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Parcel 042-1081-20-200 01i02i2007 11:24 AM
PAGE 1 OF 1
Alt. Parcel 29.29.18.458C-20 042 - TOWN OF WARREN
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 - DALSKE, ROBERT J & JODY
ROBERT J & JODY DALSKE
722 107TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 722 107TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 7.816 Plat: 3963-CSM 14/3963
SEC 29 T29N R18W PT GOV LOT 1 BEING CSM Block/Condo Bldg: LOT 4
14/3963 LOT 4 7.816AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/05/2001 656005 1714/456 WD
2006 SUMMARY Bill M Fair Market Value: Assessed with:
149727 370,900
Valuations: Last Changed: 05/31/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.816 56,900 213,700 270,600 NO
Totals for 2006:
General Property 7.816 56,900 213,700 270,600
Woodland 0.000 0 0
Totals for 2005:
General Property 7.816 56,900 211,800 268,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 219
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
Parcel 042-1081-20-100 01/02/2007 11:19 AM
PAGE 1 OF 1
Alt. Parcel 29.29.18.458C-10 042 - TOWN OF WARREN
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 - BOUMA, ALLEN J & BARBARA
ALLEN J & BARBARA BOUMA
714 107TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 714 107TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 5.537 Plat: 3963-CSM 14/3963
SEC 29 T29N R18W PT GOV LOT 1 BEING CSM Block/Condo Bldg: LOT 3
14/3963 LOT 3 5.537AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/10/2001 653531 1697/411 EZ-U
07/23/1997 1092/503 QC
2006 SUMMARY Bill Fair Market Value: Assessed with:
149726 583,500
Valuations: Last Changed: 07/1912002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.537 50,000 375,700 425,700 NO
Totals for 2006:
General Property 5.537 50,000 375,700 425,700
Woodland 0.000 0 0
Totals for 2005:
General Property 5.537 50,000 375,700 425,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 559
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
ZC1.r'NSHIPt~1~A,~iLSEC..~/ T`i ~i, nr
AD RE,SS ST. CROIX COUNTY, WISCONSIN.
JVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
~YS
SHOW EVERYTHING WITHIN 100 FEET OF
4
t J
r
e
C TANK(S)1O ,!'GR.o . coNCRETE!aEEL
NO. ings on coyer epth DRY WELL
HES NO. of width ~ length / .area
o. of lines width length area
dept to top of pipe y~
GATE IT .
RATE 60- AREA REQUIRED Z gk4 AREA AS BUILT
aimer: The inspection of this system by St. Croix County does not imply complete
iance with State Administrative Codes. There are other areas that it is not possible/
spect at this point of construction. St. Croix County assumes no liability for
m operation. However, if failure is noted the County will make every effort to
ai.ne cause of failure.
?.S AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEH
'INSPECTOR 7Yv' ✓
DATED PLUMBER ON JOB'
LICENSE NUMBER
.
RRPOI;T OF IP1SI'rC1'I0.I--I IOI JZDIIAL SE? )ACE llISPOSAI, S1'STF,11
Sanitary Permit
Stet: Septic
TOWNSHIP
t. Cro,~, County
Si:T'TTC T)VIY
e ~
0 0i
f41`---v gallons. ~vumbe-r of Compartments
Distance From: Tleli t j t, 12 0 or greater slope.!2/ L
Building (eft. Wetlands St
Righwater ft.
DTSPOS,SI., SYSaL._i Tile Field or Seepage Pit(s)
Distance From: 1.teII t. 12% or greater slopej-0 ft
Building ~~---ft. Wetlands f
FIELD Kighwater `-a ft. -
Total length of lines --L1--' f t, dumber o` lines Length of
each line ft. Distance between lines ft. •Width of the
trench /A ft. Total absorrtion area sq. ft. Depth
.of rock bclow tile in. Dp-pth of rock over the in. Cover
°ver . rocxc , . Depth of tile below grade QQ_izi. S1oPe of
trench in ner 100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS
Number of pits Outs•de/di meter ft. Depth below inlet
ft. Gravel around i t• / Yes no. :Total absorption area
_s q . ft.
.Square feet of seepage trench )bottom area required
,,quars feet of s epap.e pit-area required
Insnected by. Title:
Approved Date S1, Jm 197S.
Rejected Date 197.
(Vk)
N
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: '/4, SectionZ , Tl-'N, R W, Township o PA +3+sipality
Lot No. Block No. County G 1
Subdivision Name
Owner's Name: A L L- G: k1 A
Mailing Address: Tzi'"T_ I 'BC'X F3^' ~-c'c"L=12'T I L~~; •
TYPE OF OCCUPANCY: Residence X No. of Bedrooms 4/ Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT /
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS/-1-3/
SOIL MAP SHEET 37' SOIL TYPE L~12 t~ 1 IA1'Zb'1 NkC TA C-C` PL 6x
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL
i sUM- INCHES THICKNESS IN INCHES MIN/IN
~BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
i
P-~ 3~> ~5 S~dGr. 1 1/.3
e3
i F_
a _j
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)
- 1 Z ~ h
7 Z Na E✓ 7 7 `31 '3' ' s5 i I. s Z 6
6, 75 V 13 j-)
3 v -7 ~2 Si, 3~' ~b~~r,~~ Sf 3t>' SS1 h
y ~ 5 r~ ~ I z~-~ s) s c , - s l y 1V
3-
~Z > -1 SI , z~ l ~C s z c 11
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. ►GKx, ~1~`121(~ - it, ~~t-~ Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
L
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M I A0_ _'V I
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P, i N
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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 and belief.
Name (print) b ZiTy z_ L s 1t,~ F-C; r ~2 C=k, Certification No.
Address W'_t-t s = 7 - L DI , /,j" " L' l/
Name of installer if known
CST Signature
I~ COPY A - LOCAL AUTHORITY
J
State and County State Permit #
PL967 Permit Application County Per
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:
gLLelv /sUum A- 1q. b~~~s, s
B. LOCATION: % Y4, Section ~,cJ T.-,Z_ N, R / (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township ARg -d
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 NO Food Waste Grinder YES X NO # of Bathrooms_--
Automatic Washer _YES NO Other (specify)
E SEPTIC TANK CAPACITY-U.00 Total gallons No. of tanks QA/ El.
'Holding tank capacity Total gallons No. of tanks
','ew Installation Addition Replacement Prefah Concrete 7C
Poured in Place _ _SteeI Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) / 2) I4 3) 16 Total Absorb Area /A(-0 _ sq. ft.
New K Addition _ Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length ~e> • Width & .1 Depth " Tile Depth -gq-' , No. of Lines -r e
Seepage Pit: Inside diameter Liquid Depth 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,
NAME C/ r,-, C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signatur, oMP/MPRSW# /Ylp Phone Plumber'PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
/Y" 14 )L
~rS
Lil Cl 0 -
10
13 j5
e_v tl-
r q "C-
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7
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P-
Do Not Write in Space Below FO DEPARTMENT ySE ONLY
Date of Application ? Fees, P id: State County,-2-_ Date
Permit Issued/R6' (date) Issuing Agent Name
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) 11 'umber (canary copy)
Revised Date 6/1 /76