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HomeMy WebLinkAbout020-1098-90-000 o d d m e C v1 > > o 3 M CD 3 X O `C • _ (A 0 W T 0 C W N ° O ro y O fD a O r}r/ll CD 0 c0 O Q Z CL :z Sylt N p j 7 m W ' m o (D X, o c ( ~ N N N N d j O N N p n f0 O O O O O n = Q N co O O O CD N n N pj (J1 N (O (Ji 3 O - O 6 O l\ Vl 3 O p c rn p cn C-n (D o D C a _ m cn ° - co c\ .D = y O` N N N N O 3 O O O_ -I O O O j N@ O CD C) Q CL N CO W C 1 C!1 T1 o co 03 N p C O W p W W= rr a' p ~ Ci. C~'I n v N L' • (n ~uC,y~ to DI l~~y • (D O / 0 0 0 N p (D p H rt ri W n _-I I - ' - § < H. 3N N N O rt M CD y O W (a CD H I a C4 Dpi ccn c' 3 m a a` r M z N) ~c r Imo, C~ N Z °a Z O trti _ ° O Z co °Z d N = D ° Q 5 o O i--N v M Cn ~1 • D CD 'r m rn = m CD W 1--C CD N O m ° w I 3 ~ N ~-3 t-1 z --I cn Z M 0 0 0 Z N c " I r* = a z o 00 n W r-r to C) V V Z n~i w x cn W M 0 3 a x N O Z G H n r; p, F- rt m m • [n (D N• Z O ti O C A H ~J p w N. cn G LO ~ CY W c a d n • a ~ n ~ y ° _ -n O 3 m a z d CD 0 N co a y N H Q ,Q N N ~ O (D O - ~ I (D I c w a 0 Tr = c fD Do x to O r a 0 o b o m 0 V AS 1i11 1"1' SANITARY SYST E,M Itt"110R`I' SEC . ~ N - I' W ;)wNlt:R.1// TOWNSHIP-li(i~_ - `.C- - - ADDRESS ST. CROI.X COUNTY, WISCONSIN. S U RD IV T_ S TO N L OT LOT SIZE - _ _ - PLAN VIEW Distances and dimensions to meet r quirements of H63 SHOW EVERYTR tW-ITHIN 100 FEET OF SYSTEM w / I i 1 0 I , Indic Lit - N r h rrc w BENCHMARK: (Permanent reference Point) Describe: F.Ievation of vertical reference point:_~ ---Slope at site: SI:PTI:C TANK: Manufacturer : _GJI,e li-zt 5 Liqu=id Capacity Number of rings on cover manhole cover elevation: IG7 - Z-Tank Inlet Elevation:-/Q5 -Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; Total capacity of - pwnp_ distribution lifies__ ---gallon: size of head; _ horsepower_________ --;brand name of pump Sall_on per minute- und model number Type of warning device---- - Number of gallons II01U1NC 'LANK: Manufacturer- D',levation of manhole cover Type of warm rig feet diameter I'. I':i'AC1? PIT SIZE;_- Number of pits It.et l-i.qu:id depth seepage p-itinlet pipe-elevation- - _ feet. bottom of seepage pit ele.vat:ion__ - length the dept IiED S ZIE: numbc_r of lines width leng ;I jPAC, __3-~ length-- I:1?I'ACI, 'I'RI?NC11 : width - A, AREA AS BUILT C0LA'!'I(-)N RA'I'D: AREA REQUIRED INSPECTOR h 2 i y 11I.UMBER ON JOB- «o~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ' LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.G. BOX 7;.69 BUREAU OF PLUMBING MADISU-,t WI 53707 CONVENTIONAL ❑ ALTERNATIVE State Plan L)D Numbers assigned ❑ Holding Tank 1:1 in-Ground Pressure ❑ Mound (If NAME O. ERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Marlyn Fredrick Hudson, WI le - 3'"Oc7 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.. W SE, Section 33,Lot 1,Keller Sub.,T29N-R19W,Town of Hudson JName of Plumber IMP/MPR sW No. Cnu my Sanitary Permit Number. Roger Timm 3224 St, Croix 43692 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER - PROVIDED: PROVIDED YES ❑NO ❑YES O BEDDING: VENT DI A.. VENT AT L.. JIHIGH WATER NUMBER OF ROAD: PROPERTY WBUILDING: VENT TO RESH A LARMFEET FROM LINE AR INLET❑YES ❑NO ❑YES ❑NO NEAREST ~ DOSING CHAMBER: V MANUFACTURER. 7INGLIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDYES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: 7 D 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 FN ,rH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH NJDISTR. PIPE SPACIN(; COVER JINSIDE DIA 1t PITS. LIQUID BED/TRENCH TRENCHES e M AL: PIT DEPTH DIMENSIONS j 6 ~e / ~ GRAVEL DEPTH FILL DEPTH DISTR. PIPE OISTR. PIPE DISTR. PIPE MATERIAL. N T H. NUMBER OF PROPERTY WELL. BUI LDING. VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END. PI S FEET FROM LINE. J AIR INLET: 4 /0 ~ q3,51 U.J NEAREST--r 6 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- meets the criteria for medium sand. PIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH 1111) DEPTH OVER TRENCH/BED rF TOPSOIL SODDED SEEDED MULCHED. CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING'. JGRAVEL 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 ELEVATION AND ELEV.. ELEV. CIA.. ELEV.. PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER rLL OFPROPERTY : BUILDING: FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. f /7 SIG ATURE TITLE. V'jaMa j DILHR SBD 6710 (R. 01/82) APPLICATION SAFETY & BUILDINGS DEPARTMENT OF INDUSTRY,, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN'"ELATIONS (PLB 67) MADISON, WI 53707 Attach plans fqr the system on paper not less than 8% 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, \/Vis. 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: ~-C Property Locatio J lage o Thip_ County: j'/ate ' %S 3 T Z7N/R I (or) Cry? Lot Number: Blk No:: Subdi i Nearest Road, Lake or Landmark: State Plan I.D. Nu ber: -i (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: JX 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY Zi' - < HOLDING TANK CAPACITY -All LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: Li EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ~k New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): C. Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na.. Plumber: Sign ME-{PRSW,No.: Phone Number: elo", go, Plumb , s Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Si gnat re of Issuing Agent: Fie: Date: p, APPROVED Sanitary Permit Number: ❑ DISAPPROVED 7 1 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) JOB ROHL & TIMM EXCAVATING SHEET NO. OF 310 Arch Street j>. HUDSON, WIS. 54016 CALCULATED BY (715) 386-8664 CHECKED BY DATE_ ` SCALE r \ G M _ PRODUCT 204-1L ~lnc Groton, Mass 01471 JOB ROHL & TIMM EXCAVATING ' 310 Arch Street SHEET NO. OF . HUDSON, WIS. 54016 CALCULATED BYE(" Z (715) 386-8664 CHECKED BY ~ DiFfE_ SCALE V Sul \ in i ~ II i s PRODUCT 204-1 ~s~Inc., Groton, Masc. 01471. I9 DEFARTMtNT OF REPORT ON SOIL BORINGS AND B IVI IND08TRY, LABOR AND PERCOLATION TESTS (115) CD MI 46-1 3 HU4;AN RELATIONS y LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBD "ION E~ Nt~l/ate/ 33 /T Z9 N/R E (or) W COUNTY- . OWNER'S,BBUYJERWS NAME: MAILING ADDRESS: 3 ho USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI _E D TONS: ER LA oON TESTS: New ❑ Replace oe ' ` Residence i RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEEM1:Cpt, Ll~c VN- S ❑U ©S ❑U ❑ S ~U ❑ S ©u ~otiv~~T~au.~L ~,lS~AJrh'° ©S ❑u F DESIGN RATE: SYSTEM EL V. If an ortion of the lot is in the _t ~ ~ If Percolation Tests are NOT required Y P - under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain ele`v PROFILE DESCRIPTIONS ~ y ? ' BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNE OLO TEX E, AN PTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. I/CHEST TO BEDROCK IF OBSERVED (SEE ABBR BACK.)~,,~ v B-2- p , 4~ rf ~ " 41, .S L~ !S, . ,L7~•.s3N L 1 ~ v' 9J±s~Q B- 7 Y 1 m >i00 13 ''L-1• /3N. SL 401 P~ "S a 4~:- tics B-3 /OZ 9"gN. Sc , ~3 OR 5- , 23;,04 , 5 S- -5'7 cs- B- q5. 13 71 B- SJ~Y~cL 6 F rF{ PERCOLATION TESTS uK"-r sj ~Js4ty `l~ > TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PER D2 jM~t P_ t~ c r. P lo, O P- P- O I Y" PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the h 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 perc of land slop. Bo JTOH O 134v BALL Lit _XACTcy Ar j1, 3 Ir R A r Ati FEE SYSTEM ELEVATION EXac~~X 77 fy • /3etow U£kT• /PEf Pl-- .Ny1E ~0 ~f.1/i CED~+Q 1 • _ ht.9Nv Dui 135- Jr 3,61 13.2 x = P ~P r vir po P7- 7_010 "APPROVED' gy P3x - of ca~CRETE` 63 a 13M Data `j l) ! 2/pw H P,PoPas~-o M ~ Ll"'q~ _ ~V Inspeetove -r . ~f T. /00 t. X, \ h`05F cEv y ~~SE fUldS L1E ' c~ J10 Z' ✓y cMbSvA)Et9 j" COAX ~1~ jT. Mj',VfKv,011 Or+ o ,QEADIa~ Ct em, le f,t'Efl r 7E` T LEq 5 T _41,O WELL /"V i At/E ~RtvE' I, 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): c TESTS WERE COMPLETED ON: "obc,427- Z'/ A^I' /1 & . /y , yd~~ ADDRESS: /~tg/ 311FICATIONUMBER: 3 NENUMBE% OPt5 C~SIGNAT RE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 IN. 03/81) r r r Form - S T C 100 Owner of Property /`l Location of Property %t, Section. T N R-4L W Township Mailing Address Subdivision Name_ ZZL_ - Lot Number j i Previous Owner of Property i' /l" Total Size of Parcel Date Parcel Was Created Are all corners identifiable?J Yes No Include with this application one of the following: .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. ; and that I (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. LJLL~`- SIGNATURE 16F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) U 2 1 3 DATE SIGNED DATE SIGNED Parcel 020-1098-90-000 02/23/2006 10:45 AM PAGE 1 OF 1 Alt. Parcel 33.29.19.399131 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 MARILYN FREDERICK O - FREDERICK, MARILYN 635 PINE TREE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 635 PINE TREE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 10.030 Plat: N/A-NOT AVAILABLE SEC 33 T29N R19W NW SE LOT 1 OF CERT Block/Condo Bldg: SURVEY MAP VOL III PAGE 749 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 92174 246,100 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.030 107,100 143,900 251,000 NO 05 Totals for 2005: General Property 10.030 107,100 143,900 251,000 Woodland 0.000 0 0 Totals for 2004: General Property 10.030 70,200 118,500 188,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 218 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 I aX Address: Ownerts): U = current Uwner, U = current Uo-Uwner O - WILLIAMS, BRONWEN K BRONWEN K WILLIAMS C - GALLION DEREK A GALLION DEREK A 631 PINE TREE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 631 PINE TREE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.370 Plat: 4509-CSM 17-4509 020-03 SEC 33 T29N R19W PT NW SE CSM 17-4509 Block/Condo Bldg: LOT 05 LOT 5 (5.37 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W NW SE I Notes: Parcel History: Date Doc # Vol/Page Type 08/04/2003 733713 2346/592 WD 05/14/2003 721433 2241/183 QC 05/02/2003 719915 17/4509 CSM 05/02/2003 719914 2228/401 WD more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 92178 360,600 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.370 88,500 279,300 367,800 NO 05 Totals for 2005: General Property 5.370 88,500 279,300 367,800 Woodland 0.000 0 0 Totals for 2004: General Property 5.370 46,900 211,900 258,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 104 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Parcel 020-1099-40-025 02/23/2006 12:24 PM PAGE 1 OF 1 Alt. Parcel 33.29.19.400A-10 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 I I I I ~I i i I