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Parcel 18.28.17.135B 024 - TOWN OF PLEASANT VALLEY 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 MICHAEL CRAIG DITTEL O - DITTEL, MICHAEL CRAIG C - LARSON, ANDREA LYNN ANDREA LYNN LARSON 1522 CTY RD J HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1522 CTY RD J SC 2422 ST CROIX CENTRAL SP 1700 WITC it I Legal Description: Acres: 5.680 Plat: N/A-NOT AVAILABLE SEC 18 T28N R17W E 284 FT OF S 872 FT IN Block/Condo Bldg: SW NW TOWNSHIP PLEASANT VALLEY. Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 05/04/2004 761493 2563/596 WD 03/17/1999 599542 1411/212 WD 07/23/1997 849/610 07/23/1997 475/101 2006 SUMMARY Bill Fair Market Value: Assessed with: 156571 390,400 Valuations: Last Changed: 05/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.680 50,700 218,800 269,500 NO Totals for 2006: General Property 5.680 50,700 218,800 269,500 Woodland 0.000 0 0 Totals for 2005: General Property 5.680 50,700 218,800 269,500 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 . . AS BUILT SANITARY SYSTEM REPORT r 1 OWNERS TOWNSHIP Ceti ~(j SEC . TN -RW ADDRESS _Y4~i ~6to COUNTY, WISCONSIN / 0a, C/? Cj SUBDIVISION LOT LOT SIZE Gin-'1✓1i`-~ PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVE. Y THING WITHIN 100 FEET OF SYSTEM 1 - SCALE A I di a e or, th A. - - BENCHMARK: (Permanent reference Point) Describe: ;~v Lr~ Elevation of vertical reference point:.. Slope at site:,. 76, SEPTIC TANK: Manufacturer: Liquid Capacity: /)-C, C, Nu ber of rings on cover Tank manhole cover elevation: C ••rLG~Z:~ Tank Inlet Elevation: „ r Tank Outlet Elevation : Y~7_j r zPUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; ,totes capacity o distribution lines gallon:. size 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: um er o pets eet-diameter feet liquid dept seepage pit in et pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width ),C length ,'the de th/11" SEEPAGE TRENCH: width len th PERCOLATION RATE _AREA REQUIRED AREA AS B DATED.... PL R O~N JOB CENSE UMBER It hl POKE Of INSVLCTION INUIVIOUAL SIWACL SVSILM Sang tanrl I'trt,nt ! Sxa,te Sept4 C/41000~1 ye ~ T SC Secx~un~ Lu.t M Subdiv4e.ca~ rVn i .iutfonb Number o6 cornpun.tmert-te We. ~LTZ' 8uifd4,ny__ _-120 H~ybtwatel~ _yu J'oYta w"!uexuA e. A, Mod" Nurnbi,'i IANK yal'eon6 N ben. h Compa4lmvn.tb _ A a,, t ; it v. n: UIv1'k' butiX.dA,ny !2o aE'upv. It tyhwatvn N 111. _ T )t e. n c h rr rn: We.I!k~_ 8 u'kny - C) f2l 66ope-- Ht. ghwa.te i N . l l 1. DI MENS IONS tne.nc.h Q Re(fu4 t v d ane.ct._ 1~.(e '7 r each Une__._~1_-f---=°-4 De.pth )6 noch bveow t<kv tY! I.<.ne,6 Uepth o A n.oeh ovelt ti-I'v Z- (,r I'cYr(Ith Ub tine.,6 t Z ~t Depth o6 t4bvt'ow ('Vludv (rt hrtwvvn kIn("6 6t seop(, o6 t:nench. IOIt h! 'ilrr(Un Ait eU (,h Coven: Pa. 'l1 C) (is (ina P (titound p4 '('s rlt' ONO 11 ttrrt,tv t ~'t c pth by tow cYtXv.t ,;i•,rrhpftn,t ,nc~;t d - 6t r . T I T L E - ! C~ DATE 2= I'I h~ 0ATr IiCI1014 4 67 State and County State Permit # PLB u Permit Application County Permi 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: ae '/4, Section 4, T2f N, R-/? E (or) ~Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township A4t4?S ,,i r C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance / Single family Duplex No. of Bedrooms No. of Persons- 1 1.7110 D. SEPTIC TANK CAPACITY 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 Total Absorb Area sq. ft~ T'U New X_Replacement Alternate (Specify) Seepage Trench: No. of Linelt. idth Depth Tile depth (top) No. of Tr, ches Seepage Bed: Length Width Depth Tile depth (top)e No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- S X Distance from critical slope WATER SUPPLY: Private 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 C d Soil Tester >J JJ VV) NAME 5' C.S.T. # and other information obtained from ^ (owner/builder). I-) , Plumber's Signature P/MP, qW# Phone #yS 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. .s E e IL I t : d v e..~ ~.w. m a . - E - - Do Not Write in Space Belo//w~ FOR COUNTY AND ST T DEPARTMENT E ONLY Date of Application Fees Pai Stag 1 &--Z) ou y 4-J"_0 at Permit IssuedrRted-(date) Ifl 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 DEPARTMENT OF REPORT ON SOIL BORINGS D vG SAFE Y & B DIVISION LABOR AN ~ Sir P.O. BOX 7969 PERCOLATION TESTS (11 ' M ISON, WI 53707 HUMAN RELATIONS Cry O ~ ~ ~ C/' LOCATION: SECTION: W SHIP /MUNICIPAVY)1 C LOT NO. NO.: SUBDI ISIQ" ME: 1/~/ /jr /T.M N/RE (or TO 11leaSgal ' COUNTY: OWNER'S /BUYER'S NAME: MAILING ADDRES 'ibs USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R R ONS: ER A/ ION TESTS: F'k 1 Residence New ❑Replace u / f13 a ` d r-^ RATING: S= Site suitable for system U= Site unsuitable for system Jewe 4,2,p U, e t -f- 9' CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDST EM:(optional) ,XS ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U If Percolation Tests are NOT required DESIGN RATE: SYSTEM ELEV. I If any portion of the lot is in the under s.H63.09(5)(b), indicate: /0/- Floodplain, indicate Floodplain elevation: 7iq,~ D'* 6 ZfctQ Y e7 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.) B- 1 k o _.ff6 X7.3" /.~e' Jsi~ &Sf yd cS 1~ tJh:fie S B- "A S/ Cf`~' B- J' t s 33 "of s~ 6C Z l 'r S :W 3t" y1S ~G P s 5"~w~~ f S B- B U,, 54 g r X/ n a >5''14.d e S B- PERCOLATION TESTS TEST H WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUT S NUMBER INCHES FTER SWELLING INTERVAL-MIN. PERIOD t PERIOD PERIOD PER INCH P- r 3©" t C Sods P- O it frd P- Ai> ►IMail e~ P- P- G7 C r r4 t O P- PLAN VIEW: Show locations of percolation tests, soil borings and a di Tfi sions f suitable soil areas. Indicate scale or stances. Describe what are the hori zontal and vertical elevation reference points and show their lo Ftion th p n. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION 1 0 m I Celt; TN x Q ~ 1 ' ' ~ ,bleu. ed tU ( 1 v~ n4 e p !roc r'ee soil tests reported on this form were made a in accord with the pros dures methods specified in the Wisconsin i, the undersigned, eby a tify that `if Admimistrative C t the data recorded and the location of the tests are correct the best of my knowledge and belief. NAME,(print): TESTS WER COMPLETED ON: r Q A 4. 3 X xg), a ;l 3 ADDRESS: CERTIIFICATI N/NUMBER: PHONE NUMBER optional): D ~1 )-off (Ss CST URE: A naf Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. I ~Q i b ~r ~ seal 1" i t ffo -7 y -7-7 3 ~ r ~ • 6 60 N Wd6~ :6 ~I0 ll '3 IV 2WII PaA1 8~ l n Safety a 8ulldlRgs Division Statq. 101.63 ONE AND 'TWO FAMILY DWELLING Applicatlon No. staf~ PERMIT TO START CONSTRUCTION P9rcel No. owners rysme Malling Address Tel_ ,or 4" 1b, A / 15" z 2- R,m Contractors Neme_Lic/Cert* Metting Address s dlA g Co, s 13L: 2 2 5-6 23 111071 Sfa> c l~l"1' Z 2 Tel. S07 FAX _o y6Z-st r/ PROJECT Sanitary Permfta INFORINATION 1~ /JIF`'/ luidingAddroea 114, SE 114, of Section / T 8 N, R i7 E (or)&P SubdMaion Name ~SLZ le~w Rd T ,ya •h •.o „ ~ Lot No, l9iock No. Zoning District(s) Zoning Permit No. setbectca: Front Rear LeR /0o ft, N ~flo ~~o tZ, R~/h0oI' , t he undersigned, request to begin fooling and foundation work prior to thL, approval of the plans and isauanca of the t NIFORM BUILDING PERMIT Per Comm 20.09(5)(b)2. I agree to proceed with the tooting and foundationns only, to obtain footing and foundation inspections prior to covering that work and to not continue with the remainder of the 'dwelling, including plumbing, electrical and other vrark, until appropriate approvals and permit(s) have been Issued, l agree to make any change required after the plans have been reviewed and to remove or repleoe all non-code 1omplying parts of the footing and/or foundations. I lunderstand that 1: am subject to all applicable codes, laws, statutes and ordinances, including those described on the reverse side of the last ply of this form; am subject to any conditions of this permit; understand that the issuance of this permit creates no legal liability, express or implied, on the state or municipality, and oertlfy that all the above information Is accurate. If one acre or more of soil will be disturbed, I understand that this project is subject to ch. NR 1~1 tegarding additional erosion control and stomtwnter management and the owner shall sign the statem8nt on the back of the permit If not signing below. I exprossly glrant the building inspector, or the inspectors authorized agent, permission to enter the premises for which this pemilt Is sought at all reasonable hours and for any proper purpose to inspect the work which Is being done. Lli 1 vouch that I am or will be an ownar.occupant of this dwelling for which 1 am applylog for an sroslorl control or construction permit without a Dwelling Contracior Certification and have read the cautionary statcmen ardlnn c r responsibility on the reverse side of the last ply of this form. x A ip_t Signature Date Signed APPROVAL CONDITIONS This permit issued pursuant to the following conditions. Failure to comply may result in Susponslon or revocation of this permit or other penalty. ISSUING nTown of ❑VI lade of ❑cRy of uCo~,my of FS&ie- State-Contreaed wnicowlry "VSnbar of swelling JURISDICTION lnapeCtlon AgencyJt Locatlon PEE$; W IS PFRMT SM i PE'R7QfT MWED 9Y: Pe~mbalon to Start Wis. Permit Seal $ Name Other $ T 1 $ Date Tel. Cert St3i?-0o72 (R. 06110) ❑IattiDUte; ❑ Pl i , las No. Ply uhg Jurtsdictlon; D Ply 2- Issuer forwards to state wAn SD dare; ❑ Ply 3- Irg"etor; El Ply 4- Applicant ■ Tot d 0660'°N s~aOM °1~9nd aI~P~~O ~~!0 WdZO Ol,tiIOZ lZ'°nd.,Q~~■! 6860'°N Wd6b:6 ~I0 lZ'any ?WIJ panea°a~ (Part of Ply 4 for Applicants) Cautionary 510errient to Owners Obtaining Building Permits 101.8500 of the Wisconsin Statutes requires munilclpalitles that enforce the Uniform Dwelling Code to provide an owner who apptie9 for a bullding permit with a stat®ment advising the owner that If the owner hires a contractor to perform work under the building permit and the contractor Is not bonded or insured as required under s. 101.654 (2) (a), the following consequences might occur: (a) The owner may be Field liable for any bodily inquiry to or death of others or for any darnage to the property of otters that arises out of the work performed under the building permit or that is caused by any negligence by the contractor that occurs In connection with the work performed under the building permit. (b) The owner may not be able to collect from the contractor damagas for any loss sustained by the owner because of a violation by thta cmtractor of the one- and two- family dwelling code or an ordinance enacted under sub. (1) (a), because of any bodily injury to or death of others or damage to the property of others that arlses out of ,he the work performed under the building permit or because of any bodily injury to or death of others or damage to the of others that is caused by any negligence by ft contractor that occurs in connection with the work performed under the building permit. Cautionary $tatement to Contractors for Projects Involving Building Built Before 1970 If this project Is in a dwelling or child-occupied facility, built beforo 1978, and disturbs 6 sq. ft. or more of paint per room, 20 sq. ft. or more of exterior palm, or Involves windows, then the requirements of ch. DHS 163 requiring Lead-Safe Renovation Training and Certification apply. Call (608)281-6876 or go to !t://dhs.wsconsin.gov/lead/WtsognsiPRRPRuie htm for details of how to be In compliance Wetlands Notice to Permit Applicants You are responsible for complying with state and federal laws concerning the construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to Identify. Failure to comply may result in removal or modification of construction that vlolates the law or other penalties or costs. For more i rmatlon, visit the Department of Natural Resources wetlands Identification web page or contact a Department of atural Resources service center, Additional Responsibllitles for Owners of Projects Disturbing One or More Acre of Soil understand that this project is subject to ch. NR 151 regarding additional erosion control and stormwater rl anagement and MI comply with those standards. , Owner's Signature: Date: 8 zoZ d 0660'°N s~aOM °1~9nd a~~P~~O WdZO Ol tiIOZ lZ'~nd;iso