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Parcel 12.30.17.174 012 - TOWN OF ERIN PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit 4 Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - RARER, THOMAS R ET AL TRST THOMAS R ET AL TRST HARER 262 155TH ST AMERY WI 54001 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND 4-A ~p SP 8020 UPPER WILLOW REHAB DISTj SP 1700 WITC C ~ Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 12 T30N R17V~40A NW NE Block/Condo Bldg: Tract(s): (Sec= fwn-Rng 40 1 /4 160 1/4) 12-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 09/22/2000 630399 1545/12 WD 09/22/2000 630398 1545/09 WD 07/23/1997 962/91 07/23/1997 810/206 2006 SUMMARY Bill M Fair Market Value: Assessed with: 155836 Use Value Assessment Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 45,000 106,400 151,400 NO AGRICULTURAL G4 33.000 6,300 0 6,300 NO 00 UNDEVELOPED G5 4.000 1,300 0 1,300 NO Totals for 2006: General Property 40.000 52,600 106,400 159,000 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 52,400 106,400 158,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNEI= - TOWNSHl:P 5~.: !-_SEC . ,/,--Z T,5-R17 W ADDRESS ST. CROIX COUNTY, WISCONSIN. --r~Z~z SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - / d I Z i 77 3 at N r h r r w BENCHMARK: (Permanent reference Point) Describe: -S+EF(09-)Ce-j 1A Elevation of vertical reference point: -:Q~' _ Slope at site: d-Z SEPTIC 'TANK: Manufacturer:__yt/~~~t/-,5 Liquid Capacity: Number of rings on cover Tank manhole cover elevation: i7 Tank Inlet Elevation: Outlet- Elevation: PUMP CHAMBER Manufactur_ Number of gallons Number of pump set for a cycle gallons; Total capacity of dIstrib ines_ ga llon: size of pump head; gallo per minute-- _ horsepower _ ;brand name of pump an model number pe of warning device " i HOLDING '1 1(': Manufacturer Number of gallons Elev tion of manhole cover ; T e of warning device SEE AGE Ply SIZE; Number of pits feet diameter feed-liquid depth seepage pit inlet pipe-elevation I},ottom..-o-f seepage pit elevation - feet. SEEPAGJ'-BED SIZE: number of lines width length the depth SEEPACE TRENCHC-width- length PERCOLATION RATE _ AREA REQUIRED- AREA A BUILT INSPECTOR DAT'Ell_ _~--C PLUMBER ON JOB LICENSE NUMBER /yl~~S / .',?D - z .'D o DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION. P.O. BO}X 7969 ' BUREAU OF PLUMBING MADISON, WI 53707 ECONVENTIONAL ❑ALTERNATIVE IS,,,, PI,m 1,D. Number: If assigned) El Holding Tank ❑ In-Ground Pressure El Mound ( NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Lawrence Harer RR#1, Box 77, New Richmond, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. JCST REF. PT. ELEV. NW NE, Sec. 12, T30N-R17W, Town of Erin Prairie /L90 ` /0a Name of Plumber. IMP/MPRSW No. County Sanrtary Permit Number: Gary L. Steel 3254 St. Croix 38502 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. 11AINING LABEL LOCKING COVER PROVIDED PROVIDED 99`I? YES ❑NO [:]YES O BEDDING: VENT DIA.. VENT MATIL JHIGH WATER NUMBER O ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH w~^ ALARM. FEET, FROM /,)J ~ LINE//}} J AIR INLET./ YES ❑NO ❑YES NO NEAREST /v~ 7„ DOSING CHAMBER: MANUFACTURER BE DDING. ILIOUID CAPACI TV PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LABEL FPPRR.V COVER PROVIDED: DNO ❑YES ❑NS ❑NO GALLONS PER CYCLE: S OPERATIONAL NUMBER OF PROPERTY WELL VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST 00 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FNGTH DIAMETER MATERA 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 1111TR PIPE SPACING. COVER INSIDE DIA -PITS LIQUID BED/TRENCH TRENCHES. / MA ERIALt PIT DEPTH. DIMENSIONS ,S~ GRAVEL DEPTH FILL DEPTH UISTR PIPF DISTR PIPE DISTR. PIPE MATERIAL. NO. R. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES AHUVE COVER EL~~.jl INLET ELEV. END PIP NEAREST -►LINE / AIR INLET /'r~ b FEET FROM ~GO 49 3G zoe .2 Of MOUND SYSTEM: q Y. eC. 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- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION 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. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. [STH P IPE DISTRIBUTION PIPE MATERIAL & MARKINGELEVELEVDIAELEV.PIPESA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. A _71 S A URE. LE. DILHR SBD 6710 (R. 01/82) TIT 1 DEPARTMENT OF APPLICATION LDINGS INDUSTRY, FOR SANITARY SAFETY & B DIIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Proper y Owner: Mailing Address: / L/0_ tr YI L9E hI'' G`, i~ , (r7~ C/' /,W/'..571, Wr perty Location: Gtty; V+uage or To hip: County: W '/a/Vr'/aS /Z J ~30NiR ! R(or) W G~*l^i 1-7 rd 19-!_ /4~ &P" 47 X Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING 7" ((O~ Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: ,9-1 or 2 Family *State Approval Required. 13 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New 54Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit 2- 7 750 ❑ Alternative (specify) ~ Seepage Trench Water Supply/: Owner's Name as Listed on Soil Test Report (If other than present owner): E, Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name Plumber: T ignature: ivTP'/MPRSW No.: Phone Number: ~h" E 3.x.5 .Z Ski 60 _ C24 Plumber's A dress: Name of Designer: COUNTY/DEPARTMENT USE ONLY Si natur of Issuing A ent: F e: Date: Sanitary Permit Number: li~ )4_ a APPROVED fj5 E] DISAPPROVEDu O /a-, Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07)81) Form - S T C 100 Owner Of Vropcrty Location of Property Section Q T 3C, N R Towns hi p_ _ ~r i v` Mailing Address_.. Guy--nti~►'~~~ `7 Subdivision Name Lot Number ,row- ^ Previous Owner of Property--,. Total Size of Parcel Date Parcel Was Created Are all corners idr.utifiable? Yes No Include with this application one of the following. .Certified Survey Map .Deed .Land Contract, or .Other Eagal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as l: ocument No. . ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICAULE) DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LAEDR ANA PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN`RELATIONS MADISON, WI 53707 (H63.0911) & Chapter 145.045) LOCATION: SECTION: p TOWNSHIP/ Y; LOT NO.:BLK. NO.: SUBDIVISION NAME: 'VJ Z- /TS'C~H/1'►J~A(orlW ti COUNTY: OWNER'Sr<~S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROOUNNIPRESSURE: SYSTEM-IN-FIILLHOLDIING TAINIK: RECOMMENDED SYSTEM: (optional) OS DU NSEU [ZSE A DS EU FIJ®V If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS -3 o BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER BEFf}{-IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 5_0 211 XI-7- 1, _5 ~Lj 0 A) E_ 3 3 ~sS 33 ~ JfB ~ ~z 13 B "73 >-7 08 n i . din L , B- B B- PERCOLATION TESTS I~E~irnwp TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER '4^49S._ AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ ) 37 b 3 -3 P- z- 3 8 Z N© O 3 Z. P_ Aso A) Q b / / a P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 40 h Ed 0 C) i60/ F416 CY00 r --p /~-4 -15, CO P r7,6r g_ ~Q D-f- MAI_ i, nE S hid /coo ' o P-1 -74 0 -5~ Apo(-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 Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): 1 y TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): E GrGr] d l~r Z z 98 "5--. ' 5~6 ~ozao CST SIGNTUC E: '7 7✓ /f / J~~J F DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DII-HR-SBD-6395 (R. 02/82) - 0 VFF 4• r,l . F e 91 AXI1 :s i , `zI-S 3 .T_!m j'.l',i 11 b,t, 3.i _ . Y3'i - .7 ,3u ( ,,Z SE V1 11161 W ~€.F , ~ „•~l +=t ,C:•~ ~'~it ~31i i>3. 31 • ~-~r.. w E ?4F, `c2; <'371E~_~, is ~kv)S ,),F; I _ia. , plfcola rl res: E, i j c°3 i , -A j, ili t,. G Q 0 Lv,A~ J - z!r'-~. ~"p p" z` r t ,3 c%' 3~' ,4, 7 ~ l I I &YIX e,m, I a_z J 90 0-1 f :3~ ` Cam`' tii ✓I f a3, (f ~cK~°o/~ ~~F l r2 o