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Parcel 040-1044-60-100 06/01/2007 04:14 PM
PAGE 1 OF 1
Alt. Parcel 10.28.19.147A-10 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
03/21/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - JOHNSON, LARRY W & JUDY M
LARRY W & JUDY M JOHNSON
699 COULEE TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 689 COULEE TRL
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 26.112 Plat: 5177-CSM 20-5177 040/06
SEC 10 T28N R1 9W PT NE NE & PT SE NE Block/Condo Bldg: LOT 01
BEING CSM 20-5177 LOT 1 (26.112AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
10-28N-19W SE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
03/21/2006 821149 20/5177 CSM
08/10/2005 802997 2863/336 QC
08/10/2005 802996 2863/326 TI
07/23/1997 1210/273 WD
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/28/2006
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Health and Social Services
P1'L9 #67 10/69 Division of Health
• PERMIT APPLICATION
for
PRIVATE DUiFSTIC SEWAGE SYSTEMS
A. OWNER OF PROPERTY TYPE OR USE BLACK 1NK
Name Address (Streets City, Zip Code) n ~--Q1 ~
County
B. LOCATION OF PROPERTY _WIIl P SYSTEM WILL BE CCNSTi=TED, ALTER:.D OR EXTENDED
Check One: - ~~Ci ✓ asf V~l"~ ~ J~.~~
CITY VIU.AGE LEGAL DESCRIPTIONS
TOWNSHIP
C. IS LOCAL PERMIT REQUIRED FOR THIS iO C? YES NO J 1 PERMIT NUMER
D. SEPTIC TPNK CAPACITY Gallons NEW INSTALLATION REPLACEI~IL'NT ADDITION
MA'T'ERIALS: Prefab Concrete Poured in Place Steel Other
NUI~"i3ER OF TANKS TO BE INSTALL,
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commeroial Industrial Other
1 (Specify)
Number of Persons to be Acoorunodated Number of Bedrooms
F. APPLIANCES, ETCs Food Waste Grinder YES NO Automatic Clothes Washer YES NO
Dishwasher YES NO Automatic potato Peeler YES NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT
Tile Size Lf No.Lin.Feet Trench Width Depth Number of Lines
r~
r
Seepage Beds Leng:h f Width ~Depth a~y Tile Size No. Lines
Seepage Pits Inside diameter Liquid Depth
P E R C O L A T I O N T E S T
Test Depth I Character of Soil Hours Water Test Time Drop in Water Level Inches NLnutes
Number Inches i Thickness Ln Inches Since Hole in Hole Interval Second to Next to Last To Fall
1st Wetted Overnight in Minutes Last Period Last Period Period One Inch
Example
~P- 0 35" To Soil 10" Cia 2b" 25 es or no 1 30 1/2 1/2 112 60
r _
S,41 li
RECORD D?TA FROM MINIMUM OF 3 TEST HOLES
ompute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L B O R I N G S- Minimum 36" Balow prop osed Abso r ion System
_I
oring Toto-1 Depth Depth to Grcund Water Depth to Bedrock
umber InChHS Observed Esti-ated Observed Estimated Character of Soil with Thickness in Inches j
x=ple -
- 0 721' 72" Blaok To Soil 12"• Cla 18"• Sand 18"• Gravel 24"
7 2-
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
COMPLETE OTHER SIDE
Is 'the undersigned, hereby certify that the percolation tests reported on this form were made by me
or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and tha-; the data. recorded and location of test holes are correct to
the best of m~y~knowledge )an~d belief.
NAME ~`irI LLB A P S T I T LE
Type or Print)
REGISTRATION NO. or MASTER PL!Jt3ER LICENSE No.AeZ L(I lG~~"y
ADDRESS C
DATE / D SIGNATU~~~-L -
MASTER PLIn'DER MAKING APPLICATION h
MP
Signature: /'li+~~7~~✓~ License Number:
-e~ MP RSW
(To be Completed by Issuing Agent)
Date of Application ~U Fee Paid $ /
Permit Issued W-6 ) Permit Number le O
Agent (name) For:.
Town, Village, City, ounty, etc.
(Specify)
Note: The application cannot be considered for filing until all of the above questions are answered
and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
Do not write in space below - FOR DEPARfPENT USE ONLY
DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) (See Corresy
FEE RECEIVED VALID. NO. PERMIT NO.
(Yes or No)
REVIEWED BY APPROVED DATE
(Initials) (Yes or No)
COMMENTS: