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Parcel 040-1068-40-000 01/04/2007 04:17 PM
PAGE 1 OF 1
Alt. Parcel 17.28.19.258D 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 - LARSON, GERALD L & LORI
GERALD L & LORI LARSON
369 TOWNSVALLEY RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ` 369 TOWNSVALLEY RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 4.000 Plat: N/A-NOT AVAILABLE
SEC 17 T28N R19W ALL THAT PT OF SW NE Block/Condo Bldg:
LYING NELY OF TN RD ALSO PARCEL IN THE
SE NE DESC AS COMM E 1/4 COR SEC 17; TH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
S 88 DEG W 1338.70'; TH N 0 DEG W 17-28N-19W
820.52' TO POB; TH N 0 DEG W 511.06'; TH
N 88 DEG E 60'; TH S 0 DEG E 511.02'; TH
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
08/05/2002 686024 1941/141 EZ
07/23/1997 930/637
686 1941/141 EZ
2006 SUMMARY Bill Fair Market Value: Assessed with:
158251 241,700
Valuations: Last Changed: 07/20/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.000 66,000 154,500 220,500 NO
Totals for 2006:
General Property 4.000 66,000 154,500 220,500
Woodland 0.000 0 0
Totals for 2005:
General Property 4.000 66,000 154,500 220,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
AS BUILT SANITARY SYSTEM REPORT
OWNER K A TOWNSHIP - SEC. ~~_T_N-RW
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE _
PLAN VIEW
Distances and dimensions to meet requirements of H63
YVZRYTHING WITHIN 100 FEET OF SYSTEM
--s n 1-4 IeN
` Lot,
h#J K
{ I di a e oath Arrow
SCAL
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: _ _ --Slope at
[ ,557 Liquid Capacity: 1000
SEPTIC TANK: Manufacturer:
Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: _
PUMP CHAMBER
Manufacturer: Number of gallons
t4Luaber of gal. pump set or a cycle- gallons; total capacity of
distribution lines gallon: size pump --head;
gallon per minute- horsepower brand 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 oL pits teet diameLer
Eee.t liquid depth seepage pit in e~-t-pipe-elevation
bottom of seepage pit elevation feet.
S1 !,.}'AGE BED SIZE: number of lines__3 width a_/_lei%th_,~ __tile depth-
SI 1:1'AGE TRENCH: width _ length. _
1)1,'JZCOLATION RATE v AREA REQUIRED ~~REA AS BUILT _ ~ _
INSPECTOR
DAl'ED_ ~ PLUMBER O
LICENSE NUMBER
---~Gx
i -
7
~t
3 C>
RI-PORT OF INSPECTION - INDIVIDUAL S1_UTAGE SVSTI-M
San4 tat( -(1 Vice i na f
tit(tte. SeptiC l
f
/1M[ Tow n,5it ip St. C)co.i x Count(1
io(,a t i o n t Section L u t Sub 4 v 4 A ,i 0 v( ---T----
IVI IC TANK
gattone NurnbeA oh cornpat(tmentA
ti t (n(( (~AOm: We.('e, _ u - ` 12o Aeo.r'e----
HighwateA
1Ml'1NG (HAMIiER ,
ze Aga fonA Pump Moms ~ae.tuA.eA- Mode f'. NumbeA
I TIN(; TANK
( . ( -------gafeon-A Numbest ah COrnpct A ernes to
I'(( my AtaA.m S yA tem
ti tifYlc {nom: Wett Buitd.ing 12% 6fope.
H.ighwatut
~I;tivRPTION SITE
Tn.e.nc.h
rv( e nom: We. , Su.itding 12% Akope.
H.ighwateA
•J ~i,,,ORPTION SITE DIMENSIONS
W (d th 06 tAeneh _ At Req'ahp d aA.ea- ~.t
I rnlItit oA each .Qine.At Depth oA A-ock below tite in
Numbefe oA tin e,6 Depth o6 Aock ove.4 tife in
Totat length oh tines .6t Depth o6 t-i.Pe beXow g Lade in
DTAtan.ce between tines fittope o6 tAe-nchin. pear 100 6t
T o ta.8 abb okption a4e-a L' At Type o A Coven: Pape~t o•;. e tA.aw
II DIMENSIONS
NurnbeA o6 pits G"avve (vtound p.i.ts yes _ no
0(,tA.i de. diameter ' ,fit"` epth below inke.-t ~t
Iuta.Y abAonption anea ` t
At(ea Aequike4. At
N kl, I' I C T 1 D 8yi , T I T L E
iI' 1\1 0 V1 0 DATE ~j 19 8
i 1 C I 1 1) DATE 19 8
i A, 0 N I OR RlVJ1:CT10N
State and County State Permit # O
PLB 67 u Permit Application County Permit #
for Private Domestic Sewage Systems County
"DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. ;;N;E ROF PROPERTY Mailing Address:
~Lp 1,W131 B. LOCATION: Section 12__, T R / E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
"014 gvoeoil Cox Township r1_40 '
:10 SA~~r~,~e /-4-73 76wvs UA/lef
C. TYPE OF OCCUPANCY: 'Commercial "Industrial Other (specify) Variance
Single family _Z Duplex No. of Bedrooms No. of Persons 2-
D. SEPTIC TANK CAPACITY10-eV Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation -X Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
~ Total Absorb Area sq. ft.
E, EFFLUENT DISPOSAL SYSTEM: Percolation Rate fz
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width ~y~" Depth Tile depth (top) No. of Trenches
Seepage Bed: K_Length _3.5-~ Width~Depth,% " Tile depth (top) a No. of Lines 3
Seepage Pit: Inside~dryiameter Liquid Depth No. of Seepage Pits
Percent slope of land /0 Distance from critical slope l/o_~
WATER SUPPLY: Private ,Xt 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 Certified Soil Tester,
NAME //74M4 ; M;_ C.S.T. # 3~ L 6 03and other information
obtained from d6 V00 (owner/builder).
Plumber's Signature MP/MPRSW# Phone #7131-
Plumber's Address 722 OPT //0-PS' S
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.
5~~, //ice LcJ •9 rTi~ el .~Q / y'" ;IC
UF~T e~
Mr ~,r~H 4
A
I _
9 _
m
S~
r~
~v
Rok
o ,
f
P1
„ pdL E I opoArr,
pjrA
So
r
Do Not Write in Space Below G FOR COUNTY AND STATE DEPARTMENT USE ONLY
Da 41
Date of Application ~5- ).)"p/ Fees Paid: State_1 County / 4-0
Permit Issued/Retested (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
EH 115 Rev. 9/78
• REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION:S' r; ~e%, Section ,T,~&N R c'r'. yJ~ t->✓ •
M Township or Municipality _ I
Lot No. ,Block No. County ~O I
Subdivision Name
Owner's/Buyers Name: r 41'11-
Mailing Address: Sil^C~(Z,.^ T~j 1,
TYPE OF OCCUPANCY: Residence No. of Bedrooms-1 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW _REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS-PERCOLATION TESTS %10
SOIL MAP SHEETNAME OF SOIL MAP UNIT )
PERCOLATION TESTS
TEST
DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- INCHES SINCE HOLE HOLE AFTE INTERVAL RATE
BER THICKNESS IN INCHES
1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- t -1? 3 S 3 3
P- Z ;7 e
P_ /V < 40
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES OBSERVED ESTIMATED HIGHEST TEXTURE, MOTTLING AND DEPTH TO BEDROCK r
IF OBSERVED IN INCHES
' t€
B- 2. t 1 tV.
B- A
B-
B- 61L #3"S,1ro"6,-S
IB_ 6 11 "AIL J_" C- r
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy IF-_ Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope. 30
+ LO C 1710. Is brain R K 63 6,r«
10 e- o 90 1
~ Iown RocL.Q
s
3t~
t H yr_ 7-2. 5
_ ~ ~•---~-.-mot x i
17 _j
re i' ( N
r~,n~t
60
x
83 ELL
P
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ff y r,u
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'G
I, the undersigend, 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 Administrative Code, and that the data recorded and location of test holes are correct to the best of my
knowledge and belief.
Name (print)`
Certification No.
; NO
Address
Name of installer if known_ ,~C• c3r7.S -
Copy A - Local Authority CST Signat
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