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Home My WebLink About038-1157-90-000 n N O g T 0 [r o 1 m i ~r► CD •G v a• c C: a (n r,) cD C? ~j co O S17 N Cp Q d n tdk (D 20 O (D G N O J V O ` o OD ro N (DD N 3 3 N N 00 C (ry N N O 3 CO 0 C ~ > CD fD 0 N CL _A n - O O 3 W 3 co 41 ((n CO CO E J Z O O O r. o' 0 N Q Oz ~ v v v p fn (D d 'CD C7i N N 77 CD A d y N O N 3 J CD Q 3 O Z ~ O - D D D v O ~ !•y • (D c w m z CD --j cp o _ p Z CD v' .Z7 A Z 0 N G) 3 Z ~ N W -0 m N a , ~ z o 3 a ~ O z co N z ~ A W D (D 0I - a ~ v c Z CL W o (N O H R ti N O O 0 O b o (D oa o w O v. O a o CD O y i • AS BUILT SANITARY SYSTEM REPORT ER P , TO`sdNSHIP ,r s{ * SEC. T ` N, R j W - ADDRESS , ST. CROIX COUNTY, WISCONSIN. DIVISION LOT LOT SIZE . PLA11 VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I I ! l l! I. i)' I I ! I , ! I ; + I I IT _ _1 3 i I' I I I i , ,j ; ! E j I I I ( i I I ~ ~ ~ I ! ' i i i i I ~ ~ i 1 ! E i i i j t I L t- - -1 - + - - . j A,. ~ ' Ind~i.ca ee NUnth --AnnaW ."TIC TANK(S) MFCR. CONCRETE k' STEEL Scate ' NO. of rings on cover Depth DRY WELL *;GHES NO. of - Width length area no. of lines width length area depth to top of pipe ~::EGATE _ . RATE AREA REQUIRED AREA AS BUILT ;ciaimer: The inspection of this system by St. Croix County does not imply complete ,-Dliance 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 orcine cause of failure. _ASES AND OILS SHOULD NOT BE DISPOSED THROUGH :.`HIS SYSTEM. _-INSPECTOR U1~1`~~i''~. DATED PLU1,MER ON JOB F LICENSE Nla[BER Parcel 038-1157-95-100 02/10/2006 12:25 PM PAGE 1 OF 1 r Alt. Parcel 22.31.18.740B 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 - BLAISER, ROBERT A & PATRICIA A ROBERT A & PATRICIA A BLAISER 2087 114TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1141 CTY RD C SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 0.650 Plat: 2230-NORTHWOOD SEC 22 T31 N R1 8W W 1/2 OF LOT 20 Block/Condo Bldg: LOT 20 NORTHWOOD ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1185/359 V VD 07/23/1997 710/347 07/23/1997 710/346 2005 SUMMARY Bill Fair Market Value: Assessed with: 119989 11,600 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.650 11,400 0 11,400 NO Totals for 2005: General Property 0.650 11,400 0 11,4000 Woodland 0.000 0 Totals for 2004: General Property 0.650 11,400 0 11,4000 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 PIM Parcel 038-1157-90-000 02/10/2006 12:25 PAGE 10F 1 Alt. Parcel 22.31.18.739 038 - 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 - BLAISER, ROBERT A & PATRICIA A ROBERT A & PATRICIA A BLAISER 2087 114TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 2087 114TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.300 Plat: 2230-NORTHWOOD SEC 22 T31 N R1 8W PLAT OF NORTHWOOD LOT Block/Condo Bldg: LOT 19 19 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1185/359 WD 07/23/1997 691/182 2005 SUMMARY Bill Fair Market Value: Assessed with: 119987 233,600 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.300 27,100 202,500 229,600 NO Totals for 2005: General Property 1.300 27,100 202,500 229,600 Woodland 0.000 0 0 Totals for 2004: General Property 1.300 27,100 202,500 229,600 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 z REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM San.itar y Permit State Septic_ 007 t/,f St. Ctoix County NAME lawn~hip Location Section - 04 SEPTIC TANK Size gat onz. Numbers o6 Compar,tmentt5 l D.iztance FAOm: WeZZ 12% on greaten zZope - At Bu.itd.ing S _ At. Wettands - At. HighwateA it. DISPOSAL SYSTEM 4- D.iatance Fnom: Wett At. 12% on greaten 6tope At. Building At. Wettand/s Ft. Highwatetc. - it. FIELD DIMENSIONS: Width o6 ttcen ch At. Depth o6 Ao ch. b e.iow t iZe_2,!?,,.in . Length o6 each Zine~At. Depth o6 tc.ock oven ti.ie .2, .in. 'i. Numbers o6 Zines _ Depth o6 t,iZe. below grade- in. in ' etc 100 At. Totat length o6 tines b Slope o drench - ip r Di~Stance between Una it. Depth to bedtcock At. Totat abz orbtion atcea C.; 4jt2 Depth to groundwater 6t. ~ I s- 5 2 Required area Type o Covets: Papet otc Straw PIT DIMENSIONS: Number o6 pit6 GAavet around pitz ye/s no Out,side d,iametetc At. Depth below ,intet 'St. 2 Toxat ab6oAbtio area At A 2 Area Aqu.ired At INSPECTED BY ll ITLE APPROVED DATE c r-_ 19 7_~?. REJECTED ,DATE 197. -S~l C 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, '/4, Section ! T_~LN,RIL_11 (or) W_, Township or Municipality Lot No.~, Block No. dz_ Z/~ ~~s County sion Name Owner's/Buyers Name: ,~9-~1~ ubd& Mailing Address: %I TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS,2.;j-- 72 PERCOLATION TESTS :L_21 2! SOIL MAP SKEET JI: NAME OF SOIL MAP UNIT 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 MIDI/E ij BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- / s _ - - ' 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- C > ye, Q y B- / C e C B- 96, a~ - B PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the IFcation 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. 40fe 7_4& ~7 d a *d~ j► t~ _ N C. 3 w_.g i Q ~.r s r , 4 i 4 1, 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. Name (print) m Certification No.~ Address g > .Name of installer if known 0+41-:0 Copy A -Local Authority CST Signature ~ State and County State Permit # O PLB67 o Permit Application County Per i # 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. LOCAT N:Z _'/d1ti/ Section I-Q T N, R q (or) y1( Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE F OCC PANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons _N> D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathroomsf_ Automatic Washer 4 -YES NO Other (specify) E SEPTIC TANK CAPACITY loon Total gallons No. of tanks `Holding tank capacity_ Total gallons No. of tanks New Installation Addition Replacement Pr "Poured in Place __Steel Other (specify) FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2), j_3) / Total Absorb Area sq. ft. New Addition _ Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width X=2 Depth Tile Depth No. of Lines --c .i Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.2[ Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepares by the Certified Soil Teter, NAME C.S.T. # and other information obtained from (owner/builder). Plumber's Signatur _ MP/MPRSW# JS-6 ? Phone Plumber's Address s / jr PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). Do Not Write in Space Belo FOR DEPARTMENT USE ONLY Date of Application d Fees Paid: State iDe d D County a ate 30 Permit Issued/Re#se#o (date) Issuing Agent Name Inspection Yes/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