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Parcel 026-1081-30-000 01/16/2007 09:38 AM
PAGE 1 OF 1
Alt. Parcel 28.30.18.424C 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
GEORGE L & JEAN GFALL O - GFALL, GEORGE L & JEAN
1188 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1188 140TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 10.420 Plat: N/A-NOT AVAILABLE
SEC 28 T30N R18W 10.42A IN NE NE LOT 2 Block/Condo Bldg:
OF CSM VOL 3/889
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
28-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
177284 265,700
Valuations: Last Changed: 06/30/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 10.420 66,200 141,000 207,200 NO
Totals for 2006:
General Property 10.420 66,200 141,000 207,200
Woodland 0.000 0 0
Totals for 2005:
General Property 10.420 66,200 141,000 207,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 214
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 [`GEC F7G Flt a , TOWNSHIP C r. SEC T 4. N, R W
P.O. ADDRESS i `N , ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE r'`•
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4
U)
trJ ~ C1
I
U
z:
f
SEPTIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
TRENCHES NO. of width length area
BED no. of lines width ; length area
k'
depth to top of pipe
AGGREGATE
PERK RATE , AREA REQUIRED 1 AREA AS BUILT
Disciaimer: The inspection of this system by St. Croix County does not imply complete
compliance with State Administrative Codes. There are other areas that it is not possible
to inspect at this point of construction. St. Croix County assumes no liability for
system operation. However, if failure is noted the County will make every effort to
determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER
1 s
r` /
~
G(~
1
' ~
I I'(11~1 I IN,,XI ('I ION INUIVIUIIAI ,IUTA(,1 V':II A4 00
M//
,(k,( (,141I ~.20-e
Iit
Tow nbbtip
I'I I( IANK
. , yaYl'one Numbers o~ e(,mpantmentA
(nom: W(,ff ~iu4tIdiY1 12`o AYopN
H4,ghwa ten
~'(mI'M; CIfAM81-R
.'v gatl'one Pump Manu 6a c.tun elt - -Mo(Ivf Nu ad), 'I
oo i I) I N(; IANK
gaYt'on' Numben 06 C'unlpahtrn(rnte
Afanrn Sq6 tem._._.. _
H(llIf wat(1 11
I PIN S I TI.
/ r? l'nernch
7
I,(, 1, 61torn: WePY Bu4,ii dkvly _-1'1'! Atul.rv
ll.(. yhwa to n_ _
Ah',OKI' I ION S IT[ VIMENS IONS
UI.(,Ith oA tneneh ~-t R(Igw( i e d ane.a
f~~1
l,'r(((th (,each Y<ne t Depth oA hoclr ((vYnw t( I'v "N„rrili I, If (r~ Y triVA ~ Ovpth oA n(A0h PIP f(Y,'`
ePI y16( o~j Y~nvA Depth u~ td.Yv lrv('n(ar Ih~(,1('
r
I'. Iit r I>I,Cw('('Yt Yttit v6 ~t SYoCrv it tnvvt('dt
~,Ir1~~nlr((tiYt ((11,('(( II~pY (JA Gill: I'(IIJI'h n'( Nr'i~,~~ /
r. t l 11 N I ON.S /yam' OIL/
'i ,iA Cr( to GlLavee (ino(1
r
I((' Pit nrr,e Iv,( vv.pth beYow <'n Y(' fi - _ -
((r ~~I,nunl.r iun unva - - --6-t
A'~~~
1 N'. I'I I I IJ 6V TI I L I
I II CII U VA fL
I OR K( JE.CI ION
j,. State Permit #
PLB 6 7 " State and County
rmi
fy- Permit Application County Pe
for Private Domestic Sewage Systems County
`DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: ~?'/4 &E Section , T N, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
j Townships mi n c/
])ie Arai r/ /,,V /ij S
C. TYPE OF OCCUPANCY: "Com ercial "Industrial Other (specify) Variance
Single family Duplex No. of Bedrooms . No. of Persons _
D. SEPTIC TANK CAPACITY /G` l y Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation L/ Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area / S sq. ft.
New Lf Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenche
Seepage Bed:- 4t Length 6 --Width -Depth Tile depth (top) 2 ~ No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land e S, Distance from critical slope
WATER SUPPLY: Private Joint❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, 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, JJ~
NAME N / c- 4 e, r~ l 0/ /V ~ C.S.T. # y/ 3 and other information
obtained from (owner/builder).
Phone #J/5~-~y~
Plumber's Signature MP/MPRSW#
Plumber's Address '
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.
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT SE ONLY
Date of Application/Fees Raid: State~CJ C u ty Dat
Permit Issued /R jected (date) k / - Issuing Agent Na
Inspection Yes No State Valid# Date Recd
1. county (w ite 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
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