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Parcel 028-1017-87-000 12/30/2005 05:14 PM
PAGE 1 OF 1
Alt. Parcel M 12.28.17.91 C 028 - TOWN OF RUSH RIVER
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 - RUSH RIVER, TOWN HALL%DELORES VRIEZE
TOWN HALL%DELORES VRIEZE RUSH RIVER
1815 CTY RD N
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: 0.000 Plat: N/A-NOT AVAILABLE
SEC 12 T28N R17W PT SW SW COM 258FT E OF Block/Condo Bldg:
SW COR; TH N 3 1/2RDS; TH E 44.3FT; TH S
3 1/2 RDS;TH W 44.3FT TO POB EXC PT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
CO HWY PROJ 95-N-2 12-28N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1174/224 WD
07/23/1997 315/387 WD
07/23/1997 309/302 QC
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/07/1995
Description Class Acres Land Improve Total State Reason
OTHER X4 0.000 0 0 0 NO
Totals for 2005:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
PLEASANT VALLEY- RUSH RIVER
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PIERCE COUNTY cou V /NE
PLEASANT VALLEY TWi? }I~- ~tCco/x o~y ws
RUSH RIVER TWP,
2812 MALL DRIVE OFFICE
EAU CLAIRE, WISCONSIN 717 MAIN STREET AABY
ST. MENOMONIE, WISCONSIN
FEDERAL SAVINGS ® Business: 273 True Value
AND LOAN ASSOCIATION -4945
Residence: 273-4155 REALTOR Hardware
Car: 792-2732
Z DAR-RAY Realt
319 EAST GRAND AVENUE ~ FRIGIIIA~iE
EAU CLAIRE, WISCONSIN Raymond Huppert Authorized PAINTS
207 NORTH BRIDGE STREET 372 WEST 332 West Main Street Dealers
CHIPPEWA FALLS, WISCONSIN MAIN STREET 698-2.37']
ELLSWORTH, WISCONSIN Ellsworth, Wisconsin 54011
Woodville
Parcel 028-1017-70-000 12/22/2005 10:59 AM
PAGE 1 OF 1
Alt. Parcel 12.28.17.90B 028 - TOWN OF RUSH RIVER
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 - SCHWARTZ, WM C & JANE
WM C & JANE SCHWARTZ
449 200TH ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ` 449 200TH ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE
SEC 12 T28N R17W N 647 FT OF W 673 FT OF Block/Condo Bldg:
NW SW
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-28N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/13/2004 754185 2509/244 EZ-U
2005 SUMMARY Bill Fair Market Value: Assessed with:
82796 Use Value Assessment
Valuations: Last Changed: 08/30/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 35,000 122,300 157,300 NO 05
AGRICULTURAL G4 7.000 800 0 800 NO 00
Totals for 2005:
General Property 10.000 35,800 122,300 158,100
Woodland 0.000 0 0
Totals for 2004:
General Property 10.000 15,300 70,800 86,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 206
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 028-1017-80-000 12/22/2005 10:55 AM
PAGE 1 OF 1
Alt. Parcel 12.28.17.91A 028 - TOWN OF RUSH RIVER
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 - SCHWARTZ, WM C & JANE
WM C & JANE SCHWARTZ
449 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: 38.619 Plat: N/A-NOT AVAILABLE
SEC 12 T28N R17W SW SW EXC PT TO CHURCH Block/Condo Bldg:
& TOWN ,HALL & EXC PT TO CTY RD PROJECT
95-N-2 j Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-28N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/13/2004 754185 2509/244 EZ-U
1167/637 WD
737/396
309/302 QC
2005 SUMMARY Bill M Fair Market Value: Assessed with:
82797 Use Value Assessment
Valuations: Last Changed: 08/30/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 35.619 5,900 0 5,900 NO 05
UNDEVELOPED G5 1.000 100 0 100 NO
AGRICULTURAL FOREST G5M 2.000 3,500 0 3,500 NO 05
Totals for 2005:
General Property 38.619 9,500 0 9,500
Woodland 0.000 0 0
Totals for 2004:
General Property 38.620 5,700 0 5,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
i
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 028-1017-85-000 12/22/2005 10:55 AM
PAGE 1 OF 1
Alt. Parcel 12.28.17.91 B 028 - TOWN OF RUSH RIVER
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 - PEACE LUTHERAN CHURCH
PEACE LUTHERAN CHURCH
2084 CTY RD N
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 2008 CTY RD N
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 12 T28N R17W PT SW SW COM SW COR OF Block/Condo Bldg:
SW 1/4; TH E 20 RIDS & 25FT; TH N 3 1/2
RD TH W 20 RIDS & 25FT; TH S 3 1/2 RIDS TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
POB EXC 91C EXC PT TO CTY RD PROJECT 12-28N-17W SW SW
95-N-2 (PARKING LOT OF RUSH RIVER TOWN
HALL) (ABOUT 1890)
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1174/223 WD
07/23/1997 378/37
07/23/1997 309/302 QC
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/07/1995
Description Class Acres Land Imp~ove Total State Reason
OTHER X4 0.000 0 0 0 NO
I
i
Totals for 2005:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTMENT OF. INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
❑CONVENTIONAL ❑ALTERNATIVE Stare Plan LID, Number
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NA1ME OF PERMIT HOLDER: AHOLDER. INSPECTION DATE.
j t
I A
BENCH MARK (P ~rmanent reference point) DESCRIBE IF IFFERENT FROM LAN REF. PT. ELEV.: CST REF. PT. ELEV.
Namr• of Plumber. MP/MPRSW No. Cuu„ {y Sanitary Permit Number.
sSr~
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUID CAPACITY. TANK INLET EEC' TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED
OYES ONO OYES ONO
BEDDING. VENT DIA. IVINTMATL HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT TO FRESH
ALARM LINE AIR INLET
FEET FROM
OYES ONO OYES ONO _ NEAREST
DOSING CHAMBER: _
MANUFACTUN FH REDOING [11111111 (:APAC:I I V PUMP MODEL =N111 ACTt1H EH WARNING LABEL LOCKING COVER
PROVIDED PROVIDED
O YES ONO EYES ONO DYES ONO
GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL NUMBER OF PH0PFRIY WELL BUILDINGS VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM I INE AIR INLET
PUMP ON AND OFF) OYES ❑N_O_ NEAREST -0
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing { oln:+, T FR MATE HIAL AND MAHKIN(,
OL excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM: _ _
WIDTH LENGTH NO. OF DISTH PIPE SPAIN',, C:UVEH I'JSIUE DIA =PITS LIQUID
BED/TRENCH TRENCHES aATERIAC PIT DEPTH
DIMENSIONS
I1G "~.I 'r DEPTH [I:STl~'PL DISTH PPE DISTR. PIPE MATERIALNODISTH NUMBER OF ROPER TV WELL VENT TO FRESH
'I aTVEf+ v NLf r ELEV END PIPES FEET FROM wE AIR INLET
NEAREST
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. TIONS MEASURED.
OYES ONO _
SOIL COVER ThY.IUHE JPEHMANLNTMAHKFIiS OBSERVATION WLIIS
OYES ONO OYES ONO
DE PTH OVFH THE N(:n HLD DEPTH OVhH THE NG.U HFI1 DEPTH OF'"PSOIL SODDED JSEEDED MULCHED
CENTER EDGES
OYES ONO OYES ONO EYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
ID1rd LENC;Tn NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH A80VE COVER
RED/TRENCH TRENCHES
DIMENSIONS
'.1ANIFULD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL INO DISTH DISTR. PIPE DISTHIBUT ION PIPE MATERIAL & MARKING
E EV. ELEV. DIA ELEV. PIPES DIA
LEVATION AND
ELEVATION
DISTRIBUTION
E SIZ E HOLE SPACING OfILL ED COHH FC 7IV GOV ER MATERIAL VER rICAL LIFT CORRESPONDS TO APPROVED
INFORMATION ]II(A PLAnIs
EYES LINO OYES ONO
COMMENTS: PERMANENT MARKERS oweu-s NUMBER OF PROPERTY wELL BUILDING
FEET FROM uNE
L~ YES ❑ NO ❑ YES ❑ NO NEAREST-
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE - TITLE
DILHR SBD 6710 (R. 01/82)
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'/z x 11 inch s in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All approiate 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.
Property Owner: Mailin ddress:
Property Location: City, Village or Townshi County:
'4 S~✓'%aS v~iTo~Y NiR /'7 (or) W ;4, ✓e-/z- -7 ✓Ss • l~f~~i ~C
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
/ (If assigned)
u..-) ~K v
TYPE OF BUILDING /
Number of
19 Public* ❑ Variance* ❑ Other (specify)* w ~Si cf-c l4~ ✓ ~C Bedrooms:
Q 1 or 2 Family *State Approval Required. /I/C) RQ ~R
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY x X
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): El
New ❑ Replacement Experimental ❑ 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 inst lla ion of the private sewage system shown on the attached plans.
Name f Plumber: S g MP/MPRSW No.: Phone Number:
e '2,4, / I ZY
71 M -0 ('71 ST 612
PI er Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Stature of Issuin Agent: JF e: Date: Sanitary Permit Number:
I1 ❑ APPROVED l t~
1 --S ❑ DISAPPROVED
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 (N.03/81)
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DEPA'RTME'NT OF
REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, c DIVISION 7969
LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON, WI 53707
HUMAN RELATIONS
(H63.09(l'r & Chapter 145.045)
L CCATI i SECTION: t WT iMU!VICIPA TY: =.:IBLK. NO.: SUBDIVISION NAME:
Ste' /S/ i~ /T R ,(or, W 5 .4 ve R
000NTY: OWNER'S/BUYER'S NAME: MA'LING ADDRESS:
CRU/x _
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: GOMM IALDDESCRI/PTION: - - PR I D S RIPTIONS: MC- 1T TESTS:
❑Residence _L CUt~ g / 56New ❑Repla a C~ ~j - O _ pZ
~~~fJ G 7 0
RATING: S= Site suitable for system U= Site unsuitable for system
r50ff_N_VE_N_Tff5_N-A L : MOUND: IN-GROUNDPRESSURE: S-YSTEMINFILLHOLDING TANK: RE MMENDED SYST :(optional)
S U 0 S [DUI ❑ S_MU El S ~Q S CCU
If Percolation Tests are NOT required DESIGN RATE: [Fl:. n
y pron of the tested area is in the
under s.H63.09(5)(b), indicate: odplain, indicate Floodplain elevation:
PROFILE: DESCRIPTIONS
BORING TOTAL ELEVATION D PTH 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.)
B-
B-
B-
B-
PERCOLATION TESTS
EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AF_TERj~SW~ELLING INTERVAL-MIN. PERT _D t _PE__ D z PE RI D PER INCH
P G S - j~7 -
P- ~q►3 1o14J o o „vI
P
P tJ F
IV
H~K
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 horings and the direction and percent
of land slope.
SYSTEM ELEVATION
_ a
t.
r ~
I ~ gp r
4# /
dO Sc 4 ~-e_ US e /'Y1 e 'q 5 u .~2 e rya 1 s rJ v ~J y R K• n/ -
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 A'isconsin
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( iional):
~C~ 4 C' w , S - - - 5~IK _3 7
STSIGNA` URE: -
DISTRIBUTION: Original and one copy to Local Amhmity. Property Owns, an-l Soil Testes
DILHR-SBD-6395 (R. 02/82) CrVF7%3