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Parcel 040-1203-70-000 12/28/2005 09:21
PAGE 1 OF 1
Alt. Parcel 35.28.19.943 040 - 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 - NECHVILLE, JEROME A & SUSAN
JEROME A & SUSAN NECHVILLE
19 DRY RUN RD
RIVER FALLS WI 54022
II
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 19 DRY RUN RD
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.520 Plat: 0164-CERNOHOUS ADD
SEC 35 T28N R19W 1.52A CERNOHOUS ADD LOT Block/Condo Bldg: LOT 07
7
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
35-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
103628 202,400
Valuations: Last Changed: 07/22/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.500 41,200 153,600 194,800 NO
Totals for 2005:
General Property 1.500 41,200 153,600 194,800
Woodland 0.000 0 0
Totals for 2004:
General Property 1.500 41,200 153,600 194,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 303
i
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 J c h~z ~Y / % i / t TOWNSHIP 7i - t SEC. T - N, R% W
ADDRESS ST. CROIX COUNTY WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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SCALD : ~ I I C~-~
SEPTIC TANK(S) /L F MFGR. CONCRETE / STEEL
NO of rings on cover '3' Depth
PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of _ width length area
BED NO. of lines width ~.~length j area '7 1;
dept to top o pipe b
NUMBER OF SEEPAGE PITS -Outside diameter total pit area $
AGGREGATE
PERK RATE / AREA REQUIRED ! ! 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 I,/_~ ~•Z4 (Z 1z
LICENSE NUMBER ;3~
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REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
=f~
I -San.i.tanc Pe.nm.i.t -
State Septic,
NAME rown6h.ip S Cno.ix County
Location Section
SEPTIC TANK
Size ga"CQon6. Numb et 06 Compattments_Z__
Vistance Fnom: Wett 121 on greaten .mope 6t
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k Bu.i.Ld.ing it. Wet and.6
H.ighwazeA - R
DISPOSAL SYSTEM
j Distance Fnom: We.b.t it. 12% on gneateA scope it.
Bu.itd.ing St. W et.band.d Ft.
• H.i,ghwaten 5t.
FIELD DIMENSIONS: Width aS tench it. Depth o6 rock below z.ite .in.
Length of each tine ± it. Depth o6 rock oven t.ite in.
Numben. o6 tines Depth os -t.ite below grade .in.
Tozat, teng.th o6 tined 6t. Stope o6 ,trench in pen 100 it.
Distance between tines 6t. Depth to b ednock
Totat ab.s onbt,ion area 6t2 Depth to gtoundwateA
Requited area it 2 Type a6 Coven: Papen oA StAaw
•PIT DIMENSIONS:
Numben o6 pits Gnavet around p.it6 ye.s no
Outside d.iameteA it. Depth b etow .in.Let it.
2
To.tat abzonbt.ion area it Az
Area nequkAed it2
INSPECTED BY TITLE
APPROVED DATE 197
REJECTED DATE 197
M
Now
i EH 115 (11-74)
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
` DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
r MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: Section , T_N, R _ E (or) W, Township or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET _ SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL IN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 M
P-
P-
P-
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-
B-
B-
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give reference point. Indicate slope.
t N
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) Signature
Certification No.
Name of installer if known
Copy C - Local A€ --thnrity
PPP-
State and County State Permit #
PLB
67 of Permit Application County Permit '
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:
j~ r; r h%~ L A . I ft ; r r ! z. I IS > ~i x
B. - LOCATION: '/4 S G Section L-,~, T 2-Y N, R 1 E (or) N Lot# City
Subdivision Name, C-0 Y A C h nearest row lake or landmark Blk# L r-y fiJ n. i%1 Village
Township v-, .
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-PlaceOther (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate =Total Absorb Area f } -`s sq. ft.
New Replacement Alternate (Specify)
Seepage Trench:AA -No. of Lineal Ft. IWA Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length 'TWidth--Depth ' Tile depth (top)No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land - x Distance from critical slope i t -c -rte
WATER SUPPLY: Private KI 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 ( ct~ l . C.S.T. # 2,2 7 and other information
obtained from (owner/builder).
Plumber's Signature cz~ MP/MPRSW# i9cam Phone
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 DEPARTMENT USE ONLY P.
Date of Application , / - t l- Fees Paid: State i County Date'
Permit Issued/Rogect6d (date) Issuing Agent Name 1 i
Inspection 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) - q plumber (canary copy) Revised Date 7/1/78