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Parcel 040-1201-40-000 01/13/2006 03:32 PM
PAGE 1 OF 1
Alt. Parcel 6.28.19.925 040 - 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
GREGORY L & DEBORAH L Y SMALL O - SMALL, GREGORY L & DEBORAH L Y
544 NORDIC LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 544 NORDIC LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.020 Plat: 2204-NORDIC HEIGHTS ADD
SEC 6 T28N R19W 2.02A LOT 4 NORDIC Block/Condo Bldg: LOT 04
HEIGHTS ADD
Tracts : Sec-Twn-Rn 40 1/4 160 1/4
06-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1218/606 WD
07/23/1997 685/129
2005 SUMMARY Bill Fair Market Value: Assessed with:
103610 245,100
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 55,700 180,200 235,900 NO
Totals for 2005:
General Property 2.000 55,700 180,200 235,900
Woodland 0.000 0 0
Totals for 2004:
General Property 2.000 55,700 180,200 235,900
Woodland 0.000 0 0
I
Lottery Credit: Claim Count: 1 Certification Date: Batch 217
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
` AS BUILT SANITARY SYSTEM REPORT
PEER G~\w r lrs TOWNSHIP i rv _SEC. N, R~W
p.. ADDRESS uu~e , ST. CROIX COUN Y9 WISCONSIN.
~,/<a n is < Vo
BDIVISION klb rdi 1 ki-I LOT_L_LOT SIZE
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
F -1 4-
~ t
r~ i
- - - _ ;
/
Iridibate North Arrow I
S CALF :
?TIC TANK(S)iacs; XFGR. _ j r s e~ 's CONCRETE x STEEL
_O-. of rings on cover 91- Depth (12 to DRY WELL
LNCHES NO. of width length area
: no. of lines 3 width /,a length ~r6 area .L'
depth to top of pipe'
15=CATE
KY, RATE AREA REQUIRED ~o AREA AS BUILT'
%claimer: The inspection of this system by St. Croix County does not: imply complete
opliance with State Administrative Codes. There are other areas that. it is not possible
,inspect at this point of construction. St. Croix County assumes no liability for
Stem operation. However, if failure is noted the County will make every effort to
ermine cause of failure.
F1.SES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEI~J:/ ~
f
--INSPECTOR
-77
DATEDD ` "I -A 0,i t PLUNMBER ON JOB 4,- T
LICENSE MMER .7 / - .%I b
.a"
e
Z w
F'EPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.itany Penm.it
State Septic
NAME rownahip St. Croix County
Location '
SEPTIC TANK
Size I
a tons. N mb n o Com atctmen-t.6
i
Di4tance Fnom: Wet 12% on gtceate& atope it
Bu.itd.ing ,24` it. Wettands
Highwaten it.
DISPOSAL SYSTEM
r
D.iatance Fnom: Wet it. 12% on gneatetc scope it.
Bu.itd.ing J.; it. Wettand.b Ft.
H.ighwaten it.
FIELD DIMENSIONS:
Width o j then ch~ it. Depth o j na ck b etow t.it e Z in .
Length o j each tine it. Depth o6 hock oven t.ite `Z .in.
Numb en o f tines ~ Depth of t,ite betow gnade';?-/-_in.
Totat .length o6 tines >d it. Stope o6 trench in pen 100 it.
Di4tance between tines t. Depth to bedxocfz_ fit.
Totat abb onbt.ion area,~, jt2 Depth to gnoundwaten 5t.
'f, . '-,j ` ~t2
Requited area Type oj Covet: Papen)'an Straw
~
PIT DIMENSIONS:
Number of pits Gnavet atcound p.it/s ye.s no
Outa.ide d.iameten it. Depth below .inlet it.
2
Totat. ablsonbt.ion area it Az
Area n.equined it2
INSPECTED BY r
l~-~t~G~ ; ',,-,.TITLE APPROVED, DATE - 197 .
r
REJECTED DATE 197.
EH 115 Rev. 9/7.8
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION:` %,_5L'14, Section T2_iN,R&&1(or)( Township or Municipality of- ~
Lot No. Block No. C'aC 7~-- County .74` C`/Y'
/ division ame
Owner's/Buyers Name:-~/}/ ~'z~ d t ru cMailing Address: Z-
TYPE OF OCCUPANCY: Residence X No. of Bedrooms COMMERCIAL-
EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS / 7 - 7~ PERCOLATION TESTS IC ' ~ ZZ
SOIL MAP SHEET__----?_ _ NAME OF SOIL MAP UNIT
PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL RATE
INCHES THICKNESS IN INCHES 1STWETTED SWELLING INMINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/I
BER N
P_ Ale / d S
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- 2-
B- 3 ~tc<< c 7 ` ` y
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy C", ` dicate scale or distances.
Give horizontal and vertical reference points. Indicate slope
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1, 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) s r 'S cC -S' r Certification No. Address Z/~6 Z-4 i-E r / r ' N. 41 Scar S E`/,( _
Name of installer if known _
Copy A -Local Authority CST Signature _ -
v
1M ~ v . ' w
PLR67 State and County State Permit # Z6 6
Permit Application County y #
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
- Ate' le6 AC. to a Izzel l1s &J d,
B. LOCATION: ` '/4 S,C- '/4, Section T --ZSN, Raj (or) ~l Lot# City_
Subdivision Name, nearest road, lake or landmark Blk# Village
W i Township I Po Dr ic.--
C. TYPE OF OCCUPANCY: 'Y ommercial *Industrial *Other (specify) *Variance
Single family ( Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher A YES NO Food Waste Grinder YES_,-~CNO # of Bathrooms
Automatic Washer Fi YES NO Other (specify)
E. SEPTIC TANK CAPACITY 12000 Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition _ Replacement _ Prefab Concrete /r
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ,,5 2) 3) Total Absorb Area sq. ft.
New X Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length 1-16, Width Depth Tile Depth 30" No. of Lines :3
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land /-3 'lsDistance from critical slope
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 Certified Soil Tester,
NAME 0 111 S P 6A 5{ o.JJcer:j, r w C.S.T. # and other information
obtained from 6A& , /e ' (owner/bui r).
Plumber's Signature ::17, }r _
-JF t C`
MP/MPRSW# 111-' f'.~ 1~,C1 ~`6 Phone #-)~h l
Plumber's Address a C' l ! 1VAn ti C-7 r- a l~ hjr,: r r i ~C U 1
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well). / `
_ /VD clot ~/5 Tic.vt~c'StS aC1Gd
54
i
IY3'
jo 3S
Lje l 1
wet to
_ # EL = 17
;et',~ tan
3-0
E
L L = Iva'
Do Not Write in Sp ce Below FOR DEPARTMENT USE ONLY
Date of Application Fees Paid: State Count Date
Permit Issued/mod (date) -S- 79 Issuing Agent Narr1f L)
Inspection Yeso Valid# Date Recd
1. county (wh ~t,--,olpy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revised Date 6/1 /76