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Home My WebLink About026-1014-70-001 r n to O 3 v n r~ d c a m O T 1 X0_1 I co 3 ~ ~ ~ 3 owl m n O N Ni O z P. 7: ;u c) p O tD 0) - A N °C f =r 3 C: =Or `x. • j a z a m 0 -4 co 3° X o O C 3 co 7 7 90 C) :3 CD CD I C n CD n ° o o 0 3 0 _ f o O~1 N fA ' _ lr Cr- D O v U> ~ D CT) in a ' m m ~ I T co 3 a O N V O O C co CO N A CD N .°rr co o "WA • z ? 3 < z o f 3 Vi vi CA L II ° D Q. w 0 O t71 v N fD a N z co z O D CD O ~p "A ~Ay • N N c ry CD m N c Q :3. m V Q w a a 3 E z m co -I fn O p Z m N c N N CL A C 7 O U) -i ao~ mw 0 z ° 3 a ~ ° » cn H co z m a w ~ I a Q T N c 111 0 0. CD N y i ~ i C V A A i O N O O V A 0 w O S d0 W 69 0 \ a O * b O i Parcel 026-1014-70-001 01/30/2007 03:50 PM PAGE 1 OF 1 Alt. Parcel 4.30.18.50G 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 - MUSTA, RANDY M RANDY M MUSTA 1705 112TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1705 112TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.320 Plat: N/A-NOT AVAILABLE SEC 4 T30N R18W SE SW 3.32A LOT 1 OF CSM Block/Condo Bldg: 5/1397 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 12/21/2004 783057 2719/119 QC 07/23/1997 855/14 2006 SUMMARY Bill Fair Market Value: Assessed with: 176699 232,700 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.320 46,400 135,000 181,400 NO Totals for 2006: General Property 3.320 46,400 135,000 181,400 Woodland 0.000 0 0 Totals for 2005: General Property 3.320 46,400 135,000 181,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/04/2005 Batch 05-27 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT W SEC . T OWNER TOWNSHIP " j,f) N-R ADDRESS fJ ST. CROIX COUNTY, WISCONSIN ) ~SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FGE1 OF SYSTEM , r _ ~i ~i INDICATE NORTH ARROW ~1j, BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point:.,") Proposed slope at site: ~z_-_- SEPTIC TANK: Manufacturer: Y, iquid Capacity: Number of r'ngs used: Tank manhole cover elevation: L/r, Tank Inlet llevation: Tank Outlet Elevation:',,, _ Number of fEet from nearest Road: Front, (D Side 10 Rear, 0 %✓'Q feet From nearest property line : Front,O Side „y Rear, O 7 feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER « i 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, 0 Rear, 0 Ft. Number of feet from well: i Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench Width: Length: Number of Lines: Area Built:^ Fill depth to top of pipe: i Number of feet from nearest property line: Front, Side, Rear, O Ft._ Number of feet from well: Number of feet from building: Ji (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, 0 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: License Number: 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 ®CONVENTIONAL ❑ALTERNATIVE s,ata Plan 1. D. Number (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE. GeAatd Hcufvieux R. R. 2, New Richmond, W1 ~ - rl BENCH MARK W-anen, reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV. SE SW, Section 4, T30N-R18W, Town ob Richmond Name 10 Plumber. JMP,MPRSW No. County Sani,ary Permi, Number- Catvin Powers 1563 St. Cnoix 49417 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER _y PgOV ED. PROVIDED; - / YOI~V_C/ 100,3 } ?YES ❑NO ❑YES(/❑NO BEDDING'. VENT DIA VENT MAT L. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT TO FRESH ALARM LINE AIR INLET. FEET FROM JS _ [DYES NO c / ❑YES ❑N0 NEAREST /d0 v DOSING CHAMBER: PROVIDED: PROVIDED. MANUFACTURER BEDDING: 5N ACITY Othedephof UMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER ❑YES ❑❑YES ❑NO IL ❑YES ❑NO GALLONS PER CYCLE: PuMPAL NUMBER OF PHOPERrv wELDING IVE NTTOFRESH LINE AIR INLET(DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) NO NEAREST-~ SOIL ABSORPTION SYSTEM. Chsture at LFNaTH JDIAME T 11H 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 DISTR. PIPE SPACING. COJINSIDE DIA ttpITS LIQUID BED/TRENCH n TRENCHES M IAL PIT DEPTH DIMENSIONS /j GRAVEL DEPTH FILL DEPTH OISTH. PIPE 'DISTR. PIPE DISTR. PIPE MATERIAL. NR. NUMBER OF PROPERTY WELL BUILDING. VENT TO FRIES, BELOWPIPE~j ABOVE COVER ELEV. IDLEL ELEE1 END PI FEET FROM p jLINEE 7 Q AIR ET f 7 NEAREST L/C/ ✓ l~ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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 ❑NO PERMANENT MARKS OBSERVATION WELLS SOIL COVER rexruRE ❑YE ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCT BED DEPTH OF TOPSOIL SODDE9 SEEDED MULCHED CENTER EDGES ❑YE NO. ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: r ` FILL DEPTH ABOVE COVER WIDTH. LENGTH. NO. OF LATERAL SPACING. GR VEL PT BEL PIPF. BED/TRENCH TRENCHES: fj DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MA ED MAT I L: NO. CIS R. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.. DIA. ELEV.. l PIPES. DIA.'. ELEVATION AND j✓~ DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. COMMENTS: FEET FROM LINE ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. sIGNAruRE TITLE DI L H R S B D 6710 (R. 01 /82) Wisconsin APPLICATION FOR SANITARY PERMIT DILHRCOUNTY (PLB 67) UNIFORM SANITARY PERMIT # oEPL1RTTT1EnT OF InOl.:STRV, LF#BOR 6HUTRn REIGiTlOnS I~ , J/ ,y -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 PROPERTY OWNER MAI G ADDRES PROPERTY LOCATION' 1/4 /4, S T 30 , N, R/S AD0 W TOWN F: 6'Arn01)4 -510 LOTAN~UMBER BLOCK NUMBER SUBBDIIVI ION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER A/A f V v ~.~3 TYPE OF BUILDING OR USE SER D X 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: 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. X 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 70-6 40 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: r At7 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): 5.3 Its s f of bo Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N e of Plumbe Print): Si Mature: 40/MPRSW No.: Phone Number: Plumber's Addres r ame of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved D Owner Given Initial 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 '1' C 100 Owner of Property C` Location of Property S e c t i o n____t'_~// T N R f V W Township /c-'/V , Mailing Address c~ i;~f ;'e- r- 641 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel_ 119- <-~'%t S Date Parcel Was Created Are all corners identifiable? Vyea No Include with thia a lication one of the follOwin .Certified Survey Map .Dead .Land Contract, or .Other Vagal 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) am (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. own the proposed site for the sewage disposal system (or I (we) have obtained an Basement, 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 Register of Deeds, as Document No.. iIANATUR[ Of OWNfcq - SIWNATURE OF CO-OWNER (IF APPLICABLE) OAT[ SIONEp JJ OATS 51aNEO ! - 51 1-tiz Jt~ I~ - i -t' i I I Cey ` W l I , r r , P j1D - i j]{ I - a i i, f P!J'1i i it • P ~ ' DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDNISTRY; DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HU11,IAN RELATIONS \ / MADISON, WI 53707 • J ` ` (H63.09(1) & Chapter 145.045) LOCATION: SECTION :T R/3 TO NSHIP/MUNICIPAL TY: LOT NO.: BLK. NO.: SUBQAVISION NAME: S ki N/(or)W CY\,Y\U% h+~ COUNTY: OWNER'S/BUYER'S NAME: MAILIN ADDRESS: St r X G% e !--A~ El v L.0, S C_ Sy ®l ? USE DATES OBS RVATIONS MADE L% _3 - / NO, BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence New ❑Replace /7-:,y RATING: S= Site suitable for system U= Site unsuitable for system ME NTIONAL: =jN- -GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) is ❑U CIS ❑U ❑ S 1 ZU ❑ S INU 0 n o_,-, n 4 ; (,),Z l If Percolation Tests are NOT rff~DES~IG~R TE: I If an do y portion of the teste d area is in the V under s.H63.09('ts indicat. Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, T TURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON CK.) B-I ~d 91)1~sg m B-OZ g r C) ~~y, 7 6-1.9 5rl I -7 5/ B B st19A 15 e„ 5,1-75 „ B- 1 INv 7 D,8 ~ .8-j~ 5, 6n ~21 L~~ls1C~n (d,U- 1 B 7 o - s ( s z ) , s - .s / Broke,, L PERCOLATION TES YS 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 P- 0 v3 CU 5 3 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 ° j a 7• ~ E z E p tl .5ca1e I ills ` - 36 LC i z - t ~q 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 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: IoIn Pars ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CS~~N TURE a DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Ter_er. ino i,Ai c xs,~ _,a€', J E1S(. -<.O.. tti Cs ,Y, o?a,, ^ o a, }Y. ..t3 U3tif tirl CE? s a ;io, '1) dou-, n,Ot r 1. € t t? 9 r. E r s c c.ev' ,.,.6