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Parcel 038-1062-50-000 12/01/2006 01:04 PM
PAGE 1 OF 1
Alt. Parcel 15.31.18.271 B-1 038 - TOWN OF STAR PRAIRIE
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
GARY POLNAU O - POLNAU, GARY
1154CTYRDC
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 1154 CTY RD C
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.725 Plat: N/A-NOT AVAILABLE
SEC 15 T31 N R1 8W 1.2A IN SE SW LOT 1 OF Block/Condo Bldg:
CSM VOL III PAGE 679 & PT COM S 1/4 COR
TH N 1'E 377 FT TO POB; TH CONT N V E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
175 FT; TH N 88'W 150 FT; TH S VW 15-31N-18W
65.46 FT TH SELY TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1095/465 QC
07/23/1997 784/264
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.725 45,900 110,700 156,600 NO
Totals for 2006:
General Property 1.725 45,900 110,700 156,600
Woodland 0.000 0 0
Totals for 2005:
General Property 1.725 45,900 110,700 156,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 219
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
~j c;_,,_ - v ueaa•a~a uauiLLl 1W1 Vltl
TtiWNSHI j~ SEC. T N, R W
,0. ADDRESS #Z , ST. CROIX COUNTY, WISCONSIN.
'3DIVISION _ LOT LOT SIZE .
PLAN VIEW
Distances dimensions to meet requirements of H62.20
S O`W/ EVERYTHING WITHIN 100 FEET OF SYSTEM
. . L t` I
}
Y
TIC TANK(S) r'GR.7i CONCRETE /STEEL
NQ. of rings on cover Depth- DRY WELL
:h'CHES NO. of width length area
no. of l~i~,nes z width Lz = length _5_ area depth to top yf pipe
IREGATE ~
RATE AREA REQUIRED F j Z_ AREA AS BUILT ,~,-,_,71G4'
-ciaimer: 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
.tem operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
LASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTE4.
~'INSPECTO
Apn /I
DATED_ PLUMBER ON JOB
LICENSE NUMBER
i
l
z
REPORT OF INSP CTION INDIVIDUAL SEWAGE SYSTEM
Sanitatcy Petcm.it-
State SepticzE a
i
NAME Township Ctco.ix County
Location '4 0 Sectionl-5 'T R GI
SEPTIC TANK
Size gatton6. Numbetc, o6 Compatctmentz
Distance Ftcom: wets 120 on gtceatetc ztope it
Bui ding_j it. Wettand/s ~,3,6t.
H.ighwatvt l as 4t.
DISPOSAL SYSTEM
D.i6tance Fnom: Wett 16 d it. 120 on gtceatetc 6tope it.
Bu.itding 2, it. Wettands Ft.
H.ighwatetc_it.
FIELD DIMENSIONS:
width ob ttcench it. Depth oU tcock below tite_Z~K_in.
Length o6 each tine it. Depth of tcock oven t.ite ~2, in.
Numbetc o6 tines 1,21 Depth o4 tite below gtcade s o in.
Totat .length o6 Una 612, it. Stope o6 ,ttcench ~ in pen 100 it.
Dks lance between Una ~ it. Depth to b edtco ck ~ it.
Totat abz otc.btion atcea 6t2 Depth to gtcoundwatetc_,Z'~~~ .
Requitced atcea 5- bt2
PIT DIMENSIONS:
Numbetc o6 pit6 i Gtcavet atcound pits yes no
Outside diame etc . . Depth below intet it.
.1 !
i _
7aZa2 ab~s otcb b ` an ~a it2 , z
A
Atcea tcegr i,t,ed 2 rn
t r i, t 1 _
INSPECTED BY~ TITLE
APPROVED DATE 197
REJECTED DATE 197
v
l _ _
EH f 1 5
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEA-6T-H, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
C
LOCATION: Section /5_-, T3/N, R _t_1i (or) W, Township or INtt~ity
Lot No. , Block No. , - County
SVvision Name
Owner's Name:
i
Mailing Address: c
TYPE OF OCCUPANCY: Residence No. of Bedrooms z Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS-- P COLA~TI(?jN TESTS Z
SOIL MAP SHEET T) SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME 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-T
J6 ;L C
- ) I
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMB/ER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B- / 77. 9 2"/i' 772 " Z "r -72 7 Zit - n .
72
6- Z_ 7 /1 .r
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. /D u' Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
/41
• - #
CC tN
CC jj
_+t 44 ~,Tgl
I-I s
t I, ~P -
I~II~ ' C. G~ tc~
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) > f -77 ertification No.
Address-!Z ZC
Name of installer if known
CST Signature
State and County State Permit # /
~PL~6.7. r
Permit Application County Permi #
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:
/ _ Cy
c. L C L l ~ 'l r~ rf/ ~ C' l i
B. LOCATION: y,, Section, T N, R '6 E (or) W Lot# City
Subdivision Nam nearesst- road, lake or landmark Blk# Village
~~✓`-'l~' /~~~--~~..-L" Township.> )-1'i ,
C TYPE OF OCCUPANCY: *Commercial Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms ~ No. of Persons
D. TYPE OF APPLIANCES: Dishwashers NO Food Waste GrinderYES NO # of Bathrooms___
Automatic Washer YES NO Other (specify)
L. SEPTIC TANK CAPACITY 6t' e- Total gallons No. of tanks
'Holding tank capacity Total gallons No. of tanks
?Jew Installation L/- Addition Replacement_ Prefab Concrete
'Poured in Place Steel Other (specify)
FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) -,S- 3) 4; Total Absorb Area q. `t
New L--- ddition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length 52 ' Width Depth T r Tile Depth 1- 9' " No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size 1~,/ "
Percent slope of land r Z ~je., Distance from critical slope
the undersigned, do hereby certify that the information I have reported is in accord with Section "-"Wr
';^risconsin Administrative Code, and that 1 have sized the effluent disposal system from the EH-115
by the Certifiec.~Soil Tester,
NAME C.S.T. # and other inforn
obtained from (owner/builder).
Flumber's Signature '
MP/MPRSW# ' r: Phone #,2'/ G -
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
' -c
4'1r
L ~,Z
IGC~' --.ZOG
Do Not Write in Space elow FOR DEPARTMENT USE ONLY
Date of Application Fees Paid State s)~ County -x Date -
Permit Issued/R (date) ~ _Issuing Agent Name ? ?
Inspection Yes No Valid# Date ec'r
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
~ta±- (rink 0nn0 01LImher (canary copy)
Revised Date 6/1 /76