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Parcel 038-1069-70-000 09/20/2006 09:36 AM
PAGE 1 OF 2
Alt. Parcel 17.31.18.293G 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
GENE C & VIKKI JAMIESON O - JAMIESON, GENE C & VIKKI
987 ISLAND DR
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 987 ISLAND DR
SC 3962 NEW RICHMOND
SP 8050 SQUAW LAKE RHAB & MANAGE
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 17 T31 N R1 8W PARCEL IN NE NE S 75' Block/Condo Bldg:
OF N 875' BNDED ON W BY SQUAW LK & ON E
BY LN COM 540.25'W OF NE COR TH SE BY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEFL> 96 DEG 75 FT TOPOB: TH CONT 151' 17-31 N-1 8W
TH DEFL> 7 DEG TO LEFT 232.2FT, TH BY
DEFL> 8 DEG TO RT 502.66 FT, TH BY DEFL>
more...
Notes: Parcel History:
Date Doc # Vol/Page --hype
12
2006 SUMMARY Bill Fair Market Value: Assessed with: v
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 82,500 188,900 271,400 NO
Totals for 2006:
General Property 0.000 82,500 188,900 271,400
Woodland 0.000 0 0
Totals for 2005:
General Property 0.000 82,500 188,900 271,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 213
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 038-1069-70-000 09/20/2006 09:36 AM
PAGE 2OF2
Legal Description: cont.
73 DEG TO LEFT 335 FT MOL TO CEN LN OF RD POB ALSO COM 800.12 FT S OF NE COR
W TO E LN OF 33' RD SLY ALG RD 134. 9FT SELY ALG N LN SD RD TO E LN NE 1/4;
TH N TO POB
II
Parcel 038-1069-20-000 09/20/2006 09:25 AM
PAGE 1 OF 1
Alt. Parcel M 17.31.18.293B 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 - PITSCHNEIDER, STEPHEN L
STEPHEN L PITSCHNEIDER
989 ISLAND DR
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 989 ISLAND DR
SC 5432 SOMERSET
SP 8050 SQUAW LAKE RHAB & MANAGE
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 17 T31N R1 8W PRT NE NE S 75 FT OF N Block/Condo Bldg:
950 FT BOUNDED ON W BY SQUAW LAKE & ON E
BY R/R ALSO COM NE COR SEC 17;TH S 00 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG W 1049';TH N 77 DEG W 364.3' TO 17-31N-18W
POB;TH N 77 DEG W 105';TH N 03 DEG W
14.2470 THE S LN OF THE N 950' OF THE
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1087/158 WD
07/23/1997 1087/156 WD
07/23/1997 696/374 WD
07/23/1997 528/617 LC
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 56,500( 122,800 ! 179,300 NO
Totals for 2006:
General Property 0.000 56,500 122,800 179,300
Woodland 0.000 0 0
Totals for 2005:
General Property 0.000 56,500 122,800 179,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 502
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP . SEC . T N, R y W
ADD RE ST. CROIX COUNTY WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
w
!x
r
a r' "
t'
t
1 •t ~
I di a e 140 tSC L i
SEPTIC TANK(S) MFGR. , CONCRETE STEEL
N0. of rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. ML NO.
GALLONS Per Cycle
TRENCHES NO. of width length area
BED NO. of lines width length area
depth to top o pipe
NUMBER OF SEEPAGE PITS Outside iameter total.pit area
AGGREGATE
PERK RATE - AREA * REQUIRED AREA AS BUILT
Disclaimer: The inspection of this system by St. ICtoiX County does not imply
complete compliance with State'Administrative Codes. There are other areas thn
it is not possible to inspect at this point of construction.. St. Croix County
assumes no liability for system operation. However, if failure is noted the
County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SY
rs
sE 0 R FA--
DATED PLUMBER ON JOB
LICENSE NUMBER sj
RI PORT Of INSPECTION IN'DIVI'DUAL SLWAGL SYSTLM
Savr,i.t,zny f'(nrn.tt p7p~
State. S e p t A. c-
JAMf _St. CwuA"x Couyrt
scat tiA" vi
' Sects on~ Lu.t N Sub d4-v4-.5 i.on
N
I Pl lC LANK
-i zc Numbers o curnpantrnente
ti favice ~l-um: f vte bu,cYd4-n.d 126 5tupe.
If iIwate A.
ItMI'ING CIIAMBE N
gaY'avt.a Pump Manu(aetun.e.n M o d c t Numbers
I UINo j ANK
gaI funs Nu rnbelt u6 Compah.tme.nt,5
Pumr v l Atan.rn S y6 te.m
t«vtc!l(IIn: We.tl 6u~120 hope.
11,tghwaten
w;oK11FION SI I1.
N v d DL encl~
, taklce (n.orn: CUekt Iiu~.Pd4- n.g_ t2's s~ripe -
I I t. it It w at e
0 N11110N S77L DIMENSIONS
(v Iit a taeneIt ~t Rerlu.i Ae.d aAc.a (~t
fcviq(It u{ eaeh Derth u( h.uck be.lPow t~-ke <n
Nttmbe'r n( Y1 te.~ Depth o6 Aueh uve.n dike t-n
Ie)t~a.I' tengt11 0A e4rt t Uep,01 0A tike 1)olow gn(l de - -n
1) ('Atavi ce between Yi.neh At Se upe u( tAench pIOU (t
Iutaf abhunption an.ea (.t. Type u( coven: Papers un .ytA.aw I
II OIMINSIONS
Nurnb e n o (I Grave k around p4-t/5 yep-- ~nu
0utlS (Ie dt.arne.ten (t De-pth be-eow -Cnk-e.t
1 ,.taY aba,nl_>on acre a t
A it (o It c (I
I'I'I;C)V1 DDATL 1915
- ---G_ l - - - -1JJJ~~~"~~~ -
f l1 C 1 1 V DATE 19 d
t A,~ON I i)N RI 11 C I I ON
I
• moo: 4Yy~
9`
State and County State Permit #
PLB 67 ~
f., w Permit Application County Permit #
for Private Domestic Sewage Systems County td
DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
L
B. LOCATION: Alt Section -a, T-3j N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township,&-, ° bel
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family -X- Duplex No. of Bedrooms ,j No. of Persons
D. SEPTIC TANK CAPACITY 11)()[y Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete- Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement_
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate'~C_ taI Absorb Area 0~? sq. ft.
New Replacement- Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: -Length Ly Width ' Depth 1 " Tile depth (top)es _No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slopes
WATER SUPPLY: Private ~4 Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
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 Tester,
NAME C.S.T. # and other information
obtained from - (owner/builder).
Plumber's Signature MP/MPRSW# /S l Phone -%-S-S~
Plumber's Address S 7
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
. E
i
i
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application/Gt Fees Paid: State County Date - 00 04 Permit Issued/l ctetl (date) Issuing Agent Name A , e- -,z Q ~A-,/
Inspection Yes No State 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) Revised Date 7/1/78
'EH 1 15 Rev. 9178
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION:'/a,_AL11a, Section _47_,T-R/ N,RJ±U (or) W, Township or Municipality ~7 # fix%t
Lot No. , Block No. County fides
Subdivision Name
Owner's/Buyers Name: 6,YA/C '4,4" o2
Mailing Address: . A4~~ 41j e
TYPE OF OCCUPANCY: Residence _,Y No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT-ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS10-~2Z- Ar PERCOLATION TESTS ZQ" A0
SOIL MAP SHEET NAME OF SOIL MAP UNIT =
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- SINCE HOLE HOLE AFTE INTERVAL MIN/IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
3 3
P- / 3
1 hs~ X, 3c)
P_
P 1. „ r U11,
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B-
i
B- p > Q - .i, - -9 0 B- 7
B-
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the Ipj4tion and square feet of suitable 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.
~ sou.. ~f'inJc'~ _
- E k.C r'vc~
N
Sa~
~mwmm. ~ - yhcit - _ - ~LICI ~ t
f t
3
x
17
I, the undersigend, 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) Certification No._d:5-S- j
Address
'dame of installer if known
CST Signature
Copy A -Local Authority
k11
7
•
9-Si
V SAIZIO ~
.~U~.Slor~c
U1
~t
L
1 B." _
REPORT ON INSPECTION OF SANITARY PERMIT #
(1) Name and Address of Permit Holder Person/Persons at site (2 )Date of Inspection
J .1 GL2 t
Time of Inspection
ame, ess, icen o. o ns a ing Plumber
3 INSTALLATI N CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN ermanent reference Point) Describe:
Elevation of vertical reference point: Slope at site:
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity:
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: # ft to well:
M DOSING TANK: Manufacturer: # of gallons:
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines gallon; size of pump head; gallon per minute ;
horsepower ; brand name of pump and model number
Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO
;
8 HOLDING TANK: Manufacturer o gallons
construction ; depth to the cover ft; If septic tank is
being used are baffles removed? ❑ YES ❑ N0; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO;
Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material
Distance from building to vent
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe-elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPAGE BED SIZE: ft width; ft length; tile depth;
lineal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed ft.
11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft;
tile depth ft; ft to well; ft to ordinary high water mark of
lake or stream; ft to edge of slopes greater than 20% falling away toward lakes,
water courses or drainage ditches; elevation of tank discharge line entering seepage
trench ft.
(12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO
(13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO
DILHR-SBD-6095 N.05/80
Signature of Inspector:
I