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Parcel 022.1070.50.000 12/27/2005 04:33 PM
PAGE 1 OF 1
Alt. Parcel 25.28.18.391B 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 - GRAM, CHRISTOPHER & KENDRA
CHRISTOPHER & KENDRA GRAM
1421 EVERGREEN DR
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1421 EVERGREEN DR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 20.760 Plat: N/A-NOT AVAILABLE
SEC 25 T28N R1 8W 20.76A IN SW NW PT SW Block/Condo Bldg:
NW AS DESC IN VOL 601/399
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/21/2005 785546 2735/159 WD
01/21/2005 785545 2735/157 PR
10/23/2001 659878 1744/08 QC
07/23/1997 601/399
2005 SUMMARY Bill Fair Market Value: Assessed with:
143722 Use Value Assessment
Valuations: Last Changed: 08/11/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 80,000 298,100 378,100 NO
AGRICULTURAL G4 15.760 1,600 0 1,600 NO
Totals for 2005:
General Property 20.760 81,600 298,100 379,700
Woodland 0.000 0 0
Totals for 2004:
General Property 20.760 41,600 224,900 266,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 213
Specials:
User Special Code Category Amount
I
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
\ AS BUILT SANITARY SYSTEM REPORT
Ad, , TOWNSHIP _SEC.~ T;N, RW
.o.'ADDR t , ST. CROIk'COUNTY, WISCONSIN
',IBDIVISION LOT LOT SIZE:
PLAN VIEW
Distances 6 dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3/ V
I
Nub,,: ~
t
K y
1
G TA04(8)17HFGR.~~~ ~ CONCRETE ~ STEEL
NO. of rings on cover, Depth DRY WELL
NO. of width length area
yD
140. of I:ltses pidth_ leng h~ area^
depth to t$p of pipe_.
w: x AREA REQUIREDC~ AREA AS $UILT--
netaimer: The inspection of this system by St. Croix County (hic'; not imply ctimpl+•tt.
-Ipliance with State Administrative Codes. There are otht~r- .a)-•a! that it f!: 11ot fit>r> ; tole
inspect at this point of construction. St. Croix C'o+anty assumes no l.ial)f 1 ity hir
tem operation. However, if failure is noted the County will n>~ake every effort to
termine cause of failure.
:ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
I
'INSPECTOR
DC? PLUMBER ON JOB,
DATE
1ACENSE NUMBER i'
:r -
Gr^
Z _
REPORT OF INSPEC-NON INDIVIDUAL SEWAGE SYSTEM
San.i.taAy PeAm.i.t
State -Septic.
NAME Township St. Cno.ix County
L o c at.i o n Section
SEPTIC TANK
I
Size ga.t.tone. Numbers o6 Compa,%tment6
D.cstanee Fnom: We.t.t 12% on gxeatex a.tope 6•t
b .
Bu.i.td.ing it. Wettand,6
H.ighwateA it.
DISPOSAL SYSTEM ,
e
D.ia.tanee Fnom: We.t.t it. .12% on gxeateA z tope it.
Bu.i.td.ing 6.t. W et.tands Ft.
H•ighwaten 6t.
FIELD DIMENSIONS:
I
Width of txench it. Depth o6 xock be.tow Cite in.
Length os each tine it. Depth o6 xock oven tite Z in.
Numbex o6 .t.inez ~ Depth of -tile below gxade 2 /"-in.
Tota.t .tength o6 tines L) it. S.tope o6 txeneh in pen 100 it.
r-
1
DiAtance between tines e,- It. Depth to bedxock
Totat abs oxbtion axea it2 Depth to gxoundwatex
Lc'L' Requixed axea St2 Type o6 Coven:apex, ox Stxaw
PIT DIMENSIONS:
" Numbex o6 pits Gxavet axound p.i,t/s yens no
Out-bide d.iametex 4t. Depth b e.tow .in.te-t t.
Tota.t ab,6oAb t'on axea it2. A
Axea xequixed 5t2 rn
INSPECTED BY TITLE
APPROVED DATE 197.
REJECTED DATE 197,
'I
State and County State Permit #
APLB 67 T l
-
Permit Application County Permit #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROV~L REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: 11Z; _y,, Section T N, R L~ E (or) (W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township i~1~ '
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family - Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete L Poured-in-Place Steel Fiberglass Other (specify)
New Installation L_- Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate r , z ,ii" Total Absorb Area -1 1, 4-
,.TL sq. ft. 1;
New 4 Replacement Alternate (Specify)
Seepage Trench: No jq Gaal Ft. Width Depth Tile depth,(top) No. of Trenches
Seepage Bed: L Length idth r',S Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land 1f Distance from critical slope
WATER SUPPLY: Private 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
by the Cep2 ied^ Soil Tester,
NAME C.S.T. # , f i S. 1 and other information
obtained from (owner/builder). _
Plumber 's Signature p/MPRSW# / f Phone 'e/
Plumber's Address --2 ✓i el /1
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.
4 W
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,
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of Write in Space Below.- FOR COUNTY AND STATE DEPARTMENT USE ONLY
Application ' d e '-Fees Paid: State/ t ( County, -Date /
ed1B4tee+ed- (date) /y Issuing Agent Name ,
No State Valid# Date Recd
e copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
4. plumber (canary copy)
Revised Date 7/1/78
_ 04 115 Rev. 9/78
REPG-RT ON-SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION:- ,X14-- '/a, Section '-x ',T N,R_L E (or) W'Township or Municipality ek/rt 112 /i 1 L
Lot No. , Block No. County 5 1'-
ivision ame
Owner's/Buyers Name:
Mailing Address: C L
TYPE OF OCCUPANCY: Residence XNo. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW _ X REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS Ott 4.)2/2
SOIL MAP SHEET NAME OF SOIL MAP UNIT Ip3?7 t i1,7,it7 f1 C1t1' An lt~f -2qwd
PERCOLATION TESTS J
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME 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
P- Y0 Its" J~'B S•if r 10; h "
P- j l it" SIG l-0 e- d;n < all In.
P- e > y e,` K,. vI/ ~ A
P_ ~a ft 1A
P- • t
t
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_
B- S)F 41.1, S
3 76
B-
B- 7i -f le-we ' J ' ` G r !i .5 1
sit
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 46 freol C11 Indicate scale or distances. -5sq h-, Give horizontal and vertical
reference points. Indicate slope. et
Eve V" et i1 n~♦Ii
Key, tl'Eheme Tack
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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, c. f
Name (print) 2 M (A loot Certification No. ?2
Address 5!11 2: "
Name of installer if known
'
Copy A -Local Authority CST Signature ! tcl_