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Parcel 038-1119-95-000 02/09/2006 02:51 PM
PAGE 1 OF 1
Alt. Parcel 29.31.18.495C 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 - BOUCHER, QUENTIN R & BARBARA J
QUENTIN R & BARBARA J BOUCHER
972 192ND AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 972 192ND AVE
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE
SEC 29 T31N R18W 10A IN NE SE LOT 1 OF Block/Condo Bldg:
CSM IN VOL III PAGE 831
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/11/2001 645182 1637/49 WD
09/29/1997 566058 1266/589 WD
07/23/1997 1169/226 WD
07/23/1997 874/482
more...
2005 SUMMARY Bill Fair Market Value: Assessed with:
119683 241,800
Valuations: Last Changed: 10/05/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.000 45,500 187,100 232,600 NO
UNDEVELOPED G5 5.000 5,000 0 5,000 NO 00
Totals for 2005:
General Property 12.000 50,500 187,100 237,600
Woodland 0.000 0 0
Totals for 2004:
General Property 10.000 50,500 187,100 237,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 140
Specials:
User Special Code Category Amount
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIPI-Al J /X _SEC , T,N-R&W
s . T-T
ADDRESS ST . CROIX COUNTY, WISCONSIN.
ILL
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 1-163
i t~ 6l
YT G WITHIN 100 FEET OF SYSTEM
I dt ate or,rh,A row
BENCHMARK: (Permanent reference Point) Describe: ft'"=f
Elevation of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: ZZ
Number of rings on cover Ya'nk manhole cover elevatia :
Tank Inlet Elevation:- Tank Outlet Elevation: PUMP CHAMBER
Manufacturer: ~ Number of gallons
Number of gal. pump set for a cycle gallons; total capacity o
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: um er o pits eet iameter
feet liquid depth seepage pit in etpipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines_,_~Z_width length tile depth
SEEPAGE TRENCH: width lengt'~i
PERCOLATION RATE {-AREA REQUIRED AREA AS BUILT
INSPECTOR
DATED PLUMBER ON JOB - r
LICENSE NUMBER
b'L <-7
f1,ati L."
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR / S SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Nr,mBer
Ilr assigned)
O Holding Tank O In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE.
~02~ 1
BENCH MARK (Permanent reference point) D SCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV
a -r n k 18 (k) I Q r o"a ;
Name nt Plumber MPIMPRSW Nu.. County. Sanitary Permit Number:
1. P II 6 6 3 o~ 49 1
SEPTIC TANK/HOLDING TANK: C
MANUFACTURER- LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOFY CyC
P IDED. PR D C t _ 1 6 6 0 YES NO ES ONO
BEDDING: VENT CIA VENT MATL.. JHIGH WATER NUMBER OF ROAD: PROPERTY ~VVELL. BUILDING VENT TO FRESH
ALARM FEET FROM U~ uN N _ AIR INLET
YES ONO ❑YeS--ItN NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. 11-11111111 CAPACITY PUMP MODEL JIUMP,SIPHON MANUFACTI.IREH WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO OYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF 1PImi,
PUMP ERTY WELL JBUILDING I VENT TO FRESH
F AIR IN1-ET
IL N
(DIFFERENCE BETWEEN FEET FROM
ON AND OFF) OYES DNO INEAREST--~
SOI L ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLFV[,Ti1 --DInlTETEH MATERIAL AND MARKING j
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 INOOF IDIST11PIPE SPACING COVER INSIDE DIA T11 LIQUID
BED/TRENCH 2 TRENe+4. MATERIAL: PIT DEPTH
DIMENSIONS 1E
GHA, R [ 'PT•1 FILL DEPTH jDISTRP I PF DISTR PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROP RTV J WELL BUILDING. VENT TO FRESH
BF I'A', f IPFS / ABOVF. NOV., ELEV INLE 1 ELEV. END O
PIPES. FEET I LIN AI NI~'T~.f
{ 1c 2 7~(" NEAREST--s f V
MOUND SYSTEM: TI • `8 5 7 cl
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound s terns to e cer n that it ON REVERSE SIDE. SHOW ELEVA-
meets t iteria f mediu s d. TIONS MEASURED.
OYES NO
SOIL COVER. TEXTURE j PERMANENT MARKERS OBSERVATION WELLS
DYES ONO OYES ONO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH. BED DEPTH OF TO IL. IFODDE SEEDED MULCHED
CENTER EDGES l
OYES ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH LENGTH NO. OF LATERAL SPACING: GRA DEPTH B W IPF FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR IPE NIFO LD M TERIAL. O. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
P1
ELEV. ELEV. DIA. ELE
ELEVATION AND IPES DIA.'.
DISTRIBUTION
INFORMATION HILL SIZE HOLE SPACING DRILLED COH CTL COVER M TERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
_ ES ONO I OYES NO
COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS: NUMBER OF PROPERTY JVVELL. BUILDING.
FEET FROM 1-1NE
c~ cf OYES NO OYES ONO NEAREST-
f 1.
x,73 i~7~
c L7 I , t
c/
Sketch System on RetaZicounty file for audit.
Reverse Side. -
SIGNATURE TITLE
DILHR SBD 6710 (R. 01/82)
DEPARTMENT 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. A legible reproduction of the soil test report or the owner's copy must be
included.
PrCoperty Owner: Mailing Address:
C wq rc!' 3S1~5
Property Location: City, Village-sr-Township: County: 55 20 'i
%S NiR (or) W
Lot Number: Blk No:: Subdivision Na e: Nearest Road, Lake or Landmark: State' Plan I.D. N mber:
~ i (If assigned) ~
G
TY E OF BUILDING
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): 0 New ❑ Replacement ❑ Experimental 5Q Seepage Bed ❑ Seepage Pit
2 ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Liste on Soil Test Report (If other than present owner):
® Private 1:1 Joint 1:1 Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Sign re: MP/MPRSW No.: Phone Number:
P umber';.,4ddress: ~ Nameaf Designer:
r C ~
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: fF,ee: Date: ~y ^ ~9 APPROVED Sanitary Permit Number:
qq
-T
I`) ❑ DISAPPROVED C) 14
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)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
LOCATION: SECTION TOWNSHIP/NVU1NfEtP-A-LtTY: LOT NO.: BILK. NO.: SUBDIVISION NAME:
N/k
VC ~/4 OUNTY: OW ER'S BUYER'S NAME: CAI I G ADDRESS: _ f7 r w
t J AV
USE DATES OBSERVATIONS MADE LtA • +.c.,
NO. BEDRMS.: COMMER~!AL DESCRIPTION: R F R TONS: 7ER LA ION TESTS:
Q Residence New ❑ Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE:SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:optional)
sau sau sou ❑s u as u
If Percolation Tests are NOT re wired DESIG RATE: SYSTEJVI EL
Q , I If any portion of the lot is in the j
under s.H63.09(5)(b), indicate: _ i Floodplain, indicate Floodplain elevation: ~r
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
jJ
B-
- r -
-
' Z A,
ALI,
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD PER INCH
P-
P
P -
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 6'
:7.~«-.
00
c'tiFxv~~.~ si ib b a Ey'cc~,j4
7 -4
TN
I v
r
X i
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 S_: % CERTIFICATION NUMBER: PHONE NUMBER optionall:
i
CST GN T RE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DI LHR-SB D-6395 IN. 03/81)
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