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Parcel 042-1012-50-000 10/13/2006 03:29 PM
PAGE 1 OF 1
Alt. Parcel 05.29.18.75E 042 - TOWN OF WARREN
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 - DRINKWINE, KENT
KENT DRINKWINE
1020 110TH AVE
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1020 110TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 5.700 Plat: N/A-NOT AVAILABLE
SEC 5 T29N R1 8W SW SW LOT 2 CSM 4/1178 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
05-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1094/117 QC
07/23/1997 987/482 WD
07/23/1997 817/450
07/23/1997 768/345
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/19/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.700 50,500 60,500 111,000 NO
Totals for 2006:
General Property 5.700 50,500 60,500 111,000
Woodland 0.000 0 0
Totals for 2005:
General Property 5.700 50,500 60,500 111,000
Woodland 0.000 0 0
I
Lottery Credit: Claim Count: 1 Certification Date: Batch 145
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTMENT =F INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR 8;I HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS / DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan l.D.NumbeI r
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
BENCH MARK (Permanent reference pan DESCRIB DIFFERENT FROM PLAN / REF. PT. ELEV.: CST REF. PT. ELEV.
Na,- of Plumb-r. MP/MPRSW No.. County: Sanitary Permit Number.
SEPTIC r ANK/HOLDING TANK: S 7.
MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKI CO R
1 ac )o O ED PRO ED
3~.~,~ 1,, YES ❑ NO NO
BE DDI G. VENT DIA.. VENT MATL HIGH W TER NUMBER OF ROAD: PROBERT WELL. 8 ING. VENT O FRESH
ALAR FEET FROM /ZKi1 LINE~_ L 1[/ 111121"' lAI I ET.
YES ❑NO O NEAREST II
D SING CHAMBER:
MANUFACTURER JBEDDING. LIQUID CAPACITY PUMP MODEL JPUMP SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
DYES ❑NO DYES ❑NO DYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERTV JVVELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM I NE AIR INLET
PUMP ON AND OFF) DYES ❑NO NEAREST- IN
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing L I "('I ,i A- TER MATERIAL AND MARKING
or 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 IDISTR PIPE SPACING COVER INSIDE DIA SPITS LIQUID
BED/TRENCH TRENCHES / MAV-ntAL PIT DEPTH
DIMENSIONS `7 lF '2- (,RA`f UFPi~i FILL DEPTH UISr!7. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DIST tFEET UMBER OF PROPERTY WELLBUILDINGVENT
TO FRESH
E'-! FCy AH( C ER EI FV INLET ELEVEND PIPES (LINE y l[ FROM
/ EAREST-i►
MOUND SYSTEM: Z
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.
DYES ❑NO
SOIL COVER. rExruRF PERMANENTMARKFRS OBSERVATION VVE ILLS
1 DYES ❑NO DYES ❑NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEE) DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES
DYES ❑NO DYES ❑NO DYES DNO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDT H LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELUW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV. ELEV. DIA. ELEV. PIPES DIA.'.
ELEVATION AND
DISTRIBUTION
ATION RULE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
INFORM PLANS
_ DYES ❑NO DYES ❑NO
COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. :7tN UMBER OF 1PROPERTV WELL. BUILDING.
EET FROM LINE
(1 Ire ` EYES ENO DYES ENO EA REST-
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE.
DII_HR SBD 6710 (R. 01/82) -
State and County State Permit #
County Permit #
PLB f, Permit Application
` 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: ga
B. LOCATION: 'S 1i Section r, T N, R _,LJ K (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township jZR E/4/
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family V" Duplex No. of Bedrooms 41 No. of Persons
D. SEPTIC TANK CAPACITY 42-0,0 Total gallons No. of tanks /
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation A-f Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area YG sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: e'__Length Y6 Width. / 2_Depth -46~ Tile depth (top) __o No. of Lines 3
Seepage Pit: Inside di~j ete Liquid Depth No. of Seepage Pits
Percent slope of land- /,ir 'SLI~ Distance from critical slope
'HATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner: --3,4"VE
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,
NAME - -5i.e9,9r1Vj,'14% C.S.T. # and other information
obtained from a : (owner/t>~r).
Plumber's Signature- MP # S~~y Phone # 69441'
Plumber's Address gz> r ; e X:9 CIS 62.> /.5 -s~Erl~z
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State County Date
Permit Issued/Rejected (date) Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (white 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 7/1/78
0
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAY~BI~ OS
INDUSTRY, CF DI ON
~ABOIR'AND PERCOLATION TESTS (115) Mq - - 69
HUMAN RELATIONS AQ6 WI 7
-A A.- I-.)
LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SU ISIO E:
S",/✓ /a Vy s-- /T z~ N/R/e (or) W A1Z1Z1~.v
COUNTY: OWN-Ir~ BUYER'S NAME: MAILING ADDRESS: --~-r-•!y~\
C/zol Gco2 41znAarIo/J 77 USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: _e- I R F DESCRIPTIONS: ER LA ION TESTS:
~l_7Residence r L?New ❑Replace 7-
LL
RATING: S= Site suitable for system U= Site unsuitable for system
CONV IONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
S DU O S DU E] S ❑U F IS Flu Ds ❑U
If Percolation Tests are NOT required DESIGN RATE:SYSTEM EL V. , If any portion of the lot is in the
under s.H63.09(5)(b), indicate: 95.3 Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- / /We/CC, C" > /C Z
y yrf
134 C: 5'
B C~C~ /oU a~~ " fir! S sue" MCC( %AG
5; 3 r/ z r l
B-3 > S i 7 c s r- 1~e r:-GZ./ euY/k C'cA IlAeet
,pff"2/C /3H 5; /l 1 -~f_e " r s f~
B- ~p L 99, 0 NO /!107"1" ®/3S ~2v C=p
1a9A/V U/= T *G 4ey clz eo, 4S~4!9 BUTS G+4r/f T'i/~+ y CL/?- /-?,f4CS .
B- ,i!-T l f v0 m ~/v: ai-i r e c~i~ o ~s +~t% Cep r of o T Ova T~ s' .-~9t~~~v.q
/t/6At` CI c6- d t~//IrB/Z C4f'/101r1rvaSPERCOLATION TESTS /fa~~ suits A ~ x72~~+~~e /n/17 .
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES 1
I-NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD -1 PERIOD 2 PERIOD 3 PER INCH
P- 0 /A7 /^W Cp < c~ . .tia "AJ,
c 3 1
P -3
p=
P- I
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of able soil areas. Indicate s ale or distances. Describe what are the hi;i-
zontal and vertical elevation reference points and show their location on the plot plan. Show t e elevatio at all borings and the direction and percent
of land slop.
SYSTEM ELEVATION ~J -~'~~vs~~ ,sous
G~G~=NV 97+ Sly.,
f f /~LABC Lc`cA7_10A+ O O /V4~' 7c'W
CB$ iZr +r,.- V /T l~ar/ e6/vr46
e e- /
G L'111-1'/v AL/ QF" L"GC--G /00, /
TN
Pr 9~
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Z~ i I
_5C,9 4 15
A''3 9 7. _
X9.0
xis /-/w C, CFIV :
v
. APPjtoVED* E\
'v1 0
Dafei N
nx"Ctors ,~cn~AVL r y Diz / 3n
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 Wiscensin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
7if/S s~TG is Goc.¢~'c=o APi~Pojc/~J~r~c /.v 7H /171'P'o4 ac jyc Sw~~~/ c.=/A✓
NAME (print): - n- TESTS WERE COMPLETED ON:
T//CII/A = SwL /~'St'Al~ /vf4Y/'~ /-Y8 Z
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional
715-
CST SIGNATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
"If You Like Our Service, Tell Your Friends"
BIRCHWOOD PLUMBING AND HEATING
E. F. GROVE, OWNER
PHONE
RIVER ALLS, WISCONSIN 54022 -2-9
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