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Parcel 024-1022-30-000 01i03i2007 04:51
PAGE 1 OF 1
F 1
Alt. Parcel 17.28.17.123A 024 - TOWN OF PLEASANT VALLEY
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 - REIS, JOHN D & JODI A
JOHN D & JODI A REIS
1598 30TH AVE
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE
SEC 17 T28N R1 7W 20A S1/2 SW SW TOWNSHIP Block/Condo Bldg:
PLEASANT VALLEY
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-28N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/21/2004 777592 2679/633 WD
07/23/1997 426/190
2006 SUMMARY Bill Fair Market Value: Assessed with:
156553 Use Value Assessment
Valuations: Last Changed: 04/20/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 18.500 2,600 0 2,600 NO
UNDEVELOPED G5 1.500 300 0 300 NO
Totals for 2006:
General Property 20.000 2,900 0 2,900
Woodland 0.000 0 0
Totals for 2005:
General Property 20.000 3,000 0 3,000
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
Parcel 024-1024-95-000 01/03/2007 04:52 PM
PAGE 1 OF 1
Alt. Parcel 18.28.17.144A 024 - TOWN OF PLEASANT VALLEY
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 - REIS, JOHN D & JODI A
JOHN D & JODI A REIS
1598 30TH AVE
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1598 30TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE
SEC 18 T28N R17W S1/2 SE SE TOWNSHIP Block/Condo Bldg:
PLEASANT VALLEY
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
18-28N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/21/2004 777592 2679/633 WD
07/23/1997 703/353
07/23/1997 426/190
2006 SUMMARY Bill Fair Market Value: Assessed with:
156582 Use Value Assessment
Valuations: Last Changed: 04/20/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 17.320 2,400 0 2,400 NO
UNDEVELOPED G5 0.680 200 0 200 NO
OTHER G7 2.000 18,000 103,600 121,600 NO
Totals for 2006:
General Property 20.000 20,600 103,600 124,200
Woodland 0.000 0 0
Totals for 2005:
General Property 20.000 20,700 103,600 124,300
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
Z
AS BUILT SANITARY SYSTEM REPORT
OWNER C~W1'L-~M ~j
ADDRESS TOWNSHIP R a SEC J R i
ST, CROIX COUN ISCONSIN.
SUBDIVISION , LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
T~' Z
Pk _f$ Z).
40
I di, ate ort~hl-Arr-o-w 0
SCAL i I i
"EPTIC TANK(S) ~U C MFGR. CONCRETE -STEEL
NO. o rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. ~ MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of width length area
BED NO. of lines-' widths--length_T~! area
dept to top o pipe
NUMBER OF S~ TS outside diameter total pit area
AGGREGATE
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 T
~wIBC
DATED PLUMBER ON JOB
u
C_.ULx/
LICENSE NUMBER
AS BUILT SANITARY SYSTEM REPORT ,
I&MR , TOWNSHIP SEC. T_ Ny R W
0. ADDRESS , ST. CROIX COUNTY, WISCONSIN. ~
-3DIVISION LOT LOT SIZE
PLAN VIEW
Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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_ I 1
Indibate Noxth! Arrotw
SCALE
tPTIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
)'LNCHES NO. of width length area
no. of lines width length area
depth to top of pipe
aGREGATE
?:R1: RATE AREA REQUIRED AREA AS BUILT
lisciaimer: The inspection of this system by St. Croix County does not imply complete
.0?liance with State Administrative Codes. There are other areas that it is not possible
,o inspect at this point of construction. St. Croix County assumes no liability for
y$tem operation. However, if failure is noted the County will make every effort to
,jtermine cause of failure.
,TEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
`-INSPECTOR
DATED PLU:iBER ON JOB
LICENSE NUMBER
• *M,. REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
San4 tarry Penrn.i.t
State S e p ti c_94~_-_
AME 7own6h.ip St. Cno.i x County
ocat Oki y~Z S's _See-tionyLo-t Subdiv Z-on
f.PTIC TANK
Size.- gaeeons Numbers of eornpan,tment,6 _ -
)ih,tance {AOrn: Weee /(041 Buied.ing .16 12%
e~ape--
Highwa,te4
'LIMPING CHAMBER
Sizei --gaeeonis. Pump Manujae,tuAeA Modee Numbers
1OLDING TANK
Size gaeeons Numbe.A o6 CompaAtmentls
Pumpers Aeahm Sy.6 tem
,,t, stance 40m: We.t - Building 12%
5 Yape
High.wa-teA
ABSORPTION SITE
Bed TAench
<a tance 6AUm: Weee / Buie.ding-.~ f2% 5,eope- - -
Highwa,teA
s.
1,-;SORPTION SITE DIMENSIONS
W,i.d,th oU ,tAeneh f✓ 6,t Requ.i.ned anea-- t
Length o6 each Zone--_~~ .t_ Depth o6 Loch be.eow .tE~e_.... in
N u mb e n o{ k 4"'n eh m-.
Depth o naefz ouch t4-1'e 2 ~ w
T o t a t e ng h' u5„ ei neS' 6t 'De.pth o6 tiee below gnade ~d Sri
04A tance between fiLe~ ~ ~jt Sk.upe o~ fiAe.nch i.w. pelt 100
y.
i, tiC4t a,6uA.p.t4-un aAeu 6,t Type o6 CoveA: Papers on. to W~
IT DIMENSIONS'
Nurrnben. o{ pti,t.3 ,GAavee aAOUnd phis yeas H.u
Ou-tiside diarneteA I Depth beeow tineet ---{~-t
1 1-111-11, - - -
Totae,db6-vtptio-n aAe•a \
AAea nequtiAed _ ._..,...u 6t
NSPECTED-.B-V'" TITLE
\PPROVED - DATE-- 19
t JECTED DATE-- /98
'1ASON FOR REJECTION '
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PL13 67 State and County State Permit # 9 ~IeI6
Permit Application County Perm it #
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: L'/4Section Tr~)Y- N, R 0 E (or) ~Vy Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township fkc:5c""7 L<I~ey
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance /
Single family Duplex No. of Bedrooms No. of Persons_
D. SEPTIC TANK CAPACITY C 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 Replacement- Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (to~p)' No. of Trenghes
Seepage Bed: X Length Width ❑ Depth 36- Tile depth (top)~,~ No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope We4e
WATER SUPPLY: Privatey 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 Tester
NAME &; c j / C.S.T. # 66
and other information
obtained from L"' (owner/builder). n ,
Plumber's Signature ✓ /g P/M T# j Phone #
Plumber's Address L1 c~+ +
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 It Z d Fees Paid: State , 0.6 County c,?/. 0?1 Date C'
Permit Issued/Refeeted (60' 41 U' Issuing Agent Name
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 7/1/78
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: J"- '/4, j l- %4, Section 1 ,T_2-N,RZ~_E (or) (k 'Townsh'ip or Municipality
Lot No. , Block No. County
Subdivision amg 9
Owner's/Buyers Name:_ X Ali /K ~t1 1 1 ~f Mailing Address: of i4l m-, Z:' s .
TYPE OF OCCUPANCY: Residence No. of Bedrooms > -COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT- ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: 5kO1L BORINGS PERCOLATION TESTS 04 /
SOIL MAP SHEET- ~ ' NAME OF SOIL MAP UNIT
PERCOLATION TESTS
TEST HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES
NUM- DOH CHARACTER SOIL SINCE HOLE HOLE AFTER INTERVAL RATE
MIN/IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- .~CP- a A h ui yn e4 50 P- t''
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- Olt"
B- 13 `
i. / S t • ai~-r
B- . It S~+
la ! t
p r "mil S 5`` , C ✓
B-
B-
113-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the loca 'on od uare 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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bore pele
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1, the undersigend, hereby certify that the soil tests reported on this foFm Wi)%qre mad by Me in aclgl ~eithghe'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. 2
Address
Name of installer if known
Copy A -Local Authority CST Signature G v_~
REPORT ON INSPECTION OF SANITARY PERMIT #
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
Time of Inspection
Name, r s, License o ns ai icing Plumber
(3 )INSTALLATION CONS S 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 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 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-6Q95 N.05/80)
Signature of Inspector:
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