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HomeMy WebLinkAbout030-1025-10-000 n(nO 3.00 O m f d o CD 2. -0 v (D CD 3 xt 3 m Q o ° W °w o C n+• L, N r.r d ca W (D p (O CS v cD N N E3 CD Co ON .ay A 0 O ° CD 15D 0 6 N d 7 N 7 p O n d c a 10- cn (D e H O 71:) co cc 0 r (n 4:1 x r-7 co cc) 77 N N O Q W tJ't ~ OzJ. ~ !1 V ..p N ` !v z W O Z l~l • N CD O O O a Z Io i~ V =3 o oIli D N N N . N v D o Q C) z L D. cn cn ~ C a D er g 1.1 Z A V ti/t, 3 v rn - IN) m r- h m N o O z z z Ocl ri D D 0 N IV ' W , ^ (D Z E3 CD ~ ~ c r c s w a A o :D C3) 03 -0 m(D c z N Q C>9 N CD D J Q O T ~ C U) U) I 7 C: :E Z CL Q N O . D Z N U (D N < 0 - CD (D l N (D a cn ( A D CN o a ~ z 0 o W o a o 7 o U R b O ~ A O s a o Icy Parcel 030-1025-10-000 04/07/2005 09:06 AM PAGE 1 OF 1 Alt. Parcel 06.29.19.102C 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner HALUNEN, TODD P & CYNTHIA M TODD P & CYNTHIA M HALUNEN 1101 GOLDEN OAKS DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1101 GOLDEN OAKS DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.050 Plat: N/A-NOT AVAILABLE SEC 6 T29N R19W SE SW LOT 26 OF CSM 1/87 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/15/2003 730298 2314/420 WD 07/08/1997 1250/286 WD 681/320 2004 SUMMARY Bill Fair Market Value: Assessed with: 4925 337,300 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.050 103,800 228,000 331,800 NO Totals for 2004: General Property 5.050 103,800 228,000 331,8000 Woodland 0.000 0 Totals for 2003: General Property 5.050 58,600 172,500 231,1000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 136 Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00 r, AS !?ll_~LT SANTTARY SYSTEM REPORT OWNER-,Z" ClfYt, rQ~'rc _ TOWNSHIP- SEC. ` _o';?N-R/ry W ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION_,&~j Ze,V,e L0`1' sac LOT SIZE-- S PLAN VIEW Distances and dime~nsions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 F$ET OF SYSTEM ~c L~ ~ I 1 I 1 y Ii di at N r h rrc w BENCHMARK: (Permanent reference Point) Describe. Elevation of vertical reference point:- - Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover Tank manhole cover elevation: 'l'ank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle- -gallons; Total capacity of distribution lines 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 gallons1j!•5-0 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 3 width /,r' length acp' the depth SEEPAGE TRENCH: width- length PERCOLATION RATE AREA REQUIREll AREA AS BUILT INSPECTOR DATL'll__/~~~%/ PLUMBER ON JOB ~ LICENSE NUMBSR -dp_ r- 'DEPARTMENT OF INI,USTRY, INSPECTION REPORT FOR 1~ SAFETY & BUILDINGS LABOR RE,HUWIAN R* LATIONS PRIVATE SEWAGE SYSTEMS :y DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON , WI 53707 C~CONVENTIONAL ❑ALTERNATIVE State Planl.D.Numbe, El Holding Tank L1 In-Ground Pressure ❑ Mound II( assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HO LDER. INSPECTION DATE. BtLian W. O'Meana R. R. 5, Box 29, Hudson, GOT e,41 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV SF SW, Section G, T29N-R19W, Lot 26JTLout Bttook HiUA, Twin o4 St.Joze h Name of Plumber. MP/MPRSW No. County. Sanitary Permit Number_ Jack A. Bowman 5875 St. Cnoix 43732 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACEEF ET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER F ♦7 P O IDED. PROVIDED. J YES ❑NO ❑YES O BEDDINGVENT DIA.: VENT A L HIGH WATE ROADPR OP ERT V' WELLBUILDINGA / ALARM JVENTTQIFRE~~L AIR NLE ❑YES CZINO lYl ❑YES ❑NO j/ DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL FPROV NG COVER PROVIDED. DED❑YES ❑NO ❑YES❑NO ES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONALNUMBER OF PROPFRTV WELL VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE I AIR"LET' PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Nc;nl DIAMETER MATERIAL AND MARKING 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 WIDTH LENGTH NO. OF DISTR. PIPE SPACING COVER INSIDE DIA tf PITS _ l / TRENCHES f~4r2T RIAL: _I t PIT DEPTH. DIMENSIONS GRAVFL DEPTH FILL DEPTH OISTH. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NIO. SIT R NUMBER OF PROPERTY WELL BUILD( NG. VENT TO FRESH BELOW PIPES, ABOVE COVER ELEV. INLE I ELEV EN L 1t LINE A / AIR INLET. ILI L PP FEET FROM 47-21 NEAR EST-► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for ROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems tot, ke certain that it N REVERSE SIDE. SHOW ELEVA- meets the criteria f)er m Ed um sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE 11ERMANI T MARKERS OBSERVATION WELLS i YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH:BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES J~ ❑ ES ❑N© ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LA/ HAL SPACING RAVE DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS F MANIFOLD PUMP MANIFOLD DISTR. PIPE MAN FOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL d MARKING ELEV.'. ELEV.. DIA. ELEV.'. PIPES ELEVATION AND DIA.. DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL ERTICAL L CORRESPONDS TO APPROVED ll Ci PLANS ❑YES ❑NO I "T] YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: / NUMBER OF.. .ROE ERTV WELL: BUILDING: / FEET FROM f ll ❑ YES ❑ NO ❑ YES NO EAREST° (U 1 9,.0 7 Sketch System on dcI R ain i ounty file for audit. Reverse Side. LL - S ATU TITLE. ' DILHR SBD 6710 (R. 01/82) C w~s~onsin APPLICATION FOR SANITARY PERMIT ® 1 L H R St. Croix COUNTY FLOEPfiRTR1EnT OF (P LB 67 UNIFORM SANITARY PERMIT # ii-r- mousTav, Laeoa s Human aELaTions __1/ 3 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Brian W. & Vickie F. O'Meara Route 5 Box 29 Hudson WI 5401 PROPERTY LOCATION CITY: SE 1/4 SW 1/4, S 6 VILLAGE: , T29, N, R 19EXW W TOWN OF: St. Joseph LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 26 - Trout Brook Hills River Road TYPE OF BUILDING OR USE SERVED Ito Qc3~-~Uo?~_ /0~~~ d 1 or 2 Family Number of Bedrooms. 5 Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. [~J 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 1425 1 X 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3 1025 1080 Q Private El 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: Bowman Plumbing j MP/5875 71 5 235-4614 Plumber's Address: Name of Designer: 2819 Knapp Street, Menomo ' ,WI 54751 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 0-' L/ ❑ Owner Given Initial 4"7 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 P t 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. Bowman's Plumbing 2819 Knapp Street Menomonie, WI 54751 (715)235-46/34 / . C~.l? L / c v w / y P (T ! ,2 9AA rYP 7 f ~ /f.y f C t k , • F l'%' t<'~r Ir tc ,G ' C/~ J f I ~ v ~ M ~eUlell. . I n /7 n _41'-AA- O r ~ J L ? Kjr- e, -11-1:1 S N*P "I 46Z f S are! ,IY~,) o,- EP0N SCA ORT r'riiUILUIIVG:. ~,(soR A~)n }IU>>; ° y N ~FjUF o P.O. si)y. 7960 AN i?ELA 1or;S - E GIOLAd ION ~ IAE.3 TS' (I.1 rn SON, WI 53707 (H63.09(1) & Chapter 145.045) t~ ~L-SCArION: SECION - I~ /9 - r TONNSHIP/MUNICIPALITY: O7 NOK NO, IVI~ION E: '::OUNTY: Oi`iNER'5 ,8UYER•Sr NAME: MAI LING ADDRESS: Ln. C- I._ T Up; >i' : `.t A rJ W. V 1 cK + F- (I ~!JI ;4 y T. F t?X G ~ , t7 d cxa ` ;.a t=-"` DATES OBSERVATIONS MADE ( NO. EEDAtitS : COti1,V1ER TALC` pESCR I P TIOV: °A FILED I AIPTIONS: ri5-n A j N TESTS: Residence WNew ❑Replace RATING: S- Site suitable for system U° Site unsuitable for system ONVENTIO!VAL: MOUND: IN-GRO ND PREUF2E:SYSTEMIN-FILLNOLDINGTANK RECOMMENUEDSYS7EM:(optional) ll t' Pe,colation Tests are NOT required DESIGN RATE: _ If any portion of the tested area is in the J s.H53.0y(51fb), indicate: Floodplain, indicate Floodplain elevation: ~j . l7EGrMAr_. G7 PROFILE DESCRIPTIONS I(!')RING TOTAL _ : P Fli TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH :%113ER DEPTH %4 ELEVATION OBSERVED ES"l. ff1GHES TO 3EDROCK IF OBSERVED ISEE ABBRV. ON BACK.) ~U- J-00, 3L 5;L-; 8,v MAD, Sf l•ora I ~~r.~; Alo~i < to >3N Cs ! 0,67' r3AJ L-) s3 t3N M CS w c 1, :6:, 1 «a' ttO, 07 Eifczr../G 1Zr ao7' 3L s--) EV /5,,j L~ w G~ ~,~s' 8nt MF-D, C S v,r 6 t2.. ( r d {7' 8L S,L~a.-7 T'0.~nl, `Jil_jo•83' o SAj 5 L 3 lam. ' ~o7.9f /LIotitc /U v/ ,S,-7 5' 8 M e ~ ~ ^ti, B. 2 CJ. 0 5L L d,v ` \Arl . l,r~ c?; sU' tile, 1?r; <S ~ . 7 J ~ g •Ca7 /~la.f ~ ~(la ~ i:~ .vim' (3,.1 ~q ~ ~ ~ 2 DCC,IMA L PERCOLATION TESTS Ni~"ABEZ CoP-P-LSPOND, \NIT'N A13a~4CC°~rfT" _ rl~~"T a~=~ N► o t~ir 'l TEST DEPTH WATER IN HOLE I TEST TIMIE DROP IN WATER LEVEL INCHES RATE MINUTES P_r•1HER ++'Tr►'iES AFTERSbVtLLING INTERVAL-PAIN. PERIOD1 PERIOD-2 ER PER INCH P 1 'f , 5 5 O N tE. 7- > 3 2- NON& P- ILOT PLAN- Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hon •lntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings anti the direction and percent land slope. NG7 L~xF.AVg~\,7-1u~✓ ro rvtEcT IVIAKIMuM eoVff2- P-S(4vlt~EtArl x YSTEM. ELEVATION _)04.0o 10 I 1 t n/ Z L f '4A-0 I t J - - r., I t30 t r, i ) Q ~ji it I QP 5 ~ I I ~ 11~ s~z - - - - ! - - / t'l 6 c trhe undersigned, hereby certify that the soil tests reports on this form were made by me in accord with the procedures and methods specified in the Wisconsin Jninistrative Coda, and that the data recorded and [he loca 'on the tests are correct to the bast of my knowla lge and belief. (pant): TESTS WERE CONIPLETED ON: 'I , f:Fi~r ,l ,r~,;1 ,1,.~~-r~-~ :~!0~,= ^l t. tti •-,u,,,,,,~I)-I R19UTION: Orunlnat ~nr , -„pi to t rK~r Auth7nty, Property Owner ,nd Sniff Tester, PAGE OF CROSS SLurio .1 OF A BED SJSTEM Tcif, . SOIL FILL- Z" OF AGGREGATE UIS-I KIBU-1 10KI PIPE --1 APPKOVEU ~,JW HETIC COVER MATERIAL. OK 9'1 OF 5-1-RAW OR MAKSH HAS " 4' OF%? AGGREGATE ELEV. OF FEET,_y DISTRIBUTIOti PIPE TO bE AT LEAST It~.ICHES bELCU v vZiGIti1AL. GRADE AA1D AT LEAST -0 IAICHES BUT KIO MORE THALI `12 IIJCHES BELOW FILIAL GRADE MAXIMUM DEPT H CGF EXCAVAT10►3 FROM OKIGIIJAI_ GRADE WCHES MINIMUM DEPTH OF EXL AVAI lo" FROM bKIGIKAi L ,,KAUE WI: i IMC-HE ,S OCIIIIk.D. i Form - S T C 100 Owner of Property. Brian W. & Vickie F. O'Meara Location of Property SE ~4_S Section 6 T_ 9 N RAW Townships, ,jo, P,V Mailing Address Route 5 Box 29, Hudson, WI 54016 Subdivision Name T-mit Brook F-1i 7 Lot Number 26 Previous Owner of Property Total Size of Parcel Date Parcel Was Created 7,5- Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION A I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that 1 (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 9-1f V DATE SIG NEb ' 11 E SIGNED