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HomeMy WebLinkAbout026-1082-93-000 n U! p 0 cn 0 s n O m ° Ci E c ,' °' 3 (D (D 3 ( (p n A 'o p; • j y' M CD CD v _ � Q 0 .*,a 0 0 N O C 0 Z N � CD — O N O N eC �i • �' B N O N N S 7 N C O N () 0) CL Z Z N O N ? CL rD (D V N p O O M N a O O N N Q 3 N ( A (O C g a �t C) co M 3 3 n ° M cc n 7 O W y Q co o o $ o F m o ra N N N N A 3 O O N c A d O O D a° D m p p 0 t N N a N CD A N a S O T7 � O � Z N N o) W N N Z o (o o z o .l1 O O o 0 r y 00 00 f c -4 v a CD O O O a O O O o O w < Z a (D C (D O m y < o m a r - CD (n (° m - A o (Q N N (D .. d O m N J w d 3 3 N A Z SL z W Z Z co Z Q CD ° O o D =h = O ° D° 3 n rr N d 9 CD CD C N • 0 0 O N N CD ''� (D m 3 (P N CD N - I�f C (D (D O (D N CL a CD c6 (D 3 (° A Z CO) N cn ° () d a A 0 � Z W po W M U M p CD '�' a z 3 A ° ° o o M 3 3 � m � (!r Z tl1 ? (D n W W O i 3 3 OD w O N n 3 }> N n n 'O W 'O 1> (0) O) 3? O x O O.. D I 1 (D W p O. (A. N a 3 ( p. �^ A . 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N (Q ° :3 W X (_) 3 N 0 O (D (D EA 0 (fl 0 { C c I C 0 2 T .1 & - � � E 2 o E 0 ° # O=r U 8 - § 2/ z z\ 0 0 2 %- k e ■ �_ E k ) § CO 0 0 §§2 w k ■ ( J 0 ) § E I 0 @ > 0 � \� - © o § $ A� # § m C OD e. i � 0 e f 9 cI > � ® 2 $ 7 o k k zi 2 E c CO CO m 2 } 0 0 0 �� "MIA- I 2 0 = %§ 2 <° z R-) 2 1 23 ■ @ ■ �; % > ) \ 0 2 E 7 \ - / § . i 2 k 2 / 4 I c o / = > 2 0 o � X ; , § w CL z CD i �,k7 C :F �z0 \ CID � ! f / CO { z § % @ § M M 2 _ / a ± � E 0) c � [ E % ƒ 3 � ƒ � S � � 7 � 2 2 2 � ■ 0 � < § % / ? ® K k � 0 ro � V N � i . v c v o w o h' V Ir Q AZQC j Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 11 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: Kearns, Leon Richmond, Town of 026- 1082 -93 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Eiev: 7 28.30.18.436E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM quid Depth BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Li DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of d /Sodded xx Seede xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes I No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1340 120th S_ treet` New Richmond, WI 54017 (NE 1/4 SE 1/4 28 T30N R18W) NA Lot 3 Parcel No: 28.30.18.436E 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional Information. F= Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN �p In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER G� [Privacy Law. S. 15.04(1)(m)] ud on, WI 54016-7710 1 54016 -7710 (715)386 -4680 Fax (715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application Si yes$ 0// t y v ids M 5� �✓2:v, I Application Information - Pl ease PrintAkinformation Location: Property Owner Name ! 1 RECEIVE /11 114 S L' 114, sec 2 Property Owner's Mailing Address APR 1 2 2007 Lot Number Block Number AIR City, State Z CROI tuber Subdivision Name or CSM Number # (-/33 (,&Z 41(_ Z4 W - y 3 i/a I H 3 4 Z II Type of Building: (check one) OK 0.b •$ w�; F] a amity E3 Villag &Town of ffi 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State -owned Nearest Road ll. Type of Permit: (Check only one box on line A. Check box on line B if applicable) /'7o 5 JParcel Tax Number(s) /3 1.❑ Repair 2.�Reconnection 3. ❑Non - plumbing 4. ❑Rejuvenation C / A) Sanitation 02lo' Jb8 2` q3' OHO B) Permit Number Date Issued State Sanitary Permit was previously issued 7d [ IT1,4 41 6 IV. Type of POWT System: (Check all that apply) J< Non - pressurized In- gro und ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation '150 6 i5 y8 1 < 4a, 7 Q I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11. Responsibility Statement I, the undersigned, assume responsibility for repair / reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terrali repair or the installation of non - plumbing sanitation system. Plum rs Name (print 1PIum si er s gnatur (no stamps): MP /MPRS No. Business Phone Number I ova 2 7/� 772 3Z/ Plumbe s Address (Street, City, State, Zip de')- T "° i LCD 4 D 1 III. County Use Only on �]' Sanitary Permit Fee 7te Is ued Issui gent Sign re (N tamps) Approved iv Hill Adverse } Z Z °O i Z 7 D IX. Conditions of Approval /Reasons for Disapproval: (� �� ►�ed�T� -- ✓vt.�s� �oe.. i'�e ✓e�I �ro.� Ex; s�' � � � 06 r44.� . 2) A aer-- o � — Sea_ �\ 1 4�- Joe e s TIMM EXCAVATING S HEET NO. OF Route 1 Box 192 2/ �/- WILSON, WISCONSIN 54027 CALCULATED BY V' "�'� DATE 1�— O (715) 772 -3214 MPRS #3224 WI CHECKED BY DATE SCALE .........i.... ....... ..........i...... ......... .....'. .... .... ......... .. ....... d......... ............- .................. ..... ..... .... .... ..... ..... ..... ..... .... .... .... .... ..... ..... ..... .... ... .... ... ; i i 5 a ...................... .... ... .. ..... .... ..... .... ... . ... .................... ..... .................................:......................<............ .............................., �.......... . ��i �. e. I "��► ...... .............!^.......... ....... ..... . :..... ... 1 . .... ..... ... ................. .... v D ._ 4 - Fi`C ............ �^ b� . ... .... ....... �� .. ............. . ib ...... ............ . . � ...... ...... ..... ....... .. . .. !_ PRODUCT 20x1 Inc., Groton, Mass, 01471. To Order PHONE TOLL FREE 1 -BDO -225 -M ST, CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM l Owner/Buyer Mailing Address `� 4-d L 1,4 u W zic� Property Address /1leaJ � a-- I �( � (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number d Zd — ocx� LEGAL DESCRIPTION Property Location I(JL� '/4 , s �� '/4 , Sec. .. , T - 30 N R__IE_W, Town of )lam �d Subdivision , Lot # Certified Survey Map # ! f334161_2_ , Volume 7 , Page # f 3 2. Warranty Deed # �3�/ S�o , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staring that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. 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 3 14 �SIGNA URE OF APPI ICANT(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. 08/05 4B 396t5 6 State Bar of Wisconsin Form 5 -2003 KATHLEEN H. WALSH PERSONAL REPRESENTATIVE'S DEED REGISTER OF DEEDS ST. CROIX CO., MI Document Number Document Name RECEIVED FOR RECORD 11/29/2086 18:28AN THIS DEED, made between Leon C. Kea PERSONAL REPRESENTATIV EXEMPT t 11 REC as Personal Representative of the estate of Michael E. Kearns TRANS FEE: 11.88 COPY FEE: "Grantor," whether one or more) Leon C. Kearns and Arlette M. CC ES: (" Decedent"), ( )> PAGES: 1 Kearns, husband and wife as survivorship marital pro perty ( "Grantee," whether one or more). Recording Area Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Name and Return Address S . Cr County, State of Wisconsin ( "Property") (if more space is Leo A. Beskar needed, please attach addendurn): Rodli, Beskar, Boles & Krueger, S.C. 219 North Main Street - PO Box 138 Lot 2 and 3 of the Certified Survey Map recorded in Volume 1 7" of Certified Jiver Falls, WI 54022 f� Survey Maps on Page 1932 as Document No. 433662, being a part of the Northeast 1/4 of the Southeast 1/4 of Section 28, Township 30 North, Range 18 026- 1082 -92 -000 West, St. Croix County, Wisconsin 026- 1082 -93 -000 Parcel Identification Number (PIN) This is not homestead property. Ns) (is not) This transfer is exempt from the Wisconsin Real Estate Transfer Return and Transfer Fee as per Section 77.25 (11). Personal Representative by this Deed does convey to Grantee all of the estate and interest in the Property which Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. Dated PERSONAL REPRESENTATIVE: ••! (}1IDYL 'alt (SEAL) ) * eon C. Kearns * �� W / AUTHENTICATION ACKNOWLEDGMI A( Signature(s) STATE OF Wisconsin authenticated on S4. CA ; COUNTY Personally came before me on ou-e r� ��1� > * _ the above - named Leon C. Kearns TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the p rson(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowled the same. THIS INSTRUMENT DRAFTED BY: * d J � Leo A. Beskar Notary Public, State of (,U Rodli, Beskar, Boles &Krueger, S.C. My commission (is permanent) (expires: j — (W - - ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. PERSONAL REPRESENTATIVE'S DEED STATE BAR OF WISCONSIN FORM NO. 5-2003 * Type name below signatures. V State Bar of Wisconsin 2003 INFO - PRO' Legal Forms • (800)655 - 2021 • intapmforms.com toff A 433ss2 st s CERTIFIED SURVEY MAP Located in the NEi /4 of the SEl /4 of Section 28. T30N, R 18W Town of Richmond, St. Croix County, Wisconsin USA Owned by: Theodore Ori HL 4 New Richmond. W1 -3r1�l L+NI2€.D- �/l11� E I /4 COR. N 90 00 0� W A3.54 0 280.54' 30 OO "E 3 POINT OF BE61NN I N6 LE OE ND SECTION CORNER MONUMENT LOT I p I" X 24" ROUNO IRON PIPE WEIYNING 1.90 LOS. /LIN. PT. SET A tr SCALE IN FEET I "s =OO• � ' O SO 100 200' 400• �O — o N 90 W 30M — o w w 28Q54 I COO 1 I W me g °� W LOT 2 W z CQ N O U4 .JI I = ► IW � ° _ �. �I S�M 7 y t 280.54' NOTE; Lot 1 contains 17++,239 square feet z (4.00 Ac.) Inc.R O W 155.9oj square feet(3.5 -s Ac.) LOT 3 Excluding R O W - Lots 2 & 3 are the same. 87119 Sq.Ft.(2.Oa" "'e+ including ROW, and 3300' W 77 -,9k 2 el Sq. Ft. excluding ROW N � 8 31;154• W (1.79 Acres). UNPLATTED + .LANDS LL ri - y 0-11, �; �► va �� we BE CORNER 9� nom' T3ON.RIGV This instrument was drafted by P. Gartmann Vol. 7 Pg. 1934 4117 -1319 Form- STC - 104 I AS BUILT SANITARY SYSTEM REPORT OWNER k t�k t )TOWNSHIP ' 1 cI IYl � k.) d SEC. T JN -R�W ADDRESS _ Q0 >4 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i I I 4tP �, 1 i # 75 r a+ Y INDICATE NO H ARROW BENCHMARK: Describe the vertical reference f f point used �' y �� � ` '° ����, :�)ZI Elevation of vertical reference point: J V V, Q / Proposed slope at site: SEPTIC TANK: Manufacturer: W e� k� Liquid Capacity: I DOL) 1 3, Number of rings used: �_ Tank manhole cover elevation: f /. y Tank Inlet Elevation: -.�3 Tank Outlet Elevation: 1x.17 Number of feet from nearest Road: Front,O Side, Rear , Q Y O feet From nearest property line Front,0 Side I& Rear, O feet Number of feet from: well building: r (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SFR RRVFRSE STDR PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. , r . Number of feet from well: Number of feet from building: ! (Include distances on plot plan) . 5 kot He p loci atj q SOIL ABSORPTION SYSTEM r0q, 30 Bed: V Trench • Ta ?S p II -55 Width: �d Length: Number of Lines : Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, ht Number of feet from well: Number of feet from building: 4 ' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: S t 12 v I Plumber on job: C}' ' License Number: 3/84:mj ,.' B.L 6_7 PL OT A (� � I U S A EC ! N A M E , r��� �. - �; , , 1v1 A M E L 0CAT I - II I 0 N _..,_..._L1,.` },R/ I' i �_�� \� �7i��11 � F\ I C E �) S ....E�"� - .I v,- '..1..1.....� .... _. -. N� c,�R�reR P L - 0 k!I A P Ion, _ [I N Z . d so' 4) 81 s 08 i S64f I 1 �e "•c. ,r C? +�rr��i e l� P,3 7 10 I ( � I q�e V ��pr,�� • — 8 �b 0 1 a .Bh1 E& 100.0 1- --- -So _ (NLJ C* Ne K 1 S AT &$m) o= Bye X. Ile RC hole S FRESH All' l.l!l:,l:'L':1 - A14D OBSERVATION PIPE CRZ()',r SEC Approved Vent Cal) Minimum 12 nUovr! o _ I 9" Cast Iron Above Pipe Vent Pipe To final Gradi --. -- Marsh flay Or Syntheti Cover] ny Min. 2" Agg.r.(_19,11 Over Pipe W '�� Distributi �� -- ____ Tee Pipe '� Aggregate �Q l)et Lora Led Pipe L'elow 3 .nea t t� : I � a h Pipe -C u l .i n Te rminating A_ o p < � 9 l I3ol� Isom of System �J y I J dp Form- STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER k A 3 N -R � W '"TOWNSHIP 1 G tyl 0 k.} SEC. T ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t r , a 0 _ t' \ y, IND ATE NO H ARROW i BENCHMARK: Describe the vertical reference point used ' Elevation of vertical reference point: J VV. V Proposed slope at site: SEPTIC TANK: Manufacturer: e e k Liquid Capacity: �Q Number of rings used: _L— Tank manhole cover elevation: 1. t Tank Inlet Elevation: ,� Tank Outlet Elevation: 9 *.19 Number of feet from nearest Road: Front,O Side ,® Rear, O _j y0 Q feet From nearest property line Front,0 Side,0 Rear, O feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: Q (Include distances on plot plan) . 5 hdt 00 H e p 1 - �� • 9 �u� 93 (3 • 3 (S SOIL ABSORPTION SYSTEM loci * (a too, 3 6 Bed: Trench: 14 7 11 -55 Width: f Lenith: � Number of Lines: Built :_.w Fill depth to top of pipe: 4 a Number of feet from nearest property line: Front, O Side, O Rear, ® Ft•� Number of feet from well: 7 *: Number of feet from building: 4 ' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: ® Plumber on job: r �3 License Number: 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS ON I LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVIS P.O. BOX 7969 ' MADISON, WI 53707 NH4-R18W CONVENTIONAL ❑ALTERNATIVE IIfassigned)O Number Town U j Richmond ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound 20th St/teet NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Michaet Kecft" 14 2 ,4.Ptyndate Couht, Hudson, III 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumber: MP /MPRSW No.: county'. Sanitary Perron Number: Richard Hc,pkinz I 1059 St. ctoix 112701 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LI QUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNPROVIING LABEL LOCKING COVER I DED. PROVIDED - ❑YES ❑NO DYES ONO BEDDING. VENT DIA.. VENT MATE, HIGH WAT R NUMBER ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH ALARM FEET FRO LINE. AIR INLET DYES ❑NO ❑YES ONO I NEARESTR — � DOS ING CHAMBER: MANUFACTURER J BIDDING LIOUID CAPACITY PUMP MODEL PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ONO — ]YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIALANOMARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.I MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH J NO ' OF NC SPACING COVER IN51 UE DIA -PITS LI BED /TRENCH TRHES MATERIAL: P DEPTIf DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTR PIPE __TD_ PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ABOVE COVER. ELEV INLET ELEV. END. PIPES FEET FROM LINE AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO OIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WE LLS ❑YES — ]NO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED SEECENTER. EDGES [:]YES ❑NO ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO, OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE I MANIFOLDMATIRIAL 0ISTR DISTR. PIPE DISTRIBUTION PIPE MATEHIAL & MARKING ELEVATION AND ELEV. ELEV.. DIA. ELEV. PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PVERTICAL LIFT CORRESPONDS TO APPROVED ❑YES ONO DYES ONO COMMENTS: PERMANENT MARKERS: J OBSERVATION WELLS. NUMBER 3 PROPERTY WELL: BUILDING FEET FROM LINE ❑YES El NO ❑YES El NO NEARES Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710 (R. 01/82) Z A SANITARY PERMIT APPLICATION COUNTY (�Y fILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT / 1,9'70 —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8'% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES I ZL�'] NO PROPERTY O NER PROPERTY LOCATION _ ' /4 jF' /4,S�� T30 18 E(or PR PERTY OWN R'S M A DRESS LOT aKER BLOCK UMBER SUBD V.IS N NAME CLT , ST TE r v l`. -/LLB ZIP CODE PHONE NUMBER CITY NEAR ST R AQ, LAKE OR LANDMARK �. SC (� j 0 VILLAGE: C I ►C� /�Y 'T�] II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): C7 'I K III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. XNew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. C9 b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ee a e Bed b. ❑ Seepage Trench c. ❑ Seepage it 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED Square Feet): I PROP SE (Square Feet): q c)• Feet R Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. structed INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank A K J iz Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I the undersigned, assume responsibility for installation of the private sewa s em shown on the attached plans. 9 P Y P 9 Y Plumber's ame (Print): Plu is Si nature: o Stam s) MP /MPRSW No.: Business Phone Number: PI er's Address (Street, Ci tat Zip Code): \� Name of De igner: ZW t^na U r l 2 N� Vlll. SOIL TEST INFORMATION Certified So' Tester CST) Name ( CST # 1 1 ) rA W F CST's ADDRESS IStreet, City, tate, Zip Code) Phone Number: T.�) � I F Sk, iAA OM(- A w IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Initial Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Owner ® Approved Surcharge Fee ❑ Given Adverse Determination X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owners name and mailing address. Provide the legal description where the system is to be installed; I!. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/ Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8 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; dosing or pumping chambers; 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. --------------------------------------------- - - - - -- . ------- ------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the F >� result of over 2 years of steady nego-iation and public, debate. The groundwater biii Grounds #titer included the creation of surcharges (fees) for a number of regulated practices which Wiscor�ints can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasu..re ° is used in your building is returned t(, the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. a The monies collectec thrr_)ugh these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for rnonitor ri ground- T water, groundwater contamination investigations and establishment of standa°ds Groundwater, s worf protecting. iR.03 %86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ---------------------------------------------------/------------------------------ Owner of property Location of property /J/� /4 $ E 1/4, Section _ ,a �' , T _ 30 N -R _Zff _ W � r Township /I lc ' Mailing address � All- Hu Usc. UI � � S( Address of site j� r 1 L mQ IV � Subdivision name A Lot number I1 R Previous owner of propert ©R Total size of parcel - � i � Date parcel was created 1CAhtk-CLCS4 ' F Iq Are all corners and lot lines identifiable ? - X — Yes No Is this property being developed for resale (spec house)? Yes 5el No Volume and Page Number35V as recorded with the Register of Deeds. -------------------------------------------------- ----------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 4,1 93, 3 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). Signature of Owner Signature of Co -Owner (If Applicable) 7 - Ij Date Signature Date of Signature � � � � DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1— 1982 THIS SPACE RESIfRVFD FOR RECORDING DATA WARRANTY DEED This Deed, made between --- Theodore A. Orf, Jr.. � Wit nesse th , Th t sa G rantor � of one dollar and other valdc consideration conveys to Grantee the following described real estate in ---- S.t.___Croi.x ------------ County, State of Wisconsin: Part of NE 1/4 of SE 1/4 of Section 28, Tbwnship 30 North, Range 18 West, St. Croix 0ounty, TAlisconsin described as -follows: Lot 3 of Certified Survey btp filed January 11, 1988 in Together with all and singular the hereditaments and appurtenances thereunto belonging; � '_'_-___g - ex restrictions, covenants arld easements of record, if any, and will warrant and defend the same. July 88 ------------------------------------ ----------------_ ------------- (SEAL) rV - �__ _J9__ (SEAL) ~ ^^~~o~^e A. ~^f, ~^ , ~'^v~ ^~~^~ ~^f" ~ ^ AUTHENTICATION ACKNOWLEDGMENT ~g--'-~ STATE OF WISCONS � � St Cro \ � "..n . / ~ ~~^�� ~^ ����L~ ^`~~ A. ~r^" ^ TITLE: MEMBER STATE BAR OF WISCONSIN authorized by § 706.06, Wis. Stats.) to me known to be the person ------------ who executed the __~-- ~~ same Robert F. Wall rn'�/ws`nvwcwr°msonxrrcoa, - --'7----�aaren ------' -----------------' --- -------------' * ' E. Saboow - -----------''--'- ----'----------'--- ---^�~^s`�^ -,�1 -' ~"=^^°�--_----------------' .^. ~^~^. -'-- ----'------'-''--'-------- ( ��o�m��u�o������ mr Commission � nomanent.(If not, state expiration are not necessary.) date: ___ ---------_-`-----', *Names "f persons signing m an capacit should /e typed ". printed below their Signat U WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal m=um` Inc. FORM No. 1 — 1982 Milwaukee. Wis. WISCONSIN REAL ESTATE TRANSFER RETURN - CONFIDENTIAL Wisconsin Department of Revenue I. GRANTOR: V. PHYSICAL DESCRIPTION AND PRIMARY USE 1. Name Ti 6myl orrrn A - Orf, '►'r_ a Med J% Co:: f l 15. Kind of property 16. Primary use k 2. Full Address - New address if property transferred was residence Jr, ❑Land only a❑ Residential R . R. #4 , Box 7 6 ❑ Land and buildings ❑ Single family /condominium ❑ Other (explain) New Richmond, WT 54 017 in) Multi - farm #units 17. Estimated land area and type Timeshare unit 3. Grantor is [E Individual ❑ Partnership ❑ Corporation ❑ Other a Lot size x b.❑ Commercial es use II. GRANTEE: b. Total acres a❑ Manufacturing 4. Name Michael P.. Kea rrva a MFL / FC / WTL acres d.❑ Agricultural 5. Full Address Rt . 3 . B ox 42 d. Ft. of water frontage Adjoining land? ❑ Yes ❑ No e.❑ Other explain Allyndale Ct. VI. TRANSFER Hudson, WI 54015 18. Type of transfer: 71 Sale El Gift ❑ Exchange ❑ Other (explain) 6. Is grantor related to grantee? ❑ Yes ® No If es ex ain how related 19. Ownership interest transferred: ® Full ❑Other explain) 7. Name and address to which tax bills should be sent if different than grantee's address 20. Does the grantor retain any of the following rights? Life estate ❑ Easement 21. ❑ Deed in satisfaction of original land contract? Dated 22. Points (prepaid interest) paid by seller $ 23. Value of personal property transferred but excluded from (25) $ III. ENERGY 8. Is this property subject to the Rental Weatherization Standards, ILHR67? 24. Value of property exempt from local property tax Included on (25) $ It W -1 ❑ Yes El No Exclusion code explain VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION IV.PROPERTY TRANSFERRED 9. ❑ City ❑ Village 19 Town 25. Total value of REAL ESTATE transferred $ 5, 000 .00 County St. cmi X 26. Transfer fee due (line 25 times .003) $ 15.00 10. Street addr 27. TRANSFER EXEMPTION NUMBER, sea 77.25 11. Tax parcel number 12. Lot no.(s) Blk. no.(s) 28. Grantee's financing obtained from a. ❑ Seller Plat name If box a or b is checked, b. ❑ Assumed existing financing 13. Section Townshi pan complete Part VIII - c. ❑ Financial institution / Other 3rd party P 9 Financing Terms 14. Legal Description metes and bounds: d. E] No financing involved (attach 4 copies if necessary) Part of WE V4 of SE 1/4 of Section 18 Ti wni% 1 71arth, T�anc!e 38 Witt St. CrOix ty, Wismnsi_n descried as fol'Lows : Lat 3 of Cle �f'ic-M -Rurmy Map filed January 11, 19` 8 in Ve03. 7, page 1932, 1)0c. :1o, 4? "f-'. VIII. FINANCING TERMS (FOR SELLERIASSUMED FINANCED TRANSACTIONS ONLY) 29. Total down payment $ 30. Amount of mortgagelland 31. interest 32. Principal and interest 33. Frequency 34. Length of 35. Date of any lump sum 36. Amount of lump sum contract at purchase rate (stated) paid per payment of pymts contract (balloon) payments a $ - - -- $ -- / - - / -- $ b. $ - -• - -- $ c. $ - -• - -- $ - -/- -/- - $- 37. If the dollar amount paid per payment (32) is scheduled to change (not as a result of a change in the interest rate), fill in the line letter from above - Enter the date of change - -/- -/- - and the amount it will change to $ IX. CERTIFICATION We declare under penalty of law, that this return has been examined by us and to the best of our knowledge and belief it is true, correct and complete. Grantor or agent Grantor's social security number or FEIN Date Grantor's telephone number SIGN HERE Grantee or agent Grantee's social security number or FEIN Date Grantee's elephone number Print name and address of grantor's agent Agent's telephone number Document number Vol. Page Date recorded Date and kind of conveyance Conv. code 1 2 3 4 LEAVE Parcel number Sales number THIS AREA Assmt year 19 _ ❑ Field L County _ BLANK Parcel classification I Tax diet. - - - ❑ use - A B C D E F T Assmt. dist. __ ❑ Reject PE -500 (R. 1047) PROPERTY OWNER'S COPY ujniaj ayi wog ldwaxa oslu ow (i 1) jo,(V) `(i)SZ'LL TIMMS 3o asneoaq M oql woi3 Iduraxa SOO (0AUO3 •uoiloas Sup japun ldwoxo aq pinom lsnp aq1 ;o kmiogauoq oq3 o3 jolue2 ay3 woj3 jajsuen a ji I= a ojL (9I) •sjea,C £ iseal iu jo; Avadojd ayl paumo uoqujodioo agi `suoTIwodjoa woj; sja3suen 3o asea ay1 ui `3! pug digsjauued 2y1 ui isoiMin: tw jo uogeiodjoo ag13o )loois idooxo uopwoptsuoo ou j oj si ja;suen ag13! ` goes 3o sluepua j o siuepuoosg leau[j j o sasnodS `aje sjauuud ayl lle jo `,Cq paumo si aIoo1s agl so llu 3! sjaui ud jo sjoployajugs sit puu digsjouuud jo uogejodjoo a uaaMlag (S I ) •ioumoo puel a japun jallas g of jo o2r2uow u 2tu loy uosiod g of amsoloojo3 a 3o noq u! poop g jo amsoloojoj g japun (171) •ssol jo 001$ 3o onlgA u $ulAeg alulsa IeaJ JO (£i) uogguwapuoo 3o nay l u! jo of luensmd (ZI) digsjoni^ms jo 3u03s `jpM ,(g (1 I)* (N(Z)ZZ'LL 's ,(q pannbaj se l daoxa uonugggo jo lgop g j o3 Alunoas asealaj j o aplAojd of j opjo u! dloloS (01) •uopL lunlae lnogitm Amoilauoq u of oalsnn u wog jo led!ouud pug 3uo2u uaamlog (6) (Palms aq ismu (SZ) awl `IIA lmd uo onlUA) uopejaprsuoo ou jo leulwou joj mel ui jalq&up pug luojud jo mul ui - uos pug 3uwud `pltgodals pug iuzwddals `pliyo puu luajed `alien pug puggsny uaanqag (g) •uopwodm ,cjetp!sgns pug luowd uaamioq gloms Im!deo 3o jojsuen jo jopuouns `uonullaoueo jo uo.lejaptsuoo alos 11110 uogejop!suoo leutwou `uo!iujop!suoo ou joj luawd SIT of uopgjodioo Amq)!sgns g ,(g (L) ` suoilgjodjoo 3o sio2jow o1 iuunsmd (9) •uoppnd u0 (S) sivawssasse jo saxes luonbullop j oj alus u0 (t,) •papjooai ,(IsnolAald aoue,Ca^uoo a swj03aj j o S330jj `swRjuoo `uopejoptsuoo ou jo oig nbopeut `lgutwou j o3 painoaxo `go!gM (£) jagua ;o uoistntpgns jo `,(ouo2L `,clileluawnnsui ,cue woj3 jo oliels slgi woj3 j SMMS pa1!nn aqi woj3 (Z) '(6961 `1 jagoloO) JMdegogns slgl 3o alep 3Ag3a33a agl 01 joud (I)* :aoue,(a^uoo a 01,(ldde 1ou op joldegogns sig3 Aq posodwi saa3 ayZ •HHA Y ONO SNOIJAIVHXH - SZ'LL NOLLJHS LZ HAITI `IIA LHVd - 2133 L ONO SNOLL.Iwaxa ua33,jm goeile) 010 `uoisjanuoo opuoo `glossa a3il a luaj ou `(I 05Z-LL sapisaq aiegojd '(��Q ,(q asn joj uoneueldxa jag3o `luow2pnf unoo SuTnloui `jog30 •,Coldru3luuq pajeloap unoo ui aaisnn of jo `(oilojuod s,jaaiojq joj io ales alel!pmj of Alolos jaalojq of jojsuejl, 01 •lsojolut 2uglonuoo u 08uego jo olvolo sou swop imp luawu8isse/aoue,(a^1103 10g3o jo Tools `dlysjauugd 6-M •osnoH 8uiwooN lsuno,I jo `awol.I 2uisjnN `leildsoH paluln8aj saolA MOOS Pur glleaH 3o wounjudoa u st $uiPlini3 8 - M awoq ol!gow jo Suodojd ieiluop!soj -uou `puel lueoeA L PIo SIMS 01 Uugl ssol st PUll' `(9LISI /b 0 ^n 3 a33 0 '(L 1) PUT? (9I)Z0'19 2RYH ( lj 2 uuoj) £9 'qD 2nyu 3o swowajinbaj agi japun poionAsuoo `sl!un imuaj omi uegi wow seg SuT I!ng 9 'PIo sma,c 01 uugl ssal s! pug `(8L /1/ZI aAtloa33o) ZZ 'qa 2IH 3o sluawajinbaj agl japun palonnsuoo `si!un Ieivaj Z -1 seg SutpI!% S-M 'JMA qx1a 3o I £ gomW PuL, I iogwoAoN uaomioq poluaj oq sou ll!m (s)1!un imuag t-M (•molaq palsil are aa3 woj; suoildwaxa) •((Z)SZ'LL $ulPniotq so SZ'LL uonoos jad ja;suen idwaxa ue si slgs £ 7oenuoo puul Aq S8 /I /1 o1 joud pomajsugn sum ,(uadojd Z-M •(sliun lelluop!saj tr-1) joisurn joiju Alaleipaww! JMX ouo iseal le joj jasugomd Aq pa!dn000 oq II!m $ui I!ng i A9HHNH - III .LHvd - SAlOISf1 •sa1n1g7S uisuoosiM ag13o LZ'LL Pug (8 )9Z'LL suorloaS WS •sonlEA Jo wowomsjopun pue suo!ldwaxa powmlo Aljadojdwi joj possassu oq 1p m sanleuad �E�l Cbunftk - 'Its Or) 7'a � � I F ?, r � 1 A r I W W y i k _ � r� Ir L 1 'L In y S T C LOS r - Y SEPTIC 'TANK MAfN'TENANCE AG REEMENT r. St. Croix County _ OWNER /BUYER m ROUTE /BOX NUMBER . P _ z Fire Number CITY / S 1' A T E � �'�: ' 6 Cl- C4 (./lam _Z i P PROPE'R'TY LOCATION: lyr _k, 1 4,.. Section�p $, T 30 m, it W Town of IGR MnAlC St. Croix County, Subdivision Lot number 'K. I Improper use and maintenance of your suhtir system., could result in. its premature failure to handle wastes. Proper : maintenance can silts ,of pumping, out the septic,,tank evur ,- ;tJlree 'yea'rs or *,sooner, if nee ded, by a'' licensed supti tank L.!!i Wllat' you 1)ut into the system can 'af fect the function of Lhe� sUl)Lic tank as a treat meuC stage In the waste disposal: system. _ I, St. Croix. Cuuncy residents nia "be eligible L rec VC a_graa fur.; a_ maximum of 60% of the cost of :;replacemc.nL' of °a f�i 11ng system,`, which 'was in operatioq prior to,.Ju1y 1,: 1978 St CroixwGaiinty 4 z ; ti v this.`i�rubram tn G ' Aul;usaof.1980 . wih t.h� r,uqulr'�.mcit =that uwners':of gill ne w " syste -agree to keeh'�thuir Systems pr_uperly ili 111taine - -- y e t S r ti J } z T1►e property o wner agrees to submit. to .St. Croix CuunCy'' /.0 ling a certification form, sibned by the owner and by a master plumber, journeyman plumber, restricted.p1 unit) er'ui:,,a` licensed pumper vari fying . that (1) the 0 n -s1 - te wastewater' dispu §al ;system .is` in ;pruper.•- operating condition and -(2) after, inspect' on and pujnpi11g if nec- essary), the septic 'tank is less .than.l /3 'full, of sludge -'and scum. Certification f.urm will' be sent (approximately 30 days priori to three year expiration. 0 I /WE, the undersigned,' have read the above ,reyuirements and: agree N to maintain the ''private'sewage disposal system in accordance with x che•standards set forth, herein, as set by. the Wisconsin•Uepart- i "lent-of Natural Resources Certification form must be completed and returned 't o the St Croix :County Zoni ng within - 30.-'days of the three. yeor expiration date. t; S I C N E ll DATE l St. Cijoix County Zoning Office P.-O. f-ox 96 Hammor'd, WI 54015 715 -7S -2239 or 715 - 425 -8363 Sign date and return to above address. FIL a " JAII It 3W 433662 AMESO CERTIFIED SURVEY MAP SL CfObIC0., r Located in the NE1/4 of the SE1/4 of Section 28, T30N, R18W jj 0 'flown of Richmond, St. Croix County, Wisconsin USA Owned by: Theodore Orf HL 4 New Richmond, Wi I EI /4 COR. N90 ° 00" 00 "W '1354 S 0 0 "E 280.54' 33.00 33.00 POINT OF BEGINNING LEGEND SECTION CORNER MONUMENT'I LOT 1 1 W 0 1" X 24" ROUND IRON PIPE WEIGHING iV N 1.66 LOS. /LIN. FT. SET ti In 117 in to SCALE IN FEET 1 "■ 200' N I I M"I W IJ F = NI 0' 50' 100' 200' 400' 4 N 90 °W 313.54' o F ZI — ` W QI 280.54' 33' W r J I I 000 I W NI. V o >� k. LOT 2 i g ZI W O I Q h 1 QI 1-I J 1 �ZZ Q� O tV `b W I ",� 1 0.I o Z �I °I 1., n Z I U) N 90 °W 313.54' I NI �) -410 W i 1 280.54 33 i R� J NOTE; Lot 1 contains 174,239 square feet j.4 =' (4.00 Ac.) Inc.R 0 W LOT 3 co ICD 15'5,b0.t square feet(3. Ac.) c Excluding R 0 W tt ti ti Lots 2 & 3 are the same, 87119 Sq.Ft.(2.Oacc `" N including ROW, and 28054 33.00' N W ' 7 DL 7:,.981 Sq. Ft. excluding ROW N90 0 00'00 ° E 313.54' I = (1.79 Acres). UNPLATTED ~ LANDS W �MIINKIIry — — — ••,•., o .�� GO/y,rs�iiy J 4' HARVEY Q N JOHNSON W HUDSON L N1 WIS - N I SE CORNER g � 1n SECTION 28 T3 0 N,R18W This instrument was drafted by P. Gartmann Vol. 7 Pg. 1932 487 -1310 t O ';CIA `yyt DESCRIPTION A parcel of land located in the NE 1 /4 of the SE 1 /4 of Section 28, T30N, R18W, Town of Richmond, St. Criox County, Wisconsin, described as follows: , J Commencing at the E1 /4 corner of said Section 28, thence SO ° 00 1 00 "E (bearing referenced to • the East line of the SE 1 /4 of Section 28, assumed S0 0 00 1 00 "E) 33.0.0' to the point of beginning; thence N90 0 00'00 "W 313.54 thence SO ° 00 1 00 "E 1111.44 thence N90 0 00'00 "E 313.54! to the East line of the SE 1 /4; thence N0 0 00 1 00 "W 1111.44' along said East line to the point of beginning, containing 348,478 square feet (8.00 Acres) more or less, and being subject to all town road right -of -ways as shown and also all other easements, restrictions and covenants of record. I, Harvey G. Johnson, registered Wisconsin land Surveyor, do hereby certify that I have surveyed and mapped the above described ro ert ; that such plat is .a true and correct repre- P P Y sentation of the exterior boundaries of the land surveyed; and that I have fully complied with they provisions of Section 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance and the Town of Richmond Subdivision Ordinance to the best of my professional knowledge, understand and b elief . r ' Harvey G. h o - 1899 ��4► . * Rusch Surveying Inc. a HA RVEY 407 Second St. l JOHHS 8--s Hudson Wisconsin 54016 S. QV ' ♦� Vol. 7 Pg. 193Z This map is hereby approved by the Town Board of the Town of Richmond Date Sherry Nelson, Town Clerk , DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AND c P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSH / Y: OT :BLK. O.: SUBDIV SI NAME: '/ 24 /T3vN /R /�I�"lor COUNT OWN 'S UYER' N E: MAI LING ADDRESS: LA USE DATES OBSERVATIONS MADE NO. BEDRMS : COMMER ESCRIPTION: ,{,,, PR ONS: TS: W Residence �ew ❑Replace 0 30 l 3^ q RATING: S= Site suitable for system U= S ite unsuitable fo r system O � ENTIO ❑ NAL: M�ND: ❑� IN- G�ND- PR L LHO T�K: RECOMMEND EMaoptional) SS UU ISYSTEM-IN-Fll S �` u S F ercolation Tests are NOT required DESIGN RATE/: If any portion of the tested area is in the er s.H63.09(5)(b), indicate: \ Floodplain, indicate Floodplain elevation: h i 6m i PROFILE DESCRIPTIONS BORING TOTA PTH T GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 13- 9 73" A 4 e > 7o 0, 1 2 7 27 - s e; i . �, 3 - 6- Z /7 6, t j ��7 ° i /Yl ��. B-s��f c_r B 3 'o, 9`.75' > � ,zs �.y2�,.yz� 4.50 ! 3)' t B- S 1 L 9w` • r; 7 > (v 9 , o . s a� . 3 a /, s -� 3 . �3 �fn ��j►�,1.7s'Gfi,S' Z B- . r/ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L -IN HES RATE MINUTES NUMBER IUQkW AFTERS WELLING INTERVAL -MIN. PER 1 DPRLOD 2 PFRIOD3 PER INCH P- 8 2 3 P. z 4 f L G 6 < 3 P- 3 P_ P- P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. r SYSTEM ELEVATION 9 ,2_ 7_ 5 ' Soh, 66 1")l , x �P1CI rio slle3 f I i I � I I ' I X! I - Q,� { o Z t i Sa 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME Iprintl: J TESTS�E J LETED ON: e l 3 ADDRESS: CERTI CATI NUM ER: PHONE NUMBER (optional): 9'Z 3 6;��.�� /�y��s� W, . Sf�O /� CST vo -7V// C S WTI e. � ZUB E: / DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR R PERCOLATION TESTS ( 115 P.O. BOX 7969 HUMAN RELATIONS l � MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCA�TTION::u SECTION: TOWNSH / A _TY: OTJV BLK. .:SUBDIVSI NAME: �i ' /4/L' , / 24 /TAvN /R /0Aor �. / / / / il v J COUNT OWNE 'S UYER' N ME: MAILING ADDRESS: - . // /. c�' . kas ll.' Syo /b USE DATES OBSERVATIONS MADE N COMMER ESCRIPTION: ,�}},�ew � .,,� PR IONS: A N ESTS: `Residence kilN ❑Replace r' 0 3 c 3^ �' RATING: S= Site suitable for system U Site unsuitable for system UNVhN STC1U • M� �. ❑� IN G�� P RE: SY 0 STEM- IN- FILLHOLOING TK: RECOMMEND EM:loptional) LAM - - S all S If Percolation Tests are NOT required DESIGN RATE: ^� If any portion of the tested area is in the under s.H63.09(5)(b), indicate: < / Floodplain, indicate Floodplain elevation: F i PROFILE DESCRIPTIONS BORING TOTA DEPTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGH S TO BEDROCK IF OBSE ISEE ABBRV. ON BACK.) 73r o / B- 717 B. 3 'o" 9`7f, , 19,0 , ,z ,,.y2� s r, ,yarsyx B 'J L • /Z� 9`.�7 (v /G' 4o , .S a,. 3 �7�� /, s os) .83�C3�jl►�z.7fGfnS' B- . PERCOLATION TESTS m EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L -IN HES RATE MINUTES NUMBER I AFTERSWELLING INTERVAL -MIN. PER INCH P- K 2 3 P- z yo f Z_ 6 < 3 P- .0 L 4 G 3 P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. r SYSTEM ELEVATION �• 7 N i j E l _ Pe-al Flak sile l o o I I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified In the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): d TESTSE LETED ON: ADDRESS: /`�`c 1 CERTI CATI NU ER: PHONE NUMBER (optional): 71 3y< <8_�/ li CSTI A U I P L OT I U S S � T, l I P Cho L . 6 7 A I, , + � f= C, + �� � P(; T PLU I-' I= - -� N A M E ___Y_1�. N AM E nn _- �'�'L O C AT I O N h ��E,i�.�, i�ri �h! �'�c�t�M�r � L__ I C E N s E _ _..�.�.. _ .. _ PLO I k/1 A_P � Stake �i NUn�� i P $8 , ra . sa , 8a' r s' 08, WNotr,:W 11 s-WkeR (� it — 'rk. 504f f (z om 50' r� , jo 83 M I �-- I L 0 Ioo, o' s as (�t� C�►z �e of S K I A �}�M 0- BOK9 6le sits I x� �eRC hol Sit FRESIi AIR INLETS AND OBSERVATION PIPE Ci:cl';S SE CTION Approved Vent Cap Minimum 12 Above wa I Grip � ,Final G.ra d�__.__ __�;. .- 4" Cast Iron Above Pipe ' Vent Pipe To Final Grade - -- __ Marsh Hay Or Synt he t ic Coverilny Min. 2" Aggreyxt t Over Pipe Distribution i+ Tee U T Pipe 6AC) M 69-D Aggregate �.— Perforated Pipe Below Beneath Pi e 4 Coupling Terminating At P \Y Bottom of System ' /oY fJ h - QeL ". 7 P UT A �� ' I U S S FCT I O I\I N A M E "J",r I\1 A M E '1� L 0 C AT 10 N. `_�� r ,,,,,,,� ��,�� „� .; �i i - - I C E N S E PATE � (? __ P -� _. L 0 .,I_ fi/l A i ofc � 14 [1W-1 W-1 3 Benlzw M (o , J1 ys �G I so 8 i Y 0B1 O lt so s' I � I � � � s e �h +�. �k7Ki� Z �8 1M I SG 0 8� oQa O=Bh'1 loo.o —So —; (NLJ CP9 W R f S� AT &$ IV o= &PA0I Slt� I X. �eRC Lobe FRESH A-LD :rJii:.l. V AND OBSERVATION PIPE C[ SEC Approved Vent Cap Minimum 12” Above I lvn GR►v rinal ,I/ I •US Y►'t 1� X 4" Cast Iron Above Pipe Vent Pipe To final Grade — Marsh IIay Or Syntheti CoveiJ icy Min. 2" Aggr_cyl - i t Distributi _ Tee Over Pipe '�� _ on ,> 4� Pipe _ ... 17o��Jr,1 p Aggregate PeiforaLed Pipe Below Beneath Pipe - Cotipl i.ng Terminating At 9a �� _ 13ot tom of System �J 1