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Parcel 012-1024-80-000 1212112007 08:1 Ann
PAGE 10F1
Alt. Parcel 09.30.17.131 B 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 - VIS, DANNY W & FAYTHE E
DANNY W & FAYTHE E VIS
1665 170TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description " 1665 170TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE
SEC 09 T30N R17W 2 AC SW NW LOT 1 OF Block/Condo Bldg:
CERT SURVEY MAP IN VOL IV PG 933
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
09-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1189/594 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
207660 150,800
Valuations: Last Changed: 11/07/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 30,000 114,900 144,900 NO
Totals for 2007:
General Property 2.000 30,000 114,900 144,900
Woodland 0.000 0 0
Totals for 2006:
General Property 2.000 30,000 114.900 144,900
Woodiana 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 207
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. `L___T_~~N RiLW
ADDRESS ST. CROIX COUNTY WISCON IN.
a, a SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
14
SHOW EVERY NG WITHIN 100 FEET OF SYSTEM
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a-
I di ate ozthiArrow j
SCALt :
CONCRETE STEEL
SEPTIC TANK(S)
N0. of rings on cover j Depth
PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of wi tom- length area
BED NO. of lines width length_ - area -
depth to top o pipe
NUMBER OF S PAGE P TS Outsi e iameter total pit area
AGGREGATE p/
PERK RATE AREA REQUIRED AREA AS BUILT /
Disclaimer: The inspection of this system by St. Croix County does not imply
complete compliance with State Administrative Codes. There are other areas that
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 cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM.
INSPECTOR
DATED PLUMBER ON JOB C
LICENSE NUMBER ,-6 3
idd
` z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.i.taAy Pent i.-t
State SPp-txc77
NAME Fownbhip Ctoix County
Location Sec ion
SEPTIC TANK
I
Size gattonz. Numbers of CompaA:tmenZs I
Distance Fnom: Wett b#. 12$ on gneazen stope 6t
Bu.itd.ing it. Wettands ~ •
Highwaten it.
DISPOSAL SYSTEM
Distance Fnom: Wett ~Z. 12% on gnea,ten s.e.ope it.
Bu.itd.i.ng /.t. W ettands Ft.
• HighwateA 5.t.
FIELD DIMENSIONS:
Width o6' t&en ch 't. Depth o6 no ek. b eZow t.iZe in.
Length os each tine 6.t. Depth os Aock oven .tile .in.
Numben• o6 tines Depth o6 tite below grade .in.
Toza.t .teng.th o6 tines St. Stope o j .trench in pen 100 4.t.
Distance between tines t. Depth to bedrock it.
Totat abs urLb.t.ion anea jt2 Depth to gnoundwateA 6-t.
..Requited aAea _ it2 Type of Coven: Pape.n oA StAaw
PIT DIMENSIONS:
Numbers o6 pits-- Gnavet around pits yes no
Out-side d.iamete.A it. Depth below .inZet
2
z
Totat absonbt,ion anea it
Area aequ.ined it2
INSPECTED BY TITLE
APPROVED , DATE 197.
REJECTED -,DATE 197.
~1
EH 115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: a -*Y4, Section T_N,R-E (ory'W,'rownship or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's/Buyers Name:
Mailing Address: t
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT
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 MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-, t
P t L-
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-
B -
x 1. A 1
B- L
B- z' t
B
v
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location 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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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 hcles are correct to the best of my
knowledge and belief.
Name (print) -f Certification No. _
Address ? I) _ I r: • ( t n
Name of installer if known-.
Copy A -Local Authority CST Signature
State and County State Permit #
PLB 6 7
q Permit Application County Permits #
_ r
for Private Domestic Sewage Systems County ~ ~ - ~ - - i
~ P
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
°
f
` f 3
B. LOCATION: '/a 4 Y4, Section T N, RE (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 ! No. of Persons ° z
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 Rate Total Absorb Area / sq. ft.
New. 1 Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length- r Width Depth r~ Tile depth (top) No. of Lines 1-
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
WATER SUPPLY: Private] 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 Tester
NAME C r.t. : , j t , C.S.T. # > r and other information
obtained from (owner/builder).
Plumber's Signature - MP/MPRSW# f Phone #1 C
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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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application ` c Fees Paid: Stato(;-f~- ( County/ ' C Date
Permit Issued/Re#;9:F,-d (date) Issuing Agent Name
Inspection Yes _-A 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