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026-1087-60-000
- I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514879 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: Erickson, M Ian K. & Cynthia Kasten s Richmond, Town of 026- 1087 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/ /Range /Map No: l ��l e T 30.30.18.4598 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , , eek 3f Benchmark /O Alt. (• 't t Z5, 4 ?7. 7 2. Aeration Bldg. Sewer Ct Holding St/Ht Inlet 9• Z.. e l l , TANK SETBACK INFORMATION St/Ht Outlet 7 9 • 3 TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet �V Septic Z 7lt _711 y Dt Bottom Dosing Header /Man. _ 9.3 Aeration Dist. Pipe ,r 9 •fO 9� -3 Holding � — Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer GPM F•• Dema St Co�r � Model Number",, TDH Lift Friction Loss System TDH Ft Forcemain th Dist. to Well r - SOIL ABSORPTION SYSTEM BED /TRENCH Width J Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 L f Z —�eK SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: �' INFORMATION CHAMBER OR 1:;% 4 Type Of System: UNIT Model Number: � ,%L) -, Zo ! /t ► 5o Q01 // DISTRIBUTION SYSTEM Sc �o �-- A. = z a/_4JC,_, HeaderiManifold Distribution x Hole Size x Hole Spacing Vent to Air I take ]]� Pipe(s) Length /U Dia_ Length ` Dia ` Spacing SOIL COVER I x Pressure Systems Only xx Mound Or At -Grade Systems Only 4e— Depth Over Depth Over xx Depth o xx Seeded /Sodded xx Mulched Bed/Trench Center • 6 5 Bed/Trench Edges I Topsoii \ Yes E] No .,Yes � No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1374 100th St. New ichmond, WI 54017 (SE 1/4 NE 1/4 30 T30N R18W) NA Lot 1 Parcel No: 30.30.18.459B 1.) Alt BM Description = rt (/—Z, V4. " , `" G 660�Q� 2.) Bldg sewer length = Q - amount of cover = O / L6u Plan revision Required? ❑Yes No ' I f Use other side for additional information. 471 nsepctors; SBD -6710 (R -3/97) Date S' nature Cert. No. 00 00 00 "0 lejol sa6ae4a;uenbullaa sa6ae4a leloadg s;uawssessy leloadg ;unowy Ajo6a;eO opoa leloadg jest :sleloadS Z69 :# 4 6002 /L6 /b0 :a ;ea u01;eol;IV83 6 ''ijunoC) iule10 : ;lpaJc) /Cl8110'1 0 0 000 PUeIPooM OOL'9£Z 009'666 006'LE 000 A:padad lejauaE) :LOOZ J0; sle;ol 0 0 000 - puelpooM OOL'9EZ 009'666 006'L£ 000 Apedofd leaauaE) :8009 ao} sle;ol ON 000' 6 0 000' 6 000•£ SO 03dOl3A3aNn ON 006'9 0 006`9 000•tC t1J iv�:if11if1owov ON 009'6ZZ 009'666 000'0£ 000•£ 6J IVI1N3aIS32A uosea�l a ;e ;g le;ol anaidwl puel saaod ssela uol ;duosaa LOOZ /L0160 r :Pa6ue4C) ;sel :SUOI juewssessy anleA osN :4 ;IM pessessy :anleA;al.ieW sled :# ilia J121vwwn 8002 ELE /L99 V96 68E LL6 6/ 60/90 OO 6Z£ /O£O l , - 9b9t709 £66 WSZ /80 (IM LEb/66E6 69£9L9 8666/£0/b0 " edA1 0 /10A # ooa a ;ea :iGo;slH laoaed :sa;oN M9 6 (b /6 096 b/6 Ob 6uZl- unnl -oag) :(s)3oeal :Bpls opuo:jploole MS 3S `dOb M9 6b N6£1 £Z 03S 31f3VIIVAV lON /N field 000 aaa :uol ;dlaosea le6al 011M OOL L CIS 1S1a OVH32:1 MOIIIM 2Elddfl OZ08 dS aNOWHOR� M3N 'Z96£ QS 3Ad H100Z 09t� uol ;dl�osaa # ;sla ad�(l. Aiewud = , :(sa)SSejj d �(� o�d leloadg = dS IOOu .= OS :S;OIJ;SIa z Loot9 Inn NI Wcl �33a i' 3Ad HiOOZ 09vZ G2lOdSNMdH >1 N08VHS'8 3 SIONVRJJ >1 NO�JVHS'8 3 S(ON'd2J3 '(2JOdS)IMVH - O jeumo - oo juaiino = o 'jeumo juaiano = p :(s)aaumo :ssaappv xel 0 00 „ edAl;iwaad #;!waad # uogeollddy eeiV seleg # deW a ;ea leolao ;slH a;eo uol;ea.ia NISNOOSIM 'Jk1Nnoo XIObO 1S X ;uajana NOIAO 30 NMOl - 900 £9E'96' 6£ EZ :# laoaed 'llV 6 JO 6 39Vd wd 9V£0 90OZ/60/90 000 :# l83aed r gov commerce.wi. Safety and Bings Divt County uild 201 W. Washington Ave., Box 2 !�O � Madison WI 53707 nary Permit Numbe (to bet led in by Co.) Department of Corrttnerae State Transaction Number Sanitar y Permit Application In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this f unit is required prior to obtaining a sanitary permit. Note; Application t' Project Address (i ifferent thanmaitin dress) 1 submitted to the Department of Commerce. Personal inlbnmation you pr vide Wray usa;1 fur secuttdaty 13_7y ` 5 Pu xises in acc et�7an ce with the Privacy Law, s. 15.040)(m), Slats. -:; r - 1 . Application Information - Pleas Print All Information �'ropeny Owner's Name -- Partel p j �! Y 01 l& - Idf7- lo a �U Property Owner's Mailing Address ZON O FFICE Property Location Af 7� 1 24 /J s 7` - — Govt. Lot � - Zi Code Phone Number Gt 1 „ �tJ /, Section J City, State P � , _ • N; R � 6 a { 11. Type of Building (check all that apply) Lot 4 T Subdivision Name � or 2 Family Dwel {ing - Number of Bedrooms „�� � ,� ��<. N0 � ' / Q ,, " / � tj._ 7/C6I.Q.r� l�Lrc� �il aG Block � � ❑ Public /Commercial - Describe Use V 2-1 C�{_�i� ❑ Cav of 11 State Owncd - Descrilx; Use CJ CSM Number tuber / ID Village of _ 44 t m 111. Type of Permit: (Check only one box on tine A. Complete line Ri app A ' New S stem y ❑Replacement System ❑ Tre:attttettUHolding ?ark Replacement Only 13 Other Modification to Existing System (explain) l i List Previous Permit Number and Date Issued I ;. ❑ Permit Renewal ❑Permit Revision ❑ Change of Plumber ❑Permit transfer to New -7 Before Expiration Owner IV. Type of POV1"PS 5 -stem /Com on Check all that a r 11 Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ t- tirade (71 nPretreatment > 24 in. oil uitable soil ❑ M nd < 41p o'suita le soil C1 Holding "rank ❑ Other Dispersal Component (eaplain)O 1 - Devic ex Zvi V. Dispersa ersa Area Information-. Design Flow Ql pd) Design Soil Application Rate(gpdso Dispersal Area Required (s1) Dispersal Area Propose (sf) System Elevation lee Vl. "Dank Info Capacity in Total ut Manufacturer y J 6 J Gallons Gallons Units New Tanks Existutb Tanks Septic or Holding Tank Q 1 . l Dosing Chamber -- !N VII. Responsibility Statement- I, the undersigned, assume responsibility for Installation ofthe PO s wo on t attached plans. Plumbet's Name (Print) Plumber's Signature P QRS Number Busioess Phone Number Plumber's Address (Sheet, City, Stale. Zip Code Vlll. aunt / triartment Use O nl y pproved ❑ Disapproved Permit Fee Ds�� lss .g Agent S' atu ❑ Owner Given Reason for Denial 3 �U l� IX. Conditions of A t roval/Reasons rov far Disa t SYSTEM OW NEf�r '� ^ � P1 3 1 Septic tank, effluent filter and l'� dispersal cell must all beed plan p rovtded by plutt�ber per management asp intained _ + re uirements m ust be ma as per H{jpirCdoIC (A fLr to. the s}stem anJ iubm to the C.oton yon y ou pa ' no tcsa th !S x I 1 inch 'n size V S 98 .01 /07) Valid thni 01 /09 � %�� (� dL ��' ,h J � � � � a � sh 4 ry AJ I Rcopy i r it ��/ Ada � Ste' // IrS�J� a � •. , 1 S � � .i y „ _ i' -- x s `� � l �� �� ���: U� `�- �. �- �. J �� �=- �' � �� -� � � � -� � � b Q N � � .�� � h � �' A.. 5, � � Q� �1 �� - --- -- �� ST. CROIX COUNTY SEPTIC. TANK. MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 6 1 '1 0 1 _ Mailing Address I / CJ z - C iii - V k-�C V✓�cn LV 5 yU c'r , . r G Property Address J 3 `( 16,C) V . z "v , 1 C wt o'A c; ( �,�: l S y (Verification required from Planning & Zoning Department for new construction.) City /State Al t L,✓ w ` Parcel Identification Number 0 Z 4) - /G Y 7 LEGAL DESCRIPTION Property Location ti' 144 , A %4 Sec. SCE , T 30 N R �� W, Town of t� ` c VVA c el a l_ Subdivision _ _ _ Lot # Certified Survey Map # S O 3 C� I 0 _, Volume , Page # � V Warranty Deed # z f b _ , Volurne `T , 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 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. I/we certifv 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 �h�-- �, 274' IGNATURE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed froin the Register of Deeds office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ( of 'Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ©DQ al 0 NA Permit # Septic Tank Manufacturer ►eSe, 13 NA DESIGN PARAME'T'ERS Effluent Filter Manufacturer Cl Nq )Number of Bedrooms �? ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity Q al ❑ NA Estimated flow (average) VF Pump Tank Manufacturer Awl S, 13 NA Design flow (peak), (Estimated x 1.5) +�- () gauda Pump Manufacturer s ❑ NA Soil Application Rate al /da /fta Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 rng /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (13013 !=O mg /L CI NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ DWn tion Q Other: Pretreated Effluent Quality Monthly average Disp ' 9dial Collis) ❑ NA Biochemical Oxygen Demand IBO13 530 mg /L n- Ground (gravity) 0 In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L )NA ❑ At -Grade [3 Mound Fecal Coliform (geometric mean) 510 cfu /100rn1 ❑ Drip - Line ❑ Other: Maximum Effluent Particle Size Y in die. ❑ NA Other: ❑ NA Other; ❑ NA Other: 0 NA "Values typical for domestic wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency 1/11 Inspect condition of tank(s) At least once every: month(s) (Maxinium 3 years) 13 NA earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cells) At least once every: .� month(s) (Maximum 3 years) 13 NA y ear(s) months) ❑ NA Clean effluent fitter At least once every: /d - yrear(s) Inspect pump, pump controls & alarm At least once every: r---- O monthls) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA --- t0 y eat(s) Other: At least once every month(s) y C7 NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(a) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a tailing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank. equals one -third %) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Sorvicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 517 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellis) in one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the PO its and cannot be repaired the following measuros have been, or-must be taken, to provide a code compliant replace ystem: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area Is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. D T si d site A11 e t Tank O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DU NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER N `1r, u ,,.., y ,. �� >^ Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Sr) �0 ! f� Phone Phone '/ d � r This document was drafted in compliance with chapter Comm 83.22(2)(b)(11(d) &lf) aril 83.54(1), (2) & (3), Wisconsin Administrative Code. y :APR IVED Wisconsin Department of Comm rce Q Z EVALUATION REPORT Page � of Division of Safety and Buildings ��dd iqi� 85, Wis. Adm. Code X1 Coun ty .5;1. j -o Attach complete site plan on p er no in size. Plan must include, but not limited to: verb reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �Z 6 - /v e ll Please print all information. Rev' wed y Date y) Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location I i't t 1 SZ �t X'� Govt. Lot �,J 1/4 WV 1/4 S 3 Q T —5� N R f. E (or) Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# City State Zip Code Phone Num �/ ❑ City ❑ Village ® Town Nearest Road � .IV L.6 o'}-k 1✓1 d 1 4.. ( ) /t<' — / �/ OI I� /f W � "e-� � t' nl �t�� / . fig New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate _ s GPD I n ❑ Replacement R� Public or commercial - Describe: � _ � �_!7C�f!rrec' 1,_ �►'.SoY= c� Parent material (� L"lt✓ - S h Flood Plain elevation if applicable ft. General comments and recommendations: F1 Boring Boring # L c El pit surface elev. ft. Depth to limiting factor � ^ in. Pit 9 y Sal 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 I 6-/0 lcv3 13 — S- '.��5� � % C 1 V( s Z is z c i '//�/ — S� d /C YN r 1, 9 3 '� r �� /o ✓ / - f CTS tM Z Boring # Ir❑�n�, Boring �� A ` UJ pit Ground surface elev. ft. Depth to limiting factor J 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 i f? -IG le• ,313 — S, ,m //,r e- t S 1 VI S" Z C1' 3 X05 i tvt Effluent #1 = BOD > 30 < < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 _ _ _ mglt CST Name (Please nt nature CST Number G c- M I6 ddress Date Evaluation Con ucted Telephone Number Property Owner _ Parcel ID # _ Page of # ❑ Boring p 1� 1 Boring pit Ground surface elev. / I J & ft. Depth to limiting facto 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 I 3 L Jt, / - S� r rY Z L - Yi Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. •Eff#1 I 'Eff#2 I F-1 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 i ' Effluent #1 = BOD > 30 < 720 mg/L and TSS >30 < 150 mg/_ • Effluent #2 = BOD 130 mg/_ and TSS 130 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. SM8330 (8.6100) Y 7L 61, VIA \� r 6 2 I Parcel #: 026- 1087 -60 -000 11/30/2007 01:20 PM PAGE 1 OF 1 Alt. Parcel #: 30.30.18.459B 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner O - ERICKSON, MYLAN K MYLAN K ERICKSON C - KASTENS CYNTHIA L KASTENS CYNTHIA L 1403 CTY RD A NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1374 100TH ST SC 3962 NEW RICHMOND SP 7040 RICHMOND SANITARY DIST 1 / ��( SP 8020 UPPER WILLOW REHAB DIST / U SP 1700 WITC Legal Description: Acres: 2.400 Plat: N/A -NOT AVAILABLE SEC 30 T30N R18W 2AA IN SE NE LOT 1 OF Block /Condo Bldg: CSM VOL 2/427 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 30N -18W Notes: Parcel History: Date I /Page e 2339/085 WD 04/10/2001 642452 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 06/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.400 49,500 136,600 186,100 NO Totals for 2007: General Property 2.400 49,500 136,600 186,100 Woodland 0.000 0 0 Totals for 2006: General Property 2.400 49,500 136,600 186,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/15/2005 Batch #: 05 -13 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 J 2339P 085 7 a4S4S tt STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROI X CO.. W RECEIVED FOR RECORD This Deed, made between Perry V. Abel, Kevin L. Abel, Todd D. Abel and Gwen D. Neidermire Grantor, and 07/30/2003 11:15A1S M_vlan K Erickson and Cynthia L. Kastens WARRANTY DEED Grantee. E XF,X�' Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 591.00 (if more space is needed, please attach addendum): COPY FEE: CC FEE: PAGES: 1 Part of the SE 1 A of NE1 /4 of Section 30, Township 30 North, Range 18 West, St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map filed August 5, 1977, in Vol. 2, Page 427, Doc. No. 342158. Recording Area Name and Return Address C3 026- 1087 -60 Parcel Identification Number (PIN) This is not homestead property (is)(is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any Dated this ay of July 2003 * Pe Abel Kevin L. Abel * Todd D. Abel * Gwen D. Neidermire AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) - - — — — - -- -- mourner__ ) ss. ry Pu St. Croix _ — County ) authenticated this day of Nota ,1 j State of Wisconsin Personally came before me thq }- - \ ay of July 20 03 T the above named Perry V. Abel, Todd D. Abel, Kevin L. Abe and Gwen D. * Neidermire TITLE: MEMBER STATE BAR OF WISCONSIN (If not, -- _- to me known to be the erson(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) ument and ackn w ged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin Ogland Hudson, WI 54016 Notary Public, late of My Commissio is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac. WI STATE BAR OF WISCONSIN 800- 655 -2021 . ( (Dv D CD 3 m m _ ID sp m ° f D C�7 O v w p v co N �C 3 z c m m w °' " c� co a z C- C D aA � < 3 ° o �. CL O O a ? CA :3 CD - '1 c�'o ° 0 O O C to N n -4 f W O w 3 0 7 H A O O m c o O CD acs y ch a s W O z N 3 C. O CD CD Om � w otOD O � c7 0 N CD w CO 3 3 a O M O O O O N N N o o D m :S vvv o CA (p CD to v N D d ID _. m (y N ° z zcuz Q N ° D a CD 0 O O "It • 60i O O '' CD w Al O v CA O W 1 c m (D CL 3 E CD O J A Z n co c X 3 1 p z O CL 0 7 I U) -I Cl) W m W O O a z c 3 a A c z 3 M � N � CD A W N C y x D 3 O a y N c a CD W CD N '.• C G O a . CD a 3 T 0 N 61 7 a CD W C Cp (0=0' CD � y' z O. n a Cp O CD :3 CD 0o CL rn CD CD CL � N0 � CL O CD O cDD ti O O CD O• 7 rl O a O W O O C CD O ° r C r F Q D �. 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CROIX COUNTY IL g URvEYORE RECORD _D A GDED Ul 6 .°'c°NKE« CERTIFIED SURVEY MAP at °r 1 NORTH LINE OF SE 1/4 1 OF THE NE 1/4 1 8 UNPLATTED LAN 0 1 j 3&f 1 QI -' ,��31.65' 249.87' �1 I SCALE IN FEET � o N 89 °54'36" E °' b i o: 0 GARAGE Z 33'133'1 Q 100 0' 100 ± /M ��,, } 6 6' I J: / ,EDGER S 'HOUSE I�'� Z I W. 1 �'- d M I � p �Q 2.4 ACRES± (90 � 1 i a CENTERLINE OF .-�N �: SE — N E W ° I TENMILE CREEK- ,- O 3 1 TRUE ° I BEARING z I ,� 3ro 9.87' ( — 1 /47.71 1 17.02 252. 8 5 3.0 �. 52 ± U S 89 POINT OF I X BEGINNING LJ LEGEND UNPLATTED LANDS �o 6 2 x X EXISTING FENCE U- OWNER SUBDIVIDER o O 1 "x24" IRON PIPE SET E 1/4 CORNER w WILLIAM G. WOLF SECTION 30 z ® 1"x30" IRON PIPE SET R. R. #4 -J q NEW RICHMOND, WISCONSIN 54017 T 3 0 N, R 18 W_ • 1 "x36" IRON PIPE SET Q W W z 1" PIPE SET DESCRIPTION A parcel of land located in the SE1 /4 of the NE1 /4 of Section 30, T30N, R18W, Town of Richmond, St. Croix County, Wisconsin, described as follows: Commencing at the E1 /4 corner of said Section 30; thence N0 0 18 1 19 11 E 1014.14' along the East line of said NE1 /4 and the centerline of an existing town road; thence S89 0 54 1 36 11 W 33.00' to the point of beginning; thence S89 °54'36 "W 369.87' to a point which is 52 more or less, from the water's edge of Tenmile Creek; thence along the meander line along Tenmile Creek N22 °03 "E 323.89' to a point which is 38 more or less, from the water's edge of Tenmile Creek and the end of the meander line; thence N89 0 54 1 36 "E 249.87' along the North line of said SE1 /4 of the NE1 /4; thence SO ° 18 1 19 "W 300.00' along the West right -of -way line to the point of beginning, including all the land lying between the meander line and the water'$ edge of Tenmile Creek. Subject to an undelineated easement to Wisconsin Telephone Company as described in Volume 211, Page 392. I certify that the above description and map are correct and that I have fully complied with the P rovisions of Sec. 236.34 of the Wisconsin Statutes and Section 5.4.2 of the St. Croix County Zoning Ordinance. Date: June 2, 1977. _ Francis H. Ogden S -882 Job No. 77 -801 GON S��� I hereby certify that this map has been approved by the Town Board. H. FRANCIS H OGDEN Date: i r S-882 O qP RIVER FALLS, q pROV D �E wls. r ? APPROVAL OF TMS MINOR SUBDIVISION f JUL L 2 ' I t 1 DOES NOT MEAN APPROVAL FOR • B SITE OR SEPTIC SYSTEM, 811116 ,`��� BUI REFER TO H6220. _ ST. CROIX COU:.TY COMPREHENSIVE PARKS PIANNINI3 Volume 2 Pare 4 2 7 C4 AND ZONING Co"TTEE - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP -- tld!> SEC. y _ T �N -R_Z ADDRESS ST. CROIX COUNTY, WISCONSIN ) b 7 SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM oe )3 T' 7� y - / =id Y 7,0 hb�ur INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 1a �_ Proposed slope at site: SEPTIC TANK: Manufacturer; � Liquid Capacity: � � Numb�,r of r -ngs used: _ Tank manhole cover elevation: zzu a Tank : Inlet ,levation: Tank Outlet Elevation: Numbk.r of foet from nearest Road: Front, Side 1 0 Rear, O l.0 feet From ,:iearest property line Front 1 0 Side,O Rear, feet Numbtr of feet from: well 5 building: W (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: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench: Width: ��° Length: Number of Lines : — ,=,-? ` Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, /?� Side, O Rear, O Ft. Number of feet from well: Number of feet from building: (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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: � �_ Plumber on j ob: License Number: F 3/84:mj 6 DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 SE %,NE 4 -,S30;T30N -R18W ACONVENTIONAL ❑ALTERNATIVE Sltate Plan I.D.Number: I ass Town a6 Ric6ond ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Tenmite Ctc.eek NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE: / ViA it Abet Route 4 New Riehm nd W1 5 40 1 _ //' BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT, ELEV.. I N,,,,l Plumber: I MP/MPRSW Nn.. [C n y. Sanitary Permit Number: Catvin Powetus JA. 1563 Ch SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TAN INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDED S /�� ❑YES ❑NO ❑YES NO BEDDING: VENT DIA.. VENT 1 HIGH WATER NUMBE OF, ROAD: PROPER TV I WELL . BUILDING. I VENT TO FRESH ALARM FEET F O M C LINE. ` IAIR INLET DYES ❑NO DYES ❑NO I NEARES �Jv 7 DOSING CHAMBER: MANUFACTURER 71 N G LIQUID CAPACITY PUMP MODEL PUM :SIPHON MANUF ACT UREH WARNING LABEL LOCKING COVE PROVIDED. PROVIDED: YES El NO DYES DYES ONO GALLONS PER CYCLE: 7 7ND CONTROLS OPERATIONAL NU BEIi bF vPROPERTY J WE BUILDING J VENTTOFRESH (DIFFERENCE BETWEEN FEE FROM LINE AIR INLET PUMP ON AND OFF) DYES El NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing t I NI,TH 1 111AMF TEft MATE RIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until F RCE the soil is dry enough to continue.) M IN CONVENTIONAL SYSTEM: _ B ED/TRENCH WIDTH LENGTH NO. OF I IIIITII PIPE SPACIN(I CO EH .INSIDE DIA -PITS LIQUID BED /TRENCH / /t -1-2 TRENCHES �� MA RIAL: FIT DEPTH DIMENSION ., O � /, G M AVEL DEPTH FILL DEPTH UISTH. PIPE UISTH PIPE IDISTR PIPE MATERIAL N ISTH NU BE © PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPE$ " ABOVE COVER EI EV INLf f ELEV N L pip F FRAM{ LIN,E'J 5 ^ AIR _INLET : V NEA EST ^ -- ( �� j G ZG MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of th fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. El YES El NO SOIL COVER TEXTURE Pi HMANI NT MAHKFHS OBSEHVATU)N WELLS ❑YES 1:1 NO El YES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVFR TRENCH HE 1) DEPTH OF TOPSOIL v SOUI FU SEEDED 7HED CENTER EDGES YES ONO ❑YES ❑NO YES ONO PRESSURIZED DISTRIBUTION SYSTEM: B •EV 1TtENCH WIDTH LENGTH TR EONCHES. W LATERAL SPACING GRAVEL DEPTH HE LO PIP!- FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE M DISTH DISTR PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA ELEV. PES DIA ELEVATJON AND'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING CHILLED CORRECT LV OVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES 1:1 NO ❑Y ES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION W LLS. NUMBER O F PROPERTY WELL: BUILDING: F EET FROM '., LINE: ❑YES El NO 1 DYESEl NO NEAREST Sketch System on -Re iin in county file for audit. Reverse Side. !- / .'_��. - -•-'" LE Zoning Adm i n"i�6t atot DILHR SBD 6710 IR. 01/82) SIGNATURE � DILHR SANITARY PERMIT APPLICATION °OU , N In accord with ILHR 83.05, Wis. Adm. Code STA PERMIT # �� 9 T — 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 :4 No PROPERTY OWNER PROPERTY LOCATION 'le ' l a,S T3 ,N,R �Or2 PR17M TY OWNER'S MAILING ADDRESS LOT N BER BLOC UMBER SUBDIVI N NAME STAT ZIP CODE PHONE NUMBER E3 CITY NEAREST ROAD, LAKE OR LANDMARK VILLAGE II. TYPE OF BUILDING OR USE SERVED: GR& " 7 Number of Bedrooms if 1 or 2 Family. OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. 3 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. IM Conventional 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. ® Seepage Bed b. ❑ Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): �q a✓ Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank Li Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oft ivate sewage system shown on the attached plans. Plumber' Name (Print): Pt tier's Signatur . (No tamp) MP /MPRSW No.: Business Phone Number: Plumbe ' Address ( Stree City, Stat Zip Code): Name of Designer: Vlll. SOIL TEST INFORMATION Certif' 'I Tester (C ) Name CST # !�l CST' DDRESS ( tre t, City, Sta , Zip Code) Phone Number: IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stam s) S charge Fee 19 Approved ❑Owner Given Initial / e7 � n�� (?j r1O� Oly y � Adverse Determination L p/ X. COMMENTS /REASONS FOR DISAPPROVAL: P/eq b� 3' _eKk�o%s SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber I r 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 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 owner's name and mailing address. Provide the legal description where the system is to be installed; II. 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 dirpensions, 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 r commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco C11'S w can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure' a is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03/86) STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER lli r qI 2 ROUTE /BOX NUMBER / R f 1 FIRE NO. CITY /STATE /VP Lt?ckvr6Y, �A W1 ZIP S yO� PROPERTY LOCATION: S 1/4 ,p &!� A /4, Section _ , TN, R �d W, Town of elchM0 , St. Croix County, Subdivision AM , Lot No. 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. W e undersigned, is d " I/ E, th rsigned, have read the above requirements an agree to maintai n the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED - DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 r (715) 386 -4680 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) 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 i' L' Location of property 5 E 1/4 I'VE 1/4, Section 20 , T 30 N -R _zls_>, W Township M-A Mailing address Address of site 5AftjZ- Subdivision name Lot number Previous owner of property but v! /v 0 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? IK Yes No Is this property being developed for resale (spec house)? Yes No Volume S61 and Page Number 24�6 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 1(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. ; and that I (We) presently own the proposed site for the sewage disposal s s em (or I (we) have obtained an easement, to run with the above described roperty, for the construction of said system, and the same has-bee L d ly reco ded in the Office of the County Regis er of Deeds, as Document No. 3.3 d 9y ). Signature of Owner Signature of Co -Owner (If Applicable) '(1_d�'__ e Date of Signature Date of Signature DOCUMENT NO. ^ 1 STATE )AMR OF WISCONSIN-FORM 2 trI� VOL 561 prC 266 WARRANTY DEED { 3 433 0 9 41S SPACE RESERVED FOR RECORDING DATA ' REGISTERS OFFICE BY THIS DEED, William G. Wo lf d ST. CROIX CO., WIS. his wife Rec'd. for Record this _ZQth_ day of But, A.D. 19_77 - Grantor conveys and warrants to Virgi H 1 and Dini ce F. Abel , at 2:30 M. husband and wife as joint tenants, I' RegisfFe of Deeds 1 Grantee 8_ for a valuable consideration RETURN TO I� ; the following described real estate in St. Croix County, State of Wisconsin: � A parcel of land located in the Southeast Quarter of the Tax Ke a Northeast Quarter of Section 30, Township 30 North, Range 18 This is homestead property West, Town of Richmond, St. Croix County, Wisconsin, described as Lot 1 in a Certified Survey Map filed in the Office of the Register of Deeds for St. Croix County, Wisconsin, in Vol. 2, Page 427, Document 342158. l) FEE Exception to warranties: Ii Subject to easements of record. II Executed at HUdSOri, W'l,SCOriS].ri thi 20th day of Cartcmhpr 197.7—. i I I SIGNED AND SEALED IN PRESENCE OF �^ (SEAL) I� WILLIAM G. WOLF i (SEAL) I! W OLF I (SEAL) (SEAL) C �i Signatures of � I I I authenticated this day of 19 —• I Title: Member State Bar of Wisconsin or Other Party Authorized under Sec. 706.06 viz. 'i STATE OF WISCONSIN 1 St. Croix County. Personally came before me, this 20th day of Se? tember 19 =, �I the above named William Wolf and Marjorie Wolf, his P, I� to me known to be the persons r who executed the foregoing instrument and acknowledged he same. i .....•....... E to ,, '•. ~` This instrument was drafted by' 4 .. ;(r T TA SAMUEL R. CARI Attorney ~; N )~ Notary Public St. Croix County. Wis. Hudson, Wisconsin 54016` ~..� p (, 1 ,T U d �- s sin (Expires) Is 1 -1i 1981 I The use of witnesses is optional. ;• My Commis o ( p ) ( ) 1� • ✓ fit, . � Names of persons signing in any capacity should be'ik"4, below their signatures. KGMN� OO�Pad® WARRANTY DEED -STAt4 BAR OF WISCONSIN, FORM NO. 2 - 1971 1 - DEPARTVIENTlF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTfRY, CC DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON W BOX 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWN IP /MUDIJCrPftilTY: LOT O.: BLK. SUBDI ISION NAME: �/ '/a 30 /T3p N (or COUNTY: TER'S/BUYER S NAME: [ VIAIL11ADD ESS: 4 -; - 2&Z&,.,(& 42L USE DATES OBSERVATIO S MADE NO. BEDRMS.: COMMERCI L DESCRIPTION: (PROFILE DESCRIPTIONS: R ATION TESTS: ®,Residence ❑New Replace �q RATING: S= Site suitable for system U= Site unsuitable for system Q ONVENTIONAL: MOUND: IN- GROUND PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTE7p tional) r14S_ au X s ❑u s ❑u [IS ©u ❑ s ®u 'I "'id �,ld,,,� 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: PROFILE DESCRIPTIONS A 3 BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH W ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- 7 B- B- B- r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER IQLCNC-& AFTERSWELLING INTERVAL -MIN. P RIOD 1 PERIOD2 PER PER INCH P- P- P- 5 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. SYSTEM ELEVATION QIlit, 6, ` N / f 11 { s "' .....q..._ ...... ._ .... dUS I � I, the undersigned, hereby certify that the soil to s reported on this form were made by a 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 he best of my knowledge and belief. NAME Znt TESTS WERE COMPLETED ON: ADD CERTIFICATION NUMBER: PHONE NUMBER (optional): Afy Z� hk 5�_ 2 Z CST I N URE• DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — L INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must h1c.lude: 1. Complete legal description; 2. The use section roust clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL. CONDITIONS; 0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accrra;ately locating your test locations. Drawing to scale =, is preferred. A separate sheet may be rased if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are per 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if aopropriate; 10, if the information (such as flood plain, elevation) does not apply, place N,A. in the appropi pate box; 11. Sign the form and place your current address and your certification number; 12. Make !edible copies and distribute crs required. Al _L. SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 GAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separa9cs and Textures Other Symbols St — Stork; lover 10 ") BR Bedrock con Cobblo 13 - 10 ") SS Sandstone gr -- Gravel (under 3 ") LS — Lknestonc s - Sand F -1GVv' - High Gr ouiidwaLet cs - C c5 wse Sarlrl Perc Pl.rcolatiorl Rata i __ F, Sand Bldg Bujiciinc 1= - Lit €t Sand > ._ Greater Than sl Sandy Loam k, - , Le, Than 'I I .oaraz Br, fi ov io s ,1 __- .silt Loam Eti Black s i _. Silt G Gray sc: Sand y Clay Loarn R _ .. Red sic: — Silty Clay Loam n — Mottles sc - Sandy Clzsy v,Itt� s w. — si`ty Clay ftf - 1evv, fine, faint pl Peat corn - Many, nw(Jil"W", m - iv`uc:k d — distinct P [,rominent HWL — High vve.t_rr love.!, Six general soil textures surface water for liquid waste disposal BM -- Bench Mark VRP Vertical Reference Point 1 TO THE OWNER: This soil test report is the first Ftcp in sec urine a sanitary perrnit- The county or the Department may request verification of this soil test in the field prior to pert issuance. A complete scat of plans for the private sev system and a permit application must be submitted to the appropri'<rte local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction, Nl� /0oO - :11We I WqC4 J6 y� Z '�� 9?4 Li „r 'AGE --- C i • - . -•+ - f r`v s S ��tla�- �� ems, F� k FraiSh Air Iniota And Observation Pips A� N .W9° ._ Approrao Vent C' �r r M IN mum 12” Apawr i C I ¢ Y Y � .— - 4' Coal Iron 20 e2" AOars Plpa ! I Vant Plpa f To final Grodo _ � C Mirth F loc Or Sra tMllc foveriny p r � _. rt C A+Ff! p�Uara Distribution {!`"�,'" '.._. .._. 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