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03/24/2005 07:41 AM
Parcel 030-1096-90-000 PAGE 1 OF 1
Alt. Parcel 32.30.19.353E 030 - TOWN OF SAINT JOSEPH
ST. CROIX COUNTY, WISCONSIN
Current X
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): = Current Owner
* MESCHIEVITZ, HENRY S & JESSIE
HENRY S & JESSIE MESCHIEVITZ
1229 ROLLING HILLS TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1229 ROLLING HILLS TR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.540 Plat: N/A-NOT AVAILABLE
SEC 32 T30N R19W NW SE LOT 3 OF CSM Block/Condo Bldg:
2/514 & REPLATTED BY CSM 3/636 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
32-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 694/08
2004 SUMMARY Bill Fair Market Value: Assessed with:
5625 275,800
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.540 82,100 189,200 271,300 NO
Totals for 2004:
General Property 3.540 82,100 189,200 271,3000
Woodland 0.000 0
Totals for 2003:
General Property 3.540 48,100 146,100 194,2000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 313
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
00
Total 0.00 0.00
Parcel 030-1096-90-000 02/25/2005 12:32 PM
PAGE 1 OF 1
Alt. Parcel 32.30.19.353E 030 - TOWN OF SAINT JOSEPH
ST. CROIX COUNTY, WISCONSIN
Current X
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): = Current Owner
MESCHIEVITZ, HENRY S & JESSIE
HENRY S & JESSIE MESCHIEVITZ
1229 ROLLING HILLS TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1229 ROLLING HILL TR 1
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.540 Plat: N/A-NOT AVAILABLE
SEC 32 T30N R19W NW SE LOT 3 OF CSM Block/Condo Bldg:
2/514 & REPLATTED BY CSM 3/636 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
32-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 694/08
2004 SUMMARY Bill Fair Market Value: Assessed with:
5625 275,800
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.540 82,100 189,200 271,300 NO
Totals for 2004:
General Property 3.540 82,100 189,200 271,3000
Woodland 0.000 0
Totals for 2003:
General Property 3.540 48,100 146,100 194,2000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 313
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
0.00 0.00 0.00
Total
TOWNSIII16~ ( L SEC~~ _,rL; N, R~W
ADDRESS ST. CROIX OUNTY, WISCONSIN.
'3DIVISION LOT -13 LOT SIZE 030-10 ~'0 0,f5b
PLAN VIEW CS✓~ -3, 3
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING T,,7ITHIN 100 FEET OF SYSTEM
~-Y
TIC TANK(S) MGR. CONCRETE L,-STEEL
NO. of rings on cover Depth11 DIZY WELL
N HES NO. of width length area
nc,. of lines width L len, h area=_
dept tai top of pipe hE:GI TF. Y
)ATE AREA REQUIRED o AREA AS BUILT
:claimer: The inspection of this system by St. Croix County does not imply complete ;
pla.ance 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
.t.em operation. How-over, if failure is noted the County will make every"effort to
-ernune cause of failure.
_.ASES AN-D OILS SHOULD NO BE DISPOSED THROUGH THIS SYSTEM. °
-'INSPECTOR
DATED 6PLUMBER ON _16B
LICENSE NUMBER
z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanita,',y Penmit-
State Septic _
f
NAME ( Township / a St. CtLo.ix County
Locatioki % o~ Section T_N,R W
SEPTIC TANK
Size gattons. Numbers o6 CompaAtmentz
Distance FtLom: Wett /O _it. 12% on gtceatetc zZope it
Bu.itd.ing_it. W ettands it.
H.ighwatetL
DISPOSAL SYSTEM
D.i6tance Ftc.om: Wett lQQ it. 12% on pLeatetL 6tope it.
Bu.itding_ it. Wettandts Ft.
H.ighwatetL it.
FIELD DIMENSIONS:
w.id•th ob ttcench 2 it. Depth o4 tcock below t.i.-ez-~~in.
Length o6 each UnLA8& 6t. Depth of kock oven tite 2_ in.
Number of Zinens Depth o6 tite below gtcade~/___A in.
Totat .length o6 tine6 it. Stope of ttcench in pets 100 it.
Distance between tinez C/ t. Depth to bedtcock
Totat ablsonbtion vLea 6t2 Depth to gtLoundwateA ~ •
Requited atcea it 2
PIT DIMENSIONS:
NumbeA o6 pits ~ Gtavet atcound pits yets no
Outzide diametetc" Depth below .intet ~ •
2
Totat abis otLb o_.`.., tce it z
2 rn
Atcea tcequtitLed it
INSPECTED BY TITLE
APPROVED t ,DATE f 197
~ t
REJECTED DATE 197.
N
a
Eli 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 TESTS_
LOCATION: A-&., _5_6%, Section J;,, T_ R Z7E (or) W, Township or Municipality
County ~ ~ t Y
Lot No. , Block No. - Su d'vision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence C~ No. of Bedrooms y Other
EFFLUENT DISPOSAL SYSTEM: NEW 1/_ ADDITION REPLACEMENT -
DATES OBSERVATIONS MADE: SOIL BORINGS P RCOLATION TESTS
'
SOI L TYPE O ,
SOIL MAP SHEET
PERCOLATION TESTS
HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
TEST DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL
NUM- INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
BER
_ 5 ? (s,
P_ 17
P -3
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
c 7 1"C
s " 1
B -4 G 72- ~_c 77 /1 r3 5
h~ I
PLAN VIEW (Locate perco lat i o n tests,so i I bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable rea indicate number o uare feet of absorp ea
cale
needed for building type and occupancy. --Z
or distances. Give horizontal and vertical reference points. Indicate slope.
) f
I
i I a
F _ - - I - N
t
I I
4-4
w
i
---r.---T_
_ ji
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) Certification 10.
Address- --r 41 'k- A In J.
Name of installer if known
CST Signature LA
~THORITY
%t
B67 State and County State Permit #
County Permit
Permit Application i
aim 1 J11 k L
-
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: GL/ '/gS Y4, Section T N, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Village
S Township. * A
C. TYPE OF OCCUPANCY: 'Commercial 'Industrial 'Other (specify) *Variance _
Single family k'-~ Duplex No. of Bedrooms Z-J No. of Persons 3
D. TYPE OF APPLIANCES: Dishwasher t- --YES NO Food Waste Grinder YES L P40 # of Bathrooms-?
Automatic Washer 1---YES NO Other (specify)
E. SEPTIC TANK CAPACITY 19-- o-V Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation t/ -Addition Replacement _ Prefab Concrete
'Poured in Place Steel Other (specify) -
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) / 5, 2)_,_ 3) Total Absorb Area sq• ft.
New 1/ Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length 7P_Width Depth Tile Depth 2 No. of Lines 1-
Seepage Pit: Inside diameter Liquid Depth Tile Size y
Percent slope of land 7% 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, [
NAMEi C.S.T. # and other information
obtained from owne builder).
Plumber's Signature Gtr MP/MPRSW# /-y phone
Plumber's Address 12,1
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
3-01
f _
i
e_ e
r.
Do Not Write in Space Below FOR DEPARTMENT USE ONLY Date of Application
Fees Paid: State County Date
Permit Issued/Re}ee4ed (date) -Issuing Agent Name'~
Valid# Date Recd
Inspection Yes ~ No
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumbe _