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Parcel 014-1021-80-000 02/27/2006 03:20 PM
PAGE 1 OF 1
Alt. Parcel 9.31.15.144C 014 - TOWN OF FOREST
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 - FRANK, JOHN W & DEBRA ANN
JOHN W & DEBRA ANN FRANK
2878 CTY RD Q
CLEAR LAKE WI 54005
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 2878 CTY RD Q
SC 1127 CLEAR LAKE
SP 1700 WITC
Legal Description: Acres: 1.377 Plat: N/A-NOT AVAILABLE
SEC 9 T31 N R1 5W 1.377A IN SE SE LOT 1 Block/Condo Bldg:
CSM VOL 2/582
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
09-31N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
94744 97,400
Valuations: Last Changed: 10/17/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.370 10,000 88,700 98,700 NO
Totals for 2005:
General Property 1.370 10,000 88,700 98,700
Woodland 0.000 0 0
Totals for 2004:
General Property 1.370 3,500 50,500 54,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 110
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
:DER ' , TOWNSHIP SEC. T N, R W
.O. ADDRESS , 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 1 -
-TIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
'NCHES NO. of width length area
no. of lines _ width length area
depth to top of pipe
1REGATE ,
RATE AREA REQUIRED AREA AS BUILT
-claimer: The inspection of this system by St. Croix County does not imply complete %
?liance 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
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
DATED PLUMBER ON JOB f
LICENSE NUMBER
z
>y l REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.itaAy Peuiit-,~c
? State Septic'. le _
NAME Towns hi) St. Cno,ix/ County
Location-' - Section 1 T-,,/k, R/-5 W
SEPTIC TANK
Size
gat.Lons. Numb en of Co4paAtment~5
2
Distance FAOm: Weft L''Ly it. 12% oA gtceateA tstope it
Bu.itd.ing it. Wettand~s ~ .
H.ighwatvt it.
DISPOSAL SYSTEM
D.i,stance FAom: Wett .12% oA gAeateA zZope it.
Bu.itd,ing it. Wettands Ft.
H.ighwatvL ~ .
FIELD DIMENSIONS:
Wid"th of t,'--,ench it. Depth of hock below tite 1'~-in.
Length of each tine .a'c it. Depth of tcock oven late L in.
NumbeA of .i.ine/s Depth of tite below grade kn.
Totat t eng,th of tinez it. Sto pe of tAench in pen 100 it.
D.i/stance between Zine/s fit' it. Depth to bedtcocfz ~ .
Totat absoAbtion aAea ? ~ jt2 Depth to gAoundwateA ~ .
RequJ%tced atcea b 2
PIT DIMENSIONS:
Numbetc of pits Gtcavet atcound pitz yes no
Outside diametetc 4t,' Depth below .intet it.
r
Totat ab,s oAbtion an Lit
it , z
1~~--- A
AAea AequiAed it2 rn
INSPECTED BY--...-:- l,- TITLE
APPROVED DATE _197
.
REJECTED DATE tf. 197.
ti
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 TE
E (orK11;,Township or Municipality U F
LOCATION: 5 '/a, Section, T- N, R I-S
Lot No. BI ck No. County S y C , Q X
" •ubdivision Name
Owner's Name:
Mailing Address: - -
TYPE OF OCCUPANCY: Residence- No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW f ~ -ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS I 7 ' 7=S PERCOLATION ESTS ? 1 J ? 7
SOIL MAP SHEET SOIL TYPE: S
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
_ Z
SOIL. BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHE OBSERVED ESTIMATED HIGHE=ST (DEPTH TO BEDROCK IF OBSERVED)
15
-7 S CI- " -2 SL 72 7 3 LS ^7
--Z SL • .Z 3 L 5 -3'6 ` 7
a rte- ~i C- - S' - 2 S Z ~p^ L -3
6 -r L s ' 'z 3 c 3---
I C, -3
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet f suitably 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. C. lt~ 4
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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) C Y2 L u✓ Certification No. S S} I
Address K) 3 i C c -
Name of installer if known
CST Signature ~
COPY A - LOCAL AUTHORITY
PLR67 State and County State Permit #
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 PRO ERTY Mailing Address:
1 C . z 6 I?
B. LOCATION: _ %-S-:I_%, Section T N, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
6F q hx-1A Township
C. TYPE OF OCCUPANCY: *Com rcial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedlrooms No. of Persons
D. TYPE OF APPLIAN ES: Dishwasher ' YES _ NO Food Waste Grinder YES~NO # of Bathrooms
Automatic WasherYES NO Ot er (specify)
E. SEPTIC TANK CAPACITY- f~ Total gallons No. of tanks _f_
*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) 2) 3) Total Absorb Area - sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length 4;-i1 Width Z / Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size C/ r
Percent slope of land S l 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 Testes,
NAME _ C.S.T. # and other information
obtained from CA~,z ( wner/builder).
Plumber's Signature IVIP/MPRSW#~"-Phone # 2 yG - S1/ 3 S
Plumber's Address r3 r 7
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below FOR DEPARTMENT USE ONLY
Date of Application Fees PO: State o n y a Date 1 /0,00 Permit Issued/Ra}eete (date) - _issuing Agent Name /
}nspection 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