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Parcel 038-1112-95-000 01/17/2007 02:54 PM
PAGE 1 OF 1
Alt. Parcel 28.31.18.479B3 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
CRAIG A GRAVUNDER O - GRAVUNDER, CRAIG A
1088 192ND AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 1088 192ND AVE
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 2.680 Plat: N/A-NOT AVAILABLE
SEC 28 T31N R1 8W 2.68A IN NE SE LOT 3 OF Block/Condo Bldg:
CSM IN VOL III PAGE 835
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
28-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1136/137 WD
07/23/1997 681/436
2006 SUMMARY Bill Fair Market Value: Assessed with:
175622 191,900
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.680 36,800 132,800 169,600 NO
Totals for 2006:
General Property 2.680 36,800 132,800 169,600
Woodland 0.000 0 0
Totals for 2005:
General Property 2.680 36,800 132,800 169,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 138
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r
fin 3183s-
BUILT SANITARY SYSTEM REPORT
AS
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OWNER TOWNSHIP ~;~f SEC
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ADDRESS ST. CROIX COUNTY, WISCONSIN.
h
.`i LOT °S LOT SIZE
SUBDIVISION
PLAN VIEW
Distances and dimensions to meet requirements of H63
EVERYTHING WITHIN 100 FEET OF SYSTEM
9HO
I Hia o th Arrow
BENCHMARK: (Permanent reference Point) Describe:.9'1Si-""i~ //Zoe
U
Elevation of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer:, ~;Liquid Capacity:
Number of rings on cover Tank manhole cover elevatio -
Tank Inlet Elevation: 3= Tank Outlet Elevation:, "
PUMP CHAMBER
Manufacturer: Number of gallons
dumber of gal. pump set or a cyc e gallons; tota capacity o
distribution lines gallon: size o pump head;
gallon per minute horsepower ran name of pump
and model number
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: Number o pits eet iameter
feet liquid dept seepage pit in et pipe-elevation
bottom of seepage pit elevation feet. v
SEEPAGE BED SIZE: number.of lines width lerigth~tile depth
SEEPAGE TRENCH: width length .
PERCOLATION RATE, REA REQUIRED/ REA AS BUILT
INSPECTOR
DATED % 7--1 PLUMBER ON JOB -
T LICENSE NUMBER
lo 2- f
Kt. PORT OF INS PLCTION IN UIV IOUAL SLWAG L .SVSitM
SaYi4 ta~iq VolA4W
State ' C, c
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of- 5(I' (i urt~Lu C p SubdCv~b~On
11afkonb Nurribetc o6 oompaii.tmentb
(,~rufn: (Ue.~k--- 8 utiXdiYL _ 12n bx.ope
Highwa ten.
7If~,~iISI.
~cct!('i~n4 Pump Manuhac.tuheh Mvdce Number
iANh
gafloi,16 Numbers uA Cc;rripantrriirYlt~
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TAench.
weak ~ueXd~ny ------t2 -5~upe -
It ghwa.te h
N. I H. OIMLNSIONS
T n e n r h. - -t-- = --7 At R e. y f4 "c ( a n e. a
rll 11A each tine At Uep-th uA noch be~ow t 4 f
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De.ptkt aA n.uch uve- ~e tc ( (r,
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1) 4' tween X4 nee - 6.t S4 olre o A t.n.envIt YI . ~r, l i ou [ r
i, ti rip (4 on (olea q_ e__.6.t Type oA Covers.: Pap( „r c '-N II(w
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G"(avvf anb( d K)t b I~1 n i,.%
lIrmlrty I At Depth by o cnY(r.t (~t
,,I,flt,r(IY~ Ifll-a At
11 4 'l (I
Nv TITLL~
Z DATE O A T L
1 11 C11Ow 1
Cr -
PL E3 6 7 State and County State Permit #
Permit Application County Per
for Private Domestic Sewage Systems Count
'
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required _ State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: YL&,4- Section T_- / N, R (or) _ 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 3
D. SEPTIC TANK CAPACITY /O 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 pepth (op) No. of Trenches
Seepage Bed: Length _Width • Depth Tile depth (top) d No. of Lines
Seepage Pit: Inside dia er Liquid Depth No. of Seepage Pits
Percent slope of land- C /n 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 C Pied Soil ster,
NAME 22,4j~1iou JAG C.S.T. # and other information
obtained from ox</a.. (owner/builder).
Plumber's Signature MP,/MPRSW# Phone # ~,S
Xi,
Plumber's Address ; iLd(ir~.t1 (zt s~(r % y
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
-17 Date of Application Fees Paid: State " County fd, 6-t) Date
Permit Issued/ (date) `7 "-,,2 Issuing Agent Name -
Inspection Yes-r 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
IMPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, CC DIVISION
LABOR AND
BOX HUMAN RCLATIONS PERCOLATION TESTS (11J) MADISON WI 53707
LOCATION: SECTION: / TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
(or) W
AIZ W N R
SAW
OUNTY: OWNER'S BUYER'S NAME: MAILING A ESS: )
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional
[s❑u os❑u ❑s❑u ❑sau os❑u
< .
If Percolation Tests are NOT required DESIGN RATE: SYSTEM ELEV. If any portion of the lot is in t 1;.,1
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodpl n vation: C
PROFILE DESCRIPTIONS CY) ° can-
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH T I NES XTU AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGH-EST TO BEDROCK IF OBSERVED (SE A BR ON B
a^ 03 r
La /
L'92~ ~2
$
B-
B Q-7~3i 7_ J.C5,~J-3/S~r:3r-3S~-<~ 3u -~f45A,
B- a 7
r r
B ?
B- 91
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE 1 01 PERT D2 PERIOD PER INCH
- a 1
P- J
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
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1810
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 (printl: TESTS WERE COMPLETED ON:
I
ADD S CERTIFICATION NUMBER: [PHON NUMBER optional):
C T RE:
ster.
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil T(
DILHR-SBD-6395 IN. 03/81)
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