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Parcel 022-1071-30-000 09/06/2006 02:52 PM
PAGE 1 OF 1
Alt. Parcel M 25.28.18.397 022 - 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 - KRAMER, PAUL J & SUZANNE L
PAUL J & SUZANNE L KRAMER
136 150TH ST
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 136 150TH ST
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 25 T28N R1 8W NE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 08/11/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.000 4,600 0 4,600 NO
OTHER G7 3.000 30,000 295,300 325,300 NO
Totals for 2006:
General Property 40.000 34,600 295,300 329,900
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 34,600 295,300 329,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 128
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
L
Wisoonain Department of Health e.nd Sooial ServiCC3
Plb. }67 10/69 Division of Health
PE-rfUT APPLICATION
for
PRIVATE Da-lh,STIC SEWAGE SYSTP:",S
d
A, OWNER OF PROPS Y TYPE OR USE BLACK INK_
Name Address (Street, City, Zip Code)
County
B. LOCATION OF PROPERTY WH:°,Z _SYSTE11 WILL BE CONSTRUCTED ALTERED OR EXT :NDEU
Check One;
CITY VILLAGE LEGAL DESCRIPTION- Vr`I~ASj 0tt4~:7£.U(~~rJZ/~ S~ U6Ix
TOWNSHIP of Ski-T1(?A) dS ja{?J;11uHlf~c~l~~ ;:1~~T~}~,1!~/vu~
l 8 t.R.1 S T:
C. IS LOCAL PERMIT EEOUIRED FOR THIS W,DRKY ` YES NO pEfV..IT NUMBER
D. SEPTIC TANK CAPACITY O/ Q Gallons NEW INSTALLATION ~ REPLACEMENT ADDITION
MATERIALS; Prefab Concrete Poured in Place Steel Other
NUI 3ER OF TANKS TO BE IidSTALLED fjrr.~..~`_s
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other
Specify)
Number of Persons to ba Accommodated Number of Bedrooms
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dis:nsasher YES r NO Automatic Pot''-1to Peeler YES NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT
Tile Size ~No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pit: Inside diameter lsf Liquid Depth _-II (Oi4 D S Rae K
P E R C O L A T I O N T E S T
Test Depth I Character of Soil Hours Water Test Time Droo in Water Level Inches Minutes
Number Inches Thickness '.n Inches Since Hole in Hole Interval Second to i Next to _ Last To Fall
1st Wotted Overnight in Minutes Last Period Last Perio Period -,na Inch
E~mple
P- 0 3611 To Soil 101, Cla 26" 25 es or no 30 1/2 1/2 1 2 60
TPJ0 1L 16 • 5-14IjA A.,
/ /C0 CL4Yav' sago 60' l ~ Hsu. rJo
T to Sa1C / S.' J!J :~rJD n «
/00
_ ec.ny,- ~ srt,~o b~ • l ~ tf~5. U / ~ 9 ~ '~3 r•~
oP $a,,- 1 S +JA 4,j j
V(J r C ,s
CLAY /IRS. ° I /S~ 9 1 _ / rni
RECORD DATA FRC:`I MININ.UM OF 3 TEST HOL::S
Compute eize of absorption area in acoord with H 62.20 Wis. Administrative Code.
~ I
S 0 I L B 0 R I N G S- Minimum 36" Bolcw Proposed Absorption System I
oring Total Depth Depth to round Water Deotn to Bedrock
umber Inches Observed Estimated Observed Estimated Character of Soi'e with Thickness in Inches
Example
- 0 72" 72" Black To Soil 12"• Cla 1611; Sand 1611• Gravel 24"
b +
l m ft ru. `~y~ ~'YU? {J r ~ ~ 7-6,0 8 l 4~-_~ a 0 C L4 a ~ ° sr+ ~ ~
-v
lrn a . /Yt !rte ~eL'0-.za-. O-714, , be' ' TOP L;o i c l n sAti C e 4 sA: v D 96
(0 6
6412 TOP SoYG --,,4 0 Cc-A~` t~ cf SA,JG u
RECORD DATA FROM MIVIMUM OF 3 BORE HOLSS
COMPLETE OTHER SIDE
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me
' or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to
the best of my knowledge and belief. p
NAME--jYUA6 R T_ C . 411-PORT TITLE i / urn Le-
(Type or print)
REGISTRATION NO. [ or MASTER PLUTBER LICENSE `N/ o.
ADDRESS I o E / L A S L0I S c o ,j 6mi/ ~ Sr 0..D' 'z
'
DATE ~JIILY SIGNATURE
MASTER PLUi'13ER MAKING APPLICATION
MP
Signature: t'1.'~~~~ ' " y W~~ "~v License Numbers
MP RSW (7U
(To be 7Copleted by Issuing Agent)
Date of Application Fee Paid $
Permit Issued (date) Permit Number
Agent (name)_~, For •yi
Town, Village, City, County, etc.
(Specify)
Note: The application cannot be considered for filing until all of the above questions are answered
and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
DATE RECEIVED 3'3J7(' ACCEPTED BY / r RETi1111NED
(Initials) (Date) S,ree Corres.)
FEE RECEIVED VALID. NO. 3{ J 5 PERMIT NO. G+ a
Yes or No)
fE'VIEWED BY APPROVED DATE
(Initials) (Yes or No)
COMMENTS: