HomeMy WebLinkAbout026-1009-95-000
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Parcel 026-1009-95-000 01/23/2007 04:26 PM
PAGE 1 OF 1
Alt. Parcel 3.30.18.341 026 - 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 - RANDOLPH, TODD & DAWN
TODD & DAWN RANDOLPH
1712 125TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1712 125TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.820 Plat: N/A-NOT AVAILABLE
SEC 3 T30N R18W 1.826A IN SE SW LOT 2 OF Block/Condo Bldg:
CSM IN VOL 2/402
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/03/2000 620578 1500/007 WD
03/23/2000 620079 1497/456 SD
07/23/1997 1038/63 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
176651 194,600
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.820 44,600 107,100 151,700 NO
Totals for 2006:
General Property 1.820 44,600 107,100 151,700
Woodland 0.000 0 0
Totals for 2005:
General Property 1.820 44,600 107,100 151,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 520
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTLrM REPOWl'
OWNL:tt L r,7 ~x-t__ IOWNSHIN J~ SI:C _3 t tv W
l
AUUkt1 SS it v ST . CRO 1X CUUN''Y , W LSCUNS L1V .
1AJ
SUBDIVISION _ LOT_~.f = LOT Si"LL
PLAN VIEW
Diatancee and diMeneiona to weer reyuirett►erttb Of H63
.VKH-THING WITHIN 100 FEEE'i' OF SYSTE'm
I
I di a e o th Arrow
BENCHMARK: (Par anent raterence Point) Deucrlbe :
Elevation of vertica, _reference point. iZZ/y'_ LL- Slope at bitu.
SEPTIC TANK: Manufacturer;
~2 e, Liquid Ca c 1 t
pa Y
Number of rings on cover Tank lrnanhoie cover clevation
Tank Inlet Elevation: 'iHr►k Outlul Elevation
PUMP CHAMBER
Manufacturer: Numbur of gallunb
Number of gal . pump set for a cycle balluttb , tot al alai i 1 y oF
distribution lints ba l lun b 1 zC of, puutp Ikc'ij ,
gallon per minute huruepuwei braid mute (A })uutlJ
and model number
Type of warning ev~ce
HOLDING TANK: Manufacturer Nutubut of ballou:,
Elevation of manhole cover
l'y e of warning device
SUPAKE PIT SIZE Number------ f lei is (u~ t Ali mice I
feet liquid d~,pth- tieepaee pt.t lnlel l~iE,r elCvati
bOttOnl of seepage fait el-tvat iot, tact
5HAIAGL BL:D SIZE, tlundjuL: ul i tikcb .-wldt h ~~t i~ ;r} i li j ~2 t ~k' lit h
PAL;L. TRENCH width lel%Llt
PLACOLAI°ION KAATL / _ AREA REQ01RED Ak1:A A:; fstl l t l'
try? J'J) 3~= I'I.UMlsl.i+ oN !-JJ
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOW& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL DALTERNATIVE Sim. PI.. I D. Numb.c
III 4--di El Holding Tank D In-Ground Pressure ❑ Mound
NAME OF PERMIT f{gLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE:
;Yvonne Colton 359 Odanah Ave.,New Richmond, WI
! BENCH MARK W-4.0m 0 6-- pomU DESCRIBE IF DIFFERENT FROM PLAN: J " G r e t z Subdivision REF. PT. ELEV.: CST REF. PT. ELEV.
'SE SW, Section 3, T30N-R18W, Richmond Township, Lot 2
IN.- of Plumbs 19?/MPRSW No County, Pema Number.
'Richard Hopkins 1059 St. Croix 34818
SEPTIC TANK/HOLDING TANK:
MANUFACTURERS. r LIDUID CAPACITY, TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LA LOCKING COVER
lj PROVIDED: PROVIDED.
DYES DNO DYES ❑NO
_J 76. rBEODIN - VENT QI VENT MATL.: HIGH WA NUMBER OF -
G/ ROAD: 4 1 PROPERTY WELL. BUILDING: JVE N TO FRESH
ALARM" LI AIR
FEET FROM T K
E ❑ O 'E7N NEAREST °~6 ~ / ~DOSING CHAMBER:
MANUFACTUREF4,.~_ BEDDING UOfdi4£AtA"CfTV"` PUMP MO EL, PUMP/SIPHON j1ANU TUNER LABEL LOCKING COVER
PROVIDED: _
DYES ONO DYES ONO DYES ❑NO
GALLONS PER CYCLE: PUMP AN C R L PERA IoNA UMBER OF PROPERTY WELL BUILDING V N O RE
(DIFFERENCE BETWEEN FEET FR AIR INLET
!PUMP ON AND OFF) _ YES NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture a„(tyre depth f plow)) g L ENGTN ]OIAME TER MATERIAL AND MARKING Y
or excavation. (if soil can be rolled into a wire, const Uon she! cease fintil FOR
the soil is dry enough to continue.) / MAI
CONVENTIONAL SYSTEM:
WIDTH ILENGTH NO OF UISTR PiPC SPACING INSIDE DIA *PITS LIQUID
BED/TRENCH rHENCHES 44( MAT RIALJ~ PIT - Pry,.
DIMENSIONS
t.HA L DEP FILL DEPTH UIS H I DISTR PIPE IS I A NO O R NUMBER OF R WELL BUILDINGV NT TO IBE LOW PIPES ABOVE COVEH ELEV INLE I ELEVEN
plp~` LINE AIR INLET
eq FEET FROM _jP
7 NEAREST
MOUNDS STEM:
Mound site plowed perpendicular to slope Check the` Itet ureof the fill material f PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mouns to make certai
DYES NO n that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
~ _ ❑ ✓
(SOIL COVER TEx TURE PERMANENT MAHKERS OBSERVATION WE ILLS
YE3- " ❑NO DYES ❑NO
_fPTF/ OVER TRENCH/BED DEPTH OVER TR N H/BED DEPTH OF TOPSOIL' SODDE'D' SEEDED MULCHED
~%LNTER EDGES
DYES ❑NO DYES DNO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD OISTR PIPE MANII'O MA EHIAL INO DISTH UISTR. I DISTHIBUIION PIPE MATLHIAL . III MARKING
ELEVATION AND ELEV ELEV DIA ELEV 4, PIPES DIA
DISTRIBUTION
INFORMATION HOLE SIlF HOIf SPACING IIIL LCU (IHHf OILY COVFH All HIAL VERTICAL LIFT CORRESPONDS TO APPRUVFU
PLANS
]Y NO DYES DNO
:OMMENTS: DEHMAN N 1TFfi OBSERVATION WELLS NUMBER OF PROPERTY WELL BUILDING
-1 NO FEET FROM LINE
DYES LINO DYES I _ NEAREST-
!
_ P
ilk
iketch System on
Retain in~co ty file for audit.
Reverse Side.
)ILHR SBD 6710 (R. 01/82) ,i"~
APPLICATION SAFETY & BUILDINGS
DEPARTMENT OF
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 8'/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.
Prop y Owner: Mailing Address:
7ve,
Property Location: r Township: County:
SE_ %_e, WM 3 /T_~O N/R /9 k (or) W / c ow ~ C ~rD 1
Lot Number: 11311<Noo: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
fl 'J (If assigned) 1144
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
X1 or 2 Family *State Approval Required. /l
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): 9,New ❑ Replacement ❑ Experimental eepage Bed ❑ Seepage Pit
/ . ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Y a~ Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑Public G /31 'e-
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signa M4r7GMPRSW No.: Phone Number:
,,.,gyp
C_ A-J 14 e s - 4 / S' (,;715 - A4 3Y
Plumb s Address: Name Designer: r.
COUNTY/DEPARTMENT USE ONLY
Signat e f Issuing Agent: F e: Daatt°e:" p APPROVED Sanitary Permit QNumber:
vr,~,~dl,~ V 7°~ ❑ DISAPPROVED ~Iv
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)
1' o r nI - S '1 C 10 0
Owner of Property
V Z'-
Location of Prope rty.~,f4' !4 ~4 , Section TAN R _W
Township - 14 "1
Mailing Address_, Z"- arv~ p 5'
-y- Z
, 'Lei
Subdivision Name'
Lot Number_
Previous Owner of Property
Total Size of Parcel
Date Parcel Was Created j7
Are all corners identifiable? t/-Yes No
Include with this application one of the following:
e--Certified Survey Map
.Deed
.Land Contract, or
.Other Legal Document which describes the property
I
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 3 `'~'r' t_ ; and that I (we)
presently own the proposed site for the sewage disposal system (or 1 (we) have
obtained an gasernent, 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.
Si NATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICA6LE)
DATE SIGNED/ DATE SIGNED
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BD UIIVLDINGS
ISION
INDUSTRY,
P.O. BOX 76
,LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS (H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOW HIP/QTY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
'/1/490/4 /T3o N/R i It (or) W 4-
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE S :2 y 3
NO.BEDRMS.: COMMJ_X CRI-PTION: ~P~R,OFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence Nev ❑Replace I C,~~ry{;.~ /O~`-lam- ;7- - 5J7
RATING: S= Site suitable for system U= Site unsuitable for system
-IN-F ILL NGTANK: RECOMMENDEDSYSTEM:(optional)
CONVENTIONAL: MOUND: IN-G DUNDPRESSURE: Sao_Ei_Meu
~s ❑u ~.s ❑u s ❑u Mb. s
TE: `
DESIGN RA
[.np:d.,cs. ationTests aIf any portion of the tested area is in the
H63.09(5)(bindicate:°'! q Floodplain, indicate Floodplain elevation: , 7:1
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, E OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISE/E ABBRV. ON BACK.)
7 / i / I
B 7 2;?, 7 s ~ 7 77 /1/9 A~5 4
B-
PERCOLATION TESTS
S
TEST DEPTH ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER IINCH NUTES
NUMBER ~FQS AFTEWELLING INTERVAL-MIN. ~ ERr~IO~ PERIOD 2 PERIOD 3
2-
P - Y
P- 2-
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 locatic,
of land slope.
SYSTEM ELEVATION
13, M
3
rt, 1
. _.I
0 e,
E
33 fJ
3J - A
i~7
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods spe ified 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:
AD RED S: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST S NATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DSI_HR-SBO-6395 (R.02/82) -OVER -
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