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Parcel 030-2029-70-000 01/11/2006 03:24 PM
PAGE 1 OF 1
Alt. Parcel 22.30.20.444C 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 - LENTZ, JAMES E
JAMES E LENTZ
1435 MAIN ST
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1435 HWY 35/64
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.820 Plat: N/A-NOT AVAILABLE
SEC 22 T30N R20W NW SE COM SW COR, TH N Block/Condo Bldg:
660 FT, E 81 FT TO INT HWY & POB: E
232.3 FT DEFL > TO RT 135DEG & SWLY 342 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT, W TO CL HWY 66 FT, NELY 240 FT TO 22-30N-20W
POB
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1013/57 LC
2005 SUMMARY Bill Fair Market Value: Assessed with:
84358 159,500
Valuations: Last Changed: 09/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.820 40,000 105,100 145,100 NO
Totals for 2005:
General Property 0.820 40,000 105,100 145,100
Woodland 0.000 0 0
Totals for 2004:
General Property 0.820 40,000 105,100 145,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 125
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
'~iER TQTr7NSHIP, L y~ _SEC. T N, R W
O. ADDRESS ST. CROIX COUNTY, WISCONSIN. .
LDIVISIONLOT LOT SIZE
PLAN VIEW
.Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
- - --1------ ! _ -
E
i Indicate North Arrota A! t
i ISCALE. i {
pTIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
'NCHES NO. of width length area
no. of lines , width_4j% length area
depth to top of pipe
,u::EGATE y ' ~ i ' li t:-:D-
14", RATE AREA REQUIRED AREA AS BUILT
The inspection of this system by St. Croix County does not imply complete
,reliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
j5:em operation. However, if failure is noted the County will make every effort to
'ermine cause of failure.
'EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
`INSPECTOR
DAT -L "j= PLUMBER ON JOB
LICENSE NUMBER ~ L~~'~
Ar
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanit-n.y PeAm.Lt 1,30
State Septic
NAME O' Township . _St. Cko 'x County
Location MVO w Section_,A?Lot # Sub ivi ion
JLr'1LC IANK
Size gaffons Numb en oA eompaAtment5
Di6tanee AAOm: WeU Buitding 120 slope
H,LghwatvL
PUMPING CHAMBER
Size gaUons _ Pump ManuAaetureA Mode. NumbeA
HOLDING TANK
Size gaE,Eons Number oA CompaAtments
y
Pumper A2aAm Sy,5tem
Di,stane.e ()nom: WeQ,Q Buy tding 120 stope.
HighwateA
ABSORPTION SITE
Bed TAeneh
Di6tanee AAOm: Wetf Buitding t2o stope
HighwateA
ABSORPTION SITE DIMENSIONS
Width oA tne.neh / At RequiAe_d aAea At
Length oA each tine At Depth o() Aock below tif-e, ~ -in
{Number. oA tines s Depth oA Kock oven tote tin
Totae eength o() Zines At Depth o6 tite below grade L.. tin
3~ Distance. between eine3 ()t Stope oA tne.neh in. per. 100 At
'Totaf ab/soApttion area ~z ()t Type. oA Coven: ~PapeA oA ~stka-w
~ L;
PIT DIMENSIONS
Numb eA o (j pits GAave.f around pits yea no
Out/slide, diameteA At Depth below inlet At
Tota-t absoApt,Lon area At
Area Aequ.LAed% At
INSPECTED BY TITLE
O
if DATE 19
APPROVED
REJECTED DATE 198
REASON FOR REJECTION •
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, ress, icens o. o ns a Ong Plumber
1
3 INSTALLATION CONSIS S F: Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit 14 Seepage Bed ❑ Holding Tank ❑ Fill System
(4) BENCHMARK: (Permanent reference' Point) Descri-5e:
i o
Elevation of vertical reference point: Slope at site:
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: c: N~,S Liquid Capacity:
Tank Inlet Elevation: J Tank Outlet E1ev:~
# ft to lot or property line: # ft to well: ,j(
(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 ❑ N0; 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) S~EPAGE BED SIZE: ft width; ft length; tile depth;
li.neal feet tile; ft to residence; 7,
I- ft to well; _;~r_ ft to lot or
property line; ~C1 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? KYES ❑ NO
(13) Has system been installed in floodway? ❑ YES '2~NO Floodplain? ❑ YES PI NO
DILHR-SBD-6095 N.05/80
Signature of Inspector: G
PLB 6 7 State and County State Permit #
Permit Application County Permit #
for Private Domestic Sewage Systems Co unty~~
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: j % '/a, Section T_N, R=E (of), 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
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 Replacement S Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top)_20`~ 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 Distance from critical slope
WATER SUPPLY: Private Nr 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 (owner/builder).
Plumber's Signature MP/MPRSW# Phone # -
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.
C
Ci'~l W14
E
E
r
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v
Q
A4d
r
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY CC
Date of Application -~-,k C' Fees Paid: State County J .J Date
Permit Issued/+Re ted (date) 7- oft `C. Issuing Agent Name ZC-C ep ,<<-L- -
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 -11.5 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:1:~'/4, Section v ~ ,T 0 N,R~®(or&Township or Municipality sf' To5e
Lot No. , Block No.
County
/ ub~~diyyisipn ame
Owner's/Buyers Name: d !~-Q1/
Mailing Address: 420 Ed ~ aM. fie- R a Au ~ ~l c ~XAI 5s-11 r,
TYPE OF OCCUPANCY: Residence X- No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT~ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS -A>'~PERCOLATION TESTS 4 31'/-00
SOIL MAP SHEET -3-3 NAME OF SOIL MAP UNIT 46x 48 0ur~A~"d f S~ h1l"~
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 AFTE INTERVAL MIN/11\1
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- If See rz ® I zl o O S S_
12-
P_ Vff it see- r2 gA1,4 ~Y O 91 3s 33 3
P-.3 Set &,-e Y o 3 a r L a~
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- / a OAL c? aQ6 ~i rA 23 C
B- r0 7 rr /r r~~ i ~s! p1 G~„
B- rr ri if 6 I I I S "f" G h
B-
B-
B-
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 0100 A' Indicate scale or distances.
Give horizont I and vertical reference point . Indicate slope. ces fps d,~rAted
Ady'-3-C" ~/Vi
y
5Y She , ~r septa c mw
C'y
of EX~s{,`tie6- \
Qry WC4, `
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~~r~f M ~-K~ac fuf-~ Aid 70 ,Dvc`✓~ .~M psi ~-f/'.z - /~i9u. /7'lt~~.t~ (,t1.~s ~ B~~cM a F
.rtG
fl,AG-
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/ ~i91,tA CJ / A 7~rrts"Alder A-f ~i~1 'A~l~a.~ l~ ~Q/~ C-.~^ ~
`Cyr ~
prf ve-_ZN A10 w 119 /3 t MA,uw ?e'54 C- `*a~
7~e,3f ~ ~ k p
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) zLa,:.1 / ' Certification No.
Address Z&-6 /,qa re l
Name of installer if known
Copy A - Local Authority CST Signatur