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Parcel 026-1074-10-000 01/05/2007 10:46 AM
PAGE 1 OF 1
Alt. Parcel 25.30.18.391 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
SUSAN M ALLEN O - ALLEN, SUSAN M
1496 130TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1496 130TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 5.920 Plat: N/A-NOT AVAILABLE
SEC 25 T30N R18W 5.92A IN SE SE COM SE Block/Condo Bldg:
COR SEC 25 TH W 390' TH N 666'E 390' TO
E LN TH S 666' TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
25-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 949/511
07/23/1997 532/233
2006 SUMMARY Bill Fair Market Value: Assessed with:
177223 172,100
Valuations: Last Changed: 06/20/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.920 56,700 77,500 134,200 NO
Totals for 2006:
General Property 5.920 56,700 77,500 134,200
Woodland 0.000 0 0
Totals for 2005:
General Property 5.920 56,700 77,500 134,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 145
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 ~ 1t'Lf f if I TOWNSHIP SEC T_ ON, R~W
t_ 3
ADDRESS ST. CROIX COUNTY WISCO
NSIN.
SUBDIVISI NY LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
" 4_
I ,yc . r ~C
J-11
t 7(,
v
~C ;.5 3A
i I
I di, ate North; Arrow !
SCALD : r`- i I
SEPTIC TANK (S) MFGR. nom, s cWL2,,i. CONCRETE STEEL
50. of rings on cover j Depth
PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of width length area
BED NO. of lines width length ICP area
depth to tapes pipe `
NUMBER OF SEEPAGE ITS Outsi e iameter total pit area
AGGREGATE
PERK RATE AREA REQUIRED V,5~ AREA AS BUILT
Disclaimer: The inspection of this system by St. Ctoix 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 SYTE
INSPECTOR
DATED ~Z- 1 - Y6 PLUMBER ON JOB Ar,,,4 '
LICENSE NUMBER j,SC;_3
Z.
REPORT OF INSPECTION! INDIVIDUAL SEWAGE SYSTEM
San.i.tany Pe nm.i.t 03
State Se p.t.ic.?/ y
NAME "`~Lf Ve Townehip. Cno.cx County
Location Section
SEPTIC TANK
S.izega.t.tone . Numb en o6 Compan.tmen.te `
D.i..b.tance Flom: Wet .t
6.t. 121 of gnea.ten etope -it
Bu.i.td.Lng 6#, Wetlands 6t•
H.Lghwa-ten 6z,
DISPOSAL SYSTEM
D.ie,tance Fhom: We,tt 1 6#. .121 on gnea.ten e.tope 6z.
Bu.i.td.ing _6.t. We•t.tande _ Ft.
H.ighwaaten 6.t.
FIELD DIMENSIONS:
Width o6. trench _ 6t. Depth o6 nock be.tow..t.Ete-in.
Length o6 each tine 6,t, Depth o6 nock over. .t.ite in.
Numbers. o6 tines ? Depth o6 .t.i.te be.tow grade%0 .in,
Tota.L .teng.th o6 tinee 6.t. S.to pe o6 .trench L~ to pen 100 6 t.
D.i..e.tance between .t.inee 6.t. Depth .to'bednock - 6.t.
Tota.t abe onbt.ion anea/111.~-J-6.t2 Depth to groundwater 6.t.
Re uired anea I J; 2 ~ , ~
q / t Type o6 Cover:, P~tpen br Straw
PIT DIMENSIONS:
NumIbeA o6 p.itte GAavel- around pite yee no
OuUide diameter 6.t. pep.th be.tow .inte.t 6.t.
To.ta.t abeorb.tion anea 6t2'
Area Aequited 6.t2 m
1 ~
INSPECTED BY.'`1'r TITLE 'h
1(
APPROVED
DATE 19'
rh
REJECTED DATE 197 c
..,.,.4+µ4Ywisre~el '
I '
e ~Y?
f ~
PLB 67 State and County State Permit # Y
Permit Application County Permit # 6 3
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:
rzi,,z i 4- A 4Z L]~L~7
B. LOCATION: '/4, Section, T.~9 ' N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Du lex No. of Bedrooms
P No. of Persons_~5
D. SEPTIC TANK CAPACITY 140et► 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 Total Absorb Area sq. ft.
New Replacement Alternate (Specify
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (t No. of Tren hes
Seepage Bed: Length_Width Depth 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 X 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 ster,
NAME Jl~+r~_/ a ,1 - CS Jellf C.S.T. # S - 5~ 5 1 and other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# ' Phone t
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 I G
Date of Application sv Fees Paid: State ts', County , ° Date O C
Permit Issued/Rejected (date) Issuing Agent Name
Inspection Yes _y 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
EH 1115 'Wv. 9/78
r _ REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION:Ei(_'/4,_S Sectio _
rr,~_,T.2.~;N,R 3V (or) W, Township or Municipality Zal~,a.14
Lot No. , Block No. Subdivision Name County -sr Ox"C,A/
Owner's/Buyers Name: ~7°~r'e,~~rr✓
n
Mailing Address: r'ul~~ x111 li•
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW --REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MAD : OIL BORINGS 6 -2- J0 PERCOLATION TESTS
SOIL MAP SHEET NAME OF SOIL MAP UNIT 5,917266 -SIr .L'Ald,
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 AFTE INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
n
P- _?o . 44
P-
P-_3 ti _ l S
t fl tt - ' !I 5
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- - e ,AB-
B-
B-
L
0
B- S- > _
B- ? 1 7
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas. Indicate on the plan tlo ion an square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy ~a?T•~ .Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope. ,
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e
A &kW /I'I ' r/✓
/Y {~~YE~c 7`L•i~: iJ/!•S 7AJt'~:l✓ `t ~ ~Q~
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1100
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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.~ ,S :31
Address -
.Name of installer if known J)p
Copy A -Local Authority CST Signature'