- M Cif- 15.31.15.2286 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Qa � 1 .3.�i t'o 3,9 167,17 -if Dosing Alt. BM (oD� 6 R Bldg. Sewer 5C 0 - St/Ht Inlet 7J— TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet f Septic �r Dt Bottom 4 3 74 G 35 Dosing t Head /Man. Uu (1�•+� 0.� Aeration 3 Dist. Pipe 3 �� Holding Bot. System q . 3 99 PUMP /SIPH INFORMATION Finade 01AL4. i l Manufacturer ��� G PMand St Cover 3 2 . q QGy Z5 • / Model Number -3 15 r " Few TDH Lift •^ Frictio�n I Syst( .3. H e�TDf Ft r dri Forcemain Length Dia. Dist. to Well 441 SOIL ABSORPTION SYSTEM BED/TRItNCH Width Length o. Of Trenches ^ - PIT DIME NS No. Of Pits Inside Dia. Liquid De DIMENSIONS 3 � 20 , Q SETBACK SYSTEM TO P/L BLDG WE LAKE /STREAM LEACHI Manufacturer: INFORMATION CH 1. OR Type Of Syste ! UNIT ���5 y ( F r � Model Number: DISTRIBUTION SYSTEM ~d S Header/Manifold Distribution x Hole ize x Hole Spacing Vent to A� Intak Pipe(s) !I � �— ? j Length Dia M Length Dia Z Spacing G SOIL COVER 0% z res re Systems Only xx Mound Or t - Grade Systems Only Depth Over �,py Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / } Q Bed /Trench Edges Topsoil ��� Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / V Inspection #2: / AB Location: 2168 County Road P Cleary Lake, WI 54005 (SE 1/4 NE 1/4 15 T 1N I)15 ) NA Lot g�t� �jP�arcel No: 15.31.15.228 1.) Alt BM Description = 2 ST, CbW ( 1 �'" f I BS' C'/�:L6�� 2.) Bldg sewer length = 35 C � ^ � �C &PPjl'c�w7r�� amount of cover = , N s other for in Yes Ue ° formation. SBD -6710 (R.3/97) Date Insepctor's Sig ture Cart. No. 1 -3 0)?-/at,� 17 C51Q-ol� �b ( -�V� Safety and Buildings Division County St. Croix N VI sco A si n i � 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 1 H 0 Sanitary Permit Applicatio rLFs'"9 - 7 State Plan I.D. Number *"- /6 4, r In accord with Comm 83.21, Wis. Adm. Code, personal information ] �yj R 1288480 = Mi4pis . /Q • t'� OZ may be used for secondary purposes Privacy Law, sI5.04(1)(m) Project Address (if different than mat mg address) I. Application Information - Please Print All Informati C Property Owner's Name Parcel # Lot # Block # David Schmidt AUG Property Owner's Mailing Address UU6 Property ocation 2168 Cth P, Clear Lake, WI 54005 Sr CROOX CQ/j # 15 SE %4, NE' /4, Section City, State Zip Code hone Ntiniber Clear Lake, WI 54005 715 - 263 -32 T 31 N; R 15 W II. Type of Building (check all that apply) � �1, ° 1 X 1 or 2 Family Dwelling - Number of Bedroom 3 o S e ctm Nuillbe El Public /Commercial - Describe Use �`'��(S 8 eat - V2t;,,., ❑ State Owned - Describe Use ❑City ❑Villa X Township Forest III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 0 14 - 103Z-go-ono . Z?$g A. New System X R eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner (c r IV. Type of POWTS System: Check all that a pp I 6 -R) p, 0 Non - Pressurized In- Ground El Mound > 24 in. of suitable soil X w o , und < 24 in. of su itable soil ❑ At -Gra e ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground Wtli. ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching 911amber ❑ Drip Line ❑ ravel - less Pipe ❑ Other (explain) , V. Dispersal/Treatment Area Information: M = 3.1:57 20.0 70 Design Flow (gpd) Design Soil �Pplication Ra dsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System EI 450 .2 C a c am\ 450 450 J ) 00 ZO VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic — G Ions Gallons of Uni �/ o �"y 1 " Concrete Constructed Glass New Existing • Tanks Tanks Septic or Holding Tank X 100 1 Skaw Pre -cast X Aerobic Treatment Unit Dosing Chamber X 642 Skaw Pre -cast x VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum ignature MP/MPRS Number Business Phone Number Tom Gustum 227618 715- 658 -1344 Plumber's Address (Street, City, State, Zip Code) N13450 937 Street, New Auburn, WI 54757 VIII. County/Department Use Onl Approved ❑ Di pro Sanitary Permit Fee (' ludes Groundwater Date Issued Issuin Agent S ' nature (N tamps) Surcharge Fee) ❑ O Reason� IX. Conditions f prov SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained AWQA , as per management plan provided by plumber. UU 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper n less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) Safety and Buildings 10541 N RANCH ROAD ' comniercemi. g ov RECE►vE ::k HA YWARD WI 54843 TDD #: (608) 264 -8777 i sconsin www.commeresconsovsb, rtment of Commerce Depa AUG 0 4 2006 www•wisconsin.gov ST. CROIX Jim Doyle, Governor COUNTY Mary P. Burke, Secretary July 27, 2006 CUST ID No. 227618 ATTN: POWTS Inspector THOMAS GUSTUM ZONING OFFICE GUSTUM SEPTIC SERVICE ST CROIX COUNTY SPIA N13450 937TH ST 1101 CARMICHAEL RD NEW AUBURN WI 54757 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/27/2008 tcaiox� 1±Tutnb�rs >: Transaction ID No. 1288480 SITE: David Schmidt Site ID No 715294 2168 Cth P, Clear Lake, WI 54005 Please refer to both identification numbers, Town of Forest, St Croix County above'; in.all,corres _pandence.with the a enc . SE 1/4, NE 1/4, S15, T3 IN, RI 5W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1085483 Maintenance required; Replacement system; 450 GPD Flow rate; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), and Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -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 T1is sy, teul7s be cphst wed and QCat�d� ;�� es��losed�pprt��ed�plans anal kith the cQrnp4ttent manual() < <,re��re�eed a�c�e. The owner, as defined in chapter 10 1.0 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 Dept. per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • Proper landscaping of the mound and land surface up slope of the mound is critical to proper operation. The upslope toe of the mound must be shaped to shed surface water. No water should be trapped up slope of the mound that may impair mound performance. • This approval is based in part on an interpretive determination approved pursuant to s. Comm 85.60(2), Wis. Adm. Code and recorded under transaction number 1288479. It is subject to the conditions set forth in that approval. • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component 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(NO1 /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 (01/8 1)" 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 7/2712006 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 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 eroy G. J�hnsky, PSS, Wastewat pecialist Integrated Services Bureau WMTcode . "3' (715)726 -2544 Office Ijansky@commerce.state.wi.us Mound System pg 1 of 6 Cover Page Project Name: David Schmidt 450 GPD Mound Owner's Name David Schmidt Owners Address 2168 County Road "P" Clear Lake, WI. 54005 715- 263 -3265 Legal Description [SE %4, I NE Y. Sec 15 T 31 N, R 15 W Township Forest 1 2 County Saint Croix V 8 4t 8 Subdivision Lot# P. Parcel ID# Coll dlboltala v APPROWE Table of Contents DEPARTMENT OF COMMERCE P9- DIVI 'ON OF SAFETY AND BUILDINGS elf/ /S, 1 Cover page 2 Mound Sizing Calculations SEE C RESP i 3 Pressure Distribution Layout and Dynamics DENC ��• "["G$ARS 4 Dose Tank / Pump Curve = GIU5 Z 5 Management and Contingency Plan • 1201 6 Plot Map •• total # of pages: 6 RECEIVED Designer Name: Tom Gustum License #: D1201 JUL 2 7 2006 Date: 7/21/2006 Ph. #: 715 - 658 -1344 SAFETY & BUILDINGS 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 01/01) Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715 - 643 -6068 email: 3ba @3badvisement.com Mound System Page 2 of 6 Mound Sizing Calculations Project Name: David Schmidt 450 GPD Mound Site Conditions Design of Entire Fill Project Type: 1 or 2 Family Dwelling IW J Cell depth at upslope edge (D): 30.0 in. % Slope: 3.3 Cell depth at downslope edge (E): 31.5 in. # of Bedrooms: 3 Distribution cell depth (F): 10 in. Depth to limiting factor: 6 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: 0.2 gal /ft /day End slope width (K): 13.2 ft. Effluent quality Eff #1 Fill length Q: 1AF 44t. Max BOD effluent value: 220 mg /I Upslope width (J): 10.5 ft. Max TSS effluent value: 150 mg /l Downslope width (Toe) (1): 15.0 ft. Fill Width (W): Design of the Distribution Cell Basal Area 29.3 ft. System Design Flow: 450.0 gal /day Basal area required: 2250 ft Distribution cell width (A): 3.75 ft Basal area available: 2250 ft Distribution cell length (B): 120.0 ft Area of Distribution Cell: 450.0 ft Observation Pipes Contour Elevation of Mound: 97.70 ft Location from end of cell (� 20 ft System Elevation of Mound: 100.20 ft Final Grade of Mound: 102.03 ft Mound Plan View J Observation Pipes z� vv B K Tilled Area/Fill Material L Mound Cross Section Final Grade Observation Pipe Synthetic Fabric ` ' G s„ Distribution Cell System Elevation b , �• ° IF b Cover Material Lateral 3 Fill Material Invert Tilled Area Slope Farcemain 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 e Pressure Distribution Calculations Project Name: David Schmidt 450 GPD Mound Lateral Layout Lateral /Manifold Design Lateral elevation: 100.7 ft Lateral diameter: z In. Rows of Laterals: 1 Lateral spacing (S): ft Manifold type: Center • Lateral to cell edge: 1.875 ft Orifice diameter: 0.188 In. Lateral discharge rate: 19.77 gpm # of Laterals: 2 System discharge rate: 39.53 gpm Distal Pressure: 2.5 ft Manifold diameter: z , w J In. Lateral Length: 59.5 ft Manifold length: 0 ft Orifice Spacing /Distribution Forcemain Friction Loss Orifice spacing (X): 24.20 Inches Forcemain length: 110 ft Orifices per lateral: 30 Forcemain diameter: z 1W In. Avg. ft /Orifice: 7.50 ft Friction loss in forcemain: 3.553 ft Lateral Side View Manifold Lateral Lateral K Ir x Ir x x x x x 7 r x 7 r x x x z z Lateral Length Lateral Length Lateral Plan View Lateral Length Turrwp w/ball valve or cleancut plug 0 0 Orifices on bottom of lateral equally spaced PVC laterals and forcemain to comply with specifications per Camm 84.30(2) Clean Out Detail Observation Pipes Clean-out plug Final Grade or ball valve /' V+/ate r ti g ht cap f f or plug Lawn Sprinkler Box Slat Nate: Closet Collar 6" tVlinimu� may be used in Long Sweep 90 place of 3/8" bar or two 45's 3/8" Bar Lateral Mound System Page 4 of 6 Septic, Pump and Dose Tank Project: David Schmidt 450 GPD Mound Tank Information Dosage Volume Pump tank manufacturer: Skaw Precast Does forcemain drain Pump tank size /model: 642 back to tank? I- J Pump tank gal /inch: 16.47 Lateral void volume: 20.7 gal Tank bottom elevation (inside): 88 ft Dosage to absorbtion Cell: 90.0 gal Septic tank manufacturer: Skaw Precast Forcemain volume: 19.2 gal Septic tank size /model: 1000 Total dosage: 109.2 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: 8" bio -tube System head (distal x 1.3) 3.25 ft Vertical Lift ( "D" to lateral) 11.70 ft pr 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: 3.55 ft Pressure loss from filter: ft Total dynamic head (TDH): 18.50 ft Pump Tank Diagram Watertight Loding Cover Dose Tank Levels 4 inch � Wth Warning Label Finished Minim _ Grade In. Gal A Reserve 18.4 302.3 O utlet utlet B Pump off to Alarm 2.0 32.9 Outlet C Total Dosage 6.6 109.2 Elea. per Comm D Effluent depth for pump 12.0 197.6 16.28 and P tY Forcemain NEC 300 Total Capacity: 39.0 642.0 A Weep Hole or Anti- B Siphon Device C Pump Curve: 9EH FLOW- LITERS /HOUR D 0 1000 2000 3000 30 10 N W 7.5 W ' 20 w Pump must be capable of: 018.6Feet a 5 and head pressure of: W 10 2.5 0 0 0 20 40 60 so Little Giant FLOW- GALLONS /MINUTE 9EH PUMP PERFORMANCE CURVE 115V 60HZ Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and /or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical /biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump /Dose Tank If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump /dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems /failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. • Safety and Buildings commLsrce 10541 N RANCH ROAD HAYWARD WI 54843 ■ ■ TDD #: (608) 264 -8777 I sconsin www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 27, 2006 CUST ID No. 227618 ATTN.• POWTS Inspector THOMAS GUSTUM ZONING OFFICE GUSTUM SEPTIC SERVICE ST CROIX COUNTY SPIA N13450 937TH ST 1101 CARMICHAEL RD NEW AUBURN WI 54757 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/27/2008. Identification Numbers Transaction ID No. 1288479 SITE: David Schmidt Site ID No. 715294 2168 CTH'P, Clear Lake, WI 54005 P "leaserfcerto bosh , identilieation,numbers, Town of Forest, St Croix County above,iin- aft"cozxes ondence �vith.the. a enc SE 1/4, NE 1/4, S15, T3 IN, R15W FOR: Object Type: Soil Saturation Determination Regulated Object ID No.: 1085481 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: 1. Approval is hereby granted pursuant to s. Comm 85.60(2), Wis. Adm. Code, to estimate the depth to seasonal soil saturation based on_an interpretive determination_ process._ Approval of the interpretive-determination - negates the requirement in s. Comm 85.30(2)(b), Wis. Adm. Code to designate the ground surface as the highest level of soil saturation when redoximorphic features are less than 4 inches below the bottom of the A horizon. 2. The estimated highest level of prolonged soil saturation approved under this determination is six inches below grade. At least 30inches of sand lift on top of six inches of unsaturated, in -situ soil is required for adequate treatment and dispersal. 3. The basal soil application rate for the mound shall be < 0.20 gpd /sf, and the linear loading rate :S 4.5 gpd/ft. 4. Chisel plowing to a depth of? 16 inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. 5. Landscaping up slope of the mound shall be incorporated into the POWTS design to prevent surface water from concentrating along the up slope edge of the mound and to divert surface water drainage away from the system. 6. This approval shall remain valid unless the site is altered in such a way that the depth to soil saturation would change or if saturated conditions are observed for seven consecutive days at depths less than 3 feet below the infiltrative surface of the POWTS distribution component. 7. This approval in no way relinquishes the use of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. 8. A copy of this approval letter and attachments must accompany the mound system design for this site for purposes of plan approval and sanitary permit issuance. If the Interpretive Determination Report was accompanied with a plan and an expiration date is shown on this letter, the expiration date only applies to the plans for the design, not to the decision on the Interpretive Determination Report. THOMAS GUSTUM Page 2 7/27/2006 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. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. If this construction project will disturb one or more acres of land, an Erosion Control Notice of Intent (NOI) shall be filed with the department 14 days prior to any earth disturbing activities. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 100.00 Fee Received $ 100.00 /91 Balance Due $ 0.00 Leroy G. nsky, PSS, astewat Specialist Integrated Services Bureau WiS]VIARTWc ©de (715)726 -2544 Office Ijansky@commerce.state.wi.us Interpretive Determination Report 6/27/06 Owner David Schmidt 2168 County Rd P Clear Lake, WI 54005 715- 263 -2365 Property Location SE' /4,NE' /4,515, T31, R15W Town of Forest St. Croix County, Wisconsin by Tom Gustum CST #227618 -- x - ; A� Table of Contents 1288479 L Project Information and Index Sheet 1 II. Introduction and Purpose 2 III. Statement of Information' `'�•• 2 a) Soil Conn i, IV 2 b) Topography`` " 4 c) Hydrology r QS'�Q�R1� if IV. Additional Information C3tvt5iu or SMETY AffD 6 UIL IN 4 V. Analysis and Interpretation 5_ G:: C 5 rC. VI. Conclusion 5 Attachments Soil Evaluation Report from CST Thomas D. Gustum ( #227618) i Soil Survey of St. Croix County ii Local Topographical Map iii General Area Topographical Map iv 1 Analysis and Interpretation The soils do appear to absorb water based on observations and evaluations. The soil evaluation conducted in April showed no standing water which is typical of excessively wet areas at this time of year. The 10" of plow layer does not contain excessive organic material thus proving the first 6" cannot be saturated more than 7 consecutive days. The underlying soil profile does have a moderate subangular blocky structure sufficient to allow moderate vertical movement of water through the sil layer, and the gravelly scl did not become massive before 30" allowing even more vertical flow. Based on topography, the tested site shows little indication that surface water would ,remain on or near the site. Some surface water from the area would be absorbed with the remainder draining to the ditch and the tributary. Considering that the tested area is more than 20 feet above the elevation of the road, localized flooding would be forced along the road in the ditch going downhill toward the east, before water would back up to the tested area. Conclusion Based on the observations stated and interpreted above, and the fact that there are no redox features in the A horizon of 10" — 11 ", the author would like to state that the highest saturated elevation lies at at least 6" below the ground surface to meet code requirements of mound powts. The continuous downhill slope will not allow standing water over the site tested, and the structure of the soils will allow any surface precipitation to infiltrate into the lower horizons. All other observations indicate proper drainage and moderate absorption in the tested area to at least the first 6 " -10" of depth. After considering the facts throughout this report the author would like to make the following recommendations to provide a suitable absorption component on this site. 1) Propose a mound type P.O.W.T.S. absorption component • With a maximum 4.5ga1 /lineal foot loading rate • Using 30" (D dimension) depth of fill material above in -situ soil • With a loading rate of .2 gal /ft /day using Eff. #2 • Berm w /drainage ditch upslope from mound to divert surface water 2) The author highly recommends (but does not require) the use of an aerobic treatment system in conjunction with this absorption component. During extremely wet conditions, the oxygenated treated effluent would help counteract the anaerobic tendencies of saturated soils and reduce the required depth and volume of fill material. 5 Nytisconsin SOIL EVALUATION REPORT #2171 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Gustum Septic Service Attach complete site plan on paper not less than 8'/2 County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference poi qt (BM), direction and percent slope, scale or dimensions, north arrow, and loca ' d distance to nearest road. Parcel I.D. Please print all info Reviewed By Date Personal information you provide may be used fors nda oses (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Schmidt, David Govt. Lot n/a SE1 /4, NE1 /4, S15, T31N, R15W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2168 County Road P n/a n/a I N/A City State Zip Code Phone Number City Village 10 Town Nearest Road Clear Lake WI 1 54005 1 715 - 263 -2365 Forest I County Road P New Construction Use: 01 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement - Public or commercial - Describe Parent material sandy loam till Flood plain elevation, if applicable n/a ft. General comments Part of 80 acres. Site appears to be suitable for a mound system using interpretive design report along and recommendations: the 97.6' Contour. Boring 1 Boring # Pit Ground surface elev. 97.6 ft. Depth to limiting factor 0 in. P 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff #2 1 0 -10 10yr312 none sil 2mgr mvfr as if 0.6 0.8 2 10 -16 10yr4 /6 m2 -3p 10yr7 /2 sil 2msbk mvfr cW if 0.6 0.8 7.5 r5 8 3 16 -30 5yr4/6 map 1oyr7/2 yr. scl 2msbk mfr - - 0.4 0.6 7.5yr5/8 LLL I Boring 2 ]Boring # Pit Ground surface elev. 97.6 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3 /2 none A 2mgr mvfr as if 0.6 0.8 2 10 -15 10yr5/4 m2 -3p 10yr7 /2 A 2msbk mvfr cW if 0.6 0.8 7.5yr5/8 3 15 -25 10yr4 /6 m2-3p 2 7.5yrr5/8 5 /8 sil 2msbk mfr CW - 0.6 0.8 25 -35 5yr4/6 m3p 10yr7 /2 yr. scl 2msbk mfr - - 0.4 0.6 4 7.5yr5/8 Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD <30 mg /L and TSS <30 mg /L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St. New Auburn, WI 54757 4/20/2006 715- 658 -1344 CRT).RiiO B (17/00) • Property Owner Schmidt, David Parcel ID # Page 2 of 3 3 ❑ Boring # Boring 1/ Pit Ground surface elev. 96.3 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -11 10yr3 /2 none sil 2mgr mvfr as if 0.6 0.8 2 11 -17 10 r5/4 m2 -3p 2 Y 7.5yrr5/8 5 /8 sil 2msbk mvfr cw if 0.6 0.8 3 17 -23 10yr4/6 m2 -3p 10yr7 /2 7.5yr5/8 sil 2msbk mfr cw - 0.6 0.8 4 23 -30 5yr4/6 m3p 10yr7 /2 gr. scl 2msbk mfr - - 0.4 0.6 7.5yr5/8 F-1 j Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color I Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring Boring # J Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '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 opportunity service provider and employer. If you need assistance to access services need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608-264-877' cnn_R130 (R 07 /01) Gustum Septic Service ST. CROIX COUNTY, WISCONSIN — SHEET NUMBER 16 t� a i R. 15 W. I A A Ap aB Fn A a A Ha A Sa6 Ft��' FOBS. VaB a8� Ma& ` CoD2 AsB Aq o. nD2' �: " AoB foB" , FOR MaB - CoC AoB A5$ s SrA. SaC2 �" K AsC2n8 ScC2 i Am6 as �Ma$, PA SaB AmC2 ' a` gnD S SrA MaB MaB ✓::'' JsB FnB SCC2 - SaC2 AS62 A56. MaS:, . Fn$ pmD2 Sa FOB SaS @ ' _ APC2. \. ,w Ma x� FnB App2 ,C Z FOS mC2 A�8 SaB SCC2 : Fng 3 i+tlaB i3 11sB i OtC Sa3. FsiB SaC2 �� A Al ' e. O� ' Nis aB�. #� ; � M � � ✓ FnB Bab { a M aB FOB FoE SrA X 1LAaf m FnB "� SaB ° AMC? SAB 2 x P / SPA -, FnB SaC2 `6 a kd A maS SaB " FOB 5a8` FtiS •+tC .., B `r �. � •. i . y SaB OtC �` SrAv FnB�9� Sa6 MaB FnB AmC2 Fn6 F l SaG2 a Fna A08 SaS AmC2 T �. rA ` �, .. lot AmC2 _ i t , I: .. pt-ac>j!j A4unc>C) q ----------------------------- w -a -- ----------------------- 1 w w LPNP tpw Z tpll.p tpw C11 co� Is T 91b 77� U) CD Fb gin, o CL a. UL 0 O ca CL U) pioc>jtj Alu-c-tD (3� 2 ------------------------- ----------------------------------- 5 W w tpup LPW Z LPII.P LP)P M Own UF-N E 0 U) zl u C - g; W Lu c id d Q II II II (11 co� 04 Co LL X N CL S aQ 71 Lai 002 001• f 1 r 5 21 y 5 GPS MaLp Qetail� O Gwmin Cwp=da, W&2002 SOIL EVALUATION REPORT =_-_„„r #2171 Nytisco Department of Commerce in accordance with Comm 85, Wis. Adm. Code """" +r.r Page i of 3 Division of Safety and Buildings Gustum Septic Service Attach complete site plan on paper not less than 8Yz County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD. �Z �� ` , Please pri information. Reviewe B Dat Personal information you provide may be sed for es (Privacy Law, s. 15.04 (1) (m)). (/ * � =r �� Property Owner VCU Property Location /- Schmidt, David Ali Govt. Lot n/a SE1 /4, NE1 /4, S15, T31N, R15W Property Owner's Mailing Address�� Lot # Block # Subd. Name or CSM# 2168 County Road P n/a n/a N/A / �' c' - pm City St to zip Co �I limber Lj City � Village >lI Town Nearest Road Clear Lake WI 540 5 263 - 23 Forest Count Road P New Construction Use: V1 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD It ; Replacement :J Public or commercial -Describe Parent material sandy loam ti Flood plain elevation, if applicable n/a ft. General comments Part of 80 acres. Site appears to be suitable for a mound system using interpreti and recommendations: the 97.6' contour. F- 11 Boring # Boring sAf Pit Ground surface elev. 97.6 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0 -10 10yr3/2 none Sil 2mgr mvfr as if 0.6 0.8 2 10 -16 10yr4 /6 m2 -3p 10yr7 /2 sit 2msbk mvfr cW if 0.6 0.8 7.5 r5 8 3 16 - 30 5yr4/6 map 10yr7 /2 yr. scl 2msbk mfr - - 0.4 0.6 7.5yr5/8 F21 Boring # Boring Pit Ground surface elev. 97.6 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ConsistencE Boundary Roots GPD/ft Eff#1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • *Eff#2 1 0 -10 10yr3 /2 none sil 2mgr mvfr as if 0.6 0.8 2 10 -15 10yr5 /4 m2 -3p 10yr7 /2 sit 2msbk mvfr cW if 0.6 0.8 7.5yr5/8 3 15 -25 10yr4 /6 m2 -3p 10yr7/2 stl 2msbk mfr cW - 0.6 0.8 7.5yr5/8 4 25 -35 5yr4/6 m3p 10yr7 /2 r. scl 2msbk mfr - - 0.4 0.6 7.5yr5/8 g Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD 5.30 mg /L and TSS <30 mg /L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St. New Auburn, WI 54757 4/20/2006 715 - 658 -1344 RRTLRA30 (R 07/001 Property Owner Schmidt, David_ .,w.+ ' Parcel ID # Page 2 of 3 3 _J Boring ❑ Boring # "'-' 96.3 ft. Depth to limiting factor ��� Ground surface elev. g 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 10yr3 /2 none A 2mgr mvfr as if 0.6 0.8 2 11 -17 10yr5/4 072 - 3p 10yr7/2 7.5 r5/8 sil 2msbk mvfr cw if 0.6 0.8 r m2 -3p 10yr7/2 3 17 -23 10yr4 /6 7 5yr5/8 sil 2msbk mfr cw - 0.6 0.8 23 -30 5yr4/6 m3p 10yr7/2 gr. scl 2msbk mfr - - 0.4 0.6 4 7.5yr5/8 F Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. J Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *Eff#2 F-1 Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. _J Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *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 opportunity service provider and employer. If you need assistance to access services need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8771 9rtn_R110 rx 07/001 Gustum Septic Service ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM —� I r � OwnerBuyer _....I L)1G� V- 0 V S --�C� /� ! Mailing Addres �c/ /e (Y Property Address (Ve / rifica � ti io on n required from Planning & Zoning Department for new construction.) City /State e' ea r Parcel Identification Number 1)1q_ 22$,� LEGAL DESCRIPTION Property Location e J i /4 , /� 1 /a , Sec. /J , T .3 N R f S` W, Town of FQ r e S t Subdivision ,Lot # Certified Survey Map # C , Volume , Page # Warranty Deed # , Volume / , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staring that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms —3 060 SIGNA URE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ArcIMS Viewer Page 1 of 1 �2 �e CIq Io32 - S�v -&&V TN FOREST 15 14 SW - NE -Ip .� at �- • ,r..e'° SE- NE i ZEa a�{- 1o32 -3o - coo 1 A 2Z :f a4- lo3a40 - u6"0 � z2g� http: //72.21. 230.178/ website /LRPortal /ARCIMS /MapFrame.asp ?PIN= 8/8/2006 ArcIMS Viewer Page I of 1 1 1 http: //72.21. 230.178/ website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 8/8/2006 1 t , 4 N FOREST PLAT y W Ea T31— N•R -15W k; S 0 Farm & Home Publishers, Ltd. See Pages 115.116 For Additional Names. s� POLK COUNTY aro F & m0 m Knstie Linda Harold & Patrick & IDa V�N Vaft & ti Delores y r - 5lr 14 w Lev ki ✓q� , d P h Rosen G ay? Delores & Janet raig & Itchey Myrl 1 Robert A a� 45 69 6s Levendoski Scepurek lace Ruth 53 36 Reed Braley u> a. b Kenn¢°' • Marlyn 137 259 aulson osen T , 156 &lane ; N Priebett a & PaYtY Zurcher 80 ,�'°, ca �:K ss...,. ° , r 2 Trust 91 °` Gerald & .. 40 g; 164 u ° a Sunday 80 at "� ° ° °- 133 Sandra 63 DH &KB wtu a^ a CDrmiean Dorothy Fargms d a,m9ua tepheu Lonnie ad 163 4 Ray e I Laursen M @s K 15 @K Beauvais SSntt n r � Ca@ iskupskl a osner auvals i ohn & 91 70 a 19 is ^nm<o 40 1 40 0 0 m Gerald ee$ 0 5 ' Sandra LIWan 2 Todd ton^ Robert cro< G 20 Robert RO David& & Helen karon Armond �' Elanum \ 2 Pietr �OaGt & Cheryl Frank & Rita & Rama p Stella Fred Clemas 7 D &5� 160 0 "^< LE 39 80 _ 68 50 ay, ' Monette 110 Faller rWier Blomberg & Ilia 39 —1 L 156 S 151_ _ _ _ _ _ _ -- 40 4o Nitchey 80 &i v- ^ eon & Ne ^ R^bert e & our 230TH AVE 5 a nnarew He4 ' d u Faro � Nel.o Overby Perdes 40 ee ata & u 7 l Cress �ss g c ° �„ a Phylli 40 s Melvin «^N' 40 lnc , + Trost 40 4 Inc 8 60 40 w Shirlee S Clark r e p & rcand ay & R ose, Wayn e Brooks `-- n 80 & c .a Michael Shari Harol y MR p mbazdo &caul ±3 Hel eson O r Overb &Beverly i Bradley Brooks 160 8 1ohvsov x '� 80 g 40 y nrt birli Alverman 720 & Dena Brooks 120 Ka "" 40 40 Cress 60 Michael Ardis o Nlls Helgeson Richard ec Leon & Frank Michael Jr & Neil & Pete & 160 el n Eggert Judith LE stephanle Walana 13 ekaa PhylBs 157 on &Eileen 0 4(j elg¢son 1 Thomas 60 Ulrich 160 147 aK &wD P ,�, Clark Patrick o n Bttgmann i L 200 Orlin Wgd David 8o t@rme 40 Dennis .'eft 96 Steinb rPer 7 ding 200 `F 2 G ale c s 3 40 �REFKOtlitf 79 & � a �sch x iw @ ncw. K. 80 4o - - - B 1 r 220th AVE v, Terry & wind& O Startle oberNck ouksy j � Glennis Deborah „' l Sam oaks Frank& s 1 Neil& N' es 80 9meP« ' Wilma 97 g Marc S Sanftners Reoneth Able Walana Mary 39 David & r & Krefts I onathan & patty 140 Ulrich David Scher, oho & C s Susan 300 rM ry so day 160 &Doris JaR:160 'H ib l Delhtog etal Anderson 33 ett 20 Schmidt 80 ` 20 120 158 269 �, ®• Fouks Edgar & M Goodrich s arriet Luella avid e' & Place s Lulu Inc 220 Ted rands Harms ta radal De Lurie o gD Laura _ Ulrich e & r---- Mon & t) 5 K ert &a 160 ° a utm O 9 m o / 48 0 80 risty tl su Fouks 4 c 2 o ro,.. � &�M°2o 41 1 1 - 1'M 0 Gregg ,FK Edwards a ggert R&5 20 Li 21 Oth AVE 240 Kurtis on & NHora Scott - _ Z Brothers Rhdker KriAle °.�' -- z w °n'^O °@ heila - E �O aj Real Est E ert Rosen "'�..- s... David SY < v &Rita mi 1 5enaffan s, O SS Henry 4 40 40 40 y Lorel�t oel v u ,n 16 r drey s verne @c° Z @ns Lentz Ellis Dennis David & S lw ep cue y eo�FN des , 6an4ra en Trust Ellevold &Debra Laurie rn� vy 80 i c,rmw^ '@ •` p 102 Trust 80 155 (j / 160 i Rosen 198 Tumm 120 N V N B 40 8 '°�` 40 •mk,a 1e & e0 & �� 0 s' & drew - ^u.a 205th VE elissa Walana t- nei<xv Jo� ra on Hai Ulrich I t'!'` r duck o g o8ster 'chard sW ^ 5 l- I 40 MeC y6 168 06 11� n ai s g S° e m Telli' n £ rca,^ o g w t- James & Pal � aren Telli john 0 ^^�+a an'Y, H 'a Laura Florence nke oa 1Dal 78 Inc 116 3 40 -.°1FD Duval 115 Ulrich $0 + 160 Inc 160 ' Rc _ J• errance A1 F Z^ 1!sa� 200th AVE y &Rhea .__. __,� R n vo 7 Lawrence 4o Deboer .� M & t'" a�<a^ azille 76 resnnnn ^p;. __. 4c 40 &D- Vo �` 80 Lawrence John 4 &C ames & ! Keith reBB9hn Alfred & «Irr @n zo <r„m,,, Gary & McNamara Strom 0 Jeannette ert `"" ''y °o Lucille o 233 m°a<"" Mary 160 111 IEliason g0 i 88., " -, '1 40 Krig 200 b � Jackelen 80 1121 Orville ^e o Otto Jaime & o @ �,,.d � & Flora ,�, Bormet Robert & Junker red Rf<lurd Milton I ale & KuRh- 416 i / ^ Bariz 80 Gary 120 Annette 31 ethell ackelm & My— Hill Susan Rib. Scott �r�,.m. ewlohn �' &Frances Miller e,.a„a 0 0 Bo 229 ba y , & Lisa , ^< o �. Heinbuch 160 sn am< 0 LE tyn<em eltz B@ o y 45 au 40 3 z ° 6'�N[ r Trust 44 M 75 64 120 s �....I a. S- & r 1 4 DOU�1a$ 12 Dale & &Arlene Uj Diamond ^' _ Mew �xenee Shelley dry & scot & 39 Susan E" Hill 80 [� KFarms 80 rv3 elan° & I Riba C' Inc 155 220res 60 ate,;,, el�buch o san ` 240 L a 40 157 68 M 128 80 80 ` Sheldon ava,no. D , Norman G & Ruth w r<,r, Strande Forest Roger Ryan & m & Gerald & Simonson 70 EA Id 8& sv»nepoei I Melvin & B Ridge Susan 3 aren )arre eel n Sandra Y eo i & L aura MI <hle 100 Hunt George IBer Trust s a@o r4 Vsa$ tt s� Simonson Kenneth Club 80 tter 134 Harol udema Z Q� - ^,,,,Caruf 255 °e E &C G &G v � ."x,158 Schmidt 160 M 25 & Ida 1 kdm F F,� jackeku S EMERALD PAGE 54 GLENWOOD PAGE 56 MIRY: U GLEENWOOD CITY, WI 54013 (715) 265 -4429 (715) 265 -4384 72 (715) 265 -7255 FAX (715) 265 -7604 4 — *` ;�OGIPubEtVT P!Q- ;STATIJ 9" dF WISCONSIN FORM i< — itra: re11a arAea assawvso row aaeowo+we DATA it � MID 1 RMSTEWS QFFIM - Sr. caax CO., V . x. Q.. 11,--- �h� ►1Qt._aA/_a._Dayid._Sch>aislL .and-------- ------ Ret'd for %eR ..Vo>F f- _D?•_._Bct� d atlk/l�._Dnris. schmi,dt,._.his...._....... aR JUL 011991 D e---- •---- ••-- •- - - - - -- ----------------------------------- •- •------- -•• - -- M �qdt- elaims to . �fY Q ., _ bultidt_ slid. Dcaris_.D.. ... Schmi4 �! uaband and_- aa-_- aur�tixQrshiR .marital .gra- . .p43Yt ............................................... .... -•-------- ... .................._...... -• -- .._...._...._..._... . t •--- ••-- • - - - - - --------------------- •• - - - -- ...... ....._....._._...._......__.... -- - - - - - -- ----------- -- •--- •-- •- • - - -••. . the following described real estate is ______.. sst ,_._ CrAim ............ .. County. I - _ -- - - -- -. - - -- -- - - �NaTwaft TO� - 1 ( state of Wisconsin: f l 1� Tax Parcel No- -------------------------•---- ,t See Description On Reverse Hereof. it The purpose of this deed is to create survivorship marital property �i betveen the above named grantees. is z F. X EI(i" ii a ii I , II ti i' This .......... iB - ---------- -. hr�tead property. (is) (is not4 �! Dated this - • --- •- --•- T.l.......... - -•----_. day of ....... •- ----- --- ••--- -•---- ..... (SEAL) - (SEAL) •David _. ,... s�?»atd_._a />La avid SC dt J (SEAL) (SEAL) . MAO • .Doris D. Schmidt a /k /a - -• -------------- - - ---- - --------------- •- ••••--- •- ••••---- • - -• - -- Doris Schmidt AOTHBNTICATION ACSNOWLEDGMBNT t( s � ) I)$ V8 �gC�.�t__s11XLd.__._.._ STATE OF WISCONSIN Dav d SC Midt and Doris D. Schmidt ss. sdhee�/ -Boris � L`�11R��Ci tea if�fE�► ............ .......................... county. n ,� this _d:y Sune -- ------ --- --- try 9Q Personally came before me this -- -_-- -- ._....__day of i 19________ the above named Aku ......................... , __..._.. •...Itaaitel..IK, BY TiTLErii[EMBERSTATE OF WISCONSIN ... ................................................. :1 (If not, - - --. ------- . ...- --•• .. ...........•-•------•-•-.. ......------- ••- --......- ••-•-. anthoriaed by $ ?06.06. Wis. Stata.)t to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. -_ V THIS INSTRUMENT WAS DRAFTED B - __° ................. ......................_........ Daniel_ IK. Byrnes_ of CNAYNA & BYRNES s P 0. Box 179. Anery, WI 54001 .. .............. ...... . ......... - - --- - -- - ------- ---- -- Notary Public .. --------------------------------------- County, Wis. (Signatures may be authenticated or acknowledged. Both MY Comm asian is permanent. lIf not, state expiration are not necessary.) date: ---- --- --------- 19 ..... ( �� MAIM 98110 STATE BAR OF WISCO %AIN wieeonyla Lee�l Blank ('o. Inc. z .., Miivwkee, Mis. vm 907m Q�StiiS.i,C L ,i Ldi!M d The South Half of Northeast Quarter (S i/2 HE 113), Section 1S Township 31 North, Range 15 Nest EXCEPT that pint described in Volume 457 of Records, page 143 recorded in the office of the Register of Deeds for St. CrOI.x County, Wisconsin and The Southeast Quarter of the Southeast Quarter'(58 1/4 SE 1/4) of Section 10 Township 31 North, Range 15 West EXCEPT the following described parcel: Commencing at the Southeast corner of the Southeast Quarter of Southeast Quarter (SE 1/4 SE 1/4) of Section 10 Township 31 North, Range 15 West being the point of beginning; thence running Westerly 220 feet; thence l.ortherly 198 feet; thence Easterly 220 feet; and thence Southerly 198 feet to the point of beginning and Part of the Southeast Quarter of the Northeast Quar er (SE 1/4 NE 1/4) of Section 15 Township 31 North, Range 15 Neat described as follows: Commencing at the Northeast comer of said Southeast Quarter of the Northeast Quarter (SE 1/4 NE 1/4); thence West on the North line of said Southeast Quarter of Northeast Quarter (SE 1/4 NE 1/4) 960 feet; thence Southerly 545 feet to a point 1,030 feet Test of the East line of said Southeast Quarter of the Northeast Quarter (SE 1/4 NE 1/4); thence East 1,030 feet to said East line; thence North on said East line 545 feet to the place of beginning. ---------------------------------- ------------------------- 7 w w tpvp Z'9L=13 LPV.P tpw 6 co A Ir m 'E a } J L6 \ k \) 2 W / ca 2 ��� LLI / /» CN CL E a —� � IF � � ^� 2 - � U2 ram � \ » �« ff |� y, o CL C, �r 1.9 lb \ �� /���w© ^ ^^ m ----------------------------------- ------------------------- w w -pvp Z LPW LPIP o c) A (L 0- 2, C-1- 6 b ca z 9 ui - t- - w w o q cp lb ME i ix a "W co U) 04 m m 32 CL CL u)