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Parcel 026-1071-20-200 01/24/2007 08:39 AM
PAGE 1 OF 1
Alt. Parcel 24.30.18.370A-20 026 - 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): O = Current Owner, C = Current Co-Owner
NATHAN J & MYA D SCHULTZ O - SCHULTZ, NATHAN J & MYA D
1422 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1422 140TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 6.590 Plat: 4538-CSM 17-4538 026/03
SEC 24 T30N R18W PT SW SW CSM 17-4538 Block/Condo Bldg: LOT 02
LOT 2 (6.590AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-30N-18W SW SW
Notes: Parcel History:
Date Doc # Vol/Page Type
04/26/2006 823672 WD
06/26/2003 727426 2289/123 QC
06/12/2003 725495 17/4538 CSM
2006 SUMMARY Bill Fair Market Value: Assessed with:
177197 Use Value Assessment
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 2.000 40,500 104,700 145,200 NO
AGRICULTURAL G4 4.590 600 0 600 NO
Totals for 2006:
General Property 6.590 41,100 104,700 145,800
Woodland 0.000 0 0
Totals for 2005:
General Property 6.590 41,100 104,700 145,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
~q
► AS BUILT SANITARY SYSTEM REPOR'T'
j,c TOWNSHIP SEC . `T N-R/W
OWNER Pig
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOTS _ LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEE'T' OF SYSTEM
--T-r T-
~L f r
I d at N r h rr w
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: `a -Slope at site:
SEPTIC TANK: Manufacturer:J11I.114 Liquid Capacity:
Number of rings on cover 'rank manhole cover elevation:
'l'ank Inlet Elevation: Tank Outlet Elevation: ~S S"1
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle ____-gallons; Total capacity of
distribution lines gallon: size of pump _ _ head;
gallon per minute horsepower-__ ;brand name of pump
and model number
Type of warning device _
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device -
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width length,~_tile depth
x
SEEPAGE 'T'RENCH; width length
PERCOLATION RATE AREA REQUIRED__:~71,_~ AREA AS BUILT_ yS
s--~'-L tom-
INSPECTOR
~~i /C~c4['.E-L`rtl
DATED PLUMBER ON JOB
LICENSE NUMBER_ 6- _
0EPAH iMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR &7HUMAN RELATIONS
P,O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION
BUREAU OF PLUMBING
MADISON, WI 53707
EiCONVENTIONAL ❑ALTERNATIVE State Plan l.D Number.
Holding Tank 1:1 In-Ground Pressure 1:1 Mound (If assigned)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPEC ON DATE.
Robert A. Hendricks R# 1, Box 398, Star Prairie, WI
BENCH MARK (Permanent reference Pomti DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV
SW SW, Section 24, T30N-R18W, Town of Richmond
Name of Plumber. MP/MPRSW No.. Cou my Sanitary Permit Number.
Cal Powers 1563 St. Croix 38467
SEPTIC TANK/HOLDING TANK:
MANUFACTURER
. LIQUICAPAC TANK INLET ELEV.. TANK OUTLET E 'V.. WARNING LABEL J LOCKING COVER
~l PROVIDED PROVIDED
t L ( ❑YES LINO ❑YES LINO
BEDDING: VENT IA' VENT TL.. HIGH WA ER NUMBS OF ROAD. PROPS Tv WELL. BUILDING: VENT TO FRESH
ALARM. FEET FROM LIN I AIR INLET_
❑YES LINO ❑YES LINO NEAREST°~~
DOSING CHAMBER:
MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP;'SIPHON MANUF AC TUREH WARNING LABEL LOCKING COVER
PROVIDED. PROVDED'.
❑YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY 111111-1- BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES LINO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing evcTh- 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:
WIDTH LENGTH NO. OF DISTH. PIP SP LING COVE R
BED/TRENCH TREK Es f JI NSIDE CIA -PITS uoulD
DIMENSIONS f" ArERIALt PIT DEPTH
G RAVEL. DEPTH FILL DEPTH DISTH PIPE -I 6 IISTH. PIPE DISTR P1p EATERI NO DISTH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW P ES ( ABOV C R ELE_~` / V. END(L~/'.~ PIP L LINE} / AIR INLET
FEET FROM NEAREST -s o
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PR VIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that i O REVERSE SIDE. SHOW ELEVA-
meets the criteria for . edium sand. T NS MEASURED.
❑YES LINO
SOIL COVER TEXTURE JPEHM ENT MARKERS OBSERVATION WELLS
❑YES NO ❑YES LINO
DEPTH OVER TRENCH .BED DEPTH OVER -TRENCH /RED DEPTH OF TOPS OIL. S DDED SEE D JMULCH ED
"ENTER EDGES.
L_ YES NO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH INO. OF LATER L SPAC G'. G AV L DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BEG/TRENCH TRENCHES.
DIMEC ;IONS fr
MANIFOLD PUMP MANIFOLD DIS R. PIP M OLD MATERIAL NO. DISTR DISTR. PIPE DISTHIBUT ION PIPE MATERIAL & MARKING.
ELEVATION AND ELEV.. ELEV.' DIA. EL V.'. PIPES DIA.:
DISTR IBUTI IN A
INFORMATIOi,~ HOLE SIZE HOLE SPACING DRILLED CORRECT Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
❑YES LINO ❑YES LINO
COMMENTS: PERMANENT MARK SRS: OBSERVATION WELLS: TNEIAR
MBER OF PROPERTY WELL: BUILDING.
ET FROM LINE:
"1 ❑YES LINO ❑YES LINO EST
I
-
r , Al
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE. v
DILHR SBD 6710 (R. 01/82)
r
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 81/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Pro rty Owner: Mailing ddress:
b
roperty Location: / City, V~Jflge or Township: County:
'/a '/aS ! ~T,3 NCR It (or) W '
14 ) Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(if assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)*_ ./p'/' - Bedrooms:
1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY '
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as 'sted on Soil Test Report (If other than present owner):
Private ❑ Joint El Public f
I, the undersigned, hereby assume responsibility for installation of the private sewa system shown on the attached plans.
Na of Plumber: Sign e: MP/MPRSW No.: Phone Numbe
Abli ,.4, 6A
s Address: Nam Designer: !
2Plum
1 1 ! !
r
COUNTY/DEPARTMENT USE ONLY
Signatu a of Issuing Agent: Fee: 6L..0 Date: Sanitary Permit Number:
.APPROVED
(5 , 4 El DISAPPROVED
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, i R C DIVISION
LABOR AN P.O. BOX 76
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707
LOCATION: SECTION: TOWNSHIP/MEIiV+C-+PAttTY: LOT NO.: BLK. : SUBDIVIS ON NAME:
COUNTY: OWNER'S/BUYER'S N ME: MAILING ADDRESS:
i J
USE / DA S OBSERVATIONS MADE
NO. BEDRMS.: COMMER IAL DESCRIPTION: R D ONS: ER A ON TESTS:
Residence N ® New ❑ Replace
~T 6
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUNcD: ''II IN-GROUNND-PRESISIURE: SYSTEcM-IN-FILLHOLDIING TANK: RECOMMENDED SYSTEM: (optional)
S ~J ❑V OS E]V E]J OS U
If Percolation Tests are NOT required DESIG RATE: SYSTEM EL V.
It any portion of the lot is in the
under s.H63.09(5)(b), indicate: a
41 ,
',i ( Floodplain, indicate Floodplain elevation: ti
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- I _ _
~ 19114-
B- >
s -
S
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 PERIOD 2 PERIOD 3 PER INCH
P
61 1 -Z
P- iS'• S'
P-
P-
s T f
7
k~kW:'~Show _ 7d- 4x
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 slop.
SYSTEM ELEVATIONS
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wiscon;
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME !print): TESTS WERE COMPLETED ON:
ADDREgS: CERTIFICATION NUMBER: PHONE NUMBER
ATU,
A
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
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