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Parcel 038-1112-90-000 12/04/2006 02:09 PM
PAGE 1 OF 1
Alt. Parcel 28.31.18.47982 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 - ZDRAZIL, DAVID C & ARLENE
DAVID C & ARLENE ZDRAZIL
1086 192ND AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description 1086 192ND AVE
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 2.420 Plat: N/A-NOT AVAILABLE
SEC 28 T31 N R1 8W 2.42A IN NE SE LOT 2 OF Block/Condo Bldg:
CSM IN VOL III PAGE 835
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
28-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 602/616
2006 SUMMARY Bill Fair Market Value: Assessed with:
175621 165,500
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.420 34,100 112,200 146,300 NO
Totals for 2006:
General Property 2.420 34,100 112,200 146,300
Woodland 0.000 0 0
Totals for 2005:
General Property 2.420 34,100 112,200 146,300
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
• i
• AS BUILT SANITARY SYSTEM REPORT
X,
_ TMINSHIP
ADDRESS SEC. TAN, RIFF W
L , ST. CROIX COUNTY, WISCONSIN.
-DIVISION LOT~4LOT SIZE
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOT.' EVERYTHING WITHIN 100 FEET OF SYSTEM
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r r e
i I i I I ( I j ~ ~ , ( 1 1
( ~I I ( ti I ~ i ( I
( z /V
1I
; TIC TANK (S Indicate Nord' Atc~ wi
) C4' MFGR. y+i c• c /7s CONCRETE ~ STEEL
J CaZe
NO. of rings on coverl -Depth e ,,N ~c DRY WELL
;:INCHES NO. of - width yyy length area
no. of lines, / width length area
depth .to op of pipe 1 i
U_ GATE /It e. C- S`
RATES AREA REQUIRED AREA AS BUILT } i
;claimer: The inspection of this system by St. Croix County does not imply complete
.i-;)liance 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
,Item operation. However, if failure is noted the County will. make every effort to
_ermine cause of failure.
.:~.IIISES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTE11.
'INSPECTOR
DATED PLU" CBER ON JOB _
LICENSE NUMBER ~t
Z 4
REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.itaAy PeAm.i.t K--
NAME " ji i ownsh.ip f' 11 L WS.t. CAOiX County
j
Location, M Section
SEPTIC TANK
Size ! gattonz. Numb en of CompaAtme.M~ j
Distance FAOm: WeZZ It. 12% on gnea.teA Ko pe. It
Buitd.ing It. Wettands It.
_ a
H ighwa;teA it.
DISPOSAL SYSTEM
Distance Kom: WeZZ It. .12% on gneaten sZope It.
BuNd.ing It. Wettandt Ft.
H ighwateA 6.t.
FIELD DIMENSIONS:
Width of tAench It. Depth of mock betow tite_ .in.
Length of each tine It. Depth of mock oven We in.
Numben of tines Depth of .tile below glade in.
Totat Zeng.th of t inch It. Stope of tleneh_ .i_n pen 100 it.
Distance between Zinez fit. Depth to bediock
Totat aW oUtion anea 6t2 Depth to gloundwa-ten 6t.
Requited anea It Type of Coven: Pape:n on Stnaw
PIT DIMENSIONS:
NumbeA of p.itt GAavet a&ound pity yet no
Outside d.iameten it. Depth b etow ,i"ntet_ it.
2
TotaZ abzoAbtion anea It
A
AAea Aequined ~ 2
INSPECTED BV TITLE
APPROVED DATE 197.
REJECTED DATE 197
f'
EH 11,,5 `
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
79& 5:,~2_9 D P.O. BOX 309
MADISON, WISCONSIN 53701
' REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: '/4, ~~Section v, T;VN, R (or) W, Township or Municipality
Lot No. , Block No. _ County ~f . af& y -
Subdivision e Z Z 1 1-
Mailing Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence x No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 7,TPERCOLATION TESTS --.Z z - 7F
SOIL MAP SHEET SOIL TYPE is
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
3W ~10?
P-A 1--18" A A
P- 5~6 7+ ,y t ~4 p w tr ' ~dl c_L I 1 l? / / ! N If
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 a if QC-, j e 041
+
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas., -Ln e tuber of square feet of absorption area
needed for building type and occupancy. 'p l~L4, Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope
I C S[
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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. 11_~
Name (print) ~e~ _f d 4- Certification No. 5_S_ - .S-V T _
Address ~J
Name of installer if known
CST Signature
2,0PY A LOCAL AUTHOM ~
l
State State and County ate Permit #
~f
u 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:
r
B. LOCATION: % Section , T2,/'N, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township ,,e4 /r/A'lr
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY -/Coo 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 or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLU T DISPOSAL SYSTEM: Percolation Rate Total Absorb Area -sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Linear t. 7Width Depth Tile depth (top) No. of Trenches
Seepage Bed: _X Length Width epth~7 Tile depth (top)-07_No. of Lines
Seepage Pit: Inside diame er Liquid Depth No. of Seepage Pits
Percent slope of land- yfle VL/` Distance from critical slope )1 /
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 Certified Soil Test /
J-`/ NAME C.S.T. # ~ and other information
obtained from / (owner/builder►.
Plumber's Signature r MP/MPRSW# Phone #,,7-4r
Plumber's Address C ' C
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
l 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 USE ONLY
Date of Application Fees Paid: State (,'t; Count
y - ~ Date
Permit Issued/-Ref
e- (date) - Issuing Agent Name - ~ .L r✓. ~ - <
Inspection Ye~No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
state (pink copy) 4. plumber (canary copy)
Revised Date 7/1 /78