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Parcel 022-1033-20-000 12/06/2006 09:48 AM
PAGE 1 OF 1
Alt. Parcel 12.28.18.178 022 - 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 - BENSON, THEODORE P & PAMELA
THEODORE P & PAMELA BENSON
1453 HWY N
ROBERTS WI 54023
Districts: SC =School SP =Special Property Address(es): Primary
Type Dist # Description ` 1482 HWY N
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 12 T28N R18W NW NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/19/2001 662533 1766/345 QC
07/12/2001 650908 1678/464 QC
07/23/1997 828/595
2006 SUMMARY Bill Fair Market Value: Assessed with:
178854 Use Value Assessment
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 36.000 4,900 0 4,900 NO
UNDEVELOPED G5 2.000 200 0 200 NO
OTHER G7 2.000 20,000 94,000 114,000 NO
Totals for 2006:
General Property 40.000 25,100 94,000 119,100
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 25,100 94,000 119,100
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
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Parcel 022-1033-20-000 03/27/2006 02:29 PM
PAGE 1 OF 1
Alt. Parcel 12.28.18.178 022 - 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 - BENSON, THEODORE P & PAMELA
THEODORE P & PAMELA BENSON
1453 HWY N
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1482 HWY N
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 12 T28N R18W NW NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/19/2001 662533 1766/345 QC
07/12/2001 650908 1678/464 QC
07/23/1997 828/595
2005 SUMMARY Bill M Fair Market Value: Assessed with:
143293 Use Value Assessment
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 36.000 4,900 0 4,900 NO
UNDEVELOPED G5 2.000 200 0 200 NO
OTHER G7 2.000 20,000 94,000 114,000 NO
i
Totals for 2005:
General Property 40.000 25,100 94,000 119,100
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 15,100 57,200 72,300
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
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Parcel 022-1033-20-000 04/12/2007 08:41 AM
PAGE 1 OF 1
Alt. Parcel 12.28.18.178 022 - 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 - BENSON, THEODORE P & PAMELA
THEODORE P & PAMELA BENSON
1453 HWY N
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 2 HWY N
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 12 T28N R18W NW NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
12-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/19/2001 662533 1766/345 OC
07/12/2001 650908 1678/464 OC
07/23/1997 828/595
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 36.000 4,900 _.0 4,900 NO
UNDEVELOPED G5 2.000 200 0 200 NO
OTHER G7 2.000 20,000 94,0001 114,000 NO
Totals for 2007:
General Property 40.000 25,100 94,000 119,100
Woodland 0.000 0 0
Totals for 2006:
General Property 40.000 25,100 94,000 119,100
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 022-1001-80-400 04/11/2007 05:15
PAGE 1 OF 1
F 1
Alt. Parcel 1.28.18.158 022 - 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 - BENSON, THOMAS G & JANE
THOMAS G & JANE BENSON
47_82 CTY RD N ✓j~ S i^i 6~
RO TG WI 54023''
Districts: SC = School SP = Special Property Address(es): Primary
1
Type Dist # Description z-
SC 4893 RIVER FALLS oL
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 35'.50 Plat: N/A-NOT AVAILABLE
SEC 1 T28N R18W SW SE EXC CSM 15/4093 Block/Condo Bldg:
ALSO PT OF THE SE SE COM SE COR SEC 1;TH
N 88 DEG W 1243.09'POB;TH N 88 DEG W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
96.47';TH N 00 DEG E 265.33' TH S 88 DEG 01-28N-18W SW SE
E 68.93';TH S 01 DEG W 70.64';TH S 48
DEG E 90.79';TH S 17 DEG W 141.81' POB
otes: Parcel History:
- Date Doc # Vol/Page Type
11/19/2001 662535 1766/350 QC
07/12/2001 650907 1678/461 QC
07/23/1997 828/595
2007 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 33.650 4,700 0 4,700 NO
UNDEVELOPED G5 1.000 100 0 100 NO
OTHER G7 1.000 20,000 % 178,000 ; 198,000 NO
Totals for 2007:
General Property 35.650 24,800 178,000 202,800
Woodland 0.000 0 0
Totals for 2006:
General Property 35.650 24,800 178,000 202,800
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 022-1033-50-050 04/12/2007 08:39 AM
PAGE 1 OF 1
Alt. Parcel 12.28.18.181 B 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 - WARNKEN, STEVEN J
STEVEN J WARNKEN
816 1ST ST
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ' 1449 CTY RD N
SC 4893 RIVER FALLS 7
SP 0100 CHIP VALLEY VOTECH pl
Legal Description: Acres: 5.940 Plat: 4664-CSM 18-4664 022-03
SEC 12 128N R18VV PT NE NW CSM 18-4664 Block/Condo Bldg: LOT 01
LOT 1 (5.940 AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-28N-18W NE NW
Notes: Parcel History:
Date Doc # Vol/Page Type
05/04/2004 761505 2563/624 TD
12/02/2003 747956 18/4664 CSM
09/18/2001 656811 1720/153 QC
09/18/2001 656810 1720/152 QC
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.940 60,000 58,100 118,100 NO
Totals for 2007:
General Property 5 940 60,000 58.100 118,100
Woodland 0.000 0 0
Totals for 2006:
General Property 5.940 60,000 58,100 118,100
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
REPORT OF I11SPECTIO'_1--INDIV1DUAL S E~,JAGE DISPOSiV, SYSTE11 •
Sanitary Permit 'c
State Septic
1.7M IE
T&WNSHIP
• t. Croix County
SJ.PTIC TA'?1:
ze gallons. `lumber of Compartments
Distance From: We 11 ft. 12% or greater slope ft.
r Building ` ft. Wetlands f
Highwater ft.
DISPOSAL SYSTL:2 Tile Field or Seepage Pit(s)
Distance From: i1ell ft. 12%.or greater slope' ft
Building; ft. Wetlands f
FIELD Highwater 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 the in. Cover
-over. rock,, Depth of tile below grade in. Slope of
trench in ner 100 ft. Depth to Bedrock ft. Depth to
P,round water ft.
PITS
Number 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:
r
Approved
,.:Date 197`.
Rejected Date 197
6
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 / r
LOCATION: Section V-fN, R ~~'(or) ~wnship or Municipality 1C6*A-I'Lii,(- ^~i f ^<<
Lot No. , Block No. County
l Subdivision Name
Owner's Name: re a ~J~~~~✓
Mailing Address: gk o f R0 bet-1S v.,4" 3
TYPE OF OCCUPANCY: Residence X No. of Bedrooms -3 Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT X
DATES OBSERVATIONS MADE: SOIL BORINGS 3,' PERCOLATION TES//TS _-3 o
SOIL MAP SHEET SOILTYPE
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 MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
yo C g .,4e "12-
P L 4/77 12-
P- ~Il c~ 5 L
-3 _e e e Z4.9 L) 5
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)
~i Nei.
9/ % L- riJY
B / I 6 r Alv.u e ? lC- •'C
J` 16111e.
M~
/t4 t5 7-3
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suita le areas. Indi to nu ber of square feet of absorption area
needed for building type and occupancy. y~'~ ~Uc° - ~*10 Indicate scale
or distances. Give horizontal and vertical referen /oi ts. I~licate slope.
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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 a belie .
Name (print) Uz's's Certification No. 5 S~lS~/`/
Address 1,114 Z" %"rC
Name of installer if known
CST Signature
COPY A -LOCAL AUTHOF~I•._•
State Permit # J-4-1-0
PLB67 State and County
Permit Application County Per i # '
for Private Domestic Sewage Systems County, -
r
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
1 L~ A-d S As
B. LOCATION: /Klcf '/4M E '/4, Section /,L, T..ZXN, R[J' I9 (or) 4ELLot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township /~`.uu. ,rzws,
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family K Duplex No. of Bedrooms _3 No. of Persons
D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder YESXNO # of Bathrooms-/-
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY ICOC' Total gallons No. of tanks _
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement- X Prefab Concrete X
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) -Y 2) _ 3) Total Absorb Area_ sq. ft.
New Addition _ Replacement *Fill System ~yS e?a .41
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Sy/Width f Depth Tile Depth : r" No. of Lines 3
C~ N
Seepage Pit: Inside diameter Liquid Depth Tile Size 7
Percent slope of land /`-..L `J 4- f 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 CerAfled Soil T er
NAME hr s~~~ r `~tr,~ 3 C.S.T # ~S -IS and other information
obtained from a
Plumber's Signature MP/MPRSW# °~/mss Phone # 9/~-3G6 31v23
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
Al
Ae"' 7010 0 0,
f
FU_
Y
Do Not Write in Sp9ce Below OR DEPARTMENT USE ONLY Q
r Date of Application - C) " Fees P •d: State ® 0 Co ty Date
Permit Issueed (date) - Issuing Agent Nam -kQ Inspection Ye4te No Valid# Date Recd _
1. county (w copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)