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Parcel 008-1024-95-000 12/11/2006 04:21 PM
PAGE 1 OF 1
Alt. Parcel 9.28.16.127A 008 - TOWN OF EAU GALLE
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 - PETERSON, DAVID A & DAWN M
DAVID A & DAWN M PETERSON
476 233RD ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 476 233RD ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE
SEC 9 T28N R16W 20A N1/2 SW NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
09-28N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/12/2001 648077 1658/486 QC
02/17/1981 369383 625/308 QC
11/25/1974 324856 518/187 WD
2006 SUMMARY Bill M Fair Market Value: Assessed with:
170864 170,700
Valuations: Last Changed: 10/09/2000
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 19,500 93,100 112,600 NO
MFL BEFORE 2005 OPEN W7 19.000 19,500 0 19,500 NO
Totals for 2006:
General Property 1.000 19,500 93,100 112,600
Woodland 19.000 19,500 19,500
Totals for 2005:
General Property 1.000 19,500 93,100 112,600
Woodland 19.000 19,500 19,500
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 513
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 192.00
Special Assessments Special Charges Delinquent Charges
Total 192.00 0.00 0.00
AS BUIL'%: SAN.AtRY SYSTEM REPORT
'ER TOWNSHIP! ;}LL LrACt.r. SEC. N, R1 W
0. ADDRESS ST. CROIX COUNTY, WISCONSIN.
`BDIVISION LOT LOT SIZE
s
PLAN VIEW
-Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
l
'r
,JTIC TANK(S) i MFGR. r CONCRETF STEEL
NO. of rings on cover Depth DRY WELL
'.`INCHES NO. of width length area
D no. of lines r" width _-3f> ' length':; area a
depth to top of pipe
31R\EGATE 11"'--/' j
4 K RATE 2 4,2 G. AREA REQUIRED AREA AS BUILT ~ a
t
~ciaimer: The inspection of this system by St. Croix County does not imply complete
,pliance 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
stem operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
LASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
-INSPECTOR
J
DATED _ PLUMBER ON JOB
LICENSE NUMBER ~,f°
z ~REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.itan y Penm.ie
.
State Septic
NAME -t✓Townzhip~~~~.~k~, St. Croix County
Locatiox Section
SEPTIC TANK SvV o~IV(it~ i ~UGcG2`
Size gatZonz. Number oS Compantmen - I.
Diztance Fnom: WetZ it. 12% on greaten tope 4t
Bu.itd.ing 6t. Wettand.s ~ .
H.ighwaten - it.
DISPOSAL SYSTEM
D.ietanee Fnom: Wett 12% on greaten s.Zope
Bu.itd.ing it. Wettandd Ft.
H.ighwaten it.
FIELD DIMENSIONS: Width o j then ch it. Depth o j no eh. b et ow t.i.Ze in.
Length o j each tine it. Depth o6 no ck oven t.i.Ze in.
Number o6 .Z.ines Depth of t.ite be-Zow grade in.
Totat. .length o6 ,Z.iness jt. S.Zope o6 trench in pen 100 it.
D.iztance between tines it. Depth to bedrock it.
Totat abz onbt.ion area jt2 Depth to gxoundwaten it.
-Requited area it2 Type of Coven: Papers on Straw
PIT DIMENSIONS:
Number o5 pigs G)Lave.Z around pit~5 yeb no
Out.6.ide d.iameten it. Depth be.Zow .in.Zet it.
2
Tota.Z abzonbt.ion area it z
A
Axea requited it2
INSPECTED BY TITLE
APPROVED , DATE 197. REJECTED DATE 197.
t,
State and County State Permit #
PLB 67 v .f. Permit Application County Permit # County-5. 7
Y for Private Domestic Sewage Systems 1
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Dennis Peterson RR 1, Baldwin, Wi
B. LOCATION: S` '/4 Section _9_, T26 N, R 1 E (or) ) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township Eau Galle
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family X Duplex No. of Bedrooms 3 No. of Persons 1
D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks 1
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement X
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate-26, Zk Total Absorb Area sq. ft.
New Replacement X Alternate (Specify)
Seepage Trench: X No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X Length 32' Width ' Depth 2 "t0 2Ale depth (top "to' 6'`No. of Lines 5
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land 6/ Distance from critical slope None
WATER SUPPLY: Private ® Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
1, 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 Stephen L. Aaby C.S.T. # 1406 and other information
obtained from Owner (owner/builder).
Plumber's Signature s MP/MPRSW# 514 Phone # 698 - 2407
Plumber's Address J0X 2-54, oocivf 1e,W7 ,
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.
j !7
1dl 1'~.ESJi nt?k
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30 -
F oz) in);
Do Not Write in Space _Below R COUNTY AND STATE ~ FP RTMENT USE O) ~Y _
Date
Date of Application - Fees Paid: State County ,,,-,2
Permit Issued/Rejected (date) _Issuing Agent Name
inspection Yes 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
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: -'/4, Z\W'/4, Section 9, ?V N, R1_6 E (or)W)Township or Municipality Zhu Galle
Lot No. , Block No.--, County St. Croix
Dennis Peterson Subdivision Name
Owner's Name:
Mailing Address: iiR 1 Baldwin, A
TYPE OF OCCUPANCY: Residence x No. of Bedrooms j Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT x
DATES OBSERVATIONS MADE: SOIL BORINGS 15 Aug 7q PERCOLATION TESTS 16 Aug 79
SOIL MAP SHEET 76 SOI L TYPE SAB Santiago
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IERN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- 1 42" 6" T.S. 36" Sandy Loam 24 None 30 11/6 1 1/6 1 1/6 26
P- 2 36" 6" T.S. 30" Sandy Loam 24 None 30 1 1/8 1 1/ e, 1 1/8 26
P- 3 36" 6" T.6. 30"gSandy Loam 24 None 30 1 1/8 1 1/6 1 1/8 26
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-
1 84" None None 6" T.a. 7d" Sandy Loam
B 2 84" None None 6" T.S. 7d" Sandy Loam
B- 3 44" none None 6" T.6. 7d" Sandy Loam
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suit hl areas. fVicate number of square feet of absorption area
needed for building type and occupancy. 9bU sg Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with thE1 procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test Ql~s are°wrrecf
to the best of my knowledge and belief. r .
Name (print) Stephen L. Aaby Certification No. 1y.06 firs' 1tz
Address WOodvilie A %
Name of installer if known Aaby Plumbing, Heating & ZleCt.
CST Signature -0-
,B .a P _55"cl"ad