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Parcel 026-1022-30-000 11/15/2006 09:52 AM
PAGE 1 OF 1
Alt. Parcel 6.30.18.81 B 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 - HAUER, DUANE G
DUANE G HAUER C - HAYDEN KATHLEEN J
HAYDEN KATHLEEN J ~~tco6s
916 170TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 916 170TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.500 Plat: N/A-NOT AVAILABLE
SEC 6 T30N R1 8W 1.5A IN SW SW LOT 1 CSM Block/Condo Bldg:
VOL 2/597
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
06-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/03/2003 715752 WD
C 45/211 40 ate a 5 ~oS~~
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/19/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.500 33,800 124,300 158,100 NO
Totals for 2006:
General Property 1.500 33,800 124,300 158,100
Woodland 0.000 0 0
Totals for 2005:
General Property 1.500 33,800 124,300 158,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 135
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
`1R TOWNSHIP SEC.__(= T N, R~W
ADDRESS
X-~t ST. CP.OI COu",,.TT, WISCONSIN.
_iVIS10N LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW z"TERYTHING WITHIN 100 FEET OF SYSTE14
t
-
-
( I I
--i - -
r
,
34
i r
7
Indicate North Akrota
SCALE i
1
C TA.N?K(S) MFGR
COIIC?tETE
STEEL
' 110. of rings on Lep`t:~ _ DRY WELL
'ACHES NO. of Kidd. length ai ea
no. of li.ies ~ricatl'lengtltarea-Li
s,
dept -h to tap a p pe
.EGATE
i ' x 1R-EA AS iiUILT f
f» '
c3_aimer: The inspect:ioa of this system by St. Croix County sloes not imply complete
--)fiance kith State Administra'-ive Codes, There are other areas that it is not possible
inspect at this point: of constfi•uction. St, Croi-, County assumes no liability for
operation. However, if failure is noted the County will make every effort to
-',_'rinine cause of failure.
'.-BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
-INSPECTOR
PATER ` ) .
PLI,-,-BER ON 303
LICENSE NU21BER
i
RF"J'OI,T Or IIISPI:CTIO'_1--174DIJIDUAL SEi•IAGE DISPOSiU, SYSTEii
Sallitary Permit
r State Septic ,
.
TOt•1IvSHIP
J
` 4t.. Cro, COUnty
MEPTIC TA'?I;
Size gallons. `.umber of Compartments .
Distance From: Tell ft. 12% or greater slope i1.
Building ` ft. Wetlands f.
Ilighwater ft.
DISPOSAL SYSTL;i Tile Field or Seepatre Pit(s)
Distance From: Well
ft. 12%.or greater slope ft
Building ft. Wetlands f:.
FIELD 111lighwater ft.
Total length of lines ft. Number of lines Length of
each line ft. Distance between lines ft. Width of the
trench ~ft. Total absorption area sq, ft. Dept::
.of rock below tile in. Dp-pth of rock over tile in. Cover
nvex- . roclc-, Depth of tile below grade in. Slopo of
trench in per 100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS
Number of pits Outside diameter ft. Depth below inlet
ft. Gravel around pit: yes no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
Uquare feet of seepage pit area required
Inspected by: Title':
Approved Date 197.
Rejected _ Date 197.
EIS 1 1 5
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
F
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TEST
LOCATION: - ~ `/4l L' 1/4, Section -6, TAN, R I& Wor►'W, Township or Municipality ! L A\ w\t-, rta
Lot No. , Block No. , _ 1 G r County C ► X
c ubdivision Nth e
Owner's Name: Ste •-f - #
Mailing Address: me r\ r/ S
TYPE OF OCCUPANCY: Residence er No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS ./71 _ Al
~}-SOIL MAP SHEET SOIL TYPE 7~ :?iCAi-G I / .4 c4 y-.-,
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IERN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-1 'elQ 1V2 -5 1
P-3 4V r, / s y l
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
6
B- -
L -_2
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areass.tindicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give horizontal and vertical reference p dints. Indi ate slope. C! ce
t ,
F ~ I
I I ► i~i
4f-'
i 1
I I
' ~ I f I
- -
,
I t Z ~~V~, , , + I !
, I T f i '
t
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r x.
I, 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 location of test holes are correct
to the best of my knowledge anrv~,(_L20 f.
Name (printt~))►~ N Certification No. SS -S Z
Address
Name of installer if known
CST Signature _L__•? F i ' '
I/ I State Permit #
PLB 67 State and County Count Permit.# "
Permit Application y
` 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:
YY-N C-1 "N A
B. LOCATION: Section T__jCN, R1_S~ E (or) k Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
r Township t C1 1 ~i-
.k C e V• I A
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family -IV- Duplex No. of Bedrooms j No. of Persons
D. SEPTIC TANK CAPACITY L Q C>0 Total gallons No. of tanks 1
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 Total Absorb Area 1~ sq. ft.
New7X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: AC _Length- ~ Z ! Width. 1 7-z Depth 0 " Tile depth (top) 2 No. of Lines Z
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- & °7e, Distance from critical slope
WATER SUPPLY: PrivateXJoint ❑ 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 Teste
NAME C C.S.T. and other information
obtained from CSc~ r"~ (owner/builder). _
Plumber's Signature MP/MPRSW# Phone # l '`j 33 v
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.
E r
E
v a
.
Do Not Write in Space Pelow FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application f) %l Fees Pai
JI/ State Al < u
Permit Issued/ Date
Rgl ? r Issuing Agent Name
7T (date)
Inspection Ye~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
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