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Parcel 040-1209-10-000 12/30/2005 04:51 PM
PAGE 1 OF 1
Alt. Parcel 25.28.20.986 040 - 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 - THOMPSON, GREGORY J & KENNEYE L
GREGORY J & KENNEYE L THOMPSON
234 GLEN CIR
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 234 GLEN CIR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 5.110 Plat: 2495-ST CROIX HIGHLANDS
SEC 25 T28N R20W NE SW LOT 1 OF ST CROIX Block/Condo Bldg: LOT 01
HIGHLANDS
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-28N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 855/597
07/23/1997 730/428
2005 SUMMARY Bill Fair Market Value: Assessed with:
103671 236,700
Valuations: Last Changed: 07/22/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.110 53,000 174,800 227,800 NO
Totals for 2005:
General Property 5.110 53,000 174,800 227,800
Woodland 0.000 0 0
Totals for 2004:
General Property 5.110 53,000 174,800 227,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 124
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 Robert Mansfield TOWNSHIP Troy SEC. STN-R1
ADDRESS 979 Charles Ave., ST. CROIX COUNTY, WISCONSIN.
St.. Paul, Minn. 55104
SUBDIVISION St- Croix Highlands LOT 1 LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
YTHING WITHIN 100 FEET OF SYSTEM
f 4 _
r
y / 4
C ~
3
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z
,d i1. tit „iWlvyyl Aad r ..,rev. .,•t J.JYiW11. MMt'S41, 1i,l' ira u, mnli.: •
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I di~atie Flo th LArro,~4
_
SCL-.<
771 -1 1
BE14CHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer:`uueiser Liquid Capacity:1000
Number of rings on cover Tan manhole cover elevation:
Tank Inlet Elevation: 711' ,yam Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cycle gallons; total capacity o
distribution lines gallon: size o 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
Type of warning device
>EEPAGE PIT SIZE: Number o pits feet diameter
feet liquid depth seepage pit in eft pipe-elevation
bottom of seepage pit elevation r~ feet.
SEEPAGE BED SIZE: number of lines width „ ' length the depth
SEEPAGE 'T'RENCH: width ~ length
PERCOLATION RATE AREA REQUIRED AREA AS BUILT
INSPECTOR
DATED October 28, 1983 PLUMBER ON JOB PaUJ. R. u {
LICENSE NUMBER ZT
DPARTMENT OF INDUSTRY, INSPECTION REPORT FOR
LABOR & HUMAN RELATIONS SAFETY & BUILDINGS
U.O. BOX 796,9 PRIVATE SEWAGE SYSTEMS DIVISION
v1ADISON, WI 53707 BUREAU OF PLUMBING
®CONVENTIONAL DALTERNATIVE r!!=7
D Holding Tank ❑ In-Ground Pressure D Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER.
INSPECTION DATE.
obert Mansfield 979 Charles Ave.,St.Pau,, MN fa~~
BENCH MARK (Permanent reference point) DESCDIFFE
RENT FROM PLAN.
REF. PT. ELE V.: CST REF. PT. ELEV
NE SW, Section 25, T28N-R20W, Lot 1, Town of Troy
Name of Plumber
MP/MPRSW Nn
County Sanitary Permit Number:
Paul Cudd 2739 St. Croix 43690
SEPTIC TANK/HOLDING TANK:
MANUFACTURER /.i."
LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELE V.. WA~RM~jIGLABEL L.C / t% PRO'9- D: PR IN ER
` Fes!(\yC_ PR
BEDVENT DIFy. VENT MATL. / HIGH WATER ES NO YES ❑ NO
`r,~'( I1j ALARM.. NUMBER OF ROA Pq OPERTV WE L BUILDING : VENT TO FRESH
FEET FROM i ; LIN~r AIR IN_
NO DYES ONO NEAREST ` C h /
DOSING CHAMBER:
MANUFACTURER BEDQ ING. LIQUID CAPACITY PUMP MODEL
PUMP/St N MANUF TURER WARNING LABEL LOCKING COVER
DYES ONO PROVIDED PROVIDED:
GALLONS PER CYCLE: PUMP ANOCONrgoLSOPERAnoNpL l DYES ONO OYES ONO
(DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING IVEN TTOFRESH
FEET FROM LINE AIR INLET
PUMP ON AND OFF) EYES Q, O NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plow. g LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO. OF
BED/TRENCH DISTR. PIPE sPACIJVG covE wsloE DIA. xPITS.
TRENOHF.S. ti ERI LIQUID
DIMENSIONS 2- 3 = PIT
- DEFT
GRAVEL DEPTH FIL _ DEPTH UISTH. PIPE DISTR. PIPE DISTR. PIP ATERIAL N DISTRBELOW PIPES/ BOVCOVER ELEVINLET ELEVEND NUMBER OF PROPERTY WELLBUILDINGVET
TO FRESH
IPES FEET FROM / AIR INLET.
C ) C. L L/ NEAREST-
MOUND SYSTEM: (i
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 ON REVERSE SIDE. SHOW ELEVA-
DYES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE
PERMANENT MARKERS OBSERVATION WELLS.
DEPTH OVER TRENCH BED D PTH OVER THENCH;BED DYES ONO DYES ONO
CENTER DEPTH OF TOPSOIL / DDED SEEDED MULCHED
EDGES f
YES O DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SP ING GRAY DEPT ELOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS TRENCHES
MANIFOLD PUMP MANIFOLD DISTR IR' MANI L ATERIAL. NO. DIST DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV ELEV CIA ELEVf PIPES DIA:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING QRILLED CORRECT V COVER MATERI
VERTICAL LIFT CORRESPONDS 70 APPROVED
PLANS.
DYES ONO DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS:
NUMBER OF PROPERTY WELL: BUILDING:
4 FEET FROM LINE:
~ DYES ❑ O DYES O NEAREST
0. 1z
Cf L~
1 O o`Cl L
Sketch System on
Reverse Side. Regain county file for audit.
$16MrkTCIF. TITLE:
DILHR SBD 6710 (R. 01/82)
< .j
NOR
DEPARTMENT OF APPLICATION
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'/2 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 caner:
Mailing Address:
Z1~41 01
Property Location: City, Vil age or Tow hi : Gou ty:
t/4_5 ~T NCR .04P E (or) W I
Lot Number: Blk No.: Subdivision Name: Nearest Road, L or Landmark- State Plan I.D. Number:
r
(If assigned)
JT/l
TYPE OF BUILDING
* Number of
Public* ❑ Variance* ❑ Other (specify) Bedrooms:
TI 1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch PROPOSED( Square feet): I~ New ❑ Replacement ❑ Experimental Seepage Bed 1:1 Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
Wa
ter Supply: Owner' Name as L-is don Soil Test Report (I then p esent owner):
Ise 0
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. )
e lum er: Sig PRSW No.: Phone Number:
Plumbe ' A ress:
W-i 1/5
Name of De ignerr: /
COUNTY/DEPARTMENT USE ONLY
Sign ure of issuing Agent: e: Date: Sanitary Permit Number:
. APPROVED DISAPPROVED 3
O ❑ N
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 n-
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)
Fur (tr C
7 .
} t Y ~c
"Owner ` o f P r o p e; r t y-
"Location of Property lu>` ~>x SectiUn Z5 <;
Township
Mailing Address
`l C_21 Tri__
.
- - AU G
Subdivie,ion Name f -
_IX
Lo Nurobe r
Vi us Owner o,f Property
Totea] Size of Parcel C
hate Parcel yeas Created_ c~-h 7, ~i
Are all corners
identifiable?
yes No
;.a
nclu4". With this app ,li-tar, one of the fallowir :
-Certified Survey Map
4 ,
Dead
4 Land Co
f,. ntract,, or
'OL'hsr Legal Document which describes the property
PRi PERTY 0"ER CERTIFICATION
I (We) rxrtify that all statements on this form are true to the best of my (ur)
knowlrefrfe~ that i (we) am (are)- the owner(s) of the property described int his
information cirm, by virtue of a warranty deed a orded in the Office of the
County Register of Deeds as Document No.
presently own the proposed site for the sewage disposal system d(or that I (we)
I (we) have
obtained an,,easement, to run with the above described property, for the
construction of said system, and the same has been duly recofded in the Office
of the County Register of Deeds, as Document No.
SIQNAl7llAE OF OwNEA
5aGNATURE OF CO-OWNER (IF APPLICABLE
DATe. SIQNEO
GATE SIGNED __.^•------..._..__--..---.....,.r
INDU
I)EPARTMENT
i* OF REPORT ON SOIL BORINGS FETY & BUILDINGS
NDUSTRY'', , DIVISION
LABOR AND PERCOLATION TESTS (1 fCEIVEj ` 7969
HUMAN RELATIONS 3707
DP.O.ISON, WI BOX 53707
(H63.090) & Chapter 145.045)
Y - 9 a
zf 79 ,
LOCATION: , SECTION: i0w's'1 P/LOT N6 :BLK. DIVISIO ME:
~/a S/TzN/RE(or IN
COUNTY: OWNER'S/>R'S NAME: MAILING ADDRESS:
USE DATES OBS MADE
r~x NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence z Tv QNew ❑Replace L/ -
L/ .
RATING: S= Site suitable for system U= Site unsuitable for system
rCONVENTIONV~L:mffN D: IN- GRUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
0S DS ®U C.S ❑U ES ❑U ❑S 2U
F rcolation Tests are NOT required DESIGN RATE: I If an
L y portion of the tested area is in the
r s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-lam CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH HSr- ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B 3 J 5.Q~
B _ o .1 Z S.
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER WGHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PER INCH
P_ 73 -
P-
P- 3 3.9' - S „ -
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-
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 slope.
SYSTEM ELEVATION
'°I
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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 the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DIL-HR-SBD-6395 (R. 02/32) - OVER
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San. Permit No.
H63.05 PLOT PLAN
Show:
Location of building served Dosing chamber
Septic tank Vertical reference point
Q Building sewer Q Horizontal reference point
Effluent system Q Well
Replacement system area FA Property lines w/in 50' of system
Distribution boxes Scale = or ds ='d
Pump and controls:
Mfr. & Model No. Vertical Lift Size Forc n
Friction Loss T. D. H. Vol. Dist. Pipe Gal, per Min. Gal, per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
~Z
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i
9~ ` F \
\'F F \ 3C \ 1"\: j
0
ZS' ~4\~ \ F \ r ~ 1
110`.~~` . \3F,
\ b
F
fish ~ SPl1c_= \N
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EEL, 1,00.0D
- HPP
- - - - -
i
v the granting or apDrovina of the above plan, or upon the event of a subsequent
permit being issued,~---i, County and the c,o,xCounty Zoning Adiianistrator, 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
r._ca=lation.
Plumber's signature
r
J eJ ~ t„ t~ h C
CROSS SECTIOIJ OF A BED S~STEM_
t
-z"o= c nE~ _
4 - 501L FILL
DISTRIBUTIO►J PVPE --j PPROV~G SyIJ i H _TiC
11f-T1 R1AL DR -
OF, MARSH Hf.L
(o' OFGGRFC.ATE c ELEV. OE
DISTRIBUTIOM P)PE TO 13E AT LEAST Ifs BELD\~✓ DRIC.IQAL GRADE
AUD AT LEASTZD IULHES BUT UO MORE -TH)I\Q 42- IMCHES BELDW FlUAL GRADE
MAXIMUM DEPTH OF 1=XCAVATlOU FROM ORIGIIJAL GRAL)E vin-L 6L ~ 1 '
MINIMUM DEPTH OF EXCAVATIOU FROM ORIGIUAL GRt DL wIL L 6L II L#~
SIGUED. -
L