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Parcel 012-2002-40-000 09/08/2006 11:35 AM
PAGE 1 OF 1
Alt. Parcel 04.30.17.569B 012 - TOWN OF ERIN 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 - BOHL, ALLEN W
ALLEN W BOHL
1779 176TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1779 176TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.220 Plat: N/A-NOT AVAILABLE
SEC 04 T30N R1 7W LOTS 4 THRU 10 & LOT 11 Block/Condo Bldg:
EXC E 6 FT OF S 15.98 FT ALSO LOTS 28
THRU 35 OF BLK 77 VIL OF JEWETT MILLS Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
04-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/16/2001 659206 1738/511 WD
08/23/1994 520526 1092/240 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/21/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.220 18,300 192,000 210,300 NO
Totals for 2006:
General Property 1.220 18,300 192,000 210,300
Woodland 0.000 0 0
Totals for 2005:
General Property 1.220 18,300 192,000 210,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 123
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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• AS BUILT SANITARY SYSTEM REPORT
ER 6A VZ r.> , TOITNSHIP,s, SEC. T-C N, RbI
j, ADDRESS ST. CP.OIX COUNTY, WISCONSIN.
.
::DIVISION LOT LOT SIZE
-
PLAN VIEW
Distances b dimensions to meet requirements of H62.20 /
SHOW EVERYlT'IHING WITHIN 100 FEET OF SYSTEM _
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f 1 T- . i I i i~-. I ! ~
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I ( i I ! I i ! { I i ! { I I i .I {
i i { 1 ~ ( I
'TIC TANK(S)_ MFGR., t rl~ r rnrTCPE F Indica e Nanth AttttUW
ST. EEL Scare
NO. or rings on cover Depth__- DRY [TELI;
,-,%GHES NO. of width _ length area
no. Of lineswidth_, ' length are
depth to top of pipe
rLEGATE Ali
a RATE AREA REQUIRED AREA AS BUILT .s1
-claimer: The inspection of this system by St. Croix County does not imply complete
_:oliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assuoies no liability for
stem operation. However, if failure is noted the County will make every effort to
--ermine cause of failure.
-.LASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
`INSPECTOR
DATED PLIR~MER ON JOB
LICENSE NUMBER ;
REPORT OF INSPECT'ON,IND"tVIDUAL SEWAGE SySTLkf
San.itany Penmit
' State Sept-ic/~; ~
NAME ~iownah.i..p St. Cno.i.x County
Location Z~ - Section
SEPTIC TANK i
Size gattonA. Numbers o6 CompantmentA i
Distance Fnom: Wett it. 12 0 on greaten zt-o,pe it
Bu.itding it. wettands 6t.
~ .
DISPOSAL SYSTEM Highwaten it.
Distance Fnom: Wett 12% on gneatvL stope St.
Bu.iZd.i.ng 4t. Wettand Ft.
H.ighwatet it.
FIELD DIMENSIONS:
Width o6 trench it. Depth o6 nock below t.iZe .in.
Length of each tine it. Depth o4 nock oven. t.ite in.
Number o6 tines Depth o4 tite be~ow grade in.
Totat length o6 tines it. Stope o6 trench in per 100 it.
Distance between Uness it. Depth to bednocfz it.
Totat abs onbtion anea 6t2 Depth to g.`coundwaten it.
2
Requined area it Type oi Coven.: Papek on Straw
PIT DIMENSIONS:
Number o6 pigs Gnavet around p.itzs yeas no
Outside diameter it. Depth below ,inlet it.
2
Totat abzoAbtion anea it z
A
Area nequ.ined it2 rn
INSPECTED BY TITLE
APPROVED DATE 197
REJECTED DATE 197
EH` 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
rf REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: ~ /4, , Section , T30N, R L7 E (or) W, Township or Municipality C
Lot No. X Block No. , - CT-C, L4.1 i'7tIm / County 57~ i ,4
T Subdivision Name
Owner's Name: y P"e y P/ e -.5,0
Mailing Address: Ale- yI / c A ~'Y! c7 ~ t 4/ Iu~ ~ 3
TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW 4`~ ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET r7~ SOIL TYPE
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 AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- 0
_ r
P
~S
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST f (DEPTH TO BEDROCK IF OBSERVED)
B 2, / 7 -
7,e" t " 7- j /
7 ` a
S 51l_, y -s
R ;2
24 2.?- V
H 7~
7G 7 ' " -
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square f pet of suit ble areas. Indicate number square feet of a rption area
needed for building type and occupancy. di ate scale
or distances. Give horizontal and vertical reference oints. Indicate slope.
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I, the undersigned, 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. /
Certification No. `7
Name (print)
Address
Name of installer if known
R
-
CST Signature a4-atin~L~
PY A -LOCAL AUTHORITY
'I CO
,7
r l i3,
f
State and County State Permit #
-
PLB67 ~ Permit Application County Per _
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:
9
B. LOCA ION. '/a, Section Ta N, RJ2 V (or) W Lot# _ City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
-YPE OF OC UPW, O& *Commercial *Industrial _ *Other (specify) *Variance
7-T
Single family Duplex No. of Bedrooms .3 No. of Persons
D. TYPE OF APPLIANCES: Dishwasher __X YES NO Food Waste GrinderYES-,XNO # of Bathrooms-
Automatic Washer YES NO Other (specify)
SEPTIC TANK CAPACITY Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
ew Installation A Addition Replacement Prefab Concrete
Poured in Place Steel Other (specify)
FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) C 2) 3) Total Absorb Area scl. -1
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width Depth " Tile Depth N No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land Distance from critical slope
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
%isconsin Administrative Code, and that I have sized the effluent disposal systeel(, `r } ri the EH 1 15 prepared
')y the Certified Soil Test r,
AME C.S.T. # and other information
Obtained from (owner/builder).
!amber's Signature MP/MPRSW# Phone 41 14k 5I3S
Plumber's Address R J Aj-r
! PLAN VIEW: Provide sketch bellow of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Spa Below FOR DEPARTMENT USE ONLY ~j
Date of Application Fees Paid: State C unty i ate
Permit Issued/Rt~fed (date) ; y _Issuing Agent Name 1L-i-- -i Li,
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)