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HomeMy WebLinkAbout012-2003-00-000 n N Q ~ ~ ~ C7 d j'_ ° d ~ 7 ' i C 3 ~ ° A ~ ~ .w. v„1 ~ N . ~ i Q ~ C r ~ .C ~ ~, ,' ~. 41 ~ A • r~. ID ' 3 - ~ ~ [Al 1 ;-. a~ m~ x x ~ ~ W A v m _ °a ° '~ `C ~~ d ~ O O ~ f25 ~ ~ N O N ~ W N I~ N N O. d Q : ~ ~ O ~, ~ I ~ N m ~ m m ~ ~ ~ ~ ~ ca ~ O O -D ~ ~ i> N N ~ A S N ~ O ~ O (D U~ ~ O _ CD 0 F Q O O ~ AI ( ~ ~ ~ O ~ ~ I o ~ vn { D d~ a N c o ~ m I o ~ O ~ n I ~ Vl ~ ~ ~` n o c ~1 ~ ~ a ~ I K ~ Z '. ii K • ~ ~ ~ L -o N N N :0 ~ ~ '~ ~ a ~ vq s to ~ fD _ ~ N ~ ~ N '' ~ , a O ~- `° M A~ N I ~I W ° o I ~ D a ~ ~ '; r N ~ m !r • can N ~ i . C fD N a ' I m i ~ I m cn ' -~ -~ ~ I ~ I 'o. ~' ~ ~ 'i wA I Wv m I c ~ i -' Z -~ 3 ° ' ~ ~ I r: o z m ~, I N ~ I ~ z ~ I a I W I D 1 n. ~ O C G N C I o a I ~ ~ I ~ I ~" I '~ I m ~ a I ~ I ~ I N ti ti ° I o I a O ~ ~ 0Rp V ~ T ° ~ ~ a I o :. Wisconsin D~~artment of Commerce PRIVATE SEWAGE SYSTEM Safety and B~glding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Ballard, Michael & Susan Erin Prairie, Town of ;ST BM Elev: Insp. BM Elev: BM Description: / p-p ~ D !U~ - U 1~7~~ sib' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~~~ Dosing i, / r v~ Aeration Holding TANK SE; ` K INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 4 ~ ~' J Dosing ~ _.-S ~ ~~ Aeration Holding PUMP/SIPHON INFORMATION i Manufacturer Demand GPM Model Number TDH Lift Frictio oss Syste ad TDH Ft Forcemain Len Dia. Dist. to Well County: St. Croix Sanitary Permit No: 514870 0 State Plan ID No: Parcel Tax No: 012-2003-00-000 Section/Town/Range/Map No: 04.30.17.571 b STATION BS HI FS ELEV. Benchmark ~ U -I ~ ~ r to I ~` U l Alt. BM Bldg. Sewer ~- ,~ scy yo,s~o 8 I ~ L St/Ht Inlet _ 1 ~ N.7 ~ n- 7u~rv ~ , 2 ~~ SUHt Outlet ~~ ~ 8' ~ a Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System QD^ C,s. f V C GS~ O Final Grade st co ~ ~ ,~ 2. 3 Vv C~V~,c(~/Ybo SOIL ABSOt~PTION SYSTEM li~(/, ~77 dl //7- ~!/ l•~ r-- ~~~_ / ~7 BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: T Of S t ype ys em: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) IasryectioTl#1: 5 /~/ de rr3 0 / /_ Location: 1775 178th Street New Richmond, WI 54017 (NE 1/4 NE 1/4 4 T30N R17W) Jewett Mills Lot 19-31BIk79 Parcel No: 04.30.17.571b 1.) Alt BM Description ~~ ~ 2.) Bldg sewer length = fs ~~"~ '/+~'~ ~C L° .~j•~w~. -amount of cover = ~ Plan revision Required? 0 Yes ~O - -j Use other side for additional information. JJ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. 04/22/08 TUB 08:30 FA7i 715 388 4686 ~ oo>< eammtwcewi.yov safety era But~"ngs .~ 62 A 201 W W bu ~' ~ v ~ /~~ %'~ n ve., es rgton . Madison, WI 5370T-Tlb2 Pbmait Nmr-ber (to be filled in by Go.) 5/~ ~ Sanitary Permit Application ~'ieT N~. 9Vn:. Adra Code, mow oCth' tte Comae tt32t (2) In acoordarrce widr a . , . unit is rcgtired pea r4 otwirdag a sanspay paetrit. Nase: owned PO are Trejat Addrps (if diffaeat than mailirry address) submired ro the Oeparfnrent of Comrnetes. Personal ' you may be used for in accadaoce with dre Pri Law :. 15.01 I m Stagy. ~ ' ~ 7~ i 7 ~ f , / d'i^, L A r Irfet~fiaa -Plan PrLt Al I Property Owads / 1'arcei rt Property s Mailing wddress x,QN~N~' ` >'mP~y Loeatron /. ,5 ~~ . 7 s ~ ~ tll Cdy. State Zip Cade Phone Number ~(~ %. y~ Section ~~ iQ. ` ~ ~y ~ , , [ak T ~N; R ~ E W II. Type of Britdirs (cbedc ap that apply) ~ 3 ` vrar4a 3ubd a 2 Fantily Dwelling-Numbaof Bedtnoros f ~ n - e/1 ~ // ~~ ~ ~ ~ k * t ~ / [ {/lX-IG~ ~~ ji oc B ^ PuWielCotrmereial -Describe ilea ~ ~ ^ City of ^ State Owotd - Ddcribe lSse CSM Numtrer ^ VipaOe of IiT. T ype of Posarit: {Cleclt oily sre box or line A. Cotttpltae kre B if applic ) `+' ^ New Symem ©ReplaeaneM System TsatmmdtbWing Tank Only ^ Other Modification to Existing System (explain) li. ^ Permit Renewal ^ Permit Revisiar ^ Change M' Ptunsber Q Permit Transfer to New List Prey' Pertrrit N and Date Issued Before Expiration Owner 21 7 T T V. T d POVYTS eautG 'a: Cbaek s8 that oet-Pr~uri>td Itr ^ Prrxstrrizod In-Ground ^ At-Grade O Mowed > 24 in. oFsuilabte soil ^ Mourd <q4 in. of m~ble soil ^ ing Tsalc Other ,spersal Comparont (expiaia) ^ PreseexUnaa Dairy (esrplain) V. nt-V!'rnt~ert Atsa lsdortsatier: Design flow Ilksiga Soil App{ieation Rata(gpdst) Dispwsai Atea Required (s[) Dispers e[ Area Proposed (st) System Elavatioo t VL Tastk Trio Capacity n Total Y of Manufadrrer Gallons GaNoas Uairs ~ ~ V v NavTania EsiMiylTaaks ~ ~ ~" t ~ S ~ ~ L {it/ e f A p r Septlc oT tioldyK TanY Oaie6 Gpmbv VII. sib' ' S ert 4 the ratdeasiptat, for lasbribstioa et Me POWTS stwwa oa tote attactsed phucs. urrrya~'s Name (Print) Plum cure MP/MPRS Numbs Btrsinesa Phone Nwnber ~ ~~((//.~ o..,~. 2Z~ 7~~ =off ~ --~ .- Wumber'a Address (strert, Ciry, -Code) ~ /~.~ ~ ~ ~ w1 ~ ~ 1 Y[TI. Cerr !De at Use ~~ O ~ Pernte Fee ' Dste issuing tSignature s 225 ~ p° 5 rz a8 ^ owa<ra,~ Reason fer ~ lX. Catditt$~~asors br Disapproval \ I 1 ~ cLb~b' O 3' b` ~ om .^ Y .. 1. Septic tank, effluent fitter and .. ,,,, IG dispersal cell must all be services 12lainiltined ~ ~ /~ c~LQ ~ as per management plan provided by phJmtier, . 2 Atl suck requfremertts must be maintalMd w I+m mF'Rtat!*9sdrt~Eit INIMlPa~}slmr sad seYrr M tae Caib rrb ea trar:* aM tee tics s rn s u saes r sac SBD-6398 (R. 01107) Valid thnt 01109 ~a i PROJECT Mike Ballard NW 1/4 1/4S 4 /T MPRS Shaun Bird 226900 DATES/8/08 BEDROOM 9 CONVENTIONAL XXX IN- D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTI ANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100° Filter BEST Filter ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION Line Scale is 1" = 40' loo' unless otherwise noted 12' X 50'Bed Vent 80' 20' 5~ 50' B-1 5% Slope 10' B-4 91' B. 25' 92' 30' B-2 40' B_ Install new system along B-2/B-3 2' Below grade 172nd St ~,OT PLAN ADDRESS 1775 178th St. New Richmond Wi 54017 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX - z.~f/R~~ -~ I Db,o~ ~S- ~` . I ~ N t• ~3~ 0~ 8, b . M~ 7 ~ i M~ QLt,~-+~ilti~rl I ~~~~~ Replacement of Tank only 10' 20' A filter is to be 20' installed 0 ~ 10' Well Existing 3 Bedroom House i i (]COPY P OT PLAN PROJECT Mike Ballard ADDRESS 1775 178th St. New Richmond Wi 54017 NW 1/4 1/4S 4 /T N/R 17 W TOWN Erin Prairie COUNTY ST.CROIX MPRS Shaun Bird 226900 ~ DATES/8/08 BEDROOM 3 CONVENTIONAL XXXX IN- D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTI ANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100° Filter BEST Filter ^ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION Line Scale is 1" = 40' loo' unless otherwise noted 12' X 50'Bed Replacement of Tank only Vent 80~ 20' 10' 20' 5 ~ 50' A filter is to be 20' installed B-1 T 4 20' 5% Slope 0~ 10' Well B-4 91' B.M. 25' Existing 3 92' 30, Bedroom B-2 40' House B-3 Install new system along B-2/B-3 2' Below grade 72nd St Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safely and Buildings Page of ,,, ..,....,,,...,..,., ..,.., . ......... ..... ...~. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. ,,,,,,,. ~,,.,~ m ~ f tY ~ f ~. indude, but not limited to: vertical and horizontal reference point (BM), dir percent slope, scale or dimensions, north arrow, and location and dista n crest road. Parcel I.D. ©~ ~ ~ a ~ •3' Q~ r Please print al! informatio v~0 Review by Date Personal information you provide may be used for sewn ivacy Law, s. 15. (1) (m)). ~ /Z. d 8 Properly Owners ~ ~O ~~ ' ~ rope Location ~ ~,, 1! ~ G G .Lot 1l4 ~ 1I4 S T ~~ N R E (o W Property Owner's Mailing Address ~\x OO \ ~ # lock # Subd. Name or CSM# ~ G~ A City / fate Zip Code~j Phon umber2 / ` ~ ^ City ^ Vllage Town Nearest Road / V ] / ~ / ~ ( y r NC.!/ri ~I I.~IY J / ( ~ ~ J 4 /~ /f / s 7` . / ^ New Construction Use:~Residential I Number of bedrooms? Code derived design flow rate GPD eplacement ,//^`` Public or mmerdal -Describe: _ ____ _ Parent material ~~ - p6ca ----~~----~------ -- ft. General continents ~,,~"• J L3~~ sr~~~j~~.:yv and reoorrtirtendations: ~ ~ ~~ ~ ~ ~17~ e ..~</% System Type ~D ~ l/ System Elevation di ~ ~• Q Boring # ~ Boring Q '® pit Ground surface elev. U ~ ~ / ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 pit Ground surface elev. ft. Depth to limiting factor --~~-F-,~- in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 e- 0 3~L ~ r ~-- ~ ~ ~. ~ ~ 6 ~ ~ ~ ----- ,: ~ - y~r l r~/l~? ~ 'Effluent #1 = BOD > 30 < 220 ntg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 ntg/L CST Narr~s (Please Print) Signa CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ 715-246-4516 ~~0~ ;`° Pro~per~ty Owner I 1 I eorina # ~ Boring p'~ P~ircel ID #. ~l ~ Page of ~}--Pit Ground surface etav.~. -~ tt. uepm to umiung racror r~ v ~~~• »Y...., . Soil lication Rate ri H De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DJft? zon o p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 ~-- ) z- s ~ '-~ ~ as D s ~ ~?? ~y • ~ ~ ~ ^ Boring# ^ Boring O/ l/~~~ Pit Ground surface elev. ~ ~ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon th De Dominant Color Redox Description Texture Structure ~ Consistence Boundary Roots GP Dlftt p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 "~a- ~~~ , ~~a/ ~" ~ ~ ~ S /yip /v~ ~'• ~ ~a - s~ , s -- acs-- ~ , , © .7 Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil ication Rate 'd th t Cdor i D Redox Descxiption- Texture Structure Consistence Boundary Roots GP D/ft? Horizon ep in. nan om Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 'Effluent #1 = BODS > 30 < 720 mglL and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mgll. and TSS < 30 mg/L The Department of Commerce is an equal opportunity service providec and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Property Owner Parcel ID #. Page Boring # ^ Boring ~it Ground surface etev.- ft Depth to IimiGng factor ~ in. Soil liption Rate Horizon Depth Dominant Color Redox Descxiption Texture Structure Consistence Soundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 ' E1i#2 j- ~ ~ 6~1o 7,s, u ! Boring # ^ Boring //,, ~fJ~ Pit Ground surface elev. ~ v ft. Depth to limiting factor !~ in . Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure ~ Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff #2 / ` p 2 ~a- s~ s °~--' ~cs~ ~ ~// . . ~g ~ ~ 7 - , ~ G----- s r 6~~ ~ ~%~ N , ^ Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication Rate Horizon 'lepth Dominant Col Redox Description. Texture Structure Consistence. Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 'Effluent #1 =BODE > 30 < 720 mylL and TSS >30 < 150 mglL • EtflueM #2 = BODS < 30 mg/I_ and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-26b-3151 or TTY 608-264-8777. seo.saw trt.anoot Soil Test Plot Plan Project Name Mike Ballard Shau ird Address 1775 178th St. New Richmond Wi 54017 C #226900 Lot Subdivision Date /8/08 N W 1/4 1/4S 4 T SO N/R17 W Township ErinPrairie Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding System Elevation 90.4/90.0 *HRpSame as Benchmark Property Line Scale is 1" = 40' unless otherwise loo' noted 12' X 50'Bed Vent 80' 20' 5 ~ 50' B-1 5% Slope 10' 91' B-4 25' 92' 30' B-2 40' B- Install new system along B-2/B-3 2' Below grade 172nd St 10' 20' BAD ST 40' 3 0' vI. Existing 3 Bedroom 1 House 10' Well ST. CROIX COUNTY SEP'T'IC TANK MAINTENANCE AGREE AND OWNERSHIP CERTIFICATION FORM //!~ ~~ Mailing Address .,17 '7~ / 71~~.'~~ OvcmerBuyer Parcel Identification Number ~~ 2" ~ ~~~ ' ~~ v B~ City/State property Address o artment for new construction.) {Z7er;ficationregtiired from Planning & Zoninb ~P . LEGAL DESCR~'TON ~ ,~- . ~ 1, . '1 h 1 ~ f~ cation 'y w i/a ~ ~ i/a ,Sec. ~ . T N R~w~ Town of ,~i' ~ r~ ~ / l~'~~ Property IJo Lot # Subdivision Ceria~ied Survey Map # Volume p - , Page!# !~~ ~ ~ ~ ~ ,Volume _ ~o b pie # ~J Warranty Deed # Spec house yes no Lot lines identifiabld y~ ?~ SYSTEM MA7]~I'1'ENANCE AND O'pVNER CERTTN~CAZ'ION Improper use and maintenance of your septic system could result in its premat~fail a licensed ump ~ ,~~~u p~ into maintenance consists of pumping out the septic tank every three years or sooner, the system can affect the function of the septic tank as a Uceatment stage in the waste disposal system. Owner maintenance responsibilities are specified is §Comm. 8352(1) and is Chapter I2 - St. Croix County Sanitary Ordinance- Planning 8t Zoning Depsmnent a cattification~form. signed by the 'rhe property owner agrees to submit to 5t. Croix County v that (1) the on-site owner and by a master plumber, journeyman Plums, restricted plumber or a licensed pumper erifym8 ~ c tank is wastewater disposes system is in proper operating condition andlor {2) after inspection and pumping (if necessary), seed less than i/3 full of sludge. vase sewage disposal system with the I/we, the undersigned have read the above requirements and agree to maintain the pri ent of Commerce and the Deparament of Natural Reaotn+ces, State of Wisconsin. standards set fords, herein. as set by the Departm Ceactificaton stating that your septic system has been maintained must be completed and returned to the St Croix County Planning Zoning Departnncnt within 30 days of the three year expiration date. ~, certify that ail;ta is on this form are true to the best of my/our knowledge. l/we am/are the o~n~'(s) of the abov o a warranty deed recorded in Kegister, of Duds Office....:.,, i Prop' ,S i~ ~~~ SIG OF APPLICANT(S) ~ DATE #** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & ?.being T)Gpatpment.#'"~` Yriclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed- (REV. 08/05} Maintenance and Contingency Plan for a Septic System Maintenance Pian 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be leaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner. discharge into the system. 5. The owner agrees. to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. . 8. Discharge into system is not exceed those required as per Comm. 8:i C cy Pian Option . If system_fails, determine cause of failure, use aitemate area and install new system in tested replacement area./.~~ ~ ~a f~ ~~ ~" ~~~ Cz{~~ Option #2. Install system at a Power elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 ~ ! 1 1 ~ DOCUMENT NO. t P WARf4AN'~Y SEED -- TN1S SPACE gE6lRYED /Oq RECORDING DATA I 1 . i. ... ... i~ STATE BAK or' WlrclVtv~tiK ras:caa. ~-sewaa' ~1 _ - 1_ 6 `~ li _ _ ~ Ii i ~- _ .._ ' -- ___.. __. ~ --- _ aP~ - ~i Y ' ~;~~I:i~'Ef2S OPF@CE ~ i3 . ` .. ~ E: ~Y~ ~r ti~ ~ ~ ;~ ~ P;. ~i ~~ _ . lIQhn W. _hi~x_d E• Mark__ 'T-. Ward and _ Nl%~rgar~t -_•__._--• _ ~:y •------ - -- ~ ~,~~~. - __. ~r ~' ~ Moore --- -- ' 4 - ii - ... .. _ - 1YT ~ 9 5 ~t.+ ~. :; co, ...yes nn3 ccarrsr•4z to ..M3.C~2~~.7... W. .Ss~_1 1~.xc3- and.. 8usan....._ ' - ~! ..5..__-Liallasd.,--.husnanrt_.anci__.,Sri=e-,---a°--mar.i.t-al-.--.---•-• `' - _ _. :. ~ _ .._ - :' P ~t .._pso~2ert;t-,...sath__righ;rs...c~.:£..s_urn°ivorshi=~•----_----•--•-.-•--- `,; is ~ .{ 1 --•-- ----._...._..--•---•------ •-----•---....-----•--------•-----•----•-----••----- --- ------•-- -----•--- ~ ~ ~__ ~: _ : .._, __-- I3xst 1~3t1C17E11 ~Tllc of I~iN M ~ ~_ ...... ... ....................................................... ......................................... RETVRN TO 109 ., ;e ._.. . . .. .__......_. _I~W_-.._~,...__[_WL 59017 fi 1 ~~ . .. ...... ... rha fniio,Yine deacribed real estate in _.........St.._..C°r-C]1X ...........County, . .~ [; - -~~ _---State_et Wl$CQZlsin •` _ f~ -_ _ Tax Parcel A*o: _._.._._ . ............. - .f _ _. f 1t - 1~ _ _.. _ _ _. ! (I The. North 40.~~ feet of 3;ots "221'; 21-," "~22 ; 23- A'~i$-`24 ;--CZ~z~csth~r-- with--~_._._...._.__. ~:--.~ j the North 40. o^ J CCt of tha test 6. ~ foot of Lot 19, all in ±~ P~ B1cc;c '?A f t:;e Plst ^£ ~~A,,>~t~• ?~: _ ~ ~ ~/a ~ t=~t:.~rc3ad in thi= Itagistar !I ~~ of Deeds Office in and for St. Croix County, Wis consin; TO^-ETEiEF !~ ., WITH: Lots 25, 26, 27, 28, 29,.30 and the South 15 feet of ;~ Lot- 31, -a31 in Block 79 of the said Plat of Jetive tt Mills; ~~ TOGETHER WITH: That part of the alley shown in said Block 79 ~~ of said Plat, lying East of the above described Lots 25 through iI ii 31 -„nM *?o±-~}. .. f' Ca=.3 r.~,t~ ~n t-),rr,,,rJ,i, 2a and ,that hart of Lot 19; I! f~ together with that part of the vacated Wabashaw Street lying +! ~ ~~ West of the above described lots and alley. I ~~ --11 i ~ ,. ~ ~ ` ~is conveyarie`e is given" rn~ sa~i~-facti-ori- of ~t-hat c~rta-irs--~-aad--- --- - , ij .contract between William W. lidard and Isabel E. Liz ard, husband ~ ~ `i and wi.f?, and Grantees, dated and recorc?ed June 26, 1979 in Volumes i I I _._ ~' _-._595, na~ra 157, i~ociiment iv'o. 357822. P ! i s not This ............ ... ......... homestead property. i P ~~ (is) (is not) + ! 1 j l Exception to warranties : j ~ • i~ Dated this .............••---••-~~••--------- ...----. day oi' _ - -- -.May.......... •---- ........, 1°--8.7.. .. i ~! {{ j~/ i X-•----- - ---- ~°'!- L-~ ~------•t>Fr'--• ...................... (SEAL) -~-~~~~~G~:4 L-..rr..~.......... (SEAL) -:-tTOYl: ._W=.-.Li7a~s?_>_ _ Mark . T. Lda~'.d :-.~ 1(--- ---- ---- -- - G,^-'~~-• -_~__~__~_ ~v~Ld. (SEAL) __ ~ V---- _1_-----_,*Mar~aret__ Moore. _--------•----_------• AUTIIENTIG`"ATIQN Signature(s) ------------•--------•---...---•--------------•----•---••--- _ ,. authenticated this _.__._..day of ....................____., 18.___. TITLE: MEMBER STATE .BAR OF WISCONSIN ~,. , .._, (If not, _.. ..............•---------------------•------°-•--•----- anr_.i,grizwd fig S 706.OR. Wis. Stats_) THIS INSTRUMENT YJAS GRAFTED BY Rainstra, Van Dvk & ~7eedham_,_ S._C_ New Richmond, bdI 54G17 (Signatures may be autherticated ar acknowledgcri. Both are not necessarl'•) . .... .----. ... ............. . ............ .. .(SEAL) ACKNOWLED(~MEN? STATE OFla~>~p( ss. --R_a__m__sey-- •--- - ----------County. zc, Personally came before me this -_--_..j.t'_.__-day of --------••--------_ivlax____--------•---, 18_$_~._ the above named Joan w. ward, C1dr1C '1'. tYdLU Gt1It2 Marctaret MbZ_`irc lV ~,~c a____-_ a- at... ..~........ C ...,... nvn,•..fn,, hl+n foregsing instrumenk and acknowledge ikP game. //7~ - -. - -~ i~ Notary Public .. 114}- Commission date: •IQames o£ oe~sons sfaninR in anY C9nacltY shnu!d be trued nr rri ni.•d h••L,.c th~•ir si~oscacres. HY Mi~~erCmtiaap.~ _ _nrr RAR nr w,cr-nN S,v F'n AM No. 2 - 1u42 _ _ .-,q v ~wY.a ..ivi- i3v. - v"' ~:- !i - ...-~.~)[1.5.~ J.. .. ... .....County. WS~XM1i1 Tl . is permanent. (If not, stator ekpiration --.........__ .........:...---._.c... ~ 1J... .l S ~~~ Y = .. - ~3_ 7 H f ~ ~._ ` f /a q 3 'z .rt /3 3 .S~ /.C. ycLL-t... ~ ~ / ~ f ; a J ,~ ?J' Y J9 J' 9P- / 9 JD tf ,y. u ¢ /L 1 g IJ~ / y rS- U /O 9 a) 6 ~' H 3 L 7 ~`~ \\ ~. 2 [3 /y /S /L /~ /Y Ir 2e 1/ 12 y . MO.7'LJn . _. ~. .. -. .. -~2 / 2/ /~ ~ }o v F 7 L io /a.5 iz r: f ~ ~• ~~ J L ~ j ~ z .. /N /3 a. /i V ai '• p- // ~ f q So 2/ ?f- P 24 3 , .. / ~ ~ /) ~. Y~ /7 r O 7 s 7 6 z` :: J `I .. Y 3 i ((// yU ~ Hr N3 yy ~ 6 H7 3 S+ \z~ . ~ ' cam' Y~~` ~v~ ,3 /i " ~~ 5 f ~ s4 ~9 ?~ 3/ ? .Ji 1' Pi'K'Ll. 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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 -BALLARD, MICHAEL W & SUSAN MICHAEL W & SUSAN BALLARD 1775 CTY RD K NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 1775 CTY RD K SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 04 T30N R17W N 40.8 FT OF LOTS 20 Block/Condo Bldg: THRU24N40 8F . TOFW6.4FTOFLOT19 ALSO LOTS 25 THRU 30 S 15 FT OF LOT 31 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) BL~~L~& ALLEY LYING E OF LOTS 25 THRU 04-30N-17W 3~~&& N OF LOTS 19 THRU ST ALSO THAT PART OF VACATED WABASHAW ST. LYING WEST OF more... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 780/57 07/23/1997 596/157 9f'lAF CI IMMARY Bill #: Fair Market Value: Assessed with: C 0 Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.055 15,800 184,300 200,100 NO Totals for 2006: General Property 1.055 15,800 184,300 200,100 Woodland 0.000 0 0 Totals for 2005: General Property 1.055 15,800 184,300 200,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 501 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 012-2003-00-001 09/08/2006 11:22 AM PAGE 1 OF 1 Alt. Parcel #: 04.30.17.5710 012 -TOWN OF ERIN PRAIRIE 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 - BALLARD, MICHAEL W & SUSAN MICHAEL W & SUSAN BALLARD 1775 CTY RD K NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 4 T30N R17W W 6.4FT OF LOT 19 EXC N 40 8 FT LOTS RU 24 EXC N 40 8 FT Block/Condo Bldg: . ; . OF SD LO LK 7 IL JEWETT MILLS Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ASSESS 1 B 04-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 9(1f1R SI IMM~RY Bill #: Fair Market Value: Assessed with: 0 012-2003-00-000 Valuations: Last Changed: 09/27/1993 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 012-2003-90-000 Category Alt. Parcel #: 04.30.17.5760 012 -TOWN OF ERIN PRAIRIE 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 - BALLARD, MICHAEL W & SUSAN MICHAEL W & SUSAN BALLARD 1775 CTY RD K NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.975 Plat: N/A-NOT AVAILABLE SEC 04 T30N R17W W 20.04 FT OF LOT 19; Block/Condo Bldg: LOTS 20 THRU 24 AND THAT PART OF VA T CA ED WABASHAW ST LYING W OF SD LOTS & Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) WASHINGTON AVE LYING S OF SD LOTS BLK 84 04-30N-17W VIL JEWETT Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 723/596 9f1(1R CI IMMARY Bill #: Fair Market Value: Assessed with: - - - - - ------ -- - - 0 Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.975 14,600 0 14,600 NO Totals for 2006: General Property 0.975 14,600 0 14,600 Woodland 0.000 0 0 Totals for 2005: General Property 0.975 14,600 0 14,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code 09/08/2006 11:21 AM PAGE10F1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 .-o. ':r`ER ~%r~7fi'~•G ~.4//.9,-~a~ , TOWtJSHIP~h~,uV"rRr~E . SEC. '7` ~'o N R /7 W .. .O. ADDRESS_~. ~,.~/. ~, , ST. CROIX COUNTY, WISCONSIN. , --N ~7.r) ear ~,.~•„r-~~d "3DIVISION LOT ~ LOT SIZE~,4~~~ . - . PLAN VIEW •Distances & dimensions to meet requirements of H62.20 ' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ' a +, i i s~. -rRSL JZ ~ ~~ ,`1 1 \ , V ~ • VI • ` \ 1 ~ ~ •. ..~i' , ~ ,b~ - ~ ~ 5Z ~~ • . L~ ~ ~ ~'~ Ste, I,~Z ~ ' ` . _ . . 5~ ~. ~ ,1~ N `'TIC TANK(S)~_ MFGR. f", ~, ~ . ,CONCRETE STE .. NO. of rings on cover / Depth ~ DRY WELL• 'NCHES N0. of width length .area .3 no. of lines ~_ width a ~ length ~ ~ area 5~~a' ~ ~ depth -~o top of pipe ~o ~~ aREGATE ~d~"C ;r,~-~- ' . ~u{ RATE ,,.5' AREA REQUIRED ~~"a' AREA AS BUILT~~S--.a•' a X~ ;claimer: The inspection of -this system by St. Croix County does not imply complete j _plianc.with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for ~ >tem operation. However, if failure is noted the County 1 make every effort to -Ermine cause of failure. ~ • ASES AND AILS SHOULB NOT BE DISPOSED THROUGH THIS SYS ~ ~ ' • ~'INS1'ECTO DATED ~ ~ PLUMBER ON JOB ' LICENSE NUMBER ~ Z ' REPORT OF INSPECTION INDIVIDUAL SEUTAGE SYSTEM . San~.~an y Penm~,~ ~3~ ~ S~aZe SPp~~.cj~~~ , NAME r~~C:-~i/~~~- ~~~-~Q~ ~own.ah~,p ~.~, ~~~~~-~ S~. Cno~.x County ~. SEPT1~ TANK Szze ga.2.2on.a. Number ab Compan~men~~5~_ D.c..a~ance From: Gle.2~. ~ ~~. 120 on gnea~en a.2ape -"' ~Z' DISPOSAL SYSTEM D~.d.tance Fnam: FIELD DIMENSIONS: Bu~..e.d~.ng~~~~. UIe~,Q.and~s H.ighwa~en r"'" ~~. GI e.~.~ (~e ~ ~ ~ . Bu~..Cd~.ng~~~~. H~.ghwa~en V'" S~. ~~. ~, 12 0 on gnea~en ~s.~ape r ~~• Gie~.~and~ -' F~• Gl.idxh a ~ ~nen ch l .~ fix. D ep~h a ~ tca cf2 b e.2aw ~.i.2e ~ ~~-n . - Leng~h a~ each .~.%ne~s~. Depth ab nacFi avers ~~..~e 7i .%n. Numb en o~ .~~.ne~ o/, _ Depth o~ ~~..be be.~aw gnade~~.n. ~o~a.2 2eng~h o ~ .2~.ne~s~z ~~. S.2a pe a ~ ~nench 7i' ~.n pen i 0 0 ~~. D.ia~ance between .2~.ne~5 to ~~. Depth ~o bednacFz ~~• 7o~a.1 abb onb~~.an anew li~~ ~~2 Depth ~o gnaundwa~en ~~. ,$'~ ~2 Type a~ Caven: Papers n S~naw -~ Rec~u.i.ned atcea ~j ~ ~ PIT DIMENSIONS: ' Numb en o~ ~~,~~ Gnave.~ around p~.~~s ye.a no Ou~a~.de d" mete ~ Depth be.2aw .Ln.~e~ ~~. 2 Taza.2 a ~ n ~~. n are ~~ A Area equ "ne ~~2 ^'' TNS PECTED B TITLE APPRO'V ED ,DATE '' ~ 19 7~. REJECTED ~ ,DATE 191_ E1~ 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES LOCATION Lot No. - DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL' HEALTH P,O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TES 1, t,'-~ L~'/4, ~L~/4, Section ~, ~I, R ~ E (or) W, Township or Municipality ~~~~f1 ~ ~ 9' f ~ '~ -, Block No. ~.T~ t~t~ t- /'7__17 + ~S County / C..- t"'O 1 .~ P..L J'..._'_~ 1_.v_ Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence ~~ No. of Bedrooms 3~ Other EFFLUENT DISPOSAL SYSTEM: NEW ~-/~ ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS ~ ~- ~~'~ 7 ~ PERCOLATION TESTS ~'v ~ ~- ~7 SOI L MAP SHEET ~~ SOI L TYPE -54~~- ~ +i~'-' L o4 n. PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN FTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHE RATE NUM- BER INCHES THICKNESS IN INCHES SINCE HOLE 1ST WETTED HOLE A SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- , ~ ~ ,^ „/"'/ ~ ~ ' S^ P-z 3 '~ ~ ~ 3 c G s P 3 ~~ ` ~ .. r ~ 3 G G G .s SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 7 ~ ~ ~ '~ 5 ' .~ S ~ / ~ ~ = ~it y ~z > > ' PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) }. Name (print l G >~:~`~sr! !~L/ Tl'D/.~/` /~J S Certification No. ~ % l e ~ Name of installer if known - LOCAL AUTHORITY CST Signature I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. i. PLB67 ,«~:.. State and County Permit Application for Private Domestic Sewage Systems *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # State Permit # County Permit # ~~ County Q ~ A. OWNER OF PROPERTY Mailing Address: B. LOCATION: E''/o~~'/4, Section ~, T'~ N, R~ E (or) W Lot# City _ Subdivision Name, nearest road, lake or landmark Blk#C~T' Village .T - ` Township ~' ~ .'L TYPE OF OCCUPANCY: ~ Commercial *Industrial "Other (specify) °Variance Single family ~~ Duplex No. of Bedrooms "'~ No. of Persons D. TYPE OF APPLIANCES: Dishwasher ~-~Y~S NO Food Waste Grinder_YES_ O # of Bathroomsl~'- Automatic Washer e/4ES NO Other (specify) E. SEPTIC TANK CAPACITY [ 6+°'Z~y Total gallons No. of tanks ~.~ *Holding tank capacity Total gallons No. of tanks New Installation [/~~ Addition Replacement Prefab Concrete *Poured in Place Steel ~"" Other (specify) F. EFFLUENT DISPOSAL SYSTEM:. Percolation Rate 1),S 2)~3) ~ S°Total Absorb Area ~ 5.^ sq. ft. New '{Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length sv2 ,Width 1?' Depth 3G , ,Tile Depth ~- y ~~ No. of Lines ''L Seepage Pit: Inside diameter Liquid Depth Tile Size ~ ~ 4 Percent slope of land .S' !i. Distance -from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, L , NAME ~/G 1, e~r~.+r ,~~~D'.D ~ [ h S C.S.T. # i `ir/ 3 and other information obtained from (owner/builder-. _ Plumber's Signature MP/MPRSW# ^~~ S ~ Phone #~-y~"3`~s UO IVOL Wflie In apace 661 W t•Vn vcrr~n ~ m~i~ ~ v.a~ v~.~ Date of Application ' L Fees Paid: -State ~ (7 County .2. Date ~~2, ~ 5 Permit Issued/Rejected. (date ro~2~l Z ~1 Issuing :.Agent Name Inspection Yes~o Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1 /76