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Parcel 028-1044-30-000 11/15/2006 10:03 AM
PAGE 1 OF 1
Alt. Parcel 36.28.17.274B.275A 028 - TOWN OF RUSH RIVER
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 Cc-Owner
O - MONICKEN, DOUGLAS E & DEBORA L
DOUGLAS E & DEBORA L MONICKEN
2053 10TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2053 10TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 21.000 Plat: N/A-NOT AVAILABLE
SEC 36 T28N R1 7W W 1/2 OF NW NE & W 40 Block/Condo Bldg:
RDS OF N 4 RIDS OF N 1/2 OF SW NE
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
36-28N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 04/12/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 20,000 212,800 232,800 NO 02
AGRICULTURAL G4 13.800 2,200 0 2,200 NO
UNDEVELOPED G5 0.500 100 0 100 NO
AGRICULTURAL FOREST G5M 5.700 10,000 0 10,000 NO
Totals for 2006:
General Property 21.000 32,300 212,800 245,100
Woodland 0.000 0 0
Totals for 2005:
General Property 21.000 32,300 203,000 235,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 134
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 028-1037-20-000 11/15/2006 10:03 AM
PAGE 1 OF 1
Alt. Parcel 27.28.17.226A 028 - TOWN OF RUSH RIVER
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 - MONICKEN, DOUGLAS E
DOUGLAS E MONICKEN
2053 10TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 30.772 Plat: N/A-NOT AVAILABLE
SEC 27 T28N R1 7W 30.072AC NW NE EXC Block/Condo Bldg:
P226B
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-28N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1103/639
07/23/1997 723/253
07/23/1997 687/303
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 08/30/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 29.772 4,900 0 4,900 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2006:
General Property 30.772 5,000 0 5,000
Woodland 0.000 0 0
Totals for 2005:
General Property 30.772 5,000 0 5,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
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PLEASANT VALLEY 7 WP. -J - Sr cnO' Or y ww-~
RUSH RIVER TWP.
2812 MALL DRIVE OFFICE 717 MAIN STREET AABY
EAU CLAIRE, WISCONSIN ST MENOMONIE, WISCONSIN
°j FEDERAL SAVINGS Business: 273-4945 ® True Value
AND LOAN ASSOCIATION Residence: 2734155 REALTOR Hardware
Car: 792-2732
,i DAR-RAY Realty -"Emig-mil
319 EAST GRAND AVENUE Raymond Huppert Authorized PAINTS
EAU CLAIRE, WISCONSIN - Dealers
207 NORTH BRIDGE STREET 372 WEST MAIN STREET 332 West Main Street 698-2377
CHIPPEWA FALLS, WISCONSIN ELLSWORTH, WISCONSIN Ellsworth, Wisconsin 54011
Woodville
y } p • AS BUILT SANITARY SYSTEM REPORT
R
1UNSHIP
T0 cS:SEC 4-4- T. N, R_ W
ADDRESS ; , ST. CROIX COUNTY, WISCONSIN. T_
DIVISION LOT LOT SIZE .7'
t~ / r=
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
L-L
I y
I ~ I I i I i 1 f--~~ ~ -
( I ~ 1
14---I I
}
TIC TAh'K(S~ MFGR. Indicate Norcth Attnow'
CO.CRETE A STEEL Sca.2e
NO. of rings on cover Fj Depth Z, _ DRY WELL `<t
''_''4CHES N0. of width length area
-j no. of liness width length_, area
depth to top o pipe
.EGATE
..t: RATE :41 AREA REQUIRED S f~ AREA AS BUILT
;claimer: The inspection of this system by St. Croix County does not imply complete
,,oliance 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
stun operation. However, if failure is noted the County will matte every effort to
o-rcine cause of failure.
wZ►SES A 4TD OILS SHOULD NOT BE DISPOSED THROUGH ':HIS SYSTMi.
`INSPECTOR f Y
f
PLU:fBER ON JOB DATED
LICENSE NUMBER
Z >
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.i..ta%i.y Pet m it .1-2"zl
State Sep,ti-__
St. CItoix Count
NAVE c ownahi ~ L y
r
i
Location f,11 ~ Section
SEPTIC TANK j
Size ga.b.bon6. Numbers o6 Compantment6 _ i
D.vstanee Fteom: weZZ 6t. 12%, ot gtseaten 6tope 6t
Bu.ikd.ing _ 6t. Wet.band~s 6t.
DISPOSAL SYSTEM Highwaten 6t.
D.i.6tanee Fteom: Wett fjt. 12% ote gtseatete 6tope ' 6t.
Bu.itding 6-t. W et °.ands Ft.
H.ighwa-tek 6t.
FIELD DIMENSIONS:
Width o4 trench 6.t. Depth o j no ck b etow tit e in.
Length o6 each tine 6.t. Depth o6 tsock oven t.ite ,in.
Numbete o6 tineA Depth o~j t.ite be.iow gtsade.in.
Tota.f' .length o6 Xinu It. Slope o4 tteeneh in per 100 + t.
Distance between Una pt. Depth to bedtsaefZ 4t.
Tota..i absotbt,ion a-'.ea`'; 6t2 Depth to gtsoundwa,tets 6t,.
Requ Type o/ Covets: Papets ox, Sttsaw
2
-heed a. ~ea t ~
PIT DIMENSIONS:
Numbet o6 pits : Gtcavel atcound pxt,5 yes no
Out6ide diametetc 6t. Depth below .inlet fit.
2
Totat ab3onbtion atcea 6t
Atcea tcequitsed 6t2
INSPECTED By TITLE
APPROVED DATE 197Y
171-
REJECTED DATE 197
k
G
_ cI
N
12H 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,y/4, Section' , T, RItr (or) W, Township or ~t-~/5 1~7f l V R
Lot No. , Block No. County
Subdivision Name _
Owner's Name: Uv xl enl o /9 v lc-
Mailing Address: A W .0 t S
TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT _
DATES OBSERVATIONS MADE: SOIL BORINGS - ` 7F PERCOLATION TESTS (p ' Z 7
SOIL MAP SHEET 4?44 SOIL TYPE sa -I- -./-A e
PERCOLATION TESTS
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
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
0
P- P
go P-,5 5b It (-Ir 01, Lf No so
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)
Z /A ~r 1> k (P r if Jr6
B_It 3 7,;'," } it (o" r 5)~-
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of su~abl areas. Indicate number of square feet of absorption area
needed for building type and occupancy. _ 9AA d Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
i t r 6 , ~ s ~
~ ~ } y f ~ I t ~ t 3 ` I i f
i F
- / 1 r'J~ 17--ti
Ice
Y 1{i ' I ; O s ' t !i t
j ~ ~h f I t ~V
! i 5 e I I- I
o~
I _
r d d I i N
4-_ ~
M1
I 3 f ~ ~ 1 ~ i
I
t I I ~ E q i { icy { i ~
3 i I ~ t f I i 3 ~ I
f i , t f i
e--±--
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 knowledge and belief.
Name (print) IS ~f Certification No. ~
Address
Name of installer if known
CST Signature
COPY A -LOCAL AUTHORITY
PLR67 State and County State Permit #
Permit
Application County Permit # _
for Private Domestic Sewage Systems County 5~'T'• C i x
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
a rJ nJ T f-`~ ° GL c~ ui ; ( , S
B. LOCATION: A\/X '/4 Al = Y4, Section Th T N, R _ o (or) W-Lot# --City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township ~Sf A✓~+~
C. TYPE OF OCCUPANCY: "Commercial *Industrial Other (specify) *Variance
Single family x Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIS: Dishwasher. YES NO Food Waste Grinder YES NO # of Bathrooms
Automatic Washer YES NO Other (specify)
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 U NT DISPOSAL SYSTEM: Percolation Rate 1 2) 3) Total Absorb Area sq. ft.
w/ Addition _ Replacement *Fill System aa
Seepage Trench: No. Lin. Feet Width I Depth , - Tile Depth No. of Trenches
~J _
epage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diamete
r Liquid Depth Tile Size f
Z, Z
Percent slope of land Distance from critical slope
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
,AVisconsin Administrative Code, and that I have sized the effluent disposal system s ,q, the Ell 1 15 prepared
!:)y the Certified Soil Tester,
'AME 7F s C.c~ C.S.T. # S = .5'5Z~Z and other information
obtained from OA ~ (owner/builder). ~T L
.'lumber's Signatur v ` MP/MPRSW#!Phone #_G,~'_ 7-P
Plumber's Address vj r S _
PLAN VIEW: Provide sketch bellow of system (include direction of slope and all distances in accord with
H62.20, including well).
I
770&11 /VS p
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rZ/
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a0 a ~ ~ f"ea' ~Afc
- ~ ~ bt1.1 r A A L~ S/ f e-
P
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Do Not Write in Space Below. FOR DEPARTMENT USE ONLY {
Date of Application Fees Paid: Stahl z r' County ate
Permit Issued/ ate) -Issuing Agent Nam ^l f (a_
Inspection Yes No Valid# Date Recd _
1. county (w rte copy) 3, owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4, plumber (canary copy) R
U s
WI seO NSI N
x ra'~ rho"' Z O N I N G 0 F F I C E 796-2239
P. 0. Box 227
Hammond, WI 54015
-:dldw: ii
-s is cons in 54(
)ear Mr. Swen£.
4e have been adj. , - -t- n
1onicken property.
taet us reassure that a quaff IA-IL, Y
has conducted the ;and designed an adequate and p,-
.nitary system f,
.en met.
shall be inspec4 R6 LIle y;...
.ould - v hive arv
atac
acert,
.ROLD C. BARB I'
;B