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HomeMy WebLinkAbout012-2004-00-000 n fn O 3-0 n d ~1 O m:E C M O co 3 r. CD -0 M c O - ~ `.7 M o N O 4 o ((D _m o `C • mE5- 3 0 iD 0 = W N a CD O' O N r~ lD Z a N O ►'h c p ° co ? ~ ^ 0 41 No a C) j (D O ? ° o o ° cn 3 0 _ _ o 7 N 7 O U) U) y Cr D Ul o m co D F. t~ U) `C m n pi N m a ~ CD C: C) o 33 D o CD CD (D CD N 4CD (D CD 0 r- Ch ~:E cn o c m f! Q v z O O O 3o 0 n o CD 3 C)U)C) Wm 7 n d 'O A W CD C) - N ~3 ~ I a ~ z N z co z o ~ D O D CD O CL N • o CD Cl) CD N N O CD C (D CD W N a a 3 E Z CD -1 N O = O A Z n N c + X C') A Z O fD a p Z a oo~ m fD 2:1 CL 3 a c z 3 m -4 z CD W o> D a CL CD a D) T 1 N C O z CL O CD ~ (D N 4 O ~J ca A (D L b i ~ I p. O N O O a A 0 w O_ 04 N i CD O Efl O ti q O (D b O • „ y Parcel 012-2004-00-000 09/08/2006 11:21 AM PAGE 1 OF 1 Alt. Parcel 04.30.17.577 012 - 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 - TELLIJOHN, GREGORY G & DANETTE T GREGORY G & DANETTE T TELLIJOHN 1765 178TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1765 178TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.920 Plat: N/A-NOT AVAILABLE SEC 04 T30N R17W LOTS 1 THRU 14 BLK 85 Block/Condo Bldg: VILLAGE OF JEWETT MILLS TOGETHER WITH ALLEY LYING N OF LOTS 6-10 & W OF LOT 5 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 697/498 04-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 697/498 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.920 13,800 170,400 184,200 NO Totals for 2006: General Property 0.920 13,800 170,400 184,200 Woodland 0.000 0 0 Totals for 2005: General Property 0.920 13,800 170,400 184,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 012-2004-30-000 09/08/2006 11:22 AM PAGE 1 OF 1 Alt. Parcel 04.30.17.579B 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 - TELLIJOHN, GREGORY G & DANETTE T GREGORY G & DANETTE T TELLIJOHN 1765 178TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.940 Plat: N/A-NOT AVAILABLE SEC 04 T30N R17W LOTS 13 THRU 24 BLK 87 Block/Condo Bldg: VIL OF JEWETT MILLS TOGETHER WITH VACATED WASHINTON AVE & W LOTS 13 - 22 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 04-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 697/498 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.940 14,100 0 14,100 NO Totals for 2006: General Property 0.940 14,100 0 14,100 Woodland 0.000 0 0 Totals for 2005: General Property 0.940 14,100 0 14,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • AS BUILT SANITARY SYSTEM REPORT , TO,INSHIP~Xyj &.0SEC. T~Q_N, R W ADDRESS , ST. CROIX COJ.+lY, WISCONSIN. -~UIVTSION' LOT LOT SIZE . PLAN VIEW Distances b dimensions to meet requirements of H62.20 SHOW EIVT^RYTPItiG WITHIN 100 FEET OF SYSI'E'i - _ j - r- -I - r--- - ' - -f - I- i-~ - `=i-- --I I -1-- - I i-+~ ~ I I ' I t 1 i 1 I I i I-~ - ^i - f I I i ! I I-~ ~l`~ ! i , I I I i ! TIC TANK(S)^ _ MFGR. - nd;i..cate No) th AA ow _C'ONCRETE STEEL / NO. or .rings on cover I Depth ~ WELL S cote ;INCHES NO. of width 1-entgt-h - area -11 no. of lines _ width length area~2 '4r dept; to top of pipe K RATE AiZEA P.EQUIPED lI,S AREA AS BUILT ,claimer: The inspection of this system by St. Croix County does not imply complete :ioiiance with State Administrative Codes. There are other areas that it is not possible inEpect at this point of cons ttt2Cti0.1. St. Croix. County assu,es no liability for stem operation. However, if failure is noted the County will make every effort to ermine cause of failure. :ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~INSP OR DATED PJIU110ER ON JOB f LICENSE NUMBER z k PORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itaty Petm.it State Septic NAME l , (ownship St. Croix County Location Section SEPTIC TANK Size gat.Lon,S. Numbers o6 Compahtments j St. 120 on gneatet z.tope ~t D.i.dtance Ftom: We.t.t '>'L"' Bu.i.td.ing WetZandh H.ighwatet 6t. DISPOSAL SYSTEM D.iztanee Ftom: We.t.t 4 6t. 120 of gneatet zZope 6t. Bu.i.td.ing '7/ 7 6t. WetZands -_Ft. H.ighwatet St. FIELD DIMENSIONS: n Width o6 ttench 5t. Depth o6 to ck b e.tow t.iZe / ~ .in. F Length o6 each Zi..ne 4t. Depth o6 tock oven tiZe in. 7 Number o6 .ti nes Depth o~ tiZe be.tow grade 2-~ .in. g ~ -_~j p ~j pct 100 {t. Tota.t .ten th o 2ine/s`~' t- t. S.to e o ttench in Distance between Una 't. Depth to bedrock Tota.t ab.6otbt.ion atea(~ c , 4t2 Depth to gtoundwatet Requited area 6t 2 Type o~ C o v etc": IF .erap.et, 'o& S tt aw - PIT DIMENSIONS: Number o6 pits tave-t around pits yeas no Depth b e.tow .in.tet gt. Outz ide d.iametet J, . 2 Tota.t absotbtion at~'a 6t A Area kequi)Le'd 6t2 rn INSPECTED TITLr , DATE I r` 197/ APPRO . REJECTED DATE 197. f it L - i EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 n REPORT ON SOIL BORINGS AND PERCOLATION TEST§ LOCATION: Section - T-'N, R /-7-*(or) W, Township or Municipality RL4_16L- Lot No. , Block No. - ` Countx Subdivision Name Owner's Name: i^ Mailing Address: RR ~dIAJ TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT 7 ~y DATES OBSERVATIONS MADE: SOIL BORINGS ' 7 y / PERCOLATION TESTS j ,t~r 7 SOIL MAP SHEET a 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 BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN 6.1 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B Z _7 Z ~ 2 0-10 - ao 3L U- ~Z d'G 7~ 5/ _B 72 7i ,2 al° 7,5.t .54 G- a ~ Ao ly L) 54 A_ ;1.2, B- s 7 /a 5 L :a o 4 1 S -•f S, l o io S, /c,z8 -za 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. 57 Indicate scale or distances. Give horizontal and vertical reference oints. Indicate slope. '57 € -i©r= _ D ~ 51 ` ~ I i r I LL 1, 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 be ' f. 0, JIL/I V7 le rs Certification No. S 5 Name (print) , Address e~ Name of installer if known 1 CST Signature CC<,Y A-LCC -.L A1ie_':D '!fY J State and County State Permit ~ ~ Permit Application County P at PLB67 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 A ress: (j n r l B. LOCATI N: 4 n /4, Section T _ N, R1 E (or) W 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 -3 No. of Persons D. TYPE OF APPLIANC S: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms-- Automatic Washer YYES NO Other (specify) SEPTIC TANK CAPACITY rte' Total gallons No. of tanks `Holding tank capacity Total gallons No. of tanks <ew Installation -)e' Addition Replacement- Prefab Concrete k 'Poured in Place Steel Other (specify) I-. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) Z_ 3) Total Absorb Area sq. ft. New Addition Replacement--- *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 4Zj Width I Z, i Depth 3 E' Tile Depth .2- & No. of Lines 2- Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land S Distance from critical slope 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 ster, NAME ~~w~;r► C.S.T. # and other information obtained from _ rL wne uilder►. Plumber's Signature MP/MPRSW# /9" -Phone #2%-67 6- Plumber's Address K- 7 + / > PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 0C1. Tc:~ n 1 1 r• L d (~LT r1 rOP2~ ` Do Not Write in Spac e 11 L- low, R DEPARTMENT USE ONLY i t < /,w , Date of Application - C Fees Paid: State K' f' ount Date Permit Issued/ (ate) _Issuing Agent Name Inspection Ye No Valid# Date Recd 1. county ( hie copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy)