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Home My WebLink About022-1009-10-000 0 (n 0 3~ ~ d c "0 3 m h` m CD v A 0) CD co 3 n~ ^ 3 xx \ 1 O 0 O A N n vii O w cc) CS CD z C~7 N O L CO M N N n co C, co CO N C O Cn 1 N O 0 O O O 7 N 0 0 O 0) c O 3 O 3 O O 7 N (D ~ O Q N N 7 Dl O ~ CD O Q) (n G D a CO o B' U C 0 CD c 0- CD O A O N Q ` \ Z i CCDD co -4 O (n r - CD N (D CD c ri a ;L .N• T T T d• z O O O o = -D N rjy~ cn can fi Z n o D V til v o v N O o' A N w w N d v M _ n ~ rn m m _ a N ° z co z O O D O n =3 Z "wA • o' CD CD Z7 'Oa U) Z (D N Si O N C CD CD W D d z CD .a ~ Cn O A Z CD .nr z O N Q A C 3 Cl) --1 A m°m *co a z 3 A 3 z w z CD a CD (n Q 3 v Q O= T O FD' CD N N C N CD N 7 Z Q N O o F) (D 7c 0 S O 0 A 7 4 O O x O a) t cn (n CD d C Z N N fll O C D- O O A o N ~ b N d0 V O O °O cl Parcel 022-1009-10-000 10/05/2005 12:33 PM PAGE 1 OF 1 Alt. Parcel 4.28.18.55C 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 - VORWALD, JEANNE F JEANNE F VORWALD 1108 CTY RD N ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1108 CTY RD N SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.268 Plat: N/A-NOT AVAILABLE SEC 4 T28N R18W 1.OOA SW NW LOT 2 OF CSM Block/Condo Bldg: VOL 3/647 ALSO A PARCEL DESC AS COM NW COR LOT 2 CSM 3/647 POB; TH N 00 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 75'; TH S 89 DEG E 150 FT; TH S 00 DEG W 04-28N-18W 75';TH N 89 DEG W 150' ON N LN SD LOT 2 TO POB (.258 AC) Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 962/380 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.268 25,000 132,000 157,000 NO Totals for 2005: General Property 1.268 25,000 132,000 157,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.268 12,500 100,900 113,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 211 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i • AS BUILT SANITARY SYSTEM REPORT r J` M . ;cR TOv7NSHI o i , a34:t y -SEC " T 4,~ N, R t 'tT ADDRESS ST. CROIX COUANT , WISCONSIN. DIVISION , LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SI1019 EVERYTHING WITHIN 100 FEET OF SYSTEM Ii I -_----a~T' _ VLL i i I I I ~ I ~ I ~ , I ~ f f I + t- _ ~_I I i I _ I _ ~_I I f j I I I tn I r - - --f - - I .,,T s ' Indicate Nokth A~YI r C TANKS MFGR. 1 •3 2`Q; ~ C RE t~ 1 STEEL Sca.2e NO. of rings on cover Dept WELL t,i ,'':CHES :v'0. of width length area no. of lines r~idth j length area C`, , depth to top of pipe: ; 7.EGATE R%TEj(. AREA REQUIRED t j AREA AS BUILT -caaimer: The inspection of this system by St. Croix County does not imply complete :,affiance with State Administrative Codes. There are other -areas thac . { it is not possible inspect at this point of construct.-Ion. St. Croy County assumes no liability for '.:::em operation. Ho~ever, if failure is noted the County will make every effort to _,2rmLine cause of failure. SES AND OILS SHOULD NOT BE DISPOSED T1HROUGI1 ':HIS SYSTEM. '-INSPECTOR DATEDI~ ~^w~ PLU;BER ON JOBS LICENSE IvUIMER b 71 , RFP0RTz Or II1SPrCTIO'.1--I74D1V1D1JAL SE;•IAGE DISPOSAL. SYSTE14 r~ Sanitary Permit r^, ° State Septic_ T&RISHIP St. Croix County S,.°TIC TA-11" Size gallons. 'umber of Compartments Distance From: Well 1> ft. 120 or greater slope fi. Building z ft. Wetlands ft Iiighwater ft. DISPOSAL SYSTL:1 Tile Field or Seepage Pit(s) Distance From: Well ft. 12% or greater slope ft Building -zc 5 ft. Wetlands f:. FIELD i1ighwater . ft. Total length of lines , ft. Number of lines ~ Length of each line eft. Distance between lines ~ ft. 14idth of the drench-f=--f t. Total absorption area sq. ft. Depth of rock belcti,. tile l Zan, DP-pth of rock over tile in. Cover t jover.S OCk, Depth of tile below grade Zd in. Slope of . trench in ner 100 ft. Depth to Bedrock "ft. Depth to ground water ft. PITS f ?umber of pits 0 /Id i eter ft. Depth below inlet ft. Gravel arou d es no. Total absorption area sq. ft. .Square feet of seep a, rench bottom area required _ Oquare feet of 9~ epap.e ni e squired Ins»ected Title: Appro d :Date Ca: 197 Rejected Date 197 u . VL ~ y 1 EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 ~p REP RT ON SOIL BORINGS AND PERCOLATION T S v u LOCATI /4-Section _T' AN, 131~_ E (o W Township or Municipality -E jh~~ ~70 Lot No. Block No. County L 1 Owner's Name: s~ E-ANNE Mailing Address: K a1A-r I SG + '~I C~ C~~ TYPE OF OCCUPANCY: Residence No. f Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: StO~IL BORINGS % PERCOLATI TESTS C SOIL MAP SHEET __t<S_t_-' _I L_JIS77 SOIL TYPE ) 1 PERCOLATION TESTS 1Z- W 1 EW 81 86-_ q0' 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 MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 q0 P_a 11 1 i t o?~ IJOr.~ ~l(o 1(0 /Go 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 1 V'U 'I ! c. 1-5c, , L. 9 7,9 -S LLi r4;)N Ito' CL PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitablerareas. I di to number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal *ScaI reference poi s. Indicate slope. ~A$L Sic fy~ T p R4i-ba N o,, I j t I 1 g } r , 04 t N .L_5 Or _ C 1 I may. 1`ii i A`i 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 owledge and belief. Name (print) Certification No. S V Address Name of installer if known t r (vx CST Signature PL7 B-6 State and County State Permit # Z)`C / Permit Application County Permit # - for Private Domestic Sewage Systems County ~r ✓Pc i X *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: -4 ^1 rV t- J tn~, ,4 40 5 B. LOCATION: <.SL+ '/4 /y6✓ Section , T N, R f (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 < Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES A NO Food Waste Grinder YES_X_NO # of Bathrooms Automatic Washer _;K_YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks Zs^/e *Holding tank capacity Total gallons No. of tanks New Installation Addition _ Replacement Prefab Concrete _ _ *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1)/;., 2):,3C-) 3) Total Absorb Area ft. New A Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length /Gn Width /';r.i Depth (e •r Tile Depths No. of Lines Seepage Pit: Inside diamet r r Liquid Depth ` Tile Size Percent slope of land ` Distance from critical slope 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 CertifieSoil Tester, 74 NAME - ;t C.S.T. # ~ and other information obtained from (owner/builder). r Plumber's Signature ! MP/MPRSW# 129 J~ Phone # Plumber's Address C < ' PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 7 r` • ~ crRe /~-F o S _e. - a- C -eRniR4~ 4 a- ~ lb I or - I Him FieL~ - o nl _ mac? FRc.M c v~. c T k, e- T 61, e Ae roZo,-v, /-/cos e_ 1`liI6 4-, -7705, 6AC, IL 10 K Y" LrA + y 7RtlA) t " Do Not Write in Space Below FOR DEPARTMENT USE ONLY ll Date of Application Fees Paid: State County. rx? Gl Date Permit Issued/Rejected (date) o "-7 ~ Issuing Agent Name. Inspection Yes-X- 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 EH 115 (11-74) WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES BIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: '/4, Section T_N, 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 NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL RATE 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 percolationtests;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. fN 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 r ~1 Copy C - Local Authority Y - j TRANSFER FOR P~, ~ ~ T SANITARY PERMI~ ~ LB~ t *.i* # Sanitary Permit # County Cla t Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: f. Section , T Z N,R 1 9-(or) W Lot # -City Subdivision Name, Nearest Road, Lake or Landmark BILK # Village Townshi i ► ' ' tsvto ►L B. TYPE of Occupancy: Cgmmercial Industrial Other (Specify) Single Family Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab Concrete Poured-in-place Steel Fiberglass Other(Specify) New Installation X - Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify) D. EFFLUE T DISPOSAL SYSTEM: Percolation Rate I - d ' Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches Seepage Bed: Length Width t( Depth ~6r+ Tile Depth(top) ~77 `4- ,No. of Lines_ Seepage Pit: Ins N dyameter Liquid Depth No. Seepage Pits Percent slope of land ; n Distance from critical slope E. WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. Name \Qc b, Name Address Address A ZiP Zip I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared by the Certified Soil Tester and/or any diti it tests t may have been required. ? Plumber's Signature P/MPRSW #%MLET `AQ Phone #45 - _377 Plumber's Address V_L (L (Z 4e"+ Z Information obtained from (owner or agent) PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's property If well has of been drills( _ , e e i _ I l 1 t~ ~ e a 4-1 1 C1 Q_,~Z 1J_ 1 14 L J 4 Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701