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Parcel 030-1017-30-000 04/12/2005 02:33 PM
PAGE 1 OF 1
Alt. Parcel 05.29.19.74C 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* LINDSTROM, JAMES S
JAMES S LINDSTROM LINDSTROM, DAVID J
DAVID J LINDSTROM
1527 HERON LN
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 482 BLUEBIRD DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.700 Plat: N/A-NOT AVAILABLE
SEC 5 T29N R19W NE NE LOT 1 CSM 2/594 Block/Condo Bldg:
EXC N 83 FT
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
05-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/22/2004 777820 2681/322 QC
12/27/2000 635805 1569/612 QC
09/08/1997 1262/565 WD
2004 SUMMARY Bill M Fair Market Value: Assessed with:
4835 147,500
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.700 71,800 73,300 145,100 NO
Totals for 2004:
General Property 2.700 71,800 73,300 145,100
Woodland 0.000 0 0
Totals for 2003:
General Property 2.700 42,200 56,300 98,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 213
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
':'ER TOWNSHIP r - SEC. TLN, R W
3. ADDRESS, ST. CROIX CO TY, WISCONSIN.
`;,DIVISION LOT LOT SIZE
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
If I
-TIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on covers y Depth DRY WELL
INCHES NO. of width length area
no, of lines 'a widths length : r area
depth to top of pipe s
/-};off 1
RATE AREA REQUIRED AREA AS BUILT 1 y.{'
'.Claimer: The inspection of this system by St. Croix County does not imply complete j
.pliance with State Administrative Codes. There are other areas that it is not possible j
inspect at this point of construction. St. Croix County assumes no liability for
tem 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 PLUtIBER ON JOB_
LICENSE NUMBER z1
F REPORT OF ITISPECTION--INDIVIDUAL SLtIAGE DISPMV, SYSTE11
Sanitary Permit
r State Septic
kl, /7
1E TOWNSHIP
0-, 1 ,
• to Cr~ coot
SEPTIC Tr_-?I;
Size ~ gallons.
Number of Compartments
Distance From: We 11 I ~ ft• 12% or greater slope -ft.
Building` ft. Wetlands
Itighwater _ft.
DISPOSAL SYSTL:1 ar'~ Tile Field or Seepage Pit(s)
Distance From: Well ft. 12% or greater slope ft
Building ft. Wetlands
FIELD Hip
hwater -ft,
Total length of lines i ft. Number of lines Length of
each line ft. Distance between lines ft. Width of the
trench `ft. Total absorption area sq, ft. Dept::
of rock below the no Dp-pth of rock over tile ~ in. Cover
aver.rock,, Depth of tile below grade in.. Slope of
trench in per 100 ft. Depth to Bedrock ft. Depth to
ground water £t.
PITS .
?lumber of pits Outside di`am er ~ ft, Depth below inlet
ft. Gravel around pit:/-~s 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-.
EH 1. 15
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: ~~/4,A '/4, Section ~ , TA yyN, R /7 F (or~ownship or Municipality,`I.
Lot No. , Block No. County
Subdivision Name
Owner's Name: a e.4 #
Mailing Address: `w
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X, ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS -PERCOLATION TESTS /
e- f,7 SOILMAPSHEET - 0 SOIL TYPE ~y~ 7
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME 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
y 1' See 'rte 4 A /11
P- 2, -2x_~ 2 ly 2-,_
P .e°:. QA / 2- o .STS
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST y~ (DEPTH TO BEDROCK IF OBSERVED)
B_ / 7C Is ° t /.3 I~ G
I.&AL e 11 s o If - ,cs sly / O ~
Q
y 1.2
B- A,
sx,
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suit le areas. Indicate un)br of uare/feet of absorption area
needed for building type and occupancy. 5_%"~`gel (k~ t- 11LK In icate scale
or distances. Give horizontal and vertical refere c p dicate slope. f S- S' ell
CrK~
4__
I
{ €
i { ~ i i I I ~ ~ I fl
I I I ~
€ e s
~ i ~ ~ ♦ i t ~ ~ I i ~ ~ I I i I
,
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 an belief.
Name (print) Certification No.
Address
Name of installer if known
CST Signa r -
COPY A LOCAL AUTHORITY
f
. ate.
t
1
y 1 a
' i
A h ?
State and County State Permit #
LB 6 7 Permit Application County Perm
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. LOCATION: Y4 /4, Section T~ N, R1" & (or) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
~v Township .
C. TYPE OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms 13 No. of Persons
D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder YES_XNO # of Bathrooms
Automatic Washer __YES NO Other (specify)
E. SEPTIC TANK CAPACITY 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) :Z~ 2) 3)r.-Total Absorb Area sqq ft.
New(__ Addition Replacement- *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length'' Width ! [ -Depth y,Q Tile 36"' No. of Lines __.2_-
Seepage Pit: Inside diame r Liquid Depth Tile Size _
Percent slope of land ly -9 - Distance from critical slope 0-~
s 0;-, ,-A _0
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 C tified Soi T
NAME C.S.T. and other information
obtained from s own
Plumber's Signature MP/MPRSW# Phone #:ter
Plumber's Address Ol.
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
~c~1.e--
\ 2--5- i • J4,ueJ
..3..31 Jerte- loo
473
® / 0a j
J
Ll`
Do Not Write in Space to FOR DEPARTMENT USE ONLY
Date of Application ees Paid: State] aTv County 51 °a Date
1 ,~,1~i _Issuing Agent Name
Permit Issued/Rejected ate ►
Inspection Yes)( 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) -
A.A
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