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Parcel 010-1039-30-000 02/22/2006 02:28 PM
PAGE 1 OF 1
Alt. Parcel 16.30.16.243B 010 - TOWN OF EMERALD
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 - PRINSEN, DONALD V & BARBARA
DONALD V & BARBARA PRINSEN
2330 CTY RD G
EMERALD WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 2330 CTY RD G
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 5.580 Plat: N/A-NOT AVAILABLE
SEC 16 T30N R1 6W 5.58A IN SE SW LOT 1 Block/Condo Bldg:
CSM VOL 2/599
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-30N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
80225 Use Value Assessment
Valuations: Last Changed: 10/19/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 15,000 99,400 114,400 NO
AGRICULTURAL G4 3.580 500 0 500 NO
Totals for 2005:
General Property 5.580 15,500 99,400 114,900
Woodland 0.000 0 0
ii Totals for 2004:
General Property 5.580 15,500 99,400 114,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 208
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 30.00
Special Assessments Special Charges Delinquent Charges
Total 30.00 0.00 0.00
i I
i
AS BUILT SANITARY SYSTEM REPORT
:-ER TOWNSHIP C-C (EC. r T N, R W
J. ADDRESS , ST. CROIX COUNTY, WISCONSIN.
3DIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t
1 ,
"TIC TANK(S)_ MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
':`ACHES NO. of width length area
no. of lines width length area
depth to top of pipe
EGATE
RATE AREA REQUIRED AREA AS BUILT
tiaimer: The inspection of this system by St. Croix County does not imply complete
.)fiance 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
Lem operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
".SES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. INSPECTS-
----DATED PLUKBER" ON JOB
LICENSE NUMBER „r
Pr
REPORT Or IJ1SPrCTIO'_1--171DIJIDUAL SLt]AGE llISPOSl1I, SYSTEM
Sanitary Permit
State Septic '1; -
.A! 1E TO[•TIISHIP ~c._.
St. Croix. County
c Sr, P TIC T.A711 ,
i Size gallons. 'lumber of Compartments
Distance From: Tlell ft. 12% or greater slope ft.
Building ft. Wetlands f,
Highwater f
DISPOSAL SYS7:4 Tile Field or Seepage Pit(s)
Distance From: Well ft. 12% or greater slope ft
Building; ' J ft. Wetlands f.
FIELD ~;ilwater ft.
Total length of lines ft, !Number of lines Length of
each line ,~fya Distance between lines ft. Width of the
trench -ft. Total absorption area sq, ft. Depth
of rock below the in, np-pth of rock over tile in. Cover
nver.rock,, Depth of tile below grade in. Sloe of
trench -in per 100 ft. Depth to Bedrock ft. Depth to
ground water ft,
PITS
"lumber 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
Square feet of seepage nit area required
Inspected by: Title':
Approved Date 197
Rejected Date 197.
i -
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES 1t'~
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
- MADISON, WISCONSIN 53701
~RREPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: Y4, 54& Section i ~ , T?N, R L E (or W ownship or Municipality 0,11
Lot No. , Block No. County C A?-O1K
Owner's Name: 0~4 101 PleikW«, Subdivision Name
Mailing Address: y'oy jp,!)
TYPE OF OCCUPANCY: Residence A No. of Bedrooms -3 Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT ,
DATES OBSERVATIONS MADE: SOIL BORINGS 29 S° PERCOLATION TESTS * 1704
SOIL MAP SHEET Y SOIL TYPE -
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IACTERN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
i
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t s 5 15- 113,e- s z~ 7" - Si-11
r- -
2 a , ` r S1. tgz 2
t 3
IP 3T~, 1~2o t I SCR -3 4- 2- 1 i nf!4-~, 3_0
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMqER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
L_
2 11 F, 4 C~
7 y T t r Sta t > ~3r
J 7;' J4
7 -S S ti j l 1 I IL 3 34 2 i,
k
N VIEW (Locate percoiationtests,soil bore holes and suitable soil areas.)
i case on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
e ed for building type and occupancy. Indicate scale
or istances. Give horizont I an vertical reference points. Indicate slope.
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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.
eT 1
Name (print) 7 'fak, 1,0
! Certification No.f
Address
Name of installer i known
CST Signature '
COPY A -LOCAL AUTHORITY
PLB67 State and County State Permit #
Permit Application County Permit
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
.
Date Approval ReAceived from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
a
ay~
B. LOCATION: y_Y4 /4, Section G,~ N, R E (or) QLII- Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township 6j o
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family I- Duplex No. of Bedrooms _3 No. of Persons _
D. TYPE OF APPLIANCES: Dishwasher YES _ 1,,,-°,.'NO Food Waste GrinderYESG6 # of Bathrooms
Automatic Washer l-' YES NO Other (specify)
E. SEPTIC TANK CAPACITY- 0'ID Total gallons No. of tanks
*Holding tank capacity- Total gallons No. of tanks
New Installation l -Addition Replacement- Prefab Concrete 4----"
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1).22)-2-X3) ~Total Absorb Area e' ° sq. ft.
New Addition Replacement *Fill System I
Seepage Trench: No. Lin. Feet /4 e -Width Depth Tile Depth / No. of Trenches / sip A, Seepage Bed: Length Width Depth Tile Depth No.
of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
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 Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME C.S.T. # and other information
obtained from a cc ~ / (owner/builder).
Plumber's Signature L MP/MPRSW# Phone f l 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 FOR DEPARTMENT USE ONLY
Date of Application Fees Paid: State' County; Date ' 5>
Permit Issued/ (d te) _Issuing Agent Name 1-6
Inspection Yes__,LNo 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