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HomeMy WebLinkAbout038-1112-40-000 0 Cl) O 3 -0 0 C7 o m o m (D F)• v .o 4t c 0 CD m ^ \ 1 3 - it 3 - X _ C/) O N t~ O_ CNT N N 6 w W `C • 0:) CD (o 0.0 0) :3 CD CD (D Q Q a ` N O Cll C 7 W 7 ? 41 N CL 3 N N N N A O (D n m O 3 O (D 7 W O OO r.. Lo U) C:) 7 N ~ it c rj U> < D F F' CD (D CD N CL (D 7 N W N C CL CL 3 O O O C ' 7 CD i CD CL ::t Z' l►i Z O Cp (p CD z 0 r- (n N O C CD v v fQ z 0 0 0 :3r o 0 E-4*= c, z C) m e ccn y a ' D ar o _O CC C) N .O+ (D N < W ~y v - Ao N < N 7 3 d V 00 N 7 W W 00 N z ° z co z ? y CD o (7 O a 7 o N• 7 ~ m ~ I O N -1 U) Cc ry~ c CD CD CD W (D CL d 3 7 Z CD (p -1 N o p A Z T a A o. 7 Z w W OD M CD " z 3 00 cn 3 z CD co -n CL ~MC~7 D (D CD N d 7 a vi CAD 0) a) 7 (D N O7 T W 'Q = CD C N C O D A ' D 61 ~ N w 7 M 7 N - O N Q A 0 0p 3 n _ O O p 0. 3 O 7 7 Od 7 N Z O (D CL O C N CD j Q l0 CD p 3 Q n O CD DO W EH O CD :E 00 (D Parcel 638-1112-40-000 11/30/2006 10:11 AM PAGE 1 OF 1 Alt. Parcel 28.31.18.476B 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 - CHURCHICH, DAVID F & KATHLEEN E DAVID F & KATHLEEN E CHURCHICH 1028 192ND AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1028 192ND AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 4.070 Plat: N/A-NOT AVAILABLE SEC 28 T31N R1 8W PT NW SW LOT 1 OF CSM Block/Condo Bldg: 3/886 ALSO PARCEL DESC AS COM W1/4 COR SEC 28; TH N 89 DEG E 1316.69'; TH S 00 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) QEG,E 787.54' TO POBNT S 00 DEG E 28-31 N-1 8W 44.6'' T 89~DEG W 160.7 91.09'; TH S 89 171.05' H more... Notes: Parcel History: Date Doc # Vol/Page pe 10/01/2001 657988 1729/439 QG 9 D 07/23/1997 ( 990/182 t/VD 2 07/23/1997 07/23/1997 11~~ . O 845/134 mor J 2006 SUMMARY Bill Fair Market Value: 'S Assesse with: 0 bow~ Valuations: 1,03 Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.070 42,400 117,900 160,300 NO -T6 3 50 -'~L Totals for 2006: General Property 4.070 42,400 117,900 160,300 Woodland 0.000 0 0 Totals for 2005: General Property 4.070 42,400 117,900 160,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 211 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I Parcel 038-1112-40-001 11/30/2006 10:26 AM PAGE 1 OF 1 Alt. Parcel M 28.31.18.476C 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 5 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - FAGNAN, RAYMOND & PAULINE RAYMOND & PAULINE FAGNAN Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 5.970 Plat: N/A-NOT AVAILABLE SEC 28 T31N R1 8W 8.96AC NW SW THE E ) Block/Condo Bldg: 330.96' OF 4 SW 1/4 EXC CSM 3/886 _--EXC PART TO PARC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) (ADD'L HIST 693/293 QC-990/180) NKA PT 28-31N-18W OF CSM 12/3424 Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1092/175 QC 07/23/1997 1091/242 AF 07/23/1997 1091/241 QC 07/23/1997 990/182 WD more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/1998 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 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 r.. _ - i ' AS BUILT SANITARY SYSTEM REPORT ►+x;ER fir, TOWN ;HIP SEC, T_,~N, R , ~ W .0. ADDRESST. ROIX COUNTY, WISCONSIN. :3DIVISION LOT LOT SIZE PLAN VIEW -Distances S dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM. i Indicate North---AAr-r-ow I SCALE : ` i i tQTIC TAD1K(S)MFGR. CONCRETE STEEL NO. or rings on cover Depth DRY WELL _ :rIvCHES NO. of width length area j no. of lines- width length r~ are dept to top of gipe RATE AREA REQUIRED_ e~;/ < AREA AS BUILT izsr.-iaimer: The inspection of this system by St. Croix County does not imply complete .o.rpliance with State Administrative Codes. 'mere are oLher areas that it is not 'possible ,oi.nspect at this point of construction. St. Cro1.x County assumes no liability for IStem operation. However, if failure is noted the County will make every effort to .jtermine cause of failure. ,EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTLX. `'INSPECTOR DATED r \ ,7 ' PLUKBER ON JOB LICENSE NUMBER z cPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.i.taAy PeAm.i-t"~/ J State Sep-t.ic_ NAME rownsh.ip S CAo.ix County L o c at.i o n S e c.t.i o n = SEPTIC TANK Size gattona. Numbet o6 CompaAtmen.th i Distance FAom: Wett 12% o,% gr.eateA ztope 6-t Bu.i.Zd.ing 6.t. We.t.Zande 6t• H.ighwateA it. DISPOSAL SYSTEM . Distance FAom: We.Z.Z g 12% oA gneateA stope 6.t. ,I Bu.i.Zd.ing jx. Wettands Ft. • H.ighwateA t. FIELD DIMENSIONS: W id#h o6 ttench it. Depth o6 tack b etow .t.i.Ze in. Length of each tine it. Depth o6 tack oven .t.ite .in. i NumbeA o6 tines Depth a4 t.i.Ze below gAade .in. Totat .Zeng.th o6 -Z.ined 6t. S.Zape o6 .tAeneh in pen 100 it. Distance between tines 3t. Depth to bednocfz it. Tota.E abb or.bt.ion area j.t2 Depth to gAoundwateA_ it. RequiAed area it2 Type of Covet: Papex oA Stxaw j PIT DIMENSIONS: I j NumbeA of p.i.tz GAQVe.Z around p.itz yea no i Outside d.iame,teA it. Depth below .in.Ze.t_ it. 2 Totat abzoAb-t.ion area it . A Axea Requited ~ 2 INSPECTED BV TITLE - APPROVED DATE 197 REJECTED DATE 197. i f • i j i - oaW State and County State Permit # PLB-`67 Permit Application County Pe it. for Private Domestic Sewage Systems County rlj~ *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # _ A. OWNER OF PROPERTY Mailing Address: ~ B. LOCATION. Y4 Y4, Section s T~ rN, R r (or) W Lot# ` City Subdivision Name,/4w/~(/j nearest road, lake or landmark Blk# Village C, 511-01 Township C. TYPE OF OCCUPANCY: *Commercial *Industrial "Other (specify)- *Variance Single family _ K Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks j HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete 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 z -sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top)- No. of Trenches Seepage Bed: _X_Length Width-J _f Depth ?C Tile depth (top)-a~_No. of Lines -J Seepage Pit: Inside diame~r Liquid Depth No. of Seepage Pits Percent slope of land. L Distance from critical slope WATER SUPPLY: Private 54 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 Ce,tified Soil Tester NAME - C.S.T. #i and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# / L Phone #7)/,/ Plumber's Address r 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. ~r r L/ Ll~- , e t 4 x e.~ a .ems a m a.- e ~mr-e ...m ..m k e.... a..-. . e. ~ . m . m _ . a e. , r e . _ , e 3 a t a . , ~ ;.....,,.,e. m. . ~ e . , -,..ate e. ~....m_ a- : _.m.- „ - y w ✓h 4' & - € 3 € t Do Not Write in Space Be w FOR COUNTY AND STATE DEPARTMENT USE ONLY ~ Date of Application /f - v Fees Paid: State County X © Dat Permit Issued (date) ~ Issuing Agent Name Inspection Yes ENo 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 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 j'' n LOCATION:.r.2?%,~W, Section", T-?/N, R 1_ E (or) W, Township or Municipality Lot No. , Block No. _ County S c>'t/ X Subdivision Name Owner's Name: /1 cn Mailing Address: y e I t TYPE OF OCCUPANCY: Residence L-- No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS - PERCOLATION TESTS Z Y 7? SOIL MAP SHEET SOIL TYPE C17r_~~.1- 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 P- 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) ' r. Z rtes ^ `'t S' Y 'I.- a - B r r PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of'suita le are s. irate number o square feet of absorp~a Z- Z needed for building type and occupancy. e or distances. Give horizontal and vertical reference pints. Indicate slope. i I I I I E y~~ ! - - 1 I- ! - !f$ F--t I L71 ~ I tN I I I _ _ ~ I I z - T 4 Ix- a- i I, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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) a X !5r r` t1 ~ ~I N, Certification No._~]~_~._ _ Address Ole Le~N ► l1 y r Name of installer if known CST Signature COPY A LOCAL AUTIHOR'iTY