Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
026-1066-60-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 584718 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 Township Parcel Tax No: Gerrit & Kari Leverty TOWN OF RICHMOND 026-1066-60-100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: I~M j G5'r 22.30.18.338B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic WI% / Benchmark acs 960"T 3• Z /67.3 (C. ~~S Alt. BM GD f:','1 kA~ 06 L--4 Aeration Bldg. Sewer 14-3 /6 (6, t - Holding SUHt Inlet ~ q d St/Ht Outlet 7, h TANK SETBACK INFORMATION G• 46 TANK TO P/ WELL BLDG. Vent Air Intake ROAD Dt Inlet Septic Dt Bottom 111-71 /Z2 Zu 47 Header/Man. /O 3 Dosing - Aeratio Dist. Pipe Holding Bot. System Final Grade ~03, 2 J J PUMP/SIPHON INFORMATION m 7.7- Manufacturer Demand St Cover GPM LA_ VL- 3• Z 16 7. 3 Model Number TDH Friction Loss System Head TDH Ft Force Length Dia. D ell - SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pit Inside Dia._ Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL f LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR G f° O Type Of System: 13Z a UNIT Model Number: o a 13 7-9 ~V DISTRIBUTION SYSTEM / Header/Manifold it Distribution x Hole Si Ix Hole Spacing Vent to Jake Pipe(s) \ ern S Length, Dia Length Dia pacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 6 O Depth Over Depth Over Jxx Dep of xx Seeded/ odded xx Mulched Bed/Trench Center 3.7 Bed/Trench Edges ` Topsoil s ❑ No a No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: r 'I Inspection #2: Location: 120TH ST 1.) Alt BM Description = L 6 JPJ.-, 2.) Bldg sewer length = 2.441 amount of cover = I -719 Plan revision Required? ❑ Yes No q 1.. ` u3 ~V 1 Use other side for additional informatXn Date Insepctor' gnature Cert. No. SBD-6710 (R.3/97) ~XR~ S L I a" /'o ~i~" ~TRECEIVED Safety and Buildings Division County i p r 201 W. Washington Av .O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) PS APR 18 2016 Madison, WI 53 -7 aq v y~FFSSfOtih~~~ 1 ~ 5~~ I I V e0MMU1S- > ,pWffit Application State Transa ion Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary u oses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. L Application Information - Please Print All Information Property Owner's Name` I 1 Parcel # Property Owner's Mailing Address Property Location 10~ j y> 9 Govt. Lot City, State Zip Code Phone Number SLi~ G% ~y S Section ~Ilf ~ 1 I C~ ✓1 ~G. t ~ ? .~crrcle one 7 T 5l1 N, R 1 Aor V,l II. Type of Building (check all that app)y) Lot # 1 or 2 Family Dwelling - Number of Bedrooms i~ Subdivision Name - .......,H». ail r -,o Block4 J ❑ Public/Commercial - Describe Use 6 ~lsl c 4 ❑ City of p t El 4 v~- CSM Number El Villa--e of State Owned -Describe Use LL'f ~ t~ 7 / ~1 Townof C ~r'G III. Type of Permit: (Check only on bog on line A. Complete line B if applicable) A. ..New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner W. Type of POWTS System/Component/Device: Check all that apply) V Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) El Pretreatment Device (explain) V. Dispersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Rate (Wdsf) Dispersal Area equired sf~ Dispersal Area Proposed (sf) System Elevation -0 VW 700 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks r ~r y W /O ILK, SGS a U v VD w U c, Septic or Holding Tank e__11 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ature MP/MPRS Number Business Phone Number Plumber's Address (Street, C'ty, State, Zip Code) _ -Z YG Z s 71- 746 ~ 648 VIII. unty/De artment Use Only Approved ❑ rove Peirn!ttFFeeee ~D(ate ssuue Issui gent Signature en Reason for Denial $ 49 - - f 1 • IX. CondifikfisT&G~(0*NFAYReasons for Disapproval n _ 11 1. Septic tank, erflmnz filter and disper: s,i cell must all be ser.tc~s !nnin red; as per martagernent plan provided by plumber. "~I'k'it~`p+tst;,~lq~hlainRtitis+d n per appWille, code / ordillw n w. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) L Palle 3 of :_idr~s /y /ZU Brian Parnell f CST 2`31314 j ec,-, ✓ c~ ,c: z J~ ~ Date - Soil Lorin 7 S~~~itable Area = 40' S2~"ie --r • ZJ T ~cJ~~ I - - - - ---~~LIUr - r - I ~ - - -r-- - p i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: ( ell, ~4 Owner's Name: r L C v fi f Owner's Address: Legal Description: I: f ~C Z Z - - ON Township: r i v .•i s County: Subdivision Name.- Lot Number: / / Parcel ID Number: 2 Page 1 Index and title Page 2 Plot Plan Page 3 _ System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance & Management Plar Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Designer/Plumber: f j r' f Ct'i ~f ~f' ~l License Number: _S Date: Phone Number Signature f Designed pursuant to the In-Ground Soil Absorption component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 /•~cJ~7~F- Pale 3 vi ~ Brian Parnell ~.~icires~ /Y~ /2 u CST 231314 Date -17- ~E ell 9uc p~ VS. soil i?urin Suitable Area 1 = 40' S, .lle I i f I ~ - - - _ T 7_ i L • - -r i I I I I f; , - - - - - - ! 1- -+-.-.i_-_-T_---.~ __.-T-__~---`-T--•f_'-T--TT I --TT --i ~__r I f , i I --T - I r I r ~ ! n ~ u 360 ~ C l L15 0, 7 S'o 70 0 3 X' 7 tic., ; -7 7 /0 SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page`of_ Project Name: Per Cell ~ No. of Cells It Cell Width Y Total No of 12 03 7 ft Cell Length S?S G sq ft EISA Per Cell L/ ft Celt Spacing C' sq ft Total EISA Manufacturer Model Laying Length EISA Rating EZ1203H-5ft 5.0' 25.0 Infiltrator EZ1203H-10ft 10.0' 50.0 i1 Graveliess Leaching Unit Manufacturer: Gravelless Leaching Unit Model: 2 u + Typical cross section Finished Grade l~~~ft Observation Pipe with approved cap or vent Soil Backfill : Geotextile Fabric ft Infiltrative Surface 12 in 0 it v ft Limiting Factor i 72 in Slotted and Anchored Ventl Observation Pipe with Cap ■ , , , ■ ■ , . , f , , . Plumber/Designer Signature: ' License 17 / Date: P O~~D~lu INSTALLATION INSTRUCTIONS kw '°"°'awakr ` " of ftM* ~ PL-5251PL-625 FILTER INSTALLATION INSTRUCTIONS 1. t t t t Center filter 1 with opening LU - - ~Addif~orCat pipe cir . _ _ ~ Pofyfok=F~ctend E~ Lod ~ Glue _ - _ for c rifenng - Ilk Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS d- I t~ 'N _ t 5 M®RPREW 0 Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back i i if necessary. into the the housing making sure D NOT USE PLUMBING I L WHEN FILTER 15 REMOVED (B) Pull the filter out of the housing. the filter is properly alighed and completely inserted. (C) Hose off the filter over the septic tank USE RUBBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover WHEN CLEANING'FIbTER septic tank. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner lc""r Septic Tank Capacity '6GG gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer '7) / o c ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) v gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) ys~i gal/day Pump Manufacturer ❑ NA Soil Application Rate C~, 1 gal/day/ftz Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODO 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ N.A. Biochemical Oxygen Demand (BODS) 530 mg/L 9-in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_10` cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size %s in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 ears) ❑ NA y' 5,year(s) y Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ; ❑ month(s) (Maximum 3 years) ❑ NA JE~ year(s) Clean effluent filter At least once every: -.7 ❑ month(s) ❑ NA Q year(s) 'aspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) = aterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) At least once every: ❑ month(s) ❑ NA ❑ year(s) O then. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (%3) or more of the tank volume, the entire contents or the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisccnsr ~dm'- strative Code. All othe- se-. ces. 'ncluding but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, art a . ciro at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service -ezz-- s- to crovided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name r (sue cs~~r' E Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone document was dra` - a7ce with chapter Comm 83.22(2)(b)(1;(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ZDDiTIONAL COMMENTS ,OWTS INSTALLER POWTS MAINTAINER r / 1;z-.to Name Name Phone Phone EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5 C Clow Phone Phone -71S - 3 0~0 -Alto~ document was dra°:e. _-c"ence with chapter Comm 83.22(2)(b)' !idi&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNE7EZSH CERTIF'"ICATTON FORM OwMerBuyer /r e r t iT Lft u Ntj~v Mailing Address 19 1 Z 5+ A'e W P\f c:h m 3n . j W j: q O) 7 _ Property Address--- `V • Y (Verification required from Plaxamg & Zoning Dept for new construction.) City/State Parcel Ident ficationNumber O - G l c~ C> LEGAL DESCRIPTION Property Locatiou Y,, J' k-" V,, Sec. Z- , T- -70 N R / LW, Town of /1, c n L9-: Certified Survey Map # Volume , Page # Warranty Deed-# Volume , Page # Spec house yes ao Lot Imes identifiable C,..? no SYSTEM MAINTENANCE AND OVVMR CERTIFICATION groper use and maintenance of Yom septic system could result in its prematare failure to bandte wastes- Proper -aintenance consists of pumping out the septic tank every thtee years or sooner, if needed, by a licensed pumper- What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system owner mar ter mce responsrbr7ities arc specified is §Conar . 83.52(1) and in Cltaptser 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Cdoxx County Planu mg & Zoning Department a certification form, signed by the ovmer sand by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewrater disposal system is is proper operating condition and/or (2) after inspection and pumping Cif necessary), the septic tack is less than 1/3 f M of sludee_ Uwe. the undezsisned have read the above regaaements and agree to rmirftin the private sewage disposal system with the s'a-2dar ds set forth, herein. as set by the Depart-m= of Comnmerce and the Depaztment of Natmral Resources, State of Wisconsin. Ce czl_;on stating that your septic system has been maintained must be completed and refined to $e St Croix County Planning & Zo_,ng Depa; tment Aithin 30 days of the three year expiration dale- Uwe certify that all statements on farm are true to the best of my/our knowledge. Uwe amlare time owner(s) of the property described above, by virtue of a ' deed recorded in Register ofDeeds Office. Number of bedrooms ALt V / Y//6 SIGNATURE F APPLICANT(S) DATE "Au y information that is misrepresented may result in the sanitary permit being zevoked by the Planning & Zoning Department _ue niter this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if -ence is made ha the wanraw-v deed. Parcel 026-1066-60-100 04/19/2016 09:29 AM PAGE 1 OF 1 Alt. Parcel 22.30.18.338B 026 - TOWN OF RICHMOND Current X1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner GERRIT A LEVERTY O - LEVERTY, GERRIT A KARI A LEVERTY C - LEVERTY, KARI A 541 N THIRD ST NEW RICHMOND WI 54017 Property Address(es): Primary * 120TH ST Districts: SC = School SP = Special Type Dist # Description SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST Notes: SP 1700 WITC Legal Description: Acres: 20.000 SEC 22 T30N R1 8W 20A THE S 1/2 OF THE SW 1/4 OF THE SW 1/4 EZ-U-1413/404 Parcel History: Date Doc # Vol/Page Type 01/27/2014 991928 QC 09/10/2013 985679 EZ-U 07/23/1997 710/358 Plat: * = Primary Tract: (S-T-R 40'/. 160''/. GL) Block/Condo Bldg: * N/A-NOT AVAILABLE 22-30N-18W 2016 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/01/2014 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 16.375 2,700 0 2,700 NO UNDEVELOPED G5 0.500 100 0 100 NO AGRICULTURAL FOREST G5M 3.000 6,500 0 6,500 NO OTHER G7 0.125 1,100 24,700 25,800 NO Totals for 2016: General Property 20.000 10,400 24,700 35,100 Woodland 0.000 0 0 Totals for 2015: General Property 20.000 10,400 24,700 35,100 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 APR '18 Wis. Dept of Safel$`rjn4R(ys SOIL EVALUATION REPORT Page of Division of ~ObI~+Wt~It ~LoP ordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must C e~ lv a ' include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I D Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 4- Ptease print all information. Rev by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 14-1, /g I Property Owner Property Location s~ C.: s~ r^ t fi L <f u -elf Govt Lot S 6V 1145 1!4 S L T G N R (or o Properly er flailing Address Lot # Block # Subd. Name or W City State Zip Code PAone Number ❑ City ❑ Village Town Nearest Road R R) New Construction Use: 25 Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe. Parent material L U' " 6 Flood Plain elevation if applicable tt. General comments C/ q, c~ and recommendations: Boring # Boring n t , M ❑ © Pit Ground surface elev. ( fL Depth to limiting factor,;;//2)' actor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/R z in. Munsell Qu. Sz. Com Color Gr. Sz. Sh. fr#1 *lfff#2 X/ A f 0,7 1,6 Boring # r❑ Boring tit Pit Ground surface elev. ` 7 ft. Depth to rtmi6ng factor> in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Onsistence Boundary Roots GPDtft 2 in. Munsell Qu. Sz_ Cont. Color Gr. Sz. Sh. *01#1 ff#2 /1`111f~111 0S /111 0' q 2 910 75 OVA C e'- 1 , 0, NA 0,7 1,6 oc~ ~I ' Effluent #1 =SOD . > 30 < 220 mg/L and T 30 150 mg/L ' Effluent m2 = BOD . < 30 moll- and TSS < 30 marl. Li23 1.3 I Address Date Evaluation Conducted Telephone Number l .3 & 2 c~ ~6ry`e%a .Z'~ 'y Z'~- /,-Ir- 747- Z-1/ 7-32C'S C ,s Z'i /y r" C e Lo ep, 17 Pared ID Page of Property Owner ❑ Boring F-71 Boring # ® Pit Ground surface elev. ~ft. Depth to limiting factor~x//o in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft z in. Munsetl Qu. Sz. Cont. Color ( Gfr. Sz. Sth. tfit`1 I= l o- S S irk /fir S t- ~y > r C w G, G L/ La 0,71 E-E i } f i f i 3 f t s l t ~ ("'t ~ u Sorng ~ ~ 8orina a }a L j pit Ground surface e}ev_ ;t. Depth to limiting factor in. i o ti - ;.on Rate Sor, Applica,i , i 1 s r z n..- i T ! }•.,...-is_ yr } 7'~1iL'}r: J 'En Da nan: ] : -ed x De5-- wuuzt i i Yniu:c i i.•iiu>::lifc ~••».n:citir~ _nr~ i tr t t { S t } } I j i } f f t 1 f t { 2 i ~ i } t i 1 I Ii i i i l i ~j ❑ x t F20t2{i iora Ground surface elev. 3t. r ep'.1;t t3 :4n1u; Q is :tot in. Fat Sot iii'iG1.Gdtiun Rate i , { F-inri-gin 1 r~e1F?Cn-ior! -`rScdox t c.i Sy_C17 2 2BX UFB 3 stiUL LUr2 ~_o nstslence zs~-indary if Pc;cly t c i i i , i 4 Eff :a^ti - 80-D, > f 22n r^ ?1 and Tc >3: 150 :rya r? ` i tiGer>t _ $0 3ci o' a? T ec < The Dept. of Safety and Professional, Services is an equal otipoi-tu fivi service prm ides and eiitolover. If you treed assistance to access services or need material in an alternate format. contact the department at 608='66-3151 or TTY through Relaz=. ssr x3zo(etlati Property Owner6 Parcel ID # Page 2 of ]Boring # ❑ Boring alt Ground surface elev. + ✓ ` Yft. Depth to iirn ting factor~'//G in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence oundary Roots GPD/ft 2 in. Munseli Qu. 57- Cont. Color Gr. Sz. Sh. M G f f % ' 'Z /ff ✓ S~ s ic, # + J ft✓ C P' S (yYt 0: is-G~' 4-1 /f/, d" 3 i ~jSy f ! t } j S 71 ; 3 r 3 t # t 9 I i. ~ i i # ~ i i i 1 - t i t t t l t 3 l i ;t I t 1 i i r 7 r- 3 L Ll Fit Ground sunace elev. ;r_ Depth to iimiiing factor in. v t l_ at- nn~a 2 a, ~Rn s^ 3 T . ~ ~ -r~: : 3*~__r. Ica:,: ~r 7 i c..ti...~ ~ i*_i~s.:i~i~ ~ ^_.i~s~~~i3i.~ ~'J'1:.'•_ c •.:JJ~ j T' ~Jlit r• 3 7 3 j- ~-i ~ ~ i 3 y i-- 7 3 _ 3 :1 3 it i - i.. ! i 4 1 i S I 1 i 1 # # ) # 7 1 t ! t t iit ( e rrt i S- C in;' r . n un'd s=:aca 3v. t'-t Yfi.. I t i 3 lv ~ ~ n .__..r.. 4'`-._.-_-..,_,_ Cad.--:-~5~^:~r~:, ?~~=_ti~a. i JL: Lt;itf -~_c?;S.`~., •^.:liFv2 F~:v,.._ i j - = t ~ i i i T t i 1 i i 3 s i i 3 s - t t t t # t t i j i { { tt l 3 f i i t S ~1 1 1 t J. - 3 _ y I 1 I I ~ - _ ~ - 1 3 ! Eff.t r:-'' _ D > ^o < ^2n mg!L f ec >3n r vv - ,nrurn- z`. - lFe;l: r - v".r. r; 'D.:L-amd -cc e-1--._ --~a 2?tw: i ie Dept. of Safest' and Frofessianall &!I-vices is an Caua; c?,0oo''-willt'r Se'-vice Jr Tvider and emrvlvver - If vo i aced cassi.S'cr273Ce w, access services or need material in an aizernate format. contact the department at 608-266-3151 or 7"i`I' through Relav. z SBr%-Yi3rJ (F:i OF F; OWNER Page 3 of 3 Name G C,-/" 1- c' Brian Parnell Address 5' ~S" _ / 2 v t7 S t CST 231314 '*-l s-y&i7 Date A Benchmark 1 ' 7 off' ~ r z"~. 1~3 ~ U v.i2 ~ ~ Benchmark 2 e. L '~rl, 2 ❑ Soil Boring -T_ Suitable Area 1 " = 40' Scale t ~ ~rl I ~ t I j I I ► I ~ j! t I ~ ~ I I I I I j I t j , ~ I j l I~ I! ' r i I I i f ~ h a i 11 ! I I i! I i i ' i I I i ~ j r~ I I T ~ I 1 ! ~ v i I ✓ ~ t ~I U ! j ~ fd ~ I ~ / I t _ f''I y, n. -01 ~0 Ii I I/A A n