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Parcel 040-1202-30-000 01/13/2006 03:23 PM
PAGE 1 OF 1
Alt. Parcel 6.28.19.934 040 - 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 - BARR, RICHARD A
RICHARD A BARR
535 NORDIC LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 535 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 13 NORDIC Block/Condo Bldg: LOT 13
HEIGHTS ADD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
06-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/05/2002 697267 2037/083 QC
07/23/1997 756/339
2005 SUMMARY Bill Fair Market Value: Assessed with:
103619 216,000
Valuations: Last Changed: 07/22/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 55,700 152,200 207,900 NO
Totals for 2005:
General Property 2.000 55,700 152,200 207,900
Woodland 0.000 0 0
Totals for 2004:
General Property 2.000 55,700 152,200 207,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 223
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
RI 1'0 1,,' 1 01 1NS1'I CTION INDIVIDUAL SLWA6t SySII- M
S a vt 4_ C1 it y P c it rn
;AMI~ Towvtabti-p Sx. Cn.o=<x Cuuvnty
at'tun ..5 -`'cctt.oYI ~j Lot Sabd.*v4-/si_on
I V] IC TANK
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ION S1I DIMtNSIONS
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P-LB67 State and County State Permit #
Permit Application County Permit # 42.
for Private Domestic Sewage Systems County -~-~f -
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
7
B. LOCATION: 1/4, Section, TN, RJ_~ E (or) 67 ot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF -OCCUPANCY:Com ercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms -574 No. of Persons_ _
D. TYPE OF APPLIANCES: Dishwasher _4. Y1 S NO Food Waste Grinder /DES -NO # of Bathrooms
Automatic Washer yS'ES _NO Other (specify)
E. SEPTIC TANK CAPACITY Total gallons No. of tanks
'Holding tank capacity Total gallons No. of tanks - _
New Installation Add it ion _ Replacement- Prefab Concrete 'Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) -1 2) r 3) Total Absorb Area sq. ft.
New_A,~'ddition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width f~Depth Tile Depth No. of Lines _I__
Seepage Pit: Inside diameter Liquid Depth Tile Size 44154
Percent slope of land y / 0 Distance from critical slope
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 Ceryi#d, Soi! Tester,
NAME C.S.T. # and other information
obtained from wner/builder).
Plumber's Signature -.!F
11~P/MPRSW# -Phone
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
Do Not Write in Space Below FOR DEPARTMENT USE ONLY y
Date of Application ._d3 -YU -Fees Paid: State County e c~ Date D - v? 3 p 0
Permit Issued/Rejected/ (date) -Issuing Agent Name _AJU
Inspection Yes~No 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 6/1 /76
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: SZ-'/a, Section N,R! LLr'(or) (U<-Township or Municipality
Lot No. , Block No. /V" "-,C, tS County
ff a ubdiw~n Name
Owner's/Buyers Name/: ei c I d ,
Mailing Address: l /~f [ fly d. 2-
TYPE OF OCCUPANCY: Residence-,'- No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW_L_REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS//-/
SOIL MAP SHEET NAME OF SOIL MAP UNIT-S/L') S/~ /fry S`l
PERCOLATION TESTS
I 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_ c'E' sue 117; i[rc'
P_ 3
P-
P- -
P_
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH 1-0 GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IIN' INCHES
B- 2, .'i II l[ a
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. 4 • ~fiG~f' /
Ali s c~ /%'s ~ • ~s fps ~ ~-d1l
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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) Certitication No.
Address 1AZC~ L L S U
Name of installer if known /
Copy A -Local Authority CST Signature Via. k ~t
IL _ ,
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REPORT ON INSPECTION OF SANITARY PERMIT #
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
e, ress, License No. o ins tar ing Plumber Time of Inspection
r
(3 )'INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN ermanent reference Point) escri e:
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 ❑ N0; 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.
Ii SEEPAGE TRENCH: Total length of seepage trench ft; width ft;
tile 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 ditche7; elevation of tangy, disrha-r 1?np :z^tnrinn s9epa
trench f,
12 Has system been installed in area indicated on EH 115*e LJYE:S U NO
(13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO
DILHR-SBD-6095 N.05/80
Signature of Inspector: