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HomeMy WebLinkAbout026-1122-15-000 (2)sereNand emm eo„ao mm Wl ema PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) °waryrlw R Law I 15 wpam)I cunM1 $L Cf01% SanddrdParon°N0 624954 Wtd clan to N. James Gll ar w�"wTOWNpOF RICHMOND mTa.Nn 026-1122-15000 Lot ME,a °a0/00 a.nnT M40,1 l;P o{a t ° rt m °N 30 18.751 TANK INFORMATION f ELEVATION DATA TdPE MANUFACTURER CAPACITY STATIONtBSHIFS ELEV WINE Oft L5 17�D Bennmme* too i let Alt MAenllan Bltlg Bever Holamg SvHII,IN TANKTOffli Im do ROAD SYO D® N Aeralm Hmal PUMPISIPHON INFORMATION Manufacturer TDN I° ,, SWo atl FI F... ,� L n D,a I°w.0 SOIL ABSORPTION SYSTEM $ *�$ JS _ a 3. LeZ, Nn�.aw .,nDaNn SYSTEM TO B WEf4 ul ew�erry— RxaINFO 1' OR IMCHAMBER / IMITM q.Ary J -, INu„Ipr1N1CHe WB DISTRISU e nunn m tol Ar M pm SOIL COVER DeOh1 Caoter 3 36, Be" a.re. wn� Iz COMMENTS (imueewtlatlieareceuea.permmpreentem�)p��y1�-mpece°n Impemim 42 Mogan' 1112174TH AVE ^y \j'.1} To M41 fn�s 1)AI1 BM Dek,pW,- 2)Blag simerd le_£X�5'}I —V'a �.vN*i4AfjU -4o ,s,. tX64�� 03 fevol ALI vPSi-. .,.elnersdoorlde, Does No n 112zo 'II ZK aee4— 00 Plan newels ,mrwomwal Mlwnaaa _.. �o.,T1am.,eel o.,, m.�"nrssn.l°m a.n na R N - lU LU- UCa n. _ . satatvase ewessca ommlon .,� SEP 042020 zoi w weanlnpas n.e,po earnez .L, xnl, nllmme c,l rlZ�9S� rnaelao", wl Laval-vtei E 5. 1PAI I/ mitary Permit Application LWLTi 8 ° lm""1onNuin°" -- .,rnld8321mx ee ar^mumla pull �m lo°Lwnmpam"uy peas ^wmWy YeI AJJ,, lJ�rtmm Pm retail m) lAliffirild ffiep alodfor el Say.wprPmyne mnmmnxu it p,O,d, se MUW 4n xA�Lnmo dayeI Spo'ML l"flin a- Pil Jiim All 11filwa on NomR Nuns Ir , rcgnp Pmc i adds Amrzu njpm le.nnnn' µ-�,F on�y, exr 5�a /. p[u4 notpays, -d 'o S / 1 3�n xlusual TYP JIB.IMIq Wx4 tlINa1.pp1Y1 As Yeearvumry m �Ie{L aaadR-Nuu�MPNr,anr� Aa.I w3fumly st ❑wu.,cm,mma-sandy, L„ _ ❑c,rya ❑msoa..J-Lmae,u. ❑Vast f sM uld:__ -C �lonno�r51 ymi IlL Tvpe OfFeal ICnetk say one do se II"eA Cal liar n Ifepplhbkl ❑xe. slam, ❑ lnpasewiodea link xmlwmaa any ❑ Ira umrows, 1, r.ray Span postal Bl ❑Iwmr emw.a ❑pmnx dome. IILwy.,rnunlx. Illtmin nwrw l"V.m. •""°PassN ial l2mo rwerw.� lrvm %C ^a�'�� M4 penny aIPoM'f51 unRom nenllUnn aryl ❑pmw�mllnar.xma llwuue, JIIfImN mohonaek and ❑FNwtl <3e in dkol ofanr ecsNsa ❑ Hmgi11 at Ara laloem da nlDersda u gpi sna AppLnmm Foodat 0e,raAllrbmosyni learn a (so f)aml ek..m VL Ta"k lot, Nnoleu II rl l ins nmelaw �u Pro bra VIIO0.np nnbrLty Sblment- L OeurGnqu4mme mmdlry p ai s77 ell y n �\ 7 I Ic cee' vm u,mmr . .e Mail g(nw ❑a. J Iryn.nrn rn, tar u,�nl a e,nablam0 isua.emu j) �. ro lSL C n SYSTEM auntie S� ( fu6lh ri't(y, / 1, sp'( ^': I Special eXluenlellerantl ) j a/� Fr na $ mepe¢m call must be stblej l msnlamea nL'�"s- `'� S�yS E.a. wa4Y.('lal sliG�Val Lv O.i 4PL/{'T Lwtw� ref . aspurmer es, perLspina planrr, z mm lined aiiisined as Per and panle maalmlimgm Pill (Or A wM (rdhna �e rsel'mey.nI rvyv ninI hl vuu 11 Was, I ise n j) A,..%sr{p ProYi445t�t{w. �l1,1p bd+W °�G'^t./'�o44^4pp�aAk,''�! I n. CROLC COUNTY SEPTIC TANK MpDRENANCE AGREEIA[Et1T AND OWNERSAB CERT[PIGTION FORM DwewBuyw MdWg AdtLegg Pmpwty Addmes (yaaiSPatlmmgovCd Sam PlaminBQ®�^BaPe�°[rormw vmaa9m.1 I� N"' / '' 1/lT Pvicel ldevnfiunov Numbw ��-')'�-r` � Ciry/Smm DESCRBII01 Plopwty Location Y.,SW� Y..S«�T��NR/e W.Towvof Subdivision Plec Certified Svrvry Map N erme ,Volume Pw# wGm mtiy ne`W0 FZ96T3 (b2007)vob®e Peged sPeammaoyaagw b«ua. iawvvatlaoyapm ^v' AND Ofb'NPR CRRTIFICATION SySUM )mpmPm uy vW mupvmace afyow xpnc sYabm=oultl maWt iv iv p[emuwe fvbvew hmWlemnex, Ympv mnio[emoce=owbn OfPumPm6 ow We aeP[[c mokervymme Yeva meoonm. Jnade4 bl'e lire iPamO=[. WGef Yau Whom me ayak0 uo alf IWe NYctioaalWe xpGc mmed IM aemdmtamge m NC xaR m@melaY+leb OeeV memlemnce mpwflbilito ert WaC5CL is 45P5.3Ai33(1) � is Chepler 12- Se Cmu Cowry Saai[my (Nmmve_ sutmbm St Cmu Cowry Pleowog 6 Zoom, f%Pmmmt emtlGmtiao roam siyi d by me owm by PIumM.JmaeYme^Pbwbc. meat ipbmbv== a lr Ou,,R=`arlI d,d(1) eie smite Vet g Ieai vOomuo•W°PCaor+®S uom1mm xYarQ)Wrw+Pwmn and P'wPm66fuxcsay), Noantic eaku less Ibm w fa Ofakdge wa ma wgm�m.y tmme,ba.a«aSufeoY ebdageemm eeOIObe aewagraaoowaynm wlm m. s®immd+ W font hvein ss aabY We I#patmwaof Sefery AVE FofmtavJ iervim eoE[he 0.-lwmC°[ afNwml Remvut sm¢orWissamia Cva�mwaam[mg Wa[Yaw mPbC apron ma bew win®iom muxkemmplCiei mtl rtav dmmeA Cmu Cowry Plmmoek Zem^e f)aWm°°[ `°OLu}0 &ya oflheMc Y'+t Cap�mow G¢. Vol of yoputyd bea eboI by vb[ue oOfawVI de Meee[d m fooN o(�>ada oolcd�e, Uwe emtm meuwu(a)orttr Number bedruomg� pTURE OF APPLtCANT(SJ DATE ...q,p.aRmmoo mu u mmap,,mhd may aemh m me mfbrr wmll bong MI by we PI®mge Zwwg Dceewweal ••• beewe wiW Nu ^fpI,ea ,arte'onI wwm[Y tlmi fiom the Fgaa[n ofIXNO oce W a wPY of We¢mG=d m mapJ memare b m.ee m me w.mmy mm. ST. CROIA COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISIING SEPTIC TAN-K(S) This is to certify that I have inspected the existing septic and/or dose rank presently serving the following residence (Street address) ^`/ located at �jL Sec[ion r , Town , ?0N. Range/SR'. Town of J/P>✓i,. . St Croix County R'iscovsin Upon inspection. I cemfy that I have foanc the tank(s), to the best of my knowledge, will conform to the requirements of Comm 84 25, and it (they) appears) to be functioning properly. Most recent date of mspection or service Did flow back occur from absorption system° Yes_ No (if no, skip next Ime.) Approximate volume or length of torte: gallons minutes Tank Capacity Construction Prefab Concrete k/ Steel_ Other Manufacturer (if known) L(.�F S Age of Tank (if know n) �hw Permit nu ber rf known),97/J 9 ,3 (Licensed Plumber Signature) (Print Name) (Tale) (License Number) 49'MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s 145 06, Wisconsin Statutes) or licensed disposer (NR 113 N13consm Administrative Code) Rev 9/2008 Parcel N: 026-1122-IMOO Valle as Of 0N3V20200600 PM Ak Pu[lp: DdM18751 Omer and Melling A80mss JAMES JOSEPH GIOSSI 1112174TH AVE NEW RICHMOND WI SW V DieRlcb' Maw HWIM 3%2 ECH DIST NEW RICHMOND Appmvlawl Desenmiin. Acre SEC d TWN R18W PT NW SW WEST SIDE WINDING TRAIL ESTATES 1 TOAC LOT 15 TOWN OF RICHMOND ST CROIX COUNTV, WISCONSIN 1112174TH AVE Pamol Hlalory Mge_ ryp 07/3Y2O3fi 829583 I QC 1V15M02 _ 69%la 204aSgq _ _ WD lV21JIM 615833 799 PLAT Nat pMraraaiatla •OT-0T4WEST SIDE WINDING TRAIL ESTATES IA,WN IM 'LOT 15 2020 Valuations Values LaN Changeh on 09/2712011 m ane 31,ollporm_ A,m wd In,Ixvvsnm Gl RESIDENTIAL -T _ _ 17601 21,dCO COL 1935000I _ _TchAl _216,9W CO W 4Pm Gere 21.dN.[Ol 193,SOow 2I690O0O Woodland Wodland 0000� OCW O[O OOg _ O.N r[mwmm _ Generalny _T__1T601 --woWlaoodknd 21AWLO - 193,SOO.W 9 2160000 _ bgoD' ow Dao Dbli M20 Tmes TueS M1ave nM yel Oven "nulal[0 Key PIITery I� am �� OFL"tl 46833 1 6H}H3 WEST SIDE WINDING TRAIL ESTATES PIT X IT 1 �,..... cumEDATA LV e 9'.y .ems y — ITT Is 1p IT IMMMI == CBI a . C. p sea nv"Osminvi6.rry.d Ronlm. w.N« A SAN ERMI Ep+w wunlPOed71M n nm ame,m.mm�mm.m. .ra.a..r �aG.,a► R Iltlkm.M«3m.71a onlYlfdtM pn paWrriotlen I $f Gn.rX than 8isx In Inches in size., 2800 • Seere.erxxe•rw xnw<uonfd<dnge4rg tlra•pp i -r, ^^ „37Z)LS hmulYXamlm Ya ddW mHdW4reatl,rYd,pa•• Zpna"rieKE mm�eowb•Wum 'Ix„q W.t Shcrllmll For y,y epaM�'mr Nam• �+ 1n,5 T J N. Ry E(cri op.nromn.nusu.RAem� � e..�s aloe harbor bmpy / Zip Cad, MwHunb,r oba," nrlameorI r (/E Icne[kone) OStau OY/rxM il•y /J Roie PubL[ tor3 Femil ow•Ili -No of Merooms s GF 111. BUILDIN USE: nlamNiry[ypnpudm mmk,nmu•pgrlry n..xummN y. a0, 14.T5� 111 oJ6 10ApoVoeml[bnde 30Assembly Nall 60 Meer<al Fa[ility/Nurvrp Ndm• tOQ Outdoor R«r•exdul Fpliry 3 04mpgreund 70Me.dmndise. Solis/lIt"m t10R«uuraml4r/Gninp e pqurtb/HMd 80 Motile Nome Park 120 Hrvi<e 5lnon/4rWM 5 (]NmNIMotN 90OM[e/Fattdy 130 Omer. yeury IV. TYPE OF PERMIT: (Oi«k onlyonei on lInea, Owd box on lin•ll. if appr[able) AT I Ney 3 pRepla[ement 3 OR•pla<•mentof a ORewnrccxm of S DRepBrofan Stitt In _____________ Tank nNY_-.___________ EvsUogSLftem_________ EnalirrVSYsum_ e) DASaniury Permnwn pr•yaudylswee Permm NumWr Dau INUM V. TYPE OF SYSTEM: (qe[k only one) Non Pnvuru•J Dij;�yIWlmn Proauru•l DeMbuM1on Expenmendl OtM It{IjSeepe9•B•E Rook- 31 OMound 3005l»oM1/T 01 O Holding Tank 12rOSaep•9e Tran[b Ei OlmGrouMPreasum Qomtm" 1305aapage Pit C r% e30Vwlt Prwy 1405ystem'In-fill I. ABSORPTION SYSTEM INFORMATION: 1 Gallon Per Day l Absw Area 3 nwrp Area a lweirq Pete 6-P•rt-Rate 6 Syslami T final GreCe isc hl 5,mz El«aam boa Rad r op«eE 1w h1 1GNr/mynq [nl Q��f� M W. TANK INFORMATION in gNlo« Tow Gallons Pof Tarts Manuf«t shame a,N,b 0 Ru � serel how plea bw aor Nip` farm E rt Tanks n —4 Nb Farago Tank 6pri [name,, I ❑ Vlll. RESPONSIBILITY STATEMENT I, m• undersigned, astral reNronubilrty for imUlleFon of tM onuu sewage system sli on tM atH[nee plant mum "(at l" %um nINOS pl MVMwrb. Ndt�OY37 n Modxunex any auRu•,ctlry.5raa.Zip[oael Zai sss ae I1L TY/DEPARTMENT USE ONIY ❑Dnepdwee a.,rr., ya3$ao sNanw«bsnmyl �Apprornd 00yner Gi 66.°"`w.y'aa / 1d to inl Determinaodl X. NDIIIL] NS OF APPROVAL/RFASONSFOR DI VAL: �FS­Yps� Ixonsh Densmore M Cmvnxw saleryeiq BUNrrPameMn PRIVATE SEWAGE SYSTEM INS INSPECTION REPORT GENERAL INFORMATION p l (ATTACH PERMIT) Pe rsonal vpuprarb nuv peuMWeevCervwmpeee n.sv uw.e l¢.w Firms] PlIffl Stock, William h rRicBSimon Township ImP M r euriprwn / O ( TANK INFORMATIEN ELEVATION DATA pmrSt Croix onnar TO rnt 02&1122-15-M TYPE MANUFACTURER CAPACITY STATION AS HI F$ ELEV Septic /2 Benchmark qoG.RZikL — _ Alt BM AaatiOn. - Bldg SMNr Holding / Ht Inlet !. y/ f s c TANK SETBACK INFORMATION &Fn Nile( j /, mo TANKTO P/L WELL I SLOG y � ROAD Septic :" SU 3 YML NA Donald,— '— WaM/Man Axati NA Oil Npe dire Bat Sarum PUMP/ SIPHON INFORMATION Final Grade ip /00 G aaurer DerarM St CAM MOEN Numbr TDH Fntt lem LDN it e gtFI Dia SOD ABSORPTION SYSTEM KEO/TRENCH ArImS, I L,Nth N,Oiir LAKEISTREA r unwityps, SETBACK INEt1RMAnoN ,I ITE7T, TY PIL 4iY, BLOC WELL 1 paR UNTO war DISTRIBUTION SYSTEM S Cook DO r r/�� Paonp wnnrr� w 4r' ou J— spa[rne.lr_ 3L 2'j1 SOIL COVER x PreLRure Systems Only as Morris Or Atdrada Systems Only pia O+er peWNnwr nwptrW nLMNI5o1Md uMUNAM nanmcen l xarveryn ideas ian+pri ❑ Yx O Sep ❑ Yn ❑Sep p COMMENTS ndLOdadjam 111121 it it Avendua New IDCNnOI1qI54U W1h* W IIO SW IId 41]/ON RIB WI- Na)U ltl )IT Inwxl Side W1nGnR'Trw Emtn.Lplls 14 ,ir avc rraA 1W,S went eledfipyas 1) MtnM �rd"', (Sit/; d�K Urxer x) BNRsdwerlength=13' l-d611.J [sr_ n-d5 Y -amount ofcovcr= � If p 5)w wd( .� 4....l Naar: Fk ision�required? 0Yp NO uteomRrside mraedniMnallmormRiw E �z,p yd �� Uaoonpin wT) Eo l nrpa"stire CA" FLUI FLAN 174204 il�fis/.- PROJECT�fLA,. 1a tE ADDRESS P� -006 rF. F'RS /S?!�on Bird r 3S DATE TOWN CIXINTY_�__ {APRs ejron Irw Jf. 0518 DATE �•�¢ ye BEDROOM�CLASSPERC_CONVENTIONAL INCaROUN RESSURRE CONVENTIONAL LIFT_ MOUND_ HOLDING TANK SEPTIC TANK SIZE Z Z" LIFT TANK SIZE DOSE TANK SIZE HOLOINO TANK SRE � ABSORPTION AREA /,��D pERC RATE SC BE0 SRE Lg ��fr1 Benchmark V.R.P. gggame Elevation 100' Location of Benchmark o G f4re, • H.R.P. A O Borehole Q Well Sc a _Feat -Ok O Perc Hole System Elevation 97- G x _ a a e' � 3' a' O a• a, 6exn nob. 12. e �G .xa, l ir �4-' lark `Y -�i- _• / �I ev k+ IS =h CST zozo- a l2 -' DD ii i iD I p SOIL EVALUATION REPORT _$nawnrI v CmEb h: Mtw IW , PYxemnplePWPlan on pepsnN lusMry n81Rni1'wl�aMm flanmy,IMWe. M rvYlmM1etlMnNdvpblmiYl PYnlrywl. tl�tlman prmntaM. PeM 10 ewM w Elmer W w, rwM ammµ M balM eM Eimro b iweN mN W %(� 1 PMePE^lell l�rfanmlbr. 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