HomeMy WebLinkAbout040-1188-20-000
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Parcel 040-1188-20-000 01/18/2005 08:41
PAGE 1 OF 1
F 1
Alt. Parcel 36.28.19.805 040 - 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): Current Owner
* SCOTT, ROBERT N & BARBARA
ROBERT N & BARBARA SCOTT
55 WOODRIDGE DR W
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 55 W WOODRIDGE DR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 0.445 Plat: 2237-OAK RIDGE ACRES
SEC 36 T28N R19W LOT 52 OAK RIDGE ACRES Block/Condo Bldg: LOT 52
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
36-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2004 SUMMARY Bill Fair Market Value: Assessed with:
27597 168,600
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.445 35,000 133,900 168,900 NO
Totals for 2004:
General Property 0.445 35,000 133,900 168,900
Woodland 0.000 0 0
Totals for 2003:
General Property 0.445 25,300 123,900 149,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 104
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
00
Total 0.00 0.00
Form- STC - 1
AS BUILT SANITARY SYSTEM REPORT
i
OWNER TOWNSHIP SEC. a(. T Zxs N-R W
ADDRESS PT_5 ST. CROIX COUNTY, WISCONSIN
ys? -1 tvn
SUBDIVISION ACV-r--,LOT LOT SIZE 9-1 . a~ X
PLAN VIEW
Distances and dimensions to meet requirements of IL11R 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
i
D So -77 ~ b.e
_I"
w
52_~
Nous~ ~ "y
AZO ,
~'2zv E~..tt~~ `
fi .
1 N ' ~ ✓ - ~lo INDICATE ~ORTH ARROW
;c:-c t 's 1 r jt r~.
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: 100_400' Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side o Rear, O feet
From nearest property line Front,0 Side,0 Rear, O feet
Number of feet from: well , building:
(Include this information of the above plot plan)( 2 reference dimensions to sep+
SEE REVERSE SIDE A
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump.Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Y Trench:
t
Width: Length: .S lW'•- 0" Number of Lines: Z Area Built : 6 z
Fill depth to top of pipe:
Number of feet from nearest property line: Front, Q Side, O Rear,0 Ft. ZS
Number of feet from well: '51-6
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, 0 Rear, O Ft.~
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector.-
Dated: Plumber on jo
License Number: l - F-° -7
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
ENCONVENTIONAL ❑ALTERNATIVE SlatesPl- IlD.N-be,
4
i
E:1 Holding Tank ❑ In-Ground Pressure E Mound Ili as gn ed
NAME OF PERMIT HOLUEH ADDRESS OF PERMIT HOLDER'. INSPECT10% DATE.
Robert Scott R. R. 5, Box 161, River Falls, WI 5402 /
BENCH MARK (Pei--, 0-- ce point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.. CST REF. PT ELEV
SW NW, Section 36, T28N-R19W, Town of Troy,Lot#52, Oak Ridge Acres
N,-,0 Plumher. MP/MPHSW W ...unty S-.,, F-1-1 Number
Paul Cudd 2739 St. Croix 74974
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY TANK INLFT ELEV TANK OUT LFT ELEV WARNING LABEL LOCKING COVER
{ PROVIDED PROVIDED.
BEDDING. VENT DIA. VENTMATI HI(;HWATEH f EYES LINO DYES LINO
ALAHM1I NUM BE 11q'tw-vv~ JP OPERTV WFLL BUILDING. JVENT TO FRESH
SINE AIR INLET
FEET K
DYES LINO [AYES LNo _ NEA DOSI
NG CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPIWI TY PUMP M/)I7EI r(lr.^~P SIPS. J. VANI11 A(. I[IHE1'. JWARNING LABEL LOCKING COVER
PROVIDED PROVIDED'.
DYES LINO EYES ENO ID YES LINO
GALLONSPER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF OPFHTV WELL BullDING JVENTTQFRESH
(DIFFERENCE BETWEEN FEET FROM "E aIR"LET
PUMP ON AND OFF) []YES ENO _ NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing nr.,F I F 1r OATF RIA: nND MAHKIN(,
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH wIDrH LENGTH No OF R PIP[ SP4CIN~v[H - N]I,FF '1A PITS LIQUID
HFNCHFS,IAr[HIAL
D PIT
DIMENSIONS
GRAVEL DEP TII FILL DEPTH UISTH PIPE UISTH PIPF DISTR PIPE MATERIAL NO [ S'VI NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
BE LOW PIPFSABOVE COVER ELEV INII I ELEV END PIPF_ LIN AIR INLET
FEET FROM
~
( y r t' %'i! NEAREST
r. pl /(O ~G 9
MOUND SYSTEM:
Mound site plowed perpendicular to slope 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-
E Y ES NO meets the criteria for medium sand. TIONS MEASURED.
LI
SOIL COVER TEXTURE PE HMANFNIM1+AHKFHS UBSF HVATION WE L IS
DYES LINO DYES LINO
DEPTH OVER TRENCH BED DEPTH OVER THENCII HE II 011'111 OF TOPSOIL 11011111 I1 ~EEUED MULCHED
CENTER (EDGES
YES LINO DYES LINO DYES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO. OF LATE HAL SPACING [11AVI L DEBIT BF IOVI PIPF FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR PIPE ]MANIIOLD MATERIAL NO DI STH DISTH PIPE DISTHIBU T ION PIPE MATER IAL& MARKING
El EV. ELEV. CIA ELEV. PIPES UTA
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING OHILLF. D COHRFC I LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PL ANIS
DYES LINO EYES LINO
COMMENTS: PERMANENT MARKERS JOBSERVATION WELLS NUMBER OF PROEPERTY WELL. BUILDING.
FROM N
DYES ENO D YES LINO F N EET
EAREST-
l a - -
~ { 1
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE
DILHR SBD6710 (R. 01/82) r
wlsconsin APPLICATION FOR SANITARY PERMIT
11
T.. OJ_Y COUNTY
DILHR
~ M OEPAF~T Er r OF (PLB 67)
- InOUSTRV,LRBOR&HUTRnRELRT1Ons UNIFORM SANITARY PERMIT #
9''7y
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
Ober-1- CCU t f. 5, BOX ~61,:J'0o11'C .,?ever
PROPERTY LOCATION XLTXX
1 /4 1 /4, S 3 . , T 2 ? N, R' ~~11~ i r (wr
W TOWN OF:
UMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN .D. NUMBER
I.D. N
5 2
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: 3 Public (Specify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
iX] Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity TaI
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY:
62, KJ Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature:' MP/MPRSW No.: Phone Number:
?au ,u. P?S J2731' (71 J "-2
Plumber's Address:
r Name of Designer.
-it. 3oa 3`',1.1- J_ it
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
❑ Disapproved
Sl~tJ`_ps ❑ Owner Given Initial
O Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1 . Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what 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 system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided 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 ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal 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 maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7
Owner of Property 4 Ii-, A
Location of Property 14 Section , T N-R W
7
Township y
Mailing Address
C/
Address of Site Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel 617.
Date Parcel was Created
Are all corners and lot lines identifiable? f+j Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPFRTV OWNER CERTIFICATION
I (We) eeht 6y that att statements on this botm ahe th.ue to the best o6 my (ouh)
h.nowtedge; that 1 (we:) am (ate) the owneA(s) o6 the ptopehty desnibed in this
in6otmation botm, by vihtue o6 a wa,cAanty deed tecotded in the 066ice ob the
County Register o{ Deeds as Document No. ~ 3-,-,,? and that I (We) ptez entt y
own the ptoposed site Got the sewage dtispozat system (ot I (we) have obtained an
easement, to tun with the above desn bed ptopehty, 6m the conISPLuction o6 said
,system, and the same has been duty tecotded in the 046iee o6 the County Regi/steA o~
Deeds, - jocument No. ) .
SIG TURF F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED ✓
S '1' C- 1 0 5
SEPTIC 'T'ANK MAINTENANCE ACKELMENT
C
St. Croix County
c
k0U7'E/ jSOX NUMBER Fire Number
CI`T'Y/STATE ----z11'_
f '
1jk0PER'1Y LOCATION: ~4, Section T Wig' N, K-~
-
l'~wn i>fG7~ St . Croix County,
Subdivision Q Lut number ~j
1
i
l❑proper use and maintenance of yuur septic system could result in
its premature failure to handle wastes. Proper maintenance con- I
lists of pumping out the septic tank every three years or sooner, j
il needed, by a licensed septic tank Lower. Nlhat you i)u n t u
the system can affect the function of the sr.__ -
went stage in the waste disposal system.
St. Croix County residents may be eligible to recelvc o hrunt
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems_ agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County 'Lonin" a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-bite wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
0
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
- H
the standards set forth, herein, as set by the Wisconsin Depart- Ili
nient of Natural Resources. Certification fora ust be completed
and returned to the St. Croix County Zoning,-"Ifi_ce within 30 days
of the three year expiratioii date.
SIGNED ~ _ -
DATE St. Croix County Zon.-ng Office
Y.O. l.ox 98 ~
lfammoi d, W1 54015
715-71 6-22311 or 715-425-8363
SIs"n, date and return to 1 bove addrr- ss
d
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON, WI 537077969 P.O. BOX
HUMAN RELATIONS (H63,090) & Chapter 145.045)
LOCATION: SECTION: c
TOWNSHIP'UNICIPALITY: LOT NO.:BLK. NO.:SUBDIVISION NAME: i
'CIL
COUNTY: OWNER'S UYER'S NAME: MAILING ADDRESS:~.`~ V
;7. '
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
,Residence `f ❑New F:RReplace 21_.
RATING: S= Site suitable for system U= Site unsuitable for system
NS ENTIONAL: MOUND: USYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
❑U ❑S ❑U~ QS ❑U [Is ❑U CQU
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-1- CHfS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IRk OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- ` 7 r / b." NShJ ~7 1-- r O.~ LI 'r.. Brt r J
e ry-
r
B- CN-
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
Tv ti rr
P )/j
P- 3 - 3
P a 10 3
p_ 3 a5
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-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
_ _ _ _ ~ _ 3 - I - r- ~ _ I ~ _ . h ~ ~ ~ ~ d ~4►~? ` Tip h_
i z o(o' I _ 3<i2 to eA Le j7ej ox
r 1~ 1
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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.
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: - CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIG,NI TUBE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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