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Parcel 040-1081-10-000 04/15/2005 05:15 PM
PAGE 1 OF 1
Alt. Parcel 21.28.19.320A 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): Current Owner
* SYLLA, PAUL M & PATRICIA TR
PAUL M & PATRICIA TR SYLLA
600 CHINNOCK LA
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es):, / * = Primary
Type Dist # Description * 600 CHINNOCK LA V/
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 35.000 Plat: N/A-NOT AVAILABLE
SEC 21 T28N R1 9W NE NE EXC 2.5 AC OFF E Block/Condo Bldg:
SIDE & EX CSM 8/2123
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/02/2000 622216 1507/80 QC
05/02/2000 622215 1507/78 QC
2004 SUMMARY Bill Fair Market Value: Assessed with:
26768 Use Value Assessment
Valuations: Last Changed: 07/20/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 60,500 299,000 359,500 NO
AGRICULTURAL G4 31.000 3,400 0 3,400 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2004:
General Property 35.000 64,000 299,000 363,000
Woodland 0.000 0 0
Totals for 2003:
General Property 35.000 54,300 282,400 336,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 201
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 040-1081-40-000 04/18/2005 07:51 AM
PAGE 1 OF 1
Alt. Parcel 21.28.19.321 B 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): Current Owner
GREAT RIVERS WIRELESS LLC
GREAT RIVERS WIRELESS LLC
N7655 950TH ST
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 6.090 Plat: N/A-NOT AVAILABLE
SEC 21 T28N R19W W 423.63 FT OF S 515 FT Block/Condo Bldg:
OF NW NE AS DESC IN VOL 490 P 107
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/06/2004 7500843 2486/195 WD
01/06/2004 750844 2486/196 WD
2004 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/24/1995
Description Class Acres Land Improve Total State Reason
OTHER X4 0.000 0 0 0 NO
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2003:
General Property 0.000 0 0 0
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
AS BUILT SANITARY SYSTEM REPORT
OWNERt,~' ~1TOWNSHIP _
SEC . T-N R~W
r
ADDRESS PIERCE COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 1163
- Y RING WITHIN 100 FEET OF SYSTEM
~ZSHO 1 -41
14-
jt~Ai%
r
v
yr-7 I d i a e o z` th Arrow
-SCALE - -
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point:_ JC(' Slope at site: l
SEPTIC TANK: Manufacturer: U.`y eg e Liquid Capacity: Number of rings on cover : 91`A_P Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER N A
Manufacturer:/ Number of gallons
Nuiijlber of gal. pump set or a cyc _e gallons; total capacity of-
distribution lines gallon: size of pump head;
gallon per minute horsepower ran name of pump
and model number
Type of warning device
HOLDING TANK: Manufacturer _14! Number of gallons
Elevation of manhole cover
Type of warning de ice
SEEPAGE PIT SIZE: um er o ts feet diameter
feet liquid depth seepage pit in e~ t pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number cif li.pes~ width length _tile depth
SEEPAGE TRENCH: width 5 length='_
PERCOLATION RATE /C ,_1 3C AREA REQUT_RED_ ~_AREA AS BUILT 757
HEADER LINE ELEVATION 1' IST. PIPE ELEV. INLET ELEV. END 9.~')~'
DATED Vtl Lk PLUMBER ON JOB7~C hl s
0 LICENSE NUMBER P 31 11
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. $OX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
❑ CONVENTIONAL ❑ ALTERNATIVE State Plan I.D. Number:
F-1 Holding Tank ❑ In-Ground Pressure El Mound 111 assigned)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Paul Sylla RR#3, River Falls, WI
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF, PT. ELEV.
NE4 NE4, Section 21, T28N-R19W, Troy Township
Name of Plumber: MPRSW No.: Count Y': Sanitary Permit Number:
Thomas A. Wan 3231 St. Croix 34791
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIOUIQ CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: I=RI NG LAB Ltt~YES, G M VER
r DEDED~ .dam( 1' 75 ,,,YES ❑NO ' ❑NO
BEDDING: VENT DIAe: VENT MALT[ HIGH WAT R NUMBER OF ROAD: PROPER Y WELL: BUILDINGfA ENT TO FRESH
JALARM. FEET FR r J LIN I R LE' TA
OM
DYES FIND C DYES FIND NEAREST' _ u ] u f i.
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP Mf0 L. PUMP/SIP MA NUFACTURER. WARNING LABEL LOCKING COVER
J PROVIDED: PROVIDED:
DYES FIND DYES FIND DYES FIND
GALLONS PER CYCLE: PUMP AND CON OL ERAnoer t: NUMBER OF PROPERTY WELL BUILDING: JVENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ES ;'i❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at t depth f wing LENGTH JD RIAL AND MARKING
Or excavation. (If soil can be rolled into a wire, const tion shall se until FO CE
the soil is dry enough to continue.) M IN
CONVENTIONAL SYSTEM:
WIDTH. LENGTH. NO. OF UISTR. PIPE SPACING O JINSIDkZ14A_ SPITS _ LIQUID
BED/TRENCH 1 THEN ES MA AL' j PIT DEPTH
DIMENSIONS ) 5 12 ; ~ -
GRAVEL DEPTH FILL DEPTH 1 LS H PIPF, "DIST .PIPE ISTR. PIP MATERIAL . NO. 11 NUMBER OF PROPERTY WELL: ILDING V NT TO FRESH
BE LOW PIPE S. ABOVE VER. I'q ELE( U 2 PIPES LINE AIR LET.
I
- FEET ' ~ZC
17' ] NEARES TM A_~_~
~,MOUND SYSTEM:
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.
DYES ❑NCI f /
SOIL COVER TEXTURE JERMANENT MARKERS OBSERVATION WELLS
DYES NO DYES ❑NO
DEPTH OVER TRENCH/BED ADEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED JSEE~ED MULCHED
CENTER: EDGES
DY/lES ❑NO ❑ ES _ INO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING f"VEL DE, TH BELOW PIPF FILL DEPTH ABOVE COVER
TRENCHES.
DIMENSIONS 1
MANIFOLD PUMP MANIFOLD DISTR~ PIPE MANIFOLD MATERIAL ND DI H UIST PIPE DISTRIBUI ION PIPE MATERIAL & MARKING
ELEV. ELEV.. DIA ELEV. I PIPED DIA:
ELEVATION AND
DISTRIBUTION DR1 1! INFORMATION HOLE Sllf HOLE SPACING ILLED COHHECILY i COVER MAT IAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYE FIND ` DYES FIND
COMMENTS: PERMANENT MARKER OBSERVATIO WELLS. NU BER OF NE
PROPERTY WELL BUILDING.
LI
LJYES NO (J ❑ NO FEE FROM
NEAREST
0
(q q-b s)
Sketch System on etc.
m tam coun-le for audit.
Side.
SIG RE y_ TITLE
-
i
DILHR SBD 6710 (R. 01/82)
DEPARTMENT OF RfC~►,jb~ ION
SAFETY & BUILDINGS
INf9USTRY, »y MAR 2PM85A ARY DIVISION
LABOR AND ZONING PER P.O. BOX 7969
HUMAN RELATIONS OFFICE (PL r ) MADISON, WI 53707
a•
Attach plans for the system on paper not less than 51~ n 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.
Proper t Own r: Mailing Address:
a~ r' evC, 3 ~ vn / x
Property Location: City, Village or Township: County:
/YC'/aS 0//T ~b' NCR /f E (or) l~Ic~C~6' //-J
Lot Number: Blk No.: Subdivision Name: N,eea_rest RSA.. Lake or Landmark: State Plan I.D. Number:
(If assigned)
TYPE OF BUILDING r
l Number of
❑ Public* ❑ Variance* ❑ Other (specify)*~~ . 0Z -&kz '~qJJU Bedrooms:
5K 1 or 2 Family *State Approval Required. _5 I
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER /VA
MANUFACTURER: to, C S t' 0- .3
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA r~t
(Minutes per inch): PROPOSED (Square feet): ® New ❑ Replacement ❑ Experimental 25\Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
Water Supply: T wner's Name as Listed o Soil Test Report (If other than present owner):
Private 1:1 Joint ❑Public ! [j
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Si re: MP/MLPW No.: Phone Number:
Plumber's Addressf q Name of esigner:
/C~~~ v"'~ i~~ ~~r.~ f lll ~✓~CJ Fly
COUNTY/DEPARTMENT USE ONLY
Signa r of Issuing Agent~fJFee: eW Date: APPROVED ____fS_anitary Permit Number:
El DISAPPROVED 3 17 it7
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILIiHR-SBD-6398 (N.03/81)
t
OEPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INOUSTRf, c DIVISION
LA°SOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
LOCATION: SECTION: TOWNS HIP/M>1NJ.CLPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME:
~E 1/ 1/ /T N/R E (or, W _j _ _
COUNTY: OWNER'S Bb'VE-R!S NAME: MAILING ADDRESS:
711
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
/
- -
0Residence New ❑Replace 1177
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
CAS ❑U ❑S EJ U OS ❑U OS DU ❑S EU E.Se~ -7 s
DESIGN RATE: SYSTEM EL
If Percolation Tests are NOT required I If any portion of the lot is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B L s3 S V; 3o j
B- 2 ~b 7 a
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
i
P_
P-
P T..
P-
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal 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 slop. °~~~'iBF Y
!1 z T l~ 1-1
SYSTEM ELEVATION
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CiZ Raoul KkS
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41
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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 methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
< <=TY1 `-J r ) _ 3
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
Y
CST SIGNATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
Form - S T C 100
Owner of Property ZZ
Location of Propertyz_4_~4, SectionZ,T,,? e N R W
Township
Mailing Address
'Vo
Subdivision Name A/4
Lot Number
Previous Owner of Property
Total Size of Parcel /10 Date Parcel Was Created
Are all corners identifiable? Yes No
Include with this application one of the following:
.Certified Survey Map
.Deed
.4--.Land Contract, or
.Other I:egal Document which describes the property
PROPERTY OWNER CERTIFICATION i
I (We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No. ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an #asement, to run with the above described property, for the
constr ction of said system, and the same has been duly recorded in the Office
of the unty Register of Deeds, as Document No.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
i
DATES NED DATE SIGNED
Owner's name c~ San. Perm's
~ H63.05 PLOT PLAN
V -
Show: 4119
19
A.A
Location of building served 9 El Dosing chamber ~
17 1 Septic tank a Vertical reference poin /1Z
Building sewer Horizontal reference point
Effluent system Well ne t 0x,
Replacement system area Property lines w/in 50' of system
Distribution boxes ~g Scale or dimensioned
Q Pump and controls: tt~~]]
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. T. H. Vol, Dist. Pipe Gal, per Min. Gal, per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
;4 v '
e4 0t Gad. ~~~"tree~v. 4'=
eve ~ ~/~,n e ~ e
Site 1-otqf,~
C)i Joe
J fyyvJ ' I~Dot) gc,~ S~,url1 C 7 lv 1r ~UG G2EF^ C'~ J~C,
~4pr !t C
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By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, Pierce County and the Pierce County Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after installation.
Plumber's signature
1/F