HomeMy WebLinkAbout040-1201-70-000
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Parcel 040-1201-70-000 01/13/2006 03:32
PAGE 1 OF 1
F 1
Alt. Parcel 6.28.19.928 040 - 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 - DEROY, MARJORIE J & NANCY J
MARJORIE J & NANCY J DEROY
548 NORDIC LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 548 NORDIC LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.160 Plat: 2204-NORDIC HEIGHTS ADD
SEC 6 T28N R1 9W 2.16A LOT 7 NORDIC Block/Condo Bldg: LOT 07
HEIGHTS ADD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
06-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/20/2004 760202 2553/260 QC
04/12/2004 759301 2546/128 TI
2005 SUMMARY Bill M Fair Market Value: Assessed with:
103613 255,200
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.100 55,700 189,900 245,600 NO
Totals for 2005:
General Property 2.100 55,700 189,900 245,600
Woodland 0.000 0 0
Totals for 2004:
General Property 2.100 55,700 189,900 245,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 102
Specials:
User Special Code Category Amount
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
TOI•TNSHIP P r SEC. T ' N. R~~W
ADDRESS ,,i,_,4 3 ST. CROIX COu.ITY, WISCONSIN.
DIVf5ION e l ~cc-. Ft; LOT- LOT SIZE
s
PLAN VI EW
-Distances b dimensions to meet requirements of H62.20
SHOD' EVERYTHING WITHIN 100 FEET OF SYSTE1
i
~ I
I r ~ ~ ! ~ I , I ni i I I
J1
i I _Y e rJ -
' i I ! ' ! I I I
TIC TANK(S) ~ff GR. ~3 CONCRETE X STEEL Indicate Nottth Annow Sca.2e
NO. dI -rings on cover~R Depth DRY WELL
_''.CHES NO. of - width length area
no. of lines _3 width Jam',, ' length', area
depth to top of pipe
3\-.GATE
RATE C1z~ 51 AREA REQUIRED AREA AS BUILT
;claimer: The inspection of this system by St. Croix County does not imply complete
_zpliance 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
:,tem operation. However, if failure is noted the County will make every effort to
. ~rmire cause of failure.
.:AS1;S AND OILS SHOULD NOT BE DISPOSED THROUGH l iIS SYSTEM.
`INSPECTOR
DATED PLU11 BER ON JOB S' )
LICENSE NlaI3ER r~
REPORT OF INSPECTf~N INDIVIDUAL SEWAGE SYSTEM
Sanitary Pen►ni
• State Septic
/i
NAME Township S$. Croix County
Locatiox Section
SEPTIC TANK
Size ga.ttons. Numbers o6 Compartments `
Distance Fnom: W ett it. 12% on greaten scope - 6t
Bu.i.Ld.ing 6t. wettands ~ •
H ighwaten it.
DISPOSAL SYSTEM
e
Distance Fnom: Wett it. .12% on greaten s.tope it.
Bu.itd.ing 6.t. wet.2ands Ft.
• H ighwaten it.
FIELD DIMENSIONS:
Width o6 trench it. Depth o6 rock below tite .in.
Length o6 each tine it. Depth o6 rock oven t.ite .in.
Number o6 tines Depth o6 -tile below grade .in.
Totat teng.th o6 .i.ines 6z. Stope o6 trench in pen 100 it.
Distance between tines ~-t. Depth to bednoch it.
To#at absonbt-ion area 6t2 Depth to gnoundwaten it.
Requi&ed area 6t2 Type o6 Coven: Paper on Straw
PIT DIMENSIONS:
Number o6 pitz Gnavet around pits yes no
Outside d.iameten it. Depth below .inlet 6t.
2
Az
Totat absonbt.ion area it
Area %equi Led 6t2
INSPECTED BY TITLE
APPROVED DATE 197.
REJECTED DATE 197. R
h
ER 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
Township or Municipality
LOCATION✓yZ- E- Section T•zL,) N,R& 'VC-"'6 / / y
Lot No. , Block No. c.~" ,/-s County 5- el 'x
/ Subdivision Name
Owner's/Buyers Name: /`~f s (5tr i
Mailing Address: /G',Z /~'Jhl.`,~~~`~~. ~i~lls ~i_it~~ `hG' 2-
TYPE OF OCCUPANCY: Residence X No. of Bedrooms y COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEWREPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS AI
SOIL MAP SHEET__ NAME OF SOIL MAP UNIT
PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- DEPTH CHARACTER SOIL SINCE HOLE HOLE AFTER INTERVAL RATE
MIN/IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P_ Ll
P- 2-
P-
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
Q OBSERVED ESTIMATED HIGHEST y-~ IF OBSERVED IN INCHES
B- 2-
B- 3 K E 5 _ S
B- -7
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the fan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope. / / • by a y/'E'
/~C L~ _1 t!i~ (E - S~/S~ ucY s S t ey, 'C~y T F L
41
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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) E.u.tie,` <1~ . s Je` ''r`.._s~ Certification No.
Address / &I e ,
Name of installer if known
Copy A -Local Authority
State and County State Permit # ~y~
PLB67 Permit Application County Per #
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:
1,4,,K / es ~wol e✓ ~ 1 rc r, ~%l~~ ~ c~u sr, 1[ ~/der
B. LOCATION: E % Section , T N, R k (or) (0 Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
f Township /C
C. TYPE OF OCCUPANCY: *Comr>rcial *Industrial *Other (specify) *Variance
Single family ( Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher K YES NO Food Waste Grinder YES X NO # of Bathrooms--;V
Automatic Washer A YES _ _NO Other (specify)
E. SEPTIC TANK CAPACITY figcj /rj Total gallons No. of tanks
'Holding tank capacity Total gallons No. of tanks
New Installation lC Addition Replacement Prefab Concrete 1< _
'Poured in Place Steel Other (specify) _
F EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total A,ZorQrea sq. ft.
New ` Addition Replacement *Fill System eo~C C~}J I 11C i eg
Seepage Trench: No. Lin . Feet Width 1~ Depth AVV I ile Depth No. of Trenches
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameters Liquid Depth Tile Size
Percent slope of land .3-Yb S I Distance 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, / 1
NAME Aennf3 P CAy-, T /jNee S710k C.S.T. # and other information
obtained from ( e, (owner/build er).
Plumber's Signature MP/MPRSW# N\ k-~ L' C' k Phone
Plumber's Address ? 1 I~ Ct i 17-C % y-) 1, • `,C ~I C I (r
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well). °
Plofx~
i( Well }U-
),0'
Seekic -fay
01
0111; 0
' M-ru F'
t, r
7 ~7 T~d<
C:U
Do Not Write in Sp ce Below FOR DEPARTMENT USE ONLY / D;✓ c + s
Date of Application - Fees Paid: State1 ou y OQ00 Dat 5 -
Permit Issued/~ (date) Issuing Agent M1 i re~~f~ r
Inspection YesNo Valid# Date Recd
1. count wh' a co 3. owner
y ( py) (green copy) DIVISION OF HEALTH P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revise