HomeMy WebLinkAbout040-1020-50-000
A co O 3 v n
o d f c o A
C n
~ 3 - # y
~ ((may
n y O d 4: O O W O A C < [ J•
Q f7 O CL N
C
N 3 OFL
N Z
- O ti C
N 3 co
N 3 O t~U V7 ? C i"7
O -0 Q 7 rr CJ - O A C
fA N T O O
G a _ N
y u~ f D a
.'D o a v
v
m
n o
tv O - N co ct
Z m co cc m A r to
u w Li w o v ti
-ro G y H
1 4: r r
r vi fJ f~J7
7 1 O T
G t l
2
t
._j ur
Z
O- z co z p
zw~ (D
-Ti fl , d C D a a N
t C- (n h+ •
N Q
x r --1 cn
a D
a• ~,~,s -
W Z l - A. Z co
~_,1 7d m A Z 0
-4C) o
' W rn po
a z
n 3 a
Cf)
V. U-I
N
O a
c= O -
OJ 7 T1
~z a
G
7
O
N
OD A
rT
O
n
tv
~J
Q
a
C
~ ~ tJ
D J 00
n
ba O
CD b
0 ry \ t
r
Parcel 040-1020-50-000 0(,'21i2006 12:15 PM
PAGE10F1
Alt. Parcel 04.28.19.641 040 - 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 - THACKER, PATRICIA A
PATRICIA A THACKER
511 FRANCES AVE
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description " 511 FRANCES AVE
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.430 Plat: N!A-NOT AVAILABLE
SEC 4 T28N R19W 3.43 AC PT SE SE LOT 2 Block/Condo Bldg:
OF CSIW 5i'1335 ALSO PARCEL DESC IN VOL
765i93 Tract(s): (Sec-Twn-Rng 401;4 1601;4)
04-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
10!08i2003 742943 2431!131 QC
765i93
746i334
673122
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07! 15;2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.430 63,500 232,100 295,600 NO
Totals for 2006:
General Property 3.430 63,500 232,100 295,600
Woodland 0.000 0 0
Totals for 2005:
General Property 3.430 63.500 232,100 295,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 126
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
~Ar AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHI P SEC.' T N-R W
T r
ADDRESS ST. CROIX COUNTY, WISCONSIN.
i
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of t163
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~r
i Tnd at N .)r h 1rr w
BENCHMARK: (Permanent reference Point) Describe: f
Elevation of vertical reference point Slope at site:
- SEPTIC TANK4 Manufacturer: Liquid C:apacity:_ l,~=, llli
/,5TJNumber of rings on cover Tank manhole cover elevation:
Tank Inlet Elevation: > Tank Outlet Elevation1
7- f~ ~i✓ E_l /D/,~Eu7~/mar %c`.l )/i`
PUMP CHAMBER
Manufacturer: Number of gallons Number of gal. pump set for a cycle- ---gallons; Total capacity of
distribution l.ines_ gallon: size of pump head;
gallon per minute horsepower _ ;brand name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover
Type of warning device _
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet. {
SEEPAGE BED SIZE: number of lines--,-,,I width jam' length tile depth
SEEPAGE TRENCH: width, length_
PERCOLATION RATE , AREA REQUIRED ~ AREA AS BUILT ./~t,r
INSPECTOR
DATED% PLUMBER ON JOB lr~,u
LICENSE NUMBER J<
` /vo i j
~ti .
DRPARTM~NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LA6C4i & HUYIAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. 80X 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL _L ALTERNATIVE S1.1. PI- IC N"•.brz!
- Holding Tank U In-Ground Pressure C Mound
NAME CF PERr.11' HOLDER AGGRESS pF FFRr.1' tip _JER INSPFCT is". I:AT
Ph. Z Tad ~,yh G2 1 Oak Had•s on, wI
BENCH MARK IPr,m-"' I...--,_- 11 DESCRIBE F ) F-ERFNT FROM 1L4N '.I 1111
REF, PT, ELEV. - ! LL':
SE!-4 SF!, Section 4, T28N-R19W, Town v/ TAvy
N... PI~Ir.~, - - - w•,\u•H S+; . r. - - - - n.. v-v, -,»~NI, -n n~•--- - .
Cat PoweA6 1563 St. Cta.ix 43669
SEPTIC TANK/HOLDING TANK:
MANI, F AC.-UP FP ffn I101_:IU GAVACIIY [ANK INLE'=LEV. ANK OUT``6~7 ELEV. WARNING LIBEL LOCKING CCIVFA
( PROVIDED _ PROVInEG
u - , Z - YES -NO YES 7 NO
BEDDING VENT CIA. VENT MATL. HIGH IVATEH NUMB R,OF Rr'AC v IPFPOPERTY WELL BUILDING. 'DENT TO FRESH
AIR INLET
. / ALARM FEET FROM ILINE A. Z_
AYES INO JY, J I
ES UNO NEAREST
DOSING CHAMBER-
1,11M Ur ACTT IP [If j tIrJ1. L1 :JID C• AC' PI Moo vlr!/~, <I PII::1 I II1LII NANNINZ,LA LtFI LUCK ING COVER
IV IfIF.-) PROVIDED
_ YES 1NO YES LINO LJYES LINO
c"PERT•+_--,VLLL B1,LolN, vENTroFHLS•1
GALLONS PERCYCLE: ue1-'AN' urn+oLSOPERAnovaL NUMBER OF PF
IOIFFERENCE BE f WEEN FEET FROM L n aIH, INLLI
PUMP ON AND OFF) ~JYES LINO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture a the reptn of plowirg E'.:.tH I:I:.M T;I MATERIAL AND 11ARKIN1,
or excavation. I If soil can be rolled Into a wire, construction shall cease unt FORCE
J the so l Is dry enough to continue.) MAIN
1!(J CONVENTIONAL SYSTEM:
I%10111 LEND,-1- NO O' JDP PI F.PA;.Ir.t :)c :IA S•If~, I IOUIO
BED/TRENCH / THFVCHFS ~y~RIA_: PIT
DIMENSIONS V
CI I r'f plr, FIL ..FF'TII I'. nl ILI- F VISE DISTR, PIPE MATERIAL r. 'ISTH NUMBER OF FROFERTV WELL BUDDING VENT TO CRESH
AI IN
B F'1FL:; E:r)cFH 1 - 1:IF. 1 _1_ vD P Es FEET FROM j
1~+;~I /
L 1
'14 W° l
' ~J6 / Z Z NEAREST--r
MOUND SYSTEM:
MOUnd site plowed perpendicular to slope
I Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED,
DYES LINO
SOIL COVER -EI%HE - FF MANLNTMAR"_FHS c'B EU;,:n;lv'n L.s
I DYES INO DYES LINO
F:FPT., -,F I -Till 11 It l) 1,-,EVTH fIVLH IIILN:_11 UI_I[FIT1101 TOPSOIL S SFECFO IMILLCHED
CEr.TFR E,
1 '
IY LINO ❑YES NO LIVES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
t,\I^TH LEN;; rH NC. OF LATERAL SPA i:I GR ~F. nFP HHFI nw r•IPI FI-L DE TH ABOVE COVER
BED/TRENCH I -RENCHES
DIMENSIONS I i
•.,,N1 FFTLfI PI,NP MANII ULU DIS-Ft F1PE t7IVOL0M ERIAL NG DI$TR C L:Iitl: 1.1.1--- -I~1,-IIUNPIPL MATLHIAL B MARKING
FI Fri EI.EV D14 ELEV. VIPE$ dA
ELEVATION AND, II
DISTRIBUTION
FORMATION 511E HULL SPA' IN(. D I IILLLC C()RRVT_v' COVER MATERIAL YER 111 AL 1_11 T CORIMSPONU$ ID APPROVED
IN I F•1 A".s
_ j LYE iNO -.YES ENO
COMMENTS: PERMANENT MARKERS. [41SERVATION WELLS NUMBER OF IPROPERTY 1%%,ELL BVILDRJG
FEET UNE
_IYES LINO _IYES LINO INEARESOMt _
k~ ~r
C-0 f t
. y ; Ll
1
Sketch System on a rr~-aa_IZ~unty file for audit.
Reverse S,de.
SP:•NiHIIIP TITLE -
DILHR SBD 6710 IR. 01;821 L
u :7-1 APPLICATION FOR SANITARY PERMIT ~ -
H R CCI,NTY
(PLB 67) UNIFORM SANITARY PERMIT
~
ns
-Attach complete plans n accnrd with s. H 63.05, L'Jis. Adm. Cr)(:p fnr the s; stem, on paper not less than 8,'1 x 11 inches in size,
-See reverse side for instructions for completing th s applicat,on. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
,
PROPERTY LOCATION CITY:
- 1/4 1/4,S T., N, R (oli OWN OF: -'r y
LOT NUt,'BER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STAT7-'LA'V I.D. NJrv16ER
TYPE OF BUILDING OR USE SERVED Q- ~~a s
DIJ 1 or 2 Family Nunnbe- of Bedrooms. J PuL)lic (Specify).
THIS PERMIT IS FOR A:
~K] New System El Tank Replacerent U Repair
Replacement Soil Absorption System i Revision L 1 Privy
Alternate System ~ J Reconnection Petitiun for Mod.fication
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
_.Kl Seepage Bed U Seepage Trench J Seepage Pit L Holding Tank
System-In•Fill ~I In-Ground Pressure Vault Privy ~J Pit Privy
71 Existing, For 1i'dhich A Previous Permit Is On File, Permit # issuPC
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
I t-ii Hof Prefab. Situ Steel Fri Plastic
Gallons Tanks Cnncrele Constructed
Septic Tank Capacity
L ti Pump Tank;Siph.on Chamber
Holding Tank capac ty
Manu'acture:- i t
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: L Mound J In-Ground Pressure
fot,il #of Prefab. Site
Plast
Gal ons Tanks Cone'^te Constructed Steel F ibcrrl'ass c
Sept c Tank Capacity
Lift Pump; S Phon Chamber
Manufac-u•er:
PERCOLATION HA: i ARSOi ION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Scuare Feet}. PROI'USFU ISyuare Feet).
Private Joint _7:1 PubI c
I, the undersigned, hereby assume responsibility fur installation of the private sewaye system shown on the attached plans.
Namq o= Plumber iPnntl: Sig c MP/MPHSW Nu 77,honc Number:
P umber's Add-ess: N.~rte of Des,gner:
i
COUNTY/ DEPARTMENT USE ONLY
Signature of Issu ng Fey: ~Ll.3te:
_ LJ Disapproved
L Owner Given Initial
ApproveJ_ Adverse Determination
asor for Disapproval:
Allernate coursels) of Act on Available:
6 _-i" SBC-639N iR. 5.R2J CISTRIRLTIC:%, C)r ymal to Courtv, One Copy To; Gureau of Plur :,ir9, Ovd~rr, 'lurrher
rINSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLS 67 - SBD 6398
Tu t)e cu•-•iplete and accurate the permit applir.ation must include:
1. Property owne•'s name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, vil!age or town);
J. Indicate specifically ,,;hat type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate systern depending on systern type, check all appropriate boxes or blanks.
4. Indicate the desiyn percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
;gr,are tee? to be installed;
5. COrnplete SectiVrl Un °~al~r 5uphly;
6. PRINT the name nt the maser plurrher or master p umher restricted who wi I install the system, circle the appropriate license classi-
fication, place you license number in the space prov ded and sign the permit in the signature block,
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of -),,vnership or plumber requires a Sanitary Permit Transfer Form (67-T) to he suhmitted to the county prior to installation.
Failure to com:jh; vJil voic~ . the sanitary ner-nit.
9 . i his pe-m - may he -0nev.ed, and a- the time of renewal a•ry new, criteria in the V.'is. Ad m. Cnde II be Up) licable.
10. A new permit wil! be needed if there is a change in, estimated wasteevater flow, (number of bedrooms, etc.), location of the system,
depth of the systern, type of system,
11. All revisions to this permit must he approved by the permi- s;uinq a ithorit•y.
12. A rom,~lete plan ~clur.ing a plct pla:-, d-fi to :cafe -Jr With complete di nen;iuns.
13. Hu•izuntal anti v~2rt. cal :levation r rc ..ncc point,' ,ha-,crini riii t anal cluGr y ~hcvol.
14. Piping detail including pipe size, separating distances, distances between heds if appropriate, tank locations, effluent line from tank(s)
to system, building sevver and vent observation pipe(s).
15, The nermit kminq agent may req.:ire a cross sectio- d•awirp of the eftlue-,r di;pnsal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly marntamed- Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your systern, contact your local code administrator or the Bureau of Plumbing, Dill lIR, State of Wisconsin.
Owner of Pruj;erLY - ;'L i ,
Location of 11ruperCy~~ SZ ect W
l uwnship 7~;c~_
Mailini; Address
Subdivision Name (
Lot Number
Previous; Owner of Pr0perty_
Total Size of Parcel
Date Parcel Was Created
Are all corners identifiable? YeS No
Include WiAtl LhiS "i I,llCALiurt rune Lit Lhc tI I iil :
~.-Certified Survey Mali
. Deed
.Land Contract, or
other Legal DOCU1nC11L which dr_scribus Lhe l7ruljerty
PROPERTY OWNER CERTIFICATION l
I (We) certify that all statuments on this form are true to the best of my (our)
knowledge, that I (we) am (are) the owner t e propert scribed in this
information form, by virtue of a warm, y deed fe dad t the fice of the
County Register of Deeds as Documen N 5 ; an that I (we)
presently own the proposed site for the wage ' iefn (or I (we) have
obtained an easement, to run with the abov - •r-ibed property, for the
construction of said system, and tha same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
GIUr'4AIUHE OF OWNER SIG NA IUHL OF CO-OWNER (If APPLICABLE)
C
11117 F SIUNL6 - DATE SIGNED
IM/Ay -I%A)
yt 1
I I n
I T- ,
r' r OCC,
j
i
1 J ~ ,
77
, I
1 ~ r
i
~JNT OF REPORT ON SOIL BORINGS FETY & BUIL I'
' DIVISI
,Rt~fi AND PERCOLATION TESTS ADISOON B° 5;0
16MAN RELATIONS (1-163.090) & Chapter 145.045) I ~r
LOCATION: SECTION: !-ObVNSHIPrR4f1W+6}f~rty'fY: O B ISIAM E:
1/4 y q /Tz )N/R E W _fi ,
COUNTY: OWNS-ftSiBUYER'S NAME: MAILING ADDRESS: 1 -71
4 .1
USE DATES OElNS MADE NO.BEDRPoIS COMMERCIAL DESCP.IP-ION, ~ PROFILE DFSCRIPTIOPJS PER OLATIONTESTS
DFIesidence L! f l~Vew Replace I t ;y
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTI NAL: MOUND IN6ROUND-PRES3UR 4YSTFM IN FILLHOI DINE; IANK RECONIMENDEDSYSTEM:(option,al)
,/,,,S CU OS- EA ~S ❑U -1-EJS DU OS DU
II Percolation I gists are NO I required DESIGN RATE: If any portion of the tester) area is in the
under s.H63.09(b) (b), indicate: indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER +Ad6EFE8 -CHARACTER OF SOIL WI i H THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH fPI ELEVATION OBSERVED EST. HIGHEST TO REOROCK IF OBSERVED (SEE ABBRV.ON BACK.)
t,. o , r:~ _,r~ ` )npT AY ~ . r c~~.-) ~'IZ u`> _ , , i _S i 1.7 LT Bn ~ ' ; • 1 13r 1 S' ; 2. ~ , I A- T-t!s4
-~~4~. - r., ,};.~i Z' b•`3' ~i h,; ;i l~t 51. -.L~.j %.7'~~n S_ I,.~..J-p..~'~h ~ -
B RB>2 ~~1SuL ! Cam 3.3 ,
b.D' uy 7s,/,S'nn~1~_Y o Lr, ~
B-_=i -b l.7r[S'1fs'/• 3.?'~TJsnian' S
3.L/ y•7'-T.i3n r~o, S
B- '
PERCOLATION TESTS
TEST DEPTI I WATER IN HOLE TEST TIME DROP IN NIATFR LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERT D PER PER INCH
P- P-
P
P-
P- _
L -
PLOT PLAN: Show locations of percolation tests, soil horings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
rnnlal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all burings and the direction and percent cf la-id slope.
SYSTEM ELEVATION
~u ~t~ E- _BaiC14._;Y~fCizStc LDO.oo' ois h
- - ---r - T ~'L I' 1 T~ 11t.1 l P t Nt X T ~Z 'Ott~• 3
r
---I i - i
C .01~!A t:5Q of
t
Lem - - fN
' ~ w c. 'S101.1 S c
i ;
V -.~1-v`~-- ~L1US£~ ~~~LL 14.E ~t
r . F•~1 ' 1 ~ , S p' . trv ~ '
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 the location of the tests are correct to the best of my knowledge and belief,
TESTS WERE COMPLETED ON: NAME (print)
L ~ ~ lam- -U~(r t~V~L~ , - ~ ~'~i ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGNATURE:
TRIBUTION nrr,ii,ial and one copy to Local Authority, Property Owner and Soil Tesler.
CC,- R I
, L
!n!1 accurate soil test, Your I LpuI It r'IUSt inclu(Ie:
np)Htc 1e,1a clesCr'ption;
use section ?nus` Clearly !ndwate. vthether this k a rtiS!denCC all' cnmrne.rr!a! project;
AXIMUM number of berirtmmsOr C3MITI,erciai LISP nian; ed;
~ neLw ca replacenahnt s'ysrc~n; to the st:itahi::ty ra'i.,f1 hcx!~,. A SI i E IS SUIIABLE FOR A MOLDING TANK ONLY IF ALL
R SYSTEMS ARE RULED OUT SASED ON SOIL CONDITIONS-
SE use the ahlirev'ations shown here 'et vritinr< )10ti:e cfasrriptinns and completing the plot plan;
L C1 LFG InLE diagram acruratidy locariiln your test !oration,. D! awing to scale is preferred. A
drd:e,heet 1-lay he us>'d if de,ired;
kc sure: 1/01 -11 and ve,tical cievdtion reference print are clearly sho-,vn, and ale petman^r!t;
~nplme ali apprnpriate hnxe-. ds to dares, namas, add, vs•:es, floor) Plain date, percolation test exemp- n, if approp, late;
>?fomul- on (,ucl! dS (laud l?Iein, Vicvdt!on) does not zij fpiy, place, N.A. m the app,o,;riaw box:
Im w. at-in hlact! year current address amc your certification number:
And riktrih!Itt, is rPryu;r~., ALL SOIL TFCTS MUST F*- FII_f-D 1.~'UIT=I TyF
c (OvCr 10"I ER - Bca)ro~~k
')Ic (3 - 10") SS - S.iatclstnna,
{under 3") LS Lirr•e,to:se
HGVV - H!(jh Gruumciwatel se Sand Perc - Peu:-fl it on Rata:
u land Vv V.,(!li
Sa±tci L'icig t's,, iir+1
rY Sdr,1 > Gr, t.!:c! Thdr!
iy l o:+tn - i..ec:i ihur':
Loam BI Bi::r:k
y - G ry L!) it; y Yu locv
y C.3`y' Lo-,M)
Clay L;?aIn ntot 'VI0itir
iv taay it!I
Clay ffi - fei•v, line, mint
r7l!'aJ Itn,
irlr."t ~I
~aC^ L"JuI`f
.i 'nfa.f -f', '!llI;1 E'r. 1r Fi•• .,a !P 1;.^zl ii~rl~~ .'f :i
'agog