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Parcel 036-1079-30-000 09/25/2006 02:33 PM
PAGE 1 OF 1
Alt. Parcel 31.31.17.489A 036 - TOWN OF STANTON
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 - MICHELS, DONALD M & ALICE E TRST
DONALD M & ALICE E TRST MICHELS
1443 185TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1443 185TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 31 T31N R17W 1A IN NW SE LOT D OF Block/Condo Bldg:
CSM VOL 3/800
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-31 N-1 7W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/20/2000 630209 1544/134 QC
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 22,000 209,000 231,000 NO
Totals for 2006:
General Property 1.000 22,000 209,000 231,000
Woodland 0.000 0 0
Totals for 2005:
General Property 1.000 22,000 209,000 231,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 217
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1 188.46 252.82' 342.43' - -
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Parcel 036-2006-30-000 09/20/2006 09:11 AM
PAGE 1 OF 1
Alt. Parcel 31.31.17.655 036 - TOWN OF STANTON
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 - WEISS, TERRENCE F & MARGARET
TERRENCE F & MARGARET WEISS
1473 185TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1473 185TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Descri 2240-OAK RIDGE ESTATES 1 ST ADD
OAK RIDGE ck/Condo Bldg: LOT 33
a(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
S1 1N-17W
Notes: cel History:
e Doc # Vol/Page Type
2006 SUIT et Value: Assessed with:
0
Valuation Last Changed: 05/06/2003
Description nd Improve Total State Reason
RESIDENTIAL G1 1.200 20,000 165,700 185,700 NO
Totals for 2006:
General Property 1.200 20,000 165,700 185,700
Woodland 0.000 0 0
Totals for 2005:
General Property 1.200 20,000 165,700 185,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 137
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
-,ER rl l C S TO1dNSHIPSEC.j
_Z_ TS/ N, Rl W -
ADDRESS ST. CROIX COUNTY, WISCONSIN.
MiCLi,C'~S
t t, i S c !G~Yv y/_& p
I t rv~ t, n c1 ~
3DIVISION LOT33-LOT SIZE
PLAN VIEW tz` ! rr/
-Distances b dimensions to meet requirements of H62.20 312<lx
SHOW EVERYTEING WITHIN 100 FEET OF SYSTEM
- _ EF
! I H-4
I I I i i
_ j
J.- I
! ti
j - _ - - - i - t -1 ' -
_i
- - -
) ow Indicate Nonth. Antc.ow
'.'TIC TAh"K S MFGR. PC i ,
C )G CO~,CRET_ STEEL S ca e ~C
NO. of rings on coverL___/_ Depth ~ DRY WELL
'11CHES N0. of - width length area
no. of lines widtLi length _ area
f~ depth to top of pipe
_.EGATE
•:.K RATE _ AREA REQUIRED _ AREA AS BUILT
;claimer: The inspection of this system by St. Croix County does not imply complete
.r-aliance 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
sterin operation. However, if failure is noted the County will make every effort to
';.ermine cause of failure.
':.ASES AM OILS SHOt'LD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSPECTOR._._.._.
. 3
DATED /0.- / PLLTMfBER ON JOB -t
l LICENSE Nlaaff ER w
z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitary PeAmi t
. %
State Septic _:t
> kp
St. Croix Count
NAME iawnsh - y
Location J" Sec-t.ion
SEPTIC TANK
Size/ gaZtons. Numbers of CompaAtments j
Distance Fnam: WeZz ' 12% oA gtceatetc ~s~ape S
Bu.itd.ing WetZands
H.ighwatetc - bt.
DISPOSAL SYSTEM
Distance FAOm: WeU 120 oA gneateA 6Zope 6t.
Bui.td.ing 6t. WetZands Ft.
H.ighwateA St.
FIELD DIMENSIONS:
Width a6 ttcench 6t. Depth o5 tcock below t.iZe .in.
Length o6 each .tine 6t. Depth o6 Aock overt t.iZe .in.
Numbetz ob tines Depth o6 t-i.ie betow gtcade ~tn.
TotaZ Zeng,th o6 Una bt. Stope o6 ttzench in pets 100 6t.
Distance between Zines fit. Depth to b e.dno ck
Totaf absonb'Cion area =6t2 Depth to gnoundwatetc St.
2
Requited area 6t Type a~ Coven:1' Paren',, on Stoaw
~
PIT DIMENSIONS:
NumbeA o6 pits GAa.V..et 'around pits yeas no
Outside diame Depth below in. et 6t.
Total absonb koR nea: 6t A
2 i
Area Aequ.i ' ed bt rn
i
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
LOCATION: Section_l,~_, TAN, R%1 If (or) W, Township or Municipality ;1rt g" ai,
Lot No. Block No.zv.-+ County
Subdivision Name
/ t 1
Owner's Name: Z~"~
Mailing Address:25
TYPE OF OCCUPANCY: Residence }
--~.-,N/o. of Bedrooms ~ Other
EFFLUENT DISPOSAL SYSTEM: NEW ~X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 7~? PERCOLATION TESTS
SOIL. MAP SHEET SO I L TYPE
- - - _ ~ r~;',-
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
IJUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
~ P Ate' A_ _
C~
/ /
P _.ah ~r l1 J/ _ ~0 -i
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)
' 2 _
s
C 1 a
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. -6 IV Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
I -
A ' - ,f t
14
tN
t j/`
n
I, the undersigned, hereby certify that the soil tests reported on this form were made b ejn accord with thecedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded a location of te>:~ are correct
to the best of my knowledge and belief.
Name (print) Jx- Certification No. /
Address
Name of installer if known
CST Signature w
COPY A - LOCAL AUTHORITY
State Permit # J ~
PLB 6 7 State and County ,
s
Permit Application County Permit
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:
per (~1l ~ti.~1s P,~.~.!c:,~.~.~ ~ .~•-c_.
B. LOCATION: Section ~4, T_?,LN, Rai* (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 _X Duplex No. of Bedrooms -37 No. of Persons
D. SEPTIC TANK CAPACITY 4 EM Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete A 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 Total Absorb Area e- sq. ft.
New X -Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length 3P j2-- Width / a Depth 16 Tile depth (top))L. L- No. of Lines Z
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits 07
Percent slope of land 5,/fs - Distance from critical slope
WATER SUPPLY: Private X 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 Certif d Soil_ Te er,
NAME C.S.T. # SS :531 and other information
obtained from V1 (owner/builder).
Plumber's Signature MP/MPRSW# f Phone #-Sl
Plumber's Address ~
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.
,
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.
~C
F .
,
Do Not Write in Space_ Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State / c" County Date 1
Permit Issued/f3~ (date) Issuing Agent Name 77
Inspection Yess, 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