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Parcel 014-1026-30-000 01/12/2007 11:03 AM
PAGE 1 OF 1
Alt. Parcel 12.31.15.178B 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 - SPALINGER, LYNN E
LYNN E SPALINGER
3167 230TH AVE
CLEAR LAKE WI 54005
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 3167 230TH AVE
SC 1127 CLEAR LAKE
SP 1700 WITC
Legal Description: Acres: 21.150 Plat: N/A-NOT AVAILABLE
SEC 12 T31 N R15W 20.15A E 665' OF NW NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-31 N-1 5W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
160494 157,600
Valuations: Last Changed: 10/17/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 15,000 101,000 116,000 NO
PRODUCTIVE FORST LANDS G6 19.150 34,500 0 34,500 NO
Totals for 2006:
General Property 21.150 49,500 101,000 150,500
Woodland 0.000 0 0
Totals for 2005:
General Property 21.150 49,500 101,000 150,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 219
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
-0 o 0 0 0
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AS BUILT SANITARY SYSTEM REPORT
,A. TOWNSHIP ~ ✓ ~ SEC./ Ty N-R/J W
I: SS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE ®z
PLAN VIEW
11 i t ances and dimensions to meet requ'r\1ements of H63
1.
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VEEYTHING WITHIN 100 FEET OF SYSTEM
d
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I di a e oath Arrow I
1AlZK: (Permanent reference Point) Describe:
-',,t-ion of vertical reference point; Slope at site
`ClC TANK: Manufacturer: 4,r e) /xi Liquid Capacity: /,.-c Niember of rings on cover : Tank manhole cover elevation.
Tank Inlet Elevation: Tank Outlet Elevation: "
PUMP CHAMBER
Manufacturer: Number of gallons
j4urdlber of gal. pump set or a cycle gallons; tot-- aI capacity oT
distribution lines gallon: size o pump _ head;
;,allon per minute horsepower brand name of pump
lld model' number ;
!'ype of warning device
ii0l,DING TANK: Manufacturer Number of gallons _
llevation of manhole cover
type of warning device _
:~IJ,Alt~GE PIT SIZE: um er o pits meet diameter
1 eet. liquid depth seepage pit in eft pipe-elevation
ldottom of seepage nif A~ Qvat i f~~...
A(,F BED SIZE: number of lines width 1 ~2 l&figth tile- depth
'T'RENCH: width length
A'~' i Ud RATE )z AREA REQUIRED % r. AREA AS BUILT d-~
INSPECTOR
c' .~(p
d PLUMBER ON JO
LICENSE NUMB
FI~p; G F
jzREPORT OF INSPECTION-INDIVIDUAL SELVAGE SVSTEM
SanitaAy PeAmit
• State Septic-/` X 1
NAME rawnbhip /-crLc~s St. CAoix County
Location /i/LJ.A/c section
SEPTIC TANK
Size gattonb. Num_beA ob CompaAtmentz
Di4 tanee FAom: Wett 12% on gAeateA 4tope 4.t
Bu.itd.ing 6t, Wettandb ~ .
H.ighwateA it.
DISPOSAL SYSTEM
D•ib.tanee FAom: Wett 12% on gneateA zZope it.
Bu.itd.ing -st. wettandb Ft.
• H.ighwateA it.
FIELD DIMENSIONS:
Width o6 tteneh :Z it. Depth o6 Aoek below Cite .in.
Length os each tine it. Depth o6 Aock oven .tile .in.
NumbeA o6 tineb Z Depth of Cite below gAadeJ'~L- .in.
Tozat teng.th o6 Zineb it. Stope o6 .tAeneh in pen 100 it.
Di4tanee between tines `6t. Depth to bedAock
Totat abb onbt.ion area~~z2 Depth to gAOUndwateA it.
RequiAed aAea 6t2 Type o6 Coven: Papen on StAaw
,f
PIT DIMENSIONS:
Numbers o6 p.itb GAavet aAound pith yeb no
Out6 ide diameteA it. Depth b etow .inlet it.
2
Totat abboAbtion area it A
2 ~
Anea Ae uk led
IN~sP-EmED BY -TITLE R
APPROVED DATE 197
,f
REJECTED DATE y 197_
I
01
OL13 -67 ; State and County State Permit #
W Permit Application County Permit #
- for Private Domestic Sewage Systems County~1
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNE OF PROPERTY Mailing Addres
/,2 7
2 X
B. C ION: Sectio 12 , T.2_1 N, R_f p (°`rf Lot# City
Sub ivision Name, nearest road, lake or landmark Blk# Village
Township OAS 1`
y*/V SP_ AL jV ee f3 lox / C? L 4: It,-
C. TYPE OF OCCUPANCY-- *Commercial *Industrial * ther (specify) 'Variance
Single family A_ Duplex No. of Bedrooms No. of Persons v2
D. SEPTIC TANK CAPACITY /Q0O 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 r Total Absorb AreaQ sq. ft.
New- Replacement Alt~ernLpte (Specify)
Seepage Trench: _X No. of Lineal Ft. O 4Width -5 Depth__:U_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 `G 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 64 LC SM / ~ff C.S.T. # 176 ,f and other information
obtained from J_ v VV ,4 fN (owner/builder).
Plumber's Signature MP/MPRSW# Phone
Plumber's Address rc--
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 ON'Y _
Date of Application Fees Paid: State f-~ Count y•~te =l1
Permit Issued/Rejected (date) - ~`(ZIssuing Agent Name;WLAZL
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
state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78
EH 115y ~C~>>
ISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
s Vw C0 DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
G- P.O. BOX 309
C•~~Lt MADISON, WISCONSIN 53701
1 00 - REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: ffW'/4, &I-F114, Section 1-2, T-AN, R 0011111R) W, Township or9%Eft*W -
Lot No. , Block No. County
• Subdivision Name
Owner's Name:
Mailing Address: 3 < C~t~e. - Gl
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT -
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS 2~ E:
SOIL MAP SHEET SOI L TYPE
PERCOLATION TESTS _
TEST DEPTH F SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
CHARACTER O
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- r
~P f /C' l 7
llvi~
P_~ Al -S
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)
4, SA A10'
B S e- 4i -6-.2 Al S'.r tics'
SC Al s~#)vd
PLAN VIEW (Locate perco latio n tests,soi I bore holes and suitable soiI areas.)
Indicate on the plan the location and square feet of suits I areas. Indicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give horizontal and vertical reference Ants. Indicate slope.
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11401
~f ~ i ~ ~ I ,fir ~ ~ i 7i~ ~ ~ f 1 f ~
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.01
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I, the undersigned, 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.
Blame (print) 6:Ax g-M 11~ -Certification No. ~ 76
Address >g r r 6'1_ e N w y D d L, " ks c:
Name of installer if known -*t- N.
CST Signature'
TRANSFER FORM
SANITARY PERMIT
PLB 67 _ T State Permit # /
Sanitary Permit #
County __Y// ~i tt 4
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location % Section 12 T N,R / E (or) W Lot # -City
Subdivision Name, Nearest Road, Lake or Landmark BILK # Villa
B. TYPE of Occupancy- Commercial Industrial n Other (Specify)
Single Family Duplex No. of Bedrooms- Variance
C. SEPTIC TANK CAPACITY Total gallons No. of tanks
HOLDING TANK C PACITY Total gallons No. of tanks
Prefab Concrete Poured-in-place Steel Fiberglass Other(Specify)
New Installation Replacement
LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other(Specify)
D. EFFLUENT ISPOSAL SYSTEM: Percolation Rate - -cam Total Absorb Area ~ZZCI sq. ft.
Nev. Replacement Alternate (Specify)
Seepage Trench:_ No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches
Seepage Bed: -Length Width Depth Tile Depth(top A ~ No. of Lines
Seepage Pit: Inside dia eter Liquid Depth No. Seepage Pits
Percent slope of lands Distance from critical slope
E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No.
F
Name Name
Address Address
J F Zip Zip
I, the undersigned, do hereby certify flea, heave reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20, Wisconsin Administratv Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Tester d/ or any additio al soil test that may have been required. < ~~G S
Plumber's Signature ✓//J P[MPRSW # r Phone #,~i
f 'L
Plumber's Address 22~6LZ4
Information obtained from (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
s proer. If well has „dot been dnlle~a iodlcate,.
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Signature of Issuing Agent L/?/ lT '
County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
Tate (White copy) 4. Plumber (Green copy) P O ROX 309, MADISON WI 53701
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