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PAGE E 11:49 AM
1 1 OF I
Parcel 022-1077-40-000 02i08i2006
F
Alt. Parcel 27.28.18.P430C 022 - TOWN OF KINNICKINNIC
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
O - WANG, DANIEL L
DANIEL L WANG
129 CTY RD JJ
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 129 CTY RD JJ
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.220 Plat: N/A-NOT AVAILABLE
SEC 27 T28N R18W 2.22A IN N 1/2 SE 1/4 Block/Condo Bldg:
COM CL HWY JJ 220 FT NLY OF S LN N 1/2
SE 1/4, TH E 440' SLY = HWY 220'W 440' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TO CL HWY TH NLY 220' TO POB 27-28N-18W
EZ-UT-1349/485
Notes: Parcel History:
Date Doc # Vol/Page Type
08/01/2001 652638 1691/249 QC
11/23/1998 592259 1380/05 QC
11/23/1998 592258 1380/02 TI
2005 SUMMARY Bill M Fair Market Value: Assessed with:
143806 223,900
Valuations: Last Changed: 08/11/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.220 40,000 186,400 226,400 NO
Totals for 2005:
General Property 2.220 40,000 186,400 226,400
Woodland 0.000 0 0
Totals for 2004:
General Property 2.220 20,000 147,500 167,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 110
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
' Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER VA TOWNSHIP K~~ SEC. T N-R~W
ADDRESS P~ Coer !4<`S' ST. CROIX COUNTY, WISCONSIN
1
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 11HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Z
X° a
~W
Nave
go
~ >o t,oao al
LM J j1 xav t~~l~n~.6e~
jb'"x3b` yep ce tent F3 ed
pB~ N
NDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
i Elevation of vertical reference point: AQ0 Proposed slope at site: 120
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,o Side,o Rear, O feet
,.From nearest property line Front 10 Side 10 Rear, O feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
~ x
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
i
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: < tX 3 Trench:
Width: R Length: J Number of Lines: _-3_ "Area Built: Fill depth to top of pipe:
1U
Number of feet from nearest property line: Front, O Side, Rear, ~ht.$
Number of feet from well: ld d
Number of feet from building:
(Include distances on plot plan). r
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, Q Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: ~Illf p~ Plumber on job: / l/y1Q S- t~•`~q
License Number: 30-3 _
3/84:mj
DEPARTME"T OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
)DYCONVENTIONAL ❑ALTERNATIVE State plan 1,13. Number:
Ilf
` El Holding Tank ❑ In-Ground Pressure El Mound assigned)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER Falls, WI 54022 INSPECTION DATE
Daniel Wang Rt. 2, River /
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV..
SE SE, Section 27, T28N-R18W, Town of Kinnickinnic
Name of Plumber: MP/MPRSW No.. Coumy: Sanitary Permit Number:
Thomas Wang 3231 St. Croix 75050
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: IT ANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
_/•t PROVIDED. PROVIDED:
Y d OYES ONO DYES ONO
BEDDING: VENT DIA.: TMATL: L G R NUMBER OF ROAD: PROPERTY WELL: BUILDING. IVENTTOFRESH
FEET FROM LINE: AIR INLET:
OYES ONO YES ❑ O NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: IQ 'ID CAPACITY. PUMP EL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO DYES ONO OYES ONO
GALLONS PER CYCLE: [71ND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING: IVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) OYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I t rJ"I li DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH NO. OF DISTR. PIPE SPACING: COVER INSIUE DIA.-. #PITS. LIQUID
BED/TRENCH 118 TRENCHES M RIAL:
DIMENSIONS PIT DEPTH:
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL: NO. D R. NUMBER OF PROP RTV WELL 11111-111\11: VENT TO FRESH
BELOW PI ES ABOVE COVER. ELEV. INLET. ELE\ ENDZ: -727 PIPES: FEET FROM , LIN / AIR L/~
j~ f( J J 13 NEAREST-s 60
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
O meets the criteria for medium sand. TIONS MEASURED.
YES NO
SOIL COVER TEXTURE: PERMANENT MARKERS: JOBSERVATION WELLS
OYES ONO OYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED.
CENTER: EDGES.
OYES ONO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.. ELEV.. CIA.. ELEV.. PIPES: DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
OYES ONO OYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑ YES 1:1 NO ❑ YES ❑ NO NEAREST
t
Sketch System on
etain in county file for audit.
Reverse Side. `
SIG TITLE:
DILHR SBD 6710 (R. 01/82)
FZ: consln APPLICATION FOR SANITARY PERMIT
D I L H R ' COUNTY
(PLB 67) UNIFORM SANITARY PERMIT USTRV,LRBOR6MUTRnRELRTIOnS 7 0
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROP Y OWNE qq ~ MAI NG.P~DDRES
am -
PROPERTY LOCATION CITY:
S 1/4SE 1/4, s 07 , TO-N, R 1q_E (Or) W oL 1l~ yt t C lLlf? Is
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE 2!,~. NUMBER
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
E Seepage Bed X 5 ❑ Seepage Trench F-1 Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
( Gallons \ Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
1 S U X Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signatu MP/MPRSW No.: Phone Number:
s n 3~ 31 ( )
Plumber's Addrgss:
/ Na esigner:
COUNTY/DEPARTMENT USE ONLY
Signat re of Issuing Agent: Fee: Dr~atte/e:__ ❑ Disapproved
60 0~~ Approved ❑ Owner Given Initial
Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must'be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
« APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor,("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property l i1
Location of Property 14 1y, Section 7 T C -V N- R W
Township 2L 4 4'( t~ ' Z 117 f L
Mailing Address t K! V
Subdivision Name
Lot Number `
Previous Owner of Property L e,S Su ~~i
Total Size of Parcel ~•o~
Date Parcel was Created p6ef
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume q g and Page Number -7 as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3.- Other recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
PROPERTV OWNER CERTIFICATION
I (We) eeAti.6y that att btatemen t6 on tkiA Bohm aae tAu.e to the beet o6 my (oun )
knowledge; that 1 (we) am (ahe ) the owner (6) o6 the pnopeAty dea eh i.bed in th.i,a
.in6oAma.Li.on 6oAm, by viAtue o6 a wa4Aa.nty deed %eco&ded in the 066ice o6 the
County RegiAten o6 Deed6 a6 Document No. 5 SZ,90 c ; and that I (we)
p4e6 ent,ty own the ptopo6 ed 6.c to bon the sewage .upo6 6y6tem (on I (we) have
obtained an ea.6ement, to Aun with the above de6eni.bed pnopeaaty, bon the
con6 tn.uc ti.on o6 A aid 6 y6 tem, and the same has been duty neeo cded in the O j 6ice
o6 the County Reg.i.6ten ob Deed6, a6 Document No.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF PLICABLE)
DATE SIGN D DATE SIGNED
H
- CA
H
ST C- 105 r
r
9
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
` Y
OWNER/BUYERC ( zia
ROUTE/BOX NUMBER Fire Number
.CITY/STATE ZIP S✓~~~~
N%z
PROPERTY LOCATIONi~;4, Section,9 , T 9' N, R/P W,
!!/Jj?!o1J r
Town of r
~/h1') , St. Croix County,
Subdivision r- Lot number
I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior-to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
i
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three-year expiration. y
0
E
I/WE, the undersigned, have read the above requirements and agree czn
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- v
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
S I G N E D
DATE ~G S 7 ~6
St. Croix County Zoning Office
P. 0. 'Box 98,t-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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PA}?TWE NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
/ P.O. BOX 7969
LABOR•AND PERCOLATION TESTS (115) 1151
HUMAN RELATIONS MADISON, WI 53707
• « (H63.090) & Chapter 145.045)
LOCATION: SECTION: OWn4.4 UNI IPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
~ E I/jpf-1/a /T~ N/ S~ E (o W ;
COUNTY: OWNER'S/BUYER'S NAME: MAI I G A R SS:
of Q~ a n ell
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIA DESCRIPTION: PROFILE ESC IPTIONS: PER OL TIO TESTS:
XResidence 3 ❑New "kiReplace
2a
RATING: =Site suitable for system U iSite unsuitable for system
CONVENTIONAL: MOUND: IN-GROKOURu YSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
®S ❑U El S ❑U , ®❑S ❑S ®U 8e P'X
If Percolation Tests are NOT required DESIGN RATE: I If an
x y portion of the tested area is in the
under s.H63.09(5) (b), indicate: U Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
7 .0~ k pB/ s ~o 11 7, 6 a gn
B-
B- &00
B-
B- 3 .ao ~3 D s~ DD 14
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PE IDD 3 PER INCH
P-
P- a /00
P- =x i Q l i
P
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 9y S Q
T
IV,
_
U OW t ~l z Ly1
l
81 _ -S 60 .
3
3
E
r. _ r E 3
r `
i
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53 1-
4
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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 the location of the tests are correct to the best of my knowledge and belief.
NAME (prin TESTS WERE MPL TED N:
10" S 0414 4
ADDRESS:
of lv~~ s. CERT F C D N N MBER: PHONE NUMBER optional):
CST TUBE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) OVER -
-,TIO S FOR COMPLETING !-,,%M 115 - SBD - 6395 ~ • J
To he a cc iple id accurate sail test, your report mw
. r I description;
2. on must clearly indicate whether this is a residence or commercial project;
1 ~J urr., =drooms or commercial use planned;
4, n-n ;
~ s A _F Is Sul] I :)R A HOLDING TANK ONLY IF ALL
C IONS;
D av Cptions and com ing the plot plan;
y, 'iagram accurat 'y is preferred. A
U xd it desired;
s rk and verti_31 d are permanent;
9 [poxes as to da 3, c es, floor' 'colation test exemp-
t
10 (s.ich as flood plain, :")I the appror-'-te box;
11, ice your current a ,#ir
and distribute J s JS BE F11- THE
LE -?ITY WITHIN 30 DA' L .TION,
"°3EVIATIONS FO,, BT,FIE SOIL TESTERS
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