HomeMy WebLinkAbout026-1013-30-400
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"TER , TOWNSHIP1 SEC..,.,. T N R _w
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AfDRE , ST. CROIX COUNTY, WISCONSIN.
'3DIVISION LOT LOT SIZE
PLAN VIEW ~l
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
•
:TIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
INCHES NO. of width length area
1 no. of lines width r length area
depth to top of pipe
~REGATE .
RATE AREA REQUIRED AREA AS BUILT
-:claimer: The inspection of this system by St. Croix County does not imply complete ;
-pliance with State Administrative Codes. There are other areas that it is not possible j
inspect at this point of construction. St. Croix County assumes no liability for
-tem operation. However, if failure is noted the County will make every effort to
:ermine cause of failure.
'ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR 7
DATED PLUMBER ON JOB_
LICENSE NU:IBER
REPORT OF IJISPRCTI011--INDIJIDUAL SEI•JAGE DISPOSAI, SYSTEiiI •:,.e-,
r Sanitary Permit
State Septic
T&T-I ISHIP
t. Croix County
S,;.PTIC TA171:
ize °
W; gallons.umber of Compartment
Distance From: We 11 ft. 12% or greater slope €t.
Building` ft. Wetlands
f-
Ilighwater ft.
DISPOSAL SYST2.:1 Tile Field or Seepage Pit(s)
Distance From: Well ft. 12%,or greater slope ft
Building
ft Wetlands f.,
FIELD ;:;ighwater ft,
Total length of lines ft. !lumber of lines Length of
each line - ft. Distance between lines ft. Width of the
trench .`ft. Total absorption area sq. ft. Depth
of rock below tile ' in, Dp-pth of rock over tile in. Cover
over. xo ck,,
Depth of tile below grade in. Siope of
trench in ner 100 ft, Depth to Bedrock £t, Depth to
ground water £t.
PITS
Number of pits Ou cie iara,dt r ft. Depth below inlet
ft. Gravel a-roun p t• __yes no. Total absorption area
sq. ft.
-Square feet of seepage trench bottom area required
`square feet of seepage nit area requ l!bd
Inspected by:
Approved Date 197
Rejected Date 197
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES 4
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION Z21401_ / - .
LOCATION: ,5e_11. Section , 1_361\1, R(-&Yor) W, Township or Municipality J--
Lot No. , Block No. County
Subdivision Name
Owner's Name:
Mailing Address: w ,
TYPE OF OCCUPANCY: Residence _e!~C No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW A ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 7 PE COLATION TESTS At
SOIL MAP SHEET SOIL TYPE !;Z3
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
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- y -3
36
P_ Z
P-3 0
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)
C) Ko
.62) 0
63 O 1 c~ C ~G S 61-
C? C7 . T ZCISL 'CMG ~4 ~1l
S
+4c, i4 %;x_-,~J-s r,
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 feefof absorption area
needed for building type and occupancy. //.23-0 - Indicate scale
or distances. Give horizontal and vertical reference point . Indicate slope.
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133_ _
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 belie .
Name (print,,)//~~ Certification No. Address Name of installer if known
COPY A - LOCAL AUTHORITY CST Signatur
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lop
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PLB67 State and County State Permit # ~ J
Permit Application County Per it # for Private Domestic Sewage Systems Count;t--~%t tG
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
7ail"Ie -5/07 10 e_?
B. LOCATION: Y4 !!7 CJ Section T-'-?6 N, R I E (or) IN Lot# City_
Subdivision Name, nearest road, lake or landmark. Blk# Village
- Township C-4
C TYPE OF OCCUPANCY: *Commercial *Industrial 'Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES_,X_NO # of Bathrooms
Automatic Washer~YES NO Other (specify)
E. SEPTIC TANK CAPACITY fQ 6 Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition _ Replacement - Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) YD 2) 3()-3) 15 Total Absorb Area ) j 2 S sq. ft.
Newx Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length 'j LI / Width ) 2.~ Depth Q'' Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size 44
Percent slope of land S Distance from critical slope
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,
NAME C./ 4_ u i t ; 4- ' C.S.T. # and other information
obtained from el-u. ( wn /builder).
Plumber's Signature MP/ RSW /S" 3 Phone #2y6 -S 1.3 S
Plumber's Address L '
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
i~ L e / ter. `t-1 d C5
4+~~a - - L nF
e lJ~
Do Not Write in Space elow FOR DEPARTMENT USE ONLY
Date of Application ~ Fees Pai : State /r~e G County , L Date 1!J
Permit Issued/Rejeeterl (date) _ r Issuing Agent Name
Inspection Yes No Valid# Date Recd
1. county (vvto 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 6/1 /76
ArcIMS Viewer Page 1 of 1
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http://72.21.230.178/website/LRPortal/ARCIMS/MapFrame.asp?PIN= 3/31/2006
Parcel 026-1013-30-400 03/31/2006 12:07
PAGE 1 OF 1
F 1
Alt. Parcel 4.30.18.47F-40 026 - 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 - RUMMEL, DAVID A
DAVID A RUMMEL C - BERENDS, ROXANNE M
ROXANNE M BERENDS
1134 173RD AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1134 173RD AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.090 Plat: 4415-CSM 16/4415
SEC 4 T30N R18W NE SW LOT 7 CSM 16/4415 Block/Condo Bldg: LOT 7
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-30N-18W NE SW
Notes: Parcel History:
Date Doc # Vol/Page Type
01/10/2003 705331 2106/490 WD
11/18/2002 698938 2051/254 TI
2005 SUMMARY Bill Fair Market Value: Assessed with:
95375 190,400
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.090 41,000 122,300 163,300 NO
Totals for 2005:
General Property 2.090 41,000 122,300 163,300
Woodland 0.000 0 0
Totals for 2004:
General Property 2.090 41,000 114,700 155,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 133
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00