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Parcel 040-1117-10-000 06/20/2006 09:01 AM
PAGE 1 OF 1
Alt. Parcel 30.28.19.475E 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
JOHN H & GLADI E SIPPEL O - SIPPEL, JOHN H & GLAD] E
329 GLENMONT RD
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 329 GLENMONT RD
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.020 Plat: N/A-NOT AVAILABLE
SEC 30 T28N R1 9W 2.02 AC IN SE SW LOT 1 Block/Condo Bldg:
OF CSM IN VOL III PAGE 828 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
30-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 50,800 162,100 212,900 NO
Totals for 2006:
General Property 2.000 50,800 162,100 212,900
Woodland 0.000 0 0
Totals for 2005:
General Property 2.000 50,800 162,100 212,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 305
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
t AS BUILT SANITARY `;Y`;TEM 91-TORT
~A~
SEC.
TC,NSI; I ' SEC.,-)/,' _ Tr,N, R
~W
.d. AD S's' Z ST, CROIX CO WISCONSIN
''BDrViSION
LOT LOT SI `l.F.
PLAN VIEW
Distances b dimensions to meet requirements of 1162,20
SH W EVERYTHING WIT I 100 FEET OF SYSTEM
i
Sd t
JC TANK(S' QMFGR. CONCRETE STEEL
NO. of rings an cover Depth _ DRY WELL
k wS N0. of width length area
r0 tto., of no.410 width ! length area
depth to tap of pie
aG CRATE -
AREA REQUIRED AREA AS BUILT
scial mer: The inspection of this system by St. Croix County does not imply complete
npliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no 113bilicy for
:item operation. However, if failure is noted the County will crake every effort to
termine cause of failure.
EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
AATED_ PLUMBER ON JOL43CENSE NUMBER
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitaty Penm.i.t
State Sep.t,ic~
NAME_______ rowna h.ip S;C. Cxo.ix County
Locat.ioR Section
SEPTIC TANK
Size gattonz. Number ob Compan.tmen.ts_ _ j
Durance Fnom: Wett )e1---Tf' 6Z. 12% of gteatex scope 6-t
i
Bu.itd.ing ! f. 6.t. Wettands 6.t.
H.ighwatex a 6t. R
DISPOSAL SYSTEM
D.iztance Fnom: Wett_jl n /X/ , S . 12% of gxeatex stope S-t.
Bu.itd.ing 46.t. Wettands Ft.
• H.ighwatex - 6x.
FIELD DIMENSIONS:
Width o6 ttench 6t. Depth o4 xock below •t-ite .in.
Length o6 each tine 6t. Depth o6 xock oven .t.ite in.
Numbex-o6 .i.ine.6 Depth o6 t.i.ie below gxade,,~,zltin.
Totat teng,th o6 t Inez it. S.tope o6 ,ttench in pet 100 6.t.
`Y
Di,6tance between tines Depth to bedtock
r y~ ~
Tota.C abz otbtion area- aTs 2 Depth to gtoundwatet
Requited area 2 Type of Covet: ( Pape:n ox Stxaw
PIT DIMENSIONS:
NumIbet o6 p.i.t,5 Gtave.i around p.i,tzs yes no
Outa.ide d.iame.tet S.t. Depth below .in.iet S .
- 2
Totat abb otb.tion area 5t A
Axea xequited 6t2
r
INSPECTED BY TITLE
APPROVED -,DATE 19 .
REJECTED DATE 197_
01
I
i
E,H 1.15 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
, TXN, R 1R E (or) W, Township or Municipality
_51j" , Section 3D,
LOCATION:
Lot No. , Block No. -County
ti Subdivision Name
Owner's Name: - b !rL
01.5
Mailing Address: ' E 1
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW rL ADDITION REPLACEMENT n
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET -act SOIL TYPE __-t ~.,i1
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
CHARACTER OF SOIL
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-/ 3, ~OrJE
P _Z 3160-
P 5 s 1 n
f ~1 SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B c 4 5
b < < 6 5A . eN - 45
B _ _42
At—
14 D
i 1
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) ,
Indicate on the plan the location and square feet of suitable are s. In cate number of squa fget cif`at33vri!~ji rea
needed for building type and occupancy. 1.5 _
or distances. Give horizontal and vertical reference points. n fcate slope.
-j - s _ - -
[P1 _ ?_y~(µ [yam{ I
1- f Q{~~JJ~11 f.j
1 t t,{'14/0
' ( GIY It
tit, C)
--v _ _
~ i ~ I ~ ~ I ~ j { i Z j• i
I, the undersigned, 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) Certification No.~
Address 01?
Name of installer if known
a
CST Signature
PLB 67 State and County State Permit #
71
Permit Application County Per iy # C Z
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:
B. LOG'ATION. X1_'/4 "/n, Section Tz_'N, R s' E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township''
r
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance/
Single family Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place er (Specify) - 9y - -
E, EFFLUENT DISPOSAL SYSTEM: Percolation Rate- -
- Y
f
Total Absorb Area sq. ft.
New - Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: LengtWidth_Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land 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 Tester,, ,
NAME rsT% C.S.T. # and other information
obtained from
"(owner/builder).
Plumber's Signature MP/MPRSW# Phone # 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 Spa Be pvv FOR COUNTY AND STATE DEPARTMENT USE ONLY f
Date of Application -c. Fees Paid: State ~iG Count? ;e Date
Permit Issued/R ' =twd (date) - E3C~ Issuing Agent Nam'ee:~, i L 7
Inspection Yes No State Valid# Date Recd y
1. county (wh to 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
J
77
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