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Parcel 030-2033-10-100 03/02/2005 05:05 PM
PAGE 1 OF 1
Alt. Parcel 23.30.20.45713 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): = Current Owner
DALTON, KELLY J
KELLY J DALTON
1448 20TH ST
HOULTON 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1448 20TH ST
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.786 Plat: 0598-CSM 12/3365
SEC 23 T30N R20W PT NE SE BEING LOT 1 Block/Condo Bldg: LOT 1
CSM 12/3365
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/24/1998 592392 1380/333 W
07/23/1997 1213/308 QC
07
07/23/1997 762/103
2004 SUMMARY Bill Fair Market Value: Assessed with:
5989 150,300
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.790 67,800 80,100 147,900 NO
Totals for 2004:
General Property 3.790 67,800 80,100 147,900
Woodland 0.000 0 0
Totals for 2003:
General Property 3.790 35,600 67,700 103,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 221
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER ',l1./%l % ),IV TOWNSHIP e !~jl 5~=~"ff SEC T'!~N-R
ADDRESS I /f ST'. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
RHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
l✓f-
I _tf -
p -
J
_ll
I di a e o th Arrow
BENCHMARK: (Permanent reference Point) Describe: 1'c~T%ilY1 0/"A16
`
/4": •
Elevation of vertical reference point: Z7 " Slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings on cover Tank manhole cover elevation
Z_ ig
Tank Inlet Elevation: j- Tank Outlet Elevation: 9
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 bran name of pump
and model number ;
Type of warning evice
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: Number o pits eet diameter
feet liquid dept- seepage pit inlet pipe-elevation
bottom of seepage pit Elevation feet.
SEEPAGE BED SIZE: number of lines ___`j-> width leilgth~Y,, tile depth
SEEPAGE TRENCH: width_ length
PERCOLATION RATE1 - AREA REQUIRED, R AS BUILT _T
r
l / -
INSPECTOR DATED PLUMBER 0 JOB
LICENSE NUMBER Vii,
REPORT Of IN- !Vl CT ION INDIVIDUAL S1,WAGL SySII M
San.i IC4 I'ctmi t
tat Scpr~~~
1iUfQ 7uwn6h4->,- , tit. C~l„tx Cottntt
r,tli0 vt Scct, ovt.Lot Subd1iv464"On
1 I'T IC- TANK
Slzt 9aeeon Numbers oA eompaolxrrle_rlt6
1-tancc (y~lotrt: W ee 120 Edo )e
Fl-(g4lwa try ft--
CUMVING CIfAMBI-R
S<: c ga('Pt,no Pump ManuAac.tuneh Mader Numbc1t
l~~l UING IANK
< < gat'I'ovnb Number o~ Compaq tmen-t6
I'nmpe't Akan-m Sif te-m
U
tuvtcc Alum. UIeE'f-..- Bui~d4 n9------ 12o 5f,o-e
HigItwateh-
11: ("4' I' 1 ION S U f I.
T'lencIt
stance hhorn: IUeYf-- z Buifdi.vtld 120 tkt,pe
HI yhwatert
U:,-;ORP7ION SITE DIMENSIONS
W ( d A o 01 enc6t
R e. qu i )qed a il e a
1cn((th uA each fine (It Ueptvl 06 lock below t<-Le
Numbcn o A >
(r Depth o A loch oven ti_Tc G- t n
J x'
Total ength o6 f-4-ne.e f- ~ 6.t Depth oO ttiee be('ow gn.ade
1
Uttitance between k4ne6 ~ ~,t trope o~j toertch l." n. pc it 100 (~I
k~;' LrIrtl' tbtiokp-t~-on artea r Typc of Coven Papoit oit train;
~'1 t 1) 1 MINSIONti
N t, mh t', o ) < t6
~ K Cnavc e anound p if (h n
i>n fn r,(c di amet(2,A ~.t Depth below 4'nPc t
Ioto e abnon.ption arwa
A~cea 17 crlu.trte ht
! N`.1'1 CTLD fiyt
b" V11( ! OATC
1 n
II t'I1 U VA Tr 1yh
ASON 1 OR RI JI CT1ON
67 ! z State and County State Permit #
PLB
i'Permit Application County Permi #
-11
for Private Domestic Sewage Systems County eAAef~
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
r t_ ` em ~2ojyfr1-:? L14 Z- % //Il Z: ZZZZ ✓ T ~'AJ'~fi' C 2
B. LOCATION: Y Y4, Section ~Z, T_]LO N, R ' E (or)T Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township, i,%, s
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms
IV No. of Persons
D. SEPTIC TANK CAPACITY 1AC,),C 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 otal Absorb sorb Area sq. ft.
New Replacement' x Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width _ Depth Tile depth (top) No. of Trenches
Seepage Bed: _Length 6-Width Z4-" Depth Tile depth (top) " No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Ie Distance from critical slope
WATER SUPPLY: Private IV 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 d7 J/xly C.S.T. # and other information
obtained from y z_ cow-,/ builder).
j--j~_y j
Plumber's Signature ;s.- MP PRSPhone #7
Plumber's Address -554Vi2
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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3
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State Co my Date ~o
Permit Issued/R"jected (date) 6 -1-741 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
C
G H ' 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:'/4,S9_Ya, Section 02-3 ,~Q1,FEZQC(or)jffownship or Municipality
r`~%
Lot No. , Block No.
County
u ivisi n Name
Owner's/Buyers Name: * O 40
FFj
Mailing Address: if P. Qry-opx_
TYPE OF OCCUPANCY: Residence X No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM
DATES OBSERVATIONS MADE: SOIL BORINGS l44 -cf/PERCOLATION TESTS a- kef _R/
SOIL MAP SHEET -33 .----NAME OF SOIL MAP UNIT (24-0 C -,Z-
~'okt~ mat
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS RJ INCHES SINCE HOLE HOLE AFTER INTERVAL MIS?; IN
_BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 ,
P- / fir. S
ee- a.~ D r y e 3 .
P- O" 5er- 41c _3 6 .J
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- Afle-J.'-C
B 11 1 -4 7 d" S
B-
113-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian the loc Ion nd square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy tsr , nd~ a scat or distances.
Give horizontal and vertical reference points. Indicate slope. ~
Ala . 201, D r .acts Ar J~14 d. C4
A ~m.cs 1 t` ~ J J l
Pis
xAve-
JUVI
=-3' Cf!/ /!!1 /1 ! r.L~ SAY l/ /llf~!!!/
r
__J NIN
--e4 A;Ale
r Rid Fl,+ &s.
fo- 'OR
1'4& 0 r- A410 e.
1 _
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. c~
Name (print) : Certification No. S__r"
.dr
Address tl$ .Name of installer if known
Copy A -Local Authority CST Signature
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