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HomeMy WebLinkAbout026-1097-30-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514972 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: Keller, Herman W. Jr. Richmond, Town of 026- 1097 -30 -100 CST BM Elev: Insp. BM Elev: BM Descriptio Section/Town /Range /Map No: d 6L D 1 C) loM l C- % 34.30.18.521 B TANK INFORMATION ELEVATION DATA /0, 15 // . 15 1 TYPE MANUFACTURER �'5 CAPACITY STATION BS HI FS ELEV. Septic J-h 7 Benchma k Dosing f� S / - J � Alt. M 64 ZZ �3 9 Ga T v n Bldg. Sewer 4 rJ : f b l a o,Q3 Holding St/Ht Inlet 1 7 -.9 1 1r_7l Z SUHt Outlet TANK SETBACK INFORMATION `- TANK TO P/4 WELL BLDG. Vent to Air Intake ROAD Dt Inlet r' Septic /ab 33 / 131 Dt Bottom /4, 2 F3 • 537 /6b �V Dosing / /, )) 33 r / r Header /Man. 7,7,133 I.3 Aeration Dist. Pipe - p 3 160 Holding Bot. System A). 7 l 4 1 q Final Grade �P �• PUMP /SIPHON INFORMATION �. �6�• 33 Manufacturer l Demand St Covert GD�I� GPM t Model Number l 3 I �islch og F 9- S 91 TDH Lift Friction Loss System d L TDH Ft Forcemain Length D a Dist. to Well J z N►�-.. SOIL ABSORP ION SYSTEM BED/TRENCH Width / Length N PIT DIMENSIONS No. Of Pits Inside Dia. liquid Depth DIM SETBACK SYSTEM / / TO t � ENSIONS `7 �/ I F , /L BLDG WELL LAKE /STREAM LEACHING Manufacturer: ` INFORMATION Ty S stem: ► CHAMBER OR YP Y 33 5 1 Ajil ,l//� � I /� " UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution / 4 /� / x Hole Size / I x Hole Spacing Ve to Air Intake Pipe(s) � /G 3l� �Z 3 .� Length 3 Dia 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 xx Mulched Bed/Trench Center / / ' Bed/Trench Edges \ Topsoil I ( _±1 Yes E] No Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1� / /6 Inspection #2: �� / 7 /�/� Location: 1269 130th Ave. N Richm F i n: > r s L t Parcel No: 34.30.1S.5Z1B w nd, WI 54017 (NW 1/4 NE 1/4 34 T30N R18 35 c e —� 1.) Alt BM Description 2.) Bldg sewer length = L15 - amount of cover = s Off a il Plan revision Required? ❑ No U / / X - -- - - -- -- - - - - - -- l - Use othes de for additional information. SBD -6710 (R.3/97) Date Insepct gnature Cert. No. r — Safer and Buildi Division County comfnerce,wi.gov y g 201 W. Washington Ave., P.O. Box 7162 'sco ns i y Madison, Wl 53707 -7162 Sanitary Permit Number ((ttof be filled in by Co.) Departtmmenntt of Commerce _ 5/ ) / q / I State Transaction Number Sanitary Permit Apphcatio 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 TS are Project Address (if different than mailing address) submitted to the tars. Department of Commerce. Personal information you provide may be used for sec on a j�� `�� ur ses in accordance with the Privacy Law, s. 15.04 (1)(m S 1 1. Application Information - Please Print All Information Property Owne 's Name Parcel # /co /Y A'�7 � LIF 1—T AUG 2 8-2W— Property wner's Mailing Address � Property Location 10C/7 /J�0'7 7 1 ST. CROIX COU f�1IY_ Go` t. Lo _ City, State Zip Code r Phone 1 2~G OFFIC /., '' Section t� / I Zl �� o (circle one /L -�- -- r N � R II. Type of Building (check all that apply) Lot # _ Subdivision Na e 1 or 2 Family Dwelling - Number of Bedrooms /� �/'� Block # i ❑ Pubhe /Comt - escnb Use CSM Number ❑ Village of i ❑ State Owned - Describe Use own of 40 L!F'I - I11. Type of Pe (Check only one box on line A. Com plete li B if ap —_ System p Y g p Y ` ❑ Replacement System ❑ TreatmenUHoldin Tank Replacement Only �Othe, Modificat�t. sting System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal El Permit Revision El Change of Plumber [01 Permit Transter to New Before Expiration Owner 1V. T y_ pe of POWTS System /Compone (Check all that a tv - __� /�'+�Lf/n on- Pressurized In- Ground ❑Pressurized In- Ground ❑ .At- Gradound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 1 V. Dis ersaUTreatmentArea Information: - — --1 Design Flow (gpd) Design Soil A lication Rate(p Dispersal Area Requi (SO rspersal Area Propose (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer '� I c� n l i G allons Gallons Units P J'1`kBD v - New Tanks Existing Tanks 0 a U v.• H � ci CV n. Septic or Holding Tank Dosing Chamber V11. Responsibility Statement- 1, the undersigned, assume responsibility for insta ation o t e PO S shown on the attached ns. Plumber's Name (Print) Plumber's Signature M PRS umber Business Phone Number Plumber's Address (Street. City, State, Zip Code) ,7 .punt /D epartment Permit Us — �e it Fee Date 'sued T Iss ing Agent gnature Approved ❑ Disapproved � (jU ❑ Owner Given Reason for Denial - I\. Conditions of Approval/Reasons for Disapproval �- S STEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained 41-� e, AA"r-e (� �- a s per man agement plan rovided by plumber. —_ 2. All setback requiremerft0ttat4wter is system and su to he C o y [raper not l s t an 1 _ 112 x1 - [ c / hes ins' as per applicable code /ordinances. ai CJ� =f�X Gx Oc�Q� g7�1 Sa SBD -6398 (R. 01/07) Valid thru 01/09 A -�D of i f , i Ulbricht & As ciates { Private Sewage Consultants 2812 0th Av . E Spring Valley, WI 54767 war- 5 _ O Pt 0,0 � ; O 3y NeiW iEER ly4o Rion qo Tar L i ~ •,, of a ll PVC / The area 15 ft. below the downsloPe e e of the Ab S must remain un 'sturbed. ,' / �� Soil p Y � � � 133 Safety and Buildings ov PO BOX 7162 commerceml. g MADISON WI 53707 -7162 TDD #: (608) 264 -8777 www. com merce.wi. gov /s b/ isconsin www.vAsconsin.gov Department of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary July 31, 2008 CUST ID No. 226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/31/2010 Identification Numbers Transaction ID No. 1569899 SITE: Site ID No. 740223 Herman Keller Jr - Dwelling Please refer to both identification numbers, 130TH Ave above, in all correspondence with the agency. Town of Richmond, 54017 St Croix County NE 1/4, NE 1/4, S34, T3 ON, R18W FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1192383 Maintenance required; 600 GPD Flow rate; 34 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, F stats. Oy A copy of the approved plans, specifications and this letter shall be on -site during construction and open to AP inspection by authorized representatives of the Department, which may include local inspectors. All permits DEP required by the state or the local municipality shall be obtained prior to commencement of MV1 construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should SEE CORA conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. ROBERT W ULBRICHT Page 2 7/31/2008 ;eter cer, , Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Pagel Private Sewage Pl eviewer, , Integrated Services WiSMART code: 7633 (608)266 -2889 , M - F, 0630 - 1500 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, Wl 54767 ul Reg. Designers of Engineering Systems 715-772 -3442 Private Sewage Consultants PROJECT INDEX Plan I.D. # Date S� �' q d Owner I+ERM ,4N KE[I t= - ,T.P - • Phone &00 1& t • ~ J',S � Address N 37& 7 5/01-k 5T• 611,$ wa lkti-L W I . ,5 q O ( � Legal Description PARR- ei -If y -f4Z � �,f *V CR N , N E , S e C . 3 y , T 3 D N, R 1 W hl JV 0 16 •1 - 20.017ri Town of M County C.S.T. •R ..0 �b R 611 ZZ� 3 - S Installer Local Authority/ Supervision sT. GRo' x G r y Z-0 &I I A3 6 - a r- PROJECT DESCRIPTION - 7/5 Y cP6 . -�e6joo �vw co,v s�'r>'vc r /ov Fort .�4 3 vt)c c s & 6 �-v/�M . Cs rLr---v P.4f"1- y k)/+ 5 A9 'r 40 &66 sla-5 IV4 51-e- S y .7 �� � ✓��" }� f / J�N O o,auoirnran,rt,�� V C 0 ` fir© •� � �- FS an y . s t� Pg.1 PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC /TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OUTS) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems to (Version 2.0 SBD- 10691- P(N.01 /01) and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (version2.0) SBD - 10706- P(NOl /01). i I i �y' ppQ • � i 1 1 Ulbricht & Ass iates Private Sewage Consultants 2112 10th Am Spring Valley, Wl 54767 / 30 o w pRo ��u �L r � O 1 � �� 4 Ne Gv iEE __� C.o Gk-t C-0• CDN 3 b Tik�le e goo"'" qv' Tor L Or- a" P FoRGL r / The area 15 ft. below the downslope ed e of the o fla S stem must remain un Obed. �' ,' / �� Sall Abs � y � � � 13 3 I a R- O q •� f6' 70 1 a T� -- i CROSS SECT100 oF+ MouajD w rti lae OED eF" ro Agge wsATE pi tRit3uTto� Cs, rk ckoVS3 1P sysreo ©F - ro p 5oiL L , I E'IEvArioN � um ! FvR M To E 9 . Mao • � • . sAW►!7 /I/ PtowEf� "r a p- , 'o c .�-- uu i FORK MAW Sep 99• o GNU . G g Fr. $ — MLevAr o S �•�� Fr. • INVER•r OF /tiT£R/1rIS F'o �-� • 8th FT. ock / o o.y8 � F - rop of 5 ` N /- F T. 'To OF IATERAIS ('LAN VIEW OF MouJ ct~ EAU FOR MAix) A 7 F r• 13 �� Fr L .. --- K /o Fr F r - r r r r-r - i v ° FT Fr t W Y 30 o w Fr Be 9oF�i To 1 S" Ag REIr�;T PVc cAppaP 013SER q Fr• rRoM tru175 t t '. prp�s /oc•�T��.�s PERMlw ENT M Ae KERB (Tops - of c. CA,0 007 • � h R eh � .. � �rL� wh srF Flo RacqutRED f3ASA _ So lt. tafi 1IVATt E' y sa. F r. A?ACfT PRopoSE 13ASM ARetN � �r 5 OWNER's MAINTAINCE'OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and inspections maintenance of this system. Regular per and e of. this servicing is necessary for the safe healthy op n e of, this The owner is required by code to submit all necessary maintenance /inspection reports to the controlling,authorities. SPECIFIC CONTACT AGENTS sT•cRarx �T �. Zo.�i �G- * Governmental authority/ inspectors: * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: �. L * Licensed service / inspection agent other than installer: Ulbricht & Associates s f/'G w,v� Private Sewage Consultants 2812 10th Ave. - 7 /5 • 7 7a - 3 g L f Z, Spring Valley, Wl 54767 * Electrician, for' pump, electric controls, wiring units: 6 . IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic•(sledding, sho- fairing, etc.) across the area shall not be permitted, or frost can /will penetrate 3n the cell, freezing up the system. Discontinuos use In the winter_(a vacact.ion trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation-needs to be exercised! Or system can be hydrolically overloaded and destroyed.. This sys�em was designed for a maximum wastewater flow of Q 0 gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage. disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped Into the cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer_ immediately for advice. 5. Neglect of the vegetati ve "cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the,Qystem beneath IS NOT sufficient alone tO maintain a :Ji `-, cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualieied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. (wound System Management Plan ' Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic lank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic lank shall be disposed of In accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain-'solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. P ump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent Filter is installed within the lank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetrption. Cold weather Installations (October- February) dictate that the mound be heavily mulched for frost protection. ' Influent quality Into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed.maximuni design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and It is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the Initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning Is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 Inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual (SBD- 10572 -P (R. 6199)] and local or state rules perthining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic br pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- Inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry Into a tank or component. CContinuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shelf be Immediately repaired or replaced with a component of the some or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the groiInd surface, it will be repaired or replaced in Its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged adsorption and dispersal media, and related piping, and replacing said component's es deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. SEE, REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO 1 SITE, DESIGN, AND COMPONENTS I� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM wnc uyer . }-- Mailing Address -3 S �-� CV d r`� Property Address �a (42 s7 150 (Verification required from Planning & Zoning Department for new construction.) City /State AIVW iC e k M e & at W6 arcel Identification Number © X 6 -- / ®9 7 `— .q 0 40V 0'c'� 6 /097 LEGAL DESCRI PTION /V 1,12 4 Property Location '/4 , Sec. 3 3 , T 0 N R�, Town of �6�C Yn O 1y (0/) P Y V/4 , Subdivision _ if/f, -�-�+ 35 ,Lot # Certified Survey Map # , Volume Page # N4rr�ty Reed # , Volume , Page # Spec house yes ro 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(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms *!_ SIGNATURE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) I I Model 2188 SQ. Fr. (OUTSIDE R I \CL PORCH, K -425• �N SHEER80N ALLKOLBE AMD.KOLBE AAYN PIq.�SCASEME�A odular Co 4 280 TUS NOT 5Ga7 AVAILABLE ° 22'- 3' a a 8' 97-x°" 13.0` <KDW�I Ie3z} .tPClpA6) �e ' a a. s o LMNG 3 BATH ? ROOM O a Z i "' 'a.11 c.gltAL� 2 - ioAncFoo�'co, mvRocw a v p J KITCHEN = DINING MUORC ;m- OR3 �� m _. _ 12 4• 4 k $ DEN _ BATH -� I M#NI BLINDS MINI Reversed Floor Plan : _ OPT 3PECIFICATM DIFFE W.Z MTN FULL TRIPLE SECTION *TOWS _; r I. s` VAMTW C"VM ARE STANDARD DN OMSM SECTONS Z CENTERSECTIONWRL14AVE A IR'FLAT CE024M. :. 3.."FIT$ ARE NOT STANDARD N KITCHEN OR BATHS 4. THE STANDARD ROOF IS A4 12 HNOED ROOF WRH THE CENTER PORTION CAPPED. - '- OPT SINK ,. 6. ASEAMLESS CEILING TRANSITION YYLL BE USED ON ALL: MARWaE WALL CEILING AREAS. 6 CENTER SECTION BATHS REQUIRE A HEATEDILIOHTED BATH FAN ¢..... ¢ T. PLUMBING VENTS CAN NOT BE RELOCATED FROM FRONT TO SACK OF HOME: 72'-4' A KITCHEN OVEttlrEAD CABINETS ARE 30.5:tOPTMALar ORVARMSLEHEIGHT 4`-4" ARE AVAECFA,. ",4� #; OPTIONAL UIXITYARRANGEMENT _ __MASTER =_- MINI BLS (PC26 } } 6R2 CERAMIC SHOWER TLIBAND M SBA TN A OPTIONAL VARIABLE HEIGHT R) KITCHEN OVERHEADS (NOTE PRICE DIFFERENCE) CV1w THE OVERALL DIMENSIONS OF HOMES SHOWN DO NOT INCLUDE A 22" NOMINAL EAVE OVERHANG ALL AROUND THE HOME. DUE TO CONSISTENT PRODUCT IMPROVEMENTS FLOOR PLANS AND RENDERINGS ARE SUBJECT TO CHANGE WITHOUT NOTICE. EXTERIOR ELEVATIONS SHOWN.MAY INCLUDE OPTIONS OR ADDITIONAL ON SITE WORK. Parcel #: 026- 1097 -30 -000 osio2 /loos 0$:15 AM PA 1 OF 1 Alt. Parcel #: 34.30.18.521 026 - TOWN OF RICHMOND Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/20/2008 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KELLER, HERMAN W SR HERMAN W SR KELLER 1277 130TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 34 T30N R18W 40A NW NE EZ -U- 1419/468 Block /Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 30N -18W NW NE Notes: Parcel History: 008 FOR 2009; Date Doc # Vol /Page Type 026 - 1097 -30 -050 (521A) &NEW PARC (5216 02/13/2001 638449 1586/246 TI 026 - 1097 -30 -100 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/09/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 39.000 5,500 0 5,500 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2008: General Property 40.000 5,600 0 5,600 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 5,600 0 5,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r Parcel #: 026- 1097 -90 -050 09/02/2oos 08:18 AM PAGE10F1 Alt. Parcel #: 34.30.18.527A 026 - TOWN OF RICHMOND Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/20/2008 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KELLER, HERMAN W SR HERMAN W SR KELLER 1277 130TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 56.500 Plat: N/A -NOT AVAILABLE SEC 34 T30N R1 8W 40A SE NW FKA Block/Condo Bldg: 026- 1097 -90 (527) NOW DESC AS E 1/2 NW 1/4 EXC AS DESC IN TI- 1595/101 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 34- 30N -18W SE NW Notes: Parcel History: R534RED 20 20M; REMAINDER NKA Date Doc # Vol /Page Type 26 -109 - 0 -075 527A- ) &NEW DESC IS 03/02/2001 639639 1595/101 TI -100 (52 02/13/2001 638449 1586/246 TI 293110 444/263 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/09/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 56.500 9,000 0 9,000 NO Totals for 2008: General Property 56.500 9,000 0 9,000 Woodland 0.000 0 0 Totals for 2007: General Property 56.500 9,000 0 9,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 � - f 111111 Ilill 11111 iilll 1111111111 IIII 111111 ifli 1111 State Bar of Wisconsin Form 3 -2003 * 8 7 7 11 5 0 2 QUIT CLAIM DEED 87 7150 KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/20/2006 10:45AM QUIT CLAIM DEED E%ENPi t 8 THIS DEED, made between Herman W Keller Sr., a single man REC FEE: 13.00 ( "Grantor," whether one or more), PAGES: 2 and Herman W. Keller Jr. ( "Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the Recording Area 3 rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Name and Return Address Wisconsin ( "Property ") (if more space is needed, please attach addendum): Ronald L. Siler VAN DYK, WILLIAMSON & SILER, S.C. SEE ATTACHED ADDENDUM 201 South Knowles Avenue New Richmond, WI 54011 Part of 026 - 1097 -30.000 and Part of 026 - 1097 -90- 050 --0 Parcel Identification Number (PIN) This is not homestead property. Dated June AV. 2008 (SEAL) 7k.., -7p (SEAL) * *Herman W. Keller, Sr. (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature {s} authenticated on STATE OF W I SCDPS t L. ) ) ss. c4-0 COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on U) , 0 8 , (If not, the above -named " ti e ler Sr. authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Ronald L. Siler * u� VAN DYK. WILLIAMSON & SILER. S.0 Notary Public, State of 201 S. Knowles Ave., New Richmond, WI 54017 My Commission (is permanent) (expires: (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. QUITCLAIM DEED Q 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 * Type name below signatures. INFO -PROTM Legal Forms 800- 655 -2021 www.infoproforms.com 1 of 2 ADDENDUM Part of the Northwest Quarter of the Northeast Quarter and part of the Northeast Quarter of the Northwest Quarter of Section 34, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin Commencing at the Northeast Corner of said Section 34: Thence, South 89 degrees 57 minutes 45 seconds West on the north line of said Northeast Quarter of Section 34, a distance of 1315.10 feet to the Northeast Corner of the Northwe Quarter of the Northeast Quarter, this also being the POINT OF BEGINNING; Thence, continue South 89 degrees 57 minutes 45 seconds West on said north line of the Northeast Quarter 1315.10 feet to the North Quarter Corner of said Section 34; Thence, South 89 degrees 37 minutes 11 seconds West on the north line of said Northwest Quarter of Section 34 a distance of 663.18 feet; Thence, South 00 degrees 03 minutes 52 seconds West 771.30 feet; Thence, North 89 degrees 36 minutes 57 seconds East 658.84 feet to a point on the east line of said Northwest Quarter; Thence, North 89 degrees 57 minutes 45 seconds East 1315.99 feet to a point on the east line of said Northwest Quarter of the Northeast Quarter; Thence, North 00 degrees 19 minutes 13 seconds East on said east line of the Northwest Quarter of the Northeast Quarter 771.29 feet to the POINT OF BEGINNING and there terminating. 2of2 C) y I) 00 56T9C Cil �N V C0 406.40 625.72 - -- - 1447.71 3 rri N D z � O (P 'A 1 0 �J T s Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ` of 3 Division of safety and B uildings in acoordence with Comm 65 is. code Attach complete site plan an paper not less than a 1 cO1°4 5; - G R. D t include, but not *nited to: vertical and horimral . drcection and Parcel LD. u9 • / (7Q 7 ' Z d • U�"s7 percent slope, scele or dimensions. north arrow, and lo cation and t road. Please paint all lei fo milon. Date PersoW idornaftn ym providdrn y be unseat« M04 irn3) 8 Z 0 114 114 0 ` T 340 N Rle E (QCW oar as # S / � .5 / 4 S Y t�loar # sr,ea ntame p ooc 410 14 W5 ' l Slcte Zip Code P Rom ? �(! S IlO I ! (00 F i G It M V N New Const ction Use: Residertiat / Number of bedrooms Code derived design slaw rate C o O O C'M ❑ Ruiplamnent ❑ PuW or cornmen3al - Descritm Parent notw l tlood Plain elevation if appkable N� R Genera! Comments and.reoonrnrnendations Area x Spot Tested suitable for a 3 ,0AW s . ��A� - K- !� F'1.. mound (P.O.W.T.S.) system using .. +rand fflll, RE�o/Mn�ND� .9` G y.0 s �� 0 Boring © � Pit Ground surface elm ! _ R Depth b Mnift factor in. Soo Appicalion Rate Halt= Depth DotNnant Cdor Raring Description Texture Stricture Consistence Boundary Roofs Gpow in. MunsW Qu. Sz Cont Cdw Gr. Sz Sh. *M1 I •EtT#2 D• G io Y ! Sc z f Sh X5 11 w /.0 z • 1 lo Rsl& rfsbk of R cw l 3 •zo ?.s Vg 5 nMeeQ S 0. s dj_ ccv — / G 5 3 0 S & 95 R7 S O x a,s - •s /-a (� S Y X Y 1 6 c 2.A Mofs S GL ¢s 4e ^f i•s YR Sig Bor„g# 0 Jam 9 S S•s. a �{ Ground ound surface elev. q " ' D R Depth to Waiting factor in. Rate Floriaon Depth DonlraM CoW Red= Description Textum Structure Consistence Boundary Roots GPOJIIt In. Mmes Qu. Sz Cord. Color Gr. Si Sh. `EiM1 • EM o o / L Zfshe cull w ! • Co /-0 z ./7)/ R s Co r fS�� aQ5 �� • 4 /- 3 7sW4 r+� S Dr � a S - �• Cr 1 •S YR cz o s SL 0, .r nro►f s 1" so • Eftwnnt #1= 800 > 30 _< 220 rung& and 'M 11 1 150 "OL • Effluent #2 = = 30 n�gll and Tss _ 30 mgll. C CST Name (PO e Q LBR iCLA7 - ` — ' �'` � J Address Dale EvaNiation Conducted Telephone Number Ulbricht & Associates 7 15- 7 • �l Pilvatu Sewage C onsultants 2812 1 Oth Ave. Spring Valley, WI 54767 OR , .. nr. off- Aw" i mmm r-mmm� mm o��■ mmm fed ._ - .: �i��r � � ioi I C� I /3a hVE i D A f¢i po��R o /F rmP _�� Of 6 #14 7XWS oa lc!r/ -o L ,IFS `/ a l T ,*r OF 3 Poe- l/,- G U lbri 'ecssoiat ri a Sewage ultants 1 z otn Ave. Spring Valley, WI 54767 �VLvv� SG�4 L,E P V6,O Pala i.- 2-,. o 1 3V r , 1-y r / q5 y� s 3 Q 4 d i f 6l 90 FCQ0SS S ECT100 O Mou &j w� T3E0 loop= 1 a gg rev S e I 4r 7�i •rR�puT�a►3 �• G rkecka GS s P c.&3 s ys rEM or- T oP sort A , �� L ElEvhr c/p s • \ � 1 99 fig U01 FORK TOE w. ma p. • e 9 • Rit ' S4WP . /////t ���� Plowed Ta �-- Al um t FORM % 51opE 91WAT'Toa VA3CER 1p Ai0i Bev 91-0 g") yNNlp F T. �• 7 Fr. 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