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Parcel 038-1093-70-000 02i10i2006 09:46AM
PAGE 1 OF 1
Alt. Parcel 22.31.18.386C 038 - TOWN OF STAR PRAIRIE
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 - RICKARD, DEBORA
DEBORA RICKARD
2034 118TH ST
NEW RICHMOND WI 54017
= Primary
Distracts: SC School SP Special Property Address(es):
Type Dist # Description 2034 118TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.200 Plat: N/A-NOT AVAILABLE
SEC 22 T31 N R1 8W 1.20AC NW SE LOT 2 OF Block/Condo Bldg:
CSM 5/1358
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 834/164
07/23/1997 677/121
2005 SUMMARY Bill Fair Market Value: Assessed with:
119425 133,200
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.200 26,400 104,500 130,900 NO
Totals for 2005:
General Property 1.200 26,400 104,500 130,900
Woodland 0.000 0 0
Totals for 2004:
General Property 1.200 26,400 104,500 130,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 123
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BU j L`l' SANITARY SYS'T'EM REPORT
OWNER- LL-C4- T'uWNSHIP- SEC . T' / N-K /-~--W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
LOT SIZE
SUBDIVISION L0 T-
PLAN VIEW
Distances and dimensions to meet requirements of 1163
SHOW EVERYTHING WITHIN 100 U:-ET OF SYSTEM
t
r
1
011-
Ii di at N r h r 4w
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point; Slope at site:
\
Liquid Capacity
SEPTIC TANK: Ma nut acturer:
Number of, rings oti cover / Tank manhole cover elevation.'
Tank Inlet Elevation: tack Outlet- Elevation: Y,
PUMP CHAMBER 1~-
Manufacturer - - _-Number ol. 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
't'ype 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 riepth- seepage pit inlet pipe-elevation
bottom of seepage pit elevation _ feet.
SEEPAGE BED SIZE: number of lines--- width length / Y--tile deptY
SEEPAGE TRENCH: wid, h length
PERCOLATION RA`Z'E AREA REQUIRED- AREA AS BUILT
INSPECTOR
DATED ' PLUMBER ON JOB _ L I C E N S L I C E N S L N U M BER !
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN,RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOXt7969 BUREAU OF PLUMBING
ILiADISON, WI 53707
E~CONVENTIONAL ❑ALTERNATIVE State Plan ID Number
[If assigned)
❑ Holding Tank El In-Ground Pressure ❑ Mound (
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
Larry Rickard RR#2, New Richmond, WI -3 f 00
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
NW4 SE-4, Section 22, T31N-R18W, Town of Star Prairie
Name of Plumber. rP/MPHSVV N... County Sanitary Permit Number.
Cal Powers 77 1563 St. Croix 43724
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COV
PROy'IDE D: PROVIDED:
! ~z. ~j~• 6--0 16, a 9 rYEs LINO ❑Y S LINO
BEDDING: VENT Of A.: VENT MATL. HIGH WATER NUMBER OF ROAD'. PROPERTY WELL. BUILDING'. VENT TO FRESH
ALARM. FEET FROM LINE. AIR INLET.
❑YES LINO ❑YES LINO NEAREST
DOSING CHAMBER:
MANUFACTURER 71 NG. JLIQUID CAPACITY PUMP MODEL jP11MP,'SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED'.
YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PR OPERTV JWELL BUILDING I VENTTO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES LINO NEAREST 30 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILFN(,TH DAND 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'. JLINGTH JNO01 IDISTR PIPE SPACING COVER IDIA. 111T5 LIQUID
BED/TRENCH TRENCHES MATERIAL: DEPTH
DIMENSIONS
GRAVFI_ DEPTH FILL DEPTH DISTR. PIPE OtSTH. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL BUILDING'. VENT TO FRESH
BE LOW PIPES ABOVE COV ER D V LFi ELEV END. PIPES (LINE. AIR INLET_
FEET FROM
Z ONEAREST-
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
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES LINO ❑YES LINO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH. BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES
❑YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: JNO. DISTR. JD~STRPIPE DISTRIBUTION PIPE MATERIAL & MARKINGELEVELEVDIAELEVPIPES DA.:
ELEVATION AND
DISTRIBUI ION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES LINO ❑YES LINO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS l. NUMBER OF PR OPERTV JWELL: BUILDING:
LINE'.
❑YES LINO ❑Y, , 7 FEET FROM
LINO N
53
5
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE.
DILHR SBD 6710 (R. 01/82)
wlsconsln APPLICATION FOR SANITARY PERMIT
COUNTY
DILHR (PLB 67) UNIFORM SANITARY PERMIT #
~ OEPRRTTT1EnT OF
- InOUSTRV,LR90R 6MUmRn RELRTIonS
y-37~ 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
PROQERTY OWNER r MAj ING ADDRESS
O ER YrLOCATI N C1TY:
t VILLAGE:
r 111/4, S__'''" N, R (or)C W TOWN OF OT N MBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
YPE UILDING OR USE SERVED j
1 or 2 Family Number of Bedrooms. t ❑ Public (Specify):
THIS PERMIT IS FOR A:
1Z 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 ra
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
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):
i; C 1
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of private sewage system shown on the attached plans.
Name of Plumber (Pr nt): Sig fur MP/MPRSW No.: Phone Number:
Plumbe% s Address: ) Name of Designer:
d. l J
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
d-e
' _3 Approved Owner Given Initial
Adverse Determination
ason for Disapproval:
,ate course(s) of Action Available:
D-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
~i
Owner of Property ~fi~ IYC
.Location of Property/7L,!_1 Section T S',F N R W
Township
Mailing Address
Subdivision Name
Lot Number
Previous Owner of Property fF~'ti Rc) ~'cF.<<~/~, J=c"c~fv~=~~
Total Size of Parcel 0° - Z
Date Parcel Was Created lad "J
Are all corners identifiable? _ __Yes __No
Include with this application one of the followki,~:
Certified Survey Map
/'.Deed'
Land Contract, or
.Other Legal Document which describes the property
PROPERTY OWNER CERTIFICATION
1 (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. , 4F _ ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an casement, 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.
SIGNATURE OF O ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
OAT sIGNE DATE SIGN D
FAED
AI 'II► . 1 t 1 I JAZfj Ot /YAIU~ +3 8 8 J J 1 coa x., .~"•.1~
UNPLATTLD LANDS
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n UNPLATTED LANDS p assumed to bear N 1°-04'-46" E
r'° Vol. K ra/`P l1g8
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY,
LABOR AND • PERCOLATION TESTS (1151 DIVISION
RELATIONS / P.O. BOX 7969
HUMAN ` / MADISON, WI 53707
y (H63.09(1) & Chapter 145.045)
LOCATION: SECTION TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
OVNTY: OWNER'S/BUYER'S NAME: MA141NG ADDRESS:
i
USE " DATES OBSERVATIONS MADE
~~--yy NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
,C Residence Y~ EINew ❑ Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONS ONAL: MOUND: IN-GROUND-PRESSURE: SYSTEMIN-FILLHOLDING TANK: RECOM NDED SYSTEM: (optional)
❑u Qs ❑u oS ❑u OS au as ou -
F rcolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
r s.H63.09(5)(b), indicate: f / Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IS, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-
A/0411 L' s S J
B-7 -1 7
f
B- r l
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERI O 2 PERIOD 3 PER INCH
P_ 5
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
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1, 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:
-
AD SS: CERTIFICATION NUMBER: PHONE NUMBER (optional):I
I Z'/
ICST SIGNATURE:
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