HomeMy WebLinkAbout038-1157-80-000
h cn O K v h d ~1
U o 1
CD CD -0 y ~
~ a xx °
v CD v m
~ Q
Cn 2 c~ Z W O N C/) Ow
0 v N <t •
3 0 (D N(o n w
m Q Z C- N O O
UI (D O W O N v O 1
N O
Cl
° J
O O = N Q
m e O O O
3 0 _
7 N O O
N N
y^ ~ O
co c0 N N Q. A
73
co
(D c
n O O ~y
J O rn + V
N N (D
~ Cwt CO (D
o o Z
CD 0 CD
o O G
to
n
z 0 0 0 3
o E °
v v v ~ ~
O d 'o v ° N
CD - Ao Q
G7 y
N O ~ ~ v
CL ~
Z
N
ZW00 z
O o
o D
o @ (
CD m
cn
CC N
m CC
c co m
w ~ n
n 3 _
Z :3 m
o N _
Q z o'
v h ~
a
W v m N
CD 3 A z
Z
3 co
z
m a
w ~
O D
(nD
~ n
cn w ° ,i
o oZ CL
0
m cn
3 R7
N L.
O
N
(n Q`
~ t
~ a
a
v 4+
a ti
w o
N
CD o
o
o a
o a
3
•
a o
O 6p
'50 O
o g a
o °
Parcel 038-1157-80-000 02/10/2006 10:45 AM
PAGE 1 OF 1
Alt. Parcel 22.31.18.738 038 - 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
KURT A HATELLA O - HATELLA, KURT A
2081 114TH ST
NEW RICHMOND WI 54017-6023
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ' 2081 114TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres 1.510 Plat: 2230-NORTHWOOD
SEC 22 T31N R1 8W PLAT OF NORTHWOO LOT Block/Condo Bldg: LOT 18
18
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 682/179
2005 SUMMARY Bill Fair Market Value: Assessed with:
119986 168,300
Valuations: Last Changed: 10/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.510 28,600 136,800 165,400 NO
Totals for 2005:
General Property 1.510 28,600 136,800 165,400
Woodland 0.000 0 0
Totals for 2004:
General Property 1.510 28,600 136,800 165,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 122
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Y
AS BUI T SANITARY SYSTEM REPORT
OWNER TOWNSHIP
_ T 11t SEC -3) T ) N-R)W
F3
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE:
PLAN VIEW
Distances and dimensions to meet requirements of H63
hL~yEYTHING WITHIN 100 FEET OF SYSTEM
A Ac
77
a
I di a e o Ch Arrow I ,
SCALE:
-
BENCHMARK: (Permanent reference Point) Describe:
~cuk' ~c r SrxG:
Elevation of vertical reference point: Z, Slope at site:
-1
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings on 'cover : - an manhole cover ele atio : l}
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set o a cyc e gallons; total capacity distribution lines gallon: size of pump head;
gallon per minute horsepower ran name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of.manhole cover.
Type of warning device
SEEPAGE PIT SIZE: Number o pits feet diameter
feet liquid dept- seepage pit in et pipe-elevation
bgttom of seepage p-it ; ev tion feet. ,
SEEPAGE BED SIZE: number of lines width lerigth5~) tile depth,3;C~
SEEPAGE TRENCH: width length
PERCOLATION RATE. A REQUIRED' REA AS BUILT
INSPECTOR n
DATED., PLUMBER ON J BL
LICENSE NUMBER
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Santitany Pe,,m.(.t
State Septic
9dc
NAM ownahip St. Croix County
Location _Sec oN4 of # Subdiviacan
SEPTIC TANK
Size. Zc
-Z~ ga f Eons umb en o o ea mpantmen to
Dtia anee Anom: We2f- - Buitding o 120 mope
H.tghwaten
PUMPING CHAMBER /
Si ze. gaffovta _ Pump' Aac Hen Modet Numben_
HOLDING TANK
Size_ _ gaEQona Numb aA Co ntmenxis
A~ rn ya
Di6tance AAom: Weft ' Buifding 120 agape
Highwa.ten
ABSORPTION SITE
Bed Ttceo ch
Di.atanee Aram: (Ve.te
_ 0 Building 12% stope
Hk.ghwaten
ABSORPTION SITE DIMENSIONS
Width oA trench ~ At RequiA.ed area /5- At
Length oA each tine - At Depth oA Hoch be.eow Cite (c- tin
NumbeAu oA kti-nesDepth oA Hock oven t.EEe Z' En
Total Length oA einea 7-- At Depth oA ti e below grade Y2_ I-n
Diatance between tine-,5 l+" At Shope oA tttench in. pen 100 At
To.taf absorption area ~Z At Type oA Coven: Papuan atnaw
PIT DIMENSIONS
to yea no
Numb e A o A pith Gnav an rn~et
Ou-tatide diameteA. At /t- e ow _
T
otal aba onption area At
Area nequired At
1NSP BY- ~C TITLE
APPROVED DATE S _ 19 8)
REJECTED DATE 198
REASON FOR REJECTION
I
EH 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
LOCATION: Section-., T•--3/N, R /9 F_ (or) U~jl, Township or Municipality SnN IWAc
Lot No. J-8- Block No. County
/ Subdivision Name
Owner's Name:
Mailing Address: r
TYPE OF OCCUPANCY: Residence -__X No. of Bedrooms -3 Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS -R~
SOIL MAP SHEET SOI TYPE .~hh1Cil'~jCZi ~J,A~►l .i' : j.r,
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS ICHARACTERN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 7 PERIOD 2 PERIOD 3 MIN/IN
P- /
P
S 71A
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATE , INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATE HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
-716 - 'r
o e 1..
-
1 -
PLAN VIEW (Locate percolation tests,soil ore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. I!11 gate number of square feet of absorption area
needed for building type and occupancy. Indicate scale 445 or distances. Give horizontal and vertical reference points. Indicate slope.
jor
i
i
,
( 1 r N
AIL,
/4
- r-
I I
.~_F___- - - -
011
10
v - - _ -
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) 4i 13 1A) Certification No.~SY-
Address
Name of installer if known
COPY A -LOCAL AUTHORITY CST Signature
l
REPORT ON INSPECTION OF SANITARY PERMIT
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
y
.
7p' Address, icense No. o ns a mng Plumber Time of Inspection
Z-2
(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;
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:
~I
PLB 7 State and County State Permit #
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. LOCVr N: 42 '/4 '/4, Section T N, R E (or) IN_ 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 S No. of Persons Y
D. SEPTIC TANK CAPACITY /00(-') 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 4 Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length _WidthDepth ~z Tile depth (top) S z No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- c-Z?l Distance from critical slope
WATER SUPPLY: Private X 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 Cer~ified Soil T ster,
NAME C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signature _ MP/MPRSW# Phone Z-3,
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.
/Q
3
.v o
I
a r
S
E
E
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: Stater County '21, 'o-C) Date -7
Permit Issued/Refeete~&- (date) Z ~ Issuing Agent Name
Inspection YesA_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