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Parcel 038-1093-10-100 02/08/2006 09:13 AM
PAGE 1 OF 1
Alt. Parcel 22.31.18.383B-10 038 - TOWN OF STAR PRAIRIE
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 - HEINECKE, JEFFREY A & CHERYL
JEFFREY A & CHERYL HEINECKE
2013 110TH ST
NEW RICK IOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist / Description * 2013 110TH ST
SC 3961 NEW RICHMOND
SP 17CC WITC
Legal Des. ption: Acres: 0.000 Plat: 1374-CSM 05/1374
SEC 22 T3 I R1 8W 2.50AC SW SW LOT 2 OF Block/Condo Bldg: LOT 2
CSM 5/137 ALSO PT OF LOT 3 CSM 10/2719
DESC AS E _G NW COR LOT 3;TH N 89 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
373.80';TH 00 DEG W 105';TH S 89 DEG W 22-31N-18W SW SW
374.03';TH 00 DEG E 105' POB
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SU ;MARY Bill Fair Market Value: Assessed with:
119419 129,600
Valuatio s: Last Changed: 10/14/2004
Descriptioi Class Acres Land Improve Total State Reason
RESIDENT, L G1 3.404 36,200 91,200 127,400 NO
Totals fo 005:
General Property 3.404 36,200 91,200 127,400
Woodland 0.000 0 0
Totals fog 7004:
General Property 3.404 36,200 91,200 127,400
Woodland 0.000 0 0
Lottery ( edit: Claim Count: 0 Certification Date: Batch
Specials
User Speci. Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTMENT 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 Sltate Plan 1,D. Number if a gned
RECONNECT 1:1 Holding Tank 1:1 In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER'. INSPECTION DATE.
Je Hei_necke R. R. 2, New Richmond, W1 54017
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PL ELEV..
SW Sw, Section 22, T31N-R18W, Town o~ StoA Ptta Aie
Na- of Plumber. JMP,MPHSW N,, Coumy Sanitary Permit Number:
Cat Poweu 1563 St. Ctcoix 43734
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED'.
❑YES ❑NO ❑YES ❑NO
BEDDING: VENT DIA.. VENT MATL. JHIGH WATER FNUEj~jj BER OF ROADPROPERTY WELLBUILDINGJVENTTO FRESH
ALARMFRM LINEAIR INLET❑YES ❑YES ❑NO AREST
DOSING CHAMBER: _
MANUFACTURER 7INGCITY PUMP MODEL PU MPi SIPHON MANUFACTURERWARNING LABEL LOCKING COVER
PROVIDEDPROVIDEDES ❑NO [-]YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY IWELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF) ❑YES ❑NCI NEAREST-0
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO. OF DISTR. PIPE SPACING COVER IN:;IIJE DIA -PITS LIOUID
BED/TRENCH TRENCHES MATERIAL: PIT DEPTH'.
DIMENSIONS
(]RAVEL DEPTH FILL DEPTH JDISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV. INLF i ELEV. END. PIPES. FEET FROM LINE. AIR INLET'.
NEAREST
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 COVER TEXTURE PEHMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH: BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO.OF LATERAL SPACING. JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. JNO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV. DIA. ELEV.. PIPES DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION DOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO ❑YES ❑NO
UMBER OF PROPERTY WELL. BUILDING'.
COMMENTS: PERMANENT MARKERS: IOBSERVATION WELLS: jNEAREST----)oj
EET FROM uNE.
❑YES ❑NO ❑YES ❑NO Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE
DILHR SBD 6710 (R. 01/82)
w
lsconsln APPLICATION FOR SANITARY PERMIT DILHR t!f COUNTY
OEPRRT 1CnT OF (PLB 67) UNIFORM SANITARY PERMIT #
In OUSTRY, LRBOR 6 HUMRn RELRTIOnS
Ezz
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
P OPERTY OWNER MA I G ADDRESS
P P
Y LOCATION
Y7~ GE:
1/41/4, S -22, T3/, N, R (or) W TOWN OF:
LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN D. NUMBER
4Z4 &)14,
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. ❑ Public (Specify): IV A
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
Ll Alternate System Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
Existing, For Which A Previous Permit Is On File, Permit # q issued -
An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity f
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
manufacturer: C C, ~j
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
; Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation the private sewage system shown on the attached plans.
N e of Plumbeill Si ture: /MPRSW No.: Phone Number:
yt~
v~~~~ ,~vs / (7(S-)
Plumber's Address: Name of Designer:
~ c
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
Disapproved
0 7 Approved Owner Given Initial
y,- t(x/~~Q/[ Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
l
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.) ;
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
j
• AS BUILT SANITARY SYSTEM REPORT
'`dER n
"14 FA I TOWNSHIP SEC.,
T. a N R W
0. ADDRESS - , ST. CROIX,~WISCON'S N.~
3DIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
.
v~CY'
PIC .5
i
i
'TIC TAN (S) MFGR.
CONCRETE 1_ STEEL
NO. of rings on cover Depth ir. " DRY WELL
INCHES NO. of width length area
J no. of lines width! length are
depthP to top of pipe Ij '
1REGATE ~E~ r31dS.~~ 16e ~
'K RATE
f, AREA REQUIRED 6,( ~ 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
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.
I
`'INSPECTOR --i
t
DATED a
PLUMBER ON JOB
LICENSE NUMBER ~6
z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM t
Sanitary Permit
State Septic
f NAME Township St. Croix County
Locate,ovi L- ~ o 6 L!, Section -,-,j N, R Gl
j; SEPTIC TANK
Size gattons. Numbers o6 Compartments
t
o
Distance Fnom: GleZZ 6t. 12 0 on greater 6Zope 6t
Buitding_4c~_6t. WetZands 6t.
Highwaten 6t.
DISPOSAL SYSTEM
Distance Fnom: wetZ 6t. 12% on greaten 6Zope 6t.
Building bt. WetZands Ft.
Highwaten 6t.
FIELD DIMENSIONS:
Width o6 trench 6t. Depth o6 no ck b eZow tite f in.
Length o6 each tine bt. Depth o6 rock oven tite in.
Numbers o4 tines Depth o6 tite below grade in.
Totat .length o j tines fit. Slope o~ trench in pen 100 bt.
Distance between tina L, bt. Depth to bedrock 5t.
Totat ab6onbtion area 6t2 Depth to gnoundwaten
i Requined area 6t2
PIT DIMENSIONS:
Numb en o6 pits Gnavet around pits yes no
Outside diameters 6t. Depth b eZow inlet 6t.
Totat abzonbtion a`n.ea 6t 2
z
Area nequ.ined 6t2 rn
z
z y
3 INSPECTED BY TIT
APPROVED -?ATE 197(_.
- €
REJECTED , DATE 197
c
vt
y
State and County State Permit #
PLB67 Permit Application County P it w
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PJROPERTY Mailing Address:
F- Vj)Y-\
B. LOCATION: '/4 ~i '/4, Section, T N, R+ (or) W Lo r# -City
Subdivision Name, nearest road, lake or landmark Bik# Village
Township
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
` Lt4
D. TYPE OF APPLIANCES: Dishwasher -X YES NO Food Waste Grinder YES-X-NO # of Bathrooms-4-
Automatic Washer DYES NO Other (specify)
E. SEPTIC TANK CAPACITY 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) Vi=a- 2) 3) Total Absorb Area ft.
New-)- Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches -
Seepage Bed: Length ~Width Depth Tile Depth i' No. of Lines _Q
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land 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 Cer;~4a d S it Test ,
NAME ~ Z-A , C.S.T. # and other information
G
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# ~s Phone Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
I
(TiPE''c) ' I
i
A n n I\ 1l I\ -
e
I. ~~\9'Lf
CA yoo
I
Do Not Write in Space Belo FOR DEPARTMENT USE ONLY
Date of Application - - Fees Paid: State l~(`) Ca County ~`7` ~~Date J
Permit Issued/R*Oeted (date) - -Issuing Agent Name
Inspection Yes -A-1N o 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)
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 TESTS
LOCATION: '/4, Section T.zVN, R 6 if (or) W, Township or Municipality tt"-,ZA',:-'
Lot No. BI No. . County
. r Subdivision Name
Owner's Name: " Z 4t- ir, ✓ ir- Mailing Address: kW -A&-, ; , W4y ✓n V~
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
mod-ADDITION REPLACEMENT
EFFLUENT DISPOSAL SYSTEM: NEW /
DATES OBSERVATIONS MADE: SOIL BORINGS '3 - .2S--7-_2 PERCOLATION TESTS ZY
SOIL MAP SHEET - IX SOIL TYPE 3 i,f- l-E :g
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-
4S jkerAtL
P-_3
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)
- S
c 4 G f _ t
PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of syitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. J`i_ 7 Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
i
/1 /1
4 W
~ ! _ !
! ' - N
17
f f t j Ilia - I 1 + I ' ' f
i 3 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 A nistrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and belief.
tL
Zvi 9 Certification No.-
P.1 6
Name (print)
Address '
Name of installer if known
CST Signature -
AS BUILT SANITARY SYSTEM REPORT
R l~ , TOWNSHISEC. T~_N, R
RESS'^ T ST. CROIX COUNTY, WISCONSIN.
ADD
T
(VISION LOT LOT SIZE
PLAN VIEW
Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
70
t 3' 6
TIC TANK(S) MFGR.~ CONCRETE__t-_ STEEL
NO. of rings on cover Depth DRY WELL
';CHES NO. of width length area
no. of lines width ' length area -j
vdepth to top of pipe '
!ZEGATE ;t/ Jor
K RATE J AREA REQUIRED AREA AS BUILT
c3aimer: 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
inspect at this point of construction. St. Croix County assumes no liability for
Lem operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
/USES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.;
`INSPECTOR
DATED ~D PLUMBER ON JOB
LICENSE NUMBER
I '
I J )
L~ l 1