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Parcel 030-2057-70-000 03/08/2005 09:19 AM
PAGE 1 OF 1
Alt. Parcel 27.30.20.556 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* JONK, DAVID W & JESSICA Y
DAVID W & JESSICA Y JONK
PO BOX 553
BAYPORT MN 55003
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1396 HAGGERTY ST
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.500 Plat: 2111-HOULTON
SEC 27 T30N R20W LOT 2 BILK 7 VIL HOULTON Block/Condo Bldg: 7 LOT 2
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1161/122 WD
07/23/1997 1086/375 TI
2004 SUMMARY Bill Fair Market Value: Assessed with:
6189 170,000
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.500 50,000 117,200 167,200 NO
Totals for 2004:
General Property 0.500 50,000 117,200 167,200
Woodland 0.000 0 0
Totals for 2003:
General Property 0.500 23,000 97,500 120,500
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
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• AS BUILT SANITARY SYSTEM REPORT
eW1 *I_P_ 1e -SEC.L ? T 3d N, 1 O W
ADDRESS ST. CROIX COUNTY, WISCONSIN. _:DIVISION LOT ~L LOT SIZE r C 1C J
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
J
i l► I I I I
I ' I 4-- i
CPO
LL- -4
n;, i _I i I !
I ! ~ ~ I i i I ! I
r' Indicate NanthAtctaw"TIC TANK(S) MFGR. ~
cZ_CONCRETE N STEEL S cage f, id I
NO. of rings on cover 9 Depth 0 DRY WELL
..-'4CHES NO. of - widths length !L. ' area C~&, ~ z
no. of lines width length area
depth to top of pipe 72'~ t
~UGATE 7 H Ll
•:.I: RATE 1 O AREA REQUIRED 66CU -'f z AREA AS BUILT 66d
,claimer: The inspection of this system by St. Croix County does not imply complete
:r,Dliance with State Adm4nistrative Codes. There are other areas that it is not possible
- inspect at this point of construction. St. Croix County assumes no liability for
;:tern operation. However, if failure is noted the County will make every effort to
'~rmire cause of failure.
' 1SES AND OILS SHOt7LD NOT BE DISPOSED THROUGH ':'HIS SYSTEM.
`'INSPECTOR
DATED /C~a~ ► PLL'1"1BER ON JOB rt Q .1 `t rc~ _
LICENSE NUMBER 1
REPORT OF ITISPECTION--ENDIJIDUAL SE01AGE DISPOSAJ, SYSTEM
Sanitary Permit
State Septic
G f
TOWNSHIP Lz
t. Croix County
SEE TIC TA"1:
size gallons. dumber of Compartments
Distance From: Well ft. 12% or greater slope ft.
Building` ft. Wetlands f
Highwater ft.
DISPOSAL SYSTLi1 Tile Field or Seepage Pit(s)
Distance From: hell ft. 12%,or greater slope ft
Building; ft. Wetlands ~ f,
FIELD Highwater ft,
Total length of lines ft. Number of lines Length of
each line ft. Distance between lines ft. Width of the
trench -ft. Total absorption area sq. ft. Depth
of rock below the in. Dp-pth of rock over the in. Cover
_ over. rock,, Depth of tile below grade in. Slope of
trench in ner 100 ft. Depth to Bedrock ft. Depth to
ground water £t.
PITS
Number of pits Outside diameter ft. Depth below inlet
ft. Gravel around pit: _yes no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
"square feet of seepage nit area required
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
REPORT ON SOIL BORINGS AND PERCOLATION TESTS ,c
LOCATION: NJC '/a, Section-, T N, Rt1~' (or)fownship or unicipr a_h 0aa
Lot No. Block No.---7-, c r /`t.'11cl,r✓ County S-4 ~~'d'=~o`ic
O y~ 7L S bdivislon Name
Owner's Name: /
Mailing Address: £C L7 11~1 / - 1V /,(I,.WS-S ✓
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other Awel'eX
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT _
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE let,
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 /IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN
P-
P,,o-A4 /V0
P v
P3
_t, e D,
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- ii r L.. n /Ej rr Y-S' " C r Ct? b
"ye- "2(- sr Y/!
B- _3 w 7 f~l~ C4,A
B_ /Ylo/ /0 r-y. ~ " ~L s C~ r c4~ 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 u 4er of square feet of absorption area
needed for building type and occupancy. /r 1!4e J fZ'n Indicate scale
or distances. Give horizontal and vertical reference int Indi to slope.
1
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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.
Name (print) Certification No._L
Address
Name of installer if known
'Y h CST Signature ~ ~ 1
i
State and County State Permit #
PLB67 Permit Application County Per r`t
for Private Domestic Sewage Systems County s
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OFF PROPERTY Mailing Address:
B. LOCATION: 1AZC4/ '/4 /AF_ Section .2 T_3<> N, R,2 0 & (or) ~Lot# City
Subdivision Name, nearest road, lake or landmark Blk# 7 Village 647k/j e"y
Township
C. TYPE OF OCCUPANCY: *Co ercial -Industrial *Other (specify) *Variance
Single family Duplex--No. of Bedrooms No. of Persons e
D. TYPE OF APPLIANCES: Dishwasher _X YES NO Food Waste Grinder YES X, NO # of Bathrooms-;E-
Automatic Washer _ < YES NO Other (specify)
E. SEPTIC TANK CAPACITY J;"ZC;C, Total gallons No. of tanks /
*Holding tank capacity Total gallons No. of tanks
New Installation Addition- Replacement- Prefab Concrete X
*Poured in Place Steel Other (specify) _
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2)3) Total Absorb Area ~sq. ft.
New X Addition Replacement -Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
No. of Lines
Seepage Bed: Length J!K Width Depth y 0 ` Tile Depth 3 6 -3
Seepage Pit: Inside diameter Liq}~id Depth Tile Size
Percent slope of land /43a~ Distance from critical slope
/'A-e -S~5/4- 14 ^ ead
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 Ce ified Soil Tes Er
NAME 1.-; C.S.T. # and other information
obtained from ~owner/bui e-
Plumber's Signature P/MPRSW# Phone
Plumber's Address S l~/G
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
A,/.e yoo
E
K, c9st'4 G~Q/L~.
_ .
i
t
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Z-
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F c,,.
41, Do Not Write in Space Be w FO DEPARTMENT USE ONLY C' c
Date of Application ees Paid: State r. c `Cou t Date `
e
c.
Permit Issue eetL (date) - -~1% _Issuing Agent Name
Inspection Yes_)L_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 Date 6/1/76
TRANSFER FORM
PLS 67-T SANITARY PERMIT
State Permit #
Sanitary Permit # IV,
Sanitary Permit Transfer Date _ Original Permit Issuance Date
A. Property Location: P%c y4 AWV Section T 'ke N,13 LAL __7E} W Lot # City
Subdivision Name, Nearest Road, Lake or Landmark BLK # Village
Township
B. TYPE of Occupancy: Commercial Industrial Other (Specify)
Single Family Duplex No. of Bedrooms Variance -
C. SEPTIC TANK CAPACITY '
Total gallons No. of tanks /
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab Concrete i./ Poured-in-place Steel Fiberglass Other(Specify)
New Installation Repla~ce~ennt
LIFT PUMP TANK/SIPHON CHAMBE141 gallons Prefab Concrete Poured-in-place -Other (Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate- 70 .3 a~ Total Absorb Area sq. ft.
New. V~ Replacement Alternate (Specify)
Seepage Trench: No.Lineal Ft. Width Depth ---Tile Depth(top) No. Trenches
Seepage Bed: V Lengthy Width 19, Depth-f--Tile Depth (top) No. of Lines
Seepage Pit: Inside o arpeter Liquid Depth No. Seepage Pits
Percent slope of land % - t. Distance from critical slope
E. WATER SUPPLY: C3 Private ❑ Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. - ~r 5 ,6?:i0 .ygy~;
Sanitary Permit Transferred To: Phone No.-
Name Name
r-~ ~ rJ
Address Addre s t r {~C csy A
Zip~f
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20., Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Teter and/or any additional soil tests that may have been required.
Plumber's Signatur .*W/MPRSW # Phone #_`7 -.Z"
Plumber's Address
Information obtained from ~G c4," (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor's property If vveO ;Ka, of been drilled ple i,n~.1Gate, _ _
-
i `
1
4
Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green'copy) P.O. BOX 309, MADISON WI 537