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Parcel 038-1055-80-000 12/05/2006 10:43 AM
PAGE 1 OF 1
Alt. Parcel 13.31.18.239B 038 - TOWN 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 - ERICKSON, NILA M
NILA M ERICKSON
820 WOODLAND LA
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1352 210TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 13.540 Plat: N/A-NOT AVAILABLE
SEC 13 T31 N R1 8W 13.54A IN SE SW & IN SW Block/Condo Bldg:
SE LOT 1 OF CSM VOL III PAGE 739
ASSESSED WITH P242B Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
13-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/17/1998 593898 138728 PR
07/23/1997 ` Q745/532
2006 SUMMARY Bill Fair Market Value: Assessed with:
175040 Use Value Assessment
Valuations: Last Changed: 10/05/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 37,000 74,400 111,400 NO
AGRICULTURAL G4 11.540 2,000 0 2,000 NO
Totals for 2006:
General Property 14.540 39,000 74,400 113,400
Woodland 0.000 0 0
Totals for 2005:
General Property 14.540 39,000 74,400 113,400
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
RIE T.31 N:- R.1 8 W. 55
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GOLF
AS BUILT SANITARY SYSTEM REPORT
OWNER DRESS TOWNSHIP..~<,~'.r=SEC. J, T.-3 LN, R W
ST. CROI_X COUNTY WISCONSIN.
f
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances h dimensi.gns to meet requirements of H62.20
i~ _
SPI,,N EVERYTHING WITHIN 100 FEET OF SYSTEM
4 -1
j) 1
J ~'1
5 -
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t IdiaAp
vw
, SC LE : SEPTIC TANK(S) MFGR. CONCRETE STEEL
NO. of_ rims on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of width length area
BED NO. of lines width! -!length area ;4depth to top of pipe 3
NUMBER OF SGE PITS Outsi e ~ameter total pit area
AGGREGATE 3 ' - r ._~DCK
PERK RATE/ 1'~;'z 1tEQUIRED 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 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.
CREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM.
INSPECTOR
PLUMBER ON JOB
DATED L/- Jk
6
LICENSE NUMBER;
r3v
Kl f'01:7 01 1NSI'LCTION INDIVIDUAL SLUTAUE SyS7lM
Sarni-.t,z~ttl Pc~ttit it ~aZ
State Sepa
!AMI
-o(v AIt.i.J St. Cnu~.x Counts
0 0 av -Z
<a tt-uvtIs Sec,atuvL-I_ut Subdc.vti6.<uvt
1 I'l IC IANK
S-i rte ___._----_----_-.--gafeurt's Number u( ei~rnpantrnevtt5
t,m"c (hum: WcYY 13u-(Xd,ivttl 120 5X-upe.
H-c y6rwit
(IMPING CUAMI.il R
Si zc o(t,fCuvtA Pump Martu(actLttten. Mode Nu.mben.
% i_D 1 N lAN h
S.i <e gafkuoA Numbers u( Compan-1rrtcvt-t-5
Putit pt !I Akanm Sy, -terri
~tartc o It urrt: Wet 6oAA, d.i.vi.y 120 Mope.
I1.tyitwa.ten_
T ION 1, 1 TE
d-
T ~L e rL c it
ti topw(' (hum: (Ue.fk 13it .i.t'd-evty t2„ A f o e
fig yitwate/I
01:1'11ON S1-1L DIMLNSIONS
wl dt 17 U I/L.eV1Ch (t Regained area (,t
1.evt<-Itit u(I each t<vte- {t De.p.tit u( hock be1'.uw te- -----~vt
Nttrnbeit o0 Pi teA Deptit of hock oven t 4 f v iw
Tuta( tcnptit o6 k -tneA (t Deptir ut4te. be-fow grade „ in
L) Atavtc e between X-inee (t Shope u{ ~ne.ne.it tin. p.e.h 100 (.t
Lutae abhuhp.t-iurt a re-u ()t Type u( Coven: Papers un A.thaw
I1 V 1 M1 N ti _ IONS
Nurnbeh u( pi.tS Gnavek anuuvtd pits yeA nu
Out~idc diartteten (t Deptit be-K.ow Ln.fet (t
Tu tut (-tb!u npt~oit area (t
Arica icgt itcd (t
I'1'l~OVl D DATI 19 8
( JlC7ED DATI~ 198
I ASON 1 01: RI JI C I10 N
i
i~0
6 7 C3/_
State and County State Permit # )1
PLB- Permit Application County Permi #
u
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:
Lal),411_11 -7
B. LOCATION: S/u Section, TN, Rj.j U (or) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township lsi4w a /1=
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms _3 No. of Persons
D. SEPTIC TANK CAPACITY 1/)0t) 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 ReplacementX -Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X 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
UVATER SUPPLY: Private 54 Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information 1 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 ester,
NAME, ✓ L~zQS C.S.T. # -yj4 and other information
obtained from T , (owner/builder). /
Plumber's Signature MP/MPRSW# J,LL 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.
,
i
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{ 3
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application FeesG Paid: State & L°-el County d Date D
Permit Issued/f9}" (date) Issuing Agent Name
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
nX~ S 4~! S l,/ s tc 13; 7--3141, If)J U
Sa/
C: O
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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, License NO. o ns-a ing Plu er
(3)INSTALLATION CONSIST F: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN ermanent re erence oin , escri e:
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:
M 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 TREN H: 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:
EH 1.1x5 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 Section N,R-,L.S q (or) W, Township or Municipality '444V
Lot No. , Block No. County Sr• V
ubdiwslon Name
Owner's/Buyers Name: ILIA) AO Ali" ~
Mailing Address: ~<<! ,kJ~"1~Jhn~/~1f r
TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT_ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS i0-/7- fVn PERCOLATION TESTS
SOIL MAP SHEET/ NAME OF SOIL MAP UNIT &,EK.✓d&f Ss3VY ellwy ;X
PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- DEPTH CHARACTER SOIL SINCE HOLE HOLE AFTER INTERVAL RATE
MIN/IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWE LING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- e - t 1
/19 73 r 7
P- f r r r
P- f
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- 7 _
S
B- 9,2 7 J/La, J.
B- c _ C _ IY _26 Q 'S
B-
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the Iption and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy 11 L~ Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
_Sa"L &4,1.465 J, 911
64 94
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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
Name of installer if known a
1
Copy A -Local Authority CST Signature