HomeMy WebLinkAbout030-2081-20-000
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Parcel 030-2081-20-000 04/04/2005 09:24 AM
PAGE 1 OF 1
Alt. Parcel 25.30.20.689 030 - 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
* JENSEN, JEROME J & MARIE
JEROME J & MARIE JENSEN
1365 PINE VIEW TR
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1365 PINE VIEW TR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.650 Plat: 2644-WOODLAND HILLS
SEC 25 T30N R20W WOODLAND HILLS LOT 12 Block/Condo Bldg: LOT 12
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
2004 SUMMARY Bill Fair Market Value: Assessed with:
6399 161,000
Valuations: Last Changed: 07/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.650 71,200 87,200 158,400 NO
Totals for 2004:
General Property 2.650 71,200 87,200 158,400
Woodland 0.000 0 0
Totals for 2003:
General Property 2.650 41,700 72,500 114,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 216
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER ) F_+ O /I S TOWNSHIP, 7 SEC. -T 5 T?,c N, R 1~> W
P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION U to n Lan. ~ M r l l c fr11 LOTI Z_LOT SIZE X 3a~%
-dO
t PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
ell
r
r
F
SEPTIC TANK (S) _Lt (yjLMFGR. CONCRETE X STEEL
NO. of rings on cover / Depth DRY WELL
TRENCHES NO. of width length area
BED no. of lines -3 width length 'area 3c,
depth to top of pipe
AGGREGATE 112 ~ /_.7
PERK RATE AREA REQUIRED 4-, / AREA AS BUILT C
Disciaimer: The inspection of this system by St. Croix County does not 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
D ED P~ MBER ON JOB
'LICENSE NUMBER c_
~RyPgU OF ITIS':I]CTION--I74DIVIDUAL SETJAGE DISPO~'
Sanitary Permit
r State Septic
.,.A: IE
Tol- NSHIp
• t. Croix County
Sr.PTIC TA'?T:
.,a.ze gallons. -umber of Compartments ,
Distance From: We 11 ft. 12% or greater slope fl.
Building* ft. Wetlands ft
ghwat e r ft.
DISPOSAL SYSTF-zl Tile Field or Seepage Pit(s)
Distance From: well ft. 12% or greater slope ft
Building ft. Wetlands f.-,
FIELD Kighwater 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. Dp-pth of rock over tile in. Cover
nver.rock, Depth of tile below grade _in. Slope of
trench in ner 100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS
`umber of nits 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
Iquare feet of seepage nit area required -
Inspected by: Title:
Approved J Date 197
Rejected Date 197.
EH 115 (11-74)
• WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
• P.O. BOX 309
MADISON, WISCONSIN 53701
-t v M
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
K
LOCATION: '/4, '/4, Section , TN, R E (or) W, Township or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
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
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-
P-
P-
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-
B-
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 reference point. Indicate slope.
t N
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 and belief.
Name (print) Signature
Certification No.
Name of installer if known
Copy C - Local Authority
r
State Permit #
PLB67- r State and County
Permit Application County Permit
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. L CATION: -5E'/4 Section ,'Z, T JON, R 2 6 3t (or) d, Lot# 12- City _
Subdivision Name, nearest road, lake or landmark Blk# Village
Township 5 C2r
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family X Duplex No. of Bedrooms No. of Persons Z,
D. TYPE OF APPLIANCES: Dishwasher YES _ K NO Food Waste GrinderYES X NO # of Bathrooms
Automatic Washer _X, YES NO Other (specify)
E. SEPTIC TANK CAPACITY /600 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) _jI 2)/3) / Total Absorb Area ft. /
New Addition Replacement *Fill System gyp' e~C4rirGd
Seepage Trench: Nn . Feet Width Depth Tile Depth No. of Trenches
V'Width Depth Tile Depth No. of Lines
Seepage Bed: Len
if
Seepage Pit: Inside diameter Liclyiid Depth Tile Size
Percent slope of land Z' czy 641eS 1 eV / 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 Soi Teste ;
NAME C C.S.T. # and other information
obtained from % owner /
Plumber's Signature P/MPRSW# Phone # 7~J' ~~cli ' .3~3
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
/'P~cs ~ u.rc L~ t
f2
r
Do Not Write in Space Below FOR DEPARTMENT SE ONLY Date of Application Fees P id: State Couagy Date
Permit Issued/ (date) Issuing Agent Name
Inspection Yes-"kl/ 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