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Home My WebLink About040-1201-60-000 n cn O 9-0 n r~ d `r1 m o ~ 3 m m v ~ d 3 3 co -1 2 N z n O N N O O G O A N O N tD CNO n CO O .`J N d. tD Z CL zi- N O W N ..y ap 7 O W O O CO O C:L N (D y N C) :3 N°' O ° ° -4 C) N ° c" 3 P CD y N o o O. c uy ( D m cn m N a ~ c 3 m W o a ~ I O o o w V _ N CD co o C co co O CD co cc) N O O N (p 0 C I N ' d z Oc OC OC 2 lhli O -1 _ O rn Z ~E' < G C c - o o n~. 0 :3 0 m m v com = N w y cc N ~ d O N 7 O Q) CL Z N ZWZ D CD O O m O O_ -b o' (D !r . O (n m coo m O N N - ~r C (D CD W p d a 3 O O ja Z CD n 7 A z O N n 6) F! O Z N O) ca -0 m00 O CD z O rt (n 3 m co N Z (D ? A ~ v D CL CL CL CL C = n o v :3 -n m c ° o a 0 S N (D fD 3 Ar N A O O A A I A i ~ ti I W N O O a A ' O_ 0 b N U'Z O O E» O O ~ Parcel 040-1201-60-000 01/13/2006 03:32 PM PAGE 1 OF 1 Alt. Parcel 6.28.19.927 040 - 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 LINDA K ANDERSON O - ANDERSON, LINDA K 371 TOWER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 371 TOWER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.190 Plat: 2204-NORDIC HEIGHTS ADD SEC 6 T28N R19W 2.19A LOT 6 NORDIC Block/Condo Bldg: LOT 06 HEIGHTS ADD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 03/29/2004 757973 2536/427 QC 2005 SUMMARY Bill Fair Market Value: Assessed with: 103612 226,900 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.190 55,700 162,700 218,400 NO Totals for 2005: General Property 2.190 55,700 162,700 218,400 Woodland 0.000 0 0 Totals for 2004: General Property 2.190 55,700 162,700 218,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT O RESS ~ I , TOWNSHIP SEC. (_T~YN, Rj~W Ar ST. CROITCOUNTY WISCONSIN. ~BDIVISION / s LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN loo tEET OF SYSTEM ~ i C c' ~ L.y ~G Y Vl I di a e o,th! Arrow ' j SCAL : ~ SEPTIC TANK(S) j GR. ~c~~US,rr':s CONCRETE A STEEL NO. o rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. 0 NO GALLONS Per Cycle TRENCHES NO. of width length area BED NO. of lines 9 width length YZ area Y.74, depti to top or pipe NUMBER OF SEEPAGE PITS Outside diameter total pit area AGGREGATE PERK RATE e le, s s % ARE REQUIRED AREA AS BUILT s- 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 , 3.~/ ' REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanit,n-y PF.Amit State Se p~ i.e 0E Town,5 hip _St. CAOtix Couvntil cation Section ~Lo SubdtivFh i.on SEPTIC TANK Sti ze gat Eo nos Numb eA o6 eo mpaAtment5 Di6tanee {nom: Weef Bui dting 120 5tope HtighwateA PUMPING CHAMBER Size ga lons Pump Manu(,aetu,ceA Mode.Y NumbeA iIOLOINu TANK Size ga fon3 Numbe.A o6 CompaAtment/s Pumpe"L AtaAm System _ Dilstanee (,nom: Wet. , Buitdting 12% sfope_ _ Htighw ateA ABSORPTION SITE Bed TAeneh Di/5tanee (,AOm: WeU Butif-ding 12o sf-ope HtighwateA ABSORPTION SITE DIMENSIONS Width o A tAeeh At Req uiked a~Lea_ At Length o{ each Ztine At Depth o(, Hock be.Eow tiff tin NumbeA oA Unes Depth o(, Aock oveA ttite in Total length o(, ftine/s At Depth o(, Cite below gAade tin Di6tance between Une6 At Shope oA tteneh in. peA 100 At Totat absoAption area _ At Type o(, Covet: PapeA oA 6VAaw PIT DIMENSIONS 1:~~ NumbeA o(, p. is GAavel atound ptit6 ye.5 no Out6.tide dtiameteA. At Depth be. ow tinUt Total ab6oApttion aAea At AAea. Ae.qutined (,.t INSPECTED 6V _ TITLE APPROVED DATE 198_ REJECTED DATE 198 REASON FOR REJECTION REPORT ON INSPECTION OF SANITARY PERMIT # (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Time of Inspection Name, Address, License No. o ns a ing plumber (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth.; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; the depth ft; ft to well; ft to ordinary high water mark of 'lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: State and County State Permit # PCB 67 Permit Application County Permi # 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: haai B. LOCATION: '/4, Section , T,---2k N, R-&~ k (or) Lot#' '467 City Subdivision Name, nearest road, lake or landmark Blk# Village ) L Township r0 C. TYPE OF OCCUPANCY: *C mercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms -No. of Persons D. SEPTIC TANK CAPACITY 1300 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X 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 ('-1655 .4 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: Length Y& Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 2- ~l Distance from critical slope WATER SUPPLY: Private (X 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 Tester, NAME Vet x .v if -'14 &a~ e,' e ti C.S.T. # and other information obtained from 3 , (owner/builder . Plumber's Signature z r MP/ PRSW# -2 -4 Phone # Plumber's Address 3ey+ er/Z-L, S'L a s~'I. _e lb e b 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. i i i } E t ( m em t m p @ «t e ' r E 3 Do Not Write in Space Below ``ll FOR COUNTY AND STATE DEPARTMENT USE ONLY Yo Date of Application Fees Paid: State/-//, County frV Date d d o Permit Issued/Re}ee+ed (date) ~/Q Issuing Agent Name s" Inspection YesXNo 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 L_-- I H 115 Rev. 9178 REPORT ON SOIL BORINGS AND PERCOLATION TESTS - WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:Y ' %,_!L%, Section ,T,2L4 N,R19'(or) K__Jownsship or Municipality Lot No. , Block No. /`c c~~" (4•' `C /T f'i~~ l /--s- County ub iwsion Name Owner's/Buyers Name: 4/d/ Zv, Mailing Address: ~C~ .C!• /t`1h1~i4 /'1.`c'-F, f~llS tL', s : S YO TYPE OF OCCUPANCY: Residence X, No. of Bedrooms `r COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS `'2 7- ?y PERCOLATION TEST /L' mac' 7 SOIL MAP SHEET NAME OF SOIL MAP UNIT A119 ///'//0Z -SIX PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE iJUM INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIS!/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 c= P- Sc P- 2- P- P_ P_ P_ BORING TESTS SOIL 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- 6, c B- Z y S B- 3 /LA~C'a(E PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the to ati_on 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 refere~n//ce points. Indicate slope. 1O 44 P11 7 Tec`, p C S ~W N itch' f _ w • § ~ r e _J _4 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) /Z/c~ t ` Certification No. S ! Address /I4 ` .Name of installer if known Copy A - Local Authority CST Signature - C1'1 j i Cl'> IV< CA