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Home My WebLink About026-1051-50-000 d c c A Cn g A T. - z o w r 2 2 z - cn < z 2 to z N (n o O Ot 5. 5. Y 0 A Z I m m 0 ? 0 0 d 0 O w poA c Oo N `C • O <D A J p "� C m L >> v o0D 7 CD 0 1 a a@ N O I m a U) m j 3- o j c m a' u @ y w v d 00) u3, x , CA p co CA C) o m c c n a I M CD n = 0 �_ o W b CD O O N u c• I O N N — I O tl N 1 (n a 0 D a a (n D F a o to z D o CD Z a (p CD to a C o Cp y a a W o f m y c m W Z a CD c 0 0 o a 0 0 CO a NO CD O Z N N E N N N (w SR CD z 1 0 O c y n 0 0 Z to co V co V O N N f N Q lr Z O O O S 00 0 3 do O o gg $$ 7 co 3 IT °o o a 1 CD O_ O t� 0 D 1 CD !ri e l 3 d CL !? !? 0 ` �1 o 0 ~� D�_,o y m o D 0 0 a 0 CD m O rn y H �• co CD C m ;o . 0 c m 0) c a = m. 0 t0 M m fc 7. I w 0 n I a n 3 3 3 z m y ( m � m _ ��^, c I N v a 1 a a A 0 J w 00 ooC W( W� m a a a c° AZ 3 3 o o» ° o z M C 0 y y ;o y \ < CD 1 • 'p A w w X w _ (D CD 3 a CD mo n m 0'00 a d °-' o a, o c 07 i D c CD 0 w c m a�� o o � o a >> o CL =' M . . m Z -1 N 'Z m o -• CD co CAS. a� CD y 3 CD - I m s� Er a c CD N o 0 q 51.a N O I 07 to I — CD C O 7 y 0) a C a Q C 'a), A 7 7 (D Cn j O " a to p a N d CD CD 0) co yV a =r ^ CD N X O N I N 'G N 7 rn O 3 0 a o 0 o b 00 CD tD CD o 0 0 1 0 0 0 0 o:. o: o:. l,. . Parcel #: 026-1051-50-000 01/22/2007 08:41 AM PAGE 1 OF 1 Alt. Parcel #: 18.3.0.18.266B 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 PAUL G & RHONDA L SUCKUT O - SUCKUT, PAUL G & RHONDA L 1574 100TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1574 100TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 6.210 Plat: N/A -NOT AVAILABLE SEC 18 T30 R1 8W 6.21A PT OF E 1/2 NE 1/4 Block/Condo Bldg: LOT 1 OF CSM V4 PG 1056 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 06/06/2002 681022 1905/431 WD 10/04/2001 658236 1731/572 WD 07/23/1997 935/03 07/23/1997 784/04 more 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 177008 255,000 Valuations: Last Changed: 06/30/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.210 56,700 142,100 198,800 NO Totals for 2006: General Property 6.210 56,700 142,100 198,800 Woodland 0.000 0 0 Totals for 2005: General Property 6.210 56,700 142,100 198,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 152 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMe OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL ❑ ALTERNATIVE Staassigned) te Plan I.O. Number: Ilf ❑Holding Tank El In-Ground Pressure ❑ Mound If NAME OF ERMIT HOLDER: ADDRESS OF PERMIT HOLDER:' /� /L / /�//SJ�I INSPECTION DATE: yc BQfiCH _MARK (Permanent reference poi DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: FREE. PT. ELEV. Name of mber- / IMP/MPRSW No. County: Sanitary Permit Number: SEPTIC TAAXI HOLDIN TANK: MANU FACTt�ROER : LIOUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED: DYE ❑NO I DYES ONO BEDDING: VENT DIA. I VENT MATL.: HIGH WATER ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM :T' LINE: AIR INLET: DYES ❑NO DYES ❑NO DOSING CHAMBER: MANUFACTURER J EEDDING: LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LA OCKING COVER PROVIDED: ROVIDED: ❑Y S ONO ❑YES DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL s' PROPERTY WELL LDING: VENT TO FRESH (DIFFERENCE BETWEEN LINE AIR INLET PUMP ON AND OFF) DYES ❑NO M, SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ! LENGTH DInMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM: + �'' WIDTR LENG TH. N! F DIST R. PIPE SPACING MATERIAL: DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPF ISTR. PIPE DISTR_ PIPE MATERIAL. NO. DISTR. s ". PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLE'I ELEV. END. PIPES. yg =LINE: AIR INLET: MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL MOVER. TEXTURE - PERMANENT MARKERS: OBSERVATION WELLS. ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCRBED DEPTH OVER TRENCRBED DEPTH OF TOPSOIL: SODDED SEEDED. MULCHED. CENTER EDGES. DYES El NO DYES ❑NO DYES 1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. h... TRENCHES: MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING : ELEV.c ELEV. DIA. ELEV. PIPES: DIA.: a x: HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED q DYES ONO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: LINE. ❑YES ❑NO — ]YES ❑NO IN , IR_ I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) State and County State Permit PLB 6 7 p County Permit # Permit Application for Private Domestic Sewage Systems County - ` 4 ^•seV�`1 *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address / : -)�7--kv <5 1''f > B. LOCA ION: '/ Lys Y4, Section 1$, T-?Q N, R (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township I C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) Variance Single family ✓Duplex No. of Bedrooms No. of Persons 3 D. SEPTIC TANK CAPACITY 1 Ohn Total gallons No. of tanks 1 4 I(1 S 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. ftf- PY New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: ' Length —a- Width 1Z ' Depth Tile depth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private oint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if oth er 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 Certified Soil Tester, NAME C.S.T. # and other information obtained from (owner /builder) . Plumber's Signature - 7 IPRSW# - - Phone # - e� Plumber's Addr Z , P /Jy ,*m r i 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. , F .,.�. X6 ��d ` .,./'. �.�►'�.5 is ��,� -' ��. ��e., �.� rte:.. . .... m_ t .e , , .... s E W i m. �. R® _ .. _ .. , , , 7 , 9 i h Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application .� - Z�- a Fees Paid: -5"Wb ^ E�nnt�rj- Permit Issued /Refeemd (date) - /�� Issuing Agent Na L am. / Inspection Yes 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 i i t AS BUILT SANITARY SYSTEM REPORT TOWNSHIP SEC . .,L y' T R, J. RESS i , ST. CROIX COUNTY, WISCONSIN. < 3DIVISION LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7 ?TIC TANK(S) MFGR. CONCRETE T� N0. of rings o over Depth DRYWE L p L :INCHES NO. of width length area no. of Lines width •� , length ,5 area G 4/, ' depth to p of pipe :K RATE AREA REQUIRED /,j � AREA AS BUILT .claimer: The inspection of this system by St. Croix County does not imply complete I.:Pliance With State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for -item 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(. t 'INSPECTOR �— DATED ` PLUMBER ON JOB LICENSE NUMBER 'i 1: ♦ Y . z REPORT OF INSPECTION_INDIVIDUAL SEWAGE SYSTEM San.Ltaxy P ex m.Lt State Septic NAME _ Fownbhip b S.�. Cxoix County Locate ore Section / SEPTIC TANK size� ga.l.lanb. Numb ex o6 Compaxtmentz D.cdtance Fxom: Glen it. 12$ on gneaten slope Buitd.Lng Y. 6t. Wettands fit. Highwate& it. DISPOSAL SYSTEM D.i.dtance Fxom: well " it. 12% on gneaten zZope fit. Bu.i..lding fit. Wettandb r- F t. • H.Cghwate.x $t. FIELD DIMENSIONS: wi dth o j txen ch �� i it. Depth o x o ck b e•low tiZe Z 7. , in . Length o6 each tine �� it. Depth o6 xock oven tiZe Z�-.i Number o5 tin �, Depth o6 tite below gxade_AY—in. Totat .length o6 Zine.6 90 it. Sto pe o j txench — in pen 100 it. Distance between tine.a Depth to bedxock Total abaoxbtion area 6t2 Depth to gxoundwatex fit. Requited axea 2 Type of Coven: Pape& on Stxaw PIT DIMENSIONS: Num / bet o6 pitb Gxave.l axound pd.t.a yea no Out6ide diamet it. Depth below inlet it. 2 Total ab.d o o axea it A AxeLa quated it2 rn INSPECTED BY TITLE APPROVED , DATE 19 71. REJ DATE 197 JE D � . r - 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 SOIL BORINGS AND PERCOLATION TEST LO CAT IONSE ' /a, o, Section Lam T.?I, R/K I (or) W, Township or Municipality / G �27 d H Lot No. , Block No. Subdivision Name County •Z ot C,ro Owner's Name: !-J�,� 'oV/t' Mailing Address: G 1 J !G h ma PL c/ W TYPE OF OCCUPANCY: Residence �� No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 5 dI y — - 7 PERCOLATION TESTS 5 � � SOIL MAP SHEET 95 SOIL TYPE � 2 �j'Ijsi/"s�I� � 4 ° a ^e < l v 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 34 5 / 3 S P_�L I / 1 , ' r ""fJ P .yam, 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- 7 7 �� S sE s PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square f et of suitab areas. -IndiGoe number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference p nts. Indicate slope. oe r� r , I 1 0 U N 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. l Name (print) / Certification No. YZ I Address ' VAw Name of installer if known CST Signatur COPY A — LOCAL AUTHORITY PL8.6 State and County State Permit # Permit Application County P mi for Private Domestic Sewage Systems Count 4 *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: D �' uJ 1! y B. LOCATION: ! P = ' /4 ' /4, Section 4, T. N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCU�: * Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms 3 No. of Persons D- SEPTIC TANK CAPACITY Total gallons No. of tanks X13 HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel I erglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM:�ercolation Rate Total Absorb Area C sq. ft. New Replacement C- Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length .S Width Depth Tile depth (top " * _ No. of Line 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 p 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 Certified Soil Tester, . — NAME f G A Gym W Q C.S.T. # J,3 and other information obtained f om IQ i r (owner /builder). Plumber's Signature P /MPR�W# l_,.. a� — _ Phone 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. s j # S 3 [ _.. .. .�_. ... m - j.®... ., -- .6..=.. f ® i < 3 3 i x » m. �.l ®._.. .. _. .. d 8 . ^ I _ 4 » �; ._ �n m» .. _ � . 4, e � C x 3 Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY _ Date of Application , —p2 — 9 Fees Paid: Stat County Date a —� Permit Issued /fititefud (date) s — o7 !�� 7 9 Issuing Agent Name Inspection Yes — No State Valid# Date Recd 1. county (while 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 L 4iscorisin Department of Commerce Count PRIVATE SEWAGE SYS Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 374983 Permit Holder's Name: ❑ City ❑ Village ❑ jown of: State Plan ID No.: L arimiess. Leland I Richmond Township CST BM Elev.: f Insp. BM Elev.: BM Description: Parcel Tax No.: too •� (M NttZ( i es-� = CST_ "& ( 026 - 1051 -50 -000 TANK INFORMATION ELEVATION DATA ( �5 , TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (.up5 IJD� Benchmark ,�� t ��, luo. a' Dosing Alt. BM Aeration Bldg. Sewer Holding St / Ht Inlet ,(, O M , TANK SETBACK INFORMATION St/ Ht Outlet T."I a i Ventto -_ TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septic >IoD I s[ t $ f NA Qt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe S �� (S t Holdin Bot. System 3 qS 1 PUMP/ SIPHON INFORMATION Final Grade cct_ 4o fns Manufactur Demand St cover D 115217S_ Model Number GPM TDH I Lift Lriction System Ft e Forx m in I Length Dia. Dist. To well SOIL A PTION SYSTEM ��rS B / ENCH Width t Length i f enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 3 DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manua ure SETBACK : M INFORMATION Type O _ _ t CHAMBER M del Number : System: t >10D' i �✓ ` OR UNIT a, DISTRIBUTION SYSTEM Header /manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r Length Dia. 7 �a SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: mq /74 Inspection #2: / Location: 1574 100th Street, New Richmond, WI 54017 (SE 1/4 NE 1/4 18 T30N R18W) - 183018266B -Lot 1 1.) Alt BM Description= 2.) Bldg sewer length = -1 -3?' - amount of cover = rs2rvQ cgs y� s u�„2 , t� SpaQ� - 2"'°e t it l Gi,et�.� pf�J� Pla revision required ❑ Yes ®' No Use other side for additional information. � $W j 30 ( fw�j SBD -6710 (R.3/97) J�Iate C L S Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e a E i 7 e i 1 E a r e - _ E F e , g I p e e f ` 3 S i 3 _ € g a it I r w ,�► 3 C E g 4 9 � I t o � € A Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 14scons Personal information you provide may be used for secondary purposes Madison. WI 53707 -7307 Department of Commerce (Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if r state owne< Attach com lete plans (to the county copy only) for the s ystem. on paper not less than 8 -1/2 x I 1 inches in size. County < St to Sanitary Permit Number ❑ Check if revision to previous application State Plan 1. D. Number I. Application Information - Please Print all Information L 1 Location: Property O er Nam yy; (� Property Location � o ` , ,5 I /4 rf-1 /4, S / �T , Rl � or W Property Ow Mailing Address L.. Lot Number Block Number City, State Zip Code Phonecu�i / °' Subdivision Name or CSM Number �" Q/ �" Vol II Type of Building: (check one) ❑ City ,,._. . 1 or 2 Family Dwelling — No. of Bedrooms: �� '' ; c .. itlage 13 Public /Commercial (describe use): `�_ ;_ own ❑ State -owned III Type of Pertnit: Check only one line A. Check box on line B if applicable) Near e t Ro A) 1. w System 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Nu mber(s) Tank Only Existing System - 1 05 - 1 — —000 B) / Permit Number Date ss ed ❑ A Sanitary Permit w as previously issued 1 1 Li IV. Type of POWT System: (Check all that apply) — Ion K Non - pressurized In ground ❑ Mound *Sand Filter ❑ Constructed Wetland ❑ Pressurized In ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: / — b 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevati I.. ma-1 Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation L 75 0 3 7 S 0 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks X) ❑ ❑ ❑ ❑ Cx�, ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS sho wpmn the attached plans. Plumber's Name (print) Plumbe Signat a (no ) P PRS No. Business Phone Number ff4 V1 b 15 tY a��"A umber's Address (Street, City, State, Zip Code) VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ;K Approved ❑ Owner Given Initial Adverse Su harge Fee) < Determination a . Z IX. Conditions of Approval /Rea for Disapproval: p c_ 4je' t6F\ al pe"_ SBD -6398 (R. 07/00) ,1 1, loon 10 0 g1k.r Ido L" Yo ,µw 6P S' S 9 ti Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal re tpt (BM), direction and Parcel I.D. 026 1051 - - 000 percent slope, scale or dimensions, nor rf&;�Ir7na a on an3'digtance to nearest road. Please priiflon. Reviewed by Data Personal information. you provide may be u n as pivacy 1 ew, . 15.04 (1) (m)). ProperiyOwmer rtyLocation � Leland Langness j _._� �. GpvL Lot SE 1 /ate 1!a s 18 T 30 N R 18 (or} W Properly Owner's Mailing Address ' -- # Block # Subd. Name or CSM# 1574 100th. St. ;` - ` sr w'no na v ol 4- gg #10-96 State Zip Cod 1 - `, Phil F1C> �:' ° > -'❑ City ❑ Millage [3Town Nearest Road New Richmoncl Wi CAQ1 E' _ Richmond 100th. sT. ❑ New Construction Use:>❑ Residential / Num ` A 3 Code derived design flow rate 490 GPD El Replaoement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable l3 ft. General comments and recommendations` trenches C el. 95.80 spaced to code ❑ Boring # ❑ Boring Pit Ground surface elev. 99.4 ft. Depth to limiting factor +_ $�Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Coat. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0 -12 10 r3/3 none 1 fill terial cm 2f np n 2 12-21E 10yr3 /3 c2d 7.5 r5/6 1 fill m aterial 3 28-110 7.5yr4/6 none ms Os ml n i f3 , Boring # Boring M Pit Ground surface etev. 99.40 ft. Depth to limiting factor +110 In. Soil icatian Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I GPDflP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Efr#2 1 0 -11 10 r2/2 none 1 2f n 2 11-2E 10yr5 /4 none sill 2msbk mfr 3 1 25-110 7.5yr4/6 none ms Osg ml na E T _ n. 3. '►. 7 • Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L fli #2 = BOD < mg/L and TSS < 30 mglL CST Name (Please Print) Signature Number 02 QR Gary L. Steel Address to EvaltAition CondWed Te ne Nurr -ber 1554 200th. Ave., New Richmond, WI. 54017 9 -8 -2000 715- 246 -6200 Property Owner L. Langness ParoellD# 026- 1051 -50 -000 page 2 of 3 a Borng # ❑ Boring ® Pit Ground surface elev. 98.80 g, Depth to limiting factor +90 in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -15 10yr2 /2 none 1 2msbk mfr 9w 2f .5 .8 2 15-2E 10yr4 /4 none sil 2msbk mfr qw if .5 .8 3 25-7E 7.5yr4/6 none ms Osg ml gw na .7 1.2 4 75 -90 7.5yr4/6 none of s 1" _ na na na .4 .6 G 2 E Boring # El Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GpD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. "Eff#1 'Etf#2 BodM # O Boring F ❑ Pit Ground surface eiev. tl Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPI» In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 'Eff#2 Effluent #1 = Boo, > 30 < 220 mg/L and TSS >301 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. sBU4330OL6 o) STEEL'S SOIL SERVICE Gary L. Steel LeLand Langness 1554 200th Ave. CSTM2298 SE4NEEk S18 T ON - R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #1 -csm vol 4 -pg 1056 N 1 =40' BM. =top of nail in corner post of bunker silo C el. 100.00' Alt. BM.= top of concrete slab to barn entrance door C el. 99.30' �✓ �o�l -ins �d a r 41' Gary L. Steel 9 -8 -2000 Gy / Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 5+q C 9 3 Number of Bedrooms Design Flow - Peak (gpd) `{Sx Estimated Flow - Average (gpd) Ub Septic Tank Capacity (gal) Soil Absorption Component Size (W) "Jer `� Type of Wastewater Dorn 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) I crab Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l el�Cl e - 1 - - Mailing Address /S - ;V -S7 � J Property Address /�' �� ` '' �'��, SSG / / (Verification required from Planning Department for new construction) City /State , U6,J le,`c.�tim�, LJL Parcel Identification Number n r �l o — LEGAL DESCRIPTION Property Location r '/. `A ,% P rtY Al —r �� ,Sec. �' � T 3 0 N -R1d' W, Town of df, c'A crrial Sf'1911o,C /U E Y� Subdivision Lot # Certified Survey Map # (a , Volume y , Page # 10 5 Warranty Deed # D Volume 6 Page # y ? Spec house ❑ yes 11 no Lot lines identifiable M yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The ro owner agrees to p perry gre submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. p - I / r-1 U u SIGNATURE OIrAPPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. IZ4 SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. WARRANTY DEED THIS SrAc.E RESERVED ,nR RECPRUING DA'A STATE DAR OF wlsCONSIN FORM 2 -1982 � w 4 10617 MUG - -� RtGIS1 crt'S CHICE l Hendrik W. Van Dyk and John C. Van Dyk, as tenants ST. CROIX CO., WI .. ... Pr_'d 1 ^r Pa--M � in common ... JAN 19 1994 . Leland E. an ness,aad.Kathy.A,.. 2:00 P: con aiR* L and warrants to g �} f� Aa M Langness,. and wife as survivorship marital - v �x� , property...... . _ _ IMigNe�r of 09sds 4� FCS of NW Wisconsin P.O. Box 199 River Falls, WI, 54022 the following described real estate in ............ .. St Croix_.... . State of Wisconsin: Tax Parcel No: ........ ..... ............... Part of the East Half of the Northeast Quarter (E} of NE}), Section Eighteen (18), Township T11rty (30) Nor,h, Range Eighteen (18) West, described as follows: Lot One (1) of Certified Survey Map filed May 6, 1981, in Volume of Certified Survey Maps, p age 105 6, as Document No. 37071 k Grantor reserves the right to run a pivot irrigation system across unimproved t portions of the above described premises. Grantor grants Grantee reasonable access to corn cribs. y This deed is given in satisfaction of that certain land contract between grantors and Leland E. Langness and Kathy A. Langness, dated August 26, 1992, recorded September 9, 1992, in Volume "968 ", page 44, as document No. 488256. F" EXE This iB . nOt_ - - __ . _ homestead property. (is) (is not) p� Exception to warranties: 1' Dated this ... .. 5.0 day of Jan uar 1994 .(SEAL) _w r (SEAL) '.' Hendrik W. Van Dyk ........ ........ _(SEAL) ..... ..... No�� (SEAL► n C. Van Dyk _. 4, AUTHENTICATION ACKNOWLEDGMENT .; STATE OF WISCONSIN •-• ................•---••--•-•-•-••--...•-•••----- •-- ••-- •- ••-- -- •••- --- ° - - -••• St. Croix .. .................................... County. authenticated this - - - - -- - -day of----------- ---------- - - - - -- 19 ------ Personally came before me this •...Stir day of January ............. •- -- -•_- 19.. 94- the above named Hendrik W. Van Dyk and John C.. Van_.Dyk.. "� ! • ••...- •..- ••....••-- -..... -• - -• ---.....• ............ .. .... •.......•................ •.- ..- ......- .......... ...- •. -... 4 ! TITLE: MEMBER STATE BAR OF WISCONSIN ........ ... ............................ . ....... (If not, .................................................... ....... ..... . .................... ......................... .......- authorized by 1 706.06. Wis. State.) to me known to be the person ...91.. ,y l�E�e�at?� the foregoing instrument and acknow ' THIS INSTRUMENT WAS DRAFTED BY J ..' °..' ...... ... REINSTRA, VAN DYK 6 NEEDHAM, S.C. Sharon G Balcere . -.•----------------------------- •------- •----- •.- ....--- •-• - -•• 6. . 1 201 South Knowles Avenue, Box 127 -..- . a Dlsw- Richmond WL. 54Q1Z----- .-- •- ----------- --- -- ------ Notary Public .. ....Sk....GT.uik._ -o =.'1 ... �c{�y. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (F{a Q piratio!S an not necessary.) dat .... -.._ 113 / !1�..•.�. l9. <.....) _ *Nsmta of persons signing in any topwity should be typed or printed below their signature STATE R SA OT WISCONSIN Wisconsin Legal Blank Co_ Inc WARRANTY DEED roRM No. 2 1982 Milwaukee. Wisconsin � }�, .� g•. .. x _ . s •>< � -, se, � > - I 370716 CERTIFIED SURVEY MAP P.K. AT NE BEARINGS REFERENCED COR. SEC. � 1 p 18, TO THE EAST LINE OF T30 N, R18W- THE NE I/4 OF SEC. 18, AfA N as �98� W T30N, R 18W. ( ASSUMED BEARING NORTH.) of a �° v - s a o: O: O: SCALE 1 " =100' 0 50' 100 200 x I— 0 UNPLATTED LANDS N87005'53 "E 292.82' ase 2 5 9.78' N 89 °i7'50 "E 14.40. ob a� 303.28 ?s @� N 2 02033 "E e� 26.84 0 1. ��, I33' 33' T I U W ''^^ N VJ- LL Z. I W _ Z a • J LOT I C; 6.21 ACRES SEC. LINE o (270704 SQ.FT.) Uj: � I 5.85 ACRES TO R.O.W. Z APPROVED 1— : I a. J. NOTE: EXISTING HOUSE AND APR 15 1981 133' 33' a• OUTBUILDINGS ON PARCEL. Z ' ST. CROIX COUNTY D. COMPREHENSIVE PARKS PLANNING r MID ZONING COMMITTEE Apo o L� , 0. e� 576.94 33A1 S89 0 13'10 W 609.95 1 U_NPLATTED LANDS 0= SET 1'%24" IRON PIPE WEIGHING 1.13 LBS. PER LINEAL FOOT. E 1/4 COR. SEC. Volume 4 Page 1056 18,T30N, RISW pK. THIS INSTRUMENT DRAFTED BY ^-' "^"^� ��"^'�- R1 -97 ___ . X i a CERTIFIED SURVEY I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the-St.-Croix County Subdivision Ordinance and under the direction of Henry W. Van Dyk and John C. Van Dyk, owners of said land, I have surveyed, divided, and mapped said parcel of land, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the NEw of the NEw and the SEA. of the NEw of section 1$, T30N, R1$W, Town of Richmond, St.Croix County, Wisconsin, to -wit: Commencing at the NE corner of section 1$; thence South along the East line of said section 1196.26' to the point of beginningg; thence continuing South along said line 470.56 thence Sg °1 t10"W 60 t• thence N1° t 1 1 thence • 9 3 9 95 43 5 433 7, N$ °1 t O "E t. h . t rr 26.$ t• thence N$ ° 9 0 .2$ t N2 20 E 7 75 33 33 4 , 05 292. to the point of beginning. Contains 6.21 Acres subject to Town Road right -of -way over the easterly portion thereof. Dated this 8 Z2t day of RP2 ,19$1. Arthur L. Wegerer S Kozel, Wegerer and Assoc., Inc. River Falls, WI • ��1H�nrrrnr,,, SC0 •.. ARTHUR L. WEGERER S -963 ELLSWORTH r � j Wis. i •• • • SUR \J Volume 4 Page 1056 Wisconsin Department o f Commerce PRIVATE SEWAGE SYSTEM y t. Croix Safety and Buildings Division Count S INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar lo.: Personal information you provice may be used for secondary purposes [Privacy Law, s45.04 (1)(m)l. Permit Holde ' Name: ❑ City El VikRRG m State Plan ID No.: Langness, a an tc[t iun p CST BM Elev. Insp. BM Elev.: BM Description: Parcel T OM 2 051 -50 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Alt. 13TVI Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand t cover Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To wen SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of T x Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l• / / Inspection #2• Location: 1574 100th Street, New Richmond, WI 54017 (SE 1/4 NE 1/4 18 T30N R18W) - 183018266 -Lot 1 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = / Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. l ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I tt I—E j x I i S t � t � 3 E E E a I f E �'i fC