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026-1049-70-200
o m °o I ~ °o N 3 0 3 C; O r» p E» h m a o 0 wo o m rn I ° m I ~ as n 1 E c vi h 1 v, I o Q rn a 0 C C N y y N ; C 3 (n o N C Vl N I,~ C Z C I c Z y i n I LL c€ LL c C y x c -0 a d Q C.0 I I 3 Z E Z E ao z o « o Z ~ m I ~ m H z I o I O z III c c 'o Q 0 0 N H Z r E E '2 'C O a) .0 N M I I N a N m U) U) y c • m m a`) 0 (D z w I 0 z H z z co N Z v m m ~ C'41 rrni E > E m 10 2 2 a m 3ooa m ~N I o 3 3 a u 1 o s s a s z 0 l 000 000 = IL M IL CL IL IL cn CL m'JU M o ~rnCY) 0) Z ~ Z Z rn y \ = = ino v moo -o E t mI c r m c a 0 rn Q O N Q m ° o m Q Z Q Z in co w 0 0 0 W m e e a c 0 C-4 c H E r- 4) :3 co 0 ° II' o c o o c T N n o n C n O Op C Y `p Y O E o 5, 0) 4. C14 4 c n ° ccl t .4) m y O w o N V) 16 E N Z > N O Z C =3 E •O O> N O Z S cc CC ` V b = I = € II v~ r €a a • ay mad' ma E c w c °f 0 'o 0 IL ~ai02 ~ ~N0 A 1 Parcel 026-1049-70-200 08/12/2005 04:53 PM PAGE 1 OF 1 Alt. Parcel 17.30.18.252B-10 026 - 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 O - SANDMANN, ROBERT R & KATHLEEN M ROBERT R & KATHLEEN M SANDMANN 1591 100TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1591 100TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 5.070 Plat: 1103-CSM 14/3914 SEC 17 T30N R18W PT NW NW BEING CSM Block/Condo Bldg: LOT 1 1413914 LOT 1 5.070AC EZ-U-1406/215 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-30N-18W NW NW I Notes: Parcel History: Date Doc # Vol/Page Type 09/08/2004 773715 2651/341 WD 08/31/2000 629144 1539/165 WD 07/23/1997 1118/419 QC 07/23/1997 766/40 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.070 54,000 174,700 228,700 NO Totals for 2005: General Property 5.070 54,000 174,700 228,700 Woolan0.000 0 0 I Totals for 2004: General Property 5.070 54,000 171,900 225,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 146 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 6 //.04 "I RONALD F. >r't p~ 2 JOH S-1186 A NSON AM~RY. 6 2Z zz 7 Wis. 2 a 3 < r -e fO~,~s J KPH t%0 D~ -1 OV I 'W VEY MAP Located in port of the Northwest Quarter o h Quarter of Section 17, Township 30 North, Ronge 18 Went, low() of Richmond, St. Croix Coon , isconnin. Prepared for and at the request of: 1 F~F~ D M L5 a OWNER: LS John C. and Eileen Van Dyk 4b County Section Corner Monument 1591 100th Street of Record New Richmond, WI 54017 • Set 1" x 24" Iron Pipe weighing NOV -2 20 Drafted by. Ty R. Dodge a minimum of 1.13 pounds per linear foot. ST (,000' • • • • • • • • • • • .Denotes Building Setback Line W 3 (100' From R-O-W) l a i : : O o a 0d, y -X -A- Denotes Existing Fence z i 2 to rM UNPLATTED LANDS " I ( EXIS7JNG FENCE 7VPICAL o V I /F rrJ -dF -df aK _.X __'y -X-1F- -X-Jf- iK- E rn SOO'52'46"E 830.07' o_ cn_ - c' N W y oa EXIST LINE OF THE NW 114 a~i N l N N OF THE NW 1/4 > O M N c o 1 / 0V$ v I I g X OO > -a Or- 1 w I I p2 ~p GV ° a ai 1 I O: c w m o t2 U> W O ~ A V p J V C a -a I < FAN l~ o,, c° k Zzz Q c m ~ c°> o i Q~U_ 2A yZ a U O \ Z O vl E am 3 <oN E c 3 I ,I~ lu z4z 2t ~ 0 C) W'U a~ c0 f F5 ~o L O T 3 U W Q q U C a~ O N a o 1 W (4 LLI O w a 1,: a~ 3 a~ n N I (f) ` a a>i ° vi0 C) cnl q tu~ Q W 'i in 0 MW 'W nv d tlI E N a° rnlSI O i7 ti H ~p> 1 SI ~QW^Q y o °c'~ a~2 j M W N o}~ N °I ~L~j C) _j F_ 0 N 'K o01 ` N N W v j O in a a., 1 V) U) N o~ (Do iaNQ (j ~t a 0 g~6~ O V~ ~ 0 F0 - as°o I OI U m o~ J Mk Q Q) 0) a' Z ;n U,m•s i - rn ~W ON o W H O W V O W c I Qp N00'37'29"W 434.72, °a3 a 2 1 20- N-4 ^Q 0 ►~Qr~V Wcoo~ U w m a i lA a.a o _ 00 zFa a0 o6 ~ ~~®S 1~ N 00 ~ J 04 [t SOO.37'29N N I zoo 66.00' L O T 1 QQ ~o~ p 0 S/Og'3T29"E 329.31' to w B p to V G) W N 'K "K 01 r, o° n...... ,BOO bZ ~tL. ~~Nh Nv 'c) b 2 ~ \ 1 i MN -S0037 29"E-,,i ,ao rn--830.03 1 1\ \ I 329.31' M i 1 R-O-W _434.72' _ 4-• - 10071/ AVENUE N00'37'29"W 1796.7.9 - - 329.31' 66.00' _ _ _ _ _434.72' j~ i oI-I7~ N00'37'29"W 830.03' - - - - _ - - •'~n ai N00'37'29"W----2626.82'---- ~ 100TH STREET I I JOINT DRIVEWAY EASEMENT ~i ` UNPLATTED LANDS RESTRICTION: LOT 2 MUST al I WEST LINE- OF THE NW 114 ACCESS AT LEAST 200 FEET Y , JOB # A00080 zl II I FROM THE CENTERLINE OF 2 0l =)I 100TH STREET ON THE JOINT Prepared by (01 1 200 0 200 DRIVEWAY EASEMENT FOR V A E POSSIBLE FUTURE TOWN ROAD LAND SURVEYING do CIVIL ENGINEERING EXTENSION. n Phone No. (715) 246-4319 GRAPHIC SCALE (n ~j 109 East Third Street, P.O. Box 325 SCALE IN FEET: 1 inch = 200 feet W New Richmond, WI 54017 BEARINGS ARE REFERENCED TO THE WEST LINE OF THE NW 1/4 OF SECTION 17, TOWNSHIP 30 RANGE 18 W. 00 Sheet 1 of 2 WHICH IS ASSUMED TO BEAR N00'37'29"W . _A. Vol. 14 Page 3914 r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ \V/& 5 ADDRESS 91 7 U~~~ SUBDIVISION / CSM# o rD~ ° LOT # )lam SECTION _T 3d N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1y 01 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manh cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer- Liquid Capacity: Setback from: Well- House Other Pump: Manufacturer Model# - Size Float seperation v Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: Q Length 2c,;> Number of Distance & Direction to nearest prop. line: Setback from: well: 7 House- Other g ELEVATIONS, S ~9 91, Building Sewer ST Inlet; emzm ST outlet PC inlet PC bottom Pump Off Header/Mani old ;,e (v Bottom of system Existing Grade 99 Final grade 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 GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: VAN DYK, JOHN El City El Village ❑ Town of: State PI o.. CST BM Elev.: Insp. BM Elev.: BM Description: X Parcel Tax No.: r TANK INFORMATION ELEVATION DATA "7 25-1 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -5JQom; Benchmark Dosing Aeration Bldg. Sewer Holdi St/I/Inlet 5.83 Q~S' TANK SETBACK INFORMATION St// Outlet ~ 1 n/ 7 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >c, CD Z NA Dt Bottom Dosing A Header/Man. Aeration NA Dist. Pipe Holdi Bot. System PUMP/ SIPHON INFORMATION Final Grade M nd 9S, F1~ Model Number GPM TDH Lift LFiction System TDH ~Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length _ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DI EN I SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM L Manufacturer: CHAMBER INFORMATION p~ > ~Sd J OR UNIT Mo m System: DISTRIBUTION SYSTEM Header f DistributionPipe(s) x le Size x H acing Ve oAir Intake Length tir Dia. Length _w Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At- ems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoi ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND.17.30 18W, NW NW, 100TH STREET J11 1 r Plan revision required? ❑ Yes No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~I SANITARY PERMIT APPLICATION NT e:llll~-lllr>•lllr~ In accord with ILHR 83.05, Wis. Adm. Code COUNTY 5 *t Y C yolk STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ a46 ! a b 8% X 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. Alp- PROPERTY OWNER PROPERTY LOCATION k U&AA PL) /T/~it~'/4 s)('/4, s 1 T .34 N, R /,#*Ror) W PROPERTY OWNER'S MAILING AP9RESS LOT # BLOCK # `1 7 /y v-&- N /9- /U l~- CITY, ST AXE UAW PHONE NUMBER SUBDIVISI N NAM OR CSM NUMBER "hrrCJ l 41 5 W / - 5$ A- -2S crss II. TYPE OF BUILDING. (Check one) -1 State Owned ❑ VILLAGE: NEAREST ROAD _ iqui Q ~QWN OF: -1 I-A Mm rij zo 0 ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms Y_ PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) a /d it -76 . /$O 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. XNew 2. ❑ Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5.E] Repair of an System System Tank Only Existing System 3E i ~ Sy em -73 B) ❑ A Sanitary Permit was previously issued. Permit Date Issued 'r('7 lq V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank .12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) pELEVATION S 8 Q ~ 17 ~$~5 Feet ! S Feet CAPACITY VII. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank /two ?1s-~' 7 L4 Ej ift Pump Tank/Si hon Chamber L VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation f the onsite sewage system shown on the attached plans. Plumber's Name (,P~ Plumber's Sign ture (No Sta s) Mfr/MPRSW No.: Business Phone Number: t 11jin d we r-P 1-56.3 Plumber's Address (Street, City, State, Z' Code): Ix. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit (Includes Groundwater Date Issued Issuing Ag t big t re (No Surcharge Fee) Approved ❑ Owner Given Initial '/fX Adverse Determination S'am' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber j INSTRUCTIONS n 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will The 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6396 (R.11/88) t S4.14.2 7L- ~f v o A I x- G < . / l ~ts JT Q y~ lb) L 1 y' 9 U S ` C t 0 r1 O f'1 1') t 0 y A Tr "b(• Flesh Atr Inlet► And Ob►Stvallon PIPS a4e Nn. L_T^-Appfo,%d Vent Cap Lj latnlmum 12- Anere final Credo 20. 42' AEora Plpj Coot Iron To final allies Now PIPS wren Hat Or Srnln.lk CSrertnq yrn 2' Aggraqele Orel PIPS OletflDVltoe -Tie + PIP• a e e B' Aggraqate o %floretee PIPS below inSeI► Pip• B o -Ca.ptnq Terminellnq Al Bottom of Stelem r v")J;on SOIL FILL DISTK18UT101.1 PIPE APPROVED S4}1T1AETIC COVCp r 11ATERIh1- OR 9•r OF STRAW' 2"oF hGG9EGAlF. oR MARSN HAS S ' r L 0 Rlz-2l/2 'AGG-RCGATI: ~0 ELEV. OF FEEyY .31 DISTRIBrUTIOM PIPE 'TU 0E AT LEAST INCIAIES BCLOW ORIGIIJAL GRADE ANU AT LEAST" LO MUCHES BUT 1.10 MORE THP M 4Z MUES 6ELOW FINAL GIIADE MAXII1uM Mrli OF F-)(CAVAT100 ~?,OM OK16 JAL 6f 1,NK WILL BE eye _ INCHES 'rt Jt(IMVM ©Ep rN Of: EACAVATICO f-P\O 1 c, 16IMAL ~RrID WILL BE INCHE S SIGIJCO: 67 LIGCUSC 1.1UMBER: DATE: eon.. 'b,,jp . . Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 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 St. Croix 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. 026-1049-70-100 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION John VanDyk GOVT. LOT NW 1/4 NW 1/4,S17 T 30 N,R 18 )dor) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 917 140th. Ave. na na 25 acres CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®fOWN NEAREST ROAD New Richmond, WI. 54017 (713 246-5557 Richmond 100th. st. 1:1 New Construction Use Jx J Residential I Number of bedrooms 4 Addition to existing building j J Replacement J J Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpolft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate __,.7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.50 alt.=98.05 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ❑ S ®U E] S ❑ U ❑ S ® U ❑ S E7 U ❑ S (au SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture structure Consistence Barxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench •ivLti•}k: K•:i ' 1 0-9 10yr3/3 none 1 2msbk mfr gw if .5 .6 2 9-30 10yr4/4 none sil lmsbk mfr 9w na .2 .3 Ground 3 30-36 7.5yr4/4 none is Osg mvfr gw na .7 .8 ev. 98 35 ft, 4 36-80 7.5yr4/6 none co s Osg ml na na .7 s .8 Depth to limiting f+80 Remarks: Boring # 1 0-8 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2..-.',' 2 8-27 10yr5/4 none sil lfsbk mfr gw if .2 .3 3 27-82 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 98.05 ft. Depth to limiting factor +82" Remarks: CST Name:-Please Print Gary L. Steel Phone' 715-246-6200 Address: 1554 0th. ave., New Richmond, WI. 54017 Signature: Date: CST Number: I- -_~Ialnl or, 7-20-95 cstm 02298 PROPERTY OWNER John VanKyk SOIL DESCRIPTION REPORT Page? ' of_, 3 PARCEL I.D. u 026-1049-70-100 Boring # Horizon Depth Dominant Color Mottles (Texture Structure Consistence Bourd3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ffmnch 1 0-11 10yr3/3 none 1 2msbk mfr gw if .5 j .6 3 ?<_< <i 2 11-15 7.5yr4/4 none sl 2mgr mvfr gw na .5 I .6 Ground 3 15-96 7.5yr4/6 none Co S Osg ml na na .7 .8 elev. i 100.00. Depth to limiting factor Remarks: Boring # 1 0-15 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 4 2 15-24 7.5yr4/4 none sil lmsbk mfr gw if .2 .3 3 24-96 7.5 r4/6 none Co S Osg ml na na .7 .8 Ground elev. 102.05ft. Depth to limiting factor +96" Remarks: Boring # 1 0-12 10yr3/3 none 1 2msbk mfr gw if .5 .6 h 5 2 12-36 10yr5/4 none sil lfgr mfr gw if .2 .3 3 36-42 7.5yr4/6 none is Osg mvfr 9w na .7 .8 Ground elev. 4 42-90 7.5yr4/6 none Co S Osg ml na na .7 .8 102.35 Depth to limiting factor +90" Remarks: Boring # Ground elev. ft. Depth to limiting factor I Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel John VanDyk 1554 200th Ave. CSTM2298 NW4NW4 S17-T30N-R18W New Richmond, WI 54017 MPRSW 3254 town of Richmond (715) 246-6200 4- N 111=401 BM.=top of sill plate of basement walk out door C el. 100' 2 I Z ' 3~' `4-- ~0 0,4 ~o`l'> L S 30 3 ~ a. Gary L. Steel 7-20-95 wbisconsm Department 95 - C6 o. M of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Huma ;.Relations INSPECTION REPORT ST. CROIX Safety a,d Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Pel_m_i;No1 yk,amy0HN ❑ City El Village ( Town of: State Plan D No.: CST BM Elev.: Insp. BM Elev.: M Description: Parcel Tax No.: B - A9500103 TANK INFORMATION ELEVATION DATA 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. Syst PUMP/ SIPHON INFORMATION Final G ade V Manufacturer mand v, I Model Number PM TDH Lift Friction System TDH t Loss Head Forcemain Length Dia. Dist. To wen SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches T No. Of Pits Inside Dia. Liquid Depth DIMENSION D EN I N . SYSTEM TO P/ L BLDG WE LA /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x H e Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. J Spacing SOIL COVER x Pressure Systems Vnly xx Mound Or At-Gr a Systems Only Depth Over Depth Over xx Depth Of xx eded /Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ ❑ No E] Yes E] No COMMENTS: (Include code discrepancies, p rsons present, etc.) LOCATION: Richnond.17.30.18W, , NW, 100th Street Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY Ste. C two ~ ~ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a32 `•t'09 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER 1 JEER PROPERTY LOCATION N Q% Ntv'/4, S l T 3 Q N, R 11W Wr) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 0,l t ! o"`` 4%,~ N R IV 4 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER N ww a lag O t IS )a4 to 5 SS N . TYPE OF BUILDING: Check one CITY NEAREST ROAD 11 ( ) ❑ State Owned ❑ V TOWN ILLAGE ` O Ott s-r ❑ Public 141 or 2 Fam. Dwelling-# of bedrooms* RCELTAx NUMBER(S) OA~ - '049 - ?O _ )Oo 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 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 in line A. Check line B if applicable) A) 1. X 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 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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) Sis ELEVATION 6~ 7.50 7.5v • ! N ~ '7 lk Feet 9Sij$ Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1A50 Lift Pump Tank/Si hon Chamber i VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of a onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu is Signat e: (No mps MP/MPRSW No.: Business Phone Number: ~v~ ~o~e.~s ~Sto3 'l15 01 Lo Sl3s Plumber's Address (Street, City, State, Zip Code): [koct I dg, sv--%j -e- Ki Q-~ C-\.\ rr-a~ UD~L- SV,04-~ IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing ent Signature ( Sta S) 4'Approved E] Owner Given Initial Surcharge Fee) ~ }I Cr9J~ Adverse Determination (J X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 & Buildings Division, 6013-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property, owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of 15uilding 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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 Elie x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil, absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (8.11/88) 1 r._ " a , j 5%Y or ` a , I , M-l r i ± ?9 k E 5 i ~ ~ i ttt t + 1 , , : 1 I r I ' i : JJ , , i E f " " ' y I 1 ~ r : j ~ I f ~ 1 I " , r F_ PUSS S~e~IOn pt I"iel~ is y / l dlb Fr.►A Air INat• And Obiervallon Pipe 14 p// /[`/~7 ~ ^r-Approria Vent Cap N t'\~(.r4/~y~ J 1 1 Minimum 12'ADOra v'VJ'r1 k„J Flnol Grads > 20. 42' Abore Pip? _ 1" Colt Iron To Final Dreaa Vent PIP$ Natn Noy Or SrnlMlk Coverlna Lln 2' Aggregate Over Plpe Dl elr lbullon Pip. o 0 0 - Tea : b' Apprepale o Beneelb Pip. Perioraled Pipe below o Co"Winp Terminating At - Bottom Or SF►lem ~c•- 98'r pro ~~~eD ~jrs.c•It a 9 ~.4~d' ~ ~1r.j*A Ion % SOIL FILL DISTRIBUTiO1.1 PIPE C APPROVED S49PETIC COVCR 2"Of /1,GGREGATE -fir r P1 ATI=RIM- OR 9" OF STRAW OR ARSP RAJ q~ le 1: TF- 40-F FEE 1)15711IF)IJTIOM PIPE TU BE AT LEAST _ IUCHES BELOW ORIGIWAL GRADE At,1U AT LEAST ZO IMCHES BUT KI0 MORC THAIJ 42. IAICNES BELOW FINAL GRADE M IMUM DaPtH OF F-XCAVAT100 F'XOM OKI&WAL 6R)'\K WILL BE -ilk _ IMCHES nN)MUM CKPrH OF EACA\4ATImN r-PjOM. Ci,16I1I-aAL (j RADF- WILL BE np~ INCHC5 SIGUED: LICIUSC AJUMBEI3: ~S1S~ DAT E Z6 /--5 - - - 1 1 0 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/ Plan must include, but not limited to vertical and horizontal reference poi f slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dist fo nearest road.' REVIEWED BY DATE APPLICANT INFORMATION-PLEASE P ALL-.IWF00 1014~~ PROPERTY OWNER: VMCIPERTY LOCATION John VanDyk L9 LOT NW 1i4 j 1/4,S17 T 30 N,R 18 xk(or) W PROPERTY OWNERS MAILING ADDRESS # BLOCK # SUBD. NAME OR CSM # 917 140th. Ave. na 25 acres CITY, STATF ZIP CODE BONE N MBER CITY ❑VILLAGE RJOWN NEAREST ROAD New Richmond, WI. 54017 (Y15)' - Richmond 100th, St. [x)cNew Construction Use [ c Residential / Number of bedrooms 4 [ ) Addition to existing building i Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 I Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 _ 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.50 upper 94.18 lowerft (as referred to site plan benchmark) Addlticna design !site censiderations step_ down trench system. alt. system el. 96.50 Parent material outwash Flood plain elevation, if applicable na rt S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK 421 '0 U ❑ S- U U= Unsuitable for svstem ?aS ❑ U ❑ S M I[ S❑ U 10 S El U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon) Depth Dominant Color Mottles Texture I Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends >.....1..... 1 0-16 1.Oyr3/4 none sl 2m r mvfr w if .5 .6 2 10-78 7.5yr4/4 none S Osy ml na na .7 .8 Ground ev. ft. 96.9 1 Depth to limiting +a~81' Remarks: Boring # 1 0-9 10yr3/4 none 1 2msbk mfr gw 2f .5 .6 2 2 9-22 7.5yr4/4 none sl 2msbk mvfr gw if .5 .6 3 22-96 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 101.40 ft, Depth to limiting factor +96" Remarks: CST Name:-Please Print Gary L. Steel Phone. 715-246-6200 Address: 1554 200 h. Av.e, Ne Richmond, WI. 54017 Signature: Date: CST Number: L_ 0_4~1 4-28-95 cstm 02298 PROPERTY OWNER John Van Dyk SOIL DESCRIPTION REPORT Page_ ~f3 _ PARCEL I.D. # I r tq - 0 Depth Dominant Color Mottles Texture Structure Consistence lewicbry I Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. I Bed ITrenoh /0 G S 1 z ryf N tl S, 3 2- D--21 0 ye, 41 410 G S% mS6 u~ l ~4 i • 5 Ground 410 O C S O S / I elev. W Depth to limiting ~fac or „ Remarks: Boring # _ I 0 / Z /U vG 314 O C 2YO3 i15 a, /Z (2 cJ 2 -71 IS Ground ,t5 j 4-I /UO C S 0S C1 )-n Celev.p/ Depth to limiting factor 7 Remarks: Boring # n i Ground dlev.-4~7 ft. , p giz t S ~l l~ Depth to limiting factor > Remarks: Boring # Ground elev. ft. Depth to limiting factor r Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1 x~.~ 1554 200th Ave. CSTM2298 New Richmond, WI 54017 MPRSW 3254 A) YAt- rJ W'I+ S 17 -Y-30/v ~ / 3B (715) 246-6200 ~o CAW q1 Z-') oWA) s o l -Z ~s duo 3 sa 3vc' to, Z2' ° J . Fxp S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER C>vv<- ADDRESS FIRE NUMBER ~SQ CITY/STATE ZIP 54-ot-1 PROPERTY LOCATTION : 1~ W 1/4, ~1w1/4 , SECTION 0 , T ] N-R Loa W TOWN OF r`C4-v- M,0 , St. Croix county, SUBDIVISION , LOT NUMBER 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 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 returned to the St. Croix Co. Zoning officer within 30 days of the three year expiratio e SIGNED.' DATE: S ~Z'9-S St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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 V6." fly Location of property 1Aw 1/4 R\N 1/4, Section 1-1 N-R IQo W Township P-Ic s 4 Ma t40 Mailing address °t l-1 14aJ14 A~irc . lVc-w C 4+ ran, o t~-10 Address of site la O S-r. ~~L~ w R-Ic-t*Mo ND , \'V 1 Subdivision name Lot no. Other homes on property? Yes x No Previous owner of property - O014+1 Z; 4C=--1lL?Q4C4 . VA," -[~y V-, Total size of property '25 Ax- + Total size of parcel -Z C;, A, c-, Date parcel was created 4- 21 - 01 E2 Are all corners and lot lines identifiable? -1X_Yes No Is this property being developed for (spec house) ? Yes X No Volume U11> and Page Number '4'Iq 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. 5 Z$ olys , 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. SZ$ o t~ uivL S• nature of Appli nt Co-Applicant _n 4~- 47 State Bar of Wisconsin Form 3 - 1982 -528018 i QUIT CLAIM DEED r REM~GISMS OFFICE - • .CROIXCO., 1 DOCUMENT NO. S tins Heed for Record APR 21 1995 Hendrik W. Van Dy, a married man 2.15 P ' lfi & .-A. w~m-- quit-claims to _ John C. Van Dyk and Eileen Van Dyk, Rsptstcr of n,-rrq husband and wife, as survivorship marital Rroperty his interest in the following described real estate in St. Croix County, THIS SPACE RESERVED FOR RECORDING DATA State of Wisconsin: NAME AND RETURN ADDRESS 1060 _ The North 830 feet of the Northwest Quarter of It WA40 / L/it~-7 N the Northwest Quarter (NW} of NW}) of Section _ Seventeen (17), Township Thirty (30) North, Range Eighteen (18) West. (Parcel Identification Number) FED This is not homestead property. (is) (is not) Dated this 21st day of April 19 95 I (SEAL) ~hVUJUam, (SEAL) * * Hendrik W. Van Dyk (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. r authenticated this _ day of , 19 Personally came before me this 21st day of April , 191-5- the above named i Handrik W. Van D .60406 I s ' TITLE: MEMBER STATE BAR OF WISCONSIN ,0 (If not, ' authorized by §706.06, Wis. Slats.) to me known to be the person foregoing i strument and acknowledgellh~ o~ THIS INSTRUMENT WAS DRAFTED BY REINSTRA & VAN DYK, 201 South Knowles Avenue * Mary L. Young Now Richmond. WI 94017 Notary Public St. Croix County, Wis. ~I (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, sta'te` expiration date: necessary.) April 20 , 19 97 ) !I ii *Names of persons signing in any capacity should be typed or printed below their signatures. i QUIT CLAIM DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 3 - 1982 Milwaukee, Wis.