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pp ppp, •disconsin Def�artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Bu�tdiny Division
INSPECTION REPORT Sanitary Permit No:
506244 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 Na
Giel, Gary I Richmond, Town of 026 - 1161 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: , _ Section /Town /Range /Map No
l b `(ID - 0 .(3i'YI / S� 1 5'.30.18.. 2-13
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic !�� Benchmark D /a/
-tf �' - ,,v 1077 d
Dosing wr
Alt. BM
Aeration Bldg. Sew r S 6
tw
0 7 J
Holding St /Ht Inlet U
St /Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
73 v t Z
Dosing ead an.
Aeration Dist Pi
i
Holding Both
Final Grade
PUMP /SIPHON INFORMATION v 1,96. I
Manufacturer Demand St Cover
GPM 3. 25 lol
L
Model Number
i
TDH 1 1-ift Sys Friction Loss TDH Ft i
I
I
Forcemain Length v . Dist. to
SOIL ABSORPTION SYSTEM Iq `
BED /TRENCH Width Length li No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 0 Jt- *t , /
SETBACK SYSTEM TO Y � P/L BLDG WE LAKE /STREAM EACHING Manuf��
INFORMATION (CHAMBER OR
Type ystem: 1 36' 1 - ->3! P4' u Model Number: I E7
DI TRIBUTION 7 9YSTEM 4A 4&LV( `
.lead r /Manifold Distribution / x Hole Size x Hole Spacing Vent to Air Intak
I y Pipe(s) ![
gth_ Dia Length �� Dia Spacing_ �— 7S�
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 3 s S
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: '? / / / 0 / Inspection #2:__/
I
Location: 1546 126th Street New Richmond, WI 54017 (NW 1/4 SE 1/4 15 T30N R18W) Cherr Knolls Lot 2�4 Parcel No: 15- 30.18.1243
1.) Alt BM Description = lei / .0 � ���✓
2.) Bldg sewer length = 6; �' C�-,
/ - 1 �' P� �I4 -inn ,
amount of cover a d � •(p
3
Plan revision Required? Yes o
Use other side for additional information. J E
ns S i Date nature Cert. No. 9
SBD -6710 (R.3/97)
conw , n erce.will.gov Safety and Buildings Division County
a 201 W. Washington Ave., P.O. Box 7162 St. Croft
n cor s r i me Madison, Wl 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
-:� sod z
Sanitary Permit Application s Number
In accordance with s. Comm 83.21(2), Wis. Adm. Code, submission of this form to the er
appropriate gov tal N
unit is required prior to obtaining a sanit ry permit. Note. Application forms for ddrmws (if en dmr mailing address)
submitted to the Department of Commerce. Personal information you provide may be '�� ��
in accordance with the Privacy Law s. 15. 1 m Stagy
I. A lion Info tios — Please Print All Information
OZ (P _ I I
k M Yroper Prop Owner's Name artiea �I. Q ( Pared # l (P — I I
VC V" Property Owner's Mail Property Location
9305 Murphy Lane �2 ' l am , U� Govt. Lot
City, State Zip C N y., S� ' /., Section
EAU CLAW VA cST� Pfh/L J /t f 54703 71S,74.4225 (Check One)
T_�b N; R j 0 []E a
H. Type of Budding (check aft that apply)
1 or 2 Family Dwelling — N Block # lls
Number of Bedroo Subdivision Name
O , �c. Cherry Kno
❑ PubliclComm i
ercial — De
City of
❑ State Owned — Describe Use CSM Number ❑ Village of
Q ✓ Town of 0"Rictmnond
M. Type of Permit (Cheek only o boa o n line A. C omplete Use B if appli
A. ✓ New System Replacement Treatu tffioldimg Tank Replacement Only Other Modifical. to Existing System (explain)
�—� System
B. Permit Permit Revision Change of Permit Transfer to List Previous Permit Nth and Date Issued
Renewal Before Plumber New Owner
Exp iration
IV. Type of POWTS S m/C rinVDeviee: Check all that a '
✓ Non - Pressurized In- Ground LJpresswiwdhwxound At -Grade Mamd > 24 is of suitable soil LJ Mound < 24 in of suitable s�oil
❑ Holding Tad: ❑ Other Dispersal Componcia (explain) QPntreaanr Device fCgft
V. rsal(i realmeat Area Information- •� 7 (�(/ 6{,7
Design Flow (gpd) Design Soil Application gpdsfl Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
450 6 OL - � 3 750 ✓ T ✓ 9T
VL Task Info Capecm m Total # of Mamufactu er Material
Gallons Gallons Units
New Tanks F. acing Tanks
Sep1e or Tank tonne 1000 1 tkdh dt IRs66 Coatrtte
nosing chamber
VII. Res risibility Statement 14 the anderftud, assmae respossUARly ter installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Pi 's Signature •� 362
MP/MM Business Phone Number
Lynn M. Miafeldt Ill . (� t 0.� 224628 715.7208
Plumber's Address (Street, City, State, Zip Code)
7089 CTH K Chippewa Falls 54728
OUR /De partment Use O nly
pproved _Disapproved Permit Fce Date 75 t S'
_ Owner Given Reason for Denial S y �-p �� /�
IX. Conditions of ApprovaUReasons for Disapproval
SYSTEM OWNER: ` 0 , Sq �o (D •'r ) a ��p
1 Septic tank, effluent filter and S (J��_ �� � �? �
dispersal cell must all be serviced /maintained � S}/1Yt !!V !��
as per management plan Provided
Sutua req u I re rmM*gpgqt"W" "" and satmrtr at t4 comity osq r ltaa dues 8 =1 11 Veuea b
as per applicable code /Ordinances. Oh � ta
a� iPel
SBD - 6398 (R• 01/07) Valid thtu 01/09 QO
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- Wastewater Treatment System POWTS
Private On Site y
Index and Title Sheet
Owner:
C & M Properties
Project Name and System Type: 3 BR Corivehtio
153rd Ave.
Location:
Street Address
Legal Description
New Richmond / St. Croix
Township /County
Contents: Page 1: Title
Site Plat
Page 2:
Cross Sectio"
Page 3:
Ma iagemertt Plai
Page 4:
Ma iagemeiit P l a p
Page 5:
3EST Filter Maiotehaoce
Page 6:
Page 7:
Page 8:
Page 9:
Attachments: Design Pursua it to the followi ig POWTS Components
a id COMM 81-85 11 Grou id AtSprbtioa Comporfe it
iso - - P (N.01101
Ly Irtt Misf •
Plumber/Designer: Signed:
Credential Number: 224628 Date: 4- 1 -07 11
i
Page 1 Of 6��,
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Soil Absorption Svstem Cross Section
101 ft
4" Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ♦_ 9 8 ft
Leaching --►
Chamber 9 ft
System Elevation
3 ft 4 ft
Soil Absorption System Plan View
76 ft
J" _ 1
3 ft {
4 ft Leaching Trench 1
Vent Or Observation Pipe r Chambers
4" Dia.
Trench 2 Header
Leaching Chamber Specifications
Manufacturer And Model Itifiltrator Q4W
EISA Rating 20 sq ft per chamber • 6 Soil Application Rate 7 5 0 gpd /sq ft
7 5 0 g pd Design Flow • 6 Soil Application Rate 2 0 EISA = 3 8 Chambers
2 rows of 19 chambers each.
Page 2 of 3
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 4 of 6
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner C & M Properties Tank Manufacturer Huf f cutt ❑ NA
Permit # ■ Septic ❑ Dose ❑ Holding ol.
g /06() g al
DESIGN PARAMETERS Tank Manufacturer NA
Number of Bedrooms 3 ❑ NA ❑ Septic ❑ Dose ❑ Holding Vol. gal
Number of Public Facility Units ■ NA Effluent Filter Manufacturer ❑ NA
Estimated (average) flow 300 al /da Effluent Filter Model 13 EST 6 - Fl 0
Design (peak) flow = (Estimated x 1.5) 450 al /da Pump Manufacturer ■ NA
In Situ Soil Application Rate • 6 al /da /ftz Pump Model
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ® NA
Fats, Oil & Grease (FOG) <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Manufacturer
Biochemical Oxygen Demand (BOD5) <30 mg /L Dispersal Cell(s) ❑ NA
Total Suspended Solids (TSS) <30 mg /L ■ NA Qln -Ground (gravity) ❑ In -Ground (pressurized)
Fecal Coliform (geometric mean) <10 cfu /100ml ❑ At -Grade ❑ Mound
Maximum Effluent Particle Size %li in dia. ❑ NA ❑ Drip -Line ❑ Other:
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: 3 ❑ month(s) (Maximum 3 years) ❑ NA
■ year(s
Pump out contents of tank(s) ■ When combined sludge and scum equals one -third ('y) of tank volume ❑ NA
❑ When the high water alarm is activated
Inspect dispersal cell(s) At least once every: 3 ❑ month(s)
■ year(s) (Maximum 3 years) [I NA
Clean effluent filter At least once every: 1 — 3 ❑ year(s ) s) ❑ NA
■
Inspect pump, pump controls & alarm At least once every: ❑ month(s) 0 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 (pumper). 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 a 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 treatment tank equals one -third (%) 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,
that require servicing at intervals of 12 months or less require documentation recorded on the deed regarding maintenance requirements.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW (12/02)
Page 5 of 6
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals that may impede the treatment process and /or damage the soil 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 extended power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will
be discharged to the dispersal cell(s) in one large dose and may overload them resulting 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) discharge; 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.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may
be installed as a last resort to replace the failed POWTS.
❑ 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 L i l M. MIsfeldt Name
Phone 715-720-8362 Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name St. Croix ZO Ii ]g
Phone Phone
This document was drafted by the Chippewa County Zoning Department in compliance with chapter Comm 83.22(2)(b)(1)(d) &(0 and 83.54(1), (2) & (3),
Wisconsin Administrative Code.
N. END COMM. ED. R. H. S Fax :651- 228 -4749 Jun 28 '07 15:51 P. 01/01
ST_ CROIX COUNTY
SEPTIC TANK. MAINTENANCE AGREEMENT
AND ,
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OWNERSHIP CERTIFICATIO N FORM OW
Owne _ S u
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Mailing Address _ Q
rat.+
Property Address & Zoning De arhmnt for new construction.)
(Verification required fYonrt Planning g p
City /State
Parcel Identification Number
�d
't
]_FOAL !!
Property Location
T �N R j $ _W, Town of C-h
N � '/, , ,ice_' /+ , Sec.. I �'Z ._... - --
_ Lot
Subdivision
Certified Survey Map #
Volurne , Page #
Volume Z� Page #.
Warranty Deed # '"6
able /�c �s no
Spec house yes no Lot lines identifi ,
SYS'T' MAINTENANCE AND OWNER CERTIFICATION
Improper use and tnaintenattce of your sep tic 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 a
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 §Comte. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
' 3?
The property owner agrees to submit to St. Croix County Planning & Z De p artment 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 scptic tank is
less than 1/3 full of sludge.
I /wo, 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 Deparunnent of Commerce and the Departnncnt 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.
I /we certify that all statements on this form are true to the best of my /our knowledge_ I/we ano/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 3
W .... ... . ..
,5
' DATE
S ATURE OF APPLICANT(S)
*"""Any information that is misrepresented 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. 08 /05)
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VVMC M Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in aceordanos with Comm 85, Yft. Aft. Code
County St. Croix
Attach complete site plan on paper not less than 8112 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 ordirnensions, north avow, and location and distance to nearest road. 0 2 /1 �p/ Zo -64?�
Please print all Wormafyon. R by Date
Personal information you pride may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). 611 O
Property Owner Property Location ❑
C M Properties Gomm Lot 114 114S T N R E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
9305 Murphy L ane 20 Cherry Knolls
City State Zip Code Phone Number octy [] ViYage • own Nearest Road
Eau Claire WI 1 54703 ( 7} 5 874 - 4225 153rd Ave.
New CwWrkrction UseEl Residential / Number of bedrooms 3 Code derived design flow rate 4 GPD
❑ Replacement Pubic or eomrrrerclal - Desaibe:
Parent material outwash Flood Plain ele� 9 applicable tt
General cornnients
` SE = 97. Recommend .6 Load Rate I Jo .,.-
and recommendations: 4e ^
(� Bori # ❑ g
I - I Q Pit mound surface elev. 101.5 ft. Depth to 6 TWV factor ' in. Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
lo. Mu>sell Qu. Sz- Cont. Color Gr. Sz. Sh. 'EfE#1 *E11162
1 0 10YR 3/2 now sl 2vcsbk ds gs 1vf .6 1
2 18 -32 YR 4/6 none fs1 mass dvh as - 5
D 3 32 -60 10YR 5/6� s Osg dl - 7 1.6
4 60-93 10YR 6/6 now fs 099 dl - - 5 1
YO t
F 21 Boring # Bo w 100.2 +96
l Pit Ground surface elev. ft. Depth to rN, lb g bCtOr in. Soil Application Rafe
Horizon Depth Domnant Color Redox Description Texture Structure Cavislence Boundary Roots GPOW
in. Munse3l Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-16 10YR 3/2 now s1 2csbk ds gs if .6 1
2 16 l OYR 4/6 none mass dvh as _ 2 -5
3 32 -55 lOYR 5/6 none s Osg dl 8s _ .7' 1.6
4 10YR 6/6 none Osg dl - 1
1 3. S
" Effluent #1 = BOD > 30 1 220 n & and TSS >30 150 mglL ' Eflluert 82 = BOD < 30 mg1L and TSS 1 30 mg&
CST Norm (Please Prim 0, Signature ( - � /� CST Number
L M. Misfeldt r `r w ( ", 224628
Address Date Evaklation Corxti Telephone Nunber
7089 CTH K Chippewa Falls, WI 54729 6-20-07 715- 720 -8362
ORIGINAL
1
property Owner C& M Parcel ID S Page 2 of 3
3 �9
Boring # E] Pit Ground surface elev. 100.4 it Depth to knifing factor +88 Sou Applicalion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Murrsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfM 'Efl#2
1 0-13 10YR 3/2 none sl 2csbk ds gs
2 13 -24 l OYR 4/6 none sl mass dvh 1 as
3 24-60 l OYR 5/6 none s Osg dl lls
4 60-88 10YR 6/6 none fs osg dl
❑ Bow #F Boring
Pit Ground surface elev. ft. Depth to imiling factor in. Soft Applicalion Rabe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD11F
in. Munsei Qu. Sz. Cont Color Gr. Sz. Sh. " Efflul
Boring F-1 g Bo
Pit ring C'fOUd surface elev. it Dept to irnimng factor in.
Soi Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPD&
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 'EfW2
' Effluent #1 = BOD > 30 220 mglL and TSS >30 150 m91L ' Effluent 42 = BOD < 30 nV& and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 266 - 3151 or TTY 608 264 - 8777.
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RECEIVED
Department of Co SO ,L EVALUATION REPORT page of 3
Division of Safety and p
p` ° wittl 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on ape ti1)1,� (1 in sin size. Plan must
include, but not limited to: v 'call a ice poi (BM), direction and P I.D. Pending percent slope, scale or dime on and distance to nearest road.
Please print all Information. R Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Locati on
Steve Derrick Govt. Lot 1/4 SE 1/4 S 15 T 30 N R 18 O
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
1438 County Rd G 20 - Cherry Knolls 1st Addition
City State Zip Code Phone Number []City []V•rflage [j ]Town Nearest Road
New Richmond I WI 1 54017 ( ) County Rd G
E] New Constnxxion UseE) Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
0 Replacement E] Public or commercial - Describe:
Parent material loess over glacial outwash Flood Plain elevation if applicable 1t-A- ft.
General comments This site is suitable for a conventio below grade system
and recommendations:
6cA�, W ' dA4 0 �? - h�
Boring # � Boring
Pit Ground surface elev. 97.97 ft. Depth to limiting factor >90 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Sure Consistence Boundary Roots GPD/ft?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `EfF#1 •EfW
1 0 -13 10yr3 /2 sil 2msbk mfr as 2f .6 .8
2 13 -34 1 4/4 - sil 2msbk mfr cw if .6 .8
3 34-46 7.5yr4/4 is Osg mvfr cw - .7 1.6
4 46 -90 7.5yr5/6 - s Osg ml _ - .7 1.6
2 # Boring 99.70 >92
]Boring 0 Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 •EfF#2
1 0 -11 10yr3 /2 - sil 2msbk mfr as 2f .6 .8
2 11 -21 1 4/4 - sil 2msbk mfr cw If .6 .8
3 21 -28 7.5yr4/4 - Ifs Osg mvfr cw _ .7 1.6
4 28 -66 7.5yr4/4 - fs Osg mvfr cw - .7 1.6
5 66 -92 7.5yr4/4 - cos Osg MI - - .7 1.6
Effluent #1 = BOD > 30 1 220 rrg/L and TSS >30 150 mg/L ' Effluent #2 = R22 < 30 rrg& and TSS < 30 ng/L
CST Name (Please Print) Signature CST Number
Thomas C Nelson C " 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 4/1/04 715 -246 -2454
Property Owner Derrick 3
ck Parcel ID # Pending Page 2 of
Boring
3 Boring # O Pit Ground surface elev. 99.10 ft. Depth to limiting factor >92 in.
Soil Appilcatiori Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 'Eff#2
1 0 -13 10yr3 /2 - sil 2msbk m}'r as 2f .6 .8
2 13 -22 l 4/4 - sil 2msbk mfr cw if .6 .8
3 22-39 7.5yr4/4 - lfs Osg mvfr cw _ .7 1.6
4 39 -50 7.5yr4/4 - Is Osg mvfr cw - .7 1.6
5 50 -92 7.5yr5/6 - s Osg ml - - .7 1.6
F-1 Boring # Ong
• Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD11F
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
jam] Pit Soil Applicabori Rabe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2
' Effluent #1 = SOD, > 30:5 220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg&
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- 8330Tea (8.07/00)
T . A. Cherry Knolls Ist Addition
Lot 20
6
/ NW lot corner 98'
BM2 A.
B1 .�.
144'
187'
100
3 °r6 N
slope
127' 2
309.28'
Scale 1" = 40'
BM1 Top of iron pipe 100.00'
'� BM2 Top of iron .pipe 96.50'
53' B197.97'
4 3 B2 99.70'
B3 99.10'
Thomas Nelson
227387
B1GI1
SW lot r.nrne.r
Parcel #: 026- 1161 -20 -000 06/26/2007 08:32 AM
PAGE 1 OF 1
Alt. Parcel M 15.30.18.1243 026 - TOWN OF RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
07/07/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - GIEL, GARY
GARY GIEL
1029 ATLANTIC ST 205
ST PAUL MN 55106
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1546 126TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.020 Plat: 10/14- CHERRY KNOLLS 1 ST 026/04 LOTS 14/27
SEC 15 T30N R18W PT NW SE BEING CHERRY Block/Condo Bldg: LOT 20
KNOLLS 1 ST ADDN ('04) LOT 20 (2.0200AC)
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
15- 30N -18W NW SE
Notes: Parcel History:
Date Doc # Vol /Page Type
05/24/2005 795782 2808/133 WD
07/07/2004 767997 10/14 PLAT
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.020 31,500 0 31,500 NO
Totals for 2007:
General Property 2.020 31,500 0 31,500
Woodland 0.000 0 0
Totals for 2006:
General Property 2.020 31,500 0 31,500
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
U. 2 8 0 8 P 13 3 79s7eZR 1'
KATHLEEN H. WALSH
State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO., WI
Document Number Document Name RECEIVED FOR RECORD
05/24/2005 10:30A11
WARRANTY DEED
EXEMPT #
THIS de between Steven J. Derrick and Margaret M. Derrick - Husha
and Wife- ( " Grantor," whether one or more), REC FEE: 11.00
a Gar Giel TRANS FEE: 135.00
P
( "Grantee," whether one or more). CC FEE:
PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area
interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space
is needed, please attach addendum): Name and Return Address
Lot 20, Cherry Knolls 1" Addition. St. Croix County, Wisconsin.
David J. Estreen
L01 Aggl 304 Locust Street
Hudson, WI 54016
026 - 10405 -0 -050
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if an
Dated
(SEAL) X (SEAL)
* *Steven J err'
(SEAL)
, (SEAL)
* *Steven J. Merrick, Attorney in Fact for
Margaret M. Derrick
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Steven J. Derrick
STATE OF )
authenticate ) ss.
COUNTY )
* Kristine Ogla d Personally came before me on ,
TITLE: MEMBER STATE BAR OF WISCONSIN the above -named
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
*
Attorney Kristina Ogland Notary Public, State of
Hudson, WI 54016 My Commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
* Type name below signatures. INFO-PRO— Legal Forms 500- 655 -2021 www.infoproforms.com
` Section 155' -30 -18
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