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Parcel 106-2034-70-000 03/23/2007 1112 AM
PAGE 1 OF 1
Alt. Parcel 1.28.17.961 106 - VILLAGE OF BALDWIN
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 - WALKER, DARLENE
DARLENE WALKER
PO BOX 354
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ' 566 HWY 63
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 2.800 Plat: 0312-CSM 02/0312
SEC 1 T28N R17W PT SE NE BEING LOT 1 CSM Block/Condo Bldg: LOT 01
2/312 EXC N 1OFT FKA 028-1001-60(P4F)
EZ-U-1275/332 ASM'T INC 106-2035-00(964) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
A & W RESTAURANT 01-28N-17W SE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 784/384
07/23/1997 698/178
06/19/1997 1246/468 AX
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/02/2002
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 2.800 126,000 419,100 545,100 NO
Totals for 2007:
General Property 2.800 126,000 419,100 545,100
Woodland 0.000 0 0
Totals for 2006:
General Property 2.800 126,000 419,100 545,100
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
Parcel 028-1002-95-000 03/23/2007 11:11 AM
PAGE 1 OF 1
Alt. Parcel 1.28.17.13C 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 - WALKER, RETIRED
RETIRED WALKER
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 1 T28N R17W PT NE SE CSM 2/312 EXC Block/Condo Bldg:
PT TO TOWN IN 547 P 616 & EXC S 25'
ASS'D/W P4F NKA 106-2035-00 P964 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
01-28N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 784/384
07/23/1997 698/178
06/19/1997 1246/468 AX
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/09/1997
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 0 0 0
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
1 • e
R^:PORT OF I'-ISPECTIO ?--Ilq IVI:t')ILAL CE?JA:7E J7ISPOSA SYSTETi
Sanitary Permit
State Septic T017NSHII' ,..i. ,
St. Croix. County
` ize ` gallons . lumber of Compartments
Distance From: TTe11 ft. 12% or greater slope ft
Building ft. Wetlands ft
DISPOSAL SYSTTI~.",l Tile Field or Seepage Pit(s)
Distance From: Tell ft. 12% or greater slope ft
T,li lclint° ft. Wetlands f
FIFIT) , water t .
Total length of lines
fif ft. Zulber of lines / Lengta of
each line t Q -_ft. Distance between lines ft. !Jidth of tie
trench ~Ll
_ft. Total absorption area sq. ft. DeptI.
4, L 16 0
of rock below tile in. Depth of rock over tile in. Cover
over rock Depth of the below grade in. Slope of
trenc.1 -11- in ner 100 ft. Depth to Bedrock ft. Depth to
,-round water ~ft.
ry- C,
'lumber of nits Outsiv. diameter ft. Dentli below inlet
ft. Gravel a u d pi 'yes Tlo. Total absorption area
sq. ft.
Square feet of se na.ge trench bottom area required
Square feet of s ena,-e nit pea erJuixzd
~ 7
inspected by: A
:tle :
Approved ;ate 197_
R~]ectc,d Dare 197
Plb X67 State and County State Permit
7
Permit Application County Permit #
for Private Domestic Sewage Systems County SY'• Coe-40 / x
*DENOTES STATE APPROVAL REQUIRED f .7~ C I C/
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
dV i1qv f~J- e- ie "-Si 1, c-4 il:~~ t;o / CJ I)c 5,4o 0
B. LOCATION: (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 Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher _ YES NO Food Waste Grinder YES NO # of Bathrooms
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY 00 0 Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation X Addition Replacement- Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) Z 2) 3) Total Absorb Area 6466 sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length UIWidth (,q' Depth f6" Tile Depth ~t No. of Lines A✓
Seepage Pit: Inside diameter. Liquid Depth t• Tile Size
Percent slope of land SDistance from critical slope
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 S it Tester,
NAME c° / e- "'04 / 9 C.S.T. # 5.5' and other information
obtained from iJ P ~e_ (owner/builder),,, ~Lr p ,L
Plumber's Signature MP/MPRSW# r! ` ~T o Phone #~T 33 7
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
d p / nd L
I
u
r tU
o p w 041'
_ oa P/ ef~- cell /ac)~~~, c-^-r4,a l+J `3
4--
o See p} c A
f
~E
..4----5,te+« -rA) a Ile
all
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lVa+ 7-o s~ l
dD~cp, e
Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application Fees Paid: State/
County Date
Permit Issued/mod (date) Issuing Agent Name - /1" J
Inspection Yes J' No 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 3/1/75
L t -
EH 115 (11-74)
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, R _ E (or) W, Township or Municipality
,
Lot No. , Block No. County
Subdivision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOI L TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
INTERVAL
NUM- INCHES THICKNESS IN INCHES AFTER SINCE HOLE HOLE
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-
P-
P-
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-
B-
B-
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. Indicate scale
or distances. Give reference point. Indicate slope.
tN
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) Signature
Certification No.
Name of installer if known
~ ( f ,~G/~ pZK lp~I -(gyp) ~ j
Low
CJy~ ~'c+'apai'~ i
rnhln-an f1Fl-1. ..oust. Co.
12000 Riverwood Drive
Burnsville, MN 53 -7
Plan Identification No. 76-04309
Gentlemen:
Re: A & W Restaurant
Robert Walker, owner
Sewage Disposal
NE 1/4, SE 1/4, Section 1, T28N, R17W, Rush River Township
St. Croix County
Examination of plumbing plans and specifications for the above-mentioned
project has been completed.
In accord with Chapter 145, Wisconsin Statutes, and Chapter H 62, Wisconsin
Administrative Code, the plumbing plans and specifications are approved
contingent upon compliance with the stipulations indicated on the plans and
the following code sections. Please review your code for the requirements
of each code section noted.
1. H 62.04 (4) (a). Building sewers - oradient.
2. H 62.04 (4) (b). Building sewers - depth.
3. H 62.20 (2) (b) i. Percolation and sell boring tests - distribution
and depth.
4. H 62.20 (4) (c) 4. Specified material - Inlet and outlet of sew in- tank.
5. H 62.20 (5) (c). Sizing absorption systnrri - other.
6. The architect, professional engineer, registered designer, owner or
plumbing contractor shall keep at the construction site one set of plans
bearing the stamp of approval of the department.
,r -
Grahlman Mfg. A& CtiETst. Co.
Page 2
,Uvember 22, 1976
7. li~~ the event installation of the plumbing improvements or system has
not commenced within two years from this date, this approval shall become
void and new application shall be made for approval of these plans before
work may commence.
In granting this approval, the Division of Health does not hold itself
liable for any defects in plans or specifications, plan omissions,
examination oversight, construction or any damage that may result in
or after installation and reserves the right to order changes or additions
should conditions arise making this necessary.
This approval is based on Chapter H 62, Wisconsin Administrative Code,
requirements. It shall be necessary to obtain and fulfill the permit
requirements of the city, village, township or county in which this
installation is to be constructed. Failure to obtain local permits will
automatically void this acceptance.
,y order of Edwin R. Larkin, M.D., Acting Administrator, Division of Health.
i ncarc- 1 f. ,
Jaunts i't. 'argent
thief
.JAS : JH : cmc
au Claire
.."role. C. 'Oaru;r, -owing Administrator
,ubert !Talker, owner
+toy L 'I .4ry, °.hi.a4 -7 !uL 15 an Restaurants
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?'fumbing and Fire "ro}eciion S;''"eru, 5ureau
of Environmental N::;:,!}y, Ciaisian of Heal}i1,
flepcrtment of ;aai}iy cmn 5.ciai S~rvi;:es,
J.~:'1»~ A. S~;r',v~:~T, Crier
~!~{t1V!i CI Plum~:;g Lt Fi:'t: 1~'r~.lt@C'}IQn
APPR~1iEfl by ~~!~e flivisien cf !-,ea}h, (1rt.,t. of . ~t!caith anal JoC'tll Ssrv,ces; sur•inct tc ccndttiors .
;s~fi forth in th2 !otter c~ c~r~rcvcl. 1 r f~ 6 2-
~ _ l.. ! EDWIN R, LARKIN. t~ _
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