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Parcel 014-1017-10-000 10/12/2006 03:25 PM
PAGE 1 OF 1
Alt. Parcel 8.31.15.113 014 - TOWN OF FOREST
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 TURKEY FARMS INC
NELSON TURKEY FARMS INC
2290 CTY RD Q
CLEAR LAKE WI 54005
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 2290 CTY RD Q
SC 1127 CLEAR LAKE
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 8 T31 N R1 5W NE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-31 N-1 5W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 683/635
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 10/17/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 36.000 6,400 0 6,400 NO
UNDEVELOPED G5 2.000 200 0 200 NO
OTHER G7 2.000 10,000 290,600 300,600 NO
Totals for 2006:
General Property 40.000 16,600 290,600 307,200
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 16,600 290,600 307,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 014-1020-60-000 10/12/2006 03:31 PM
PAGE 1 OF 1
Alt. Parcel 9.31.15.134 014 - TOWN OF FOREST
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, TRUST%ROBERT OR LAUREL H
TRUST%ROBERT OR LAUREL H NELSON
2291 CTY RD Q
CLEAR LAKE WI 54005
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ` 2291 CTY RD Q
SC 1127 CLEAR LAKE
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 9 T31 N RI 5W NW NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
09-31N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1130/542 QC
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 10/19/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 15,000 141,000 156,000 NO
AGRICULTURAL G4 33.000 5,000 0 5,000 NO
UNDEVELOPED G5 2.000 200 0 200 NO
PRODUCTIVE FORST LANDS G6 3.000 4,500 0 4,500 NO
Totals for 2006:
General Property 40.000 24,700 141,000 165,700
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 24,700 141,000 165,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 108
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
Kx+tER ;1T~t 'r L sr' TOWNSHIP
.
'O. ,~7DRESS SEC. . f T_ N. R W
ST. CROIX COUNTY, WISCONSIN.
VT
A. LOT LOT SIZE
PLAN VIEW j
Distances dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
--T - - - ------i-
i i
1~ ~ I I 17r ~ I
VAr
i i
f•r' ~ l~I~ t I ' I / ~ k ~
! I I s
f
i I I 1 i i f
In dilcate North: Arrow
I I ' S CALEO. --i-r---
r
tPTIC TANK(S) MFGR. ij~ OIICRETE ,.L STEEL
NO: of rings on cover Depth - DRY WELL
t'LNCHES NO. of width length area
J no. of lines width length area -7777T
"
dept too top of pipe P
P
aGREGATE -
I;W RATE " AREA REQUIRES? AREA AS BUILT
I,sciaimer: The inspection of this system by St. Croix County does not imply complete
.orpliance 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
IStem operation. However, if failure is noted the County will make every effort to
.jterssne cause of failure.
"EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
`INSPECTOR r-- e
DATED o (r PLU:IBER ON JOB
LICENSE N'JAH3ER
z / REPORT :'F INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.itaAy Pehm.i,t
• State Septic
NAME i own.bh.ip St. Cno.ix County
Location Section
- t
i
SEPTIC TANK
4.
Size gattonz. Numbers o6 Compatc.tmen,tA
Distance Fteam: Wett 12% an gAeateA Mope it
Bu.itd.ing ` it. WetZandA S .
H.ighwatvL ~ .
DISPOSAL SYSTEM j
Diztanee Fnom: Wett 12% an. gteatetc 6tope=
Bu.itd.ing it. Wettand,s Ft.
H.ighwaten it.
FIELD DIMENSIONS:
Width o6 ttcen ch it. Depth o6 tco ck b eZow t.ite _-in.
Length o6 each fine it. Depth o ti tcoch over tite .ir".
Numbers on f:.ines Depth of t.ite below grade -_in.
Total length o6 tin e. t. Stope o6 ttcench in pv, 1,90 it.
Distance between tines it. Depth to bedt,ock
Tout abzmbt.ion a&ea 6t2 Depth to g`LoundwateA
Requit ed atcea i 2 Type, of Covet,: Papers o,,, St,taw
4..
PIT DIMENSIONS:
Numbe& o6 pit.6 i Gtc.avet at~ou.nd pitzs yes__no
Out,side d.iametetc Depth bepow in. et u A_
2
Toga. absoAbt,~;on atcea bit
Area teequitced g2
' ~t f
INSPECTED BY TITLE
APPROVED r DATE 197.
REJECTED , DATE -197-.
~EH 115 Rev. 9/78
f, • * REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: I~L~ Section--S_,T-:iLN,R (or) W, Township or Municipality
Lot No. , Block ND. - -County--9,7 0-'ea/Y -
1\ Subdivision Name
Owner's/Buyers Name: -;2- ,--t j S 0
Mailing Address: J O` V- kie
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER -
DATES OBSERVATIONS MADE: SOIL BORINGS z ' I I PERCOLATION TESTS
SOIL MAP SHEET 7"41C'~e Z NAME OF SOIL MAP UNITE4 4~J% 9f'z" SST ►~n1
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- SINCE HOLE HOLE AFTER INTERVAL RATE
MIS!/IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-
P-
P-
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 Q _ 916 S
B- > d Br i 5,4 G
B- ? D'l0 -
B- G 7
B- ? Q , 22
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan th _ ation_and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy Indicate 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. f
Name (print)-'/IA4Ja l .lJtrf'C ~7C` -Certification No., ~
Address- LYrsr TL~rJsheW1S A)at :S ~f31 7
Name of installer if known i~1RLJ.raj /'w.1,1S .Je
Copy A -Local Authority CST Signatur ` '
f '
RLB67 State and County State Permit # '
Permit Application County Perrpit
for Private Domestic Sewage Systems County i~ C~'~
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: Section T-3_L N, R IS I (or) W Lot# City
Subdivision Name, nearest road, lake or landmark E31k# Village
Township Ace4rt
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _ Duplex No. of Bedrooms- No. of Persons
D. TYPE OF APPLIANCES: Dishwasher __X_ YES NO Food Waste Grinder YES NO # of Bathrooms)
Automatic Washer -X--YES NO Other (specify)
E. SEPTIC TANK CAPACITY tal gallons No. of tanks
'Holding tank capacity Total gallons No. of tanks
"Jew Installation Addition Replacement Prefab Concrete
'Poured in Place Steel Other (specify)
EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) JO 3) 30Total Absorb Area ~3zGsq. ft.
ew
X Addition _ Replacement *Fill System _
See age Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length 91 Width Depth s Tile Depth 1 No. of Lines
l~
Seepage Pit: Inside diameter Liquid Depth Tile Size 9
Percent slope of land 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
!:)y the Certified Soil Tester,
iN'AME - ' _ C.S.T. # and other information
obtained from a v (owner/builder).
'?umber's Signature MP/MPRSW# f Phone #_Q -,j"1 3
-5 .3 -Y4 Plumber's Address 1
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
loo
56
'
04
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I
Do Not Write in Space Below FOR DEPARTMENT USE ONLY _
Date of Application Fees Paid: State Couryty_,_.C Daje
Permit Issued/ (date) -Issuing Agent Nam `,-c -
Inspection Yes No Valid# Date Recd
1. county (whi a copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4, plumber (canary copy) Revised