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HomeMy WebLinkAbout026-1119-19-000 0 6-P Ni a > 0 C) C) 0 C. cn z C\l a) LL O m Cl) z 00 W E Z 0 z (D 4) 0 LL, CN m a. m cq E U) 0 z :!t ° v c 0 ( C O L 0 N E M 0) C 0 0 0 0 m (D a U z 0 C) O 0 < (D 0 0 "r O Z z Z o z E 0 CD 4i > a < E m co (D CL o 04 0 13 CL 0 cn U) IL I-- IL U) > 0 0 0 M IL CL 0) (D U) 0 cn 0) C) m �2 C> W a) co 0 1 C 0 E C) C) '0 LO a) r co < A (n o .2 U) 3: 0 d) Z 0 (D M 0 0 LO W r a to (D 0 m '0 0 • 0 v d N 0 1 0 1 z M co Aj E 0 2 L: (L CL r U o Con E 9z L) CL 0 U) sa, w Wise usin•bepastmentof�Commerce PRIVATE SEWAGE SYSTEM C ount y: • - safet and Buildings Division INSPECTION REPORT ST CROIX 'GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344649 Permit Holder's Name: ❑ City ❑ Village 20 Town of: State Plan ID No.: DERRICK, Richard RICHMOND CST BM Elev.; Insp. BM Elev.: B Description: Parcel Tax No.: ST. CROIX TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ie�✓ 00G Benchmark Z. 0 lee Aeration Bldg. Sewer .a �: L Holding S / Ht Inlet f Z TANK SETBACK INFORMATION 5 / Ht Outlet TANKTO P/L WELL BLDG. vent to ROAD Airintake Septic '� �i - f 12 ' /'s e NA o tom D NA Header /Man. Aeration Dist. Pipe H ing Bot. System 4L h } i fs 9S 3 YS"6 PUMP/ SIPHON INFORMATION Final Grade M 3 r Ma turer and haf Model Number G 2 . yZ /00- TDH Li Lriction S stem TDH t ad I Forc ain Length Dia. t. To well SOIL A RPTION SYSTEM `' I Z t BED /(rRENC Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 I v, S I DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACH G man u acturer: INFORMATION Type O r o el Numb System: O T DISTRIBUTION SYSTEM Header/Manifold !� Distribution Pipe(s x Hole Size x Hole Spacing Vent To Air Intake Length y Dia. / Length // � Dia. /4]- 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) (Q 0� RICHMOND 22.30.18.714,SE,NE 1295 146TH AVENUE — PONDVIEW MDWS LOT 19 �) l�f� ��► � hoC�. o� 3r �� / y) sr s�c..ti ����:..� .r�.oc�cd, a.�d R W. re pt Plan r�vlslon require J] Yes L_j No Use other side for additioAal information. V (? V / (v SBD -6710 (R.3/97) Dat Inspector's S ature Cert No. Q V(4, ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e a e $ € s . f d 5 < . 4 � .44- . I 3 ®-< d.M.gy...Mm m A-4--j— 5 i ... _..... 1 . _ ...�...... . ...,a....A e..<mea 3 3- ..,.. e ...,A., [ LA 1 S ZZ M F F S 1 S L p .a ; % tD, A Jf` n WNT&W —k 1 T 17t e < °a E _ _.... A. �. 4--i-f-41-4-2- E [ 6 19 _.f -. f . , -. ,. ..m ...m. r <ma ee<..,� <m <.e� .e.-, _.�. <., .. 5... e, m m< € T++ 1-10-1 i 4 y 3 t 3 f 3 a $ E s E € Y—^ i g y F £ p A d d — i ............ .._. _. .m ve .«,.......« �.,.m..e.= €. ,.....�, a A ; e S h[ { �. w..__..�.. _�.. —<__.__. . F* i — OT t 4n,d gliJdir,�s �;sac� 'T` W, Weshi*on Avg. P.O- BOX MadIM W I !3707 ! 2 9";. A LX-- ._...± Notary Permit Apps OIL i MUM wok Cor W23• We. AAW Cede. you plavia Chu tf uvwcm � Lt3 Nusxibet' r X e . i ptomw Down 7d �) = ; ;• ` k Nti z o uglJo�f , '�• j v , F r_ j_t _� ty ult►b1r j , II / IJ• r G , �Ol�rx • . Type e>t t y►p(Y) � f tl�b � 4 or x Pig* - Jwi of bdroeaw pu�itolGbi�urottl - Dadit Ulm Kok q Baal o wnec � w Tyr t 'ewe box an A �btrlft for w urt)� C b �rre tC s! lfaebb) �, as ; osnbet � t 31. a" It f'1'lAwhI } y ecbe�e as wt) 141, NO - prwui'swd taf �:0 i t 41 161W pow s� 0 co ►vw�t wotls�sd 41 a 11old 4 Teak M 61x6!• P+u i1 Cl 01* Lira Cl r m►ent iJ • i9 Reetron adrt t~ C yn a - AtK s 11 i esem vt 3�uy6i Gztde ✓ pop" ✓ RfNQtWa. /ShydBq ) S3 Q�4s ; �levadan z ' cams Cotutrucad } ��s • s � 1 ae - ab o l eo e r ....... -. L IM test o T: P ()W Ibe att�d � a anedaao PbM N UMba Mow; 4w 1104W d t AP; i�seuuI (N - 0 ts�pi) � A 9 awhw Pee) D 4waer tllve>o let Aevetw • �� U I ( (z U E W. C w ho f k t veers �A– V".t- S ���oc� � Q��ev 4" `�0 1^r F'c�c� a 3 !qw " B oom • T. w � I � �r 11-3 '1 1� i +o ( f 1 �� SOIL EVALUATION REPORT page —of 3 Vmeonsin f D,'i vision of Safety and Buildings m accordance with 85, V& Adm. Cade mi S4. Wl .Attach complete site plan on paper not less than S 112 x 11 ouches in size. Plan must include. but not iiamed to: vertical and horizontal reference point point (BIB, direction and Farrel I D. percent slope, scale or doymmons. north arrow, and location and distance to nearest road. Date Reviewed by PWW print aw/ ' Paraonal irdormador► You Provide may be Pam Law, S. 15.04 (1) (m)). Property Location Property Owner - Govt Lot S W 114 Al F 114 S Z Z T Q N R J 5 E (or) wU Co I to Address Lot # Bbdc# Sulxt Merriam CSM# property Owner's Mailing f l V _70 F , -.. Town l Road ❑City ��e citY State ZP LINTY ' . , #-,-v New Construction Use: l3 Residential i Code dernred design flow rate /3 GPD ❑Replacement ❑ Putmcor �� it. parent material 0 0-� "i4 Food Plain elevation if aPPr� General conments SYs 4 r wt e l e U. +e 9H $ d w ar Qy Z Q and recommendation: 41—f• ele l/• f0P 9y 6v 4 G w � q3 �O I R Bori # Boring in. surface ele,r. 8� Depth to limiti g factor in. a Pit Sad Rate Dominant Cob Redox Description Texture Structure Consisienae Boundary Roots GPDW Horizon Depth '01#1 'Etf#2 in. Munsell Qa. Sz. Cont Color Gr. Sz. Sh. n I V 9 2 . 3✓ r/ Si Cl 2m3b- m �'r C _s ` 2 16 -2-6 ID (` 1 3 D 3 Lv S c 1 2 S (� , -1 8-9� i S L 2- rr)Sbk YL�' — `� ✓ 9 PY ❑ egg a # © Pit Ground surface elev. ft. Depth to limiting factor q la in. Sol A Rate ~ Horizon Depth Dornirrent Co Redox Description Texture Structure Con ee Boundasyr Roots GPDll in. Murrell flu. Sz. Cont Color Gr. Sz. Sh. Etill 1 * Eff#2 I 6- 1p 3 — S'll 2 m rq1± Scl 6<- r jar vJ 1p . ti 6 --,. � 5 I v � c s _ . -1 / • Z � L 2rr, k� _ 5 9 '/ yo• ~ Effluent #1= BOD > 30 220 mg& and TSS >30 150 nV& ' EMmd #2 = BOD < 30 nV& and TSS _5 30 nV& CST Name (Plee�e Print) Signature A CS. T Nurrier Address Date Evaluation Conducted Telephone Number f 1 Hof 1� of C l l J0. Parcel ID # Page 2 Property Owner O El Boift # ° Grourxisurfaoeelev. � to - � in. Sol Rate a Pit Redoor Desaip6on Texdme Struchme Consiatenoa Boundary Roofs GPDItf? Horizon Depth [Don:*xint 'Eif#1 'EM in. nsell Qu. Sz. Cont. Color Gr. Sz Sh. O l 3 �S ✓ ./ 2 Q �► ID 51 cI Zrn bk S - 2 3 1�o SCI Zm5 c �r s LS S E l m my �'� 1 /. 2 2 -Pr 5 Q Boring El # ❑ Pit =dhce elev. tt DWM i0 s factor Soy Rate Horizon Doh pmt color Redox Desaipdon Texture Stuclrae Con�ance Boundary Rood GPDlIf in. MCI Qu. Sx. Cont. Color Gr. Sz. Sh. 'Eif#1 •Efr#2 El Boring # ° Ground surface elev. R Depth to lirrilorg factor in. El pit Sod Rate Horizon Depth Dominant Redooc Desaip4ion Texture Structure Consis�oe ► Rom GPDJIt? in. Munaeii Qu. Sz. Cont. Color Gr. Sz. Sh. - EW * E 1 • EAhmnt #1 = BOD > 30 220 mg/L and 7SS >30 1 150 mg/L ` Effluent 42 = iBOD <_ 30 mg/L and TSS < 30 ff9t The Dgwtment of Commerce is an equal opPorhmity service PTOVW" arul employer. If you need assistance to access services or need material in an alternate format, Please contact the department at 608'266"3151 or TCY 608 -264 -8777. �oa3aoc)eo�ao) PAGE 3 OF 3 NAME Co 1 o yn, LOU P/ LEGAL DESCRIPTION s w '' /4 A EY.,S& T Y),N,R E (or) SCALE: F'= yd BM 1 ELEVATION l(� BM 1 DESCRIPTION I 4 ,,a sdak G "4bo, 6 T x BM 2 ELEVATION `/s• 3 Cv ` . zQ on BM 2 DESCRIPTION 4- Car etA r- SYSTEM ELEVATION Qy �� Lo� �Y• ALTERNATE ELEVATION 00 G CONTOUR ELEVATION q 7c o IT, act J 9 9 0 0 A Ott, i ok sH�P� oo oo LL c � Q g -3 � L 1 a M'L SIGNATURE /�� �� DATE Safety and Buildings Division ,■ - SANITARY PERMIT APPLICATION 201 W. Washington Avenue �cons�n I r h P O Box 7302 Department of Commerce n accord with ILHR 83.05, Wis. dm Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system pp less County than 81/2 x 11 inches in size. Ib sr eye ,' 9- • See reverse side for instructions for completing this appl` �` � State Sanitary P r� it NuSn 1� , `' � '__ Personal informatio ou provide may be used for S �Condary s �C��t Check ' evlsion to prevlo application [Privacy Law, s. 15.04 (m)]. r��1 / �/j? L O to n I.D. Number I. APPLICATION FORMATION - PLEASE PRINT INF P►rl I QN Property Owner Name cati C�1 at 2 "c ON . 1 ;j 2 T 3d , N, R /8E (or)9 Property Owner's Mailing Add ss'1 Lo r Block Number City, State Zip Code, M one Number i i� or CSM Number gal od P F BUILDING: (ch k one) ❑ State Owned V It Nearest Road pV ge �� -� y Public 1 or 2 Family D ellin - No. of bedrooms - � wn of •c III BUILDING USE (If buildingtype public, check all that apply) rcel Tax Number(s)0 �� �q 1 E] Apartment/ Condo o• g •fit 2 F1 Assembly Hall 6 ❑ dical Facility / Nurs' g Home 10 C] Outdoor Recreational Facility 3 E] Campground 7 ❑ Me handise:Sales epairs 11 E] Restaurant / Bar/ Dining 4 E] Church/School 8 ❑ Mobl Home Par 12 C] Service Station / Car Wash 5 E] Hotel /Motel 9 ❑ Office actory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box oNn Check box on line B, if applicable) A) 1. New 2. ❑ Replacement Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an -- _ -- ystem System Tank Only -------- - - - - -- Existing System -- - - - - -- Exlstin System --- - - - - -- -- - - - - /iued. -- -- - - - - -- B) E] A Sanitary Permit was previously rmit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution essurized Dist\'on Experimental O ther 11 E] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground �1 i L 42 ❑ Pit Privy 13 ❑ Seepage Pit � S'�7S /EGG— 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM FORMATION: 1. Gallons Per Day 2. A orp. Area 3. Absorp. Area 4. Loading to 5. Perc. Rate 6. System Elev. 7. Final Grade Re fired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. .) (Min. /inch) y� Elevation YS� ! 7G Feet S r7Q Feet Capacit VII. TANK in gallons Total # of Prefab. Site Fiber- Exper. Con- INFORMATIO New Exist in Gallons Tanks Manufacturer's Na Concrete strutted Steel , glass Plastic App Tanks Tanks epticTank /< �QQ r' G/� T CY.t/ El ❑ ❑ ❑ 1:1 Lift Pump Tank /Sipho Chamber ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ VIII. RESPO IBILITY STATEMENT I, the and signed, assume responsibility for installation of the onsite sewage system sho n on the attached plans. Plumber's Na : (Print) Plumber's Signatur (No Stamps) /MPRSW No.: Business Phone Number: ex I A,4 T,,,4& r" Plumber's Address (Street, City, ip Code): St i . s. IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Di at Issued Issuin nt ignatur (No Stamps) M / Ap proved ❑ Owner Given Initial Surcharge Fee) z3 y Adverse Determination /1100 / I 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 permit must be approved by the permit issuing authority. m 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be,ubmitted to the county prior to installation' 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licer-kc! pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administwator or the State of Wisconsin, Safety and Buildings Division, 608 -3151. y ,. n _. To be complete and accurate this sanitary permit application must include: 1. 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�ff 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 fbr 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 Wk, 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 game, 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 smalf6r than 81/2 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; buildMg 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. Va K s��`7 /� ✓��r� '/ 3© (I l f�G� ``O � �� �.� �l eG/ �� d/L e /i� _�r'C.It it O!/dL 5 e� l �r 9Z •I 9�:<so V1W rr nsin Department of Industry SOIL AND SITE E V A L U A +0 I4 T Page 1 of 3 L , and Human Relations • Division of Safety'& Building's ' in accord with ILHR 83.90, wls: Adm. Code r OUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in soft Plan must taut + St. Croix not limited to vertical and horizontal reference point (BM), direction an °C of slop kale or .P CEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ] ' �, 026- 1065 -50 -000 fl IEWED BY DATE APPLICANT INFORMATION— PLEASE PRINT ALL INFORMA PROPERTY OWNER: RROPE N;'` Richard De rrick OVTyt4 .I_...__. ;i /a1V 1/4,0 22 T 30 N,R 18 �r) W PROPERTY OWNER':S MAILING ADDRESS LO B �0 k - BD. NAME OR CSM # 1310 H 65 L � CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE JUOWN NEAREST ROAD Rilchmond 146th Ave. [�] New Construction Use [x] Residential / Number of bedrooms 4 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 3 bed, gpd /ft • trench, gpd /ft Absorption area required 2000 bed, ft 1500 trench, ft Maximum design loading rate • 3 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) 92.70 trenches ft (as referred to site plan benchmark) spaced to code Additional design / site considerations 3.0' below surface grade, recommend mound for system lo ngevity. Parent material glacial drift = Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem EI El ID S El E3 El ®S ❑ U ❑ S CC 0 S ER SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft ..... in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T . rench ........ ...... .......... ..... <? >:: >::1«<: 1 —12 10 r 3/3 none I 2fpl Mfr if n 1 .3 2 2 -28 10 r 4 4 none sicl lcsbk mfr gw if .2 .3 Ground 3 8 -82 5 r 4/4 none sl M na na na .3 .4 elev. 9 5.70 ft. Depth to limiting factor 821 -1 Remarks: Boring # 1 0 -8 10 r 2/2 none 1 2cp1 mfr gw if np .2 2 8 -23 l0yr 4/4 none sicl lcsbk mfr gw if .2 ' .3 ................. Ground 3 23 -80 7.5 r 4/4 none sl lcsbk mfr na na .4 .5 elev. 95 ft. Depth to limiting (� factor 80" AIX Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. ew Ric and I 540 Signature: Date: 4_24 -99 CST Number: m02298 4-&fL PROPERTYOWNER Richard Derrick SOIL DESCRIPTION REPORT Page 2'pf PARCEL I.D. # 026 - 1065 -50 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdwy Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends U j 1 0 -10 10 r 3Z3 none 1 2c P1 mfr qw if n .2 2 10 -24 7.5 r 4 4 none scl lcsbk mfr gw if .2 .3 Ground 3 24 -80 5yr 4/4 none sl lcsbk mfr na na .4 .5 elev. 9 4.50 ft. Depth to limiting 1. factor 80" Remarks: Boring # 1 0 -12 10 r 3/3 none 1 2cp1 mfr 9w if np .2 4 2 12 - 10 r 4/4 none sicl lcsbk mfr 9w if .2': .3 Ground 3 33 -68 7.5 r 4/4 none sl lcsbk mfr gw if .4:: .5 elev. 4 68 -80 5 r 4/4 none sl lcsbk mfr na na .4 .5 93.30ft. — Depth to -- limiting factor Remarks: Boring # 1 0 -11 10 r 2/2 none 1 2cp1 mfr gw if np .2 '« 5 2 11 -24 7.5 r 4/4 none sicl lcsbk mfr gw if .2 .3 Ground 24 -80 7.5 r 4/4 none sl I M na na na .3 .4 elev. 9 30 1t. Depth to limiting factor 80" Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: S13D- 8330(8.05/92) I I STEELS SOIL SERVICE Gary L. Steel Richard Derrick 1554 200th Ave. CSTM2298 SE4NE4 S22- T30N -R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #19- Pondview Meadows This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. N 1 " =40' BM.= top of NW lot stake C el. 100.00' Alt. BM.= top of SW lot stake C el. 97.90' DO n r 3` lot p• A �. Gary L. Steel 4 -24 - i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / ku A 10z ' C R / ( - K Mailing Address 12 7 N vw• 6 <- - 9 Property Address a"2 �` S (o 11h 'Q t<C (Verification required from Planning Department for new construction) City/State &44.) o d?. Parcel Identification Number LEGAL DESCRIPTION Property Location 6:F %,, 4Z-E %,, Sec. 9 d N - W, Town of Subdivision _ PU N O V i f f.c ) 1 &,4- & ) "J Lot # �. Certified Survey Map # Volume , Page # Warranty Deed # 48 3 V 7 Volume 95 ;. S � Pa e # g Spec house K { yes ❑ no Lot lines identifiable *es El no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature.fadure 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 masterplumber, journeymanplumber, restrictedplumberor a licensedpumperverifying that (1) 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. I '-j--j ' SIGNATURL 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 owner(s) of the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 7 SIGNATURE'F APPLICANT DATE * * **** An information that is mis - re resented may * * «••• Y p y result m 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 T , 13140 te4 (For are b ACA, rea, MCA, PcA) VOL 952PAGE 539 ' Pare 1 of 2 48399'7 LIMITED WARRANTY DEED THIS INDENTURE, made this 21st day of May 19 92 between AgriBank, FCB, formerly known as REGISTER'S OFFICE Federal Land Bank of St. Paul ST CROIX CO., NVI a federally chartered corporation, with a post office address of a. Reddfonccord 375 Jackson St. St. Paul, MN 55101 MAY 2 91992 party of the first part, and Loren D. Derrick, Rose H. Derrick Richard L. Derrick, Joan L. Derrick, and Robert J. 10:1551 A. Derrick 0 whose post office address is Route 114, Box 48, New Richmond o Reglsfer of Deeds Wl 54017 party of the second part, (hereinafter referred to as party whether singular or plural), WITNESSETH, that the said party of the first part, for and in consideration of the sum of Fifty Five Thousand Eighty and Recording Information 00/100 --------------- - - - - -_ DOLLARS, (E 55, 080.00 ), to it aid the said a p by party of the second part, the receipt whereof is hereby acknowledged, does grant, bargain, sell, and convey unto the said party of the second part, his /her /their heirs, successors and assigns forever, the following described real estate, situated in the County of St. Croix. and State of Wisconsin , to -wit: E}NEI except Lot 1 of CSM recorded in Volume 4, page 1144 of CSM of Register of Deeds. NWINEI All in Section 22, T30N, R18W. it ca r D C EXFb4PT subject to all existing easements and rights of way; also subject to all taxes on said premises for the year 19 92 and following years; also subject to all unpaid parts and installments of special assessments on said premises which have fallen due, or will fall due hereafter. EXCLUDING therefrom and excepting and reserving to said party of the first part all mineral and royalty rights, interests, estates and titles heretofore reserved or excepted of record by The Federal Land Bank of Saint Paul prior to January 22, 1986, if any, with such easements for ingress, egress and use of surface as may be incidental or necessary to use of such rights. The foregoing exclusion, exception and reservation shall include, but not be limited to, all oil, gas, hydrocarbons, coal and other minerals of whatsoever nature lying in or under the above - described lands and all royalty interests as to oil, gas and other minerals produced and saved therefrom. It is expressly understood that the said party of the first part will make no warranty as to the extent of its ownership of minerals, or as to its title thereto. TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all estate, right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. TO HAVE AND TO HOLD the said premises as above described, with the hereditaments and appurtenances unto the said party of the second part, and to his /her /their heirs, successors and assigns FOREVER. AND THE SAID party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said party of the second part, his /her /their heirs, successors and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, by, through or under said party of the first pail, and none other, it will forever WARRANT and DEFEND. . 13140 J n x et z VOL :: 62PAGE 5 �., `Jg r• • IN WITNESS WHEREOF, the said party of the first part, has caused these presents to be executed in its corporate name the day and year first above written. AgriBank, FCB WITNESSESS:�� BY� - B Lehne z Regional Vice Presid (Nam) Md.) of Farm Credit Services of Northwest Wisconsin, FLCA Acting as Attorney -in -fact for Farm Credit Bank of St. Paul. or: By: (Name) (title) STATE OF Wisconsin lss. COUNTY OF St. Croix JJ The foregoing instrument was acknowledged before me on (date) May 21, 1992 by (name) Jerry Lehnertz , (rirle) Regional Vice President o f o-PATT "0. dit Services of Northwest Wisconsin, FLCA ai••�b in • &, , behalf of Farm Credit Bank of St. Haul. J nna tip _ '' r Norsr� lia,• ti O,t. Croix C ounty, Wisconsin 4 -9 95 I N --'' Y My commission expires 19 ...., W•,, STATE OF 1 ss. COUNTY OF 1 The foregoing instrument was acknowledged before me on (date) by (name) (title) Of on behalf of said corporation. Notary Public, County, My commission expires 19 f� This instrument was drafted by: Farm Credit Services of Northwest Wisconsi FLCA r� R. Anderson, P.O. Box 199 V River Falls, WI 54022 C� '� `.)4 •, " <Z W T 11J U Imo— >- m _ I Q I 0 n. ZI I ci o W I O! I w r1 _J, �I AA i �-- j R I U' 00 \ „L2,21.00N �-j 3 I o z - I w ; I j Q I I- w Z I I - S9 'H'1'S �o I Q Q o n °�ofooQ Q, p oo Z OD _1 C ,SL' 00 9 / ,89'00S M„L2.21 *00N �� 'e�'9zz c� oiia ld 3H1 01 G31VOIG3a ! �o C) M,.LZ,Zt.00N o o I ° OD 83MOd Qd3H3 ---\ o - - - -) - - - - - -- - - - -- -- -- t- - - - - -- -- - - - - -- -�__. A 30 - 1HO I8 .S 'H' -- -- -- w— _ <Q _ GV08 30d1NONA� - m 0 \ ® r� ,9S'8t8 M „LZ,zZ.00N ` N (T �Q U 5:__ __ _— -- -- -- -- — \ ' CC2 SNV81 83d NOV913S '1'd'Q� n D z U7, < -- — — z W I o .s O . ��• ........... .,�......... . L.j �- W to ? W \ es = I S� . ` �, �. O u v, ZI 011 c"� f \ o i ol u J� � \\ � i q8' 40 „W 307.7 a I W' OD 0 Zl7W Z -I Z cel w -i 3 ' , o , \0 ! W'00 m � ----------------------- - - - - -- C:) W %D �z ;ODD v h cu W T C \ �i ; �\ I � ` i`. �i M Q `0 V , Z, oi' o I I�I� � I W ,OOI co \ �, I ' , � . \ (U, , O I \ I I I • Cy) 7 i� \ —J , I \\ U' C) W I OD I � ,6210C M „62,0 .00 f C-50 cli ST. CROIX COUNTY WISCONSIN ZONING OFFICE 111 t ■ 1 N u ■ U ■ Noted ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 Thursday, November 15, 2001 Richard Derrick 1295146th Avenue New Richmond, WI 54017 Regarding septic inspection for Richard Derrick. Location of Property in St. Croix County: Municipality: Richmond Township Subdivision or Plat: Pondview Meadows Certified Survey Map: Lot: 19 Address: 1295146th Avenue Dear Applicant: A septic inspection of the above reference property was conducted on July 06,2001. This property is located in the SE 114 NE 114 of Section 22, T30N R18W, Pondview Meadows (Lot 19), Richmond Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 3 bedroom home. If you have any questions regarding this, please contact our office at 715.386.4680. Sin,, on Sonnentag Zoning Staff cc: file