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HomeMy WebLinkAbout020-1135-60-000 ~ I M 03 e°a I °i N 4 o h N n O U 01 A I I ~ I z C LL c 0 c 3 , I ~ a Cc M a m E z ~ € d a H z a m o I ozg a~i Z a c fn F- r c E Z 2 •p Cl) N CM C N N y~ N CO a 1 a ° o a) v z co z o N a Z d 04 ) N O CL C o D O d ~ !r w LO co co trro v> > p w o n.m O O • N ~ IL CL IL c o y m rn v, co J U = rn rn D Cl) 3 O ° 9 E D (D > m C CL cn 4) CD a? 00 O N C O ~~y °o co v a o co Cl) r \ O (OG i, L Y C- 1 M t2 - (D ce) v Q ~ O n- p C C a T M W cc N 0 U N 3 n N 7 00 O FN O N pMp r Z` C L VJ f0 l4 • O O N= fn O z C (n C~ I y a. V1 a a IL • e~ a m m "~1 A ca~ !Ovid t Parcel 020-1135-60-000 12/07/2005 02:06 PM PAGE 1 OF 1 Alt. Parcel 20.29.19.666 020 - TOWN OF HUDSON Current X I 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 - PETERSON, RICHARD A & BETTY J RICHARD A & BETTY J PETERSON 438 VALLEY VIEW RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 438 VALLEYVIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.410 Plat: 2624-WILLOW RIDGE 2ND ADD SEC 20 T29N R19W WILLOW RIDGE 2ND ADD Block/Condo Bldg: LOT 57 LOT 57 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/30/2001 655237 1709/557 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 92538 288,400 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.410 62,800 231,300 294,100 NO 05 Totals for 2005: General Property 1.410 62,800 231,300 294,100 Woodland 0.000 0 0 Totals for 2004: General Property 1.410 32,300 203,000 235,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 111 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 - I- V • FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / 17St/ 1q- el TOWNSHIP T G~~ 0/t/ SECTION Z e T~J /N-R + • to&b ADDRESS -X13,-' 2l ale 4/IE~C~J A%+1.-6R-OIX COUNTY, WISCONSIN SUBDIVISION ~~~l1 LOT LOT SIZE C)ZO ^ I I) s -(o(~ -CCU p PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 014 S ter, ~?D~UCrn VAIV R. 1 a kK i w 9 y„ y 9 J CIA sst,,, 0L i 94 91 3 J n F INDICATE NORTH ARROW BENCHMARK: Elevation and description: ljci IQ C,Olocge G IVa, G Alternate benchmark ll SEPTIC TANK: Manufacturer: US\-c1 Liquid Cap. 6JO ~Aj Rings used:i_Manhole cover elev: (o Final grade elev: w ~o Tank inlet elev.: Ll Tank outlet elev.:Iy(%~ i No. of feet from nearest road:Front , Side, Rear Ft._ From nearest prop. line:Front , Side , Rear_~<_Ft. 3a No. of feet from: Well -R.S/ , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear-Ft. Distance from: Well Building U So SOIL ABSORPTION SYSTEM 1 13 j F"' 4~ y a . 3 Bed: Trench: Seepage Pit: Width: (r~ Length 3 Number of Lines: Q Area Built Exist. Grade Elev. 9'f.0 Q) Proposed Final Grade Elev. Fill depth to top of pipe: G1 7 i No. feet from nearest prop. line:Front , Side, Rear Ft.~ No. feet from well:' No. feet from building r~ HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front Side Rear Ft. No. feet from: Well , building nearest road Alarm Manufacturer: INSPECTOR: w p DATE:- c of 3 g PLUMBER ON JOB : C3L(~' LICENSE NUMBER: 3 y 6/90:cj • 1 / r ` DE^RTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON WI 53707 State Plan I.D. Number: NE . N. W3l-, Sec . 20 , T29-R19 El CONVENTIONAL El ALTERATIVE (If assigned) Town of Hudson Lot n7 Holding Tank ❑ In-Ground Pressure ❑ Mound INSPECTIO NAM "OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: Phil Sti-bbe _qv BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF PT. ELEV.: CST REF. PT. ELEV.: V 0 J'Q Name of lumb M RSW No.: County: Sanitary Permit Number: L Jim Boi1mc-_P_,qt-P_r Z' SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: Via ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LIN AIR INLET: o~~ y ❑ YES ❑ NO ❑ YES ❑ NO NEAREST---* DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO Y: PUM ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS JR ION NUMBER OF PROPERTY WELL: BUILDING: VER TO FRESH AIET: (DIFFERENCE BETWEEN FEET FROM LINE: PUMP ON AND OFF ❑ Y NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the dept O pl wi F R LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shal ce un I AIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: MA ERIAL: PIT DEPTH: DIMENSIONS ' l f") i GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIP MATERIAL: 0. STR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH q r LINE: AIR INLET: BELOW PIPES: ABOVE COVER: E V. INLET: ELEV. END: G PIPE : FEET FROM - a 1 NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. OBSERVATION WELLS; SOIL COVER TEXTURE: PERMANENT MARKERS: ❑ YES El NO El YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER, F PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST-♦ `k * yi e r tr'' 14- •r)~,, /0. o .a-: i_F.1- - tip rte:. 4.: f Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITL . SBD-6710 (R. 06/88) ` ~r ,-SANITARY PERMIT APPLICATION E 1 hLR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ^ STATE ANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than / S'i 8% x 11 inches in size. El C/ea via n /pre sous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION '/s '/a, S T , N, R E or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK 111G \1 r Ir t R CITY, STATE ` t ZIP CODE PHONE MBER SUBDIVISION NAME OR CSM UMBER N II. TYPE OF BUILDING: (Check one) NEA ST ROAD F1 State Owned VILLAGE ; kjk~ D S ❑ Public 01 or 2 Fam. Dwelling4 of bedrooms. A ICU TAXI e O ©aU _ _00,.0Q III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2.54 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) !l ELEVATION so Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistln Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber, f C Vill. RESPONSIBILITY STATEMENT - I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: 9 Plumber's Address (Street, City, ,State, Zip Code) , JC, IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing Agent Signature (No Stamps) Surcharge Fee) ! Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS OR DISAPPROVAL: f . l_+'Ct,.✓ ~ ~ v~~ ' J}. l' y !-L i ~ t 7) . -T)"t. , fir. ~ -t' C...l°_.a i-' c-• r < dad SBD-639 ormerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber DfPARTMEN`T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INi)US,RY, DIVISION P.O. BOX 7969 LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) MAUISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION : TOWNSHIP/M44N1E.tPAt-t'I'Y: OT NO.: dLK. NO.: SUBDIVISION NAME: N Tz-i N/Rid o W /Jinn S7 ~'e .Zwo _ 1L COUNTY: WNER' E: AIL a ADDRESS: i; t_~OI)f u1C CTI$g~ 4?8 N//IL-E'/ VIEW )~Ck /YIJ1~'~•~ti VV// USE _ DATES OBSERVATIONS MADE ( TWK).8E o TIO : r}~ PROFILEDESCRIPTIO TS: ~XJResidence I CitNI~ _ CI Now sl3iRePiace I r d Nrr.. J 7 Bk kNrt2bT 'Soft.-. ~K- PG '3a S01(6 RATING: S- Site suitable for system U- Site unsuitable for system M U OLDI U A KI RECOMMEND60 SYSTEM:(opllonal) [JU r S S ❑U S ❑U S ❑U ❑ S,~,GNi~_ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: CLASS Floodplain, indicate Floodplain elevation: Nf-c t PROFILE DESCRIPTIONS BORING TOTAL DEII, R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHW. ELEVATION B E V EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B q.,'? _q , 23 NE >9• ~7 6'$« z9""$RNSL t''i', l_ q';?,;`,,r,` i~)S-Efjr~ 8- 6 P- B- Z 6'9 97.SU tic) Ni~' ~i //-Oa Z(w L 24"9L Q7 $PNKr-4,p 13- .4 ~i4►v 1tl j NOnfLe ' T- 25 h.~r15~L 68~01:NMS1iAQ3~ QNr~~ 13~~` (r PERCOLATION TESTS T DEPTH WATER IN HOLE TEST TIME DR I WATER L V INCFLES RATE MINUTES NUMBER WQSLES AFTERSWELLING INTERVAL-MIN. PERIOD I I PER INCH P- 3 3-90 o q~.4 ? > Z > Z 3 P- _ ELEV_ATION A-r GRC. _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori• rontel and vertical elevation reference points and show their location on the plot plan. Slow the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION q ► S o o'iLj / 1~;/E X;IS11►J~e JLI ~tL a~~)~ItiMdQI.- FIW4Lr- P0lnfr: rN h (nn , OLTI L i P 4 :9 4 o` i -r,a N h✓fi5 ~ E t,Ci E or Co,4 c o cr ID ! z5 L a: .7 ~g.Z c.rA -77 736 27 Ib. kv-jF-WAY \ P3 I R,,- i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures anti Fnethods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowlndge and belief. NAME print : TESTS WERE COMPLETED ON: Q,/ &N pIJrJSON 'K Scl4i l , CERTIFICATION NUMBER: PHONE NYMBER(optiunal): ADDREES: 46? SCLC0NL, X4,3 -1GY,c) CST SIGN T URE Z DISTRIBUTION: Original and one copy to local Authority, Piopnity Owner rind Snil Testa. ~l DILHR•SBD-6395 (R. 02/82) - OVER I? Q. PLoT A H N A M N..A.M E ~i k~L 0CAT 10 N ',la R.u? , L [-IC E NS E:/f 1) A YO PLO 0p 7b 100 ~k 1 S I 1 N~ !L 1+~ ,S.p~,~~ G 4 ,S Se'N L NAP, : will ~ s 30 7Y ~f ~sfir>>>r~ '~Izair•, St~~jG SyS~ -A 6~~1 t V A5v e ; -1 7n d7• D&IVeWA 133 ~a~e c~ GaN cR~~ J> Q -W p) FRESH All'. INLETS AND OBSERVA'PIO0 PIPE C1t0SS SECTION Approved Vent Cap Minimum 12" Above i n SXF3S~G---`._ 9F~ A" Cast Iron Above Pipe Vent Pipe To Final Grade ay Or Synthetic Coveri.ng Marsh It Min. 2" Aggrcg'I;.~l o _ Over Pipe Distribution Tee » - I Pipe Aggregate _ Per-f.orat-ed Pipe Below Cncath Pipe Couh).ing Terminat:ing P I~'sbgd' h, RoLtom of System 1