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HomeMy WebLinkAbout026-1065-50-200 • A STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER :Lyno- S d?~ tr 'L ADDRESS c;~A-3dy~ /d' SUBDIVISION / CSM# Q CLOT # O SECTION 4Q T 30 N-R IS W, Town of 11 1 G~vr~rC7~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i 5 ' 41 9m' b INDICA E NOR H ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: 44-sh4la ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well ~d House 4*9 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: .S Length (~6 Number of trenches C9_1 Distance & Direction to nearest prop. line: /oZ.5 Setback from: well: A)AI .1 House d 'Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system. /moo. Existing Grade Final grade -ell DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 289355 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: BLITHE, JAMES RICHMOND CST BM Elev.: Insp. B BM Description: Parcel Tax - ? 0266-1065-50-000 CI) TANK INFORMATION ELEVATION DATA A9700171 '91&&Iq'7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6c-)r eccr Benchmark Dosing Aeration Bldg. Sewer Hold' St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit TANK TO P/ L WELL BLDG. Aii to ntake ROAD Dt Inlet rl Septic 5U> >z 2 k 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 Ft TDH Lift L Ion Y I n Length Dia. Fi Dist. To wen Forcerrr SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length , No. Of Trenches I'1T_ No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 90 DIMEN I LEA Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL INFORMATION Type O a%.,, UMBER Model Number: System: sn.w OR NIT DISTRIBUTION SYSTEM Header /faTd Distribution Pipe(s) x Hole Size x Hole Vent To Air Intake i / Length 7`I Dia. sf ~ Length f~ Di a. Spacing SOIL COVER x Pressure Systems Only xx Mound Or A rade Systems ly Depth Over TE epth Over xx Depth Of xx Seeded/Sodded ed Bed /Trench Center e d /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 22.30.18.331,SE,NE 1290 146TH AVENUE LOT 2 a Plan revision required? ❑ Yes ❑ No Use other side for additional information. FE Ll I SBD-6710 (R 05/91) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau 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 8 112 x 11 inches in size. ST G ','x • See reverse side for instructions for completing this application State Sanitary Permit Number a?17 3 53- The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property O er Name Property L cafion 13 MO-C, 6, S11r__ N 1/4 ' 1/4, S T 30, N, R ~~r) W Property Owner's Mai ng Address 11 - Lot Number Block Nt~rgb 5 rte: Q 011t e-T nJ Ci St e Zip Code one Number Subdivision Name or S umber k 305(yin ay -s a5 5 I.,E~ U o` o II. TYPE OF BUILDING: (check one) ❑ State Owned city Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ❑ Townn of i III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo O a r0 f b (O5 ' s0 JAW 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. ❑ Repair of an System System Tank Only______________ Existing System _________Existing System B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 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) 1& Elevation 50 qOD ?40 t /DO Feet /O Feet TANK Capacity VII. FORMATION in gallons Total # of Prefab. Site Fiber- Exper. Gallons Tanks Manufacturer's Name Concrete COn Steel glass Plastic App New Existing strutted Tanks Tanks I per o ov~ to, .1 Septic Tank or Holding Tank (70G to e, _2 Lift Pump Tank /Siphon Chamber ❑ El VIII. RESPONSIBILITY STATEMENT El 1 1:1 1:1 I, the undersigned, assume responsibility for insta jon of the onsite sewage system shown on the attached plans. Plumber's Name: (Pr Plu er's Signatur : (No am s) /MPRSW No.: Business Phone Number: aa : r\ A eo 0-,) " Q_ I r r~ 1503 `r L 5 _oZ (o - 5 f ~S Plumber's Address (Street City, State, Zip Code): A t =n sto IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (!"dudes Groundwater ate Issue Issuing Agent Signature (No Stamps) 'Approved ❑ Owner Given Initial Surcharge Fee) Lik Adverse Determination 'I y I/ V X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Di-ion, Owner, PlurnWr INSTRUCTIONS i 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. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815._ To be complete and accurate this sanitary permit application must include: 1. Prope-ty owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2'x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; Q soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i t ' I I I I ~ i i I Y r I _f 1 . I t' Pf"i , I~c -1 - I r l I i I I I 1 I _ a9 I I I I i I I i , I i I I I I i G ~IL - - I- - CJr -t- ! ! L ' I Aim 1 ' I i I I I i I I ~ I 40 1 -~-I- i - f i - I ~ ~ I I I i I I I i i i I I ~ I I I , I - i - I_ t 1- I I I I I I ! ! it I I i i I ! I_ I I I I I ~ ! I ~ ' {r'~" cr~ I ~ I , I I I i 4 , I ~ i C I ' i I i i I I ' ! I ! I I I ' I i ' - i - j - ' I i f i ~ I ~ i ~ I I I i ~ I I I I ' i _I i I I , , I I , - ~ j ~ I I ( ~ I ~ i ~ I I 1- : 1 I 1 : I r , , i + 1 1 I + ~ ! I ~ ' I I I _ I f I r I : r I ~ I I I I I I ~ ~ I : I I : I 1 I I ' I I I i i ' I I + _i _ ~ L ' ~ ~ ~ I ' I I I I 7 - 11 , - t ' f- ~ I I I ` I : I ' ~ a I ~ I -I t 1 I I ~ I - - ! - r I ~ i - I - I I I - I I fi I - i I 1 I I - r- ~ r I 1 i 1 \ n 11 PAGE OF . `.rvSS S~c~lOr, o~ A ~rl~ S~Ste~-~ • w • .F Fre►A At( Inlol► And Ob►ervallon Pipe Approv4d Vent Cap Minimum 12* Above final Grade 20- 42' Above Plpp _ 4" Cool Iron To final Grade Venl Pipe margin hot Or Syn•nelk Coverlny min 2' Ayyreyal• • . Over Pipe Olerrlb~lion a Pipe o 0 -Too 0 b~ Ayyreyote Perforated Pte bete. Beneelb Pipe o V o -Covp11n0 Tuminollna AI 8otlom Of System SOIL FILL OISTK►BUT101.1 PIPE • APPROVED S'10 lETiC COVER- OK 9" OF STRAW 2" oF A G G R E G Al E OR MARSH HAy /~D Ie0FAGGREGATE ELEV. OF r FEET_~ - T DIS-rRI61JTi(.:)IJ PIPE TO BE AT LEAST 3& IIJCHES BELOW ORIGIMAL GRADE AQU AT LEAST LO INCHES BUT 1.10 MORE THA/J 42 IKICHES BELOW FINAL GRADE /"tMUM DEPTH OF EXC/IVATIO0 FROM ORI&WAL 6RAoF- WILL BE INCHES mKiMuM gEr" OF EACAVAT100 FROM, 04~14INAL C3R4pF_ WILL BE 3G INCHES SIGME0 LICEUSE AJUMBER: DATE:_~~ 110 XMsconsin Department o Industry, SOIL AND SITE EW N R E P U H I rage i of -D Labor aj-d Human Relations Division ot,Safety & Buildings in accord with ILHR 83.05. Wis. Adm. Code COUNTY Attach complete site plan on paper not less than '8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. 0-_7&- G &!5- APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWN PROPERTY LOCATION O n a~-r Y~ I C- t< GOVT. LOT S 1/4 n1 1/4,S Z Z T 30 N,R ) 9 f .(or) W PROPERTXER':S M !I.ING ADDRESS LOST # BLOCK # SUBD. NAME 0 CSM /.7 I CITY, T ' ZIP CO'E PHONE NUMBER ❑ClTY QVILLAGE [OWN "A ST ROAD ~ m GUS , o f 7 (7~~ z'ttlo -5+z 5 New Construction Use [ -A- Residential / Number of bedrooms -_7 ( ] Addition to existing building j ( Replacement [ ] Public or commercial describe Code derived daily flow So gpd Recommended design loading rate __Ll_bed, gpd/ft2 ; .5- trench, gpd/ft2 Absorption area required //z s bed, ft2 ~Fq o trench, ft2 Maximum design loading rate I_bed, gpd/ft2 h trench, gpd/ft2 Recommended infiltration surface elevation(s) LCD 8 It (as referred to site plan benchmark) Additional design / site considerations '~7~FrlNh ~,L~ Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system I 9S Q U ® S ❑ U -®-S ❑ U OS E ]U Q S W'U ❑ S ICU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundarj/ Roots GPD/ft Boring # Horizon) in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I Bed TMrIch 0 - 9 //")Yo 3/ D NG- rrr s,0 S - 5 G, ' y- om p 'fl rU G SG' Z m 5t3/S a~~ ; < 5 Z~ St3/ A/A a 5 Ground -~o o Gf S elev.33 /ca--ft. Depth to limiting factor T 80'~ Remarks: Boring # G_/a 0 i 3/ /O/UC ZrriSG' " 'd LR f" o 5 I C S' S /W e4-tv rv.~ , _5 Ground elev. 33 103 ft. Depth to limiting factor Remarks: CST Name: Please Print Phone: Address: / Signature: n Date: CST Number: ~J z y 1 PROPERTY OWN rte ,c- SOIL DESCRIPTION REPORT Page G;' of PARCEL I.D. 8 006 - /0 6 5 -56 Boring # Horizon Depth i Dominant Color Mottles I Texture . Structure Consistence iftrc ry I Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed iTrer& i Ground O So v '4/ ro _ S z m S r'L A S i elev. / ~ ' Tf. Depth to limiting factor r r,o I I i Remarks: Boring # JoytZ4A SO I ?r" -5/61-< Ground elev. q g Depth to limiting factor 17 Remarks: p Boring # /1)0 IV Ground elev. q~ Uz ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: S' 330(R.05/92) s . STEEL'S SOIL SERVICE Gary L. Steel e C.S.T. 2298 0YI& New Richmond, WI 54017 MPRSW-3254 f / p t (715) 246-6200 St-- Y+ N c-Yjj- s I.~. ry-~-Ctvt(j Z, jai 4- 6 39 Can we y Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of ,Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ZVI ~J not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 0Z&-J0&5- 50 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNE PROPERTY LOCATION GOVT. LOT S 1/4 nl L 1/4,S 2 Z T 3 p N,R 1 fs (or) W NER':S MA!l_ING ADDRESS LO BLOCK # SUBD. NAME 0 CSM PROPERTY 0 CITY, T gTIE) ZIP CODE PHONE NUM SCI WGE KOWN NEA ST ROAD ~7 ( 017 (7i~ Z y k ~j New Construction Use Residential / Number of lid ooms 4 [ ] Addition to existing building j j Replacement [ ] Public or commercial dssriie 1 Code derived daily flow 50 gpd . ReOmmendetl doson loading rate...! bed, gpd/ft2 . 5 trench, gpolft2 Absorption area required z 5 bed, 112 o trench, ft , "Waximni . ign loading; mate , -4 bed, gpd/ft2 ' trench, gp~ Recommended infiltration surface elevation(s) /60 /8 _ ft (as_eferred to site plan benchmark) Additional design / site considerations ZFr~c~ L_ Aeon Parent material _74a ~Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem 9S ❑ U ®S ❑ U JaS ❑ U OS ❑ U O S RM ❑ S au 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 Tmnch Ground _---3.2f-9b Li) 0 07 S zmSt3 M 4L IV,4 4 5 6, elev.33 Depth to limiting factor T olt Remarks: / Boring # / ~ ~D 0 iZ 3/ ~f4/1/C- zrr/St3 ~ a la- ZL2~ l >2 / O r► C 1 rn 6' C~ 9' / G S l St3 rtr I/f~ .5 Ground elev. 33 /03 ft. Depth to limiting factor > 8o, Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number: PROPERTY OWN r)6~r,^, Cv- K'- SOIL DESCRIPTION REPORT Page, L- of "'3 PARCEL I.D. # ~Z(c /0 6 5- 6 ) Depth Dominant Color i Mottles Structure i GPD/ft Boring # Horizon I Texture Consistence IBou Y Roots i in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed ITrericin I I / o-q o IzW7sr~K Ground 0,80 C, to 6- 5 Z vYt S r2 fl I , elev. j Depth to limiting factor Remarks: Boring # So I on-7 Ground ®v0 C S 1 j HI-Se-j- ✓°~t, v,-9- elev. y /o z t. Depth to limiting factor yam„ Remarks: Boring # ( -~Z p ~3/ Y, 44 ~v Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE 5- ; Gary L. Steel e C.S.T. 2298 'I Y' r New Richmond, WI 54017 MPRSW-3254 J p 4 d (715) 246-6200 SL Y+ A c-Y4- s z. z - -1~-3o iv - ~z I8 ~Y1 K/O sue, A'A- 9L-, 100 d i^ rs !9-r a~ 5~' ~yr 39 -`f r /39 ' g E 561 ~ rh ccz', cvz- 07*X a ~ F11-E'D 9 APR 18 Ag94 515494 ~ ,A~ o'coNNEU ~ cod St aobc CERTIFIED SURVEY MAP Located in part of the SE4 of the NEh of Section 22, T30N, R18W, Town of Richmond, St. Croix County, Wisconsin. OWNERS AREA Loren D. Derrick LOT 1 " 2.41 Acres (104,885 Sq.- Ft:) Rose H. Derrick Richard L. Derrick LOT 2 2.00 Acres (87,161 Sq. Ft.) o 39 Joan L. Derrick Ld yJ n LOT 3 2,00 Acres (87,162 Sq. Ft.) „ Robert J. Derrick H 1310 Highway 116511 Lot 4 2.00 Acres (87,161 Sq. Ft.) o 4- c u ° z New Richmond, Wi. 54017 C.4t Y W L L Z A N P' ATTCD ANDS _ . - - 4 o 44 v ~ L o v • io d ® NE CORNER o, YY~f' C/) I S89°43' 03" W 339.73' SECTION 22 J M C) l ON I + H G © 1 co W N U S89 43'03"W 273.7 I Jr a a0 0 L (0 M M v Z _ LOT 4 I-i c )i I- N to a a L71 < L I CO o L I ~ 50': ( I n j o S89°43'03"W 337.!3' 80, 4d W v _JI __I Q w o.. In . ~7( `n o ~ 0; 00 t.s01 M I W 0 x S890431 0311V 543.48' L~J LOT 3 0 0 o M $95.61' ` Q 80.00' 3 cn 0 = I- I 0 V) p~j .~h2 'l M _ I I 10 ~ N 60 i O Ln N <1 (D _j W-4 66' LOT I M H (D uiI cL ® ® \`L N z I LOT 2 7°2500" N~ z;' ®'~0 80.00' 0 N 239.08' Inq A, ID °1 S89°39'31"E 289.08' o~~iP cN\i z° \ ROAD c 589039' 31"E X137025' 0011E Son ti APPROVED 289.08' 50,00' _ 8 °0 a ' U N IDI-A T i ED `P\%NDl Z APR 16 '4( ro to 1 U_ _ lL V W LEGEND ~ N ST. CROIX COUW* • r SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin, Land Surveyor, hereby certify that by the direction of Loren Derrick, I have surveyed, mapped and described the land parcel which is represented by this Certified Survey Map; that tt,c exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of 'the SE1/4 of the NE1/4 of Section 22, T30N, R18W, Town of Richmond, St. Croix County,; 'Wisconsin; further described as follows: Commencing at the E1/4 corner of Section 22, thence N00011'53"W, along the east line of the NE1/4 of said section, 500.75 feet to the point of beginning; thence continuing N00011'53"W, along said east line, 226.12 feet; thence S89o43'03"W, 543.48 feet; thence N01o54'16"W, 348.83 feet to the point of curvature of a 80.00 foot radius curve,.concave westerly, whose central angle rrL-asures 270008'20", whose chord bears N00016'57"W and measures 113.00 feet; thence northerly, along the.arc of said curve, 377.18 feet to the point of curvature of a 80.00..foot radius curve, concave northerly, whose central angle measures 411004'10", whose chord bears S67010'58"W and measures 61.32 feet; thence westerly, along the arc of said curve 62.93 feet; thence 5890 43'03"W, 339.73 feet; thence,, S000 16' 57"E, 623.00 feet to the point of curvature of*a 233.00.fQbt radius curve, concave northeasterly, whose central angle measures 89022'34", whose chord bears S44058'14"E and measures 327.71 feet; thence Southeasterly, along the arc of said curve 363.46 feet; thence S89039'31"E, 289.08.feet to the point of curvature of a 233.00 foot radius curve, concave northwesterly, whose central angle measures 52055'29", whose chord bears N63052'44.5"E and measures 207.65 feet; thence northeasterly, along•the arc of said curve 215.22 feet; thence N37025'00"E,;- 50.00 feet..to •the point of curvature of a 167.00 foot radius curve, concave soutAasfer`ly, whose central angle measures 52023'07", whose chord bears N63036'33.5"E and measures 147.42 feet; thence northeasterly , along the arc of said curve, 152.69 feet; thence N890 48' 07"E, 80.00 feet to the point of beginnings. Above described parcel contains 12.25 Acres (533,734 Square Feet) and is subject to all easements of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in survevina and mapping same. CURVE LOT RADIUS CENTRAL CHORD CHORD ARC... TANGENT TANGENT NO. NO. LENGTH ANGLE BEARING LENGTH LENGTH BEARING BEARING 1-2 4 • 80.00' 45°04110" S67°4415211E 61.321 62.93' N89°4310311E S45°1214711E 2-3 80.001 270°081201' NO0°16'5711W 113.001 377.18' S45°1214711E S44°3815311W 3-4 80.00, 4500411011 S67°1015811W 61.321 62.93' S44°381534 S89°43'034 CERTIFIED SURVEY MAP Located in part of the SE4 of the NE4 of Section 22, T30N, R18W, Town of Richmond, St. Croix County, Wisconsin. OWNER'S CERTIFICATE OF DEDICATION As owners, we hereby certify that we caused the land described on this plat to be surveyed, divided, mapped and dedicated as represented on the plat. We also certify that this, plat is required by 5236.10 or S236.12 to be submitted to the following for approval or objection: St. Croix County Comprehensive Planning, Zoning & Parks Committee and Town of Richmond. WITNESS the hand and1s9ea of said owners thist 5day of APPROVED la .0'r In the presence of: APR W' ne s ore D. Der ickt X COUNTY _ iva Plam* Ri rd L. Derri R e err "~9and arks Canmiftw Jo L. Derrick obert J. Derrick 11 not recorded with h 30 dM of approval d&% State of Wisconsin ) SS 100mapohs#bo nt & County of St. Croix) void . Personally came before me- this f Sday. of. Po r 195 the above named Lorih-D: Derrick, Rose H. Derrick, Richard L. Derrick, Joan L. Derrick and Robert J. Derrick to me known to be the persons who executed the foregoing instrument and acknowledged the same. „ Uary Public, $A' CrD i X ,Wisconsin My Commission expires ~ ` ti .1?^ red; . . TOWN OF RICHMOND CERTIFICATE I hereby certify that this Certified Survey Map is approved by the _ ichmond Town Board. 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 ~LLM~-S e:>. bL4-r~ Location of property ~)G 1/4 0%6 1/4, Section Z2 T 190 N-R W Township VA c.4 rA0 KO Mailingaddress ~lS PwCAE: 141 . C0'-4VZT b%A ri p U A '~0S i 43 Address of site a 0 / 4( ~ Subdivision name LS M 01J X145 Lot no. Other homes on property? Yes X No Previous owner of property Uop-eN, Total size of property 1,610 Total size of parcel Z"Jo p-CV Date parcel was created 4 - Is * 9 + Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes No Volume 1181 and Page Number G91,"' as 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 in the office of the County Register of Deeds as Document No. G7b00-b-1 , 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. ycoo 0 ature of Applicant Co-Applicant 6o 9 __7 Date of Sianature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ) P N1qS Q2. rJ~L ~ MAILING ADDRESS I %C.7 i7r--vt.G jtwS Gou aT, eMfo3 t t , la A, S 100 PROPERTY ADDRESS /al 1 io ) ' 4 y1 ~ 1~ ^ (location of septic system) Please obtain from the Planning Dept. S CITY/STATE gcW IWAc44v%AO W Q,, \03C PROPERTY LOCATION A::*, 1/4, 1"~ 1/4, Section T 140 N-R W TOWN OF t MO U0 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER r7 CERTIFIED SURVEY MAP VOLUME JO , PAGE Z74S, LOT NUMBER y 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 Julv 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 returned to the St. Croix County Zoning Officer within 30 days of the three year ex iration date. SIGNED: DATE: ~a1 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 "/03/97 TITE 12!36 FAX 715 386 4687 REGISTER OF DEEDS 0001 • ~ rQ„tom bQCUMENT NO. WARRANTY DEED 560037 VOL 1241. Pu 592 0 C "`'M F Sr CROIX CO., W1 TIM DEED, made between Lorm D. Derek, Rose H. De Rick, MAY, 2 $ 199" Richard L. Derrick, Joan L. De Birk, and Robert J. D*Tkk, Grantor, said - James B. Bllthe, Sr. and Suraruae Blithe, Glztntee, 11:0 0 A 1M ~ . ~ WITNESSETH, 'T'hat the said Grantor, for a valuable cousidembon of d rfreoa one dollar and other valuable consideration conveys to l3rantee the following deschbW seal estate in St. Croix County, state of Wisconsin: „"""•'i"`"""" Lot 2 of the Certified Survey Map recorded in Volume. 10 of Certified RECORDING 1190BA"TION Survey Maps an page 2745 as Document No. SL9494, bring a part of the , . Southeast 114 of the Nord"fit V4 of Section 22, Township 30 North, NAME AND RET~JkZd ADDRErSS Range 18 West, Town of Ricbmond. I&A./ k 'SFER 026.1063-SO 200 (Parcel Identification Number) This is not homestead pmpmcty. Together with all and singular the hereditaments and appurtenances theramto belonging; and Grantor warrants that the title is good, indefeasible in fee simple and free and cleat of co mbramces except: Eases, highways, utility rights and reservations of record, and will warrant and defend the same. Dated ,*is day of Mew' w (SEAL) (UAL) &wn • • L.1)artick (s1aAL> (sue-) AUTHENTICATION ACKNOWLEDGEMENT ) sigatgwo(s) of STATE OF WISCONSIN sa. ST. CRODf COUNTY ) autttenticatcd this - day of Pononally come before tae this day of MAY I9_V_, ttw abow aaamed + Long D Dudek Rm H Dor&k, Richard L Dtai& low t Donick and TITLE r ER STATE BAR OF WISCONSIN _ Re~beit I. oinkk_ (If ,sot, , : - •r known to be the person_n L who .saaectned the ibeegoing instrument authcriwd by 1706-05, Nrs, Stets.) ad acknowledged then=. TF11S IIJSMUMENT WAS DRA1r= BY: . Sprott Irlmomy J BASE NORMAN, S.C.`~ NEW Rlic:ffi19OND, WISCONEN Sad? $ r.. r pub t, _ County, V'rManain •lvamw of patrons sighing in nay capwky should bts typed or slow thin tCoua aiasien Bxplaea- aigaetu[oa. '3 ti;•1" i '•W