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Parcel 022-1036-60-000 10/16/2006 11:57 AM
PAGE 1 OF 1
Alt. Parcel 13.28.18.203B 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 - SMITH, TIMOTHY D & EVA M
TIMOTHY D & EVA M SMITH
307 SHERWOOD FOREST
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ` 307 SHERWOOD FORST
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 20.550 Plat: N/A-NOT AVAILABLE
SEC 13 T28N R1 8W 20.55A S1/2 SW SW LOT 2 Block/Condo Bldg:
CSM VOL 3/804
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/02/2002 685890 1940/363 WD
07/23/1997 809/189
07/23/1997 807/162
07/23/1997 587/383
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 80,000 315,500 395,500 NO
UNDEVELOPED G5 10.000 25,000 0 25,000 NO
PRODUCTIVE FORST LANDS G6 5.000 30,000 0 30,000 NO
Totals for 2006:
General Property 20.000 135,000 315,500 450,500
Woodland 0.000 0 0
Totals for 2005:
General Property 20.000 135,000 315,500 450,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 520
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
.r
TOWNSHIP N, R~W
r1DDRESS ST. CRO ~COUNTYWISCONSIN.
)IVISION LOT LOT SIZE
PLAN VIEW
Distances b dimensions to meet requirements of H62.20
SHOW E`,TEE RYTFING WITHIN 100 FEET OF SYSTEM
- _4
w _
fi
t 1
I_-
~ L
--J- t~.~ --T_ -
4 ! I Indi bate fVorth; Arrow
! II I I SCALE:
IC TANK(S)_~ MFGR.__-- ,ee e CONCRETE STEEL
NO. of rings on cover Depth ii DRY WELL
CHES NO. of width length area
no. of lines width " 1 length ' area=
depth to top of i
rCATE ( <
RATE AREA REQUIRED AREA AS BUILT
i,aimer: The inspection of this syst,~m by St. Croix County does not imply complete
Rance with State Administrative Codes. There are other areas that it is not possible
r:spect at this point of construction. St. Croix County assumes nc liability for
>in vperati.on. However, if failure is noted the County will make every effort to
mire cause of failure.
ES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
-"INSPECTOR
FATED PLUMBER ON JOB
LICENSE NUMBER 7i(
4 .
_77
.
r -r ,
RFPOP,T OF IT]S1'_1' ,CTI0:1--I:JDIJIllUAL ~L,•MGE llISPOSAI, S 'r'~,, ~'EIi
Sanitary Permit
a2D
State Septic
T01)I1S2iIP
• t. Croi;; County
SF.T'TIC TA77K
Size - gallons. 'umber of Compartments
Distance From: Well ft, 12% or greater slope ft.
Building' ft. Wetlands ft
Highwater ft.
DISPOSAL, SYST; :i Tile Field or Seepage Pit(s)
Distance From: Well ft. 12% or greater slope - ft
Building £t. Wetlands f.
FIELD Klighwater f- t.
Total length of lines ft. Number of lines Length of
each line eft, Distance between lines ft. Width of the
trench rft. Total absorrt-i,on area sq, ft. Depth
of rock below the in. Dp-pth of rock over the in. Cover
nver.rec~;. Depth of tile below grade ix. Slope of
trench in ner 100 ft. Depth to Bedrock yft. Depth to
ground water ft.
PITS
II
Number of pits Outside diameter ft. Depth below inlet
ft. Gravel around pit: s no
.`ye . Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
Square feet of seepage nit area required
Inspected by:
Title':
Approved Date 197.
Rejected Date 197.
•
EK 115
r ' ,WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
-DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
~JU REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION:'/4, Section , T N, R d E (or),I( t, Township or Municipality f
Lot No. , Block No. County °4"10
,e s Subdivision Name
Owner's Name: jL f'l f' -
Mailing Address: ' C n I- J6 '
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other -
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS /l PERCOLATION TESTS
~ '
SOIL MAP SHEET SOILTYPE
-F L
PERCOLATION TESTS _
TEST DEPTH OF SOIL HOURS WATE_R1 N TEST TIME DROP IN WATER LEVEL, INCHES RATE
CHARACTER
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BERt ,~~11 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-O IaQ ) l/ 4 (tar/ r~1 ? 1 47 F
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)
IVY` ~v / r1 a. ~ti? ~e=. tn. (trL:' _ ti, ( ~ti
h • r1'1
14 tiv
B
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil a
Indicate on the plan the location and square feet of suitable areas. ndicatee number of square feet of absorption area
needed for building type and occupancy. ~ `k e / 11 Indicate scale
or distances. Give horizontal and vertical reference points. In i e slope.
f `
14 1
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedui
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are ct
to the best of my knowledge and-belief.
Name (print) [.a / Certification No.y~~7~~~~ -
i l
Address (.:r7 i-
Name of installer if known
CST Signature
k
State and County State Permit # '1
PLB67 ~ Permit Application County Per it #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF P P1 RTY Mailing Address:
I ,
c
B. L ATION: '/4~ /4, Section T~N, /"E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Townshi4L
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES:, Dishwasher YES /-'NO Food Waste Grinder YES I0 # of Bathrooms
Automatic Washer A,--YES NO Other (specify)
E. SEPTIC TANK CAPACITY Total gallons No. of tanks
*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'2 I) Total Absorb Area_ sq. ft '7~5~
New A-'-'-Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet idth Depth Tile Depth No. of Trenches _
Seepage Bed: Lengt#*~ 5~Width Depth Tile Depth No. of Lines
7 .7 Seepage Pit: Inside diameter- Liquid Depth Tile Size
Percent slope of land Distance from critical slope
7_-TF
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 oil a er,
NAME r 2 C.S.T. # and other information
obtained from (owner/builder).
'40,
Plumber's Signature PhoneSW#
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
17
r
r
Do Not Write in Spac elow FOR DEPARTMENT USE ONLY
Date of Application Fees Paid: State Co y Date
I Na
(date) Agent ssuing
Permit Issued/Re{ '
r
Inspection Yes_ 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