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Parcel 026-1071-30-000 01/22/2007 09:03 AM
PAGE 1 OF 1
Alt. Parcel 24.30.18.370B 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 - RAYMOND, DWAYNE A & PEGGY A
DWAYNE A & PEGGY A RAYMOND
1421 140TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1421 140TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 18.740 Plat: N/A-NOT AVAILABLE
SEC 24 T30N R18W SW 1/4 SW 1/4 18.74A Block/Condo Bldg:
LOT 1 OF CSM V 5/ 1206 653/167
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 653/67
2006 SUMMARY Bill Fair Market Value: Assessed with:
177198 Use Value Assessment
Valuations: Last Changed: 06/30/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 27,000 116,300 143,300 NO
AGRICULTURAL G4 10.000 1,400 0 1,400 NO
UNDEVELOPED G5 7.740 11,300 0 11,300 NO
Totals for 2006:
General Property 18.740 39,700 116,300 156,000
Woodland 0.000 0 0
Totals for 2005:
General Property 18.740 39,700 116,300 156,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 137
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
a J,
OWNER r«'A~~.~fl TOWNSHIP ~f SL'C .1`X N - ltf: W
t
ST. CROIX COUNTY, WISCONSIN.
ADDRESS
Si'LE
SUBDIVISIO h'- LOT _ LOT
PLAN VIEW
Distances nd dimensions to meet requirements of H63
YEI;YTHING WITHIN 100 FEE'T' OF SYSTEM
i
i
T-J
3
7-1
T di a e o th Arrow I
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference Point; Slope at site: SEPTIC TANK: Manufacturer:/,, Liquid Capacity:
Number of rings on cover _ rank -matluole cover elevatiurtj:
Tank Inlet Elevation: Tank Outlet Elevation, I
PUMP CHAMBER
manufacturer: Nuu►ber of gallons
Number of gal. pump setor a eyc gallons; total capacity o
distribution lines gallon: size of' pump_ - head,
arne of pump
gallon per minute horsepower bran
and model number
Type of warning rev ce
HOLDING TANK: Manufacturer, Number of Eallori5 _ _
Elevation of manhole euver_
0
iype of warning device - -
SEEPAGE PIT SIZE: Feet diduieter
feet liquid d~p-th~ seepage pit inlet pipe-elevation_-.__
bottom of eeepa~e pit~elevat~ori feet 1
SEEPAGE BED SIZE; number of lines _ dtb lei+h th/~_ Cite do p tt
SEEPAGL TRENCH : wid h i length
AREA AS BUILT
PERCOLATION RATE ' -
INSPECTOR
PLUMBER ON TbB
DATED
LICENSE NUMBER--
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR , ~C;~' SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 79§9 BUREAU OF PLUMBING
MADISON, WI 53707 ~
Stare Plan 1_D. Number.
CONVENTIONAL ❑ ALTERNATIVE
III assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER 7DDRESS OF PE HOLDER: K - INSPECTION DATE.
BENCH MARK (Perms .nt ref _ ce point) SCRIBE IF DIFFERENT FROM PLAN. 1 V REF. PT. ELEV.. CST REF. PT. ELEV.
!/q tJX4 ILL
Name Plur r MP/MPRSW No_. County. Sanitary Permit Number:
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACIT V. TANK EINLET VTANK OUTL ET ELEVWARNINGDLABEL LOCKING COVER
PROVIDPOVIDED❑YES ❑NO DYES ❑NO
BEDDINGVENT DIA.VENT MAIL HIGH WATER NUMBER ROAD PROPERTY JWELLBUILDINGVENT TO FRESH
ALARMLINE AIR INLETFEET FR❑YES ❑NO ❑YES ❑NO NEARES-~
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACI iY PUMP DEL P ION MANUFACTURER JWARNING LABEL LOCKING COVER
PROVIDED. PROVIDED-.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: ONO OPERATIONAL NUMBER OF FIUPERrv WELL Bu1LO1NG IVENTTOFHESH
(DIFFERENCE BETWEEN ! FEET FROM INE AIR INLET
PUMP ON AND OFF) Y S ❑ NO NEAREST->
SOIL ABSORPTION SYSTEM. Check the soil moisture at then~Y pthofplowing Eh~rl~ A"-"-TER IMATERIALANOMARKINe
or excavation. (If soil can be rolled into a wire, constructi shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM: _
WIDTH. LENGTH IN O. OF DISTR. PIPE SPACING; COV EH INSIDE DIA # ITS' LIQUID
BED/TRENCH ! 6 TRENCHES r f,1ArE 1AL PIT DEPTH
DIMENSIONS C-
Rr, V I I~E - TII FII L DEPTH UISTH. PIPF DISTR. PIPE DISTR. PIPE MATE IAL'. NO DI NUMBER OF ROPER TV WELL BUILDING. VENT TO FRESH
BEIO W[S ABOVECOVER ELV.1NLFT ELEV_END PIPE FEET FROM LINE' , - AIR I,144T'.
Cw7 f NEAREST-s
MOUND SYSTEM:
Mound site plowed perpendicular to slope C eck the xture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: o nd s Yrrisa to make certain that it ON REVERSE SIDE. SHOW ELEVA-
m is e for Ilium sand. TIONS MEASURED.
❑YES ❑NO
SOIL COVER TE %T URE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH: BED DEPTH OVER TRENC, D DEPTH OF SOIL. SODDED SEEDED MULCHED
CENTER EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYST /M: _
WIDTH LENGTH NO. OF LA RAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
T n;1ANIFOLD PUMP MMATERNODISTRJDISTRPIPE DISTRIBUTION PIPE MATERIAL & MARKINGFLFVELEVEPIPES. DIA.'.
ELEVATION AND
DISTRIBUTION HILL SIZE HOLE SPACING DRI LE C RREC LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS
YE ❑NO ❑YES ❑NO
COMMENTS: PERMANENT KERS. OBSERVATION WELLS NUMBER OF PROPERTY WELL. BUILDING
FEET FROM LINE.
❑YES ❑NO ❑YES ❑NO NEAREST
L r ~ ~i . `l v
Sketch System on Retain in my file for audit.
Reverse Side.
SIGNATURE TITLE
DI l_HR SBD 6710 (R. 01 /82) J--
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.
Property Owner: Mailing Address:
Property Location: C+z or Township: County: M
'/4S iT ' N/R (or) W
Lot Nu ber: Blk No. Subdivision Name- Nearest Road, Lake or Landmark: State Plan I.D. Number:
1 t1 i~ (If assigned)
~ ,r 7
TYP OF BUILDING
Number of
E] Public* ❑ Variance* El Other (specify)* Bedrooms:
QI 1 or 2 Family *State Approval Required.
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: -v L
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental CK Seepage Bed ❑ Seepage Pit
' ❑ Alternative (specify) ❑ Seepage Trench
/yam y ~
Water Supply: Owner's Name Gds Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name) ,of Plumb i er: Signat i MP/MPRSW No. Phone Number:
,r
Plurn4er', Address: , Name of Designer: l
Zj <
404iL~ -A
1
COUNTY/ DEPARTMENT USE ONLY
Signatur f suing Agen Fee: Date ❑ APPROVED Sanitary Permit Number:
S n ry i
C"f 4C ✓c~t IOIt~/O ❑ DISAPPROVED Z'gLa0~ !
Re on r 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)
DEPARTMENT OF DEPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, 1,V DIVISION
LAB0#R AND P.O. BOX 76
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707
LOCATION: SECTI N: TOWNSH P/Mt}Pd#€if ALITY: LOT NO.: BLK. NO.: SUBDIVfSION NAME:
4 /T~,~ , N/R~ (or) W
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: -
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: 115ROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
RResidence ] IK New ❑ Replace
RATING: S= Site suitable for system U= Site unsuitable for system
C NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
sEU RIS❑U ]S []U ESEU ❑SCZU J
It Percolation Tests are NOT required DESIGN RATE: SYSTE EL If any portion of the lot is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. II7HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1j
B-
IfA,
a/
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERT D 1 PERIOD 2 PERIO PER INCH
P- -
P- ' J r z )
P-
P-
P-
/PLA VIEW: 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 slop. t Cl
SYSTEM ELEVATION c~
/ .
i
36
,
the undersigned, hereby certify that the soil tests reported on this form were made by me in accord i{lt the procedures methods specified in the Wisconsin
^,dmimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAM (print): TESTS WERE COMPLETED ON:
ADDR /j CERTIFICATION NUMBER: PHONE NUMBER optional):
C=~GN U BE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
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