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Parcel 026-1088-30-000 06i07/2005 08:03 AM
PAGE 1 OF 1
Alt. Parcel 30.30.18.461 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): * = Current Owner
* VAN DYK, HENDRIK W
HENDRIK W VAN DYK
931 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * =Primary
Type Dist # Description * 931 140TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE
SEC 30 T30N R18W THAT PT OF NW NW LYING Block/Condo Bldg:
E OF WILLOW RIVER
- Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
30-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 736/168
07/23/1997 593/255
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/07/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 22,500 261,600 284,100 NO
PRODUCTIVE FORST LANC G6 9.000 16,200 0 16,200 NO
Totals for 2005:
General Property 10.000 38,700 261,600 300,300
Woodland 0.000 0 0
Totals for 2004:
General Property 10.000 38,700 261,600 300,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 219
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 026-1088-30-000 06/26/2006 10:39 AM
PAGE 1 OF 1
Alt. Parcel 30.30.18.461 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 - VAN DYK, HENDRIK W
HENDRIK W VAN DYK
931 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 931 140TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE
SEC 30 T30N R18W THAT PT OF NW NW LYING Block/Condo Bldg:
E OF WILLOW RIVER
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
30-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 736/168
07/23/1997 593/255
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/07/2002
II~ Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 22,500 261,600 284,100 NO
PRODUCTIVE FORST LANDS G6 9.000 16,200 0 16,200 NO
Totals for 2006:
General Property 10.000 38,700 261,600 300,300
Woodland 0.000 0 0
Totals for 2005:
General Property 10.000 38,700 261,600 300,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 219
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
A
1
• AS BUILT SANITARY SYSTEM REPORT
OkXIER TOWNSHIP SEC. T N, R W
ADDRESS , ST. CROIX COUNTY, WISCONSIN.
_DIVISION LOT LOT SIZE
PLAN VI EW
Distances b dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Indicate Nozth Arrow _
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CALF
,,PTIC TAbT(S)_--L_ MFGR.
JL_
CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
1rLNCHES NO. of - width length area
l no. of lines width length area
depth to top of pipe
~G IIEGATE
4'~W, RATE AREA REQUIRED AREA AS BUILT
Aisciaimer: The inspection of this system by St. Croix County does not imply complete
capliance with State Administrative Codes. There are other areas that it is not possible
AQ inspect at this point of construction. St. Croix County assumes no liability for
sjStem operation. However, if failure is noted the County will make every effort to
Attormine cause of failure.
:;P'ASES A'JD OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. +
'-INSPECTOR
DATED PLG';iBER ON JOB
LICENSE NUMBER
1
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REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitatcy Permit
• State SPp-tic
NAME i owns hip St. Ctcoix County ~
Location ✓ / 1 Section
SEPTIC TANK j
I
Size gatton4. Number o6 Compartments I,
Distance From: Wett it. 12% otc gtceate& 4tope it
Suitd.ing it. Wettand~s ~ .
H.ighwater it.
DISPOSAL SYSTEM .
D.i.dtance Ft om: Wett S 12% on greater 4tope it.
Suit ding it. W ettands Ft.
• H.ighwatetc 6t.
FIELD DIMENSIONS:
Width o6 trench it. Depth o6 tcock below t.ite in.
Length a6 each tine it. Depth o6 rock oven t.ite in.
Numbet oS tinu Depth o6 t.iZe below grade .in.
TotaZ length o6 Una it. Stope o6 trench in pets 100 it.
Distance between Zine/s it. Depth to bedrock it.
Totat absorb.tion area 6t2 Depth to gnoundwatetc it.
2
Required area it Type oi Covets: Papetc or Sttcaw
PIT DIMENSIONS:
Numbers o6 pit/s Gtsavet. around pits yets no
Outside diametetc it. Depth below ,inte,t it.
2
Total. ab6orbt on area it A
Area required it2
INSPECTED BY TITLE
APPROVED DATE 197.
REJECTED DATE 197
t
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EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
' P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON~rSOIL BORINGS AND PERCOLATION TESTS
LOCATION: I~ E'/4,N- Section 30 , TRN, R& E (or) W, Township or Municipality /f
Lot No. , Block No. r County C"ey
,rVP/?' L (V L+ f V4N ,~yy Subdivision Name
Owner's Name: I~
Mailing Address: 19TTC~Ey~Sj v E(•y/~/j~iYC~'~?~~/x s 7~/
TYPE OF OCCUPANCY: Residence X No. of Bedrooms ! Other
EFFLUENT DISPOSAL SYSTEM: NEW 7C ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS fiki/ J-6e PERCOLATION TESTS
SOILMAPSHEET~~' _ SOILTYPE BXL)Z
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IACTERN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P_ 3( 6 A &;Y. 11V S'/ ~ a " z f . S/ 9 T~+~ ~ .11.1 -
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P_ 3y 12e. XV op.},v5e Trvi 1A ~ESs / Ess ~4,0
w `oar i~t1 vT
P- 3 32 u>> y , l1 " C' aRA~fGE S , c , tF .
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)
B_ 77.- NPAle P' 7-- 3 " AX AV S/ 1. tf 5~ /Z- e.6N. S cv I^.
z '7i ,V0AlE > l 2 d • l3u S~ z „ 1_f. 4,v S/ AV,- t/. fl v S"
3 72- 4/avE T), /s^ 10*1 V S B Si r z c. yr 5 w h.
y 12 ilO~Nt > 72 " GrF Bw
B 5 ;71 1110 E 7A ~vs; 30 "41ys~' 4,,. or. S.
Co 7z AIOVE- > 7:2_ i 'ok.Q,v 3/ y` `'L/•/YN s/ z~„ C. cir. S.
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number f square feet of absorption area
needed for building type and occupancy. 6~ " T/Q5w« ,~Z17 62g Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
.
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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 and belief.
~~~6` 211h 1*(hT- Certification No. ~
Name (print►.
Address (d . )ff/ &bp.Sry (~V/y
Name of installer if known
CST Signature ~Zc
°'?~~tgTY
y State and County State Permit #
PLB 67 Permit Application County Per i#
for Private Domestic Sewage Systems County r~
"DENOTES STATE APP,ROV.AL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: 454-: '/4) '/4, Section , T_ es N, R, E (or) ~W Lot# City
Subdivision Name, n rest road, lake or landmark Blk# Village
t fib ~ ~ 6 ,K, rL, ~ 6 Township ICh~lGf L~~~~
C. TYPE OF OCCUPANCY: Commercial `Industrial 'Other (specify) `Variance
Single family _ Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY 2- Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete- X__ 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 L sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. IPidth DgPth Tile depth (top) No. of Trenches
Seepage Bed: Length_Width Depth Tile depth (top) No. of Lines 3
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land 3~ 44 k 4' '-I c 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 rtified Soil Tester,
NAME ~ o 0 L T ' L 1_ C.S.T. # . and other information
obtained from ry~w'~ t-~ ►C (1A l (owner/builder . /
Plumber's Signature .ri / Phone
MP/MPRSW# #3
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.
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Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application t Fees Paid: State ) 00 Conty 0 Date / J
Permit ISSUediRe}ectecI(date) Issuing Agent Name
Inspection YesNo I- I State Valid# Date Recd
1. county (wh e 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
Parcel 026-1057-40-000 06/26/2006 10:48 AM
PAGE 1 OF 1
Alt. Parcel 19.30.18.290A 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 - LANGNESS, EMMETT M & MARGARET L
EMMETT M & MARGARET L LANGNESS
932 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 932 140TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 3.430 Plat: N/A-NOT AVAILABLE
SEC 19 T30N R18W 3.43A IN S SW LOT 1 OF Block/Condo Bldg:
CSM VOL 3/864
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/23/1997 570304 1284/316 TD
07/23/1997 931/125
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/19/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.430 46,800 94,000 140,800 NO
Totals for 2006:
General Property 3.430 46,800 94,000 140,800
Woodland 0.000 0 0
Totals for 2005:
General Property 3.430 46,800 94,000 140,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 157
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
,+Of Total 0.00 0.00 0.00