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Home My WebLink About014-1026-20-000 A) 0 g „ 3 3 - o 5i O m 0 o cn N 7 O N~ `C 3 O -I CD CL 1D FBI ~l 41 cn N C O Co O O -I 1.11 N O N = NO N v, O rk \ 0 'a O r CD 7 1~D !07 S_ O O O O cn 3 CD o o D O° n1 7 N O !i N C j fl1 1D (n O !n O. N N O W O 3 ° ° Z) 0 1D N N D (~~1 N N !D CO co 0 N 00 --A m N o c m 3 c • z o O O m !r a r N 0 m 3 N cn cn ° v 3 v N CD M A O O 1D f/I O CD C ' D] 'O O CD Cn N N 1D 7 d 3 z O z O Z -i z D m o C N CD c CD CD M. c N CND co fa a a 3 CD a OZ O O A A (n c n O A Z O v a_ O a a. W N CL z °o rl' z v, 3 z m N. D 9 d !n_ a CD o_ CD m c n z O o x i °o w Nt ° O I ° ° n C°m a M m t 1D "O N n N N O ~ O ~ I a 0 b W O D'Q Oo C) ti po 1(D b O CL ? Parcel 014-1026-20-000 10/12/2006 03:34 PM PAGE 1 OF 1 Alt. Parcel 12.31.15.178A 014 - TOWN OF FOREST 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 - ANDERSON, PHILIP K PHILIP K ANDERSON 3153 230TH AVE CLEAR LAKE WI 54005 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 3153 230TH AVE SC 1127 CLEAR LAKE SP 1700 WITC Legal Description: Acres: 19.850 Plat: N/A-NOT AVAILABLE SEC 12 T31 N R15W 19.85A n W NE EXC E 665' Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-31 N-1 5W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/19/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 43,800 58,800 NO PRODUCTIVE FORST LANDS G6 18.850 33,000 0 33,000 NO Totals for 2006: General Property 20.850 48,000 43,800 91,800 Wo :)dland 0.000 0 0 Totals for 2005: General Property 20.850 48,000 43,800 91,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 108 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges To tal 0.00 0.00 0.00 Parcel 014-1026-40-000 10/12/2006 03:34 PM PAGE 1 OF 1 Alt. Parcel 12.31.15.179 014 - TOWN OF FOREST 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 - ANDERSON, PHILIP K PHILIP K ANDERSON 3153 230TH AVE CLEAR LAKE WI 54005 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 1127 CLEAR LAKE SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 12 T31 N R1 5W SW NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-31N-15W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/17/2005 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 40.000 72,000 0 72,000 NO Totals for 2006: General Property 40.000 72,000 0 72,000 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 72,000 0 72,000 Wo,)dland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT r , TOWNSHIP SEC. N, R W 1. ADDRESS Y , ST. CROIX COUNTY, WISCON~ S N "DIVISION LOT LOT SIZE Fes' r PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i . j 'TIC TANK(S} MFGR. CONCRETE STEEL NO. of rings on cover Depth DRY WELL ACHES NO. of width .'J length ,s . area / c7 no. of lines width length area depth to top of pipe 3IZEGATE RATE AREA REQUIRE11 AREA AS BUILT claimer: The inspection of this system by St. Croix County does not imply complete )liance with State Administrative Codes. There are other areas that it is not possible _rspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if.fail~ure is noted the County will make every effort to .ermine cause of failure. '.:ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. . INSPECTOR DATED. PLUMBER ON JOB LICENSE NUMBER Z - REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itany Pvr mi t State Septic- NAME rowndh.ip S~. Cno.ix County Location Section I SEPTIC TANK Size gattond. Numbex o6 Compan.tmentz Distance Ft om: Wett it. 12% on gxeate& 4tope °_W..... it Bu.itd.ing it. Wettandh r_ ~ . H.ighwaten it. DISPOSAL SYSTEM . Distance Fkom: Wett 12% on gxeatetc stope 6.t. Bu.itd.ing St. Wettanda Ft. H.ighwatetc it. FIELD DIMENSIONS: Width o5 thench it. Depth oS nock below t.ite .in. Length os each tine it. Depth o6 xock oven t.ite .in. Numb en a 6 tin ens Depth o6 .t.ite b etow gtcade n.. Totat teng.th as t.inezs 5t. Stope aj ,ttcench in pen 100 it. Distance between Una=t. Depth to bednack it. Totat abz oxbt.ion aAea 6z2 Depth to gxoundwateA it. Requited atc.ea it2 Type of Coven: Papex ox Stkaw PIT DIMENSIONS: Numbex o6 p.i.tz Gxavet atcound p.i.t~s ye.a no Outside d.iametetc it. Depth betow inZet it. 2 Az Totat abzonbtion atcea it Axea &equitced iz2 61 D -8'Y TIT INS P E L APPROVED DATE ~1471 REJECTED DATE 197. 01 y E H .115 , WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES f i DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESJ,S LOCATION: N0_'/4, Section JQ, 121N, R OE (oreTownship or Municipality C~ L C Lot No. ,Block County div'sion Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other low EFFLUENT DISPOSAL SYSTEM: NEW- r), -ADDITION REPLACEMENT A DATES OBSERVATIONS MADE: SOI L BORINGS c~ S_` _Ix_/PE COLDATION TESTS Iq u-- SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME 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 P_ 31 30 1% e_ 90 ilL aLfq_ 9 el hn Y-~ 11-3 it t 13 i 41 P 10 / fix. -3 10 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- " ~J sC7 G 6 ee, 19 S ~ 7 96 > q - y AntiF .00 Z& 7-4 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square f of suitable areas. Indi a number of square feet of absorption area needed for building type and occupancy. e>ys ___,,10(/g Indicate scale or distances. Give horizontal and vertical reference l i ts. Indicate slope. s ( ) 1 1 1 1 t a ,..~.____m__,.' ____.L...._._. t I _ 1 ~i T:L . i~ i~leL~'~Y 4 I- ~ a _ e vA ~ ~ i { i I i i ( I I I I i , 5 1 3~_ } _ _ _v - I 1 a.._..r....l I _ I 1 ,.m, - - - I -t i - I 1III i , . .._L._._.__ _ i.._ ...__f __.I 1 i l € 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 ` hest of my I owled e and belief. t) Certification No.__s - o O . ui ~uy s alter if known r L AUTHORITY CST Signature boa:, P67 LB- State and County State Permit # r Permit Application County Per it # for Private Domestic Sewage Systems County,- i L 6 t -_74 *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: cz- B. LOCATION: _yV % Section f~, T N, RS-E (or) W~) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village C i Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family i✓ Duplex No. of Bedrooms -No. of Persons D. SEPTIC TANK CAPACITY % C Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete l 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/3--!~-- Total Absorb Area sq. ft. New. Replacen ent Alt mate (Specify) Seepage Trench: o. of Lineal Ft. ~ Width Depth~Tile depth (top) ? No. of Trenches- Seepage Bed: Length WidthDepthTile depth (top)_No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 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 Certified Soil Tester, / NAME = 1) 32 C.S.T. # sLCC~~ and other information obtained from (owner/builder). / Plumber's Signature MP/MPRSW# Phone #6-' Plumber's Address C° 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. i 2 s E 3 s~ e. , m d mow. _ a.. .._e e. ~ a , _ r r E c e i r .a . y e e a ...wm. e s..., s _ ....e .q. . _ nP e , . 3 3 ~ J i -to p P~ s n^ n Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY 1h ion Fees Paid: State County, C• Date f acted (date) ;`G } - Issuing Agent Name _No State Valid# Date Recd copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI I 4. plumber (canary copy) Revised D