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HomeMy WebLinkAbout276-1043-35-122 0 c/A 0 g v 0 C7 O `r1 C "0 3 CD 'a D 3 G A: "Ol K o O m A O_ co N a) v • CD O (D N 0, Q N ~ co 7 n T] co W O Q O S N ~ o n O T O 7 N N N O N O !V (n Z D a o ~ O N G (Ii N d W Z O O -(7 S ~0- ~o lei b ('T W O co oD I'fn 0 0 C 411 cr C1 ( C M h• o h O O O c~ ~r c T -n cp oo oc. 63 D ul vvo (D fT1 (D fp ~ N z 0 (D - CD c) 3 G O N N ZCO o D C O CD ( oc (CD • oa CD 411 m c I -1 Z CD I ~ -I cn IV rn O p Z CD on N ~ Z Z 7 A Z O 71 cf) N w M C) CD CD 00 cL p :zt Z ~ o M~- w m a a~ CD Q ~v - N a O -n N ~ D X =r z Fn" G O D O 7 N a (a N N 7 < (D CD X = A a O 4 O v O n. G N CCD D fi (D =3 A m35 (D (D N S?osCD N O N N a ~ A O -0 t-j On O O < ft 0 ~ V (D p yb Parcel 276-1043-35-122 02/28/2006 10:39 AM PAGE 1 OF 2 Alt. Parcel M 36.28.19.322G-22 276 - CITY OF RIVER FALLS 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 - FAMILY TR, THEODORE D & JACQUELINE THEODORE D & JACQUELINE FAMILY TR 1052 N MAIN ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1052 N MAIN ST SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.379 Plat: N/A-NOT AVAILABLE SEC 36 T28N R19W PT E1/2 SE NE BEGIN E. Block/Condo Bldg: R/W HWY 35,608.5'W & 172'N OF SE COR SE NE, TH N ALG R/W 100', TH W 20'; TH N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 13', TH E 170', TH S 113', TH W 150' POB 36-28N-19W EXC PT TO STATE 910/62 FORMERLY 040-1139-60 (563K) Notes: Parcel History: Date Doc # Vol/Page Type 03/02/2005 788588 2757/363 QC 03/02/2005 788587 2757/362 QC 08/04/1997 1255/355 WD 08/04/1997 1255/354 WD more... 2005 SUMMARY Bill M Fair Market Value: Assessed with: 133110 345,400 Valuations: Last Changed: 10/30/2001 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 0.000 107,600 166,500 274,100 NO Totals for 2005: General Property 0.000 107,600 166,500 274,100 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 107,600 166,500 274,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 502 Specials: User Special Code Category Amount 013-SEWER&WATER SPECIAL ASSESSMENT 1,382.87 Special Assessments Special Charges Delinquent Charges Total 1,382.87 0.00 0.00 Parcel 276-1043-35-122 02/28/2006 10:39 AM PAGE 2OF2 Parcel History: cont. 07/23/1997 910/62 07/23/1997 860/463 07/23/1997 817/298 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING 'MADI ON, WI 53707 • REPAIR ,CONVENTIONAL ❑ALTER NATIVE [1,1, Plan LID, Number: It assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ted Ha bun - Centun 21 Hwy. 35, Malin St., Riven FaM, W1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PL ELEV NE NE Section 36, T28N-R19W, City o4 RivvL FaM , W1 54022 Narne of Plumber_ IMP/MPRSW No. 1C.-iy. Santa ry Permit Number_ Rvbent UtbtLc.ch.t 3307 St. Cnv~.x 58866 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED-. ❑YES LINO ❑YES LINO BEDDING'. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD'. [ROPERTY WELL. JBIJILDING'. JVENT TO FRESH ALARM. FEET FROM INE'. AIR INLET. ❑YES LINO ❑YES LINO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. 11-11111111 CAPACITY PUMP MODEL. PUMPSIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY ]WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing NGUf oIAMFTER 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 INSI OF CIA. -PITS' LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILI_DEPTH JOISTH.PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO DISTR. NUMBER OF PROPERTY WELL BUILDING'. VENTTO FRESH BELOW PIPES ABOVE COVER ELEV. INLEF ELEV. END PIPES FEET FROM ALINE. AIR INLET. NEAREST 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. ❑YES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES LINO ❑YES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCT BED JOEPTH OF TOPSOIL SOD)EC SEEDED MULCHED CENTER EDGES. ❑YES LINO ❑YES LINO ❑YES LINO 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. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.. DIA.. ELEV.' PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE MOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑YES NO ❑YES LINO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) • 4 Wisconsin APPLICATION FOR SANITARY PERMIT K COUNTY 1 11111111 1~)DILHR (PLB 67) UNIFORM SANITARY PERMIT # ~ DEPRRTTT1EnT OF InOUSTRV,LRBOR GHUmRn RELRTIOnS S f~m -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 l S"', /~UC ,p MAILING ADDRESS OPERTY OWNER ' PROPERTY LOCATION f, CITY: VIE' ^ /V C~1/4 W1/4, S T ZP, N, R E (0r)~ 5 LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 60 3S ti _ TYPE OF BUILDING OR USE SERVED D 1 or 2 Family Number of Bedrooms. 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. ❑ Seepage Bed ELI Seepage Pit ❑ Holding Tank System-In-Fill El In-Ground P ressure rlvy Pit Privy ❑ Existing, For Which s ermit Is On File, Permit # issueo An Exi g ystem That Has Been Inspected And Is Compliant As Far As Soil Conditions. r Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 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 Tank Septic Tank Capacity Lift Pump/Siphun amber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ❑ Private ❑ Joint Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. No.: Ph D Name of Plumber (Print): HOMESITE SEPTI '~d(I~G CO. MPRSW one Number: ~ ~ n (1(,S' 1 Q l~ RT. 3 O'NEIL RD., H DSON, WIS. 54 Plumber's Address: ULIJf?ICHT Name WIS. MASTER PLUMBER LIC.NO, 3307 MAR.S. of Designer: MINN. IN COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved - ~j J~ ❑ Owner Given Initial (J7 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 /P4 o,~, Si90 . t . 191 / fLJE~ tr EX/'S'Ti'tij 70 Sc ,O~f ?A ,N,,e -s &--Yf' ST'/U G-- 9 .t' y w E //S . 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^' ° i a... CO) > O v c <::>::>>>::>< c < E N3 o a~ - -6 (0 C N N p 0) O C O 'D m C j 4 O m(D A O C 0 N V N = CAA to 16 to `C L i O •C M m C= 0 0 c ca W ocv>>~U 3Oc 0 3 0 E c C) C ° `o N DO Lc N 0.- Z Q _ U 0~0 = ycamUccc o((D V N O L O O co W E-CCov?N o0L c 0 3 -0 c0 n a cn ~cc0--t ~)B CC O r p L c~ i C C y N O O Q L U a~ ~ CO Cc wf Q Z 'gin ~ 6. 1- V~ y W a L C C) N O ; (a C w ° U to 71 0 3:.o (D (a cm V U O O ` O cn ` +O• _ C D Q 0 C N O O C N 1 L N cr c Q 0 a.o -a) o (a c o O c O ' co .6~ N i CO ca co 3 cb :3 CZ.c U*10.0 E75 ° :3--E to C O O ~S o- Cwf c = = C c I.. i z ca o cv°'CM L-*-0 vEU y (Mt C -O t w e NJ v(n cn (D a) ~43~ 0) c v0.. O ((a v 0 'C O ~ i o N o c 0 a 3 v o 3 co o C ,rO „p O CL E~ L: cm C O D ~C 3 r; U O O c o N C o w w m G 0 E c-4 a vi ~ H b- N ~ J N G L t k~ PA' (/2 ~if E'~1I,4'GeS~f~~~) ~ CLo SS f- L l>~ .v T Li N ~,S' . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND C P.O. BOX 7969 LABOR1 RELATIONS PERCOLATION TESTS (115 MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION-.'- SECTION: T$HCft3fitiP/IUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: Nt '/a '/a 3 /T N/R /1 E (or AO:vt p t/~s COUNTY: . OWNER' MAILING ADDRESS: SI -Choix T,-.Z> y~(r /3E~P G-- ,kw/ 3 S~ ~,GI,4i v l~> ~C'%v~-.~ frt~~r lv:s r L USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: JE ce Cfli!-70 2 ❑ New El Replace A G O p C r Q 0 D SE , a- ryS 7-e67-e6, RATING: S= Site suitable for system U= Site unsuitable for system 'Pe /0414 D~ eX/ XTjIV CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDSYSTEM: (optional) ®s ❑u RI s [:Iu R] s ❑u ❑s ©u ❑s ©u Aemly ory,,fr1*v Ae w is If Percolation Tests are NOT required DESIGN RATE: 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 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEEVgATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / 20. > 2 D. j- 16,5-1 /I'oF (,4 't-/ ? S,4 AJP ~4SE °f TAU SrIND yR~1VE L , /57 3. B- ~/U w p FL B- B- B_ YOIL5 Ado B PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER ;,T• AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH P- &:94124 S 47- P_ a ' /ale P--d- Z P- ~r ICS L 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. Ci X 5 71"A) Cr----- SYSTEM ELEVATION Pgy'd T©p o ~x!'STf•U c , E , Ct , 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): HOMESITE SEPTIC PLUM ING CO. TESTS WERE COMPLETED ON: RT. 3 O'NEIL RD.: HUDSON, WIS. 54016 or--/. lf(flel ADDRESS: ROBERT ULBRIN; CER IFICATION NUMBE : PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ~0 L yf L- ~ "6 _ Df p DESIGNER LIC. NO. 00663 7 Q Q CST SIGNATURE: 'TION: Original and one copy to Local Authority, Property Owner and Soil Tester. (P 02/82) OVER UNWa I NAG MM 1 15 SODS Y sty and accuraw sail test~. yern 3'-oport rausr: dutla: i.x ion; ,.i 6asF; sei-ti it-' sl clearly in€iicatr w„iF=` Tor Ads is r €"=w. ,ice or cor Y7 e r 4 this "r new in Q _ rr:;~i the ..~r;33,._ t r ttl.~tj ~?t., s i-~?.F a U. I" OR fJL°c' IF U E R T Y S T E RA sa ?3'E RU ED ...F U I a.L ON 'c. ,t sS< 4e ) N EA £ i 0 F'~,! ,)r C PLEASE v c thv ^w N afi, 3 ~v srar ti r ??w Wir urir€iny in of He des r Ip.:_W coniplei;in the riot p1w. MAKE A _ 3 i. M r_ da„.;;ram nc.w.rY=`.y having 'y :3-1,. bot 3CaC.sitdwty Yawing to We i rai"efurned. t,1 i t # h e i 'r iy iit us=ti it dusted; 1€lr... , 'a v ..t be =4r'mark and voted i ec m! > i_ iencr' point are {1iu3rl shown and aie j r rns,nwi? 9. Con-iritv?e all apowca5e khe b oxns as to {tr,feso rlcrm C Women, Ham! plain duian pe tcolation 'Lest foxy'€l P Quo if amwopkaw 10 . 3 r i `i,:e E ..r ,3. wh s 4,s_d i iii°, ^.r akn';} ,7r„ s P `Twr a Uz v? t'3. A. fE'1 We a"waiaw Hens; 11, `uq [_}m oaa` A en- y,rte: _u<,€..n caihl.. , v.r;ts you ce -Aw i..,";3,ar€L,. 12 We 1001310 COMO o! diS rA)r [ as r, stet€EEk ail.;... FU rC G` F R LED ITTI-1 Ti-11-. I FORI TESTERS Sam, Win W Wko"~k AT cawye i3 - 1w," SS Sawmwic . r d>1.,~j r,uSatj ff'f 3sx,1 L',- ~ 2 stClr Yr-; w ,rwd S S . Syr=. Y s n3 , - P it °=?W ;_4[cl?., Swu 'i - ruin '01 Salt Loan tig i - oil, rer s (AM AMA V PAW 11th w?i i