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HomeMy WebLinkAbout026-1118-10-000St. Croix County PlarTning ai d Zoning Detail Sanitan� Information Computer #: 026-1118-10-000 Sub/Plat: Willow Valley Section: 1 Parcel #: 01.30.18,690 Lot: 10 TN/RNG: T30N R18W Municipality: Richmond, Town of CSM: 1/4 114: NW 1/4 SW 1/4 Owner: Derrick Construction Inc., c/o Michael R. Stevens 1407 174th Avenue New Richmond, WI 54017 State Permit: 338945 Issued: 08/12/1999 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 08/19/1999 POWTS Detail: Infiltrator -- High Capacity 16" Bedrooms: 3 POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Rod Eslinger Yes Powers, Calvin out to Ryan - problem? Kevin Grabau Signed Off: Yes Maintenance Notification Scheduled Pump Date Pumped Notification 8/18/2002 4/1/2002 04/20/2006 4/1/2005 9/27/2006 04/20/2006 9/27/2009 10/9/2009 10/9/2012 WI Fund: No Additional Notes Fridiu, August 13, 2010 at 9:50:44 AM Page I of I Money Owed $0.00 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner �--r�, ,—i r u C� � a v� Property Address f6 City/State - k) W t , Legal Description: 0 Lot /P Block Subdivision/CSM, # A)aJ 1145 (�J 1/4, Sec. , T 30 N-R Ido W, Town of PIN # 6 P;?./(a _,/ " I - Fo __, 6r" SEPTIC TANK —DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer LJ i o _h Size ST/PC Setback from: House4y Well90 P/L/ab— Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Meter location Alarm location ent to fresh air intake SOIL ABSORPTION SYSTEM: Water Line Type of system: J_!q 70 rjhrY7 Width Length 7"V Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS: C6l,� Description of benchmark JXJ Description of alternate benchmark Building Sewer ST/HT Inlet ?4 J -ST Outlet ��. 9 PC Inlet PC Bottom Header/Manifold Distribution Lines (I) !� Bottom of System (1) Final Grade (1) 9a,y c� 9 b, �Z� Elevation Elevation Z Top of ST/PC Manhole Cover ? 79 Date of installation 9/ /8/-,771?ermit number State plan number 0--.4 j License number Date c) 01 Plumber's signature Inspector Complete plot plan or 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. Wiscotisin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division 0 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s-15.04 (1)(01 a a r rr6,��ef m6,❑ City [] Village [?,,Town of: ONSTRUCTION, INC RICHMOND 3T BM Elev Insp BM Elev.- BM Description: I - ac V14A,6t� AKIV IKICr%DKAATlr%Kl ELEVATION DATA 11101 %01%9V1jr_% 1 1%091" TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. Vent to Air Intake ROAD Septic NA Dosi ng NA Aerati<n: NA Holding PUMP/ SIPHON INFORMATION Manufactur Demand Mod umber GPM T H Lift Friction S M TDH Ft Loss �We <a I F�emrain LenDia. Dist __ell County: Sanitary Permit No ST. CR( 338945 State Plan ID No Parcel Tax No , 026-1118-10-000 A99UUJ33 STATION BS HI FS ELEV. Benchmark*- 1 1;2 /0 s q 2_ jD 10,D Bldg- Sewer tcio to,-- ^'440 St/ Ht Inlet St / Ht Outlet 2— Dt_.1a14@A Dt Bottom .. Header / Man. `� Dist. Pipe -S 4. f7 Loa- Bot. System Final Grade -:5 - 2 4 KO 2 SOIL A�ORPTION SYSTEM t) 4 0_, r2 p.Ld.,j RENCH "N, Width f Length No Of ranches PIT No. Of Pits inside Dia. Liquid Depth DIM3 DIMENSIQNS- , I SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manuf turer: Ur SETBACK INFORMATION CHAMBER T;Z� Type Of I I rAodel Number. System: l5p," 14 3(o > OR UNIT 4_� —CAPOLC tt:�..e DISTRIBUTION SYSTEM 3s I \-,I Header / Manifold U Distribution Pipe(s) awwwo x Hole Size x Hole Spacing Vent To Air Intake Lengt<+C.�- Dia — Length Dia. Spacing 4- 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 n Yes D No [] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 1.30,18,690,NWISW 1407 174T ' t H AVENUE — LOT 10 2 Cf04 V " B M�9- t "kvwz, '� - I or Plan revision required? © Yes No 1W Use other side for additional information. 12- ZZ- q � � "_A& 7- SBD-6710 (R-3/97) Date inspector's Signature Cert No Ix As PI -Rct v-,,- Y4 Po �aK i� l�w� (vS a w Va II .*I Lc�( !C� N 4�t�-> csn rno n& t.c� SY a ► 7 �� A vv�o nc� C ro : � �e.�. ��D tea b coo cp At OV -401 Tar "Tir a" %.. "W F3tl�. # aaa537 E197.7 ��- asa f nqa.,Oap =74-/ t-�- Jb ..A _6� Safety and Buildings Division SANITARY PERMIT AP_P1 I ZAI��KON 201 W. Washington Avenue P 0 Box 7302 isconsrn in accord with ILHR 83. 1 Madison, W1 53707-7302 • Department of Commerce • Attach complete plans (to the county copy only) for the to n, on,pe* of less tha n 8 112 x 11 1 aches i n si ze. ,County ro't 4:0 • See reverse side for instructions for completing this a t i041�pv state Sanitary Permit Number 3 3 sc?4!q-5 Personal information you provide may be used for secondary purposes 1%9 yCheek it revision to previous application [Privacy Law, s. 15.040)(m)]- *t fate Plan I.D. Number 0 V*1 0 I. APPLICATION INFORMATION -PLEASE PRINT A "AW hN/-�,zi Pro Owner Owner NamV LPro 5,a io n 1/4's T R (or W 3!a IN# Property Owner's mailing AcTane er Block Number Ain Ic & 19 Subdivision 4Ame or CS M Number City, State Zip Code Phone Number A -, (:ZJ's ) t E] Cit Negrest Road [] Village Rk-'C 11. TYPE OF BUILDING: (check one) ❑ State Owned Public 1 or 2 Family Dwelling - No. of bedrooms own ©F M oil -44 D -S 111. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Number(s) 3o. /F. e>cio ca 1 F] Apartment/Condo 2 n Assembly Hall 6 Ej Medical Facility/ Nursing Home 10 El Outdoor creational Facility 3 Campground 7 r-1 Merchandise: Sales/ Repairs 11 Ej Restaurant/ Bar/ Dining 4 Church / School 8 [:] Mobile Home Park 12 ❑ Service Station / Car Wash 5 El Hotel / Motel 9 Fj 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. E] Replacement 3. [] E] E:] Replacement 4. ❑ Reconnection of 5. ❑ Repair of an 1ASystem System Tank Only Existing System Existing Svstem -------- ------------- -------------- --------- B) A Sanitary Permit was previously issued. Permit dumber .302.--4q9q50* Date IssuedlKau, V. TYPE OF SYSTEM: (Check only One) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 [-] Seepage Bed 21 [:] Mound 30 E] Specify Type 41 [:] Holding Tank 12 DZSeepage Trench 22 F] In -Ground Pressure 42 Ej Pit Privy 13 0 Seepage Pit 43 E] Vault Privy 14System b WWI E] -In -Fill w�_J_146 C104u 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 r. 7S D e 1 Wi Feeti � L Feet VI I. TAN K Ca Dacrty in gallons Total Gallons # of Tanks Manufacturer's Name Prefab Concrete Con -INFORMATION steel Fiber- glass Plastic Exper. App. New Existing strutted Tanks Tanks eptic TaJnor H&144." Xa."k j 4? ML:e e._.s [I o 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ E] I El 1:1 1:1 1:1 Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for ilation of the onsite sewage system shown on the attached plans. Plu er's Name: (PrIna Pluj ber'sSi natur : (N tamps) MP/MPRSW No.: Business Phone Number: 537 :715 to *�5/a5ft Aa\ 0 L I(\ r'Sp, ff Plumber's Address (Street, City, State, Zip Code) A0 V, I IX. C6Vf4TY / DEPARTMENT USE ONLY 1 0 Disapproved Sanitary Permit F e (I ncludes G roundwater at Issued IssuingAgeptsi nature (No Stamps) Approved ❑ Owner Given Initial Surcharge fee) 1 ;1 1), 1 � 1 0), Gk Adverse Determination X. CONDITIONS OF APPROVAL / REASONS F09 DISAPPROVAL: SBD- 6398 (R.1 1/97) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber THE INFILTRATOR° Chamber High Capacity Model 16 Side View G46S MCA& V"( .Sty 11 C - 2r A - 750 End View 34 0 - P, Product Features • Lightweight units offer easy assembly and installation. • Louvered MicroLeachingTm sidewall provides maximum infiltration. • Open chamber bottom allows additional infiltrative area. • High -density PolyTuffTM polyethylene construction guarantees strength and durability. High Capacity Infiltrator Chamber Specifications C; XA/ v I v H) 34" x 750 x 16* z_ U k LO © Storage 122 gal./16.3 ft3 AILRJ jim - 31 lbs. SYSTEMS INC Weight Leading the way in septic and stormwater chamber systems 4 Business Park Road 0 P.O. Box 768 0 Old Saybrook, CT 06475 860-388-6639 e 800-221-4436 * Fax: 860-388-6810 329.9S9. 2.004.W Cthw U S. Cargdan. and loreign Pst*rft Pw4ng a,", jnofgor Systems W_ Piftd in U.Sk COWS97AG US, Patents: 4,759,661. 5.017-041. 5.156-485: 5.336.017; 5-401116. 5.401.459: 5.511.903, 5,588.778. 1.915.925. 1.974.M. 1.729=, "5,338 Cana6an Patefts: ff. pw#tArch, and SnapLock- I.file—jew rrnmfiyac and S4*Wwider are registered trademark$ and Im soacwing are tradeffmvm of Infaiator Systs, k1C.: COrOO10, Max'r"zw' Max"n. "C�*acNng' Poly TU Wisconsin Departn-jent of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ST_ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel 1. D. # Page of APPLICANT INFORMATION - Please print all information. Re 1 �,d fy #w D,4 e Personal information you provide may be used for secondary purposes (Privacy Law, s. 15,04 (1) (m)). Property Owner Property Location Govt. Lot 1 /45 114, S T N,R E (o rW Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# PC) C-t- city St to Zip Code Phone Number �7 city 0 Village Town Nearest Aoad ry\ o&k Jk New Construction Use: A I Residential / Number of bedrooms _r Addition to existing building Replacement Public or commercial - Describe: Code derived daily flow LJ-.:> Q gpd Recommended design loading rate ----bed, g,pd/fF j(0 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft 2 Maximum design loading rate -5---bed, gpd/fF trench, gpd/ft2 Recommended infiltration surface elevation(s)�4:0 --ft (as referred to site plan benchmark) Additional design/site considerations Parent material AIA ft 5; 3; 0 Flood plain elevation, if applicable S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill 01 Holding Tank U Unsuitable for system F91 S U b(I S El U 4S EU 1�1 S E U El S 41 U El s 0 u I Aj I I I Boring # Ground elev. %_43ft. T Depth to limiting fac;pr 7b SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh, Consistence Boundary Roots GPD/ft2 — Bed Trench 0-7 0 Y r /6 yr pre) _wc ©.t 1r / -J. I ..7 W44 r r Remarks: Boring # 0? Ground elev. . ?L -1 Yeft. I/ Depth to limiting factor q I;e >q1jin Remarks" rP 5�k_ -� % '� �� r 4 5-- /OVr 64�1 C 1Y -YA '7- AL CL4.., 1- iv r b / �5C) -- / ,� ,� V CST Name (Please Print) Signat e Telephone No. Aldorp*s Date CST Number k-j S91L DESCRIPTION REPORT PROPERTY OWNER f)P0("N:S-k PARCEL 1.1134 �'r i -- .._ .: ^} Boring # j Ground elev. ,F Depth to limiting factor in. Boring # Ground elev. ft Depth to limiting factor in. Boring # Ground elev. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in Page "a 01 —3 Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Gep/ft 2 Bed Trenchl r . ............... 7 elto �-j Remarks: Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPQ/ft2 Bed Trenchl Remarks: Remarks: SBD-8330 (R. 07/96) nlwy �'iw� 1os PC) ac)t. A oU,.j 0c4l 41 IUQ-CAP 91%c�%VVI.-JoAk PN %1kc-�vv\0 AOL e PCt (% C>f)J O a(1p. foal *Afl -rot f6owv. &&,% zwr-, 61 16 a A"z To? -T-ra v%-qo 92, w_ v � Pro � A8m�z pqs b 'T7-7nll)B.;lS b �� v'k 0 Safety and Buildings Division .X SANITARY PERMIT APPLICATION 201 W. Washington Avenue sconsin In accord with ILHR 83.05, Wis. Adm. Code P 0 Box 7302 Department of Commerce Madison, Wl 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit 1\1um er �revifsyion Personal information you provide may be used for secondary purposes ❑ Chec it to previous applic-ation [ Privacy Law, s. 15.04(1)(m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pr Owner N cx_�C, Property y Location ( 1/41S T N I R t (or) i 3C-1) Pro rt Owner's ailina Address A y rC /VW%/. (OA5 Lot Number 1 C Block Number to A- Cit State 1p Code qc*" Phone Number Subdivision NWe or CSIVI Nu be 4 1 1, 0 ID C_ it Nearest Road 11. TY E OF BUILDING: (check one) El State Owned ] U 1 10 mily Dwelling [ Public r 2 Fa - No- of bedrooms c3 V11(age V <�_ VTown OF 0% _� vy%t 0 V% 111. BUILDING I'll S F: * (If building type is public, check all that apply) Parcel Tax Number(s) 1 Ej Apartment/ Condo n 2 [] Assembly Hall 6 E] Medical Facility/ Nursing Home 10 Outdoor Recreational Facility 3 E] Campground 7 [--] Merchandise: Sales/ Repairs 11 Restaurant/ Bar/ Dining 4 E] Church / School 8 E] 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. E:] Repair of an )(System -------- System ------------- Tank Only -------------- Existi ng System- _ExI sty ng System B) Ej 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 [j Specify Type 41 [:] Holding Tank 12JK-Seepage Trench 22 ❑ In -Ground Pressure D 42 E] Pit Privy 3 13 E] Seepage Pit V 43E] n vy 14 System-In-h I I J 1ex. E] e7it- " 5 /4 -// tea ko�% oeA Pool" VI. ABSORPTION SYSTEM INFORMATRYN: 0' 4�1 L10-1 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate F. System Elev. 7. Final Grade 1-� Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation "7( c7y,.5 611000� Feet j Feet L I Q V11. TANK Capacity in gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Con_INFORMATION Steel Fiber-plasticExper glass App. New Existina �ic Tanks Tanks structed k ;e7p t T aar*e1?wl1b+dtrg'00 Tank �� � Y 10Z❑ 7TTO`Pump Tank /Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plug er's Name: (Print) Plumb igna re: o Sta m ps) MP/MPRSW No.: Business Phone Number: (I f y2s pr 2na co-,, I , > - 71 . . ..... Plumber's dress Street, City, Se IX. COUNTY/ DEPARTMENTUSEONLY .!Z0 10 Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing A e t Signature (No Stamps) M/Approved R Owner Given Initial n-IN-5— / Surcharge Fee) 00 ct;� pp 9 4 1 Adverse Determination I 6Z) I X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: LL SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety& Buildings Division, Owner, Plumber Q-D e, {� �. Ato I Poi Plo VNI Nu-)Yy (*,4 7- -3 0 tj .4je I k- (.L) Lllo CLoT 16 o L) CL "tr ST C ro '%C A rZ, of Oro Ueo 00 , W/le 5� ', 6 < THE iNFiLTRAToR° Chamber High Capacity Model Side View End View A IN 34" INS 13 SYSTEMS INC Leading the way in septic and stormwater chamber systems DUZ)1"uSS Park MUdU - K U. b0X 768 • Ulu Saybrook, 00K, CT VU'+ I %J 860-388-6639 e 800-221-4436 • Fax: 860-388-6810 U S. Patarft 4,759,661. 5.017.041- 5,156 498. 5 33&017. 5,401,116. 5,401.459: 5,511,903. 5.58ft,778 ' 1.815,925. 1,974,938. 1,729.383; 448,338 Canadian Palwrts: 1.329.959. 2,004.564 Other U S. Canadian, and foreign patents pending. Infiltrator. Equakzer. and SideWindef are registered trademarks and the following are trademarks of infiltrator Systems Inc. Contour. Mawnizoor. MaxWtn. MicroLeaching, P*Tuff, PowerArch, and SnapLock Product Features 0 Lightweight units offer easy assembly and installation. 0 Louvered MicroLeaching TM sidewall provides maximum infiltration. 0 Open chamber bottom allows additional infiltrative area. 0 High -density PolyTuffTM polyethylene construction guarantees strength and durability. High Capacity Infiltrator Chamber Specifications Size (W x L x H) 34" x 75" x 16" Storage 122 gal./l 6.3 ft3 Weight 31 lbs. R A 01997 Infiltrator Systems Inc. Printed in USA, C060597AG Wi,sin Department of Commerce SOIL AND SITE EVALUATION Page -1 .. of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm., Code J..nxuonniental Bv Design At County , Rach complete site plan on paper not less man 81/- x 11 inches in size. P!an must include, but not limited to: vertical and horizontal reference point (13M), dirgoon and St. Croix percent slope, scale or dimensions, north arrow, and location and dista .,,nearest (q#C, I P - Parcel I D I APPLICANT INFORMATION - Please print all informatton. Personal information you provide may be used for secondary purposes (Privacy L-4w, s- 15-G4 (1) (m)).1 TA1eW By to &4 Property Owner 'Fro P, '\,F rope rty, Loq#jql�"% Dem'd,-, Construction- INC I'W W I / 4 q I T .2 30 N,R 19 W Property Owner's Mailing Address 1505 14wv 65 Block # SuV. Name or CSM# Willow Valley - -_ - -_ ­ _ '_"' 'L-'-- - _- - --------- city State Zip Code PhoneNumber City Vliia'q-e Town Nearest Road New Richmoiid W1 54017 Richmond 1140Th St. New Construction ___'Addition to existing building �, Residential Number of bedrooms o 3 r I Use: " Replacement U Public or commercial describe Code Derived daily flow 450 — gpd Recommended design loading rate .5 bed, gpdff---A— trench, gpd/ft2 Absorption —area required 900 bed, fr 750 trench, f? Maximum design loading rate .5 — bed, gpd/ft2 .6 trench, gpd/112 Recommended infiltration surface elevation(s) 94.5 ft (as referred to site plan benchmar Additional design / site considerations Parent mateiria' Loess Over- 'Ia6al Outwash Flood Plain elevation if applicable NP S=Suitabie for systemConventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U=Unsuitable for system I S E] U j F I [71 S Li S U L�J !___ 11 S U 1 U S I K---" " S F] U SOIL DESCRIPTION REPORT Bodng# I GrOUnd elev 97.63 ft Depth to 11inifing factor >86 Ground elev 97.91 ft Depth to limiting factor >86 Horizon Depth in. Dominant Color Munsell Motfies Structure I Texture Consistenc Boundary Roots Qu. Sz. Cont. Color Gr. Sz. Sh. GPD/ft2 Bed Trench 1 0-11 10yr3/2 A 1 2msbk mfr CW 2f .T 5 .6 2 11-25 1 Oyr4/4 Sil � 2msbk mfr CW I f .5 .6 .3 5 - 33 2 7.5yT4/16 Is i /.MSUK mfi CW ow i .7 .8 4 32-86 1 Oyr4/6 S* M1 CW .5 .6* Remarks: * W/ lenses of Ifs. _7.5yr3/4 T 1 2 0-11 1 0yr3/2 11-22 1 Oyr4/4 sit sil 2msbk 2msbk mfr cw 2f mfr Cw If mfr CW 5 6 .. .5 .6 .5 .6 3 22-33 7.5yr4/6 ifs 2msbk 4 33-86 7.5yr4/6 S* Osg rnt CW .6* An %A V Remarks . .--* W/ - lenses of Ifs 7.5-vT3/4 CST Name (Please Print) Signature: I .............. . . . . . . . . . . Telephone No. 715-246-2454 Thomas C. Nelson kddre,qs EnNironrnental By Design Date CST Number Ref # 1432 120th Street, New Richmond., WI 54017 1/20/99 227387 189 Owner/Buyer ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM l_1�L—i?�- j �--fc % � /�! ��,1 C�i �? r.� � �i� L H-4-�Z � �% EV`'N_.1 Mailing Address -7 lqo ­7% '' c Property Address (Verification required from Planning Department for new construction) Yi City/State f4'X-J el LEGAL DESCRIPTION Parcel Identification Number(C' Cs I Property Location PW' '/4) '/4, Sec. r T'' N-R W. Town of Subdivision Lot # Certified Survey Map # Volume Page # 4 2 . Warranty Deed # Volume 7 6 S' —.,Page# / Spec house )< yes 0 no Lot lines identifiable Ayes D no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman pl*ber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 %W I days the three year pi Vio n t e. GNATURE OF APPLIC4;f DATE OWNER CERTIFICATION (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 p M des rib bo virtue of a warranty deed recorded in Register of Deeds Office. LLt S �'. S GNATURE. .� OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning' Department.""" Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed W.P.S. COMPANY lob MKNOMONKK FALLS, WISCON:IN oell , I 16 0 f , 0 t.. 4; Po A4 100 0 BOO P r � , STATE OF WISCONSIN . r2L CROIX- - COUNTY, CIRCUIT COURT PROBATE BRANCH SALE OF REAL ESTATE OF PERSONS UNDER LEGAL DISABILITY —DEED BY GUARDIAN WHEREAS, On application to the Circuit Court of _ �St. - CrnG_.x County, Wisconsin, to sell all right, title and interest of Leo T . Domke, also known as Leo Domke pendthr1ff-- , in and to the real estate hereinafter described, such proceedings were had that the undersigned was duly authorized as guardian to proceed in said matter; -H rr sr rt -L, S-pt Lift? at `=- a ---L -6 e , v ra `#- and whereas, the undersigned, as such guardian, has done or caused to be done all things necessary and required to be done by law in such cases made and provided, before conveyance of such real estate may be made; and whereas, the undersigned, as such guardian, was duly authorized by order of Court herein dated on the 16 th day of December, 19 , to execute, acknowledge and deliver to Derrick Construction, Inc. a deed of conveyance of all the right, title and interest of said Spendthrift . .` in and (I , nV "["" M mat —,AA Li1"jfirtL't7TT t�TET�Tl � "�' j to said real estate: NOW, THEREFORE, 1, the said by authority of the Court above named and in my capacity as such guardian, in consideration of the premises and of ------------------ ------------------------- Dollars to me in hand paid by the said Derrick Construction, Inc, , do hereby grant and convey unto the said Derrick Construction, Inc. all the right, title and interest of the said Le© T. Domke , also known as Leo Domke SDendthrift in and to the following described real estate in _ S t__. _C rc74 j x ( I rISnf""'1V�nor— -6r'7ncompFtEn`r "7 — County, Wisconsin, to -wit: The Northwest Quarter of the Southwest Quarter (NW4 of SWh) of Section One (1) , Township Thirty (3 Q) North, of Range Eighteen (18) West. 6UEG151 OFFKE ST, CR{OM 00, W „ Tm 'd. for Record ft 2nd 7 File No. aE. A R1NG5 A l -L KEFEREIvCCD To t - wE S 1tiINE OF T#iE Sw1 / OF SEC ION ASSUME 11 10 9E AR S00'38'21+E - moon ,.-Ist-or Full Poiy_Aent-tow I _ _ WM-DERRICK CONST INC T13WIL 11 TXTE Sequence - No. 01039 Real s Etate DIARY M KELLY PROPERTY TAX BILL FOR 1998 Bill No. 0007020 -TREASURER 1156 CTY RD G STw CROIX COUNTY Correspondence should refer to tax number. NKW RICHMOND WI 54017 Sao reverse side for Important lnforffwmtlon 715-246-4129 Calauter # 026-1001-90-000 - Assessed Value Land Assd. Value Improvements Total Assessed Val 27YSOO 273,500 PAR 1,30018010 •Asurt. cn > Ave Ratio 81,46% Est, Fair MM. L" Eq. Fair Mid. lryproven-ants TOW Est. Fs w Mkt. A star In this Wx nuns uNOd Pft "a( t"Os. 33r800 33 r 1300 K M 19 i998--- t-ft 0 Net Property Tax 496w17 Est. State Aids Taxing Jurisdiction Allocated Tax Dist. STATE Est. State Aids 1997 Allocated Tax Dist. Net Tax 1998 Not Tax %Tax Change M > z 0 57419 6f,*30 53893 143.64 6e,59 137 32 4 a 6"/, -4.4% C 9--1 ....C13UNTY JOWN OF RICHMOND 130227 NEW-RICHMOND­ 1716180 128254 61e,44 1715965 263e,50 a 60e,52 291,*63 -1.5% 10,w7% > X vo ,UPPER WILLOW REHAB 0000 I VOCATIONAL SCHOO 29706 25915 48w53 49.37 1w7% z z 0 1933532eOO 1924027*00 523,41 Total 545w43 4w2% TOTAL 1 )> Lottery Credit 70w83 49a26 •FOR FULL PAYMENT MM __4 School taxes reduced by Net Property Tax 452 a 58 d___ 9a6% BY JANUARY 31 ?1999 M M 0 school levy tax credit 61e34 I Net Assessed Value Rate (Dbos NOT refoct Wary credit) ;PAY 496w17 $ $ M IMPORTANT: Be sure this description Covers your property. This 0 v 0 19833872 Warning.- If not paid by due dates, installment option is description Is for property tax bill only and may not be a full legal description. BILL NO 7020 lost and total tax is delinquent subject to Interest and if 765/ 166 763/ 590 18-,'990A 026-1001-90-000 applicable, penalty. (See reverse) .01-30N-18W WM DERRICK CONST INC Or Pay I st Installment And Pay 2nd Installment SEC 1 T30N R18W PT NW SW .BEING LOT 8 OF CSM 9/2504 $ 223v46 $ 272w7l 1999 18e,99A f 1505 HWY PO OA 65 BX By. JANUARY 31 By: JULY 31 1999 NEW RICHMOND WI Special special 54017-0000 Charge Paid Tax Paid Special Assessment Paid Total Amount Paid Property atd TaxDue Balance Paid by Rec'd by Date I i VFW Pt • •�..+..,.�+� 1 ---�- __•.fir �..�—""'"�—•"'� � "t"�—�--"�•" �-w-i r. ----� f 40 TH S rPaar �------•- — ... ._ ......_.._.. . .«Z 4, af4o No ,9 c4 r W� a313now ANSIM ., 16*4 mow BMW -MM .� Nowolmm No VA" i r� SIIY ..0"• wry 40=0 ii _ TFF I fora I � a N wr 4 1 ford .. _ _ _'s oow n • Tarr I ,� 1 1 I goo I �: l I I � • , , Y.� — f1'..r ! y + - - j ..-�. ...•.. y r-. - rw�.a.—r r—r � _ ... .. _�. r - .. irc •yr1. •�.. 617n'N ••,. .t. _- •r - e•rs •�.. - *r" iR� ,•4i �~��i i.S+. �,y�i .ar+.�'�t:-� ...® _ ... t'r..yG.�f �• . -� '� rJ'. 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