HomeMy WebLinkAbout038-1051-60-001
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Parcel 038-1051-60-001 01/17/2007 09:14 AM
PAGE 1 OF 1
Alt. Parcel 12.31.18.218C 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 - RICKARD, JOHN A & CONNIE L
JOHN A & CONNIE L RICKARD
1313CTYRDH
STAR PRAIRIE WI 54026
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1313 CTY RD H
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 21.380 Plat: N/A-NOT AVAILABLE
SEC 12 T31N W1 8W PT SW NW LYING S OF CO Block/Condo Bldg:
HWY H EXC W 350 FT EXC CSM V4/1030
~~cr~reLoT c2t jl~i 32 1 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
12-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1021/346 WD
07/23/1997 798/257
07/23/1997 583/460
2006 SUMMARY Bill Fair Market Value: Assessed with:
175006 Use Value Assessment
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 32,000 207,300 239,300 NO
AGRICULTURAL G4 10.000 500 0 500 NO
UNDEVELOPED G5 9.380 23,500 0 23,500 NO
Totals for 2006:
General Property 21.380 56,000 207,300 263,300
Woodland 0.000 0 0
Totals for 2005:
General Property 21.380 56,000 207,300 263,300
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
' r
OWNER TOWNSHIP
ADORES A ' . SEC. T N, R / W
ST. CROIX COUNTY WISCONSIN.
SUBDIVISION
LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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SCAL
SEPTIC TANK (S) MFGR._ CONCRETE STEEL
NO. of rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of wic tai length area
BED NO. of lines width i length area ! )yd
d4N to top o Pipe
NUMBER OF SEEPAGE PITS -Outside " ameter total pit area
AGGREGATE
PERK RATE RE REQUIRED- AREA AS BUILT j
Disclaimer: The inspection of this system by St. Croix County does not imply
complete compliance with State Administrative Codes. There are other areas thn
it is not possible to inspect at this point of construction. St. Croix County
assumes no liability for system operation. However, if failure is noted the
County will make every effort to determine cause of -failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH- IS SY
ti
DATED,- PLUMBER ON JOB'
LICENSE NUMBER L;
REPORT OF INSPECTION - INDIVIDUAL SLWAGE SVSTf.M
Sani,tany P~>>irnit a..3
S t a t e S e. p -t .i. c
1! _Town15h4J44A:~ J S,t. Chu i x Cuun ty
rtioYl Sectton_/ Subd--vi/5,ton
I'TIC TANK
Si ze gafto ns Numbeh o6 eompan,trnents
trance 0 '1am: wek"Y- Buit(l.ng 120 5eope
H-C ghwa ten.
%1PING CHAMBER
ga ton.5 Pump Manu6ac,tunen Modek Number.
(DING TANK
S4' ze gaffons Numbe.n o6 Com.pan.tme.nt,s
Pumpers`- v Atakm Sy.5 tem
tan c. e. Anorn Qlek~--- Buitding 120 ~~ope
H,tghwa-ten
SORPTION SITE
Bed Tneneh
ti tance. Anom: COe Building 12% e gape
H.Eghwa.teA
tiORPTION SITE DIMENSIONS
Width o o #n.e neh At Req utined anea - _ _ t
Length oA each t4'ne. At Depth o6 kock beEow ttiPe in
Numbers oA kl(.ne's_ _ Depth o6 noek oven ,t,i. e - i.n
I o~t,aX k.eng-th 06 tine At Depth o6 Mite befow gnade i.n
D.i 5 tance between fines At SL.ope o6 -t4enc6i i,n. pen 100 At
Y
f ~4 uti aLo u~i.p tiuvt anea 6t Type oA Covet: Papers all 6 tn.aw ~1 DIMENSIONS
Numbers o6 p-i..t,5 GnaveE anound pith yep na
OutAide dli-ame-ten__ At Depth bee.ow inke,t
To.ta ~ absonp.tion anea
Area nequ~ned
~ ~ . ~ . . T I T L E
PROVI D DATE f 19 &
tI CVi D DATE 19ts
A 0 N FOR R1:1VCT10N
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7 State and County State Permit #
PLB 6 of " Permit Application County Permi
for Private Domestic Sewage Systems County y
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: '/4 1, '/a, Section , T N, R~ = (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township(,
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons{
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.
New ' Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length Width Depth Tile depth (top) 1 No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land 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 Certified Soil Tesler,
NAME j,_, ( C.S.T. # i and other information
obtained from (owner/builder).
Plumber's Signature I MP/MPRSW# ' -5 Phone -
Plumber's Address /j
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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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY, L
Date of Application Fees Paid: State /'r7z• Cram) County D5
Permit Issued/Rejected (date) - . 3 Issuing Agent Name
Inspection YesXNo State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 531$
2. state (pink copy) 4. Plumber (canary copy) Revised Date
EH • 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: %,x'/4, Section T N,RZJ JrJor) W, Township or Municipality
Lot No. , Block No. County 517 C rr b!I!~
ubdivision Name
Owner's/Buyers Name: C.( C+ V Gm yN ~ L ~
7
Mailing Address: sta Y, t'' 44L
TYPE OF OCCUPANCY: ResidenceNo. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW -REPLACEMENTALTERNATE SYSTEM OTHER
DATES OBSERVATIO MADE: SOIL BORINGS r 1 L 42 PERCOLATION TESTS
SOIL MAP SHEET NAME OF SOIL MAP UNIT rig
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- SINCE HOLE HOLE AFTER INTERVAL
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIO 2 PERIOD 3 MIN/IN
P- I I ~Z vC'. 05
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 IF7O-BSERVED IN INCHES
B- - 1. JL
B- 2 Ci f, c .7 - A. 4.5 16, 17 -5 f-
B- c• - .,2 < -5 C
B- 7Z 7Z f S-2 LS rC.,.
B- 5 72 7z ' - ~L tf13 i 2.- c 3 z S~ L
PLA VIEW (Locate percolation tests, soil bore holes and suitable soil 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 - Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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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) } ✓Certification No. -5 /
Address '
Name of installer if known ~
Copy A -Local Authority CST Signature C )Z-t"4t,
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REPORT ON INSPECTION OF SANITARY PERMIT # /
(1) Name and Address of Permit Holder Person/Persons at site 2 Date of Inspection
Time of Inspection
me, ress, License NO.,OT ns a Ong Plumber (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN Permanent reference Point) Describe:
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:
M 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 ga ons ;
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 TREN H: Total length of seepage trench ft; width ft,;
tile depth ft; ft to well; ft to ordinary high watermark 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-6095kN.05/8
Signature of Inspector: