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AS BUILT SANITARY SYSTEM REPORT
OWNER (_,(/ �,�,0j7a TOWNSHIP ,rre, SEC. T2 ON, R _W
P.O. ADDRESS , ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION , LOT LOT SIZE
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
�o d
SEPTIC TANK(S)�_ MFGR. P c,y ers CQ�.,,, ,.,�T CONCRETE STEEL
NO. of rings on cover - Depth /' DRY WELL
TRENCHES NO. of width length area
BED no. of lines L width 12," length Jd ' area
depth to top of pipe
AGGREGATE 1 Yz — 2
PERK RATE AREA REQUIRED 2-0 AREA AS BUILT 9'/ O
Disclaimer: The inspection of this system by St. Croix County does not imply complete
compliance with State Administrative Codes. There are other areas that it is not possible
to inspect at this point of construction. St. Croix County assumes no liability for
system operation. However, if failure is noted the County will make every effort to
determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
~'INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER /S�
- t
REPORT OF IMSPEMON--VMVIDUAL SMAGE DISPOSAL SYSTEM
Sanitary Permit
tate Septic / t
.LL
T,A 4 /�~G�''J
TO[•IIJSHIP
t. Croix County
SEPTIC TAM(
Size 1 gallons. "lumber of Compartments
Distance From: We.11 ft. 12% or greater slope ft.
Building ` �J 0 ft. Wetlands f
Highwater ft.
DISPOSAL SYSTMI X Tile Field or Seepage Pit(s)
Distance From: Tiell 71 ft. 12% or greater slope - " f t
Building ft, Wetlands
FIELD
r,T•
iphwater ft, .
Total length of lines ,2,1) ft. number of lines ?i Length of
y each line �, ft. Distance between lines t1,,0 ft. Width of the
trench ft. Total absorption area
—sq. ft. Depth
—
�y of rock below tile �in. Depth of rock over tile in. Cover
aver .rock Depth of tide below grade
O in. dope of .
trench
dnei'100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS
Number of nits Outsid diameter ft. Depth below inlet
ft. Gravel -r nd _yes no. Total absorption area
rsq. ft.
. Square feet of se age trench bottom area required
Cquare feet of s epage nit ea equired
Inspected by Title:
Approved / fiJ Date J01 rr 197
Rejected . Date
197
i
State and County State Permit # �
Permit Application County Permit #
for Private Domestic Sewage Systems County S{' C enjX
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing--•,Address:
B. CATION: '/4 S Y<, Section 2- , T,o N, R IN E (or) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Pc>6 Township
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIAN ES: Dishwasher YES NO Food Waste Grinder_YES_kNO # of Bathrooms--Z-
Automatic Washer
YES NO Other (specify)
E. SEPTIC TANK CAPACITY /,A50 Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement_ Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) •a 2) 3) Total Absorb Area 901A7 sq. ft.
New X Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width ! '_-" Depth : Tile Depth �Q'IV No. of Lines Z
ii
Seepage Pit: Inside diameter Liquid Depth Tile Size N
Percent slope of land 5-°l7 S Distance from critical slope
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,
NAME C L U !h o w er ,- C.S.T. # S 3 / and other information
obtained from 0 e,- n (owner/builder).
Plumber's Signature MP/MPRSW# ��+ �� -Phone #2�11G- �fo3y
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
I
I
Lo c1 HT
Do Not Write in Space Below - FOR DEPARTMENT USE3(64LY f;v
Date of Application Fees Paid: State_County —' Date
Permit Issued/RZec d ( ate Issuing Agent Name
Inspection Yes o Vali d# Date Rec'd
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 6/11/76
� A
EH 115
y WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH
P.O.BOX 309
MADISON WISCONSIN 53701
C REPORT ON SOIL BORINGS AND PERCOLATION TEST
LOCATION: 'a J '/a,Section �2 T&I, R[j E (or) Township or Municipality L a yb o n�
Lot No. , Block No. Su vision ame :5T.County C r— O I X
b i N
Owner's Name: ,�
Mailing Address: e Y'
TYPE OF OCCUPANCY: Residence — No.of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS J l — ,/4j 7 7 PERCOLATION TESTS / / — 1G2 — 7 :2
SOIL MAP SHEET 3 — SOIL TYPE '? L 5 `2i''°°'°fy 4 42 00tg"
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE
CHARACTER OF SOIL
NUM— INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P_ U01 2r
ro
A121 _7�
/ SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
p G - 4• v4 c 15 2 lr'� —0-
�� ►�. _ 7 F -a
y
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the locationand square eAof s i1?le areas. Indicate number of square feet of absorption area
needed for building type and occupancy. *� Indicate scale
or distances. Give horizontal and vertical referen points. In icate slope. 5 14 LC_
Ole a
tN
ry
I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin ministrative Code,and that the data recorded and location of test holes are correct
to the best of my knowledg and beli .
Name (print)' '���' �` Certification No. �--'-
Address
Name of installer if known
CST Signature i
COPY A—LOCAL AUTHORITY -
Parcel #: 026-1005-60-000 03/31/2006 12:45 PM
PAGE 1OF1
Alt.Parcel M 2.30.18.21 B 026-TOWN OF RICHMOND
Current 1K 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
ERNEST E&PAULA SHORES O-SHORES, ERNEST E& PAULA
1736 140TH ST
NEW RICHMOND WI 54017
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description * 1736 140TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
I
Legal Description: Acres: 1.970 Plat: N/A-NOT AVAILABLE
SEC 2 T30N R1 8W PT OF NE 1/4 SE 1/4 LOT Block/Condo Bldg:
1 OF CSM 5/1202 1.975A
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-30N-18W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1137/587 QC
07/23/1997 1006143 WD
07/23/1997 781/138
07/23/1997 716/156
2005 SUMMARY Bill M Fair Market Value: Assessed with:
95325 208,100
Valuations: Last Changed: 06/19/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.970 40,100 138,400 178,500 NO
Totals for 2005:
General Property 1.970 40,100 138,400 178,500
Woodland 0.000 0 0
Totals for 2004:
General Property 1.970 40,100 138,400 178,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 220
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
7
.379475
1 C E R T I F I ED SURVEY MAP
4 Is ocix LOCATED IN THE NEI/4 OF THE SEI/4 OF SECTION 2 , T30N,
FILED RIB W. TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN
SEP 11982 EI/4 CORNER
i_
A"n a L !p I SECTION 2, T30N,R18W
bower Of D"ds
y�•WR I 1
8 4 °� UNPLATTED LANDS
RAILROAD TIE FENCE ( S89021'30"E 354.70' R.) I I
POST AT CORNER,UNABLE S 89021'55"E 354.64' 1 33. 66 33, I
TO SET I"IRON PIPE POINT OF BEGINNING
s 106.70' 214.94' 133.00' !
ai (215.00'R.) to
___ _ _
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0 1.9756 ACRES(86058 SO.FT.)
` INCLUDING RIGHT•OF-WAY ,� 3
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-1 N 89056'4511"E 354.58' m I I n
C) I 321.58' N 133.00' W I = -n�— O
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10'W1DE ELECTRICAL EASEMENT I I fN11
N 5' FOR LOT I 01 I R1 O
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V 1 2.7309 ACRES(118969 gpFT.) m y V I O M e I EXCLUDING R/W y N l N t� I D
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66' I
33' 33'
NORTHERLY RIGHT-OF-WAY LINE — d (21 5.00'R.)
106.70' I 214.85' 33.00'
p N 8901232"W 354.55'
e
o ( N.89011'30"W 354.70' R.)
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W - COUNTY_ _ _ TRUNK _ _HIGHWAY W 11G G(1 - - -
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4
SCALE IN FEET I"=100, I iD I
0 100 200 300' 40d
LEGEND APPROVED �
SECTION CORNER MONUMENT (�
• 1 3/4" IRON PIPE FOUND SEP 01 1982
0 1"X 24" IRON PIPE WEIGHING O
1.68 LBS./LIN. FT. SET ST. CROW COUNTY ,
>COMPREMENSIYC PARKS PLANNINQ
R.) PREVIOUSLY RECORDED AS �flMTt "C�3klittML
Volume 5 ?age 1202 ..r
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