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Parcel 040-1050-20-000 10/03/2006 05:06 PM
PAGE 1 OF 1
Alt. Parcel 12.28.19.1848 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 - NOLEN, THOMAS D & CYNTHIA M
THOMAS D & CYNTHIA M NOLEN
833 COULEE TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 833 COULEE TR
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 4.450 Plat: N/A-NOT AVAILABLE
SEC 12 T28N R19W 4.45 AC IN NE SW LOT 1 Block/Condo Bldg:
OF CSM IN VOL II PAGE 524 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/07/2006 822347 QC
09/11/1998 586916 1356/394 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/19/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.400 68,000 209,700 277,700 NO
Totals for 2006:
General Property 4.400 68,000 209,700 277,700
Woodland 0.000 0 0
Totals for 2005:
General Property 4.400 68,000 209,700 277,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 123
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
A S B U I L T S A 11 1 T A PL Y P E P 0 R T
01r1NER : 4 Township , Sec ~~Tn. Pd, R T' .
P.Q. ADDRESS:-_~__~ Pierce County, ti^lisconsin
Subdivis-on Lot Lot
PLA;J ~1
Distances & dimensions to meet requirements of Sec. N62.20
(,P)00 vi
ye
ov0 i
d
-s7 fl
Septic tank(s)9, ?Ifgr.-~~ No rings__LZ- , Dept to cover
Dry well size Type of Aggregate Covered
Depth of seepage system
DISCLAI177R: The inspection of this system by Pierce County does not imply complete
compliance with State Administrative Codes. There are other areas that it is impossible
to inspect at this point of construction. Pierce County assures no. lability for systerr
operation. ` i
IN SPEC TOR - _ ~ •
PLUMBER ON JOB: DATED: LICENSE ?'`I3rH:
.
r 'cam1,~.
'RFPOI;T OF ITISPI:CTIO?I--I:4DIVIlliJAL SE ~L,,JAGL llIaPOSi'1,I, oTEI1
Sanitary Permit
• State Septic
T&WNSHIP
• t. Croix County
S'JRPTIC TA'?JC
Size gallons. 'umber of Compartments
Distance From: Tlell s ft, 12% or greater slope ft.
r Building' ft. Wetlands f
Highwater ft.
DISPOSAT, SYSTL:i T Tile Field or Seepage Pit (s)
Distance From: well ~ ft. 12% or greater slope ft
t Building; ft. Wetlands f:.
FIE6 Hipt~ ~water ft.
_ r, .
Total length of lines ft. dumber of lines < n , Length of
each line
ft. Distance between lines
ft. Width of the
trench '•~ft. Total absorption area sq. ft. Depth
of rock below tile /'2- in. DP_pth of rock over tile in. Cover
ever rock, Depth of tile below grade ~G in. Slope of
-
trench in per 100 ft. Depth t;o Bedrock /A- ft. Depth to
ground water i- ft.
PITS
Number of nits Outside diameter ft. Depth below inlet
ft. Gravel around pit: `yes no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
Iquare feet of seepaj..e pit area ,.required ,
• ~cr-.._:.L.~ i.- / ui
7
Inspected-Sy. Title ~
Approved J .Date 197.
Rejected Date 197.
State and County State Permit #
PLB67 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:
- 1-7 ~dcls icy
B. LOCATION: 5~1/4, Section, TAN, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
_~~~`'G~X ~ Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Y Duplex No. of Bedrooms V~ No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms
Automatic Washer AYES NO Other (specify)
E SEPTIC TANK CAPACITY Total gallons No. of tanks
'Holding tank capacity Total gallons No. of tanks
New Installation x Addition Replacement Prefab Concrete X
`Poured in Place Steel Other (specify)
1-_ _FFLUENT DISPOSAL SYSTEM: Percolation Rate 16)_? 2j z13) Total Absorb Area sq. ft.
dew Addition _ Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length4~0_Width ! Depth Tile Depth cod 11 No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land Distance from critical slope
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 < Y ~S C.S.T. and other information
obtained "from 7-7-9? U A7 (owner/builder).
Plumber's Signature MP/MPRSW-6E,"_ Phone
Plumber's Address OAe~
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
R
a~ ~
~e
o
Do Not Write in Spac Below r/FOR DEPARTMENT U E ONLY
Date of Application rJ Fees Paid: State G 06) Count ---i Date y p07 'f
Permit Issued (date'_Issuing Agent Nameit--;~ GC
Inspection Ye 7 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)
I - Revised Date I'
EH Rb (11-7
• 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
LOCATION: '/4, '/4, Section TN, 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 PERCOLA 0IN TESTS
SOIL MAP SHEET SOIL TYPE IV61~
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 71 PERIOD 2 PERIOD 3 MIN/IN
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-
i
PLAN VIEW (Locate percolation testssoil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of squ r~ft &bs;1-l;&n area f W
needed for building type and occupancy. Ane4t Ie~
or distances. Give reference point. Indicate slope.
/_I C
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
f Copy C - Local Authority