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Wisconsin D partment of Commerce County: Safety and Bbilding Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 538764 0 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: Basel, Brian G. & Sara I Richmond, Town of 026 - 1086 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range/Map No: U L �� t t RAI I 30.30.18.458C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic e Bgacbmark t' l`s wy. D0, o J v Alt. BM Aeration S , r�� B ldg. Sew erj� 7 Holding �— -� Su inlet c St/ OufleL TANK SETBACK INFORMATION �rr, Y Z - 7 - 7, `7 TANK TO /L WELL BLDG. Vent to Air Intake ROAD Inlet Septic B 2 —N ` r1 rj D ' g 3 Heade Man. 1 - 7 �. l'vt SI 5 ' Aeration Dist. Pip Holding Bot. System Final Grade PUMP /SIPHON INFORMATION f I 'S /o 0 Manufacturer Demand St Coverr - GPM 14 cf ?. C 1 .:4 .= 31 D / C� Model Number TDH Lift Friction Loss System Head TDH Ft� Forcemain Length Dia. S. to well SOIL ABSORPTION SYSTEM CI-0o -- F �i ( j L 2, t' �1 c 'r ✓y , L ' �ZL .1 � BED /TRENCH Width Length , / No. Of Trenches' PIT DIMENSIONS No. Of Pits Inside Dia. Liquid pth DIMENSIONS 78 1 SETBACK SYSTEM TO P/L 0 JBLDQ WELL LAKE /STREAM HING Manufact INFORMATION HAMBER OR --l�ti T7 Typ d Of Syst�em� ro] r �l� f j UN Model Number: ` D!§iIRIBUTION SYSTEM > n' Bader/ nifold I D istribution x Hole Size x Hole Spacing Vent to Air Intake `�i, ?f Pi Len pe(s).�1)f "r tvl rd�'� v � f Length �G Dia gth Di a `r fpacing 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 j Bed/Trench Edges Topsoil E] Yes E] No E] Yes Ed No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /� / / Inspection #2: / / Location: 1357 County Road A New Richmond, WI 54017 (SE 1/4 NE 1/4 30 T30N R1 8W) NA Lot 1� Parcel No: 30.30.18.458C 1.) Alt BM Description = I c e) 2.) Bldg sewer length - amount of cover = Plan revision Required? � Yes / No / F nn /� Use other side for additional information. f (L SBD -6710 (R.3/97) Date Insepctor's Sigrlature Cert. No. ° C? 0 6q 0 y ran o o c � I � I � ti w O L p �C70 y 3 O O Y L;- O C CC C C N N ` Z N N (0 'O 47 N a N Cl Q ) O p . Z Z rn C Z m 7 c C O1 LL CO LL C O L LL O N mrna N M N M ( M co LU Z a+ 0 O O ` ZO a m `m d o r) w ;' a CO a m M F- U) O Z a c r p N N 73 N O` c US P r rn N ° Q) c 0 E E N V N ` N 3 •� N O N N [�1 m U cu . N Q. 'N O N N N N d N N N N N III ! • �� i d � L 1� d (n t d � t O C O Q O O Z S Z `� Z m Z ° Z I Z C N Ln > � .. (D � .. C (0 � I ':, 'O R E C p N V C E y E .. a E c. m m v a «� E a V W O N= d' W N N C U N N N a 3 0 o a E Q E Q Z j ! 3 I F F- ' m z F F Fes 3 p N E = N F- F- F• a 2 �►i w Q 0 0 0 a a o O O O Z 0 0 0 ►v mn.m owaa aaa G, m O O (A J U O p 7 p � N m z Z _ ti d C O ^ .\- CO N N N U w E N I.- O 'O 0 0 LO 7 N ICI m C m N LO .O m O v N N Q 3 'D co 'O � Q �- (n N Z I'I co d : 5 c) 7« 0 Ci p j. fn 7 .+ 7 (n U) O O c odS N c O O N O LO F- C N m C .ro N N n C a O f0 N � ?j G m ro [Q p � v O l 00 O m \ - N co N C O O E N I- d O C U p N N O O O N M .NO j C C D N 1�1 M U N pp +' y N p N 0 O N f0 c0 c6 � O N E O N U O M CO In O Z N w Z r Z °' 2 2 C� N O Z N Z �► s"" 9t = E E = E L L C a CL r `fv i ' c :3 c c �? r A U a� I O U O U) U O Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538764 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: Basel, Brian G. & Sara I Richmond, Town of 026 - 1086 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 30.30.18.458C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well _:�:il I I 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: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of ded xx Mulched 7�� Bed/Trench Center Bed/Trench Edges Topsoil El Yes 0 No Yest No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1357 County Road A New Richmond, WI 54017 (SE 1/4 NE 1/4 30 T30N R18W) NA Lot 1 Parcel No: 30.30.18.458C 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes FN No Use other side for additional information. - - -- — Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) commeree.vvi.gov Safety and Buildings Division County j 201 W. Washington ve. Q' x 7162 7` C._ r ro I t iconsi n Ma isot7 7'1 Sanitary Permit Number (to be filled in by Co.) Departmertt of Commerce ljj 53 '97(o 4 Sanitary Permit App&a OII State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submissic 6 ' the approoriate &Uri imental A ) A- unit is required prior to obtaining a sanitary permit. Note: Ap licatio f d PO S are Project Address (if different t an mailing address) submitted to the Department of Commerce. Personal informati n you 9= for se ondary f- 1,3j C p urposes in accordance with the Privacy Law, s. 15.04 1 m), Stats. I. Application Information - Please Pri 1 Informatio Property Owner's Name M 1 Q 1 Parcel # 1 q I ✓� i 6L 11 . �4f e 2 8v / �" boo ST CROIX COUNTY Property Owner's Mailing Addres PLANNING & ZONING OFFICE Property Location C� Govt. Lot / City, State Zip Code Phone Number y , r 1 3d x / � _ C/ /r 1 _ _ City Section /VeGl� tQ �!/T c/0/� 7i7- ZYG-- Z�� lrcleone T 3� N; R � � t or U. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Litt Block # ❑ Public /Commercial -Describe Use ❑ City of ❑State Owned - Describe Use CSM Number l ❑ Village of / l 12L Town of I C H 111. Type of Permit: (Check only one llox on line A. Complete line B if applicable) A ❑ New System y Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal El Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Numbe and Date Issued Before Expiration Owner �I 1. / e& IV. Type of POWTS System/Component/Device: Check all that apply) 5 ®-No Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil El Holding Tank Other Dispersal Component (explain) El Pretreatment Device (explain) V. Dispersal/Treatpfient Area Information: Design Flow (gpd) Design Soil Application Rate pdsf) Dispersal,Area Required (sf) Dispersal Area Proposed (s System Elevatii VS s 6 YZ� CJ 2 6 9� o VI_ Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units -0 o g New Tanks Existing Tanks � // / � � c d � L w V v� H ti is. C7 a. Septic or Holding Tank r 1 / ��Q l� / / Z ( VQG ,k_ x Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' gnature MP/MPRS Number Business Phone Number ll IG� ^e�( 23131V 71.5 -Z 7 -32-0 3 Plumber's Address (Street City, State, Zip Code) '? /7, (* �' e ,�O/�. erte T G,- Z VIII. /De artment Use Onl Approved lsapprov Permit Fee Date I sued Issuing A t Signature ry eason for D ial IX. Conditiff"wNffeasons for Disapproval 7. Septic tank,. effluent flfter and ',�-� A- dispersal cell must all be services 1 maintained as per management plan provided by plumbssi. PAA2 . All sq ack requ e"I" must.be makft1r4d v Attach to complete plans for the system aad submit to the County only on paper not less ihan 8 1/2 x 11 inches in size /,� d. t� `�+ v r SBD -6398 (R. 02/09) Valid thru 02/11 OWNE& Page 3 of 3 Name 130.i-el 1 0 - 577 C T— Brian Parnell Address 13 '1 9 -Xl� CST 231314 12 s 7 Date... Benclu-nark I e, T Ce- ADenchmark 2 ❑ Soil Boring I I 1--j Suliable Area F 40' Scale 7'1 tc i I �ep k4el 4 -- T 1 A M e 1 T pofO Ie C -7- -J CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: �f c 80 Owner's Name: Sa S-C / Owner's Address: 13 -57 C f, XJ A) Legal Description: S /�� Sec 30 ��D0A Township: County: Sf, C 40 Subdivision Name: Lot Number: Parcel ID Number: (. (j 10,?6 / �j — Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 _ System Cross - Section Page 5 Filter Specs Page 6 Maintenance & Management Plan Page 7 Septic Tank Maintenance Form Page 8 _ Warranty Deed Page 9 CSM or Plat DesignerlPlumber: r/ e .� FcA -3 >3 V License Number: Date: Phone Number 715 -2 y7 - 3203 Signature Designed pursuant to the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01/01). Page 1 0 WNE ],�, Name 1�1 1`6 8"Je Page 3 of 3 Address 1,357 C / 9 Brian Parnell CST 231314 Date_ Benclu 1 11 / A Benchmark " 'T J,,� Soil Boring _ - i Suitable Area 40' Scale - i - -- .. -�,Se �X /s �, �>�_ ! i ) � 1 � i I i � i j I - i j — 4 - 7 . ....... . .. /A T7 k as 0 1 T - 7 7 Hose ge�Ae TF le T ... . ........ i Ti 4 - 7 - 7 77 -- T 7 - 4-4- ( r � ROO-` HO CA e 3 Z.00 Cite" S� s';�� T�� vim, s,�z� any? J7/7 sx-a 0,.;ee%S Z. Ire I o lr z �O Clf'4 Q : 2_ 3 X 7� Ile h e---' 6 --�'fti 19 Q y 1 �� •� � z 39 'Ps s IG� -7 711 G z i Soil Absorption Svstem Cross Section ft 4' Schedule 40 Final Grade PVC Vent Pipe With Vent Cap Leaching CL Chamber ft 3 , System Elevation ft ft Soil Atssorpt:on System Plan Vi �8 ft ER 3 ft r ft Vent Or Observation Pi Leaching Trench 1 � � Chambers 4 Dia. Trench 2 Header Leaching Chamber Specifications // / / Manufacturer And Model I/I h I /7'� 0� S�aJ6. Q 7 EISA Rating sq ft per chamber Soil Application Rate 7 gpd /sq ft gpd Design Flow + P Soil Application Rat EISA = �07, Y Chambers 2 rows of I / chambers each. Page of PDLi�4KM, INSTALLATION INSTRUCTIONS ® ApaPayhkl,c PL-525/PL-625 FILTER INSTALLATION INSTRUCTIONS Center filter 3 with opening ' c� fi RIM tr a f "Tt. �, µl's h " : - ::.v -.. - Step 1: Step 2: (A) Locate the outlet of the septic tank. (A) Before installation lace the Step 3: (B) Remove tank cover and pump tank filter housin g on to the p (A) Glue the filter housing on the e outlet pipe. outlet pipe, if necessary. (B) Make sure that the housing is positioned so the filter can e ( B) Insert the filter cartridge in the housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing, MAINTENANCE INSTRUCTIONS MIR i s ih` �-?�'.£+' .�_ i i ' u'• '@ 4iCEvLFs. ' Step 1: Step 2: q Locate the outlet of the septic tank. Step 3: - DO NOT USE ( ) Remove tank cover and pump (A) Insert the filter cartridge back PLUM WHEN FILTER IS REMOVED MR if necessary. into the the housing making sure (B) Pull the filter out of the housing. the filter is properly alighed (C) Hose off the filter over the septic tank. and completely inserted. owmt Make sure all solids fall back into the (B) Replace septic tank cover septic tank. S -A Page OT RT UP AND OPERATION `or ne- construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals t at 71 aY impede the treatment process and /or damage the dispersal celi(s). if high concentrations are detected have the contents o' the tank(z) removed by a septage servicing operator prior to use. c 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 d_scharged to the dispersal cefi(s) in one large dose, overloading the ceff(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. fro not drive or park over, or otherwise disturb or compact, the area it S 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 POW i1 S: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; roundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; , nting products; pesticides; sanitary napkins; tampons; and water softener brine. :� SA NDONMENT ','', hen 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: Alf 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 l; the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant r euiacement sys`.em_ E 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 fines and wells. Failure to protect the replacement area will result in the need f or a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. l_..i A suitable replacement area is not available due to setback and /or soil (imitations. Ba advances in POWTS Technology a holding tank may be installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. fJ Mound and at -grade 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. :00ITIONAL COMMENTS 'C+WTS INSTALLER POWTS MAINTAINER Namel Name Phone! `7�s Z �/? �2 3 Phone ;EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name �I�Of < C -/ Phone Phone �� 3�Ej- y6 0 c "ante with chapter Comm 83.22(2)(b)(7)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of -[LE INFORMATION SYSTEM SPECIFICA77ONS t4 4f e Septic Tank Capacity ga l ❑ NA Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer p L© ❑ NA E °Vun^v of Bedrooms 1 ` j ❑ NA Effluent Filter Model ,L2� ❑ NA tiunber of Public Facility iiniLs ANA Pump Tank Capacity ga l ❑ NA Estimated f iovr (average) ©Z) gal /day Pump Tank Manufacturer ❑ NA resign fiow (peak), (Estimated x 7.5) gallday Pump Manufacturer ❑ NA ( Scii Application Rate p 7 gal/day/f 2 Pump Model ❑ NA `! Standard influent /Effluent Quality Monthly average'` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <30 mg /L ❑ SandfGravei Flier ❑Peat Flier Biochemical Oxygen Demand (BOD <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: pretreated Effluent Quality Monthly average Dispersal Cefi(s) ❑ NA Biochemical Oxygen Demand (SOD <30 mg /L Wn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <30 mg /L ANA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <70 cfu /700ml ❑ Drip -tine ❑ Other: 'Maximum Effluent Particle Size y in dia. ❑ NA Other ❑ NA i ❑ NA Other: ❑ NA V a::es typical for domestic wastewater and septic tank effluent. Other. ❑ NA �sAINTENANGE SCHEDULE Service Event Service Frequency e soect condition of tank(s) At feast once every: ❑ month (s) (Maximum 3 y ❑ NA 3 J& y ear(s) re - p out contents of tanks) I When combined sludge and scum equals one -third (l) of tank volume ❑ NA -soect dispersal celf(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA l Kyear(s) y vlsan effluent Ater At least once every: 2 ❑month {s) ❑ NA 0- years) cumo, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) la' =-aa and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) ❑ months) At feast once every: ❑ year(s) ❑ NA v< 0 N , OA(NTENANCE 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 ceilW 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 (% 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. Ali other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 572 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the focal regulatory authority within 70 days of completion of any service event. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM r Sa f-e l Mailing Address 1 3 �7 (- f 4 / /`1' 41 4. ,� �� ,� �� C.�? S Y0 /7 Property Address -) C �� /�O� )I w ��'c�i� . �f1 4 So /7 (Verification required from Planning & Zoning Department for new construction.) / City /State Parcel Identification Number LEGAL DESCRIMON 7 / Property Location„5C '/� , 44C '/ , Sec. / , T N R l W, Town of i C A Mons Subdivision _ ___ _ Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume , Page # Spec house yes Lot lines identifiable &D no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What_ you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 8352(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. 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATUR40� PP LICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** hiclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if Terence is made in the warranty deed 4REV. 0810- PAiD � 2 Wisconsin Department of Commerce SOIL 5VALLIATION REPORT Page of J Division of Safety and Buildings in acco ance with Comm 85, Wis. Adm. Code / Attach complete site plan on paper not less tha 81/2 � '*+ r - County 7 • C/o include, but not limited to: vertical and horizon la reference r IIfVA1JJ„ on nm an t percent slope, scale or dimensions, north arrow and location and distance to 10A nea st road. Parcel I.D. O� ! , _ Yr Please print all i nn 4%W. I Q I tt 11 Revie by O C � ! pate Personal information you provide may be used for ndary oses (P acy Laws. 15. 1 m t Property Owner PLANNfNG & ZONING ' 6 ��e Location Q t Q e l of S 1/4 /VL114 36 T N R 1O S (or)® Prope Owner's Mailing Address Lot # Blodc # Subd. Name or CSM# 73S7 c /-, /?) city fl State Zip Code Phone Number Ale iv �r C � �&tsX 1 ,.5 - y0/ . 7 ., �� f y ❑City ❑Village ®Town Nearest Ro d ( ) 2 a Yam AC M On c C �� A ❑ New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material _ O u l� l.�- / /��w �' a� Flood Plain elevation if applicable g General comments / s D and recommendations: 5 yj4C°� EG. IT Boring # E) Boring ® Pit Ground surface elev. q I ft. Depth to limiting factor _> /z 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 D- Il DY/�3 " IVY L ms m Z w 2 m , q 0.7 rn 10, 6 1 0,8 3 2239' 75M 6 Al S O.s mil, cw lur- 39 11 srg /f ® Boring # If 0 Boring I� Pit Ground surface elev. � �� � $, Depth to limiting factor in. Soil Apolica tion Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffti in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 t 1 U DYR %Z /A SL rns 2/-h 0, q 0, 7 1 2 C w 0, 6 D. 3 20- TSW 4_ Xis rns os 6- �1i �.s rn % �1/�- m s os — 0, 7 a r� toy * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name {please Print) � Signature CST Number Address �3' 3 Y Date Evaluation Conducted Telephone Number z 03 c Pro perty Owner `� � S e Parcel lD # ©� Page of 3 F Boring # 1:1 Boring pp ® Pit Ground surface elev. l I tt Depth to limiting factor ; in. . Soil A licati on 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 I *Eff#2 1 6- y lord 3 iz SZ 0 , q - 3 l a� 7S Y a % A/ 14 ms Gs w lug 1 0, 7Q 113 7 A114 ,l h F-1 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 ❑ p Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure - Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EW * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 rngA_ and TSS < 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. SBD -8330 (R.07 100) MENNEN Him UliittttttiiNE ► t ititittil'i1% RXIA �►,tittiii, i��l►�t,1�t�Itiiiilit�ll�iCJ{ �tttttt" ttli��It/ Ittt�i�ill`1v�lt ►�ttit►�tttittt �� titttllisi \�tttt�t!ti►�ittiitttME tlnitiii t►i�1 ttit�lt Inttl®In�ntltt►�t ��i �t�t�tttt� titit�ttti�ltttiME ■�iMttttttl nt�ti�tt�t��tltn ��lt��ttlt11ILLLM 0 t tilt �tt►�Ntoi�ttti�� �MOLIttttt� IIItMEMO i:a" �t � ttiitiltttMliq Ott tt t�itiilt t� ttttt��lttiltFa ��� tltitlttt uttt�itt�t r 0 spoil ttt��ltME Itit�ittt�ri�tti t/ tt0 lit0 OMEiit OMEN .OMEN Il�i�itt��tiil BURNS �0 SON a i ►, :iiliititit00 liit WIN iI mail im- 1110iai1■tittNNEN loom l�, iliilNt■ Iltiii tiii liiiH lttt !UiiMMUMM RUNE 213 Itit t 111111111111110P W E tlltSSIUMM ZZ Itit mom mom ME Oiiittt�C1'Itttititi IMtEi t��t��tt���t�t�Irt�t��ttt� IN ON mom MEN mmommomitttmttmm Now Itt�ttt�tt����ttt�t����t�tt��ttt� It��tt MMMMMMt�t��t�t�tt���tt�� aoiZ i " .c WARRANTY DEED - --� - -- • -_ _ STATE BAR OF WISCOE S9N FORM 2 — im - CE t: Rose M. Lo-r l e , = G i nP l e wg iman ST. CRc�!X CO., VW %a Rose Lowrie �,� R for Rewrd _ ....... ........ - * 31, 1987 . t� - Brian G Basel and Sara N BaS el 1•45 -- ` husl>and 'a wire as survivorastilir rar! La i r - i 1 .. r. - !i - .. . t! ....... _ .. ° e Tl °..e a ^.:h„A *•a;.i o e.ato +T - JC cromx ....... ......... ....... - - 'S tate O NYisconsinc' - �I Tax Parcel No: .............:. _ Fart of S--11, of °�I£! of Section_30 - - described 3s __... it foJ laws Lot 5 of Certified Survey' filed' April 15, 1983,' _in volume "'S ", Sege = ru- II 1271 I l ,r z !I Is -... homestead Droperty. F i (13)'(nUq)q '{ Exception to 'warranies: easements, protective covenants and restrictions of record I if any. Muted this .:.�•.--� C�.G / d.:4 0: December in 87 +� .. ...... (SEAL) .� Lf - • • - -. -- -Rp.,e,_K, LQwr -a k a Rose Lowrie .. . . ..... ... . ..... L -- __(SEAL) ..r. .... .. .. .:.. .. ....: - AIITIIENTICATIaN ACKNOWLEDGMENT SigcTature(a) ft I A.1't] OF \V1SwNSiti S .._. _ _ ........ of . Q ........ ..... . ..... f ou ss. ... St . Croix ......... C n t v - authenticated tl s 1.. Perronaliv came he nrr nto this Ce. ^.e ber $7 _ ..t1av nt - m t 1:+ the above n: .... _ .. Rosc M Lc _ 3/ k i -e ._...`v .._. M. �rtdr.a �� 1 e TITLE: MENIBER STATE BAR OF WiSCONsl iii not..,..._........._. . ..... - au? �erized b,. § ;pa.nr;, tt'i Lois A. ?!i rrn3 - , H CZAR i F. M!R�,AY T Bo.x- 229, .i 5 � ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to cert ify that I have inspected the existing septic and /or dose tank presently serving the following residence: (Street address) 33 C �- Rj fF Mew AZ 4 ^4" Q located at: '/4, ' /4, Section 3 , Town N, Range W, Town of ti /-z 10.h , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /000 Q / Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): Permit number (if known) (Licensed Plumber Signature) (Print Name) 23 13 1Y (Title) (License Number) MP /MPRS 5--13.- (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 t► 0 ' a f m Maloof dt ON , r FORM NO. 985 -A Stock No. 26273 >n 2 t S 1 9 , 9 IAN1�rG -- ®�F� CERTIFIED SURVEY MAP 'z LOCATED IN THE S 1/2 OF THE NE 1/4 OF SECTION 30,T30N,RIBW \ \(b IC F gsT F T, �\ TRUE BEARING Z s - o s° tiT �� ', ti -1 3 J I� 10 cn G �u is rte, w HOU B C `� � Z m m S E 3 ° � I+ �' � � -� 5 s2 °o SHEp 2.0 A C. ± R S S0 8 7,12 0 S. F.+ ° 98 O Ipo ti 2 2� . �W `ID B , R z c' Cn -0 4 O g O ` �► c�qr m -- oz�z CD z NCO Cl V Q —+ O rn 0 9 �F APPROVED a rn r z � -4 (n z N0OZ ro wrnm APR O 6 Cn G) -4 z -40 SCALE IN FEET 13 3 0< o 0 0 -;u z z r,;�rseN,IVE N. �s rr •sHINQ # � N * O 0' 100' 200' AND ZONING CON "Mk IEE w K - D .4 D C.) N X C7 m rn m O r O F X m , N 0° 18' 19" E 1014.141 N 819 : E �� w � { 7 � K ƒ 0 m § B ` © g 2 2 (D \ CD $ f _§ o 2 / k ; E ! ° 8 8 , n 3 � � _ , � « l c o p ` � k d E E a o k_ c \ m / z> C a c o\ e..Jl § 0 e o o 0 \ / / EI. z >; o § k £� n E r 4 ® :E $ z o 0 0 3 rr / J I ca } } C _{ z S "a ® = N3 E -4 f .. / g §f{ 0/ 1 1- � (D B / w { E E a \ \ � \ k / � \ k z o 0 ■ M $ 2 § 8 CL § k ; m = �ƒ W 2 $ƒ± a ¢ 2. \ 9 m � «)k � ! 0 E& 0 cr Co m �0 J / S a Ch / c ; � � 2 � ; J 0 \ * / @/ �§ k � 7 Parcel #: 026- 1086 -95 -000 02/14/2005 02:31 PM PAGE 1 OF 1 Alt. Parcel #: 30.30.18.458C 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 BRIAN G & SARA N BASEL " BASEL, BRIAN G & SARA N 1357 CTY RD A NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 1357 CTY RD A SC 3962 NEW RICHMOND SP 7040 RICHMOND SANITARY DIST 1 SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 30 T30N R18W SW NE THAT PT OF SW NE Block/Condo Bldg: LYING ELY OF HWY OF TEN MILE CRE 2/ 4 THIS Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) PAR ALSO KNO AS CSM 5/1271 30- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 800/212 07/23/1997 722/214 07/23/1997 692/316 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 20295 169,500 Valuations: - , Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 40,500 113,300 153,800 NO Totals for 2004: General Property 2.000 40,500 113,300 153,800 Woodland 0.000 0 0 Totals for 2003: General Property 2.000 40,500 113,300 153,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 125 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry SOIL AN EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accorda 00 it 9, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 ' in si r&t County include, but not limited to: vertical and horizontal referenc (BM), rt' laid s-t percent slope, scale or dimensions, north arrow, and locati d distance to nearest road. r eni i Parcel l.D.# I ^,f i o at - Ip -9s APPLICANT INFORMATION - Please print al i rmat c' x Reviewed b COUNTY v Y Date Personal information you provide may be used for secondary purpose (� y La{Yjl(�q). Property Owner Prc�perlrr lion Q B el , L, f,.bvrt. IS E 1/4 NE 1 /4 3a T 30 ,N,R / g E (or)o Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1 3S - 7 C o, Q i 351 -°tf City State Zip Code Phone Numb r� cw Number ❑ City El Village Village Town Nearest Road I I,JZ I SY0 17 1 ( '7 IS )ay - y.)qg co R ction Use: [� Residential / Number of bedrooms 3 Addition to existing building ' Replacement P-ei P blic or Commercial - Describe: Code derived daily flow y S0 gpd Recommended design loading rate '_ bed, gpd /ft _ trench, gpd /ft Absorption area required L V 3 bed, ft 2 __ % 6_&L_;L_ 4 �_ trench, ft2 Maximum design loading rate _ bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 9 S. y a ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft I F: — Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank Unsuitable for system EA S El U RS El U [$ ' S El U [o S 11 U El S [9 U ❑ S [) U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench o' -) i aY 3 /A - -- S; L -a in�►Fr q a f . $ . cL a rh sb t n Er e w I F Ground awls 7.S Q`�/ el v Sc.L -2 h, b M Fr G w 1✓F •4 : rS 9 it y 1 -3 1. 7. S VP, y/ 1- fh'1 L C W , Depth to `� Y Q V �o "'�� — L limiting factor —20 in. Remarks: Boring # r Ground -- D • elev. ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signatur Telephone No. o- - 7I - 4 - 35C9 Y Address Date CST Number a� a t`' s + Pr4l s - y SVDate IMF yy� sue.. 3a - r 3ow� aac�� lof�: C o, n P b M jbQ �•. i uc� p, p b�s 97.98' ^, - - . . . . . . . . . . . . pr,,., c7 co 0 00) 0 ; 0 d v1 C O R 1 C M O 7! A M CD CD z :=* Q j m 0 O C O Co M d N fA O 0 NNN O N `C O • O) d. = fD O. C� N C.0 N O O C lD N ! S 0 A fD d d �_ y 1 _ p CD 3 (D 7 O W W W O C 7 co O O ^ N) CL y Ol O) Va = ! a �'I C fOD CCD n ! - CD I n OD CL O W O n 0 N� N N W 1 W C n Q c1 C v O O D m a N C 4 co (D �o ao C L co m v, c ° c co m y co o I o o D co CL 1 O 4 m m ti OODD 0 CD cr a o O O O 3 0 0 0 2 D 0 3 N -h N N N a v CO) (4 CO) a l D cr D7 7 r i N ( � 7 O y i CA = = W A N Z 0 ! O D D CL 0 O CD N CD Ch V! N ll I m n 7. m m Oro C Gp. N C O N 0 G a 3 m fD az 0 > j v CL a A ` Z 1 co -i W W CD m ° CL CL z °° 1 $ z 3 ! m w 1 H y z o CD ? W y W I CO CVO a CD CL v co 5. a —I O O p' (D 3. "M O _ C 3 N z a ° z o ° a d m N z m N CD ° m I I CD I E v �C m a o - I m' I I g I I s I S ° 1 ° o I a � A ° 0 �. ° I � CD 1 m do v A I o 0 ° 0 CL o a • AS BUILT SANITARY SYSTEM REPOR OWNER TOWNSHIP ,f SEC . �) T o N, RAW P.O. ADD SS / ST. CROI COUNTY, WISCONSIN SUBDIVISION ' � LOT LOT SIZE .PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM • Ir SEPTIC - MFGR. �iG� /�� �l/s/ CONCRETE ,1 STEEL NO. of rings on cover , Depth ,ff— DRY WELL TRENCHES No. of width length area BED no. o lines width lengt�i z area 1,,,� yc4' dep th to to of pipe M'' AGGREGATE '� � 1 Y2 P- A- U,Z,, �d PERK RATE e _,� AREA REQUIRED / 5 AREA AS BUILT 6 ? y p DISCLAIMER: The inspection of this system by St, Croix County does not imply complete compliance with State Administrative Codes_ There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operatio HoTwever, if failure is noted the County will make every effort to det mine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROU THI SYST �. INSPECTOR DATED 3 c p PLUMBER ON JOB LICENSE e REPORT Or IIISPECTIO ?i-- INDIVIDUAL SEWAGE DISPOSAI, SYSTEM Sanitary Pernit /2 G' - r State ,�� " `' ��," • , • Septic Z_2_ _;7- . TOWNSHIP �3t. Croi^ Count; SEPTIC Tt,' ?I: Size gallons. ` ?umber of Compartments , Distance Front: hell ft, 12% or greater slope e ft. Building` ft. Wetlands . f= Highwaterl ft. DISPOSAL SYSTL. Tile Field or Seepage Pit(s) Distance From: Well j ft• 12% or greater slope ft Building ft. Wetlands f FIELD `E _ft. . Total length of lines ft, wumber of line Length of each line ft. Distance between lines ` ft. Width of the y trench �ft. Total absorption area sq. ft. Depth of rock Uelow the P-' n. Depth of rock over the in. Cover nver.rock, epth of tide below grade �in. Siope of trench in *per . Depth to Bedrock — ft. Depth to ground water -- � ft. PITS . Number of pits ut ide al ft. Depth below inlet ft. Gravel a d it es no. Total absorption area _s ft. f Square feet of se page trench bottom area required / J :square feet of ee a .e n' P are required Inspected h Title:. J 'Approved • • , . Date , 197 EM 115 ' WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH r P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS / LOCATION: � /a, #� ' /a, Section - , T264, R D ?E (or) W, Township or Municipality ;%/ / c A y" l e n d Lot No. , Block No. County bdivision Name ' Owner's Name:�� Mailing Address: TYPE OF OCCUPANCY: Residence `/ No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW f ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIILBORINGS > OLATIONTESTS SOIL MAP SHEET / / SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P— C S SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) ,� B j z „ s.— B 7 r' IV S /O' i jo G 7,;?- 7�� PLAN VIEW (Locate perco lat i o n tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and square f et of suit ble areas. Indicate numb s re feet of absor ea needed for building type and occupancy. /S ."'� ca e or distances. Give horizontal and vertical reference points. Indicate slope. ti 6 t N r I C , _472r f � � i �+ State and County State Permit PLB67 Permit Application Count Permit PP Y for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: Section J, T� N, R E (or) W Lot# City _ Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family C! Duplex No. of Bedrooms 3 No. of Persons ;Z-- D. TYPE OF APPLIANCES: P�shwasher YES NO Food Waste Grinder YES of Bathrooms__, Automatic Washer C / qES NO Other (specify) E. SEPTIC TANK CAPACIT Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks _ New Installation Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) � 2) _,_t7 - 3) Total Absorb Area �� y sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length �' ' Width / ;? 1 Depth 7s „ Tile Depth No. of Lines 2 Seepage Pit: Inside diameter Liquid Depth Tile Size e Percent slope of land S Z; Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certifi d Soil Tester, NAME yI ^� �/� b s /! C.S.T. # / and other information obtained from (owner /builder). Plumber's Sig nature �� '�1_ MP /MPRSW# �C ,S L — Phone # Plumber's Address " PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well).. TJ Parcel #: 026- 1086 -95 -000 04/04/2006 09:52 AM PAGE 1 OF 1 Alt. Parcel #: 30.30.18.458C 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 BRIAN G & SARA N BASEL O - BASEL, BRIAN G & SARA N 1357 CTY RD A NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1357 CTY RD A SC 3962 NEW RICHMOND SP 7040 RICHMOND SANITARY DIST 1 SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 30 T30N R18W SW NE THAT PT OF SW NE Block/Condo Bldg: LYING ELY OF HWY A EXC S 210' LYING WLY OF TEN MILE CREEK & EXC CSM 2/ 429 THIS Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) PAR ALSO KNOWN AS CSM 5/1271 30- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 800/212 07/23/1997 722/214 07/23/1997 692/316 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 96033 179,300 Valuations: Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 40,500 113,300 153,800 NO Totals for 2005: General Property 2.000 40,500 113,300 153,800 Woodland 0.000 0 0 Totals for 2004: General Property 2.000 40,500 113,300 153,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 125 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AMMS Viewer Page 1 of 1 3 0.30 . �C S 4STC-) 6,-� 1 Z (� aAA 1 ,- http: //72.21. 230.178/ website /LRPortal /ARCIMS /MapFrame.asp ?PIN= 4/3/2006 Wisconsin Department of Commerce Count y PRIVATE SEWAGE SYSTEM Safety and Buildings Division ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarx`ir lN ttii Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. L SS �y 33 �� BASEL, DRT� &UNlle Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: 7M Description: Parcel lfx x- _:1086- 95-000 TANK INFORMATION ELEVATION DATA A9700194 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 30.30.18.458C,SE,NE 1357 CTY RD A Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION B ureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less county than 81/2 x 11 inches in size. sr C fd • See reverse side for instructions for completing this application State Sanitar Permit Number 3 The information you provide may be used by other government agency programs E] Chec if vision to prevlous 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 1/4 .. 1/4, S T , N, R / E (or)(T Property Owner's Mailing Address Lot Number Block Number r3 f ' City, State Zip Code Phone Number Subdivision Name or CSM Number 5 / A -7/ II. TYPE OF BUILDING: (check one) E] State Owned El ❑ ot y Nearest Road Village ❑ Public 4yr 1 or 2 Family Dwelling - No. of bedrooms 5k To , f I11. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 30. /8. f5.8c 1 F1 Apartment/ Condo 1 - 30 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_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 ,� f Repair of an _____System ________System Tank Only _____________ ______________ Exf sting System _________ExfstfngSystem 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 1 1,A'Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation �� o , � 1 94 4 � Feet Feet VII. TANK Capacity Site Exper. in gallons Total # of Prefab. Fiber- Plastic INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass App New Existing strutted Tanks Tanks Septic Tank or Holding Tank / ❑ I El Lift Pump Tank /Siphon Chamber ❑ ❑ I El 1-1 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) Plumber ig ur (No Stamps) MP /MPRSW No.: Business Phone Number: YVIV Plumber's Addre s Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Si ps) Surcharge fee) 2 pproved ❑Owner Given Initial tl a, Adverse Determination U X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SaD -6398 (R. 05194) DISTRIBUTION: Original to Codtily. One copy To: Safety & Buildings Divrion, Owner, Plumber ���� r ��� 1 S ;. ..,.Si ., �x :,x li � .. ... -� _�'.i - ' �.. ' 1 �. i 1. �€ 1R� FM ", .�. Y ,. i . I ... _. .. �.. . �......... . �.. '. . �...,.. ., .., ...w.�..wr,..... .. �. ..� . _ I .. _. '- � 'y 4 p�. ,.__.�✓ B ,. ,. �, 111 „ „� + ... � t .:, .. � s .. k f'� .. .. s A i - ,, ., ......... ti 1 .. _. `.+ t ... r ..� .� *. �. .z, I ,� _� :, y �� -� ..�� r.. - , �. � # 1.a; � 1 •a� Y �, ... _.� y ( y l.' J! - � -.�•� ! sk FORM NO. 985•A / R / � NCMu1��rCp� ®R r• �O f rI Stock No. 26273 � BAR 2� v IOb/N6 Offiri Ali ' -- CERTIFIED SURVEY MAP LOCATED IN THE S 1/2 OF .THE NE 1/4 OF SECTION 30,T30N,R18W co IN, r f, �N IC �gsTF T\ TRUE BEARING lz D 2833 � R /Gy � /Yr t y, z C6 rl OD i Igo v 33 o p OO <�,�, ,q �� APR. fF 1983 w F �� L AI (o r HOUSE m ° CID Z CD w 30429 33•. •n Iv i+ N •B 6y vi IN v 5 2 yE 2.0 A C. + y 87,120 S.F.± 6 ly m A < 29 Cv 0 3 W � . 99 o a), jA s B v � -.9 F Z0cn-V 4 C 0 0 — — O Z 0 Z OD `? ,o R, m . -+ 0 cc � ��ti FG F Sao - c� o � � 0 rn.n -n_. \<9 APPRb1/ED -N m r z -4 cn z Nv o"Z N wrnm cc .� o 0 APR 0 61983 °o 4"n o U o SCALE IN FEET p< 0 0 0 z Z Si. CROIX COO - 1Y rn m : 0 CD m C-)lrIPREHENSIVE PARKS PLANNING (n -U O O IOU 2 00' AND ZONING COMWTTEE W � 74 D D A ;0 N_ ;a m 01'npr O I= X IT! LIM v v j 1614.16' N 0'18'19"E 1014.14' N O ° 8'19 "E DESCRIPTION A parcel of land located in the S1 /2 of the NE1 /4 of Section 30, T30N, R18W, Town of Richmond, St. Croix County, Wisconsin, described as follows: Commencing at the E1 /4 corner of said.Section 30; thence N0'18 11 E 1014.14' along the East line of said NE1/4 and the centerline of an existing town road; thence S89 0 54 1 36 11 W 1270.00 thence Southerly 277.89' along the Easterly right -of -way line of County Trunk Highway " A " on a 5774.58' radius curve concave Westerly whose chord bears S27 0 05 1 50 11 W 277.86 thence S28 0 28 1 33 11 W 304.86' along said Easterly right -of -way line to the point of beginning, said point of beginning being the SW corner of Lot 4 of St. Croix County Certified Survey Map filed in Vol. 2, Page 429, Document #342160; thence S28 0 28'33 "W 330.00' along the said Easterly right -of -way line; thence N89 0 53 1 18 "E 327.57' to a point which is 60 more or less, from the water's edge of Tenmile Creek; thence along the meander line along Tenmile Creek N29 173.28' to a point which is 100 more or less, from the water's edge of Tenmile Creek and the end of the meander line; thence N61 °31 "W 290.54' to the point of beginning including all the land lying between the meander line and the water's edge of Tenmile Creek. Subject to an undelineated easement to Wisconsin Telephone Company as described in Volume 211, Page 392. Containing 2.0 acres, more or less, being 87,120 Square Feet, more or less. I certify that the above description and map are correct and that I have fully complied with the provision of Section 236.34 of the Wisconsin Statutes and Section 5.4.B of the St. Croix County Zoning Ordinance. January 24, 1983. Francis H. Ogden S -88 Job No. 83 -1404 Ogden Engineering Co. 123 E. Elm Street River Falls, Wisconsin 54022 OWNER AND SUBDIVIDER WILLIAM G. WOLF R. R. #4 NEW RICHMOND, WISCONSIN 54017 Volume 5 Page 1271 �oocu ENI N O. WARRANTY DEED THIS SPACE RESERVED pon RECORDING DAfA S TATE BA` OF WISCONSIN FORM Y —l 433415 tvGl. 50UPA;r 2u REGISTER'S OffiCE Rose M. Lowrie, E single woman ST. CROIX CO., W1 a /k /a 'Roes Lowrie _ .............. . .. Reed for Record _ .... ... _ w it Dec. 3 1, 1987 #A conve's and «: ;manta to .Br�Bn G. Basel and ..•.Base 11:45 A .. husband.and wife as survivorship marital property _ ......... ............................... of Duds _ _... .. the following described real estate in .. .......St. Croix County, State of Wisconsin: Part of S' of NFh of Section 30 -30 -18 described as Tax Parcel No: .............................. follows: Lot 5 of Certified Survey Map filed April 15, 1983, in Volume "5 ", page 1371. FU This i s - -. - -- . ..... homestead property. (is) (otlaxdc) Exception to warranties: easements, protective covenants and restrictions of record, if any. Dated -this December G_ day of . - . _ ......._(SEAL) - - - - -- - Rode M. Lowrie. ' _. a(�c�Rose Lowrie -- - ---- (SEAL) .. . _ ... .(SEALS AIITSBNTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croix authenticated this ........ day of ........................... 19 .. ................ ............. -•----County. .... '1 Personally came before me this __- -day of Dcmb ---- ---- --•- --••-•. e e ....... • . er ......... 1987 _.. the above named Rose M. Lowrie - -- •--- • . ............. a /k /a- Rose Lowrie ......... TITLE: MEMBER STATE BAR OF WISCONSIN (If not . ....................... -•----•--••--•-----•- ...... ... ... ...... ......................................................... --•--•-•--..... authorized by j 706.06, Wis. Stats.) - . to me known to be the person .- ------ .— who executed the foregoing instrument and acknowledge toe same. 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 residence located at: Sec. 73r,,, T _}e2_ N, R Town of 22; St. Croix County, Wisconsin. 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 Did flow back occur from absorption system? Yes No line. � (if no, skip next Approximate volume or length of time: Sod gallons ZS minutes Capacity: lam© Construction: Prefab Concrete -;r Steel Other Manufacturer (if known) : Age of Tank (if known) : (S igli& e (Name) Please int (Title) (License Number) (Date) --, Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) r (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I c(�`rtify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except or inspection opening over outleLa; e . Name Signature MP /MPRS yZ STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS , /�� a�2 PROPERTY ADDRESS /- (location of septic system) Please obtain from the Planning Dept. s1 CITY /STATE �/ Gr/ C �n�ay r �V3 PROPERTY LOCATION , 5 E 1 /4, 4f_ 1/4, Section 30 TOWN OF ��c�, � ., ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP OLUME PAGE /Z 7l , LOT NUMBE 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has-been maintained must be completed and re med to the St. Croix County Zoning Officer within 30 days of the three year p' n date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property _zZiZoa Z& 2&.Z Location of property /4 , Section �a N -R J� W Township Mailing address Address of site Subdivision name Lot no. Other homes on property? - Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume D'�i and Page Number �Zj )t�s recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded the office of the County Register of Deeds as Document No. Y.�V y/� , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co- Applicant Date of Signature Date of Signature