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HomeMy WebLinkAbout026-1088-20-000 c S A. m CD A d N O CA O C v O N f �• CD 5. n m p W W W p s W 9) MN c Y l CL O �_ Cn A O f��'i. o _ O 7 OD OD N N O = a 0 CA a CL v O N O O CO r C C m A 3 a o y = C) ICA' x o co v (_n v ID eD CD OT CD a W O O G N O i to W O O L OZ O •p` N N O O O CA CD 0 0 N °° Q z 3 CL 00o °.: • o z N s.Q C . " m CD A d o N z M v I Z �� N z-iz D O X 0 O !V O > > 7 N Er � y �• X m C CD CD 'C N C N CD W (D (a C1 a 3 5 z CD V1 �i a - C A Z O z w o W T o CL z ° '* z o0 � I o CD � I SOHO -I D vm m am d f > > o 3 r. m su- = c �? c =Xmcp 0 CD °�' z a co IS O 0 p 7 C CD 7 CD U) _W � fU x0 � N p N CD y N C 0 n 0 CD Z 7' O N - 7 C) i yy O N�� O@ O O V CD Cr C1 C C C Q, Cn - CD — A X ^' C [] (D — y A� Cn C O 7 n CD CD N .Z 0. 7 7 y f1 A � N a ? y N N aa_N COED O C N Cn .. 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N N 4 � CL Z N o v a •g m a) 0 o 0 f• w f° • 0 o C f0 (p 3 0 S N 3 V CD N y O N C7 ° N O CD m Er ° O O Vi M C C A i o ° p N (D pQ N p tsi 0 t» 0 O o C o CD �? as 0 L ° CD CD i ^� Parcel #: 026- 1088 -20 -000 06/07/2005 08;03 AM P 1 OF 1 Alt. Parcel M 30.30.18.461A 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * VAN DYK, HENDRIK W HENDRIK W VAN DYK 931 140TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 911 140TH AVE OR SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 33.900 Plat: N/A -NOT AVAILABLE SEC 30 T30N R18W NW NW EXC PT E OF Block/Condo Bldg: WILLOW RIVER Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1126/544 QC 2005 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 06/30/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 9,000 73,900 82,900 NO AGRICULTURAL G4 28.400 2,900 2,900 NO UNDEVELOPED G5 0.500 100 0 100 NO OTHER G7 4.000 11,400 223,500 234,900 NO Totals for 2005: C 'k� General Property 33.900 23,400 297,400 320,800 Woodland 0.000 0 0 Totals for 2004: General Property 33.900 23,400 297,400 320,800 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 •lp►Iuapisaa aq IOU AM 'panouaaa sails Sulpllnq $b', sim guluaMa =na Mt WO (OW 1) 8 I £ 0£ I WWI) 8t+ O� l 2y anisnlax3�� ' =die ! �� �•;� Department dings Divi Commerce PRIVATE SEWAGE SYSTEM Count ety and Buildings Divi INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Persorlal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353341 Permit Holder's Name: []City ❑ Village ❑ Rown of: State Plan ID No.: Richmond Towns h1 CST B E{ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: (6U , o / &cad (5 26- 1088 -20 -000 TANK INFORMATION ELEVATION ATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic s( Benchmark 0 3,>�� Dosing Alt. BM 3 $s r i Aeration Bldg. Sewer 150 W. (} Holding St/Ht Inlet 6 -SZ `j`7-.30 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. geintake ROAD Dt Inlet Septic �/ �p / �� I p ' NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System �D PUMP/ SIPHON INFORMATION Final Grade I °� Z-) lo•�S ��,1(' Manufacturer emand St cover . `IT -9'Y Model Number GPM t,, TDH Lift Fr' * n S stem TDH Ft� oss Force ma' Length Dia. Dist. o /nit `f 'j4, , /Z SOIL ABSORPTION SYSTEM RENCH Width , Len r No.O Trenches PIT No. Of Pits Inside Dia. Liquid D DI J� DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE / STREAM LEACHING Man ctur INFORMATION Type Of Z CHAMBER ( 1 / r CHAMBER el Numbe S r �^ 1 � DISTRIBUTION SYSTEM maces wrf , He er / Manifo istrNbution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Len D 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 E] Yes ❑ No E] Yes E] No COMMENTS: (Include code discrep ancies, persons resent, etc.) p P Inspection #1:OS /O6 /oO Inspection #2: - f -- Location: 911 140th Avenu , Nevv Riphmond WI 54017 ( 1/4 NW 4 T R18W) - 30.3 4_ 1. Alt BM Description - kkf���J� ►J °�'"^" _ 2. Bld g sewer length - -,- 2 - amount of cover = • 2- `t • 3� 3) Cam 4&,-u g, jr 1.3v L 9. 1e 9.20 3 - 1 F Plan revision required? ❑ Yes No Z Use other side for additional information. 05~ o(p I ft 4�L _A� I F - � SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Z °� }��lw�2� 08 "56 sllb , .: )C) e SN 0 U ^59 z • o -- a �S �. -- Z C4 ^ b� Safety and Buildings Division �i�r■r. SANITARY PERMIT APPLICATION Bureau of Buildin Water Systems - r-- - _ 201 E. Washington Ave. in accord with tLHf3 85, V11q. Adm, `Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) fo ha systerrijvn Paper not Less County than 8 112 x 11 inches in size. - • See reverse side for instructions for completing t jS application State Sanitary Permit Number f 3 i3 3 %+ 1 The information you provide maybe used by other government acy programs _ ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL I R 41i'I*hO s lb Prop rtyOwnerNam�e Pro rty rotation ..t 7V� 1MA gj 1/4, S S C T ?I � C , N, R / r) W Property Owner's Mailing Address LgitNuffiber Block Number 93 c 1 4, 4 . -- City, State Zip Code Phone Number Subdivision Name or CSM Number 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C y Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms To of Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo it s So • I N /°lA 2 F1 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 (a Other: specify 8 IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 _ New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 E3 Repair of an System System Tank Only -------------- Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number 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 ELSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit S I 43 [] Vault Privy E] 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 E. 17. Final Grade �C Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min./inch) 93,E Elevation 9Q x.15 /C6 . (C /�+� ;� Feet c17, 9 Feet VII. TANK Cap acit in lions Total # of Prefab. Site Fiber- Ex p er INFORMATION g Gallons Tanks Manufacturer's Name Concrete Co Steel glass Plastic A p p New Exist in s trutted Tanks Tanks Septic Tank or / G / 54-9 / U-4x— ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I /Q I I I ❑ I ❑ 1 ❑ 1 ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: 0o,j �-- /V ,e -k.: )IC_ L ,; c .2*L7 - 7 !e 7 /5 - - - 7q 33 Plumber's Address (Street, City, State, Zip Code): rC ci IT COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) )g roved Surcharge Fee) pp ❑Owner Given Initial dp Adverse Determination 3-2-0- X. CON DITIONSQF APPR VAL /REASONS FOR Q APPROVAL r C- �(OU S D -6 998 (R. 0 /94) DISTRIB 10 : Original to county, One copy To: SAty & Buildings Divm: ion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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 and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. 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 on 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 for numbers 1 through 7. VIL Tank information. Fill in the capacity of every new /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 1/2 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 contamination investigations and establishment of standards. Safety and Buildings \' * isconsin 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary March 15, 2000 CUST ID No.227710 ATTN: POWTS INSPECTOR ZONING OFFICE WALTER F NECHVILLE ST CROIX COUNTY SPIA 967 HWY 65 1101 CARMICHAEL RD ROBERTS WI 54023 -8510 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/15/2002 Identification Numbers Transaction ID No. 301765 SITE: Site ID No. 188154 Site ID: 188154 Please refer to both identification numbers, ST CROIX County, Town of RICHMOND L above, in all correspondence with the agency. NWI /4, NWIA, S30, T30N, R18W Facility: HENDRICK VAN DYK POLE SHED 931 140TH AVE, NEW RICHMOND 54017 FOR: CONVENTIONAL SYSTEM, 590 GPD Object Type: POWT System Regulated Object ID No.: 652280 This approval is for a conventional system to serve a farm service building with 5 employees, 2 floor drains, 1 automatic washer, 5 showers per day and a break room where no meals are prepared, but 15 GPD have been included by the designer for sink usage. 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 P.O.W chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Conn itil The following conditions shall be met during construction or installation and prior to occupancy or use: %P , 1. This plan action is subject to designer comments on the plan. pEp TMENV C 2. The plumbing for this project discharges to a private sewage system. The approval covers only plVl SAFE domestic /sanitary wastes directed into this system. The Department of Natural Resources (WDNR) must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with ' domestic /sanitary wastes. SEE CORRE 3. This approval does not include plans for the general plumbing systems or sewer piping leading to t e septic /holding tank that may be required for this project. See section COMM 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. ��,/ 4. The system elevation shall be no lower than 93.7 due to conditions at oring Z w• <. 5. Maintain well and waterline set backs per CUMM 83.10(1) and 83.14(4) a . UU A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 4ATRICIA DATE RECEIVED 03/08/2000 FEE REQUIRED $ 120.00 _. FEE RECEIVED $ 120.00 SHANDORF , P TS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 w y « z J r!b � Y t � {� 1 Q G -�'�'� "- � �,ti.��_: �,�.c.ltt..� (" .. �, V��aIL.. ��- Yte - r , n_ •� l S � - t _ 4 r IVO y y JAY,—* fllljf t Y ,.� .. _.. ._......yyam� .. _....,. .w'•W ��°'"- • - � / , . .y am � " ,/�,�(L�,'hV •�G+'1,.V_'�t.,f i, 'r't:... n . VC ' ill `•"�C -A �.. _ , ... 0' -- Q _'J' ,.�.c c -.1 , UL.11 .X J ..Cri%•- t"o"` 1!/ r— _ . _, y ,._.1�t%"� -C-d r7•�..14Q.'-�� ,� .�°6Y1A -; ,. ',- . `43'.a�, 4- 0.q..L' (5 l A - 4 3 ILL ,... _.._..._ L � 4 i ? 5 " 0 IV IN t n 9 W �F r EP r J v t� c , Y " — ( -Iq ui 4 AF let G a. it y '.. .: .. .., ♦ l k , 1,� ioa yV d k y 4 44 41T 4. RE ti t x - r" NAP ter i k` � � 3 S� � q3,, t I �k r- ^x, °710 .s . r Y eI 'L V1406row Lmnxu wni at inousuy, b V 1 L A N U' I I G t V A� U A I I V M h G I' V rs 1 rays jL w a j_ °r 9w1a1nps in accord with ILHR 8. `)5, Wis. Adm. Code COUNW ;ca ete site plan on paper not less than 81/2 x 11 inches in siz Plan must include, but St. Croix r t Vertical and horizontal reference point (BM), direction and 1 slope, scale or PARCEL I.D. # " slowed, north arrow, and location and distance to nearest road, 026- 1088 -20 -000 ' REVIEWED BY DATE a LICANT INFO RMATION = PLEASE PRINT ALL INFORMATI t q . l?RtJPIrRI"YOWNER: PROPERTY LOCATION iCk Van Dyk GOVT. LOT NW 114 NW 1/4,S 30 T 30 N,R 18 Wor) W OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # # €' 140 Th. Avr. na na na STA ZIP C E PHONE NUMBER ❑CITY []VILLAGE IDOWN NEAREST ROAD A. _• • Rlchtnond, WI. 5401 17151246 -5454 Richmond 140th. Ave. Fxa� NOW C mstruchon Use [ j Residential / Number of bedrooms ! (j Addition to existing building Replacement [ Public of commercial describe offic 3 employees— showers 3 -2 floor drains Cdrte declved daily now 205 Recommender resign loading rate • 5 bed, gpd/tt •6 trench, gpcW 3 &rea retied 4I0 bed, ft 341 trench, ft Maximur.. esign baling rate • 5 bed, gpd/ft . trench, gp0 "{ infiltration surface elevations) 93.60 ft (as referred to site plan benchmark) design I site considerations na } P mp"i stream terrace Flood plain elevation, it applicable na ft t +SIJII811181�)r system CONVPlOw MOUND IN -GW. ID PRESSURE AT•GRADE SYSTEM W FILE HMOM TRX M UMLA a for step+ ®$ ❑ U Drs ❑ U W S 3 U L S U ®S ❑ U D S La t SOIL DESCRIPT AN REPORT Depth Dominant Color Mottles Structure GPD no Horizon � xture Consistence 9otrd3y Roots x in. Munsell Qu. Sz. Cont. Color Gr. Sr. Sh. Bed #R 1 0-9 10yr3 /3 none 1 2msbk Infi .� yw 2f .5 j .5 i .2 9 -14 10yr4 /4 none sicl 2msbk mfr 9W if .4 1 .5 3 14-40 5yr4/4 none s /ls Osg mvfr gw if .3 .6 4 40 -90 7.5yr4/4 none co s Osg ml na na .7 .8 JD Remarks: " ng 1 0-9 10yr3 /3 none 1 2=1* mf i 9W 2f .5 ; . 6 + 2 9 -34 10yr4 /4 none soil 2msbk mfr gW if .4 .5 r 3 34-44 7.5yr4/4 none Fs Osg mvfr gW if .5 .6 4 44-90 7.5yr4/4 none C-0 s/f Osg mvfr na na .5 .6 b Remarks: H -4 stratified CST Name: -- Please Print Gary L. Steel ' - Phone: 715- 246 - 6200 : Adelr= 1554 200th. New d W I 54 7 �- Si gnatum Date: 1_29 -2000 CST Number: m02298 k�7:VU1 ivE� t Ylt li:k Van Uy SOIL DESCRI : ION REPORT 026- 1088 -20 -000 P ie - Depth Dominant Color Mottles ng iM Horizon i .xture Structure Consistence �CbY Roots Bed D aar. in. Munsell Qu. Sz. Cont Color Gr. Sz. 5h. 0 -13 10yr3/3 none tbk Fmvfr f 2 13 -29 10yr4 /4° none if .4 .5 3 29-90 7.5yr4/4 none CO na .5 .6 Remark s: H-4 stratified 1' 0 -14 10yr3/3 none 1 2msbk mfi gw 2f .5 .6 ..` 2 14 -37 10yr4/4 none sicl 2msbk mfr gw If .4 .5 q 3 37 -56 5yr4/4 none Cs Osg mvfr gw na .5 .6 w:.:.. 4 56-90 7.5yr4/4 none Tns Osg mi na na .7 .8 4 Remarks: e - 1 0 -12 10 /3 none Z 2msbk mfi gw Zf .5 .6 2 12 - 32 10yr4/4 none sici 2msbk mfr gw if .4 .5 t 3 32 -56 5yr4/4 Wane f5 /is Osg mvfr _ gw na .5 .6 4 56 -90 7.5yr4/4 none co 5 /fs Osg mvfr na na .5 .6 Remarks: Rwrrti A�ltC• tt � r, ' STEEL'S SOL , SERVICE L. Steel 1554 200th Ave. r M2296 New Richmond, WI 54017 RSW -32, CA (715) 246 -6200 k , WC=tip of septic tank c/o C el. 100.00 y � Alt. - ]ELI.= bottom of steel siding of shed C e.a 101.80 IV, W dial, Gary L. Steel 1 -29 -2000 ..... .... . : 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 F - 1088 -20-000 . Attach complete site plan on paper not less than 8 1/2 x 11 i size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (B irtetibr� and %of slope, scale or # dimensioned, north arrow, and location and distanc rte resf"r6ad. t R VIEWED BY DATE APPLICANT INFORMATION— PLEASE PR I L ll fp "tIl0N _ � - —Z PROPERTY OWNER: f PROPERTY LOCATION Hendrick Van Dyk _ f" �_ A, GOVT. LOT NW 1/4 NW 1/4,S 30 T 30 N,R 18 5(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 931 140 Th. Avr. 1C ;u 4s na na na CITY, STATE ZIP CODE HONE NU.bQH U �` ❑CITY ❑VILLAGE KFOWN NEAREST ROAD New Richmond, WI. 54017 �k5f)246 -5454 A 11 Richmond 140th. Ave. [lq New Construction Use [) Residential / Number AedrdDms- [) Addition to existing building I ) Replacement [ If Public or commercial describe office 3 employees- showers 3 -2 floor drains Code derived daily flow 205 gpd Recommended design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Absorption area required 410 bed, ft 341 trench, ft Maximum design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Recommended infiltration surface elevation(s) 93.60 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U MG El N S ❑ U ® S El INS ❑ U ❑ S [au 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 Trends 1 0 -9 10yr3 /3 none 1 2msbk Mfi:, , gw 2f .5 ( .6 1 2 9 - 14 10yr4 /4 none sicl 2msbk mfr gw if .4 I .5 Ground 3 14 -40 5yr4/4 none fs /ls Osg mvfr 9w if .5 .6 elev. le . � t 4 40 -90 7.5yr4/4 none co s Osg ml na na .7 .8 Depth to limiting factor , L +90" Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfi gw 2f .5 .6 `? 2 2 9 -34 10yr4 /4 none 2msbk mfr caw if .4 .5 3 34 -44 7.5yr4/4 none fs Osg mvfr gw if .5 .6 Ground elev. 4 44 -90 7.5yr4/4 none co S/fE Osg mvfr na na .5 .6 9 7.9 ft. Depth to limiting factor +90 Remarks: H -4 stratified CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. v New d WI 54"7 Signature: Date: 1 -29 -2000 CST Number: m02298 I PROPERTY OWNER Hendrick Van Dyk SOIL DESCRIPTION REPORT Page 2 - _ of 3 PARCEL I.D. # 026- 1088 -20 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 -13 10yr3 /3 none 1 2msbk mf i gw 2f .5 2 113-29 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 129-90 7.5yr4/4 none co s/f E Osg mvfr na na .5 .6 elev. 9 7.7 ft. Depth to limiting factor Z -9 2- +90 Remarks: H -4 stratified Boring # 1 0 -14 I0yr3 /3 none 1 2msbk mfi yw 2f .5 .6 4 >_ 2 14 -37 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 ................. 3 37 -56 5yr4/4 none fs Osg mvfr gw na .5 .6 Ground elev. 4 56 -90 7.5yr4/4 none HIS Osg ml na na .7 .8 97.6 ft. — Depth to - limiting factor A - -------- T +90" Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2msbk mfi gw 2f .5 .6 >' 5 2 12 -32 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 32 -56 5yr4/4 none fs /ls Osg mvfr gw na .5 .6 Ground elev. 4 56 -90 7.5yr4/4 none 60 s /fs Osg mvfr na na .5 .6 9 8.0 ft. Depth to limiting 5"Z. 8 factor ` +90" Remarks: Boring # Ground elev. ft. Depth to limiting factor L I Remarks: SBD- 8330(R.05/92) r STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 New Richmond, WI 54017 MPRSW -3254 (715) 246 -6200 �N - 1 =40 —BM. =top of septic tank c/o C el. 100.00' Alt. BM.= bottom of steel siding of shed @ el. 101.80' �° X I I rib Gary L. Steel 1 -29 -2000 F ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/lk"r 6 ln �'- -L) °w' � Mailing Address 9 / I y ° 4-A 7 Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number a LEGAL DESCRIPTION Property Location 'h w 1 /., h 1 /4, Sec 3 0 . T 3 a N -R i 8 W, Town of 14. Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 5 3 ° J- , Volume ! / , Page # y y Spec house ❑ yes ® no Lot lines identifiable M yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three ye exp do te. L 116 / L SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the pro descri d above, by irtu of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ... .�, DOCUMEN No STATE BAR OF WIS CO NSIN NSIN FORM 3-1982 TRH• SPACE R[4[RVC0 Von SS�CMOIM4 DATA QUIT CLAIM DEED 5 3n295 FI 1126P 544 -. ST 6 i.k AGE I „. Van D k and Eileen Van D k R r.1dt x F3w ,�, y .....:Iojlti.G......... ..X. ....................... Y--- r.... ............................... , . ----------------- •-------------------- - - - - -- JUN 2 0 1995 quit - claims to RAd= .k .Wa.:V81I DY -- •------- -------- - --• •- •• -•.... •-- .•••...... � :� 9:30 A.`,, # y II ......... ............................... ......_..their - intzrest.aT►... C ._---- • .. ....... . ....... - �� the following described real estate in .....Y.(.r.. Croix, County, [T State of Wisconsin: See Description oa pt ii Reverse Side i� 1 1 �I l Tax Parcel No: I� I II II i This -- ---• -- a ............ ... homestead property. (is) (is not) -` Dated this ............ ... .... ....................... day of .... ...... ........................................ 19. -95 . 's �Ca (SEAL) ..................................................... (SEAL) ........ . .............. 9 C •J h gn..Dl! ...... ....... . ................................................. ...,... li _ ......._ (SEAL} P� (SEAL) a Eileen Van nyk -• -- ----_---------- ................................................ ........__. -..... .••- � I AUTHENTICATION ACBNOWLSDGiMENT I III Signature(s) ............................................................ STATE OF WISCONSIN I sa. --------. ..................................------ .............------- •......... St. unty. Croix ... ................ Co 1 s t authenticated this ........day of ........................... 19...... Personally came before me this .. ...... June of June ------ ......••...... °.......... 19--95-- the above named •---•---......--• ....................•-•.......----------------- ... Joh?1._ G.. Y dA. .DJ!k_.R11S1. Eilgel}. Van- nyk ..... ..... ..... .. •.........-- •- - - - - -- • .............•....-•------- •------ ••......------- •...... .....-- •-- ... - -• - -- ---------.._..... ..........------ •----- ......• -- --- • - -• - -- `;_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not . .............. ..... - to me known on .._. •------•-------•--•----.._....._.......................--•-------- authorized by 708.08, Wis. State.) 9 ........ who executed the tp•be the qjr foregoing 9$ 4m&t aV 1I knowledge the same. THIS INSTRUMENT WAS DRAFTED BY ........ ...... . .. . .............. REINSTRA b VAN DYK. S.C. : . # 201"9oufh "Knowles - Avenue ............................... - New._Rich: nd.._W1._.. 54017 .. ............. .................. Notary blo t • fio.- -.County, Wis. (Signatures may be authenticated or acknowledged. Both My Co r i i nt:(It not state expiration ''. r 9 7... are not necessary.) date: �:__.- � J0 ' I QUIT CLAIM DEED 82_�AE BAR OF WISCONSIN Wbeon.in Leal Blank Ca Ine. FORM No. 3 — 198E Milwaukee. Wis. 6(101126 PAGE54`� =' ; •� � r�'�� r p F � � The Northeast Quarter (ME 1/4) of $action Twenty !•iv{' ' North, a nineteen (14) MNat, r .� pip Thirty (3 ) Rang , Y The North" Quarter UM 1/4) o! the Northeast Quarter (MY 1/4). s f ^- section T'n�>;ty ( 30), Township Thirty (30) North, Range dighiwa�z�� !* Part of the Nprthesast Quarter (NE 1 /4 o! the Northa8st Quarter' (ItE >> "+ 30 Township Thirt Northwest corn y (30) Montt, Range b • ,: i/4) o! seat " Thirt y ( ). r Eighteen (it) Meet described as f011awst Commencing at the corner Of said Northeast Quarter (NE 1/4) of Northeast ( ME 1 /�)► them• South 80 rods, the East 7 rods 9 teat to " a:ntesrl ine of County Trunk Highway "A"; thence Northerly on 4 said c•ntesrline to the north line or said Northeast Quart r Northeast Quarter (ME 1/4 of NN 1 /i)i thane Mast on said NpriZt' r line to the place of beginning, > ., Tiles Northwest Quarter ( Eighti•af(1�1Mest�sxcBPT(3o), Township .hirty (30) north, 1 The West Throe- quarters (3/4) Of the Nast Hal! of Northeast Quarter o! the Northwest Quarter (N 1/2 of NE 1/4 of NN 1/4), section Thirty (30) , Township Thirty (30) North, RAN* Eighteen •' , 9 ,; fit ar o! the No Quarter Lll that part o! th Northwest Quart hi Thirty (301 Y (NM 1/4 of W 1/4), section Thirty (30), T �. North, Range Eighteen (16) Nest, lying Sast of the Millar River. k r' c i part o! the Southeast Quarter (SE 1, of the Southeast Quarter (SS [; .? 1/4) of Section Nineteen (19), Township Thirty (30) North, Range k• ` Quarter (SE (18) Nest described as f011ars t All that Past of said sou Quarter (SE 1/4) of S out h eas t i/4} lying s Masterly of the Hoardean Plat except CONIencing at the Southwest id plat; thence North aornet of Lot TWO (2), Block Five (5), of sa 228 lean thence East 172 feet 9 inches to County Trunk Highway tb•n<:e southerly on County Trunk Highway " 1 feet to the .•.� Northeast corner of Lot one (1) , Block li ( (5 5) o ! said Plat f o thence southvastly on County Highway "A" to the ` - Southeast corner , of said Lot Two (2); thence Northwesterly to the place Of r' beginning. t Quarter (see 1/41 o f the Southeast Quarter (SE 1/4) • s R z of section Nineteen (19), Township Thirty (30) north, Range ,. f Eighteen (16) Nest, �, t f r Th South Three (S 3/4) of Northwest Warier (NM 1/4) of z, �*` a• ; South" (�). Township at Quarter (sE 1/4) of Section Mina Thirty (30) North, Range Eighteen (18) Most, .. rs S 3/4) of the -quarto ` The South Three - quart S One o ( 2/4k K ` t of the Northeast Quarter (NE 1/4) of the Southwest Quarter (See Township Thirty of Section Nin•tasst (19). (301 North Ram Eighteen (18) Mast, also described as all that part Of the South £' a. Leo- quartars ($ 3/4) at the Northeast Qu (ME 1/4) of the $outbwsat Quarter (SW 1/4)• +yang east o! tea willow River. The Northeast Quarter (ME 1/4) of Section Eighteen (18) Township Thirty (30) north. Rang* Eighteen (18) West EXCEPT Lot ' at certified survey Nap filed Nay 6. 1981, in v 4, pegs 1056 as r Document no. 370716. , f q part a! the Bast Hal! of the No (;.Art•r (E 1/2 of xN 1/4), r 47 ` > Soot Twenty (20), Township Thirty (30) North, Range Bighta.n (18) west, described as follows: ?r Commencing at a point 800 feet south and 280 feet East of the t Northwest corner of tea Northeast Quarter of the Northwest Quart (NE 1/4 of NN 1/,4), Section Twenty (20), Township Thirty (. North, Range Eighteen (18) Most, being the Point of Beginning; thence directly Nest, 280 feet; thence south along the Meat ling of the East Halt of the Northwest Quarter (E 1 /:: of NN 1/4} at said }, section Twenty (2 to the Southwest corner of said East Half of Northwest Quarter (E i/2 0! MW i/4); thence along sE s o u th / l �. Of the Southeast Quarter of the Northwest Quart ( .r 1/4) to the vast side of the right- Of for County Trunk High •A•, thence Northeasterly along said right -of -ray to t•. 8outhwasterly corner of Lot one (1) of Certified Survey Nap Sou 21, 1990, in Volus• "8" of Certified Survey Naps, Page 2214, Ka y 00'17.36" Bast, 544.56 feet, as, Document Nthence ISO. 458732; the North ; hence North on a line the North 53' 2456" East, 500.00 feet; t parallel to the East line of said East He l! of the Northwest t r Quartet (E 1/2 of NN 1/4) to a point 700 feet South and 66 feet'' west o! the northeast corner o! said East Half of the Nort most 7.00 feet; thaws r Quarter (E 1/2 of ON 1 /4); thence diractlyR MITti an easement ee southwesterly to t Point o! Beginning. described propertyt for ingress and egress over the following t T of Certified survey Nap Commencing at the . outheast corner Of Lo filed Nay 21, 1990, in Volume "8", pegs 2214, 08 Document 0458732, being the po'1 W1t, •Pt beginning, thwwo N 0o' 17 East 544.56 toot, !' , •. thence North an a lino parallel to th East line of the East Halt of the (E 1/2 of MIN 1/4) of section Twenty (20), '1`ownsh Jihirt ('30 North, Range Eighteen (18) Most to s point 4 700 flat ¢ 4 feet West o! the Northeast corner of said t; East tibi3t bt No " # Quarter (E 1/1 of NN 1/4), `.hence East 66 feet to the EN &elinec of said East Halt of Northwest Quarter (E 1/2 d 1 /l') South along sai of NiR East Tina to County Trunk highway "l� ",�''jnuthwst to point of beginning. '� ti NVr n of O n co 3 T n 0 d C 3 —1 �1. CD M rr ! ~• O d N O W C N O N N O O 00 N - O N ( :• 3 C w CO 7 3 p C F"p' N C O 7 z a m rn O z a: y o v a o .� Ul M to CA 0) N (D C1 O 90 .04 _ N I CD CD 7 (,�D O CD 0 (O� O � !� ca rn to to o p Si m sr a s cn D co a e A (D y I o CL o D l CD y c� o o O cn c� m l O o 0D s j iS F o OD D zt :t 3 R m CD OD 00 m 00 OD r- g m 3 c X I CD I 'o 000 3 000: o I m- y w CA m 1 to N cn o m o 0 v (D v a Ch CD C3 i - J " lv D a D n� O I zr 5 (D m CD CD U ) y N CD C COD �N C (OD N �I I a a �_ I c A J CL a z 0 Z W W fl CD 0 �Z CL CL o r o " z N y z I v CD a W 0 I w C1SN a d C N ? C O O CD 55 CL C N, CD N O . G O y _ CD y O I (n a CD ID a w 'm CL v �. (D e ID N Z I s�oOy O a C) ON CD o a a NOON �O N C!i.y 4 ( Cn O O yy C N 3 U1 CD O .. W O ^ 41 Co O N \G A. 7 0 S d A CD CD Cil O cr � ' N A fi Nao a a) �c O O C1 7 o tp C. cc 0) D 0 N ON N 7 O W_ N N apO ON I j O a N to O fD .. O b (D m o O o v o o � CD N Parcel #: 026- 1088 -20 -000 06/26/2006 11:30 AM PAGE 1 OF 1 Alt. Parcel #: 30.30.18.461A 026 - TOWN OF RICHMOND Current I X ' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co HENDRIK W VAN DYK O - VAN DYK, HENDRIK W 931 140TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 911 140TH AVE OR SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST Gam - SP 1700 WITC Legal Description: Acres: 33.900 Plat: N/A -NOT AVAILABLE SEC 30 T30N R1 WNW NW C PT E OF Block/Condo Bldg: WILLOW RIVER Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 30N -18W n /f Notes: A �' � Parcel History: Date Doc # Vol /Page Type 7 07/23/1997 1126/544 QC 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 06/22/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 9,000 73,900 82,900 NO AGRICULTURAL G4 28.400 2,900 0 2,900 NO 00 UNDEVELOPED G5 0.500 100 0 100 NO OTHER G7 4.000 11,400 231,000 242,400 NO Totals for 2006: General Property 33.900 23,400 304,900 328,300 Woodland 0.000 0 0 Totals for 2005: General Property 33.900 23,300 304,900 328,200 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 AS BUILT SANITARY SYSTEM REPORT OWNE n TOWNSHIP SEC T ADDRESS ► *4 ST. CROIX COUNTY, WISCONSIN. rrrtrry SUBDIVISION LOT LOT SIZE A, ,' PLAN VIEW �/7 /Vo Distances and dimensions to meet requirements of H63 sHm THING WITHIN 100 FEET OF SYSTEM o I o � I di6-a e No thjArrow'' ' I SC LE : D' _ BENCHMARK: (Permanent reference Point) Describe: 3 W1re -,' Elevation of vertical reference point: �� Slope at site: D— Z O70 SEPTIC TANK: Manufacturer: Liquid Capacity: m Number of rings on cover : 0 Tank manhole cover elevation: — Tank Inlet Elevation: ' •� Tank Outlet Elevation: ' 2 ,—, PUMP CHAMBER Manufacturer: Number of gallons Number of g pump set for a cycle gallons; total capacity o distributi lines gallon: size of pump head; gallon p minute horsepower ran name of pump and mo 1 number ; Type 9 device HOLDING Tufacturer Number of gallons Elevatnhole cover T yp e o device SEEPAGE P o pits eet iameter feet 1 seepage pit inlet pi bottouC of seepage pi a evasion feet. sh gw SEEPAGE BED SIZE: number 'of lines wi t L;0 lengthlj geptWO SEEPAGE TRENCH: width length PERCOLATION RATE AR EA REQUIRED A AS BUILT ,� y INSPECTOR DATED I PLUMBER ON JOB Id LICENSE NUMBER -5 - 3 'v REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit State Septic __ �� 1� 0 NAME , kNSHIP ' Pi " St. Croix County I,OCA'TION -Awl Sect # Subdivision SEPTIC TANK Size gallons �f Number of compartments Distance from: Well / Building / j 12% slope Highwater 1'UM PING CHAMBER Size gallons Pump Manufacturer Model Number HOLDING TANK Size gallons Number of Compartments Pumper_ Alarm System_ Ulstance from: Well Building 12% slope Highwater • ABSORPTION SITE Bed Trench Distance from: Well _ Building__ 12% slope Highwater ABSORPT _S DIMENSI Width of trench. ft Required area ft. Length of each line ft Depth of rock below tile in. Number of lines Depth of`rock over the 2 in. Total length of lines J ft Depth of tile below grade in. Distance between lines ft Slope of trench in. per 100 ft. Total absortptton area ft Type of Cover: 1 D IMEN SION S Number of pits Gravel around pits yes__ - no Outside diameter f l Depth below inlet _ _ft Total absorption rea� ft Area required ft INSPECTED TITLE APP-ROVED J DATE_ 1 198_/ REJECTED DATE REASON FOR REJECTION b M r 1 .ir X . t Y .e i � AMA PLB 6 7 S tate and County State Permit # Permit Application County Permit # for Private Domestic Sewage Systems County s�•� t * DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: " �) n 011 de P1 J�- V I(! i � V n V B. ' LOCATION: 0 % jVW %, Section %,.?o, T N, R 149S (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Towns C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family Duplex No. of Bedrooms No. of Persons - D. SEPTIC TANK CAPACITY /O005 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete I-- Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New y` Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top No. of Trenches Seepage Bed: ✓ Length S2 Width Z Depth - Tile depth (top Aa " No. of Line Z- Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land d — Z 1!7e Distance from critical slope WATER SUPPLY: Private ® Joint ❑ Community ❑ Municipal ❑ Owners name as listed o EH 1 15 i other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified p Soil Tester, t NAME 11 g,.-,/ L. - f . L C.S.T. # Z Z 59 and other information obtained from 14 , ner builder). _ Plumber's Sign Pin.,, _ MP /MPRSW# &Z5 Phone # 2 4 e4 — (oZdd Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. e ' ; F f i j t� I � E € € 3 � ., -4­ m t 1 ` i € } a E � [ 1 € E pp i } ..... ,. . ............ se.. e. ,. „u ... .m . 3 ,.m a. .. _. y_ ,.._ . ..... — e ..._ ._.�_W .... e .,._, .. u...._- 1--- ..a.,, -;.., e.. ........ A Do Not Write in Space Belo FOR COUNTY AND STATE PARTMENT SE OIJLY �}p / Date of Application' Fees State County / 01 Date Permit Issued /R'ejet'tE'd (date) ¢ ,b'( Issuing Agent Name Inspection Ye4te No State Valid# Date Recd 1. county (w cop y) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 REPORT ON SOIL BORINGS ANr'0 9 , DEPARTMENT OF ` SA T BUILDINGS INDUSTRY, r T C DIVISION LABOR AND` PERCOLATION TESTS 115 C CR BOX 7969 HUMAN RELATIONS / 27 1981 I WI 53707 OCATIgN: SECTION: p TOWN P/ Y T :SUB NAME In1 �/ % /T3oN /R /Mor) w /C ->�ir" aj "OFFICE COU TY• NE BUYER'S NAME: MAILIN ADDRES A'k a r4� t4" d 12 .-#'4 USE DATES OBSERVAT NO. B DR : COMMERCIAL DESCRIPTI O STS: �esidence D(New OReplace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: S ST -I N- HOLDING TANK: RECOMMENDED SYSTEM: (optional) W. S DU C) $ ©U S ❑U D S U EIS ®U If Percolation Tests are NOT required DESIGN RATE: If any portion of the lot is in the under s.H63.09(5)(b), indicate: l Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION. OBSERVED EST.HIG H T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 0 1 3rz ©►� e - ? 8 0 ! 1 �(. .f S. 15 . S.4 B. z So Io 1YZ B- 3 80 I 01 r) ✓I L 7 8a B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD t F!ERIOD PER INCH P_ t o 3 (p to 40 < 3 P_ N 3 < P_ •, to < P -. RE PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop, SYSTEM ELEVATION 28 't/ ve PI f t '1„ z)? 4 _._ j_.. - ---- - t i t E ----- - (._ tN t _. . I _. _ ' -e 3 f ._ _ )� 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLET ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): 8 Nc�i '' �� Z ,Z 98 CST SIGNA�U i DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester, DILHR -SBD -6395 (N. 03/81) i j. �r T 12' Q ( c I( I 8' SA'= �C�D L. t . . ,; �.. i f � t. �_ 1 i _. � E i 1 e 1 � j � .. _�. _.... �. � i 1 7 '•' !. � � ' ?? �CC'r? � �Y'� I .. ,. ., ,. '. �� h, , C . a G �.; c t � ;'-2 ... . {j, :'± � i '; 1 � :;: ,' f ; . Parcel #: 026- 1088 -40 -000 06/07/2005 08:19 AM PAGE IOF1 Alt. Parcel M 30.30.18.462 026 - TOWN OF RICHMOND Current I X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner ' HENDRIK W VAN DYK VAN DYK, HENDRIK W 931 140TH AVE 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: 43.800 Plat: N/A -NOT AVAILABLE SEC 30 T30N R18W 40.80A SW NW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1126/544 QC 2005 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/30/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 22.000 2,900 0 2,900 NO PRODUCTIVE FORST LANC G6 21.800 33,800 0 33,800 NO Totals for 2005: General Property 43.800 36,700 0 36,700 Woodland 0.000 0 0 Totals for 2004: General Property 43.800 36,700 0 36,700 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 #: 026- 1088 -50 -000 06/07/2005 08:19 AM PAGE 1 OF 7 Alt. Parcel M 30.30.18.463A 026 - TOWN OF RICHMOND Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HENDRIK W VAN DYK VAN DYK, HENDRIK W 931 140TH AVE 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: 39.500 Plat: N/A -NOT AVAILABLE SEC 30 T30N R18W SE NW EXC STRIP SOLD TO Block/Condo Bldg: H P DURAND IN VOL 477/380 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1126/544 QC 2005 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/30/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 34.000 4,600 0 4,600 NO PRODUCTIVE FORST LANC G6 5.500 9,000 0 9,000 NO Totals for 2005: General Property 39.500 13,600 0 13,600 Woodland 0.000 0 0 Totals for 2004: General Property 39.500 13,600 0 13,600 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 #: 026- 1088 -90 -000 06/07/2005 08:20 AM PAGE 1 OF 1 Alt. Parcel #: 30.30.18.465 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HENDRIK W & BONNIE L VAN DYK VAN DYK, HENDRIK W & BONNIE L 931 140TH AVE 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: 43.820 Plat: N/A -NOT AVAILABLE SEC 30 T30N R18W NW SW FRL 43.82 ACRES Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/2311997 1005/362 WD 07/23/1997 907/598 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANC G6 3.820 12,000 0 12,000 NO ENTERED BEFORE 2005 OI W7 40.000 125,500 0 125,500 NO Totals for 2005: General Property 3.820 12,000 0 12,000 Woodland 40.000 125,500 125,500 Totals for 2004: General Property 3.820 12,000 0 12,000 Woodland 40.000 125,500 125,500 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 f ' • AS BUILT SANITARY SYSTEM REPORT OWNER �j/ TOWNSHIP SEC., T30N -R /9 W ADDRESS ST. CROIX COUNTY, WISCONSIN. J SUBDIVISION LOT LOT SIZE PLAN VIEW Distances,and dimensions to meet requirements of H63 SHO ERYTHING WITHIN 100 FEET OF SYSTEM 4- i sz -4 lindilca e o th jArrow SC Li L i BENCHMARK: (Permanent reference Point) Describe- Elevation of vertical reference point: 100 Slope at site: © - Z 0 2, SEPTIC TANK: Manufacturer: (t2LE fnk Liquid Capacity: Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: 9 21 Tank Outlet Elevation:g7` " PUMP CHAMBtR Manufacturer: Number of gallons Number of pump set for a cycle gallons; total capacity o distrib ion lines gallon: size of pump head; gall per minute horsepower ran name of pump a model number ; ype of warning device HOLDING TANK: Manufacturer Number of gallons El vation of ole cover -"y pe of ping devices SEEPAGE SIZE: Number ot pits teet diameter fe liquid depth seepage pit in eet pipe- elevation ottom of seepage pit evati n feet. SEEPAGE BED SIZE: number of lines Z_ wi t - /z , length , tile depth " SEEPAGE TRENCH: width length PERCOLATION RATE Z MA RE QUII D G/t - A' ARE BUILT INSPECTdR DATED PLUMBER ON J B LICENSE NUMBER REPORT OF INSPECTION - IN DIVIDUAL SEWAGE SYSTEM San.i taA-y Pe4mit State. Se.ptcc NAM Tow n3htip !St. Ctcoix County Lac ion ectio Lot # Subdivi.6ion SEPTIC TANK Size gattms Numbers o6 eompaAtmentA / l � Di, stance Atom: wetf 5 Building C7 1.2 0 stope Highwaten PUMPING CHAMBER Size jons cCmp M u6aetuti. Mode. Numb en - ---- -- HOLDING TANK Size m e.n om o� pa . tmentb Pumper A,m Sy�s�em Di6tanee 6 k om: GIe �Buit 120 .6tope _ Highw ten ABSORPTION SITE Bed X Trench Di/s,tan.c Pcom: Wet Z Buy.. -din 12a .6tope -- _- Hi ghwaten ABSORPTION SITE DIMENSIONS Width o6 tkeneh 1,2 At RequiAed area Length o6 each tine � � 6t Depth o6 rock below Cite in Number o6 fine6 J -�: Depth o6 rock oven tile. In Totat Length o6 tines �� ' (7 6.t Depth o6 tite below grade c.n Di6tanee between Zinea At Sope o6 trench in. pen. 100 At Total absotcption area ` 6t ype 6 Covets: Paper otr 6ttcaw PIT DIMENSION Numb etc o6 ptitb A k et akound pit6 yeti no Outside diametetc _ � D pth below inlet At Totat abA otcption tce At A to e a A e q u�. ti. e d -- - --it INSPECTED TITLE APPROVE % "� DATE 19 REJECTED DATE 198 REASON FOR REJECTION r ' i I 1 al • } I i P L B State and County State Permit # Permit Application County Permit # m for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailin g Address: ja", r1l k '/a B. LOCATION: '/4, Section , Y SO N, R44& (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Towns C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family � Duplex No. of Bedrooms No. of Person D. SEPTIC TANK CAPACITY /O (nt5 Total gallons No. of tanks / HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement L_� Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Z Total Absorb Area sq. ft. New Replacement L-- Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top No. of Trenches Seepage Bed: z, Length 52- ' Width J Z " Depth u "/ , Tile depth (top )%46 " No. of Line �— Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land O —2 M Distance from critical slope WATER SUPPLY: Private AJoint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other tha pre o w n er: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, ll NAME T � z E L_ C.S.T. # Z and other information obtained from p) h 40) K Oi Er builder). Plumber's Signature MP / Mefts # � Phone Plumber's Address 0 PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. � .. i � } ._,.. r � t , i t ; e $ � 7 t f i r t m t t t m, tea. 5 ' t E 3 a i d E Do Not Write in Space Below FOR COUNTY AND STATE DEP RTMENT USE ONL Date of Application Z 41 Fees Paid: Stat C my �• Date Permit Issued/ (date) .=`— / / — el Issuing Agent Name Inspection Yesro State Valid* Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 EH 115 SOI L SOlSIN s AND PFJICOLATION TESTS ' NSIfN DE( HEALTH AND SOCIAL SERV=8 dr s a P.O. BOX 399,11 , DISON, WISCONSIN 53701 LOCATION:4ibA,9.W,14, SectiA ,T.1,.'N.R.,�ES (or) W, Township or Muawpwiy Lot No. , 8190k W. County . , Subdivision Name Owner's /Buyers N x d -- "- � Mailing AddreaR; r TYPE OF f fie a ,_ .., ,.,,,.COMMERCIA I {� EFFLUENT QI �. R. FNT ALTERNATE 816$�'6i M.,,.,..,-OTHER T DATES OBSERVATIONS: MADE:, � 1f !PERCOLATION TESTS SOIL MAP SHEET ' - ----- _'NAME O F l l l Mle►a ia}iT t,f - PERCOLATION TESTS I S� DFPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHE, NUM INCHES THICKNE!I , , SINCE HOLE HOLE AFTE INTERVAL Istf It 4 1c , I 1 WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 t l y a . P. E`r y ,r 1 •,•. t q ,ld r r•,...` * ` " 8C WBORING TKM TEST DWA1y$ 1NCN B "% ' ARACTER Q H THICKNEIIS, COLOR, NUMBER ' INCHRIi TEXTURE, MOTTL D QEPTH T04MU pCK ? 'yis? IMATBD HJQid$BT IF BSERVED IN INCNGS tw r^ PLAN VIA „ nu mber of a r�u e f a s la+ o es and aulta 1 e 1 areas.) 1 ioete on the plan the location sled "Were feet of suitE Indicate number of agl�an feet of 1•na I+eeded fiie l� IndW to scale or z 1. ! Give horizontal , I - - - r p olt - Y . • 1 t ° ,1 �:� , Y I I 1 • LL tltl a4W I� 17 P 7 1 w r 3 ' r, r 4 "t__ 1, the undereipend, hereby certify tho a soil tests reported on this form were made by me in aoewd with the procedures and me specified In the Wisconsin Ad : Cos, and that the d am recorded and location of teat holes am correct to the bat of my knowledge enid�bolsef, y : . ;�s 4 � Name( a�° Certification No. �- r Address ') Name of I nstaller If known ' Copy C _.. palialaiy Owall CST Signature 13825 REPORT ON INSPECTION OF SANITARY PERMIT # (1 ) Name and Address of Permit Holder Person /Persons at Site (2 )Date of Inspection Name, Address, License No. o ns a Ong Plumber Time of Inspection (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepa a Bed ❑ Holding Tank ❑ Fill System Permanent re erence oin Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? [:]YES ❑ NO Wired? [:]YES ❑ NO 8 HOLDING TANK: Manufacturer of gallons ; construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES []NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES [:]NO; Wired? ❑ YES ❑ NO; Locking device on cover? []YES ❑ NO; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe- elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth.; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES [:] NO (13) Has system been installed in floodway? []YES ❑ NO Floodplain? []YES ❑ NO DILHR -SBD -6095 N.05/80 Signature of Inspector /l/!1J * tid Sr, '3D f329 /2 /B a 2 ir• a.C6 IA . ^ Sol r, 1� f ** 1 i ryt � A _�> y �' ' , � 4zt f 1 1 �pi r� F