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HomeMy WebLinkAbout020-1157-10-000 0 cn O 3 n d ~1 O v* C a) O fD c > > "0 3 .O► A W -0 M O d N 1 m 3 v v o n J o r5 ~ (D m 0 N m 0-0 N O a O N 3 7 C: CD ~o Q~ N ~ J ~ O 0 0 ~ o 3 S O 7 N N O~ O O N_ N O ~ N 4, a UJ < D CD o G N CO d T CO Cl C) 0 CD 2! 7 O W ccp w m co r- 0 r- cn 00 0) in O C y W CD K a 2 ~ "0 M "Ali o O O O N Y tr o N cn ? co O ~ Uf fn V1 A d O N (D fD N fT C CD 0) 'a 0 CD N N 3 0 H d rn m N !~L CD p~ N a 7 cn N Z N z co z O O D a h• O N CD N N O N (V Z7 ~ v c O N C (D cD w m a n 3 F Z cD 1 cn O p p Z CD c A z O fl a C 7 O 7 m m < O v a z 3 a ~ °O " z H z O _ ~ A W ~ o D 00 ° aD o - N C z o m' o N m N D o y Elo W rn ~ n CD a Q m z N N O O A O_ ~ O a CN O O ~ O a C) (D o Parcel 020-1157-10-000 10/11/2005 03:57 PM PAGE 1 OF 1 Alt. Parcel 17.29.19.878 020 - TOWN OF HUDSON 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 - WARECHAM, THOMAS A & CHRISTINE V THOMAS A & CHRISTINE V WARECHAM 461 GREEN MILL LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 461 GREEN MILL LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.214 Plat: 2277-PARK VIEW ESTATES 3RD SEC 17 T29N R19W PT NW SE PARK VIEW Block/Condo Bldg: LOT 84 ESTATES 3RD ADD'N LOT 84 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/28/1999 605706 1437/219 WD 07/23/1997 1188/233 WD 07/23/1997 904/132 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.214 24,300 130,400 154,700 NO Totals for 2005: General Property 1.214 24,300 130,400 154,700 Woodland 0.000 0 0 Totals for 2004: General Property 1.214 24,300 130,400 154,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r AS BUILT SANITARY SYSTEM REPORT OWNER G L-'1C'O TOWNSHIP ~~114 66 j`~~'I SEC.1 / 122N-R JqW ADDRESS-C/ I `t t~ ST'. CROIX COUNTY, WISCONSIN. z~ 4; SUBDIVISION -`~OAOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I di at N r h rr w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: 2 3 74 SEPTIC 'LANK: Manufacturer: Wi r _ Liquid Capacity: 1GtL u( a Number of rings on coverer Tank manhole cover elevation:'.: J, i Tank Inlet Elevation: 71 C _ Tank Outlet Elevation: PUMP CHAMBER 3" Manufacturer: Number of gallons Number of gal. pump set for a cycle //4 - gallons; Total capacity of distribution lines //-gallon: size of pump- ✓/±head; gallon per minute /t//~ horsepower Ali ;brand name of pump and model number -A119- ; Type of warning device / HOLDING TANK: Manufacturer _ ~/4- Number of gallons Elevation of manhole cover ; 'type of warning device Ax, SEEPAGE PIT SIZE; -Number of pits feet diameter feet liquid depth- _ ifi/,/ seepage pit inlet pipe-elevation y- bottom of seepage pit elevation _ meet. SEEPAGE BED SIZE: number of lines= - width length .7C tile depth SEEPAGE TRENCH: width length PERCOLATION RATE AREA REQUIRED / 5- AREA AS BUILT INSPECTOR _ DA`Z'ED PLUMBER ON J0B LICENSE NUMBER— f✓j ~ ~ 3 _AA .A MCI 41 5 ~i a li 1 r /d~~ LXII~ /00/ o~ - f E f 1 i I f~ i i I i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HLYMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.*BOX 2969 BUREAU OF PLUMBING OADISON, WI 53707 E~d CONVENTIONAL ❑ALTERNATIVE slate Plan 1D. Number, (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Mike Mc Donell 14-4th St . , Hudson, WI Dr-~,~ a~71 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. own O Hudson REF. PT. ELEV.: CST REF. PT. ELEV.. NW SE, Section 17, T29N-R19W, Lot 84,Parkview Est-III, Name of Plumber. MP/MPRSW No County. Sanitary •Permit Num Douglas Strohbeen 5732 St. Croix 38471 SEPTIC TANK/HOLDING TANK: q IV c__ ,'-t,_6, MANUFACTURER. LIQUID CAPACITY. ITANq K INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDED 3,~ YES ONO OYES ONO BEDDING. ENT DIA.. VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTY WELL: IBUILD~dAIR VENT TO FRESH G'L- ALARM FEET FROLINE: INLET. l1/l YES ONO OYES ONO NU DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUF AC TUNER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. EYES LINO EYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING IV ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) EYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I FN(;TH 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: WIDTH. LENGTH INOIF IDISTR PIPE SPA NG CO INSIDE DIA -PITS LIQUID BED/TRENCH TRENCHES ro, TE IAI PIT DEPTH DIMENSIONS i S tl GRAVEL DEPTH BILL DEPTH UISTH PIPE DISTR. PIPE DISTR. PIPE MATE L'. NO DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BFLOW PIPFS ~A ABOVE COVER. ELEI .I NLET E V. END. n PI P'j FEET FROM 1 LINE: `tea t, ~yL AIR ET: ✓ / / l ✓ NEAREST 'j MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- O meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER TEXTURE PEHMANENT MARKERS OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH:'BED DEPTH OVER TRENCH 11111 =SOIL. SODDED SEEDED MULCHED CENTER EDGES OYES ONO EYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. ID:STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVELEVDIAELEVPIPES DA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. OYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE EYES ONO OYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. I N TURF ry TITLE. DILHR SBD 6710 (R. 01/82) DEPARTMENT OF REPORT ON SOIL BORINGS AND 18~ON HUMAN USTR RYE,, i ANDLATIONS PERCOLATION TESTS (115) ~ ' MADIS O 153707 HUMA c LOCATION: SECTION: OWNS HILOT NO.: BLK. NO.: SU 1 I if 40 Y ~E /as '/4 l /T~2q N/R ~(or (o 11 00 Aa4vw COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ;X New F D R TONS: PERCOLATION TESTS: Residence ~aNew ❑Replace 5--,2643 S---I& J So: 114,41, $ we e 490-14 RATING: S= Site suitable for system U= Site unsuitable for system /ZZAO 106. -5- CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ZS [:]u NS ❑U .®S ❑U ❑ S ®U ❑ S DQU ,ev htlaol 'X16' It Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the under s.H63.09(5)(b), indicate: 4_1A Floodplain, indicate Floodplain elevation: PROFIV DESCRIPTIONS ,re& BORING TOTALS DEPTH TO GROUNDWATER-INS"ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Lid! ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- l . S ' •S' /..3 815 t . 4~ ldh / 1. ~ f 3, 0 14 cs B- o~ ' .s` d~• 7 ;P ,s*' •7 8 s/ / .O 3 o n rs r B- ` /V0. •K B - / . ys&/s .,t d S- 40 0 CI r B- 2~ s" /.S`B%s i . A' 10,2. l d s 2.1 ~3h C s /0 0. 13- s% O S n.S Bpi e B- PERCOLATION TESTS TEST DEPTH' WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER +4@44E-9 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- . 3 ` o 3 uL • P- 3 o L -3 6 6 Ir~ I-P- l P_ PLAN VIEW: 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 t :,e plu-1 plan. Shorn the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION 9E. Y ` 14 6 e4,41 j r 7 A%.a s 6 '1tvr e- '00 5 As,~Wfi ©rA-4, `O Ae _r0~o 0 f' /9 nLw a~ 44 n G~/ a2 -.3 ~1 n s/o/o~ f~.3Gs't . 04 a t the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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: wI - ,S= 30 -83 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): f CS NATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd P age-'Property Du.;ner, 4th page-Soil Tester. DILHR-SBD-6395 IN. 03/81) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS .INDUSTRY, FOR SANITARY DIVISION LABOR AitD PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: Property Location: CK --WT"717M Township: County: L✓/a%SX7,T~IN,R/g9P(or) 14L.j50 1 5r G Lot Number: Blk No: Sub ivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) a 7 TYPE OF BUILDING ❑ Public* F-1 Variance* ❑ Other (specify)- Number of G U _157 Bedrooms: 1 or 2 Family *State Approval Required. lei, TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS QF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY 0, 4'y HOLDING TANK CAPACITY 4- LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: Y r EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ~ New ❑ Replacement ❑ Experimental seepage Bed ❑ Seepage Pit 3 ~ ~ ~ ❑ Alternative (specify) ❑ Seepage Trench Water SS ply: ]Owner's Name as Listed on Soil Test Report (if other than present owner): L7 Private ❑ Joint E] Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signa re: MP/MPRSW No.: Phone Number: IMF' 3L (217 3,2 33 Plumber's Address: ~ Nam of Designer: COUNTY/DEPARTMENT USE ONLY Sign t re of Issuing0,ent& , Feeo © Date: Y~~ _ APPROVED Sanitary Permit Number: v 6 EE/?? ❑ DISAPPROVED _3U Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) i Owner of Property Location of Propertyt Section t ti J 4 L N h 1 t ~J ld" Township Mailing Address Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel_ f f~ Date Parcel Was Created Are all corners identifiable? ---yes_ No Include with this applic >tion one of tale folly-W-1 l_" .Certified Survey Map .Deed .Land Contract, or Other Legal Document which describes the property - PROPERTY OWNER CERTIFICATION 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. presently own the proposed site for the sewage disposal system d(or that I (we) 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 OWNE _ SIGNATURE OF CO-OW NER (IF Af PLICAHLE) UATE SIGNED - `ENE OATS SIGNED - i„ s ~OhGO ,/~vi~ rL(h~nr~ ~r4h~R 3C~ r h la' on taj`' a r 03 :L I)z~, 0 70 "~5~ , 14 0.4 Jk 0 A- L n ry 41 J ~ II I W, NJ\ wh IS* C~- T-q I"N Q S