Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
026-1044-20-000
I C7 fA Q C) fA 0 3 'G C) d c3 4,.. p w C Lt) p Q. o 13 m "�' �^ v 3 0 3 = - U AD co 3 E. Z+ O v o n `C Ps o w m o ( rn h d m o ti (.(..n o cm F PD CD CT a is a o. - m o o CD o a Q, ° N ,.* 1 c co Z w W o. N Q co W co W N K g O N o C W O 1 O 13 Cp CD CD 0 0 N C-D O 7 ■ 5 o y O O C 3 . a • S CT co C co N '. co C 0 O O C 0 y CD O 7 m u> Z D a y v_' Z D m a c a mR o �' a cT o a j I c c. rn a 3 ilit o °IV 1 - . N I co ! O rn m o co V m y C c CD CD N N 3 'I 3 !. C? 0 O ! 'fl Z Z 0 0 0 2 0 0 0 °: : • D o c y -1 -I* c N • N x I Q a D C a o m G G 5. 1 y N - n O M co vit co VIF C7 N Z.Z. 1 N 7 3 Dl 7 a �V Z 0. .. cn co o � N ZHZ � ZWZ o Q O D N 7 V O D a 7 V m 7 (n N 7J -o c !+l CD CD : CD a C N N C CD CD (D 1 W N CO a (1-1" a a m m Cp -1 CA 0 7 O 3 ? Z n - 73 I m a a A 7 m W 3 tD 3D W co m z w rn a ^ a ; .._-• Z B 3 B 3 o o " z m co N Z N Z co - co p * o , O E. a O= d • ■ N O O c 'O 7 m 'TI - j co N * N C N = 9) C ry z a ° z a X 7c Q N O O o O I co a., d m A n B.O O ?. 7 •F Fe m CD y m y X. o CD rn , Q 3 3 co n 30 0 0) W C a CD 7 f Cr 8 I.! cn ^m i o� y c ?. am-oi ti CDW S S ct,C O 1 N N p D V CD O O A. d < 0 •C/1 4i4 o o O `2 p •C O CD O CD 0 (0 0 0 (0 0 y . n - p 0 d * 0 E F c o c 7 c .. 3 7 3 r. ,O. co CD 3 CD n A v �' o -o n ,< -o . a c .... C 3 C 3 m m II CD n O O . 0 0 0 a O N y O O V N 73-- CT N `'C ( ;• CD 3 3 c ° _ c a- w °' - girl I ° CO CO a Z Z z sin CO 7 I m a C D 0 CO Q2 . o a 03 5 co O O Oo O. -. 0 c7C 0 in- N o O W to CD = N 7 C 1 O O 3 < ':, a N 5 1 O c0 c - 7 7 o CD S CD r0i r --I CT CP O (T O V 7 O a o O co O r,-. 7 co U� 7 tT gO 7 O Q d to w c O d A (n a O = �1 C D m a = ! Z Y m a o m = 7 m a D N a m W C ir2; 70 O 1 0 C. o r o o CD o o cn CO U 7 N co a N Z L. CO O O ■ _ I co V L "`" CO Co • CO N = V V N N N .. a lY 3 z • - Z 000P- 000 xi a- N ( * 3 y N 2 D d _ N co N 3 j o GrCil CD v g o 7 m o v v p � Q ' m a w m D 0 ° at m y m '0 C 3 °' 3 3 co co N c, z T I ■V lam] D W o Z m o ■ 0 CO O ° 7 O D m 7 o co - m CD A 00 �' CD 2 m CO CD c CD 0 c m w m a m a a 3 3 5 oO 0O p Z_ MCA m c m c '' f1 0 a 1 a ;i Z o v O. I .. 7 ] , Z -I -' 03 CO " m Co cn 1 ID CD a a CD ID g I Z °o Fi 1 °o Z I m a, 3 0. Z CD CD A 0 F w 7 O CD -< 3 CD n o' 8 0D a m03"Z - 7 70o - CO f7 O T I N N N T C 0 N a a) c D' 6 cc) o a g �.o o 0. m X0.0 m� a � 3 a I 3 *y 1 • c 3 m 7• I 3 a A.cr T CD Dl N CO 3 0 ti D CCU Co 0 a ao° ',a 0 o °O I 7 I 3. y o ° 7 QO -a 70.- O 7 <C.N A N 0 0 G. N N co N �\ 3 N C._ P CD N N V N CD 3 3 TO J w o j , O cz a- O K O O • 1 CD < O 0 O 0 r p °O d. 1 ° O ° 0- n N 0 3 d C d et n d OZ K C p . d !! N O• 3 N w O S O 9 0o co Oo a F N Z - N co 7 3 •• Q M W w N C 7 N co > > 00 *' O\ r0 O Oo 0. =Mt = O CT N O \ O t00 000 -a n 7 7 0 co -1 C71 p CZ V7 O V 3 A a p ; D p orlt l� I v goo 03 = a q Oo m D c w I O N N Z Q Pt S Q 000 M� z ° I I o c -0 § '! o� Z Orq 1 � E cntoto D 0 moo ' g e y ° \ Q 1 n) CD ., m Z6 a 0 V 1 Z 0. , , \_____tr .1. - O N co 01 II t ....ca. w m a C, --'7- o p z co o 1 2 a A 0 c 1 §.. a Z —I — 1 a z m (6.) cn I � $ :» z — cp 42. w I CD <� ° CO Da O. ' 1 \� (n y p - 7 co g C 1 ( o 1 a'< Z a I Jr ! .-74/1 c .O • �I a� ` O Iv n v i ` C 0 ti fD O I Ng a° p N A 69 C.11 (.0 O O h. ....1 � a O 'I a DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUIL INGS SP LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION ,I1r'.O.BUa1 7969 BUREAU OF PLUMBING MADISON,WI 53707 t NE',PE%,S15,T30N-R18W X�CONVENTIONAL RECONNEC�ALTERNATIVE State Plan I.D.Number: (If assigned) Town of Richmond ❑Holding Tank ❑ In-Ground Pressure ❑Mound ��jj���� HWY 65 ii(�(/ NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER' INSPECTION D E. Robert Dalton Route 4, Box 8, New Richmond, WI 54017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV of Plumber: MP/MPRSW No. County: Sanitary Permit Number: James DeYoung 5813 St. Croix , 99068 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED PROVIDED El YES LINO OYES LINO BEDDING: VENT DIA. VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH ALARM. FEET FROM LINE AIR INLET: DYES ONO ❑YES ONO NEAREST 7,- DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: CI YES LINO CI YES ONO EVES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST----0* SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: y -WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID BED'/TREK r TRENCHES. MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE (DISTR.PIPE (DISTR.PIPE MATERIAL NO.DISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END: PIPES. FEET FROM LWE: AIR INLET: NEAREST I,, MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS. LIVES ❑NO OYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER EDGES. DYES LINO Ell/ES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: ED/TRENCH WIDTH: LENGTH TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER DIMENSIONS t MANIFOLD PUMP MANIFOLD DISTR.PIPE 'MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. DIA.. ELEV.: PIPES: DIA.: ELEVATION AND INFORIMATION !`HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED INFORMAtION` PLANS LIVES LINO OYES ❑NO COMMENTS: , PERMANENT MARKERS: OBSERVATION WELLS: NUMBER- Or■ LIRNEERTY WELL. 'BUILDING' FEET FROM ❑YES LINO DYES ONO NEAREST- ',. ,),..; • Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Administrator DILHR SBD 6710(R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT , APPLICATION y w TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- . rooms, etc.), depth of system, or type of system; 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.. Private sewage systems must be properly maintained.(The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; • III. Purpose of application: Check only one in #1. Complete#2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/ 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground • titer included the creation of surcharges (fees) for a number of regulated practices which Wisco -.iri:'S 4 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) S AITARY PPCATION COUNTY rR In a ccord with ILHR 83.05,Wis.Adm.Code 6/ • CD/ STATE SANITARY PERMIT# 1 -Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8Y2 x 11 inches in size. -See reverse side for instructions for completing this application. PETITION • I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE YES N NO PROPEn OWNER PROPERTY LOCATION 6 b s.,..tl- stZ,o- +t) -,_ pe ' fie. Y4, S jy T 30, N, R f8 $'(or) W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ATE `� c�,� ZIP CODE CODE PHONE NUMBER 0 CITY n NEAREST ROAD,LAKE OR LANDMARK /�v 4-�1 t rn 0-,Z -CVO/ -7 ( 71.' ) Z S«. 3/�Z ii MAW ICS e �1 II. TYPE OF BUILDING OR USE SERVED: 23>�»Ro oivrns ,Z- • do�e9,/ow-Gv- Number of Bedrooms if 1 or 2 Family I FQ Yn i I y OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d.M Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. An Existing System has been inspected and soil conditions meet minimum requirements. 4. The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) • 1. a. e Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑Seepage Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet ❑Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Manufacturer's Name Prefab. Con- Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Concrete glass App. Tanks_Tanks strutted Steel Septic Tank or Holding Tank i Zoo ) _ �j 0 Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ LJ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.(as is) Plumber's Name(Print): P umber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Countryside Plbg. & Htg.10. ^ MP #5813 ( 715/246-2660 Plumber's Address(Street,City,State, ;,;��e): Name of Designer: 753 S. Knowles Ave. , Richmond, 54017 VIII. SOIL TEST INFORMATION Certifil Soil Tester(CST)Name CST# CST's ADDRES (Street,City,State,Zip Code) Phone Number: C) Sg n0-z-61, .moo - ( '7iS ) z_ 9'4. 12-co IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial c,,1 CS;charge Fee �r p Adverse Determination /� ""�•vC) b p 7 \ ��/►1 f� X. COMMENTS/REASONS FOR DISAPPROVAL: * k c,-,G/J C . k.L G SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT S T C - 100 his application form is to be completed in full and signed by the owner(s) of the .roperty being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property Ida (1,Ag 1, "-2-t4, Location of Property n‹..._ h;, Section /-5-- , T 3c N-R /2 W Township �c.ti►..�K ��r Mailing Address e"}e. se , ;r /L4 cju • Address of Sitea+-.,.� Subdivision Name • • Lot Number Previous Owner of Property tii )c- � �e G- r <, h C4, st � Total Site of Parcel • /' .4rc Date Parcel was Created • Are all corners and lot lines identifiable? 7/1?-4 Yes No Is this property being developed for resale (spec house)house) ? Yes lta No Volume _3 and Page Number ,894 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION i (We) cut-UN that aft statements on th,iA 6olcm ace thus to the best o6 my (ouA) hnaatedge; that I (we) am lake) the ownen(A ) 06 the phopenty deAc, abed in this in6ohmation 6o/m, by viAtue o6 a wawcanty deed Reco'ded in the 066.ace o6 the County Regustet o6 Veedh ah Document No. ; and .that I (We) pneeentty awn the pkoposed b.Lte 60A the Assuage di�spasat system (on. I (we) have obtained an easement, to Run with the above deAcAibed p'opehty, bolt the consthuction o6 .said sys.tvn, and the same has been duty R.eeo'ded .tn the 066Zee o6 the County Reg•idtek o6 Veeds, a.6 Vocunnen t No. ) ELAb SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED • . DATE SIGNED • ANN • )tote of Wisc nam County of St. Croix J hereby certify that this irk a fali true and correct copy of the doetun.oi and of record in my office a co. mpared by me. �� Attusf August 20 19 87,,. James r7ames O' /7 Deputy uggw 3z w ...`: "r" * . :r� .rr 'r a rr i + y ,+ a '! : ; . . . '^ Paul Casey and ..,r t a: ` a,: ,.,;..s ,-4.-,....,,,--_..•••,-.-,,,,.,- .....„........7.tir2nz,-,!--.--77.--------,--,,, , ...,. . , -----------.1,4'-'-. -.. .iiis,Js.`", -..b . " nd l s eta 4° ;` ► efit ata1toi a ad'i n ! r 'Wi� - ' \;■/ ,fe "M` r+�'- `'R _' 2,:t.:..1......_ °3..=...Yr='-. ' _- -. ..;� st• C' Ix " " 41i, �w•.f wisgaesins " ' ..• a * t�R. .- ,'sr - .:.. ::'. - Lot as ,set ;�forths,in Certified `Survey Map - 'recorded in,Volu 3..'of' Certified Survey Maps � ; .`"� ag+, '.89b, . - tNO.>f361646., being a part of Northeat carter o .the lortheast quartear ( toy`., `� r hi l'hirty ,30)w tort1 . Range Eighteen 4 ! --• rt }�' L ,� l K$f A-a yy F,A` si 5-' r 1 *4 yyg W d.! ` AJ �� NSF -j " •.,. r 4 .. . '.,,,` .�.` ' C . ..* .r . . - .�- ��� stsi irMP aiM1 � L � W. f , Y 1Y Y yx A°J °� .fir. � :: lX g ';;;.:':472,,f,..-s-,--...t-,:,-4,- .'"-_-,- ,,- .:"=:,.20 01-.:,. ‘`'-', :.,::',...-.01.:i;:--4:47.0f.,.--.4.4.-4,:-.'-:-..,-"k: ''''''4''',Y%I.'''''..--': '' : ' --l't..:14'41-,ittf. ishori ;art � L� contain • �� �„fi } : r e r EL) '' ww y .." � .(SA ,- ti F y 4,e 7... + t :-. ,- at . ,,! 7�*y L: ,a° 3;t' p .:T v cif t sue!K k,.. _ . {x•' ; , ; ,I�$Y .. J.r �s �l�Caea �"'"°i 1.,',4:;.:,w,y �:�� �'�� 3Yy@ .... ..f:wwfw ...M .--7*,'� 4+J fides -,-=-L.--,Y^ i. �` .. ..,-K,,,: , .. T 1 e ust .�s„-,.;` .0..e. M �s� '+� ay1*,th''. .,*04., :::,--'...-Icl,,--t„,-,,;:4,-, _„*„.-..,;.a.,,,iii.lat'll*-4,-''-,:'tfi-4*-;f:--...'.z,-,*ttlt;-. 7.to,.* .'77-r4 -,,,::...,..- ,,.....-:-.,-;.. , _ :1'44,,,,-:4, '-'1.7,,',..- • s, :�,�.yf•���4 s � a e � t," a ; r. � ro i, :.;...4-',,. at i _ e r 2 ",. e r r-; t Oct!. T SF 1 g � � '�" f At:,� k �� L""i_:_t?'.;''.,.:- .-; _'r-. 2 .. - -- .. `ft ...:,_ ..:.._', _.T. -.'d,:'. z cn H STC - 105 H SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County z OWNER/BUYERb �� ,�}t„� ROUTE/BOX NUMBER N.�. aY Fire Number $. CITY/STATE , �;1.� ' L��;� ZIP YO w.�h Si PROPERTY LOCATION: fit. 1, n e. 1, Section , T So N , R Jp W, Town of ick St . Croix County , Subdivision , Lot number • 1 Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein , as set by the Wisconsin Depart- ment ►u of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED ak � DATE S ' "[.-x-57 St . Croix County Zoning Office P. O. Box 9& Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; . 3. MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement system; 5. Complete the suitability rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation) does not apply, place N.A. in the appropriate box; 1 1. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS • Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob --- Cobble (3- 10") SS -- Sandstone yr - Gravel (under 3") LS -- Limestone s - Sand HGW - High Groundwater cs - Coarse Sand Perc --- Percolation Rate mod s - Medium Sand W _ Weil fs _ Fine Sand Bldg -- Building • Is - Loamy Sand > --- Greater Than `sl - Sandy Loam < - Less Than ' 1 - Loam En -- Brown sit --- Silt Loam E l --- Black si - Silt Gy - Gray *el -- Clay Loarn y Yellow sc! - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot -- Mottles se ..- Sandy Clay with sir - Silty Clay f`rf --• few, fine, faint c --- Clay <c - common, coarse p•t Peat rim -- Many, medium m - Muck d -- distinct h -- prominent H`11WL - High water level, Six general soil •textures • 'su.'-face water for liquid waste disposal -- Bench Mark • VRP --- Vertical Reference Point • • TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. .A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to, obtain , permit. The sanitary perrnit must be obtained and posted pilot'to the start:of any construction, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, 1 DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W BOX 53707 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TO HIP/MUNICIPAL4;Y: LOT NO .:BLK..NO. SUBDIV VISION NAME: At t- 1/ A /5 /T 3c N/R 10L(orn Vf r 1Y►0-61 a NC Nl4 < C UN LA OWNER'S/BUYER'S NAME: MAILING ADDRESS: � 8 .'ZD l4e-r 12,41 I , O :(o ► e tv....,,t cl, ,,,a4 . USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMME CIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: esidence 2— i rC 4-6-6"--P Cl New ❑Replace 9.-. //_ ' 7 �7 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL:CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMME DED SYS E optional) YS ❑U ES DU , ®.S ❑U DS �.0 ❑S C <11 z u ,11 ((��++ tl1'i7r�0 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: )i - Floodplain,indicate Floodplain elevation: /0/4 PROFILE DESCRIPTIONS . 4.34e Q el,BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, LOR,TEXTURE,AND DEPTH NUMBER DEPTH TM. OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 8� `I b- o-1v ..- >1 6=- y l I •_ 3. , . B- B- 00 00 B- QCC\ cal B- SE�1�N6 L-4 PERCOLATION TESTS p tE . TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAT • INCH NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PER P- ' P P- P-- P- PLOT PLAN: 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 slope. SYSTEM ELEVATION "Hip. g K 5 64143 43 S.1`"" c L. z 9 2 _ ( I[F 4; � _ I _ _ I t , I 1 1 r i z { ` 1 i E _,., i __ __ ._. ..... _ �.. t t ' t I t .� _..M-- N OA a.m., 1 1 ri i,AE [ .4... F1 t j 3 I t 1 t I a i i F _ M ..... 1 Neg (t 1 --L ' t t E a 3 1 f 1 a I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods pecified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ,.NAME(print): ,,ft TESTS WERE COMPLETED ON: C -S C j yr_ 9 ADDRESS: / CERTIFICATION NUMBER: PHONE NUMBER(optional): <Z �. z Ei /v�� d- 2ao r : ;L C f _ / �i_ I iiiipuir C ✓e.`_ AMR' DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 1 1 2 I'll A J csq Cl.. 4 �� o o .. J aC `d " 3 k c�a -. d v cL lh o* J f Ki w . iv- Z ■ h, 1 1 . . . , . ?,... i ! t, •\_. .., / .----- 1 , , - 'Fi" r . 1 — (2// / I-e,e I el / r )c. - Q - .,-.. — Ir. I OCi 1 ,.... _ _ _. _ _ _ cx...1 I+ , f• ,....,, , (.< . ,,.....) v _'sr . c•: 0, c! . Q., ST. CROIX COUNTY ev,_, ,ya > WISCONSIN t d �7" ZONING OFFICE at a. . 7 3 . c µ., ZO N-,„1.4:1? : f 7 796-2239 (HAMMOND) l,,-,-t 425-8363(RIVER FALLS) - - HAMMOND, WI 54015 September 17, 1987 Ms. Vickie Smith Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Ms. Smith: Enclosed is a EH115 form that goes with permit No. 99068, St. Croix County for Robert Dalton which was not included with the permit when I sent it to you. If you should have any questions, feel free to give me a call. Sincerely, ■` XC'EntJ 63(0 Roxann Croes Administrative Secretary Enclosure 3 1F4 rP ;d_ i TI . I $ r—�---- F 1 L E D . OE :C 61979 1 L . c :,;! .,,, ,-JD(c!'!,,,;;Ty Vi Circa 401.170, CERTIFIED SURVEY 146,2 ,._1_L:_?IP J `. _, - PAUL CASEY @ Z Part of the Northeast 1/4 of the Northeast 1/4 of Section 15, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsi . o N 90°00 C)6.0- 208.�I ( SIC 0t'l °, 8 i'o 4 JI N I. e r 9 co '^ o° 0o O x ‘9 0 0 F N �a0 it vi 2 R ff.TA..� W Dl s }" -- EST. to lA ,Q Di (1 ea-row?) O 0 (Q 34 0 d0 O 7 /5 (7 ° ...„..L. .c IV To'oo'' w S' Q ' ^ ' ` O 5.Oo 1`1 90°00'06v./ 208.71 W 00 8 4 0 Indicates 1" x 24" iron Pipe stake weighing 1 .13 #/ft. $ 1 p i 0 5E Cott.. 2 Se_L. IS, T30).1 Description: R.IBW (nna'4). That certain parcel of land located in the NE 1/4 of the NE 1/4 of Section 15, T 30 N, R 18 W, Town of Richmond, St. Croix County, Wisconsin, more fully described as f8llows; Commencing at the Southeast corner of said Section 15, thence go N 00 00' 00" E (assumed bearing) parallel with the West right of way line of S.T.H. 65 a distance of 4168.68 feet; thence N 90° 00' 00" W a distance of 75.00 feet to the Point of Beginning of the parcel to be herein described; thence continue N 90° 00' 00" W a distance of 208.71 feet; thence N 00° 00' 00" E a distance of 208.71 feet; thence N 90° 00' 00" E a distance of 208.71 feet to the West right of way line of S.T.H. 65; thence S 00° 00' 00" E along said right of way a distance of 208.71 feet to the Point of Beginning, the above described parcel containing 1 .0 acres. State of Wisconsin ) County of St. Croix) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Paul Casey, I have surveyed and divided the above described lands in accordance with official records, Chapter 236 of Wisconsin Statutes, and the Ordinances of St. Croix County; and that the above map and description is a true and correct representation thereof. 28 July 1977 004/�/ol 5 0 V. �' � f�/ J ape sq Murphy''. Re i ve r g : e ESL. �'4 •.� 1 MURPHY - Can Vol. 3 Page 896 SR 0 4 2 r — Certified Survey Maps .�. IVER FALLS, :°o APPROVED St. Croix County Records ti;:.. wlsc. :f Jt4,, f!�� St. Croix County, Wisconsin �'%,,'�F®''7A O---.-,��•�` �y 29 � � APPROVAL OF THIS MINOR ///�I 0 OR SUB iu ,r.r,�un��"vv,, DIVISI DOES ON T z N NOT MEAN ST. C O1X COUNTY EAN APPROVAL FO COMPREHENSIVE PARKS PLANNI ' BUILDING R SITE OR SEPTIC SYST AND ZONING COMMITTED �� REFER TO H62.20, Volume � Page 896 00 / �o�` i.,�y I, o 4 tr.,6\1A, -1--- 5 �e " Vi :jive., ■ 'S. \A�Z 11P .`,2( 10/12/2006 05:10 PM tiZo ' 4'°o�b e f; ' PAGE 1 OF 1 026-TOWN OF RICHMOND -\);;\3:cec),V �90� �> ST. CROIX COUNTY,WISCONSIN �e� y� eel ,pi/1 �A Permit# Permit Type•e"s;' eo{' �j �l Q ��� ge u ,iner(s): O=Current Owner, C=Current Co-Owner• cps*" () ( 0*(6' O-CASEY,THEODORE J&KRISTI J 'd\` I V1 Di ..nool SP=Special Property Address(es): *=Primary Typ .n * 1578 HWY 65 SC rICHMOND SP ePER WILLOW REHAB DIST SP .■ WITC Legal Description: Acres: 17.360 Plat: N/A-NOT AVAILABLE SEC 15 T3ON R18W PT NE NE&NW NE BEING Block/Condo Bldg: CSM 11/3027 LOT 2 17.36AC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 15-30N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1215/582 LC 07/23/1997 :. r0G&-� . - /IS 2006 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment -70-116 Valuations: Last Changed: 06/20/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 7.360 1,200 0 1,200 NO AGRICULTURAL FOREST G5M 6.000 6,000 0 6,000 NO OTHER G7 4.000 49,500 126,100 175,600 NO Totals for 2006: General Property 17.360 56,700 126,100 182,800 Woodland 0.000 0 0 Totals for 2005: General Property 17.360 56,700 126,100 182,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 120 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 261-1286-06-000 10/12/2006 05:09 PM PAGE 1OF1 Alt. Parcel#: 15.30.18.691 261 -CITY OF NEW RICHMOND Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 04/28/2004 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-CASEY, PAUL&COLLEEN PAUL&COLLEEN CASEY 606 JEWELL ST STAR PRAIRIE WI 54026 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: 23.640 Plat: N/A-NOT AVAILABLE SEC 15 T3ON R18W PT NE NE EXC P215B AS Block/Condo Bldg: DESC IN 560/461 &EXC CSM 11/3027 ANNEXED('04)FKA 026-1044-10-100(215C) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 15-30N-18W NE NE Notes: Parcel History: Date Doc# Vol/Page Type 04/28/2004 760868 2558/556 ANNEX 2006 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/25/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 23.640 4,300 0 4,300 NO Totals for 2006: General Property 23.640 4,300 0 4,300 Woodland 0.000 0 0 Totals for 2005: General Property 23.640 4,300 0 4,300 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 #: 026-1044-10-100 10/12/2006 05:07 PM PAGE 1OF1 Alt. Parcel#: 15.30.18.215C 026-TOWN OF RICHMOND Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 04/28/2004 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner ANNEXED CASEY O-CASEY,ANNEXED 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: 23.640 Plat: N/A-NOT AVAILABLE SEC 15 T3ON R18W PT NE NE EXC P215B AS Block/Condo Bldg: DESC IN 560/461 &EXC CSM 11/3027 ANNEXED('04)NKA 261-1286-06(691) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 15-30N-18W NE NE Notes: Parcel History: Date Doc# Vol/Page Type 04/28/2004 760868 2558/556 ANNEX 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/08/2005 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 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 r Parcel #: 026-1044-20-000 03/21/2007 08:44 AM , PAGE 1 OF 1 Alt. Parcel#: 15.30.18.215B 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): 0=Current Owner, C=Current Co-Owner 0- DALTON, ELIZABETH A ELIZABETH A DALTON 1590 HWY 65 NEW RICHMOND WI 54017 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description * 1590 HWY 65 SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 15 T3ON R18W 1A IN NE NE COM SE COR Block/Condo Bldg: SEC 15TH N 4168.68'TH N 90DEG W 75'TO POB W 208.71'TH N 208.71'TH E 208.71' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH S 208.71'TO POB CSM 3/896 15-30N-18W Notes: Parcel History: Date Doc# Vol/Page Type 06/11/2001 647915 1657/342 TI 08/23/1985 404610 719/196 WD 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 1.000 36,000 227,500 263,500 NO Totals for 2007: General Property 1.000 36,000 227,500 263,500 Woodland 0.000 0 0 Totals for 2006: General Property 1.000 36,000 227,500 263,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 516 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 NAME: COUNTY: „ 1 SEPTIC TANK PERMIT NUMBERS REPORT ON SOIL PERCOLATION TEST AND SOIL BORINGS TO �t' /_ter , 77 DIVISION OF HEALTH • PLUMBING SECTION /7/ Pursuant 309, Madison, Wis. 53701 77 Pursuant to H 62.20, Wis. Administrative Code PERCOLATION TEST TEST DEPTH CHARACTER OF SOIL HOURS WATER TEST ?IME DROP IN WATER LEVEL INCHES MINUTES NUMBER INCHES THICKNESS IN INCHES SINCE HOLE IN HOLE INTERVAL SECOND TO JEXT TO LAST TO FALL 1st WETTED OVERNIGHT IN MINUTES LAST PERIOD LAST PERIOD PERIOD ONE INCH, EXAMPLE P — 0 36" TOP SOIL. 10", CLAY 26" 25 YES OR NO 30 * 60 1 2 3 - - RECORD DATA FROM MINIMUM OF 3 TEST HOLES COMPUTE SIZE OF ABSORPTION AREA IN ACCORD WITH H 62.20 WIS., ADMINISTRATION CODE. S O I L .B 0 R I N G S • MINIMUM 36" BELOW,PROPOSED ABSORPTION SYSTEM BORING TOTAL DEPTH DEPTH TO GROUND WATER DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED OBSERVED ESTIMATED CHARACTER OF SOIL WITH THICKNESS IN INCHES EXAMP B • 0 72" 72" BLACK TOP SOIL 12": CLAY 18". SAND 18". GRAVEL 24" 1 2 3 RECORD DATA FROM MINIMUM OF 3 BORE HOLE.& TYPE OF OCCUPANCY: RESIDENCE: NUMBER OF BEDROOMS OTHER: (SPECIFY) NUMBER OF PERSONS FOOD WASTE GRINDER: YES NO DISHWASHER: YES NO AUTOMATIC CLOTHES WASHER: YES NO EFFLUENT DISPOSAL SYSTEM: NW/L.. EXTENSION ADDITION: REPLACEMENT TILE SIZE NO. LIN. FEET /1/ TRENCH WIDTH DEPTH NUMBER OF LINES, SEEPAGE BED: LENGTH WIDTH DEPTH TILE SIZE NO. LINES SEEPAGE PIT: INSIDE DIAMETER J LIQUID DEPTH 5 I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision 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 belief. J NAME ..... C �.-- TITLE -(TYPE or PRINT) REGISTRATION 1$O. OR MASTER PLUMBER LICENSE NO. ADDRESS �� �� r/ / SIGNATURE /: e-/ / -_ DATE ., .� DO NOT WRITE IN SPACE BELOW - FOR DEPARTMENT USE ONLY DATE RECEIVED ACCEPTED BY RETURNED FEE RECEIVED VALID NO. PERMIT NO. REVIEWED BY APPROVED DATE INITIALS YES OR NO Plb #67 7 1 6240-- ( o ti(f 10-(bb h Wisoonsin Department of Health and Social Services * Division of Health SEPTIC TANK PERMIT APPLICATION TYPE OR USE BLACK INK - PLEASE PRINT --t A. OWNER OF PROPERTY Name 60' ///' Address (Street, City, Zip Code) /. B. LOCATION OF PROPERTY WHERE SYST WILL BE CONSTRUCTED, ALTERED OR EXTENDED COUNTY , T ' - Check Ones CITY VILLAGE LEGAL DESCRIPTION r J° y /C. /2' ct/ TOWNSHIP q , (Block, Lot, Sec.) / - C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES No 7PERMIT NUMBER D. SEPTIC TANK CAPACITY / ='' ' GALLONS NEW INSTALLATION /_ REPLACEMENT ADDITION MATERIALS: PREFAB CONCRETE POURED IN PLACE STEEL OTHER NUMBER OF TANKS TO BE INSTALLED: / E. TYPE OF OCCUPANCY /: . Check Ones One or Two Family Residence Commeroial/ I mistrial Other . (Specify) Number of persons to be Accommodated Number of Bedrooms F. APPLICANCES, ETC: Food Waste Grinder YES NO Automatic Clother Washer YES NO Dishwasher YES NO Automatic Potato Peeler -- YTS NO OTHER (specify) YES NO G. MASTER PLUMBER MAKING INSTALLATION Names a _s -- Address: 1 , SIGNATURE OF APPLICANT: C c\..Q_ _ ‘75;;: ' // License Numbers MP ADDRESS: ,(:G t� / �-l'_ , ., � � ,.iC� � �`' ASW H. (TO BE COMPLETED BY ISSUING AGENT) /�' �/ Date of Application ___;e: / } Fee Paid / Permit Issued (date) / ;;/ ./ Permit Number 47 / t/ Agent (name) f For: �s town, village, oitya coat ele (speoity) NOTE: The Application cannot be considered for filing until all of the above questions ars answered and the fee paid. Agents will forward application, the fee of $1.00 for each septic tank and the third copy of the permit (canary) to the Division of Health. Cheeks and money orders should be made payable to the Division of Health. COMPLETE OTHER SIDE 1 • INFORMATION REQUIRED FOR SUBMISSION OF PLANS • 1 . Legal description of property on which septic tank and effluent disposal system is to be installed. 2. Percolation test data from a minimum of three test holes. Tests are to be conducted in the area and to the depth of the proposed effluent absorption system. Where ground • water and/or bedrock conditions exist, the vertical depth from grade level to same shall be indicated. 3. A detailed plan of the proposed installation specifying the location of the building served, size and design of septic tank, effluent absorption system with location and numerical identification of percolation test holes. 4. Indicate on plan lateral distances between septic tank effluent disposal system and building, well and lot lines. 5. Include complete data on expected use of the building. See Section H 62.20. LAKE O STREAM 50' PAGE 50 1 / is' 0 T R E N C H I M�2P 3— o 1 i__ '.J -Y- 14_1 —75! . SEEPAGE BED 25' IOD 25' P4 1 \ Y T cpi. W E L L W L L ; so'�„-- 2� — — ___ __I i F 3 A 6 P4. _ 1000 GAL. BLDG. �6' ( k5� T ".,� A— IGcY--� p 3 i l 1ir 5O 25/ � � ® 50 tilt /O 5'-_ • W E L L S E E P , G E • I TS f / P P f ` LOT L I N E O— P • Peroolation test hole SAMPLE PLAN DEPICTING SEEPAGE TRENCH, SEEPAGE BED AND SEEPAGE PIT - "yam n.'.. rill,717 , Plb 60. NAME OF BUSINESS ! ck LX L !...41z L ,r,c.c i .S L'""'c 12 C.. d 6 7 LOCATION L' (la tT` (.P iiYY1 �f - ( k19/2 s t or y or township county 11�1G ,."T LEGAL DESCRIPTION /CPT°��V 7I)e1 E� �'-.1i --fie' /"�J • IL / e(.0 1�u ',. .:r. :` OWNER L.,j (—elf.) 12 Mailing address I VA.�.t.% Ck_r, VYYL:-t""a �� L L. `� ZIP $ SiUI i ARCHITECT OR ENGINEER Address ZIP PLUMBER ( €3tt�-�-°.�) Address ,� lL1.Zti.��kA../ , ZIP Sfi^ B I 1. Check appropriate building usage(s) and till in the information requested opposite each usage listed: Existing building New building >C Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant Car spaces ( ) Restaurant Seating capaciT.77 10 sq. ft./person) ( ) Dining hall Per meal served Toilet waste Yes No ( ) Motel ( ) Hotel .( ) Cottages . . . Number of units: 2 persons/unit 4 persons unit TOTAL NUMBER OF UNITS ( ) Churches Number of persons Kitchen Yes No ( ) Bar or cocktail lounge . . Seating capacity (10 sq. ft./person) ( ) Nursing or rest home Number of beds ( ) Mobile home park . . . . . . Number of units - dependent (camper trailer) - nondependent (mobile home) ( ) Retail store Number of employees Number of customers (10 sq. ft./person) ( ) Servioe station Number of oars served (daily) ( ) School Number of classrooms Meals served Yes No Showers provided Yes No ( ) Factory or office building . . Number of persons (total all shifta)- ( ) Residence Number of bedrooms ( ) Apartments Number of bedroo : Other Specify .-y 4_ L, 165,),....4.--- 1, „SQL LE 2. Indicate whether or not the following facilities are oonneoted: Food waste grinder Yes No Dishwasher Yes No }C Automatic clothes washer . ,//Yes No ' 3. Fill in'the appropriate information for the following as indicated: �s#,/j✓i✓JIC�- Septic tank capacity planned /�t e) TOTAL Septic tank capacity required Percolation test results - ATTACH PERCOLATION TEST REPORT SHEET Seepage trench bottom area planned width linear feet depth Seepage bed area planned width linear feet depth page pit/lamed outside diameter depth below inlet . depth .� /a9,R�j /7 N'4 pit A pp, eS‘Eo fci PX Seepage trench bottom area required width linear feet depth Seepage bed area required width linear feet depth Seepage pit required outside diameter depth below inlet Signature of person oompleting form: THIS APPROVAL SHALL BE VOID IF REVISED STATE DIVISION Of HEALTH, PLUMBING SECTION `? / _•L") WITHOUT THE WRITTEN APPROVAL OF THE P. O. Box 3 dison, Wisoons 3701 < Q ii i 11 -74? T,'�•"-:; INVISpN OF HEALTH. Approved: y Address t f�� "_ s /t1-sw, f'.,%..[,. rr X�, 1.kj pp e �, /1 ZIP SEP 19 197 V Dates '7 /II— 7 Z Date: THIS APPROVAL SHALL BE VOID IF THIS APPROVAL IS BASED ON STATE PLUMBING NOT INSTALLED W+THIN TWO YEARS CODE REQUIREMENTS AND DOES NOT EXEMPT THE FROM THE DATE OF APPROVAL INSTALLATION FROM CITY, VILLAGE, TOWN- SHIP OR COUNTY i+■IMMINNrS OR PERMIT (OVER) REQUIREMENTS. NAME: • COUNTY: SEPTIC TANK PERMIT NUMBERt REPORT ON SOIL PERCOLATION TEST AND SOIL BORINGS TO DIVISION OF HEALTH ...PLUMBING SECTION P.O.BOX 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administravive Cod. PERCOLATION TEST TEST ' DEPTH CHARACTER OF SOIL HOURS WATER TEST TIME "DROP IN WATER LEVEL INCHES MINUTES NUMBER INCHES THICKNESS IN INCHES - SINCE HOLE , IN HOLE INTERVAL SECOND TO VEXT TO LAST TO FALL lst WETTED:, OVERNIGHT IN MINUTES LAST PERIOD PERIOD PERIOD ONE INCH EXAMPLE P - 0 36" TOP SOIL 10", CLAY 26" „ 25 YES OR NO 30 * * Is. , 60 ,-4 ,. . ::,- © Iv /( d r...ro .s>4' 2 3 ?..4 f .. ?o fie Av lid RECORD DATA FROM MINIMUM OF 3 TEST HOLES COMPUTE SIZE OF ABSORPTION AREA IN ACCORD WITH H 62.20 WIS., ADMINISTRATION CODE. S O I L .B O R I N G S - MINIMUM 36" BELOW PROPOSED ABSORPTION SYSTEM BORING TOTAL DEPTH DEPTH TO GROUND WATER DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED OBSERVED ESTIMATED CHARACTER OF SOIL WITH THICKNESS IN INCHES EXAMPLE B - 0 72" " " 71 " 72� 72 BLACK TOP SOIL 1 �: CLAX 18 18,E GRAVEL 21" 2 /d t 1 2 ., ,d .l 6. 3 /6 V _ _ 1 i''e,) -a p ) e RECORD DATA FROM MINIMUM OF 3 BORE/1012S TYPE OF OCCUPANCY: RESIDENCE: NUMBER OF BEDROOMS C1 OTHER: (SPECIFY) L J 1 L *'L..6tiw+. NUMBER OF PERSONS FOOD WASTE GRINDER: YES NOS__DISHWASHER: YES NONAUTOMATIC CLOTHES WASHER, YES NO Al EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT TILE SIZE NO. LIN. FEET TRENCH WIDTH DEPTH NUMBER OF LINES SEEPAGE BED: LENGTH WIDTH DEPTH t IL E SIZE NO. S Lao",SEEPAGE PIT, IN DIAMETER LIQUID DEPT = 1Z)379‘5". 7 INSIDE —F -- ...am I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (3 ), Wisconsin Administrative Code, and that the data recorded and looa n of test holes are correct to the best of my knowledge and belief. NAME r I v 1 (1. t: CO c. r..-0 TITLE !1 C (TYPE or PRINT) i S 4 REGISTRATION NO. OR MASTER PLUMBER LICENSE NO. ADDRESS .Y .t•�./' 7".-i (..144,,--'‘''' .:(../+,,--'‘'' DATE SIGNATURE DO NOT WRITE IN SPACE BELOW - FOR DEPARTMENT USE ONLY DATE RECEIVED ACCEPTED BY RETURNED FEE RECEIVED VALID NO. PERMIT NO. REVIEWED BY APPROVED DATE INITIALS YES OR NO Plb #67. 7/71 Wisoonsin Department of Health and SoltServioes Division of Health +^ .. " ' SEPTIC TANK PERMIT APPLICATION �� TYPE OR USE BLACK INK - PLEASE PRINT riv` ``es A. OWNER OF PROPERTY Name Address (Street, City, Zip Code)N pj ck,A.) P,A,,,„c)",„"-, ,A.--v--,...(0,:., p 3 n , ,$ B. LOCATION OF PROPERTY WHERE SYST WILL BE CONSTRUCTED. ALTERED OR EXTENDED COUNTY _1 (.� Check Ones 411- I '/ CITY VILLAGE LEGAL DESCRIPTION ! Wit,! TOWNSHIP (Block, Lot, Sec.) ---0 1 ;. # f S , i 1 C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES No PERMIT NUMBER D. SEPTIC TANK CAPACITY /Ob GALLONS NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: PREFAB CONCRETE POURED IN PLACE STEEL OTHER NUMBER OF TANKS TO BE INSTAL : , E. TYPE OF OCCUPANCY Check Ones One or Two Family Residence 4ammerefal Indust:4ml Other y' Spe. fy) Number of persons to be Accommodated / Number of Bedrooms ( dam, 4 e'er - F. APPLICANCES, ETC: Food Waste Grinder YES NO Automatic Clother Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO OTHER (specify) YES _NO G. MASTER PLUMBER MAKING INSTALLATION Address: ., . c Names 4� i . 1 t A a ,_r ,4. ..- 0-7w SIGNATURE OF APPLICANT: t 1 Lioense Number: MP ADDRESS: sue'; .. MP RSW ij K. (TO BE COMPLETED BY ISSUING AGENT) Date of Application Fee Paid Permit Issued (date) Permit Number , Agent (name) Fors town, village, city, county, etc. (specify) NOTE: 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 $1.00 for each septic tank and the third Dopy of the permit (canary) to the Division of Health. Cheeks and money orders should be made payable to the Division of Health. COMPLETE OTHER SIDE v. s A ;ti r ' . . . • , ' ' / , Se. Z ig` . ..i. ' 41Ft Vey f 730N-Rivw This appro..al is based on state plumbing code requirements and dosos.liot exempt THIS APPROVICSIVILL. BE VOID IF REVISED the install:lion from iW7 village,town4 Wi IV,T i H, .SiTTEN APPROVAL OF THE ship oi county permit requirements. •INISaiii OF rsEALTH. T H I S ANP sP TRAOL IV AEADL E SHITtNEET V001Dy Alcs A111111 ' KIT I w w E pr. ed 4, DATE .......- . PLUMBING SECTION :PA1 r fil 1 WIS. DEPT. OF HEALTH & SOCIAL SERVICES 4P, 111 i /41afirf,cfPa/Aft•v#41 lot i t 1 I )ct • fi .ti.■ ir ............. •ri • , clr \ • j 7 jit; lir ir Pxivit.4 ... . LZOE dfWd II 3JIA'IOA . 0 Z ;o l 4004S 0.1... L10b5 IM 'ONOWHOIb M3N 'SZ£ X08 '0'd 61.C-17.-917Z # 3NOHd C 'aolnpo J0; pJDO8 uMoi a}DIJdoJddD ay} puo aol;10 buluoZ ONIA3A21f1S ONb'-I 3 V X}unop xloJp •}S ay} }oo}uoo 'IaoJod Xuo 6uldolanap JO bulsoLOJnd aJO;aB '(•o}a 0 'iaoJod o} SSaOOD 'azlS lo! uJnUJ!ulw 'SpUD1}aM •a'I ) suogolnba., puo saInJ `sMo1 dlysuMoi puo ,(}unop 'a}D}S o} }oafgns sl dow sly} uo uMoys slaoJod ayi :310N II SONV1 a311V1dNn XI <: _- 3 „tZ,Z0.00 N ,8l'£SS -'Cs1oOz = q3Ui l 1 �•-X—X—X—X 1333 M ) 1r 'L'L x \� %x x \ 004 00£ 00z ON OS 0 I 31VOS OIHdV80 saJoo 9£'Yl 7d•bs z9f 9SL I V...761" 3„£5,00.00 S 8V38 01 03WnSSV SI HOIHM M 8L 3DNV8 ''N 0£ dIHSNM01 S NOLLO3S 30 4/l 3N saioo LL•91 3H1 JO 3NI1 1SV3 3I-U. 01 03ON32133321 3MV S9NIl V38' /I( me ' M.. JN/On7OX3 V3 V 1 3 10-1 1 1 z _ I 0 r I Z 1 m 1 N c O I Z A m :; m 1 z _ ry o so papJooad = d w v I 031-15 i z 90U$J SO10uaa X—x--X 03 I 1 m IS N 1 adld uoJI "L Punod O •}00; JOG U1,1 Z $ r Jed spunod £l'l ;o wnwlulw D o m -.4 + 6Uly6laM adld UOJI „tfZ X „l }aS • O 0 rn N c I w (}uawnuoW wnulwnly) ilioos 140 4- �,, 1 0 m m I w }uawnuoW JawoO uol}pas �C}uno0 • OI 103HS v I Cn = I I I 0 _ I I CI N3031 ,[\Eros��NN I I n of ,• ,- 6♦♦', I ` + 0:I / }lnDJB W sawDp Xq pa};DJa o `L 1r`Z cn / L 10�b5 IM 'puowyolel MaN c' "N(PA ' srenOa .�~ i 59 XDM46iH £L£l m ♦ "V r �(as00 Pal o. \ ;o }senbeJ ay} }o puo Jo; paJodaJd D N ! V) A x ° / ��`^ lL'80Z -'/ I 0 y m 0 / i I 0 L 1015 IM P(DM 60121 MON m o 1, I M„S 1,t�.00 S o N N n t, I H1iION=2! I 59 4 H 8L91 /(aSD nD m I X O N (n I z III N N N .: 'nod I i_ U1 _' u, N N ,00-c0 :JBUM� Cn / (D ,I ( CO CO II IAI ((0 Co N CP N b p)-2 m ., (n 96 X ���� I` Wpm-`n � Q I r�^� I` I I Sl 'oJs 213N2103 1SV3H1210N j. - 7 rt j I l 5 / ,80'0££l \ AVM3A1280 ? I 5 / \\ �1NIOf 9NLLSIX3 o / A 3nIa c: o / ,06'9LL - _j �\ ,l9'�lZ - cs'od szz !on ---,-179.6Z l' T .,� \\�� �'9 •H•1•S S '335 b/L 3N 3I-LL 30 3NI1 ISV3 I ��/ ^' ----,Sl'099Z 3 „£5,00.00 S ---- `1 _-- az) ap b o SONVI 0311V1dNn f 'UISUOOSIM 'A}uno0 )(Iwo •}S 'pu0wyol8 40 UMO! '}saM gl abuD8 'y}JoN 0£ diysuMol 'Si, Uol}oaS Ul Ho Ja}JDDO ISDOLOJON ay} 40 J9}JDnb ISOMy}J0N ay} 40 }JDd puo Ja}JDnp }SDay}JON all} 40 Ja}JDnO }SDall}JON ay} 40 }JDd UI pa}DOO1 r dVw A] . ns 031A1.1. :130 0 xlo,0'ls 6 Sp oo to�a oat' I HS1YM•H N331H1VN AIN 14 r N ,"` Sbbl 4 L 330 ZSCS \ç ) 9661 8 -- NV(' ?1.1 36164. ,,,„......_...n-. 414 9 41 `O .. ..�_. _ FfLED t r � DEC 61979 Mm a dawN.c 1..W -----; ir T aOIR CERTIFIED SURVEY . ,...,,.. °? .. ...w,...,, W1ris PAUL CASEY 114411 Z Part of the Northeast 1/4 of the Northeast 1/4 of Section 15, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsi . o N 90°oo oo'L- zoS.-r ( O 63•`' _ ' N *0 0 w vi to oil 0 ' O IO Ta.,. r 'p V, Jj CsT• o 4 ,O (t ST°2Y) • O O ' O o - p o 1.0 Ac.rLts to o 3 O 2 ;fit. /5 9 C) NL9 D0000 vv I-76' -0 Y A it i_ Y A 0 IQ, 90°oo'oc�. W 208.71 ?5.00 lJ aO 8 `9 0 Indicates 1" x 24" iron Pipe stake weighing 1 .13 #/ft. O N 5E Gom x S�c.. IS, T304 Description: RIi�sw (nna,.l)• That certain parcel of land located in the NE 1/4 of the NE 1/4 of Section 15, T 30 N, R 18 W, Town of Richmond, St. Croix County, Wisconsin, more fully described as follows; Commencing at the Southeast corner of said Section 15, thence go N 000 00' 00" E (assumed bearing) parallel with the West right of way line of S.T.H. 65 a distance of 4168.6 8 feet; thence N 90° 00' 00" W a distance of 75.00 feet to the Point of Beginning of the parcel to be herein described; thence continue N 90° 00' 00" W a distance of 208.71 feet; thence N 00° 00' 00" E a distance of 208.71 feet; thence N 900 00' 00" E a distance of 208.71 feet to the West right of way line of S.T.H. 65; thence S .00° 00' 00" E along said right of way a distance of 208.71 feet to the Point of Beginning, the above described parcel containing 1 .0 acres. State of Wisconsin ) County of St. Croix) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Paul Casey, I have surveyed and divided the above described lands in accordance with official records, Chapter 236 of Wisconsin Statutes, and the Ordinances of St. Croix County; and that the above map and description is a true and correct representation thereof. 28 July 1977 e0wLI}�r7"J y Ja�� ,r: �Murphy''..,!l, ''%-2:-.IT S7/ Regiggtqci IMPOE11.1121.eNr % 4■1,,,... • MURPHY ` V Cr' ol. 3 Page 896 r. S 1 0 4 2 1::,"-1 Certified Survey Maps RR'ER FALLS, APPROVED St. Croix County Records "s 111% wlsc. .rJt, f�� St. Croix.County, Wisconsin ',;,e,Qea"-i,, i; S....?:‘<c, �; �/ r� � � o APPROVAL OF THIS MINOR F"Oi" H 7 i�"y""vv J J 0 DOES NOT MEAN SUBDIVISION ST. C OIX COUNTY DOESNG SITE OR APPROVAL FOR COMPREHENSIVE PARKS PLANNI L SEPTIC SYSTEM AND ZONING COMMITTER REFER TO H62.20, Volume i Page 896