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HomeMy WebLinkAbout026-1013-10-000 I � I 0o A cc V L h Q N j N I I I O Z v LL 0 c 4 I � � I m � � I c oo E v Z E` O W a m v I Z O o za' m z a o to 1- O a=i Z c E -P M N O. 0 N CO •�V N N CL L L C O L) N Z H Z Z c o 1 C N j n •• N N Lo aea.. m S o I = t co Z 0 C N > t 3 z I m •N ° aa a a N R a ' o N z } M J U y M rn j O N .-� U N Q M M 0 L O O D L m W m � r y N (n 0 O 7 w �i ° E 04 cc O O 0 H L y V 0 - 0 0 ' U O C V C C o O N N N • ~ N fM _U N co O w E R U O y l o v m Cl) 0 Z c Cn RS I rn d R a r `1v + E 2 c r A ciao Ornv Parcel #: 026- 1013 -10 -000 05/26/2005 08:47 AM PAGE 1 OF 1 Alt. Parcel #: 4.30.18.47D 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): " = Current Owner BILLIE BILLIE JO STOCK BR E M SE CHAEL BRIESE MICHAEL J 1129 175TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 1129 175TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.260 Plat: 0653 -CSM 12/3428 SEC 4 T30N R18W PT NE SW BEING LOT 2 CSM Block/Condo Bldg: LOT 2 12/3428 3.440AC EXC PT DESC IN WD 1330/075 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 04- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 10/2911998 590175 13701612 PR 07/23/1997 504/612 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.260 41,900 74,900 116,800 NO Totals for 2005: General Property 2.260 41,900 74,900 116,800 Woodland 0.000 0 0 Totals for 2004: General Property 2.260 41,900 74,900 116,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 519 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safejy & Buildings in accord with ILHR 83.05, 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 St. Cr not limited to vertical and horizontal referen nt,(8M); direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location d,d'is'1 ke to nearest,road. 026- 1013 - APPLICANT INFORMATION -P AU 'P INT�ALL INFORMATION R VIEWEDBY DATE •fir PROPERTY OWNER: _ 'r .. PROPERTY LOCATION Al Schultz GOVT. LOT NE 1/4 SW 1/4,S 4 T AR 18 k(or) W PROPERTY OWNER':S MAILING ADDRESS %'> 1 LOT # BLOCK# SUED. NAME CSM # 1129 175th. Ave. ' "� r ..... - 2 na na o� Z CITY, STATE ' ,CO,DF ONI �lUMBE ❑CITY ❑VILLAGE [MOWN NEAREST R AD Richmond New Richmo WI . 54 ( ) ` . `�` New Construction Use [X ] Reside 'tfn ms 304 _ [ ] Addition to existing building eplacement [ ] Public or commercial describe C I y flow 600 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Absorption area required 500 bed, ft2 500 trench, ft Maximum design loading rate • 4 bed, gpd /ft .5 trench, gpd /ft Recommended infiltration surface elevation(s) 99.50 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 98.50' Parent material glacial drift Flood plain elevation, if applicabkq ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem I ❑ S ®U ® S ❑ U I ❑ S C2 U ❑ S El U ❑ S 6 U ❑ S [� U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncl ry Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTrench 1 0 -10 10yr3 /2 none 1 2msbk mfr qw 2f .5 .6 1 2 10 -24 10yr4 /4 none sici 2msbk mfr gw if .4 .5 Ground 3 24 -42 7.5yr46/ abne sl lcsbk mvfr gw na .5 .6 elev. 1 ft 4 142-50 7.5yr4/4 none scl lcsbk mfr gw na .2 .3 Depth to 5 50 -70 7.5yr4/4 water sl lcsbk mvfr na na .4 .5 limiting factor 50" Remarks: Boring # 1 0 -10 10yr3 /2 none 1 2msbk mfr gw 2f .5 ':.6 2 10 -17 10yr4 /4 none sici 2msbk mfr gw if .4 .5 3 17 -38 7.5yr4/4 none scl lcsbk mfi gw if .2 .3 Ground elev. 4 38 -60 7.5yr4/4 c2d 7.5yr5/8 sl lcsbk mfr na na .4 .5 98.8 ft. Depth to limiting factor 38" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 20 ve. New, Ri mond WI 54017 Signature: Date: 3 -20 -98 CST Number: m02298 PROPERTY OWNER Al Schultz SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 026- 1013 -10 lot #2 Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0 -10 10 r3/2 none 1 2msbk mfr gw 2f .5 .6 2 10 -22 10yr4 /4 none sic 2msbk mfr 9w if .4 .5 Ground 3 22 -57 7.5yr4/4 none sl lcsbk mfi gw if .4 .5 elev. 4 57 -70 7.5 y r4/4 wet sl lcsbk mfr na na .4 .5 9 3 ft. Depth to limiting factor 57" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # kti•::i ?iii::i ? ? ? ? ? Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor LJ Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Al Schultz New Richmond, WI 54017 MPRSW -3254 NE4S S4- T30N -R18w (715) 246 -6200 town of Richmond lot #2 -CSM N 1 =40' BM.= top of SE lot stake C el. 100' Alt. BM.= nail in corner post C el. 100.20' 4 , Y) Ai Ck Q Z 3 S 4 17- Cr t -4 h2 Gary L. Steel 3 -20 -98 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANffARY REPORT Owner I �- Property Addr City /State Legal Description: Lot Block -- Subdivision/CS # Gs '/4 t / a, Sec. T - R/ W, Town of / 9-0-9 PIN # �T °l --/.7 SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Oo�-z-� Size ST/PC, Setback from: House Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM ,2 Type of system` rr «Gl3 Width Length 7r Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Ile— Description of benchmark '� � � -- Elevation Description of alternate benchmark Elevatio f !. Building Sewer �° X � s � & /HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold 4W 7 Top of ST/PC Manhole Cover Distribution Lines Bottom of System) Final Grade () () ( ) Date of installation ermit number �� State plan number Plumber's si nature 4da.,4LOLicense number v�7 Date f� Inspector -� Complete plot plan r r � NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW p 0 f � 3 o /7 3 INDICATE NORTH ARRO y l G Wisconsin Department of Commerce Count y PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338804 Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.: BRIESE, MICHAEL RICHMOND CST BM Elev.:- r Insp. 13M Iev.: f BM Dgscription: Parcel Tax No.: 026 1013 -10 -000 TANK INFORMATION ELEVATION DATA 3/2Z1119 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Y Benchmark Dosing ( tGi +► Aeration Bldg. Sewer C _-� Holding St /Ht Inlet' TAN BACK INFORMATION St /Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet irl Septic / (}11 J6 2 NA Dt Bottom r Dosing NA Header4 9 r/d Aeration NA Dist. Pipe Y ' e" y � t P Holding -- Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Numbe GPM TDH Lift Friction Y a TDH Ft Force In Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width / I Length No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 � DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM 1&44 1' ufacturer. �� INFORMATION Type O /n �a t ' OR UMT R Model Number: System: t,re;� °;Z,.s l S� cJ, 4-7 YW DISTRIBUTION SYSTEM Header /isiaAAQfG' �y Distribution Pipe(s) x Hole Size pacing IttToAir Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx MOund Orly i -Grade System 6�►I .__ __ �,,._. Depth Over Depth Over xrr [depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑Yes ❑ No E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 4.30.18.47D,NE,SW 1129 17„�TH AVENUE � /✓tQ.c'`'r � : f-v Plan revision required? ❑ Yes° / Use other side for additional information. j 2 Ste. SBD -6710 (R.3/97) Date Inspector's SignaYure Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ; , �_. f i m ht f F k � F _. . m .._ } a A-4-1- r tt 40, , nttv7� a' Z 4 J 6 j o ; E E R E t 1 a t n d �3 �. ..- } a g € ! l � i t Vi m , . � .�v, - ,w,C _. ... ..�.- 444- € mm e.e.. «.. ». 3p.. e E � ' • x i 2 55 _ , ...... , 1: _ _ e E t E G ' P Safety and Buildings Division Visconsi SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 0 Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x,11 inches in size. C f • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used for seconds �� Personal information y p y second purposes ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location r 2.dR/ 1/4 t/4, S T 3(f), N, R I E (o 8 Property Owner's Mailing Address Lot Number Block Number / /.2 9 a -- City, State Zip Code Phone Number Subdivision Name or CSM Numbe 540 1 t ( /9 �- �d z a TY PE OF BUILDING: (check one) ❑ State Owned ❑ !t� - Nearest Road ❑VII age / C Public or 2 Family Dwelling - No. of bedrooms wn of ! J III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo I Q c)_ D — /0 ` > 3 ^ M -000 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2�;611eplacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System System Tank Only System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12,l4eepage Trench 22 ❑ In- Ground Pressure r r 42 ❑ Pit Privy 13 ❑ Seepage Pit X 75 43 ❑ Vault P 'v 14 ❑ System -In -Fill 2. VI. ABSORPTION SYSTEM INFORMATIOIT. 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Re wired (sq. ft.) Prop o ed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevatio / 3 i Feet Feet Capacit VII. TANK i Ca allo s n Total # of Prefab- Site Fiber- Exper- INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tan / dQ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb s gnature: (Alp m P /M ) MPRSW No.: Business Phone Number: Plumber' Address (Street, City, Sta e, Zip Code): c. , C' l-ec , 601 24 a IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing a ig ture (No Stamps) A roved urcharge Fee) pp ❑Owner Given Initial ��}. CC? Adverse Determination `I' , � J �� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber - INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this ermit must be approved b the permit issuing authority. P PP Y p 9 . Y 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 - 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; 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; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i PLOT PLAN PROJECT Michael Briese ADDRESS 1129 175th Ave New Richmond Wi 54017 NE 1/4 SW 1/4s 4 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3 /6/99 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 763 # of chambers 24 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 9 3.1 Alt. BM Top of Steel Fence Post with Orange Ribbon @ 100.3 175th Ave Vent 0 Sidewinder High >12" v Capacity Leaching r , of Cover Chamber with 31.8 6' Long 16" ft ^2 per chamber 34" Grade at System Elevation Existing 3 Bedroom 21' Well House 2 ' 30' 16' 15' 25' 1' B -2 15' 0' ST Existing 1000 Gallons Powers Tank 0 ' 12% 75' A1t.Slope _ Failed System B.M.50' B -1 Vent Vents 2- 3' X 77' Infiltrator 0' Trenches with 6' Spacing Property Line iNisconsi" Department of Commerce SOIL AND SITE EVALUATION Divisk of Safety and Buildings Page of Bureau of Integrated services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less thainches 812 x 11 inches in size Plan must , l Coun � (7 i include, but not limited to: vertical and horizontal reference point (BM), c�ectlon and percent slope, scale or dimensions, north arrow, and location and distance- tar' nearest *d. Paicel I.D. # 10 666 APPLICANT INFORMATION -Please print all inf `anon. R e Date Personal information You provide may be used for secondary purposes ( Low, s. 19.'04 Property Owner Pr lion way 1%4 1 /4,S T3� ,N,R E (odo Property Owners Mailing Address LQt # Block#; ,S Name or CS M# ; -` 3y�0 City slaw Zip Code Phone Number ❑ City ❑ Village ,;� Town dNearest R ❑ New Construction Use: residential / Number of bedrooms Addition to existing building Replacement El Public or commercial - Describe: Code derived daily flow. z lc gpd Recommended design loading rate bed, gpd/fl f b trench, gpoltl 9dD b Absorption area required ed, ft ch, ft 2 Maximum design loading rate i s bed, gpd/ft - C .-- trench, gpd P Recommended infiltration surface elevation(s) 23. ' it (as referred to site plan benchmark) Additional design/site considerations __ 1 ) Y` - f b P , C LX T o stiti�a Ya r5, tP.8 Parent material 4�'_L Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I ks ❑ u s ❑ u fes ❑ u ,4-S ❑ U ❑ s u ❑ s U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 13 1 �5' O Z.t_ Ground / m �j ✓ `?/ � hl� S7 - 6 elev Depth to limiting factor Fr Remarks: Boring # Ground �ft. 9 lx , Depth to limiting " l factor rot;.f3' Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number 5! s 5 s s4. �0' S 5_ 3 -3r 9 6 /�%i�� DESCRIPTION REPORT PROPERTY OWNE P a ge of ' PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 1pg '613 Ground N!q ' 5,, elev. Depth to limiting factor 7/ in. 1�.8 t� •D Remarks: Boring # 13, Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # r "M Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. , Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/96) Soil Test Plot Plan Project Name Michael Briese Shap Bird Address 1129 175th Ave N Ri Wi 54017 CSTM #226900 Lot 2 Subdivision ------- Date 3 / 3 /99 NE 1 /4 1/4S T 30 N/R 18 W Township Richmond R Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon System Elevation 93.1 * H R P Same as Benchmark Alt. BM Top of Steel Fence Post with Orange Ribbon @ 100.3 175th Ave b c � r � 5' CD Existing 3 Bedroom 21' Well House 2' 30' 16' rting 25 B -2 15' 1000 Gallons Powers Tank 0' 75 A1Ze -3 Failed System 15' *g.M.50' 44 04 B -1 Vent 0' Property Line ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the fi;Q.d� residence located at: /f/ ; , ; , Section, T N, R W, Town of � ;e�rnt Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: 3-1 Did flow back occur from absorption system? Yes XG No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concret Steel Other Manufacturer: (If known):f b� Age of T nk (If known) .: - (Name) Please print itle) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). ,/ /) Name ������� z2 Signature MP /MPR �O//v ST CR OCK COUNTY SEPTIC TANK MAINTENANCE AGREEMENT' AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e ?_ Mailing Address Property Address (Verification required from Planning Department for new construction) City/State �� /,� Parcel Identification Number 6 0 AEG ^ DESC�tIPTI01� ✓ l, /< �' Property Location �_' , -� i�4, Sec. , T SU N -RW, Town of Subdivision Lot # Certified Survey Map # /.�' , Volume Page # 3 Warranty Deed # 5 / 0) 7 - . Volume � 7Q Page # Spec house 0 yew no Lot lines identifiable - 0 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 putla a. 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 master plumber, journeymm plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition aadJor (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 our sep em has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 Y days of ftthrec year expiration _ DATE SIGNATURE OF APPL CANT 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 prope described a 7 vc, by ' e of a warranty deed recorded in Register of Deeds Office. / -- DATE SIGNATURE OF APPLICANT ant. * *•'` *` +•• * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Departm #* Ipclude with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if teferenee is made in the warranty deed �_ ,.•�v.+s.'.s� �a4-s � �:€ct ., � . : , � , � , _r� , .1P�5�.J�' 't�tRl€:� � 53'1. 5 Y DOCUMENT NO. f PERSONAL REPRESENTATIVE'S DEED J Dennis D. Schultz, as Personal Representative of the Estate of +5r. CR Alvin J. Schultz ("Decedent'), for a valuable consideration � conveys, without warranty, to Billie Jo Stocl. and Michael H. OC j $ Briese, Grantee, ...e following described real estate in St. Croix County, State of Wisconsin (hereinafter called the "Property'): tw i TRAgSFCP - REMINGTON LAW OFFICES 126 South Knowles Ave. ME P.O. Box 177 New Richmond, WI 54017 Parcel No. 026 - 1013 - 10 Lot 2 of Certifies: Survey Map filed on March 25, 1998 in Volume 12 of Certified Survey Maps, page 3428 as Document No. 575750 located in part of the Northeast Quarter of the Southwest Quarter (NE '/4 of SW 'h) of Section Four (4), Township Thirty (30) North, Range Eighteen (18) West EXCEPT the following described parcel: Commencing at the West quarter corner of said Section 4; thence on an assumed bearing along the East/West quarter line of said Section 4 South 89 0 57'53" East a distance of 1330.59 feet; thence along the West line of said Lot 2 South 00 °50'44" East a distance of 225.03 feet to the point of beginning of the parcel to be described: thence South 89 East a distance of 159.57 feet; thence South 01 0 10'40" East a distance of 135.03 feet; thence South 89°57'53" East a distance of 163.59 feet to the East line of said Lot 2; thence along last ' said East line South 00 0 02 1 07" West a distance of 100.00 feet to the North line of Lot 3 of said Certified Survey Map; thence along last said North line 89 0 57'53" West a distance of 321.35 feet to the Southwest comer of said Lot 2; thence along the West line of said Lot 2 North 00 *58'44" West a distance of 235.04 feet to the point of j beginning, all in St. Croix County, Wisconsin. ! i Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. Dated this a,� A A day of October 1998. (SEAL) 'Dennis D. Schultz, Pe al Representative AUTHENTICATION ° Signature(s) Dennis D. Schultz authenticated this 2/ _Aday of October, 1998. *k s th A. Remington E: MEMBER STATE BAR OF WI NSIN (suffiorized by Sec. 706.06, Wis. States.) THIS INSTRUMENT WAS DRAFTED BY: � Judith A. Remington i REMINGTON LAW OFT a' 126 S. Knowles Av-. P.O. Box 177 New Richmond, WI 54017 Vi - tt w a: 'k,n �T -�t �i�• k . t'�,t' J."y�.'�.'...i"'M' .±s• -+d r i ' N 4 °`LP r � e.' R as .. 4 2 57575-0 t ., Ei �r�� i 1 998 00 CERTIFIED SURVEY k4AP t Located in part of the Northed6t Quarter of the Southwest Quarter of Section 4, Township 30 North, -- Range 18 West, Town of Richmond, St. Croix County, Wisconsin; being that land parcel as recorded and described in Warranty Deed, Volume 504, page 612, Document No. 319248 at the St. Croix County Register of Deeds Office. AREA LOT 2: Prepared for and at the request of: 149,927 SO. FT. / 3.44 ACRES r CENTURY ENTURY TT AREA SOUTH do EAST OF R.O.W.: 1237 Knowles Avenue North 124,662 SO. FT. / 2.86 ACRES New Richmond, WI 54017 AREA LOT 3• OWNER: 64,017 SO. FT. / 1.47 ACRES Al Schultz AREA EXCLUDING R.O.W.: Drafted by. Kristi A. Eylandt 59,026 SO. FT. / 1.36 ACRES F1VD 1" IRON PIPE IS UNPLATTED LANDS N8550 JJ "W 10.04' EAST 114 CORNER WEST 114 CORNER FROM PROPERTY CORNER SEC 4 -30 -18 SEC. 4 -30 -1p 17 5TH AVENUE (ESTABLISHED FROM R= SB9'39'13 "E 5289.82' COUNTY 77E SHEET) ' -- ---------- M= S89'57'53"E 5297.35'-- - - - - -- R =EAST_ - 330 CENTERLINE �— — — — 'S89'57 53 E 330.00' 30.00 M_S89:57�53�EV 13 1 89 "E 2 333 0'� \ �\ �w-- -N89'S7'53 "W636.76- R -S89 58 56 E 1320.38' — — 1 — — — R =S89 39'13 "E R= S89'39'13 "E 1330.68' ��© R.O.W I 1 rte I '� j l l I \I EAST -OUST 1/4 L /NE OF SEC. 4 -30 -18 NORTHWEST CORNER OF A O 11 1 W THE NE 114 OF THE SW r \`O i I I 1 c 114 OF SEC. 4 I II ` . ........... 1 , . 1 GARAGE I I j l 0-4 LOT 1 1 i t I WE641r'4b I D C o 0 00 C.S_M_ 1 rnI� 1 HOUSE I I m x o y m VOL_2 PAGE 518 �1 oI� 1 I 1 0 =r I I I o m v s 1 �I A i CC - 1� I O IO V :3 I i C = Zo Q 1 d Ic Iz ° v --- - - - - -� I I I� OW C b II I p — = 0 Q i - I o to I m lr w(A o. 0 O' 1 ° ; O C 1D � m m n � cn ° 1 �� v 1 j m LOT 2 XZ0 11'o 3E I ID I� O D O to (n 1 11 I T 1 1 1 0M 10 ly n 0 VOL_ 11 PAGE 3204 I r i �24.61: I 1 I rn Im Io C' n 0 0 Ii1 0 I o 0 lao 'N r- 0 3 0 _ 1 297.24' o o Z a y o o \ N89'57'53 "W 321.85' i 1 � v� o o r" s 10 a, 1 I I ai°� m oo , -------- Mrn - f �v I I I 1 o 'A lc 0 1 I cr I I Z 1 N O ► aJ v m CL O S ON � 0 1 1 m ° :LOT 3 ° ' wD= y I ol�. o I 1 � M0 oofo I M m LOT 3 11 � W 0 Z o 01 1 : o l 1 v m rn , , -1 / N C•S_M, 11- t j I L,,v- 25.31' 17.2' j ( FENCE I '� o o n c VOL. 11 PAGE 3204 112 I i li 293.01' 1 n • y ------ - - - - -- I f co X— X— X— X— X— X —X —X —X X —X —X—X x— N Z Z m 0 3 rt 11 33'1e\ -N89 "W 318.32' - CO. v o 3 0 R =WEST 330' r a `D- Cn 1 1 � NORM UNE OF THE SW 1/4 O ' p n 3 - ---- --1 lml ME NE 114 OF ME SW 114 Z � o m LOT 5 C.S V. 11_PG. 3204 IM 1 z a - - - - - - - - - �I to UNPLATTED LANDS a 0 N n I 11. \ .. o LOT 4 1 1 o ti VOLUME 515 PAGE 497_ ° 0 � C.S_M_ 1 :^ �= o m� m o� VOL_ 11 PAGE I 1 z (no 0 LEA o�, oo G) a County Section Comer Monument :k x / C Z o Record 7 _- • Set 1" x 24" Iron Pipe weighing _K _ Q F. O1 a minimum of 1.13 pounds per "' .1 rTi linear foot. 8 - 1.1Ae O Found 1" Iron Pipe 11YISY. M= Measured As R= Recorded As 40 � • • • • • • • • Building Setback Line X4 0.." S R ; �"'. o 150 JOB #98009 (R14) Prepared by. N TH A & E GRAPHIC SCALE LAND SURVEYING do CIVIL ENGINEERING SCALE IN FEET: 1 inch = 150 feet Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE EAST -WEST 1/4 109 East Third Street, P.O. Box 325 LINE OF SECTION 4, TOWNSHIP 30 N., RANGE 18 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR S89'57'53 "E. Sheet 1 of 2 VOLUME 12 PAGE 3428