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Parcel 014-1025-70-000 01/12/2007 10:46 AM
PAGE 1 OF 1
Alt. Parcel 11.31.15.176 014 - TOWN OF FOREST
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 - HEIBEL, MELVIN & GENEVIEVE(LE)
MELVIN & GENEVIEVE(LE) HEIBEL
3092 220TH AVE
CLEAR LAKE WI 54005
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 3092 220TH AVE n`
SC 1127 CLEAR LAKE
SP 1700 WITC
Legal Description: Acres: 38.700 Plat: N/A-NOT AVAILABLE
SEC 11 T31 N R1 5W SE SE EXC N 7' OF S 40' Block/Condo Bldg:
OF W 626'ALSO N 5.5'OF S 55'OF E 749'
ALSO N 12' OF S 45' FOR HWY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
11-31N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1061/08, WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
160491 Use Value Assessment
Valuations: Last Changed: 10/17/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 10,000 114,400 124,400 NO
AGRICULTURAL G4 36.700 3,700 0 3,700 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2006:
General Property 38.700 13,800 114,400 128,200
Woodland 0.000 0 0
Totals for 2005:
General Property 38.700 13,800 114,400 128,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 213
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r
AS BUILT SANITARY SYSTEM REPORT
TOWNSHIP ~/'i~~J f SEC. ',L1_T j/ N-IL,-W
ADDRESS 4,, ST. CROIX COUNTY, WISCONSIN...
SUBDIVISION LOT LOT TZE r 5 c~
PLAN VIEW
Distances and dimensions to meet requirements of H63
W-EVERYTHING WITHIN 100 FEET OF SYSTEM -
I di, a e oath Arrow ~ ~ '
S C L I
BENCHMARK: (Permanent reference Point-) Describe
Elevation of vertical reference point:_/ Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: /eic j,,
iVumber of rings on cover : 3 Tank manhole cover elevation
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
number of gal. pump set or a cycle gallons; tom -capacity o
distribution lines gallon: size of pump head;
gallon per minute horsepower brand name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device _
SEEPAGE PIT SIZE: Number o pits feet iameter
feet liquid depth seepage pit in epe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width length the depth
SEEPAGE TRENCH: width '5-11 length 7i
PERCOLATION RATE- - J ]-,_AREA. REQUIRED ;7 ' AREA AS BUILT. > i -c'
INSPECTOR
DA`Z'ED ~f PLUMBER ON JOB 3dyn i,,~4~a~,.
LICENSE NUMBER /~-/p
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitary Perm.ii ,
y
State S e p,t.i c_
NAME Tawnahip S~. Croix County
Location Section
SEPTIC TANK
I
Size gattonb. Numbers o6 Compartments j
D.iztance From: Wett 12% on greater 6tope 6t
Bu.itd.ingg it. Wettand.6 ~ .
H.ighwa.ter a it.
DISPOSAL SYSTEM
D.ia.tance From: Weit .12% on greater 4tope it.
Bu.i.Cd.ing _ i it. W ettand.a Ft.
• H.ighwater it.
FIELD DIMENSIONS:
Width o j trench it. Depth o6 rock b e.iow t.i.ie in.
Length og each tine it. Depth o6 rock oven .tile .in.
Number of tines Depth o6 t.ite below grade .in.
Totat .Eength o6 .E,i.ns,5 jt. Stope o6 .trench in pen 100 it.
D.iatance between Zinez fit. Depth to bedrock it.
Totat ab.sorbtion anew 6t2 Depth to groundwater it.
Requited 2 Type o6 Cover: Papen or Straw PIT DIMENSIONS:
Number aj pitz ` Gnavet around pits yeas no
Out-6 ide diameter it. Depth b e.iow .in.iet it.
2
To.tat abaorbt.ion area it A
Area required ~t2 rn
INSPECTED BY TITLE
.
APPROVED , DATE 197,
REJECTED DATE 197
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PLB'67 State and County State Permit #
Permit Application County Per
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:
B. LOCATION: 5,cF_'/, SA; Section Tj~/ N, R_,Lj:~E (or) W Lot# City
Subdivision Name, e?(1i-0J' nearest road, lake or landmark Blk# Village
Township ri;~rS1`
C. TYPE OF OCCUPANCY: *Commercial *Industrial "Other (specify) *Variance
Single family t Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY (4100 Total gallons No. of tanks /
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Y 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 / Replacement Alternate (Specify)'
Seepage Trench: • No. of Lineal Ft. 1 Width Depth"IiL_Tile depth (top)✓ No. of Trenches
Seepage Bed: Length Width Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land_ w. Distance from critical slope
WATER SUPPLY: Private 1'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.S.T. # and other information
obtained from t .-r. b+ I owne /builder).
Plumber's Signature f ,/qtr Flzr.. nP/- SW# 1"Alf66 Phone
Plumber's Address .C3c x 9 -;~G c`/fci ,G<-/mot _i..T ~ s 4 : ,
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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N, 220 ~
Do Not Write in Space Belo FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State 1,51eir Coin y Date - ~
Permit Issued/ (date) -y - Issuing Agent Name 1
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/
E,H 11 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS G
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES 7i
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: SE Y4, SE '/4, Section 11 T31 N R 15 E (or) W, Township or Municipality Forest -
Lot No. , Block o. 40 acres County St. Cl~oix c
Subdivision Name
Owner's/Buyers Name? Heibel " Q, r
Mailing Address: RR 1 Box 46 Clear Lake, Wis. 54005
TYPE OF OCCUPANCY: Residence X No. of Bedrooms 2 COMMERCIAL f<
EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM O R
DATES OBSERVATIONS MADE: SOIL BORINGS _ 10/28/79 . PERCOLATION TESTS 10/28 & 29/79
SOIL MAP SHEET NAME OF SOIL MAP UNIT Amery sandy loam
PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME
NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL DROP IN WATER LEVEL, INCHES RATE
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- I M 6" No S !5/ 11, r
Nib "he h
P Ip Y- rj 7 _S/1
0
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- I 7 7 c) rl IF S, - -A
B- V• 911 t% '14 ZYN --5,1
B-
'0 I'M in, ) 1 h i
B- a 1. n 7 F'l K" 4 -Si 0 91 <; X11
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the I ation and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy q Q 5 .Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope. use be~~OCMIS 31Seac1^
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10$O1th eS" ~ I%A
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Slope c5' Approx aZ
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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) Michael D Jensen Certification No. 1269 p®,
Address 700 Wisc. Ave., Amery, Wis 54001
Name of installer if known John Madden
. ,i
Copy A -Local Authority CST Signature L+~ LLB