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Parcel 022-1063-20-000 01/04/2007 02:50 PM
PAGE 1 OF 1
Alt. Parcel 22.28.18.P338 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 - NELSON, EMIL&MARY FAM-TR %DENNIS
EMIL&MARY FAM-TR %DENNIS NELSON
2037 PLANTE AVE
EAU CLAIRE WI 54701
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 300 CTY RD JJ
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
I
Legal Description: Acres: 39.000 Plat: N/A-NOT AVAILABLE
SEC 22 T28N R18W NW NE EXC HWY Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-28N-18W
it
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 864/76-
1
~I
2006 SUMMARY Bill M Fair Market Value: Assessed with:
179194 Use Value Assessment
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 50,000 197,100 247,100 NO
AGRICULTURAL G4 35.000 2,400 0 2,400 NO
AGRICULTURAL FOREST G5M 2.000 4,000 0 4,000 NO
Totals for 2006:
General Property 39.000 56,400 197,100 253,500
Woodland 0.000 0 0
Totals for 2005:
General Property 39.000 56,400 197,100 253,500
Woodland 0.000 0 0
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
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AS BUILT SANITARY SYSTEM REPORT
' TOWNSHIP ~ SEC . T*_ JW
~
OWNER ,
ADDRESS-A.., ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW 3 U / Pi.
Distances and dimensions to meet requirements of H63 QZZ. ~~(03
OW EV.E-RYTHING WITHIN 100 FEET OF SYSTEM
i
I di a e o th Arrow I
S C& - I i I I
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
mber of rings on cover Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
UMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cycle. gallons; total capacity o
distribution lines gallon: size o pump head;
gallon per minute horsepower ran name 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: um.er o pits feet diameter
feet liquid dept seepage pit in et pipe-elevation
bottom of seepage pit elevation _ feet.
SEEPAGE BED SIZE: number of lines width -leagth~~tile depth
SEEPAGE TRENCH: width 1 n th
PERCOLATION RATE -AREA REQUIRED AREA AS BUILT
' INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER
fr
a
REPORT OF INSPECTION - INDIVIDUAL SLWAGL SYSTEM
Sav14"ta (y Pe-)On,tt 33
State Sept.("e
NAME fll? Town,5 hip
t. Cn.o..(.x County
14 W~ E dw cd.
Location_NW AIL Sectionpp,:)Lot # Subdivil5.ton
SEPTIC TANK
Si 7-C_ gat Cons Numbers o o eorripalctmentb
,0- O
D4,6 tanee ()hom: W cefl 8uizdin_q 12 0 Isdope
11tghwatetc
PUMPING CHAMBER
S.tze _ ga2ton6 Pump Manu~aeturceA Mode.f Numbers
HOLDING TANK
Si ze gaUon6 NumboL q6 Compatctme.nts
Pumpers- .,AZaA-m `Sy6tem
Oi6tanee 6Aom: wet _ Buitding 12% elope.
Highwate,
ABSORPTION SITE
Bed 7n-e.vreh
D-i_etanee_ nom: W f f Buifd.tng t20 ~~ofaer~i
High.waten.
ABSORPTION SITE DIMENSIONS
Width o tic e n c h - ~ . ~ .
Xlf - 4t Requtined anea ~t
Length o6 each Zi,n.e. 6t Depth o6 nock below tife
Number o{ tin.ee Depth o6 noeh- oven. ttite J._ in
TotaP den th o Unee t -
g { / - 6t Depth o6 ti U be.fow gnade. tin
Dtietance. between Unee r=~~ -(I t S. ope o(j t~(, e.nch. n 100 {t
TotaP_ abeoAption anea {t Type o6 Coven: Pape.A, on-;`etLaw
PIT DIMENSIONS
Numbers oo pite G ),a eP_ ahound p.tte yc no
. t
Outeide diameters 6t 11epth betow tini'et At
Total abeonptt.on anea 6t
Arse-a ~cequi4ed ~6t
INSPECTED BY TITLE
APPROVED DATE- 19 n/REJECTED DATE 198
I
REASON FOR REJECTION
i
State and County State Permit #
PLB 67
Permit Application County Permit #
O'k 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:
B. LOCATION: ! % Nj-F ection T- , N, R .A- E (or) Vy/ Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township nn ilk, /I
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _X Duplex No. of Bedrooms 3 -No. of Persons
D. SEPTIC TANK CAPACITY 6C'O _Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete _X Poured-in-Place Steel Fiberglass Other (specify)
New Installation ,1~-_Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
- - - - - - - - - - -
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate "G Total Absorb Areal sq. ft.
New--Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. idth Depth Tile depth (to )No. of Trenches
.,7 , it I
Seepage Bed: Length Width. Depth
Tile depth (top) c-26 P No. of Lines -
Seepage Pit: Inside di meter Liquid Depth No. of Seepage Pits
Percent slope of land 96 Distance from critical slope /1761~~
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 Certt fi, d Soil Tester, 4 j'/J
NAME ~f, m 4 S f -)4 /j C.S.T. # S'r°rAO O and other information
obtained from S t (owner/builder). q
Plumber's Signature Mp/MPRSW# ~gLl,. Phone #{l~3✓-Q'fC/
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.
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3
Do Not Write in Spac Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State Ciunty Dat
Permit Issued/RQoe+ed (date) - - Issuing Agent Nam
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
EH 115 Rev. 9/78 ~aF4
REPORT ON SOIL BORINGS AND PERCOLATION TESTS t,
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
i
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: J4 ~~~H``{'~ i
~L01/4,L1L_Y4, Section 2a ,T AN,RAE (or 11 , Township or Municipality G 11
Lot No. , Block No. ST. I
County
ub i isigqn ame
Owner's/Buyers Name: -
p 1r ~(S
Mailing Address: tote If a C_t i r
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT -ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: ¢S~O/IL BORINGS /Y r l PERCOLATION TESTS ►t I / V _
is 4"
SOIL MAP SHEET ,?J 7 NAME OF SOIL MAP UNIT 21k j C k On'
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 AFTE INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- 3~" D E: lea /S
P- 0 I ~e^
P- G 0? 1,,' 04 Oral I il P- o 6
P- G
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- MI) NE /,B s 1 /d C 4s S`tGr
B- , f - S D 1f 4 s ~/_s'6,94 P
B- 3 y'I I si 21` el S' Sir
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plant the Igcatio and sq are feet of suitable areas.
- A7
Indicate number of square feet of absorption area needed for building type and occupancy B dicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
X ~
X
A )Ob ~E
e
pi~ofvs e4 -4,1k
93
IN
3
,l
a
VtV
a E
a1=lie': Elev, 9rh 6 ('d ar Po3l Fro, Cdri1er
Vlore ~C)/65
(fVIte ~in <4
E
Stale q01 = /eo'46„ ,6V-14)13
I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and m
specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of m
knowledge and belief.
Name (print) TA "O LU4 41 Certification No. 5"5 o
Address a A F,2 P
~ l.✓!
Name of installer if known
Copy A -Local Authority CST Signature ✓ c
REPORT ON INSPECTION OF SANITARY PERMIT #
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
Name, Address ,f icense No. o ns a Ong Plumber Time of Inspection
3 INSTALLATION CONSI S OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
(4)BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: Slope at site:
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity:
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: # ft to well:
(7)DOSING TANK: Manufacturer: # of gallons:
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines gallon; size of pump head; gallon per minute ;
horsepower ; brand name of pump and model number
Is the warning device installed? ❑ YES ❑ NO Wired? ❑YES ❑ NO
;
8 HOLDING TANK: Manufacturer o gallons
construction ; depth to the cover ft; If septic tank is
being used are baffles removed? ❑ YES ❑ N0; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO;
Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ;
Distance from building to vent
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe-elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPAGE BED SIZE: ft width; ft length; tile depth;
lineal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed ft.
11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft;
tile depth ft; ft to well; ft to ordinary high water mark of
lake or stream; ft to edge of slopes greater than 20% falling away toward lakes,
water courses or drainage ditches; elevation of tank discharge line entering seepage
trench ft.
(12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO
(13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO
~DILHR-SBD-5095 N.05/80
Signature of Inspector:
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ENGINEERING GRAPHICS NAME- TIME GRADE
AND DESIGN PROBLEMS FILE NQ_ SEC.- DATE = MINUTES
Copyright 0 1967, Addison-Wesley Publishing Company, Inc.