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HomeMy WebLinkAbout022-1015-40-000 0 fn O m a n d m O nl. 'o 3 0. I ~ a I -a at c lot 0 0 O 67 uNi O W C) N :3 d) N U7 • N CD O d O N O Q 7 `ry c (D E N E N CO (D > O> F+. o a=W~ o co 5. 0 m m n NOO m o SO CD E3 Q o S o o ' to :E o p' N_ N N L, 7 rrf ~1 r- o 0 m W a -1 I v (n Z D m 0 m n o W a ~ c > p O o l~ l:D Z o r. c \r o J t~l z O O O U < z a ai rn D a v o o O m < K O N W < D m a a m = ~ co N v r. m N f3D Cn Z N z co z 0 Da' o o (n m (D (D N C CD N I W ~ d n 3 z > (D -A cn O N oC I A ~ CY t~ a A Z O m W a < co NCD > z o y Z CD I w ~ D ' Q Q o - m c z a p N p A A t n N ~ V N O O a i A n 0 ti p b (D f» O o O ya ti y Parcel 022-1015-40-000 03/27/2006 10:32 AM PAGE 1 OF 1 Alt. Parcel 6.28.18.87E 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): 0 = Current Owner, C = Current Co-Owner 0 - JACOBSON, KEITH C & DARLENE KEITH C & DARLENE JACOBSON 924 TOWER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 924 TOWER RD SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 6 T28N R18W E 466.69' OF S 466.69' Block/Condo Bldg: SW NW CSM VOL 3 PAGE 735 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 143111 266,100 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 189,100 269,100 NO Totals for 2005: General Property 5.000 80,000 189,100 269,100 Woodland 0.000 0 0 Totals for 2004: General Property 5.000 40,000 141,400 181,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 310 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I Rx:PORT OF IJISPLCTIO_I--INDIVIDUAL SLT'IAGE DISPOSAL SYSTEM Sanitary Permit State Septic / ~ T61•1I1SHIP t.~ Croix County MEPTIC TA'II~ Size gallons. %,"umber of Compartments Distance From: Well _ ft, 12% or greater slope ft. Building` ft. Wetlands ft ltighwater ft. DISPOSAL SYSTE:-J _ Tile Field or Seepage Pit(s) Distance From: tjell ft. 12% or greater slope ft Building; ft. Wetlands ~ f FIELD Hig1-lwater ft. Total length of lines ft. Number of lines Length of each line ft. Distance between lines ft. Width of the trench -ft. Total absorption area sq. ft. Depth of rock below= tile in. Dp-pth of rock over tile in. Cover nver.rock., . Depth of tile below grade in. Slope of trench in ner 101 ft. Depth to Bedrock ft. Depth to ground water ft. PITS ' Number of omits 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 Oquare feet of seepage nit area required . Inspected by: Title:. Approved Date 197 Rejected Date 197` C . A ~ PLB67 State and County State Permit # Permit Application County Permit # for Private Domestic Sewage Systems County ~f ,0, C- r *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY e- 1 A Z L Mailing Address: Hoc%S B. LOCATION: '/4 N Section _L_, TCjy N, R 0 (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township W J rr ViL C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher J-YES NO Food Waste Grinder YES XNO # of Bathrooms ~~e-, Automatic Washer XN YES NO Other (specify) E. SEPTIC TANK CAPACITY / b Total gallons No. of tanks _,O/J *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete X *Poured in Place Steel Other (specify) -r-FLUENT DISPOSAL SYSTEM: Percolation Rate 1),AO 2) 3) Total Absorb Area sq. ft. I`wew X Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _ Jeepage Bed: Length ! Width /~2,' Depth 6"' Tile Depth `r No. of Lines 7Zc3O L ` rr Seepage Pit: Inside diameter 7,;Z, -Liquid Depth---C(-4 Tile Size 7- Percent slope of land go Distance from critical slope the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, `Jisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared l.ly the Certified SS it Tester, ',AME CL i" C.S.T. # jr~- ~z}-T and other information btained from rt3 e K (owner/builder). ~ F" umber's Signature MP/MPRSW# Phone # 61,~ " //7 937f Plumber's Address •v PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). I t~rvn~~fy ~ii7 70- 12 ~ &e~ 111Y)122 &16 jx Jl~ o fl c7 i Z7 4 k x~ ~ o ~o~~ 1'~ I SA=P or \ ~ N Nous~ FS, ( I ~I I Tea) shy 1190 I Do Not Write in Space Below - FOR DEPARTMENT USE ONLY -70 46, ate of Application - O Fees Paid: State' Count © Date tJ - D Permit Issued/Rxjeoied (date) -6Z - '_Issuing Agent Name r /7 ~4A Inspection Yes 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 --7 17 LOCATION J W '/4, A(0%4 Section , T N, R /yk (or) W, Township or AAuai~itX 1,0w f N v Lot No. , Block No _ County 0__,jR/51X Subdivision Name Owner's Name: Z L ' Mailing Address: s O TYPE OF OCCUPANCY: Residence x No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS-g-~~' PERCOLATION TESTS SOIL MAP SHEET I Z SOIL TYPE 1509 ~J tl 66 t' 19~►t° PERCOLATION TESTS TEST DEPTH OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN SOIL BORING TESTS C1 TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) if- B- 5 ) TAP SO1 a /~x> y eAm 6 q-° 11 B_ ~v S y cL`i 11 erl l 13 rl ti !r ~c PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the locationand square feet of suitable treas. Indicate number of square feet of absorption area needed for building type and occupancy. -94 S-- 13 Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. V!W r- I " - - VT P-1 Z7_1 11-- 1 ` ( I 1 5 1 ~M I F 4 s j , i t ~ ! 1 ~ 4 4 -4- # 6e , x _I - Zoe` R I C I I f 1 i f I f , I 1 ~ { I 1 1 ! i ~ t ~ ; ~ ~ ~ ~ I + ( I ~ IF— ` r f ~ i 1 I 1 I 1 `r 4 I f i 1 4 t 4 I I I , i { I ! ~ 1 ~ ~ I i f I i + 1 I a 1~ ( I i t 3 ~ 1 ; 1 t I i I 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.]j Name (print) e--' -T 6 L 1 1 Certification No. Address LL) S Name of installer if known n CST Signature