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REI.com: Your receipt Page 3 of 3
Parcel 042-1042-60-000 12i21i2006 11:24 AM
PAGE 1 OF 1
It. Parcpl fl: 16.29 224gA 042 - TOWN OF WARREN
i~rprngt n oX ~ *11$J6-2006 REI Buy gift cards now! Continue> 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 - TOKHEIM, DANIEL, &NATALIE A HOPPE
DANIEL, &NATALIE A HOPPE TOKHEIM
990 110TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 990 110TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 13.030 Plat: N/A-NOT AVAILABLE
SEC 16 T29N R18W PT W1/2 NW1/4 BEING LOT Block/Condo Bldg:
5 OF CSM 10/2767 13.03 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1100/278 WD
07/23/1997 934/305
07/23/1997 829/320
2006 SUMMARY Bill Fair Market Value: Assessed with:
149292 Use Value Assessment
Valuations: Last Changed: 07/11/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 9.030 60,500 158,400 218,900 NO
AGRICULTURAL G4 4.000 600 0 600 NO
Totals for 2006:
General Property 13.030 61,100 158,400 219,500
Woodland 0.000 0 0
Totals for 2005:
General Property 13.030 61,100 158,400 219,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 141
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
https://www.rei.com/online/store/orderReceiptView?krypto=UKn 1 szZX95cfsVlyl%2BQ... 12/21/2006
Parcel 042-1042-80-000 12/21/2006 10:57 AM
PAGE 1 OF 1
Alt. Parcel 16.29.18.246A2 042 - TOWN OF WARREN
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 - MELSTROM, JAMES E & KAREN E
JAMES E & KAREN E MELSTROM
998 110TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): U. = Primary
Type Dist # Description ' 998 110TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 3.660 Plat: N/A-NOT AVAILABLE
SEC 16 T29N R18W 3.66 A IN NW NW LOT 1 Block/Condo Bldg:
CSM 3/791 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1064/80 WD
2006 SUMMARY Bill M Fair Market Value: Assessed with:
149294 165,200
Valuations: Last Changed: 10/22/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.660 44,500 76,000 120,500 NO
Totals for 2006:
General Property 3.660 44,500 76,000 120,500
Woodland 0.000 0 0
Totals for 2005:
General Property 3.660 44,500 76,000 120,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 216
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
Parcel 042-1042-70-000 01/28/2005 04:45 PM
PAGE 1 OF 1
Alt. Parcel 16.29.18.246A1 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
HEDBERG, SCOTT M
SCOTT M HEDBERG
1105 100TH AVE
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1105 100TH AVE
SC 2422 ST CROIX CENTRAL ~J
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABL
SEC 16 T29N R18W 3 A IN NW NW LOT 1 CSM Block/Condo Bldg:
3/697 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-18W 11M,,.,
JV
Notes: Parcel History:
Date Doc # of /Page Type
06/14/1_999 604862 1433/614_ WD
0 23 199 - 11897 f _ _Qc
07/23/1997 737/158
07/23/1997 691/124
2004 SUMMARY Bill Fair Market Value: Assessed with:
38138 193,500
Valuations: Last Changed: 10/22/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 42,500 127,800 170,300 NO
Totals for 2004:
General Property 3.000 42,500 127,800 170,3000
Woodland 0.000 0
Totals for 2003:
General Property 3.000 42,500 127,800 170,3000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 523
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges 00 Delinquent Charges
00
Total 15.00
r
• AS BUILT SANITARY SYSTEM REPORT
,.,R TOWNSHIP SEC. f_i _ T; Ns R W -
A DRESS ; _ WISCONSIN.
ST. CROIX COUNTY DIVISION
LOT LOT SIZE/ -
PLAN VI ` - ! i.
Distances b dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Indicate N a tc.th Atc.~,Lv u,+'
,TIC TANK(S) .,1 GR. ='.,.lam ,1~ v~,/ COPiCRETE Scale iorJ
STEEL i' NO. o zings on cover Depth DRY WELL -
~'!NTCHES NO. of width length arer
no. of lines widths length area a
fepth to top of pipe
;NEGATE
RATE AREA P.Ei~UIRED ' . n AREA AS BUILT
,claimer: The inspection of this system by St. Croix County does not imply complete
.roliance with State Administrative Codes. There are other areas that it is not possible
- inspect at this point o., construction. St. Croix County assumes no liability for
s~em operation. However, if failure is noted the County will make every effort to
,-,ermine cause of failure.
'.LASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
4-t T,
INSPECTOR
[ 7
DATED PLU; EWER ON JOB
LICENSE NUMBERT
_ ~
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REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.i.taAy PeAmi t
State Septic `NAME.
i owna hip St. C loix County
Location Section
SEPTIC TANK
Sszel` !'l ( gattons. Number o4 CompvLtmen-ts
Distance Fnom: wett jl it. 120 oA gneateA zZope
Bu.itd.ing it. Wettand~s ~ .
K.ighwateA - it.
DISPOSAL SYSTEM
D.idtanee FAOm: Weft it. 12% oA gAeateA 6tope it.
Building % it. wettands Ft.
N.ighwateA it.
FIELD DIMENSIONS:
Width o5 tAeneh % it. Depth of Aock below ti.Le ~ .in.
Length ob each tine it. Depth o6 )Lock oveA tite ~ in.
NumbeA o6 Zine~s Depth os tite betow gAade 7'( in.
Totat .length o6 tines it. Stope of tAench in peA 100 it.
D.i,sLance between Zines 1 it. Depth to b edreo ck rat.
Totat absonb,tion aAea ,).,,2) it2 Depth to gtoundwateA it.
RequiAed aAea it2 Type o6 CoveA: Papet o Stkaw
PIT DIMENSIONS:
NumbeA o6 pits GAavet around pitz ye/s no
Out,s.ide diameteA it. Depth below intet it.
2
Totat abzoAbt,ion area it z
AAea A,equiked ~t2 rn
INSPECTED BV TITLE,
APPROVED ~r DATE
fs' - 1R7.
REJECTED DATE 197 \
EH 11 5
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
• DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
rr~~ //REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: 4, Section , TwN, R/f I? (or Township or Municipality tt_~ ^,-ex.'
Lot No. Block N A11
- : ~F•`~5 W-A qt ~1-7
County
Subdivision Name / Owner's Name- r e, ~
Mailing Address: 0ze,/s Lv,s,
TYPE OF OCCUPANCY: Residence X - No. of Bedrooms / Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT ri
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RAT
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/!
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-
P_ .
re- A0 / x
P- XZ,_ AID 3
~ 3% 3w 3
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)
B- % ~Alf" 70, /~-)e S,
0 S o p .Sc3 ' r e'l S
B-3 W,
/(1u,La /Owl" 16 c, S
Y A6" ,cl u~ 7/96'' ' s s-,
/ arty ~o S 0,,~
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 umber of square fe t of absorption area
needed for building type and occupancy. /~r% - S Indicate ca e
or distances. Give horizontal and vertical reference points. Indicate slope. F~► ~5 r ~~~i0gei.cc k
> s' o J elFed To i~r~co~rJc s e- YS~c-..L.
t 4
( ~ ~ I~ / • ,o K'~~ des ,~~s s
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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) 20 &~r Certification No.
Address 11Z61
60
Name of installer if known
LL 11Y A -LOCAL AUTHORITY CST Signa L
State and County State Permit #
PLB67 Permit Application County Per it #
for Private Domestic Sewage Systems County +
*DENOTES STATE APPOOVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
'XS "A/ B. LOCATION: W '/4 y4. Section ; T N, R /f (or) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township (,CJ,Qrs env
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 YES ENO # of Bathrooms ~
Automatic Washer /K YES NO Other (specify)
E. SEPTIC TANK CAPACITY-/,20C.) Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation X Addition- Replacement_ Prefab Concrete X
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 1/ 2) ,,Z 3) .3 Total Absorb Area S-2y sq. ft.
New X Addition Replacement *Fill System kl a
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length 4' Width /J:;• Depth -36" Tile Depth o2t Y' No. of Lines -3
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land /,Ppo -5-c9~f4+ E.~S Dijtance from critical slope
~S S/Q i¢rt q TC Q~ S`i el re d
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 Ce ified Soil Tester,
NAME , ~ C.S.T. # SS and other information
obtained from e,cr (wider).
Plumber's Signature M /MPRSW#/gam Phone # 71l=3c~-.~'N!~
Plumber's Address Z.Zll,
-
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H6220, including well).
Nlo
SC"/1 ~ - ~`S ~,Q.,+.cc' cis ,gs J • ~/i J`~
rev i`,v or c+er- to
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Do Not Write in :space Below FOR DEPARTMENT USE `ONLY
Date of Application Fees Paid: State /e Count Date c7v 7
Permit Issued/Rejected (date) - -7 ~ _Issuing Agent Name
Inspection Yes No Valid# Date Recd
1. county (whi Aeopy) 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