HomeMy WebLinkAbout034-1045-60-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
567271 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:
Le ue, Thomas& Kalen I Springfield, Town of 034-1045-60-100
CST BM Elev: Insp.BM Elev: BM Description: Sectionfrown/Range/Map No:
/40 GS k 20.29.15.31 OD
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �} �.1 Z /O�Q Benchmark -3 09- /Q6
r T.
Dosing ' AI BM a «
o.��on to va �a
Bldg.Sewer
'Ce.. 4-:
Holding t� St/Ht Inlet �t�3 13• �,
i
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet .� \
Septic > 5a ✓07 Dt Bottom
Dosing 7 56. 67 f 5 75 Header/Man. -7. 7
Aeration Dist. Pipe -7.-7 1.60 rr--
Holding Bot.System $, -�) /6V
Final Grade r
T
`
PUMP/SIPHON INFORMATION V,7 A/
Manufacturer Demand St Cover p 2
; fb c GPM v CO cam.-
Model Number V Ce�,��+r F r i
TDH Li `� Fricti n LLoss System Head TDF g
4 t /
Forcemain Length Dia.L it Dist.to Well /
1-7
SOIL ABSORPTION SYSTEM
BEDITRENCH Width /� Length No.Qf Tre ches PIT DIMENSIONS No.Of Pits Inside Dia, Liquid Depth
DIMENSIONS a
SETBACK SYSTEM TO HILO I P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type stem:// nn 1 � r CHAMBER OR Model Number:
� %3$ AJ ►V '`�--
DISTRIBUTION SYSTEM All
Header/Manifold Distribution / x Hole Size /� x Hole Spacing/ V Air Int ke
Length Dia` Length 61 Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ,%
Depth Over Depth Over xx Depth of xx Seede odded hed
Bed/Trench Center r Bed/Trench Edges Topsoil Yes No es 0 No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 7 /—��/ Ins�pectio #2:
r
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(�lti i ScSG�
Location: 877 280th Str Woodville,WI 54028(NW 1/4 NW 1/4 20 T29N R15W) NA Lot 4 >vl� J <0 PC4 1 Parcel No: 20.29.15.310D
1.)Alt BM Description=
2.)Bldg sewer length
-amount of cover
Plan revision Required? z Yes Xon o •"'� A ! 7
Use other side for additional informs
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SepticTank,effluent filter and ;ti inn_ ( ,C C3(� �'
dispersal cell.must all be services I maintained t. ` P�-.1- I /
as per management plan provided by plumber. tt
2. ` k requirements must be maintained *)a•. L � a
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as per applicable code I ordinances.
ter alttet:3ii siesiaatee
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MD4 9$(S-11/11)
fipxstrr 47 DIVISION OF INDUSTRY SERVICES
g. - ck, PO BOX 7162
o`,f 'c, MADISON WI 53707-7t62
a14. Contact Through Relay
www.dsps.wi.govlsbl
40 www.wisconsin.gov
s'sw Scott Walker,Governor
Dave Ross,Secretary
October 25,2013
OUST U)No. 221889 ArIN.POWTS 1►rvpc for•
EDWARi}J RF.RGII ZONING OFFICE
11I)BERGI1 CONSTRUCTION ST CROIX COUN'T'Y SPIA
N4050 CTY HWY H 1 101 CARMiCHAF.T.RD
ELK MOUND WI 54739 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/25/2015 Identification Numbers
Transaction ID No.23254116
Silt: Site Ill Nn. 796940
I otn I,egue Please refer to both identification numbers,
877 280111 St above,in all con-espondence with the:agency.
town of Springfield
St Croix County
N 114,NW1J4,S20,T29N,R1 S Y*F
Lot:4
FOR:
Description:Three-bedroom At-Grade, 12-13%Slope
ObjectType: POWTS Component Manual Regulated Object ID No.: 1455347
Maintenance required; Replacement system; 450 GPI)Flow rate; 42 iu Soil minimum depth to limiting factor from
original grade; System(s):At-grade Component Manual,Version 2.0,5131)-10854-P(N.03/07,R. 1112), Pressure
Distribution Component Manual•Ver_2.0;SRI)-10706-P(N_0110I,R. 10/12); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes A
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed bpx
and located in accordance with the enclosed approved plans and with any component manual(s)referenced ahuv• PROD O,
The owner;as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code {v/S/CJ 1/i
requirements. N" //i
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.063
stars. 1,44 ,
The following conditions shall be met during construction or installation and prior to occupancy or use: So::7.7%,_
iiir Reminders k t1 5
• The existing POWTS shall be properly abandoned per SPS 383.33,Wis.Adm.Code.
• The area within 15'down slope of the dispersal cell shall remain undisturbed. Vehicular traffic,excavation
or soil compaction is prohibited in this area.
• Building sewers shall be insulated beyond 30 feet per SPS 382.30(1 I)(c).
• Your septic tank and pump chamber cross section and specifications references"I LHR",an outdated code.
Please update this limn to be current SPS code.
Owner Responsibilities
• I'he current owner,and each subsequent owner,shall receive a copy of this letter including instructions
relating to proper use and maintenance of the system. owners shall receive a copy of the appropriate
operation and maintenance manual and/or owner's manual for the POW1 S described in this approval.
• the owner of a FOW'L'S shall be responsible for ensuring that the operation and maintenance or the
POWTS occurs in accordance with this chapter and the approved management plan tinder s. SPS 383 14(1).
EDWARD J 131:RGH Page 2 10,025/2013
In the event this soil abso,Ttion systcrn or any of its component parts malfunctions so as to create a health
harard,the property owner must follow the.contingency plan as doscribed in the approved plans.
• The owner is responsible for submitting a maintenaoce verification report acceptable to the county for
purposes. Reports shall be submitted at intervals appropriate for the corn r nont(s
maintenance tracking].urp p pp 1 p )
utilized in the POWIS.
A copy of the approved plank,specifications and this letter shrill he on-site during construction and open to
inspection by authorized representatives or the Department,which may include local inspectors. All permits
required by the state or the local municipality shall he obtained prior to cotruuencementof
constructionlinstall aii on/operation.
Jn granting this approval the Division of.Indusby Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance.As per state scats 101.12p),nothing in this review
;shall relieve the designer of the responsibility for designing a safe building,structure,or component.
inquiries concentiug 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 and the FOWTS management plan to the owner and any
ushers who are responsible for the installation,csperation or maintenance of the POWTS.
Sincerely, Fee Required: 250.00
'Phis Amount Will Be Invoiced.
1161_44104----- When You Receive That invoice,
Stilly She er Please Include a Copy With Your
11.I.T.,En .' eering Consultant,integrated Services Payment Submittal.
(608)264-7782,Monday-Ilriday 7:45 am-4:30 pm WiSMART code:7633
sal ly.sshumakcr(sywisconsin.gov _..
cc; Edwin A'Taylor, Wastewater Specialist,(715)634-3484, Monday-1/ridgy 8:00 am to 4:30 pm
•
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Private Onsite Wastewater Treatment System
Index and Title Page
Project Name: _ rew 14'/sre •- .�- .�.
. Afr-GA..®e parr r-s
Owner's Name: .t• lb'4ear
Owner's Address:. 877 4180 '=''` ,. r crrrr
�+o,AurcrEr �r ya�28 _
Legal Description: yam/4/4./1 dal 079 NI/5 6.1
. Mtmicipality: Town, Wine, • {may of ,;,/t.,./4 Aitz0 _
County: .)`r [,talg
• Subdivision Name:
Lot Number: —_-I/ Block Number: -
Parcel LD.Number: 039-/o y.5"-Go - /od
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NameofDesigner: E.0 d4'i,44' License Number: /)'Ails.- .2..MAiiii
Signature: iiriAL Date: !d yo-,74/.7
Designed Pursuant to .,7 allowingPOW S Component Manual and Comm 81-85:
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- : SEPTIC TANK E' PUMP CHAMBER CROSS SECTION. AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN. ABOVE GRADE 8 WEATHERPROOF
/a' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE ---- WITH CONDUIT MANHOLE COVERS
'
WI PADLOCK S y ar a ,
-WARNING LABEL
L IelallrNry 4/1/104-� c.Odr. I ' ---4" MIN.
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WATER TIGHT SEALS Ages , GAS- '., _ mim,
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PIPE 3' $ , M APPROVED PIPE
ONTO SOLID - +ON SOLID SOIL
SOIL PUMP OFF ELEV. Q3o FT. -- — tijorr ` * RISER EXIT
• D PERMITTED ONLY
• , S I 1 IF TANK
MANUFACTURER
3" APPROVED BEDDING UNDER TANK HAS APPROVAL
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE
TANK MANUFACTURER: ., 4-,4 144-sosr NUMBER DOSES PER DAY: S. 109,, ye)
TANK SIZES; SEPTIC /c:7449 GAL. DOSE VODUME INCLUDING 82 5 # 3.
DOSE Gep GAL.. FLOWBACK: 90.8 _GAL.
ALARM MANUFACTURER: ..: .T I 4,16,a4.5.- CAPACITIES: A = .11.5 INCHES = 387 8' GAL.
--,- MODEL NUMBER; 7`,g 'K AtLEdr I
SWITCH TYPE: 1 44-4' V.vicil- B = ` 2 INCHES = 3� p COAL.
POMP MANUFACTURER: fiffd. ria c-44-47-e/4 r..mdl C g 5...5- INCHES r o.8 GAL.
MODEL NUMBBER: SE'-ro
SWITCH TYPE: "ix ,f;t.v4411. D .. 8 O INCHES • J3.?.O GAL.
REQUIRED DISCHARGE RATE .31. .3.? GPM PUMP E ALARM WIRING AS P -ILHR 16: WAC-)
VERTICAL-DIFFERENCE BETWEEN PUMP OFF' AND DISTRIBUTION PIPE . . T S. FEET
. + MINIMUM NETWORK SUPPLY PRESSURE
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•o4 FEET FORCEMAIN ••X .7. / FTl lop FT. FRICTION FACTOR . . ..5'_ FEET
TATAL DYNAMIC HEAD r : R.d FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH 5y ' ; WIDTH a " ; DIAMETER –
LIQUID DEPTH
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POWTS OWNER'S MANUAL AND MANAGEMENT PLAN
•
FILE INFORN>!ATIOIti
SYSTEM SPECIFICATIONS _
ne Tank Ca aci
I'emtit Se is _ ty _ Oop al C7 TQA _
DESIGN .Se tic Tank Manufacturer S r.1 rtfr
RS Effluent titter 141anufactut�er � T [J NA
Number of Bedrooms(140,+d/bedroom) ' ,3 Effluent}Filter Model 5, ,4 In NA j
Number of Commercial Units Pump Tank Capacity .Cdo al 1•Estimated flow(average) _Pump Tank Manufacturer �
oo.gaUday ir�i.�+ .RdC�sr 0 NA
Design flow(DWF),estimated x 1.5 dump Manufacturer
'I*',fG gal/day
r.. -- x ,,r drti-crwie a NA
soil Application Rate - a d x Pump 1VIode1 r �
! iy " ay it rep ❑NA
1ntluentfF.Fflucnt Quality(NA❑) Monthly Average Pi'etrcatneent Unit Br NA
Fat..d;(&Grease(FOG) _.< Sand/Gavel Filter ❑Peat Filter
s 30 mgtL ❑ Mechanical
Biochemical Oxygen Demand(BODs) Aeration Q Wetland
I Total Suspended Solids(TSS) 2?0 mg/I, La Disinfection
❑Other
_ _ Manufacturer: Modeler I
Pretreated Effluent Quality❑ Monthly Average Soil Absorption Gatnponent
Biochemical Oxygen Demand(BOD5) 30 mg11 ❑ In-ground(gravity) 7 In-ground(pressurized) ,
Total Suspended Solids(TSS) At-grade ❑ Mound
Focal Coliforrn(geometric mean) < 30 n�gfI. ❑Dri -line q Other; _ .•
h
X 10 chill Dorm 0 Dispersal Units-Manufacturer__
L Maximum i~ifluent Particle Sipe 118 inch diameter Q Aggregate Cell(s) Model
Soil Dispersal (FISA)or
•
im!-Application rate-=Area.Re-uuircd (Aggregate Trench Wtdth) #Units or total Len of A re ate 1'rcnchfs)
.' _÷ - ._.__- - /1.7.3" ,- /O - ►L_ i
DESIGN CRITERIA
❑"Design of Pressure Distribution Networks for Septic Soii Absorption Systems"Publication 9.6(SSWMP Manual)
❑ "ICC riowteclr Mound Component Manual"Version 1.2
!.1"LLFIaw Mound Component Mlanual"Version 5120/2007
pEf SI3D- 10854---P(8.1/12)"At-Grade Component Manual Using Pressure Distribution"
• ❑ SBD-10705--d' Version 2.0
JI (2�f.41/41)"In Ground Soil Absorption Component Manual"Version 2.0
i
❑ SB D- 10691—P(N.01/01)"Mound Component Manual"Version 2.0
❑ SI3D-10657 P(R.6199)")rip-line Effluent Disposal Component Manual"
or SI3D- I0706—P(N.01/01)"Pressure Distribution Component Manual"Version 2.0
Q Other• _ - - -
NM MNTE.IYANCE MONrTORINC SCHEDULE-MAINTENANCE AND MANAGEMENT
Service 1<.vent /3a,,,>ps' Service Frequency
iumpfittspect tank(s), inspect dispersal cell(s),clean filter At least once ever y .nrontlrs- �3 years ❑;
inspect pump&pump controls,alarm,pretreatment unit At least once every� -l3 months 3 years ❑iNAer-
L'luslt and pressure test laterals -- �
- - 111(cast once every: -❑d months 3 Itears 0 NA
START'UP AI1[D OP�Tj4Al:For new construction,prior to use of the POWYS check treatment tank(s)for the presence of '
painting products or other chemicals that may impede the treatment process andfor damage the dispersal cells). If high concentrations
are clatectod have the contents of the tanks)removed by a scptage servicing operator prier to use.
System start up shall not occur when soil conditions are front at the infiltrative snrruee.
The property owner is responsible for the operation and maintenance orthe POWrs and submission of required reports.The quantity
and quality of the wastewater stream will affect the performance and longevity oiyour POWTS.The installation of water-saving
appliances and fixtures along with prompt repair a leaks reduces the wastewater volume.Also the brine or waste from water
softeners, iron removal units, other clear water treatment des'ices and foundation drains should be discharged lo the ground surface
whenever possible.Note:this does not include launch),waste,shuworr,dishwater,etc.
This system is designed to handle domestic strength wastewater,however the disposal of food based greases and oils,vegetable/fruit
peels and seeds,bones,and food solids such as those produced by a garbage disposal should be minimized, Toilet tissue is the only
paper that should be discharged into the system.Other non-biodegradable items such as baby wipes,tampons,sanitary napkins
condoms,cigarette butts,dental floss,and cotton swabs should not enter the system.Chemicals such as petroleum products,paint, '
Page.7 of 9
disinfectants,pesticides,antibiotics,solvents,etc.,should not be flushed into the system as they can seriously damage your POWTS
and contaminate your drinking water supply.
Maintain a regular steady now by spreading laundry washing throughout the week.Avoid vehicle traffic over all system components.
Compaction of snow over the dispersal unit may cause it to freeze up.
INSPECTIONS&MAINTENANCEe Inspection shall be made by an individual cairying one of the following licenses or
certifications:Master Plumber,Master Plumber Restricted Sewer,POWYS Maintainer or Septage Servicing Operator(per the attached
Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware,
identify any cracks or leaks,measure the volume of combined sludge and scum and check for any backup or pending of effluent to the
ground surface and test all electrical equipment such as pumps and alarms.Any defects shall be promptly corrected,Exposed openings
greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks.
When the combination of sludge and scum in any tank exceeds one-third(1/3)or more of the tank volume,the entire contents of the
tank shall he removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR l 13,Wisconsin Administrative
Code.
The outlet filters)shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications.Solids
washed from the filter shall be retained in the tank.Filter cleaning may be necessary at more frequent intervals than stated hi the
maintenance schedule to keep the system operating.
Alarms should be tested on a regular basis by the home owner.If an alarm sounds,contact an individual licensed to service. POWTS,
There is normally a I day reserve under regular operating conditions,however water should be conserved until any problems with the
system are corrected to prevent back-up of sewage into the dwelling or surfacing,
ABANDONMENT:When the POWYS fails and/or is permanently taken out of service the following steps shall be taken to ensure
that the system is properly and safely abandoned in compliance with Ch. SPS 383.33,Wisconsin Administrative Cade.
- All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
- The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
- Auer pumping,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil,gravel or other inert solid material,
CONTINGENCY PLAN: If the POWYS fails and cannot be repaired the following measures have been,or must be taken,to provide
a code compliant replacement system:
0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells.Failure to protect the replacement area render it unusable.
Replacement systems must comply with the rules in effect at the time of replacement.
n A suitable replacement area is not available due to setback and/or suit limitations.Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
)lif The site has not been evaluated to identify a suitable replacement area.Upon%-allure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area.Beer replacement area is available a holding rank may be installed
as a last resort to replace the failed POWTS.
AMound and at-grade soil absorption systems may be reconstructed in phice following removal of the hicrmat at the infiltrative
surface.Reconstructions of such systems must comply with the rules iti effect at that time.
«WA R l INf:nn
SEPTIC,PUMP AND OTHRR TREATMENT TANKS MAY CONTIAN LETHAL GASSES ANIaIOR INSUFFICIENT
O t er; N,DO NOT ENTER A SEPTIC,PUMP OR O'f ut TREATMENT TANK UNDER ANY CIRCUMSTANCES.
DEATH MAY RESULT,RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR
IMPOSSIBLE.
ADDITIONAL COMMENTS
POWYS INSTALLER POWTS I+MATTAINlsR
Ttigme Ed 4 ex tri rvpits-‘?.7r889 Name Si edt~�e[1tl -1
Phone - ',.f 5 77- g.?a I I Phone Tic ,377- 8.N..5- .1
SEITAGE SERVICING OPERATOR(Puntperi- 4/n1�C,dorani LOCAL REGULATORY AUTHORITY
� --
NP ame Agency ,rr. eao,,t 2o.rindt ef f.�c£
Phone __._ Phone /� 38d- $14�'d__
Page 8 of 9_
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer .1A air
Mailing Address `;' (ivy a \1 �i titi ),`'S vus c �4-
Property Address .�1 ,11 . J '' _ .A 1 ,'. 7 -"Cl2
(Verification required from Planning& oning Department for new construction.)
City/State ,A�, Parcel Identification Number 6 3'' /6 4455-60- /00
LEGAL DESCRIPTION •
Property Location u kJ '/4 , �>A/ '/4 , Sec. 20 , T Z1 N R I W, Town of ('. C.e,. .
p PJ
Subdivision Plat: , Lot# .
Certified Survey Map# 3 3 Lo 3-7 ,Volume 2- 1 , Page# 'j Z(o".
Warranty Deed# qCalil b (before 2007)Volume , Page# .
Spec house❑yes❑no Lot lines identifiable❑yes❑no
SYSTEM MAINTENANCE AND OWNER CER'1'!N'1CATION
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 o wner agrees to submit to St.Croix County ty Plannin &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.
Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this rm are true to the best of my/our knowledge. Uwe am/are the owner(s)of the
property described above,by virtue of a w ty deed recorded in Register of Deeds Office.
Numb• • 1 f 1 e l ooms 3
.Ji lJL'
=I'f'NATURE OF APPLICANT(S) 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.09/07)
986426
BETH PABST
REGISTER OF DEEDS
STATE BAR OF WISCONSIN FORM 2 - 2000 ST. CROIX CO., WI
Document Number WARRANTY DEED RECEIVED FOR RECORD
09/24/2013 08:30 AM
THIS DEED, made between William Daly, a single person, EXEMPT # N/A
Grantor, and Thomas D. Leque and Kalen Leque, husband REC FEE: 30.00
and wife, as Survivorship Marital Property, Grantee. TRANS FEE: 118.50
Grantor for a valuable consideration, conveys and warrants to PAGES: 3
Grantee the following described real estate in St. Croix County, **The above recording information
Wisconsin: verifies that this document has
been electronically recorded
SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART &returned to the submitter
HEREOF
Recording Area
Name and Return Address:
Edina Realty Title, Inc.
400 South Second Street, Suite 115
Hudson, WI 54016
1072673
Exceptions to warranties: 034-1045-60-100
Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number(PIN)
This is NOT homestead property.
Dated this September 12, 2013
A/444-D
William Daly
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000
1 of 3
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF �IS1/4i-Croy(ii �5ng
COUNTY OF
authenticated this September 12, 2013
p
qIiz1 Personally came before me this
the above William Daly, a single pers to a known
TITLE: MEMBER STATE BAR OF WISCONSIN to be the person or persons who executed the
(If not, foregoing instrument and acknowledged the same.
authorized by§706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Martin D. Henschel Cheri Brow
6800 France Avenue South, Suite 410 Notary Public, State of Wisconsin
Edina, MN 55435 My commission is permanent. (If not, state the
(Signatures may be authenticated or acknowledged. expiration date: 03/01/2015)
Both are not necessary.)
*Names of persons signing in any capacity must be
typed or printed below their signature. •
CHERI BROWN
NOTARY
PUBLIC
STATE OF WISCONSIN
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000
2of3
Exhibit A
Legal Description
Part of the Northwest Quarter of the Northwest Quarter (NW 1/4 of the
NW 1/4) of Section Twenty (20), Township Twenty-nine (29) North,
Range Fifteen (15) West, Town of Springfield, St. Croix County,
Wisconsin, more particularly described as follows:
Lot Four (4) of Certified Survey Map filed September 1, 2006 in Volume
21 of Certified Survey Maps, Page 5268, as Document No. 833637,
Office of the Register of Deeds for St. Croix County, Wisconsin.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000
3 of 3
RECEIVED 3
8 3 3 E.3?
OCT - 4 IO VOL21 PAGE 5268
KATHLEEN H. WALSH
REGISTER OF DEEDS
UNTY RECEIVVEDxFOR.RECORD
CERTIFIED SURVET� 09/01/2006 11:15AH
VOLUME 21 , PAGE 5268 `FOR° CERTIFIED SURVEY MAP
THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER OF REC FEE: 13.00
COPY FEE: .9
SECTION 20. TOWNSHIP 29 NORTH. RANGE 15 WEST, PAGES: 2
TOWN OF SPRINGFIELD. ST. CROIX COUNTY. WISCONSIN
UNPLATTED LANDS
Northwest Corner North 1/4 Corner
Section 20-29-15 2651.76' Section 20-29-15
Found 2' Iron Pipe (s89'46'17"E) (1325.87') NE corner
N89'59'47"E 1325.88' 90th Ave_ Nw/Nw Fd Aluminum Cap
N$9 5.9 47"E 1 325.88'
P 279.42' centerline N89'59'47"E 1046.46 g _ _Aria
` 246.42_ ,� 1046.42' O1 / N89'59'47"E
T 33.00' N89'59'47"E o 1292.84' 33.00'`
f well buildin setback line Corner is fence
�i 1 cr 9 west of fence
ON N ho se 17 N
°`O septic 304,977 sq.ft. 270,445 sq. ft. oNO liv,1CD , 1 \ barn o 0 7.00 acres LOT 1 6.21 acres
c:,
I ^^ cl. r-o-w not incl. r-o-w ox
2 l`rr �
I ° 0 N89-59'47"E 1046.15' Corner is ±12'
'� �I 0 1 F LOT 2 west of fence O o
3 �� °7 w-. I ' (19-""Soil tests i`1 " d co
1 1' ` 1 `° V ( 478,960 sq.ft. 451,289 sq. ft. °°-
5o'I 1 11.00 acres 10.36 acres o tO m
i=i not incl.
o O v 33.00' r-o-w Corner is ±1'
1 ° ° 1292.24' west of fence '0 1.3
cz ., on o z N89'56'01"E 1325.24'
IGO 00 ° /�
CAI LA LOT 3 f/" w
tV .opz soil tests 467,038 sq. ft. on
1
c....1 I 478,966 sq.ft. �- 10.72 acres ''lc` I�
c„i I 11.00 acres (-�v not incl. r-o-w w E 13
33.00' - - AL J V !co
I 1291.86' t-'-
I
N89'56'01"E 1324.86' o Corner is fence
I iv to I eost of fence 'll
Ps L I i N al1L_ (
:o I LOT 4 478,966 sq.ft. �,c,�
11.00 acres .c<`°.& �x
incl. r-o-w
it 467,034 sq. ft. co
I °�° i 10.72 acres . Corner is ±16'
33.00' soil tests not incl. r-o-w east and 6±
1291 47' north of fence
SW corner 1 ——
NW/NW T =—" 589'56'01"W 1324.47' t SE corner
ZOI Corner is north of fence (589'49'54"W) 1324.51' I NW/NW
) ( )
I N DRAFTED BY: PREPARED FOR:
o I( Joel A. Brandt UNPLATTED CHARLES DALY TRUST
* JB SURVEYING LLC LANDS 1241 Fifth St
966 Rustic Rd 3 - -- St.Paul, MN 55106
Glenwood City, WI
West 1/4 Corner
Section 20-29-15 Note: Each parcel on this map is subject to State and County laws, rules and regulations
Found Aluminum Cap (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing .
any parcel, contact the St. Croix County Zoning Office for advice.
Note: A possible violation of the St. Croix County Zoning Ordinance
/( � will be created if the existing structure, located within 100 feet of /
��/ the property line, ever houses livestock or poultry.
SCALE: 1' = 250' .�.�‘$ `4/ti
7N -- C.' 8 1 l 500' Z * 8-2e03T
I 0' 250' GLEN WOOD C4r..
LEGEND wi �4'
' ' 0 Government Corner (as noted) `-'-?+__� OLO
_ �►lJFiv"
North is referenced to the o._..... Set 3/4" x 24" Iron Rod • 30' MO
North Line of the Northwest weighing 1.502 lbs./lineal f t � �'
Quarter of Sec. 20-29-15, 9
which Dears N89°59'47"E •... Found 1.25" Iron rebar gg
(St. Croix County Grid System) ( ) Record Data Page 1 of 2 —
1 of 2
Vol 21 Page 5268
lin
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!
i
r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
' Division of Safety and Buildings In accordance with Comm 85,Wis.Adm.Code
Attach complete site plan on paper not less than 8'/2 x 11 inches in size. 'Ian mRE C EIV ED Co ty St. Croix O
Include but not limited to:vertical and horizontal reference point(BM),t irection and Par.-I I.D. 034-104 -604.04-
Percent slope,scale or dimensions,north arrow,and BM referenced to n:: st road. 31 0
Please print all information AUG 0 3 2006 Re, d by/ / sated
Personal information you provide may be used for secondary purposes(Privacy : ,s.15.04 I t -why ___,A1 i7 « 6 •
Property Owner ' :pert),1,,,e r.•,.- --
William E Daly ' ■ , -4 S I 29 R 15 w
Property Owner's Mailing Address Lot# Block# Subd.Name o r�� J
202 Oak Street;Apt 122 4 ( S�tog
City State Zip Code Phone 0 City 0 Village Q Town ...., Road
Woodville WI 54028 651-274-1547 Springfield 7 1 280th Street
0 New Construction Use: Q Residential/Number of Bedrooms 3 Code derived design flow rate 450 GPD
Q Replacement 0 Public or Commercial—Describe:
Parent Material Loess over Till Flood Plain elevation if applicable N/A ft.
General comments
#10„,JL 6... ta-,6 - c-c-.S.sz.and recommendations: 1 1)lo...,) 4-c. �D r L v r f i ct
OBoring I
1 Boring#
Q Pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor 52 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-8 10YR3/3 - L 2-f-gr ds gs 3f 0.6 0.8
2 8-16 10YR4/4 - L 2-f-bk ds cw 2f 0.6 0.8
3 16-23 7.5YR4/4 - SL 1-co-pl dh gw If 0.4 0.6
4 23-52 7.5YR4/4 - LS 1 10 mvfi gs If 0.7 1.6
5 52-58+ 7.5YR4/4 7.5YR5/8 f-1-f SCL 1-m-bk mvfi - - 0.2 0.3
O# Boring
2 Boring QPit Ground Surface Elevation 100.0 ft. Depth to Limiting factor >60 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-8 10YR3/3 - L 2-f-gr ds cs 3f 0.6 0.8
2 8-15 10YR4/4 - SL 1-co-pi dsh gs If 0.4 0.6
3 15-34 7.5YR4/4 - SL 1-m-bk dh gw If 0.4 0.7
4 34-53 5YR4/4 - SCL 1-m-bk mvfi cs 1f 0.2 0.3
5 53-60+ 10YR5/6 - S 0-sg ml - - 0.7 1.6
*Effluent#1=BOD5>30<220 mg/L and TSS>30<_150 mg/L "Effluent#2=BOD5<30 mg/L and TSS<_30 mg/L
CST Name(Please Print) S' re CST Number
Mark Iverson a 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 1j5 Hammond, WI 54015 July 28. 2006 715-796-5664
Property Owner William E Daly Parcel ID# 034-1045-60-000 Page 2 of 3
0 Boring
3 Boring#
OPit Ground Surface Elevation 96.4 it Depth to Limiting factor 42 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-9 10YR3/2 - SIL 2-f-gr ds gs 3f 0.6 0.8
2 9-19 10YR5/3 - SIL 1-m-pl ds gs If 0.4 0.6
3 19-28 10YR4/4 - SICL 2-m-bk dsh cs If 0.4 0.6
4 28-42 5YR4/4 - C 2-m-bk mvfi ca 1f 0.2 0.3
5 42-55+ 10YR5/6 10YR5/2 &4/6 c-2-d S 0-sg ml - - 0.7 1.6
0 Boring
4 Boring#
Pit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
El Boring
5 Boring#
Pit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
*Effluent#1=BODS>30<_220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<_30 mg/L and TSS<_30 mg/L
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Page 3 of 3
0 ft. 24 ft. 40 ft. 80 ft.
place system on
NO the 100.0'contour
LOT 4
<340 feet from B-2 to west property line
147'to shrub/fence line
from B-1
101' al 112"P�P1
100' 100.0 o B 1 81-10 1p0 0'
99'. `100.0
98'
97' B-3
1 96.4
96' 9s.a
95'
BM#2-Top of 1/2 inch PVC pipe Property Boundary
91.2'
BM#&Description Bench Mark -
Elevation = 100 - Boring Location&Elevation
All property lines not identified on the map are greater than 100'from the borings
Owner: William E. Daly Site Information: Lot 4 Completed By: Mark Iverson
202 Oak Street;Apt. 122 NW 1/4, NW 1/4, S20, T29N, R15W 680 Larcom Street
Woodville, WI 54028 Town of Springfield Hammond, WI 54015
Phone: 651-771-1258 St. Croix County 715-796-5664
PSS#198/CST#46672
'' RECEIVED 3
8 3 3 6 3?
OCT — 4 VOL 21 PAGE 5268
KATHLEEN H. WALSH
REGISTER OF DEEDS
UNIT RECEIVVEEDDxFOR RECORD
CERTIFIED SURVE � 09/01/2006 11:15AM
VOLUME 21 PAGE 5268 ` COt�°
CERTIFIED SURVEY MAP
THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER OF REC FEE: 1 33.0
.00 0
SECTION 20, TOWNSHIP 29 NORTH, RANGE 15 WEST, PAGES: 2
TOWN OF SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN
.
UNPLATTED LANDS
Northwest Corner
Section 20-29-15 2651.76' North 1/4 Corner
Found 2' Iron Pipe (589'46'17"E) 0325.87') NE corner Section 20-29-15
L.N89':9'47'"E
N89'59'47"E 1325.86' 90th Nw/Nw
Ave. Fd Aluminum Cap
PO-B14? 279.42
centerline N89'59'47"E 1046.46' p� \ 1325.88' n
•346.42' oa 1046.42' 6' /� N89'59'47'E—V�
T ggeell}} 33.00' N89'59'47"E o 1292.84' 33.00'!
r- / well building setback line Corner is ±12'
IQ p N N ho se: .'.R g N N west of fence
° o m septic 304,977 sq.ft. 270,445 sq. ft. po ,o
�, 0 - $ , , oreo 7.00 acres LOT 1 6.21 acres W CO
W iad ( cl. r-o-w not Incl. r-o-w I�
O I ° barn j'jv,!
f
Z I tD -" ° �°� O N89'59'47"E 1046.15' Corner is ±12'o
CJA �cn 4,I� - so LOT 2 west of fence o 0
\ x o izu�+ I. soil tests N> o
\ 3 _ i f— 478,960 sq.ft. 451,289 sq. ft.
j 11.00 acres 0 °
a c 50' ∎ 10.36 acres o n
Z incl. r-o-w not incl. r-o-w « r"
33.00'
0 o o , 1
Corner is ±1'
L Iz od N.i o I 1292.24' west of fence IZ
lay v I Z N89'S6b1"E A 1325.24'
l�
°° co ° t....3
H
N wlwl LOT 3
I a> soil tests 467,038 sq. ft. rn '
CV
o ce
478,966 sq.ft. 10.72 acres '�` i�
ti _-•i. x.00 acres not incl. r-o-w - w i�
33.00' Ai4. Ak- ID
� 1291.86' c^'-
N89'56'01"E 1324.86' O x Corner is t6'
w I N <e east of fence
is in I I ce O
N a, LOT 4 478,966 sq.ft. 5r�
11.00 acres o E'l'x
TIN I _----incl. r-o-w
467,034 sq. ft. co
/1 10.72 acres Corner is ±16'
33.00' soil tests not incl. r-o-w east and 6t
1291.47' 911e. north of fence
SW corner __
NW/NW r x—x 1 324.47' SE corner
889'56'01"W
Z I Corner is ±11'
north of fence (589'49'54"W) (1324.51') Ajar 5-6 1 1I. NN W J/i: " e
-4/y
\
O
N DRAFTED BY:
I� PREPARED FOR: �7 ���
Joel A. Brandt UNPLATTED CHARLES DALY TRUST C�
JB SURVEYING LLC LANDS 1241 Fifth St
966 Rustic Rd 3 — —� St.Paul, MN 55106
Glenwood City, WI
West 1/4 Corner
Section 20-29-15 Note: Each parcel on this map is subject to State and County laws, rules and regulations
Found Aluminum Cap (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing
any parcel, contact the St. Croix County Zoning Office for advice.
Note: A possible violation of the St. Croix County Zoning Ordinance
/' will be created if the existing structure, located within 100 feet of ,
��/ the property line, ever houses livestock or poultry.
�aG4ks
SCALE: 1" = 250' �.s0*•• .- .'y
IV -∎ir""._ �* * BRANDT * -
10' 0' 250' 500' ; 8-2803 r ,
r '•,G1ErANOOD Ci•r,,
LEGEND s�� wi .--�Q.- ;.
0..........Government Corner (as noted) y���(/FtV�;,,'` , OLD N
North is referenced to the �� 0� MP
03)06 b North Line of the Northwest o.. Set Sing x 24" Iron Rod
Quarter of Sec. 20-29-15, weighing 1.502 lbS./lineal ft
()I which bears N89°59'47"E .._ Found 1.25" Iron rebar
(St. Croix County Grid System) ( ) Record Data Page 1 of 2 —
1 of 2
Vol 21 Page 5268
Vill