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Parcel 022-1095-20-000 12/28/2005 10:07 AM
PAGE 1 OF 1
Alt. Parcel 33.28.18.513B 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, BRUCE L & LORETTA
BRUCE L & LORETTA PETERSON
87 EMERSON VALLEY DR
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.060 Plat: N/A-NOT AVAILABLE
SEC 33 T28N R18W 1.77A IN NE NE LOT 1 Block/Condo Bldg:
CSM VOL 3/834 595/560 ALSO COM SE COR
LOT 1 CSM 5/1485 N 29 DEG E 92.30'N 22 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG E 44'S 87 DEG W 139.39'S 113.85'S 33-28N-18W
88 DEG E 73.29'-POB
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 826/38
2005 SUMMARY Bill M Fair Market Value: Assessed with:
143989 347,100
Valuations: Last Changed: 08/11/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.060 50,000 301,000 351,000 NO
Totals for 2005:
General Property 2.060 50,000 301,000 351,000
Woodland 0.000 0 0
Totals for 2004:
General Property 2.060 20,000 230,600 250,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 311
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
WxNER TOWNSHIP r r
0. AIDRES; SEC.. T N, R W
ST. CROIX COUNTY, WISCONSIN.
3DIVISI0;1 ` LOT LOT SIZE
Ila
PLAN VIEW bzz- l 095~ -Distances °-/5373
b dimensions to meet requirements of H62.20 J
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Irxdicate North, Arrow i
i SCALE:
tPTIC TANK(S)Y MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
ANCHES NO. of width length area
j no. of lines widths- length - . ' area -
dep`t to top of pipe
aGREGATE
?:K RATE AREA REQUIRED AREA AS BUILT
lisclaimer: The inspection of this system by St. Croix County does not imply complete
.0pliance 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
,jtermine cause of failure.
,tEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
f7
`INSPECTOR
DATED U t1 PLIR fBER ON JOB
LICENSE MMER
i SRS
Z
> . >ZEPORT OF INSPECTION INDtv~TDUAL SEWAGE SVSrEM
San.itaAy PeAm.it ~-2~
State Septic`--_,i'- J
NAME ` own.bh.ip t S;r. CAO.ix Cou►tty
LocatioK.' Section
Y
SEPTIC TANK
Size, uz gatfonz. NumbeA oti CompaAtmentz
Distance Prom: Wetf- 120 oA gAeateA ZZope, it
Bu.itd.ing ) it. Wettand.6 - ~ .
H.ighwateA it.
DISPOSAL SYSTEM
D.iztanee Fton, WeU 12% on gteateA ~sZope c' tit.
BuiZding11C_tit. Wet -andA-_ Pt. j
j
1
H.ighwateA it.
FIELD DIMENSIONS:
Wid=th ob ,tnench it. Depth o' ,ock below ti"e_Z in.
Length oti each tine j it. Depth oti Aoch oven tite ~ .in.
/ e7
Numbers oti Una J Depth oti tite below grade ,:.l Lin.
' L
f Tota.i Length o l tine.6 it. S~'ope oti tneneh in pen 100 it.
Distance between Zine.s it. Depth to bedAock _6t.
Tota.i abzoAbtion a,Lea 2 tit2 Depth to gnoundwatvL
2
Requi&ed aAea it Type oti Coven: Pape:n of~ \ StAaW
PIT DIMENSIONS:
NccmbeA 06 Pits-- GAave..? vLound pitz ye.a no
Outside d.iameteA it. Depth b eZow inlet
2
Totat absoAbt.ion area it A
AAea Aequk.Aed nt2
INSPECTED B TITLE
APPROVED DATE i 197 REJECTED_ DATE
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EH -115
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 TESTS
LOCATION: ,~✓~/4, /-_,Section, TN, Rr E (orTownship or Municipality fCt~~I NA?`C
Lot No. , Block No. County S~ ~ 4) n
Subdivision Name
Owner's Name: L'~ -Sc,
~Pd
Mailing Address: -5,4k
TYPE OF OCCUPANCY: Residence >"--No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW / ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS I -.a ® 7 PERCOLATION TESTS
SOIL MAP SHEET ` / SOIL TYPE ?i-Y7
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
e so "If too.,K
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p ``v►E ! 4/
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7_ ~ , fi/"~ ,
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)
c~ s
PLAN VIEW (Locate percolation tests,soi I 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. +y try z-k Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
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I, the undersigned, hereby certify that the s it tests reported on this for were mad~y me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that t~data recorded and location of test holes are correct
to the best of my knowledge and belief.
Name (print) )eoOL el- Certification No.
Address L`---
Name of installer if known `
CST Signature
`f A - LOCAL AUTHORITY
67 State and County State Permit # I
PLB
u 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. LOCATION: 1/4 '/4, Section T_ N, R_ E (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 i ` Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY Total gallons No. of tanks l
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length Width Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land I- 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 Certified Soil 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. 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.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State County --'C Date
Permit Issued/ Rejected (date) s ' Issuing Agent Name V.- I rid
a
Inspection Yes__(No State 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 7/1/78