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01/04/2007 04:06 PM
Parcel 040-1207-95-000
PAGE 1 OF 1
Alt. Parcel 16.28.19.984 040 - 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 - MOEN, JOHN L & SUZANNE E
JOHN L & SUZANNE E MOEN
373 MILWAUKEE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 373 MILWAUKEE RD OR
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.410 Plat: 1993-GLOVER STATION
SEC 16 T28N R1 9W 2.41A GLOVER STATION Block/Condo Bldg: LOT 30
LOT 30
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
159358 423,500
Valuations: Last Changed: 07/22/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.410 90,000 296,300 386,300 NO
Totals for 2006:
General Property 2.410 90,000 296,300 386,300
Woodland 0.000 0 0
Totals for 2005:
General Property 2.410 90,000 296,300 386,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 308
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
. REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit
State Septic
NAME TOWNSHIP St. Croix County
Sub ivision
LOCATION Section / 6Lot
19
SEPTIC TANK
Size gallons Number of compartments
Distance from: Well Building / 12% slope
Highwater 10
PUMPING CHAMBER
Size gallons Pump Manufacturers Model Number
HOLDING TANK
Size gallons Number of Compartments
Pumper Alarm System
Distance from: Well Building ✓12% s`l fYope f_
Highwater
ABSORPTION SITE eq
Bed Trench
ll 12% slope
Distance from: Well `;)I- Building-
Highwater o LD'L'-1
ABSORPTION SITE DIMENSIONS 011A nre P 1`lJ
Width of trench ft Required area ft.
r
0 7j- ft Depth of rock below the-}-fiiin.
Length of each line
Number of lines Depth of rock over tile in. /
F
Total length of lines ft Depth of tile below grade in.
Distance between lines ft Slope of trench in. per 100 ft.
Total absortption area ft Type of Cover:
PIT DIMENSIONS
Number of pits Gravel around pits yes no
outside diameter ft Depth below inlet ft
Total absorption area ft j n ( 7 4
: ~1 ate-- c~ S ~-,~~I
Area required ft a u
INSPECTED BY TITLE
APPROVED DATE 198_
REJECTED DATE 198_
REASON FOR REJECTION
i J 1
m-~1 F
1/5
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSW r, 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'/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.
ail
Property Owner: Ming Address:
i 62.2-1
Property Location: City, Village owns County:
/yu,7 t/4 A1,C t/4S f /T 2 N/ R 19 E (or & Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
!'YiC (If assigned)
TYPE/ OF BUILDING l~-r
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
Q 1 or 2 Family *State Approval Required. 0 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY 12t;; ✓
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER -
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PR~POS D (Square feet): EE~rNew ❑ Replacement ❑ Experimental Seepage Bed E:1 Seepage Pit
z b . ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
2Private ❑ Joint ❑ Public 0 'a
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: MP/MPRSW No.: Phone Number:
11~7 /17
Plumber's Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signa re of Iss in Age t: Fee: Date: Sanitary Permit Number:
t1 / APPROVED /i
ll ~v ❑ DISAPPROVED fJ~~~ . i&_,~ 1,F1 F
eason for Disapprove :
Alternate course(s) of Action Available:
i
L
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
st. `)ation. 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)
DZP,ARTMENT OF
REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUST.W'T Y, c DIVISION
.,LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069
HUMAN RELATIONS
LOCATION: SECTION: TOWNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME:
AlW t/ nA/4 /Tz -,N/R /9'E (o '61 I % (2,LcvZ;FZ ST 7/e
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDR COMMERCIAL DESCRIPTION: R DESCRIPTIONS PERCOLATION TESTS:
Q-Residence
L~New ❑Replace J
014 L
RATING: S= Site suitable for system U= Site unsuitable for system -Se,,k SOZE" 13Z 4* Af14 NTION CO ES EI M❑S.❑u E]S ❑URE:SY~STS -l[:]N-F TANK .RECOMME/YG.L/1/
/ t.N pti onal )
L~~ C l I
If Percolation Tests are NOT required DESIGN RATE: SYSTEM E
If any portion of the lot is in the
under s.H63.09(5)(b), indicate:; (E Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- e 41
1 /0 -K Z:1 1, i✓ 2 Z S L
B- .G (-O `r % G / %D s.G .7 EJ a~ =f ' N , *r 1 21 IL 3& 71
B- rY /rZ -14 2 ,r Lvl 4-
B- ' /04o rr
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- AMP - 4.1 /VP QA1 E1 :S
P- v S b
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 to tion on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slop. Ie- e6' ov
SYSTEM ELEVATION lr~~'~ 36 `3
I
..qAI\f~` ew ?"re,? .LlN_0--
p
n
1
N'
Nk.
1, 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:
®ru CERTIFICATION NUMBER: PHONE NUMBER (optional):
F
C L _ CST: SIGNATURE
li, ~'nAr~e_2
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of P!umhing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
A
I
BIRCHWOOD, PLUMBING,
HEATING, & AIR CONDITIONING
105 South Fremont
River Falls, Wisconsin 54002
Phone 42546ft `i i~ j
r -!;I VF C,- C'IV A/ 'VE
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