HomeMy WebLinkAbout026-1065-20-000
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Parcel 026-1065-20-000 01/25/2007 11:10 AM
" PAGE 1 OF 1
Alt. Parcel 22.30.18.32813 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
O - SIMON, JAMES H & KAROL K
JAMES H & KAROL K SIMON
1492 HWY 65
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ° 1492 HWY 65
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 11.640 Plat: N/A-NOT AVAILABLE
SEC 22 T30N R18W 11.64A NE NE LOT 1 OF Block/Condo Bldg:
CSM V 4/1144
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 731/95
2006 SUMMARY Bill Fair Market Value: Assessed with:
177142 220,100
Valuations: Last Changed: 06/19/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 11.640 72,000 99,600 171,600 NO
Totals for 2006:
General Property 11.640 72,000 99,600 171,600
Woodland 0.000 0 0
Totals for 2005:
General Property 11.640 72,000 99,600 171,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 118
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form -STC - 104
` AS BUILT SANITARY SYSTEM REPOR
OWNER Jtrfi°~~e OWNSHIP Vie/ err SEC.,-2, ~ T ~ N-R /5 "W
ADDRESS ft y ST. CROIX COUNTY, WISCONSIN
1//lE't~ ' rrf9IC''r7
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 11HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
-
i -
1 I '
r I COS-
I
I
a'~r 7 tom:
I
I -
1
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used 41) rr'
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation:_ Tank Outlet Elevation: <<
Number of feet from nearest Road: Front,O Side,O Rear,
-4 feet
'.From nearest property line Front,OSide,ORear,~ feet
Number of feet from: well 7 , building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER ,
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: , Trench:
Width: / Length:' Number of Lines: s3 Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, / Side, O Rear,O Ft.~ s
Number of feet from well: I:p C.,'c
,17
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job: l /
License Number : ~a=3 /'5;~
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL EJ ALTERNATIVE slate Plan LD. Number
` (If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
/ x,1(7
NAME OF PERMIT HOLDER. ADDRESS of PERMIT HOLDER. INSPECTION DATE.
Bernard Hammelman R. R. 4, Box 41, New Richmond, WI 54017 /;,L- S
BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.. CST REF. PT. ELEV
NE NE, Section 22, T30N-R18W, Town of Richmond
Nay of PI, ml>er - -
IMPIMPRSW Nr, C~,u ty n,t,ry Per-~r Numbr:-.
Byron Bird, Jr. 3318 St. Croix 74987
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY TANK INLE'EIA V TANK OUT LET ELEV WARNING LABEL LOCKING COVER
' PROVIDED. PROVIDED
C. `z~`' FVYES LINO ❑YES LINO
BEDDING. VENT A
4
DI VENT M T I HI( ;H VVATEH NUMBER OF ROAD PROPER TV WELL J BUILDING. JAIR VENT TO FRESH
ALARM _ FEET FRO~r1 INE ~ INLET
❑YES N
O r_JYES ( NO NEARES_T_ _
DOSING CHAMBER:
MANUFACTURER BEDDING LIQUID CAPACITY PUlv1F'M1 IDE1 ;7.()N ^;IANU f A(, T 1)H E H WARNING LABEL LOCKING COVER
PROVIDED PROVIDED'
❑YES LINO ❑YES LINO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL N UMBS OF PFir P EHTV WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET R M I I AIR INLET
PUMP ON AND OFF) I-YES C_INO NEA S
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I~ ff T , uI~~ME i,r H MATE HIAI AND MAHKIN(,
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:
WI DI LT NO UE ois1H PIP( 11 vtR LIQUID
BED/TRENCH rN( EH PIT DEPTH
DIMENSIONS L I
M :O F3AVFL DEPTH FILL DEPIPE DISTH PIPE DISTR_PIPF MATERIAL NO IS1H NUMBER OF PROPERTY WELL A
BUILDING
FRESH
FE V IERN1TTOLET
BE LOW PIPES ABOVE COVER FI EV INI F T ELEV END PIPES LINE-
NEAREST
REST
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.
❑YES LINO
SOIL COVER TEXTUHE - PFif NIAN ENIMA Ii KIRS OBSEHVA nr)NVIE ILS
L_I
JYES ~N0 ❑YES LINO
D E P T H OVER THEN(:H HFD DEPTH OVER iHFNCH HFD Df P 1110E Tf)PM)IL. =0 E I) OFF DE MULCHED
ENTER EDGES
YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO. OF LA T THAL SPACING GRAVEL DEPTrI HFLOW PIP[ FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTH PIPE MANIFOLDMATEHIAL NO DISTH DISTH PIPE DISTHIBUTION PIPE MATERIAL & MARKING
ELEV. ELEV DIA ELEV PIPE S DIA
ELEVATION AND
DISTRIBUTION 1
INFORMATION HOLE SIZE HOLE SPACING, OHILL EU LOI{HL (-IIY JCOVFR MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES LINO ❑YES LINO
COMMENTS: fb PERMANENT MARKERS
J
OBSERVA TiON WELLS NUMBER OF PROPERTY WELL BUILDING
-C~' JFEET FROM LINE
C LJ YCtS ❑ NO ~ AES ❑ NO NEAREST-
41-)
,r
~r 7 3 T
Sketch System on Retain in county file for au
Reverse Side.
SIGNATURE TITLE.
DILHR SBD 6710 IR. 01/82), 111
wisconsin APPLICATION FOR SANITARY PERMIT
~ DILHR COUNTY
OEPRRTRIEnT OF (PLB 67)
UNIFORM SANITARY PERMIT #
IrtOUSTR V, LRBOR 6 NUTRn RELRTIOn- 7
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
& I,
PROPERTY LOCATION C1TY:
/'-1/4 A l_' 1/4, S 2,2 , T ~ N, R E (or) ) ~I F: r~
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME REST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
- NE C
i
TYPE OF BUILDING OR USE SERVED
K 1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: .e f
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name o Plumber (Print) Signature: IMP/MPRSW No.: Phone Number:
r 2-1
Plum is Address: Name of Designer:
4 l / C
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
D ~ /EJ / p ❑ Owner Given Initial
< ~I lk ! y__ Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.) ;
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
H
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ST C- 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
OWNER/- R 17
ROUTE/BOX NUMB ER_J~Cil C__ Fire Number C
fem
.CITY/STATE d'& /C ZIP
PROPERTY LOCATION: f 'l_ ;L, 4f_- ;4, Section T _ C N, R W,
Town of/r-<( c/ St. Croix County,
Subdivision '411o 'k) Lot" number
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 If
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. H
0
E
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- lid
ment 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,
cr-c
DATE
St. Croix County Zoning Office
P.O. Box 98'
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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APPLICATION FOR SANITARY PERMIT
S T C - 100
This application form is to be completed in full and signed by the owner(s) of the
property 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 f)t(b G
Location of Property , Section , T C N-R W
14
Township l j i ✓ { k)l 0 rZ
Mailing Address Rz' ~~~f -
Address of Site I)( / ft,
C-A
Subdivision Name -4 16)
Lot Number
Previous Owner of Property ~c G/7 l~1 i1 h~ ei: rL -
Total Size of Parcel 1Z y (L~ 5
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume Zr' and Page Number 14 c 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) cent 6y that att dtatements on this 6otcm atce ttue to the best o6 my (outs)
knowledge; that I (we) am (ake) the ownetc (d) o6 the ptco petr ty deg Ch ibed in thus
in6o,tmati.on jot[m, by viAtue o6 a wavtanty deed Aecotcded in the 066ice of the
County Registeh o{ Deedsaus Document No. and that I (We) ptaentty
own the pkoposed site 4otc the 6ewage dispo6 byztem (otc I (we) have obtained an
easement, to nun with the above desn bed ptcopeA.ty, 6otc the con6ttuct%on o6 said
syztem, and the Same has been duty ttecokded in the 0{j jice o6 the County RegisxeA o6
Deeds, ass Document No.
Gf.. +f t., •__~<r`Y.~.. ✓'f" ~ P /`A.nzC:..,r'~ L~:%%E.%`/4 lry .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
PROJECT be f," LlI z 1,17 e 1 -trn ADDRESS X t y 6/ d 4a~ c/~.~
17~-1/4/5V- 1141Sa7,21T,?eN1Rf4W TOWN m-o,,7d UNTY , G2c,;•,r
PLUMBER ISCENSE NO. MPRS3318 DATE
BEDROOM CLASS PERC--Z- CONVENT IONALIYIN-GROUND PRESSURE-
CONVENTIONAL LIFT- MOUND- HOLDING TANK_
SEPTIC TANK SIZE LIFT` TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA' PERC FATE
'.R.P H.f W fur, c,fc~~ 5- ~r x
r
47
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS (I MADISON, WI 53707
LHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/MUNICIPALI Y: LOT NO.:BLK.NO.:SUBDIVISIONNAME:
CQVNTY:, OW ER'S/BUYER'S NAME: MAILING ADDRESS:
.41
USE DATES OBSERVATIONS MADE
NO. 3EDRMS7 COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence New eplace I ~5 l l~~
RATING: S= Site suitable for system U= Site unsuitable for system 1
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-Fl LLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
S ❑U S ❑U S ❑U ❑S' U ❑S ZU
/10011
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation:' ,
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- v
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
)
? C11r) 4
P_
P- 7
91-
P_ .
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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
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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 and methods specified 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): TESTS WERE COMPLETED ON:
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ADDRESS: CERTI ICATI N NUMBER: PHONE NUMBER(optional):
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CST SI NA URE/
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
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