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Parcel 012-1011-50-000 09/14/2006 03:27 PM
PAGE 1 OF 1
Alt. Parcel 03.30.17.47B 012 - TOWN OF ERIN 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 - HOLLAND, THOMAS H, & JEAN M BYGD
THOMAS H, & JEAN M BYGD HOLLAND
538 PARK VIEW DR
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description &PARK-VtEW. DR
SC 3962 NEW RICHMOND j
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC Legal Description: Acres: 3.120 Plat: N/A-NOT AVAILABLE
SEC 03 T30N R17W 3.12A IN SW SE LOT 1 OF Block/Condo Bldg:
CERT SURVEY MAP IN VOL IV PAGE 948 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1131/435 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/07/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.120 45,400 159,400 204,800 NO
Totals for 2006:
General Property 3.120 45,400 159,400 204,800
Woodland 0.000 0 0
Totals for 2005:
General Property 3.120 45,400 159,400 204,800
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
• AS BUILT SANITARY SYSTEM REPORT
OMER '14 1 JA
0. AD~DRES , TOS7NSHIP ;JV SEC. T I N, R~W
ST. CROIX COUNTY, WISCONSIN.
'BDIVISION LOT LOT SIZE
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
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i
- I I 1r="-
r---
-T-
North, Arro'
7
J ! I S CAL f o
tPTIC TANK(S) MFGR.
COPICRETE_ STEEL
NO. of rings on cover 1 Depth DRY WELL
't'LNCHES NO. of width length area
no. of lines -_.2 widths length area
de~t to top of pipe.
®ATE ' 1 t'tr~y rc i~
' Y. RATE AREA REQUIRED //,-)s-" AREA AS BUILT
t,Sciaimer: The inspection of this system by St. Croix County does not imply complete
:a,.pliance with State Administrative Codes. There are other areas that it is not possible
,p inspect at this point of construction. St. Croix County assumes no liability for
4$tem operation. However, if failure is noted the County will make every effori~t to
,E~ermine cause of failure.
,EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS 77SYSTE~K.,
''INSPECTOR
DATED
PLUMBER ON JOB~,,~",,;
LICENSE NUMBER ~-iL 3
z
c .OREPORT OF INSPECTION INDIVIDUAL SELVAGE SYSTEM
San.i.taxy Pexm.i-t 46
Sate Sep,tico? 3
NAME;' ` Towns hip &U2 St. C)Loix County
S c~, S c_> Section
Location j
SEPTIC TANK
Size gattona. Numbers o6 Compaxtmentd I
Vi4tanee FAom: Wett 6#. 12% on gxeatex ztope 6t
Bu.itd.i-ng 6t. Wettanda 6.t.
H.ighwateA 6t. r.
DISPOSAL SYSTEM
Distance FAom: Wett 6t. .12% ox gxeatex stope 6.t.
Bu.itd.ing 6t. Wettandd Ft.
• H.ighwatex
FIELD DIMENSIONS:
Width o6 tench 6x. Depth o6 xo ck b etow .t.ite in.
Length o6 each tine 6t. Depth o6 xock oven .t.ite .in.
i
NumbeA o6 tines Depth o6 tite below gxade.,_ in.
Toxat teng.th o6 tines/ 6t. Stope o6 .txeneh in pet 100 6t.
Distance between Z.ines t. Depth to bedxock
To tat abb oxbtion axea -W Depth to gxoundwatex ~ .
..Requited axea 6t 2 Type o6 Covex: Papen ox Stkdw
PIT DIMENSIONS:
Numbex o6 pits Gxavet axound p.itz yeas no
Outside d.iameteA 6t. Depth below .inlet 6t.
2
Totat ab,6oxbt.ion axea St
AAea Aequ.ixed 6t2 R'
INSPECTED TITL
APPROVED DATE _,,z 191-
REJECTED DATE 197_
67 State and County State Permit # 2 1 9 s3
PLB
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:
1 j
B. LOCATION: -~4-Ya ' C Y4, Section , T~ R (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 j No. of Persons
D. 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 or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation RateL, _ 4 Total Absorb Area 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 L~ Depth E Tile depth (top)~c~~~ i~ No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land K. Distance from critical slope -
WATER SUPPLY: Private U 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 tified Soil Tester,
NAME Ce-J, C.S.T. #j / and other information
obtained from (owner/builder).
Plumber's Signature Phone
; i
MP/MPRSW# ~ # 7~
Plumber's Address
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.
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8
44
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Do Not Write in Space Bel w FOR COUNTY AND STATE DEPARTMENT USE O LY
Date of Application Fe s Paid: State /S County Date
Permit Issued/Rejec ed (dat) s 13 Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (w ite 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
' E H "115 Rev. 9/78 I
s REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
1
LOCATION: S'+.: '/4,1c`'/4, Section T,L_N,R LSE (or) W Township or Municipality Z
Lot No. , Block No. County -
/ t Subdivision Name
Owner's/Buyers Name: Z 'A %A
Mailing Address: 2L ;Z, 7 "-y
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS 17-
SOIL SOIL MAP SHEET J NAME OF SOIL MAP UNIT
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
RATE
NUM- SINCE HOLE HOLE AFTER INTERVAL
MIN/IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- C / S
C
a
Z_s
P-
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 .1
B- -J : -
v
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the ocation 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.
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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) - - Certification No.
Address S "
Name of installer if known
Copy A - Local Authority CST Signatur