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HomeMy WebLinkAbout040-1056-95-000 o f r M 0 d O = CD ID COD 'a ,2 CD c !1~ CD 3 \ 1 g 'All (n 2 m z m ao ° `c • S 3 D) Q C - O v° < N rl N CD Z (D N OVD x p r') C (D W= N ° CO M Q ^ N a 0) O N N > j N O K' \ 1 I p a) C a _ 0 o 6 7 N O d V ° (D (n a V m (o' N W a G) 3 Q c°fl m m O V C> N) o ~ CD co C CD OD a O Q z 0 0 0 y • z CO CO CO ll~lii 7 3 N < 9 v v ° v 7 ° N -O p N (D 3 H N N ~ z N z co z - o ' D CD O ty o' c !r • CD m N Z in (o CD CD c w a I Q 3 ~ z (D -4 to ° = o A Z m n c ;o n A z 0 v a C) F! o. ° M 0 W CD z o O cn y ;o CD n (D ° c D 3 = cn a CD 3 a a a- CD - CDD N 7 O N C o~ z o x N N v CD c. a~ y 0 00 N O A ° O (D (0 CD Nw O 53 -p N }CL 00 (D A h ° W O N A Parcel 040-1056-95-000 01/04/2007 03:13 PM • PAGE 1 OF 1 Alt. Parcel 14.28.19.221 040 - 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 - WILCOXSON, CLAIR H & DONNA J CLAIR H & DONNA J WILCOXSON 1027 HAZEL ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 747 GLOVER RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 14 T28N R1 9W 40A NW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/10/2005 797282 2820/285 EZ-U 05/19/2005 795436 2805/558 WD 05/29/1979 357159 594/402 LC 2006 SUMMARY Bill Fair Market Value: Assessed with: 158166 Use Value Assessment Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 38.000 7,300 0 7,300 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 1.000 10,000 78,800 88,800 NO Totals for 2006: General Property 40.000 17,400 78,800 96,200 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 17,400 78,800 96,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I'M Parcel 040-1055-90-000 o1io4i2oo7 03:11 , PAGE 1 OF 1 F 1 Alt. Parcel 14.28.19.216A 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 - WILCOXSON, CLAIR H & DONNA J CLAIR H & DONNA J WILCOXSON 1027 HAZEL ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 747 GLOVER RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 38.000 Plat: N/A-NOT AVAILABLE SEC 14 T28N R19W 38 AC NE SW EXC N 420' Block/Condo Bldg: OFW210' Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/10/2005 797282 2820/285 EZ-U 05/19/2005 795436 2805/558 WD 07/13/1995 531195 1130/244A LC 2006 SUMMARY Bill Fair Market Value: Assessed with: 158157 Use Value Assessment Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 7,100 0 7,100 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2006: General Property 38.000 7,200 0 7,200 Woodland 0.000 0 0 Totals for 2005: General Property 38.000 7,200 0 7,200 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 OWNER `.TOWNSHIP ------SEC. jWN-R17W ADDRESS ST. CROIX C NTY, WISCONSIN. SUBDIVISLON~(,ay~.~~ LOT LOT SIZE 1,AN VIEW Distances and dimensions to rneo requirements of H63 HOW_ EVERYTHING WITHIN 100 FEET OF SYSTEM ` 1 C'. I MV U itte-- nth Arrow SCALE : I I BENCHMARK: (Permanent reference Point) Describe: ~~-BltlJl~ Elevat.ion,of vertical reference point: Slope at site: v - - - SEPTIC TANK: Manufacturer : _W AJ A.a,l1 Liquid Capacity: Number of rings on cover _ Tan~c manhole cover elevation: Tank Inlet Elevation: - Tank Outlet Elevation: Ir PUMP CHAMBER • Q Manufacturer: _ _ _ _ Nurr er of gallons Number. of gal. pump set -foracycle- _gallon. toga capacity distribution lines gallon: irc of pump head; - - f;rlLon per minute Q ; horsepower ; rand name of pump and model number 'T'ype of warning e ce HOLDING TANK: Manufacturer Number of- gallorrS Elevation of manhole cover _ Type of warning device _ SEF.PA ;E PIT SIZE: burn er o~ i t ti feet -c~iamc t: er feet liquid deptfl seepage pit: in-ret pipe-elevation--_ _ b~ _ tom of seepage pit e e-vati_on feet. 7 SEEPAGE BED SIZE: number of lines wl h 1e~v tli file de th SEEPAGE 'TRENCH: wi tIr I r1 T_" - PERCOLATION RATE REA RFQUIR D~ Q AREA AS BUILT CTOR DATED- PT UMBER ON JOB;r-• - /tICLNSE NUMBER 40 ZPAS - r z 4- cn /•3C) REPORT Ol' LNSP1sCTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit -O State Septic JAMF 'r0WNSIIl _ St. Croix County I,0CA`CION Section Ad/ Lot # Subdivision PTI:C TANK Size gallons Number of compartments Distance from: We11.-__1_-T_------- f3ui_lding 12% slope----'~- Ilighwater I'LIMPING CHAMBER SJ ze~ _ gal-Ions Pump Manufa('ture> Model Number IH)L,D I NC TANK Size gallons Number OI Compartments Pumper Alarm System n i :;tarnce from: Well Building 12% slope Highwatcr \I3SORPTION SITE Bed Trench _ ` - oistance from: Well 1 Building 12% slope H i g h w a t e r AIiSOIZPTION SITE DIMENSIONS Width of trench - ft Required area (j * ft. Length of each line ft Depth of rock below tile 4 in. Number of lines- Depth of rock over til-e 2 In TotaI Length of lines ft Depth of ti le below grade in. Distance between lines ft Slope of trench in. per 100 ft. Total absortption area &-2 ft Type of Cover: e ` - - rr - - ITC DIMENSIONS Number of pits_ Cr.ave_L around pits _ycs no Outside diameter ft Depth below inlet ft Total absorption area ft Area required t INSPECTED TITLE C APPROVED - 4 DA'Z'E - - .198 REJECTEDDATE 1.98 REASON FOR REJECTION--GL`ti-~ PLB 6 7 State and County State Permit # q Permit Application County Permi # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 1 ~ w B. LOCATION: C '/4, Section f! T_ N, R_L E (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township -kr C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Varianc Single family Duplex No. of Bedrooms/' No. of Persons_ D. SEPTIC TANK CAPACITY PZ")! Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab c cr to Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM-, Percolation Rat o I Absorb Area sq. ft. New Replacement_Alternate (Specify Seepage Trench: No. of Lineal Ft. Width Depth Tile depth ~(tpo-p~) No. of Trenches Seepage Bed:_ X -Length .`b z Width~_Depth - 21 ' Tile depth (top)-r_No. of Lines Seepage Pit: Inside di meter Liquid Depth No. of Seepage Pits Cl> Percent slope of land IV Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, 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 Cert fie I Soil Te to J NAME L+ri1r; C.S.T. # S 5C-~ and other information obtained from (3;v' (owner/builder).? Plumber's Signature MP/MPRSW# .)cT j Phone' Plumber's Address L 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. , 1 xm_ .M.~ ~.-m. ..a _.,.rv. . . I E 1 t ; { 3 , j E , , , Do Not Write in Spac Below FOR COUNTY AND STATE DEPARTMENT SE ONLY Date of Application 'OQlu' Fees /laid: State' Co n y Dat ff Permit Issued/RtieULtd- (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 .DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS • INDUSTRY, cc DIVISION BOX HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 LOCATION: SEfTI N: OWN P/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: l~/ /T<H/R/ E (o T lv 44 COUNTY: OWNER'S BUYERAME: ILING ADDRESS: ~r©r- ~,lGr svvl . USE DATES OBSERVATIONS MADE NO. BE RMS.: COMMERCIAL DESCRIPTION: NS: jPE_R_C5EA_ ON TESTS: Residence ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for sy em Se - m - l6t C NVENTION'AIIL: MOUND: IN-GROUND-PRESSURE: SY M_-IN-FILLHOLIING TANK': RECOMMENDED SYSTEM (optional) - S ilV OS ❑U ~S LIU OS OU If Percolation Tests are NOT required DESIGN RATE: Y TEM EV. [Floodplain any portion of the lot is in the under s.H63.09(5)(b), indicate: , indicate Floodplain elevation: PROFILE DESCRIPTIONS 1~6C7 t a / BORING TOTAL -aFPTH TO GROUNDWATER- CHES CHARACTER OF SOIL WITH T IC NESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) It it B-3 ~149 B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCH S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- 17- SO Be 44 j/T Ntqdf 4- _43.0, ./y a IIn-;,o 'Bdre P_ d(-# th Of _Shoiz ;icr -f .1k f 0-P611 01 i) P_ .7 b , P- ' P- PLAN VIEW: Show locations of percolation test , soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the t zontal and vertical elevation reference points d show their location on the !plot plan. Show the surface elevation at all borings and the direction and per of land slop. SYSTEM ELEVATION 77d'e ~r~ St me - at 5 ~v Prese~~ S~p~+c lrl~u~l tN a x a 5 s;eV Ce uilre~ tabs Ct fs r. te, a a 1, n e jd 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 mimistrative Code, and that the data recorded and the location of the tests are correct to the best of knowledge and belief. NAME (pri . ~ TESTS WERE COMP L TED ON: q~ C~ ADDRESS: CER IFI ATION NUMBER: PHONE NUMBER optional): S J CST ATURE: 1..~1 r)ISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. -6395 (N. 03/81) t~~ ,r, ~ ~ ~ tt~ __._..~._..._.e.._.__ • ;;r ~'St F~ t ~ rY 4t ~1 ;g a l kt ~ ~ ~ t' P,~ Lf Y i i., ) T 1 a:ti 3 ~ ~ T ~ Vin., ~ `a; f A~ ~ 4, i }