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Parcel 008-1023-40-000 01/11/2007 09:12 AM
PAGE 1 OF 1
Alt. Parcel 8.28.16.116 008 - TOWN OF EAU GALLE
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 - TERPSTRA, EUGENE T & OLIVE I
EUGENE T & OLIVE I TERPSTRA
2272 CTY RD N
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 2272 CTY RD N
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
`"I o~ a S Ste'
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 8 T28N R1 6W 40A SE SW Block/Condo Bldg:
(EZ-U-1113/036)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 894/543
07/23/1997 837/78
2006 SUMMARY Bill Fair Market Value: Assessed with:
170840 Use Value Assessment
Valuations: Last Changed: 07/15/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 38.000 3,900 0..,, 3,900 NO
UNDEVELOPED G5 1.000 100 0 100 NO
OTHER G7 1.000 1,200 12,500 13,700 NO
Totals for 2006: /
General Property 40.000 5,200 12,500 17,700
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 5,200 12,500 17,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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Parcel 008-1022-95'5-000 01/11/2007 09:14 AM
PAGE 1 OF 1
Alt. Parcel 8.28.16.113 008 - TOWN OF EAU GALLE
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 - TERPSTRA, EUGENE T & OLIVE I
EUGENE T & OLIVE I TERPSTRA
2272 CTY RD N
BALDWIN WI 54002 AZp
Districts: SC = School SP = Special Pro y Address{es): nrnary
Type Dist # Description 272 CTY RD N \
SC 0231 BALDWIN-WOODVILLE AREA ~SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 8 T28N R16W 40A NE SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-28N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/03/2005 802191 2856/510 EZ-1
07/23/1997 894/543
07/23/1997 837/78
2006 SUMMARY Bill Fair Market Value: Assessed with:
170836 Use Value Assessment
Valuations: Last Changed: 07/06/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 34.000 4,300 0 4,300 NO
AGRICULTURAL FOREST G5M 4.000 1,000 0 1,000 NO
OTHER G7 2.000 6,800 109,900 116,700 NO 05
Totals for 2006:
General Property 40.000 12,100 109,900 122,000
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 12,100 109,000 121,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 192.00
Special Assessments Special Charges Delinquent Charges
Total 192.00 0.00 0.00
EAU GA L L E T.28 N.-R.16 W 21
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P/ERCE COUNTY StC o.x County, ovs
A & H TOM'S
BUILDERS, INC. Electric Motor
Baldwin & Woodville Jacobson 's Pontiac Inc. Clinic
Wisconsin SALES AND SERVICE Tom Vandeberg, Owner
General Contracting NEW AND USED CARS
Also Authorized Factory PHONE:
Dealer & Installer of BODY SHOP 715 - 698-2421
Hagen Cellulose insulation 698-2463 • Woodville, Wiseonsin 111 River Road East
Phone: 698-2934 Woodville, Wisconsin
or 698-2664 54028
AS BUILT SANITARY SYSTEM REPORT
OWNER E-0 e TOWNSHIP E,4u 07-A I l e. SEC. 8 T_N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet.requirements of H63
17 Bend) A'r YTHING WITHIN 100 FEET OF SYSTEM
F r 3'
ve -
I
I di leloi7thj Arrow I
T
SC L L) /f?
BENCHMARK: (Permanent reference Point) Describe: ` -,y4c F`
Elevation of vertical reference point: /OO -Slope 'at site: qo
SEPTIC TANK: Manufacturer: ~tJ G 5 Liquid Capacity: /000
Number of rings on cover :Tan manhole cover elevation: f' (a'
Tank Inlet Elevation: q_3 g Tank Outlet Elevation: ;?r'1
PUMP CHAMBER
Manufacturer: Number of gallons
Dumber of gal. pump set or a cycle gallons; total capacity o
distribution lines gallon: size of 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 ccver
Type of warning device--'
SEEPAGE PIT SIZE: Number o pits eet lameter
feet liquid deptE seepage pit in et pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number cf lines ~o wi th /_,z' lerigth_,6'~5tile depthZ-V
SEEPAGE TRENCH: width length
PERCOLATION RATE- -AREA REQUIRED / AREA AS BUILT
INSPECTOR
DATED 7- PLUMBER ON JOB
LICENSE NUMBER r yip 4,¢
RII'ORT Of INSWCTION INDIVIOUAL StWAGL SVNHM
tiani (a,llt I'~~lrllt ( ~Q~
rar Scpt< /G/~/
NA?II Town 6h.ip.._ f'? Cluix CoaHll1
I , .r r < < rl - ---Sv_c.tion 1_0 t Su(~~.<v.lh t on
`;1 V I I C LANK
---gaVton4 Numbeh o6 eompantment6
Di ti tane v 6Aom:. Welk Building ' 12 o t eope-
H~.ghwa.ten
PUMPING CHAMBER
S4 zv ga tonh Pump Manm6actuAv~l Model' Numbvil
HOLDING TANK
S4cv _gaQtons Numb err oA CompantmenA!
I'umpe tr Atanm Sq stern
Dig lance 6 0r►I°'r -W~.f Bu~Xd~n 12 laps
Highwa teal
MORMON SITE
104 I ~rencll
W qty "Co Atom: Wetl Bu~.ldcng ?2~ hTupv
HI ghwa-tv
ABSORM ON SITE DIMENSIONS
Width 06 tnvnch 6.t Rvyu4 nvd a4ea (t
vngth v A each fine - - - At Depth 06 crock below We in
Numbeh ok We.b Depth o IV& oveA the in
T'otal' length o6 lines - ' 6t Depth 06 We below gladv ~ to
v(s tanov between V4 "V6 (t Slope 06 tnvnch 100 AI
h'fac ablonption avea - At lltpr PA Covet: Papvt W, Maw
A 1 01,WNSIONS ,
VI11NIi A 0 p{ t1 ~irf((11N1' 01olrnd iii f1 1-1vA VIOllt- dv Aamctvt 6t Depth below (nlvt (t
Iota ab& ot1_>.tion aIt va f
A40 gvy"<f d t
I N1 1P1 C-11. 1) By I I1 LE
AVVROVI v DATI
RI ft CTI v DAM 19 h
MASON I OR RE A CTION
L{~GVViq`' j
State and County State Permit # 1 /
PLB 67 of Permit Application County Permit
u
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:
B. LOCATION: Stir Section , T-11 N, R_Z(~:L 6 (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township ,4u C-CA
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 O/✓e-
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete x Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement X
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb AreaTS~ 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 '555 - Width Za z Depth_ 2d Tile depth (top)-cUl _No. of Lines -yG
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- X Distance from critical slope O
WATER SUPPLY: Private 19 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 G' O,L, f C.S.T. # sV$l and other information
obtained from (owner/builder).
Plumber's Signatur MP/MPRSW# MP- 4N J7 Phone # 715r_6?V-33700
Plumber's Address
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.
f s i
F .
a
E
E 3
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3 ,
a v~
E
t
3
E
G -
Do Not Write in Space B Io FOR COUNTY AND STAT rARTMENT US LY
Date of Application S Fes Paid: State Count Date, - 30 /s/
Permit Issued/Rejected (date) Issuing Agent Name
Inspection Yes~_No State Valid# Date Rec'd
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
DEPARTMENT OF REPORT ON SOIL BORINGS AND DINGS
INDUSTRY, D ISION
HUMAN RELATIONS PERCOLATION TESTS (115) RF, d~ g x969
LOCATION: SECTION: r TOWNSHIP/MU ICIPALITY: LOT NO.:BLK. NO.: IVISI E:
SE 1/4~ 1/ g /T gN/R/6#(or)W GAU Arlc tw;
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
T `~Ro~n e>v eR S7~RA tt / ZALc~w.t~~
USE DATES OBSERVATIONS M
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: P~ FILE DESCRIPTIONS: PERCOLATION TESTS:
esidence ❑New Replace - 1!7_ 1 rp - / -
RATING: S= Site suitable for system U= Site unsuitable for system t
CONVENTIONAL MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
®s ou E ]S au F ]S ❑u DS ❑u 0S au
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL If any portion of the lot is in the
under s.H63.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
r ~ rr t r r(
cL, ( a
B- 3 9(5 > 4 v
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 PER D PER INCH
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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.
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I, 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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
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T SIGNATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
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