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HomeMy WebLinkAbout020-1148-70-000 4 p A (D -a 3 ` 1 n co c W~ O m cN o ° CD o @ w ~ a N) n z a N o 0 C z O 7 A 00 (D m = O co O m N Q O \ 1 O -D n 7 Q CD (D cn O Ln O CD ( p C.n _ co 7 p N ° O 0 x y p tp G G G t H m cnn Q° O C _ R~ O r ~ m m W N fD b O rGt CL w m n rt ` O ° o ° by _ _ m O V CD (D co 2 C-) O C G o ~n w co OD w n Q W W ~ 0" p 7 N 00 v v v . o 0 0 z 0 o F-q 00 CZ/) a J N fA N o 0 {j y cl, vvv 0 (D CD CD 2) a 9 1 D N r = a th r o r y t~ o N 0 3 v < t7 CD z cn N cn CD 00 0 d. Z W 00 z 0 C) O D CL N OO G H ° m m N• W 0 G O .0 (a 7! N CD CL m O N w N a ~ ~h "O z cu Z y Cv z ° z a d O x I c ~a a n A Z ~ C C1. r-• W rt N• a n N O z O N) W N p W v m CD W C/) a (D CD z C7, 1 m m o 3 U) X fD 3 N N A W W ~ W D Q o - c z a O m N v S ,A r I p. I A A N N O O a A O C=D A ti Q) O o °p o m a O i Parcel 020-1148-70-000 02/23/2006 08:12 AM PAGE 1 OF 1 Alt. Parcel 33.29.19.795 020 - 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 - PETERSON, ROBERT & PRISCILLA ROBERT & PRISCILLA PETERSON 578 TWIN OAKS CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 578 TWIN OAKS CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.300 Plat: 0215-COUNTRYSIDE VILLAGE SEC 33 T29N R19W COUNTRYSIDE VILLAGE LOT Block/Condo Bldg: LOT 9 9 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: 92663 273,500 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.300 76,200 202,700 278,900 NO 05 Totals for 2005: General Property 2.300 76,200 202,700 278,900 Woodland 0.000 0 0 Totals for 2004: General Property 2.300 31,500 165,100 196,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch 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 AS BUILT SANI LAIZY SYSTEM REPORT I OWNER 56 VM I i (O~ TOWNSHIP SEC.3-~l~ (N-R/ /W ADDRESS rhGuf 91®411V' fl~ _ ST. CROIX COUNTY, WISCONSIN. l~ S n , S t1' ~ h4y~, ~ r SUBDIVISION_6Du1lr~y LOT, LOT SIZE PLAN VIEW Distances and dilrlE:nSions to meet requirements oi` 1163 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 17-1 Ste" J Indic at N r h rrc w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: U ,-Slope at site: G SEPTIC TANK: Manufacturer; ~l S e r Liquid Capacity: ((J UO G Number of rinks on cover : 2 Tank manhole cover elevation: q 7; o '.Tank Inlet Elevation: q d , 4; Tank Outlet Elevation: PUMP CHAMBER ~f~ Manufacturer: _ Number of gallons _/1 _ Number of gal.~pump set for a cycle /t%¢ gallons; A,'T``otal capacity of distribution :Lines 414 __gallon: size of pump /v off head; gallon per minute -zV ; horsepower Al A- ;brand name of pump and model number ///-t- ; Type of warning device IVA HOLDING 'TANK: Manufacturer _ /L/ / + _ Number of gallons l:l.evation of manhole cover IVA- ; Type of warning device __/_%1" SE'EI AGE 11 IT SIZE; ~ Number of feet diameter N4 tees liquid depth seepage pit inlet pipe-elevation ✓V A bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines_ width ,(3- length tile depth SEEPAGE TRENCH: width PERCOLA'T'ION RA`Z'E _ AREA REQUIRED 1~ AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER AIT h n ~ ~ ' ~ o. , I ~ a -3 i -a-- ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ w ~ _ ~ ~ ~ ~ s tiJ / Y , n i ~ --,e ~ ~ ~ o _ / ~ • ~J n ~ ~ ~ °m ~ Yrl" \ ~ J 0 ~ ~ ~iC ~ ~ 0 s ~ y~ I r`~ e ~ Vill- DEPARTME=NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BO_ 7969 BUREAU OF PLUMBING MADISON, WI. 53707 C~d CONVENTIONAL ❑ALTERNATIVE State Plan lD.Number. assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (lf NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Sam Miller TroutBrook Rd., Hudson, WI '9-T "83 31: 30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. Nw Se, Sec.33,T29N-R19W,Lot 9,Countryside Vill.,Twn.of Hudson Narne of Plumber: IMP/MPRSW No.. County Sanitary Per— Number: Douglas StrB`gbeen 5432 St. Croix 38487 SEPTIC TANK/HOLDING TANK: MANUFACTURE LIQUID CAPACITY. TANK INLET ELEV.'. TANK OUTLET ELE V.. WARNING LABEL LOCKING VE 98.8 1 PR VIDED. P El ID S ❑ N O D E S N BEDDING'. VIENTDIA, : VE NT MAT L. HIGH WATER NUMBER OF ROAD: / PROPERTY WELL. BUILDING VENT O FR H C ALARM FEET FROM JC~71L L1? M~ AIR ET DYES NO 1 ❑ E O NEAREST r//~//j~/// DOSING CHAMBER: MANUFACTURER. 7ING L IQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER PROVIDEDPROVIDEDES ❑NO D 1 - ❑NO DYES ❑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) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I FNGTH 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 NO. OF DISTR. PIPE SP ING COVER INSIDE DIA. -PITS LIQUID BED/TRENCH TRENCHES / MAT A PIT DEPTH DIMENSIONS GRAVFL DEPTH FILL DEPTH UISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABO ECOVER ELIV .INIIT ELLEEV_END. PIPE ILI E. AIR INLET : 4 17 ?_C1 NEAREST qr OM MOUND SYSTEM: Mound site plowed perpendicular to slope Check t to re of the fill materi for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mou syste s to make certain at i ON REVERSE SIDE. SHOW ELEVA- D me the cri r a' for medium san . TIONS MEASURED. YES ❑NO SOIL COVER TEXTURE /RMANINT ARKERS OBSERVATION WELLS ❑Y S ❑NO DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH/BEU DEPTH OF TOPS IL SODD SEEDED MULCHED CENTER EDGES DYES DYES ❑NO DYES ❑NO _=/jtLCr-_ PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TOE NCHES LA ERAL SPACING G L DEPTH BE LO PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PMANIFOLD llfISTR. PIPE ANIFO LD MAERIAL. NODISTRDISTRIBUTION PIPE MATERIAL & MARKING ELEVDIALEVPIPES ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE DRILLED CORR CTLY COVER ATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPE RTV WELL: BUILDING: FEET FROM LINE: { O b DYES ❑NO DYES ❑NO NEAREST 2 Sketch System on kli ( triTt✓ unty file for audit. Reverse Side. 5 / SIGNATUR TITLE.. DI LHR SBD 6710 (R. 01 /82) 10 DEPARTM)=NT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR `AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for 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, 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: GNJ~ r vA /~r✓{ l!t~of SDI Lv i ~ ~J^ ~L`l1. 5 o f"I A 1lc - I -A 3 Property Location: u C~ttc,.~ii+hege-er/Township: County: ✓V/ail"'/aS 33/T~(NCR tj 1 0(or) / e:~ sa/t 4;?~ Lot Number: Blk~N/o:- Subdivision Name: / Nearest Read Lake or Landmark: _ State Plan I.D. Number: V ! [ ~{j-~r+ (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: IV, or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY UC U HOLDING TANK CAPACITY A' LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: i 0, S H EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA s,/ (Minutes per inch): PROPOSED (Square feet): L's New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water SS pply: Owner's Name as Listed on Soil Test Report (If other than present owner): t Private ❑ Joint ❑ 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: /a M~' -3'33 ()L47)- 3z i Plumber's Add ess: Name of Designer: ` A et w v n ~l ~r~ j y~ T G~ ~ Z Po -t2 5 rr a y 0 c^-, COUNTY/DEPARTMENT USE ONLY Signatur of Issuing Agent- I Fee: Date: APPROVED Sanitary Permit Number: 197/ -93 -30 ® DISAPPROVED O 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) 1?orul - S T C 100 Owner of Property mo w' Au Location of Property ~J) Z SE I-,, Section ,`1' N R W Township . Ia Mailing Address 2 Subdivision Name- 111,9 Lot Number _ ` Previous Owner of Property ~Z Total Size of Parcel Date Parcel Was Created Are all corners identifiable? X Yes No Include with this application one of the followiuv: .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. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED U, CAF REPORT ON SOIL BORINGS D zql B DI )ND VISION INUSSTRRYY, /N 98 LABOR AND' c .0. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115 rE' 0 SON, WI 53707 LOCATION: SECTION: TOWNSHI L. 31 AME: k)1/t!P/a 33 /ToZy N/R/y& C Sr 1-9- COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVAT NS MADE NO. BEDRMS.: COMMERCIAL D SCRIPTION: PROFILE DESCRIPTIONS: ER DILATION TESTS: XOesidence -3 KNew ❑Replace I P; Ji W - ~sX~~ ...5'(rq C x ^ - RATING: S= Site suitable for system U= Site unsuitable for system (p (o S~ 11A a ~ow, CENTIO❑NU IMxOUNSD: ❑~N-G S IND PLRESSU IU RE: SEI S IXN-rILL U [OLDIEISNGXU TANK: I RECOMMENDED :(optional) O~ v x36 ~ cAl* If Percolation Tests are NOT required DESIGN ATE: SYSTEM EL V. I If any portion of the lot is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFIL DESCRIPTIONS e BORING TOTAL' ELEVATION DEPTH TO GROUNDWATER-IA} 74&v CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHLPQ OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 5-1, © A5,7 is r • S e &Z 13- B-3 ,v' o,2. r 0` v Y gli o?, / do, 1, A/ /st r 3: S r B- `Qr lor.e, /uaue_ 7 o & r ~ Bh / jo s, •O~Itf~t ~ r~~sl B- S' o' v7.6. IJaAA-~ 7f, 0 . K. 611, 7, OA 1 1; -7 B- PERCOLATION TESTS ' TEST DEPTH 0 WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES I NUMBER I•Pi r4C--e AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH ' O 3 02 3 . .2 ` P.. ce' o S _ .3 l_P- o 3' 3 P- p- 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 on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. ,q o SYSTEM ELEVATION y le 6 e,,. itlvl e - Ca'f' T d B0- A ti, 's r4a v ~ 02- -to ma,-,- ~v Rerl A 7L - D ~33 ~ py ,S . %3 - 3s ~3Y ?3 10 t7 I AS5,4me4 64. _ /00. .0 COa-K"ti"' O~' ~I a p~CS C (~s~ Q~ / ~y'l 4.0fi s its P4,~~J- 11 M&C*4 4*fX44 0- -4 Ne N Of 4L 0-Al. s~Lt F ewe r~ 00S r 10,41_AJ)4-J 01-AA-4t. 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. 1-1 NAME (print): TESTS WERE COMPLETED ON: ve,",tFr t a s 0, !t~- (Q 1 ,S 4DDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): CS TU E: J !,0 2nd page-Bureau of P!u^.birig, 3rd page-Property 0 wner, 4th page-Soil Tester. w yr e S t1 ~ r C P C J _ h yC 3 c r ~ ~y . c, 14- 41 VII m~ C, t v w ~ - ~ ti1 ~ V ~ ~4 i ~-d 3 • o r c 4 c_ J 'S y J \ U ,Q J J Lv b M v I I~ rN ` r. I ~ r.