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Parcel 026-1083-20-100 01/18/2007 10:56 AM
PAGE 1 OF 1
Alt. Parcel 28.30.18.438C 026 - TOWN OF RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
03/29/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
DARYL F ORF O - ORF, DARYL F
1172 130TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1172 130TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 1093-CSM 04/1093 026/1981
SEC 28 1.1611A LOT 1 CSM V 4/1093 INC AS Block/Condo Bldg:
DESC IN WD 2807-262
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
28-30N-18W SW SE
Notes:
Parcel History:
".1 Date Doc # Vol/Page Type
05/23/2005 795693 2807/262 WD
4 05/23/2005 795693 2807/262 WD
07/23/1997 1194/363 WD
07/23/1997 866/337
2006 SUMMARY Bill Fair Market Value: Assessed with:
177301 193,700 (,-:3 7 12
Valuations: Last Changed: 06/22/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.160 29,300 121,700 151,000 NO 00
Totals for 2006:
General Property 1.160 29,300 121,700 151,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch
Specials:
User Special Code Category Amount
II
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER' TOWNSHIP., c'; EC. T,N-R,, ~W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
- VFMTHING WITHIN 100 FEET OF SYSTEM
-
f
TF
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I- ,
Trdicntr 11o Arrnw
qCAL
BENCHMARK: (Permanent reference Point) Describe:
s
Elevation of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer: f'Liquid Capacity:
Number of rings on cover an manhole cover elevation
_ Tank Inlet Elevation: F? Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cycle gallons: to--tai capacity o F
distribution lines gallon: size o pump head;
gallon per minute horsepower ran name of" pi ii7,j)
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 o pits feet diamel-er
f
eet liquid depth seepage pit in eipe-elevation..
bottom of seepage pit elevation. feet.
SEEPAGE BED SIZE: number of lines width Z,_leragth ti-le deb
SEEPAGE TRENCH: w'dth length ,
PERCOLATION RATES AREA REQUIRED' REA AS BUILT.&?,s
INSPECTOR
DATED PLUMBER ON JOB_~li
LICENSE NUMBER.---___-,~
'9
t` REPORT OF INSPEC'T'ION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit
~Q
State Septic
LAME-Oa~Y4;c --TOWNSHIP Zeze'/!51~ - St. Croix County
Subdivision
LOCATION SW 'Cz- Section Lot #
~F1''1'IC TANK
Siz g!~r" gallons Number of compartments
Uistarrce from: Well Building 12% slope
Highwater
PUMPING CHAMBER
Size gallons Pump Manufacturer `_-----Model Number-
IIULDING 'T'ANK
Size gallons Number of. Compartments
Pumper _ Alarm System
Ui st_ance from: WellBuilding 12% slope-----
Highwate.r
ABSORPTION SITE
Bed Trench
ui-stance from: Well Building__ 12% slope
Highwater----_ ABSORPTION SITE DIMENSIONS
Width of trench ft Required area ft.
Length of each line ft Depth of rock below tile------ 4, _in.
Number of lines Depth of rock over the _-_in.
Total length of lines ft Depth of tile below grade in.
Distance between lines ft Slope of trench- in. per 1-00 ft.
Total absortptdon area ft Type of Cover:
.f -
111'1' DIMENSIONS
Number of pits Gravel around pits yes no
Outside diameter ft Depth below inlet---- __f t
Total absorption area ft `
Area required ft
I NSPECTE ' TITLE
APPROVED DATE, 198
- - C-- - - - - -
REJECTED DATF 198
KEASON FOR KF. I);C'T'TON
State and County State Permit #
PLB 67 f Permit Application County Permit #
for Private Domestic Sewage Systems County -AeF L-
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required _ State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCAT N:' Sections , T QN, Rd~ (or) V Lot# - City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township Ji
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms .,_No. of Persons
D. SEPTIC TANK CAPACITY &OLI Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete-- Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT, DISPOSAL SYSTEM: Percolation Rate -AAg Total Absorb Area-7 Z sq. ft.
New. Replacement Alternate (Specify)
Seepage Trench: No. of L n~fe I Ft. Width epth Tile depth (top) No. of Trenches
No. of Lines
Seepage Bed: _Length- Width Depths Tile depth (top) v✓
Seepage Pit: Inside dia tte/r Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil
Tester
< C.S.T. # and other information
NAME 6 J Z4,
obtained from (owner/builder).
Plumber's Si nature
9 MP/ PRSW# Zi6 Phone # ~
Plumber's F.ddress
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
pp ~r ~ Fees Paid: State County Q., Date
Date of A lication i /
Permit Issued/ (date)f/ Issuing Agent Nam L~
Inspection Yes No State Valid# Date Recd
1, county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2, state (pink copy) 4. plumber (canary copy)
Revised Date 7/1 /78
NDQ NT OF f ~0 UILDINGS
INDI~S-rRYTFiY, REPORT ON SOIL BORINGS AND IVISION
LABOR AND CC / R~rF''``''CCr(~~P. X 7969
HUMAN RELATIONS PERCOLATION TESTS (11J) i - MADISON, 1 53707
LOCATION: SECTION: OW HI /MUNICIPALITY: LOT NO.:BLK. N UBDIV (P/iY&AME:
(or) W OFFICE
COUNTY})- R'S B ER'S NA E: A G ADDRESS:
USE DATES OBSER ATIO
NO. BEDRMS.: COMMERCIAL DESCRIPTION: R R TONS: ER LA ON TESTS:
Residence New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHO DINGTANK: RECOMM NDEDSYST . optio 1) J_ ! [
XS ❑u 1 [0 s ❑u 2s 1:111 as c u as u I rr
Zc""! J .
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the"' Qt(!y
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
r i
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, T , AND DEPTH
NUMB/ER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-
B- C' -7
7A Y.2 r. -2 B
B- J/ 7 y 9L 7:_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE too 1 PERIOD2 PERT D PER INCH
P- +i J
P_ ' J-. f
P-
P-
P-
PLAN 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.
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 methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (pript) : TESTS WERE COMPLETED ON:
Ale
ADDRES : CERTIFICATION NUMBER: PHON 'NUMBER optional):
CST SIGNATUR
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
NOW-6395 (N. 03/81)
-,SA) -Sze- r2o
11.41 1
i
. Wisconsin Department of Industry,
• PLB-1 INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing, Platting & Fire Protection
Name o remises Date an No.
Street City County Sanitary Permit „
Master Plumber irm Name dress
Journeyman Plumber Address
Owner Address
-
i
- - -
Discussed with Signature
( )See Attached.
DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. On-Site Waste Specialist
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner