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Parcel 042-1094-10-000 10/03/2005 10:02 AM
PAGE 1 OF 1
Alt. Parcel 33.29.18.519B 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
MICHAEL A & JANICE I HERMERDING O - HERMERDING, MICHAEL A & JANICE 1
1150 60TH AVE
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1150 60TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 7.220 Plat: N/A-NOT AVAILABLE
SEC 33 T29N R18W 7.22A IN SE SW LOT 1 Block/Condo Bldg:
CSM VOL 4/912 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 880/213
07/23/1997 721/06
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/23/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.220 55,200 120,900 176,100 NO
Totals for 2005:
General Property 7.220 55,200 120,900 176,100
Woodland 0.000 0 0
Totals for 2004:
General Property 7.220 55,200 120,900 176,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 221
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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• AS BUILT SANITARY SYSTEM REPORT
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' _ER_ Jt Al ~ C _ i TOWNSHIP ra SEC. T ' N, R - W
.J. ADDRESS ST. CROIX COUNTY, WISCONSIN.
0
DIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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TIC TANK(S) MFGR. k, CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
'NCHES NO. of width length area
no. of lines width length area
dep,th to top of pipe r
P,EGATE €.ti b G i ~K RATE .-7 AREA REQUIRED AREA AS BUILT
claimer: The inspection of this system by St. Croix County does not imply complete %
)liance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
--em operation. However, if failure is noted'the County will make every effort to
ermine cause of failure.
ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
-INSPECTOR %
DATED PLUMBER ON JOB ~LICENSE NUMBER
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R5POP.T OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.i.tany Permit
State SPpti
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NAME rownbhip S$. CAoix County
Locatiox Section
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SEPTIC TANK
Size loir7 gattonb. Numben o6 Compartments
Distance Fnom: Well 12% on greaten tope 6t
Bu.itd.ingit. Wettandb - 6.t.
H.ighwaten 6t.
DISPOSAL SYSTEM .
Distance Fnom: Well 6t. 12% on gneateA 4tope 6t.
Bu.itd.ing 6t. Wettandz Ft.
H.ighwatenst.
FIELD DIMENSIONS:
Width o6 trench /j6 6t. Depth o6 rock below tite_/2. .in.
1
Length o6 each tine Z-- St. Depth o6 Aock oven t.ite Z .in.
J~3 Numben o6 tines ~ Depth o6 tite below gnade2 O in.
Iotat .length o6 tines ~6t. Stope o6 tAench i n pen 100 6t.
Distance between tinea-L--it. Depth to b edno ck 6t.
Total abs onbt.ion anea'~st2 Depth to gnoundwateA 6t.
Requited area Ste Type o6 Coven: Pape.n o Straw
PIT DIMENSIONS:
Numben o6 pits, ~ GAavet around pits yez no
Outside d.Lamet*ae Depth below inlet 5t.
2
Tata.l absonbti6t ~
Area Aequ.ine j!~r 2
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INSPECTED BV TITLE
APPROVED DATE -19 7'9~"
REJECTED DATE -197_
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EH .115 Rev. 9/76
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION Section = E ,TL- N,R_LL~E (or W ownship r Municipality
Lot No. , Block No. County ~ -
Subdivision Name
Owner's/Buyers Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence k~ o. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS 7e PERCOLATION TESTS
SOIL MAP SHEET La NAME OF SOIL MAP UNIT
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
RATE
NUM- SINCE HOLE HOLE AFTER INTERVAL
INCHES THICKNESS IN INCHES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
BER 1ST WETTED SWELLING IN MINUTES
P -
P-
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-
B- -
B-
B_ - -
J -
B- _ -
PLAN VIEW (Locate percolation tests, 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 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.
r%j__ a (Swint 4 y/-7z 7 M LJ~ ,`f~ ~ Certification No.
Address es / zt:~ OX ,42
Name of installer if known cr 4~'
Copy A -Local Authority CST ign~ture~
State and County State Permit #
PLB ~67 Permit A lication County Perm
to pp
County
for Private Domestic Sewage Systems
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
~r
B. LOCATION: /4, Section , T.2`i N, R (or) (Y1 Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
i It 4 C1} Township !l ~l~ jyF-71/
/,w; 4~
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family pl- 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 l Replacement
Lift Pump Tank or Siphon Chamber - Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate -t7-1L3 (''3 Total Absorb Area JXS__ sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length S3 Width "s Depth &L " Tile depth (top) 20" No. of Lines
Seepage Pit: Inside td~~yiiameter _ Liquid Depth No. of Seepage Pits
Percent slope of Iandi'll 7c 2"` LOAA r Distance from critical slope
WATER SUPPLY: Private [~IJoint ❑ 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 4 ""IialC'~~~( C.S.T. # and other information
obtained from l- t` _Qowner✓builder).
Plumber's Signature MP/MPRSW# 'T"dL~ Phone # 77
Plumber's Address lz'- wle-,Y 7- ~iG max- / /7[! s Le It ~ 3kZ z`
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 Spac Bel w FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State County A-e Date
Permit Issued (date) 4- 4 ~ O Issuing Agent Name ' rl
Inspection Yes4No 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