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Parcel 042-1042-10-000 11/14/2006 11:14 AM
PAGE 1 OF 1
Alt. Parcel 16.29.18.241 042 - 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 - RUSMAR FARMS INC
RUSMAR FARMS INC
992 120TH ST '
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 992 120TH ST
SC 2422 ST CROIX CENTRAL
C S
SP 1700 WITC q6
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 16 T29N R18W NE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 798/511
07/23/1997 531/356
07/23/1997 486/139
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/11/2003
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 33.500 4,600 0 4,600 NO
UNDEVELOPED G5 1.500 200 0 200 NO
OTHER G7 5.000 24,000 387,100 411,100 NO
Totals for 2006:
General Property 40.000 28,800 387,100 415,900
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 28,800 387,100 415,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 2 Certification Date: Batch 129
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LF,130R & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan I D. Number.
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NA F PERMIT HOLDE ZI.M DERINSPECTION DATE
BENCH MAAARK (Permanent reference pointDES RIBE IF DIFFERELAN. REF. PT. ELEV.: CST REF. PL ELEV.
Name of L%rbec MP/MP SW No.. IC,,n,y Sanitary Permit Nummbber.
SEPTIC TANK/HOLDIN TANK
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED
❑ YES LINO ❑YES LINO
UMBER OF - ROAD. PROPERTY WELL. BUILDING. (VENT TO FRESH
BEDDING: VENT DIA. VENT MAIL. JHIGH WATER [NNEARESTO
ALARM LINE. AIR INLET.
FEET FRM
❑YES LINO ❑YES LINO -DOSING CHAMBER: _
MANUFACTURFIT BEDDING LIQUID CAPACI LV PUMP MODEL IPUMP,SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
❑YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYC LE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING JVENTTCIRISH
(DIFFERENCE BETWEEN FEET FROM NE AIR INLET
PUMP ON AND OFF) ❑YES LINO NEAREST____)._
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing - LF v:, r•, MAT 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. JLENGTH NDIS TRPIPE SPACIN(~ COVER NSIDE DIA PITS LIQUID
BEd/TRENCH TNCES MATERIAL: PIT DEPTH:
DIMENSIONS
GP,lNEL DEPTH TILL DEPTH UISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO_ DISTR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
Bf 1W, PIPF 5 ABOVE COVER ELEV. INLET ELEV. END PIPES. FEET FROM , LINE 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.
❑YES LINO
SOIL COVER. TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES LINO ❑YES LINO
I)EPTH OVER TRENCH BED DEPTH OVER TRENCH,BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED
CENTER EDGES
❑YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM: _
WIDTH. LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW 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
BOLL SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS.
_ ❑YES LINO ❑YES LINO
-7 J
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING:
FEET FROM LINE
❑ YES ❑ NO DYES ❑ NO NEAREST-
Sketch System on Retain in county file for audit.
Reverse Side. _
SIGNATURE. TITLE.
DILHR SBD 6710 (R. 01182)
State and County State Permit #
PLB 67
W Permit Application County Permit
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:
r ~t X000-
04 )1 5 B. LOCATION: .,tr Section, T N, RZ~~W) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANf.Y: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms ' 3 No. of Persons
D. SEPTIC TANK CAPACITY Z t16-y'in, Total gallons No. of tanks rr+~ i ~f ,7~
HOLDING TANK CAPACI Total gallons No. of tanks /
Prefab concrete Poured-in-Place Steel Fiberglas~ 0 her (specify)
New Installation Replacement ~C r, !z "
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area 4sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft.-Width Depth Tile depth (top) No. of Trenches
Seepage Bed: -Length
Width / ,;=_Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land ~ 'i ^_Distance from critical slope
WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
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 Cer _ ede
NAME C.S.T. # / :3 / y and other information
obtained from (owner/builder).
Plumber's Signature 4 MP~MPRSW# Phone # 14
Plumber's Address
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.
A,e
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a .k.. m _ ma,. e. w m e...... e m a. a' e m,. ,w s ..e w,u. a o e. a... m
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT U ONLY ,h
Date of Application y~ Fees Paid: State County Dam
Permit Issued/Rejected (date) - p-~- Issuing Agent Name ~O
Inspection YeAit-copy) No State Valid# Date Recd
1. county (w 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
9111111L -
vaL 6~
37711---Z
ONE AND TWO FAMILY
r
` *The existing system must be inspected for compliance to bedrock and high
groundwater requirements of the code.
If the existing system does meet minimum requirements for groundwater and
bedrock depths and if it is functioning, an addition can be added in most
instances without updating the existing system. If the existing system is
utilized for the addition, every attempt should be made to locate and reserve
~
an area which is suitable for a code complying replacement system for wnen the
system fails. If the addition will substantially increase the wastewater
discharge the existing system shall be replaced with a code complying private
sewage system.
V T cf S~c{rzo /L;
ection p
1/4 Subdivision & Lot ow n s h
; R U ; 75
Rural Route Address Post Office, Zip Code
(I)(We) 40 7-e-- plan to (build an addition
to, remode the bui ding at the above named ocation. The present private
sewage system has been working satisfactorily as far as disposing of wastes.
If the present private sewage system does fail, it will be replaced witrn.one
that is code complying.
1) 4ssSS 7 2
wner gnature
-ITaa
REGISTERS OFFICE
ST. CROIX CO., W IS.
Subscri/band sworn to before me Recd. for Record this 16th
this`O day of 19day of April PA.D. 19-82
at
_c'
~y Notory Isub ii c James O'Connell
v %
County, Wisconsin ~ R•obtr of~••d. _
• My,Commission Expires deputy
7 COUNTY
ounty Authority
Plot plan attached (show location of building addition to drainfield and
septic tank).
11-81
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Parcel 042-1042-10-000 11/14/2006 11:11 AM
PAGE 1 OF 1
Alt. Parcel 16.29.18.241 042 - 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 - RUSMAR FARMS INC
RUSMAR FARMS INC
992 120TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 992 120TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 16 T29N R18W NE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 798/511
07/23/1997 531/356
07/23/1997 486/139
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/11/2003
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 33.500 4,600 0 4,600 NO
UNDEVELOPED G5 1.500 200 0 200 NO
OTHER G7 5.000 24,000 387,100 411,100 NO
Totals for 2006:
General Property 40.000 28,800 387,100 415,900
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 28,800 387,100 415,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 2 Certification Date: Batch 129
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP ag ',urr SEC . j_,~-_ TN , Rr W
P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100FEET OF SYSTEM
~y
¢3 e
.
i SEPTIC-TANK(S) MFGR. u~ CONCRETE~_ STEEL `
N0. o rings o cover Depth - DRY WELL
TRENCHES No. of width ength = area -
I BED no. o-f lines widtF j length area
de t to top of pipe
AGGREGATE y yr
PERK RATE AREA REQUIRED AREA AS BUILT
DISCLAIMER: The inspection of this system by St, Croix County does not imply
complete compliance with State Administrative Codes. There are other areas
that it is not possible to inspect at this point of construction. St. Croix
County assumes no liability for system operation. However, if failure is
noted the County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSPECTOR
DATED PLUMBER ON JOB
LICENSE d-
4
7 el
REPORT Or ITISPECTIOI'I--I7IDIVIDUAL SEWAGE DISPOSM, SYSTEM
Sanitary Permit ,2
State Septic _f7
'..AIIE TO<<IT3SHIP
St. Croix County
S??PTIC TA',
Size gallons. "umber of Compartments
Distance From: Y?ell e ft. 12`70 or greater slope J.
Building _ ft. Wetlands f"
ig}ic• ater ft.
DISPOSAL SYST;',i1 Tile Field or Seepage Pit(s)
Distance From: Tell ft. 12% or greater slope f4
Duildinr -7,✓ ft, Wetlands f:
FIELD I'iFhwater ft.
Total length of lines ft. Number of lines ~ Length of
each line Et. Distance between lines (Ci ft. Width of the
trench _ft. Total absorption area sq. ft. Dept:
of rock below tile in. Cover
in. Depth of rock over tile
over rock
Depthh of file below grade in. Slope of
11
trench in frier 100 ft. Depth to Bedrock l~ ft. Depth to
ground water V-) ft.
t_
'lumber of nits Outside i4 ,ete ft. Depth below inlet
ft. Gravel around nit:f 1 esi no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required f'>
`square feet of seepage nit area required f ~t
Inspected by Title
r+T +
Approved Date _1977.
Rejected Date 197` ,
1
's
State Permit #
PLB67 State and County
`v Permit Application County Permit
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF lPROPERTY / /Mailing Address:
B. LOCATION: Section /Z:,-, T_"N, R_)_!j5'E (or) W Lot#
Subdivision Name, nearest road, lake or landmark Blk# _ Village
Township LfJrr
_ -
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family! Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: ishwasher YES 4----NO Food Waste Grinder YES 0 # of Bathrooms_e~-
Automatic Washer ES NO Other (specify)
E, SEPTIC TANK CAPACITY eo~z*-z -Total gallons No. of tanks
'Holding tank capacity Total gallons No. of tanks
dew Installation Addition Replacement -Prefab Concrete
Poured in Place Steel Other (specify)
E FFLUENT~DISPOSAL SYSTEM: Percolation Rate 1) 2)___3)_Total Absorb Area - sq. r.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: LengthWidth /,^,L'_ Depth Tile Depth-.;2-!/ No. of Lines 12--
~r
Seepage Pit: Inside diameter Liquid Depth Tile Size `i
Percent slope of land -:P1 Distance from critical slope
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
':isconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certifi Soil Tester,
ItsAME W h ',.S.T. # / and other information
obtained from (owner/builder). _
P'lumber's Signature MP/MPRSW# ? Phone #
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
zld
ell -e'?
Do Not Write in Space elow FOR DEPARTMENT USE ONLY p
Date of Application Fees Paid: State/0, DD County , 0 U Date
Permit Issued/ACT date) 7 Issuing Agent Name
Inspection Yes~No 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 6/1 /76
r',5 (11-74)
f WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
• P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: Section , TN, R E (or) W, Township or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B-
B-
B-
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give reference point. Indicate slope.
I I tN
v
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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) Signature
Certification No.
Name of installer if known
Cop; C - Local Au ho, 8y