HomeMy WebLinkAbout026-1149-00-003 Wisconsin Depfirtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division INSPECTION REPORT t I Sanitary Permit No: 42061 0
(ATTACH TO PERMIT)
GENERAL INFORMATION ( `t` State Plan ID No:
Personal `Formation 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:
Derrick, Steve I Richmond Township 026- 1149 -00 03
CST BM Elev: Insp. BM Elev: BM Description: #
TANK INFORMATION V ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark i
Dosing %0 Alt. BM
S L .
Aeration Bldg. Sewer P w
Holding I St/Ht Inlet
1 9 , 72— 103.03
TANK SETBACK INFORMATION St/Ht Outlet C/A a O OZ. -SS
TANK TO P/L WELL BLDG Vent to Air Intake ROAD Dt Inlet ,
Z `'+- $� C
Septic g / Dt Bottom
33
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
PUN /SIPHON INFORMATION Final Grade
M nufacturer Demand St Cover
M 16 6 - 9o) v� I I 0 • `�
Model Number
vin
TDH Lift Rt Iction Loss System Head TDH Ft
Forcemain Length Dist.
SOI ABSORPTION SYSTEM 5q
BED/TRENCH Width t LengtFr No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 7J 3
SETBACK SYSTEM TO I,, /L BLDG WELL LAKE /STREAM LEACHIN Manufact er:
INFORMATION CHAMBER
Type Of ystem: ( V
r , / 3r � Model Number:
Z�/ 1
DISTRIBUTION SYSTEM E l �s{ 't �PL
Header /Manifold N Distribution x Hole Size x Hole Spacing Vent to Air Intake
o Pipe(s)
1 1-engthia 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 Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
FBI Yes [W No [j Yes L] No
COMM TS: (Includg code di s repencies, persons present, etc.) Inspection #1: MW� / Inspection #2: �
bh�yv. f% ppeet1 "h a cc�e
Location: 127 6 2nd Ave New Richmond, WI 54017 (SW 1/4 SE 1/4 15 T30N R1 8W) Cherry Knolls Lot 3 Parcel No: 15.30.18.110
1.) Alt BM Description = J �" YI �'� G�I,(�, 5 Gr _ cZ•_
2.) Bldg sewer length
- amount of cover = � t' , 26s9e � • O m l °2- ,
Plan revision Required? [] Yes o
� �.
Use other side for additional information. D U_._,'
-- -- XnepAtorls Si at - ure SBD -6710 (R.3/97) Date Cart. No.
Safety and Buildings Division County S rG�d k
201 W. Washington Ave., P.O. Box 7162
,ScDnSI � Madison, WI 53707 - 7162 Site Address
3 / a /a -/7 -D Z IZS� 1 S2J �v
De 8f :mant of Commeroe � Sanitary Permit Number
Sanitary Permit Application 4t- �tT
N ' in accord with Comm 83.21. Wis. Adm. Code, ponoml information you provide ❑ Check if Revision
wa be used for Wen Pri Law, a15. 1 m State Plan I.D. Number
N I. Application Information - Please print All Information
property Owcer'a Name y Parcel Number 0 ZG -If `� �- °Q ' o0 3
�� is'• so
Ue— Oe Y, Property Location
p Property Owner's Mailing Address z ''
A- T
3 Lot Number Block Number
City, State Zip Code Plan:' r
,^ •°"° CSM Number
Subdivision Name
� 7 0? �fG / 5 W e v lS
II: Type of Building (check all that apply) o „ s �,, S ,.,L,.,�: cQ ❑City
91 or 2 Family Dwelling - Number of Bedrooms -S Village
❑ Public/Commercial - scribe Use ownshi .`G`t l,� O"ej
earest Road
❑ State Owned N
t: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
M. Type of P
A' I New 2 ❑Replacement system 3 C1 Replacement of 6 C3 'Add' . h to
For County use
stem Tank Onl , Existing S stem Date Issued
❑ Check if Sanitary Permit Previously Issued
Permit Number
IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) .... - -
3 44 Non - pressurized In- Ground 21 ❑ Mound
47 ❑Sand Filter SO C1 Constructed Wed nd �
22 ❑ Pressurized In- Ground
41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade
46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 Other
V' V. Dig ergal/Treatmeat Area Information percolation Rate Sys Elevation Final Grade
p'
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application in Mch) evation
Required Proposed �(��$� Rate(Gals. /DayslSq.FtJ (TI y r 9171 19
i
/ moo do ,�- �o� _ z i /o
L> Prefab
Prefab Steel Fiber Plastic
VI. Tank Info Capacity in Total Number Concrete Constructed Glass
Gallons Gallons of Tanks
New Existing
Tanks Tanks
Scot or Hording Tank
Dosing Chunber
VII. Res ousibility Statement Y, the undersigned, assume responsibility far lion o! lira POWTS shown on the attached
1ne phone Number
Plumber's Name (Print) Plumber 'a Signature PRS Number
N k/ /���t G Yria !lam
S � Plumber's Address (Street, City, State, Z Code) >
VIII. County !De Partment. Use Only
Sa nitary Permit Fee (includes Groundw of Data Issued log at SignaAUe (No Stamps)
at
f $[ • Approved ❑ Disapproved Surcharge )
d [] Owner Given Initial Adverse •
De rmimtdon =y- nn
EK. Conditions of Apprav Me . a s son ns s f Disapproval - SD
�T� s y� S� .1 � •�-K `�` � � ,�9 %��1 so n o_,,,SZ S t�-� �- .
6 �, w, /�-Q ►opt --s�� C
tt ff -- -- •• At_ta eetnpiete plans sie �tthee County o�nl7) t � , � 0 ° Pa c' t lsa o 1 ;11 tnel►�
�• !�� � / tM0..t..►�J�°•".it ��- ^-- �'(`p+t,(L `L>�' C.lr<tAt� `tom
SB -63 (R 5141) � s� r� �� � ��''"�t . •o�Z- . -�' Q�° %� ��;
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Wisconsin Demrtment of Commerce SOIL EVALUATION REPORT Page 1 _ of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. evpwed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). '2-11b /0 Z —J 4 Property Owner Property Location
Steve Derrick Govt. Lot SW 1/4 SE 1/4 S 15 T 30 N R 18 E
Property Owner's Matting Address Lot # Block # Subd. Name or CSW
1438 County Road G 3 - Cherry Knolls
City State Zip Code Phone Number []city Vitlage� r Ta — T Nearest Roam
New Richmond WI 1 54017 1 ( 7j5 County Road G
New Construction UseE] Residential / Number of bedrooms _ 3 to 4 Code derived design flow rate 450 to 600 GPD
RepfacGmerd !I Public or commerciat s Describe:
Parent material f .oecc over till Flood Plain elevation if applicable
Generall commerft Site suitable for a conventional below grao
and recommendations: c system
k
Boring #
Boring
Ej pit Ground surface elev. 103: tt. Deptt► to limiting factor }98 in .
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Oyu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -12 10yr3 /3 sil 2msbk mfr cs 2f .5 .8
2 12 -33 l 4/4 sicl lmsbk mfi cs if ,2 .3
3 33 -98 7.5yr4/4 sl 0m mfi - - .3 .5
27 Boring # 99.(10 >99
Q pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -8 10yr3/3 sil 2msbk mfr cs 2f .5 .8
2 8-20 7.5 4/4 I scl lmsbk mfi cs if .2 .3
3 20 -38 7.5yr6/4 s Osg ml cs - .7 11
4 38 -43 1Oyr3 /6 scl lmsbk mfi cs - .2 .3
5 43 -98 5yr5/4 sl Om mfi - - .3 .5
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD < 30 mgtL and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Thomas C Nelson - - — 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, Wl 9 -25 -02 715- 246 -2454
l
PAP
Ejtvf )Phopelt tall a3 P
WWW.ehV� ?ptiNrth �AC��I�ES��jh.CpNr
79- 246 -2454
CHERRY Mw411- L9
zo
o Cp
7
�D t�
7Top G��/'D�
15-3
Thomas Nelson Scale V 227387
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each for maintaining the system within
System (POWYS) shall include information and procedures royal by the department, agent,
the parameters of Comm 83 and 84, and the conditions of app
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Des i n S eciflcations
Sanitary Permit Number
Number of Bedrooms 3
Desi n Flow - Peak { d)
Estimated Flow pd)
mastic
in
Average C'°
Septic Tank Capacity {gal) boo
Soil Absorption Component Size (ft) S�
Type of Wastewater
Table 2: Soil Absorption Corn onent - Limits of Reliable operation
Se ti To Como nt Soil Abso tion Co n t
m o l
Design Flow -Peak (g d �Sa
1/8
Maximum Influent Particle Size (in) 220
Maximum BOD (mg /L) 150
Maximum TSS (m L)
Table 3: Maintenance Schedule
Se tic Tank inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
Tanks, pumping Chambers, Grease
Septic or Holding
Ta P 9
Code (Servicing Se
NR 113, Wis. Adm. Cod ( g P
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
f the se nd outlet filter shall be assessed at least
The operating condition o necessary to ensure
once every 3 years by inspection. Th
outlet filter hall b
cleaned as
e
p roper operatio The filter cartridge shou no a removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
r
' o,nent --
Management plar< fa, , a Septic 7a„ K and Soi� Aosorptian Comp ' `
o
filter is eq u ipped with an alum, the filter shall be son+ ►rid if the slam' Itinuou6 alarm tThe �iY
Intartriment ilter alarms may Indirelte surge Mows or an impsno s ouronnand sludge In the tank
k 11811 have h oontenta removed when the vOl � not removed at the
ge do tan nk a
e ceads 113 the liquid volume of the tank. if the Coto n� of the to ow ner of when the NA eeMae
time of an aaeeasment, mO tensn > then maximum um and accumulation in the
needle to tree performed to rnalntal
teak.
Manhole risers, aocess r and covers should be Inspected for water tlghtne" and
soundness. A4Cess opentr�g6 used for service and assessment shall be aaalsd Atert�ht upon to fe" m ust
the completion of "Nice. Any opening deemed unsound, defeCtlWisrn�r a al be secure y
be replaced. ,Exposed access openings greater than 840hes
IM d
on sffeative locwgq devies to prevent accidental or uneut� OmtrY' hito tine tank.
No one should enter a septic or other twe! OP � for
out being In full OOMP1�enorr
an Mason with m► ery, wltr�In the ar�fc a' other
aunt Hng a oonllned qwoe. Two �lat►nio and Mew th +r
�t of ho�n# �n� Me took miY� 1 �� .
peceoa ftrona U lnhllor
Tank abandonment shall be in s000rdarm with Comm 83.33, Wia, Adm. Code when the
tank is no Longer used as a POWTS component,
The soli absorption component serving this strUOUS 15 deslOn to eomare ohowncri
w from a residential facltity The limits of operation of this Po n
Table 3.
The longevity of a gall absorption Omponont depends greatly on proper and tmely
maintenance, end system us* within or below the limits of reliable operation Good water
cor"rvatica'►► pmetices by Sit occupants and tits installation of WOW gneerving plumbing
fixtures an key factors in extending the Useful life of this oompo
The ga ll absorpti oompo
rwnel operstion mat be amwu6d by Inspootlon at least
ones awry three year:. The Inspection shad include evWen+�� urfa gee►page oa an in
r discharge
the obaervtiort pipes, and a v is u al Inspection for a Y
from the component. On steeply :loping eltee► areas of domestic uwasewaterflor **wage
reported tv the owner for repair. The surface discharge
from ttte system is prohibited and 0 044** a Duman health hasacd
Traffic around or over the $oil absorption component should be avoided patticulmay lead
during winter months, The compaction or remov of snow cover over the ugled alt m or
to hydrautic fallurs by freezing. This type of failure Is usualily temporary, lflan over this
impossible tO repslr until w c n
Mg# Inimpr e soil l end dis a pe ii ae�which may lead to
component will reduce ddtusto v oxyg
more intense► find earlier, manic 01%ang of the soil.
2
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep - rooted trees and shrubs directly over of within ten feet of the component
should be avoided since root intrusion into the component may obstruct wastewater flow.
Contingency Plan
In the event of system failure, a new system could be installed in an alternate area. With the
Installation of a diverter valve, the existing system could also be roused after a period of three to
four years,
it is the property
owners responsibility to maintain the a lternate area free from any planting of
trees, shrubs, etc. Incase ow failure retheo riglheaaltamate�area they wial have to be roved at
any trees, shrubs, etc, have planted
property owners expense.
R alternate area is destroyed, there are other alternative systems that can be used, in which,
could result in added expense to the property owner.
Any tank abandonm e a n i t act you local onin Office Wisc- Code 83.33.
the Inttalling Plumber'
question
regarding this code, p
61. o
c
ST CROIX COUIT�c'
SEPTIC TANK MAINTENANCE AGREEMENT
AND
0"ERSHIP CERTIFICATION FORM
OwnerBuyer Z5 /Jff'z
Mailing Address -:� S 9 Lam
Property Address it: I S - �'
(Verification required from Planning Department for new cotutructian} CQ
Two or ��, k
City /State Parcel Identification Number
L EGAL , DESCIII
t
Property Location '/4, S E '/4, Sec. 1�,, T-a- N -R Town of 12��
Subdivision ��° �N a �� S _ Lot #
Doc. 0- (o 2 , Volume Page #
Certified Survey Map #
Warranty Dead # (.0 `(Z I , Volume I , Page # 3g
Spec house. -yes ❑ no Lot, hues identinable ELyes ❑ no
MTEM U629 -Mac
Improper use and maintenance of your septic system could result i its premature failure to handle wastes. Proper maintenance
eo msu of pumping out the septic task every three years or sooner, if needed by a licensed pumper. What you put into the systom
can affect the function of the septic tank as a treatment stage m the waste disposal system.
I"= Property owner agrees to submit to St. Croix Zoning Department s cordficadoa form, signed by the owner and by a
masterplumber, jo=,eymanplu=ber, restziotedplumber or s Ucensedpumperveri** that (1) the on -site wastewaterdisposal 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 road the a roquizvmants and agree to maintain the private sewage disposal system with the standards
set forth, herein, as se the bout of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating ur c tom has ma twined must be completed and returned to the St. Croix County Zoning Office within 34
days of ar te.
SIGNA OF kPOLICANT DATE
93 MER CE =CA'IZON
I (we) certify that all statements on this form are true to the best of lay (our) knowledge. I (we) am (are) the o'ner(s) of
the property desonbod above, by virtue of a wattsnty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
+• + + «+ Any information that is mis- ropresented may -result in the ssnitiry permit being revoked b� the Zoning
Dep artment- Include with ails application: a stamped wam mty deed from the Register of Deeds office
a copy of the certified survey rrup if reference is made in the warranty deed
3/� 3
Wisr.onsin Department of Commerce SOIL EVALUATION REPORT Page / of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Cro/
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
54 ey 17crrl Govt. Lot 5 W 1/4 5E 1/4 S /.S T -3b N R/ g E (o W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
Iy3 S C (--, 3 1 Chem 1 6 %1t >
City State Zip Code Phone Number ❑ City ❑ Village IA Town Nearest Road
WI I 6LU)1 1 (1t Lq 3 I 1 0 12 c�t�ncr-�d C
O Construction Use: Residential / Number of bedrooms Code derived design flow rate `{SO b0 GPD
❑ Replacement / ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable ft.
General comments 00, 00 RECEIVED
and recommendations: .5c ��y.
Con- ix)ur_ leu . , oo MAR 1 3 2002
Boring ST. CROIX COUNTY
F1 Boring # WG OFFICE
® Pit Ground surface elev. ft. Depth to limiting fa
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1
0- 2►r-6 b k ff4r c-5 1 4 .5
Z /Z Z7 t p 4r 41 3 5 ('CJ b k m-�r C
3 - kb 15 9/ :5 sbk _ 5
Z Boring # ❑ Boring p�
' ® Pit Ground surface elev. 9 �. dU ft. Depth to limiting factor 2 �D in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 a -►a a 312 - s ' Znnsb �- Ss ( V C . 5 .8
2 ►0 - I 3 s' c l Z,rs ry,
- Z - 1.5 5 Z k — .9
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /l- * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) nature CST Number
A im G,l -a,ker- - -- �� - - -- -- 253 3 o 9
Address Date Evaluation Conducted Telephone Number
Zlt 6 54- Se-1 CJ/ SyoZ /Z /3 =o/ 2q 7--1-06.9
SBD -8330 (R07 /00)
I
t
Property Owner D- er'('O — Parcel ID # Page Z of 3
F- E] Boring
Boring # ty � p,� q
i1 Pit Ground surface elev. � • OU ft. Depth to limiting factor Z O in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
6 -g C /v�' .5
; 2, 5 - Y
C2 1.5 ILo Si-
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-I Boring #
[] Boring
El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
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 - 266 -3151 or TTY 608- 264 -8777.
SBD -8330 (R.07 /00)
PAGE 3 OF 3
NAME r i LOT# 3 LEGAL DESCRIPTIONS � XS CZ ,S lS T-SD ,N,R. 15 Elor@
SCALE: I"= y�
BM I ELEVATION /OG • 0 _
BM I DESCRIPTION " 4v - e,' e c
BM 2 ELEVATION
BM 2 DESCRIPTION �� ! t
SYSTEM ELEVATION ,OG • O t
1
ALTERNATE ELEVATION
CONTOUR ELEVATION 0 Q O t
13. 3
5
ei� 3ho
v
o � �
• $vn'L
O
5
SIGNATURE ' DATE
U 1858P 387
~ E,7421'9
Document'Number WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., VI
This Deed, made between CRAIG R WARREN and LUCILLE R RECEIVED FOR RECORD
WARREN 03 -21 -2002 1:15 PH
husband and wife Grantor, YRRRfWTY DM
AND STEVEN I DERRICK EXEMPT i
REC FEE: 15.00
TRANS FEE: 60.00
G COPY FEE:
Grantee,
CERT COPY FEE:
Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 3
dollar and other valuable consideration, conveys to Grantee the following Recordina Area
described real estate in St, Croix County, State of Wisconsin: Name and Return Address
This is not homestead property. ROBERT F WALL
Together with all and singular the hereditaments and appurtenances 522 SECOND STREET
thereunto belonging; And Grantor warrants that the title is good, HUDSON WI 54016
indefeasible in fee simple and free and clear of all encumbrances except
easements, covenants, and restrictions of record,
and will warrant and defend the same
t
(Parcel Identification Number)
026 - 1046 -20 -000
SEE ATTACHED DESCRIPTION
aced this day of %!� 20��
CRA1 , WARREN ILLE R WARREN
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF
COUNTY OF ST. CROIX
Personally came before me this /
authenticated this _ day of the above named CRAIG R V ur
R WARREN ' 71: ti
to me known to be the person(s) 0 eecutQd twit foregoing
signature inst ent and noyvledge the 1 Ae.6 ,
type or print name r � g g1
si nature PU t ele d 6 2t�
TITLE: MEMBER STATE BAR OF WISCONSIN type or print name -- NotillY
ttssr F�iRlr ®s.iwlX — —
(If not, . ST CROIX Count
authorized by §706.06, Wis. Stats.) Notary Public Y
My commission is permanent. (If not, state expiration date.
THIS INSTRUMENT WAS DRAFTED BY )
Robert F. Wall
'Names of persons signing in any capacity should be typed or
printed below their signatures.
U 1858P 388
Description:
Part of the Southeast Quarter of the Southeast Quarter and part of the Southwest
Quarter of the Southeast Quarter of Section 15, Township 30 North, Range 18
West, Town of Richmond, St. Croix County, Wisconsin, described as follows:
Commencing at the South Quarter corner of said Section 15; thence, on an
assumed bearing along the south line of the Southeast Quarter of said Section 15,
South 89 degrees 58 minutes 05 seconds East a distance of 1016.75 feet to the
west line of Parcel 1C of a Certified Survey Map recorded in Volume 1 Page 93 in
the Register of Deeds Office for said County; thence, along last said west line,
North 00 degrees 23 minutes 22 seconds West a distance of 683.12 feet to the
north line of said Parcel IC; thence, along last said north line, South 85 degrees 42
minutes 15 seconds East a distance of 284.92 feet to the point of beginning of the
parcel to be described; thence, continuing along last said north line, South 85
degrees 42 minutes 15 seconds East a distance of 66.22 feet to the east line of said
Parcel 1C; thence, along last said east line, South 00 degrees 23 minutes 06
seconds East a distance of 657.01 feet to the south line of said southeast Quarter;
thence, along last said south line, North 89 degrees 58 minutes 05 seconds West a
distance of 66.00 feet; thence North 00 degrees 23 minutes 06 seconds West a
distance of 155.95 feet; thence, along the arc of a curve concave to the west, a
distance of 29.15 feet, said curve has a radius of 167.00 feet and a chord that
bears North 05 degrees 23 minutes 06 seconds West a distance of 29.11 feet;
thence North 10 degrees 23 minutes 06 seconds West a distance of 101.95 feet;
thence, along are of a curve, concave to the east, a distance of 40.67 feet, said
curve has a radius of 233.00 feet and a chord that bears Nort h 05 degrees 23
minutes 06 seconds West a distance of 40.61 feet; thence North 00 degrees 23
minutes 06 seconds West a distance of 65.00 feet; thence along the arc of a curve,
concave to the east, a distance of 40.67 feet, said curve has a radius of 233.00 feet
and a chord that bears North 04 degrees 36 minutes 54 seconds East a distance of
40.61 feet; thence North 09 degrees 36 minutes 54 seconds East a distance of
101.95 feet; thence, along the arc of a curve, concave to the west, a distance of
29.15 feet, said curve has a radius of 167.00 feet and a chord that bears North 04
degrees 36 minutes 54 seconds East a distance of 29.11 feet; thence North 00
degrees 23 minutes 06 seconds West a distance of 101.27 feet to the point of
beginning. Containing 49,235 Square Feet (1.13 acres). Subject to County Trunk
Highway "G" along the most southerly line of the above described parcel. Also
subject to all easements, restrictions and covenants of record.
The above described parcel is being added to the adjoining parcel already owned by Steven I
Derrick described in Volume 699 Page 295 Document Number 397481 St. Croix County Register
of Deeds Office. His existing parcel, the one to which the above parcel is being added, described in
the volume and page in the previous sentence is described as:
l
1858P 389
A parcel of land located in the NW' /. SE' /a, NE' /4 SE' /<, SE'/a SEA, and the SW %a
SE' /a of Section l5, , r30N, RI 8W, Town of Richmond, St. Croix County,
Wisconsin, described as follows: Commencing at the S '/< corner of said Section
15; thence NO °14'36 "W (assumed bearings referenced to the monumented East
line of said SE' /< of Section 15, bearing NO °37'40 "W) 707.67' along the
monumented N -S %< Section line (previously recorded as NO' 14'30"W) to the
point of beginning; thence continuing NO °14'36 "W along said line 1922.33' to
the monumented center of said Section 15; thence N89 °56'20 "E 1872.44' along
the monumented E -W %< Section line to the West line of that Certified Survey Map
recorded in Volume 4, page 927; thence SO °37'E 430.00; thence N89 °56'20 "E
60.00'; thence S0 1378.45'; thence S89 °47'W 372.25'; thence SO °37'40 "E
175.00'; thence N85 °59'40 "W 900.39'; thence S89 °47'06 "W 675.57' (previously
recorded as S 89 675.71') to the point of beginning, subject to all
easements and restrictions of record,
The parcel conveyed is added to Derrick's existing parcel to create a single parcel.
Warren DerrickDeedDesc -0
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Wisconsin Department of commerce SOIL EVALUATION REPORT p age 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not lirnded to: vertical and horizontal reference point (BM), direction and Parma I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all Information. Reviewed by Date
Personal informadon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Steve Derrick Govt. Lot SW 1/4 SE 114 S 15 T 30 N R 18 E( ) )W W
Property Ohs Mailing Aaddress Lot # Block # Subrt Name or CSM#
1438 County Road G 3 - Cherry Knolls
fky State Zip, Code Phone Number itsr �vittaw [DTOVM Nearest Roars
New Richmond I WI 1 54017 1 ( 715 - 246 - 3120 County Road G
New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Reptacernent Public or amrmerclot =Describe:
Parent material i neyuq pUer till Flood Plain elevation if applicable ER F F'° / ft.
fitconallm Site suitable for a conventional below gra Ic system
and recommendations: 7
[ 002
t� Ong # �13 Ing
I pit Ground surface eiev. 102.75 tt. Depth t& hrrrft factor ' in
Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-12 10yr3/3 A 2msbk mfr cs 2f .5 .8
2 12 -33 1 1 4/4 - sicl lmsbk mfi cs if .2 .3
3 33 -98 7.5 4/4 sl Om mfi - - .3 .5
Q 2 goring # Boring 99.60 >98
El Pit Ground surface elev. ft. Depth to limiting factor in.
Sal loation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflf
in. Munsell Qu. Sz- Cont. Color Gr. Sz Sh. `Eff#1 I "Eif#2
1 0 -8 10yr3/3 sil 2msbk mfr cs 2f .5 .8
2 8 -20 7.5 4/4 scl lmsbk mfi cs if .2 .3
3 20 -38 7.5yr6/4 s Osg ml cs - .7 1.2
4 38-43 10yr3/6 scl lmsbk mfi cs - .2 .3
5 43 -98 5yr5/4 - sl Om mfi - - .3 .5
` Effluent #1 = BOD > 30 220 mg1L and TSS >30 150 mg/L • Effluent #2 = BOD _< 30 mg/L and TSS _< 30 mg&
CST Name (Please Print) Signature CST Number
Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, W1 9 -25 -02 715- 246 -2454
nTn A11I T/7 MI,\
t
Property Owner Stev D Parcel ID # Page 2 of 3
Boring Boring
# Pit Ground surface elev. 104.60 ft Depth to limiting factor >I00 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eft#1 - Eff#2
1 0-9 10yr3/3 - sil 2msbk mfr cs 2f .5 .8
2 9 -29 7.5 4/4 - scl lmsbk mfi cs if .2 .3
3 29-62 7.5yr4/4 - sl Om mfi cs - •3 .5
4 62 -100 7.5yr4/6 - s1 2msbk mfr - - .5 .9
FIB rig # Boring
ori pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 'Eff#2
Boring # Boring
Pit Ground surface elev. l ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAP
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg1L and TSS < 30 mgA..
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- 266 -3151 or TTY 608 -264 -8777.
SBD- 8330Tesc(R.07 /00)
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