The URL can be used to link to this page

Home My WebLink About026-1294-42-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 483964 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: city Village X Township Parcel Tax No: Richmond Acres LLC, c/o Gerald J. Smith I Richmond, Town of 026- 1294 -42 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: / fy\ 5 28.30.18.1524 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER � CAPACITY STATION 3 BS� l � I FS ELEV. Septic _r-A p , Benchmark l�� ' / •5 I , 05 Iol, o �ac5 Alt. BM s • 3 `1 7.7 Aeration Bldg. Sewer 1 7 - 7 9 S. 3 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 9• b 47 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aerati Dist. Pipe 4'Z Holding Bot. System 9. 3 9/ 1I. / , 1 5 PUMP /SIPHON INFORMATION Final Grade � - Manufacturer Demand St Cover r I � C 9 3 7 7 GPM t s• Model Number TDH Lift Friction Loss System H T Ft Forcemain Length ----- Dia. Dist. to Well k�l .................. , SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 /_11 Z �rti�C�' �_ SETBACK SYSTEM TO tt�� `` P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type CHAMBER OR vA 0 r i 0 /J n AJ UNIT Model Number: .1 ,L -. DISTRIBUTION SYSTEM /4, F (0 = 3 h4 -_0_ Header /Manifold ri Distribution x Hole Size x Hole Spacing Vent to Air Intake Q J, Pipe(s) \ "IN ` N Length I Dia T Length \ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center 7 , xx 5 .3 Bed/Trench Edges ` Topsoil Yes bi N '*Yes ®No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1143 132nd Ave. ew Richmond, WI 54017 (SE 1/4 SW 1//4 �6 d 1/4 28 T30N R1 8W) 11 Richmond Acres Lot 42 Parcel No: 28.30.18.1524 a h va 1.) Alt BM Description = r O O 2.) Bldg sewer length = 33 n� L - amount of cover= 14Z . �T, , Plan revision Required Yes No c� J Use other side for additional information. SBD - 6710 (R.3/97) Date Insepct is Signafure Cert. No. r eorrtnMV6 wi.gonr Safety co' IN 201 W. Washington Ave., P.O. Box 7162 tc epw1linent of r C.o1 Madison, WI 53707-7162 Sanitary permit (to be filled in by Co.) Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a .sanitary permit. Note: Application forms for state -o Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you prov' r 11sj � �/ 32 n es in accordance with the Privacy s 1 Law, 15. m , Stats. 1 Vl M " G ►moo[ L A Iication Information - Please Print All Informa ' �� el # Property Owner's Nal� �O �O Ild - J00 I' JI 'r e," C? to A- t— Property o Mailing AAdress T C'R& Z coo OFF E Property Location S vfc.I,ot Z- City, State Zip Code yti 4 - won circle 1 m �� 7 J T N; R E rW fo ype of Building (check sII that apply OK " # Subdiviaion Name r 2 Family Dwelling - Number of dr";e �la� Bloek# bl ic/Commercial - Describe Use J ❑ City of CSM Number ❑Village of ❑ Sta Owned - Describe Use wn of ZTc I U 6 ",h to III. Type Permit: (Check only one boilon line A. Complete line B if appUcable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑Permit Rene 1 vision Change of Plumber ❑Permit Transfer to New Before Expiratio IV a of POWTS S stem/Com nent/Device: Check ail that a urized In- Crround ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank r tspersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsaMTrea ent Area Information: Design Flow (gl-r Desi S it Application Di�l Area � Require fl Di Area Pro (sf) System Eleviltio Z VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks C - -- Se n or Holding Tank EC"ml ty Statement -1, the undersi asib ility for installation of the POWTS shown on the attached plain. int) PI gnattere MP/leRS Number Business Phone Number Plumber's Address (Street, City, State, y / Z� ILCouny Use Only — Pemtit Fee Date Issued Issuin gent Signature proved isapprove o0 9 Reason for Den n M ConditienS o0ftMns for D isapproval 3, k7 l�a.. p '� n ,,,� w• 1. Septic tank effluent filter and 'J 1 / _ �t�-�c dispersal cell must all be services / maintained mss, -: yl.>t- as per management plan provided by plumber, 2, fAM sllbaek� must be maintaiMd Attach to complete plant for the system and submit to the County only OR paper not less than a 111 :11 laches In slze SBD -6398 (R. 01/07) Valid thm 01/09 Soil Test and System PLOT PLAN PROJEC.' Richmond Acres LLC ADDRESS 11160 190th Ave NW Elk River Mn 55330 SE 1/4 SW 1/4s 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/14/10 BEDROOM 3 CONVENTIONAL )00( IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 93.6/93.2 5' below qrade B.M. * 132nd Ave 464' Property Well is to meet all setbacks required by WDNR 0 5% Slope B -3 2 -3' X 66' cells with >3' spacing Vents 20' 10' B -2 B -135' 35' 20' �� 0 sa 10' Pro 3 Bedroom House 377' Property Line Vent >6 » Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 5.8f A2 /pair of end caps 4' Long 12" 3 4" Grade at System Elevation Y. 200' Property Line 1 _ Soil Test and System PLOT PLAN PROJECT Richmond Acres LLC ADDRESS 11160 190th Ave NW Elk River Mn 55330 SE 1/4 SW 1 /4s 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/14/10 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 IL BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 93.6/93.2 5' below qrade B.M. * 132nd Ave 464' Property i Well is to meet all setbacks required by WDNR 0 ' 5% Slope B - 3 2 -3' X 66' cells with >3' spacing Vents 20' IF 10' B -2 35' 35' B -1 20' 0' ST 50' 10' Pro 3 Bedroom House I I 377' Property Line Vent >6 „ Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 5.8f A2 /pair of end caps 4' Long 12" Grade at System Elevation 34" 200' Property Line ILA -" Wisconsin Department of Commerce SOIL EVALUATION REPO Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code < �N Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County v -f include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. b Please print all information. Revi ed by D ;7 n1;o Personal irHorrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner / Property Location C I J A, , 1 L Govt. Lot r 1 /4 tt,. 1 A S 2 S T D N R/ E (o W Property Owner's Mailing Address Lot # I Block # Subd. Na Of CS City State Zip Code Phone Number ❑ City ❑ vi lage M Ne Roa K )Z tJ 5S 2 �� 13� New Construction Us esidential / Number of room deriv d design flow rate J�J GPD ❑ Replacement Public or co ercial - D scribe: Parent material �� x F op��jn elev 'on if applicable - ft. comments coents SEP �U li and recommendations: J NNINGR& Z Ni U NTY OFFICE System Type O A - , U FlA evation / ZFS 117 - 4:71 Boring # [] Boring Pit Ground surface elev. _/ _(L" ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff# # 1 'Eff#2 S Os -� CAD �iP d ® Boring # ❑ Boring � ,,- pit Ground surface elev. _1 _( , � 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 •Eff#2 1 to �� (0 Effluent #1 = BOD > 30 220 mg/L and TSS >30 1 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nart1s (Please Print) ^Sire CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 / 9 715- 246 -4516 Property Owner _ Parcel ID # Page of FS] Ong # Boring / Pit Ground surface elev. ft. Depth to limiting factor 1 , in. Soil App 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 ,,22,z tJ- a /, n 3 ^r�l vlF} ,)A-- i Ila lip 3• ' Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring E Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 'lepth 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 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. SOD -9330 (8.6/00) P Property Owner _ Parcel ID # Page of Boring # Boring /- Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 s 1- 1 F-I 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 a Boring # F] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Iepth Dominant Color Redox Description. Texture Structure Consistence Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L 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. sBD -5330 (It.6100) 4 cornmerce.wi.gov Safety and Bungs Division County�� n % 201 W. Washington Ave., P.O. Box 7162 soon Madison, WI 53707 - 7162 Sanitary Permit Number (to be qb co-) pepsrgnsnt o< Cwnmerce ( /l/ State Transaction Number Sanitary Permit Application I JIA In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate govemmentac Pr 'ect Addre a (if different tha unit is required prior t o obtaining a sanitary Pe rmit. Note: A PP lication forms for rvi may submitted to the Department of Commerce. Personal information you p // �� U oses in accordance with the Privacy Law, s. 15. l m , St4ts. I. A lication Information - Please Print All Information � P l # 1 / Property Owner's Name j l C m h` G ST i pp tty Location i S� Property Owner's Mailing Address FLAN NG & ZONING OF 1 // / /; G C ovt. Lot (� V Zip Code Phone Number ✓� /. '/4, Section City, State trcle o .. T .s �G% _ N R �1L_ E L / Ii. Type - of Building (check all-thai rtppiy) .3 ot # '/71 r W Subdivision N e /J I or 2 Family Dwelling Number of Bedrooms % � 11 � 1 . 0 p,� Block # CGC�LLL��111 !i✓� (�' ❑ public/Commercial - Describe Use - �_ / ' ❑ City of CSM Numbc ❑ Village of ❑ State Owned - Describe Use Town of / / - - -- III. Type o f Permit: (Check only one box on lin Complete B I I I f plieable) ❑Othe A- r Modification to Existing System (explain) ew System [I Replacement System Treatment/i ank Replacement Only List Previous Permit Number and Date Issued [] Cho of ber [] Permit Transfer to New i B. E] Permit Renewal El Permit Revision Owner Before Expiration IV. a of POWTS S stemlCom oneutlDevice: Check a h l Non Pressurized In- Ground ❑Pressurized In- Ground ❑ rade and > 24 in. of suitable soil ❑Mound < 24 in. of suitable soil ❑ Rol ing Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: ersal Area pmpoaed (sfl System Elevat nsign Flow (gpd) Design Soil Application Rate(gpdsf) is ersai Area Required (std {// Capacity in �s 7 / J� .1 —115- 1 # of V anufac-e�r ° o VI. Tank Info Gallons Gallons Units New Tanks Existing Tanks a A I U rn ti V. C7 P. Septic or Holding Tank f^ Dosing Chamber VII. Remponsibility Statement - L the undersigned, assn aponsibility for installation of the PO MPIMPRS attached Business Phone Number Plumber's Name (Print) Plumber' ture Plumber's Address (Street, Ci , State, Zi ode) VIII oun /Department Use On — — Permit Fee Date Issued Issuing Agent S ature Pproved ❑ Disapproved $ �J 1 3 /t7 �iY✓r� ❑ Owner Given Reason for Denial rovallReasons for Disapproval /L 2 11 � 1 Septic tank, effluent filter and (XJ dispersal cell must a ll r v ded by plumber. ( Z TX Yt �iY1 C� as per management P an pr 2. All setback requirements . must be maintained o as for the system and submit to the County only on paper not less than m 112 s 11 Inches in du SBD -6398 (R. 01 /07) Valid thru 01/09 PLOT PLAN PROJECT - Richmond Acres LLC ADDRESS 11160 190th Ave NW Elk River Mn 55330 SE 1/4 SW 1 /4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/4/10 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 kk BENCHMARK V.R.P. Top of Nail in Wood Fence Post ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 94.0/93.7'4.5' below grade Well is to meet all setbacks WDNR required by 464' Property Plans Designed Using Conventional Powts Manual Version 2.0 o 3 oom Hou 4 30' ST Vent 30' > 6» Quick4 Standard -W of Cover Leaching Chamber B -1 with 20.0 ft2 of Ar 1219 5.8ft ^2 /pair of end caps Y Elevation P e 4' Long Grade at System El 2% Slo 34" 88' B -3 50' I 0 2 -3' X 92' Cells with >3' Spacing Vents B -2 156' C,A B.M. #1 200' Property Line E.M. #2 63' Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 8/5/10 Owner: Richmond Acres LLC Location:SE1 /4 SW1 /4 S28 T30 N,R18W Lot 42 Richmond Acres System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance and Contingency Plan 6. Filter Specifications Sheet Signature UV License numb #226900 • PLOT PLAN PROJECT Richmond Acres LLC ADDRESS 11160 190th Ave NW Elk River Mn 55330 SE 1/4 SW 1 /4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of Nail in Wood Fence Post ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.0/93.7'4.5' below qrade Well is to meet all AL setbacks required by WDNR 464' Property Plans Designed Using Conventional Powts Manual Version 2.0 Pro 3 Bedroom House 1n ST Vent 30' >6 „ Quick4 Standard -W Leaching Chamber B-1 of Cover with 20.0 ft2 of Area 4' Long 12 „ 5.8ft ^2 /pair of end caps 34" Grade at System Elevation 2% Slope 88' B -3 50' 0 ' 2 -3' X 92' Cells with >3 Spacing Vents B -2 156' 200' Property Line B.M. #1 JB.M. #2 63' Cross Section of Quick 4 Standard -W Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard -W Leaching Chamber with 20.0 ft2 of Area per Chamber 5.8ft ^2 pair of end plates To be >1' above grade / Finish grade elevation Ty Installation 98.0 Vent Grade Vent 4' 4" 4' X30/34 Septic Tank 4' Long 115 5' 4' Long 1 Grade at System Elevation 34 Grade at System Elevation 34" Spacing 5' 2 -3' X 92' Cells Same on other end Observation tubeNent 9.5' A B 23 chambers per cell System elevations: A__94.0 B 93.7 Maintenance and Contingency Plan for a Septic System Maintenance Plan Tank i # um once eve 3 i. Septic s o be ,pumped ped ry ears. y 2. Effluent filter is to be cleaned once a year. Please note: a larger filter Is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor delve over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 ncy Plan Option #1., if system fails, determine cause of failure, use alternate area and install new system ' tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing blomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 -386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 7 Z W a_ �LL F a m � asp U LL CD Z OP flm rn O W 0 0 0 Z Cl) C7 C. (D o W - LU O F t- Z W= m O ¢ `� iL r I dw� LL iz JO N n � O O N Z O F U- � EL LL O co Jill . . . . . . . CV 0 N 0 0 N Q� r F- a a J O Q rn S 0 D � 4 O �oLL O O of Aug -10 -2010 0124 PM St, Croix County Plan /Zoning 715 -386- 4686 2/2 ST, C'ROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer �iG�lvV►a> _ �}� /es �^l C- �6 ,rd �rti• `l l Mailing Address Ace .t�GcJ k Q; �e.L /YI �J 553 Property Address / (Verification required from Planning & Zoning Department for now construction.) City /State L Chi L Parcel Identification Number o LEGAL DESCRIPTION n n Property Location �/, , J�IJ '/a , Sec. z , T 36 N R W, Town of Subdivision Plat: �� Lot #�- Certifiied Survey Map # , Volume , Page # Warranty Deed # g 6 Z3 (before 2007)Volume 2$5 1 , Page # a 77 Spec house e no Lot lines identifiable e 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 o 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) utter inspection and pumping orneecssary), the septic tank is less than 1 ?3 full of sludge. 11we, 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. Itwe certify that all statements on this form are true to the best of my /our knowledge. Uwe ant/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 6f2i (� � I /el /zpeo sidVATUR19 OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * *• Include with tills application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is ntade in the warranty deed, (REV, 08 /05) Wisconsin Department of Commerce `> ALUATION REPORT Page of Division of safety and Buildings in a rda a n with Comm 85, Wiis. Adm. Code , County 5...{. C t� t 1 :1 4 Attach complete site plan on paper not less than 8 1/2 x 1 1 include, but not limited to: vertical and horizontal referenc point + +fin Parcel I.D. percent slope, scale or dimensions, north arrow, and loca n anl�oad. Q 2 V�a''�� Please print all lnformat n. ( *006f— R viewed Date Personal information you provide may be used for secondary pur ses Property Owner tt ST. CR S trom r 't' ZONI 1/4 S a$ T3(� N R E(or Property Owner's Mailing Addre # Subd. Name or CSM# 90 T*% e• Nw at o F Lc rn ccc City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road F K R V r- R I PIN 3 D ( ) 8 K; C t :% try 1 r°I? 14v c (3 New Construction Use: T� Residential / Number of bedrooms Code derived design flow rate — SO _— GPD ❑ Replacement ❑ Public or commercial - Describe: — _ — Parent material —Q V *�6? S �• — Flood Plain elevation if applicable — ___— ft. General comments S "SS 3 -�r� �� S C . S� For fte• -L�+ S and recommendaUons: ; to T 1 ; F4 T. t C4Y.39') , (9y.ns) �J7OW611ILZIN� t ?.1 (g4.�4'`J $��'!}t.a, 7.$ (93.55' ) . IS Yew -c49 i T3 93.1`)`) 5 Boring # 0 Bori — 4p Pit Ground surface elev. _� b� ft. Depth to limiting factor — l7 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 0 �� Y,' —� L 2 Ln PL rn I r aLJ a b r o - 7, 5yr O lv - 5 L , C { YP'/ _ u` L l m sh cup I I v-F 4 - 7 (� 55 -i/o Io YR 'pl ® Boring # Boring 9 Pit Ground surface elev. _ ' 1 . ft. Depth to limiting factor 100 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 YR 'a -- L sb rn;r l0 1. D 01) `t, l' sj K m C L'i 1 e- q 72(r, y/ _,._. - S h-) Ln Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L T Name (Please P Signatur _� q��-,, CST Number A d S� . Date Evaluation Conducted Telephone Number 0 wM 7,� -d s `715 y8 :3ss8 r Property Owner Gera Sm At, Parcel ID # Page of F 1 Boring # ❑ Boring - I _ g t -2 3 ft. Depth to limiting factor o u in. Pit Ground surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a I -) - 7. s R y / 5 L a b r G GtJ F , 3 1 P 2 4Ite N �" �) s r C/"- tt) E4 J -3 1y 1_ C c,,J — . "7 1- 5 3 44 Y, � 5/� S e C L'o llf No -?,Syq SIL, F-1 Boring # ❑ Boring — ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soii 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 Boring # ❑ Boring _ El Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil A 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 5 220 mg/L and TSS >30 5 150 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 altemate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. SBD -8330 (RAU) Property Owner Gera S rn , Parcel ID # _ _ Page � _ of a Boring # F1 Boring 0 1 Pa Pit Ground surface elev. t l � 3 ft. Depth to limiting factor 0 u in. soil liption 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 'Y� w 5) y , r n Y/ 4, 1 6G' 9 O =; � F-1 Boring # ❑ Boring E] _ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ 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 GPO/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 < 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•2330 (R.6I00) __�-- C(I L- - S A , C- 1 Lev � �raA�. v 5 E /7 5\--3 l , scc., �8� 7 3 P, S Gti le; / tlz yo' T 40 Ob "C " / 5e r1r) CQ • a/ t r r�1 LOT �Ia „ op e-1f<< �d �5p.I,.t I�hL� I � r HLIG-2� -2dd5 11:43 FROM:JEO CONSULTING GROUP 715 -248 -3830 TO:2487B39 P.001/001 PRELIMI NARY PLAT O F RICHMOND ACRES a e H ' u► cscx�m �u1r iw•a�aa N pvl g1 M. SaNh•far rr4 atiY M• Sr,m.ou Ip of M Mott k-,. ,J Iwfc Tatty of mw~4 Jr a.b RD.MA 06 -p! �j ~• '• {•. `h. �� \ ALA • r• �.� AM %lYs ✓YJC ifi Ih1 G /I 'r 1. �• 1 ...� M •r �i"ar f •< ••F+. ^ "�",. ��.__ ._ rr•. / ,rat .� 1 � +�� I n 4Z _, rr, r T.sO 7srds « i ' �� i+`'tau ' '"^•a� I .r' � r.ecbiiiaa ...f, t ' / ,,,. / ..r-1 Jot •i a ,�ypa,n I Zr ' / ^ 9 do I � eGr " "' y . N a Itpi .r / .' ^.'`n --•— F N p AA 2. s 1 ,. g u y, a O.uA� • =�•�!/ .rr"t X 447 '" . ^�L�1.9 `"..�17 � 4 S` vdt J91"O J � 11 M.d , L 1�.1 appf ' . � `� ``��.,. . ...,� y-' ,/ _./,r+ /' �_+''� -/' •' � �`. A of � �.'�/ �, � \ �` I � \ � a \ � i t(/; F "�•"J,../ -!i"� f " ' � �.•....� t f �\� �� _ � � l�� q. for x .75 0 =r17f A AA + r9 \._ I a `�• . M �.��' VIA s b, 1 J47Pa ^ - `_� % ,� ��7" 1198 • �-� ` � x°� � t �' .f� I y r 2 1 noes t 7 OCfeg Z, r Jf vc ` JAI l � / "" i °, j 1 OC • Na w,&n igp.1 •F / ' f . •n.OA is 1' ' 11# O& l.'9J+owa r:iF �ei•!�' ii ( '•• / r / zis / E r axw �• r'3-t• �A, °a I 1 .. • • •y, "...,... , ! fit s I ,�'!' 41�O." � , ww B r P J _ 1 nl• t 12.4 oc e 1 r ^ are$ , [ - - - i p� gs rrpa^� r �• ix �• s 1 .11 / .- -- a y wa t.79 ocro; 11.74`gves / rfi t? era 1.94 s ataA, . 1 1 u p Eres A ,� ya: y . �fi .. �;.��' � . k ti + i y�� t ld o"::.r wJ� - r.ar+� � t 1� • 1 N6A � /� � \.. t W,J '=, �'e,Fro7{ � apw I. t7 !ww NfJ A)1 \'- Q - 1 „ A01 t•rN / �} N ttiA"..11 � '°• � f •r'I If.+ , �`�. 1f84 � h• •.M' 89 j abrvs of ..,., �-• I+ ` �'a+f - "� fW N1.720J Mk b PfA +tOJ L_J f 1 1 Sd5? ' r acren J,y dA N!f f w h W a w f• • . 1 . aw .w r• �G I N.Own�WaN/rY. v .. , 1y (5aa• M - i ,rre wwfn•.. .r` "--�'` JOd' ,r ' r.: • 1 .i �.. NpwN Ofw 1 1 NNnu, \ . 7 V:MIW 91 Ilnl LM / I i • I L �Ar1RM , W Am • �.- N+'� ' � T Al v Fl 'NW .M WY,Ii�r(OA1��W[G j{.r( -- {r• '• r (� +..v ►111 .a YrAi., I , .1 fad 171t IIr1 Ylr�w ,,rr'' �� q, �,� ••JGrC ♦ N i V t.W',In4 Tna WN s y�.� I IM, to pt 1 l[w" I ! y t ••1;•#C acres wl' I I.. "•+w• A. �aA Yp II I, 1 ��• 7NNr lfla Y a01..rNl II�uM wa ai VIM, I ` '? - • • !-C..J agiM DwMa1 M',wiY•MI ucaw rl. MY r tr . :t alA INw / •,' MrWfa NIIYi2 r 1 i r � � � I MY• Isl� ti�lE,ll I 1"71!9. 1/• 4UirPr A ,A L. ^. �� - -• lJ r, 1 I •�';;. ti ONlfp a11iM .un i �-� :. ' �. •u..+r... .. 1 `t > p�r..w R'• .. .,IiY r . T". talns:wlt,� • �1e1� - r. � ��[ •INNn y " r P '""'� I y' '1, C -+•7aM Un M w S A.4 -^ N N CPA1 WAIS 1 r..fr ! . ` W � . - M d4 M •�. mfWw L � 1 r{MI iiYi 1N ` NNI •RN WI!�.R.� INf a :a VW /,r MMi 1111 MN 1 N•r1M MM 1,i�i f ... o,ur p.alu.rw ir,u auwyr MWi •� AYB GpNCGPTNY 1M 1 1 INr N MN+r1 t1fiv(SMA"amim AIRTOIAY7aT+Pr r J ]�Iam0a1 a9GmItNr. trK+it •�•�•�'�' ``��.�•" Fl -�`-W LA! flkMYtlril:•JfNtl TR.:: N.B.A. Ar ' A 3e.-I 521 4A X, 1 07/' • '�� :� ! ' / �, � ` o � � 2% cr s C 41 2.23 acres i �A C; \ +1 98 ;. e . 'S'-, j��,IA 24,3 �,cr� '9' N 963.3 . ...... .8 acres 1.96 does A A ....... 9632 4 N 7 ..... . . .... . .... wo - rdO' lEM ..... ... ... 002A\ I . 1 .... ........ \ .. .... ...... • (R7 1".. ........ =;;w_vov OF ROAD? . ..... ------ ✓ PIS-, cc s �?8 N.B.A." .7J acr 5\ k 4 cc1res 2� (.qK 04�res 972 2_25) (rerks' N.aA. 72 .2,64cro N N N.&A. )2. 40 9-.7 \ \2. �( aixes� j \ N_�.A. 9�.7 7 .57 ucfes�, N b vc 2.2 0 .......... ...... 4t 166. �'� ` '' 1 +� \ `..._. NB A 446 C S 2.18 acre 9632 4" 20 A,. 3i\ 37 acres 2.111 acre, 7M X \, cc S Mf. A. 961 N.B.A. F sa acres - lw)\ NI, 1 9 N.B. r B�A.e� + 2.V I a cr s acr .... . . . .......... ..... 34 cCres x 1 0 2.481 ages ....... 1, 62 ccr S N.B.A. R. AJ, 96" 2. , 9398 \ N.B. 1 1 171 12 acres ........v ...... ...... .... J A- 2010 Ifo � , , r :� � _._r � i �_ t... � % � _ � irk Ate_ - -� M 960,7 r Z60 x 959.2 Z 4 _._. 3_1".� � " 44 (45 46 7 CGKeSI - 1.79 acres 1. 8�3_ 3s \+96 acres 1. 74Vcre "'� N.B A cres II A 7 acres 1. 79 acres N. B . A . M B. A. �q 'es 1. 74 960.9 ocr Q) 1 ?7a7 96&7 284 2.63 acre�s' I 7L4 \96 7. .200 x "o 180 0' 96 964.6 1.96 acres LOT x N. B. A. 967.7 1,95 acres CER TIFIED SUR MA _20J 20J' VOL 8 PG2199 452' \ IrD SUf?Vf. PENDING, APPROMMG AUTHQGl llf VCPM MAP SM M T. 30 N. R.16 W. TOVA4 (W Pl) LA &n • ..' 5�� 3, �� Z8 5 1 P 0 7 7 State Bar of Wisconsin Form 3 -2003 KATHLEEN H. WALSH QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIK CO.. WI Document Number Document Name RECEIVED FOR RECORD 07/26/2005 10:06AN QUIT CLAIM DEED THIS DEED, made between Gerald J. Smith and Jeannine B. Smith, husband and EXEWT # 10 wife REC FEE: 13.00 ( "Grantor," whether one or more), TRANS FEE: and Richmond Acres, LLC, a Wisconsin limited liability company COPY FEE: ( "Grantee," whether one or more). CC FEE: PAGES: 2 Grantor quit claims to Grantee the following described real estate, together with the rents, Recording Area profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address See attached Exhibit A Kristine Ogland Attorney at Lw P.O. Box 359 Hudson, WI 54016 026- 1082 -40 -000:026- 1083 -10 -000: 026 -1082- 70 -000: 026 -I082 -40-000 Parcel Identification Number (PIN) This is not homestead property. Dated'' i (SEAL) (SEAL) erald J. SnA We nnine B. Smith (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF n ) c1 ) ss. —�T • C SIX COUNTY ) TITLE: MEMBER STATE BAR OVO4 ONS Personally came before me on (If not, e above -named Gerald J. Smith and Jeannine B. Smith authorized by Wis. Stat. § 6. usband and wife * V o me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED B instrument and acknowledged the same. h STA E T CJF Kristina O land Estreen & land �- 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: 2- a ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 • Type name below signatures. INFO -PRO'" Legal Forms 800 - 855 -2021 www.infbprOforms.com U 2851 P 0 ?8 ' M i EXHIBIT A P,gtc,81 I The East Half of the East Half of the Southwest Quarter (El /2/E 1/2/SWI /4) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin. EXCEPT Lot One (1) of Certified Survey Map filed April 24,1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter (SW 1 /4/SE1 /4) and part of the Southeast Quarter of the Southwest Quarter (SEIVSWI /4), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West. Parcel 2 The West Half of the Southeast Quarter (Wl/2/SEl /4) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin, EXCEPT the following described parcels: I. Lot One (1) of Certified Survey Map filed ,April 24,1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter (SW1/4/SEl /4) and part of the Southeast Quarter of the Southwest Quarter (SE1/4/SWl /4), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 2. Lot One (1) ofCertiSed SurveyMap filed August 13,1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, being part of the Southwest Quarter of the Southeast Quarter (SW 1 /4/SE I /4) of Section Twenty Eight (28); Township Thirty (30) North, Range Eighteen (18) West; 3. Commencing at the Southwest comer of Lot One (1) of Certified Survey Map filed August 13,198 1, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, for the point of beginning; thence N89 0 59'15" West 20.00 feet; thence N0 °01'41" East 262.00 feet; thence S89 °59'15" East 224.00 feet; thence SO °01'41" West 15.00 feet; thence N89 °59'15" West 20940 feet; thence SO °01'41" West 242.00 feet to the point of beginning; 4. Commencing at the Northeast corner of the Northwest Quarter of the Southeast Quarter (NW1 /4 /SE1 /4) of said Section ' 28; thence South 16 feet; thence Northwesterly to a point 10 feet West of the point of beginning, thence East to the point of beginning, —'— v�w iV 89'25'18" E • _ • -- \ °N 104.81' i C24 ` • 578'45'21 �W -- C • 105. /IN 8925'18" E 392.28'E �s 32.1 f' N8975'18 E 260.1 n N78' • -_ -- 27 7¢ 4 11 N i • ' 105. 00 ' • S6 0 �i435.82' , N 89'25'18" E 196.57 02 • 1 S• y h 232.39: 28. 0' �• /640 8860 1 ~ F WAGE S8925'1 241.00' • YCNT 58 . 86 ' o O +3 m S2725'06 "W ............... I H. 27.23\ W.E. =95 ..0 /"',. Z Z • e Op O � O O O (O (p W Z ....... (,j L O W W d Z O O N W tV 4 43 2 44 40 m 1.97 acres 7 1.83 acres 85, 936 sq. ft. 1.79 ac 97 acres 9,816 sq. ft N 219 sq. ft. 77,876 sS 9 46 O. 2.76 acres v C 955.0 120,151 sq. ft. N Cn L. B. O. 955.0 ry 50',E o r- for P1 v --- - - - - -- Pr"s --- - - - - -- --- + — 200.04' 180.00' S8 '49'16 "W 180.00' 7' Ed"menf 0 .5 600.00' 969 Pmk* Gross 0 ( =EAST) LOT I ' vserwtan ^ ER T/F/E - D - - - M_AP ----- - - - - -- o oil SURI/EY 9579 - - - - - m VOL 8 PG 2199 - 203.62 969.6 202.81' 589 406.43' LEGEND: '49'16 "W '49'11 406 E 40641) Section Corner Monument of Recorc I I O Found 1" e Iron Pi � J P I O Set 1 -1/4" x 18" Iron Rebar CER_T /_F/_ED UR VEY MAP (weighing 4.303 lbs. per linear foot. LO T 1 — I _5 — L OT — — — I other lot corners marked with a 1" — _ _ 2 Pipe weighing 1.13 lbs. per linear fo I O 20 PG 50 I Building Setback Line f _ — (100' from Right of way or as notec Proposed Driveway Location L.B.O. Allowable Elevation of Lowest Building Opening 88 BASED ON GPS OBSERVATIONS. H•WE• 1 00 —Year High Water Elevation TO THE SOUTH LINE OF THE 854.2 WHICH IS ASSUMED TO BEAR Benchmark — Top of Iron Rebar or S MAP ARE SUBJECT TO STATE, COUNTY 12' Utility Easement along roddways D REGULATIONS (I.E. WETLANDS, MINIMUM R Recorded as :TC.). BEFORE PURCHASING OR DEVELOPING CR 0� IX COUNTY. Aug -10 -2010 03:24 PM St, Croix County Plan /Zoning 715 -386 -4686 1/2 o 1A t,,U P I ING & ZONNG F AX M EM O DATE: s fi b /o 7"O: &;a t� W 7i�a�s6 n . 1 46�0 FAx NUMB 743 - 'IW/'- 1972 Land In formathn � Pknn i ng M 386-4 74 FORUM: ; (a.,,%!, FAX NUMBER: 715- 386 -4686 Rent 4677 PHO NE NUMBER: '71 -- 39 +vA? R Ong 386.4675 NUMBER OF pAoE$, INCLUDING COVER SHEET: RE: / G�ea� J 9 41 1 6 e.A 4& fP.!' uttil° P /04, mAt 66mf- 66 t es Rr v4o Me. Q r / Sr CRM COUN71' GOMNMMrCENM ffA1=ftQ%-w' us I 10 1 CARMrCHAEL RW Q, HU tM :6¢016 713,986 4688 Faar ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/]Buyer �� k ` C Mailing Address Z Z �Q i 9' W Ae/ Properly Address (Verification required from Planning & Zoning Department for new cOnst uction.) City /State Parcel identification Number LEGAL DESCRIPTION property Location '/4 , '/4 , Sec. , T 3O N R / W, Town of �l , Lot # Subdivision � �/' �� Cerdfiied Survey Map # Volume , Page # Deed # 0 d / Volume � J Page # 0 - Warranty D - ' Spec house yes no Lot lines identifiable 00 SYSTEM MAINTENANCE AND OWNER CERTIFICAT Improper use and maintenance of your septic system could result m its premature failure to handle wastes. Proper maintenance consists of pumpm$ out the septic tank every three years or sooner, if needed, by a licensed pamper. What you put into the system can affect the fimcdon of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comma. 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 banter, restricted plumber or a Hosed owner and by a master plumber, journeyman plumber, pumiper verify 'sag 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 road the above requirements and agree to maintain the private sewage disposal system with the Res standards set forth, herein, as set by the Department of Commerce and the Dep artment of Natural nieces, State of Wisconsin. and returned to the St. Croix County Planning & ed must be c Certification stating that your septic system has been maintain � Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property descnbed above, by virtue of a warranty deed recorded m Register of Deeds Office. Numbe edrooms ' SIGNATURE OF APPLICANT( S) I DATE result in the sanita permit revoked by the Planning & Zoning Department * ** information that is may � p� t be .Any nssareprescnted Include with this application a recorded warranty deed from the Register of Deeds office and a copy of the certified survey neap if reference is made in the warranty deed. (REV. 08105 Parcel #: 026- 1294 -42 -000 08/13/2010 08:20 AM PAGE 1 OF 1 Alt. Parcel M 28.30.18.1524 026 - TOWN OF RICHMOND Current [X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 11/10/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 0 - RICHMOND ACRES LLC RICHMOND ACRES LLC 7925 STONE CREEK DR STE 120 CHANHASSEN MN 55317 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1143 132ND AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.830 Plat: 10- 086 - RICHMOND ACRES LOTS 3/49 026 -05 SEC 28 T30N R18W PT SE SW RICHMOND ACRES Block/Condo Bldg: LOT 042 LOT 42 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 28- 30N -18W SE SW Notes: Parcel History: Date Doc # Vol /Page Type 11/10/2005 811739 10/086 PLAT 2010 SUMMARY Bill M Fair Market Value:' Assessed with: 0 Valuations: Last Changed: 09/09/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.830 47,500 0 47,500 NO Totals for 2010: General Property 1.830 47,500 0 47,500 Woodland 0.000 0 0 Totals for 2009: General Property 1.830 47,500 0 47,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r"• � E C • 1 g Fla a .c Z'd B6C :90 b0 90 AON • f P : r ray ..., WMI C'd ezc :90 ti0 90 ^oN III f i 6'd BL£:90 b0 90 ^ON