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Parcel 036-1074-40-000 07/24/2006 10:10 AM
PAGE 1 OF 1
Alt. Parcel 30.31.17.463K 036 - TOWN OF STANTON
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 - RIVARD, BRIAN D & MELINDA R
BRIAN D & MELINDA R RIVARD
1414 HWY 64
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 1414 HWY 64
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.260 Plat: N/A-NOT AVAILABLE
SEC 30 T31 N R17W .26A COM 522'E OF SW Block/Condo Bldg:
COR OF SW 1/4 E 70' ALNG N LINE OF HWY
64 N 160' W70' S160' TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
30-31 N-1 7W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/26/1998 581881 1335/310 WD
07/23/1997 1129/632 QC
07/23/1997 1120/599
07/23/1997 789/113
more...
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.260 8,000 85,500 93,500 NO
Totals for 2006:
General Property 0.260 8,000 85,500 93,500
Woodland 0.000 0 0
Totals for 2005:
General Property 0.260 8,000 85,500 93,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 138
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER- OWNSHIP_ - - -SEC.-~FVT*-R~
ADDRESS- ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/45
Stv D n
p ~ S
In di at r h rr w
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point:- - Slope at site:
SEP'T'IC TANK: Manufacturer: ofd Capacity: ~C
Number of rings on cover Tank ma4hole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
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 m/ber'of lines width~/_length.2d !tile depth
l (/~JL1~ i i ~4BUL Afz/ l e n g t h _
S,,FPAG '
RENC,PERCOLATION RATE'
AMA REQUIRED L11~1`~ AREA AS BUILT
r
n INSPECTOR
PLUMBER ON JOB
DA'1'Ell
LICENSE NUMBER
~.omti
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 ❑ALTERNATIVE State Plan I.D. Number
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE /
Ruth/Eugene Pickard RR# 1, Deer Park, WI 29-,P3- /d-30
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. IT ELEV.
SW4 SW4, Section 30, T31N-R17W, Town of Stanton
Na- of Plumber. __~MP,MPHSW No.. County. Sanitary Permit Number.
Byron Bird 1309 St. Croix 38523
SEPTIC TANK/HOLDI TANK: 1
MANU CTUR ER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
Fn .2 )6` t-C C^s C ~7
, -7f 9 ! • l ❑YES LINO -]YES LINO
BEDDING: VENT DIA.. - VENT MATL. fGH WATE ER OF ROAD: PROPERTY WELL BUILDING VENT TO FRE H
LARM F ET FROM LINE ~C IAIR~Lak
❑YES NO ❑Y S NO EAR EST 7 II j/
DOSING CH M ER:
t MANUFACTURER BEDDING. [1111111 CAPACITY PUMP MODEL PUMP; SIPHON MANU AC7URE WARNING LABEL LOCKING COVER
- PROVIDED: PROVIDED
❑YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OP 10 L. N B OF PROPERTY WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN EE TIF R0 LINE AIR INLET
PUMP ON AND OFF) ❑YES NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of I win LING Tll DIAMETER MATERIAL AND MARKING,
or excavation. (If soil can be rolled into a wire, construction shall a unt ORCE
the soil is dry enough to continue.) MAIN
1
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO. OF JDISTRE SPACING COV INSIDE UTA. -PITS LIQUID
BED/TRENCH Z TREN~4: i lAL: IT DEPTH
DIMENSIONS C
GRAVEL DEPTF F ILL FPTH DISTR. PIP DISTR PIPE DISTR. PIP ATERIAL NO DI NUMBER OF PROPERTY WELL. BUILDING'. VENT TO FRESH
BEL0 ES AB()V ' )VEH F FV IN ET ELEV END l PIPEe FEET FROM L C C AIRj~
L/ L`/~~` NEAREST-► ~ J'J C
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check th texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound s stems to make certain t t it ON REVERSE SIDE. SHOW ELEVA-
meets e crl eria for medium sand. TIONS MEASURED.
❑YES LINO
SOIL COVER TEXTURE PE A ENTMARKFRS OBSERVATION WELLS
YES LINO ❑YES NO
JUOVER TRENCH BID DEPTH OVFR TRENCH BED DEP H OF TOPSOIL SODDED SEEDED. MULCHED
CENTER EDGES.
YES LPft_NlO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO. OF LATERAL SP CING. GRAY EPTH BEL W PIPE. FILL DEPTH ABOVE COVER
BED/TRENCH TREN H S.
DIMENSIONS
MANIFOLD PUMP M I OLD DISTR. PIP MANIF LD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV ELEV.'. DI ELEV.. PIPES DIA.:
ELEVATION AND
DISTRIBUTION
CAL LIFT CORRESPONDS TO APPROVED
INFORMATION HOLE SIZE HOLE SPACING 71-LID CORRECTLY LX/ COVER MA ERIAL PLANS
❑YES O ❑YES NO
COMMENTS: PERMANENT KERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE
❑MES LINO ❑YES NO INEAREST-
5_4(1z.
0
Sketch System on in in county file for audit.
Reverse Side. r~
n="..~. SI E TITLE.
DILHR SBD 6710 (R. 01/82)
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 8% 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. The owners copy or a legible reproduction of the soil test report must be
included. AU "
i
Property Owner: . / Mailing Address:
' x / )~Jr_ / d~_ If k /671 /7 ZI <Z161 10
14,47-4 7 Prop y ation: City, Villagb or Township: County:
!
PU/ '/4,T NI"/4S jCJ iT NiR / E (or T G` , e,
Lot Number: Blk No.: Subdivision Nan-4: Nearest Road, Lak or Landmark: State Plan I.D. Number: I
/ '4,{ (If assigned)
,4 A
rt/ C.Jr Cp ~ /y
TYPE OF BUILDING
Number of I
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: I
1 or 2 Family *State Approval Required. 17
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY r i
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: WE e- .
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New .Replacement ❑ Experimental E(T'Seepage Bed ❑ Seepage Pit
3 El Alternative (specify) El Seepage Trench
Water Supply: Owner's Name as Listed on Soil Tes Report (If other than present owner):
Private ❑ Joint ❑Public
0'17,.- -f hP ~d r
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name Plumber: Signat MP/MPRSW No.: Phone Number:
Plumb e s Address: Name o Designer:
.ter 66/1 (f
COUNTY/DEPARTMENT USE ONLY
Signat re of Issuing Agent: Fee: 0 Date: Sanitarily Permit Number: C7 APPROVED ~ ❑ DMSAPPROVED ~67 ^3
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 (N.03/81)
Fu rill - S T C 1 00
Owner of Property
LOCation Of Pro ert `
P Y S-. sit) > 5 u c t i u n D `1' N It )77 W
`lownahip_ ~ ~N 0
T
Mailing Addreea -;r u, e-ivz PiCkat d
Deems 2r J,0 J., yda 2
Subdivlaion Nauie
Lot Number
Previoua Owner of Property
'total Size of Parcel 70 ,,"eeT
Date Parcel Waa Created
Are all cornera identifiable? -Yes -Nu
i
_ j
Lriclude with this dppiication one of the fulluwin~:
.Certified Survey Map
. Deed
.Land CGntrdct, or
Uther CUgai Ducuutunt which duscribus the property
PROPERTY OWNER CERTIFICATION
I (We) certify that all state17ients 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 Registur of Deeds as Document No.~ y 9 5~ _ ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an gawmunt, 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 Regiotur of Deeds, as Document No.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
.722-~3
DATE SIGNED OATS SIGNED
n
DEPAR4-MENTOF 3,r ~UI~ GS
REPORT ON SOIL BORINGS AND fLNN I ON
fIVDUSTRh, O
LARoR Af~
D PERCOLATION TESTS (115)W 7o7
HUMAN RELATIONS 69
(H63.09(1) & Chapter 145.045) LOCAT ON: SECTION: TOWNSHIP/MUNICIPALILOT NO.: BLK. NSU AV'
1/a& 14 ~ /T3 ' N/R (o COUNTY: OWNER'S/BUYER S NAME: MAILING ADDRESS: n
'gre I _59 1007
USE DATES BSERVATI S MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
A 'NJ 6esidence w, ~T ❑Neweplace All f
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
CONVENTIONAL: ❑ S LMU XS ❑U ❑ S ®U ❑ S ®U g-W&,'ti '
If Percolation Tests are NOT re uired DESIGN RATE: I If an
q any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TQT6 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DTQ+54ktL ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B ~r 7J 0~ 10,
p
B-
i
B-
7.7 "s r'4 s s v rB
&dine
B-
oD
B • / i ,lw 7 • Big' S~ , 7 i 1",4,S
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IPd.Q` AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- 11 J
I Z2
P-
P- A.7. G
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-
plot pIan. Show the surface elevation at all borings and the direction and percent
zontal and vertical elevation reference points and show Jo~~i
of land slope.
1-16, `
LEVATION' F~
SYSTEM E
n-
E ~
fi
c'~ o to ,
4
to
'0 0%
ro
x c.
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 e n 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 CO ~_PLETED ON-
ADDRESS: CERTIFICATION NU BE P ONE NUMBER (optional):
CST SI
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DI LHR-SBD-6395 (R. 02/82) - OVER -
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i- ^i a ^9 q.~ Fiji; i RO M OW RAW i Q U ~.ru°a `e, ~
jdHtF rtr3='i ,ai:;a i, rsl c' ON Wt Yell 1"rMMI MUM hallliC:lt :
I~W USe s t t it:'3 17 U UITI .Y inn q u h € ,fir w v is r, aiC,,MCV of C owm c,r.l ;)ropig;
MAX lRMt7 M omnlun of e) dr4 ones or 0t-:065 -Wl }.)lu;1E1HT
tnt a t, .x or tt iol in nt 4tjm,
HER : ,4 ,,i, Fr b .xk- A r:: IS 4t~~JI a f~F~_F: F-.-)R A HOLDING Tt;,`~9K ONLY IF Ar, SUIL CONDITIONS;
ASE we w Wa wA Rm.; Va n 1wIsy at M&F-ttj prom, {€€...E.,,Nti_=rxs 3l'tol co ar ple=iri,s the n lot p!«:
WAKE A &FW A W+ rn r,tcating 4'(} Y t .i i
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e :tYil. €".fl is' pfC.t{{.(,tg
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tofir he wi w and t a ical .Ietaiiicm }sftwonce l:'pirt are cC U? i, 1-n ghn-'
all ctj: pia , :ile ` o',',scs as rt :.1. t I'.:trlt€;,,, ad;Jl e.:ns 15cid Q&
raw, H
> ,}t;tl I t"r; ,,t{1,t' mum m <thu. .s '<n' tt+€.?, i,l#,,,...<.,„1, ,..}fiat°_r
and 1holmy as wwpTW ALL SWIL. TESTS PAUS'T BE FILED W1 W
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