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Parcel 182-1025-95-200 01/08/2007 04:40 PM
• PAGE 1 OF 1
Alt. Parcel 311707-23-02-00-00-000 182 - VILLAGE OF STAR PRAIRIE
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 - CLOUTIER, BRIAN J & LORI L
BRIAN J & LORI L CLOUTIER
2263 30TH AVE
OSCEOLA WI 54020
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.030 Plat: 3553-CSM 13/3553
_SEC 7 T31 N R1 7W FRL SW NW FKA PARCEL Block/Condo Bldg: LOT 2
219E~BEING LOT 2 CSM 13/3553
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
y~ d J~ 07-31N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/03/2004 764737 2588/213 WD
05/02/2002 677840 1882/390 WD
11/17/1998 591836 1378/199 LC
2006 SUMMARY Bill Fair Market Value: Assessed with:
182716 167,900
Valuations: Last Changed: 10/21/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.030 12,000 124,100 136,100 NO
Totals for 2006:
General Property 1.030 12,000 124,100 136,100
Woodland 0.000 0 0
Totals for 2005:
General Property 1.030 12,000 124,100 136,100
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
PXiER " , TOWNSHI =__SEC.Z_ T_5 N, RRW
p. ADDRDS~S
ST. CROIX COUNTY, WISCONSIN.
."BDIVISION , LOT LOT SIZE
•
PLAN VIEW
-Distances b dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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IrXdicate North; Arrow j
SCALE :
~TZC TAh'K(S)_ MFGR. I y~ CONCRETE STEEL
C1~%tt~ei9oloit. V'71~11,r~ .a.S"
NO. of rings or cover Depth DRY WELL
ANCHES NO. of width length area
no. of lines_ width length areal • "
depth t top of pipe
aGREGATE
RATE AREA REQUIRED AREA AS BUILT
11 F-~ lisclaimer: The inspection of this system by St. Croix County does not imply complete
.opliance with State Administrative Codes. There are other areas that it is not possible
,0 inspect at this point of construction. St. Croix County assumes no liability for
,stem operation. However, if failure is noted the County will make every effort to
,etermine cause of failure.
.,EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM
`INSPECTOR
DATED C22 ^ PLU; iBER ON JOB _//10
LICENSE NUMBER /~1
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
S anitat y PvLmitl,~1-9
State Septic
NAME. Town/s hip St. CtLoix County
Location &kI Se tion~Lot # Sub divilsion
SEPTIC TANK
Size gat ones NumbeA o6 compaAtments
Distance 6tom: we2t Buy 2di ng 1-2% tape
Highwatet
PUMPING CHAMBER
Size gattons__ Pump Manujjactutet Model NumbeA
HOLDING TANK
Size gattons NumbeA o4 CompaAtment/s
Pumpet AZaAm System
Distance 4tom: Wett Building 120 /stope_ _
HighwateA
ABSORPTION SITE
Bed h, Ttench
Diztance ~Aom: Wett Building 120 stope
HighwatvL
ABSORPTION SITE DIMENSIONS
Width o6 tAench j ~ 6t Requited area 6t
Length o6 each tine 6t Depth o{j Aock below Cite ~ .2- in
Numbers oA Una ~ Depth o6 tock ovei tite in
1 ~Totat .length o4 Una C~` l 6t Depth o~ tite below grade in
Di6tance between tine6 6t Sope o6 ttench in. pet 100 6t ~
Total ab.sotpLion aAea ( t Type o CoveA: Pa ot ~s ttaw r"
~i ~i p ~
PIT DIMENSIONS
NumbeA o6 pits GAavet around pith yes no
Outside diameteA 6t Depth betow inter 6t
Total ab6 otption aAea 6t
Atea tequi. Le 6t
INSPECTED By 'L TITLE C
APPROVED mm- DATE - c 198V
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
Name, Address, icense No. o ns a Ong Plumber Time of Inspection
(3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
(4)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;
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-6095 N.05/80
Signature of Inspector:
PLB 67J I State and County State Permit #
4, Permit Application County Permit
- - for Private Domestic Sewage Systems Count
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY M Add ess:
B. LOC TION: .Zq2 /4 dAJ /4, Section , TI N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township mSaArw
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms -No. of Persons_
D. SEPTIC TANK CAPACITY 0,0 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 44 q Total Absorb Area sq. ft.
New Replacement__Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width ppth Tile depth (ttop) No. of Trench
Seepage Bed: J Length <,!U Width a I Depth Tile depth (top) cz2zSNo. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land - Distance from critical slope
WATER SUPPLY: Private CK 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 Ce ified Soil Te, r,
NAME -Liiw l&,U- 'S ~IT" C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signature
11 1. MP/MPRSW# ~j. Phone 'Z_
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 DEPRTMENT USE ONLY
Date of Application 21~~7 (i Fees Paid: State County - Date
Permit Issued/Rejected (date). Issuing Agent Name 9
Inspection Yes,4- No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 5371y1
2. state (pink copy) 4, plumber (canary copy) Revised Date 7
EH L1 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:S1e_''/.,AL%, Section 7 j6LN,R, 7_0 (or) W, Township or Municipality ~r AIMAI
Lot No. , Block No. County
ub ivision Name
Owner's%Buyers Name: '
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT~ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS S-Z-740 PERCOLATION TESTS 9-,12-90
SOIL MAP SHEET '3~ NAME OF SOIL MAP UNIT &4k ~'hhr -54A 941
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE BOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- j 1-2 S _ 7~ a
hr
y
P- _ J6 ZA
P- ~r ?
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-
B- > 7 8'1 _S
B- > 'ac
B- -
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the Igation and square 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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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) Certification No.
Address &All
Name of installer if known.-- J
I
Copy A -Local Authority CST Signature
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