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HomeMy WebLinkAbout014-1033-30-000 I, (D C~ a o 3 0 a~ M 0. O w I ~ C b p p I N n N L C ti i v I ~L w N O z C L 6 LL C O <L co ~ ~ Z I E U) O v = O E z v I C d ~ 0 m a m O C a m o Z c r c O Z v c o u> P m a Z c E o 0) 0 ~1/ N N 7 O N CL ry • (n 0 !i C '6 U O O N Q w Z m z o c Z N O cu E N CD co E C N > m co Ll a U c i N V7 O N M N y LL O O o~ Z r> H H F- C) N _ d d ~i O O O z CL M CL a m ' o o E Q) U) -i L) Lu } Q M O _ O s co ° E O o O m d C N N N N '1Vv N m y Q> cq O ~i C o N S oo m o 0 o E O c o ce) 3 0 c v -0 0) r N O C Ly _ V p Co p C op -a~i 4. o N Z d3 O C N OM ..0+ •C { H M 0 c M O co N 0 t3 IF L6 0 • y~y O LL III Q f-- N 04 Z 2 F- U) a' CL T `m . • m E ` c c `~1 A v OT 0 in V Parcel 014-1033-30-000 02/27/2006 03:46 PM PAGE 1 OF 1 Alt. Parcel 15.31.15.235B 014 - TOWN OF FOREST 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 - ANDERSON, ROGER A & ROXANNE ROGER A & ROXANNE ANDERSON 2916 210TH AVE EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2916 210TH AVE SC 1127 CLEAR LAKE SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 15 T31N R15W 1A IN SW SW LOT 1 CSM Block/Condo Bldg: VOL 2/600 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-31 N-1 5W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 94845 138,800 Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 10,000 130,600 140,600 NO Totals for 2005: General Property 1.000 10,000 130,600 140,600 Woodland 0.000 0 0 Totals for 2004: General Property 1.000 3,000 65,200 68,200 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 TOWNSHIP , SEC. T. N, R_ W 0. ADDRESS ST. CROIX COUNTY, WISCONSIN. '3DIVISION LOT LOT SIZE . PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM II I • { i •i I 1 ,TIC TANK(S) MFGR.`. CONCRETE STEEL NO. of rings on cover Depth DRY WELL INCHES NO. of width length area no. of lines width length_ area depth to top of pipe :,REGATE .:K RATE AREA REQUIRED AREA AS BUILT 'claimer: The inspection of this system by St. Croix County does not imply complete j -pliance with State Administrative Codes. There are other areas that it is not possible j inspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if failure is noted the County wili make every effort to :ermine cause of failure. 1ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. 'INSPECTOR DATED PLUMBER ON JOB LICENSE MIBER r z REPORT OF INSPECTION INDIVIDUAL SELVAGE SYSTEM ; Sanitatcy Petcmit State Septic /,-If NAME Township St. Cnoix County Location' % o6 Section /~-T_IN,R/S W f SEPTIC TANK Size gattons. Numbers o Compatctment6 J~ Distance Ftcom: W ett 4u-4 6t. 12% otc gtceateA sto pe 6t Buitding St. Wettands 6t. r Highwatetc 6t. DISPOSAL SYSTEM Distance Ftcom: Wett 6t. 120 otc gtceaten slope _ ~t. Building _6t. Wettands Ft. Highwatetc ~ . FIELD DIMENSIONS: Width o6 ttcench a fit. Depth o6 tcock below tite % in. Length o6 each tine 6t. Depth o6 tcock overt tite 2 in. Numbetc o6 tines j Depth o6 tite below gtcade in. Totat tength o6 Zine,5 6t. Skope o6 ttcench in pen 100 bt. r Distance between tines 6t. Depth to b edtco ck 6t. Totat absotcbtion atcea,.r c:~L 6t2 Depth to gtcoundwaten 6t. Requi. Led area s Z 5 6t2 PIT DIMENSIONS: l Numb etc o~ pis` GtcaveZ atcound pits yeas no Outside diameTetc 6t. r Depth below inter 6t. 2 Tota.L absonb/tio4%atcea 4t z r A Anea tcequitced m INSPECTED BY TITLE DATE 197(' . APPROVED REJECTED DATE 197 - ~t J n 7 L- EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 S REPORT ON SOIL BORINGS AND PERCOLATION TS ,2 ~~[llN, RSE (or p or Municipality 0W_)eS Kp(jTownshi LOCATION: Section T Lot No. -Z,ck No. County ~7 _ C ~ ubdivision Name Owner's Name: Z,601" - Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW -ek ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS-7 - PERCOLATION TESTS 7" ~97- 29 SOIL MAP SHEET 0/ SOIL TYPE C7' PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P_ 7, f /7 P- I k~~Q ) " ~Y/ / I~L 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) Z /r6 0 - C( c -5,4 5 -2X 57 G+- t Y Sr 1 2 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. it 3~T 05 Indicate scale or distances. Give horizontal and vertical reference point . Indicate slope. 7 S_'. eat 1,F/ - 5"u ` i { jL y _ r1 ! 4* }~~'}y t)/1f i i E ~~1 t I , t N I J - ~ ---h-_~__'~__". f i • i ~ ~ ~ 1 f it i i- v' - _ s f l I i f t7W Y'~ ©19- 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 beli Name (prin C_ U_j -4p Certification No. S~ S J4 j b6 Address Name of installer if known CST Signature I-"Y A . LO4.:,f11 !jUTHCF,, TY State and County State Permit # PLB67 Permit Application County Per # - 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: B. LOCATION: Cd~ Section T N, R jS-E (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANC : * ommercial *Industrial *Other (specify) Variance _ Single family X Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher) YES NO Food Waste Grinder YES 1kNO # of Bathrooms- 1-Automatic WasherX-- YES NO Other (specify) E :SEPTIC TANK CAPACITY (000 Total gallons No. of tanks 'Holding tank capacity Total gallons No. of tanks ?•lew Installation _X Addition Replacement Prefab Concrete `Poured in Place Steel Other (specify) t? FLUENT DISPOSAL SYSTEM: Percolation Rate 1)Lj_o 2A_(;-_3) 2.0 Total Absorb Area ll __sq. ft. I,zOwK_ Addition _ Replacement *Fill System :seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches t eepage Bed: Length 4.3 -Width !x Depth Tile Depth Z.~f No. of Lines r~ S.-Lepage Pit: Inside diameter Liquid Depth Tile Size 9_ Percent slope of land 2-% r 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 T, er, NAME C /JL VL_,, r CST # ~ x"31 and other information obtained from wn /builder). ~ 6 Phone Plumber's Signature _ MP/ Plumber's Address P-Z but PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). ~ t r, (yl q~ 00 ~I Do Not Write in Space Below F DEPARTMENT USE ONLY 0 ~ Date of Application - Fees OPaid: State l0r Qd County Date Permit Issued/Ram (date)-3~ -Za -Issuing Agent Name Inspection Yes )e __No 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) Revised Date 6/1 /76