HomeMy WebLinkAbout026-1119-10-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Coun
Safety and Buildings Division �t. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitgl` tNo -:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: ❑ City ❑ Villa e [] own of: State Plan ID No.:
eterson, Dean Ric?Lond Township e —_
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
I CD . ob i C � 026- 1119 -10 -000
TANK INFORMATION ELEVATION DATA aa- 30 � 1 8, ')0S
TYPE MANUFACTURER CAPACITY STATION S HI FS ELEV.
Septic (� Benchmar 4( L C O _ 0
Dosing Alt. BM 3' 7 4, 3, S$
Aeration Bldg. Sewer
Holdin St/ Ht Inlet q u S (Jo
TANK SETBACK INFORMATION St/ Ht Outlet
rl! 4 S•93 eo•2$' ,
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic 35-� �a r -� NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe r fo �o r
p Z .s3 ° 14 . 3 g
Holding Bot. System / 3 r i
" 8 - .2 4 94.92-
PUMP/ SIPHON INFORMATION Final Grade h0.°
o �?
Manufacturer Demand St cover �Yz 3�8
Model Number GPM
TDH Lift Ion S stem TDH Ft
Force Length Dia. Dist. To Well
SOIL A SORPTION SYSTEM C9 ecLc_L
RE Width ! Length ( No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 11a. DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manu acturer:
SETBACK XIIWE+' -
INFORMATION Type of CHAMBER Model Numb
System: CmW 3z 5 OR UNIT lk -Coe& u
DISTRIBUTION SYSTEM
Header / nifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- T e g
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed / Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No E] Yes [] No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: CBb3 /CDInspection #2: — 4--f
Location: 1270 146th Avenue, New Richmond, WI 54017 (NE 1/4 NE 1/4 22 T30N R18W) - 22.30.18.705 Pondview
Meadows - Lot 10
1.) Alt BM Description =
2.) Bldg sewer length=
- amount of cover = > 3!v cow
Plan revision required? ❑ Yes W No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
Vi scons in SANITARY PERMIT APPLICATION 201 W. Washington Avenue
P O Box 7302
In accord with ILHR 83.05, Wis Odle
Department of Commerce 4 i Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the syst �3rS paper r less Ce ty
than 8112 x 11 inches in size. ^` f r�'E)'V CV • See reverse side for instructions for completing this applic 'qf1 State anitary Permit Number
Personal information you provide may " 36 3 P 3 Z
Y p Y be used for seconda purposes 1 -
v it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. ' oT C 0X State tan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL F.
Property Owner N@ Me Property ocation
}� �5 �r,47 1/4, S Z T 30 , N, R j,' lk(or�W
Property Owner's Mailing Address L bef ?ff� mber
12 i y tti il�'�+Z
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE OF BUILDING: (check one) ❑ State Owned 0 C it y Nearest Road
Public 1 or 2 Famil Dwellin - No. of bedrooms Iow o f t
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
() - I//9- /o - Z2. 30 - I P - ImS
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. A New 2. ❑ Replacement 3. ❑ Replacement of 4- ❑ Reconnection of S. ❑ Repair of an
System -------- ------------- --- ---- - - - - -- Tank Only ___ - __ - _ - Existing System -- - - -___ Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank
12P Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill ,� >
VI. ABSORPTI SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5- Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /s . ) (Min. /inch) � Elevation
y ✓ Z� z � /Zoe ,/ 0 3'7 98. a ►Feet / Z 3 Feet
VII. TANK in Capacity g Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks �}
eptic Tan eF F4e4dirn3ienk UIXX> /GC�t2 4J.¢t� 5 C LISA ❑ ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number:
Z All `I 1 2-4.5 _21V 711 - 77Z -3
Plumbei s Address (Street, City, State, Zip Code)`.
31 2.Q Ag>P14 l9vP- 'I l t4 z
IX. COUNTY / DEPARTMENT USE ONLY
E] Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Ilssuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination X D�o �� C)
X CONDITIONS OF APPROVAL/ REASONS F OR DISAPPROVAL: 4 p /Q:� _ zey,<
1. �rh, i � IJ a S GI9e 5i g c cod L. ,-4, ) :5 6( 1 ley f - y #e � y (profe �c r f' /
z-� �� - 12 ,,.12 s 11 �.�- b� ��•s ��.� b.�d / /
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber ,
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD -6399) to be submitted to the
county prior to installation
le
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII_ Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or'siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
---------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
1
JOB �`e�f
TIMM EXCAVATING SHEET NO. OF
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE � Z -60
(715) 772 -3214 (715) 386 -5443
MPRS # 24 WI MPCA 0696 MN CHECKED BY DATE
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PRODUCT 2051 ®Inc., Groton, Mass, 01471, To Order PHONE TOLL FREE 1.800 ,
r Wisconsin Department of Commerce OR'GI f% SITE EVALUATION Page I of 4
Division of Safety and Buildings m accor�c with Comm 83.05, Wis. Adm. Code
Certified Soil Testing
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must Count
include, but not limited to: vertical and horizontal reference point (BM), direction and y St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcell.D.# 026 - 1065 -50 -000
APPLICANT INFORMATION - Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). R ed Date
7 QU
Property Owner Property Location
Peterson, Dean Govt. Lot NE 1/4 NE 1/4 S 22 T 30 N R 18 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1270 146th Ave. 10 Pondview Meadow
City State Zi Code PhoneNumber ❑ City R Village ®Town Nearest Road
New Richmond WI 54017 715- 386 -2411 ichmond 146Th Ave.
New Construction Use: Z Residential / Number of bedrooms 4 ❑Addition to existing building
Replacement ❑ Public or commercial describe
Code Derived daily flow 600 ✓ gpd Recommended design loading rate -3 ' bed, gpd /ft • trench, gpd /ft
Absorption area required 2000 bed, ft 1500 trench, ft' Maximum design loading rate • -�ed, gpd /ft • 4 ench, gpd /ft
Recommended infiltration surface elevation(s) 98.0 / ft (as referred to site plan benchmar
Additional design / site consideration install 2 - 2.7 150' Sidewinder, Hi capacity "turtle shell" trenches
Parent material till Flood plaiii n elevation, if applicable NA ft
S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ® El ® S El U ® S El ®S ❑ U ❑ S ® U ❑ S Z U
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed I Trench
1 1 0 -3 7.5YR 3/2 - sl 2 m gr mvfr cs lf/m .5 .6
2 3 -8 - 7.5YR 3/2 - sl 2 f sbk mvfr cs If .5 .6
Ground 3 8 -17. 7.5YR 4/3 - sl 2 f -m sbk mvfr cs if .5 .6
elev
101.4 It 4 17 -29. 5YR 4/4 - scl 2 m sbk mfr cs if .4 .5
Depth to 5 29 -90, 7.5YR 4/6 - is 1 m sbk mvfr - if .7 .8
limiting
factor
> 90" Kn G �'
Remarks: hon m .7/ g compromi y S 4 s bands (, m, m -6 ; ov u to 0.3/0.4f
2 1 0-6. 7.5YR 3/2 - A 2 m gr mvfr cs 1 f/m .5 .6
2 6-16- 7.5YR 3/2 - sl 2 f sbk mvfr cs if 5 6
Ground 3 16 -29 • 7.5YR 4/3 - sl 2 f -m sbk mvfr cs if .5 .6
elev
102.3 ft 4 29-39 7.5YR 4/6 - is 1 m sbk mvfr cs if .7 .8
Depth to 5 39 -90, 5YR 3/4 - sl 0 m mfi - If .3 .4
limiting
factor 8. o
> 90"
Remarks: orizon 4 -5 boundary dips 8 to N at about 30 grace: this p read middee of cast wall; onl - sat so
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715- 665 -2681
Address C ertif ied of esttng Da CST Number Ref #
P.0 Box 57, Knapp, WI 54749 417/2000 222774 1081
ii I
PROPERTY OWNER: Peterson, Dean SOIL DESCRIPTION REPORT. Page 2 of 14
PARCEL I.D.# 026 - 1065 -50 -000 Certified Soil e7�sting
Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed � rench
3 1 0 -4 7.5YR 3/2 - sl 2 m gr mvfr cs If/m .5 .6
2 4 -11 7.5YR 3/2 - sl 2 f sbk mvfr cs if .5 .6
Ground
elev 3 11 -25 • 7.5YR 4/3 - sl 2 f -m sbk mvfr cs if .5 .6
102.4 ft 4 25 -90 • 5YR 3/4 - sl 0 m mfi - - .3 .4
Depth to
limiting
factor
> 90 Z
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
�K
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
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'Wisconsin Department of Industry SOIL AND SITE E V A L U A - IP O R T Page 1 of 3
Labor a td Human Relations r� i
Piviskin of Safety & Buildings In accord with ILHR 83 , il: A fm & .
COUNTY
>.
St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in 'is Plan milst *Iudt? but -
not limited to vertical and horizontal reference point (BM), direction nd.% of slope, scale bS PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest roa ^' 026- 1065 -5 -
a
APPLICANT INFORMATION- PLEASE PRINT ALL INFO R 'p N TI' 1 �• n
� �� REVIEWED BY DATE �p4� G-4Lr i►-+c. -fit- S � i 7 � � �
PROPERTY OWNER: 8TI0�1'`
Richard Derrick 'GOVT. LOT NE' 1i4 E 1/4, T 30 N,R 18 (or) W
PROPERTY OWNERS MAILING ADDRESS (jT# �LpGK UBD. NAME OR CSM #
1310 H #65 1 Pondview Meadow
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE kJOWN NEAREST ROAD
New Richmond, WI. 54017 (71$ 246 -5425
] New Construction Use k ] Residential/ Number of bedrooms 4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft
Absorption area required 1500 bed, ft 1200 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd /ft
Recommended infiltration surface elevation(s) 97.80 ft (as referred to site plan benchmark)
Additional design/ site considerations trenches spaced to code 3.0' below surface grade
Parent material glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem E S ❑ U ® S ❑ U ® S ❑ U ®S ❑ U ❑ S [IU ❑ S CRU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertch
.................
..................
.................
..................
1 0 -6 10yr3 /3 none 1 lcsbk mfr gw 2m .4 l .5
2 6 - 20 7.5yr4/4 none scl lcsbk mfr yw lm .2 .3
Ground 3 20 -80 7.5yr4/4 none sl lcsbk mfr na na .4 .5
elev.
100 ft.
Depth to
limiting
factor
80"
�tv
.�r
Remarks:
Boring #
1 0 -11 10yr3 /3 none 1 lcsbk mfr gw 2f .4 .5
2 11 -27 7.5yr4/4 none scl lcsbk mfr 9w if .2 .3
3 27 -80 7.5yr4/4 none sl lcsbk mfr na na .4 .5
Ground
elev. 1
10 ft.
Depth to
limiting
factor
Anti I
5
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave. w RichmonchWl 54017
Signature: Date: 4 - -99 CST Number: m02298
PROPERTYOWNER Richard Derrick SOIL DESCRIPTION REPORT Page 2 _` of 3
PARCEL I.D. # 026- 1065 -50 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
1 0 - 10 10yr3 /3 none 1 2msbk mfr gw
2 10 -24 7.5yr4/4 none scl 2msbk mfr gw if .4 .5
q�
Ground 3 24 -84 7.5yr4/4 none sl lcsbk mfr na na .4 .5
elev.
99 ft.
Depth to
limiting
factor 3
Remarks:
Boring #
1 0 -12 10yr4 /3 none 1 lmsbk mfr cs 2f .4 .5
<' 4 #s 2 12-30 7.5yr4/4 none scl lcsbk mfr gw if .2 ? .3
0t v 3 30-69 7.5yr4/4 none sl lcsbk mfr gw na .4 '.5
Ground
elev. 4 68-96 10yr4 /6 none fs Osg mvfr na na .5 .6
98.2 ft. —
Depth to
limiting
factor
„ y
Remarks:
Boring #
1 0 -11 10yr3 /3 none 1 lcsbk mfr gw 2f .4 .5
2 11-28 7.5yr4/4 none scl lcsbk mfr gw if
OA's' 3 28-8C 7.5yr4/4 none sl lcsbk mfr na na .4 .5
Ground
elev.
97.6 ft.
Depth to
limiting
factor
801 y
Remarks:
Boring #
13
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
� r
r
STEEL'S SOIL SERVICE
Gary L. Steel Richard Derrick 1554 200th Ave.
CSTM2298 NE4NE4 S22- T30N - New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #10- Pondview Meadow
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use.
N
1 =40'
BM.= top of NE lot stake C el. 100
Alt. BM. =top of 1 pvc pipe C el. 101.40
5 r �
5 �
7a �`
Gary.L. Steel
4 -24 -99
Wisconsin = partrnent of Industry SOIL AND SITE r f�- �3 O R T Page 1 of 3
La , uman Relations 3 I I
o�sio� of Safety & Buildings in accord with IL: !t'dtn Code
r` COUNTY
Attach complete site Ian on a er not less than 8 1/2 x 11 inches �t �u but St. Croix
P p p PARCEL I.D. #
not limited to vertical and horizontal reference point (BM), direction e, sca a t- ,
dimensioned, north arrow, and location and distance to nearest ro -+ 026 -1 — — i) 999 _ R VIEWED BY DATE
APPLICANT INFORMATION— PLEASE PRINT ALL INFOR s- cflax
PROPERTY OWNER: Bl1C TIOJLI`�
Richard Derrick GOVT. LOT 4 Ld E v4,S22 T 30 N.R18 for) W
PROPERTY OWNER':S MAILING ADDRESS T;# 4ltpK UBD. NAME OR CSM #
1310 Hy. #65 1 1 Pondyiew Mea
CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE JJOWN NEAREST ROAD
New Richmond, WI. 54017 (71$ 246 -5425
j New Construction Use J Residential / Number of bedrooms 4 ( ] Addition to existing building
j J Replacement (] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd/ft
Absorption area required 1500 bed, ft 1200 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd/ft
Recommended infiltration surface elevation(s) 97.80 It (as referred to site plan benchmark)
Additional design /site considerations trenches spaced to code 3.0 below surface grade
Parent material glacial dri Flood plain elevation, if applicable na It
7SUunisuitable able for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
fors stem I ® S ❑ U ® S ❑ U ®S ❑ U ®S ❑ U ❑ S 12 ❑ S 11
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxt3y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T ch
1 0 -6 10yr3 /3 none 1 lcsbk mfr gw 2m .4 I .5
�•, <i 2 6 -20 7.5yr4/4 none scl lcsbk mfr gw lm .2 .3
Ground 3 20 -80 7.5yr4/4 none sl lcsbk mfr na na .4 .5
elev.
1D0.�n•
Depth to
limiting
factor
80-0
Remarks:
Boring #
1 0 -11 10yr3 /3 none 1 lcsbk mfr yw 2f .4 .5
2 2 11 -27 7.5yr4/4 none scl lcsbk mfr 9w if .2 .3
3 27 -80 7.5yr4/4 none sl lcsbk mfr na na .4 .5
Ground
elev.
lo n.
Depth to
limiting
facto
Remarks:
CST Name: -- Please Print Gary L Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave. w RichmonchWl 54017
Signature: Date: 4_24 -99 CST Number: m02298
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STEEL'S SOIL SERVICE
Gary L. Steel Richard Derrick 1554 200th Ave.
CSTM2298 NE4NE4 S22- T30N -R18w New Richmond, WI 54017
715
MPRSW -3254 town of Richmond � � 246 -6200
lot #10- Pondview Meadow
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use.
N
1 "= 40 '
BM.= top of NE lot stake @ el. 100'
Alt. BM. =top of 1" pvc pipe C el. 101.40'
t WV
8
c
7
off.
Gary.L. Steel
4 -24 -99
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ' ��- 1�_e, er srm
Mailing Address
Property Address 4" A ve-
(Verification required from Planning Department for new construction) 7—
City /State ��-�cJ &4j rrc,4j CJ C– Parcel Identification Number
LEGAL DESCRIPTION
a 2(" - /o - ovc)
Property Location '/4, '/4, Sec. , T N -R W, Town of icl�a1a� -a(
Subdivision - Po r1 Vie UJ p a' Lot #
Certified Survey Map # . Volume , Page #
Warranty Deed # �lL���nQ'1 ?i , Volume 4 1 2 Page # 3
Spec house ❑ yesA no Lot lines identifiable JZ yes ❑ no
s
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix 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
stating Lethree eptic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
'? days of year expi ration date.
SIGNA
OF APPLI
CANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pro described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* » » » ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * *•
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
A N
f V42PAC�3 1 iv
STATE BAR OF WISCONSIN FORM 11 — 1982 6QEs 973
LAND CONTRACT KATHLEEN H. WRLSH
Individual and Co 'late
(TO BE USED FOR ALL TRANSACTION5 WHERE OVER REGISTER OF DEEDS
DOCUMENT NO. - %25.0W IS FINANCED AND IN OTHER NON-CONSUMER ST. CROIX CO., WI
ACT TRANSACTIONS)
RECEIVED FOR RECORD
Contract, by and between Loren D. Derrick, Rose H.
07-19-1999 8:00 RM
Derrick, R iCb;ird T._ rrcrrinL - Tnan i Tlerrin , Find LAND CONTRACT
g nhor }_ J _ I]Farri rle ( "Vendor ", EXERT t
whether one or more) and Titian Paterson and M ary 7. CERT COPY FEE:
TA?tarson, husband and wife. COPY FEE:
( "Purchaser ", whether one or more), RECORDIN � G FEE: 12 12.70
EC�tDIN.00
Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance PAGES: 2
of this contract by Purchaser, the following property, together with the rents, profits, !!
fixtures and other appurtenant interests (all called the "Property "), in
S} _ (lrni y County, State of Wisconsin:
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
ii KRL' i 1NA OGLAND
Estreen & 0 $ 1 ane
P.O.. r• O. Box 359
Ilnclson� WI 54016
026 - 1065 -10; 026 - 1065 -50
PARCEL IDENTIFICATION NUMBER
Lot 10, Pond View Meadows in the Town of Richmond, St. Croix County, Wisconsin.
This is not homestead property
X)O= (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at place Vendor directs
the sum of $ 26, 900.00 in the following manner: (a) s 20.000.00
at the execution of this Contract; and (b) the balance Of $ 6'2. 900.00 , together with interest from date
hereof on the balance outstanding from time to time at the rate of ei(:Iht (8%) percent per annum until paid in full, as follows:
Commencing on the 16th day of August, 1999, and on the 16th day of each and every month
thereafter, equal monthly installments of principal and interest in the amount of
$139.91.
Provided, however, the entire outstanding balance shall be paid in full on or before the 16th day of July. 2004
)I KKK (the maturity date).
Following any default in payment, interest shall accrue at the rate of _% per annum on the entire amount in default (which shall
include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special
assessments, fire and required insurance premiums when due. To the extent received by Vendor. Vendor agrees to apply payments to these
obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow
fund or trustee account, but shall not bear interest unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid
without premium or fee upon principal at any time
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of
principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that
said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be
continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the tide evidence submitted to Purchaser for examination except:
None.
Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until
the full purchase price is paid.
Purchaser shall be entitled to take possession of the Property on day of closina. X Xj!$ OC
Croce an one.
STATE BAR OF WISCONSIN Wisc —In Lapel Blank Co.. Irc.
LAND CONTRACT - Individual and Corporate Farm No. 11 - 1982 miwaukee. Wis.
>,1: ;.1442PAri 372
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendors interest in it and to deliver to Vendor
on demand receipts showing such payment.
Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils
and such other hazards as Vendor may require, without co- insurance, through insurers approved by Vendor, in the sum of $X/n
but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premium
when due. The policies shall contain the standard clause in favor of the Vendors interest and, unless Vendor otherwise agrees in writing, the
original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies
and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property
damaged, provided the Vendor deems the restoration or repair to be economically feasible.
Purchaser covenants not to wmmit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable
condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and
regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed
at the times and in the manner above specified,Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of
the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except:
Easements, restrictions and rights —of —way of record, if any,
Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for
a period of ec (Z days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which
continues for a period of (o0 days following written notice thereof by Vendor (delivered personally or mailed by certified mail); then the entire
outstanding balance under this contract shall become immediately due and payable in full, at Vendors option and without notice (which Purchaser
' hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those
provided by law or in equity: (1) Vendor may at his option, terminate this Contract and Purchasers rights, title and interest in the Property and
recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire
outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which
event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the
Property if Purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment on
the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event
the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid
purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on tide in a quiet-
title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and
have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (fi) or (iv) above. Notwithstanding
an oral or written statements or actions of Vendor, an election of an of the foregoing remedies shall only be binding upon Vendor if and when
Y Y Y g Po
pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether
abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred,
and shall be included in any judgment.
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment to
a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action
and such rents, issues, and profits when so collected shall be held and applied as the court shall direct.
Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchascrs rights under
this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance
payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchasers interest under this Contract solely
as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire
outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendors option without notice.
Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any
mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amount then due under this
Contract. Purchaser may make such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be
considered payments made on this Contract.
Vendor may waive any default without waiving other subsequent or prior default of Purchase.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor
and Purchaser. (if not an owner of the property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the
subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.)
Dated this I & day of July , 199.
21 _ 1? (SEAL)
Derri
(SEAL) (SEAL)
Der rick • De Pe tersoxi
(SEAL) , f �' (SEAL)
- Richard L. Derric • Ma J. Peter
I 1 ue,,ZJ _____ SEAL) - (SEAL)
n L. Derrick Robert J. frisk
AUTHENTICATION ACKNOWLEDGMENT
T renD. Derrick, Rose H. Derrick,
E- r , ricn - ure(s) Richard L• Derrick, Joan L. State of Wisconsin,
end .Robert J. Derr ck; Dean ss.
County
authemicated th' ay of July 19 Personally cams before me this day of
19_, the above named
e
K�isCink fql t
TITLE: MLQPI p3[A'6� 0 OF WISCONSIN
(If not, ' , 5 w
authorized by 6706.06, Ws. Stats.) to me known to be the person who executed the foregoing
instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED By
Attorney Kristina Ogland
Hudson, WI 54016 Notary Public, County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary.) 19 )
• Names of persons signing in any rapacity should be typed or printed below they signature.
LAND CONTRACT — Individual and Corporate — State bar of %Ucoosln, Form No. 11 — 1982
J� 1. I L V J L J" Y 1 .L V 1. LI l 1 L `/ 1 1 ICJ
THE NE 1 /4 OF THE NE 1 /4 AND IN PART OF
TION 22, T30N, R 18 W, TOWN OF RICHMOND,
,,W 45 115 68 '
S
� . = 7 $ . 4 3 , 17
337.2
'❑ RETAIN OWNERSHIP OF OUTL ❑T 1. ® 10
IS RESERVED FOR TOWN ROAD EXTENSION. Ir
HAVE EASEMENT OVER ❑UTLOT 1 FOR \ l9, 2,001 ACRES 2.001 A Irr 1 146TH AVENUE. S
AREA OUTLOT 1 �. �� �In. 87 ,179 SQ.FT. � 87,171
'E ROAD EXTENTION WOULD 0.159 ACRES ��. all
ACCESS TO C.T.H. 'G'. 6930 SQ. FT. \ �'' M
S86 °40'35 11W 355.38 \
��.�\ \ , S89 °43 „ W
Ln
; 66.00' CD
'w 11
Q --- • - - - - -- OUTLOT 100'
i o
�N j - w 2.004 ACRES ......... �.. ......... Ln
iN i o w 87,313 SQ.FT. i ° 273.73 �I
o —
.� o
1n Q ; 100' - — 197.81' -- �'�� - 75.92
M N89 °4 s3'j� � - 73'
25' :o
' S89 °43'03 "W 380.66' :
• 1 A
33 33/T
� I
i
CD
12 ; co o
. M
N .......... ; >-as cu
^ LOT - - -4
` 2.005 ACRES o N �,0 w C, S,M,IN
87,318 SQ.FT. °CO i n 45
% `r' V. 10, PC. 27___
cv i ----------------
S89 °43'03 "W 380.68" % CD AWNED BY OTHERS `<
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C) F
vi
M C)
co 13 LOT 3
w N _.._._._. o I C.S.M. IN
cu 2,005 ACRES 6
N
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