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Parcel 026-1011-70-001 01/30/2007 03:59 PM
PAGE 1 OF 1
Alt. Parcel 4.30.18.41 B 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
WESLEY W HALLE O - HALLE, WESLEY W
1449 CTY RD K
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1767 115TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.130 Plat: N/A-NOT AVAILABLE
SEC 4 T30N R18W 1.13A SW NE LOT 1 OF CSM Block/Condo Bldg:
5/1398 683/56
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 683/56
2006 SUMMARY Bill M Fair Market Value: Assessed with:
176658 199,100
Valuations: Last Changed: 06/19/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.130 28,800 126,400 155,200 NO
Totals for 2006:
General Property 1.130 28,800 126,400 155,200
Woodland 0.000 0 0
Totals for 2005:
General Property 1.130 28,800 126,400 155,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITAit Y SYSTEM REPORT
i ~'14 OWNER LUWNStill SEC. 1' N-K w
ADDRESS ST. CKO IX COUN'T'Y, WISCONSIN
SMWIV1S.LON iA T LOT SIZE
PLAN VIEW
DisCanceS acid dlutCusiurtS to III ccC r(2 quIrumcuts of H63
SHOW EVERYTHING WITHIN 100 FE.ET OF SYSTEM
rte'
~ ~S•- I r i at
t Nr h r r r w
BENCHMARK: (Permauent reference Point) Describe:
ElcvaClon of vurt.ical reCcrcucc pUiiit:- Slope at site:
f ~
SEPTIC: 'LANK: Mauulac Lure r: Liquid Capacity:
Number of rings ou cover Tank manhole cover elevari n:
'l'ank Inlet Llevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. PUMP set tor- a cycle gallons; Total capacity of
distribution lines gc -rllon: size of pump head;
gaJLoa per minUte - hursepower ;brand nave of pump
and model number ;
't'ype of warning device-
HOLDING 'L'ANK: Ma ii ufacturcr Number of gallons
Elevation of manhole cover ;
Type of warniut device _
SEEPAC;E PIT SIZE; Number of pits feet diameter
feet liquid depth- - seepage pit inlet pipe-elevation
bottom of Seepage. pit elcvatiuu _ feet.
SEEPAGE BED SIZE: nu°uber of lines width length /J" tile dept
SEEPACt3 TRENCtI: widt i length
PERCOLA ION RATE- AREA KEQUIIt ED AREA AS BUILT
f ~~TT iNSPE,CT 0R
/
llA'lEU PLUMBLK ON JOB
t LLCENSE NUMBER -~S'G' -
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
L
I'l). BOX ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
MADISO~ESON, WI 969 53707 BUREAU OF PLUMBING
PP~CCNVENTICNAL ❑ALTERNATIVE State Plan l)D. N-ber.
(It
Holding Tank El In-Ground Pressure D Mound assigned
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE:
William Mc Nally RR#2, Box 270A, New Richmond, WI 54017 6
a _31
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT. ELEV..
SW NE, Section 4, T30N-R18W, Town of Richmond
Name of Plumber. MP/MPRSW No.. County Sanitary Permit Number.
Cal Powers 1563 St. Croix 49425
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. POV ARNING LABEL LOCKIN C
1 -v r) IDED. PROV E
YES ❑NO ES ❑
BEDDING NO
. VENT D A.. VENT MATL. JHIGH WATER NUMBER OF ROAD. PR OP ERTV I WELL: BUILDING. VE T TO FRESH
fl~ jFJ
ALARM FEET FROM LINE. f AIR INLET.
❑ YES ❑ NO 4/r*! ❑ YES ❑ NO NEAREST ( ' f•<~
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACIFV PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL EPROVIDIED
NG COVER
PROVIDED: DY❑NDYES ❑N
YES ❑NO
GALLONS PER CYCLE: P AND CONTROLS OPERATIONAL NUMBER OF PROPERTY JWELL G VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ❑NO NEAREST 1110
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LFNGTII 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:
BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER JINSIDE DIA aPITS ILIOUID
THE INCHES MAT RIAL, PIT DEPTH
DIMENSIONS 12 IO - - / r:
GRAVEL DEPTH FILL DEPTH DISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL. N D 1 H. NUMBER OF PROPERTY WELL. BU LDING. LAIR ENT TO FRESH
BF LOW PIPES ABOVE COVER Ell EV. NILE i ELEV END PIPE'` LIN ( INLET.
a FEET FROM NEAREST ► ~GV~ t q~C~7~f ~JvT
MOUND SYSTEM: ~.~.J f c4
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-
DYES ❑NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS.
DYES ❑NO DYES ONO
DEPTH OVER TRENCH: BED DEPTH OVFR TRENCH,'BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES
DYES ❑NO DYES DNO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO, OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV.. CIA ELEV.' PIPES. DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ❑NO DYES ❑NO
COMMENTS: ___]_PERMANENT MARKERS: J OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
l~ DYES ❑NO DYES ❑NO NEAREST
rr
w~0 "
o `Y
S
B.~
Olk . ~I>
l N
'Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE ~ TITLE
-)ILHR SBD 6710 (R. 01/82)
wisconsin APPLICATION FOR SANITARY PERMIT
,1L)t D 1 L H R (P L B 67) -Yjl - COUNTY
OEGggTfrlEnT OF
9~ mouSTRY,Lg9og6HUmanRELqTrons UNIFORM SANITARY PERMIT #
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
yy PROPERTY OWNER \ l MAILING ADDRESS
J.I i {
PROPERTY LOCATION
J01/4 1/4, S T M] N, R ;'in' ~(or) W To N OF: 1~. (C~\ arc
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
7 1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision I❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
n 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
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity y~.r,•
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: t..v
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
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):
7 v' Q Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (P Signature
/~M.RSW No :
} ?uJL r' rl
I Y-\
Plumber's Address: L
Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: 74- Yck. ❑ Disapproved
/ t ❑ Owner Given Initial
c, !O ~1Z -p 7 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.
Form - S T C 100
Owner of Property
~r3c yj~
,Location of Property j ,
Section T N R W
Township
Mailing Address 1& A?/10
Subdivision Name _
Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel Was Created
Are all corners identifiable?
Yes No
Include with this a lication one of the followie~
Certified Survey Map
/
Deed
.Land Contract, or
.Other I:egal Document which describes the property
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) em (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No.~ qi's`
presently own the proposed site for the sewage disposal syste; an that I (we)
m (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County R )star of D as Document No.
iIGNATuRE F OWNEq
j SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED
DATE SIGNED
• f
unplatted lands i
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CENTERLINE TOWN ROAD L2
NORTH-SOUTH 1/4 LINE N00°2/° "
SOOo24'35"E 210.00' W N
W 1493.51'
N TOwn Road easement - N
- SOOo24'35"E
S000241 4311E
210.00'
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.RTMENTOF REPORT ON SOIL BORINGS AND
,,i[)USTRY' SAFETY & BUILDINGS
LABOR AND , i P.O. BOX 7969
PERCOLATION TESTS ( / 1151 DIVISION
HUMAN RELATIONS (H63,090) & Chapter 145.045) ` / MADISON, WI 53707
LOCATION: SECTFN: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDI~LSION NAM E:
~/4A")F/ f /T c N/N / (or) W c \"V ~Vl t~,
COUNTY: OWNER'S/BUYER'S NAME:
MING ADDRESS:
_S11 Cr cm ` 5
USE l
NO, BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSE VATIONS MADE
Residence XNew ❑Re lace PROFILE DESCRIPTIONS: PERCOLATI N TESTS:
Lx y
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE, SYST EM-IN-FILL HOLDING TANKrREC-06-MM EN DED SYSTEM:(optigna1)
ES ❑U NS LIU MI S ❑U ❑S U [is ~U = rL Ifsn4,c,~t~ /
If Percolation Tests are NOT required DESIGN RATE:
under s.H63.09(5)(b), indicate: t1(! If any portion of the tested area is in the
y /T I
Floodplain, indicate Floodplain elevation: L
PROFILE DESCRIPTIONS -l
BORING TOTAL Ct~' X /r~C
NUMBER DEPTH IN, ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE - ND DEPTH
OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
q~ll
b~r 5 L' i 1 hn
/d S. ? L)
A0 ;7
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTT IME DROP IN WATER LEVEL-INCHES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. RATE MINUTES
PERIOD 1
P D2 RIOD 3 PER INCH
P
d. j ,V 3/ y~
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 horn
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
E. i 1 ao a - W ham. I ~ ,t ~ ,
j4i~•
I f
CJ CP
r
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o r• ~ j3"', _ t
lix 3
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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 Wisconsii fi
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME ( rint):
1 TESTS WERE COMPLETEDON:
t li k ,y\ Jt.J Irt! / - 1f""Y
ADDRESS:
r' : CE TIFICATION NUMBER: PHONE NUMBER (optional):
k3 a C'h ' ~J s S yc 17 5--,5-,;l 7/_!~ -
t' r
CST, IGNATURE:
'w
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DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
'i ~-SBD-5395 (.R.. 02/82)
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