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Parcel 002-1051-50-100 02/14/2006 03:34 PM
PAGE 1 OF 1
Alt. Parcel 21.29.16.318D 002 - TOWN 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
DEREK M LEE O - LEE, DEREK M
878 240TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 878 240TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 1.840 Plat: N/A-NOT AVAILABLE
SEC 21 T29N R16W THAT PART OF LOT 1 CSM Block/Condo Bldg:
6/1695 INCLUDES P319B
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-29N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/08/2003 742963 2431/251 WD
10/08/2003 742963 2431/251 WD
07/23/1997 979/289 WD
07/23/1997 909/267
2005 SUMMARY Bill Fair Market Value: Assessed with:
87029 169,900
Valuations: Last Changed: 11/02/1999
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.840 8,500 100,600 109,100 NO
Totals for 2005:
General Property 1.840 8,500 100,600 109,100
Woodland 0.000 0 0
Totals for 2004:
General Property 1.840 8,500 100,600 109,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 510
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 45.00
Special Assessments Special Charges Delinquent Charges
Total 45.00 0.00 0.00
A-
J
• A.S BUILT SANITARY SYSTEM REPORT
:DER - ~Y -i - TOWNSHIP N, R
SEC. l~ T!
J. ADDRESS ST. CROIX COUNTY, WISCONSIN.
3DIVISION , LOT LOT SIZE
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i<-
i•
TIC TANK(S),'; MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
"INCHES NO. of width length area _
> no. of lines_ width length area
depth to top of pipe
EGATE , - -
_:;K RATE S% AREA REQUIRED AREA AS BUILT ~T
:claimer: The inspection of this system by St. Croix County does not imply complete
_pliance 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
:item operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
_ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
'INSPECTOR
DATED - f - - i ' U -
PLUMBER ON JOB
LICENSE NUMBER
I .
E SLI SYSTEM
RfiPOP,T OF ItISPCTIO?1--I:IDIVIllUAL ~L,~)AC,E llXaPOSAI, Sanitary Permit State Septic
T61•1I1 SH I P _ r
F. Croiy. County
.y -
MR.PTIC TA'?K
•}dZe gallons. `lumber of Compartments ,
Distance Front: Tell ft. 12% or greater slope fi.
Building` ft. Wetlands ft
lei hwater -
~ ft.
DISPOSAL SYST:1 Tile Field or Seepage Pit(s)
Distance From: jlell ft. 12% or greater slope ft
Building ft. Wetlands f:.
FIELD i;ig;hwater -ft.
Total length of lines ft. Number, of lines Length of
each line ft. Distance between lines ft. Width of the
trench -f t. Total absorption area sq. ft. Depth
of rock below tile in. Dp-pth of rock over the in. Cover
nvex .roc=; , Depth of the below grade in. Slope of
trench in per 100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS
(lumber of pits Outside diameter ft. Depth below inlet
ft. Gravel around pit: ___yes no. Total absorption area
sq. ft.
Square feet, of seepage trench bottom area required
Square feet of seepage nit area required '
Inspected by: Title':
Approved Date 197
Rejected Date 197.
State and County State Permit #
PLB67 Permit Application County Permit # -
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Pc~r4/Zc/ A-:f) A/~ q~ cam. s✓ Cc/~ S
B. LOCATION: % Section 7-/ , T-,A9N, R,/L 11 (or) W Lot# -City -5 vV Subdivision Name, nearest road, lake or landmark Blk# Village
ll
Township
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family x Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES X NO Food Waste Grinder YES_7( NO # of Bathrooms--
Automatic Washer X YES NO Other (specify)
E. SEPTIC TANK CAPACITY ~A Total gallons No. of tanks O/V iE,
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement Prefab Concrete
L7
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1)~, 2) aZ(~, 3) --Total Absorb Area sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet _Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width /-Z/ Depth Xg! Tile Depth No. of Lines
ti
Seepage Pit: Inside diameter _Z,~Z u -Liquid Depth 14%Z " Tile Size
Percent slope of land Distance 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 Soil Tester, 11
NAME 74 L~T C.S.T. # and other information
obtained from N (owner/builder).
Plumber's Signature MP/MPRSW# ~_'~5LF 9 Phone #1094-33 79
Plumber's Address ~L, r'.v Ct,2 r'
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
LAn l Slope
. , x~
11 60 r~. Stp+-~ c Tr~nK
0 WRK Noies
BoRe Holes V~
d
I ~ oo
(101 i
pQ i p0
3 Qo
0
_ r
4,
Do Not Write in Spac Below , R DEPARTMENT USE ONLY
Date of Application Fees Paid: State / r unty 'T' Date (c~ ! /
Permit Issued4W&* ted-(date) a Issuing Agent Name -
Inspection Yes-4- 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)
EH 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: V., Section~_, TA, R&,6 (or) W, Township or IMenreipali~y,
Lot No. , Block No County Oleo i Y_
Subdivision Name
Owner's Name: AlG" LA- 4 A ~ e
Mailing Address:
TYPE OF OCCUPANCY: Residence A No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X -ADDITION REPLACEMENT
1
DATES OBSERVATIONS MADE: SOIL BORINGS-('-' 7 7 PERCOLATION TESTS 7/0
SOIL MAP SHEET SOIL TYPE ~i✓ Sd S%L 1_ 46 ~y yh `
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME 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
P_ ~Vo
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)
6 6
B- 04- 6 -1
# Z_ 7A ~i
B- Ir
7Z ? tr ~f If
0 L/
B 11, 66
72- t/ 6 1, l/ r, v 66
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable gVes. Indicate number of square feet of absorption area
needed for building type and occupancy. _ ~1c7 F :~-f Indicate scale
or distances. Give horizontal and vertical reference points. Ind' to slope.
. I
_ ►.01 _ ICO _ i _
r
I
411'il
067
~ y 1 I
~l tN
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) ~'v 4 Certification No.
Address
Name of installer if known CST Signature
COPY A -LOCAL AUTHO;?i T Y