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Parcel 038-1079-20-000 01/17/2007 12:00 PM
PAGE 1 OF 1
Alt. Parcel 19.31.18.3258 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 - AMMERMAN, HAROLD & SHARON
HAROLD & SHARON AMMERMAN
2094 90TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 2094 90TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 6.000 Plat: N/A-NOT AVAILABLE
SEC 19 T31N RI 8W 6A IN NE NE N 417.44 FT Block/Condo Bldg:
OF E 626.16 FT (MINERAL DEED 889/516)
EZ-UT-1234/97 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 454/388
2006 SUMMARY Bill Fair Market Value: Assessed with:
175282 180,900
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.000 50,600 109,300 159,900 NO
Totals for 2006:
General Property 6.000 50,600 109,300 159,900
Woodland 0.000 0 0
Totals for 2005:
General Property 6.000 50,600 109,300 159,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 107
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 , TOWNSHIP SEC. T ,N, R W
P.O. AilDRESS , ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
• 0 PLAN VIEW p y!~ Gf ST
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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t h i r
76
SEPTIC TANK(S) ! MFGR. CONCRETESTEEL
NO. of rings on cover Depth DRY WELL
TRENCHES NO. of width length , area
BED no. of lines- r. width - length- area
depth to top of pipe
AGGREGATE
PERK RATE AREA REQUIRED AREA AS BUILT
Disclaimer: The inspection of this system by St. Croix County does not imply complete
compliance with State Administrative Codes. There are other areas that 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 THIS SYSTEM' l
J / 1
"INSPECTOR
{
DATED PLUMBER ON JOB
LICENSE NUMBER
S
Fk
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4
I:II'OI:I Of INtiI'(CTION INO IV (UUAI tiIUTAUt tiVSIIM
`l'
(oWn.6 h(p.7Chu~x l'uuYilil
_ Svct~on Lot q Subd.tvils oYI
l' I 1 i' I ANK
(J gae one Numbeh oh eornpahtmeYtte
, llum: We(t'- - buy d4:n9 nkupv If i yGtwate.h
I N6 CIIAM61. R
gaeZone Pump Manu,~ac.tuheh Mudee Numbvh
I f) I N . I ANK
ti akxco n.6 Numbc4 oA Cornpahtin eYlte
Atahrn Stye tem
13ii4Xd4' ny 12'a eIC ope
Hiyh.wa-Le.h~
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s~. Z J ~t e YI C Jt
h'<<,rrl: lUeTY ~ - _ Bui.Yd~ny eXuve
It 4.yit wateh
nl' I ION SITE DIMENSIONS
W'( (I tit o / ; j
~ tneneh tip Reyuchv.d anea
I_cYl,gth oA each. Zirte ~ 6t Depth oti Mock bveow t'I(2
Numbch oA- No e6.__ _ Depth o A tuoch ovc h ti fv" , r
!7 iota( reYtgth 06 t'i.nee `fit Depth oA We bveow cl"Ud() Iit
It r ti 1,4 kiI, by tween Yd rlea 6t St i~pv o (t tke.ncGl I-)v 11 I UU r
I,rIC ab~oIt.J_)t~un ahv.a ~►t Iypv u(, Cuveh: ►'ctJ-) ,I (,If ,
2111
I'I I 1~iMINtiIONS Gh.avee ah,11.n11 i~t5 IfcA
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hI H C H O DAT(:
I:I AsoN I OR RI JECTION
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Parcel 038-1079-20-000 06/15/2007 10:52 AM
PAGE 1 OF 1
Alt. Parcel 19.31.18.325B 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): 0 = Current Owner, C = Current Co-Owner
0 - AMMERMAN, HAROLD & SHARON
HAROLD & SHARON AMMERMAN
2094 90TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 2094 90TH ST ll
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 6.000 Plat: N/A-NOT AVAILABLE
SEC 19 T31 N R1 8W 6A IN NE NE N 417.44 FT Block/Condo Bldg:
OF E 626.16 FT (MINERAL DEED 889/516)
EZ-UT-1234/97 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 454/388
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.000 50,600 109,300 159,900 NO
Totals for 2007:
General Property 6.000 50,600 109,300 159,9000
Woodland 0.000 0
Totals for 2006:
General Property 6.000 50,600 109,300 159,9000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 107
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
d
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S
AP-. LIC ATICn1 FOR SAillITARY PE.~MIT
for
INSTALLATION OF A "F,PTIC ^1 aJTK
(Sec. 144.03, Stats.)
A. O:iIJ C PROPERTY
Name Address (Street., City "Lip Code)
D. L^CITIC11 CF `P.,.-CP':-TY SEPTIC T.-'~Ml< IS T(B INST LLD
Check 1. City TV11 it 1kdr'r ss. County-
one, 2. _Village __1-~ ,1~.vt{ v
3. LTown
C. IN~TALL-~;:Z Give L~-cense number held:
Wisconsin Restricted
Licensed Sewer
Plumber Services
PJarne C~j1dre. s
D. SPTIFIC=.TICNTS OF S7,7TIC TAL1K
Size in g Ions: (check ore)
1. 1,000 Gal. 5. 4,000 Gal.
2. 1,500 Gal. 6. _ 5,000 Gal.
3. 2,000 Gal. 7. If over 5,000 gal., give capacity.
4. `3,000 Gal.
hlAterials: I. ~Prefab concrete 2. Poured concrete 3. Steel
TYPE CF OCCUPANCY
1. ~LSin-rle Family residence 3. Commercial establishment j
2. h! ;ltirle family residence 4. Industrial establishment
F.. APPKX'rDL E Ntr,3=1-i OF P'115ONS 5 'RV:H~D D.~ILY
G. PE`?CCLATIC i'-'.cf' ADr _l~' Yes 2. D?o Date l ~ Z'
y
%
By whom s ~s l t._
(To be completed by County Clerk)
c~
Date a plicatinn is filed and fee paid
Permit issu~.,d (date) ~t'ermit P,Iumbe
Clerks } z l t ~~~1 p
- - l7
PLB 67 State and County State Permit #
f. 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:
S'yc
4
B. LOCATION: L-'/4 Section T N, R~ E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township r
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 i
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-PlaceOther (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area f sq. ft.
New Replacement L---' Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed:- 4'A Y Length S Width Depth 3 l ' Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land_ 3 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 Certifi Soil Tester,
NAME / C 11 T- C.S.T. # and other information 06 obtained from (owner/builder). _
Plumber's Signature tM /r_ ,mss MP/MPRSW# Phone #'~75 - .zii~ j ~xJ
Plumber's Address V i5;W-eAo,
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 ount Date /
Permit Issued/Rejected (date) _Z 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
CH 115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS ,
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVIC
P.O. BOX 309, MADISON, WISCONSIN 53701 [CFIVF
jjjAr tit. 98
~ .r"
LOCATION: Section -Z-I--,TAN,R E (or) W, Township or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's/Buyers Name: a
sze
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET NAME OF SOIL MAP UN IT~`~s'
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 AFTE INTERVAL
MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-
P- 3
P r
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- 7 -7
B- 7 FF
B-
B-
B-
PLAN 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 method
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) fJr -711 I g S} Certification No.
Address-
Name of installer if known
Copy A - Local Authority CST Signature
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` Form Plb 67 Wisconsin State Board
APPLICATION FOR PERMIT of Health
for
PURCHASE OR INSTALLATION OF A SEPTIC TANK
(Sec. 144.03, Wis. Stats.)
A. OWNER OF PROPERTY Type or us° BUCK 6*
Name Address Street, City, Zip Code
B. LOCATION OF PROP~;RTY WHERE SEPTIC TANK IS TO BE INSTALLED
Check 1. _ City Mail address County
one: 2. Village
3 Town
Give license number held:
C. INSTALLER Wisconsin Restricted
Licensed Sewer
Plumber Services
Name Address
D. SPECIFICATIONS OF SEPTIC TANK
Size in gallons: Check one
1. 500 gal. 4..- 1,500 gal. 7. _ 4,000 gal.
2. _ 750 gal. 5. 2,000 gal. 8. 5,000 gal
3.-1,000 gal. 6. _ 3,000 gal. 9. Dover 5,000 gal, give capacity
Materials: 1. Prefab concrete 2. -Poured concrete 3. Steel
E. TYPE OF OCCUPANCY
1. Single family residence 3. _ Commercial establishment
2. Multiple family residence 4. Industrial establishment
F. APPROXIMATE NUMBER OF PERSONS SERVED DAILY
G. PERCOLATION TEST MADE 1. r° Yes 2. _ No Date
By whom4 f
(To be completed by County Clerk)
Date application is filed and fee paid
Permit issued (date) Permit Number
County Clerk
Note: The application cannot be considered for filing until all of the above questions are
answered and the fee paid. County Clerk will forward application, the fee of $1.00,
and Copy (b) of the Permit (yellow copy) to the State Board of Health. Checks and
money orders should be made payable to the Wis. State Board of Health.
ST. CnOI)C COUNTY GONIAG Ul~DI1~~LiUC?
STATE HIGITWAY
7 7 - _ Highway Center Line LL
150 Highway setbacks are as follows
Town Road 100 feet
VISUAL THI~.NGLE I County icad .........100 feet! r'
150 r 300t + State Highways 160 feet' I / Interstate Highways..160 feet'
j ' A:'i Highway Interstate
Fence-30 feet]
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10 rc , Tank
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April 19, 1968
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5:~. CROIX COUNTY ZONI14G UtDINANC~,
LOT PL-N
Indicate North
Lot Width 1001
- Lot Line _
L L
0, Rear Yard `0 C
C1 T T
L
L~ I E
T
Building
I+ G
i T
Side Yard l aide Yard 1 ' H
_ Total Side Yard Minimum ! 2001
s 25 Feet t
Bui ldd nlg '
Line
{
i Front - - - - - - Highway - -
i' ' Yard Set Back
i
Lot Line
Centerline of Highway
Highway setbacks are as follows:
Town Zoad 100 Feet
County :load 100 Feet
State Highways 160 Feet
Interstate Hi7hways 160 Feet
Highway Interstate Fence 30 Feet rinril 19, 196$