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County:
WiscoAsin Depeertment of Commerce PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division ..
INSPECTION REPORT Sanitary Permit No:
488139 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)j.
Permit Holder's Name: City Village X Township Parcel Tax No:
Willett, Jesse I Richmond, Town of 026- 1127 -38 -000
CST BM Elev: Insp. BM Elev: BM Description: / Section/Town /Range /Map No:
b Z) L ��P7ti� 25.30.18.848
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 7, r Benchmar b /0 1, 3
Dosing Alt. BM
Aeration BI . 7,2 t • Ad• sS
Ho ing t/ t net .�� q-) Q,
TANK SETBACK INFORMATION t t ut et t r7 77 1. G
TANK TO P
VVEL BLDG. V ent o it IntaKe ROAD Dt In '-
ep is B ottom
1• 3
osing ea er an. 9 q-7-
42 - 1
era ion Dist. P ipe 2 d
. l 0 `•
o ing o . ys em
Z„ p .
I na l G
PUMP /SIPHON INFORMATION ,. Z•J .
M anufacturer Demana st (70 er ! o
�.. 3. 2 p - t o t
o e um er
Z i nc i oss a
oc ain eng ia. ZN%n 1
Mr-Lif I
DIMENSIONS Q 3
INFORMATION CAMBER OR s
We uWyb"
UNIT
U SYSTEM
Pipe(s) 4_ !L __(c r--\
Length Dia Length y Dia Spacing
x Pressure Systems Only xx Mound Or At -Grade Systems Only
Bed /Trench Center Bed/ nch Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2:
Location: 1343 144th Street New Richmo d, WI 54017 (NE 1/4 SW 1/4 25 T30N R18W) Richmond H Is Lo 38 Parcel No: 25.30.18.848
1.) Alt BM Description Z' V•' ' f - t4x, S�/'S7
2.) Bldg sewer length = p J? 3 NAAJ
amount of cover
Plan revision Required? Yes ] No T
Use other side for additional information. J D7 ��� or's to
- -- at
SBD -6710 (R.3/97)
,old. %L /a �
V
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
r visconsin diso 26 1 " C n I nitary Permit Number (to be filled in by Co.)
Department of Commerce ) �CE V GV
to Plan I.D. Number
Sanitary Per lica io1� 3 Zp06 —
In accord with Comm 83.2 1, Wis. A7Code, ersonal in o at io may be used for secondary pvacy Law, s 04(I)(m) P 'ect Address (if different than mailing address)
ROIX COUNTY / 2 (/ 1 ST,
I. Application Information - Please Print All Information J / _ Of a
Property Owner's Name Parcel # Lot # Block #
Property Owner's Ma iling Address ,L PPropertyLocations
a
7 d / / /� �' '., Section
City, State Zip Code Phone Number
' / le o
c C i?2 G%l T � N; R
II. Type of Building (check all that apply) /
Subdivision Name CSM Numb r
PK1 or 2 Family Dwelling - Number of Bedrooms
r
❑ Public/Commercial -Describe Use
❑ State Owned - Describe Use ❑City ❑Vill a �ftb ship of
Z
IIt. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. JKNew System ❑ Replacement System g P Y
❑ TreatmendHoldin Tank Replacement Only Other Modification to Existing System
List Previous Permit Number and Date Issued
B• Permit Renewal nit Revision ❑ Change of ❑ Permit Transfer to New
en
Refore Expiration Plumber Owner / Q'/ 3 y D C
1
D 0
IV. Type of POWTS S ste a appl
X No n - Pressurized In- Ground , ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Grow 11 Holding Tank ❑ Peat Filter 1:1 Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter Ching Chamber ❑ Drip Line ❑ Gravel -less ❑ ' Aker (explain)
V. Dis ersal/ Trcatment Area Information:
Design Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Required (sf) Dis er (s Syste !- - "'m Ele ^atior
o� 5 r -_ � ;
!o ` r
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Stee r` .her` Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing]
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement 1 , the undersigqo, assume responsi 'lily for' ton of the POWTS sh own on the attached plans.
Plumbst,' s Name (Print) ! -- Plumb ignature RS Number Business Phone Number
Plut er's Address (Street,, City, S Zip C
VIII. nt JDe artment Use Onl
pproved ❑ Dipproved
Owner Given Reason for Denial S nitary Pennit Fee (i clttdcs Groundwater Dam ssued wing Agen S
Surcharge Fee) 7
ignature St _ mps)
❑ �� , 5 1 l� �
LLA a l Q
IX Conditions of Approval /Reasons for Disapproval
Attach complete plans (to the County only) for the system on paper not less than 81/2 a 11 inches in size
SBD -6398 (R. 01/03)
PLOT PLAN
PROJECT Jesse Willett ADDRESS 1729 220th st NewRichmond Wi. 54017
1/4 SW 1 /4s 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Byron Bird Jr. 220527 DATE 5 -11 -06 BEDROOM 4
CONVENTIONAL XXX At rade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE C3 LOAD RATE •5 ABSORPTION AREA 1200 # of chambers 39
BENCHMARK V.R.P. top of walk out ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL - H.R.P. Same as BM
Vent SYSTEM ELEVATION T -1 =96.4 T -2 =96.3 T -3 =96.1
A6'
Of Bio Diffuser with ft
31.1 ^2 per
chamber
6"
Lon 34"
Long Elevation
PL
181'
4 bed O ob pipe
house
BM
140' 18' BI g l 3 %slope B2
st 8'
garage 25' 15' _.
40' B3
B2
$l
100' BM 86' 10' 10' 255'
PL
Pa ge / of
T
T {O
N REPORT
Wisconsin Department of Commerce {-
UA
Division of Safety and Buildings in accordance an m 85 r
y.e--
Attach complete site plan on paper not less than 81/2 x 11 in es i Plan must
include, but not limited to: vertical and horizontal reference poi t (BM),_di recti aan_d P rr�
�
percent slope, scale or dimensions, north arrow, and location nd dish t e e( Date
Please print all information. evi
r pr
Personal information you provide may be used for secondary purpose (Privacy L' aW, S`.'ida4Pf]1Y —
lion �
Property Owner
r
Govt Lot 1/4 ,1/4
prope Owner's Mailing Address Lot # Block # Sutxi or CSC
rty
City State zip Code Phone Number ❑ City ❑ Village ,�77 Nearest Road
/ 4O !�
New Construction Use: Residential / Number of bedrooms
Code derived design flow rate
rMReplacement ❑ Public or po mmergal - Describe: - -- ft
Parent material Flood Plain elevation if applicable -
General comments
and recommendations: T� `� -'
Boring
U Boring # ft Depth to limitin factor ��� in.
Pit Ground surface elev. P g Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -EGPD Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Boring G
® Bering # ❑ pit Ground surface elev. �C��J /� Depth to limiting factor Soil Application
in.
,/_�___ ft• g gtion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -EGPD Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
` Effluent #1= BOD > 30 < 220 m9n -and TSS >30 1150 mg/-
Effluent #2 BOD < _ 30 mglL and TSS < 30 m9
::Name (PI Print) CST umber
Date Evaluation Conducted Telephone Number
CST Add
Property Owner
LC/! Parcel ID # Page of
a Boring # Boring f Ground surface elev � ft. Depth to limiting factor l� ° in. Soil Application Rate
❑ Pit �
Horizon Depth Dominant Color Redox Descripfion Texture Structure Consistence Boundary Roots GPDIff
Gr. Sz. Sh. 'Eff#1 'Eff#2
in. Munsell Qu. Sz. Cont. Color
o- D G _� -
d K
❑ Boring
Boring # ft. Depth to limiting factor in.
❑ pit Ground surface elev. Soil Application Rate
Horizon Depth Dominant Colo Redox Description Texture S tructure Consistence Boundary Roots GPDfftr
in. Munsetl Qu. Sz. Cont. Color
Gr. S7- Sh 'Eff#1 'Eff#2
.
Q ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPDM
in. Munsetl Qu. Sz Cont. Color
Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 mglL and TSS <_ 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SOD-9330(RAM)
• Safety and B ildin t Coun y
m as 201 W. Washing[ Ave., (�Q ox 162 y o t
�scons�n Madison, 53707 -7162 Sanit ry Permit Number (to be filled in by Co.)
De partment of Commerce (608) 66 31 �pR 1 7 2006 g� /3
Permit A licati n State Plan I.D. Number
Sanitary PP ST. CRO{X COUNT
In accord with Comm 83.21, Wis. Adm. Code, personal informati you provide
may be used for secondary purposes Privacy s15.04 ct Address (if / diff f erent than mailing address)
I. Application Information - Please Print II Info matio l �
/? / 3 � 3j 1 , 1
Property Owner's Name Parcel # Block #
„Z 3
Property Owner's Mailing Addres Propert/Loca
City, State Zip Code Phone Number �� ection s2 S—
T/ c or W e) V r V
I. Type of Building (check all that app p rc q s
Su ision Name M Number
❑ I or 2 Family Dwelling - Number of Bedroom 140. SL Iq
❑ Public/Commercial - Describe Use Z
2
❑ State Owned - Describe Use Z d G, 14 & 4 G ❑City_ ❑Villa egTownship of
III. Type of Permit: (Check only one box on line N Complete line B if applicable)
A, ,New System p y g p Y
❑ Replacement S reatmenUHoldin Tank Re laces t Only j <A � aj6 j Gt 1 0.Wten ,
B. ❑ Permit Renewal ❑ Permit Revision ❑ Ch a a of ❑Perm' ransfer to New st P vious Permit Number and Date Issued
Before Expiration Plumber Owne
t �
N. Type of POWTS System: Check all that appl
,O t J
A Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ALine d < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland Pressurized In- Ground El Holding Tank Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter El Leaching Chamber ❑ D❑ Grave l -less Pipe ❑ Other (explain)
V. Dis ersaVrreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Re fired (sf) Dispersal Area Proposed (sf), System Elevation
. 7 ✓'. 1 j�
VI. Tank Info Capacity in Total umber Manu cturer Prefab Site Ste el Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing ��
Tanks Tanks L YJd J�JCL
S ept ic Holding Tank
obic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- , the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' gnature MP/MPRS Number Business Phone Number
/ -
P u is Address (Street, ty, State, Zip Code)
k121 e r
Vti ounty/Dep ment Use
Approved isap pp?pved, Sanitary Pen-nit Fee (includes Groundwater Date ssue Issuin gent Sign ture
Surcharge Fee)
Owner ' en Reason tbr- Denial
IX. Conditions of Approval /Reasons for Disapproval
SYSTEM OWNER:
1. Septle table, M Lom Aker and
diapereal vale must an ba senftn / maNOW
as per nw alpmwtt plan WVkled by per•
Z. All sa *Ck n**wnwft Must be m*tsined
as per applicable code / ordirova.
Attach complete plats (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
�,,,.,,,�,- .,.,•�.�"'•_,�� ° "fir.
.Si:7.71..•;; rll �:-t i'� .. v tt?a�i;'1q�l� "6i°: '9C; ai
PLOT PLAN
PROJECT Jesse Willett ADDRESS 1729 220th st NewRichmond Wi. 54017
1/4 SW 1 /4s 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Byron Bird Jr. 220527 1% % , DATE 4 -18 -06 BEDROOM 4
CONVENTIONAL XXX At rade O
CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28
BENCHMARK V.R.P top of 1 in. pipe A SSUME ELEVATION 100'
❑ BOREHOLE (DWELL *H.R.P. Same as BM
Vent SYSTEM ELEVATION T -1 =94.2 T -2 =94.3
> 12"
of Bio Diffuser with
Cove 3 1. 1 ft A2 per
chamber
6
Long 34" Elevation
PL
0 .j� v 2 181'
boo.
` X
house fit(• �/ O ob pipe � y'
140' "15 e-= ---
\ garage _
{ 88'
' /C)t' 7
B
B ,
1 1W BM W , V 0' 255'
CO PY PL
PLOT PLAN
PROJECT Jesse Willett ADDRESS 1729 220th st NewRichmond Wi. 54017
1/4 SW 1/4s 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Byron Bird Jr . 22052 i r_`� DATE 4 -18 -06 BEDROOM 4
CONVENTIONAL XXX rade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE C3 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28
BENCHMARK V.R.P top of 1 in. pipe ASSUME ELEVATION 100'
❑ BOREHOLE O WELL - H.R.P. Same as BM
Vent SYSTEM ELEVATION T -1 =94.2 T -2 =94.3
>12
of Bio Diffuser with
Cove 31.1 ft ^2 per
chamber
6 "
Long 34' Elevation
` PL
181'
4 bed
O ob pipe
house
140' 25' B3 3 %slope B4
st
garage 15'
469
O ' ill
r\
B2
BI 100' BM 86' 10' 10' 255'
PL
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must St. Croi
include, but not limited to: vertical and horizontal referepce and Parcel I.D.
percent slope, scale or dimensions, north arrow, arxH4catibn grid Oist,ncp to nearest road. p endin q
Please print all kifordfation. R viewed by Date
Personal information you provide may be used for pu Law, S. 15.04 (m)). ` tZ
Property Owner r-tupu Location I
�. Govt_Lo NE 1/4 SW 1 14 S _ T N R 18 �(or) W
Property Owner's Mailing Address Lot • Block # Subd. Name or CSM#
1
1868 Ct . Rd. C Richmond Hills
City State Zip Code hone NupL wNG Ui ❑ Village ® Town Nearest Road
New Richmonq WI 1 54017 1 ( 715, 247 -5721 ,' Richmond I 140th
El New Construction Use: ❑ Residential / Number of bedrbar6s 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material g i agta i dr i ft Flood Plain elevation if applicable ft. net
General comments
and recommendations:
trenches spaced to code 3.50' below grade
Boring # Boring
1 ® pit Ground surface elev. Q9 ��, ft. Depth to limiting factor + in. =Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2
1 0 -16 10 r 3/3 none L 2msbk DSH cs if .5 .8
2 0 r 5/4 none sil 2msbk mfr qw if .5 .8
7.5yr 4 none ms osci ml qw na .7 1.2
84 5yr 4 none sl 2msbk mvfr •5 •
fr
F 99 Boring # f�n1 Boring
. Pit Ground surface elev. ft Depth to limiting factor + 8 6 in. = GPD/fF Horizon Depth Dominant Color Redox Description Texture Structure
Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-12 10 r 3/3 none L 2msbk DSH cs if .5 .8
none sil 2msbk mfr qw if .5 .8
oscl mvfr UW na •7 1.2
tt
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L uent #2 = BOD _ 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel 02298
Address Date E luation nducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 10 -19 -2000 715- 246 -6200
I
f_
Property Owner R ,T C DavPl nnmen Inc. Parcel ID # o n Page 2_ of
❑ Boring # ❑ Boring
3 ® pit Ground surface elev. 9 8 . 3 0 ft. Depth to limiting factor + 9 6 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
3 ms Os
4 8 -96
1
pl r
4 Boring # ❑ Boring
9 7. 7 0 _
® Pit Ground surface elev. ft. Depth to limiting factor + 9 0 in.
Soil Ap lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
1 0 -11 10 L 2msbk mfr cs if
2 11- 2
3 28 -90 7.5 r 4 6 OSq mvfr
F-1 Boring # F1 11 Pit Boring
Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 I '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 or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.6 /00)
Property Owner R .T C' Dlaval nnman , InC. Parcel ID # none } Page 9 of _1_
F Boring # F! Boring
3 ® pit Ground surface elev. 9 8 . 3 0 ft. Depth to limiting factor + 9 6 in. - §o - i -- Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. `Ef1#1 'Eff #2
mS OS
4 8 -96
1
t r
4 4] Boring # ❑ Boring
® pit Ground surface elev. 97.70 ft. Depth to limiting factor + 9 0 in.
Soil — Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
1 0 -11 1 L 2msbk mfr CS if
2 11- 2
3 28 -90 7.5 r 4 OSCI my
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
` Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS 5 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.6100)
- STEEL'S SOIL SERVICE
Gary L. Steel RJC Development, Inc. 1554 200th Ave.
CSTM2298 NE S25- T30N -R18W New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #38- Richnmond Hills
�
�1 " =40'
- top of 1" pvc pipe @ e:100.00'
lt. = top of 1" pvc pipe @ el. 99.25'
L IT 0
,3
5
Gary L. Steel
10 -19 -2000
1
7
V -2631P 301
KATHLEEN H. WALSH
S OF RESISTER DEEDS
ST. CROIX CO., WI
STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD
Document Number WARRANTY DEED 88/84/2004 01:45PH
THIS DEED, made between Gregg L. Dertinger and Diane M. VARRANTY DEED
Dertinger, husband and wife, Grantor, and Jesse A. Wille a single person,
EXEMPT #
Grantee. REC FEE: 11.80
Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 112.50
the followin, described real estate in St. Croix County, State of Wisconsin: COPY FEE:
CC FEE:
- L e QQ8, Plat of Richmond Hills in the Town of Richmond, St. Croix County, PAGES: 1
Wisconsin.
Recording Area
Name and Return Address:
Edina Realty Title,
400S.2 . St. — tte 115
Exceptions to warranties: Hudson, 4016 ')
Easements, restrictions and rights -of -way of record, if any. 441409
IQ =
iiir
026 1127 - 38 W
Parcel Identification Number (P"
This is no homestead property.
Dated this 14th day of July, 2004.
'* " regfe . Dertinger * Diane M. Dertinger
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
authenticated this 14th day of July, 2004
B ARRON Personally came before me this July 14, 2004 the above
ubUc named Gregg L. Dertinger and Diane M. Dertinger, husband
*
and wife to me known to be the person(s) who executed the
TITLE: MIiMBER STA E b"0W58 foregoing i ment and acknowledged the same.
(If not. _ /A ,�
authorised by § 706.06, Wis. Slats.) �Vt/�C t 4
TI IIS INSTRUMENT WAS DRAFTED BY * "powwow oi a-i U l'1
Notary Public, State of Wisconsin
Peterson, Frain &Bergman — Steven H. Bruns My commission is permanent If not state expiration date:
50 East Fifth Street, St. Paul, MN 55101 ammew
fit- lit -ct00 Lo )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of pci lens signing in any capacity must be typed or printed below their signature Metro Legal Services
EDMET 441409 A
383922 WD 3113926
WARRANTY DEED STATE BAR OF WISCONSIN FORM Nol -2000
01. I—KUTA UUU1NTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �5� e'� � ?� f
Mailing Address 1,7 ,2C,
Property Address (j
(Verification required from Planning & Zoning Department for new cons on.)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location 1 /4 , _5ZV 1 /4 , Sec., T N R'�W, Town of
Subdivision Lot # ��
Certified Survey Map # , Volume , Page #
Warranty Deed # C`i , Volume 5 , Page # o
Spec house yes no Lot lines identifiable es 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.
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 form are true to the best of my /our knowledge. I/we 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
.,-SIGNATURE. 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)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 40 `� Septic Tank Capacity a l ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model 6-z� ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) 0"1:5) al /day Pump Manufacturer ❑ NA
Soil Application Rate , al /day /ft2 Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD _ <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometri mean) 510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
❑ year(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
❑ year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
❑ year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
❑ year(s)
❑ month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
Page _
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• 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.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to •provide a code compliant
replacement system:
rO 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 will
result in the need for a new soil and site evaluation to establish a- suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
• A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER 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
POWTS INSTALLER POWTS MAINTAINER
Name Name
-C c Zc
Phone 1-11 Phone — ' . 57 l
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name C,
Phone - Phone
This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code.
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS. antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• 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.
filled After II removed or their covers removed and the
void space with
pumping, , a tanks and its shall be excavated and remo P
P p 9 P
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to .provide a code compliant
replacement system:
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 will
result in the need for a new soil and site evaluation to establish a •suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER 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
POWTS INSTALLER POWTS MAINTAINER
Name A7 Name { ' 1'rlP
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone 02
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
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' Parcel #: 026 - 1127 -38 -000 04/18/2006 01:29 PM
PA 1OF1
Alt. Parcel #: 25.30.18.848 026 - TOWN OF RICHMOND
Current I]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
JESSE A WILLETT O - WILLETT, JESSE A
1343 144TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description * 1343 144TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.240 Plat: 2382- RICHMOND HILLS LOTS 5/48 '00
SEC 25 T30N R18W PT NE SW RICHMOND HILLS Block/Condo Bldg: LOT 38
LOT 38 2.240AC
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
25- 30N -18W NE SW
Notes: Parcel History:
Date Doc # Vol /Page Type
08/04/2004 770708 26311301 WD
05/02/2001 644371 1630/438 WD
11/30/2000 634465 8/24 PLAT
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/20/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.240 29,700 0 29,700 NO
Totals for 2006:
General Property 2.240 29,700 0 29,700
Woodland 0.000 0 0
Totals for 2005:
General Property 2.240 29,700 0 29,700
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