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Parcel #: 028-1013-80-000 03/29/2006 01:59 PM
PAGE 1 OF 1
Alt. Parcel#: 11.28.17.68C 028-TOWN OF RUSH RIVER
Current 0 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
O-GUSKI, RANDALL R&DIANE K
RANDALL R& DIANE K GUSKI
458 200TH ST
BALDWIN WI 54002
Districts: SC= School SP=Special Property Address(es): '=Primary
Type Dist# Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 1.900 Plat: N/A-NOT AVAILABLE
SEC 11 T28N R1 7W 1.9A IN SE NE LOT 2 OF Block/Condo Bldg:
CERT SUR-VEY MAP IN VOL III PAGE 635
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
11-28N-17W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1139/623 WD
07/23/1997 944/42
07/23/1997 792/526
07/23/1997 579/271
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
82760 193,900
Valuations: Last Changed: 08/30/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.900 29,000 162,100 191,100 NO 05
Totals for 2005:
General Property 1.900 29,000 162,100 191,100
Woodland 0.000 0 0
Totals for 2004:
General Property 1.900 12,200 93,500 105,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 206
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
CERTIFIED SURVEY N0. 6335
Part of the Southeast 1/4 of the Northeast 1/4 df Section 11 , Town 28 North,
Range 17 West, Town of Rush River, County of St. Croix, State of Wisconsin,
described in Volume 3 of Certified Survey Maps, page_ as Certified
Survey No._ 635
350256 D w Rill
ST.CROIX COUNTY
UNPLATTED LANDS SURVEYOR'S RECORD
N OOo 05' 08" W • 424.00
B 212.00 212.00 11,
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X}� - EAST LINE OF THE N.E. I/4 �o
Q+„Z OF SECTION II T 28 N OM
R 17 W ASSUME BEARING N2
N 000 05' 08° W r-vz
�su APPROVED
„Z R
,IUL 19 1978
2
ST. CROIX CGu.� Y ......
l� COMPREHENSIVE PARKS F.ANNINO •��
FILED AND ZONING COMM-TEE
JUL 201978
o. MAN a COMM � APPROVAL 4PP THIS MINOR SUBDIVISION SHEET 1 of 2
RN of D694 DOES NOj MEAN APPROVAL FOR
BUILDING SITE OR SEPTIC.SYSTEM. t
g L REFER TO H62.20,
Volume 3 Page 635 (�
AS BUILT SANITARY SYSTEM REPORT lvew
WNER . /� , TOWNSHIP l/ /f fi I SEC. TjjN, RL7W
.0. ADDRESS _ , ST. CROIX COUNTY, WISCONSIN.
`UBDIVISION LOT LOT SIZE
PLAN VIEW
Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
IVeivr
1
�X joe 'tneiveN
N
zo N�as
1 ovo (srfj4 s e nl— ,
PTIC TANK(S) MFGR. _Ae I f-SleRS CONCRETE_ STEEL
N0. of rings on cover p Depth DRY WELL
TENCHES NO. of width length fd o � area ez,
D no. of lines__ width 4- length ZOo % area ,&o
/�,
depth to top of pipe
]GREGATE
.RK RATE AREA REQUIRED T�� AREA AS BUILTd U
=_sclaimer: The inspection of this system by St. Croix County does not imply complete
' )mpliance .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
:'stem operation, However, if failure is noted the County will make every effort to
2termine cause of failure.
'.EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSP
i
DATED �r�6�7O PLUMBER ON JOB L�
LICENSE NUMBER �'O
'z t
E REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
. y Sanitary Perm.it)-O
State Septic ��
NAM Township 1lemjSt. C,%o ix County
Locat.ion.5f4l o sue%, Section&T2N, R W
SEPTIC TANK
Size//'&V _gattonA . Numbers ob Compartments /
Distance From: Wett1jo4 ,j it. 12% on greaten ztope it
Bu.itd.ing wit. Wetlands fit.
Highwateh '— � bt,
DISPOSAL SYSTEM I
Distance From: Wett /f 6t. 12% or greater s.loper St.
Bu.itd.ing it. Wetlands Ft.
Highwater it.
FIELD DIMENSIONS:
Width o6 tren chit. Depth o4 rock b etow t.it e / 2 in.
Length of each tine /&o it. Depth ob rock oven t.ite Z .in.
Number. o6 .Line's l Depth of t.ite below grade n.
Totat .length o6 tines IA2-2 it. Sto pe o6 trench in pen 100 it.
Distance between .Lines ::-- fit. Depth to bedrock fit.
Total absorbt.ion area 6t2 Depth to groundwater it.
Required area 6t2
PIT DIMENSIONS:
Number o6 pits Gravel around p.itb yes no
Outside diameter i
Depth below n.let it.
io
Total absorbt pia4 it 2 z
A
Area required 6t2 rn
INSPECTED �-""�� TITLE'
A PPRO Vj ,DATE G 197
REJECTED ,DATE 197
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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
�'/4,Section 1L ,T IN, R l MOW) W,Township 01- i�
1LOrC.AATION: /4, —
County
Lot No. , Block No. ubdivisio—Name
Owner's Name:
! � o
w
Mailing Address:
No.of Bedrooms Other
TYPE OF OCCUPANCY: Residence �_ REPLACEMENT
EFFLUENT DISPOSAL SYSTEM: NEW
ADDITION—PERCOLATION TESTS ( I^� � 7�
DATES OBSERVATIONS MADE: SOIL BORINGS
�
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE
TEST DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL MIN/IN
NUM- INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
BER
P_ ;L a /o � / z 7
A si Ale
_36 0
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER INCHES
DEPTH TO BEDROCK IF OBSERVED
NUMBER INCHES OBSERVED ESTIMATED HIGHEST
> 7;2 "s
ly
B- 3 > 2 �� o 00
2- SC
PLAN VIEW (Locate percolation tests,soil bore holes andls arable slndareas number.of square feet of absorption area
Indicate on the plan the location and square feet of suitable Indicate scale
needed for building type and occupancy.
or distances. Give horizontal and vertical reference points. Ind ate slope.
D�
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I,the undersigned,hereby c at 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. >
,+L s Certification No.
Name (print)
Address—,R Q GL. w d
Name of installer if known
CST Signature L�
COPY A--LOCAL AUTHORITY
State and County State Permit # 30
l:• L B 6 7 Permit A pp �
Application County Per it # 0
�
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:
X-r R ijF� l- SON A4Ld�& , N is ;
B. LOCATIO : SO % Atie- Y4, Section 7//_, T,2kN, R 17 J1jMjj6r) W Lot# -City_
Subdivision Name, nearest road, lake or landmark Blk# Village
Township R T.0 RAjeq
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance
Single family X Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder--X-YES NO # of Bath rooms+2-
Automatic Washer _YES NO Other (specify)
E. SEPTIC TANK CAPACITY 11100 Total gallons No. of tanks j
*Holding tank capacity Total gallons No. of tanks
New Installation X Addition_ Replacement_ Prefab Concrete Ily
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) Z 2);_3) VTotal Absorb Area sq. ft.
New_X Addition Replacement *Fill System 1
Seepage Trench: No. Lin. Feet lGG" Width .6-1 Depth Tile Depth .2 No. of Trenches.
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land --4- Distance from critical slope .f"e `
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, & 4 'e. S' I
NAME M C.S.T. # f 7 and other information
obtained from T L (owner/builder).
Plumber's Signature r. MP/MPRSW# Phone
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
! L rhk
lop rReNe#
r
VeN _
Do Not Write in Space Belown FOR DEPARTMENT U E ONLY lop
Date of Application �� � /�Fees Paid: State 0 C n 'rf Date
Permit Issued/Rao"ad (date) -�� :;?Y_Issuing Agent Name
Inspection Yes No Valid# Date Recd
1. county (whit 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
l