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HomeMy WebLinkAbout038-1055-40-000 f bra r;~ 6~$ j055 ~b-doc l~~ 3 ~o s tie / uca4"on s 3 (pwn Q.-e MAY 1 5 2018 .far oz., cr-a( - eere.+c+2 ("-"Or S4,5 ply St. Croix County _ Community Development 2//7 Co. /1d. C Qj ?R~ ,4oz~o/ esnq /off O j Sw119OScvfi4; 5t e- 13 T.v34 A, E brave/ dlvocwc}y fo C'o.f ++y. 0 Q~s~ ~cc FXiS~in Cor+cet,6e i i i i • •'n 4r-,5 0 C %k Ii , t ES~ii,~a~t c✓at i,2 'XS-Z' d io (Lc to be Co»s~u~ed ~.t3%~ 0 tn0 1 ,K-0 n d ~1 o c m o m m CD v y H` I ~ v ~ v ac c v m ^ 3 m 3 ~ O co o v N o o o U) 0 0) w w o • N o m co 3 c _ W Q' Z Q N y CWO O j O N d= O N m CD O N O 0 0 :3 00 0 0 N O i O N O" O o 3 O 7 N ~ 7 O C c o (mil O N (D J v U) D F a n ' m cn N (n a _0 :0 rz CD 3 0. (D .0w. OV N n z CD CVO -co CD 4 n r- (n N O C Cn CD 0 ~ 'I 3 ~ 3 d N~ S z OC OC OC o O < G G a ~y- c~i,v,cn~ 11 o ~D vq ED v v v o 'O ~ fO (D ~ A W ~ W 'a 411 n ' D) c !V N ~ _ D 0 N V N 7 3 0 (11 D CD a z !T N z 03 o 0 O D a !r 0 :3 a" m tt~~llh. V) m 'a CD CU N N 0 N C CD CD W 2 a 3 5 Z CD (n i -1 to o p Z N ~ i T any, n ~ A Z O v a O W M Q 1 ! Z 9. 1 a ;a o C/) w y Z < CD , N L (D cn O CD O T (47 C am Z o o v o N CD f17 N N C O CD d a CD a C1 CD O O 0 ~ O 7 t0 CD ty. 3 ti It v o cv WO o (0 1 p a A o b m Dro o O w C> Parcel 038-1055-40-000 11/27/2006 09:45 AM PAGE 1 OF 1 Alt. Parcel 13.31.18.238B 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 - SLAG, JEFFREY A JEFFREY A SLAG 2117CTYRDC NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2117 CTY RD C SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 13 T31 N R18W 5A IN SW SW LOT 1 OF Block/Condo Bldg: CSM IN VOL III PAGE 795 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 11/11/1998 591327 1376/69 WD 07/23/1997 1116/525 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 29,000 159,300 188,300 NO Totals for 2006: General Property 5.000 29,000 159,300 188,300 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 29,000 159,300 188,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 125 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r. • AS BUILT SANITARY SYSTEM REPORT 13 `r T0JNSHIP~ 4 SEC. . T ~I N, R / W - ADCRESS~f , ST. CROIX COU;ITY, WISCO SIN. _DPJISION LOT LOT SIZE II! PLAN VIEW -Distances b dimensions to meet requirements of H62.20 S1?Ok' EVERYTHING WITHIN 100 FEET OF SYSTEM I I I I I I ~ i I I ! ° i i i ( I I I ~ I III i-I I i I I -I i I I i I ' ! I i I I I ! I i _l I I I I I _ i I I I I i ~ I i _ ~ ! i I 1 + ~ I ~ 1 TIC TAIv'K(S)_ _ MFGR. L ac"~i~ :fie 1; _c _COiICT.ZETE Indicate NoAth. Arnow _k.- STEEL Scate •r= . NO. or rings on cover Depth - DRY 14ELL `._NCHES NO. of width length area v no. of lines width length L _ azea L~~. depth to top of pipe--,-, S::..EGATE ?ins i 1~ - r % J t: RATE ,c AREA REQUIRED G!f AREA AS BUILT 7ciaimer: The inspection of this system by St. Croix County does not imply complete _:oliance 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 ::e« operation. However, if failure is noted the County will make every effort to ,-ermire cause of failure. SES AND OILS SHOL-LD NOT BE DISPOSED THROUGH ':'HIS SYSTEM. '-INSPECTOR DATED ;7 - PLIPI'MER ON JOB ~ cax!aKS LICENSE NUMBER TRANSFER FORM SANITARY PERMIT PLO -T 67 State Permit # Sanitary Permit # County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location 6'`r Section T N,R r r) W Lot # -City Subdivision Name, Nearest Road, Lake or Landmark BILK # Village Township_l I;-;%_ 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 Poured-in-place Steel Fiberglass Other(Specify) New Installation Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other(Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate A 'Total Absorb Area sq. ft. New- 2S Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches Seepage Bed:Length Width Depth Tile Depth(top) 6r-~ No. of lines -h Seepage Pit: Inside di%rneter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. y - Name Name Address < / Lbw, `E C"'t k-- Address Zip Zip 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 Tester and/or a6y-lditional soil tests that may have been required. 1 - Plumber's Signature rcMP/MPRSW # Phone #L_~L Plumber's Address Information obtained from 1L"AI- (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 pro pert . If well has -iot been dn_Il pj y _'T f pit N, \1 i i J 7-77 --H -H _ T - Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green lcopy) TRANSFER FORM PLB 6 7 SANITARY PERMIT State Permit # Sanitary Permit # County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: /4 Section , T N, R E (or) 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 Poured-in-place Steel Fiberglass Other(Specify) New Installation Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches Seepage Bed: Length Width Depth Tile Depth(top) ,No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. Name Name Address Address Zip Zip 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 Tester and/or any additional soil tests that may have been required. Plumber's Signature MP/MPRSW # Phone Plumber's Address Information obtained from (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 ~roert~r If well has riot been drll( *asejfAca, a E a I i 3 I I I i 7{9 j4 3 i E 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 53701 z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itarsy Petsm.it State Septic— NAME ownsh.ip St. Crsoix County Location Section SEPTIC TANK Size/ gatZons. Numbers o6 Comparstments Diztance Frsom: We.l.l 6t. 12% on grseaters zZope 6t Bu.itd.ing 6t. wet.land/s 6t. H.ighwaters 6t. DISPOSAL SYSTEM Diztance Fnom: WeZe ` 6t. 12% on grseaters ~sZope 6t. Bu.itding 6t. wettands Ft. H.ighwaters 6t. FIELD DIMENSIONS: Width o6 trsench 6t. Depth o6 tsock below t.iZe,-'f .in. Length o6 each .Line. 6t. Depth o6 tock oven t.i.le in. Numbers o6 Zinels Depth o6 t.i.le below grsade_ in. Total .length o j Z ine/s 6t. Sto pe o j ttsench in pen 100 6t. Di, stance between .roes 6t. Depth to b edto ck 6t. Total ab.s onbt.ion atcea 6t2 Depth to gtcoundwateA 6t. 2 Requited area 6t Type o6 Covets: Papetc,'otc Stttaw PIT DIMENSIONS: Numbers o6 pit/s Gtsavet atsound p.itzs yetis no Outside d.iameten 6t. Depth below .inlet 6t. 2 Total abzorsbtion atsea 6t A Atea nequited 6t2 f INSPECTED BV 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: L, Section LT-?LN, RAI& (or) W, Township or M+tiei~+;#y f-''~"►'/ ~ Lot No. , Block No. County X ~ Subdivision Name s T` ► r n Owner's Name: A" /L, Mailing Address: /-2 (2 Z-2- ~~7~C TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS iP 1>;'Z PERCOLATION TESTS i9rc~r~7;-/'il! SOIL MAP SHEET SOIL TYPE - -4-1 'L -IL-411- 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 P_ 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_ l ~ S,W1 9 Y'_-5;4 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. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. y 4 ~ ~ i i + i } ~ I f I ~ I 4 y + r X11 j .11 ` I + + E 1 1 I f I Y~ I 1©`+ ~~Q N i I ~ I ~ ( ' ( + I I i ~ I I 't 1 ~ ~ ~ i ~ + f { ± t 1 ~ r ( { 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. t Name (print) r ficaation No. Address Z, A" Name of installer if known CST Signature. LB67 State and County State Permit # 11"' " f t zp% Permit Application County Permit # ' for Private Domestic Sewage Systems County ~'t *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: / /cJ//, 4- B. LOCATION: Li % + h.' '/4, Section /3 T--4'/ N, R-/-f ,9- (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 Duplex No. of Bedrooms No. of Persons C D. TYPE OF APPLIANCES: Dishwasher L~ES NO Food Waste Grinder YES =-WO # of Bathrooms Automatic Washer 4---YES NO Other (specify) E. SEPTIC TANK CAPACITY L e--4r' Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation C.-/ Addition _ Replacement Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) j6 2) 3) :•S Total Absorb Area e;~- s q. it New 4-- Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length,-5'Z' Width Z ' Depth -3 „ Tile Depth 7- z1 " No. of Lines -z Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land l ~ Distance from critical slope _ 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 , , } ► C.S.T. # % e and other information obtained from (o wn a rtbu4der). Plumber's Sir Cv' MP/MPRSW# __Z Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 1Z ~Jf . ~fc / % >Z 1iErc~ U l i L Do Not Write in Space Below FOR DEPARTMENT USE ONLY n Date of Application ~2 7 1-7 ~ Fees Paid: State /G', c 'C' Count Date c / Permit Issued/114ecd (date) jf - - Issuing Agent Name Inspection Yes No Valid# Date Recd 1. county (wh to 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 6/11/76