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,Parcel 002-1046-90-000 02/15/2005 03:18 PM
PAGE 1 OF 1
Alt. Parcel 20.29.16.297C3 002 - TOWN OF BALDWIN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
* DOORNINK, RUEBEN W & DOROTHY J
RUEBEN W & DOROTHY J DOORNINK
841 220TH ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 841 220TH ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 2.160 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R16W IN NW SW LOT 3 CSM VOL Block/Condo Bldg:
3/825 ORD TOWN BALDWIN
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-29N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 785/205
2004 SUMMARY Bill Fair Market Value: Assessed with:
42355 235,500
Valuations: Last Changed: 11/02/1999
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.160 9,200 149,100 158,300 NO
Totals for 2004:
General Property 2.160 9,200 149,100 158,300
Woodland 0.000 0 0
Totals for 2003:
General Property 2.160 9,200 149,100 158,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 510
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 45.00
Special Assessments Special Charges Delinquent Charges
Total 45.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
r:.R f\ C.cJ ~Je n3 l lG~~_~ Nr _
TOWNSHIP 64Ldw,.J SEC. T-~ ~ N. R~W
ADDRESS , ST. CROIX COU'N'TY, WISCONSIN.
w s
"DIVISION LOT LOT SIZE as 00ot-/0
~~-~o►'^~
PLAN VIEW
Distances b dimensions to meet requirements of H62.20 ~ioT 3 GS~/v1/g~J~
SHOW EVERYTEING WITHIN 100 FEET OF SYSTEM _
07-
j I11 -r - - 9
-
_ 1- J
Indicate Nahth. A:I
:'TIC TANK(S)/ 0o MF'GR. e-1 S~.t _ CONCRETE X STEEL S eat e - zty "
NO. of rinSs on cover Depth DRY I,TELi ~
".CHES NO. of width lens,th
no. of lines J? *aiGth length area __Z C,~~
depth to top of pipe
33-EGATE " " A?,,
a AREA REQUIRED
RATE -Z,~tc/,6_ AREA AS BUILT _Z2 C, U?
:ci3imer: The inspection of this system by St. Croix County does not imply complete
.::)fiance with State Administrative Codes. There are other areas that it is not poss'i'ble
inspect at this point of construction. St. Croix County assumes no liability for
;gem operation. However, if failure is noted the County will make every effort to
.:.2rindne cause of failure.
-ASES AND OILS SHOULD N0." BE DISPOSED THROUGH THIS SYSTM
.r
DATED
PLUIiBER ON JOB ✓~-~c.C~
LICENSE N'J:MER
- r
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.i-tany Penm.i t
State Septic-
E ` rownb h.ip S.~. Cno.ix County
NAM
Location Section
SEPTIC TANK
I
Size/ Z&O gattonz. Numbers o6 Compantmen.tb
Distance Fnom: WeU_~ it. 12% on gneaten etope it
Bu.itd.ing it. Wettanda 6~.
DISPOSAL SYSTEM Highwaten a it. 6~
Distance Fnom: WetZ bz. 12% on gnea,ten ztope ' it.
Bu.itd.ing it. Wettandz Ft.
N.ighwaten 6t.
FIELD DIMENSIONS:
Width o6. tnench !g. it. Depth o6 nock below tite-Z-Zin.
Length o6 each Zine 'T it. Depth o6 nock oven tiZe Z .in.
Numbers o6 Zines Z Depth o6 tiZe below gnade 3G in.
Totat- Zength o6 Zines 1 it. SQope o6 .tneneh in pen 100 it.
Distance between Zine6_~___l.t. Depth to bedn.ock
Totat abbonbtion areas`:: 6t2 Depth to gxoundwaten S` 6t.
Requ.ined anea 6t2 Type o6 Coven: ap n t Stnaw
PIT DIMENSIONS:
Numbet o6 p.itz nave. anound p.i,tz ye.a no
Outside d.iame.te'e /ea epth below inZet 6t.
Totat abz o&b.tion a it 2
z
A
Anea &equ.ined it rn
INSPECTED BY TITLE
APPROVED DATE - - 197
REJECTED DATE 197
r
4#a.;iii'w:eeYNlir.nek.ert nu~.,.«.
Wn. . 9 /78
~ EH
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
' WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: /4,-:i '/4, Section ~ jT 12N,RA-IJ5 (or) W, Township or Municipality
Lot No., Block No. County ~Jza x
Subdivision -Name
/
Owner's/Buyers Name: b C; c~ r4' n~dG A R Q/ ~i` ~E rn.4 ~
Mailing Address: 'd
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW, kREPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS A? - - PERCOLATION TESTS -
SOIL MAP SHEET ] - NAME OF SOIL MAP UNIT 14!
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- SINCE HOLE HOLE AFTER INTERVAL
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- t 1J1 i 1 a ri Ct 3
P~ ` 11
c75 7 /
P- 40
P- T r ~a l i P f' s- y 7 C)
P- It
P- J 1 f I gy pi Ar / l
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- 7,;2- .r y l - r~ D~ C_ ' T ~ t~Id • ~ t✓" Yr! 3 " ~_~/4,rV!~ ~d'n ~Qr4
13- 1
J r i
B- L(
, rJ
171-
113- K
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy f~ qr .Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
5.2 F
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1, the undersigend, hereby certify that the soil tests reportetion this fGin 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.
Nacre (paint).-___ 16'" ~'ee ^-"L'`n// Certification No. ~y
Address f3 C/ "o w 1
Name of installer if known L t
Copy A - Local Authority CST Signature
State and County State Permit #14-1Z
P 67 Permit Application County Permit #
for Private Domestic Sewage Systems County e*77• G012oix
"DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: Y4 [A) Section 20 , T N, R 6,o (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: `Commercial "Industrial "Other (specify) "Variance
Single family _ CX Duplex No. of Bedrooms_ _ No. of Persons. -51_
D. SEPTIC TANK CAPACITY 0O Total gallons No. of tanks Oi✓e,
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation X Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete X Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area 4Z', ,c sq. ft.
New X Replacement Alternate (Specify)
Seepage Trench: No. of eal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: XLength " Width z Depth z' Tile depth (top) No. of Lines 3
Seepage Pit: Inside dia er Liquid Depth No. of Seepage Pits
Percent slope of land Z Distance from critical slope
WATER SUPPLY: Private X 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 Certified Soil Tester,
NAME el2e- -k o~ f C.S.T. # and other information
obtained from CA O n> (owner/builder). v
Plumber's Signature MP/MPRSW# /YJ - ~41k,? g Phone # 6.9 1 9S 70
Plumber's Address z S
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.
S
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010
.~)OP w6117~~r QIFld
Dr Feld-8.5'X/5
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Do Not Write in Space Bel FOR COUNTY AND STATE DEPARTMENT USE NLY
Date of Application Fees Paid- State 1,5.0 0 C u Date lg6- 4Z
- Issuing Agent N
Permit Issued/ (date)
7K
Inspection Yeso 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