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HomeMy WebLinkAbout040-1207-30-000 n N O 3 T n d O LO) 0 fu 1 fD ro ro C) T (D n O Cn g 2 v, Z o rn -I o .Z. n o 0) u, o c' Ap- 3 OD `C m o c x N CL z a N N tD u! CO N v :E ~c3~W~ _ Q N CD N ° n C) 0 D CD CD = o 4 O 0) C) cn ° Z ~3 C) (D F-3 U, cn v~ r~r ~ 0 m cn D a 3 f H. (D CD N z N W a ? W `CA rt ~ (D c c W C-4 3 ro do con V CD J v x O M o= 00 e Z ON z o W co Cw c c O• r z z O O O v° O p -4 ~ w `ice CJ H o cn C,) to o F T ro ro v 7~• I y N V N 3 C~ H z a 00 O N r! I rt 00 0 z w z O N IZ d p D nCD 0 :3 tr Li t~l 00 0 Ln V Cn : m vro F (D C N ~ N C) ~ ro mC: O rt c N H. CD ((D O O w ro CL PI 'I._j O n N ? - I V) O O Z ro - O (D rt O a) °c n W Fh n O A Z O rt v a C o . F.,. H 0 O z n~i rn co T m w 3 c z a z 0 z ro p w ~ a d n 0 3 v c 0 o a ro n N N I a y O 7 A i O Z I A ~ N N O O V A O_ ro OQ O cfl O N O ~ ' Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 7SEC. T N-R W i ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions Lc meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r 1 I { INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /rcr, Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,o Rear, 0 feet From nearest property line : Front,0 Side,0 Rear, O feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet Erom nearest property l.iae: Front, O Side, 0 Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lenith: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: it Plumber on job: License Number: 3/84:mj DEPA9TMENT'OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 ' BUREAU OF PLUMBING MADISON, WI 53707 XX~MNVENTIONAL ❑ALTERNATIVE Stale Plan l D. N-1a (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTI N DATE. John Mattison 1879 -6th St. White Bear Lake, MN55110 ~s BENCH MARK (Permane,t reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.- NE NW, Section 16,T28N-R19W, Town of Troy, Lot#23, Glover Station Name of Plurnber_ IMP/MPRSW No County. Sanitary Permit Number. Eugene F. Grove 5569 St. Croix 64869 SEPTIC TANK/HOLDING TANK: i% MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER ' PROVIDED: PROVIDED. T ~ ~t; ~ f •T J~ !EYES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.. HIGH WATER NUMBER OF ROAD: 1PROPERTY WELL. BUILDING. VENT TO FRFSH ' / dE ALARM FEET FROM' LINEv ~7 LAIR NLET YES [:]NO C\ ❑YES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. 11-11111111 CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PR OPERTV WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST 30, SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LFNOrH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: LNTH. LENGTH NO. OF DISTR. PIPE SPACING. COVER JINSIDE DIA. -PITS LIQUID BED/TRENCH TRENCHES VRITA PITDEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTRPIPF DISTRPIPE DISTR. PIPE MATERIALNO . NUMBER OF PR OPERTV WELL BUILDING'. VENT TO FRESH HE LOW R,IFES ABOVE CClVER EL V. INLF/ ELEV. END - ( Pl tf FEET FROM (LINE. AIR INLET: G~ /9 4 w ? NEAREST-----p- f> MOUND SYSTEM: 1 ` j-' Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED = 1 TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL'. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.. DIA ELEV. PI PES. DIA.. ELEVATION AND DISTRIBUTION LANSCAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING JDRILLED CORRECTLY COVER MATERIAL pVER ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE. ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on detain in county file for audit. Reverse Side. S : TITLE. _ DILHR SBD 6710 (R. 01/82) 1 -4-7 i w,sconsin APPLICATION FOR SANITARY PERMIT COUNTY (PLB 67) Zll ~ UNIFORM SANITARY PERMIT # ®ILHR OEPRRTTEI-lT OF - I1-1pU14TRV,1-RH0R 6 HUR1Rn RELRTIOnS flLilJ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION C-f+Y-- . ~ 1/4/j(k'1A S 1 , T N, R /'i E (or W TOWN OF: LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED -I 1 or 2 Family Number of Bedrooms. 'j Public (Specify): THIS PERMIT IS FOR A: 21"N ew System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. LJ Seepaye Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity , Lift Pump Tank/Siphon Chamber ~j Holding Tank capacity Manufacturer. ? y' / ] ~1c5 7 AY J- IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total # of Prefab. Site Steel Fiberglass Plastic I'V 4 Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Zc :7i 21-Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No. Phone Number:'yt_r /(f AENI& 42 fielo Plumber's Address: 5L~Z L Name of Designer: r.r X 1 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved / ~E L~ Owner Given Initial { f AApproved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 • To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water suppi i 6. PRINT the name of the master plum C1a357- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C 100 This application Iorm is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property; / C4-- 0-Ax D. 0121S) Z5 Locit ion of Property A1411 J, ~1, Section 162, T 19 N - R I? W Jv wnship TRat No i 1 i_ng Address `subdivision Name Women. STV?70w Lot Number .23 Previous Owner of Property __Dfn415 Total Size of Parcel - a.;>,/7 aCy,g S Me Parcel was Created /079 Are all corners and lot lines identifiable? 1 Yes No is this property being developed for resale (spec house) ? Yes K/ No Volume and Page Number 8 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING; 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (WA eejy that A statements on this 6oAm ate hue to the best oA my (out) knowledge; that I (we) am (ate) the ownest (s) o6 the pAopen-ty dessuibed in ,tpk s in~)onmation 6onm, by vi,,Ltue o6 a waAAanty deed AecoMed in the 06liee of ,the County Registut o A Deed, as Doc ment No. 3 2 111, and that I (we) pmentxy own the pAoposed site QA the sewage spb a.~ system VA I (we) have obtained an easement, to tun witit the above desuubed pAopetty, 6oA the cons.ttuct%on o l said system, and the same- hat been duty Aeeoided in the 016ive o6 the County Regi6teA o6 Deeds, as Document No. 4; L j,,! SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 1,e DATE SIGNED DATE SIGNED M L•M GP 6.19 of 11w 114 4APo r wLw-. 84000.__. ~Ijgy am"o-_. ~w ~D' io' .T•u W'.. - I' y 6 ~ rI ~ ~ 9 _ i $ 6 g • 5e. r "ooby "rww5 WCw'... lg ~ ~ •a. r~ G . I pt. ~ ~ ~ a fi M I y .IIeW 1 M ~ $ I 12 ti l..r A li Mt ..wt _ h+o«.» . 1• II ~ I wren',we.. waoN' nrarM"4.......,:_•:..,, Meth ~ ~ II • • • r ~y ,y u t. >t ba 14. * a t a 7 rl•, Gam; ~ \ 4r•~ rr Mw'n^t •Ot w' a. a 6 ~ ~ e ~ w•.„ a 8 b} ~I s F ~ N \ r 'Fol 4r t M 8 a R u ~ ~ ,~V . N' errJ~~ ,y~ '/r r oi, a %l t~t~ N M 4.f G~~ H H a ST C- 105 r r ' a ti SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z 0 H OWNER/BUYER roNJ ) ! ROUTE/BOX NUMBER I~ ~~Sr Fire Number C I T Y/ S T A T E ' `i Z I P PROPERTY LOCATION: 4', 4, Ila) 4, Section T 2 S N, R~_W, Town of St. Croix County, Subdivisionbtl~z~u Lot number 121-5 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o E I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- u ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. A SIGNED I I ~xoL/ i DATES St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 0 Z~ L O i J ~ r > O O- E o CL 0 m 4p 0 i 0 C 3 a. . W V ' U O (1) f- a) ca " (fl- c c C~ N V 0 C)) O c p 0 c cm (D A :3 W 0 (o o =3 U) 3 0~ 3 o .0 -o E CC c °'=)a' :3`O = CU .0 tt= c i O _ ON (D (n C r_ :3 CD (n . o d U 3a)-ar- i 'aM 0 0r~w (D WE Cr. N o f p m C 0` ~0v,3 ~ la.. Q t w w o E U N O 3 a) f. r- U a) O C • Z C M y ` t LL cm 0 3: Q a) (n h C r / V) = CA cc a -C c rn vi O ; 0 o O U p cu ° 0 O ` < ca. CL CO a) w O ~Q N a) c 00) o (D o = U) -C5 c m c 3 c~ r ~ `c cu o c E =O =3 C y C r- O~ ~ E cc 0 C .C i - - o~ 0 ca 0 0) w C C C,i :3 a) O co a) a) o U 0 D E L- CA 8 U) (D ~ a) co CU - _ - co r- CD ca a) - W O cU V Q- d a 3 cn ° 3 a) co a) j a N q7 0 o a) a) C1 (D Y O c a L 7 W y E C- E a cd c0 c0 Q p O O 0 0 0 U ~Y Q) - n ECL) C O j j a) C -C c0 m m F-03= `cn C S C S _J co 0 DEPARTMENT OF REPORT ON SOIL BORINGS AND MUST•RY, SAFETY & BUILDINGS LABOR AND PERCOLATION TESTS (115) DIVISION HUMAN RELATIONS P.O. BOX 7969 (H63.09(1) & Chapter 145.045) MADISON, WI 53707 LOCATION: SE TION: TO N MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: NE '/4';J/ 16 /T28 N/R /9 E (or TROY 23 NA GLOVER STATION COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: ST. CRO/X JOHN E. MATT/SON /4979 6TH ST. WHITE BEAR LAKE, N1NNESOr4 33110 USE NO. BEDRMS.: COMMER IAL DESCRIPTION: DATES OBSERVATIONS MADE R L16 esidence 3 N A New I PROFI 4 L -/6 DES 493 11 1 IPTIONS: A ION TESTS: ❑Replace - 'P -?2 -BS RATING: S= Site suitable for system U= Site unsuitable for system Ofd E;VIAL: MpUN : ~ IN-GRQUN URE: S~ _l~ L HOLDING TANK: RECOMMENDED SYSTEM: (optional) U(I--J,S ❑ SOU , FIS Eu CON VENT/ONAL If Percolation Tests are NOT required DESIGN RATE: under s,H63.09(51(b), indicate: INITIAL CL ASS / If any portion of the tested area is in the REP. CLASS A2 SS indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H TO R UN)WATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / 6,6' 1/0.2/' NONE 7 6.6 Ba / 10.29 Bn s1111.7') Bn s/ /0.8'1 BIOS r 7.8 //2.2/' i B- 2 7.0 Bn I /0.6'J Ba si / /2.01 Ba s/ /3,2'1 B_ 3 8.0' 112.41 78.0' Bn/ /0.3'1Bn r11/2.09 Bn Is //.8'1 *as /3.9') B- 4 9.0 //4./8' II T 9.0 Ba 110.8'1 0a s//. 41 Ba sI t6.8'1 3 //3.18 B. 1 ' Ba I / 0. 6'J Bn 39 On s/ /6.2'1 B_ 6 3.949' } 49.3 Bn / 10.3')-B,7 s , LZ_ 9'1 On sI/2.3'1 Bns/3.8 1 SOIL MAP SHEET 82 PERCOLATION TESTS BURXHARDT SATIRE COMPLEX TEST DEPTH WATER IN HOLE TEST TIME NUMBER INCHES AFTERS"" LING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES P_ / 2. /49' NONE 30 MIN. PE1~1 Di p I D P PER INCH P- 2 3. 149' / //2 / //a / %/2 1i 20 r P- 3 3.98' ti 2//2" 2//4" 2314 I/ >r 4 2.0/ 2 1.116." / 13/.161, 2 //8" 144 P- ' 4 1/8" 3//2" 33/4 P- 3 F-4.-2 / it 8 # P 6 4 0 4 4 9116' 4 3//6 7 » 3 112 " 3 " 3 3 /4 " 3 ~ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- contal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. INITIAL 108.2' SYSTEM ELEVATION REP. 1 / 2.00 TEST RUN 4 HOURS N OR. B- - V. R.P I TO E ~OR.LOT 3 t. ®PE.Mc. HOLEl f - j LE - - - N . q/P E FOU NO . + III CAE ~~`140 _ ' 00 SO.fT 0ifT I I ;I 4+4 I SE G NV LO 23 - --A O N 3 Sp. FT SUI A EA . - - _ -P_~. 4 v: P3 ry ( ~ I o. ,A -T- 1 1 0 - Rf' : 493' - - 1 i - ----I-- 3 1, 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 the location of the tests are correct to the best of my knowledge and belief. NAME print LAURfNCE W. MuRP1iY TESTSWERECOMPLETEDON: 4 - 22 -493 ADDRESS: R/ BOX 36 A R/ VCR FALLS, W/ 34022 CERTIFICATION NUMBER: PHONE NUMBER (optional): 55- 2443 413 - 9032 CST SIC*NATURE: DISTRIBUTION: Original and one co / py to Local Authority, Property Owner and Soil Tester. , 011 IIR SRD 6395 1F1 0218~1 (-1VFF? tai F ~,H ~Ue~ TI (~LeuF K :i rll font Lo? 13 44~OV4t. 14P SU9 =>:.^~Al&' yo' unt.~ss rvJA~'KEU Bo R~5• to caRNE1, I r.! . U B, zo 4m" ~#G' &GRi 8 2 evB2 m,Ap Ae.Crre.ATT uNvzr ©MAH4 p 0 w ~ 415, ~ d 8-3 .E A, ~iZ.ff bi- 13 el d 8'~ b'h X v ,Tr A L $oTf a nn a tr 18xv ,EEC /o Q, z Clk A ~B 6 r~. BIRCHWOOD, PLUMBING, HEATING, & AIR CONDITIONING - 105 South Fremont River Falls, Wisconsin 54002 Phone 425-5824 MatYO I HEATING • COOLING • HUMIDITY CONTROL • AIR CLEANING AIR CIRCULATION Parcel 040-1207-30-000 01/25/2007 08:37 AM PAGE 1 OF 1 Alt. Parcel 16.28.19.977 040 - 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 O - MATTISON, JOHN E JOHN E MATTISON 555 OMAHA RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 555 OMAHA RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.170 Plat: 1993-GLOVER STATION SEC 16 T28N R1 9W 2.17A GLOVER STATION Block/Condo Bldg: LOT 23 LOT 23 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 01/13/1999 595669 1395/337 TI 2006 SUMMARY Bill Fair Market Value: Assessed with: 159351 403,200 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.170 90,000 277,800 367,800 NO Totals for 2006: General Property 2.170 90,000 277,800 367,800 Woodland 0.000 0 0 Totals for 2005: General Property 2.170 90,000 277,800 367,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 311 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00