Loading...
HomeMy WebLinkAbout040-1118-10-100 I , I o W W a ro n (D ~3 (D Fl- w ' o ` O r• C-1 ~:j rt N 0 w ( r In W Cn 00 Z 00 H (D Oa I ~O \7i W 00 C O N L~J ~ ~ I CrJ O 'd rh F' o H E fD • H~ rt 1 O q W W li L O C p1 O CD h~ a a CD m - • n fl it r- (D d ^ , 3 3 ~ Q w Z Z CD ~ m j 0 ~ ".A• o Da o m 0 00 o o k h (COD r.'j ((D CCDD m n 00 0 ~ co 00 O NO Q (L] N 00 O C7 _S O O C O Cl) -O Cp cri fi O 3 3 N A O C N N m c (D m v c D m a . "41 a X, W o~ a N 3 j N W O (D 0 Z to Co CC) CD (7 r U7 o Co CC) CD to A A T 3 6 • V -0 0 0 0 0 Y 0 m N y ri a D 6 Mv2CD O' (D fD W (n N v :3 O t N D W = CD (Q N d N (3D 7 CO Q .n Z O c CO z 7 O O_ 0 O 7 (1 F~ E; p p 7 - 7 (n CD C C CD m _ Cl) CD -i N z (O ;A Z CD O N O n C C A Z O a G~ R 0 Z N 00 0 m co C , zt z 0 3 A x o z 3 m y z CD -P, N ~ COi 3 T. Z Cp 5, w (n OD. p C1 CD (D -p -o CS Q C (D C < CD C G o a c D_ T =o : n p, p c m c s o N oz a < N N O 3 O CD CD C)_ Q CD CD cn Np-O . , (s(D cD W3 i N N& 0) p m o- cD P 3 N' O A N ,-.'O X N Coo o CD Cd f0 SU 1 L q O d b CD CD p O~ (D a N 3 `G v N CD O A - CD (o 1 O Cn O 7C CD 7 ((OD N N S `G D O N (D CL CJ C D p (D j 3 (TQa o N Q (a N 0 O. A O j m 3 - r (D 7q N cn O ti O (DD `may O C, ? LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040-1118-10-100 Parcel Number 31.28.19.480B OWNER NAME: First MARK C & BETH ANN M Last RICHTER PROPERT DRES~___Hse-#--4/2- -v-u --Streel_Name-~T pe SD Apartment 401 CTY RD MM 7_ MTT&g SECTION 3 O WN 28N RANGE 1 4 4 Line Description Line Description TOTAL ACREAGE 3.640 PLAT LOT BLK 01 _SEC 31 T28N R19W NE NE 2 76 15 02 AC LOT 1 CSM 7/1899 ALSO 16 03 TH L DESC AS 17 04 COMM NE COR SEC 31; TH N 89 18 05 DEG W ALG N LN 211.25'; TH S 19 06 22 DEG W 66.03'-POB THS 2 20 07 DEG W ALG CSM 7/1899 274.33' 21 08 THS ODEG W ALG W LN CSM 22 09 7/1995 957.71' TO S LN NE NE 23 10 TH N 3 DEG W 869.87';TH N 82 24 11 DEG E 30'; TH N 7 DEG W 25 12 302.31'; TH N 30 DEG E 26 13 145.67' POB (.88AC)(SALO) 27 14 INC 040-1118-10-200 (480C) 28 I F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, 178-History, F10-Exit I ICI Form - S T C - 104 s AS BUILT SANITARY SYSTEM REPORT ~y OWNER TOWNSHIP SET`N-R_Z _,/_W ADDRESS M ill 10 19 j ST. CROIX COUNTY, WISCONS N ` ~i~~c~''~' SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~r )INDICATE NORTH ARROW { i BENCHMARK: Describe the vertical reference point used c~r QQ Elevation of vertical reference point: /d d Proposed slope at site: oil ) SEPTIC TANK: ;Manufacturer: d ith lie S Frt(I Liquid Capacity: L 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, 0 feet From nearest property line Front,0 Side,0 Rear, O _ feet Number of feet from: well b? building: .(Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Liquid Capacity: Manufacturer: 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, 0 Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: 3 ~ Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: act dpi l0P ~ SO ~ 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, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: l Inspector: Dated: Plumber on job: ~/JGav1.Q License Number: a 3/84:mj COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 CIPWAr '4'j 715-962-3121 800 - 962 - 5227 +.X ZONING REPORT NO.* 17927/01 PAGE 1 ~tAOIX COUNTY REPORT DATE: 2/11/92 COURTHOLISE DATE RECEIVED: 2/07/92 HUDSON, WI '14016 )WNERI May CTED. 9200 AMPLE', K ;ATE ANALYZED102--07- CME .i e Bac ter i a/100 ii. ig N r i :;:a 0 ~i Z C G m ~ N OF.NDEPENpFry _ , 0? 7A Y € \ 4J 1 5 0" rte.- tears LC:S I'ie etitab~t? }_~-!-vet r+ ~ri,ved b o PROFESSIONAL LABORATORY SERVICES S114CE 1952 ~'j a3~ _ (0 AyI I ST. CROIX COUNTY ZONING OFFICE 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix Co. Zoning office offers the service of septic and water inspection to Lending Institution, Realty Firms, and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING FEE:$ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION FEE:$ 25.00 PROPERTY OWNERS NAME: i1~1,~{PLC r PROPERTY OWNERS ADDRESS : 4 r, CITY: Legal Description 1/4 /-L 1 4, Sec. Town of - Lot: No. , Su division on • " c~ C FIRE NO. C> ~ K~BOX NO. Color of house r , y Realty sign?t,,,_Firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e., COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting~ervices • Telephone No. .1~~.._,.REPORT TO BE SENT TO : A k) u L,Lt ) J-~( CLOSING DATE. Signature: LIAy-1 'L'Y1 l-t;,L t, s ~ ~ V 'L... ~it 'A, l 1\ ~ l,t_,. y 1, i. t- i....} ~ i b^- ? .(.~i_ ` ~ •,-~~1'. 7 ,y ~ ~`e IUGi ~"L` ~ ~ 1 ~ ~ N,l.~~ ~ (i'L N~i'~. ~ L ~T l.lJi,'1/4~`✓ ~ ~ s t DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWArSE'S ti"STEMS DIVISION P.O. BOA 7969 BUREAU OF PLUMBING MA;a ISON, W I 53707 0 )6~ CONVENTIONAL ❑ALTER NATI VE IS,,,, PI,, I,D. Number ( Holding Tank [:1 In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Douglas Page R. R. 3, River Falls, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.'. CST REF. PT. ELEV.. NE4 NE-4, Section 31, T28N-R19W, Town of Troy Name of Plumber_ JMPIMPRSW No County. Sanna,y Permit Number Tom Wan 3231 St. Croix 58888 SEPTIC TANK/HOLDING TANK: MANUFACTURER- LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER PROVIDED- PROVIDED- IYI 11&11:..A' ~ 'u_CC':k EYES ENO EYES ENO BEDDING: VENT DIA.. VENT MATL. EH ATER NUMBER OF ROADPROPERTY WELLBUILDINGVENT TO FRESH FEET FROM LINEAIR INLETDYES ENO ES ENO NEAREST )III DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP,'SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED EYES ENO EYES ENO DYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING IVAIERNITNLTOETFRESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) DYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing It FNC,TH IDIAMETFH 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: WIDTH. LENGTH NO.OF DISTR. PIPE SPACING;. COVER JINSIDE CIA. YPITS LIQUID BED/TRENCH TR ENCHES. MATERIAL: PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE cOVER. EL EV INLET ELEV. END PIPES FEET FROM LINE: AIR INLET: NEAR EST--i MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. EYES ENO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS EYES ENO DYES ENO DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. EYES ENO EYES DNO EYES 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 MANIFOLD MATERIAL. NO DISTR. JD PIPE DISTRIBUT ION PIPE MATEHIAL & MARKING ELEVELEVCIAELEV.PIPESDA.: ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS DYES ENO EYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: =NB OF PROPERTY WE M LINEE YES ❑ NO D YES ❑ NO Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE'. TITLE'. DILHR SBD 6710 (R. 01/82) APPLICATION FOR SANITARY PERMIT ILHR COUNTY (PLB 67) 1:7: TOF UNIFORM SANITARY PERMIT # Y, LRBOR 6 HUMRn RELRTIOnS ~yf -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 'innchaesoinasize. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWN R MAILIN AD RESS / ~ u er / Gel 5. 5/d PROPERTY L TION CITY: ~r L_AL E: /F1/4 f 1/4, S ~ , Tom' N, R / E (or OWN OF LOT NUMBER BLOCK NUMBER SUBDIVISION NAM :ffS OA AKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedro-Oms: , ❑ Public (Specify): THIS PERMIT IS FOR A: k 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. LN Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny 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 Z n c fir, manufacturer: r 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): < mil(/ Wo R Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for instal ation of the private sewage system shown on the attached plans. Name of Plumber (Print): , ) Signa re: MP//MPRSW No.: Phone Number: ~t c IIQ ~~T d') gyp ; `bl Plumber's Address: Al Name of Designer: ,q I✓,il S 5- COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Ilk ❑ 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. i c 4 o C)) _ ° +0~ C uJ E -6 ca E O E p C U = t t 0O j p C S m U f" O) o V H E p p .p+ N~ 0 0) O C~ O _N •i _N t 'p C L A N a 3 D O C N p ~ W O cov > > U) 3 ov -3'0~~ ~Ec N c CD :3 o U) F- Q m ~ ) o, •v o U N NM p c p p o c N cci cc (D E in t c (D 'a •r ~ 10 D (a ca 0 Co 0 4) LU N p3 0'v ° 0 C C U _ ) t = O O t C `'V C~" cc L- W c v 3 o prv p ~Q" ' D C p p m E U U) " 4) Cc Z 7 c ~ ~ v~ cc$ c °'3mcv3~, F- N c Q Z N N p N p O ~ a c~w o 0) p t0 1- cm 72 N O V U M= O U O N (7 ~R V er O ~ 3a N N > Q O p et cb p C CL CL 00 C p C 0 O = O 0 L _ N ~ r. = U) 3 C a OZC cUnc0 »a E O O r cu N O O c c ~ O w ch O co ` 7 N O co p p O E L. O Y O .L-. C ~ rL-. ♦ U~~ C ca p Y CD O CO U C rn c p w O co U F 3 N N 0 p co p=3 a p o 11311 C 0 p p C a p w O c Z ~,Y N O= ? •OC. ~V a a r- cL .0 0 C U E p 3 C A N U 0) OY C O p C L cc N y ° O E N N N y W cc Q J N O DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY„ , DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS \ MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP NICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: N~ 114NV 1 /T AN/R~I'E or COUNTY: O ER'S/BU ER'S NAM MAILI ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence r VNew El Replace RATING: S= Site suitable for system U= Site unsuitable for system f -PRESSU K:IE CON Isis VENTIONAL: MOUND: IN-GZS [_]URE:SYSTEM-I ILLHO❑LDING®V R M~f{IEND ~`M:(optional)~~~ F ercolation Tests are NOT required DESIGN RATE: If an k~ y portion of the tested area is in the er s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- l'j '13 1 G) r ti B -50 5 ` ~`Z) 1~6 )6 B yl TI' ll goo :?/a.00 no &n B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- r /0 -77-2- 1 >l P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dista ces. 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 borin s and the direction and percent of land slope. SYSTEM ELEVATION / ~rh f'r PS x Uo o k t, s~ rUGn6rJ ~ ~l -PY'oG'rl top bxw"n I Q of-, TN Ile . ~lnr~ ` s- pike ~(P~.areyn~~'3 ~1,' S`( k w/r`I~ ►'~~I r ~y!~ ~7~a~)L 7rr~ ono r I, the undersigned, hereby ertify that t e soil t sts reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and t at the data re orded and the location of the tests are correct to the best of my knowledge and belief. NAME ( rant ] TESTS ERE COMPLETED ON: y. p !U /mar . J i 0 Ott /l! W- _ ADDRESS: CERTIFIbiAbTION N MBER: PHONE NUMBER( t l) i na: gop CST SIG RE: i c:s Fr f.~, k l 4 t o t: } ~ a "c E: E } L ~ l a ,e_.z_ II rc- a7,>its i? tait'q, s~ .t~`J ~9t~ fl~ (IH EF, a 3'S 1_;: .I'. C, s e ( (F0 r F ` 'C", JoI 01") Ion Te<t I J, .f. . .:j '.:S I,I;• z~, r ct i:i Y Y :`~'b7;s I~ ykl~ j~ 1, a t s tf e a°i ,f 1,3 a'kin E # , .ar•- n , tz'~ E, r: 9 A l i .b I eve, vfi O'ff` ~a~°~~° 11vr> p I;xs fi'r' ~S P GI t i I1g3 ~ ' a yh ~oYh. s s ~~yNt '!1 i i :i I