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Parcel 024-1036-10-000 10/16/2006 03:45 PM
PAGE 1 OF 1
Alt. Parcel 30.28.17.231 B 024 - TOWN OF PLEASANT VALLEY
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 - KOHL, THOMAS J & JILL ANN
THOMAS J & JILL ANN KOHL
1525 18TH AVE
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description 1525 18TH AVE
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
71 r
Legal Description: Acres: 3.026 Plat: N/A-NOT AVAILABLE
SEC 30 T28N R17W IN SW NW COM W1/4 COR; Block/Condo Bldg:
TH N O DEG. E 1321.27 FT; S 89 DEG. E
1025.09 FT TO POB; CONT E 361.5 FT;S 0 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG. E 391.47 FT TH N 89 DEG. W 361.48 30-28N-17W
FT N 394 FT TO POB, TOWNSHIP PLEASANT
VALLEY.
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/25/2001
Description Class Acres Land mprove Total State Reason
RESIDENTIAL G1 3.260 45,300 121,000 166,300 NO
Totals for 2006:
General Property 3.260 45,300 121,000 166,300
Woodland 0.000 0 0
Totals for 2005:
General Property 3.260 45,300 121,000 166,300
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
• AS BUILT SANITARY SYSTEM REPORT
`iER , TOWNSHIP SEC. T. N, R W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
:>DIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions tz meet requirements of H62.20
SHOW `ERYTHING WITHIN 100 FEET OF SYSTEM
y
2 .
•
TIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
'NCHES NO. of width length area
no. of lines width length area >
depth to. -top of pipe
REGATE
:_K RATE AREA REQUIRED 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
inspect at this point of construction. St. Croix County assumes no liability for
tem 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.
"INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER
Z -
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.itaty Petm.it
• State Septic
NAME u / Township Ct0.ix County
Locat.iom Section
SEPTIC TANK
I .
Size gattonb. Numb en of Compattmentz j
Viztance Ftom: Wett it. 12% on gteatet stope St
Bu.itd.ing it. Wet.l'and.b ~ •
H.ighwatet it.
DISPOSAL SYSTEM
e
D.iatance Fnom: Wett it. .12% on gteatet z tope it.
Bu.itd.ing 6t. Wettandd Ft.
• H.ighwatet it.
FIELD DIMENSIONS:
. W.iRh oS trench it. Depth of tock below t.ite .in.
Length o6 each tine it. Depth o6 tock oven t.ite .in.
Numb en o S tin e6 Depth o j t.iZe b etow grade in.
Totat .length os tines 6t. Stope o6 trench in pen 100 it.
D.i4tance between .2.iness it. Depth to bedrock
Totat abb oxbt.ion area 6t2 Depth to gxoundwatet St.
Requited axea it 2 Type oj Covet: Pap et et on Stxaw
•PIT DIMENSIONS:
Numbet o6 pits Gtavet atound pitz yez no
Out6 ide d.iametet it. Depth below .inlet it.
2
Totat abbotbt.ion area it . A
Atea %equiAed it2
INSPECTED BV TITLE
!c
APPROVED DATE 197
a
REJECTED DATE 197.
r
ty
.
i
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 '/4, j~"/4, Section _ma j 1YIN,R7 E (or~Township or Municipality ~~Q f~ L)
Lot No. , Block No. County r d
-J- / Subdivision Name
Owner's/Buyers Name: ~7t'~9 !F
166
Mailing Address:
TYPE OF OCCUPANCY: Residence XA No. of Bedrooms COMMERCIAL n
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
`
DATES OBSERVATIONS MADE: SOIL BORINGS ~ PERCOLATION TESTS mhh
SOIL MAP SHEET NAME OF SOIL MAP UNIT L) r>
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
RATE
NUM- SINCE HOLE BOLE AFTE INTERVAL
BER INCHES THICKNESS IN INCHES 2 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P_ L&
P- of /C w ( - E "r. $l'., ~`1P , . ~ •j-
13
P- 3 'NJ 2
P-
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- 20 >2,) B-
B-
B-
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 CZ)V a, ' , Z A Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope. 0 _
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3
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'i, 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.
•-a /1
Name (print) - t^ i 0 r Certification No.
Address
Name of installer if known
Copy A - Local Authority CST Signature "
r
PLB 67 State and County State Permit #
Permit Application County P' it #
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:
B. LOCATION: Section , T Z N, R_L2 E (or) W L o t # 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 "'74, No. of Persons 5
TANK CAPACITY kn X06 Total gallonpe No. of tanks
(9-'Z NG TANK CAPACITY Total gallons No. of tanks
concrete Poured-in-Place Steel Fiberglass Other (specify)
nstallation Replacement
mp Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
NT DISP STEM: 'erco tion Ra.t-2
Total Absorb Area G sqft.
Replacement Iternate (Specify)
Seepage Trench: a t. Width Depth Tile depth (top) No. of Trenches
Seepage Bed:- -Length C) Width Z 9' Depth 3CTile depth (top) ,A"' No. of Lines;
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land
--`Z Distance from critical slope
WATER SUPPLY: Private14 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 7-170;171. s C.S.T. # f3 -.,11 04~ er and other information
obtained from ,ter.
(owner/builder).
Plumber's Signatur c
-
/ O l
Plumber's Address ~ ~ MP/MPRSW# y/''S'" G 3 Phone # --~~j tj
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. y
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application : % Fees Paid: State e, '}J , Count -_,~/-C,0 Date
Permit Issued/Reje"e"€ed (date) j % Issuing Agent Narrre./
Inspection Yes ~ No 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