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HomeMy WebLinkAbout036-1034-95-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538831 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Frank, Robert & Tamara I Stanton, Town of 036 - 1034 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 15.31.17.223 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG JWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of odded xx Mulched 7�� Bed/Trench Center Bed/Trench Edges Topsoil FE] Yes M No Fm] Yes E No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2109 170th Street New Richmond, WI 54017 (SW 1/4 SW 1/4 15 T31 R1 7W) 80 acres Lot Parcel No: 15.31.17.223 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [ Yes 0 No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) me Safety and o oun� O1 W. Washin on Ave., P. ox 7I 2 0 " Madison, WI 53707 -7162 Sanitary Permit Number (to bt: filled in by Co. t 1 : i: C rIt of In accordance with s. C ppliCation sta te TraC ion Number fission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 (m ), Stats. I. Application Information - se Print All Inf ion ,Slj / , 4,5 1 70 44A. — Property er's N me �- ,�,,,,.,p,j'q, / Parcel # Property wner's Mailing Address Property Location (a 0 City, State Zip Code Phone Number /C/ y, y, Section I1. Type of Building (check all that apply) Lot ii I or 2 Family Dwelling - Number of edrooms Subdivision Name Block # ❑ Public /Commercial - Describe Use -- ❑ City of Number ❑ e ❑State Owned - Describe Use CSM Village — -- . - -_ - -_ __ LJ ! f / I f", /01 Town of— -�� y� =- - - - - -- III. Type of Permit: (Check only bne box on line A. Complete line B if applicable) — A. - ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 2�/ �3� _ IV T e of POWTS 5 stem /Corn o nent /D evice: Ch all that app (1 �__ on- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ` El Holding Tank El Other Dispersal Component (explain)_. --- 11 Pretreatment Device (explain) � ls1 'r *a r te_ V. Dia ersal /Tr tmeat Area Information: Design ^ Flow (gpd Design it Appf ttxOt ionRate(gpd Dispersal Areaequ / �sf)� Dispersal Area Proposed (sf) yttem Eievar' n j VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units g o U New Tanks Existin Tanks w ° y U r�n� v ci w c7 w Septic or Holding Tank - — Dosing Chamber - .3L? VII. Responsibility Statement I , the undersigned, ass u spon sibility for inst allation of the POWTS shown an the attached plans. Plumbe 's Name (Print) Plumber' i aturc MP /MPRS Number Business Phone Number Plumber's Address (Street, City , State, Z Code) , ��, X6/ VIII. County/ De artment Use Onl Approved ved Permit Fec Date I sued Issuing t Signature 5. lven Rea or Denial IX. Condit ons for Disapproval f �ta G,b - 6 1 Septk tank, effluent filterantt dispersal cell must all be services / maintained 111 I� U 1 as per management plan provided by plumber, led �2�-- ` 2 lV a lck-re4t*6 i ents must be maintained / as Pk Attach to complete plans for the system and submit to the County only on paper not less than a 112 x t I inches in size SBD -6398 (R. 01/07) Valid thtu 01/09 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 8/25/11 Owner: Robert Frank Location: SW1 /4 SW1 /4 S15 T31 N,R17W 2109 170th St. Stanton System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance and Contingency Plan 6. Filter Specifications Sheet 7. Pump Chamber Cross Section 8. Pump Curve 9. St.Croix County Existing Septic Tank form 10. -12. So/Te Signature License n PLOT PLAN PROJECT Robert Frank ADDRESS 2109 170th St. New Richmond Wi 54017 SW 1/4 SW 1 /4S 15 /T 31 N/R 17 W TOWN Stanton COUNTY ST. CROIX 9 MPRS Shaun Bird 226900 8/23/11 BEDROOM 3 DATE CONVENTIONAL IN- GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 170 # of chambers 57 IL BENCHMARK V.R.P. Bottom of garage siding ASSUME ELEVATION 100' Filter Biter ❑ BOREHOLE O WELL * H. R. P Same as Benchmark - SYSTEM ELEVATION 9 4 .5' be l o w qrade 170th St. 800' Plans Designed Using , Conventional Powts Manual Version 2.0 Well 15' Existing 3 �*1 bedroom 0 ' 15' house 40' e 0% Sl 5' 3 - X 78' cells P T with >3' spacing B -1 Vents 10' 5 ' Old System is to be pumped and buried' Scale is 1" = 40' D �' 110' unless otherwise * 10' B -3 B.M DT 80' noted 10' Garage , 35 , 40' 0' Vent 100' B _ 2 25' Vent >6 „ ! Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 5.8ft ^2 /pair of end caps 4' Long 12' Grade at System Elevation 34" 1320' property Line Cross Section of Quick 4 Standard -W Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard -W Leaching Chamber with 20.0 ft2 of Area per Chamber 10.1ft ^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 97.3 jV , en, / Vent /� Grade 4" 4' X30/34 Septic Tank 5' 4' Long 1 3 4 Grade at System Elevation 34" Grade at System Elevation Spacing 5' 3 - 3' X 78' Cells Observation tubeNent Same on other end To be located on end of Cells % A B System elevations: C A -92.9 B___92.8 19 chambers per cell C___92.7 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan Option #1. If system fails, determine cause of failure, use alternate area and install new sy m in sted replacement area. ption #2; Install system at a lower elevation, by removing chambers, removing biomat, 5all new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Zip Fr 4' Mailing Address o� 1 1 -7 01X 5 Property Address (Verification required from Planning & Zoning Department for new construction.) City /State _ Parcel Identification Number LEGAL DESCRIPTION // s Property Location f� 1 /a " % , Sec. /5 , T _&N R /ZW, Town of Subdivision �� , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (� _� ,Volume /c , Page # Spec house yes n Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance co pumping septic eve consists of out the s tic tank three ears or sooner, if needed, by a licensed pumper. What you put into every Y the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. I/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property; described above, by virtue of a warranty deed recorded in Register of Deeds Office. N her of edrooms SIG PLICANT(S) DATE * *'Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08 /05) I 4 L l { 5 rt I I i ' 4 I ................. - i 'I i NOTE: INLET AND OUTLET ARE FEMALE 11 SOCKET WEED JOINTS FOR 3 PV PIPE, + k A <9 , ,� I ilk;., 1 , �, ftiJF.l UN M Y �9i lf' f I l l U k - 4': " ...,, _ ..I I "IuU 'J 9U f m l _. v....._... _.. SJM /ILN I Hit'? ASS;" l 11 ball PAI'LNI .`.It +`r'I`�,' LAfcY k111L'�;I;[.Y CJWN1 S111(lU ': 50 /E0 39Gd 03 dWnd Q3683d38d 898LPL89TZ Lb :0T TT0Z /9R /I GI Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance Required Tank Model Number .2 GPM @ Ft TDH Total Tank Capacity V p Max. Bury Depth Total Dynamic Head (TDH) -Feet Pump Manufacturer l Elevation Head Pump Model Number S" 9. Di Pr re Alarm Manufacturer U 5"k-4< NeWwfe*�e�e Loss Alarm Model Number oz- c/ 4 Force Main Pressure Loss , S Switch Type �1� r C Total Manhole Min. 4" Above Grade With Locking Device Vent Min. 12" Weather -proof Above Ca Junction Box � 1 -- .� - Finished Grade _ — — r — -- •� _ I I Depth of Cover Ft Disconnect ��/1 c Means r r> a s s} r }> r } > s s s} r r s s Y } { }[, < ' Outlet }[ [ Switch Settings and Reserve Capacity _ _ _ _ _ -------- Inlet }i Tank Volume = l,� GPI ' { i > ' S { } Dimension Inches Volume Gal. A ' >c Y{ 1/471 [ ;{ (reserve) A .�` { ' < Weep ;: (alarm) B 2 ® B �; Hole (dose) C 4 ev Off Elev. C ;< (dead) D / Ft ? < i Total ;< D < ' Bottom of Tank Elev. �� Ft ; < Y; S t 1 rr a > > a > > > > sa > } } } a > > r > } a a a r > } > > > > > a } > > } r a } } > > > > G ENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05 lgj Page of 101 DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE w MODELS 53/55/57/59 EFFLUENT AND DEWATERAG 25 Model I 53/55/57/59 6 20 Ft. Meters Gal Ltrs. 5 1.5 43 '.63 15 10 3.1 34 - 1 ' 29 -- 4 �. 15 4,6 1- -19 72 10 Shut -off Head 19.25 ft. (5.9rr) 2 5 -y 3 5/16 — 6 5/321 4 �/8 - 1 112 -1`; /2 NFT U.S. GALLONS 10 20 30 40 50 Ir z� I 3 15/15 LITERS go 160 _ 1 , i 0 ell FLOW PER MINUTE o09e97 ?� l 4 ; /l6 J L I ,r. Variable level float switches available. Variable level long cycle systems available. Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. 10 Duplex systems available. 3 3/32 SK86e Liatln al control required. s .f'iFtifv Single Sea[ Control selection 9 . Model Volts Phase triode ' Amps simplex Dud ex CSA UL 1. Integral float operated mechanical switch, no extern M53155 & M57/59 115 1 Auto 1 9.7 1 -' Y Y 2. Single piggyback - variabie level float switch or double piggyback variable level N53155 & N57159 115° 1 Non 9.7 2 3 or 4 & 5 Y Y float Switch, Refer to FM0477. BN53 115 1 Auto 9.7 "' 3. Mechanical alternator "M Pad 10 or 10 ' BN5'— 7 115 _ __ 4. See FM0712 for correct model of Electrical Alternator. Auto 4.8 Y BE53/57 23D 1 y 5. Variablb level control switch 10 -0225 used as a control activator, with Electrical D53/55 & D57159 230 1 Auto 4.8 1 E53/55 & E57/59 230 1 Non - -4.8 2 3 or 4 & 5 Y YJ Alternator (3) or (4) float system. Single piggyback svdtch included. o cnunoe r " °1 .7 For information on additional Zoeller products referlo catalog on Piggyback Variable Level Float Switches, FM0477; j le , t a >ara , S sr loci r a „a i•;we ,s r t z ,rc t Electrical Allemator, FM0488; Mechanical Alternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase ii scd ,a . . :e. Sirnplex Pump Controitftrn systems, FM0732. RESERVE PO DES"G y For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - - -- -- - - -- MAIL TO P.O. Boa` 17 Louisville, KY 40250 -,=- Manufacturers of . . SHIP T0: 3649 Cane Run Road 0 ® Louisville, KY 40211-1961 Qv�uirr )U11 ai P6' Sh''E /999 ® (502) 778.2731.1(800) 928 -PUMP PUMP CO. FAX (502) 774 3624 hKpJ/www.zoeller.com -- - -- -- ©Copyright 2002 Zoeller Co. All rights reserved. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK 'I'his is to certify that I have inspected the septic tank presently serving the �O,D residence located at: Section T 31N, R W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. I..,ast time serviced: . Did flow back occur f am absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /G� construction: Prefab Concrete Steel Other - - - - - -- Manufacturer: (If known) Age of (If known),;�iw�C���� na ure) (Name) Please print (Title) -�-� > (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisccnsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — -- -- Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding isting septic tank condition, I certify that the tank to the be of my knowledge will conform to the requiremen s of ILHR 83, Adm. Code (except. for inspecti n opening over tlet baffle). G �� Name c , a,4i � / Signature MP /MPRS � � 'rY . � � 1: _�r`y�a n++�4ss ^� �[w*aexa. - sue ..,�...._.•�q /_-.AJ._. —e - -` - - VOL h � ►� STATE BAR OF WISCONSIN FORM 1 - 1982 WARRANTY DEED DOCUMENT NO. James A. S tenhenc and Helen L S tephe ns , LMAR TY.. YVl ` as marital proper 1997 conveys and warrants to Rohcarr -T - 'qraaik anti Tamara K _ Frsan4_ A. M husband and wife, Ra marital propert DeaCy -. THIS S PAC E R FnR RECORDING DATA MWE AND RETURN :ADDRESS the following described real estate in St. Croix __ County State of Wisconsin: BANK OF NEW 'RICHMOND 355 South Knowles Avenue New Richmond, WI 54017 The S 1/2 of the SW 1/4 of Section 15- 31 -17. PARCEL IDENTIFICATION NUMBER — �! ' II I ( � FM it l( This Is homestead property- li (is) Exception to warranties: { If I II Dated this. 26th day of December A.D., 19 96 - (SEAL) - - a (SEAL) l Ja mes A. Stephens I (SEAL) •�e — �_� (SEAL) . Helen L. Stephens �! AUTHENTICATION ACKNOWLEDGMENT Slate of Wisconsin, I� j Siguuture(s) ____— ss l ---- B arr on C jl —_ ounty I authenticated this day of , 19 Personally came before me this 2 h t d o f I � December _ 19 96 , the above named j -- James -A. Stephens and Helen L. Stephe TITLE: MEMBER STATE BAR OF WISCONSIN authorized by §706.06, Wis• Stats -} to me owtt to��ae �Lagl�er ns '`.. who executed the foregoin i lost nt a dTe_t4ge t� y II Tuig IN' TRIIMFNT WAS DRAFTED BY O f t !� Liden & Dobberfuhl S.0 - ba'tJrt M. Nelson fi Notary Pub c " County, Wis. (Signatures tray be authc:,ticated or acknowledged. Bah arc not al}• COMM i on i; Perm anen� not, s expiration date: �I n' cessary) 1I rr 8 19_ 8.) i Names of jxr ns signing in any capacity should by typed or printed brlou rh tir signatures. - ji srATE BAR OF WISCONSIN W.con. Lepal 8t. * C.. t+,c WARRANTY DEED Form No. 2 - 1981 MtweUcee. W'S Property Owner _ Parcel ID # Page of a Boring # ° Boring )"'� it Ground surface elev. � � ft. Depth to limiting facto r,�� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 � f F -1 Boring # El E] ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. El pit Soil lication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPDtlf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mgll- ' Effluent #2 = BOD < 30 mgA- and TSS < 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. S8"330 (RAW) Soil Test Plot Pla Prdject Name Robert Frank Sh ird Address 2109 170th St. New Richmond Wi 54017 S M #226900 Lot ------ Subdivision -- --- ---- Dat /23/11 S W 1/4 S W 1/4S 15 T 31 N /R W Township Stanton Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of garage siding System Elevation 92.9/92.8/92.7 *HRpSame as Benchmark 170th St. 800' Well 15' Existing 3, bedroom 90 15' house 40' 5 0% Slope ;35' ' B -1 5' Scale is 1" = 40' B.M unless otherwise 0' B -3 noted 80' C I O , Garage o' Vent 100' B -2 25' 1320' property Line 0 ? \ o c /< 0± 0 0 A§\ m§ S ( / 0) 2 § s - P + 0. » ƒ \ 7 2 / \ \ § \ \ \ o 0 2\ m 0 &§\ S$ ■ Q ° ® � E E 2 \ 0 \ / / 0 y � ° m \ � F 4) k\§ 0 a ° °CD k . M M \ 9 g \ k \ 3 / 3 @ ■ 2 0 / co 3 CD M M m a to a § CL 2 # 2 \ z / z e z \ C) ° �\\ \ . \ / CD co CD -� / k 0 \ / / 3 ® § = \ \ § % 8 _ � \ \) 0 CL l \ 2 7 . 0 r § « ; 3 2 \ » » `/ C\ CD ) { R 5 § a & - g.w �/f \ / \ ® IF \ CD � G . � \ ° \ 2 ! � / 0 \ < ] \ . 0 \ � 0 i \ � k Parcel #: 036- 1034 -95 -000 06/27/2007 02:02 PM PAGE 1 OF 1 Alt. Parcel #: 15.31.17.223 036 - TOWN OF STANTON Current 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 -Owner ROBERT J & TAMARA K FRANK O - FRANK, ROBERT J & TAMARA K 2109 170TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description 2109 170TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 15 T31 N R1 7W 40A SW SW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15 -31 N-1 7W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1226/185 WD 07/23/1997 908/425 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/16/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 18,000 183,400 201,400 NO AGRICULTURAL G4 37.000 6,000 0 6,000 NO UNDEVELOPED G5 1.000 700 0 700 NO Totals for 2007: General Property 40.000 24,700 183,400 208,100 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 22,800 183,400 206,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 146 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Health and Social Services Plb. �67 10/69 Division of Health PERMIT APPLICATION for PRIVATE DOMESTIC SEWAGE SYSTEMS 03 6 2P Z1 223 A. CWNER OF PROPERTY TYPE OR USE BLACK INK Q 9 7 V Name Addresss� (Street, City, Zip C County B: LOCATION OF PROPERTY WH YRE SYSTEM WILL BE CONS TRUCTED, ALTERED OR EXTENDED Cheek One: CITY VILLAGE LEGAL DESCRIPTIONS _ TOWNSHIP C., IS LOCAL PEF14IT REQUIRED FOR THIS WORK? YES NO ; PERMIT NUMBER D. SEPTIC,` TANK CAPACITY 'C O Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALSt Prefab Concrete V Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: U' /Y E• TYPE OF OCCUPANC`� J Check One: A or Two Family Residence / Commercial Industrial Other Specify Number of Persons to be Accommodated .1� Number of Bedrooms . L�} F. APPLIANCES, ETC& Food Waste Grinder YES NO Automatic Clothes Washer .' YES NO Dishwasher =YES NO Automatic Potato Peeler YES_ NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION J REPLACEMENT Tile Size No.Lin.Feet 6'� Trench Width Depth — -5e' Number of Lines Seepage Bed: Length - Sr/ Width Depth _..�,�. Tile Size No. Lines Seepage Pits Inside diameter - Gr'* Liquid Depth 4 L P E R C O L A T I O N T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water L evel Inches "mutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last to Fall 1st Wetted Overni ht in Minutes Last Periodl Last Period Period One Inoh Example P— 0 36" Top Soil 0" Cla 26" 25 yes or no 30 1/2 1/2 1/2 60 it Ie R ECORD DAT FROM MINIMUM OF 3 TEST HOLES umpute size of absorption area in accord with H 62.20 Wis. Adninisttw.tive Code. S O I L B O R I N G S- Minimum 36" Below Prop osad Absorption System _ oring Total Depth Depth to Ground Water Depth to Bedrock umber In ohe9 Observed Estimated Observed Estimated Character of Soil with Thickness in Inches xample 0 72" 72" Blaok Top Soil 12 18"• Sand 18 "• Gravel, 24" RECORD DATA FROM MINIMUM OF 3 BORE HOLES COMPLETE OTHER SIDE I, the undersigned, hereby certify that the percolation tests reported on this forth were made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and be4ef. NAME �7Zc'Z' z-�`ti � TITLE Type or Print) REGISTRATION NO. !'�� at: or - MASTER PLUMBER LICENSE No. ADDRESS =� ��� l� !` .f�v u�L -« DATE rry, 7 �� �� SIGNaTUrtE MASTER PLUMBER MAKING APPLICATION MP Signature: 4%.'Sr.G .� License Number: MP RSW (To be Completed by Issuing Agent) Date of Application �' / ' Fee Paid $ Permit Issued (date) Permit Number Agent (name) "! For: Town, Village, City, County, etc. (Speoify) Notes The application cannot be considered for filing until all of the above questions are answered 'and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow oopy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY DATE RECEIVED `J ' a / 7 0 ACCEPTED BY ` RETURNED (Initials) / (Date) see Corres. FEE RECEIVED VALID. NO. �° PERMIT NO. ^ (Yes or No) REVIEWED BY APPROVED DATE (Initials) (Yes or No) COI MINTS: � v v i v I .J I N. . d: POLK COUNTY 65 x� y /✓e /f7use,7 3 O/e 'M's e , . • L 9 h vh 1;0 /as e Au re A7e /v Ile 73 F GQ O% 6 �er W Poy Jacobson elM o.x ence F zz6 � v c � c v� oun tees 9 /6er> s 00 r ` p L.wra 1. V a iss.99 y� New u y W� 44 �ose¢nn Ql y Oa hmond 0 C y C %rs G /en 0 V zan7 l V Nu sin N me9 {nders0n /6B 4 i s ®Pobe> Po6ert W Q C Leyte �I • / ¢Leona_ /So the w i/e /erJ ,Qus,� do ,� D_� Q '7 40 • /60 '�• v Uohn 4Mac {Sin e d ms- U 9 -:: Boche 4o Na fen y d0 Pcha d D bay 0 Lo %z C 0 �� 44 er � � y • ,s 3 l fau,E.s \ y�, .. • H /60 Ife 6 ck yMa d� �l✓a ne Leo M of /Pa /o/s V H q� .�0e e 6o F /oyd Bo 1 /e 40 q9 f/o es ti, o 0 7a9a ife T C ¢ °Y 117 B° C o O /sor u J hn on .EYm�r if /inQn oo �� ✓won 6 Hari u,Bo /s �V� v /zo M° y `C l 4 Ma vis Croes Ge C3effke } P �� \ 7�u uis /Go /6s Bo � a 197 .. / U�v � � • ^ 3x37,+ Bo < - � /s7 e OAKR�OG L. �Y ti dC do Cro.x n W y L =o and - -- �Courrf /6 o z ¢o Jacobson7 Reed 9 s ,, r /c/ 7s 1/o /kert 40 : f C /sg Kve9er •� ZS4 D eE /ina C isd/iame ' ` ka / /en 60 Fa m Inc /yj / /earn La Vey 76 Me /✓, a Ca / Cor/rads .her � c v //mscfi /e.- /l¢rnac verr/ o� u eTa f P IJua/ne s 1/o %Eert •Bet/jke �S'a6ean Q E' Fyn �3ao /ZO r/a / I /6o Jacabsor7 r � ,p N /6B Morris /6D /60 O � l� J , {er/nan ' OPP Lazsn o obso „ Edward h Loo 16 7y i7 �� �Q8 Lczrson /60 � Krusch,Fe /60 0 ' E� enc, Leos 4 v /oo Gt/i /6erf l VUO u M 9 0 Ma �. A5 , C a�� �� tfopk %ns 7¢ Fxan,E /ice 'f/a/nm es ry. zo y� k W _ Bo mid>< tl lC o /zo a R Ja > es E /6s /Sy fro ward / a h b �, q ® V l'1 � � •& N �e�he/7s /6O do JzGOS�or� y� h Cha /as L. S. L✓ / /an lX Kun e p0 Be Bo o Q NN 40 • W H c v"1 Mer /i 40 D/:z Ee v Maras C E c h 0 /rs. 6 //e r7 era / Gc/ y Pa/�f7 M 0 J 0 C N Pober7 J TO E Pau/ y h r dUe / %s Frank was /ems C' 71 f� /3ar eff C w U Q1 / Weimar 6o s _ Ov� � /6o v�2 C � /scs- 16oefur i B et/0 d d Be /nd Q a v Edwa d s .z sa Cie y/e cTae /P.chacd /Pay ,�e� D H W sc Frdda .//7 Garys(ath j� j vic.zl n hre N. `7 /easor/ De /bed s zo97 y Ste hens a Fr znk /7auser F /oyd (A na samPerf zoo nda �a"'a -r'¢- 760 �fii 11 Lumph/r J E / • / Ba .f` /60 /n E /mer • t F/f •�i�C ' Ew. Leweien J �� hh o ken • Lawrence 7B 8z 'j 76 Lema/ 0 Friday °. F /2o tl v P ..ser 40 /Pa C7r✓a./ /yke 1111 117 0 y F C B • o eta/ /6o c y 65 ar xzo % N / ,6c n. cf7nn y a M", 17 • � Rde � 1p ` 7 21 1111 l \, f/atcfi Ivar 4a 5 Ee \l V I deat� c c C �� �x Lgvon £ 9, Jfin f7 .2s6 ooyy ick v° c 2 v Gie 0x7 o u Barb C f C J�� K,'dde n Errc F s orb v a� F 3 7 'Al �" G � 4 N� 41 8o Bo QA J 9� l ' m Vl 3/6.47 � : zo Meal vcTea • �• 64 '' •3 o�r Gi/o /s v Joe .gmos j . F4r�co /s Pco'ccso .Tam ¢ I o C i /moo /zo Were/ Bros. Wayne 5 79s y�x/ise Cody T k'ar/ H /an 5 Leo i We //s Bo `""P ands Possea / N RICH OND 1',akeS ward /sP.3 Ar ss 9 /60 � aensen ,S6 tR z4o U /ri�7 /rg �� /s7 9 iiii />oP ® C zoo Franc /s ' .cs CaL S Ph r!:I o: ak f/a rev sE /a/eii L h 0 m�/6o e y /�ar /in � Powc � t i av C/iri fi anso \� cke /zo en /, k r/ Cleo M -`F/do ns GOOSE Tra /se/ •. .. ook. B: /60 Bo Bo POND /yard,- /7a y L}. f K rr4 /s 20 T� ;ser 160 C✓a¢eii E i°a�s .W /L O� R E 12 ® /97z Poc�L ord Map /sl c. SEE PAGE sf Croir o n y Wis. POLFUS IMPLEMENT 9jv'a New Richmond INC Granite Works CANNING CORPORATION PHONE: 246 -20II PHONE: 246 -6565 MARKERS - MONUMENTS NEW RICHMOND, WISCONSIN BRONZE rAeIErs NEW RICHMOND, NEW RICHMOND, 54017 WISCONSIN 54017 WISCONSIN