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Parcel 038-1034-60-000 07/11/2011 0949 AM
PAGE 1 OF 1
Alt. Parcel 08.31.18.153E 038 - TOWN OF STAR PRAIRIE
Current X. ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
CHRISTOPHER D & KIMBERLY H PLOURDE O - PLOURDE, CHRISTOPHER D & KIMBERLY H
918 221 ST AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description 918 221 ST AVE
SC 3962 SCH DIST NEW RICHMOND
SP 8050 SQUAW LAKE RHAB & MANAGE
SP 1700 WITC
Legal Description: Acres: 9.590 Plat: 0152-CSM 01-0152 038-75
SEC 8 T31 N R18W 9.59A IN SE SW & IN SW Block/Condo Bldg: LOT 02
SE LOT 2 OF CSM IN VOL 1 PAGE 152
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/29/2009 894380 TD
10/02/2008 882281 TI
11/26/2007 864657 TOD
05/31/2006 826427 Tl
2011 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 9.590 71,100 119,000 190,100 NO
Totals for 2011:
General Property 9.590 71,100 119,000 190,100
Woodland 0.000 0 0
Totals for 2010:
General Property 9.590 71,100 119,000 190,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 215
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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Parcel 038-1034-60-000 11/22/2006 04:27 PM
PAGE 1 OF 1
Alt. Parcel 8.31.18.153E 038 - TOWN OF STAR 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 - KURZHAL, ALVINA M
ALVINA M KURZHAL
921 221 ST AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 918 221 ST AVE
SC 3962 NEW RICHMOND
SP 8050 SQUAW LAKE RHAB & MANAGE
SP 1700 WITC
Legal Description: Acres: 9.590 Plat: N/A-NOT AVAILABLE
SEC 8 T31 N RI 8W 9.59A IN SE SW & IN SW Block/Condo Bldg:
SE LOT 2 OF CSM IN VOL 1 PAGE 152
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/31/2006 826427 TI
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 9.590 71,100 119,000 190,100 NO
Totals for 2006:
General Property 9.590 71,100 119,000 190,100
Woodland 0.000 0 0
Totals for 2005:
General Property 9.590 71,100 119,000 190,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 215
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 038-1034-60-000 05/01/2006 05:23 PM
PAGE 1 OF 1
Alt. Parcel M 8.31.18.153E 038 - TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
O - KURZHAL, CECIL & ALVINA
CECIL & ALVIA KURZHAL
921 221 ST AV
NEW RICHMON"I 54017/!
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 918 221 ST AVE
SC 3962 NEW RICHMOND
SP 8050 SQUAW LAKE RHAB & MANAGE f
SP 1700 WITC
f L!(J II
Legal Description: Acres: 9.590 Plat: Ij N/A-NOT AVAILABLE
SEC 8 T31 N R18W 9.59A IN SE SW & IN SW Block/Condo Bldg:
SE LOT 2 OF CSM IN VOL 1 PAGE 152
~ ~ Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
/
08-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 9.590 71,100 119,000 190,100 NO
Totals for 2006:
General Property 9.590 71,100 119,000 190,100
Woodland 0.000 0 0
Totals for 2005:
General Property 9.590 71,100 119,000 190,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 215
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
• AS BUILT SANITARY SYSTEM REPORT
T
OVER , TOWNSHIP SEC. T N, R W
0. ADDRESS , ST. CROIX COUNTY, WISCONSIN.
-"LDIVISION LOT LOT SIZE .
PLAN VIEW
-Distances dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _
t
I
I ~ I I i a
- r
1 HL
Indicate North; Arrow
I I i j SCALE .
tPTIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
`'ENCHES NO. of width length area
no. of lines width length area '
depth to top of pipe
AGREGATE
RATE AREA REQUIRED AREA AS BUILT
1isclaimer: 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
,o inspect at this point of construction. St. Croix County assumes no liability for
y$tem operation. However, if failure is noted the County will make every effort to
,itermine cause of failure.
-IE.ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
`INSPECTOR.
DATED PLUMBER ON JOB
LICENSE NUMBER
z
REPORT OF INSPECT'AON_INDIVIDUAL SEWAGE SVSTEM
Sanitan y Pe tm.it
• State S e pt-ie
NAME fownahip St. Cno.ix County
Location Section
SEPTIC; T/A'~,1~K, n
Size gat on.5. Number. o6 Compartments
D.i.atanee. Fnam: Glett it. 12o 0 on greaten zZape'zD it
Building it. Wettand.6 ~t•
HighwatvL
DISPOSAL SVSTE,k{
Distance F&orn: Wetit. 12% an greaten ~s gape ~yti.
Buitd.ing~~it. Wettand.6 Ft.
J
H.ighwatet it.
FIELD DIMENSIONS: -
W.iRh o6 thench l 6t. Depth o6 rock betow t.iZe_/-Z-i n.
Length o6 each t-i..ne_ ~ Limit. Depth o6 tcock oven tiZe 2-- .in.
Number P6 Zine.s _ Depth o j tiZe below gnade,~ OL-in.
Totat Zength oS Zinn 1-6t. Stope oii thench Z in pen 100 fit.
Di.s Lance b etweer -E i.nez Depth to b ed,Lo ck
Total ab,~c);Lbt.ion areaa,2416t2 Depth to gnoundwateit ~t•
Coven: P )en on St.,.aw
,-yea ~ t 2
Requ~.ned aType oi t
PIT DIMENSIONS:
Number o6 pit ~ Gnavet' around p,i.t,S ye/5 _no
Guts i.de diam to ` • fit.. Depth b etow "inZet it.
2
Tota.E ab.sotc . "on a yea
2 B.
rn
AAeanequi.`ced it
INSPECTED B' ~IC4 TITLE
APPROVED _ DATE__ 19 .
REJECTED , DATE 197.
A
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ppppp-
State and County State Permit # sC
PLB 67 Count Permit
Permit Application County
County ` L 1yo
for Private Domestic Sewage Systems
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: Section _S_, Tj_ N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township ~;jtK f i~fir
C. TYPE OF OCCUPANCY: *Commercial *Industrial "Other (specify) *Variance
Single family _,Y- Duplex No. of Bedrooms .3 No. of Persons
D. SEPTIC TANK CAPACITY /ay LC Total gallons No. of tanks -4
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation X Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate ~n Total Absorb Area- , sq. ft.
New. X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed:_ Length ~ ~ . Width Depth2-C ff Tile depth (top) - ' tr No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope = 1
WATER SUPPLY: Private b< 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, ,-d°ilU
and other informaiion
NAME C.S.T. # -J
tM`~
obtained from (owner/builder).
Plumber's Signature _ MP/MPRSW# Phone
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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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT ySE ONLY
Date of Application /ci Fees Paid: State '%C= County t Date 61
- - -
Permit Issued/Rejected (date) ` - T Issuing Agent Name 1_4 Z~
inspection Yes I- 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
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
75-
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
PP1
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
&
LOCATION5 /a, /a 9
Section TZN R A E (or) W Township or MuniciPalitY,5~~0,
Lot No. Block No. v o/ / ' County 5~• ~
' Subgivision Name
Owner's Name: ,/~1 • C ~Li / G'~ 1
Mailing Address: iV-Z UL
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
/
DATES OBSERVATIONS MADE: SOIL BORINGS-Tu'y c ~ U PER~CjOLATION TESTS (f 7q
SOIL MAP SHEET S~ SOIL TYPE ~MA 141'YE~1
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
20 11 1/. Z;
P- 2- 3- 13" 1-?N , LOAMI .57d 17'"Z-1-41v, Ll
1_s a AI
temn~ s, 7_1
3 3 AN
G o M 5 G ha ED. car-,8.v S / / /!a / /
rp--
SOIL BORING TESTS w/per rc'(-
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WIT HICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDR K IF OBSERVED)
B_ / 72- 1vt'V E '7a / .,g S 1 S Zj " 004 -.4,V o.lrx S 4
z 416AAC 2 72 zG /l.t< 34/`.R-13n, LS wig
B._ 71 /l/o',`E ~ 7Z "113 S_f 0"/_/_/3y [5
1/ 72- ,O oA; ~ 72 / N S Z ' L f BN S/ 1 ' s/
B- 72- t(/O~F 1 72-1 S1, 2_" 1'f '8A/ 20111 S w i
.7 7Z av 51. - ~ ~•5 Of PLAN VIEW (Locate percolation tests soil bore holes and suitable soil areas.)
y :L Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
os~ needed for building type and occupancy. z ~ ?,~E,t/ej~ e, 13F1 Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
All
Will I /oil )Io E
121
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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 belief.
Name (print) ei 0// A6?/ t 4 / _ Certification No._ Address 4?r_A/VPfO" 4t-)/ 5. Name of installer if known
CST Signature -
EH 11.5
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
• DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
_ ~JREPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: '/4, SC '/4, Section a T/N, R/~3 E (or) W, Township or Municipality
Lot No. Z Block No. 0 f S~r~UE ~d~ /f 2 120C 32 7 ~3 z County
w S Y~ L Subdivision Name
Owner's Name: 1 /
Mailing Address: /n al 7~ hray .5-1- Pa--Q ~
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET 3 SOIL TYPE ~~FEn~1 ~i`f L 1
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 MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- ~O,Q6 Sill ~1Sf~G.~j fiCNlS !✓Erf/e Zav 5 £~'1S®. fi L
P_ A?C>iQ,~t T/ ~'U ~4'iPG H% ~E~V ~P a L aVV 5£y9 S~i-tJ L
&)&72F;< E X5
P- CJ G~UG!> ,~1anv f~ C> / 5 r L .•g/YS ~1ip~J s~ sj~£ s'
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 / 60 4/0,j,6- p " .24`1 S.`L C' C MQ-t Z2 "S% w/'A O< A 6
-3D " 26 " 5-L o, G Mat 42 "31 0. M® 74.
0 22 Zd"S`L C G . No7K 20'"S/- 0. lllef
B 4 g7 1l-~" sp",;A R, No 2 71 _A40
GO .55 i.r" 13N e)"s,~ q R Mat w,'V4
at.
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. It4H t®/ATE ~'~FA -yeT t~~e Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope. Fi*,O16E,(
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FIV ;0Ak T2E S - - dOCAD - -
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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) 0heeF Certification No.
Address Z?~' ~'/V /'FL
Name of installer if known
CST Sianatiire -
mod
- - -