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Home My WebLink About040-1075-60-200 (2) ~o o Q o c~ O Ef) C C C ti ~ C r_ O C n~ O ti •IA N Q Z 7 m LL C: G ~ U Q) J E Q y mm M d ~ ? - N m_ LJJ O Z °j~ d am z cl 0 mm c C7 o Z c w V c O N O Q C !A F- ~ y Z C 9 y M: a y y j 07 ~ a ~ N • y y t LI V.Q zo m z 0 G N Z E N R m Q) N 43 v N n O ~coa c E 'd h~ (nurr~y N z~> ;A 33 c F- z aaa EL o B ;j 2 C) CD fn 0 U cco. co 'V LL 0 v Q O~ ` a -~I cl y ~ m N c V8'~ ~ cI ~ ~ C ~l N ~ ? O O M U N C N r.+ N LL _ m c co d m O cO N G t~.1 00 L6 co m (0 V) m y V o c co y r- 75 -,zj w o. o H :2 Z a o m °v co c4 ti o uc R E C L a I- C7 c> N Z ^ 2 F (Cn 's E m v a 3 # a a • ct Q- ~ ~ m c c r~ o `0 0 3 n o V ~1 V L O to Parcel M 040-1075-60-200 oli09!2007 08:25 AM PAGE 1 OF 1 Alt. Parcel M 18.28.19.285F-20 040 - TOWN OF TROY 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 O - JONES, KEITH T KEITH T JONES 4848 BLOOMINGTON AVE S APT 2 MINNEAPOLIS MN 55414 Districts: SC = School SP = Special Property Address(es1 Type Dist# Description 33 CT',' PIS I SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.500 Plat: 4575-CSM 17-4575 040103 SEC 18 T28N R19W PT NW SE BEING LOT 1 Block/Condo Bldg: LOT 03 411018 (5.000AC) NKA CSM 174575 LOT 6 (2.500AC) Tract(s): (Sec-Twn-Rng 40114 1601/4) 1B-28N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 02!1212004 754103 25081446 WD 07/28!2003 732441 17!4575 CSM 2006 SUMMARY Bill Fair Market Value: Assessed with: 158314 256,600 Valuations: Last Changed: 07!2012004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 67.000 167,100 234,100 NO Totals for 2006: General Property 2.500 67,000 167,100 234,1000 Woodland 0.000 0 Totals for 2005: General Property 2.500 67,000 167,100 234,1000 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT D11 ld I L~ - 0 yl- TOWNSHIP SEC. I ~ T jd N, R Iy W dER 1 0. ADDRESS I~~ uke 3 , ST. CROIX COUNT-1, WISCONSIN. •~J,~ c~.so-sue S'~ ar G: . --DIVISION , LOT LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WIT-EIN 100 FEET OF SYSTEM 3~ t i ( 5 - - I i 4 77 i i t 1 .V -1 I - i I Ili i I ! c t "e. ) I I i i i i i I I I I r n icate ort Arrow I SCALE: i TIC TANK(S) MFCR. CO?ICRETE__4_ STEEL NO. of rings on cover Depth_ & _ DRY WELL 'NCHES NO. of width length area no. of lines 3 width i,P,' length-,; area &5/&' ~ depth to top of pipe yc. ?'LEGATE / / , RATE ` /(,5 ; / AREA REQUIRED AREA AS BUILT 4, yj ciaimer: The inspection of this system by St. Croix County does not imply complete liance 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 tern operation. However, if failure is noted the County will make every effort to ern,ine cause of failure. ES A.D OILS SH01 LD NOT BE DISPOSED THROUGH THIS SYSTEM. DATED .2 / PLUNIMER ON JOB LICENSE NiJIOER 1~~ a) -71 Parcel 040-1075-60-200 10!04,12005 02:54 PM PAGE 1 OF 1 Alt. Parcel 18.28,19.285F-20 040 - TOWN OF TROY 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 0 - JONES, KEITH T KEITH T JONES 4848 BLOOMINGTON AVE S APT 2 MINNEAPOLIS MN 55414 ~ f Districts: SC = School SP = Special Property Address(es): y ' = Prima Type Dist # Description ' 333 CTY RD F SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.500 Plat: 4575-CSM 17-4575 040,103 SEC 18 T28N R1 9W PT NW SE BEING LOT 1 Block/Condo Bldg: LOT 03 411018 (5.000AC) NKA CSM 17-4575 LOT 6 (2.500AC) Tract(s): (Sec-Twn-Rng 401/4 160114) 18-28N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 02il2!2004 754103 2508/446 WD 07i28!2003 732441 17i4575 CSM 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07!2012004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 67.000 167,100 234,100 NO Totals for 2005: General Property 2.500 67,000 167,100 234,100 Woodland 0.000 0 0 Totals for 2004: General Property 2.500 67,000 167,100 234,100 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 INSPECTION INDIVIDUAL SLWAIiE SVS11M V Sari.i ta/cPenrn<.t QState sept4.c-1,~p Ai~_.. ,,,M E 7ownahip St. Cn04 X C'uunty cutcun~/~f ~f Sec-.t.ion_aLut M Sub di v.io.'0n OPTIC TANK - S -kZe. /&lip'" gatlonb Numbers o6 eumpa4tment4- s tance 64um: WeCY p Huitdi.ng 12 $ eYupe H'ghwaten - IMPING CHAMBER S i z e a YunA _ .Pump Mariu aetu2e.A 6 Mudet- Numb ea .)LDING TANK -7 S-Cze gatto.,4Mumee,h U4 rmmWIhtMMPit A Atanm Sye.tem e tarice 640m: Welt Bui.xd.iny 12~ oCupe H.ighwa.teh i50RPTtON SIT Bed Tae nch e tance 640m: Wett D su-itd.in 9 t 2 e l o p e H.iyhwa.ten - -S-ORPTION SITE DIMENSIONS ul,i dth o6 trench b 6t Rey u4 Ze_d aaea_--~ Lenyth u6 each tine 3 0 6.t Depth 06 Huck beeow t4Ye A- ~1 Numbe/+ u6 Ytineo 3 Depth u6 /tuck uvPh tk _Z. c P I u tat Yenyth u6 etneo cy Q 6t Depth „6 ttYe. beYvw y,Kude_ ~4.n Doe tarnee between ti.nea 6.t Slope o6 tnencli_,_ - 4n. ///pl n 100 At z ~ 1 u, uL0 v/~N.C4Un anew r• 6x. Type u6 Cuven: Pape-A unctnuw 11 DIMLNSIONS- Numbers u6 p.i-t,e / G4avek aa.ound pit, yee__ rtu Ou.teid4 di.ame-ten 6t Depth beYow 4.nYe.t_ 6t Total abauap.t,ion a4 6t ,Area nequi -ted L 6t Ns PECrED BY TITLE _ PPROvED D ArE 19~ -112&~ t IE CTED _ DATE_ 19 e IASON FOR REJECTION - PLB 6 7 State and County State Permit # T A , Permit Application - County Permit # ~ ~ G for Private Domestic Sewage Systems County 'DENOTES STATE APPROVAL REQUIRED Date Approval Received from State It ReUUired State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION- Q.5 Section ~ Sut,division Name, N, R lorl ~Lotx City nearest road, lake or landmark Blk# Village C. TYPE OF OCCUPANCY- 'Commercial Industrial 'Other Township (specify) Single family _2<_ Duplex No at Bedrooms ~Var once --3 _ No. of Persons 3 D. SEPTIC TANK CAPACITY /4 Total - gallons No. of tanks--L-- HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel-.Fiberglass New Installation Ott,-,r fal ".ilyl Replacement _A Lift Pump Tank or Siphon Chamher -Total gallons Prefab concrete E. EFFLUENT DISPOSAL SYSTEM _ Poured in Place Other (Sper.ify)_ Nevr_~_ Percolation Rate~3 `Total Absorb Area- Replacement Alternate (Specify) -sQ- ft. Seepage Trench;-_No. of Lineal Ft. Seepage Bed: Width Depth Tile de th (top -~_Length~~~Width De th a~~ p t No• nt Trenches Seepage Pit:~lnside diameter p Tile depth (top)---. • No. of Lines~3 Percent slope of land - y -Liquid Depth__No. of Seepage Pits Distance from critical slope WATER SUPPLY; Private Joint F1 munity 7-1 Owners name as listed on EH 115 if other than present wnericipal ( 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 _ • obtained from ~e C.S.T. # S' 7t1 and other mfurmatior Plumber 's Signature (uwner,rbuilder). Plumber's Address MP!MPRSW# 7a' Phone PLAN VIEW' Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well I tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. 1 f , r Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONL Y te a of Application Fees Paid: State ~ to Issued; , County e--C.1 D Ate IF Fmit F3*feeted (date) -Issuing Agent Name _ "L pection Yes_~_No 1 State Valiri# -u-y twnae copy) 3. owner (green co udte Recd stat.. (pink copy) py) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 4. plumber (canary Cony) Revised Date 7/1 l/8 Ell 115 Rev. q 78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS l7 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES 6\ -Q =R~ P.O. BOX 309, MADISON, WISCONSIN 53701 ~ p ~p LDATION/_~'='/, Section ,T~N,RLl. @ {orlQTownship or Municipality Lot No._, Block N Owner's/Buyers Name: O u ivlsion ame County %,Iailing Address: C ! c !5`-3 u SU L(/r'Si 0~6 TYPE OF OCCUPANCY: Residence - NO. of Bedrooms 3 COMMERCIAL F-FFLUENT DISPOSAL SYSTEM: NEW - DATES OBSERVATIONS MADE: SOIL BOR _11-41 do ALTERNATE SYSTEM --OTHER PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT / PERCOLATION TESTS T ST TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME - -HA S HER INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL DROP IN WATER LEVEL, I,.CHES H 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/ 1 P ee k 0 3 P 3 e Are ~Z 3 • P- y P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES OBSERVED ESTIMATED HIGHEST TEXTURE, MOTTLING AND DEPTH TO BEDROCK B- & IF OBSERVED IN INCHES B IP TS lot SZ S3" C e. SAC*► ; S B- 7 y S,C !.Z s o'r v 6" S~ + r~ C se S r6r B- B- 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 Uc) Give horizontal and vertical reference points. Indicate slope. r p, Indicate scale or distances. ToP of 7el,* ~e Ad'41141 N~' ar sd \ 0 \ - r '\Q 0 \ :2 S; /c's 1V X Q, ldr-- / Pr~`~~ / / Cts~s.v ~N e,. Are,4 ~ + o \ owl- ~ l a ° x y~~ z 90 F Bw~ l~ is 3~Y Ala,,-t-4 \ ~eXis><r/'v ~S}9 ~t U//Az.,41 'Dr,9,,, 6 e 4010 C-74 t- ? a3 E~-, 96.5 I I, the undersigend, 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) D c Address Ceriific:ation No. c /sue r e So Chi's d - Name of installer if known Copy A -Local Authority CST Signatu / rn i Q o S' t!s' CA- /e foci' Ifou s 90' Weil REPORT ON INSPECTION OF SANITARY PERMIT # ' ` ' ~ (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection ame, A-daress7fcense NO. 0 n5 a i n 9 P umber. Time of Inspection (3)INSTALLATI'O'N CONSISTS OF: _.7 ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepa a Bed ❑ Holding Tank ❑ Fill System B N ermanen reference oint escri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES [:]NO 8 HOLDING TANK: Manufacturer , o ga ons construction depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ NO; ft from residence; ft from well; _ ft from property line. Type of warning device Is the warning device installed? C] YES ❑N0; Wired. ❑YES ❑ N0; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; _ ft diameter; ft liquid depth; _ft to residence; _ ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to ed g'^ of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 1 SEEPAG THE H: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lake,, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-5BD-609 N.05/8 - Signature of Inspector: REPORT ON INSPECTION OF SANITARY PERMIT # (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Name, ress, License o. o ns a ing Plumber Time of Inspection (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank Fill System BEN Permanent re Terence oint Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer:- Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute _ horsepower _ ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? DYES ❑ NO 8 HOLDING TANK: anufacturer o gallons construction depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Ts the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ N0; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material Distance from building to vent ' (9) SEEPAGE PIT SIZE: of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; _ ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 1 SEEPAGE RENC : Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? DYES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: