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Parcel 022-1008-60-000 10/05/2005 12:05 PM
PAGE 1 OF 1
Alt. Parcel M 4.28.18.52B 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
DAN L & JACQUE NELSON O - NELSON, DAN L & JACQUE
1188 CTY RD N
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1188 CTY RD N
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 15.000 Plat: N/A-NOT AVAILABLE
SEC 4 T28N R18W SE NE EXC W 50RDS E OF Block/Condo Bldg:
CL ST TR HWY 65
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 837/145
2005 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 20,000 112,000 132,000 NO
AGRICULTURAL G4 12.000 1,600 0 1,600 NO
OTHER G7 2.000 16,000 95,100 111,100 NO
Totals for 2005:
General Property 15.000 37,600 207,100 244,700
Woodland 0.000 0 0
Totals for 2004:
General Property 15.000 21,600 171,300 192,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 208
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r ~
AS BUILT SANITARY SYSTEM REPORT
OWNER--- 0 t Is c ~ C1 TOWNSHIP SEC . 9j6_N-R//AQW
ADDRESS W1 ST. CROIX COUNTY, WISCONSIN.
SUBDTVTSION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
VEUTHING WITHIN 100 FEET OF SYSTEM
t
I
a
-
I di a e a th A ro
BENCHMARK: (Permanent reference Point) Describe :,1#54F,1-1y j49, 0r0rja''x~+
Elevation of vertical reference point: loci Slope at site: ~ ~t la
>EPTI:C TANK: Manufacturer.: Liquid Capacity: l .
Number of rings on cover : Tan manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: r~
PUMP C11AMBER
f .
Manufacturer:' _ Number of gallons P(~-
--1 -
Number of gal. pump set for cyc~e~_ gallons; total capacity of
distribution lines ,4_T gallon: size pump ,/p,Z 4 head;
gallon per minute A I,3r,~, horsepower brand name of pump
;
and model number -G v_tA-
`t'ype of warning, device
HOLDING TANK: _,_Manufacturer_ Number of gallons
E-evatto of manhole cover
yp e oi~ warning device _
SEEPAU PIT ZE: - Number o pits feet--iciameter
feet 'uid dept~i seepage pit inert pipe-elevation
bottom of seepage pit EIevation_ feet.
SEEPAGE BED SIZE: number of lines S width ' le,%th'7c,?'tile depth /Z"
SEEPAGE TRENCH: width length__ -
PERCOLATION RATE EA REQUIRED .~(j,!_AREA AS BUILT ,;t)
INSPECTOR
DATED PLUMBER ON JOB
~,vrtf,l~
LICENSE NUMBER
ARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
30R & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
J. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
❑CONVENTIONA4_, ❑ALTERNATIVE S(if tate Plan ID Number
J`i j assigned)
❑ Holding Tank In-Ground Pressure ❑ Mound
NAM F PERMIT HOLDER. ADDRESS O ERMIT HOLDER INSPECTION DATE.
U e &
v r Y ~~~T
r 01,7
BENCH MARK Permanent ter-c- point) DIF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
Ilk 46
Name of lumb jMPMPRSV1 No. JCounty Sanitary Permit Number:
;2 ye 7A 32(I
SEPTIC TANK/HOLDING TANK: c'
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL KL0CK:Q ING O R
P OV DED. O:
G YES ❑NO VS NO
BEDDING. VENT CIA VENT AT L. HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING V T TO FRESH
AL M
FEET LINE. "I ET.
YES ❑NO ES ❑NO INEARES~M
DOSING CHAMBER:
MANUFACTURER BE DDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL L CKIN COVER 7
f J J PRO DED. PR ED
❑NO YES ❑NO YES ❑NO
GALLONS PER CYCL PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BU DI , VENT TO FR.'
(DIFFERENCE BETW EN FEET FROM ye ASR INL
PUMP ON AND OFF) YES ❑NO NEAREST-~► ` Ll '4
SOIL ABSORPTION SYSTEM. Check the soil moisture at t,6 clpthofplowing 'Fl, T7 ❑In`rIrER MArERIALA MARJING
or excavation. (If soil can be rolled into a wire, co struction shall cease until L
FORCE V the soil is dry enough to continue.) MAIN 3 C ~6 U
CONVENTIONAL SYSTEM:
I,NIDTH. r/ Hill NO. 91F DISTR. PIPE SPACING. COVEH Ts' DE DIA. SPITS LIQUID
BEd/TRENCH TR cH s MATERIAL: PIT DEPTH
DIMENSIONS
rFI FILL DEPTH 1715 .i Plf F DIST .PIPE DISTR. PIPF. MATERIAL : Pi F DISTR NUMBER OF PR OPERTV WELL. BUILDING. VENT TO FRESH
HF I!iW PIP[ F ()VF COVER EL V IN E ELE END. PPES. LINE AIR INLET_
FEET FROM
NEAREST
MOUND SYSTEM: O
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. TIONS MEASURED.
❑YES ❑NO _
SOIL COVER. TEXTURE PERMANENT MARKERS OBSERVATION WELLS
I ❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH, BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
W 17,'1 11 LENGTH NO. OF LATERALSPACING. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES /
DIMENSIONS `r
%ANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIP A~IAL & MARKING.
ELEV ELEV. DIA. ELEV. 'r' PIPES. DIA.'.
ELEVATION AND
DISTRIBUTION / ~-gr
HO~f' El 7- HOLE SPACING DRILLED CORRECT LY ' r CVERTICAL LI ORRESPONDS TO APPROVED
i INFORMATION / PLANS
L _ -3 4 YES ❑NO `ES ❑NO
COMMENTS: PERMANENT ARKER JOBSERVATION WELLS: NUMBER OF : PROPERTY. WELL: BUILDING:
FEET FROM LINE
YES ❑ NO YES El NO NEAREST °
L S
Sketch System on __...:fie in ounty file for audit.
Reverse Side.
SIGNAT14FrF_ w TITLE. y' r'?
DILHR SBD6710 (R.01/82)- j
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY- FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/2 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. The owners copy or a legible reproduction of the soil test report must be
included.
Proper ner: Mailing A s:
Property Location: City, Village or ownship:' County:
-S C' '/4S iT--?Y'~N/RE=(or) W ir7~71e-Xi -
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
TYPE OF BUILDING oo~~
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required.
Z
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTA ATION MENT (Specify)
SEPTIC TANK CAPACITY y
I
A
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER ge)r 1.
MANUFACTURER:F
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit IIII
~l Alternative (specify)~~c-yFr,2, /iCJ!v'cG 16cy~/• ❑ 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.
Na Plumber: Signature: ' , MP/ RSW o.: Phone Number:
T21/4-y- Plumb's Ad[yess::► Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signat re of Issuing en Fee: Date: APPROVED Sanitary Permit Number: 3 4 ~ ❑ i
DISAPPROVED
eason 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 !n
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
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S, T. C R 0 1 X COUNTY
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WI SIC 0 N S I N
ZONING OFFICE 796-2239
HAMMOND, WI 54015
• s;
May 7, 1982
Division of Safety and Buildings
Bureau of Plumbing
P.O. Box 7969
Madison; WT 53707
Dear Sir:
An on site invest,gation for the Roger Nelson property
located at the SE4 of the NE-4 Section 4, T28N-R18W,
Kinnickinnic township in St. Croix County, revealed
suitable soils at a depth of60 inches, below which
•
was noted.
water
`seasonable high ground
This site should be suitable for an in-ground pressure
system.
Should you have any questions, please feel free to
contact this office.
Adb
Yours truly,
Thomas C. Nelson
Assistant Zoning Administrator
TCN:81
~ 1. ` 198
y~MB1NG SECfiON
v STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location Township
<66 34 I/V ' S 7 T N / R / . (o r) W /7~`? ✓C / r i~17 C c~.•+ -i' G! '
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
~r ezl4s
I (We), the undersigned, hereby make application for an alternative system on
the above-described premises. I recognize that the above premises are not
suited for a conventional private sewage system. If approval is granted, I
agree to have the system installed in conformance with the Bureau's approval
of plans and specifications.
I.further understand that an alternative system is more complex in nature than
a conventional private sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to permit both county officials charged with administering county p
sanitary ordinances and Bureau employes or other authorized persons to have
access to the above described premises at any reasonable time for the purpose
i of inspection the construction of or monitoring of the system. I further agree
to either personally or by my agent contact the proper county official to
arrange the time and date to begin construction of the system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin installation. If the system is approved, the ~
Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have to ~C~
obtained.
.f {(~M
I agree to give notice to any subsequent buyer that an application for an t~Ay~ Gv
} alternative system has been made and if installed, that the premises are fs"ed
by an alternative system and further agree to give the buyer a copy of this
application.
The Bureau accepts this application subject to this understanding and subject
to all the conditions and obligations set out in this application.
gn ure of Applicant D Ate
STATE OF WISCONSIN Subscribed and"swgrn:;to before me
SS.
a _
COUNTY OF S f a l1 This 1. day of I r 19
r,
Not "y Public,-State-of Wisconsin
My Commission Expires:
DILHR-SBD-6413 (N. 05/81)
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTECTION
POST OFFICE BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of St. Croix
Location SE 1/4 NE 1/4 S 4' T 28 N, R 18 :Ex~&4 W
Town or Municipality Rinnickinnic Street Address Roberts, W1 54023
Lot No. Block Subdivision
Landowner's Name: Roger Nelson
The application for this site is to serve a: 4 f-.
MX new construction use. r r
1982
z ❑ replacement system use.
4. p
If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be
included as:
` ❑ part of the 3%/5% limitation. This is number of the applications
made through this office.
' ❑ one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
❑ an individual lot for which a sanitary permit was issued but was later
ruled unsuitable due to new or changed soil criteria established by
the department.
J~a
u ❑ a lot that meets the site criteria for a conventional private sewage system.
v: If this a REPLACEMENT.SYSTEM USE, the mound is replacing: y
Y=. ❑ a failing conventional soil absorption system.
❑ a holding tank that was installed and in use prior to February 1, 1980.
❑ a privy that was installed and in use prior to February 1, 1980.
I certify that the above information is true and accurate to the best of my knowledge.
Name Thomas C. Nelson Signatur
T` Title Assistant Zoning Administrator Date May 7, 1982
~v* et
Poo a I
DEPARTMENT OF REPORT I BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND TI TESTS (115) MADISOP.O. BOX 76
HUMAN RELATIONS
N WI 53707
LOCATION'- ECTION: TOWNSHIP/MUNJCIPAL+TY: OT-W.:BLK. NO.: SUBDIVISION NAME:
, ~ 7~ (or) W
COUNTY: OWNER'S 13AXYER'S NAME: MAILING ADDRESS:
Y, 0
USE f- - to - fir'`
DATES OBSERVATIONS MADE
NO BEDRMS.: COMMER IAL DESCRIPTION: PROFILE ; PER I-:I~tt,
4xtesidence ehaAteplace
RATING: S= Site suitable for system U= Site unsuitable for system
OOENTIO❑NAL: MOUND: IN-GR~O`UN5PSS URE• 3SM EM-IN-FIL: RECOMMENDED SYSTEM:(optional)
SS UU S SS s , d e t74 r"wE.
If Percolation Tests are NOT required DESIGN RATE: S T M If any portion of the lot is in the
under s.H63.09(5)(b), indicate: (Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPT H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B yi rT L.{I f o;
e' • ,i' g' i l r"` ~ d/
B- - t t ; :J a: r. ? n ! <f;~ .;t¢fi. _ f F! t Sao
f
B /
L Z r, / t .f' : 3.. f , f! r ! r°.: a } 6"`s ¢.''~1 • ..S a ~4.. a / 11 . ~ i
f
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LB-_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN, PERIOD 1 P RIOD2 PER INCH
P ° t
P-
P-
P
PLAN VIEW: 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 slop. #
SYSTEM ELEVATION "t
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (printl; TESTS WERE COMPLETED ON:
ADDRESS. _ f CERTIFICATION NUMBER PHONE NUM ER optional):
,r'`'~> .v; . rC'". " r..... ^v ~,j,..~ ,;F~._
CST SIGNATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
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