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St. C-L, CotuttyPlanning and Lnning
- -
Parcel 038-1096-90-000 01/17/2007 02:59 PM
PAGE 1 OF 1
Alt. Parcel 23.31.18.403B 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
JOSEPH L & KAREN LANGER O - LANGER, JOSEPH L & KAREN
1254 200TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1254 200TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 23 T31 N R18W 5A IN SW SE COM SW COR Block/Condo Bldg:
SW SE, TH N 660', E 330 FT, S 660 FT, TH
W 330 FT TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
23-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 496/467
2006 SUMMARY Bill M Fair Market Value: Assessed with:
175490 228,900
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 44,600 157,700 202,300 NO
Totals for 2006:
General Property 5.000 44,600 157,700 202,300
Woodland 0.000 0 0
Totals for 2005:
General Property 5.000 44,600 157,700 202,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 134
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,Clr''Z SEC,~T N=Rj
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION_ LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
ERYTHING WITHIN 100 FEET OF SYSTEM
- -I i
I '
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i
FZr din e o,thArrnw
ALI . ~ i
BENCHMARK.: (Permanent reference Point) Describe:
Elevation of vertical reference point: 'Slope at site:
SEPTIC TANK. Manufacturer:
• squid Capacity: &,r,E7
Number of rings on cover an manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Nt.unber of gal. pump set or a cyc e__ gallons; tot-a~ capacity W
distribution lines gallon: size of pump head;
gallon per minute horsepower _ ~ranc~ name <J
and model number
Tvpe of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
SEEPAGE-
1-
EEPA E PIT SIZE: Number o pits feet diameter
feet liquid depth seepage pit in etpipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines , witz _lengtt~~tile depth.QC `y
SEEPAGE TRENCH- width length
PERCOLATION RATE AREA REQUIRED R, AS BUILT
INSPECTOR 7,
DATED PLUMBER ON JOB
LICENSE NUMBER,j'_
t
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit _
State Septic
A M E
TOWNSHIP~/~/ro l~ St. Croix County
)CATION Section,-%~Lot # Subdivision
I?PTIC TANK
Size i
gallons tC NUVber compartments
istance from: Well ,5 Building 12% slope
Highwater
LIMPING CHAMBER
Size gallons Pump Manufacturer Model Number
IOLDING TANK
Size gallons Number of Compartments
Pumper Alarm. System
i.stance from: Well- Building 12% slope -
Highwater
IIiSORPTION SITE
Bed Trench
)istance from: Well Building 12% slope
Highwater _
ABSORPTION SITE DIMENSIONS
Width of trench _ ft Required area 7 _ft.
Length of each ft Depth of rock below tile-/g -in.
Number of lines _ Depth of rock over tile--_ L _in.
{ Total length of lines ft Depth of tile below grade~~ --_in.
~Z -
~Distance between lines' ft Slope of trench 1 min. per 100 ft.
Total absortption area ~f - .ft Type of Cover: 1---, ' i
I' CT DIMENSIONS
Number of pits Gravel around pits yes no
Outside diameter ft Depth below inlet ft
Total absorption area ft
Area required ft
INSPECTED BY TITLE APPROVED DATE 19 8
REJECTED DATE-
10EASON FOR REJECTION
DEPARTMENT OF APPLICATION
SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Proper y Owner: [Zma~ijng Address: Property ocation: , Village or Township: County:
'/a;, '/aS ~T S NCR ' (or) W
Lot Number: B I k No.:" Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(If assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY v
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: r
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental Q Seepage Bed ❑ Seepage Pit
' ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
54 Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the I to sewage system shown on the attached plans.
Nam of Plumber: Signa r MP/MPRSW No.: Phone Numbe
_ ( )
Plumb 's Address: Name of Designer:
Ak L41 ee4dA1,nV4J 17
COUNTY/DEPARTMENT USE ONLY
S n t e of Issuing Agent: Fee: Date: Sanitary Permit Number:
t APPROVED
❑ DISAPPROVED
Flason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
LABOR AN P.O. BOX 769
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
LOCATION: SECTION: JTOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
I/c, 1/ N/R,i (or) W n
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
i_ -i
USE DATES OBSERVATIONS MADE
NO. BEDRMS.:'COMMERCIAL DESCRIPTION: I-P-R TONS: ER LA I N TESTS:
Residence ❑New ®Replace -
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDIN TANK RECOMMENDED SYST~ :(optional)
s❑u ❑s❑ ❑s❑u ❑s❑u ❑s❑u
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the
under s.1463.09(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.)
r'
SEP
B npN O" t f y v
..i
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P_
P 1
P-
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 h
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 pert
of land slop.
SYSTEM ELEVATION
I
,
i
~ H
~ p
ww e e tcs'e~J~
I, the undersigned, hereby certify that the soil tests reported on this form were mad 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:
ADDRESti CERTIFICATION NUMBER: PHONE NUMBER optional):
L/8-i;L
CST ,N TU
G'
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
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