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j Parcel 030-2013-60-000 05/26/2006 08:29 AM
PAGE 1 OF 1
Alt. Parcel M 36.30.19.407A 030 - TOWN OF SAINT JOSEPH
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 - SIEGFRIED, JOHN T
JOHN T SIEGFRIED
1275 CTY RD A
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1275 CTY RD A
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 25.000 Plat: N/A-NOT AVAILABLE
SEC 36 T30N R19W PRT SE NE E OF RV & HWY Block/Condo Bldg:
ALSO KNOWN AS PT OF LOT 1 CSM 4/1153
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
36-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/02/2002 700581 2065/617 TI
12/02/2002 700580 2065/615 PR
07/23/1997 647/614
02/15/1995 525980 1111/481 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 37,900 242,600 280,500 NO
PRODUCTIVE FORST LANDS G6 9.300 171,200 0 171,200 NO
ENTERED BEFORE'05 CLOSE W8 13.000 54,800 0 54,800 NO
Totals for 2006:
General Property 12.300 209,100 242,600 451,700
Woodland 13.000 54,800 54,800
Totals for 2005:
General Property 12.300 209,100 242,600 451,700
Woodland 13.000 54,800 54,800
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SAN LTARY SYSTEM KEPORT
OWNER TOWNSHIP S1%
ST. CRO 1X COUNTY, WISCONSIN
ADDRESS Ll Ile A W -l"
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Diutancee and dimenuiunu CO meet ruquiremunts ui U63
L:VEj{YTHLNG WITHIN 100 FEET OF SYSTEM
V
r
72
115
i -
kt_
_ Al
It dt atle Wrh~ Ai:row i
SC~Lf i,_
BENCHMARK: (Permanent reference Point) Deacribe: Pti:rt y c
/ - -
JEItVation of vertical.,,. reference point: S lulu a t 6 i Le
SEPTIC TANK: Manufacturer: _ Liquid Caj)ac: r t y
Number of rin a on cover : - Tank manhole cover l eva i ion
Tank Inlet Elevation: Tunk llur icc 1'1i.•vui 1On 7-
PUMP CHAMBER
Manufacturer: Nwabei of nal tun:.
Number of gal. pulp aet Eor a cyc e_ gallonb, total cap,l( 1iy of
diutributiun linen 1Ion .3 [ze of puu►p lit"I 1.
gallon per minute huraepower brand iiauiL• 0I pump
and modal number
Type of warning aevAe
HOLDING TANK: Manutacturer NLuabci of ~!,at tau:
Elevation of manhole cover
1'y ,e of warnQg device
SUPAUE PIT SIZE. Number of pits 14-cI I Kim.I , I
feet. llyuid dhptl~ a.:cpagC p11 WWI p i pt I L Val 111,
ho(LOW ut deuprKe Pit rlev-1 1 -1,
SEEPAGE 11ED WE. number it 1 incu _w1(1i I1 TRENCH width le Ii
Pk kt ul.ATION }iATE - r W.'A 121'QUlRED
5
L Y
L-
DE'.'ARTM~NT OF INDUSTRY, INSPECTION REPORT FOR fir SAFETY & BUILDINGS
LABOR & HUMAN R*LATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.#.OX 7909 BUREAU OF PLUMBING
MAG~ON, WI 53707
L~CONVENTIONAL OALTERNATIVE State Plan l.D.Number
O Holding Tank ❑ In-Ground Pressure O Mound (If assigned)
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
y
BENCH MARK (Perrnanent refer point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. CST REF. PT. ELEV.
SE nf S T 304l, R 1 S~. uos
Na,- of Plurnher. MP/MPRSW No. County Sanitary Permit Number:
DonfiLkLirk • a 1y436
SEPTIC TANK/HOLDING TANK: G
MANUFACTURER. LIQUID CAPACITY: TELEV.. TANK OUTLET ELEV. WARNING LABEL LOCK GWAT F1
D G PRO DE ,:1,
ES LINO ES NO
BEDDING. VENT DIA.: VENT N~.T L.. HIGH WATER NUMBER OF ROAD//~~ PRNNOEEP ERTV WELL JBIJILDING. VE111 TO FRESH
ALARM FEET FROM / ~i'7Jt LI J AIF~INL E
YES ONO OY ONO NEAREST Il...>
[O NG CHAMBER:
MANUFACTURER BEDDING. LIQUID' P CITY JMP EL P IJ M PiS I P H O N M A N U F A C T t.I R E R. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
OYES ONO _ OYES ONO OYES ONO
GALLONS PER CYCLE: PUMP NO NTROLSOPERATIO NAL NUMBER OF ''f{UPPRTV WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) YES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture the depth of plowing lFh:r~I- - 1E11 MATERIAL AND MARKING
or excavation. (if soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
-ID TH. LENGTH NO. OF 7'U SPACING COV H INSIDE DIA st PITS LIQUID
BED/TRENCH TRENCHES M , HIAL DEPTH
DIMENSIONS C° PIT
GHA~r D-PTI1 FILL DEPTH DISTR PIPE DISTR.PI PE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
B[I!ll PIPES ABOVE COVER ELEV INLET ELEV-END PIPES LINE AIB.INLET'.
V - l FEET FROM .
NEAREST--s
MOUND SYSTEM: _ ~i •
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 crite 4 for medium sand. TIONS MEASURED.
OYES ONO
SOIL COVER. TEXTURE PERMANENT MARKERS. OBSERVATION WE LLS
OYES ONO OYES ONO
DEPTH OVER TRENCH BED DEPTH OVER THENCHBED fEP O OPSO __]SODDID SEEDED. MULCHED
CENTER ED<~ES
OYES ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO. OF LATERAL SPACING. G AVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR p`Lqr (FOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.'. ELEV. DIA. ELEV PIPES. DIA.'.
DISTRIBUTION
HOLE SIZE HOLE SPACING DRILLED CORREC L COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION ~ PLANS
FEE
❑YE O OYES ONO
COMMENTS: PERMANENT MARKERS O ERVATION WELLS NUMBER OF PROEERTV JWELL: BUILDING.
EARESOM LIN
'1 1 OYES O OYES ONO N
y~ i LL Lv r.;• ti 1~ , c ' ► LJ
Sketch System on Retain i my file for audi
Reverse Side.
SIGNAT TITLE
c SBD 6710 (R. 01/82)
P Z 143-
LB- ~6 7 State and County State Permit #
Permit Application County Per it #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Z~7 , Ri'' V C3ux 101,r /all, B. LOCATION: _IXE_'/a Section 36, T 30 N, R_ E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township S", CaIgmf
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family -,X- Duplex No. of Bedrooms 13 No. of Persons
D. SEPTIC TANK CAPACITY /"000 Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concreted Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement, K
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 3 Total Absorb Areal sq. ft.
New Replacement X Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X Length- S. Width /A Depth V2" Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land !4% Distance from critical slope
WATER SUPPLY: Private X 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 ~CIViV/S l ~1~iST[~pifEar".pSf1~Y' C.S.T. # and other information
obtained from ((owner uilder). _ J
Plumber's Signature MP/MPRSW# 9~ Phone
Plumber's Address aA` .
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.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
c
Date of Application Fees Paid: State o Gountv Date jj( U
Permit Issued/-Li4ee4e~d;(date) - Q Zc ssuing Agent Name T1L?."~t~! Ck ) ~1' -
Inspection Yese!~_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
I
tz 4:Z
NDllSTRYENT OF REPORT ON SOIL BORINGS SUETY & BUILDINGS
DIVISION
LABOR AND PERCOLATION TESTS (1 DISOP.O. BOX 7969
N WI 53707
HUMAN RELATIONS
LOCATION: SECTION: TOWNSHIP/A41dA1161R~L1.TY: LOT N : SUBp~S . NAME:
yNA -36 /W N/R a ~ it Jas' sr
S~ 1/
COUNTY: OWNER'S /BUYER'S NAME: M/reAI LING ADDRESS:
Cy' /y
i r_ fJ ` aI Yt.W COIL I~iG l
, o• yc d41.cd _ CY h.
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
Residence ❑New Replace 47- 7_ 0 7_ ?
Sip,~ )P et- S- P, 0
RATING: S= Site suitable for system U= Site unsuitable for system /r* .3 .5-,¢ e Q
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDED SYSTEM: (optional)
zs ❑u s ❑u Xs ou os Qu 0s ®u COAXv eAA, rl eAJ
ilf Percolation Tests are NOT required DESIGN ~RATE: SYST~EL V. If any portion of the lot is in the
under s.H63.09(5) (b), indicate: AJ/ Floodplain, indicate Floodplain elevation: AI/A
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 BE/D~/ROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 47
cr p /
~6 rr 7 9 t S 62 A S(+ 97,2,- Oil /Y t S
it oiv
B Y" 7
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES i
(NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD( PERIOD2 PER IOD3 PERINCH r
P_ 'lly r/ e3
P- r/ C G 3 i
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 t`c.:~ location on th plot plan. Show th; surface elevation at a!! u;,irgs and the direction arid peic'--it
of land slop.
SYSTEM ELEVATION 7-3
"ii0l' APPROVED" 3 ~f A-zr
_ e A
Date: H
Inspector:
%
7 [JAS Xe c"' Wel( 91. \
rrprGa7 c?n pif?
C '4
4.)v a #-*.a 6 e-
PPROVED"
Prep _ atet 9~j Z
Inspector: 1V211 61
OP44~ce,
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proced r~ meth e6AeBtir nsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and bel
NAME (print): TESTS WERE COMPLEX
2-2
ADDRESS: CERTIFICATION NUMBER: P R optional):
f CS ATURE: I'>
.
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
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