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HomeMy WebLinkAbout038-1156-40-000 o fn O 3 '9 o d ~1 0 f c m 0 rD fD n N II A> • II O II 1 D) fD A 3 3 iUj ` \1 K ' A7 0 W `C ems(x~, • N uNi O N ° N Dj o W V l O Q O (D N N II W .`S c 1 9 Z d O d LU N r J 'S °O °O m O o CD N W 7D. 4". ° O 0) N c 0 o A7 3 O N O O N CD O o C7 O y ~ O O U) < D D (D fl m CD a o w c D (D c o o a N O CD F~ ° i W z (o (D z co fl m n r cn (o y O v v v h• z O O CO o P _M~f C w N N O r- ° CD CD 3 C,7 T O v 41 m (D 0 Z W < d V v o (D H ~ m N z W z N CD CD (D N -1 cn CD a) t i m CD 7 I n CD Q~ (n A Z CD y 'p c~' W Q o O ` Z Z ip' n A z o co - ° t Z tCIO W v m D t~ Q a (D CD 1 1 0 I O Z C C O Y CC ~ 1 QO Z < ✓V Q $Z N W 7 O' ,z a -I D a v o CL CD L:L v a 0= cN n n n c CD 3 N o o a o m o 3 N N. fn CD m a ~ C o' a 0 0 o N N N CD CD 2: m 'n. A D 0 0 ~ o o ~ oti CD o C a N C7 N D1 n ~ b N dQ O O b O (D 5 ° s S Parcel 038-1156-40-000 02/10/2006 11:06 AM PAGE 1 OF 1 Alt. Parcel 22.31.18.724 038 - TOWN OF STAR PRAIRIE 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 - DEAL, CHARLES A & PATRICIA A CHARLES A & PATRICIA A DEAL 2080 ASPLUND RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 2080 ASPLUND RD SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.650 Plat: 2230-NORTHWOOD SEC 22 T31 N R1 8W PLAT OF NORTHWOOD LOT 4 Block/Condo Bldg: LOT 04 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 685/49 2005 SUMMARY Bill Fair Market Value: Assessed with: 119972 171,100 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.650 29,600 138,600 168,200 NO Totals for 2005: General Property 1.650 29,600 138,600 168,200 Woodland 0.000 0 0 Totals for 2004: General Property 1.650 29,600 138,600 168,200 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 AS BUILT SANITARY SYSTEM REPORT OWNER Cv`y TOWNSHIP - SEC. iyi- W - - ADDRESS ST. CROIX COUNTY WISCONSI SUBD tV IS LON LOT LOT SIZ - - - - ti PLAN VIEW >2 T Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a; i /f `r p 7Ii dic at +Nrl h rrc w BE CHMARK: (Permanent reference. Point) Describe: fC?- t-Q-6C4F- PSf 1?y Elevation of vertical reference point: e~\/DO Slope at site: a2 76 SEPTIC TANK: Manufacturer: ~ ~r.r~rfCi a 'f ff*Liquid Capacity: jOCX~ Number of rings on cover Tank manhole cover elevation. Tank Inlet Elevation: /G Lank Outlet Elevati011_-~6'!~l,,-4Z PUMP CHAMBER Manufacturer: Number oL baIIoas 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 de.vice-~ r-_--- HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE; Number of pits teet diameter feet liquid depth__ seepage pit inlet pipe-elevation bottom of seepage pit elevation _ _ feet. SEEPAGE BED SIZE: number of lines-_.~ width_ Q length stile depth SEEPAGE TRENCH: width length__ PERCOLATION RATE___ AREA REQUIRED-- AREA AS BUILTC;?~~____ INSPECTOR DATED /~J Z PLUMBER ON JOB---- L I C E N S E S E NUMBER Sl~_--_--_ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 78x9 BUREAU OF PLUMBING MAPISnN, WI 63707 LNCONVENTIONAL ❑ALTERNATIVE State Planl.D.Number G ~~u. ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 11 a, ,o Id) ~rtC ~J CnL~S% 129e NAME OF PERMIT HOLDER: ADDRESS OF PERM H DER'. INSPECTION DATE: LaAAy Hanson R. R. 2, New Richmond, 611 J -14-S-11 1-11130 BENCH MARK IPermanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. NE NW, Sec. 22, T31N-R18W, Lot#4, Notcthwood, Town o~ Statc PnaiAie Name of Plumber_ MP/MPRSW N,, County IS,,,,,,, Permit Number_ Cat Poweu 1563 St. Ctcoix 43731 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY'. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED. PROVIDED'. EYES ENO EYES ENO BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD'. PROPERTY WELL: BUILDING. VENT TO FRESH ALARM. FEET FROM LINE. AIR INLET. EYES ENO EYES ENO NEAREST' DOSING CHAMBER: MANUFACTURER. 7ING J I LIQUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTIIREH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED'. ES ENO EYES ENO DYES ENO EERTY WELL BUILDING I VENT TO FRESH GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL . NUMBER OF PL HINOP AIRI NL ET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) EYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth o'plow 'in, 1 FN ,TH 1DIAMPTER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease util FORCE the soil is dry enougl`40 continua:) MAIN CONVENTIONAL SYSTEM: BED/TR EAIL '.W;OTH LENGTH NO. OF DISTR. PIPE SPACIN(; COVER JINIIDE DIA. SPITS LIQUID TRENCHES NIATEHIAL'. PIT DEPTH "DIM ,NSL G~R AV E ViD F PTH # F11I 4E.R IT OiSTFi _PtPF DISTR. PIPE DISTR. PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES tl# Ad,Wj COVE'b1 EPV INLFT ELEV. END PIPES FEET FROM LINE. AIR INLET- " NEAREST 0-M0 UN o S` 9T'r Mgtlnd saiec " d°perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrovusrovwn upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. GJYrz S NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS EYES ENO EYES ENO DEPTH OVER TRENCH BED DEPTH OVER TR ENCHBED DEPTH OF TOPSOIL ISODDED SEEDED MULCHED CENTER EDGES EYES ENO EYES ENO OYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL. NO DISTR. DISTR. PIPE DISTHIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.. CIA ELEV.. PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY 1COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS EYES ENO EYES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE. EYES NO EYES ENO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT COUNTY r DILHR o aRRTmEnT ov (PLB 67) UNIFORM SANITARY PERMIT # ~ In OUSTRV, LRBOR 6 HUTRn RELRTIOnS / -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 ADDRE S 1 PROPERTY L C TION; 1/4' 1/4, S T , N, R or) -VItt~ IM W TOWN OF: I LOT VBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKlz_ F1 LANDMARK STATE PLAN I.D. NUMBER X16 r r, u~, GG~I he 0 TYPE OF BUILDING R USE SERVED N 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): / THIS PERMIT IS FOR A: N 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. ~Seepaye 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 Lift Pump Tank/Siphon Chamber Holding Tank capacity ~i 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): t f Awl' 1. X 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): Signa ure: MP/MPRSW No.: Phone Number: (e) a rr ~xN3 r I / 6 (Jiff) 3® Sf' Plumber's Address: Name of Designer: )-rti-~"~ s Cf C NTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Disapproved . , Q d / J/~ riyf ❑ Owner Given Initial 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. F'o rm - S 1' C 100 4. Owner of Property L='~Vv-y j`7n n 5 c 'Location of Property Section 2-2 T 3( N R W Township_ j7`ar fi'r u I r1 e Mailing Address ll , I \ .c l ~ ~ Inn t~~ r~ U-1 l S ~ T Subdiviaion Name-11,11 i T*-~ Lot Numbar_ Previous Owner of Property ~a y- Total Size of Parcel -r - v Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map Dee Contract, or .Other Legal Docuwent which describes the property PROPERTY OWNER CERTIFICATION (We) cartify that all statements on this form are true to the best of my (our) knowledge; that L (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty eed recorded in the Office of the County Register of Deeds as Document 4. ~ _ ; and,.that I (we) presently own the proposed site for the se `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 Quads, as Document No. IIGNATURE~OF OWNER' SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DUSTIVI OF REPORT ON SOIL BORINGS AND SAFETY & BUILDIN, INDUSTRY, , DIVISIOi, LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS \ ) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LO ~ TAI SECTIO%~ ~ ~ ~ ~ lorl ~ TO `NSHIP/Mlyfd•~CIPALITY: LOT[jNO.: BrL~Ke~NO,: SUBDIVISION NAME: COUNTY: OW E 'S/BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERV TIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: L esidence XNevv ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: M UND: IN--GROUND-PRESSURE: SYSTEM-IN-FILLHOLDI G TANK:RECOMMENDED SYSTEM:(optional) S ~U S ❑U-S ~U [_]S ZU [:]S 4 UN1;QiY,, If Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the under s.H63.09(5)(b), indicate: tyS Floodplain, indicate Floodplain elevation: j PROFILE DESCRIPTIONS BORING TOTA DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH LEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) l> p 1 Irv _s, s , 96r A B D ',Kn''' 7 n~ B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH -1 Aj P- - "5 ,S c P- 16) 5 -5 P-,5 #3 P- P- P- 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 99' 2 F4 f., e 11 fc6+ 50 . I I a - E ~ ~ t i 1, 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(optionall: CST SI.GNATURV. C Z"t .Yi t 1, r ~X INI M; 31iri} t, rr 1._ satingrho,v_ aiEIS l t` t F f) C, a S srv , l ioE ~"j i , r~--; pr . E :dent I ? rr F, x;51 'fI a :`tc,a-.t t ,ti~1 { tde l,O 0 E or ~ t l 1 1,110~ _ , ~ t 61 F?, rSu G F, XS a3~ n .,t<C3 eta _ coOC 0- ` 31, e ~ r F'F . 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