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Parcel 040-1161-80-000 06/04/2007 10:57 AM
PAGE 1 OF 1
Alt. Parcel 25.28.20.630D 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 - KIGIN, THOMAS J & DONNA AVERY
THOMAS J & DONNA AVERY KIGIN
764 GOODRICH AVE
ST PAUL MN 55105
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.200 Plat: N/A-NOT AVAILABLE
SEC 25 T28N R20W PT NW SW COM W LN SEC Block/Condo Bldg:
25 A DIST 1152.7 FT S OF NW COR NW SW TH
N 42 DEG E 367.1 FT,TH N 2 DEG W 103.3 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT,TH N 16 DEG W 352 FT, N 68 DEG E 25 25-28N-20W
FT S 16 DEG E 357 FT TH S 2 DEG E 159.3
FT,TH S 11 DEG E 111.3 FT, TH S 22 DEG E
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1086/366 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.700 417,500 154,300 571,800 NO
Totals for 2007:
General Property 2.700 417,500 154,300 571,800
Woodland 0.000 0 0
Totals for 2006:
General Property 2.700 417,500 154,300 571,800
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
4-
` Wisconsin Department of Health and Social Services
3/70 Vilri.ion of Health
SEPTIC TANK PERMIT APPLICATION
TYPE or USE BLACK INK 6.1 tC Z' I
A. OWNER OF PROPERTY % / 1 G'~ 1 l` f~
Name Address (Street, city, zip code)
Be LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED` OR EXTENDED X
COUNTY
Check One=
CITY VILLAGE ELEG DESCRIPTION may/ L l~ 7 ~G'
TOWNSHIP
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? _ YES NO
7( PERMIT NUMBER,
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other
Humber of Persona to be Accommodated Number of Bedrooms Specify)
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer i~ Yi;S NO
Dishwasher _ YES NO Automatic Potato Peeler YES X NO
Other (Specify)
G. MASTER PLUMBER MAKING INSTALLATION
Name: Addresst
License Number:
s
Signature of Applicant: MP RSW
Address: ' ✓YL 4 - _ /.F y~ `G :t'/ _
H. (To be Completed by Issuing Agent)
Date of Application Z' Fee Paid /iri
,I r
Permit Issued (date / i l Permit Number
r
Agent (Name) For:
Town, illage, City, County" etc.
(Specify)
Note: The application cannot be considered for filing until all of the 40ove questions are answered and the
fee paid. Agents will forward application, the fee of $1.00 for each septic tanK and the tnird copy
of the permit (canary.' to the Division of Health. Checks and money ordars s:o;ad be made payable to
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED I~ C ACCEPTED BY RETURNED
(Initials) ? (Date) See Cor s.lj
FEE RECEIVED VALID. Noe a PERMIT NO. J l~p /
tYes or No
I REVIEWED BY APPROVED DATE /
(Initials)
Yes or No
COMPLETE OTHER SIDE
SEPTIC ?1NX PLRMI? NO: u:
`F V
R I P 0 R T O N S O I L P Y R C 0 L A T I 0 N T 9 S T }
„ A N D S O I L B O R I N G S -
TO
DIVISION OF HEALTH - PLLHBING SECT16M
P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code R
a
'r
h
P S R C 0 L A T I 0 N T T S T
Test Depth Character of Soil Hours Water Test Time Crop in Water Level InOheS Minutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to 1 Next to Last To Fall
lst Wetted Overnight in Minutes Last Period Lant Period Period One Inch
r-xample
P - 0 3611 To Soil 10",--C la2511 25 Yes or No 30 1/2 / 1/2 1/2 60
/ jam., ,}~y r.' i~ _ ~ ~ ! C ~ L. ~Z C ~z C G-
12-
RECORD DATA FRCM M LNL,`UM OF 3 TEST HOLES
Computs size of absorption area in accord with H 62.20 Wis. Administrative Code.
,
S O I L B 0 R I N G S- Minimum 3611 Below Pro osed Absorption System
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Soil with Thiokness in Inches
P.xaaple
B - 0 721, 7211 Black To Soil 12" Clay 18"• Sand 1811• Gravel 2411
~///i i(I` ~ rel. ~.•1!
T7
RECORD DATA FROM MLNL`iUM OF 3 BORE HOLES
YPE OF OCCUPANCYs
RESIDENCE: Number of Bedrooms OTHERS (Speoify) Number of Persons
FOOD WASTE GRINDERS Yes No Dishwasher: Yes es No Automatic Clothes Washer: Yes .'k No
FFUIENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMM
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
Seepage Pits Inside Diameter Liquid Depth
I, the undersigned, hereby eertif`r that the percolation tests reported on this fors were made by me or under my super-
vision in acoord with the procedures and method specified in Chapter H 64.20 (13), Wisoonsin Administrative Code, and
that the data recorded and location of test 'notes are correct to the best of my knowledge and belief.
NAME TITLE lei, -7 A
Type or Print
r a
REGISTRATION NO. or MASTER PLUMBER LICENSE NO.
ADDRESS
DATE SIGNATURE F
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h
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