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Parcel 030-2079-40-000 04/01/2005 08:51 AM
PAGE 1 OF 1
Alt. Parcel 33.30.19.671 030 - 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
GERALD R JEPPESEN "JEPPESEN, GERALD R
1216 RED OAK RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ` 1216 RED OAK RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 5.060 Plat: 2234-OAK KNOLL ADD
SEC 33 T30N R19W OAK KNOLL ADD LOT 14 Block/Condo Bldg: LOT 14
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/2002 684796 1931/455 QC
2004 SUMMARY Bill Fair Market Value: Assessed with:
6381 251,300
Valuations: Last Changed: 07/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.060 100,200 147,000 247,200 NO
Totals for 2004:
General Property 5.060 100,200 147,000 247,200
Woodland 0.000 0 0
Totals for 2003:
General Property 5.060 58,900 107,300 166,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 134
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
TOWNSHIP'; . SEC. T J N, R_.1._W
ADDRESS=' is ST. CROIX COUNTY, WISCONSIN.
,DIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
•
4
i
` STEEL
TIC TANK(S) MFGR. CONCRETE—,
NO. of rings on cover 7area-
NO. of width length area
depth h DRY WELL
no. of lines width / ` length to top of pipe
, , GATE
RATE.AREA REQUIRED AREA AS BUILT
'claimer: The inspection of this system by St. Croix County does not imply complete /
.)liance 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
tem operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
:USES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER
I
i
a
REPORT OF Il1SPI4CTIO'_1--I?1j')IVIDIJAL SE?,IA(,E DISPOSAL SYSTEM
Sanitary Permit
t, S t a e Septic 717
TOWNSHIP
. Croix ounty
SFDTIC TA71K
Size gallons. M
`umber of Compartments
Distance From: Jell ft.
12% or greater slope ft.
Building ` ft.
We t I an d s f
Itighwater ft.
DISPOSAL SYS TL:~1 Tile Field or
Seepage Pit(s)
Distance From: Tell ~
.ter ft. 12°l0 or greater slope ° ft
Building ft. Wetlands
FIELD t. f
E'ighwater ft.
Total length of lines ft. Number of lines
Length of
each line --.f t. Distance between lines ft. W_idth _
of ti7_e_
trench --ft, Total absorption area ..q.
~ ft. Dept;;
of rock below the in. Dp-pth of rock over the in
. Cover
. aver. rock , Depth of file below pads
g in. Slope of
trench in per 100 ft. Depth to Bedrock
' -.ft. Depth to
ground water ft.
PITS
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 _
%,,quare feet of seepage nit area required
Inspected by:
Title'
Approved Date
197
Rejected Date `
197.
v`. ~ C
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 TESTS
LOCATION: 14,'%, 'C6%, Section .3, T20-N, Rlq 0(or) Township or Municipality ~f• ~p~~~ ~~''~r
Lot No. Block No. c1 41 ~icrC"/ f Il County
ubdivision Name
Owner's Name: [r' e r`oq ~~c PAe S
Mailing Address: 87Y Czt'r
TYPE OF OCCUPANCY: Residence- No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS_3-//-7P PERCOLATION TESTS 3 'i1'2k
SOIL.. Pv1AP SHEET 021f -&r SOIL TYPE ! Y_0-2- X4r_~ / S'411-e 6,0v, IF 019 ex
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_
A ~L A/C 3 y3 Y3 -a
~P_
1 -3
SOIL BORING TEST:
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CH/-
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
Y rrrfff
I_ /y/ /11A t 7V 19 O,f /
I 2- / V
ts,
J6 " S/
J~ S
H
odaw e- 62
•_AN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
iicate on the plan the location and square feet of suitable areas. Ind to numb r of square feet of absorption area
seeded for building type and occupancy. ,'000 4?~/-~O~ fc Indicate scale
o distances. Give horizontal and vertical referen o' ts. I date slope. slss~.
_ 3( I
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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.
41 1
Name (print) `
- Certification No. f %`Y
Address IAA a u
Name of installer if known
CST Sig trrr~' .:z
COPY A - LOCAL AUTHORI T Y
S ~
State and County State Permit
PLB67
' 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:
eWfi I- b i J PEESeA) blU bx-
zlilze O
B. LOCATION: ' G(.1 Y, -_F: y, Section
43, T a N, R E (or) (gj Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
r" 1(G/ oIf 14boi71 0/V Township 5Z,~ C. TYPE OF OCCUPANCY: "Commercial -Industrial "Other (specify) *Variance
Single family Duplex No. of Bedrooms _ No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES - NO Food Waste Grinder YES?_X'NO # of Bath ooms_- _
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY /00 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)
FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) ~3) 1-_Total Absorb Area sq
New Addition Replacement *Fill System Y-I~lD
Seepage Trench: No. Feet Width Depth Tile Depth No. of Trenches
eepage Bed: Length 7 Width Depth - Tile Depth No. of Lines -
Seepage Pit: Inside diameter Liquid Depth Tile Size ,s
Percent slope of land Distance from critical slope 3s
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, ~j
NAME jU2°fS /57-/9 C.S.T. # 5=f~~7 and other information
obtained from L e P e C, (owner/bualdec).
Plumber's Signature G ~-t MP/MPRSW# Phone #j~(c
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
N
Q~
n
N
bill.
~e fir; C
f{U ~ `
Ropr,}ee~)
C~
D _
Do Not Write in Space.-~ lo_w FOR DEPARTMENT USE ONLY C'
Date of Application 55 Fees Paid: State /C rc-, Count ~T Date
Permit Issued/R - ( ate) _Issuing Agent Name
Inspection Yes No Valid# Date Recd r
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
.
_ Revised Date 6/1 /76
-7
P,,P,, .TR4NSFER OF PLUMBER DOING INSTALLATION
State and County State Permit # n787
B67
Permit Application County Permit #
for Private Domestic Sewage Systems County Gt Croix
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required
State Plan I.D. #
A. OWNER OF PROPERTY
Mailing Address:
Gerald R. Je esen _ _ Little Canada Minn.
B. LOCATION: Stir '/4 SE Y4, Section 33 , T 30N, R-1-9 E (or) W Lot#
City
Subdivision Name, nearest road, lake or landmark Blk#
Village
Lot 14, Oak Knoll Addition Township St. Joseph
C. TYRE-01F-
YRE OF OCCUPANCY: *Commercial "Industrial *Other
(specify) *Variance _
Single family XXX Duplex No. of Bedrooms 4
No. of Persons -4
D. TYPE OF APPLIANCES: Dishwasher YES X -
NO Food Waste Grinder YES X NO # of Bathiooms2__-
Automatic Washer XX YES -_NO Other (specify)
E: SEPTIC TANK CAPACITY 1200 -
-Total gallons No. of tanks
'Holding tank capacity -Total gallons No. of tanks _
New Installation XXX Addition
- Replacement _ Prefab Concrete
'Poured in Place
__Steel Other (specify)
EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) ~3) _1 Total Absorb Area 828 s
New_XXXAddition Re lacement q'
p *Fill System
Seepage Trench: No. Lin . Feet Width Depth -Tile Depth No. of Trenches
Seepage Bed: Length _-4f)L'-Width -1&! Depth -4$-" _ Tile Depth "
No. of Lines --3
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land 0 Distance from critical slope 35-40+
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 Dennis P. Ch_risto_phersen C.S.T. # 55-1599 and other information
obtained from Gerald JePpesen
(owner/builder).
Plumber's Signature Brown MP/MPRSW# 4982 Phone
# 549 647n
Plumber's Address -
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
Ire
M
666
L
Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application 5/5/78 Fees Paid: State 10.00
Permit Issued/R4ej4 (date) 5/5/78 - County 24.00 Date 5/5/78
-Issuing Agent Name Harold C. Barber
Inspection Yes XX 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)
ReviczP'