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12/02/2005 11:26 AM
Parcel 036-1003-90-000 PAGE 1 OF 1
Alt. Parcel 2.31.17.30D 036 - TOWN OF STANTON
ST. CROIX COUNTY, WISCONSIN
Current X
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 - PLACE, COREY G & BARBARA E
COREY G & BARBARA E PLACE
2333 185TH ST
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 2333 185TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 4.420 Plat: N/A-NOT AVAILABLE
SEC 2 T31 N R1 7W NW SE LOT 3 CSM VOL Block/Condo Bldg:
1/202 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-31N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/09/1998 580636 1330/193 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Last Changed: 05/05/2003
Valuations:
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.420 25,000 121,300 146,300 NO
Totals for 2005:
General Property 4.420 25,000 121,300 146,3000
Woodland 0.000 0
Totals for 2004:
General Property 4.420 25,000 121,300 146,3000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 137
Specials:
Category Amount
User Special Code
Special Assessments Special Charges Delinquent Charges
00
Total 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER ~fr TOWNSHIP SEC. VLN-WZW
ADDRESS-4 ( l ST. CROIX COUNTY, WISCONSIN.
-A1~', ,I 1y~~
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H(
- - EEYTHING WITHIN 100 FEET OF b Y s'i' a i
r - _
"E "S7
di a e o th Arrow
t
SCA
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point:ZM ',0'' Slope at site: C v
4,t,5~
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings on cover - Tan manhole cover elevation:_
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons ~ s
Number of gal. pump set or a cycle gallons, total` apacity o
distribution lines gallon: size o pump head;
gallon per minute horsepower ran 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 o pits feet diameter _
feet liquid dept! seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width leytgth tile depth
SEEPAGE TRENCH: width length _
PERCOLATION RATE AREA REQUIREDy AREA AS BUILT
INSPECTOR
DATED PLUMBER ON JOB,;
LICENSE NUMBER'/_~1
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEMY`
r'
Sanitary Permit o2 7
State Septic _ / 7
NAME TOWNSHIP St. Croix County
LOCATION } Section Lot # Subdivision
SEPTIC TANK
Size gallons Number pf compartments
;~istance from: Well ~Builditg 7 12% slope `
Highwater
PUMPING CHAMBER
&L. Al ifr gallons Pump Manufacturer A 1 Model Number
HOLDING TANK
Size gallons Number of Compartments
Pumper Alarm System
Distance from: Well Building 12% slope
Highwater
ABSORPTION SITE
Bed Trench
Distance froth: Well Building 12% slope
Highwater r
IABSORPTION SITE DIMENSIONS
Width of trench ft Requ'i>pd'area ft.
Length of each line
ft Depth aof-:, rock below the in.
Number of lines Depth of rock over tile in.
Total length of lines ft Depth of tile below grade
Distance between lines` ft Slope of trench in. per 100 ft.
Total absortption area ft Type of Cover: PIT DIMENSIONS
Number of pits Gravel around pits yes no
Outside diameter ft Depth below inlet ft
Total absorption area ft
Area required ft r
LNSPECTED BY TITLE,
APPROVED DATE 19a/
REJECTED DATE 198
REASON FOR REJECTION
nEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY; FOR SANITARY DIVISION
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'/2 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. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address:
L ~ f r _
Property L ation: ity, Village or Tons ip: County:
as t/a %S_2 /T,,3/ N/R t (or) W 7
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(if assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required. 3
ST/.J4 ~(iLx7 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
J GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Speci y)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER X
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental ;K Seepage Bed ❑ Seepage Pit
-2/ ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature- MP/MPRSW No.: Phone Number:
$ 1-7Z je '
Hlumber s Address: Name of Designer:
X, COUNTY/DEPARTMENT USE ONLY
Signature Issuing Agent: Fee: Date: ~J APPROVED
cam. I / ❑ DISAPPROVED San/ity /itumber:
ason 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 (N.03/81)
DEr ;RTMENT OF ORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, r
DIVISION
LABOR AND RFPF-IvF(j ERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELA N sNov 1 198, P.O. BOX 76
.J
LOCATION: ECTIO TOWNSHIP/MUNICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME:
N/" ~r) W r
COUNTY: l R'S BUYER'S N MA LING ADDRESS:
T
USE
DATES OBSERVATIONS MADE
Residence NO. BEDRMS.: COMMERCIAL DESCRIPTION: ❑New [ R ON
Replace
771
RATING: S= Site suitable for system U= Site unsuitable for system i
CONVENTIONAL: MOUND: IN-GROUND-PRESSUR E:S11TEM-1 -FILLHOLDING TANK: ECOMMENDEDSYSTEM: (optional)
®s ❑u ❑ s ❑u ❑ s ❑u ❑ s ❑u [7] s ❑u j
rcolation Tests are NOT required DESIGN RATE: SYSTEM EL I If any portion of the lot is in the
Funnders.1-6309(5)
.(b)
, indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
13- Z-2 Z2 _,O
I
r
B-
>
2 5
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD PER INCH
P_ Z 26 Ala A& /v N 3
P-
IVQ At 1: _?0
AS- i .2 -36 P-
- -30 3 &b Al 4:
-
P_
P-
P-
PLAN VIEW: 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 slop.
SYSTEM ELEVATION 9V% "
I _
Ai('
r
4
61.1 if
X
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
AD RE CERTIFICATION NUMBER: PHONE NUMBER optional):
CST SIG{VA URE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6396 (N! 03/81)
0
~c
i
9s" i
-.4Q 9~ ~
•
/7puS~E
sv•
[J/~ fC/CCc'
vI
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e
D.I.L.H.R.
Leroy Jansky O.W.S. Wisconsin Department of Industry,
13 E. Spruce Street Labor & Human Relations
PLB-1 INSPECTION REPORT Chippewa Falls, WI 54729 Safety & Buildings Division
(715) 723-8786
Bureau of Plumb in , Platting & Fire Protection
Name o remises a e an No.
Street i y oun y Sanitary Permit
as er um er irm Name dress
Journeyman Plumber -Address
Owner -Address
Discussed with signature
( )See Attached.
DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. on-Site Waste p
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Gre,
ER ~ r TOWNSHI$S ' SEC. T ,~_&J N, R~ W
3. ADDRESS ST. CROIX COUNTY, WISCONSIN.
SDIVISION LOT LOT SIZE,
~Z Ems.
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
(C~
y
X71
s
I
'TIC TANK(S)MFGR.J CONCRETESTEEL
NO. of rings on cover o Depth DRY WELL
',NICHES NO. of width length area
no. of lines width I? , length 5,, • area ,z
de th to top of pipe
:.:LEGATE
:u: RATE r,, AREA REQUIRED_,S` AREA AS BUILT c
claimer: The inspection of this system by St. Croix County does not imply complete j
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
tent operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
w'INSPECTOR
DATED
0a Z_ ~ PLUIIBER' ON JOB
LICENSE NUtfsER
Z.
' REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanita&y Pettmit-•11'
State Septic
NAME _Township St. Croix County
Locationl)4% o4Y' Section-,~ T'51N,R PIW
SEPTIC TANK
Size gattons. Number o4 Compa,cLtment,s
Distance Ftcom: Wett it. 12% otc gtceaten stope it
Building 1 it. Wettand~s 4t.
Highwaten - it.
DISPOSAL SYSTEM
Di,s.tance Ftcom: Wet.t it. 120 otc gtceatetc stope it.
Building it. W ettandls Ft.
Highwatetc it.
FIELD DIMENSIONS:
Width of ttcench it. Depth of noch below tite in.
Length os each tine it. Depth of rock oven tite in.
Number o6 tinez Depth of tite below grade in.
Totat .length o6 tinez 6t. Stope of ttcench in pen 100 it.
Distance between Uneb jt. Depth to bedrock it.
Totat abls onbtion area 6t2 Depth to gtcoundwaten
2
Requited atcea it
PIT DIMENSIONS:
Numbers o6 pitz Gnavet atcound p-i.t/s ye/s no
Outside diametet it. Depth below intet b~.
2
Totat ab,sotc.btion area it z
A
Akea tcequitted it2 m
INSPECTED BY TITLE r
APPROVED DATE 197
REJECTED DATE 197
0
CLI 1WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
GG DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
` MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS /
ION:Section , TAN, R I_r/t (or) 1#6 Township or *w*ims~ ✓ ~~t C? /'l~
r =~I" X
County
-ot No. , Block No. Subdiv'sion.Name
Owner's Name: l t 1 ~.5 i~ ff _
Mailing Address:
16 C_Zc in /(I n~cb
TYPE OF OCCUPANCY: Residence J'No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS ~PERCOLATION TESTS Zd
SOIL MAP SHEET 1-_- r - SCI!. TYPE t ' - -
PERCOLATION TESTi
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
CHARACTER OF SOIL
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 5- It
P-'7 t. l
3/-7 Z
i /
I ) l
SOIL BORING TESTS
C TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
r-
-7 4.
72 -7 7
!'?_AN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
dicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
.eeded for building type and occupancy. C; 1j" Indicate scale
)r distances. Give horizontal and vertical reference points. Indicate slope.
s ,
P.
I
_4_4
i
I
r
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) 3 Ce ific ion No.
Address )
Name of installer if known,
hkhlh,- CST SignatuL
-111 AUTHO.RiTY
State and County State Permit #
P tP Permit Application County Permit #
for Private Domestic Sewage Systems County
,jENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: Section 3 T - N, R (or) 'W Lot# City_ {
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher yYES NO Food Waste Grinder YES z--NO # of Bathrooms
Automatic Washer L-YES NO Other (specify)
SEPTIC TANK CAPACITY / e e o Total gallons No. of tanks
`Holding tank capacity Total gallons No. of tanks
'Jew Installation Addition Replacement Prefab Concrete _
'Poured in Place Steel Other (specify)
_FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) Z 3) (5~,_Total Absorb Area_
"`Jew L-Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenc
Seepage Bed: Length-5Z / Width Depth _3j:~m - Tile Depth e 4~~- No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land ~ ~ 4
Distance from critical slope
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
1:1Jisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepare:'
by the Certifi d Soil Tester,
NAME - / C.S.T. # and other informatic
obtained from
(owner/builder). _
y~ -
Plumber's Signature MP/MPRSW# Phone
Plumber's Address
p, 9111
L-A
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
I
-
P,A
Do Not Write in Space elo FOR DEPARTMENT USE ONLY
Date of Application -Fees Paid: State %I* County 41-4 Date _ -7f;7-9J77t9- Permit Issued/Rejected (date) Z 170 Issuing Agent Name _
Inspection Ye~No Valid# Date Recd
1. county (w itR e` copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI
=state (pink copy) 4. plumber (canary copy)
Revised Date 6/1,
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Wisconsin Department of Industry,
PLB-1 INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing, Platting Fire Protection
Name o remises Date an No.
Street City County Sanitary Permit
Master Plumber Firm Name dress
Journeyman um er Address
Owner ress
-
-
u1scussed with nature'
( )See Attached.
DILHR-SBD-6192(N.09/80) Signature o Mist. Plumbing ing up. On-Site Waste pecia is
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner