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Parcel 030-1046-30-000 09/26/2006 09:40 AM
PAGE 1 OF 1
Alt. Parcel 21.30.19.173B 030 - TOWN OF SAINT JOSEPH
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 - BRADFORD, DENNIS L & DORACE K
DENNIS L & DORACE K BRADFORD
517 VALLEY VIEW TR
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 517 VALLEY VIEW TRL
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.330 Plat: N/A-NOT AVAILABLE
SEC 21 T30N R19W SW SW LOT 1 OF CSM Block/Condo Bldg:
3/867
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-30N-19W
Notes: Parcel History:
Date Doc # Vol/Pag ype
03/19/2002 673835 1856/52 WD
03/1912002 18 TI
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.330 77,900 103,900 181,800 NO
Totals for 2006:
General Property 3.330 77,900 103,900 181,800
Woodland 0.000 0 0
Totals for 2005:
General Property 3.330 77,900 103,900 181,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 140
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 030-1046-20-000 09/26/2006 09:37 AM
' PAGE 1 OF 1
Alt. Parcel 21.30.19.173A 030 - TOWN OF SAINT JOSEPH
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 - MARTY, JOHN C & KATHLEEN
JOHN C & KATHLEEN MARTY
1451 50TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 36.670 Plat: N/A-NOT AVAILABLE
SEC 21 T30N R19W SW SW EXC CSM 3/867 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/28/2003 737818 2391/564 TI
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 05/31/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 33.670 3,000 0 3,000 NO
UNDEVELOPED G5 3.000 800 0 800 NO
Totals for 2006:
General Property 36.670 3,800 0 3,800
Woodland 0.000 0 0
Totals for 2005:
General Property 36.670 3,800 0 3,800
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
KER _ , TOWNSHIP SEC. T N, R W
p. ADDRESS ST. CROIX COUNTY, WISCONSIN.
BDIVISION LOT LOT SIZE
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Z
i
j I
• _ j
1
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1
Indiicate North; Arrot
1 SCALE :
',QTIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
ANCHES NO. of width length area
no. of lines- width length area
depth to top of pipe
~GREGATE
RATE _ AREA REQUIRED AREA AS BUILT
lisclaimer: The inspection of this system by St. Croix County does not imply complete
,appliance 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
j$tem operation. However, if failure is noted the County will make every effort to
:jtermine cause of failure.
-'EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
`1NSP0TW -
DATED PLU1BER ON JOB
LICENSE NUMBER
i
Z yr}
r REPORT OF INSPECTION INDIVIDUAL SEWAGE SVSTEM
San.i•tany PeA► .i.t0
` State S P p~ti
NAME rown4 hip -s 1 ~,L6 S p ,QZj S~, C40 ix County
Location S1j ZYWyd Section -c:p/
SEPTIC TANK
Size gatton4. Numb en 06 Compa4tmen•t4 I
D"tance Fhom. Wetlr___ 6t. l2 o,. gnea.ten 44ope it
Ou"ding 6.t. Wettanda _ 6t.
N~.9hwa•ten~
DISPOSAL SYSTEM 6.t.
Di4tance Faoms Wets c
6t. 12$ on gnea.te4 4,cope it.
gaud.ing____,__,__6•t. We.ttand4 Ft.
ffig hwa.t en~ St.
FIELD DIMENSIONS:
WidU 06. •tnench 6t. Depth o6 pock bet0w tiLe Z in.
-4-' Length o6 each tine St. Depth 06 nock ove4 t.ite L in.
Numbers 06 .L.i.ne4 =s Depth o6 tiee bebow gnadein.
Total length o 6 tin e-4 `t 6t. Sto pe o6 trench in pen 100 it.
DiAtance between tine4__ Depth •to'bednock 6t.
Totat ab.4 o4bt,.on a4ea -Z ? 6.t2 Depth to guundwa.ten 6.t.
Requ.iud area / 4.t2 Type o6 Covear Papea ai StAaw
PIT DIMENSIONS.
Numbers 06 p.it4 G4av ,.=a4ound pit-4 e4 no
D""ide dtamet~6 t. a pth` be~aw 444e.t 6.t.
To.tat ab4onb.t.ion a a 6 z
Area nequ red 6,t~ rn
INSPECTED-'V-:L-- I TL E
APPROVED DATE 191
REJECTED ,DATE 197.
-100
C~ 1 /7 i
State and County State Permit #
a Permit Application County Permit # for Private Domestic Sewage County 7~
Systems
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
L 1
B. LOCATION: '/4, Section .1j, T '7,,, N, R E (or) X4(1 Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial I *Other (specify) *Variance
Single family 14 Duplex No. of Bedrooms No. of Persons
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 A Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length 3( -Width -Depth Tile depth (top)__3L%'No. of Lines 3
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land jk'?, A&&ZA % c: 17,= 5if~i~ r=c=/~ Distance from critical slope
WATER SUPPLY: Private I 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 &--1&1( C.S # 573 and other information
obtained from (owner ilder).
Plumber's Signature h~ MP/MPRSW# '3 1 Phone #7%j
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.
ON j
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G" ~0 S4s~~c=
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State/,5-, `T Co my - .may Date 6 /6
Permit Issued/Rejected (date) ( G~ Issuing Agent Name,`
Inspection Yes_X_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 \
=r REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCAT10N:_ It-"/4, Section..g~4,T~ON,R_0$ (or 11!Vownship or Municipality eF '
Lot No.Block No. County
Sub vision Name L r
Owner's/Buyers Name: AZ k ~i A3/-'V I 1
Mailing Address: Sf a-4 ,2- /3c9"e i E` •~-i cr' T L ea ~S -
TYPE OF OCCUPANCY: Residence X No. of Bedrooms - COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS /S-- 7 f PERCOLATION TESTS 2 ;7
SOIL MAP SHEET 3 NAME OF SOIL MAP UNIT 64 02-
PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL RATE
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MINUIN
P- I J_
P- 2_'t~ rzc?~-e !3
P- 3 5le e_ <Q L s' '3 ~3
P-
P-
P-
I
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- ii ~fl,LetC`, 7_7 F(
B-!
B- 9 C" ' /t d ~C - , it ~L► "C " i r o'~ J D~ C`
B- C
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 /_S~G Indicate sr alp or distances.
Give horizontal and vertical referen a oints. Indicate slope.
Y
am=Lr sfr~~•~l = C~.~- / r h'~ She //FMS/mil!`/r
rO ~ 4s' s 4,*e-
C te-'o'C S _ 5,9
cr ~c' ~,rl 1~ C'~ees c- rgr. y
:w € rc)
izor wes,d~,~~~
l r
I 7 ~ 2Q -~oT- Bass 44,
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 (printl_ Certification No.
io
Address
Name of installer if known
i
Copy A -Local Authority CST Signature
Plb. t-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES
Division of Health
Section of Plumbing & Fire Protection Systems
ON-SITE WASTE DISPOSAL INSPECTION REPORT
Name of Premises
Street City County
Master Plumber Address
Owner Address
❑ County Permits ❑ Appropriate State Permits
Type of Building: ❑ Public ❑ Single Family or Duplex
CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM
❑ Building Sewer ❑ Conventional Soil Absorption System
❑ Septic Tank ❑ Conventional System-in-fill
❑ Holding Tank ❑ Alternate Mound System
❑ Seepage Bed ❑ Holding Tank
❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System
BRIEF, FACTUAL COMMENTS AND SKETCH:
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❑SEE ATTACHED
DISCUSSED WITH PLUMBER ( ) Yes ( ► No SIGNATURE (Voluntary)
DATE OF INSPECTION
Signature of Inspector
White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party