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Parcel 040-1201-10-000 01/13/2006 03:09 PM
PAGE 1 OF 1
Alt. Parcel 6.28.19.922 040 - 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 - FREDRICKSEN, SCOTT E & REBECCA A
SCOTT E & REBECCA A FREDRICKSEN
536 NORDIC LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 536 NORDIC LN
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.050 Plat: 2204-NORDIC HEIGHTS ADD
SEC 6 T28N R19W 2.05A IN NE SE NORDIC Block/Condo Bldg: LOT 01
HEIGHTS ADD LOT 1
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
06-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill M Fair Market Value: Assessed with:
103607 263,100
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.050 55,700 197,500 253,200 NO
Totals for 2005:
General Property 2.050 55,700 197,500 253,200
Woodland 0.000 0 0
Totals for 2004:
General Property 2.050 55,700 197,500 253,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 302
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 -F16~1 SEi', . (o .r-) R/F W
ADDRESS ST. CROIX COUNTY WISCONSIN .
SUBDIVISION LOT LOT SIZE
i
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 iEET DF SYSTEM
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14
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7~4
I di a e of t-h~-A-r}rro_w
SCAL :
SEPTIC TANK(5)r GR. G t; CONCRETE STEEL
NO. ,rings on cover -7- Depth 6
PUMPING CHAMBER SIZE PUMP MFGR. - MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of -Width length area
BED NO. of lines -3 width /21 length area
deptK-to top oT pipe
NUMBER OF SEEPAGE PITS -Outside diameter total pit area
AGGREGATE J
PERK RATE e16 5,~ / ARE REQUIRED 9 S?~; AREA AS BUILT }
Disclaimer: The inspection of this system by St. Croix County does not imply
complete compliance with State Administrative Codes. There are other areas that
it is not possible to inspect at this point of construction. St. Croix County
assumes no liability for system operation. However, if failure is noted the
County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM.
INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER T~ 3.~ 1/
Z RBPORT OF INSPECTION-INDIVIDUAL SEWAGE SVSTE6
San.itax y e mit -
S.tate Se p.t i
t
NAME rownah.ip - S~. Cxo.ix Cou
Locat.iorc Section _
SEPTIC TANK
Size ga.L.Lonz. Numbers ob Compaxtmenta j
Vi6tance Fxom: We.E.E 12% on. gxeatex mope 6.t
~ •
Bu.i.Ld.ing_ 6t. Wettand.6
H.ighwatex_ - it.
DISPOSAL SYSTEM
D.iztance Fnom: We.Et 12% on gxea.tex ztope ~ .
Bu.itd.ing_ Jt. Wez.Eande Ft.
• H.ighwatex it.
FIELD DIMENSIONS:
Width o6 txeneh it. Depth o6 xock below .t.L.Ee .in.
Length of each tine it. Depth os rock oven .t.ite .in.
Numbex o6 tine-6 Depth of t.ite below grade in.
To#at .Eength o6 tined j.t. Stope o6 txeneh in pen 100 it.
D.i.atanee between tines__ z. Depth to bedxock it.
Tota.i abaoxbt.ion area St2 Depth to gxoundwatex it.
Requited axea it2 Type of Covet: Papex ox Stxaw
PIT DIMENSIONS:
Numb ex of pits Gxavet axound p.ita yea no
Ouxa.ide d.Lametex it. Depth below .inlet it.
2
Totat abzoxbt.ion axea it A
Area xequkxed it2
INSPECTED $Y TITLE
r-.
APPROVED DATE 197.
_
REJECTED , DATE 197
'NN
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PH . 5 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:Z~'/4 ~'/4, Section -6,T-23 N,
FV_,LclE (or)( M Township or Municipality
Lot No.- Block No. ' C~ ~ l~~ ~ ~~C % <<~X
ubdivision ame County
Owner's/Buyers Name: 4, ale . i
c
Mailing Address: O : / c G E r %";L Ct'' •S+
TYPE OF OCCUPANCY: Residence X No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS A'2-7-
/
SOIL MAP SHEET a__? NAME OF SOIL MAP UNIT -_Z/5 /7/' Jc
_ PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- DEPTH CHARACTER OF SOIL SINCE HOLE BOLE AFTER INTERVAL RATE
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- St_ E= /~c"rte l L /~4' k •S/
P- Z;Q S' _3
F . 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- c
B- Y's I
B- A4, 1~2 t
16 ,C
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 Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
/har..e C .
C ke,-C \
4
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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.
0
Name (print) ~it1 C1< 5 ~t%r S ' t SE Certitication No.
Address ///r/ 'z
Name of installer if known
Copy A -Local Authority
- { ~oa~+aE 1y
State and County State Permit # y~o~s
PLB -67 Permit Application County Permit #
`r
for Private Domestic Sewage Systems County ~Jtr-tom
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: C Section T~o'N, R_Zj fr (or) &?Lot# _LCity
Subdivision Name, nearest road, lake or landmark Blk# Village
5 Township '
L C~
C. TYPE OF OCCUPANCY: 0mmercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons 411
D. SEPTIC TANK CAPACITY 0-00 Total gallons No. of tanks %
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concreted 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)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate !'U~L/ Total Absorb Area sq. ft.
New _X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X Length / Width/ Depth 'lA Tile depth (top) No. of Lines 51
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- 3 624,
Distance from critical slope
WATER SUPPLY: Private 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 Certified Soil Tepr, -
NAME D / d t,,s e.,v C.S.T. # S5 - 1.:rJ` and other information
obtained from s 1 (owner/builder ~
Plumber's Signature P/ PRSW# d Phone # - ~ 16 -7/
Plumber's Address
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.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTM9-,1.
Date of Application ~e / 1--,~Q Fees Paid: State//-/. az; CouDate
Permit Issued/R9ieeted (date) '/0 Issuing Agent Name C----
In
spection 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
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