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Parcel 026-1057-50-000 06/21/2006 01:27 PM
PAGE 1 OF 1
Alt. Parcel 19.30.18.290B 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
MITCHELL PAQUIN O - PAQUIN, MITCHELL
922 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 922 140TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.250 Plat: N/A-NOT AVAILABLE
SEC 19 T30N R1 8W COM SE COR SE SW TH W Block/Condo Bldg:
1041' TO POB N 175' TH S88DEG W 28.81'N
81 DEG W 490.71'S1 1 DEG W 80.6' SLY 175' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TO S LN TH ELY TO POB 19-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/27/2005 807642 2896/563 PR
09/27/2005 807641 2896/561 TI
07/23/1997 780/449
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 1.250 76,100 92,100 168,200 NO
I
III
Totals for 2006:
General Property 1.250 76,100 92,100 168,200
Woodland 0.000 0 0
Totals for 2005:
General Property 1.250 76,100 92,100 168,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 125
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
H iER ~c~ f , TbtdNSHIP , Z4 SEC. T N, R~W
0. ADDRESS , ST. CROICOUNTY, WISCO
_3DIVISION LOT LOT SIZE
PLAN VIEW
Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i ~
(r ,
' j
• ~ 6 , 1
S
IA 11 1
t
1
t
i '
T-1- -r-;-t-~
Lidicate North,, Arrow
i ! a ; SCALE
tPTIC TANK(S)MFGR.
CONCRE T EL/_ STEEL
NO. of rings on cover Depth - DRY WELL
'ttNCHES NO. of width length area
no. of lines width_IC length_ area _
depth/ o top of pipe
~GREGATE
RATE AREA REQUIRED AREA AS BUILT
t,sciaimer: The inspection of this system by St. Croix County does not imply complete
,o;pliance with State Administrative Codes. There are other areas that it is not possible 1
to inspect at this point of construction. St. Croix County assumes no liability for
IStem operation. However, if failure is noted the County will make every effort to
;itermine cause of failure.
({EASES A,TD OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
IN5MTOR
1
DATED PLUMBER ON JOB
r/.,r. 4 c~r'S ,1
LICENSE NUMBER
~w
• • REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sani tarry Pe.nm.i.t
Sure Septic Q
NAME Towns hip_~~ ~ St. Croix County
Locat.Lon,4 E S li Section /I Lot # Subdivision
SEPTIC TANK
Size gaefon Numbetc o6 eompa4tment6
Di,5tanee (Inom: We.X.,e Buti2d.Lng d4lor -1,2% 5-Eope
Highwaten
PUMPING CHAMBER
Size gaeeon . Put;/Van 4 etu)terc Mode. Number
HOLDING TANK
Size gaf2ons Nu en o{ mpantments
Pumpers t y,5 em
Di,5tance ()tom: W e U Building 120 slope
HighwatetL
ABSORPTION SITE
tied Tneneh
DtiAtance OAom: Wet Buitding 1'2o stope
H.Lghwa.te.n
ABSORPTION SITE DIMENSIONS
Width o6 tneneh t Required anea_~~~ ~t
Length o6 each tine e16 {yt Depth of hock below ti e. /7 tin
Numbers oo fin.el 2 Depth oo noek overt .tile 2- tin
Total Length o(j tines. 6t Depth o6 tite below gttade -7 in
beiween 6t Shope o6 tneneh in. pen 100 6t r
Totat ablsonption anew ()Z Type o6 Coven: Cape on tst4aw r,PIT DIMENSIONS.
I
Numb et o o pits G v o d pi tts yet6 ~no
Outside diameters e t b~ how infet 6t
Totat ab6 onption area
Area nequtined 6t
INSPECTED - { f TITLE
APPROVED DATE C 19&
-
REJECTED DATE 198
REASON FOR REJECTION
67 State and County State Permit #
PLB
Permit Application County Permit # "z
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: .-S E % r. r Section , T R_a If (or) VV Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family- Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY 4:166) 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 A
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate hT Total Absorb Area -sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Line I Ft. Width Depth Tile depth (t ) No. of Trenches
Seepage Bed: X_Length. ;Q Width-Zd ' Depth ~I Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
WATER SUPPLY: Private 5~ 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 C tified Soil Tester,
NAME C.S.T. # and other information
obtained from )(owner/builder).
Plumber's Signature ' MP/MPRSW# Phone -~f r
'
Plumber's Address )Cwlamea
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.
S C ¢L..c: 11
1 3
r~
3
. .v '64 F,~ Qi W
{
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State County Date
Permit Issued/ Rejected— (date) Issuing Agent Name
Inspection YesNo State Valid# _ Date Recd
1. county (whit copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
I
2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78
EH 115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION 6,L_%,6_1 1 Section Z,T-_k_'N,RJ_?'j (or) Vy, Township or Municipality ~Cdkadd
Lot No. , Block No. Subdivision Name County ."~2014
Owner's/Buyers Name: jg a,- ;nljn "O
Mailing Address: =.,J 4 rr"j
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENTZALTERNATE: SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS7::,29- xn PERCOLATION TESTS 7 _ j 9 - M
yr.Pst~R,PaJ'-SA7T1~c
SOIL MAP SHEET NAME OF SOIL MAP UNIT
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- / / /in I W 7
P
P- 1 - '7 7
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- ® ? - r S
B-
B-
B-
B-
B-
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 of square feet of absorption area needed for building type and occupancy Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
L~ SO1~.i.VGS m~ jk
0 ) ~F C 7-AZ SNw
oyak psec, sws 77,ke.41 97
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I, the undersigend, 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.
Name (print) Certification No.5
Address -
Name of insta;'er if known
Copy A - Local Authority CST Signature
REPORT ON INSPECTION OF SANITARY PERMIT # .22,1'
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
y Time of Inspection
Name, Address, icense No. o ns a ing Plumber
(3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN Permanent reference Point) Describe:
Elevation of vertical reference point: Slope at site:
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity:
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: # ft to well:
POSING TANK: Manufacturer: # of gallons:
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines gallon; size of pump head; gallon per minute ;
horsepower ; brand name of pump and model number
Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO
8 HOLDING TANK: Manufacturer o gallons
construction ; depth to the cover ft; If septic tank is
being used are baffles removed? ❑ YES ❑ NO; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO;
Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ;
Distance from building to vent
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe-elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPAGE BED SIZE: ft width; ft length; tile depth.;
lineal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed ft.
11 SEEPAGE TREN H: Total length of seepage trench ft; width ft;
tile depth ft; ft to well; ft to ordinary high water mark of
lake or stream; ft to edge of slopes greater than 20% falling away toward lakes,
water courses or drainage ditches; elevation of tank discharge line entering seepage
trench ft.
(12) Has system been installed in area indicated on EH 115? [-]YES [:)NO
(13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO
DILHR-SBD-6095 N.05/80
Signature of Inspector: