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Parcel 008-2003-20-025 12/11/2006 04:35
PAGE 1 OF 1
F 1
Alt. Parcel 12.28.16.554A 008 - TOWN OF EAU GALLE
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 - KITCHNER, CLEO M
CLEO M KITCHNER
2616 SANDPIPER LA
WOODVILLE WI 54028
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 2616 SANDPIPER LN
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 4.320 Plat: 4678-CSM 18-4678 008-03
SEC 12 T28N R16W PT SW NW CSM 18-4678 Block/Condo Bldg: LOT 01
LOT 1 (4.32AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-28N-16W SW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
02/23/2004 754879 2514/45 TI
12/23/2003 749953 18/4678 CSM
05/17/1992 483079 949/424 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
171597 244,100
Valuations: Last Changed: 07/19/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.320 27,100 133,900 161,000 NO
Totals for 2006:
General Property 4.320 27,100 133,900 161,000
Woodland 0.000 0 0
Totals for 2005:
General Property 4.320 27,100 133,900 161,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 1112212005 Batch 05-54
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 192.00
Special Assessments Special Charges Delinquent Charges
Total 192.00 0.00 0.00
NOT E: PRINTS MADE FROM THIS, MAY NOT AGREE WITH THE RECORDED DOCUMENT
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SECTION 1Y, TOWN YB NORTH, RANGE 16 WEST,
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./-,F7 •l Cr - c AS BUILT SANITARY SYSTEM REPORT
,NI ER L. / c,, ~T_ z Lid TOWNSHIPf;F4,,, 6,7L4 SEC. TEL N, R_,L_ L_W
.0. ADDRESS _,.7 ST. CROIX COUNTY, WISCONSIN.
7BDIVISION LOT_.,__LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20,t,,
i
SHOW EVERYTHING WITHIN 100 FEET OF i STEM
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TIC TANK(S)/-~ MFGR. CONCRETE _ STEEL
NO. of rings on cover 3 Depth f " DRY WELL /VCy
INCHES NO. of 1V~. r width length area
no. of lines width •2~ lengthy' area,
depth to top of pipe " j
:1REGATE
RK RATE ,_,z y _ AREA REQUIRED o AREA AS BUILT / c
_sciaimer: The inspection of this system by St. Croix County does not imply complete
::pliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
stem operation. However, if failure is noted the County will make every effort to
termine cause of failure.
-EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
/ 0 IJ _INSPECTOR;✓!C
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DATED PLUMBER ON JOB
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LICENSE NUMBER'}~~ / -
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REP09T OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.i.tany Penm.i•t -
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State Septic-
NAME r _ Township Cnoi x County
Location . Section
SEPTIC TANK
Size {,,t ~ gattona. Number os Compa,%tments j
Distance Fnom: WeQE 12% on greaten 6tope it
y Bu.itd.ing ► J St. Wet.Eandz
f
Highwate c S 4
DISPOSAL SYSTEM
Distance Fnom: Wett S#. 12% on greaten stope S~.
Bu.itd.ing /l/ St. Wettand.a Ft.
N.ighwaten St.
FIELD DIMENSIONS:
Width o j then ch St. Depth o6 no ck b etow tit e / in .
Length os each tine ~ it. Depth o6 rock oven t.ite ~ .in.
Numb en o6 tine.6Depth os tite be.Eow grade in.
Totat .beng.th o6 tines 1' 1/// it. Stope o j trench ~ in pen 100 St.
Distance between tines St. Depth to b edno ck it.
Totat abs onbt.ion area t St2 Depth to groundwater St.
Requ.ined area St2 Type os Coven:( Paper on Stkaw
PIT DIMENSIONS:
Number os pigs G)tave.C around p.it.a ye.a no
Outside d.iame*en Depth below .in.ie.t St.
2
Tota., abzonbtion gxeea. it
A
Area %equk)Led St2 R'
INSPECTED By k. TITLE -
APPROVED UX/ , DATE / f 19, IWO
REJECTED DATE 19 7_
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: Sid '/4, NW ''/4, Section 12 T26 N,R 16 E (or)ZW)Township or Municipality Eau Gal-Le
Lot No. , Block No. Country Estates County St. Croix
Subdivision Tame
Owner's%Buyers Name: John LaCosse
Mailing Address: 11h 1, Baldwin, Wi
TYPE OF OCCUPANCY: Residence x No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW x REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET 79 NAME OF SOIL MAP UNIT- Santiago
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER !N TEST TIME DROP IN WATER LEVEL, INCHES
LRATI NUM- SINC
E HOLE NO LE AFTE INTERVAL BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- K .
P- 1 8" T.S. 12" Loam 12" Sand to 2 Nona O Min 2" 2" 2" P- 2 12" T.S. 18" Loma 2 None 30 Min 1 " 1 " 11-" 20
P- 3 12" T.S. 12" Loam 12" Sand Lo a 24 None 0 Min Jim 1 " 1i" 20
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- 1 72" None 84" 6,t T. s. 12" Loam 540 Sand loam
B- 2 72" None 8 " 12" T.S. 12" Loam 8" Sandy Loam
B- 72" done 64" 12" T.S. 12" Loam 8" Sand Loam
B- 4 72" None 84" 12" T.S. 18" Loam 2" Sand Loam
B- 5 72 None 84" 12" T.S. 18" Loam 2" Sand Loam
B- 72" None 84" 12"`1'.S. 12" Loam 8" Sand Loam
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 LO sq. ft. Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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t, 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)-- Stephen Le Aeby Certification No. l a6
Address WdAdville, Wi
Name of installer if known Stephen Aaby. baby Plumbing Heating & Elect.
Copy A -Local Authority CST Signature-
State and County State Permit #
PLB67'& - Permit Application County Perm #
for Private Domestic Sewage Systems County _
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. # _
A. OWNER, O PROPERTY Mailing Address:
/ `L`J F 1
e AH1, Baldwin, Wi
B. LOCATION: SW /4 NW 4, Section 12 , T28 N, R 1 E (or) (,V4 Lot# -City _
Subdivision Name, nearest road, lake or landmark Blk# _ Village
Township EaU Galle
Country Estates _
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family X Duplex _No. of Bedrooms .3 No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES X NO Food Waste Grinder YES X NO # of Bathrooms-j-
Automatic Washer X -YES NO Other (specify) _
E. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks _ 1
'Holding tank capacity_ Total gallons No. of tanks
".iew Installation X Addition Replacement Prefab Concrete X
Poured in Place Steel Other (specify)
G=FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) _W 2) 20 3) 20 Total Absorb Area 750 sq. ft.
ew Z Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet _182_ Width 480 Depth 'ile Depth-24" _ No. of Trenches
Seepage Bed: Length _Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size 40
Percent slope of land 104 Distance from critical slope none
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 Tester,
NAME Stephen L. Aaby C.S.T. # 1406 and other information
obtained from (owner/builder).
Phone #698 - 2407
Plumber's Signature, !(!;r' MP/MPRSW#
Plumber's Address s> fG-L ,
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below FOR DEPARTMENT USE ONLY
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Date of Application L{ Fees Paid: State Count li Date
Permit Issued/ (date) -Issuing Agent Names
Inspection Yes No 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
Plb. t-A, WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES
Division of Health
Section of Plumbing & Fire Protection Systems
ON-SITE WASTE DISPOSAL INSPECTION REPORT
Name of Premises
Street City County
Master Plumber Address
Owner Address
❑ County Permits ❑ Appropriate State Permits
Type of Building: ❑ Public ❑ Single Family or Duplex
CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM
❑ Building Sewer ❑ Conventional Soil Absorption System
❑ Septic Tank ❑ Conventional System-in-fill
❑ Holding Tank ❑ Alternate Mound System
❑ Seepage Ber! ❑ Holding Tank
❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System
BRIEF, FACTUAL COMMENTS AND SKETCH:
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❑SEE ATTACHED
DISCUSSED WITH PLUMBER ( 1 Yes ( ) No SIGNATURE (Voluntary)
DATE OF INSPECTION
Signature of Inspector
White - Inspector Yellow Local Inspector Pink - Plumber or Responsible Party