HomeMy WebLinkAbout002-1066-10-000
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Parcel 002-1066-10-000 10/18/2006 09:41 AM
PAGE 1 OF 1
Aft. Parcel 27.29.16.400A 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): O = Current Owner, C = Current Co-Owner
O - NICCUM, DAVID & KAREN
DAVID & KAREN NICCUM
780 250TH ST
WOODVILLE WI 54028
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 30.000 Plat: N/A-NOT AVAILABLE
SEC 27 T29N R16W NE NE EXC CSM VOL 3/839 Block/Condo Bldg:
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Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-29N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
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2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/28/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 26.500 3,400 0 3,400 NO
UNDEVELOPED G5 1.500 200 0 200 NO
OTHER G7 2.000 4,000 144,000 148,000 NO
Totals for 2006:
General Property 30.000 7,600 144,000 151,600
Woodland 0.000 0 0
Totals for 2005:
General Property 30.000 7,600 144,000 151,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
ER , TO,dNSHIP SEC. > TZ~LN, R to W
ADDRESS , ST. CROIX COUNTY, WISCONSIN.
DIVISION LOT LOT SIZE .
•
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOO,' EVERYTHING WITHIN 100 FEET OF SYSTEM
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'TZC TANK(S) MFGR. Indicate NUnth At tow
wGI~S' Oi~CRE'" STEEL Scale
NO. of rings on cover Depth DRY WELL
.CHES NO. of - width length area
no. of lines___,g.,Y width length area BO
de pith to top of pipe_ 114
;UGATE _
RATE AREA REQUIRED S~ AREA AS BUILT
;claimer: The inspection of this system by St. Croix County does not imply complete
oliance with State Administrative Codes. There are other areas that it is not possible
-i.n2pect at this point of construction. St. Croix County assumes no lio-bility for
mein operation. However, if failure is noted the County will make every effort to
-_rrnine cause.of failure.
,:,z%SES AND OILS SHOULD NOT BE DISPOSED THROUGH 'HIS SYSTEM.
`'INSPECTOR
DATED PLU1111BER ON JOB
LICENSE NUMBER ;7~ _ ~
z
REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
S a n-i,.t a ay P e.,~_ m i t\ :
State Septic.
5
NAM E /,I' dJnahi ( S C1coix Caun u
t.
Location /L Sectian
SEP7 . C TANK
Size. 1attons. Nwnbet oD Compaatme=ttils
Diz Lance Er,om: We.Z.E .~j t. 12% o,,L g.tcaten -6yope _6t
$uit di na !r.' 6.t. Wet.Zand,s-,
LL.ighwQ~e_-°c
DISPOSAL S YS T Ekf
D.iz.t_Lnce Fao,m: wek'Z 12% ol`L gaea-te1: .6 tope it.
Buitding 6t. Wettandl., Ft.
Highwatek t.
FIELD DIMENSIONS: -
W;;.dth v6 .t.,Leach ' 't. Depth o~ :toc h. betow iZe
Length o~ each Une _6t. Depth onock overL tiZ1 in.
Numbe,,, o6 tines Depth of ti-Ze befow g ade 114- -in.
oval. Z2. ngfh v C'tine~s~r` .t. Stone o6 .t.,en.ch_- in peA 100
D~"As'-( lice bet~uc~e17 .".ane-s_~ ~t.. Dept~l to bvu,°ca~~;~
r 1
Ta"tak ac!,6 t))Lb a yea-~ Depth to gnouf~dwQtelc
t 2 Type o~ Cvve t: P ape:t o1L 3tP-tj-+r '
o._
PTT D 4T'NSI0 Numbe.-°t ~ pi,t.5 Ghavet. anousid pits un no
Depth below inZet_
2
L
Tc, z,C ab1sc1cbL-r,on a ea Sa z
A1Lca kequ,!_1Le.d ! fJ' rn
INSPECTED Bi!':~a',^ i ITL E
APPROVED -9A7 E ~ -,197
REJECTED_ , DATE- -_._^19 7,
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E H 115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION 0-C Ivi SectionT,RZ-62=E (or) W, Township or Murric~patity -
Lot No. , Block No. County `5-4. !po~X -
ubdiv,s,on Name
Owner's/Buyers Name: DA ✓rr~ No C C, J r, -
-
Mailing Address: Woo 4 yi'11-P- r LO LS
TYPE OF OCCUPANCY: Residence -No. of Bedrooms COMMERCIAL -
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT -ALTERNATE SYSTEM OTHER -
DATES OBSERVATIONS MADE: SOIL BORINGS ` A.1 ' 79' PERCOLATION TESTS ~3 - 7X -
SOIL MAP SHEET 0 7/ NAME OF SOIL MAP UNIT S -
PERCOLATION TESTS _
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
DEPTH CHARACTER OF SOIL RATt.
I NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL
I MII~?/Ir;~
~BER 1ST WETTED SWELLING IN MINUTES PERIOD1 PERIOD2 PERIOD3
tr D tr r I 11
P- 2
P- r` h r~ ` fr O v tf q tf S tr .S_
fl lr n u ~Q rr lr 1 I rr /
P- u e u fl rr f~ r t u S 7 pCC~
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- l 5~ r > ~6 r v L t' N D r+7 fi
B- rf > G ' tr li it
B-
B- f 4 rr tr tl
B- t/ > if fr of
B- > / fr i/ tr
tf
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the lopp ion and sq are feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy !24 Sf f?, dicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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I, the undersigend, 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.
Narne {print} 1-le-e e Certification No.
Address t' 44J/'~ /
Name of installer if known _ - O C'
Copy A -Local Authority ST Signatd _
i:.. State and County State Permit # `5
PLB 67 U a Permit Application County Permit #
`\9 u
f.
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:
Iq 1 / 1( C J M 4f ~_)o Off
B. LOCATION: Section, TA2 N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township q~C.e~cc/~.✓
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY /000 Total gallons No. of tanks 0/y e_
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete X_ Poured-in-Place Steel Fiberglass Other (specify)
New Installation 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 sq. ft.
New K Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X Length Width /A Depth -fk ' Tile depth (top)es ~No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- / /U Distance from critical slope
WATER SUPPLY: Private A 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
Tester,
by the Certified ?~Vl
r T off- C.S.T. # and other information
NAME e-
obtained from Gcl c? (owner/builder).
Plumber's Signat r / MP/MPRSW# I'}D - ~`f b q Phone #
Plumber's Address ICS c uyr rJ
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 _Zl-), 6j? Coun Ga Date
Permit Issued/ *0w4ed- (date) - -Z Issuing Agent Name r
Inspection Yes No State Valid# Date Recd
1. county (wh• e 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
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