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Parcel 026-1100-30-000 11/21/2006 12:07 PM
PAGE 1 OF 1
Alt. Parcel M 35.30.18.545A 026 - TOWN OF RICHMOND
Current ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
08/16/2006 00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - DERRICK, RICHARD L
RICHARD L DERRICK
1247 HWY 65
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1247 HWY 65
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 36.590 Plat: N/A-NOT AVAILABLE
SEC 35 T30N R18W 36.59A NW SW EXC CSM IN Block/Condo Bldg:
VOL 2/488
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
35-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 867/618
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 18,000 129,000 147,000 NO
AGRICULTURAL G4 35.440 5,600 0 5,600 NO
UNDEVELOPED G5 1.150 100 0 100 NO
Totals for 2006:
General Property 37.590 23,700 129,000 152,700
Woodland 0.000 0 0
Totals for 2005:
General Property 37.590 23,700 129,000 152,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 211
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
:~~R J , ~;,r TOWN SHIP,i< i~
. ADllRES ~I<.lia SEC. T' N, R SW
ST. CROIX COUNTY, WISCONSIN.
,DIVISION
LOT_J_LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20 !1f~l
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
TIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on covert/ Depth DRY WELL
"CHES NO. of width length area
no. of lines width/.` length area
depth to top of pipe
REGATE i• r
-K RATE AREA REQUIRED AREA AS BUILT.
-,claimer: The inspection of this system by St. Croix County does not imply complete
:)li.ance 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
:ernine cause of failure.
-.ASES AND COILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR
DATED
PLUMBER ON J013,
LICENSE NUMBER
i_
f
RFPOr,T OF It1SI'LC'1'IO?i--I:1DIJIlliJAL SL,JAGa llISPO.,AL aY,,'!'Eii
Sanitary Permit
r State Septic f € (,)S
.,mss 1E ~
- ~ T&WNSHIP _ J
t. Croix County
SF,DTIC TA'?Y
:size gallons. 'umber of Compartments
Distance From: We 11
ft, 12% or greater slope) ft.
Building ft.
Wetlands f:
Highwater ft.
DISPOSAL SYSTI.:1 Tile Field or Seepage Pit(s)
Distance From: Well , ft, 12% or greater slope ft
Building; ft. Wetlands ~ f„
FIELD 'Highwater ft -
Total length,of lines ft, dumber of lines L_ Length of
R
each line ft, Distance between lines
f_ ft. Width of the
trench '.eft. Total absorption area Z. sq. ft. Dept..
of rock below file in. Dp-pih of rock over the in. Cover
over .rock,, Depth of tile below rade ~
g , in. B3_ope of
trench in per 1,00 ft. Depth to Bedrock ft. Depth to
ground water ft.
• w
PITS
~~umber of nits 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 nit ;arda required
Inspected by. Title
Approved _ t Date -'197`//.
Rejected Date 197.
L _
EKI 15
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
• MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION:'/4, Section ' r , T*-N, R 1' Mor) W, Township or Municipality ~h i ( /I ?•~z c _1.. L/
Lot No. , Block No. County Z ~ ✓ -
Subdivision Name
Owner's Name: ~Z" ~ r" t" j h
Mailing Address: ~Z1 y
TYPE OF OCCUPANCY: Residence - No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW t° ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE -
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-
.7
P-3 ~1 G 5
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) ketku
7 :Z1
y
PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of suitable areas. Indicate num r of square feet of abso area
needed for building type and occupancy. °z7 ` ica tale
or distances. Give horizontal and vertical reference points. Indicate slope. G[ in
{ f
~ I f~ ~ E i i ? j I i i X~ f N
# E--
_ I-_ t ,
- -ttt ~ rt
fi f I i ~ 4 i f f ~ i ~ f
s t i f f f ; I I I i 1 f
f( y
I
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`.
Name (print) ~L G rL.z!- -may cT t-,- ~`l Certification No. Z Z
r J ~
Address-
Name of installer if known ,
CST Signature
°Y A -LOCAL AUTHORITY
w
State and County State Permit # PLB67 L Permit Application County Permit #
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: Section T j['~ N, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk#_~_ Village
Township a/ z
C. TYPE OF OCCUPANCY: 'Commercial *Industrial "Other (specify) *Variance-
Single family Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher t,rES NO Food Waste Grinder YES -IVY # of Bathrooms
Automatic Washer L,--'?'ES NO Other (specify)
E. SEPTIC TANK CAPACITY ~r d!77~-V Total gallons No. of tanks cs-h~
'Holding tank capacity Total gallons No. of tanks _
New Installation L''n Addition- Replacement- Prefab Concrete
'Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) r z 2) 3) - Total Absorb Area L/ sq. ft.
New C----Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length r3; Width /.;Z' Depth- `Tile Depth No. of Lines ';I-
Seepage Pit: Inside diameter Liquid Depth Tile Size 4"
Percent slope of land fy ? ~-I 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 001f Q / vh c am/ /y l i'(C C.S.T. # 1 I and other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# 4~Phone # y~'-% f
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
ti.
s.
'4 7 @ v
1111
Do Not Write in Space Below FOR DEPARTMENT USE ONLY
Date of Application Fees Paid: State County___ _ Date _
Permit Issued/Rejected (cl te) Issuing Agent Name
Inspection Yes No Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink cop,-,) it r_.- I - -