HomeMy WebLinkAbout040-1007-60-250
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Parcel #:'040-1007-60-250 02/23/2006 10:35 AM
PAGE 1 OF 1
Alt. Parcel 03.28.19.37C-40 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
11/11/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - VEVANG, LARRY M & SANDRA
LARRY M & SANDRA VEVANG
594 GILBERT RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 594 GILBERT RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
III
Legal Description: Acres: 3.190 Plat: 4878-CSM 19-4878 040-04
SEC 3 T28N R19W PT NE NW FKA CSM 17-4564 Block/Condo Bldg: LOT 04
LOT 1 (10.760AC) BEING CSM 19-4878 LOT 4
(3.19 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
03-28N-19W NE NW
03-28N-19W NW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
11/11/2004 779661 19/4878 CSM
10/25/2004 777940 2681/623 EZ-U
07/11/2003 729887 17/4564 CSM
2005 SUMMARY Bill Fair Market Value: Assessed with:
102053 281,200
Valuations: Last Changed: 09/06/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.190 60,500 210,200 270,700 NO
Totals for 2005:
General Property 3.190 60,500 210,200 270,700
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
J=~
AS BUILT SANITARY SYS'I'F:M REPORT
Rr
~W
OWNER l - rowlvs}}1P SEC.
' # 1
ADDRESS PIERCE COUNTY, ` ~ISCONSIN
" ° SUBDIVISION IAT LOT SIZE
r PLAN VIEW
Distances and dimensions to meet requireyiients of }}63 ,
SHOU THING WITHIN 100 FEET OF SY, ~ M 6;" ✓
,
100
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a e o th Arrow
SC -.C
BENCHMARK: (Permanent reference Point) Describe:
of vertical reference int: _ Slope at site:
ElevOtion
_
SEPTIC TANK Manufacturer: 'u- c2~ I..iquid Capac i ry : 'r ,
Number of rings on cover rn~~nhol c~ cover C~ l.c'vr1( 1oll:"
Tank Inlet Elevatftn: 'LEiiik outlet Elevation:
PUMP CHER
Manufacturer: Number of gal Ions
Number of gal. pump 'set or a -cycle--- _ gaI I oils ; total c=~E,.ic i t.y
dtstr:3bution lines gallon: size of putnp_
horsepowe), ~~ran-Tc cmc of pump
Bed]on per minute a
and model number
Type of warning device
NQLDtNG TAIW: Manufacturer Numper of gaLIons
Elevation of manhole cover
r Type of yarning device _ T-- - _
SEEPAGE PIT SIZE: Num~ei:-of pits ~r-Tcc~t c3iameter__.._-___-...
feet liquid dept seepage pit inlet pipe-elevation
-bottom of seepage p ft elevation _ feet. -
SE'E GE BED SIZE: number of lines with ~ length-tile depthV5-1"
l_~
_ -
SEEPAGE TRENCH: width l etig t
PERCOLATION RATF _ARFA itFQtII RF ll 1~~ -AREA $UILT
DATED PLUMBER ON JOIE;r2,~~,C >
~L_ - LICENSE NtJMBI:h"
- -
~.~•7
Sanitary Permit
• State Septic s -
,SAME ----TOWNS111P St. Croix County
v /ov 7
1, 0CATI0N_'Ar_e~ _--Sectionj_--Lot it Subdivision-
'1
I? P 7' I C 'I' A N K ~
Z-
S ize gallons Number of compartments-
Distance from: Well Building _ 12% slope
Highwater
PUMPING CHAMBER
Size gallons Pump Manufacturer - --Model Number__-_
HOLDING TANK
Size gallons Number of Compartments___
Pumper____ - - Alarm System______- -
Uistance from: Well Building- _ 12% slope _
Highwater
ABSORPTION SITE
Bed Trench
Distance from: Well Building 12% slope-_
Hi.ghwater
ABSORPTION SITE DIMENSIONS
Width of trench f t Required area--_-- _f t .
I,engt}i of each line ft Depth of rock below the in.
Number of lines Depth of rock over file in.
Total length of lines - - - ft Depth of tile below grade in.
Distance between lines ft Slope of trench in. per 100 ft.
C o v c: r:--
Total. a b s o r t p t i o n area ft Type of
1' I'I' DIMENSIONS
Number of pits Gravel around pits -__yes no
Outside diameter ft Depth below inlet-_-_ __-_-___-_-ft
Total. absorption area ft
Area required ft
l`
INSPECTED BY TITLE
APPROVED DA'I'S 1.98
1\ EJECTED DA'CI's 1.98
RI?ASON FOR REJECTION - -
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State and County State Permit # f 7
p C
ount Pt #
Permit Application Y ,
PLB 67 O'k
for Private Domestic Sewage Systems County f
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Z
B. LOCATION: r Al 'Sectio T N, R1 'E (or) W Lot# City
Subdivision ame, ne road, ake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons_
D. SEPTIC TANK CAPACITY tal gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete V' Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percol R Total Absorb Area sq. ft.
New Replacement Alternate Specify)
Seepage Trench: No. of Lineal Ft. Wi5th_ Depth Tile depth (to ) No. of Trenches
Seepage Bed:- L Length WidthDeptTile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land ~ :2 !7~~ Distance from critical slope
WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Cer ied Soil Tester, _
NAME C.S.T. #1 and other information
obtaine from (owner/builder). _
Plumber's Signature PRSW# Phone .01 Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Do Not Write in Space Bel w FOR COUNTY AND STATE ARTMENT SE ONLY
Date of Application Fees Paid: StatCo .~f )ate
Permit *Issued4k-jeeted (date) Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. Plumber (canary copy)
Revised Date 7/1/78
DEPA`RTM'ENT OF REPORT ON SOIL BORINGS AND BUILDINGS
INY, LAf30R AM DIVISION
C P. BOX 7969
HUMAN RELATIONS PERCOLATION TESTS (115) 9G„`,'DIS WI 53707
LOCATION: SECTION:
TOWNSHIP/MUNICIPALITY: LOTNO.:BLK O: SUB E: ,
1/ 1/a /T 7N/ E(or)W
E If
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVAT M
NO. BEDRMS.: CDESCRIPTION: 15ROFILE TONS: [1:HCULATION TESTS:
OResidence ❑New Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND:SYSTEMIN-FILLHOLDINGTANK: RECOMMENDED SYSTEM:(optional)
❑s ❑u ❑s E__T1iN-_GRGla''5JT:;:!;;;::;0F:::~
u ❑s ❑u ❑s ❑u ❑s ❑u
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V.
i If any portion of the lot is in the
under s.H63.09(5) 161, indicate: - Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
13-
PERCOLATION TESTS
TEST DEPTH^WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P_
P
P_
P_ -
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.
SYSTEM ELEVATION - -
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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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional)
CST SIGNATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
61 1 LHR-SBD-6395 (N. 03/81)
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Parcel 04U-1007-60-100 02/23/2006 10:34 AM
PAGE 1 OF 1
Alt. Parcel 03.28.19.37C-10 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
11/11/2004 00 4
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - VEVANG, RETIRED NUMBER
RETIRED NUMBER VEVANG
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 10.760 Plat: 4564-CSM 17-4564 040/03
SEC 3 T28N R19W PT NE NW BEING CSM Block/Condo Bldg: LOT 01
17-4564 LOT 1 (10.760AC) NKA CSM 19-4878
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-28N-19W NE NW
Notes: Parcel History:
Date Doc # Vol/Page Type
10/25/2004 777940 2681/623 EZ-U
07/11/2003 729887 17/4564 CSM
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 04/26/2005
Description Class Acres Land Improve Total State Reason
Totals for 2005:
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