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Parcel 038-1059-30-300 01/17/2007 11:54 AM
, PAGE 1 OF 1
Alt. Parcel 14.31.18.258C 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 - BLIETZ, RONALD B
RONALD B BLIETZ
1266 CTY RD C
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1266 CTY RD C
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 9.120 Plat: N/A-NOT AVAILABLE
SEC 14 T31 N R1 8W PT SW SE BEING LOT 1 OF Block/Condo Bldg:
CSM 9/2411 EXC PT TO HWY DESC 993/477
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/16/2005 806597 2889/592 QC
01/08/2003 705061 2104/195 WD
06/05/2000 624180 1516/129 WD
993/477 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
175079 281,500
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 9.120 67,600 181,200 248,800 NO
Totals for 2006:
General Property 9.120 67,600 181,200 248,800
Woodland 0.000 0 0
Totals for 2005:
General Property 9.120 67,600 181,200 248,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 109
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r
_ - •-V_
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP , SEC. ,tV-T,' N-R14 W
ADDRESS 12~~ ST. CROIX COUNTY, WISCONSIN.
ko~
SUBDIVISION LOT / LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
W-Y-VERYTHING WITHIN 100 FEET OF SYSTEM
I di.ca e oath Arro4l
SC L : I" I
BENCHMARK: (Permanent reference Point) Describe : 54so 5iktrc
Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: F_1C Liquid Capacity: ;„ZQo
Number of rings on cover Tan manhole cover elevation:,' _
Tank Inlet Elevation: Tank Outlet Elevation_2,61-3-'
PUMP CHAMBER
Manufacturer: Number of gallons
Dumber of gal. mp set or a cyc e gallons; total capacity o
distribution Ines gallon: size pump head;
gallon pe minute horsepower ran name of pump
and mod number ;
Type o warning device
HOLDING TANK: Ka ufactuter Number of gallons
Elevatio of manhole cover
Type o warzyrng device
SEEPAGE PIT JSTIZE: Number o pits feet diameter _
feet 1' uid dept seepage pit in et pipe-elevation
botton of seepage pit elevation feet.
SEEPAGE BED SIZE: number cif lines z wi th 12_. le igth --:7o'tile depth
SEEPAGE TRENCH: width length
PERCOLATION RATE `3 AREA REQUIRED AREA AS BUILT gyp
INSPECTOR
DATED s PLUMBER ON JOB-,
LICENSE NUMBER[7(7 emu. -:25-1/-
i
REPORT OIL INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit_~~
State Septic/
DAME O~Cy~~-" IOWNSII1PlJ~~St. Croix County
I.OCAT7ON_ -Section/4/Lot 11 Subdivision
;IEPTIC TANK
Size ~ gallons Number of compartments____-__
Ui_stance from: Well Bui ]-ding- ]-2.% slope -
Highwater
PUMPING CHAMBER
Size gallons Pump Ma nufacturer. Model Number
HOLDING 'T'ANK /
Size gallons Number of Compartments
Pumper- Alarm System _
Distance from: Well Building - 12% slope _
HighwSter 2 LA
i -
ABSORP'I'10N SITE ~ z,
Bed Trench
Oir,t_anceffrom: Well Building__ ll% s].ope
ll i g h w a t e r--------_--------- ~ 2.
~vORPTION SITE DIMENSIONS
- - -
Width of trench ft Required area_____,/.,_`_ f t .
- - -
Length of each line 10 ft Depth of rock below tile in.
Number of lines Depth of rock over tile in.
'T'otal length of lines _ ft Depth of tile below grade_/_
~~!-~'1---in .
Distance between lin.es_ ft Slope of trenc_h__--_in. per 100 f.t.
Total absortption area- (ft Type of Cover:
]17
111T DIMENSIONS
Number of pi-ts Gravel around pits ye.s no
Out Side. diameter ft Depth below inlet _ _ ft
---7
Total absorption rea ^ ft 0
Area required ft
I N S P E CT E D3Y_-=G`' T I T L 1? is -
`l DATE - 1-98 .
APPROVED
- _.F
I:EJECTED 1) ATE ]_98
REASON FOR REJECTION \v~~
boa _ -
State and County State Permit #
PLB 67 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:
) 44
~ Q V idi Jj I A 3,Z V-,
B. LOCAT ON: Section ff )r-
T~N, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township W fff^[~
C. TYPE OF OCCUPANCY: *Commercial *Industrial "Other (specify) *Variance
Single family ✓ Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY /Z00 Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete L' Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement L--
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate < 3 Total Absorb Area a~ sq. ft.
New Replacement i--' Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length -7 Width / 2 Depth -3 & Tile depth (top) s24' " No. of Lines 2
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land 9 Distance from critical slope
WATER SUPPLY: Private K 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 Certif d Soil Tester,
NAME C.S.T. # Z Z5F9 and other information
obtained from E fylE ( caner builder).
Plumber's Signature _ L MP MPRSW# Phone I-'G
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.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT SE ONLY
Date of Application Fees Paid: State,& Co n y Da e
Permit Issued/Rejbe*ed (date) 9-1,2 -,F Issuing Agent Name
-r--
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/
IN
PUSTRY NT OF REPORT ON SOIL BORINGS AND Y & BUILDINGS
NDUSTRY, Qr `t} DIVISION
7969
LABOR AND PERCOLATION TESTS (115) co O. BOX N
HUMAN RELATIONS c , WI 53707
3707
LOCATION:, SECTION: TOWNSHIP/MbNtC1PALITY: LOTNO.: I OWNM
N/R
1/4
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: CJ 1,.
evv ax
USE DATES OBSER 'N MA
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE D R LA ION TESTS:
Exaesidence ❑Newieplace_
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL:
S MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑U [Is ❑S [U ❑S ®U ❑S Qll
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. I If any portion of the lot is in the
under s.H63.09(5)(b), indicate: 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.)
13- o7- -7
r t 3
i
Oy 41
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P- 3 J lt. / i K _
P-
P-
P-
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.
SYSTEM ELEVATION ~i r~'~.•~~;
G
,
13 -1-3
A7 A
P" 3
'Tie AJ9
Ave- .5#
A161
j
f ~_o t40 r
<Z
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:
1 c I
0
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
2%~'~.ti-7_/,-
CST SIGNATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 IN. 03/81)
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