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Parcel 022-1036-80-000 10/16/2006 12:03 PM
PAGE 1 OF 1
4. Alt. Parcel 13.28.18.204B 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 - PETERSON, DANNY L & COLEEN
DANNY L & COLEEN PETERSON
317 SHERWOOD FOREST
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 317 SHERWOOD FORST
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE
SEC 13 T28N R18W 20.01A S1/2 SE SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/08/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 80,000 196,500 276,500 NO
UNDEVELOPED G5 7.000 17,500 0 17,500 NO
PRODUCTIVE FORST LANDS G6 8.000 48,000 0 48,000 NO
Totals for 2006:
General Property 20.000 145,500 196,500 342,000
Woodland 0.000 0 0
Totals for 2005:
General Property 20.000 145,500 196,500 342,000
Woodland 0.000 0 0
I
Lottery Credit: Claim Count: 1 Certification Date: Batch 215
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
v"ER /9e4 NN Y 1'~t= h 7 S N , TOWNSHIP A;. a o ~tv C. 1.2 _.2, N, R W
.Oer ADDRES ~.,dC%3, it 1.3. 1~- ST. CROIX COUNTY, WISCONSIN.
'3DIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~~r jt S~rt?pt/' ti¢N;
r.1,
'?TIC TANK(S) ~ MFGR. , t' y CONCRETE
STEEL
NO. of rings on cover_,&AL,--_ Depth DRY WELL
TENCHES NO. of ` width length j~j' r area j`/_
FJ no. of lines width length area
depth to top of pipe 4
:'CREGATE
K RATE AREA REQUIRED Z. !t AREA AS BUILT
.sciaimer: The inspection of this system by St. Croix County does not imply complete
mpliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
stem operation. However, if failure is noted the County will make every effort to
~termine cause of failure.
3ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR-- '
DATED PLUMBER ON JOB_
NUMBER d
I
k ~
REPOP,T Or IMSPrCTION--17MVIDUAL SE?~JAGE DISPO SAL SYSTEIi
Sanitary Permit
r State Septic ".A'. iE ,
TOWNSHIP
t. Croix County
SIEPTIC TA77111
S Aze gallons. `umber of Compartments
,
Distance From: T•Je11 f , ft. 12% or greater slope ft.
Building` ft.
Wetlands f
HL
ighwater
DISPOSAL SYST2.:1 41'_'Tile Field or Seepage Pit(s)
Distance From: Well ft. 12% or greater slope ft
Building; ft. Wetlands f...
i•
FIELD rJighwater . -.__ft. - -
Total length of lines ft. Number of lines Length of
each line eft. Distance between lines ft. Width of the
trench ft. Total absorption area _ sq, ft. Dept
of rock below tile in. Dp-pth of rock over the in, Cover
nvex.rock, ' .
_N ' Depth of tile below grade in. Siope of
trench in ner 101 ft. Depth to Bedrock ft. Depth to
around water £t.
PITS
i
Number of pits tsz' dle d" ameter ft. Depth below inlet',
ft. Gravel a-ro d x~it : / yes no.
Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
:square feet of seepage nit area required
Inspected by:
- Title
Approved _ j / Date 197
Rejected Date 197.
EH 115 1610-15 D/'/
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
• _ DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TEST§
LOCATION: ~ '/4, ~W'/4, Section l- TtTt ~1, R&"/ W, Township o ~ fil ~1~~✓ /r✓~
Lot No. , Block No. County l/ x
Subdivision Name
Owner's Name: 3~N ~RS qi
Mailing Address: R_, a se'R 2` f
TYPE OF OCCUPANCY: Residence- _ No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOILBORINGS7f PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
17~4'~G
PERCOLATION TESTS
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
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST i (DEPTH TO BEDROCK IF OBSERVED)
(
' !i
B- "7 ~ r -
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. 'r e ~r2e^ Indicate scale
or distances. Give horizontal and vertical reference points. n icate Ape.
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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 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) e- 1'7-,,l Certification No.
Address C-_ /V A, v a c~ rr -h Z 3
Name of installer if known
'3PY A - LOCAL AUTHORITY CST Signature
State and County State Permit # L' -2
PLB61 Permit Application County Permit #
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:
B. LOC, ON: /4, N, R_'ww$w
) W Lot# City 1/4, Section T Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial 'Other (specify) *Variance
Single family X Duplex No. of Bedrooms y No. of Persons (
D. TYPE OF APPLIANCES: Dishwasher _X YES NO Food Waste Grinder X_YES NO # of rooms42-
Automatic atic Washer RYES NO Other (specify)
E. SEPTIC TANK CAPACITY /.2pp Total gallons No. of tanks /
*Holding tank capacity Total gallons No. of tanks
New Installation J( Addition Replacement Prefab Concrete ly
'Poured in Place Steel Other (specify)
FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) F 3) Total Absorb Area 6o sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet; Width Depth_? Tile Depth ~2~e " No. of Trenches
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land U ~e Distance from critical slope
1, 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 Certi i dSoil /,Tester
NAME C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW#Phone
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
y I,e,v5~1
I
j;Z.S-'
~5 yv~~L
Do Not Write in Space./Blow FOR DEPARTMENT U E ONLY
Date of Application /'Z-/76/ Fes aid: State County Date 2/Lb _
Permit Issue d/Rej tecl( ate) h Issuing gent Name
Inspection Ye No Valid# Date Recd
1. county ( hite copy► 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4, plumber (canary copy)
1 _