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Parcel 030-1058-50-000 03/23/2005 10:55 AM
PAGE 1 OF 1
Alt. Parcel 23.30.19.203E 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): Current Owner
* JOHNSON, MARK H
MARK H JOHNSON
721 WEST SHORE DR
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 721 W SHORE DR
SC 5432 SCH D OF SOMERSET
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.760 Plat: N/A-NOT AVAILABLE
SEC 23 T30N R19W GL 7 LOT 1 OF CSM 3/644 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-30N-19W
114114 fl & 7-►~r
' a.
Notes: Parcel History:
Date Doc # Vol/Page Type
12/29/2004 783691 2723/35 SC AF
12/16/2003 749252 2475/146 WD
01/11/2001 636662 1574/475 T
12/11/2000 635025 1566/122 TD
ore...
2004 SUMMARY Bill Fair Market Value: Assessed with:
5224 313,100
Valuations: Last Changed: 09/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.760 229,600 78,400 308,000 NO
Totals for 2004:
General Property 1.760 229,600 78,400 308,000
Woodland 0.000 0 0
Totals for 2003:
General Property 1.760 138,200 93,300 231,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 208
Specials:
User Special Code Category Amount
040-OTHER ASSM'T SPECIAL ASSESSMENT 541.10
Special Assessments Special Charges Delinquent Charges
Total 541.10 0.00 0.00
As B S IM~e v~ ~ ~ 9 ,~.L
7RY SYSTEM REPORT
OWNF.R ~a - S/LEJt
ADDRES. TOWNSHIP SEC.1N R_J~W
* _ , ST. CROIX C UNTY WISC SIN.
Z7
i
SUBDIVISION LOT LOT SIZE
Distances & dimensions to meet requirementsWof H62.20
SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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I di a e oath Arrow
SCAL ~i C I I
SEPTIC TANK(S) MFGR. STEEL
NO. o7 rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. nTL NO.
GALLONS Per Cycle _
TRENCHES NO. of width - length area
BED NO. of lines width r length ' area
depth t `t'op of pipe -
NUMBER OF SE PAGE PITS Outsa- e i.ameter total pit area
AGGREGATE
PERK RATE_ ATTA REgUIRED_ AREA AS BUILT Z,2
Disclaimer- The inspection of this system by St. Croix County does not imply
complete compliance with State Administrative Codes. There are other areas thi
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 THIS SYTEM.
INSPECTOR_
DATED l(j° ) PLUMBER ON JOB
( 7riJ,~•~`
(411r ilL S
LICENSE NUMBER %5G
Plb. 1-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)
PATE OF INSPECTION _
Signature of Inspector
4 kite - lnspector Yellovi Local Inspector Pink Plumber or Responsible Party
REPORT OF INSPECTIJN INDIVIDUAL SEWAGE SYSTEM
San4 tarry Peirrii
SZa4 e SPpJt.ic
NAME rowns hip jd.SgQ h. 5 Cnoix County
. 4'n Loca.t.iox NF AIQ Section _
SEPTIC TANK
- 1
Size ga.t.tons. Numb en o6 Compa,%tmen.ts I
Distance Fnom: Wett6.t. 12$ on gheaten aLope 6t
Bu.itd.ing ^ 6.t. W e.t.tands 6 t.
_ 6~•
DISPOSAL SYSTEM Hi9hwa.ten
D.is.tance Fnom: We.tl ,,,=,_._.,6#, 12$ of qua.ten s.tope 6~.
Bu.itd.ing `r 6t. Wettands Ft.
i
H.Lghwazen 6.t.
FIELD DIMENSIONS: 4
Width o6* .then ch 6.t. Depth o6 no ck b et ow..t.ite in.
Length o6 each tine _6.t, Depth o6 rock over. .tile > .in.
Numb e) L. o6 tines ~ Depth o6 .t.i.te b etow grade ~ in
Tota.t teng.th o6 -tines 6t. S.to pe o6 .trench .in- pen 100 6.t.
Distance between tines ~ fit. Depth to'bednock 6.t.
To.ta•t abs onbt.ion anew
6.t2 Depth to gnoundwaten 6.t.
Requited anea 6,t2 Type o6 Coven: Paper on S.trcaw
c;
PIT DIMENSIONS:
Numbeh o6 pits Ghave.t around pits yes no
Outside d"ame.tex i 6t;... 7 Depth be.tow in.te.t~6.t.
To.ta.t absonb.tion anea 6t2, r
Area kequ.ined 6,t2 rn
INSPECTED
TITLE
APPROVED ,DATE C. 197~C-' ,
REJECTED DATE 197-.
•
H 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
• P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS 44
LOCATION: .~_'/4`x'/4, SectionTAN, R (or) W,, Township or Municipality
Lot No. Block No. County.
• Subdivision Name
Owner's Name:
Mailing Address: C> -a--
TYPE OF OCCUPANCY: Residence No. of Bedrooms a Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS C - 1~K PERCOLATION TESTS r•
SOI L MAP SHEET SOI L TYPE + y.~L r r z L_
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SO] L HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
r C
P- 7
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES 1
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
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PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suita4l6 areas. Indicate number of square feet of absorption area
needed for building type and occupancy. i , Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope. ,
1
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__~_4 __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.
Name (print ' Certification No. SJ
Address AZ -
Name of installer if known
COPY A -LOCAL AUTHORITY CST Signature z~
'PLB i' State and County State Permit #
67
w I,' Permit Application County Permit #
for Private Domestic Sewage Systems County r
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: i /4 fir /4, Section T_ N, R (or) 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 1t C Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete- A Poured-in-Place Steel Fiberglass Other (specify)
New Installation A Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate t 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 Width Depth _Tile depth (top)_Ll No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land r' ' Distance from critical slope -
WATER SUPPLY: Private N ] 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, t
NAME :cam , 12i C.S.T. # y1 and other information
obtained from ` i (owner/builder).
Plumber's Signature -•.j~': j~_~' Phone #
Plumber's Address * MP/MPRSW#
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( Fees Paid: State, County Dat- Y-(FG)
Permit Issued/Rtteeted-(date) If Cti Issuing Agent Name c
Inspection Yes 11~No State Valid# Date Rec'd
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 /7
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