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Parcel 012-20055-90-000 09/14/2006 03:19
PAGE 1 OF 1
F 1
Alt. Parcel 04.30.17.592 012 - 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 - SCHMIT, DORREEN F
DORREEN F SCHMIT
1746 CTY RD T
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1746 CTY RD T
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 3.500 Plat: N/A-NOT AVAILABLE
SEC 04 T30N R17W BLK 100-107 VIL JEWETT Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/22/2004 780610 2700/328 TI
10/16/1957 252230 344/544 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 3.500 47,000 86,700 133,700 NO
Totals for 2006:
General Property 3.500 47,000 86,700 133,700
Woodland 0.000 0 0
Totals for 2005:
General Property 3.500 47,000 86,700 133,7000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 221
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 012-1013-10-000 09/14/2006 03:18 PM
PAGE 1 OF 1
Alt. Parcel 04.30.17.57B 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 - SCHMIT, DORREEN F
DORREEN F SCHMIT
1746 CTY RD T
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1746 CTY RD T
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 04 T30N R1 7W 1A IN NE SE COM CEN CO Block/Condo Bldg:
TRK "T" AT NE COR NE SE TH S 8 RIDS, W 20
RIDS, N 8 RDS, TH E 20 RIDS TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
04-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/22/2004 780610 2700/328 TI
08/26/1971 306567 475/449 QC
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 1.000 15,000 0 15,000 NO
Totals for 2006:
General Property 1.000 15,000 0 15,000
Woodland 0.000 0 0
Totals for 2005:
General Property 1.000 15,000 0 15,000
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
OWNER TOWNSHIP SEC .T_N, RI W
ADDRESS ST. CROIX COUNTY WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62,20
SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r:
F- 41 1 1
r
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I di a e oath Arr w
L
SCALi--:- - -
SEPTIC TANK(S) MFGR. CONCRETE STEEL
s on cover ~_Depth
NO , of ring
PUMPING CHAMBER SIZE PUMP MFGR. ~L N0.
GALLONS Per Cycle
TRENCHES NO. of width length area
11FD N0. of lines width _ _length area
depth to top pipe
NUMBER OF SEEPAGE PTTS OlitsiT ampf- total pit area
PERK RATE G RE REQUIREDAREA AS BUILT
Disclaimer: The inspection of this system by 5t. ICtroix County does not imply
complete compliance with State Administrative Codes. There are other areas thn
it is not possible to inspect at this point of construction. St. Croix County
assumes no liability for system operation. However, if failure is noted the
County will make every effort to determine causero£ failure.
GREASES AND OTLS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM.
INSPECTOR
z /K
DATED, PLUMBER ON JOB
LICENSE N1_TMBER
REPORT Of- INSPECTION - INDIVIDUAL SEWAGE SYSTEM hh Saner -t a rc y P E ~t m ,(*t 9a~
Sate Sep,tcc
NAME Township ~St. Cnoix county
1.o c (i-t 1 o n__&E -Section ~ Lot di v i,5 .tan -
til I'T-IC TANK
z e 1 ~l ga Uo n.a Numbers o6 eo mpan-tments /
:.o
U<,ti l~cttr~{~ttofri: Welk Buieding ~ 12o 6 t o r ze
Highwa,ten
PIMPING CHAMBER
Si c> gatton.5 Pump Manu6aetu)wL Modet Numbe.n
I)INc, i ANK
~t ze ga toms -.Numbers o6 Compa4tments
Pumpefc. Ata4m System
Uin"tanCe fih.om: WettBui ding 12%
ePope_
High.wa.te.n
t 61:0I: PTI ON S I TE
Ned Trench
h1,~1` 41 ile. n.om: WeU Buitding t20 .5tope__
fl ghwa-ten
At~,,ORPTION SITE "DIMENSIONS
Width of ,tne.nch % At Required area
I-cvigth ob each. tine__ {t Depth o6 tock below -tiEe~~
Nurnben. (,6 eines Depth o6 hock oven lZ ~-n
f o taf X.ength. o6' fines 6,t Depth o6 ,tile betow gA-ade-___,._) c vi
U<.e tance be-twe.en Tin.e.e 6 St.ope o6 -trench ,(.n. pelt 100 At
I o taf abls oii.ption an.ea~ ~ At Type o6 Co ve.a: Pape.n b ,th aw
I'IT DIMENSIONS
Numb e n. o A p.i.ts Gnavel around p~ to yee - _ _ _nu
Outside di.ame,ten At Depth betow _6t
Tota"C absotcp,t,i.on aAca At
A4 c a 4cquC ne 6 '
1- -1 a
1 N P f (I'll 1) 6v ' TITLE 4
AI'I'ROVf D DATE 19
I't 1LCIVD DATE 198
I:I ASON FOR REJECTION
State and County State Permit '
PLB 6-7 y Permit Application County Permit #
u
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:
J- Al-i
B. LOCATION: Section TIQ N, RJ (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township A/_I
C. TYPE OF OCCUPANCY: `Commercial *Industrial *Other (specify) *Variance
Single family 4 Duplex No. of Bedrooms No. of Persons 1'
D. SEPTIC TANK CAPACITY 1606 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 Rate c,. 4 Total Absorb Area ~t sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. -Width Depth Tile depth (too) No. of Trenches
Seepage Bed: -Length - Width -Z2 - DepthTile depth (top)ic / No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
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 Cer ified Soil
T ter,
NAME J,= 'S & _C.S.T. # and other information
obtained from nullda -(owner/builder).
Plumber 's Signature -MP/ PRSW# PhoneZW
Plumber's Address sljL, 1Gt~~~~-~•'~ -s~
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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Do Not Write in Space~ Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application ! F Fees Paid: State 4"-c' County Date
Permit Issued/Rejected (date) Issuing Agent Name
Inspection Yes e 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
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EH 115 Rev. 9/78
REPORT ON SOIL BORIINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION:/ 'L% Sr '/a, Section ,T 2N,RZZ 9 (or) IJ~L Township or Municipality C" J4A01)1Z1t"
Lot No. , Block No. County S 2 ®/Z
' Subdivision Name
Owner's/Buyers Name:
Mailing Address: 7
-TYPE OF OCCUPANCY: Residence XNo. of Bedrooms; - COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT~ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS ?-m - go PERCOLATION TESTS e90
SOIL MAP SHEET ®S~A NAME OF SOIL MAP UNIT
_,Z ,4&2 l
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
RATE
NUM- SINCE HOLE HOLE AFTER INTERVAL
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIWIN
P- 7 7 44bld AS 43:)44a:s X? Q
F-
Ilk Ald &2 J V-?
P-
P-
P-
SOIL IBORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B-
B-A -S
B- '7 ro 7 7 0__/10 B-
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan theAocation 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.
t7 San 2/"h! 4j, 4#o
• Pay: 72s1-
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44100
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I, 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.~si5~- n,~l
a ~
Address
Name of installer if known
Copy A -Local Authority CST Signature
REPORT ON INSPECTION OF SANITARY PERMIT #
.Name and AddFes~ of, hermit Holder Person/Persons at Site (2 )Date of Inspection
7
11~z~~Lll Time of Inspection
Name- , ress, License NO. o n a Ong Plumber
(i i ;
(3 )INSTALLATION NSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN ermanent reference Point) Describe:
Elevation of vertical reference point: Slope at site:
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity:
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: # ft to well:
(7)DOSING TANK: Manufacturer: # of gallons:
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines gallon; size of pump head; gallon per minute
horsepower ; brand name of pump and model number
Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO
;
8 HOLDING TANK: Manufacturer o gallons
construction ; depth to the cover ft; If septic tank is
being used are baffles removed? ❑ YES ❑ NO; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO;
Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ;
Distance from building to vent
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe-elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPAGE BED SIZE: ft width; ft length; tile depth;
lineal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed ft.
11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft;
tile depth ft; ft to well; ft to ordinary high water mark c
lake or stream; ft to edge of slopes greater than 20% falling away toward
water courses or drainage ditches; elevation of tank discharge line entering seepage
trench ft.
(12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO
(13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO
DILHR-SBD-6095 N.05/80
Signature of Inspector: