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Parcel 022-1038-80-100 01/08/2007 03:46 PM
PAGE 1 OF 1
Alt. Parcel 14.28.18.215A-10 022 - 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 - BRENES, RODRIGO & ANNA
RODRIGO & ANNA BRENES
363 OLD CEMETERY RD
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 363 OLD CEMETERY RD
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 9.495 Plat: N/A-NOT AVAILABLE
SEC 14 T28N R18W THAT PT OF SW NW LYING Block/Condo Bldg:
SLY OF LN DESC AS BE 772.77'N OF W 1/4
COR TH S82DEG E 332.26' S3DEG W 63.82' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
S80DEG E 187.05'S72 DEG E 641.24 ' TH _ 14-28N-18W
Y ALG WLY LN OF LOTS fi&-2-OF-C.SM VOt
1/252 BEING LOT 1 OF CSM VOL 4/942 EXC
more...
Notes: i^ Parcel History:
Date Doc # Vol/Page Type
11/05/2002 697201 2036/316 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
178912 277,100
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 80,000 164,800 244,800 NO
UNDEVELOPED G5 4.495 11,000 0 11,000 NO
Totals for 2006:
General Property 9.495 91,000 164,800 255,800
Woodland 0.000 0 0
Totals for 2005:
General Property 9.495 91,000 164,800 255,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 215
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1
CMTIPIID SURVEY MAP
HELMER JORGENSON
Part ofcthe Southwest 1/4 of the Northwest 1/4 of Section 14, Township 28 North, Range 18
West, Town of Kinnickinnic, St. Croix County, Wisconsin.
o Indicates 1" iron pipe found.
o Indicates 1" x 24" iron pipe weighingo .13 lbs/ft. set.
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P 00~ _o~C I N I APPROVED
MAY 21 1980
• 0~ ~ I ~ I
u ST. C~OIX COU;-TY
V U I I pj COMP,I[NENSIV~ PAIMS PLAPININO
AND ZONING COMMI1(EE
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State of Wisconsin)
County of Pierce)
I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the
Owner, Helmer Jorgenson, I have surveyed and divided the lands shown hereon in accordance
with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. Croix
County; and that the above map and description are a true and correct representation thereof.
Dated: 16 May 1980
Vol. 4 Page 942 ~ James L. Murphy
Certified•Survey Maps Registered Land Surveyor
St. Croix County, Wisconsin
bliLh deed 9 t " IUA
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AS BUILT SANITARY S`.'S`1 EM kEPO&
OWNy
ADDRESSx'# ST . ;,ROIX COUNTY, WISCONSIN.
iCC~/ 1r ~t_< 3 j~TC
f
;SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
- - EVERYTHING WITHIN 100 FEET OF SYSTEM
` -r
elf,
r
Ac~
I di a e ox`th; Arrow
l S CAL
BENCHMARK: (Permanent reference Point) Describe:,
Elevation of vertical reference point: Slope at site:/ SEPTIC TANK: Manufacturer: / Liquid rapacity: f'/7
Number of rings on cover Tanc manhole cover elevation
Tank Inlet Elevation: - Tank Outlet Elevation: PUMP CHAMBER
Manufacturer: Number of gallons
iJumber of gal. pump set or a cycle gallons; total cai~jc ity o;f
distribution lines gallon: ~size oo pump heal;
gallon per minute ; horsepower --;ran~nanre of pump
and model number
Type of warning device -
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: l ~umTer A pits - -~`eef J'iawe c,
feet liquid dept1i seepag(, pit inlet pipe-elevat: u;f
bottom of seepage pit evati~,n feet _
SEEPAGE BED SIZE: number of liner - - t.~ dth le:igth Lite leptli
SEEPAGE TRENCH: ' dth length PERCOLATION RATE ,
-A--A +{EQUIREb _AREA AS BUILT
INSPECTOR
DATED ;r
~ _ q^G. P 1 i LU L L \ .;V ~1 ,~_~.yi +C`" t"c~'^C .
LICENSE NUMBER
DEPARTMENT•OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. PRIVATE SEWAGE SYSTEMS
BOX 7969 DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
®CONVENTIONAL OALTERNATIVE F777
❑ Holding Tank ❑ In-Ground Pressure Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION ATE.
Timothy Rehberger R. R. 2, River Falls, WI
BENCH MARK (Permanent reference poi)t) DESCRIBE IF DIFFERENT FROM PLAN , •
REF. PT. E EV.'r CST REF. PT. E(LEV
SW4 NW-4, Section 14, T28N-R18W, Town of Kinnickinnic
I
Name of Plumber. MP/MPRSW No.. CountY Sanitary Permit Number_
Paul Cudd 2739 St. Croix 43709
SEPTIC TANK/HOLDING TANK:
MANUFACTURER
LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED:
BEDDING: VENT DIA.. VENT MATL. HIGH WATER OYES ONO OYES ONO
JA M. NUMBER O OM F ROAD. PROPERTY WELL: BUILDING: VENT TO FRESH
FEET FR LINE: AIR INLET.
OYES ONO OYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER JBEDDING: LIQUID CAPACITY PUMP MODEL PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO OYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR I"LET'
PUMP ON AND OFF) OYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until L FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF DISTR PIPE SPACING; COVER
BED/TRENCH NSIDE DIA APITS LIQUID
TRENCHES MAT E.R IA L.
DIMENSIONS ---v l J PIT -.-----DEPTH.
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
13FLOW PIPES ABOVE COVER ELEV. INLET ELEV. END. PIPES - LINE.
FEET FROM J AIR INLET
NEAR EST-s
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. 710NS MEASURED.
OYES ONO
SOIL COVER TEXTURE PERM 'NENT *ARKERS OBSERVATION WELLS
ES NO OYES ONO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SE ED MULCHED
CENTER EDGES
❑ E ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL EPT FLOW PIPE FILL DEPTH ABOVE COVER
TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIF ED M RIAL NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV ELEV DIA FLEW PIPES Dla:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL j VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
EYES ONO OYES ONO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
LINE
.
FE E T FROM
EYES NO OYES ONO 1NEATREST-----)iH
T L
Sketch System on
Retain in county file for audit. l
Reverse Side.
SIGNATURE.
ITITLE.
DILHR SBD 6710 (R. 01/82)
DEPARTMENT OF APPLICATION
INDUSTRY, FOR SANITARY SAFETY & BUILDINGS
DIVISION
LABOR AND PERMIT P.O. BOX 7969
HU110AN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal +
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mailing Address:
Timothy Rehberger Route 2, River Falls, WI 54022
Property Location: (i*AXDf9XXi- Township: County:
SW '/4 NW '/4S 14 /T 28 N/R 18 EX(k) W Kinnickinnic St. Croix
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark
_ _ _ [Sf tate Plan I.D. Number:
---r- assigned)
TYPE OF BUILDING
* Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
® 1 or* Family *State Approval Required. 3
TOTAL NUMBER PREFAB POURED-IN NEW 7MENT LACE- OTHER
GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New ® Replacement ❑ Experimental LK Seepage Bed ❑ Seepage Pit
< ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signatur MP/MPRSW No.: Phone Number:
Paul R. Cudd
` - 2739 (7l5) ~z5-2049
Plum er~sAddres ''~~s' Box 364, Rived Falls, WI 5402 NamerDesi ner:
Art V~egerer "
COUNTY/DEPARTMENT USE ONLY
Si natu e of Issuing gent* Date: p Sanitary Permit Number:
Q
lD lO 1//- d " 0 DISAPPR APPROVED OVED 1IG39
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81)
, 1nl ~ ?dG.
0 :rJT PLAN
Show:
r t'~ "
t-~E] Location of bui lding served Dosinc c.,amhcr
Vertical reference point
Septic tank
Building sewer Horizontal reference point
J
(fluent system well
NA~ rep-'acen,ent system, rrea qf~
{ Scale = 1 = SO c' _ -o`; _
T-1 , - -l - I J 2 1 1 n
_ 1C- on LOSS T. D. :i. Vol. Dist. Pipe Gal. ^1 per CVclc
:=lace check mark: in appropriate boa_, indicating, item is shown on plot plan. belcK:
nr~R17. Lt.loo.oo'
Cop, c. Fvuu~t-,'T)oN AT X002 5 Rl~-, @ .
egIST•we, L
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the granting or approving of the above plar., or upC'n the event of a subsequent
,;>rmi t being issued, sT-cFoix County and the 5--cro,x County Zoning Administrator, does
r;ot assume or hold itself liable for any defects in plans or specifications, plan
examination oversight, construction, or any damage that may result in or
after installation.
Plumber's signature
CROSS SECTOIJ OF A-BED
_ j
~9a~~_ FlU15Rm._G2a+~
s-) ti
a- SOIL FILL-41 OF L GGREGATE.
DiSTP,IBUTIOF~ PIPE _ -APPROVED S'3QTHETIC COVER
MATEft1AL OR 9*' OF STRAW
0
OF, MARSH }-lA~3
1 '
ELEV. OF_~ ' JFEET
DISTRIBUTIOU PIPE TO BE AT LEAST ?9 IULHES BELOW ORIGIUAL GRADE
AUD AT LCASTEO I"LHE5 BUT ►JO MORE THA►J `i2 IMCHES BELOW FI►JAL GRADE 1
- ~ b 11,7CHE5
MAXIMUNx DEP_1 H OF f-XCAVATiOU FROM ORIGWAL GRADL -JILL BE
MItJIMUM DEPTH OF EXCAVATIOU FROM ORIGIUAL GRADE WILL BE INCHES
51GuED:
L Ic E U SE UUMBE R:
DEPARTMENT OF, REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IN
DUSTRY, DIVISION
H
LABOR-AN
UMAN RE PERCOLATION TESTS (115 P.O. BOX 7969
HUMAN RELATIONS \ ) MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATIQN: SECTION: TOWNSHIP/Pdl.644WLR4q.L-I 4: LOT NO.:BLK. NO.: SUBDIVISION NAME:
w 1/a1 /a ) y /Tz%N/R 1~1E (or ► ~ c; t~ ~~..J . .
COUNTY: OWNER'S/Bt~f~F}'S NAME: MAILING ADDRESS:
\ IUL1
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: [R-OFILE ONS: PERCOLATION Residence A. ❑ New Replace
RATING: S= Site suitable for system U= Site unsuitable for system l
1ZS ONVENTIONAL: MOUND: IN-GROUNDPRESSUREHOLDING TANK: RECOMMENDED SYSTEM:(optional)
❑U XS EA11 IRS DU ❑S ZU ❑S MU
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-111 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH4# OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
1 4' ~o3.p iV ~r~t_ > 5•Z' 1,37l7_ ? . L T -S 3• bh L j 3.-)' L J r~C' S.2
B Z S. 7' 3E7• f~CiJ~ Vt,oT NT 3. 1•u' 3` z.y'3n}~ tinjGyl. sPvi)'
3 S.~` 111 ~ S.~'
B- ~LS b'2 A7-
L/ S. 6' lv l • J' ~ov~l .4.T -6D' J •,9'
~•cD `zUns;l ),3' L 8: 3')3h S e
CV J~.J PJ~r._iL > S~ ' Si ~ y bin
B- 7 9 c lax.>;J p°. 6
L > ._'i' Z it gy 3.9 L}n ~ ~~h
B
6-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER FNG4E8 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P_ 21 -3
P_. A
P-
3 sly 3 ~ Z
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, 1
SYSTEM ELEVATION L v. y l • '
moo
Z'P~Cr't 8s->F '_i~ LpG..
{ L,~ _ l~tlt> SAO 4~~Q
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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 (print):
_ TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(opnonal):
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DIL HR-SBD-6395 (R. 02/82) OVER -
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Owner of Property
Location of Property Sectiun
W
Tuwnahlp
Ma111n6 Address
Subdivision Name
Lot Number
Previous Owner of Property
Tutul Size of Parcel
Date Parcel Was Created
Are all corners idenrlfluble'? Yep Nu
Include WlLII Lill lIcaLlull onu ul` Lllu Iulluwlu ;
.CerCitled Survey Map
.Deed
.Land Contract. or
.Other Legal Doculucnt which deycribeS the property
PROPERTY OWNER CERTIFICATION i
(Wu) certify that all statements on this torm are true to the best of my (our)
knowledUe; that I (we) am (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed rucordud in the Office of the
County Register of Deeds as Document No.
and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said systum, and the same has boon duly recorded in the Office
of the County Register of Deeds, as Document No. )
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICHEI
(DATE SIGNED -
QHTE SIGNED