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HomeMy WebLinkAbout026-1002-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 572858 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Jacobson, John H. Richmond, Town of 026-1002-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: R C Z- C'J's 01.30.18.111 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. S Septic y Benchmark a J Z 4, 2-41 7cy !]acing Alt. BM 4:::~ L., a ~r, 5 Z C•a Aeration Bldg. Sewer Iv. v, Holding 000, St/Ht Inlet L Z51 W • C) St/Ht Outlet 7 TANK SETBACK INFORMATION 57. 75 TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. 9L Aeration Dist. Pipe 7 ~p Z .a 7 Holding Bot. System 9S~ Zq PUMP/SIPHON INFORMATION Final Grade Z- Z I 1 Manufacturer GP and St Cover 7. Z 16(- Num r Model -7 TDH Lift Friction Loss System Hea TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dept= e- I DIMENSIONS 3 • Ix .9 SETBACK SYSTEM TO /CJ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer- INFORMATION CHAMBER OR Type Of System: UNIT Model Numb~v`~~ CIO 0-je- v DISTRIBUTION SYSTEM eat- 17 354 Header/Manifold if Distribution x Hole Size x Hole Spacing VenLto ' Intak ` Pipe(s) Length -lfJ DiLength Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Dept~Qf xx Seeded/Sodded xx Mulched Bed/Trench Center 5.71 Bed/Trench Edges Topsoil \ Yes E] No Yes a No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1423 Cty GG New Richmond, WI 54017 (S~I 1/4 SW 1/4 1 T30N R1 8W) NA Lot 1 Parcel No: 01.30.18.111 ~'I Ci0 J~l~. 1.) Alt BM Description = I Cl 1ti~+~ 2.) Bldg sewer length = f - amount of cover = n n g Q✓~, ctJCX- - Plan revision Required? 0 Yes VINO Use other side for additional information. 1 Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) v~"fir County RECEIVED Safety and Buildings Division J , Q 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) p S; NOV 2 6 GU 14 Madison, WI 53707 6 Ta I 572 F 5F ST. CROIX COUN 4 ~ a`r`y'ernut Application State Transacn'op Number In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ~TT is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secon purposes in accordance with the Privacy Law, s. 15.04(1 m , Stats. /jJZ 3 C -T~ GG L Application Information - Please Print All Informati -j l Property Owner's Name Parcel # J-0-4, 0/;)& -1o n a _ _o Property jOwner's Mailing Addre Property Location / J 7 iEJ C~J-/V~. Govt- Lot C City, State Zip Code Phone Number W Section L~Q l 7 7/-5- 76 T N, R 6 (circlE one II. Type of Building (check all that aPPly) Lot # J6 J or 2 Family Dwelling - Number of Bedroo Subdivision Name Xok ald Blo # ❑ Public/Commercial - Describe Use ❑ City of DJ ~ -r _,og%5IF~>- ❑ State Owned - Describe Use CSM Number El Village of / ` / 38 ,Town of z ~.e ll~ ! k l~ A,C.I Al et5 UP y`{ 1 v III. Type of Permit. (Check drily one box on line A. Complete line B if applicable) Iy A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ^ a„ d J: Jr- IV. Type of POWTS System/Component/Device: Check all that apply) JKNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil G ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Trea ent Area Information: Design Flow (gpd) Design Soil Application Rate dst) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation yso 10 7 121 ° s- Lv 0 0 95. VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n o d J U U l0 New Tanks Existing Tanks ~7 C y v~ U L Q d aU W:~. co u.3 a Septic or Holding Tank G~ d l d 60 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POR TS own on the attached plans. Plumbe S,4~Z 6~ r's~m(Print)~ Plumb Sign a RS Number Business Phone Number I®Addr s City, tate,~Zip r „ P J b® r r VIII oun epartment Use Only Approved El D' ed Permit Fee~j Date sued Issuing nt Signature ❑ er eason for -fiat $ !X / DL Condi yp 'Reasons for Disapproval 1. 3eptictank, effluent filter and .Qi perse1 cell must all be ser0ces / maintained t* W management plan provided by plumber. 2. c r"Ulreme* Mt bot ined as pec applicablecods'% otriJiraufoes. Attach to complete plans for the system and submit to the County only on paper not less than 8 la z 11 inches in size SBD-6398 (R. 11/11) it V6 Po LL -o s _ /®af 7e -4-7 X (31.3` r l Y ) LL a~ a ~oC>© A' 1 13-Y C' !,G CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: IT~~ Owner's Address: 1 L.~ t S AJJ2,4-t~ V(3 Legal Description: UJ- . Township: County: 5 7L; Subdivision Name: Lot Number: Parcel ID Number: 00 R - gQ -000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat ttach en oil Test & House Plans Designer/Plumber: License Number: o9d o 3,577 Date: Phone Number 7/S - Z6 CS ' O~/ Signature Designed pursuant to the In- ound Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 I 7.6-7 ~ `303 0 0O° O t ao` X 3 13_ ~o q Soil Absonodon System Cross Section ft 4' Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching ♦ _L_ -L Chamber Chamber ~ ft System Elevation Soil Absonrtion System Plan View ~P ft 3 ft { I ft Leaching Trench 11 Vent Or Observation Pipe Chambers god- "Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model N r EISA Rating --a-o sq ft per chamber Soil Application Rate ar /7 gpd/sq ft Y~5S40 gpd Design' 'Flow z`Soil Application Rate --CIO EISA = 3 r J Chambers 2 rows of _ chambers each. t , 7 = y8.S =o = 3), I ~y ,70 j Page 3 of t g 77 ti it 0 1 ~ -f N r fry 'v` M I ~ L 7 1 tP'~ ~ I CU ~ r I'y { I i II i j y r 1 I i I~ \ \ \ v \ \ \ V v V - CD N. \ C i x ~r j y t.U Lij U.J CL n ors~ `f C1 > >C aO m -°r Q a LI1 u t C~ U) LL) ~ 'v y cli / \ \ \ x d 1 / \ m 'N CD ~ ~ v1 y y v t v Q Cy &5 LLJ n t \ v ~i A , l \ \ \ , d r _ ca c) to - ~I j ' / f / C) X/ L9 -21 of START UP AND OPERATION Page For new construction prior to use of the POWTS check treatment tank(s) for the presence of painting Products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' a o mgank be ' e a. a R D~-l l ~ T1;1~ n P- A/r 1r_ CaNS`T7et1Cqt ON/ ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone 7i~`- 7~a - o y Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name bVN Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 16 QQ gal ❑ NA Permit # Septic Tank Manufacturer NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms '3; ❑ NA Effluent Filter Model - ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) S~ gal/day Pump Manufacturer ❑ NA Soil Application Rate 17 gal/day/ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) 530 mg/L 4In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :510' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA fa year s) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 01KI year(s) Clean effluent filter At least once every: Akmonth(s) ❑ NA ❑ year(s) 3 Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot fines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. - -its -met been evaltrated to idemtify alua ' a o ing ank W/ lb T be ' e ai a FRD4415 nEM~, fbP- A/16k/ C0tJS7-9 JC~0N ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name , Name Phone 7. j - 7~i>a - y Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 6 ( C7 20,Aj ~l Phone Phone -71S- 3W(0- (0 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~J G Mailing Address e z P_ Property Address P/" (Verification required from Planning & oning Department for new construction.) -~r City/State N.,,t.►' 4;4"ej Parcel Identification Number 0 o7In -/0 d a ^ 80 _ 660 LEGAL DESCRIPTION 6 Property Location 5t'k 1/4 ,,S Gam( 1/4, Sec. T 3ON R/)~_W, Town of Subdivision Plat: , Lot # Certified Survey Map # 3 Volume , Page # 7 Warranty Deed # a / G R / (before 2007)Volume , Page # Spec house 0 yes ,4 no Lot lines identifiable Kyes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a wairan deed recorded in Register of Deeds Office. Numb r of bedrooms SIG OF APPLICANT(S) DATE **Any informati 7thatis may result in the sanitary permit being revoked by the Planning& Zoning Department.*** Include 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. 04/12) • II ~III~I~IIIIIIIIIIIIII) II 1 FI III DOCUMENT NO. - STATE BAR OF WISCONSIN FORM 16-1982 8.256838 • .TX:4209880 ~ TRUSTEE'S DEED 1001629 BETH PABST Shirley M. Leverty, as Trustee of Howard T. Leverty and Shirley M. Leverty Revocable Trust dated.January 11, 2007, for a valuable consideration coveys to REGISTER OF DEEDS Jobn H. Jacobson and Joan M. Jacobson, husband and wife as survivorship ST. CROIX CO., WI manual proper ran'e tolI: w"t3ig-dd9z rtbed real estate in ST CROIX 09/16/2014 10:06 AM County, State of Wisconsin: EXEMPT#• NA REC FEE: 30.00 TRANS PEE: 63.00 PAGES: 1 LoUaf Certified Survey Map filed May 12,1980, in Vol. 4 of C.S.M., pg 938, as Doc. No. 364112 being part of the SW'/. of the SW Y. of Section 1, Township 30 North, Range 18 West, Town of Richmond; Sts Croix County, Wisconsin. RETURN TO 1 St. Croix County Abstract & Title \ 219 S Knowles Avenue New Richmond, WI 54017 Tax Parcel No: 026-1002-80-000 Dated this 12th day of September, 2014 Howard T. Leverty and Shirley M. Leverty Revocable Trust dated January 11, 2007 (SEAL) (SEAL) Shirley M. Levv4y Trustee... Trustee AUTHENTICATION ACKNOWLEDGMENT.. Signature(s) STATE OF-.WISCONSIN . s authenticated this day of , 20 YOF ST- CROIX } ss: - FOUNT TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this 12th day of September, 2014, the (If not, above'named Shirley M. Leverty, as trustee of Howard T. authorized by § 706.06, Wis. Slats.) Leverty d Shirley M. Leverty Revocable Trust dated January 11 00 to me know to be the person(s) who executed?the f e i tru ledge the same. THIS INSTRUMENT WAS DRAFTED BY, ,~`;f,• r. Loberg Law Office/Robert L Loberg m Pal 1419311 alp/ Notary Pub r St. Croix County; Wis. M Commission is permanent. 4 s 0 -to M Si atures ma be authenticated or•acknowledged. Both are If not state expiration date: 10/21/17 not-necessary.) ' . TRUSTEE'S DEED . Fblt~lYQ06=I982 r ~ ~ t 1 N 1 Illfl I - X: St.'Croix County 1001629 Page— 1 of 1 I _ - - F 3E C3 - MAY 121980 'Maw of ow"" W1/•4 CERTIFIED SUR-VEY MAP r ~ CORNER SECTION. I, SET UNPLATTED LANDS rn - - M 3-02' S89`31' 20`£ en ro II 72.33 ~ ~ o~ M ; t POINT OF }BEGINNING; - 6g ~ 147,57' O' N'99-31'26"W SOUTHERLY RIGHT-OF-WAY LIN 3 +n 1 ui N , - v UNPLATTED a LANDS - z, - - CODY Q w V O I- X130 PAGE 28 o a 6 1 T&°5&'54 # 287133 W -s • cv m - - z: 1.01 ACRES s w s w L0 31 cn - TRUE SEA,°,ING, J "ate - ~o a :n N C SW CORNER SECTION I w z T30N. R18 W,FOUNi? ~Se ~d 1 5 0. 00' LEGEND: sss°3I'24"E 6' 1 ~ 0 1"x 24" IRON PIPE SET UNPLI~TTED LANDS - 0 I.68 LOS / LIN. F i. - - ! IRON PIPE FOUND SCALE IN FEET SECTION CORNER MONUMENT R- FENCE 200 10 O' 100 laUrmwoo a0"* THIS INSTRUMENT DRAFTED SY~- ~ - LLsi Q ~;r a l~.© dd'~ APPROVAL OF THIS MINOR suBOrVISrQ>.r D(0ES NOT MEAN APPROVAL FOR SEPTIC SYSTEM. REFER TO 1162.20 1 28%U' 4'w 24'-0" I I I I I I ~ I I y ro X ~ I I b $ I I nxi D ~ ~ p I I G G I I a m d m z D I I - fj1 I I ~ J it I I s 248W 2 N o ~O N m NZ W K W x -I F- I I -I m _ 3oee r ,I I ~ I 11 ~ ,p U Of . ~ z r m m x Q x 0 28'-0" PROPERTYOWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # 1 y Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. /y Bed Trerch D-- V :rte G~ V • 42 3 Ground r- -6 elev. Depth to limiting factor Remarks: Boring # FA Ground - loll ft. Z Depth to limiting factor 3 Remarks: Boring # XZ: ~ 121-i /1l I✓ !.7 4 t nvti? 1 "a AZ Ground elev. t~- o Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) Vy~~scopsinDep rtmentoflnndustry, SOIL AND SITE EVALUATION REPORT / Page _of bor and Human (Relations J1441111116. of Safe a Buildings in accord with I LH R 83.05, Wis. Adm. Code A ~ ti COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but / r G r°` X 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. 0 411X _40 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R WED DATE PROPERTY OWNER PROPERTY LOCATION GOVT. LOT 4 /4,S T p ,N,R /V~E (oe / PROPERTY OWNS ':S MAILING ADDRESST BLOCK# SUBD. 7E 0 CSM CITY, STATE ZIP CODE PHONE NUMBER TY VILLAGE OWN NEAREST ROAD New Construction Use Residential / Number of bedrooms [ Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow s0 gpd Recommended design loading rat ':?~be~, gpd/ft2 - "0r trench, gpd/ft2 w I~ Absorption area required 46!X bed, ft2 trench, ft2 Maximum design loading r e 7 bed, gpd/ft2y-jCtrench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as ref ed to sitePfan benchmark) Additional design / site considerations Parent material ur 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 s stem jo S ❑ U ®'S ❑ U [as ❑ LI AS El U ❑ S M ❑ S ~e}U 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 T al O%o O 3 e G • ~ _ r G`'.) Ground 3 74 elev. 7-V f I. Depth to limiting , factor / I 0 ZOO Remarks: Boring # 4 I~ ~2 q- ~ / 7 i Ground el v. qfft.` Depth to limiting « Remarks: CST Name:-Please Print . Phone: p C7 Address: Signature: Date: CST Number: /4* J 4• / - 7 Wisconsin.DepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page of Lnbor and HunYan 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 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION N GOVT. LOT 1/4 14,S T _70 N,R / E (or PROP RTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. N MME OR CSM # S Uo / y,3a ,9- 1 CITY, STATE ZIP CODE PHONE NUMBER []CITY VILLAGE OCOWN NEAREST ROAD New Construction Use Residential / Number of bedrooms -3 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpolft2 trench, gpd/ft2 Absorption area required, 6!X bed, ft2 -T trench, ft2 Maximum design loading rate :bed, gpd/ft2trench, gpolft2 Recommended infiltration surface elevation(s) yS ft (as referred to site plan benchmark) Additional design / site considerations -y Parent material / f`ccr K s Flood plain elevation, if applicable ft n5~Estem CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK system S ❑ U ®S ❑ U [23.S El U S ❑ U ❑ S 0U ❑ S B'U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 y ~ o r Ground elev. . 9 ft. 7: Depth to limiting factor 319 Remarks: Boring # y Ground 1 elev. if ft. Depth to limiting i 3- Remarks: CST Name:-Please Print Phone: Address: Signature: 1101, Date: CST Number: w / _3 7 PROPERTY OWNER ~7`ac✓~Lr~c/ .~c~~`{'~J°r SOIL DESCRIPTION REPORT Page of PARCEL I.D. tt Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground t n-c_ r ~F✓ ~'L , j tv elev. Depth to limiting factor Remarks: Boring # Ground -574 ft. lo, Depth to limiting factor Remarks: ` Boring # . Ground elev. 6't ~44~ 001/-/ 0, -//1X Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: - - - - - - - - - - ;arR.osi2f i 97 /'~'S S G <v to ~ ~ ,go 1° jq 3 Y 7 i G. Parcel 026-1002-80-000 12i01i2005 03:42 PAGE 1OF 1 Alt. Parcel 1.30.18.111 026 - 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 - LEVERTY, SHIRLEY SHIRLEY LEVERTY PO BOX 235 SOMERSET WI 54025 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: 1.010 Plat: N/A-NOT AVAILABLE SEC 1 T30N R18W 1.01A IN SW SW LOT 1 CSM Block/Condo Bldg: VOL 4/938 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.010 19,400 0 19,400 NO Totals for 2005: General Property 1.010 19,400 0 19,400 . Woodland 0.000 0 0 Totals for 2004: General Property 1.010 19,400 0 19,400 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 I 1 ~ by L. . 8 9 w t FILE1980 MA`t! 12 Q R , F of COMAL i ftow *mile W 1/4 CERTIFIED SURVEY MAP £ • CORNER SECTION I, SET UNPLATTED LANDS _ C .T_ H_ GG -M 3.02 S89°31' 20"E M M c0 W 1172.33' o 0 M ► ( in 1 POINT OF BEGINNING 89°/p• N89°31'20'W JA W 3 SOUTHERLY z~ RIGHT-OF-WAY LINE 3 3 in cn 3 O ~-O W O s,. U) I d 4 N t o N <n; j cn C-4 1 UNPLATTED_ z ° z LANDS z CODY w VOL_ 430 w v -O O PAGE_ 28 o a 1 0 0 I w 178°58'54° # 287133 _J: N O z z; b c\1 1.01 ACRES I w 3 SW-SW I TRUE BEARING 3 o rn 060 a `n >n N SW CORNER SECTION 1 w 01 T3ON, R18 W,FOUND z o~9`a 1.50.00' 190/0 LEGEND: S 89-3 1'20 "E l 0 I"X 24" IRON PIPE SET UNPLATTED LANDS WEIGHING 1.68 LBS / LIN.FT. O IRON PIPE FOUND SCALE IN FEET SECTION CORNER MONUMENT FENCE 200, 100, 0 100, I 3gLtIWW~~ OtONOZ at~► 3MNNVid SAW 3A1SW"3ad~ X1(107 %10r:) THIS INSTRUMENT DRAFTED BY i-- - - LL6l 0 Nnr Q31\01iddd APPROVAL OF THIS MINOR SUBDIVISION FOES NOT MEAN APPROVAL FOR SEPTIC SYSTEM. REFER TO H62.20 Volume 4 Page 938