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Parcel 040-1135-50-000 12/16/2005 04:45 PM
PAGE 1 OF 7
Alt. Parcel 35.28.19.556T 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 - KILLIAN, JOSEPH W & SHELLY M
JOSEPH W & SHELLY M KILLIAN
30 PINE RIDGE TERR
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description PINE RIDGE TERR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
i
1
Legal Description: Acres: 4.530 Plat: N/A-NOT AVAILABLE
SEC 35 T28N R19W NE SE BEGIN S LN 813'W Block/Condo Bldg:
E LN NE SE TH N 350'TH W 501.7'TH S
350' TH E 503' TO POB & BE- GIN 732'W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
SE COR NE SE TH W 81'N 250'E 94' SWLY 35-28N-19W
-POB
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 964/53
07/23/1997 794/467
2005 SUMMARY Bill Fair Market Value: Assessed with:
103114 276,200
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.530 69,000 196,800 265,800 NO
Totals for 2005:
General Property 4.530 69,000 196,800 265,800
Woodland 0.000 0 0
Totals for 2004:
General Property 4.530 69,000 196,800 265,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 218
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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AS BUILT SANITARY SYSTEM REPORT
OWNER` TOWNSHIP SEC. " TAN-RAW
ADDRESS ;3 COUNTY, WISCONSIN
SUBDIVISION LOT 'i / LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
YTHING WITHIN 100 FEET OF SYSTEM
t
E
7
_tp
t -
I di a e oath Arrow
- ~ ~
SCALE:
r
BENCHMARK: (Permanent reference Point) Describe: i.
Elevation of vertical reference point: i Slope at site: r
t
SEPTIC TANK: Manufacturer: Liquid Capacity: _
Number of rings on cover ) Tank manhole cover elevation:
/9•/G
Tank Inlet Elevation: l=f Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons /
Lumber of gal. pump set or a cycle gallons- total capacity o
distribution lines gallon:. size o pump head;
gallon per minute horsepower ran name of pump
and model number
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: Number o pits ; r j' eet iameter
feet liquid depth r?~~ seepage pit inlet pipe elevation f-
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines - wi th i length is ti L-? depth_
SEEPAGE TRENCH: width length z
PERCOLATION RATE _ AREA REQUIRED AREA AS BUILT
HEADER LINE ELEVATION 7 DIST. PIPE ELEV. INL~T j2,sC ELEV. END ?jJ
DATED PLUMBER ON JOB
LICENSE NUMBER „f~
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 796; BUREAU OF PLUMBING
MADISON, WI 53707
A CONVENTIONAL El ALTERNATIVE State PlanI.E.Number:
(If assigned)
D Holding Tank ❑ In-Ground Pressure E Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER'. INSPECTION DATE'
Carrot LeBneck , RR#3, Box 15, RivvL FaUs, W1 9- y7'V 3
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV..
NB SE, Sec. 35, T28N-R19G1, Town o4 T7f.Oy dTl t /DD",
N,-e of Plumber: IMP/MPRSW No.. County. Sanitary Permit Number:
Eugene GnOve 5569 St. Cnoix 43654
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
n C C/ PROVIDED: PROVIDED'.
J000 ~40'•'F L9 J7 YES ENO EYES ENO
BEDDING: VENT DIA,'. VENT MATL.. HIGH WATER NUMBER OF ROAD: PR OP ERTV WELL: BUILDING: VENT TO FRESH
AIR INLET.
,.t. ALARM: FEET FROM LINE=
YES ENO l EYES ENO NEAREST- 15 ,5'
DO ING CHAMBER:
MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
EYES NO DYES ENO EYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PH OPERTY WELL BUILDING I VENT FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) EYES ENO _ NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JIINI~Tll DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE_
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA. =PITS JLIQUID
BED/TRENCH ID TREND, It / RIAL PIT DEPTH
DIMENSIONS (p
GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: )NI TRNUMBER OF R OPERTV WELLULDINGVENT TO FRESH
BELOwPIPES O EcovER ELEV INLEL END FEET FROM LINE6~ 6~ AI IvT.1
a f/,l I /k NEAREST
MOUND SYSTEM: S- D- /
Mound site plowed perpendicular to slope 17back 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-
meets the criteria for medium sand. TIONS MEASURED.
EYES NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
EYES ENO EYES ENO
DEPTH OVER TRENCH.'BED DEPTH OVER TRENCHREU DEPTH OF TOPSOIL SODDED SEEDED JMULCHED.
CENTER EDGES
EYES ENO EYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH: NO. OF LATERAL SPACING'. GRAVEL DEPTH BELOW PIPE: 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.: PIPES: CIA
ELEVATION AND
DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS
OYES ENO DYES ENO
PROP I
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE ERTV WELL'. BUILDING'.
M
FR
O
FEET
❑ YES ❑ NO ❑ YES 1:1 N::~]NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
G A URE: IT I T L j
DI LHR SBD 6710 (R. 01 /82)
DEPARTMENT OF APPLICATION £~3 SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND - PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/z 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:
Ci91~'e C.c RA5-a I, Rr 3 13,~,x 116-
Property Location: City, Village o ownshi c County: C Q j I(
1415' 1/4 0EN4S ' ~TZ , NCR ! E (or
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
A nl (If assigned) 1051
Idy TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
LC1 1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE: INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY n r ~i
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: 9 5
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PRO1319§ Fl(S we feet): ❑ New Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
r~ i El Alternative (specify) lsJeepage Trench
--r
ter
Wa Su ply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public C"f -
I, the undersigned, hereby assume responsibility for installation of the priv to vage system shown on the attached plans.
Name of Plumber: Signature: MP/AAPRwA41 Alo.: Phone Number:
1,19 57549 9
Plumber's Address: Name of Designer:
1,05- 'T COUNTY/DEPARTMENT USE ONLY
Signa ure of Issuing A ent,. / Fee: C Date: Sanitary Permit Number:
qiAlt&u d I~,ya.) (/~J 744- Q19--J41 ❑ DISAPPROVED
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
DILHR-SBD-6398 (N.03/81)
e
FU rIII C 100
Owner of Property GA go L- ItiC- Cc e- C 11c
Location of Property &&~ 14 -4, Section_ T N lt~ W
Township - - - -
Mailing Add ress=_~~.x
t\ 1 J w S VJ r- /o ~y
Subdivision Name
Lot Number
Previous Owner of Property cc,Ur ~slra
Total Size of Parce L ct e ~S
(
Date Parcel Was Created
Are all corners identifiable? _yes__ No
Include with this application one of the following:
.Certified Survey Map
.Deed
.Land Contract, or
.Other f-egal Document which describes the property
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) WTI (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
)rat
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 1 C.
obtained an easement, to run with the above described property, for the r 1 -
construction of said system, and the same has been duly recorded in the Office
c~ v-v
of the County Register of Deeds, as Document No. r a (2E .
SIGNATURE OF OWNER SIGNATo HE of- CO-OWNER (IF APPLICABLE)
DATE SIGNE:~ DATE SIGNE.O
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
LABOR AN Z P.O. BOX 76
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MVTgrC PAtYTY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
jzZ;N/RV7AI W
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS;
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS:
~4,Residence ~J ❑ New ,Replace l
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
NS DU ISS❑U ®S EA ❑S~U EISEU ~Xt r
If Percolation Tests are NOT required DESIGN RATE: If an
~ y portion of the tested area is in the ~ C
under s.H63.09(5)(b), indicate: [Floodplain, indicate Floodplain elevation: k~
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-Ittat±ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH 0, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
, l,Y
B wfirt~ aev-N
C7 c~ C3 ,a 1
B r~3. p.1cJ~ Z tJK3., s~\ { C3r,.,a.«vS5<,~
3 hRCan 5 51 ~.5 $,r
13- 7 F)
3.p OK V,J ,>,'>~O ~S L7.S N'R'tec. J\c
1
•e. 'fr.~CJ ~ -~S ...SC~4v,.,-.ru-'~ ~A,v IVSOJh
B (
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IW&W.ES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD I PER INCH
P_
P_ 1Cj! 1~-
P- c
P-
P-
P-
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. T4~E~k~1 - ; PG
SYSTEM ELEVATION'r`-'
E
dT+~.:~ st~~( \
_ EXISTING ~ - '
PtittOµ EC\ K•.
~Z6
HOUSE
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371
I, the undersigned hjrqby certify that the soil tests reported on this form were A de by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code aT,d_tltat tha-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):
T S,(GNATURE:
RIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
-SBD-6395 (R. 02/82) - OVER -
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