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Parcel 030-2122-80-000 03/17/2005 02:59 PM
PAGE 1 OF 1
Alt. Parcel 23.30.19.998 030 - 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
MOSES, TIMOTHY J & KATHLEEN L
TIMOTHY J & KATHLEEN L MOSES
719 W SHORE DR
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 719 W SHORE DR
SC 5432 SCH D OF SOMERSET
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 3.100 Plat: 0075-BASS LAKE MEADOWS
SEC 23 T30N R19W PT GL 7 LOT 8 BASS LAKE Block/Condo Bldg: LOT 8
MEADOWS
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/26/2004 772728 2644/389 TD
07/24/2003 731805 2329/139 WD
2004 SUMMARY Bill Fair Market Value: Assessed with:
6668 505,000
Valuations: Last Changed: 07/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.100 294,300 202,500 496,800 NO
Totals for 2004:
General Property 3.100 294,300 202,500 496,800
Woodland 0.000 0 0
Totals for 2003:
General Property 3.100 178,700 171,300 350,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
040-OTHER ASSM'T SPECIAL ASSESSMENT 700.92
Special Assessments Special Charges Delinquent Charges
Total 700.92 0.00 0.00
Parcel 030-1058-50-000 03/17/2005 02:53 PM
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 r JUl
SP 8040 BASS LAKE REHAB DIST ~-1
SP 1700 WITC
Legal Description: Acres: 1.760 Plat: N/A-NOT AVAILABLE
SEC 23 T30N R1 9W GL 7 LOT 1 OF CSM 3/644 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-30N-19W
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 TD
12/11/2000 635025 1566/122 TD
more...
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 BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T N, R W
ADDRESS- _ i ST. CROIX C LINTY WISCONSIN.
SUBDIVISION LOT ~ LOT SIZE
PT,AM ITTF't.1 w, CS►~ 3
v~5tanceG dimensions to meet requirements of H62.20 /
SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM NK
I di a e o th Arrow
SCALD- - I
SEPTIC TANK(S) MFGR. CONCRETE STEEL
NN a rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. ~)fiEL NO.
GALLONS Per Cycle
TRENCHES NO. of with length area
BED NO, of lines width length area
depth to top OT pipe
NUMBER OF SEEPAGE PITS Outs e i.ameter total pit area
AGGREGATE
PERK RATE RE 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 thn
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 PLUMBER ON JOB
LICENSE NUMBER
.REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM 3 j
San4 tan y Poirnit d
State Septtie-
J
AM Towneh.ip~ St. CAO' X,
County
u c a ti o nrc- S4) S c•ti o nZIlL o t h S u d.i v.ie o n
FPTIC. TANK
Size gallo nd Numb en o6 eo mpantmentc
,i,5tanee 64Om: Well ' Building 12% slope
HighwateA
'UMPING CHAMBER
Size gallo n.4 _ . .Pump Manu 6aetuneA Mu del Numb eA
OLDING TANK
Size gallona NumbeA o6 Com.pa4tment,6
PumpeA AlaAm Syatem
11:etanee 6AOm: Well Building 12% olupe
H.ighwateA
8-SORPTION SITE
Bed TAeneh
4
iatance 6AOm: Well Building M elope
H.ighwateA
IiSORPTION SITE DIMENSIONS
W.id.th o6 tAeneh 6t Requ.i Aed an.ea - ___6t
Length oA each line At Depth oA Aoek betuw tile Numbe.n o A
A l.i _ Depth uA hock uveA tt'xe
Totak kength u6 tine4 At Depth uA tile betow gAade_=
0i,6tance between tine-6 At Slope u6 tAeneh Cyl. pen 100 At z
l u 1.,,a aLo u~Lptiurt aAeu At Type o6 CuveA: PapeA un atAaw
IF DIMENSIONS"
Numbeh uA p.ite GAavel a4ound p4.tb yee nci
Outside diameteA At Depth below inlet 6t
Total abeonption aAea At
A.Aea Aequ.iAed 6t
NSPECTED• BY ~i TITLE
1111ROVED DATE 19 8
t JECTED _ DATE 19 B
IASON FOR REJECTION
REPORT ON INSPECTION OF SANITARY PERMIT #
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
ame, ress, cens o. of ns a. ing plumber Time of Inspection
(3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BENCHMARK: (Permanent 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;
li.neal 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-6095 N.05/80
Signature of Inspector:
PLB,67 State and County State Permit 3 C'
u V Permit Application County Permit #
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: Are '1,54tl Section T N, Rl
iw4wp* /W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# 1 77,
Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify)
Single family A 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 X Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate m Total Absorb Area`' sq. ft.
New y Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: -N Length Width " Depth je Z 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 [ 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 (own builder.
Plumber's Signature MP/MPRSW# =t Phone # ~%y -
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.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application --.4 C t' Fees Paid: State 1 V, TO County ~ OL' Date l ~ Z
Permit Issued/Rejected (date) / 2 i , Issuing Agent Name, t ~~fe
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
-
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I S? T~ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
, a ' DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH ` p
`Sf r C7
'~'x ~C P.O. BOX 309 \ " - ~•9
MADISON, WISCONSIN 53701 ~C
1C3 REPORT ON SOIL BORINGS AND PERCOLATION TESTS N ~CFj
f~
LOCAT Qect 3 , T$O-N, R/--?- fe[%(or)fownship or Municipality y' J~~P v
Lot No. B o1 No. .54-`r40/ f County Ti ~J/;? IAN/N 8~
U Subdivision Name
Owner's Na -e--
Mailing Address: W, ~w c`,ut/i rS
TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 4; - 7q PERCOLATION TESTS J '/k~ -
SOIL MAP SHEET SOIL TYPE 'O/ d
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P Z_ -ln rr Sf' c? ~ rP TA /L' /l,(Q ~ fC (G ~
P__3 12~
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST .JJ (DEPTH TO BEDROCK IF OBSERVED)
B- 2" ecgi-Se S.-51,-64t/flaw,
/S,1/1 Ct e,44. 64 " eu,*ts o S - s lvr_ ~ t 6r,
.2 Y"~~ 7"x5. s' cc:Rrse S-~~iGl~t ~r
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144 4a(~- > ~E rt s ,2~/'' 7 ",L-S S+`" Cc~'►¢rse S S/ ~t
B e, ~..--S, ,2Gs,,L, Cet,9r4zS-Sle&l,
`l6'' y-SY" ,C 9 ",C.s 57" 6u,41-SZ t~,
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet % suita e areas. Indicate' _nrm e of square feet of absorption ared
needed for building type and occupancy. L1 C, •r t° F~s 1i I"E41 Indic~ate scale
. ;7 11 -11 A~ or distances. Give horizontal and vertical reference points. Indicate slope. k-~ -/Y•
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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~beliV.
Name (print) Lrf'~ ~ Certification No.
e
Address L -j-/ r ~t C •
Name of installer if known
CST Signature°L-
;OPY A - LOCAL AUTHORITY
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