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Parcel 038-1156-50-000 02/10/2006 11:05 AM
PAGE 1 OF 1
Alt. Parcel 22.31.18.725 038 - 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 - LESCARBEAU, STEVEN J
STEVEN J LESCARBEAU
2079 ASPLUND RD
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2079 ASPLUND RD
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.260 Plat: 2230-NORTHWOOD
SEC 22 T31N R1 8W PLAT OF NORTHWOOD LOT 5 Block/Condo Bldg: LOT 05
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
03/03/1999 598730 1407/590 QC
07/23/1997 673/66
2005 SUMMARY Bill Fair Market Value: Assessed with:
119973 215,800
Valuations: Last Changed: 10/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.260 26,800 185,300 212,100 NO
Totals for 2005:
General Property 1.260 26,800 185,300 212,100
Woodland 0.000 0 0
Totals for 2004:
General Property 1.260 26,800 185,300 212,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 222
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
X
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC~ 'Z N-RDW
ADDRESS 14 ST. CROIX COUNTY, WISCONSIN.
241
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
JT-
i
Indic at N r rr w
~0,~
BENCHMARK: (Permanent reference Point) Describe:
i
Elevation of vertical reference point: Slope at site: -
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings on cover Tank manhole cover eleva on:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle gallons; Total capacity of
distribution lines gallon: size of pump head;
gallon per minute horsepower ;brand name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover ;
Type of warning device _
SEEPAGE PIT SIZE; Number of pits- feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet. ,
SE1P4GE BED SIZE: number of lines- width V length~tile depth
SEEPAGE TRENCH: width _ I/ngth_ L
PERCOLATION RATE AREA REQUIREDAREA AS BUILT~_ _
INSPECTOR _
DATED PLUMBER ON JOB
LICENSE NUMBER- '
i
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.G. BOX 7969 BUREAU OF PLUMBING
MADISON, Ntl 53707
L~d CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE'.
Larry Hanson RR# 3, New Richmond, WI / -e3 ~/Z 0a
BENCH MARK (Permanent reference p mt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
NW NW, Sec.22, T31N-R18W, Lot 5,Northwood,Town or S.Prairi
Name of Plumber. MPIMPR SW No. County Sanitary Permit Number:
Cal Powers 1563 St. Croix 38473
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK UT LET ELEV.. WARNING LABEL LOCKING COVER
c PR IDED: PROVIDED'.
'A 4., ~ / S LINO ❑YES LINO
HIGH WATER NUMBER OF ROAD: PROPERTY WEL BUILDING VENT TO FRESH
BEDDING. VENT DI VENT MATL_
I I 1~ /
<< ALA FEET FROM LmE 7/ AIR/L
❑YES LINO NO NEAREST d / 1
DOSING CHAMBER:
NG COVER
MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOC V IKI DED
PRO
❑ YES LI N PROVIDED
O ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL UMBER O PROPERTY WELL BUILDING (VENT TO FRESH
TI"E AIR"LET
(DIFFERENCE BETWEEN f FEET F 91<1
PUMP ON AND OFF) ❑YES LINO _ N E
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing t FNGfH Z DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until RC
/ AIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH LENGTH JNIDISTR PIPE SPACING. COVER JINSIDE DIA -PITS LIQUID
BED/TRENCH TRENCHES / MGYER L PIT DEPTH
DIMENSIONS l G
GRAVEL DEP H FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT 6fR H
BELOW PIPE ABOVE COVER EL V. INLE T ELE VEND eJ PIPES' FEET FROM L / AIR L
glYtl~/ L_ l NEAREST ' 2 'l
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
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 PERMANENT MARKERS OBSERVATION WELLS
❑YES LINO ❑YES LINO
DEPTH OVER TRENCH. RED DEPTH OVER TRENCH RED DEPTH OF TOPSOIL. SODD SEEDED MULCHED
CENTER EDGE S
YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERALS A IN GRAY DEPTH BEL W PIPE. FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS ?
MANIFOLD PUMP MANIFOLD DISTR. PIP 111ANIF7D MATERIAL. N DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV.. CIA.. ELEV.. { PI S'. DIA.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY 1 COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES NO ❑YES LINO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING:
FEET FROM LINE
❑YES LINO ❑YES LINO NEAREST
T
y 12,
Sketch System on R In ' county file for audit.
Reverse Side.
SI NAT r/ ^ TITLE. i
DILHR SBD 6710 (R. 01/82) i X,
DEPARTMENT OF APPLICATION
INDUSTRY, FOR SANITARY SAFETY & BUILDINGS
DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/z 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.
Property Owner: i Mail' g ddress:
roperty Lo./ ion: Grotty, `fie or Township: County:
t/a yJ '/aS ~T NCR It (or) W -
of Number: Blk Nd.: Subdivisjon Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
S' ! ! I (If assigned)
0
TYPE OF BUILDI G
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required.
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 ❑ Replacement ❑ Experimental ® Seepage Bed ❑ Seepage Pit
"I ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name assisted on Soil Test Report (If other than present owner):
9 Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Nari}e of Plumber: /1 / ISign re: MP/MPRSW No.: Phone Number:
Plumbe 's Address:- r / ^i ! Name Designer.
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Age t: Date: APPROVED Sanitary Permit Number:
gy1 (~D b d DISAPPROVED ! V
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)
r-
Fo rill - S `1' C 100
Owner of Property ~,C.'~~, l{ Z-/►'J/)L 11-110-5'0 61
Location of Prope rty %4 I-4, Section _1 N R W
Tow n s h i p ! q//~~
Mailing; Address 7
Subdivision Name_j~?rt~ yrr G-~C~
Lot Number
Previous Owner of Property_ ~SC^~+
Total Size of Parcel '7
Date Parcel Was Created C~-! 'AZ 777--
Are all _ corners identifiable. ye No
Include with this application one of the followi_uy,:
Certified Survey Map
.Deed
.Land Contract, or
.Other Legal Document which descr-i.bus Chu 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 recorde in the Office of the
County Register of Deeds as Document No..s.
rand 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 Ctq Register of e s, as Document No.
SIGN 'URE F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
TE SIGNED DATE SIGNED
D'~PARTMENT OF SAFETY & BUILDINGS 1
INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION
LA¢OR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS \ / MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: / SECTION: I TLOT NO.:BLK. DdO.: SUB 'VISION NAME:
/T;' N/R;'~ (or) W
COUNTY: OWNER'S/BUYER'S N/,ME: MAILING ADDRESS:
r ~
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: r:~ PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence 1ZNew ❑RepIace
_3 4A t_ lc ' !ter - 3
RATING: S= Site suitable for system U= Site unsuitable for system ) 1JXe11j_ ,4J1 1
ME] ENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLIHOLDING TANK: RECOMMENDED SYSTE optional)
S❑U 0S❑U S❑U [IS U ❑S U
If Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
4 r
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHIM, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- I -
Zia/ z
04R/ "aAcs
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER HVCH-FS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- - ) - L S
P- 4~ AL
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 y' 1
sue; ~ ; I
T
-
I
f
_ _ i
top
H
~t
a Q
q~~ I
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedui s and methods specified in t nsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAM,E-(print): 7 TESTS WERE COMPLETED ON:
AD R i CERTIFICATION NUMBER: PHONE NUM/ BER(optional):
i ' L- 5 1
CST YNATU, E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
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