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Parcel 042-1036-90-000 01/16/2007 03:58 PM
PAGE 1 OF 1
Alt. Parcel 14.29.18.215 042 - TOWN OF WARREN
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 - NECHVILLE, HENRY
HENRY NECHVILLE
967 HWY 65
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 967 HWY 65
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 14 T29N R1 8W SW NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/12/1998 572884 1295/516 TD
07/23/1997 811/209
07/23/1997 525/159
2006 SUMMARY Bill Fair Market Value: Assessed with:
149243 Use Value Assessment
Valuations: Last Changed: 07/11/2003
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 35.500 5,600 0 5,600 NO
UNDEVELOPED G5 0.500 100 0 100 NO
OTHER G7 4.000 30,000 147,000 177,000 NO
Totals for 2006:
General Property 40.000 35,700 147,000 182,700
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 35,700 147,000 182,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 126
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP L~2 SEC. l T21N-R 40
ADDRESS R J .V9 ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE 9C, PLAN VIEW
Distances and dimensions to meet requirements of H63
OyLEVERYTHING WITHIN 100 FEET OF SYSTEM
I di a e
SE-.- - - thI Arrow
C L
5 W C cr~n.x
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: /00, Slope at site: 0 - !c.
SEPTIC TANK: Manufacturer: ( ~ (_~.1,~&, Liquid Capacity: /000
Number of rings on cover Tan manhole cover elevation:,7y y%3' "
Tank Inlet Elevation: _ Tank Outlet Elevation: ~s'- Syr
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cyc e gallons; total capacity o
distribution lines gallon: size o 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: um er o pits feet diameter ,
feet liquid depth seepage pit in et pipe-elevation
bottom of seepage pit evation feet.
SEEPAGE BED SIZE: number of lines width length t%1 edepth
SEEPAGE TRENCH: width a~ length REA AS ABUILT (00
PERCOLATION RATE REA REQUIRED ~U
INSPECTOR
DATED PLUMBER ON JOB nQ~Y~
LICENSE NUMBER jP AS 325 g-
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitatt.y Pv mit
State Septic
/ ►C 2t)cLrre NAME ,P7own~sh.Lp rn St. Ctcoix County
Location d s 14) Section Lat # A~L Subdivision
SEPTIC TANK
Size T7::7q, gatto ns Numb et o6 ea mpahtme.nts
Distance Okom: WeU Building 120 sfope
HighwateA
PUMPING CHAMBER
Size_ ga tons . Pump Manuoaetunett Mode. Numbetc
HOLDING TANK
Size gaUon6 Numbers o6 Compatctmentb
Pumpe.te Atattm System
Distance ()Aom: Glee' Buitding 120 s tope
Htighwaten
ABSORPTION SITE
Bed 7neneh
Distance ()tzom: (ue.U,
BuLtding _ 120 5tape
d 751
Htighwate.tr.
ABSORPTION SITE DIMENSIONS
Wkdth o{ tkeneh At Requited altea 4t
Length o6 each tine. {t Depth o6 lock be.tow ti.-e in
N mb n
u e o{ tines Depth. o tt.oeFz ove.tc tiT.e_ in
7otaf length o(j Unes. r 6t Depth o4 tite be.fow gtcade.Se ~ L tin
Distance between tines ~t Stope o6 ttt.ench tin. pelt 100 ~t v
TotaE absotcption. atcea __6t Type o6 Coven.: Papetc o straw
PIT DIMENSIONS
Numb e tt. o (j pits ~ Gtc t atcound pits yes no
Outside. diameters t XD . h below intet
7otat absotcption attea j` 6t
Atcea tcequined - 6t
INSPECTED f TITLE
APPR VED DATE - / 198
REJECTED DATE 198
REASON FOR REJECTION
7 C
R i State and County State Permit # 1-3
■ LB67 Permit Application County Permit #
~
Y_~~-.
for Private Domestic Sewage Systems Count
S s
Y
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
y C 2- .
B. LOCATION: Ntl' Section _L,~t, T V `i N, R/,? E (or) (-W) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township L;i~t
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family f Duplex No. of Bedrooms No. of Persons 3
D. SEPTIC TANK CAPACITY Total gallons No. of tanks /
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete i/- Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Yic~~4-Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation RateP>~jpry~. - Total Absorb Area ?5 sq. ft.
New Replacement Alternate (Specify)
Seepage Trench:_Jf" No. of Lineal Ft. /40 Width A"' Depth LTile depth (top) No. of Trenches
Seepage Bed: Length Width Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land C - 1 'lc 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 Certified Soil Tester,
NAME Li tt ~i
3. _
c 4, `G C.S.T. # 64- 9 9 14' and other information
c
obtained from { r t' (owner/builder).
Plumber's Signature ✓ ' MPRSW# ~JO_ Phone # ref ~ ' -"_J~-L
Plumber's L ddress
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. c, G
D~ v 0 V
S
E a
F 3
i
4
r
I
. , 3
E
13 M e'
P
13
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application 6'O Fees Paid: State.-;1-35✓ County I~S . d-~ Date
Permit Issued/R-efee4ed (date) -7 '.21 Issuing Agent Name 2a
Inspection YesX_No State Valid# Date Recd
1
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, W~
2. state (pink copy) 4. plumber (canary copy) 1/
Revised Da
P` 1 Vpe~
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REPORT ON INSPECTION OF SANITARY PERMIT # ~d
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
Time of Inspection
ress, License o. o ns a ing Plumber
3 I TALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
(4)BERCHMARK: (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:
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 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:
1-74)
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: Nom' '/4, ~ •'/4, Section / , TP' N, Rb E (or) U Township or Municipality
Lot No. , Block No. County c .4
,n - Subdivision Name
Owner's Name:
Mailing Address: i2 1~ ( cn ~ti L' Az 3 5!C _-9-
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
;2 6
DATES OBSERVATIONS MADE: SOIL BORINGS'
PERCOLATION TESTS
SOILMAPSHEET SOILTYPE ~Z.u~.- Lc+a •r~ N,M7
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 MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MI
I I'v "Z 13,
P-Z
P-: ►.~(t tt. iS IL
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B-
oZ 1 yA. I 7 10 i B_ Rs,
,
V 0 11 0 011 16- &,1 Alt
I 11Y S,
PLAN VIEW (Locate percolationtests;soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. 7 C p C ~4 'l aao ,~-t ~e 1 e _ Indicate scale
or distances. Give reference point. Indicate slope.
D'
L~,•,x , tea: -
,cy f
N
A 13
1 i.7 B ~ t~
a 1
NIP
.Yz
Yt'
_7 7 17+
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) C - I ~ e_ 1Je-0 k V r~ ~fo
Signature L (X i
Certification No. T4 4 ~2 7-7
Name of installer if known
" ,=rop iey Owner