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Parcel 014-1037-40-200 01/12/2007 12:04
PAGE 1 OF 1
F 1
Alt. Parcel 17.31.15.269B 014 - TOWN OF FOREST
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
02/04/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - FRANK, HARRIET J
HARRIET J FRANK
2138 280TH ST
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 2138 280TH ST
SC 1127 CLEAR LAKE
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.430 Plat: N/A-NOT AVAILABLE
DRV 17 T31 N R1 5W NE SE CSM 18-4698 LOT 1 Block/Condo Bldg: 4698 LOT 01
(2.43 AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-31N-15W NE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
03/10/2004 756237 2523/623 WD
02/04/2004 753477 18/4698 CSM
01/26/2004 752706 2498/299 QC
05/15/2003 721656 2243/159 TI
more...
2006 SUMMARY Bill Fair Market Value: Assessed with:
160600 140,600
Valuations: Last Changed: 10/18/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.430 17,500 116,800 134,300 NO
Totals for 2006:
General Property 2.430 17,500 116,800 134,300
Woodland 0.000 0 0
Totals for 2005:
General Property 2.430 17,500 116,800 134,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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AS BUILT SANITARY SYSTEM REPORT
.OWNER / Fff .fN1~ TOWNSHIP SEC . -T&N-R45 W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
EVERYTHING WITHIN 100 FEET OF SYSTEM
SHO
IR9i a Gr
J.A
r
r c D
I di a e oath Arrow
SC Lt:
BENCHMARK: (Permanent reference Point) Describe: S W 604NeC o F 7r'o Po F
GhSeM r-Nr W AGG
Elevation of vertical reference point: /o or Slope at site:
SEPTIC TANK: Manufacturer: li, eSe/3!~ Liquid Capacity: ~p00
Number of rings on cover / Tank manhole cover elevation: 92'lo
Tank Inlet Elevation: qo' y n Tank Outlet Elevation: 9a'
PUMP CHAMBER
'Manufacturer: Number of gallons
Number of gal. pump set or a cycle gallons; total capacity 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 wi th length tile depth
SEEPAGE TRENCH: width length
PERCOLATION'RATE AREA REQUIRED RE S BUILT
INSPECTOR
DATED PLUMBER ON J B or
LICENSE NUMBER 5--6o
KI I'UKI 01 INtiI'f ('I ION INUIVIUUAI ti1wAa%1 It M
? ---fi
„i( f(hi~ I'r ini, ( Nl~l
?97
49se Section Lot M Subd4' vcn n
(o
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A
~ - _ - - -
t I'1 1C IANK
' ' attune NaambeA oA cornpuntmente
t't,i.'I, AIt l,rn: Ulf, Yt a Buctdtn(
t 1i ghwa tc A
iMI'INi, CHAMKI R
i
r c ____`-gattone Pump Manu6actu4e4 Modct Number,
II DING TANK
c -gattons NumbeA o6 CompaA-tmen-te
I't(rn1,c n - AQaAm Sye tem
trance ATOM: Weft 6utPdi n_q 1?~ Atop('
H.i yhwaten
li OKI'f ION SITE Thench
v
WetP Bu4fdin9 - - 12$ eY,~pe
4 Hi ghwa ten
i)KI' I ION S I TE DI MFNS IONS
(A), 1I.0h ,fA tAeneh 6t Re yu, ha d at ea
It- nttIIt u 6 each tine _,i - At Death t,6 noch ) v f w ti Ye
Numltt", t'6 f<neb - Depth nA nueh uvv I t41'c
I t ,Y Yt nrlth o~ ti nee t De rt6t
rt tcte beY(,w y7adc
between Yinee_ v - 6t Stor) e tnenet( - dn. pch /00 ~f
,,11 hl.,l4 ur1 ,Ant'a - ? / t Type o(~ Coven: Vapeti on e of aw
i
I I 1a1MI N IONS
Nurrib('n -pj to / GAaveY ati if und r,I to yen Y,
Outnt~lr (14ameteA_ 4,t Death 1)v row infer ~
I,.taY r(beuApt.ion a A e a
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ITWOVI 1) 19 h
I I I C I I V DATI: 19 k
1 A1,0N I OK RI.1FCTION
5~.
Y~Y
State and County State Permit # 9Y77
PLB 67 Permit Application County Permit
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OW`/NE~Ra OF PROPERTY/,/ n y Mailing Address:
B. LOCATION: '/4Section j.7 , T_[N, R_W41NOft W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township &OR a±S J°
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family - x Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY /(1 pQ Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete- X 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 DISPO-
-----SAL-SYSTEM:-
AL SYSTEM: Percolation Rate Total Absorb Area ~19:~" sq. ft.
New X_Replacement Alternate (Specify)
Seepage Trench: a No. of Lineal Ft. Ile Width7-Z ' Depth-I~Tile depth (top)+2 No. of Trenches
Seepage Bed: Length Width Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land 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 .S-/w / w C.S.T. # and other information
obtained from 4,. P41 R A:WA A, (owner/builder).
Plumber's Signature 4, MP/MPRSW# Phone #,24"-!~kea P
Plumber's Address c '
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.
t 3
,
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,
,
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State/"/ a 'V Co n y Dat
Permit Issued/RE" cl (date) 011/ Issuing Agent Name
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
EN .115' Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: Section-0-T-V N,R kfiW) W, Township or iiy ^
Lot No. , Block No. County
Subdivision Name
Owner's/Buyers Name: -I,.,, - 71, Mailing Address:
TYPE OF OCCUPANCY: ResidenceX No. of Bedrooms
COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM
DATES OBSERVATIONS MADE: SOIL BORINGS_~ PERCOLATION TESTS
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- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- 44
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- Ave > 71:2-
B- 21r %I
6ZA
„ G
B- /V 61 4 .
B- N42
B- lye) Al „ 5
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soi areas.) Indicate on the plan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy 4 67' Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
0
E _ i 3
41
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q
19 Y3
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potet
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) 15::!,4 -M ill ~ Certification No.
Address C /V k' D d C/ X
.Name of installer if known 1-
c
Copy A - Local Authority CST Signature
i
REPORT ON INSPECTION OF SANITARY PERMIT # 7
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
me, res License-NO. Of s a ing Plumber Time of Inspection
C-
3 INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ S page Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN ermanent reference Point) escri e:
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:
(7)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 ❑ NO; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ N0; 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:
Smith Plumbing PHONE (715) 265-4838
GLENWOOD CITY, WISCONSIN 54013
G✓ ll-elI R rS'lWN 111
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Wisconsin Depa-FT
PL'B-1 ' INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing, Platting & Fire Protection
Name o remises Date an No.
Street City oun y Sanitary Permit
Master Plumber 1rm Name dress
Journeyman Plumber Address
Owner ress
Discussed wi Signature
( )See Attached.
DILHR-SBD-6192(N.09180) Signature o is Plumbing up. On-Site Waste Specialist
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner