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HomeMy WebLinkAbout026-1093-50-000 (4)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic �+ t3 � D ' w Fii _ _ W�1In(f/ r° Lte-G`F� TANK SETBACK INFORMATION WEVAMAWNWAIn MMFA► =u = PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Nu bar TDH Lift V riction L ss S tem Hea T Ft Forrzmain Length Dia. Dis . to Well STATION BS HI FS ELEV. Benchmark Z.-7 bZ, Gov Alt. BM Bldg. Sewer SUHt Inlet 7 i ot.3 SUHt Outlet 1 r' J IG. r �2• Z_J rx .trt !oz.5J Dt Botto Header/Man. T 6.03 9G • &7 Dist. Pipe 3 r JOLISS 'S Bat. System T G 7 St Cover F' `i.15 97.75 SOIL ABSORPTION SYSTEM B4- / / + j 7-+1-Ag3 ck-L"n r /-5 BEDTTRENCH DIMENSIONS Width t Length O No. Of Trenc PR DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO JPIL JBLDG WELL LAKE/STREAM LEACHING Manufacture� rr• INFORMATION CHAMBER OR UNIT { hYl r Type te„ L! t 7 I V -7 / ` Model Number. .0� C- DISTRIBUTION SYSTEM HeaderlManifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 'Z, r / J If `i Pipe(s) ' Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded m Mulched Bedr-rench Center' _ / % Bedrirench Edges Topsoil No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspect In #2: Location: 1272 110TH ST — �f��`p j., ?'V - ^ a �. S (}� 1.) Alt BM Description = �P�-{ L '�.�ryl � �/ o � 7 V 1 O /1 v 2.) Bldg sewer length = ,,�r�•// .�'�.�L t%l V � .. to 0� add;�i off A 1 - amount of cover = �J��'7 - • , `,ter 1 4 aL„Y t ! I 1 l 11 N t JM lnf r, LAI Plan revision Required? Q Yes rY�IINo �%� �• ``tt�t l'f v—„ Use other side for additional information. ; "" / Q SBO-6710(R.3/97) Date Insepcto Si at re Cert. No. -I; (V ,)�aaa _ /fa - N 10 2022 Awa �-- - 62 St Croix County Mkttisoq velopm nt Permit Application m wan srs 302](7). Va Ada. cads obmissim cf" fad iodw Wpoptm Wo m nxWad pnm to abW=*&z. axy perm[ Now App xvbw form for setb mll rovers. The Depdeat of Sd* and rtu&=wml Savica Femmd iadors - rm PorW Adr be ued TO z79 110", SrMET Jam, P(tor2FamdyUdli�-Wu .fllLdt 0P*4oC0WWArC l-De=&e Use ❑ swC oases-D=nb= Uw to 5T.. (,ax my FeandN eer(lo be seainbyt .7lwesctim DAaaber Dz4,-I093- ._ E0( raope"i taeatiee Go Let — n1c %. smmim 3Z (ado T 30 W; ANY E Nfl- t c eQ ❑ cky oe .ie ❑ vi`war Toad of-EIcrff nnou-� ❑NM SYMM Siam 13T-0-0lawft Tak Ye ---iQ* IL ❑yyea R.AW ❑w.*ftlim ❑Chsnse fn.*. ❑r-T.sswrbtis B6ue %Tym drown aselt No tEitet b0.wd ❑ Prtaa.wd � „ ❑ A"kada ❑ >2'n I_ ofMallesad HWdWg T.k ( W DV d Ca®pmem (szp .) r&JZ ( G11 N Xra . iG =Vo SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumbe z. Au SetDaCK requlrsmdffmdwjwmpd�*m as per applicable codelordinances. =42)�a- 1 sy=USA,% Qa4m ❑ 0aw ua&&�=to famnoa syms- (MAlin) �t irk. Sew i zzqb37 sy�rqu�r Le- U U tV�QJ"'� � CCti2.1AA� �►� r ce ATE r us t' 6.j pirepiov Plot Plan P�qp �vwq PROPERTYOWNER: i��A-PAs Bt7Ti A\uRgAy L-ALCAW Legalnescrysim: R kL W se/ o>=,3RE nlC-Y4A s;e, S? TaWu,P19W -CoWp of , 5r CDVNIX. W�ScaNsl r3 t)-I- -1n9g —So- 000 l Z72- II M IL IIte location: '9.1 bkk.s" hoDOS Y � YV FT. (•+r b=pi.t a.;7y.,�rm FDRING ; e2us+.En Rae DRY � 3 �SW'd gZWO14 J m 2 4 d �L'ICO?v T Plot Plan it L-ALc-Ajvw Legaloesuip m: A PeL IN 5s`4 of -taE AE�� sty. 3? -rscw QmW, `Townlc�"i�Ct+�naNa� sr. C�OtX CauNTYf W�ScaNslt3. location: 0�K aNu IE u � _ d 1 � N4 4 : �Rc�an�hnopS t I q M s on•�,r; is Wi,sv'�, x nar I--YV�(� — + 1" � FT. (except Where noted) b= .Ot C.)_� }�qop �OtZING North a r W K W� J Q c PAGE 1 OF 4 Pg 1 of 4 Pg2of4 Pg3of4 Pg4of4 Attim1unents: _.' Fir In -Ground Gravity Plan Index & Cover Sheet CaMmed MvxW neatn Rerererx: version 2.0, SBD-10705-P (N.01ID1, R. 10M) Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan POWs Soil Eva. SGPT(C Project Name / Description for Review OwnerNams(s): �McK i $a:T+4 AugsU LA= My4fone: - - Owner Address: I Z72- I(T+ 15T.10 I )EW 1zlC-4t tSNtJ Zip: 9fol . Project Address: Govt Lot: 5E A of Nis 1M, Section_ 3z . T -�N Rey E ❑ or WM Township: County: 5� = C f uX Project ParCei m #. czl,2- Its 3 - 50 -- c n Designer Information Designer Name: Z I; y -1 -HuPPc,�T Pirorre: 715 - 42b -��75 Deelgner AddMM zT4q-1 KIN& AxTHKds Ct..p zip: 64&8 z E-OW11: k01[,'s)trde5i n r ou+fwK. coin This P License Number 185q - 00 7 WZI(-720 lag Signature: IIZGLr�0 t d D wq a aaq. IN -GROUND GRAVITY DISPERSAL AREA WAMm Elevation Trenches with Ckock4 Standard-W Chambers s-Ev= 0 3-ftTrench (down-srdngcredit) trr�: 3of y L,t�l+N�tw' �lcTKICI� SqfilcI&AmA� -04 _ gal -ad —ir � Fow , 4 rI u� �cs umrc cT to CROSS SECTION VIEW (NO scale) Syshm 6uvafon:�00 0 t lbp� 9'1. y0' a*WSi"4W 94. ZO' TmNt cop (Shot loolbn of ff" I o bd pbe ovteedlon on phn �Am-) F• e= �sirYbF1: cao� Piwift R**nmu 3 t sap.awnh8rKt s TYPICALTRENCH PLAN VIEW SLAB? rtNSTALL PER TRENCft :i4C "by kneowsn�...W DirYASWWQ20fe EMA hWdW. 120 X Wr..�bnrre��n• . + P*soflntlCap6Q6f E3&vo r• 74 W Propo,W Elr&.Wt",m-' 7 fe R.**.d Yiiden/ M.75D.d` t' plUl pf c v0WM = Proposed Tale) BSA• ,� _Y !JC D m Cl) O m A AJAZ 7� 2 : 2a Et ujw = 3,7.6 0+� 3$ unrcl s 3W lw" AL4'ar�5i` 9 H 38` oR @ 7 PAGE 4 OF 4 In -ground Gravity Management Plan The owner of flue irt-grow-W gavfly system shelf be responsible for is perpolual operabn and rrrakrl ww= pasuard to ratuiremente of WS 382-3" Mae- Adm:L code- P1sment to ma's 3" (21 Wisr- Adnin_ code, ris system d" be considered a human health hazard if not rrnsir**wd in accordance wflh flea approved marepemmd plan. Furf arffa , elf irperson and rnakdona tce scWtiaa sW be performed by a npisiered POWTS NM*dno in awordence with SPS 3MM (31 Wiac. Admit. Code- /MaxWo an Dkwetsel Ate ooentingi r4.ttltsp:��� .fM R� eve M �n Design Plow a ��� 1p1 BODs S iav rngO; T aV 5 15Q r11gC; FW 5 30 rng-1 nsoac8on Gedcfat INSPECT EVERY 3 YEARS o type of use o ape of system o nuisance fadors (La. odors, user complaints, etc) o medBa®I ngwaM*M (Le- pumps, valves, s,sidues, 9oels. etc.) o malarial fatigue (Le, Ieafoe, breaim, corrosion, aft) o sofids voitlna in anaerobic bealmerd tallk(s) and any d9bib Aun appurk nonoe(s) (Le-, dLstr ixamon f drop boxes) o neglect or improper use (Le., excwdr9 deaigr wpeaifas. P"*dxWd actrvibas, etc.) o extent of pondamg In destbmAam coN prior to dosing o dashN bege{ariies - 6 applic" (Le-• purg re-cycYn9. float s "sev6gs. efc-) o efechical components - if sppicahle (Let, wising. connections, swmctww, Qari, , Imes, alarms, etc) o dslibuion iateal or';', al ofifice plugging (nwasus latard detail possum - Compare to des;gn spedealion) o srface dradiage of effluent or sewage back-W 6Ao structure Served NlakrimuKtce Checklist KAMAN EVERY 3 YEARS (or when necessary) o SeoGe and dow tankfig shell be pumped by a certiied septega servk*V operabr faenaod under s. 281.48 We-. Suss warn Ow vokwo of sonde 1n on knii(a) excesift on►tltrd (IM do tiquW vokese of dw I I I ) or as regtwa I by local onInarce. Di Wood of cordeits shall be pmr pua t to UR 113. Wier AAnn. Code. o ENUOnt Nbrtsl shall be inspected every 3 yam ad shell be cleaned wlnsn newsy to remove any aoamialed wilds awordhg to maafac"Ws speciflunboris A swwc ng period wit always be Beeler than 12 "Kwd me. Syshan makWrence reports shell be submiMsd to the proper focal gorerrrerend unit in accordance with SPS 3fl3.56 Wise AbNrc Cade. Wpw arty component failae or maNundioe to: Name ofindvidualarcanpay: %Plies=.'� `-_?,`_�-1,'.S`� G-f Phone_ Localgovownedunit -5V C420(), C6AlMVJJljy DEdELDPMEArr Pharr 715— 356-L4W Local gmwmwO urA address: P u DSO1J WTI - ZN3- 4uo/(2_ Any ddaodve pert of this system shall be repelled, replaced, or mmwad pursuant to SPS 383.51 (11 VAM AdnwL Cade- Repel or replaoemerd Of failed Q MWWWfiiariitg camparMft shell 001o* wall SIPS W3, Wfsc. Ad *L Code. No product for chenatml or ptryrsiral mo onion of the POWTS ally be tmed wdew approved by fare departne t in aocedatoe with SPS 384, Wise- Admit Code. In the avert that any failed treetrnert oomponert of this POWTS tarot be repaced. it shelf be replaced pursuant b a plan sudndted to the appropriate agency for review and approrA. A failed in -ground dispersal oongonert may be abandoned and repisced by a code,.oargly V dispersal eongcaed in a pre detarnimed area of suitable sods. ff use of this POWTS Is dh=ntlnued, it shall be abandoned In accordance with SPS 383.33. Wise. Admin. Code. 2714304BA a SECTION A -A J 1 u 24.70 T-- 12.00 A QS 24.20 - 25.70 SECTION A -A I A 13.00 Drainage and Septic Products Tui-Tlte, Inc. TELEPHONE: 847.560.1011 1200 Flex Court ^^ - TOLL FREE: $00.382.7009 � � s 1 4 Material: Copolymer Polypropylene Color: Green PART NAME: 24 X 12 RISER PART #: 24 X 12 - RIS - GREEN r A 025.00 ----� SECTION A -A PERMANENT FOAMED -IN POLYURETHANE GASKET THIS AREA MAY BE FILLED WITH CONCRETE FOR ADDITIONAL WEIR I A Material: Copolymer Polypropylene 3.10 Color: Green 4.50 Drainage and Septic Products Tut-Tite, Inc. TELEPHONE: 847.550.1011 1200 Flea Court TOLL FREE: 800.382.7009 PART NAME: 24" RISER LID PART #: 24 - RISL - GREEN tf INFILTRATOR The Quick4 Plus Standard Chamber offers maximum strength through its two center structural columns. This chamber can be installed in a 38-inch-wide trench. Like the original line of Quick4 chambers, it offers advanced contouring capability with its Contour Swivel ConnectionTM which permits turns up to 15-degrees, right or left. It is also available in four -foot lengths to provide optimal installation flexibility. The Quick4 Plus All -in -One 12 Endcap, and the Quick4 Periscope are available with this chamber, providing increased flexibility in system configurations. AA%L Maximum Strength Quick4l Plus Standard Chamber Specifications size 34"W x 53"L x 12"H (864 mm x 1346 mm x 305 mm) Effective Length 48" (1219 mm) I Louver Height 8" (203 mm) storage Capacity 47 gal (178 Q Invert Height 0.6" (15 mm), 5.3" (135 mm), J 8.0" (203 mm), 12.7" (323 mm) APPROVED in Quick4 The QuickC' Plus Standard Chamber Quick4 Plus Standard Chamber Benefits: • Two center structural columns offer increased stability and superior strength •Advanced contouring connections • Latching mechanism allows for quick installation Four -foot chamber lengths are easy to handle and install Supports wheel loads of 16,000 Ibs/axle with 12" of cover Quick4 Plus Ail -in -One 12 Endcap Quick4 Plus All -in -One Periscope Benefits: I Benefits: • May be used at the end of chamber 1 row for an inlet/outlet or can be installed mid -trench Mid -trench connection feature allows construction of chamber rows with center feed, as an alternative to inletting at the ends of chamber rows Center -feed connection allows for easy installation of serial distribution systems Pipe connection options include sides, ends or top • Allows for raised invert installations • 180" directional inletting • 12" raised invert is ideal for serial applications Certified by the International Association of Plumbing and Mechanical Officials QAPMO) (� Quick4 Plus Standard \\ 12• n Quick4 Plus All -in -One 12 Endcap FRQW VIEW Quick4 Plus All -in -One Periscope WICK/ PLUS ONE PERISCOPE D'SVA9F.0 Quick4 +_c 11111-21, ~=�� �� ar•Mjlaa r a a� .i PRESRLYd2® PIPE GRILL POINTS LOCATIONS (2 PLACES) 4a. EFFECTIVE LENGTH SIDE VIEW INFILTRATOR WATER TECHNOLOGIES, LLC MNFILTRATOR9 tnrYvata Water Taldndcglmh LLO STANDARD UMM0 DrelNleld WARRANTY (a) The structural rltegrity, of each chamber, mdGW E211ow expat0ed Polystyrene eMla other accacmry manufacturer! by Mltator CUnks'L when IeWaled and operated in a Imdhfield of an oevia seplic system In accmW" weh k4bices k.ouctimra, it wmmd to the original Pw rhma CHdder') against dafa twe malerieb and s'atanmtdllp for me year front Me date tlmt the septic permit is Mw! for the septic system codairvng the Unda pravfded, however, that 4 a septc pcTlt s not re"goi by applicable law, raw warranty period will begin upon am date swt indata- von of the septic system mrmarncea. To wwdw be wmady rigift Holder must nofity toll In acahg at a Corporate HeadWamra in Old Saybmck CmraLalt wedn Mean psi days of the alleged detect. Infiltrator will soppy replamnamt Urns for Inds detemtlned by INitrdur to be coveted by this Lorded Wwwty- edRrdoes hbilsy specduaily axdhdx the cad of rarn nal wW a Installation of fie Units. p) THE U.aTED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTS N7TH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF NERCHANTAB4RY OR FITNESS FOR A PARTICULAR PURPOSE Rd TNs Umad Wanmlty del be vad d any part a the dwntw sydan s ntnufactured by anyme other than Infiltrator. The United Warranty does not ektad to ncWmtal, cmisequential, special w • ndyea damages. Irdmator ebb not be liable Ior panald. a 1qukWW damages, ndudi g lose at predudeon sod profits, labor and mdenola, cr beed ooate, or other Waves or expenses incurred by Cte Holder or my thid pally. Speakmily miucled from Umlted Wamany coverage are damage to 5a aM I1Noo due to ordinary wear and tam, aamagann, accident, mlwee, tooter a neglect of the Unit; the lkds being subjected to whade trdfic a Mlle condifims which ere na pwn*W by the trWei- taboo wndru tune; felon to mddmn ale miN11Wn1 Vou d cc1 9d forth an the rEwAm kedc- 5' . goon: Inc placement W npoper materials Into the aydem owWrang toe Lints; failure of the Urdu or the septic %stun We to inmcyer ddng a rnpnopa vdrg, ercamtw wars, usage, npcpm Breese daposd. a Improper operation; or my other await not crated by Infirda. This united WarMty droll be wid 9 the Hdda tad to comply, with all of the lama sel forth in to Linked Warranty. ruAw, in no event shag Will. or be responsible for awry ices a damage to the Holder, the Ur t4 or any dmi poly minting fmn udaANm or Mpprmd, a here any product Debility claim d Holder warty bard party. For this LmW Warranty to apply, one hats must be it sivfad n accordance with all site conditions rewired by date and oral coder, all other applicable laws: and Inli bd Ws Installation nsNidbm. 4 Suaneas Pak Road (di No mMsenUft" of Inamraby has tN authority to change or wand this Umited Warranty. No warranty applies to any party afrer than as origin Holds. The /hove represents the Standard P.D. Bur Tee ae `Wloradc Or oa475 limbed Warranty clped by Ddbdor. A WNW number of rides mod comes have cif iermf war �22stt�"'°°' � applicable In p� of Units mould �a�caINFILTRATOR' Caa�� .4; www.intthdowdr tom s , /Mad carefully rem and wmrmly, prim to be pumme of Lnbn US. Ramos: 4.752,661; 6p17,011: 5.15&49& SM5,01 T, 5,401,1 tq 5:Y11,4S4, 5,511.830; &716.1R 5,em.Tre: 5AM,BM Cwa*M Palaces 1,329.9159; 2A01.554 Otlw paaa9 pang. hWaeer.EW.Lao%Paad batleal dhuiY"Wets Tl".8vvm,himnebri•rapatredeedanmkeiaMae k Weer Tendvebyrh•raPtlaetl tredaroMn Maio ChaKabaner Mu Wwe,, and Setlpdak rWsdkRtata Weaa TxNraople\ Cabe,aapdatl.p Pyy11A, ,NaaaMt.Rhitai,wk ca UOTr(E.I INC. Poifiok m a trademd aPaytaL Ino.NF-TRE "s a regLilmad hadanedu dNF-Tf1E. INC. Utters -tub IPEXh is a andanrk c IPETI hro. e amaaAlr.ts WesT leebyr, LLL`AadpNrrs.v.d R:xedn US0. PI.USM Barb ST. CROIX COUNTY SEPTIC TANK 19[A.II7ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/ 'tte10K Bern, mu"riy Lai ur-� (QAA Mailing Address Property Address ( Sys \F ) (Verification required from QWSWC Alec) 'R)et!MCtiT�. Parcel Identification Number oza 1Cct3-SD-006 LEGAL DESCRIPTION Property Location _-,C '/. , .+); E Y. ,Sec. 3Z T 3C N R l_Y_W, Town of R I C h A1O.� Subdivision Plat AJA Lot # — Certified Survey Map # Volume — Page # Deed # �I 1 (before 2007)Volume Page # Spec Muse 0yeslzirio Lot Hoes ide rmflabi5wesono r I a I) 1' 77' y'' I;i Y 1 Improper on 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 lireosal pumper. What you pat in4t the system can affect the f faction of the septic tank as a treamient stage in the waste disposal system. Owns mainten®ce responsibilities are specified in MS. 393.52(1) and in Chapter 12 - St Croix County Sanitary Ortbnence. The property owner agrees to submit to St Croix County Planning & Zoning Department a car ificatim form, signed by the owner and by a master plumberr, joumayman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site Wastewater disposal system is in pmperr operating conditiort aad/or (2) after inspection and pumping (if neeemyry the septic tins is lass it=1l3 fall of sludge. Uwe, the undersigned have read the above regtcremmu and agree to maintain the private sewage disposal system with the standards set forth, horeiq as set by the Departmeat of Safety And Pmfe%ional Services and the Department of Natural Rmomces, State of Wisemosia Certification seating that your septic system has ban maintained must be omoptenxt and returned to the St Croix Comity Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all stelemmats onthis term aretrm to the best of mWour lmowtedge. Vwn am/me the owners) of to PmPenY described above, by virtue of a warranty deed retorted in Register of Deeds Offiee. Numberofbedroom OF APPLICANT(S) �i gi�- DATE " Any informsion that is misrepresented may result m the =mtmy permit being revoked by the Plamarag & Zoom Depaaheent. — Include with this application a moorded warranty deed from the Regia cr of Deeds Office tad a copy of We testified scours amp if reference is made in the warranty treed. (HEY tW12) ST. CROI K COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) -FA-rn, CY, � B Wit+ M uReAy L u tt,�csa�l This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) I v72- I I e 4" ST located at: SE 'A, NC Ya, Section 4?- , Town 3f3 N, Range / W, Town of 1�tdAAAV A)P , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(S) to be fimctioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes?' No (if no, skip next line.) Approximate volume or length of time: gallons_ minutes Tank Capacity:_ Construction: Prefab Concrete �_ Steel Other Manufacturer (if known): NK Age of Tank (if known): 1970 Permit number (if known) cf z2-6� 4mt �6s (Licelised Pl tuber Si ) (Print Name) 1;1 nn 2-02L{0 3`7 (Title) (License Number) FM RS .gleD (Dbl a�a Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 22012 F 14 Parcel #: 026.1093-50-000 07mr2007 10:20 AN PAGE 1 OF 1 Alt. Parcel #: 32,30.18,4918 020 - TOWN OF RICHMOND Current X ST. CROIX COUNTY. WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit Is Permit Type 00 0 Tax Address: Owner(s): O=Current Owner. G=Cunern Ca4)wra- BETH.B PATRICK UIUGMNAN MURRAY O - MURRAY. BETH.B PATRICK LAUGHNAN 1272 1TOTH ST NEW RICHMOND W154017 Districts: SC = Smoot SP = Spec al Property Addressles): - = Pn4ar, Type Dist# Description •1272 110TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST i SP 1700 WITC i 1 Legal Description: Acres: 10000 Plat: WA -NOT AVAILABLE SEC 32 T30N R1BW t0A N 330' OF SE NE Block(Condo Bldg: Tract(s): (Sec-Twn-Rrg 401iii 160114) 32-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/2311997 842i22 07/2311997 7761415 10712311997 1 717'630 2007 SUMMARY Bill 0: Fair Market Value: Assessed with: 0 Valuations Last Changed: 0&20l2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.000 53.500 102ADD ISD.900 NO Totals for 2007: General Property 10.000 58.500 102.400 160.900 Woodland 0.000 U U Totals for 2006; General Property 10.000 Woodland 0.000 58.500 102.400 0 160.900 0 Lottery Credit: Claim count 1 ar6natlon Data: Batch a: 125 Specials: User Special Code Category Amount Total Special Assessma ts Special CharOges 0 Delinquent Charges0 St. Croix County Planning and Zoning 11eduesday—frrp• u. 200- in rrt. n:Sn.lu Detail Sanitary Information l 1 of I Computer A: 026-1093-50-000 Sub/Plat: metes 8 bounds Section- 32 Parcel 8: 32.30.18.4918 Lot: TNIRNG: T30N R18W Municipality: Richmond. Town of CSM: 114114: SE V4 NE 1/4 Owner: Colbum, Gerald 1272 1101h Street New Richmond. WI 54017 State Permit: 4225 issued: 06102/1970 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: OV0911970 POWTS Detail: Seepage Pit Bedrooms: 2 WI Fund: POWTS Pretreatment: NA issueglnr�ooclor An. Built Harold Berber No Not determined >cllcrly j(29 Pump Wig ytPP22 61912007 I'�und�a, Wuioc Ro uucmtms Zappa, Anthony No irl NotdirmliQn 214 NOLIcalioll 3rcf N,glitipai�n A i nql Nnlgc, Man• . k'4w d Dittman sold north 300' to Colbum in WD 4581323 50.00 Parcel $: 026-1093.50-000 07011=7 10:20AM PAGE OF AIL Pareel %: 32.30.18A918 026. TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map % Sales Area Application% Permit% Permit Type 0 Owner(s): O - Current owner. C = Current Coon \ O - MURRAY. BETH.B PATRICK LAUGHNAN BETH.B PATRICK LAUGHNAN HURRAY 1272 110TH ST NEW RICHMOND WI 51017 -- fet�cts: �s5'cigW SP Special Property Address(sa): '=Pnmary Mypo_DisF%- xdptlon - 7272110TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC ( Legal Description: Acres: 10,000 Plat: NIA -NOT AVAILABLE SEC 32 T30N R18W l0A N 330' OF SE NE Slock/Conde Bldg: Tract(s); (Sec-Twn-Rng 40 1/4 150 114) 32.30N-15W Notes: Parcel History: Data one % Voupage Type 07r2311997 B42122 07.'2311997 776r415 07123/1997 7171030 2007 SUMMARY Bill 0: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06120;2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10000 58,500 102,400 160.900 NO Totals for 2007: General Property 10.000 58.500 102.400 160.900 Woodland 0.000 0 0 Totals for 2006; General Property 10.000 58,500 ID2.400 160,900 Woodland 0.000 0 0 Lottery Credlt: Claim Count: f Certification Des: Batch %: 125 Specials: User Special Code Category Amount Special Assessments Total 0.00 Special Charges Delinquent Charges 0.00 000 Plb. #67 10/69 -w,4 al�enQ i5; i! Wisconsin Departtoont of Health and Social Servloes • Division of Health PER4T APPLICATION for PRIVATE DO'ESTIC SEWAGE SYSTE"S fiG(�— /'� I A. OWNER OF PADPS:Sf - ' TYPE OR USE BLACE IXd L // L Name . , r,0/ Address (Streets C1ty. Zip Code) r c �i1 .• r, r. i •<< sj f ^lit., rf ifh/:rr./l. D /, r=, County B. LOCATION OF PROPERTY WP'R_ S' EM WILL BE CONSTRUCTED AL" R=- 7R EXTENDED _ Check One: .. _ ---�� 11 J -1 „ate • :.f VILLAGE I LEGAL DESCRIPTION, _CITY � TOWI(SI1IP 5, �T-�' ICP) LC/G/,cil✓ .'Z r__rl-ri.' C. IS LOCAL PER7IT FVUTAED FOR THISS FDRKI YES NO PEWIT NUSER D. SEPTIC TAXI CAPACITY r, Gallons NEW INSTALLATION ti/ ;REPLACEMENT � ADDITION MATERIALS, Prefab Concrete �� Poured in Place SIMal Other VUYdER OF TANKS TO BE I'7STALED. E. TYPE OF OCCUPANCT Check One: One or Two Feaily Residence Commercial - Industrial Other _ -- Specify) 7 Number of Persons to be ACOO.Tmodated - Number of Bedrooms F. APOLIANCES, ETC, Food Waste Grinder YES NO Automsatic Cloth" Washer YES NO Dislaasher YES NO Automatic Potato Peeler _ YES _ NO .` Other (Specify) G. EFFUWZr DISPOSAL SYSTLM HEN EXTENSION ADDITION REPLACE'U" Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed, Length Width Depth ale Size No. Lines / Seepage Pit, Inside diameter_ Liquid Depth 7_ P E R C O L A T I O N T E S T Test Depth i Character of Sall Hcurs Water Test 'rime Drop Ln Water Level Inches �Lnutes Numcer 2nehem' Thldmese in Inahas Sinaa Hole Sn Hole Interval re Fall Second to Next to Last Ratted Overnl ht in Minutes Last Period Last PerIO3 Period one inch E:cmple P- 0 36e Too Soil 43" Cll 25"! 25 yes or no 30 112 1 2 1 2 60 RZOG.M3 DATA FROM MIYI:..IY OF 3 TEST F. LiS Compute size of absorption are in accord with H 52.20 Wis. At�inlstr tive Code. 1 S 0 I L B 0 R I N G S- Mi.imu 36" Below Pr000aed Abso,�tlon System oring Total Depth Depth to -,ro.nd ''rater Derh to Bedrock umber Inzh" maerved I Esti:ated Ooserved 'es:ir^atad Character of Soil with Thieknees En lnchas x upls 0 72" 72" Black Too Scil IV; Clav la"• Send 18"• Gra-;el za" / 2- d ti ,m 2' : .t RECOiD DATA PROM MI':I.^Rl OF 3 N07E HOLES COMPLETE OTHER SIDE Ie the undersigned, hereby certify that the �srcolation tests reported on this form were made by me or under by supervision in accord with the procedures and method specified In Chapter H 62.20 (3)e Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and oelief. NAME 2 ) e -1 !(r, r- tl ' (t I"I h . TITLE A[ Type or Print) REGISTRATION NO. or MASTER PliMER LICENSE No. Ir `' ADDRESS DATE _ �I :y t 1 / / U SLGYFTU,� ,! 1 . . %t_4 !t- MASTER PL:Rfidi MkK(NG APPLI ATION 7 / 'i MP Signatures ..wtL� �• `1 �IC,Q- License Number: J (To b/e//,,CComp/le/y,ed by Issuing Agent) Date of Application O / w / / �� Pee Paid / Permit Issued ((datr) G' -Z/7 /I permit NuaDPr Agent (name) 5 ,-. ' ! ( C jC f: n. �--� I J Pora���`� T/L>2 _I'i Tam, Village. City. County, ate. (Specify) Note. The application cannot be considered for filing until all of the ahave euestioas are answered and the fee paid. Agents will forward application, the fee of j10.DO and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space belsw - FOR DEPARMENT USE ONLY DATE RECEIVED ACCEPTED 3Y _ %nl- RETUMM (Initials) p� (Date) Se'e/Cor�rss�` FEE RECEIVED ✓ VALID. NO. �J ES� PERRIT NO. Y�^' (Yes or ;Jo) REVIEWED dY APPROYEb DATE (Initials) (Yes or No) COKWTS r 323 // IVI70 CS-r-aoo - la 3 Page 1 of 4 .. ma ante wan "aeo,ors. rwm. w u Attach mplefe pp;n 1 itY (g65 tu n 8 112 x 11 inches in size. Plan must inGude, not IfR>w ntal reference point (BM), direction and percents neions, north arrow, and location and distance to nearest road. Please print all information. Personal iNpma4an you provide may he used for secondary purposes (Privacy Low, s. 15.06 (1) (m)). Count)' ST. CRODC Parcel I.D. 026 - 1093 - 50 - 000 Reviewed by Data Properly Owner PATRICK & BETH HURRAY LAUGHNAN Property Location CovL Lot --- SE 1/4 NE 1/4 S 32 T 30 N R 18 E❑(or)❑W Property Owners Mailing Address 1272 110TH STREET Lot# — 1 Blodt# Subd. Name or C_%V — city State State one Number NEW RICHMOND, I WI 1 54017 ( ) ity []Vdlage L!JTown Nearest Road 110TH STREET 0 New Construction L)seEj Residential I Number of bedrooms 3 Code derived design Flow rate 450 GPD aReplacement © Public or commercial - Describe: Parent material sandy loam till Flood Plan elevation if applicable b1A`1L General COR ments Conventional In -ground trenches — 0.6 loading rate — shallow with cover. 11 and recommendations: � 11.l�t�I� dnL Boring # ❑ Boring S ft6tr?/ el�e'��l Pit Ground surfaceelev. 6.20 ft. Depth to limiting 50 n- Fs—ooAPPIKation Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sm Cont Color Texture Structure Gr. Sm Sh. Consistence Boundary Roots GPDRP " Eff#1 'EFl#2 1 0-10 7.5YR2.5/2 1 2fsbk ds as 2vf-m 0.6 0.8 2 10-20 10YR3/3 — I 2fsbk ds as Ivf-m ILL 0.8 3 20-50 7.5YR3/4 -- sl 2fsbk ds cs Ivf-f 1.0 4 50-52 7.5YR4/4 III7.5YR4/6 sl Ifsbk ds — 0.4 0.7 (some gr.) 2] Boring # Boring 96.57 52 Pit Ground surface elev. ft. Depth to limiting factor m. Soh Apolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDAF -0191 'Eff#2 1 0-12 7.5YR2.5/2 — 1 2f-nlsbk ds — -- 0.6 0.8 2 12-22 7.5YR3/3 — I 2fsbk ds — — 0.6 0.8 3 22-52 7.5YR3/4 — sl 2fsbk ds — _ 0.6 0.8 4 52-55 7,5YR4/4 f1f7.5YR4/6 sl Ifsbk mvfr — — 0.4 0.7 (some gr.) Effluent #1 = BOD > 30 < 220 mgrL and TSS >30 < 150 rrt #2 = BOD <30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' CST Number MARY JO HUPPERT (Hollister's Soil Testing&Design) 224832 Addroaa Dab E.W n Conducted Telephom Number 28497 King Arthur's Court, Danbury, WI 54830 07 - 20, 2019 & 06 - 08, 2020 715.426-1775 SBD4330 (R07/13) Property Owner LAUGHNAN, Pa( & Beth Parcel ID # 026 - 1093 - 50 - 000 2 4 Page of_ Bmoring # U Boring 95.15 3 / 60 1 pit Ground surfaceelev. ._I ft. Depth to lirrtidrlg factor m. FgR—Appk2fion Rate Horizon Depth in. Dominant Color Munsell Redox Descdpfon Qu. Sz. Cont color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIIF 'Eff#1 I 'Etfi2 1 0-10 7.5YR2.5/2 — I 2f-ma&sbk ds — — 0.6 0.8 2 10-24 7 5YR3/3 — 1 2fsbk ds — — 0.6 0.8 3 24-6 7.5YR3/4 _ sl 2fsbk ds — 1.0 4 6 2 7.5YR414 Rf7.5YR4/6 sl lfsbk mfr — 0.4 0.7 ■Boring Boring O-Apit Ground surfaceelev.• !"! ❑ ❑ # Boring ❑ Pit Ground surfaceelev. ft. Depth to lintiting factor in. Sal Application Rate Horizon Depth in. Dominant Color Munself Redox Description Qu. Sz. Cont Color Texture Structuns Gr. Sz Sh Consistence Boundary Roots GPDff •Elf#1 I •EM ' Effluent #t = BOD,> 30 < 220 mg& and TSS >30 < 150 unglL 9ee-0130(rtm/n) Effluent 82 = BOD. < 30 r grL and TSS < 30 niWL Plot Plan Page 3 of PROPERTYOWNER: TA-rvor-K sl L-effi tepiDescription: A PCB, W E I4 0-- -laic- fJcXt, See. Zz -raoN,i214W, -toWac�• WIWt ova ST� C42VA CDW-JTY, WISCMS1 0210 - l0`f 3 — SD- OOd �� ! L7L //p�� s—UEC — W. ply - LOd"FP Z Uu 'i `'Opas 1" - 40 FT. (except where noted) i L=bpit (j.={fnr+n �gK1N4 North e 4" 3 rs3wldN/t} W Z J Site location: ' Itolh AVG;UE '> J gEc.•3z T �i u