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Parcel #: 026- 1102 -60 -400 05/04/2007 01:46 PM
PAGE 1 OF 1
Alt. Parcel M 36.30.18.564A -40 026 - 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 - MAREK, TODD R
TODD R MAREK
1234 150TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special P y d es): ` = Primary
Type Dist # Description ' 1226 150TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 3.560 Plat: 4657 -CSM 18 -4657 FKA PT CSM 13/3554
SEC 36 T30N R18W PT NE SE BEING LOT 3 Block/Condo Bldg: LOT 03
CSM 13/3554 (19.90AC) NKA CSM 18 -4657
LOT 3 (3.560AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
36- 30N -18W NE SE
Notes: Parcel History:
Date Doc # Vol /Page Type
01/0712004 750908 2486/487 EZ -U
11/26/2003 747560 18/4657 CSM
2007 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.560 47,700 224,800 272,500 NO
Totals for 2007:
General Property 3.560 47,700 224,800 272,500
Woodland 0.000 0 0
Totals for 2006:
General Property 3.560 47,700 224,800 272,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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Wisconsin Departmerst of Commerce PRIVATE SEWAGE SYSTEM County: S t. Croix
Safety and Building DivislDn
INSPECTION REPORT Sanitary Permit No:
430580 0
(ATTACH TO PERMIT)
GENERAL INFORMATION 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:
Marek, Todd I Richmond Township 02 b'
CST BM Elev: Insp. BM Elev: BM De tion.* ^ Section/Town /Range /Map No:
T 36.30.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV,
Septic Benchmark , ,
Dosing Alt. BM I
Aeration Bldg. Sewer -7u
Holding St/Ht Inlet f. ' r13.ZS £ L3
C_.sa.1 ky
TANK SETBACK INFORMATION St/Ht Outlet << q4 7 cr 91c?
TANK TO P!L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 9. 9.2 75 5 7 3
Septic v , 3
�' /� Dt Bottom (Z 5 / 7T
75 5 1, ;,4 P s f P 9.3
Dosing , r 7 r Header /Man. G v b, t 4 .4
4 75'
Aeration Dist. Pipe
Holding Bot. System N t '7.2 14 7t
-7-4 9 `f . - 2 - 7-3 , 3
3
�I w 7 `I 7, 4,G
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
;= �l _-✓ GPM
Model Number 12
TDH Lift . Friction Loss System Hea TDH Ft
Forcemain Length Dia. Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length yul.a No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 t -j ---._
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manuf turer:
INFORMATION CHAMBER OR • C�
Type Of S Model Number:
' r 7 / Ci ' f �j `� UNIT ,
DISTRIBUTION SYSTEM j , �, , ,.,
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipes)
Length 7 S 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 � I Bed/Trench Edges Topsoil — Yes Yes No [ Yes F_ No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: `{ ! Inspection #2: f /
Location: New Richmond, WI 54017 (NE 1/4 SE 1/4 36 T30N R1 8W) NA Lot 3
- � n ci •t � r� c -1c t l •e_ J
1.) Alt BM Description= ����" "�i 4
2.) Bldg sewer length
- amount of cover =
thy. -p «S
°
r N�CS- _
•ision Required? Yes �Ot No - - - - -- - _---- �-- _ - - -_ -I r
I a
'de for additio I I ormation. —
4.3/97) 1 4 JJ „� !� .ctor's S rer
LEGAL ST. CROIX COUNTY, WISCONSIN NEW TXSCR02
REAL ESTATE TOWN OF RICHMOND
COMPUTER NUMBER 026- 1102 -60 -400 Parcel Number 36.3 -40
OWNER NAME: First TODD R Last MAREK
PROPERTY ADDRES • -- Street Name -- Type SD Apartment
150TH ST
SECTION 36 T W 1 /160 SE 1 /440 NE
Line Description Line Description
TOTAL ACREAGE 3.560 PLAT CSM 18 -4657 FKA PT CSM 13/3554 LOT03 BLK
01 SEC 36 T30N R18W PT NE SE 15
02 B 13
0 (19.90AC) NKA CSM 18 -4657 17
0 LOT 3 (3.560AC) 18
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
PLOT PLAN
PROJECT Todd Marek ADDRESS PO Box 228 NewRichmond W. 54017
NE 1/4 SE 1 /4S 36 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Byron Bird Jr. 2205 DATE 11 - 25 - 03 BEDROOM 4
CONVENTIONAL XXXX At4rade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE a LOAD RATE •4 ABSORPTION AREA 1500 # of chambers 49
BENCHMARK V.R.P Top of PVC pipe ASSUME ELEVATION 100'
BOREHOLE O WELL sH.R.P Same as BM
>12" Vent SYSTEM ELEVATION T -1 =9 .8T- 2= 94.5T -3 =94.3
O f
C ov Chamber with 31.1 `
^2 per chamber ��
ft
6" Grade at System
Long 34" Elevation
1320' PL
380'
200'
2 trenches 100' �
1 trench 106.25 98'
150th st
B3
20'
O ob pipe
50 ,
' )L
1
279' (? It
B2
4 bed
house
5f
Y
Garage
B1
PAC,I GF
PUMP CHAMBER CR055 SEC T IOIJ AIJD SPECIFICATIOR!S
� VEKJT CAP
4 VEA7T PIPE
WEATHERPROOF APPROVED LOCKING
JUKICTIOtJ BOX MAIJHOLE COVER
" 25' FROM DOOR,
WIUDOW OR FRESH 12 "MIU.
AIR IKITAKE I
I
GRADE
4" Ml U.
I8
"MIN.
IwMIN. \ ---- - - - - --
• \ 11�
PROVIDE I - ---
INLET AIRTIGHT SEAL
/ r
* A
ALARM
I I
*APPROVED I ON
c JOINTS WITH I
ELEV. FT. APPROVED PIPE __�
3' ONTO PUMP - OFF
D SOLID SOIL
CONCRETE BLOCK 1 _
A-o
RISER EXIT PERMITTED OMLy IF TANK MANUFACTURER HAS SUCH APP OVAL
SEPTIC E SPECIFICATI OKJS
DOSE -
TAWKS MAN UFACTURER: IN fie/ fJUMBER OF DOSES: PER DAy
TANK SIZE: �� L GAL LO DOSE VOLUME
ALARM MAI NUFACTURER: Ct ri % t /��C� IAICLUDING BACKIFLOW: d ` GALLONS
MODEL ►DUMBER: CAPACITIES: A IWCRE5 OR GG S GALLONS
SWITCH TSPL: _ g = _ INCHES OR 442 GALLONS
PUMP MANUFACTURER: a (( C = — IKICHES OR GALLONS
MODEL NUMBER: ls� 1 19- . D = INCHES OR l -I0 . GALLONS
SWITCH TYPE: 5r NOTE: PUMP AMID ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. o z FEET
+ MINIMUM NETWORK SUPPLY PRESSURE � .. . . . .... .. 2.5 FEET
♦ FEET OF FORCE MAIN X `� F /opFRiCTtoKI FACTOR_ FEET
'TOTAL OSUAMIG HEAD = / FEET •
INTERNAL DIMENSIONS OF TANK: LEAIGTH ;WIDTH ;LIQUID DEPTH
51GUED: LICEOSE NUMBER: � :f S ATE:� O
r
San ary Permit Application Safety & Buildings Division
In accor with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
C 6ee]rejQside r instructions for completing this application PO Box 7302
lV iscon n D Personal information ou provide m ay be used for secondary purposes Madison, WI 53707 - 7302
Department of C rce Submit completed leted form to coup if not
ST. CROIX COUNTY rivacy Law, s. 15.04(1)(m)] ( p �'
Atta copy only) for t he system, on paper not less than 8 -1/2 x 1 I inches in s
state owned.)
County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number
lX 30 5
I. Application Informatio - Please Print all Information Locatio
Property Owner Name n Property Location
1'J ili�GGe/'�Q ) g 3 �2-vl - '1/4 Gl /4, �N,
Property Owner's ailing Address Lot Numb r Block Number
City State ip Code Phone Number S*disde otCSM Number
II. Type of Building: (check one) , l ❑ City
- X 1 or 2 Family Dwelling - No. of Bedrooms ❑ Village
❑ Public /Commercial (describe use):_ /// Mown of
l
❑ State -Owned le ,
,,� .�/ � Nearest Road,
K// , � P cel Tax N /um ) 7
III. Type of Perm : (Check only one box on line A. Check b on line B if applicable)
A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑Addition to
System System Tank Only Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
- S4on - pressurized In ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. DispersaUTreatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
jr Required Proposed /523.`) Rate (Gals. /day /sq. ft.) (Min./inch) h —� 9 y Elevation
VII. Tank Capacity iA Total # of _ anufacturer Prefab Site Steel Fib e - Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the PO WTS shown on the attached plans.
PI er's Name (print) Plum S gna[ure (nos ps): MP/MPRS No. Business Phone Number
PI ber's Address (Street, City, State,, Zip Code
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I ssuin Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee) c
Determination }1' 2 u, Z6a3
X. Conditions of Approval /Reasons for Disapproval: `
SYSTEM OWNER:
1 Septic tank, effluent filter and So
dispersal cell must all be serviced / maintained >^ l �' —
as per management plan provided by plumber. ,re S ��r-e- o- cwt
All setback requirements must be maintained
as per applicable code /ordinances. 1 -
�
(R. 07/00)
PLOT PLAN
PROJECT Todd Marek ADDRESS PO Box 228 NewRichmond W. 54017
NE 1 /4 SE 1/4s 36 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MFRS Byron Bird Jr. 220529`— DATE 11 - 25 - 03 BEDROOM 4
CONVENTIONAL XXXX i - Grade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1 260 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE o LOAD RATE . 4 ABSORPTION AREA 1500 # of chambers 49
hL BENCHMARK V.R.P Top of PVC pipe ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H.R.P. Same as BM
A nt SYSTEM ELEVATION T- 1= 9>8T 2= 94.5T-3 =9 4. 3
SVMVMCt-f*"ng
Chamber with 31.1
ft ^2 per chamber Long 34 Elevation
1320' PL
200'
2 trenches 100'
1 trench 106.25 �
150th st
B3 20' Y h.
O ob pipe '
50'
1 '
279'
B2
4 bed J7
house
BM
U� \
30 0 alt B h �...�.
45'
-- - ... - ---I - _ij
Garage �, 3
copy
PLOT PLAN
PROJECT Todd Marek ADDRESS PO Box 228 NewRichmond Wi. 54017
NE 1/4 SE 1 /4s 36 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
11 -25 -03 BEDROOM 4
MPRS Byron Bird Jr. 2205 DATE
CONVENTIONAL XXXX A -Grade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE .4 ABSORPTION AREA 1500 # of chambers 49
BENCHMARK V.R.P Top of PVC pipe ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL *H,R.P. Same as BM
Vent SYSTEM ELEVATION T- 1= 9#8T- 2= 94.5T -3 =94.3
> 12" ng --r—
Of mber with 31.1
Cov ft per chamber "' /�' � ( '
6"
6 rnda at QUetpl
Long 34' Elevation
1320' pL '
0'
200'
2 trenches 100'
1 trench 106.25
150th st
B3
20'
O ob pipe
50'
1 '
279'
B2
4 bed
house
BM
p 30' alt B
st
45 ,
.�-
Garage BI
n
x; ti�
Property Owner / v G Parcel ID # Page of
n Boring # Boring
,L
l �,/ I ❑ pit Ground surface elev. "� ft. Depth to liming factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
-rgxc
F] 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 # ❑ 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/f'
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 a 30 mg/L and TSS 5 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
SBD8330 (R.07 /00)
Soil Test Plot Plan
Project Name Todd Marek Byro Bird Jr.
Address PO Box 228 NewRichmond Wi. 54017
M #220527
Lot Home Subdivision Place Date / /2003 County CROIX
N E 1 /4 1/45 T 30 N /A W Townshi R
Boring 0 Well PL Property Line# Alt. BM top pvc 1" pipe 99.4
,BM or VRP Assume Elevation i 00 ft Top of 1" pvc pipe
System Ely. T- 1 =94.8T-2=94.5 H.R.P. T -3 =94.3 Same as BM
1320' PL
380'
200'
97'
98'
150th st
B3
50'
10(l
279'
B2
BM --
alt B
B1
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 'rt !^G Septic Tank Capacity 1 2 f' al ❑ NA
Permit # O 5;rD Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer L a ��� ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model jam. -e-- ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow {average) 6-v' gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA
Soil Application Rate al /day /ftz Pump Model 13 NA
Standard Influent /Effluent Quality Monthly erage* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Oar- ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ onth(s) (Maximum 3 years) ❑ NA
W ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume , (3 NA
Inspect dispersal cell(s) At least every: 13 Pr yea��s(s) (Maximum 3 years) 13 NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
year(s)
Inspect pump, pump controls & alarm At least once every: ❑ ❑ year(s month ) ) m ) ❑ NA
❑ month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
❑ month(s)
Other: At least once every: ❑ year(s) [3 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 cellis) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
I
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
l '11)* tech ologgyy a_holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been ev d_V identify a replacement area. Upon failure of the POWTS a soil and site
evaluation must be med to to a replacement area. If no replacement area is available a holding tank
/ may be installed s r o rep lace the failed PPOVffS.
❑ Mound and at- rade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER –�— POWTS MAINTAINER
Name �, s lv�t �./ Name
Phone Phone 3 77 eft k
SEPTAGE SERVICING OPERATOR (PUMP R) LOCAL REGULATORY AUTHORITY
Name Qj? G3 ,— Name C rp / 0 < Cd
Phone r Phone
This document was drafted in compliance with chapter Comm 83.220(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer G
w
Mailing Address / /�_ �vZ� JG' ✓� t G ?ear �� /�� S c7
Property Address t`�J" Ste- Aw
(Verification required from Planning Department for new constructi n)
City/State Parcel Identification Number
LEGAL DESCRIPTION d -
• gj� 1 �ti ` w O 1
Property Location /g /4, t ,�., Sec. , T��T -R W, Town of I C
Subdivision 9 Lot # T
Certified Survey Map # S (V o , Volume _ i g . Page # �f6 S�-
Warranty Deed # ( o 12 , Volume Page # 5 9
Spec house ❑ yes A no Lot lines identifiable ❑ yes 9 no
: SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
1
mastorplumber, journeymanplumber, restrictedplumber or alice that nsed pumper verifying ( ) the on -site wastewaterdisposal 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.
1/we, the undersigned have read the above requirements and agree to maintain the private sewage g 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 Zoning Office within 30
days of the y e Xe.
SI TORE F APPLICANT
DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property described , by virtue of a ty deed recorded in Register of Deeds Office.
SIGMA OF APPL CANT DATE
« « « « ««
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. « « « « ««
«« Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
1.4180bGC 549 iv
STATE BAR OF WISCONSIN FORM 2 - .1982: 601 X77
WARRANTY DEED KATHLEEN H. WALSH
• REGISTER OF DEEDS
DOCUMENT NO. i p ST. CROIX CO., WI
— - - - - - VOL 1408PAGf 57 - -- --
RECEIVED FOR RECORD
Debra L. Ferguson, ntir /a Tbhra T_ Feranig.,,, 04-154999 9130 M
(Mii lli{ta_n) , a singgne_rson WARM" DEED
CERT CDW1 FEE:
coneys and warrants to Todd R. ?iarek, a single person, CDP TRA R FEE 56,40
RECORDING FEE: 10.00
j PACES: f
�I THIS SPACE RESERVED FOR RECORDING DATA
' NAME AND RETURN ADDRESS
the following described real estate in St. Croix County,
State of Wisconsin: KRI., i 1NA OGLAND
Zilz, Estreen & Ogland
' P.O. Box 359
Hudson, WI 54016
026- 1102 -60
{ PARCEL IDENTIFICATION NUMBER
Part of the NE1 /4 of the SEl /4 of Section 36 -30 -18 described as follows: Lot 3
f of Certified Survey Map filed November 11, 1998, in Vol. "13 ", Page 3554, Doc.
No. 591432, St. Croix County, Wisconsin. i
1
This deed is being re- recorded to correct the legal description in that
certain deed recorded April 15, 1999, in Vol. 1418, page 549, as Doc. No. i
�f 601277.
ii I
This is not homestead property.
(is mt)
�I Exception to warranties: Easements, restrictions and rights -of -way of
record, if any.
,I
I I Dated this day of October A.D., 19 98 •
I (SEAL)
� -s,`� - s-� , . � fn . a s - - ^- (SEAL) I
I Debra L. Fe u s on (Milligan `!
(SEAL) (SEAL)
Ii w
AUTHENTICATION ACKNOWLEDGMENT j
Signature(s) State of 16'%Vffi%1d]S1CFlorida II
ss.
authenticated this day of 19 County. _ Personally came before me this ., day of
October 19 98 . the above named I
Debra L. Ferguson (Milli an)
f/k a Debra L. Ferguson, �
TITLE: MEMBER STATE BAR OFWISCONSIN a single person,
(If not, I'
authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing
instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY KARU K. ROCUS
Attorney Kristina Goland LeRE CITY n. 0u
jj Hudson, WI 54016 Notary Public. 241.7 County, Wis. 1
I� (Signatures may be authenticated or acknowledged. Both are not M
I� d Ke Y� a expiration date: i
necessary.)
• Namts of persons signing to any tapuny should by typed or printed below their signatures f10111fd TMU tbyry psble I —.
WARRANTY DEED STATE BAR OF WISCON onsin Lypal ltltvdt Co., inc.
Form No. 2 — 1982 moyaut —, Way I:
- VOL 1408PDGE 56 61783
KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
02-02 -2000 3:50 PM
EEXXEEMPTTN DEED 3
CERT COPY FEE:
COPY FEE:
TRAJOER FEE:
RECORDING FEE: 12.00
PAGES: 2
Raeortlbhg Ara
>Z-w— LAND
:::;!seen & Oglanc;
:`• %• =r Box 359
liud::ua, W! 54016
026 - 1102 -60
PARCEL IDENTIFICATION NUMBER
Part of the N:1 /4 of :he SE1 /4 of Section 36 -30 -16 described as follows: Lot 3
of Certified Survey Map filed November 11, 1998, in Vol. I a Doc.
No. 591432, S`. Cr Co unty, Wisconsin.
This deed is being re- recorded to correct the legal description in that
certain deed recorded April 15, 1999, in Vol. 1418, page 549, as Doc. No.
601277.
We lofo,medon mut be completed by wbadtur: ,Lectmtent dde_ OM A reswu farm.. and 1W N regWrea odwr k&--d- such
as *e s,m,dns elawes. legal desalpdon, ter. may be placed an d* ilm pane al du doaanm or w4y be placed an a urfa al poses of Ae
documem. Note. We of this cows page addr one page ra ya,r decrnen, erd X00 rte dw recatdlR: Are. Wucon,ln Sra es, 59.317. WROA 2Nd
1
74756
VOL 18 PAGE 4657
KATH><.M H. W ---.
REGISTER OF DEEDS
ST. CROIX CO., WI
REIVED CERTIFIED SURVEY MAP 11/26/2003
Located in part of the Northeast Quarter of the Southeast Quarter of CERTIFIED SURVEY MAP
Section 36, Township 30 North, Range 18 West, Town of Richmond, being REC FEE: 13.00
Lot 3 of a Certified Survey Map recorded in Volume 13 Page 3554 in the COPY FEE: 3.00
Register of Deeds Office for St. Croix County, Wisconsin. PAGES: 2
Prepared for and at the request of: icy
Todd 112th Marelt Street
1738 112th �} Section Corner Monument
Y
New Richmond, WI 54017 of Record
Drafted by: Michael H . Lynekey • Set 1" x 18" Iron Pipe weighing
1.13 pounds per linear foot
O Found 1" Iron Pipe
? ra N D O o --4 z - - - - - - Building Setback Line (100' from Right of Way)
°ORN a•o
9'a - ° c 0 3- .. NEST LAVE OF #E ME 114 O- 7HE SE 114
v aAO o c° �'a-6j
UNPLATTED LANDS
a °° n K n to c N00 "01'20 "W 657.32'
o- c 0 c m 2 °— FOYC�E'
'� c •+ �, r z NOTE: AREA WEST OF FENCE IS A
s a O° a O C " POSSESSED BY OTHERS. CONTACT a +
N z rt o n o. 3 �E R T ADJOINING OWNER OR AN ATTORNEY N
f i
BEFORE REMOVING SHOWN FENCE
,aO -a aC�O /� N ;C7
=5 a 0 1 0 4 C 30 o =r I
0 7
��arr aoo— �` R1
0�rt 073 � R �� Y Mq �•
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o E
W a< o 3 - U s ° a 0;0 CA r 1`�J P A rt-
1 a ° >> 0 N (A tnm -4 v-4 O G F 3 $
r-r - i'a G Q Q D ril r ~ 5
°,a o 0 0 0 A N >CDPno`OO� '° 4
>0 CL C '`` 3 rn ;arn N o00
aaE r4 �� $_ r� ND / Z �.
CL 0 8 n c ° � � N � � � P y����v�� c�D � 0
3 s c a° 3 O ST. CROIX COUNTY
I. ' o o — Ir CTI nj X Planninq Zoni and Parks Committee p
j r rt 0� O C y� 1 1 0 1
n °, ° a. o �! � i� ! NO V;,j 6 2003 i r*i IN 1 0
ro a r ' o= ns\ N N N rJ
C O O p � a a �# 9
o o o n to If riot recorded within 30 days of
approval date approval shall be .p 0
W I null +and void I
i I Lod
r N SOO'01'56 "W 311.26
OD
N00 1'56 "E 280.00' _
m> w aw - -•I• W 0
Dw�ao�*r at IR
no r �
V3 h , mno co 0 ~
P mA O oa►, O w p
ii Fn m o a . cn -
�` -+� CO an j I
ti
p p �p -1 .W O * O 0)
I
C
.+
L6004.4 . . . . . w o o$ t g SOO'01'56 "W
— N 56 " E P n 657.23 I ` i 657.23' 131 S00'Ol'56 "W 6' 311.23' � 280.00'
_ 311.23 _ _ 66.0 _ _ 2 80.00
S00 '56"W 657.23'
150TH 3Tf�T ,
— — S00'01'56 "W 2828.92'— —
UNPL LANDS
N S1 Pr ared b57SU146 m � � r NEST L4W OF 7W AV 114 OF 7W - W 1•/4
Pr y o7� �
l�� Consit ft Group, Ina m y X � (nt --i
Phone No. (715) 246 -4319 ; m
Fax No. (715) 246 -3830 o
P.O. Box 325 1 BEARINGS ARE REFERENCED TO THE EAST LINE OF THE
New Richmond, Wi 54017 SE 1/4 OF SECTION 36. TOWNSHIP 30 N.. RANGE 18 W.
Sheet 1 of 2 WHICH IS ASSUMED TO BEAR S00'01 "W.
Vol 18 Page 4657
i
CERTIFIED SURVEY MAP
Located in part of the Northeast Quarter of the Southeast Quarter of
Section 36, Township 30 North, Range 18 West, Town of Richmond,being Lot
3 of a Certified Survey Map recorded in Volume 13 Page 3554 in the
Register of Deeds Office for St. Croix County, Wisconsin.
SURVEYOR'S CERTIFICATE:
I, Ty R. Dodge, a Registered Wisconsin Land Surveyor, do hereby certify that by the direction of
Todd Marek, I have surveyed, divided and mapped a parcel of land located in part of the
Northeast Quarter of the Southeast Quarter of Section 36, Township 30 North, Range 18 West,
Town of Richmond, being Lot 3 of a Certified Survey Map recorded in Volume 13 Page 3554
recorded in the Register of Deeds Office for St. Croix County, Wisconsin, described as follows:
Commencing at the East Quarter Comer of said Section 36; thence, on an assumed bearing along
the east line of the Southeast Quarter of said Section 36, South 00 degrees 01 minutes 56 seconds
West, 657.23 feet to the point of beginning; thence, continuing along last said east line, South 00
degrees O 1 minutes 56 seconds West, 657.23 feet to the south line of said Northeast Quarter of
the Southeast Quarter; thence, along last said south line, South 89 degrees 56 minutes 02 seconds
West, 1318.22 feet to the west line of said Northeast Quarter of the Southeast Quarter; thence,
along last said west line, North 00 degrees 01 minutes 20 seconds West, 657.32 feet; thence
North 89 degrees 56 minutes 16 seconds East, 1318.84 feet to the point of beginning. Containing
866,638 square feet (19.90 acres). Subject to 150th Street along the most easterly boundary of
the above described property. Also subject to all easements, restrictions, and covenants of record.
1 also certify that this map is a correct representation to scale of the exterior boundaries surveyed
and described, that I have complied with the provisions of Chapter 236.34 of the Wisconsin State
Statutes and the Subdivision Ordinance of the County of St. Croix and the Town of Richmond in
surveying and mapping the same.
�d— to— 03
Dodge- Registered Wisconsin Land Surveyor No. 2484 Date
JE Consulting Group, Inc.
P.O. Box 325 ��� a �npnmiaa, u �
New Richmond, WI 54017 1 -,
TY R. 1r
DOME
8.21
CM11 n,
anem
i
Sheet 2 of 2 Vol 18 Page 4657