HomeMy WebLinkAbout006-1082-10-000
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• AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP a SEC- T-~-LN, R-LLW
P.O. ADDRESS ST. CROIX LINTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE I ffe-3 3 Z~OA S-r
PLAN VIEW ~~/S~ ~C. ~ S'• /
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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SEPTIC TANK(S) MFGRt^~<, /CONCRETE STEE .
NO. of rings on cover -~TDepth rr DRY WELL
TRENCHES NO. of width length area
BED no. of lines width len th area
depth to top of pipe
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AGGREGATE , C~ 1~-~ ✓>i ✓r<< x
PERK RATE AREA REQUIRED AREA AS BUILT • f~/;I, '
Disclaimer: The inspection of this system by St. Croix County does no's imply complete
compliance with State Administrative Codes. There are other areas that 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.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSPECTOR I
DATED PLUMBER ON JOB_ f j <-SIX
LICENSE NUMBER /
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11RPOP,T OF ITISPECTIO'_1- -1741MIDUAL SE!JAGL DISPOSAL SYSTEM
Sanitary Permit
State Septic 7a,5"
IS TOt1I1STiIP
'V St. eroix County
SEPTIC Size gallons. `umber of Compartments !
Distance From: 'Jell , ft, 12% or greater slope
ft.
Building _ ft. Wetlands 1 ft
lLighwater LLP ft.
DISPOSAL SYSL.:J Tile Field or Seepage Pit(s)
Distance From: Tlell
ft. 12% or greater slope ft
Building ft. Wetlands Z2
FIELD ~ r~lighwater ft.
Total length of lines ft. !Number of lines- Length of
each line ft. Distance between lines ft. Width of the
trench -ft. Total absorption area sq, ft. Depth
of rock below the .___.__..in. Depth of rock over the in. Cover
nver.rock, . Depth of tile below grade - _in. Slope of
trench in ner 1,00 ft. Depth to Bedrock ft. Depth to
ground water ft.
Number of pits Outside diameter ft. Depth below inlet
ft. Gravel around pit: ____yes no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
Oquare feet of see nit area required
Inspected
y • Title:
Approved Date 197.
Rejected Date 197
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State and County State Permit #
61
PLB67 Permit Application County Perm)t # s_-
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:
cl,
B. LOCATION: S~J Y4 '/4, Section , T N, R y Ir (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *-Commercial *Industrial *Other (specify) * ariance
Single family( Duplex No. of Bedrooms j No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms--
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY lz~M Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks `
New Installation Addition Replacement- Prefab Concrete x
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1 U 2). U 3) Total Absorb Area sq. ft.
Newer` Addition Replacement *Fill System
Seepa Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width / _ Depth ;'w Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size y ~r
Percent slope of land Distance from critical slope
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Co nd that I have sized the effluent disposal system from the EH-115 prepared
by the Ce i d oil Test r
NAME v ' t C.S.T. # s S and other information
obtained from ?rv~ (owner/builder).
C'
Plumber's Signature MP/MPRSW# Phone #2y6-3
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write In Space Below tt1 FOR DEPARTMENT USE ONLY /
Date of Application-- O Fees Paid: State hip A'_+ C _ C un ~I - 66 th Date
Permit Issued/Rojeeted (date) ~2~~ -Issuing Agent Name-~f"-L~
Inspection Yesx No 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 6/1 /76
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 TES~Sd
LOCATION _'/a,ISE'' '/c, Section ; T_. _ N, R _ f>(or) W, Township or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's Name: - u. -
Mailing Address: o__5 TYPE OF OCCUPANCY: Residence No. of Bedrooms '3 Other
EFFLUENT DISPOSAL SYSTEM: NEW N ADDITION REPLACEMENT
-~4 7
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL. TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
'JUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
3ER
I--
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)
f
CS.. fl'~Z 14 ~fl~ SL
3 6
1 -3 s
J- -
T S -,zy 4- ~ y -~6 SC
17 s T r z
6
AA. 1~t 6 _V -_3d
J
PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of squar feet of absorption area
needed for building type and occupancy. /l~SI Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.-
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I, the un ersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and meth ds 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
i
Name (print) 0 /L Certification No.
Address A Y 3
Name of installer if known L
CST Signature
COPY A -LOCAL AUTHORITY _
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Parcel 006-1082-10-000 05/09/2011 12:10 PM
PAGE 1 OF 1
Alt. Parcel 35.31.16.545 006 - TOWN OF CYLON
Current X' ST. CROIX COUNTY. WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - HENDERSON, LATON N & RANAE J
LATON N & RANAE J HENDERSON C - ERICKSON, SAMUEL C
SAMUEL C ERICKSON
1790 220TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ' 1853 240TH ST
SC 3962 SCH DIST NEW RICHMOND 11 U l~-~
SP 8020 UPPER WILLOW REHAB DIST ILCl'~t~--j
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 35 T31 N R1 6W 40A NW SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
35-31 N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
03/03/1998 574222 1302/044 WD
07/23/1997 1191 /160 WD
07/23/1997 863/304 LC
07/23/1997 7481436
2011 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/10/2010
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 15,000 24,900) 39,900 NO
AGRICULTURAL G4 38.000 7,800 0 7,800 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2011:
General Property 40.000 22,900 24,900 47,800
Woodland 0.000 0 0
Totals for 2010:
General Property 40.000 22,900 24,900 47,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0 00
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Parcel 006-1081-80-000 02/17/2006 01:27 PM
PAGE 1 OF 1
Alt. Parcel 35.31.16.542B 006 - TOWN OF CYLON
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 - HENDERSON, LATON N & RANAE J
LATON N & RANAE J HENDERSON C - ERICKSON SAMUEL C
ERICKSON SAMUEL C
1790 220TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property-Address(es): Primary
Type Dist # Description 3 240TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 2.060 lat: N/A-NOT AVAILABLE
SEC 35 T31 N R1 6W PT OF SW1/4 NW1/4 COMlock/Condo Bldg:
NW COR OF SW1/4 OF NW1/4 TH S ALG CEN LN -
TOWN RD, 561' TO POB; TH E 495' TH S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
1815TH W 495' TO CEN LN TN RD TH NLY 35-31 N-1 6W
TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
03/03/1998 574222 1302/044 WD
07/23/1997 1191/160 WD
07/23/1997 863/304 LC
07/23/1997 748/436
more...
2005 SUMMARY Bill Fair Market Value: Assessed with:
685 242,800
Valuations: Last Changed: 09/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.060 15,000 196,500 211,500 NO
Totals for 2005:
General Property 2.060 15,000 196,500 211,500
Woodland 0.000 0 0
Totals for 2004:
General Property 2.060 15,000 196,500 211,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch M PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00