HomeMy WebLinkAbout026-1011-40-000 S Z N Z O Cl) O N `C •
O N O O F A
000 (D =
CL CD ? fD N Q O O r�
O (D M -� 7 OD O
o N
N o CD cOi c O O O O CD
U)► _
m m �' C
U) D m
N N Q 3
CD N N
O
O .. Ln Z "%I
0 (O (D
Cl)
CD co m f
N CO w I; 3 p lV
T 3 C •
O O O o
p n
z
ci vi
O
ai ai g D
33 Q v c
m
CD
D30
p
CD
A
cn
v Oro
3' m a
7 p Z N
N C -' z 0
CL
CL
I c m �
a o
l,z
-�l �p�
U O z
m �
� N
` zD D
CD M a CD
a C
p (D G
D ' CD T
° z a
_ O
3 m
Q o N
CD
7 !
N = y
Ln 3
r
60
oa
n �
` N
N O
CD
I
O_ b
CD
pq
o O j ti c
C) CD y
ti
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRES
SUBDIVISION / CSM# LOT
SECTION °/ T -30_ -R Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
- Ile
ios'
a �
/a
INDICATE NORTH ARR Of
Provide setback and elevation information on reverse of this for
Provide 2 dimensions to center of septic tank manhole cover.
r
B ENCH24ARK
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING_TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons /cycle:
Alarm Location
':SOIL ABSORPTION SYSTEM
Width: � Length /gyp' Number of trenches
Distance & Direction to nearest prop. line: ,, f
Setback from: well: _-J House Y , ,�D Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet
PC inlet PC bottom Pump Off
Header /Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
L( 1 rt Q 4.30.18. ATE SEWAGE SYSTEM county:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitar
GENERAL INFORMATION y er
Permit Holder's Name: ❑ City ❑ Village R an Town of: State Pl o.:
CST BM Elev.: Insp. BM Elev.: BM Description: 11�� Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9300289 )
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �.. Benchmark
Dosing t�- 2. v LE W` a 7, t
Aeration Bldg. Sewer
Hol St/ PK Inlet
TANK SETBACK INFORMATION St /�I'f Outlet
TANK TO P/ L WELL BLDG. vent to ROAD - -9t -4ft+ e# (.�j � 6 7 qF
Air Intake'
Septic >�� ' /Ga� NA Dt Bottom
Dosi NA Headerfi�i.
Aeration Dist. Pipe 9, ,U
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Demand S,� p- 'y
Model Number M ,�•�; '
TDH, Lift Friction S TDH Ft /Zq,17 1� $ '
For Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width _ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS � � D E N S I O N S
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING ........... Man
SETBACK
INFORMATION Type O C'� . }` OR UNIT CHAMBER M m er.
System: {qty,
DISTRIBUTION SYSTEM
Header / " ". Distribution Pipe(s)� Hole Size x Hole Spacing Vent To Air Intake
Length _LL--- Dia. Length Dia. Spacing //
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx ed
B�firench Center WTrench Edges Topsoil ❑ Yes ❑ No Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) '}
LOCATION: RICHMOND D4.30 18.40A 1 /%'�,,��
Xxc
r�
Plan revision required? ❑ Yes Er
Use other side for additional information. ,
SBD -6710 (R 05/91) Date Inspector's Signature Cert. No.
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY MIT #
–Attach complete plans (to the county copy only) for the system, on paper not less than ❑ d,
8% x 11 inches in size. c ec if revision t previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
I. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION.
PROPER W R PROPERTY LOCATION
'/4 '/4,S T ,N,R ! (Or
PROP RTY OWNER'S YAILING AD ESS LOT # BLOCK #
C71, STX c�daaja ZIP CODE
PHONE NUMBER SUBDIVISION NAME OR CSM NUM ER
Iw
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VIL : NEAREST R AD
IM TOW OF
J
❑ -# Public [Z 1 or 2 Fam. Dwelling of bedrooms PARCEL • NUMBER
III. BUILDING USE:- (If building type is public, check all that apply) r _
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. ❑ 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 El 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. tt.) (Gals /day /sq. ft.) (Min. inch) 9 7-1 ELEVATION
Feet 99 Feet
VII. TANK
CAPACITY
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New sting Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank
Lift Pump Tank/Si hon Chamber _ . - --A- I F1 I [I I F 1 11 1 11 LJ
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' ame (Print • I Plumber'�Ign ur e: o ps MP /MPRSW No.: Business Phone Number:
'71 711
Plum r' Address rest, City, State, zip Co e): 'y 10T Z,: 2t �Ar
LINTY /DEPA TMENT USE ONLY
❑ Disapproved Sa)t)tary Permit Fee (Includes Groundwater Yate Issued Issuing A nt ature ( S
; �( Approved ❑ Owner Given Initial 0 Surcharge Fee)
Adverse Determination �XL
X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL:
SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
x ,
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, 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 aid /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 -6398 (R.11/88)
t 90 - New
Zj.
ate'
?.2 T/
r
y3�
s7' wy -
PAG E OF
C,ro co A Zr17 Sy S�ern
AD �.��
froth Ali Inlol► And OD►0ivallon Pipe
Appror�d Von, Cap
Ntnlmw� 12� ADOr*
final Grad*
20- 42' Above Plpp — 4" Co*1 lion
To final Ge°do Von$ Pipe
n1w►n
Her Or Syntn*tk Covering
Yin 2' AyQr*pol*
0r*1 PlpO
OI UrlOrllon
Plpa —' 0 0 o '-- To
` AYYr*pal*
Don**la Plp* ° 1`6(1614114d Pipe B*lor
o �C001Ay Twminaling Al
8011041 01 Sy►1*m
1 /
5_ ftT
SOIL FILL
DISTRIBUTIOF.1 PIPE
APPROVED S4)JPr_TIC COVER
^• .r C __ OR 9" OF STRAW
2" OF G R E4A OP. MARS►+ HAy
L = (a. �' O 2/ 2 AGGREGATE
DIS I RIf��JTIOU PIPE TO BE AT L6A57 IMCHES BELOW ORIGIMAL GRADE
AUU AT LEAST LO IUCHES BUT 1.10 MORE THAIJ 42 IAICHES BELOW FMAL GRADE
M xtmurl DE Prvi of EXCAVATloo rKom oK IGwAL (iX AVF_ WILL BE _ I
ruKIMUM ()q" OF EACAVATION fAOM 0 4JAL GRADf_ WILL B1= _ INCHES
SIGI.IED:
L I C E u S E 1.J U M B E R:
r
+ v
DATE . L4
- - -- - - - -,... 1 10
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.
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Pau]- 0. Swenby GOVT. LOT M�T 1/41TF, 1/4,S4 T30 N,R 18 )Nor) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR.CSM #
1-164 11y. #64 n/a n/a n/a
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE &IOWN NEAREST ROAD
New Richmond, WI. 54017 (715) 246 -2223 Richmond I Hy. #64
(] New Construction Use Residential / Number of bedrooms 3 (] Addition to existing building
kkReplacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate n/r bed, gpd /ft trench, gpolft
Absorption area required n bed, ft2 1000 trench, ft Maximum design loading rate n/r bed, gpd /ft trench, gpd/ft
Recommended infiltration surface elevation(s) 9 6. 74 -95 .69 It (as referred to site plan benchmark)
Additional design / site considerations bed not reco , ended -step down trenches at above elevations
Parent material outwash Flood plain elevation, if applicable n/a ft 1 1 S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM
IN FILL HOLDING TANK
U = Unsuitable fors stem laS El U aS ❑ U I iaS El U O S ®cU ❑ S E3d.f
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
1 0 -8 10yr3/3 none L. 2/m /gr rifr g/w 2 /rl .5 .6
<'`'r 2 8 -18 10yr4/4 none scl 2/m /sbk mfr n/w 1/m .4 .5
Ground 3 8 -25 7.5yr4/4 none sl. 2/m /sbk mfr g/w 1 /f_ .5 .6
elev.
98 .44 ft. 4 25 -65 10yr4 /6 none Is. 0 /sg mvfr g/w n/a .7 .8
Depth to 5 65 -78 10yr3 /4 none s_l 1 /c /pl mfr n/a n/a n/p .3
limiting
factor
>7 811 ------ t
Remarks:
Boring #
:.,, 1 0 -7 10yr3/3 none L. 2 /m /gr rifr g/w 2/m .5 .6
2 >` 2 7 -28 10yr4/4 none scl 2/m /sbk mfr g/w 1/m .4 '.5
3 28 -69 10yr4 /6 none ls. 0 1sg mvfr g/w 1/f .7 '.8
Ground
elev. 4 69 -80 10yr3 /4 none sl. /c /pl mfr na/ na/ is /p 1.3
99 ft.
Depth to
limiting
factor
>8
Remarks:
CST Name: — Please Print Gary L. Steel 715 - 24 P 6 h kOO
Address: 1554 7%th. AVe. Te Ri d, WI. 54017
Signature: 8 -10 -93 Date: cstm 2298 CST Number:
PROPERTYOWNER e.Sa- VI'749V SOIL DESCRIPTION REPORT Page 2 6f 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Thatch
1 0 -16 1 3/3 none L. 2/m/gr mvfr /w 2/m .5 .6
2 16 -27 10yr4/4 none scl 2/m /sbk mfr g/w 1/m .4 .5
Ground 3 27 -38 7.5yr4/4 none sl. 2 /ri /sbk mfr g/w 1/f .5 .6
elev.
98. ft. 4 38 -74 1 r4/6 none ls. O/sg mvfr /w n/a .7 1.8
Depth to 5 74 -90 1 r3/4 none sl. 1/M/ P1 mfr a/ na/ n/ .3
limiting
factor
>90 1,
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
FT
Remarks:
Boring #
k ?i•
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
€<
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
I
STEEL'S SOIL SERVICE 1554 200th. Ave
Gary L. Steel
C.S.T. 2298 Paul 0. Swen
New Richmond, WI 54017
b
MPRSW -3254 y ( (715) 246 -6200
NW -,,NF r, S4- T30N -R18�J � �7 ,p
town of Riclunond t �/1 ,
10
�0)S�
14o v-
1
/
n
Gary L. Steel
8 -10 -93
I
vviscorwn Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
'Labor and Human Relations
Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
V „ COUNT
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.
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Paul 0 . Swenby GOVT, LOT Ma 1/4 1/4,S T30 ,N,R 18 M a) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK M I SUBD. NAME OR CSM #
1.16411. 4164 n I n n
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE WWN NEAREST ROAD
New Richmond, WI. 54017 ( 715) 246 -2223 1 Rictunond I fly. #64
( I New Construction Use dad Residential / Number of bedrooms 3 [ ] Addition to existing building
UReplaeement ( J Public or commercial describe
Code derived daily now 450 gpd Recommended design loading rate n/r bed, gpd/ft trench, gpd/ft
Absorption area required n/r bed, ft 1000 trench, ft Maximum design loading rate n/r bed, gpd/h2 trench, gpd/111
Recommended infiltration surface elevation(s) 96.74 -95.69 ft (as referred to site plan benchmark)
Additional design/ site considerations bed not recormiended -step down trenches at above elevations
Parent material outwash Flood plain elevation, if applicable n/a ft
S - Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDWG TANK
U - Unsuitable fors stem I kaS O U EIS O U jaS ❑ U FE ❑ U [] S Eku ❑ S ®dl
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 ITrwch
1 0 -8 10yr3 /3 none L. 2 /m /gr raft 8/w 2/n .5 .6
1
2 8 -18 10yr4 /4 none sel. 2/n /sbk mfr g/w 1/m .4 .5
Ground / 3 8 -25 7.5yr4/4 none sl. 2/m /sb1c mfr g/w 1/f .5 .6
elev.
; -44 fL 4 25 -65 10yr4 /6 none l.s. 0 /sg mvfr g/w n/a •7 .8
Depth to 5 65 -78 10yr3 /4 none s1. 1 /c /pl mfr n/a n/a n .3
limiting
;actor
Remarks:
Boring #
1 0 -7 10yr3 /3 none L. 2 /m /gr rifr g/w 2/m .5 1 1.6
'' 2. - 2 7 -28 10yr4 /4 none scl 2 /rn /sbk mfr g/w 1/m .4 I .5
j 3 28 -69 10yr4 /6 none I.S. 0 /sg mvfr g /w 1/f .7 1.8
Ground
elev. 4 69 -80 10yr3 /4 none s1. /c /p1 mfr na/ na/ n/p .3
.49 it.
Depth to
;imiting
factor
Remarks:
CST Name: — Please Print Gary L. Steel 715-24' -
Address:
1554 7OQth. AVe. Ie , Richmond , I -T. 5401.7
c'uinature: �---•� v.. Date: CST Number:
V- 10-.y3 cstm 2298
cr /.��. T Page 2 of 3
PROPER7iFOWNER << � SOIL DESCRIPTION REPOR g _
• �T
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
In. Munseli Qu. Sz, Cont. Color Gr. Sz. Sh. Bed Trends
y' 3 1 0 -16 1 r3/3 none L. 2/m/gr mvfr /w 2/m .5 .6
} 2 16 -27 10yr4 /4 none scl 2/m /sbk mfr g/w 1/m .4 .5
Ground 3 1 27-38 7.5yr4/4 none sl. 2 /ri /sbk mfr g/w 1/f .5 .6
elev.
98.4ft. 4 3E -74 10 r4/6 none ls. 0/sp nvfr w n a .7 1 .8
Depth to 5 74 -90 10 r3/4 none sl. 1/nl/pl mfr a/ na/ n/p 3
limiting
factor i.
>90
Remarks:
Boring #
Ground
elev.
It.
Depth to
Gmitlng i
factor
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to
limiting
facto
Remarks:
Boring #
[3
r
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD•8330(R.05/92)
STEEL'S S OIL SERVICE 1554 tooth. Ave.
Gary L. Steel
C.S.T. 2298 New Richmond, W1 54017
Paul 0. Swenby (715) 246 -6200
MPRSW -3254 NtA�,NF,, S4- T30N -Rl8W
town of Riclvond
II
�I) y1 )
oo
a, L )47'
C N
y
C�
�--'
Gary L. Steel
8 -10 -93
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER /BUYER
ADDRESS F E NUMBER
CITY /STATE ZIP
PROPERTY L N: 1�4, � 1/4, CTION , N -R W
TOWN of /V St. Croix'County,
i
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 /Ile, 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 sep ha een mainta' ed must be
completed and returned to the St. ro Zoning cer within
30 days of the three year expiratio e.
SIGNED:
DATE:
St. Croix co. Zoning Office
911 4th St.
Hudson, WI 54016
STC -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 �n delays of the pormit issuance. ,Should this
development be intended for resale by owner /contractor,(spec
house), thent second form should'be retained and completed when
the property is sold and submitted to this office with the
appropriate deed - - - -- recor g.
------------- - - - - - - -- - --- - - - -- ----------------------
Ow ner of property V
'/ c�
Location of p r y T e o t 4 N -R/2W
Township
Al
Mailing address ZZZ2 _/
Address of site
Subdivision name Lot no.
Other homes on property? s o
Previous owner of property
Total size of parcel
Date parcel was created
'Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes \ � t No
Volume 3111/,� and Page Number V6W as recorded with the Register
of Deeds.
STATE OF WISCONSIN - FORM NO. 30 (1?", 1960)
273330 DOCUMENT NOV ��'��� -` 6
- A l -. - Set t u n 235.16, Rhuone.n Stanktr.
xUlaul ll M elt, - hhat the undersigned_ _ _ Paul 0. Swenby arid.
Marion 11. .Swenby, his wife �y
of._ New Richmond _- -- County of_ -_ St. Croix __ - - , State of Wisconsin, hereinafter called \tort. Iflmrs,
herchy mortgage to First Federal Savings and Loan Association of Eau Claire �� � orpor itlon,
�I located in _ Eau Clair.^., _ - -_ Wisconsin, hereinafter called tht Aiortl i,;ec,
for the sum of Twelve thousand and no /100 -------------------------- Dollars S 1?, (100, 00
the following described renal estate in St. Croix County, Wisconsin, to \t it
The Fast I /2 of the North: , 7est Quarter of Itlortheast Quarter
of Section If, Tntiniship 30, Ran (3 1,1;
I ,
i
/i
including all appar:Itus, cyuir-ment, f -,t!ns or articles, ,chetiier Ill ,tn1jc• unit; or centralk eonirolle_ , uJ to supj,ly
heat, Etas, air conditioning „, tatter. li,�l�+ I-,rittcr, it III teraiion, ycntilatu or otheml ant! ant• c,lu_r thh:,; t1uN or
hereafter thereul or Ihercoll tilt liar 1 1 111;1 of tthuil h\ 1 1 tcs , twtonriry or i proi it tc, w k:;' rterl;,
uindov. shades. stolen doo!'s . "nu ;I(x)r c<ntrill,,,, -, dean ut +rs, lrt a -Ji„)r I c. is ;ca +rile,; a'ta• , trni 1tat, r ut n(r:
(all of vthich are declared to h:• n t)aut of a:i.; rcai c, pll\ aik :ttt::: hid therctoor ;_,'l �. t the +t
pritjlclres, hercditanlellts appurtct�:anecs and inn ;�rot.cn�cnts :�W, tar hrr(:a!t,r hcic,r n ;„ 0 t,% t thcrrt >n, ;1111 111
ll
the rots
- 'i profits and inco me \\i;ic!1 shall ;anse or x�r
i)e haul ticfn
ru nerc:�), I.•Ier�iry�, ;,n�.l ta1�. in;; all r;;,!;t-. un.lrr rarni hit �
,
v irtue of any l lomestc'ad 1 :xentptiola I .arts, 'Ind all ri to refill') pos of said I)renliscs after anti �Icl.ltik 111 I gat net rut
of the alxwe obligation, or breach of any of the cut*enants or agreement; herein containe ;l-
'I his mortp,a is gn en to secure the following indebtedness.
Twelve tlio it ;nnd ;and no ------••------- -------- -------- -- - - - - -- Dollars (r 12,000.00 )
payahle in installrients iitith Interest acarrding to t1le conditions of a rert;ain nu)rtgage not(- hearillg t!.lte llcrc�tith,
executed h said Nortgap,urs to s, tid X10;tg zll ;ce, and all additi(mill anal suh,cliucnt ad\;ances or p:l,ments nutde ht s.Ild
\tortf;a All Ow terms and coedition; of the note arndl additional atl� ancc ar; :enle�nts secured herch�• tare iu,: orpucated
herein and make part herein \\1111 the some tOI and curet .!, thou;:;h fully set firth herein, lncludingr, duty to .ran:uit
title. Ill��AIIe gully. keep in rep ;Iir.,nd free from lien a
;, nn)rti�c t;r<c, an m
d utsuri,n�i� onthly, pai III �Ihcl intcre_-t on notirc
anti defaults, have due date accelerated, and action at luv or in equity corlurenecd because of tieiault”
file A1ortga ;,ors ar;rcc that in the c%crlt of ill(. fOCCCII);Jre of this nx>rtgn(;c prrn P,Wt ,
of Section 278.101 of the Wit-cons-in Star.uc,.
Ille \lortgilgors agree Il'1 bath all tiIXes tend a,tiCSsnl ClltI Ull sdid prcn1IseS and it tlllStifla '11111 of IilulltV ;iti Aflil �
for attorneys tees in cane of foret:losule belch(. In the e%ent OI the nun - pu folnlance of nn,' of th et 111 ":xs contained
r in the note or mo ruga:gc, s,Iit: Nloit „a is hC!01 V authori-cd to (,rant, hal�taln, sell and Co ,,,\,(,, - re,;l . j,itr it pul)I;c
j' auction, and make all necdfnl deeds of' Coll cyance to the hurthaycl tilercof
All coven. ants, agreements, stipttlntions and condit.on -• 'lcreln and ir; said note contained .hall he f upon
r ' and inure to the henefrt of the paruC, hereto ilea! thee- resi)teti\c heirs. n sI tcssors ;Ind
• N WFF\I:SS W1 II: - ('I: , ~aid NlortgaL;ois hay !Icroint t set (heir hands and seal. , at jktttl:tilAiit� =t
Wisconsin, this ninth d IY of _ auL-ttst 1r' 63
, p) d, "al I nd d"i "J .” th. p ,cncc ,I.
Ji i t r a
N c on lug 0 1 . Swenby �
Verne R. Lotz vita ion li. Stirc nby
I ;sl At )
THIS INSTRUMF_NT WAS OtZAF TE " ":) tit 1 . -. .. S A 11'. 01' �� 1S O'NSIN,
Phyllis xt wfi bt. Croix in <.outif)
- R
RECEI VEO FOR FZECORO Perwnally Carne Ix-tore nic •hi.. 111 ' J 4 , o f - At A. I) lt> 63 ,!
the alxwc named Paul O. - SwQhby and
this 12t1l dal' of Au "USt . A U 1(63 TMr s . / f
.z2on•,Io ; �weiiby,. his w: fe
I t _ 1 :nn _ n ciocl ... n. )\A_, an �o
d recorded to rile known to he the perns w1ji executed foregoing instrument and alnnu ledge.)
the sane as their free act hnd dWC�ji
in Vol 396 Of Morta�es, on page _166 , Z�z et�lllf
(SEAL)
xi ilzncy C. Olson
Nbtttrj2'Pu�ilic,__._ X�'�}'t�i+7ix _ ('ounty, Whs
- " - - - - `26 66
h Ikl)uty ttrgistcrof Ueeds My commission expires /
(Sec n,m 59 51 (1) of the 0.iscousa 11 So at LIT provides that kill instnunrnts to lr• recor,W ~hall have plainly thereon 6 9116
j the names of the grantors, grnnt<t �, witnesses and not Section 5k) 513 sunilarry, reyUires that the n;nue ill the M"n ai or go-111
�� mental apency which, drafted such matrument, shall be printed, typo%ritten, stareir ed or written thereon in a legible manned �'
0 Cl) O 3 v 0 O V1
o m m o
I c
3 m m 0(D
�*
3
4
Cn T, X to z ? Z (7 O N
C < C 0 (D CD
Z co
m Q Q N 3 (D
N d * Cj rte.
O r7 O
to C C n 7
CD
ai to 0 3 0
O d 0 3
CD CA c
W
O C -
O (D W a)
` O Q
Ila N)
Z (n !i
CD o
(n N O O fD Co !V
0) 0)
� I, I
CL v v rn
Z 0 0 0 a Ii tv
o s E m c Z
n 0 N to N D
zT vvv�
a ' cD � m y
D m o cc
m a N
N
CL w
Z '
z z 4 1 4
D D o 0
v O �
O N• CD
.0 Q
� 3 Ii OI Q
w o
n 3 m
Z CD N -` -4 N
O C p Z n
ri Q A z O
D CD (7 3
o (n
o
Z A
W m ('
0
CL Z
0 3 a
c z
C � <
CD A
O N
CD
�*a) 0 3 : C D 3
- = ;u 0 'co�i Q CD
�_ -
C. . m o . m n
w o' o 3 a °-' o� D c
o a o o m
o 2c o-o 03 0 = a
O C pk c 3 0 0 u,
E O CD O it
_ , x A
a Q°3 DN � (D a
o A -i CD @ a o C = 0
�. } -a 7 N Cn CD CD C
o (D CD 0 :E 5
a
Zoffn caD
O (D N =c
(D
p 0 3�
F �
p w
CD
I CD
A
fA O w
O CD
CD
Parcel #: 261- 1285 -02 -300 10/09/2007 03:46 PM
PAGE 1 OF 1
Alt. Parcel #: 261 - CITY OF NEW RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
08/16/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - NEW RICHMOND GOLF CLUB
NEW RICHMOND GOLF CLUB
1164 HWY 64
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: 12.260 Plat: 5001 -CSM 20 -5001 261 -05
SEC 4 T30N R18W 20A PT E 1/2 NW NE Block/Condo Bldg: LOT 02
ANNEXED ('04) FKA PT 026 - 1011 -40 (40A)
FKA CSM 18 -4788 LOT 2 (19.32 AC) NKA CSM Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
20 -5001 LOT 2 EXC CSM 21 -5258 04- 30N -18W NW NE
Notes: Parcel History:
Date Doc # Vol /Page Type
08/22/2006 832749 EZ -U
08/16/2006 832290 21/5258 CSM
10/25/2005 810269 2915/147 QC
06/29/2005 798950 20/5001 CSM
more...
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 03/08/2007
Description Class Acres Land Improve Total State Reason
UNDEVELOPED G5 12.260 36,800 0 36,800 NO
Totals for 2007:
General Property 12.260 36,800 0 36,800
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 #: 261- 1285 - 02-000 10/09/2007 03:45 PM
PAGE 1 OF T
Alt. Parcel #: 261 - CITY OF NEW RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
06/29/2005 00 5
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - NEW RICHMOND GOLF CLUB, RETIRED
RETIRED NEW RICHMOND GOLF CLUB
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: 19.320 Plat: 4788 -CSM 18 -4788 026 -04
SEC 4 T30N R18W 20A E 1/2 NW NE ANNEXED Block/Condo Bldg: LOT 02
('04) FKA PT 026- 1011 -40 (40A) NKA CSM
18 -4788 LOT 2 (19.32 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
04- 30N -18W NW NE
Notes: Parcel History:
Date Doc # Vol /Page Type
07/27/2004 769925 2624/613 TD
07/23/2004 769677 2623/153 ANNEX
07/16/2004 768944 18/4788 CSM
07/23/1997 1154/541 QC
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 03/28/2006
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
i
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Safety and Buildings
4003 N KINNEY COULEE RD
commerce.wi.gov LA CROSSE WI 54601 -1831
: TDD #: (608) 264 -8777
isconsin
www.commerce.wi.gov /sb/
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
August 14, 2006
CUST ID No. 30021 ATTN.• POWTS Inspector
JAMES K THOMPSON ZONING OFFICE
A.C.E. SOIL AND SITE EVALUATIONS ST CROIX COUNTY SPIA
340 PAULSON LAKE LN 1101 CARMICHAEL RD
OSCEOLA WI 54020 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/14/2008 Identification Numbers
Transaction ID No. 1307896
SITE: Site ID No. 716449
Arthur -Rose Community Based Residential Facility Please refer to both identification
1164 State Hwy 64 numbers, above, in all
Town of Richmond correspondence with the agency.
St Croix County
NW1 /4, NE1 /4, S 4, T30N, R18W
FOR:
Description: Replacement Commercial Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 1090251
Maintenance required; Replacement system; 897 GPD Flow rate; 24 in Soil minimum depth to
limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-
10691-P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P
(N.01/01)
The submittal described above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY
APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible
for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the
Department per s.145.06, stats.
The following conditions shall be met during construction or installation and prior to occupancy
or use:
• This system is to be located and constructed in accordance with the enclosed approved plans
and with the component manual(s) referenced above.
• A sanitary permit must be obtained from the county where this project is located in
accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the POWTS installation is required. Arrangements for inspection shall be made
with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),
Wis. Stats.
JAMES K THOMPSON Page 2 8/14/2006
• The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular
traffic or soil compaction in this area is prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the
owner of the tank explaining that periodic cleaning of the filter is required. Access to the
tank/filter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm.
Code.
• Comm 83.22 ( 7 ) - A copy of the a s pecifications and this letter shall be on -site
pp roved p lans, p
during construction and open to inspection by authorized representatives of the Department,
which may include local inspectors.
Owner Responsibilities:
• The current owner, and each subsequent owner, shall receive a copy of this letter including
instructions relating to proper use and maintenance of the system. Owners shall receive a
copy of the appropriate operation and maintenance manual and/or owner's manual for the
POWTS described in this approval.
• Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the
operation and maintenance of the POWTS occurs in accordance with this chapter and the
approved management plan under s. Comm 83.54(1).
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved
management plan or as required under s. Comm 83.54(4) shall be considered a human health
hazard. In the event this soil absorption system or any of its component parts malfunctions so
as to create a health hazard, the property owner must follow the contingency plan as
described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the
county for maintenance tracking purposes. Reports shall be submitted at intervals
appropriate for the component(s) utilized in the POWTS.
Note: The natural gas utility must be contacted prior to the system installation. This is required
to alert them of the proposed construction of the mound in an area where an easement for an
existing gas line maybe present. The county ma� require proof of this contact prior to issuing
the sanitarypermit.
In granting this approval the Division of Safety & Buildings reserves the right to require changes
or additions should conditions arise making them necessary for code compliance. As per state
stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for
designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed
below, or at the address on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are
responsible for the installation, operation or maintenance of the POWTS.
JAMES K THOMPSON Page 3 8/14/2006
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Gerard M Swim
POWTS Plan Reviewer, Integrated Services
(608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633
jerry.swim@wisconsin.gov
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
I
I