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Parcel 022-1009-80-100 01/03/2007 03:05 PM
PAGE 1 OF 1
Alt. Parcel 4.28.18.58A 022 - TOWN OF KINNICKINNIC
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
03/02/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
GALEN R THOMPSON O - THOMPSON, GALEN R
1105 CTY RD N
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1105 CTY RD N
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 5.559 Plat: 5023-CSM 20-5023
SEC 4 T28N R18W NW SW LOT 1 CSM 20-5023 Block/Condo Bldg: LOT 01
(5.559 AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-28N-18W NW SW
Notes: Parcel History:
Date Doc # Vol/Page Type
07/20/2005 800922 20/5023 CSM
10/22/2004 777794 2681/188 EZ-1
10/22/2004 777793 2681/186 EZ-1
07/23/1997 1145/345 QC
2006 SUMMARY Bill Fair Market Value: Assessed with:
178590 Use Value Assessment
Valuations: Last Changed: 06/06/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 30,000 152,000 182,000 NO
AGRICULTURAL G4 3.559 500 0 500 NO
Totals for 2006:
General Property 5.559 30,500 152,000 182,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 10/12/2006 Batch 06-17
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS B U I L T S A N I T A R Y R E P O R T
Tn. % T1 R%,C/ W.
Sec. Tkj Z)
01-MER Township ) ' / ,7- t: ,
P.O. ADDRESS • County, Wisconsin
Z-a. G
Subdivision , Lot, Lot size
PLAN VL
Distances & dimensions to meet requirements of Sec. H62.20 J
je,
0,9
J
I I I , .t
~ Ve~ks
k~ (~p,y~ ads 5~~~~5
Septic tank(s)-_4__,_1•Ifgr•_ ~ No rings,t e Dept to cover
Dry- we11 size Type of Aggregate Covered faith ct
Depth of seepage system Vent caps in place 'Jnumber used-
DISCLAIi-LFR: The inspection of this system by Pierce County does not imply complete
co:~ali.ance with State Administrative Codes. There are other areas that it is impossible
to inspect at this point of construction. Pierce County assumes no liability for system
operation.
OB : LPh ;n /'e
PLUMBER ON JOB:--L1^
D', _
LICEP'SE MOM: DATED -
RI PORT 01 1NSNt CFION - INDIVIDUAL SL_WAGL SYS-1f M
S cc vi t"z ii y P ~t rn.t -1
State Sep-t~.e
1AM fowvl~h4"p~ --St. Cn_ot.x Cou.vity
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crrttiuviN W__5 ecttiovt I_o -t S ubdiv.{~i.ovt
I III IC IANK
S4.ze ga.efakie Numbed o cornpaAtme.vLtb
i 5 tavic -e 6n.orri: W(Iff buy kdi_vrg f, b.ope.
Hc.cllcwa
HM I'I NG CIIAM61 R
+ zr yctYYovl-~ fiurr N. U 6ac-tune11 Mode. X. NIA ml>en_
I1)1No IAN K
S-'ze gal fon6 NAmbeii of Co rnpantmvki6
F'urnpeti "1AQanrn Sy6-tern
~htavlce 6~rorn: W(?'ekI / Ku.cTd't.vi .q.- 12% s o p e
Il.tgh,waten
I~~,ORI'TION SIT1
heal 7"aevicir
o vi c e 6 n o rn : (U el x - a u -t .t- di n q-------- r 2'f) h o p e 111', _q waten
0 R11T10N S I T L PIMLNSIONS
Width. otit en.ch 6t Re -qu.ined a rea - ~l
lr
~l_c'vl yth oeach Y"-ivi.e (yt Depth o6 n.ocl below t' e Zvi
Nurnbe n rI6 tee Depth o 6 n.aCa ven te
- -
7o tae . CcYi(Ath o6 tioC.b 6t Depth o6 t-('..fe below grade - ~ i vi
I),<_nt:avico betwcevi Y -tvieb 6 t Skope o~) tn-eneh_- 4vi pct-r±~100 6t
I otat ab6 oIr1 _~t,i_on ar ea ' t Type ofi Coven.: I arpen of 6Vi
= --~'--(I II I)IMLNSIONS
Number o6 p4't6 ~Ggavve around p,t.th -Jeb vio
0uta <.dc (14, arne_( e"n {t Depth be eow tinket- At
I o t a "t a b s o ~i p t 4 o vt cur 1) If
6 t
Aitea ncga:tncd _ 6=t
N1:VI C I 1 U -1 1 T L I
11I'ROVL 0 OATL 19 B
I I C H v VAT[ 19 is
'I nSON LOR 1;I ILCTION
I
J
State and County State Permit #
C~
PLB'67 Permit Application County Permit # t
r
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
OF PROPERTY Mailing Address: }
A. OWNER
te 70
f J L.E Z G f
B. LOCATION: Section, T N, R_,~r&-+&rr W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family lo-~ Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY CC) Total gallons No. of tanks i
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete -00' Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement i®
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate -Total Absorb Areal f''%" sq. ft.
New Replacement ✓ Alternate (Specify)
Seepage Trench: No. of Lineal Ft. env Width ~a Depth f/0) Tile depth (top)es-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 f de 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 7-Acu- &/06- "i r C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signature ' - -F~--f 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 elow o- FOR COUNTY AND STATE DEPARTMENT USE ONE Y
Date of Application `Q QU Fees Paid: State ) County Date ~L
Permit Issued/Re}eexed (date Issuing Agent Name
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
REPORT ON INSPECTION OF SANITARY PERMIT # r
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
a
Time of Inspection
a ress, i nse NO. o r7rn a Ong plumber
3 INSTALLA ON C9ySISTS OF: SeptV Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN ermanen re erence oin Describe:
Elevation of vertical reference point: Slope at site-
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity:
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: # ft to well:
M DOSING TANK: Manufacturer: # of gallons:
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines gallon; size of pump head; gallon per minute
horsepower ; brand name of pump and model number
Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO
_
8 HOLDING TANK: Manufacturer o gallons
construction depth to the cover ft; If septic tank is
being used are baffles removed? ❑ YES ❑ NO; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO;
Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ;
Distance from building to vent
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe-elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPAGE BED SIZE: ft width; ft length; tile depth;
lineal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed ft.
Ill SEEPAGE TRENCH: Total length of seepage trench ft; width ft;
tile depth ft; ft to well; ft to ordinary high water mark of
lake or stream; ft to edge of slopes greater than 20% falling away toward lakes,
water courses or drainage ditches; elevation of tank discharge line entering seepage
trench ft.
(12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO
(13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO
_ DILHR-SBD--609N., 05/80 j
Signature of Inspector RM
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U o c, n to 1 AA) E
GENNRF h1kL6 V S0PJ _ '?L.V, 31 ! 5,
HELGESON TRUCKING. INVC,
Sp-rin, Ucaleps WiscorisiA 54767
EH 1,15 Rev. 9/78
_ REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: Section _L j N,R,! '~E (or W, Townsh'sp or Municipality 1 1
Lot No. , Block No. County % X
Subdivision Name
Owner's/Buyers Name: C a C,;
Mailing Address: ~~'~'tyJ
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NENJ~REPSYSTEM OTHER
F& i -L
OIL BORINGS PERCOLATION TESTS A
DATES OBSERVATIONS MADE:
SOIL MAP SHEET AME OF SOIL MAP UNIT._-_'
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- SINCE HOLE HOLE AFTER INTERVAL RATE
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
1(16J lsiws( go
42 "A 5,1 1, L Ts 1 If 35~
P-
P-
P- 7-1
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
4 SY
B-1,0`1944 1
B- 3 4 tl ~t v l j;1 p ty Se it 5i
B- i- "'w S
B- PG j;; lit S
13- :5 f
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the locat' n and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy .Indicat scale or distances.
Give horizontal and vertical reference points. Indicate slope. t-V -
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JUL
~I ZONiNG
I, the undersigend, hereby certify that the soil t r~porte is fora'i.'~1 re made by mein accord with the procedures and methods
specified in the Wisconsin Administrative Code, an tf%at.the data re ~d and location of test holes are correct to the best of my
knowledge and belief.
%ame (print)er Certification No. 55 -
Address C;-:; i (i l S l.%
Nlnme of installer if known
Copy A -Local Authority CST Signature