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Parcel 040-1197-10-000 07/18/2006 04:27 PM
PAGE 1 OF 1
Alt. Parcel 4.28.19.895 040 - 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
JOHN D & CONNIE R TR MACLEOD O - MACLEOD, JOHN D & CONNIE R TR
562 HIGH RIDGE DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 562 HIGH RIDGE DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 4.700 Plat: 2081-HIGH RIDGE COURT 1 ST ADD
SEC 4 T28N R19W 4.7A HIGH RIDGE COURT Block/Condo Bldg: LOT 23
1 ST ADD LOT 23
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/07/2005 796831 2816/161 QC
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.700 72,600 262,500 335,100 NO
Totals for 2006:
General Property 4.700 72,600 262,500 335,100
Woodland 0.000 0 0
Totals for 2005:
General Property 4.700 72,600 262,500 335,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 112
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER
TOWNSHIP ^C _ SEC._,LT2N-R,_W
Yt
ADDRESS Pak I ST. CROIX CO~NTY, WISCONSIN.
SUBDIVISION f/d C° ~fLOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
V I~~
L
I
Indic at
i! :3 N r h rr w
BENCHMARK: (Permanent reference Point) Describe: 9455 Fit!, &,K
Elevation of vertical reference point: (110 C Slope at site: /Gl /jS
> "Liquid Capacity: C
SEPTIC TANK: Manufacturer: L;~+
Number of rings on cover : c? Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle -gallons; Total capacity of
distribution lines -gallon: size of pump head;
gallon per minute horsepower______ -;brand name of pump
and model number
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover ;
't'ype of warning device
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines--?-_ width- ~ length S the depth
SEEPAGE TRENCH: width fen
PERCOLATION RATE-- AREA REQUIRED ARE BUILT/
IN SPE
DA`1'Ell PLUMBER ON JOB 4 Sr
- - 7 '
LICENSE NUMBER'~~/
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR.& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS
DIVISION
P.O. BOX 7LkS9 BUREAU OF PLUMBING
MADISON, LN, I 53707
CRCONVENTIONAL ❑ALTERNATIVE State Plan I.E. Number
❑ olding Tank ❑ In-Ground Pressure ❑ Mound assigned)
k (1
NAME OF PE RMI HOLDER: AD ESS OF PERMIT HOLDER: INSPECTION DATE.
John Delano McLeod RR, Hudson, WI /p-fie-83
BENCH MARK (Permanent re ,,ence point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. IT ELEV.
SE-14 NE4,Sec.4,Lot 23,HighRidgeCt,T28N-R19W, Town of Troy
Name ber. IMP/MPHSW No. County. Sanitary Permit Number.
$a••9 33~ St. Croix 38520
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. ILIOUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOC NG O~{ R
P OV DED PRO IDkD '
I'~ !J ryt 41 a ' YES LINO YES ~ NO
BEDDING: VENT CIA VENT MATL.. HIGH W~ NUMBER OF ROAD PROPERTY WELL BUILDING: IVENT TO F ESH
AFAR FEET FROM? LINE' 7 AIR LE
E YES NO ❑ ENO NEAREST
DOSING C AMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY Pl P MODEL PU MP; SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
EYES LINO / 1X 1 ES ENO OYES ENO
GALLONS PER CYCLE: 77ES NLSO RATIONAL NUMBER O PROP RTV WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ENO 6EA"REST 3.1
SOIL ABSORPTION SYSTEM. Check the soil ist eat the epth of o ing LENC(TII JDIAMI ER MATERIAL AND MARKING
j
or excavation, (If soil can be rolled into a wire, constructiortishall cease until FORCE
the soil is dry enough to continue.), MAIN
CONVENTIONAL SYSTEM: l
WIDTH LENGTH INOIDISTR OF. PIPE SPACING CSj,1LEf4-- INSIDE [)kA si PITS LIQUID
BED/TRENCH l TRENCHES G MA RIAL"
PIT DEPTH
DIMENSIONS o 101- / _11 : L-
GHAVFL .
DEPTH FILL DEPTH IDISTH PIPE CISTR PIPE DISTR. PIPE M TERIAL. O. STR NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
BELO)y PI,PES, i Ak(E V ER ELEVINLEi ELEVEIP FEET NE~ ",E1_.r 701 7 NEAR
70
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it O EVERSE SIDE. SHOW ELEVA-
E meets the criteria for medium sand. O S MEASURED.
YES ENO
SOIL COVER TEXTURE PERMA ENT MARKERS OBSERVATION WELLS
ES r ❑N ❑YES LINO
DEPTH OVER TRENCH'BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL . SODDED 16EEDED MULCHED
CENTER EDGES
❑XE NO ❑ TE S ENO DYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO. OF LATERAL SPACING. GRAVEL )EPy • BELO PIPE. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES /
DIMENSIONS f
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD M TERIAL. [EI DIS~RDISTRP E DISTRIBUTION PIPE MATERIAL & MARKING
ELEVELEVDIAELEV.DIA.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MAT L VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
EYES ENO EYES NO
COMMENTS: PERMANENT MARKERS: OBSERV TION WELLS: NU BER OF PROPERTY r LL: BUILDING.
FEE FROM LINE
r0 C. EYES NO DYES ENO NEA EST
O 4-
0 c,
7i C- ),3
70 7,
Sketch System on
t~tS in county file for audit.
Reverse Side.
SIGNATURE. TITLE
DILHR SBD 6710 (R.01/82)~'
DEPARTMENT OF SANITARY PERMIT SAFTY & BUILDING
INDUSTRY, DIVISION
LABOR AND, TRANSFER FORM P.O. BOX 7969
HUMAN RELATIONS (PLB 67-T) MADISON, WI 53707
SR.1 rAjR PERMIT NUMBER: PERMIT TRANSFER T : ORIQJNA~L PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER:
PROPERTY LOCATION: d
CITY, VILLAGE OR WNS IP: COUNTY:
'/a %a S T N,R E (or~W /`L S' e JCS
LOT NUMBER: BLOCK NUMBER: SUBDIVISION NAME: NEAR T ROA L KE R LANDMA
L CO
T
PREVIOUS SANITARY PERMIT HOLDER IF CHAN D): SANITARY P RMIT TRAN ERRED TO:
N ME: SIGNATURE: NAMPV
PHONE NUMBER:
~~ADRESS: PHONE NUMBER: ADDRESS:
L ua~V 1^//S lG ~ mss?
BUILDING USE (IF CHANGED):
❑ Public* ❑ Variance ❑ Other (specify)* NUMBER OF
BEDROOMS
1 or 2 Family *State Approval Required
I, the undersigned, hereby assume responsibility for installation of the private sewage system that has either previously been approved
for this property, or that is shown on the attached revised plans.
PLU SIGNATLJ iE PREVI SPLjMZR'S~TE (IF CHANGED):
`[j' `,DJ
PLUMBERS ADDRESS: PREVIO PLUMBER: A RESS:
MP/MPRSW NUMBER: PHONE NUMBE : MP/MPRSW N UMBER: PHONE NUMBER:
707 (YIS' )Wls5_ i91) ~ ~ 3 ( ►
SIGNATURE OF ISSUING AGE DATE APPROVED: DISTRIBUTION: Canary - County
White - Bureau of Plumbing
v O t) Pink - Owner
DI LHR-SBD-6399 (N.03/81) Goldenrod - Plumber
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DEPARTMENT OF APPLICATIONS SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address:
John Delano MacLeod RR, Hudson, WI 54016
P?pe ation: 1 City, Villa e or Township: Count
4/ I. NIR E (or) W Troy Township ~t. Croix
='4S
of Numb 181-k.No.. ]§uRdivision Name; _ Road, Ila ke or Lan k: State Plan I. D. Number:
High Ridge Court (If assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required. 5 %
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY Yes Yes
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
i
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
3 1 , 026 ❑ Alternative (specify) El Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
A Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Na a of lum er: natur =P/MPRSW No.: Phone Number:
tau ~udd & Sons, Inc. 739 (715)425
-2049
Plu{g4e;s A~dres ox 364, River Falls, WI 54022 Name QfrDls egerer
COUNTY/DEPARTMENT USE ONLY
Si nat re of Issuing Agent: Fee:Date: APPROVED Sanitary Permit Number:
❑ DISAPPROVED J
Reason for Disapproval: l
Alternate course(s) of Action Available:
i
I
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to ir:-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
Form - S T C 100
Owner of Property mac,,
Location of Property :-1 Section T ae' N R '(4' W
Township ~
Mailing address
N
Subdivi,aioa Name f
Lot Number Previous Owner of Pvouerty~~~` _ v -
Total Site of Pared ci
Date, Parcels Wa.a Cre ;r_ ed
Axe all corners iderkLifiable? Ye: No
Include with this atpcation one of the followine
.Certified Survey Map
.Deed
Land Contras(:, or
.other legal Dcf:ikment which describes the property
PROPS R s Y OWNER CERTIFICATION ~
I (We) certify that alt statements on this form are true to the best of my (our)
knowledge; that 1 (we) am (are) the owner(s) of the property described in this
information town, by virtue of a warranty deed recorded in the Office: of the
County Register of Deeds as Document No. ~ 5--.__ and that l (vie)
presently own thU,Pp-Oposed site frsc &J ~ -towage disposal system (or (we) hey e
obtained an case rtent, to run with the .;'snvu described property, for the
construction of said ' id ~ x
system, and t11e tae has e b ~
cn
duly recorded in the Office
of bhe County Register of Deeds, as Document No.
.i
a b J.,
SIOh.ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE4
DATE SIGNEdk _T - ~ DATE 51GIgF0
D ?ARTLIENT OF REPORT ON SOIL BORINGS AN. ~AF~Ns BUILDINGS
I N OU41-R.X DIVISION
LABOR ADD BOX 7969
EiUc'-AN RE-LATIONS PERCOLATION TEST'S (11155) I~rDIS' WI 53707
(1-163.09(1) & Chapter 145.045) ! ~~"~•wi ~
LOCATIJN SECTION: TOLVNSHIe;-tv1U1V1CIPALITY: OT NO.: SLK. NO]SU ME:
t A,
1/~ y t-t 4 .`T z&V R 19 E 1
COUNTY: O'rVNERS BUYER'S NAME: MAILING ADDRESS:
1A I
USE
DATES OBSERVATI ADE
NO.BEDRMS,: COMMERCIAL DE5 RIPTION: PROFILE DESCRIPTIONS: PER" ZS TI ON TESTS:
;Residence KI s\ 2rNew ❑Replace
T..~a
7-48, -e
RATING: S- Site suitable for system U- Site unsuitable for system
i ONVENTI NAL: ^.tOUND: IN-GROUNDSYSTEM-IN-FI--T LOING TANK: RECOMMENDED SVSTEM:Ioptionall
S ❑U ~ s D Ms ❑u TEIs au ❑5 Mu cawaivrioN*
It Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the
~unJer s,H63.0915)Ib►, indicate: `•.t 1 . Floodplain, indicate Floodplain elevation: '
1.~C.e~Y!r PROFILE DESCRIPTIONS
8,7R'NGI TOTAL HT GR UNOWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
°NtmiaErt OEpTpa"ps} ELEVATION OBSERVED, ES HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
-3 0
ms"
t _ /i 70 ~ L L_; Z •O5 I..) D. +S Jx^ ~N t// iG,~
/L, Ahv it / 0, S /,6(1 D.,/ L< S w Csr 4 ,fee BUJ rn S w I
I v ~.t~ar"K' 4> Cr✓
o m. 1 /•6- 7 3L 4.. 5* 8 rd r ..1(... 3rti
`,g //J~ •
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la .c•/ ~ I b~ n ..'$7 ~ J VV L'7. ~ ~-f✓. G .,r~ • c.~ ~ l~ Vw \.111 r.r~
L L 1 /•O$?a+J S.'~ ,4;; ~N S.L w -aR,..;D./eaO
1 @
mfr t. .F CI"fa: tO t .~fJ t-t ~Q 3. G~ 0 e ti i L W% r! • 2..
/.oo 3L, t_> 0.33 644 l,17 6- bL-~ 31!YO, tni>.j L
ti.~,G t rA I, _ PERCOLATION TESTS NO-rc A~ U aep-• `-5 C.0
~fss SET
TEST r.
DEPTH VJATFR IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE Mr^a U7 ES
b
NUMBER +FS AFTERSNELLING ! INTERVAL-t.1+N.
1 P C1D T Rlt PER INCH
P. i Z I 'A E r^
P112 ac
i P'
OT PLAM: Shoes 10•_?SiOrrs =f Percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
untal and verticaf elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the directive and percent
.1 land slope.
oTC: Be17c;avt 1~s rrtJ4?`~ 0~1 T-.,E t
a STEM. ELEVATION Y, ,t 41 vM 1'-) c P r"q t Z cM 1-5 N7-5
+
s I 1 , = I~ ro oQ ~r =
4b 1-4
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•
c
1 }(C T.. i t. - - - i -
y~ r-•r ,e ~p ~ l~t1,,1 ~
o
i__.~r}~ -L__
~2--100.8-e
the undersigned, hereby certify that the soil testslFporte~dMy this form were made b ine jn accord with The procedur s and methods specified in the Wisco nsin
dministrative Code, and that the data recorded and tYk'lQcaticvl of the lasts are correc to the best of my knoriledge a( belief.
~ r
`AME (print TESTS W ERE COMPLETED ON:
JA V0 F-S
01,
_ CFRTIF CA ION NUMBER: PHONE NUMSER(nptjonal).
T
)O'tE' W 000?; A/ CS NATURE
S 7
t'.STRIf3U71QfV: -31 7r,~ nor n to t-i,caF Au!h )rity, ro ertY OWner.tnd Soil T-estor. lQ~•r~
_ (J)
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name
h C) PT .t-u'
}i'W:
Location of building served Dosing
Septic tank a Vertical reference point
Q Building sewer Q Horizontal reference point
I/ Effluent system well
Replacement system area Prolarty lines of system
f0 dimensioned
Distribution, boxes ~ Scale or d
Pump and controls:
Nifr. S Model No. Vertical Lift Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal, per Eli.n, Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
~J
T S S - y
- PV
1 c h
I rL~ J ! ~l l
Ilr ~ ~ 6~ / ,
V4~14r
SP~1 t 1-1RP /
~ IOC),S S oNj
r '7~.'t:~r
1tJS'T~~l, uJ~'~~ H I L~i1 ST
/ SO' 1=f1Jf" ~L~Pc 11J FlEL'[} r
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i
Rv the granting or approving of the above plan, or urn the event of a subsequent
permit being issued, County and the s-.cno:x Courity Zoning Administrator, does
r;ot assume or hold itself liable for any detects in plans or specifications, plan
C'M: ssion, examination oversight, construction, or any damage that may result in or
~,r;_E," installation.
si mature
- I'AG C v
#v tz7t s IJ 1. 1--~ C
T ,
f
1
CROSS SECTIDU OF A BED S~STENI
_ ~'t V E1JT TJ 1 pE - _ 1 Z" ~-QOV
~~tJ~SH~ GSZ.A~e "
2" OF AGGREGATE
a- SOIL FILL
Li I P~1 C
DISTRIBUTIOU PIPE AFPP.OVCD 5y3QTHCTIC COVER
- o~ MhT1 R1AL OR 9" OF 5TRAW
OR MARSH KAY
Jp'OF%2-21~Z AGGR~GATE !088
ELEV- OF FEET r
- nE~z.~oFZATE-n P~ P~ To
~T~"~M O~ BEp
Al- GR
DISTRIBUT10M PIPC TO BE AT LEAST BELOW--' ORIGIIJADE
AQD AT LEAST ZO IUC.HCS BUT UO MORE THAl.1 92, IUCHES B=LOW F1T1AL GRADE
N-JiLL EL
MAXIMUt✓~ DCP-l-H pF L'iCAVATIOU FROM ORIGIIJAL GRADE
!'MIfJIMUM DEPTH OF EXCAVATIOU FROM ORIGIIJAL GRADE WILL BC It` cm
SIGIJED:
LIGEUSC DUMBER=
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