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CROIX COUNTY
0 P LANNING & ZONING
NOTICE OF VIOLATION
July 15, 2009
ALLAN & EVELY14 POWERS
1256 OLD MILL ROAD
NEW RICHMOND, WI 54017
Code Administrad RE: Failing P WTS at 1256 Old Mill Rd.
715 - 386 -4680
Land Information & Town of Star Prairie- St. Croix County, WI
Planning Computer # 038 - 1045 -50 -000 Parcel # 11.31.18.195K
715 - 386 -4674
Dear Mr. Powers:
Real Pro ty As required by th ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in
715- -4677 violation of § 25 .59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and
Article 12.1.F.4.d of the St. Croix County Zoning Ordinance. This Private Onsite Wastewater
R cling 5- 386 -4675 Treatment System ( POWTS) has failed under the definition in § 145.245(4)(b) Wisconsin Statutes
(Category I ) . This violation was first noted on 10 -6 -08.
9
The violation has :)een documented as septic effluent discharging to the surface. An on -site inspection
conducted July 115, 2009 verified that septic effluent was discharging to the ground surface. If fines
and or forfeitureE become necessary to bring about the abatement of this violation, they will be
assessed from Ju y 15, 2009 in accordance with Chapter 145.12(4) Wisconsin Statutes.
THE FAILING P WTS ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND
NEEDS PROMP ATTENTION!
REQUIRED ACT ON: A sanitary permit must be issued through this office. You have already
contracted with a certified soil tester (Shaun Bird) to have a soil evaluation conducted. The soil
evaluation determines the type of on -site wastewater treatment system necessary, the required sizing,
and its location. You must then contract with a licensed plumber who will design the replacement
POWTS and apply for the sanitary permit. The POINTS must be replaced by December 15, 2009.
If you have any questions or concerns that I can address for you in this matter, please feel free to
Your cooperation i in this violation is contact me. You cooperat o n abating t s appreciated.
Sincerely,
'Y
Ryan Yarr/gton
Zoning Technicia
cc: file
ST.CRo1X COUNTY GOVERNMENT CENTER
110 1 CARM/CHAEL ROAD, HUDsoN, W1 54016 715386 FAX
PZ @C0.SA 1NT- CR01X.W1. US WWW.CO.SAINT- CROIX.WI.US
r --
a
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building, Division
INSPECTION REPORT Sanitary Permit No:
515101 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:
Powers, Allan I Star Prairie, Town of 038 - 1045 -50 -000
CST BM Elev: Insp. BM Elev: BM Description: No:
11.31.18.195K
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ' CAPACITY STATION BS HI FS ELEV.
Septic f 6 Benchmark
Dosing - Alt. BM a r lr
Aeration / Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet
TANK TO /Lc L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
�•, �l�yl tj
Septic o' ' s :) Dt Bottom
Dosing _., •" y ; Header /Man.
Aeration Dist. Pipe
Holding ~' _ Bot. System '� 13Z
/
PUMP /SIPHON INFORMATION Final Grade -
Manufacturer k k Demand St CoveL„
, _.i • f•-- ..,.ly `r`. GPM �f' a ��" /� �� r ! A
Model Number • [R
it ,
TDH 1 1-17, . -, ,. Friction J_o s System Feed `,, TDH, „ } 3 x F't
Forcemain Length st _ F Dia. Dist. to Well
Forcemain T
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS �? ^
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: — - ��* j r
INFORMATION CHAMBER OR 41.A , 1 ,�
Type Of System: i r UNIT !
1 t �. .., �,�, � Model Number: +'•,, , � ,
,.., a s'!r � i,.e ,16 w' � t ..d✓ . 1 .� f � -• O� i.� :, � •.� � � U• tu� i.._. -
DISTRIBUTION SYSTEM
Header /Manifold ii Distribution x Hole Size x Hole Spacing Vent to Air Intake
+` Pipe(s) _
Length
Dia __!t Length Dia Spacing v '
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 y Bed/Trench Edges Topsoil
,.,. I ` .{� . ay Yes r No xes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1256 Old Mill Rd. New Richmond, WI 54017 (NW 1/4 NE 1/4 11 T31 R1 8W) metes & bounds Lot Parcel No: 11.31.18.195K
1.) Alt BM Description -
P
2.) Bldg sewer length
- amount of cover
Plan revision Required? L] Yes No t , -; •i I
Use other side for additional information.
SBD -6710 (R.3/97)
Date l Insepctor'5 Signature Cert. No.
I A
I '
RECEIVED
A 2 0 2 oas D
JUL
n
.90V Safety and $uildings 1�1TtANG & ZONI
701 W. Washington Ave., P.O. Box 7162 C D
S eD of
Madison, WI 53707 -7162 S.nitatGPixt as14ber (ou be filled in by co.)
a
State T ltnber
Sanitary Permit T / 1 .►-
In accordance with s. Comm. 83.21(2 m. Wis. Ad Code, subtnissioa of ibis form to the smi" wtt r a governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for tatooed POWTS are Projget 1' �� dtTM>a
m oe. Personal , You Provide may be used far secondary
submitted to the Departmait of Com � 1�.7�P / • t t
in accordance with the Law, s. 15.040 m Stater. Jv�Qi
A n Iigformatbn - Please Print All Info n Parcel # '
Property Owner'sNarae � _
l P12 w
Property Owner's Mailing Address
Govt. Lot C •
1 �
City, Smte Zip Code Phone Number �,� y,, Section Vk' 2 circle
7 �`) / T A N; R�E W
IY type of BuAding (check all that apply Lot #
Subdivision Name
or 2 Family Dwelling – Number of Bedroo
i Block #
❑ Public/Commercial – Describe use –' ❑ City of
C 0 Number ❑ Village of
i ❑ State Owned – Describe Use
^ own of
j e box on line Complete line B if applicable)
III. Type of Permit: (Check my �•
3
❑ New System lacement System ❑ IYeatmem/Holding Tank Replacement Only ❑ Otber Modification to Existing Symem (explain)
A. List Previous Permit Number and Daft Issued
B. ❑ Permit Renewal ❑ Permit Revision ! ❑ Change of Plumber ❑ Permit Transfer to New f � • t Lit
Before Expiration Owner
•
IV, of POWTS syste mJCom nest/Device: Check sU that 21 DO W
N on - Presgurixcd 1n - otound ❑ Pressurized IwGrour4 C1 At - Glade C1 Mound 2 24 in. of suitable soil Mound < 24 is of suitable soil
❑ Holding Tank ❑ Odkr DiSWW Component (explain) ❑Pretreatment Device (explain
V. De Die eatment Area Infer don Dispersal Area aired (at) / Dispersal Area Pt opwea A f� n
De sign Flow D
(gpd) esign Soil App
7` JU Main facuirer
VI. Tank Info ,
Capacity in Total # of }�
Gallons Gallons Units /� r
New Tina Existing Tanks
SepBc or Holding Tank ..
Dosing Cumber
Responsibility Statement L the undersigned. ry for lastallatioa of the POWTS shown an the attaesad plans.
VII.
MP/MPRS Number Business
Number
Puuber's N (Print) PI _
7/✓ J
Plumber's Address (Street, City. State. Zip Cod /
Vl1L Conn ffie6artwifint Use Od
I Issuin S m
Signad
'� Permit Fee Date
Approved reapproved S L f �/• �
ven Reason for ! 7 q
JI
DL ConditiOW l !sons for Diappgoval
1 Septic tank, effluent filter and
dispersal cell must all be servkes / maintains!
as per management plan provided by plumber.
2. Al ge%Wkrequifements must be maintained
ft w . system aad uh" to the c"aty o* oe Paper sot l- than $ lA s li hwass hi das
SBD -6398 (R. 01/07) Valid dun 01/09
PROJECT OT PLAN
T AI Powers ADDRESS 1256 Old Mill Road New Richmond Wi 54017
NW 1/4 NE 1/4S 11 /31 /R 18 W TOWN S tar Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 _ DATE7 /15/09 3
BEDROOM CONVENTIONAL IN -GROURE CONVENTIONAL LIFT XXX HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651
IL # of chambers 32
BENCHMARK V.R.P. Top of edge of garage roof
ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
Old Mill Road SYSTEM ELEVATION 92.5/91.8 4' below qrade @ B -2
Well is to meet all Vent
setbacks required by
WDNR >6 „ Quick4 Standard -W
Plans Designed Using of Cover Leaching Chamber
Conventional Powts with 20.0 ft2 of Area
Manual Version 2.0, and 1 2„ 5.8ft ^2 /pair of end caps
pressure distribution 4' Long
manual version 2.0 3 4 „ Grade at System Elevation
Well ;:.. .
Scale is 1" = 40'
10' unless otherwise
35' B-4 Old tanks are to noted
Existing 3 be pumped and
Bedroom 5' buried
'
House 1 ' 5 5' 15' D W
T
W Failed system
100' 90'
Garage
B.M. 30'
B -2 40 , 10' 25' S
V ents
75'
25' B -1
Ecopy 10% Slope
40 '
B -3 Property Line
Property Line
P OT PLAN
PROJECT Al Powers ADDRESS 1256 Old Mill Road New Richmond Wi 54017
NW 1/4 NE 1/4S 11 /T 31 /R 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/15/09 BEDROOM 3
CONVENTIONAL IN -GROU PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of edge of garage roof ASSUME ELEVATION 100' Filter BEST Filter
❑BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 92.5/91.8 4' below qrade @ B -2
Old Mill Road
Well is to meet all Vent
setbacks required by
WDNR >6" Quick4 Standard -W
of Cover Leaching Chamber
Plans Designed Using with 20.0 ft2 of Area
Conventional Powts 5.8ft^2 /pair of end caps
Manual Version 2.0, and 4' Long 12"
pressure distribution Grade at System Elevation
manual version 2.0 34"
Well —
Scale is 1 » — 40
10' unless otherwise
35' Old tanks are to noted
Existing 3 B_4 be pumped and
Bedroom 5' 5 buried
House 1 15' 15' D W
T
W Failed system
100' 90,
Garage
B. M. 30'
25'
B -2 40 , 10'
Vents
75'
25' B -1
10% Slope
40' B -3 Property Line
Property Line
PAID
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — 0 —
Please print all informilMEIVED Review y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Zo D
Property Owner JUL 2 .0 200 Property location Jor
/ I 0 W e Govt. Lot i ,J 1/4 i 1/4 S J T 3 1 N R E (or W
Property Owner's Mailing Address ST CROIX COU Block # Subd. Name or CSM#
' I l NNING &ZONING ock 4 / -e'
City State Zip Code Phone Number C] City ❑Village Town Nearest Road
CC
❑ New Construction UseoResidential / Number of bedrooms _ , Code derived design flow rate GPD
Replacement ❑ Public or commercial - Describe:
Parent material l.C.'�C.t� Flood Plain elevation if applicable ft.
General comments J ] n 4 w � L p
and recommendations: S C rr q; t u f re— . /'(del �Jl o�XR . (J
System Type CO'Y� v System Elevation 71' 6
Ong # E] Boring
I ® pit Ground surface elev. R. Depth to limiting factor 1 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
1 c-g to 3�L s ,�
Z
oa
a Boring # RBPOilring
Ground surface elev. ft. Depth to limiting factor in.
/ , Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 - 0 -1/ / 0"" ' 3/z S ` r,--
L- t " , > - 1 v
01 _
lv
Effluent #1 = BOD > 30 220 mg/L and T§S >30 < 150 mglL ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 ;/7- 1 _ 715- 246 -4516
Property Owner _ Parcel ID # Page of
F�11 Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
Pit r*Eff#1 oil 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#2
i
ti
�6
Boring # ❑ Boring
a � Pit Ground surface elevp O ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
�.�
�} S .s rn j N ltl
m
F-1 Boring # Pit Boring
Ground ur
❑ d face elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtlf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mgA- and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD•8330 (8.6/00)
Property Owner _ Parcel ID # Page of
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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Z- 5 K D
g _ _ N
i
t�
Fq-1 Boring # ❑ Boring n
Pit Ground surface elev. �' ft. Depth to limiting factor in.
Soil li '
cation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. M *Efl#1 / • � Eff# / 2 2
- � � S m y✓ ry r
0
F1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Effluent #1 = BOD > 30 220 > -
s < _ mg/l. and TSS 30 < _ 150 mg/L 'Effluent #2 - BOD < 30 mg/L and TSS < 30 mg/t.
The Department of Commerce is an equal opportunity service rovider and employer. If ou need
p y assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (8.6/00)
Soil Test Plot Plan
Project Name Al Powers Shaun
Address 1256 Old Mill Road
New Richmond Wi 54017 C #226900
Lot ------ Subdivision ----- --- Date 71A 5/09
NW 1/4 NE 1/4S 11 T 31 N /1418 W Township StarPrairie
Boring Q Well PL Property Line County ST. CROIX
IL BM or VRP Assume Elevation 100 ft. Top of edge of garage roof
System Elevation 92.5/91.8 *HRPSame as Benchmark
Old Mill Road
Scale is 1" = 40'
unless otherwise
noted
Well
10'
35'
B -4
Existing 3
Bedroom 5' S ,
House 10 , 5' 15' DW
T
D W Failed system
90'
Garage
B.M. 30'
25'
B -2 40 , 10'
5 '
75'
B -1 96'
25' 10% Slope
98'
40'
B -3 Property Line
Property Line
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned .once a year. Please note: a larger filter is being installed In
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
O 1. if system fails, determine cause of failure, use alternate area and install new
min t ed replacement area.
�ption #2. nstall system at a lower elevation, by removing chambers, removing biomat,
and in i new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715- 246 -4516
St. Croix County Zoning 715 -386 -4680
Pumper Tom Mondor 715 -246 -5148
Shaun Bird #226900
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer A- r
Mailing Address /a s - (o a /ca fv, i 11 - Pccl New 26 C U . 2 / S XD) 7
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number 4 16 S 0 - ODD
LEGAL DESCRIPTION
Property Location N 1 /4 , N 1 /4 ,Sec. , , T 3 j NR
U_ W, Town of
Subdivision — , Lot #
Certified Survey Map # , Volume Page #
Warranty Deed # Z7 7 - 76 6 , Volume �� Page #
Spec house yes Lot lines identifiable no
SYSTEM CE 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.
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.
Itwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Numbe of b ooms
2-4-ii 1 2 7
NATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/0
PIMP � p FHEK C'itoSS SECT O� A�
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ic -a -vo c.aa -�r, , may �• ••
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9 E- H SERIES
SUMP /EFFLUENT PUMP
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ewe terwerererra�t+w > Up. ea t erma!ff
lip
p W ) aces= � +t +� _ +� � �. at1 :118ta89�
ee 55 a+ 32
� va 115 gl 17A •n 70 & 55 or V 511:11btse9t
Willi
MW 1A m AM = 81t a 10x0 � Bid $ � 8! 7S! 2? a 811 s 1t W :88�
S� till fee 115 9M 13A I=
ryfl�glt�ltt•�eMl�tow tKel
CaAw �sBeb� —"iJO4�aet�OaCe►asbef��7`� •
consm~ Cast Iron
FLW- t-tTE Motor Ho -
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as 1c Not ADS
ate A -
y Power Cord SSCW -
73 M ipd Shaft Scat Nc cubon and
faces
°a s g Fsstener$ -_ - Srsints Suet
shaft
io z, t3 upper gloom and L4YWer
Batt Belli
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0 PUMP PER CUR VE LKuE 7ali t 7XW
tt3+/ ielQ rb Aaa:N 6 J iif11fe
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• IIIIIIII IIII IIII III IIIIIIIIIIIIIIIIII
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TRANSFER N AT DEED 897766
BETH PABST
REGISTER OF DEEDS
Document Number Document Name ST CROIX CO., WI
RECEIVED FOR RECORD
06/11/2009 11:15AM
THIS DEED, made bet en Allan G. Powers and Evelyn C. Powers, husband and TRANSFER ON DEATH DEED
wife ^ EXEMPT I IOM
( "Grantor," whether one or more), REC FEE: 13.00
and April L. Leverty and Stephanie J. Sinyerhouse, as joint tenants PAGES: 2
( "Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area 3-
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address
needed, please attach addendum): Christine A. Rasmussen {
Doar, Drill & Skow, S.C. F
SEE ATTACHED. 103 N. Knowles Ave.
New Richmond, WI 54017
This is a TOD ttransfer -on- death) Deed under Wis. Stat. § 705.15, which conveys
ownership - uf the above real estate to the Grantee named above upon the death of the
grantor as a non - testamentary conveyance without probate.
038 -1045- 50-000
This document is only designating a transfer on death beneficiary and exempt per s. Parcel Identification Number (PIN)
77.21(1), Slats., and s. 77.25(l Om), Stats. This IS homestead property.
(is) (is not)
Grantor is the sole owner of this real estate while Grantor is living, and Grantor has the right to revoke or change this deed in any
manner, including the right to record a new TOD Deed to change the Grantee named herein or to remove all TOD beneficiaries, and
the right to sell or otherwise convey this real estate and to retain the sales proceeds, without the permission or involvement of the
grantee(s). C�
Dated
G sue✓ " �-� . �� (SEAL) _
* 11an'G. Powers * 1`_velyn C. P
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
STATE OF
authenticated on 1 �u COUNTY ) ss "...MU38
1►`
•' ri ` `t '.'• s
Personally came before me on D I : �y�
the above -named Alg^
TITLE: MEMBER STATE BAR OF WISCONSIN II Y
✓2 h ht � � r v
([f not, to me known to be the person(s) who executed t Fgre haj
authorized by Wis. Stat. § 706.06) inst and cknowledged the same. `? • S .� ic ''C,c
THIS INSTRUMENT DRAFTED BY:
* s r-I t+f e
Christine A. Rasmussen, Doar Drill, S.C. Notary Public, State of Wisconsin
103 N. Knowles Ave., New Richmond, WI 54017 My Commission (is permanent) (expiQrS— )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
1 of 2
PART OF NW 1/4 OF NE 1/4 OF SECTION 11 -31 -18 DESO14IW6 AS FOLLOWS Cl A T SVII
CORNER OF SAID NW 1/4 OF NE 1/4; THENCE N ON W UNI: OF 8AIp NW 1/4 Ot= NL 1/4 21 ll
NO ;
THENCE E 104.67 FEET TO CENTFRUN
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FEItT 83.0
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Parcel #: 038 - 1045 -50 -000 06/15/2007 05:12 PM
PAGE 1 OF 1
Alt. Parcel #: 11.31.18.195K 038 - TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner
O - POWERS, ALLAN G & EVELYN
ALLAN G & EVELYN POWERS
1256 OLD MILL RD
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): " = Primary
Type Dist # Description " 1256 OLD MILL RD
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A -NOT AVAILABLE
SEC 11 T31N R18W 1A IN NW NE COM SW COR Block/Condo Bldg:
NW NE, N 215.39', E 104.67' TO CL RD &
POB: N 17 DEG E 40' TH N 17 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
151.01', N 83', E 167.8'S 17 DEG E 11- 31N -18W
211.78' WLY ON RD 208.3'
Notes: Parcel History:
Date Doc # Vol /Page Type
2007 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 30,000 130,500 160,500 NO
Totals for 2007:
General Property 1.000 30,000 130,500 160,500
Woodland 0.000 0 0
Totals for 2006:
General Property 1.000 30,000 130,500 160,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 217
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Health and Social Services
. Pib. 10/69 Division of Health
PEF?IIT APPLICATION /
for
PRIVPTE DOMESTIC SEWAGE SYST12'1S
A. OWNER OF PROPERTY TYPE OR USE BLACK INK
Name Address (Street, City , Zip Code)
n �
County
B. LOCATION OF PROPERTY WK RE SYSTEM WILL BE C ONSTRUCTED, ALTERED ^ R EXTENDED /
Check One: / 3 / /L1 /Z �' Lt�� �' C/� '�i�
CITY VILLAGE LEGAL DESCRIPTION:
TOWNSHIP �, !
C. IS LOCAL PEF1MIT REQUIRED FOR THIS WOF1K? YES NO 7 /✓ ✓ PERMIT NUMBER
D. SEPTIC TANK CAPACITY / GPI Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete !� Poured in Place Steel Other
NUMBER OF TANKS TO BE IP?STALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other
Specify
Number of Persons to be Accommodated Number of Bedrooms _�
F. APPLIANCES, ETCs Food Waste Grinder YES NO Automatic Clothes Washer .YES NO
Dishwasher YES ��' NO Automatic Potato Peeler YES 70
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW K EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
= Seepage Pitt Inside diameter f Liquid Depth <,'
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours Water Test 'time Drop in Water Level Inc Minutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to j Next to Last To Fall
1st Wetted Overnight in Miimtes Last Periodi Last Peri Period One Inch
Example
P- 0 36 Tco Soil 10" Clay 26f' 25 yes or no 30 1/2 1/2 1/2 60
-3 c - 3
RECORD DATA FROM MINIMUM OF 3 TEST HOLES
t t
ompute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S 0 I L B O R I N G S- Minimum 36 Below Prop used Absorption S stem _I
oring Total Depth Depth to Ground Water Depth to Bedrock
umber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches
Example
- 0 7211 72" Black Top Soil 1 2 11 , 18 °• Sand 16n• Gravel 24
3'
"yj
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
COMPLETE OTHER SIDS
H
I
I the undersigned, hereby certify that the percolation tests reported on this fonn were made by me
or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3),
Wisconsin, Administrative Code, and tha; the data recorded and location of test holes are correct to
the best of / my knowledge and belief.
NAME C j � /. �/� t" 6 Q, z A� 3 TITLE - 9 0 ) �/,� j 1
(Type or Print)
REGISTRATION NO. or MASTER PLUMBER LICENSE No.
ADDRESS J 1 - U_ X�����/J /L f'1�
DATE 7 /�� SIGNATURE
MASTER PLUMBER MAKING APPLICATION
MP
Signature: r y p.� ti's `` i_.. a :� -, License Number:
MP RS-W S
/ o be Completed by Issuing Agent)
Date of Application �/ �� /��� Fee Paid Z
Permit Issued (dat ) %� Permit Number�
Agent (name) lCz� - (t /� _ G t,/ i For:_ `, �� ( �!`� - ✓i ��/
Torn, Village, City; County, etc.
(Specify)
Note: The application cannot be considered for filing until all of the above questions are answered
and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
Do not write in space below – FOR DEPARTMENT USE ONLY
DATE RECEIVED c� o ACCEPTED BY - 1 1 4 RETURNED _
(Initials) (Date) (See Corres.
FEE RECEIVED V VALID. NO. J� J C PERMIT N0, j
(Yes or No)
REVIEWED BY APPROVED DATE
r (Initials) (Yes or No)
I
COMMENTS
M1
�e