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Parcel 040-1174-50-000 12/14/2005 02:20 PM
PAGE 1 OF 1
Alt. Parcel 24.28.20.671 040 - 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 - HENSE, DAVID W & MARY D
DAVID W & MARY D HENSE
282 COVE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 282 COVE RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.500 Plat: 2490-ST CROIX COVE
SEC 24 T28N R20W ST. CROIX COVE LOT 14 Block/Condo Bldg: LOT 14
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill M Fair Market Value: Assessed with:
103383 443,600
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.500 240,000 187,000 427,000 NO
Totals for 2005:
General Property 0.500 240,000 187,000 427,000
Woodland 0.000 0 0
Totals for 2004:
General Property 0.500 240,000 187,000 427,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
h
HOMESiTc SANITATION CO.
SEPTIC CLEANING - SEWER M""VICE
ROUTE 3, O'NEIL ROAD
HUDSON, WISCONSIN 54016
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t• '
AS BUILT SANITARY SYSTEM REPORT
OWNER'/, TOWNSHIP; SEC.Z~T&N-R&W
j -
ADDRESS ST. CROIX COUNTY, WISCONSIN.
0
c f-)
SUBDIVISION LOT LOT SIZE
i
PLAN VIEW
Distances and dimensions to meet requirements of H63
16 YEBYTHING WITHIN 100 FEET OF SYSTEM
t.
r
L C c, j
I d-ica reN o t-h--A-,row ' I
SC fJ
BENCHMARK: (Permanent reference Point) Describe: yr PT,. c- ~~`A
Elevation of vertical reference point: ICy" r~ Slope at site: &
SEPTIC TANK: Manufacturer: Liquid Capacity:/p(-,r
Number of rings on cover : Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number 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 Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: _ Number o pits ---e~iameter
feet liquid depth seepage pit in e~ t pipe-elevation
bottom of seepage pmt eleva on feet.
SEEPAGE BED SIZE: number of lines 2_ width iZ_' length the depth
SEEPAGE TRENCH: width _ length
PERCOLATION RATE- ) AREA U RED y/0 AREA AS BUILT ,
INSPECTOR
DATED" PLUMBER ON J B _
LICENSE NUMBER
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.C,. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
QCONVENTIONAL 1:1 ALTERNATIVE IS,,,, Plan I D. Number.
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME 9,fPERMIT HOLDER'. JADDRESS OF PERMIT HOLDER'. INSPECTION DAT
n
D Li', C
BENC MARKIPermanent el ~rence point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. EL ST REF. PT. ELEV.
nl Plumber. MP/ PRSW No. Coun(y. Sanitary Permit Number.
SEPTIC TAN /HOLDIN16 TANK:
MANUFACTURE LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARM G LABEL LOCKIN OV %R
Y Ov ED. PROVI D
4t~. ~I Lw" lia'` YES ENO NO
SET
BEDDING. VENT DIA.. VENT MATL HIGH WATER NUMBER OF ROAD PROPERTY WELL BUILD NG VENT T F
UK H LI J AIR
ALARIA ET Y 0 NEAREST
YES
DOSING CHAMBER:
MANUFACTURER BEDDING LIOLIIOA(A(~i TY.'~ PUMP )EL PUMP; SIPHON MA NUFACTURER WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED
DYES NO DYES ENO DYES ENO
GALLONS PER CYCLE: t U CONTROLS OPERATIONAL NUMBER OF PHr)PE-RTY WELL BUILDING VENT TO FRESH
IJNL AIR INLET
(DIFFERENCE BETWEEN FEET FROM 1-1 PUMP ON AND OFF) YES L_.NO_ NEAREST _
SOIL ABSORPTION SYSTEM. Check the soil moistures at th depth of plowing II )InMF T E H MATE HIAL AND MARKIN(,
or excavation. (If soil can be rolled into a wire, constructi n shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WI)TH LENGTH NO. OF 1715TH PIPE SPA(:I% 111111 INSIDE DIA zPITS LIQUID
BED/TRENCH THPNNCCES r IATERI , PIT DEPTH
DIMENSIONS
v'IV[ 15 ` 1)FPTH UISTH PIPF rDISTH PIPE IDISTR. PIPE MATERIAL NO DISTR NUMBER OF PHOPERTV WELL BUILDING VENT TO FRESH
u a ,wEa)Vel{ r{EV INI{ I ELEV END 15 PPE FEET FROM = uNE / ~ S AIR2NL
i °15.2 S I
I MOUND SYSTEM:
,It Mound site plowed perpendicular to slope Chec the to ture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mou d syst s to make certain that it ON REVERSE SIDE. SHOW ELEVA-
(~b me s he cr er a or medium sand. TIONS MEASURED.
y EYES ENO
j SOILCOVER TEru)HE PEHMANFNTMAHKEHS ORSEHVAnoNWELLS
>I _
L_]YES NO DYES NO
DEPTH OVEH THE NCH µF1) 'P"' ')V"' IHENCH BE I) D iH OF ("PI), SODDED SEEDED MULCHED
CENTFH (EDGES
EYES ENO DYES 0NO DYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO.OF LATERA PACING. G ELDEPTHBELQW PIPF FILL DEP rH ABOVE COVCH
RED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MAN IFOL I) DISTP IPE M NIFOL M TF IAL NDISTR. PIPE UISTR IBL1710 PIPL (v9ATEkJIAL F. ^.1AHKING
F IEV. ELEV. DIA ELEV. PIPES DIA
ELEVATION AND
DISTRIBUTION vERnCAL uFTCORRESPONDSTOAPPR vED
Isite HALE SPACING DRLLED coHRFGT;AERIAL
Lnn~s
DYES NO _ DYES NO
COMMENTS: it PERMANENT MARKERS BSERV TION WELLS NUMBER OF PROPERTY WELL BUILDING
FEET FROM LINE
t C~ I EYES ENO DYES ENO NEAREST--__ _
l
0-1 -2
Va ~ r~ o-t.° e G.~ u..• l.~ h~c:~ Pas ~
Sketch System on Retail in county file for audit.
Reverse Side.
SIGNATURRE,,,.....-. TITLE
DILHR SBD 6710 (R. 01/82). .
3A;P 1W, 4'
IN
DUS R'f, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, 1 c DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76
HUMAN RELATIONS
N WI 3707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
NA) '/at#/a 2V /TAN/RAE(or)W T,Q&' l 'r~> err>~-
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FILE DESCRIPTIONS: -PERCOLATION
TESTS:
I)OReside ❑New Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑s ❑u ❑s ❑u ❑s []U ❑S ❑U ❑S ❑U oNvevrl,+yl_ ~3Ev ~Xz~X/D
If Percolation Tests are NOT required DESIGN RATE: [Floodplain, f an _
y portion of the tested area is in the
under s,H63.09(5)(b), indicate: indicate Floodplain elevation:
d0%1' 4V PROFILE DESCRIPTIONS
t
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 13~
B-
B- 7-
B- /
C>
r('
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PER-INCH
P e-60A
P - rr/
P- F t
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. ~CT%O
A4 OF j3el) 7'b L'.ir J,5` fT• 13E4ot:,> 13oee;sr-/
6z ~7
SYSTEM ELEVATIONr1°'"'0~ a
yq _
e
_ ~a
M 13' .
~LSo .SANE /,eo u
N
jqo
y
*4: R 315
a
I, t e gndersigned, 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
Ad in(Istrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
i
N ME (print): TES S WERE COMPL I ED ON:
A DRESS: ~ CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST IGNATURE:
a 4. 4 c . J 4 e r_ s ~ • s a,. w= Y r r t~ - _
~r
=_Jumber o
~'r~',
` s,. A.,6-. He i:~€rhF, !}3E _
G 1 E . irn r,~ € i y ' Fc„~s_~"! , rt)iF , wsi4fi)£1c- a.
J t,;.a `S t It -t r,. and 34 ~1 zee Elbi'° r ti i, :?.$.r'=, t ,d .esiL,vt€tsi iE?".€ e
4 i "s, E v 1. c<, ` t~ IBC ° X11 r E7 ,r tE .f,.t
al(; p,a t.e y t?i.. e;i c.€~rr.,
r`
lol
iy`
a< <i 3
QA/
PLB ~ 7
pc~or and CRO55
' vote,* tor i-IWr
5 E + Q N P I A N S
} 1 a rli,ui au~ ~ :T 7, WVEO
i t a srE~c SE,v~'i c T.~~✓~
o
I f i~~" z
ti~ ! `'moo
v _ wAC,~ cu~y
o ; - - - - r yi 5T/,v 6
A'0N CIPOWir
f ~ ~ i I ~oi1•!~
4 f, $_6 - ~ ~'XiST/N(J- Gc>EGL v` q r ur s/oP ~
3OQ3 F/t~.fT%ov /0 fr.
i
1 ` I I I
4o7- /y
Mit/~HD/l I fr•
&dA
_q 16AAED
1 .
Fresh Air Inlets And Observation Pipe '
i 5 r Soil TES ~
REF Approved Vent Cap
lR~'v
14V'tflov) 1oP D" Minimum 1211 Above
l) fT • Final Grade
iy boa,
411 Cast Iron
30 " Above Pipe
'TO Final Grade Vent Pipe
Marsh Hay Or Synthetic Covering
Min. 211 Aggregate
Over Pipe
o~-JdM Distribution
7ES7) pipe LO 0 0 0 0 Tee
r f1~ "Aggregate o Perforated Pipe Below
Beneath Pipe 0 Coupling Terminating At
7' Bottom Of System
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
ll` DUSTRY, FOR SANITARY DIVISION
L•A9OR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 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. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mailing Address:
/?&)A/ ca r- 107- 3 C0 Lc- AV
Property Location: ~ ~ City, Village or Township: County: p`~x
/a S ~/T NiR ~E (or
Lot Number: Bilk No.: Subdivision Name: Nearest Road, Labe or Landmark: State Plan I.D. Number:
~00 p13~LJ (If assigned)
TYPE OF BUILDING 1 f
Number of
❑ Public* ❑ Variance* ❑ Other (specify)' Bedrooms:
X1 1 or 2 Family *State Approval Required. 2__
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
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New X Replacement ❑ Experimental I'Vt Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
Wate Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private El Joint El Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber:. Signa MP/MPRSW No. PhoneUumber:
Plumber's Address: Name of Designer:
14jelaoZ~~ 57 COUNTY/DEPARTMENT USE ONLY
Si n ture of Issuing Agent: Fie: Date: ❑ APPROVED TsariLary a Permit Number:
XAD-_r(_; 1~. ❑ 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 (R.07/81)