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Home My WebLink About024-1035-90-000 n cn O 3 T n d ~1 >y H~ M (D (D CD .0 T M c CD 3 d 3 X O 0 ~ ~ 2 F z o ww wo ° ~ :7 O C O v Q N N A - CD O N (D (O CD N N- = N d N (O (A N :.x O O `A\ C-n N O O O < N 1 Q C:) O -U C7 7 (D (D N O O (n a W j O O N cn O cn < D (0 4 m a CD w C. O o N T co a q! il- D m -4 oD ~ Ai CD co m (O < (n 00 0 y M c Q C1 ~ x b m O N W O t-i m v l~r • F5 -a 3 El td M z O O O ~r cn i m < z (D ~d O O Cn o (D m .3 fA lA to T D rt n a - v v v m o Z W 7d D - [n W W H y r m cn H r N (D o V v O- 7 N N z N t~ z ~10 - o z03z Q £ O D a CD 0 I O CD CD - A N ON I 0 D N I N C CD CD I--00 W CD O. v I a - z m N OC) ~ (o A Z CD 00 W I- O U) C _a .n. w W a a p O Z3 Z 'a m m ri O z C N C z rn d G7 W ~ ~ ~ z m z I- I r\ CD A 7J v~ (D w O rt r OP (D -1I c D (D (D H ~ (D Q i I O n rt a c (A W - ~ O z C. O_ b (D I fi a, C ti v N O O a A O O 4. CD DO O fA O ~ a p b O D Parcel 024-1000-90-100 10/17/2006 03:26 PM PAGE 1 OF 1 Alt. Parcel 4.28.17.6A 024 - TOWN OF PLEASANT VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/27/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - NYHAGEN, RETIRED RETIRED NYHAGEN Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description *EVERGREEN DR SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 28.860 Plat: N/A-NOT AVAILABLE SEC 4 T28N R1 7W, NW NW TOWNSHIP PLEASANT Block/Condo Bldg: VALLEY. EXC CSM 17-4498 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-28N-17W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 04/23/2004 760448 2555/235 QC 10/06/2003 742544 2428/310 EZ-1 04/17/2003 717783 17/4498 CSM 02/28/2000 618894 1492/373 QC more 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/21/2005 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 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 Parcel 024-1035-90-000 10/17/2006 03:28 PM PAGE 1 OF 1 Alt. Parcel 30.28.17.230B 024 - TOWN OF PLEASANT VALLEY 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 - THOMPSON, DAVID A & LAURA J DAVID A & LAURA J THOMPSON 1518 18TH AVE RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1518 18TH AVE SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 30 T28N R1 7W PT OF NW NW LOT 1 OF Block/Condo Bldg: CSM 5/1215 TOWNSHIP PLEASANT VALLEY. Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 749/280 07/23/1997 657/180 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/25/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 33,000 107,100 140,100 NO Totals for 2006: General Property 3.000 33,000 107,100 140,100 Woodland 0.000 0 0 Totals for 2005: General Property 3.000 33,000 107,100 140,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT • OWNER 1'0WNSHiP41A514j SEC.. T %N-Ri~W ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and d~ime:nsions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ti ~ 1 r i I' I di at N r. h rr BENCHMARK: (Permanent reference Point) Describe: 7`r~' (~-?~.~n~°✓ Elevation of vertical reference point:_ /may` Slope at site: (9-7, 70 Liquid Capacity:loc<i ~3t~ SEPTIC TANK: Manufacturer: zy- Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation:/,--/ PUMP CHAMBER Manufacturer: Number of gallons Number of pump set for a cycle gallons; Total capacity of distrib ion lines gallon: size of pump head; gall per minute horsepower ;brand name of pump a model number- ype of warning device HOLDING T Manufacturer Number of gallons El ation of manhole cover ; ype of warning device SEEPAGE SIZE; Number of pits feet diameter f t liquid depth seepage pit inlet pipe-elevation ottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines j width length 3S` the depth SEEPAGTTLENCH: width length PERCOLATION RATE AREA REQUIRED 1"; AREA AS BUILT " INSPECTOR DATED Gg PLUMBER ON JOB , LICENSE NUMBER t1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P .O. BOX 7969 BUREAU OF PLUMBING MADISON, 1N1 53707 CONVENTIONAL ❑ALTERNATIVE state Plan lo. Number: IH assigned) E-1 Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jerald Medes Box 333, Hammond, WI 54015 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. NW'-4 NW-4, Section 30, T28N-R17W, Pleasant Valle Township Name of Plumber: /MPRSW No.: County: Sanitary Permit Number: Gary Steel 3254 St. Croix 34799 SEPTIC TANK/HOLDING TANK: MANUFACTURER: 1 LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKIfyG COVEF~ _r PROVIDED: PROVYQED;' X; . ~r C! 1;~ YES ONO dl'ES NO BEDDING: VENT !I~VENT MATLBER OF ROAD PROPERTY WELL:BUILDING: NT TO FRESH ALARM R FEET FROM r LINE, ' . f AlFjrl t!T DYES ONO ❑ E - NEAREST~~ DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP M EL. PUMP/SIPHON MANUFACT 1RER. AR ING LABEL LOCKING COVER PRO IDED: PROVIDED: DYES ONO YES ONO DYES ONO. GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL N BER OF ERTV WE LL BUILDING. V NT TO FRESH (DIFFERENCE BETWEEN 1= FROM NE AIR INLET AND OFF PUMP ON A ) DYES ONO E REST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing / LEN rTH JOAND 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. I J LENGTH. NO.OF DISTR. PIPE SPACING. OV INSIDE DI *PITS LIQUID BED/TRENCH f TRENCHES MAXEpIAL: PIT DEPTH DIMENSIONS 4. GRAVEL DEPTH FILL DEPTH VISTTi PIPE DISTR. PIPE ISTR. PIP MA RIAL. NO.•DIS: NUMBER OF RO E TV WELL: BUILDING. V NT TO FRESH BELOW PIPES AB(JVE C'QVER ELEV INLF I ELEV END PIPES LINE y^ s ~r AIR INLET. / i -1 [ r FEET FROM {L G T dC /r G NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture ' tine fill material or PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems, malke certain t t it ON REVERSE SIDE. SHOW ELEVA- meets the crit 1 form dium sand. DYES NO TIONS MEASURED. O SOIL COVER TEXTURE PE ANENT MARIZ OBSERVATION WELLS ES 7ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF OPSOI SODDED. SEEDED MULCHED CENTER EDGES YES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: f WIDTH LENGTH. NO. OF ;7HAL SPACIN GDEPTH BELOW PIPF FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES / DIMENSIONS MANIFOLD PUMP MANIFO n DISTR. PIPE MMATERIAL NO UI TH ID;STR1 DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.CIA ELEVPIPES DA. DISTRIBUTION INFORMATION HOLE 1I11 HOLE SPACING DHIL ED OHHECILV COVER MATER AL VERTICAL LIFT CORRESPONDS TO APPROVED / PLANS YE NO OYES ONO COMMENTS: PERMANENT MARK OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM DYES I _ J NO ~ U YES ONO LINE NEAREST Sketch System on Retar►L(n cgd'nty file for audit. Reverse Side. i% SIGNATUNF ` - TI LE ,Mt:' DILHR SBO6710 (R. 01/82) / f DEPARTMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & BUILDINGS ' 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'h 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. Propert Owner: Mailing Address: Id 01 s- A e -S 6 X . Pro rty Location: City, Village or ownship: County: v) % '/aSvim0 / T~?,g NCR/7 1, (or) W lcC S c Z~4,,91X Lot Number: Bl{k NNo.: Subdivision Nya~me: Nearest Road, Lake r Landmark: Ttfate Plan I.D. Number: / A W1191 TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. 2- TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY /Ov / HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: W$ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental 2f Seepage Bed ❑ Seepage Pit 7 ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): X Private ❑ Joint ❑Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP PRSW o.: Phone Number: CA-7- y A. 1 77 6- 1 Plumber's Address: Name of Designer: ` t COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Ag t: Fee: Date: p Q..~ APPROVED Sanitary Permit Number: El DISAPPROVED 3 j7 117 9' 2 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) Form - S T C 10 Owner of Property Location of Property ,&L&(.) 4~4, Section 06) 1',,7E3 N R17 W - Township 15 g, Mailing Address gy 33:3 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel Was Created Are all corners identifiable? 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 1 (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. -381,3 X ; 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. SI ATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) ry DATE SIGNED DATE SIGNED DDPART9nT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR BOX 1'IUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LNO.: SUBDIVISION NAME: tv_w_ o /Tzy N/R/7E c 1 f' jj COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDR S: .5o612o ' 'ex ve._ F54 la Ly t- _S-*C2;Z'5L USE DAT S OBSERVATIONS MADE 1~ 1<sidence NO. BEDRMS.: COMMERCIAL DESCRIPTION: New PROFILE DESCRIPTIONS: PERCOLATION TESTS: ~!J ❑Replace 1 7 p 7- -9 1 RATING: S= Site suitable for system U= Site unsuitable for system MI CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) SA(J•J~ U S ~1(-J/~V( S (u~1u t n I If 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: /V Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONSgL BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKN SS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. -HIGHEST TO BEDROCK IF OBSERVED EE ABBRV. ON BACK.) 3 Bit 51? 2 3" 8A s' r w o i B 72 1., V~►re 71 mo ! P B w 544,--5-2 B B- if s Q ~S r. t 8.r B- S' 5- /p/'.1 d O.r -4- S- B- ? 3s 00 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ i .t' e P- P P_ q_ 7 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. SYSTEM ELEVATION 9.7's-" - OIL] S,'~L /t kQ mr 27v Q 30 i l'1 I~ ~ -,l l ~ sb 3/ 1JD ; lam 11 13 ~ laoo'~ ~ H S~ _ re pasrcP ca r, i4- X. ~ ~A-r Gn N~~~r r~~ /ro /~s F----- verger ri v 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): TESTS WERE COMPLETED ON: ld R lc> 2_ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): 3 m~ r - CST SIGNATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 IN. 03/81) 1 Vj 1 (3 l+ i u>~ it I! -'CE' ✓J ~^E E' 12 c_✓ P" too, F-j~3 U)E ►c l~ ~v~ ~S rBB,~ ~2d Oll~~ c S ri INDUSTRY, OF R _ rT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN RELATIONS N WI 53707 M63.09(1) & Chapter 145.045) LOCATION: I SECTION: j 7A TOWNS HIP/IVT~LITY LOT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY; OWN R'S/B*W-E-Q $ NAME: MAILING A DRE / r g USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PER OLATION TESTS: XResidence ,New ❑Re lace 2- p a ~ 'o -c~~-r !!J - _ 2 3 RATING: S= Site suitable for system U= Site unsuitable for system nCOjNV:EjN7Tffl0NA6L: MOnUN(D: INGROUN(~DPRESSURE: SYSTE(~M-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) [xJ ~U ~J ~U ~ J EIS [A If Percolation #s.a e NOT required DESIGN RATE: If an y portion of the tested area is in the under s.H63.indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- Z a Z - ) r B- J02- t / B- 1,9-3 B- B- t PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER *614€S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- Z - ! 3 • P- 3 % yg x P_ 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. SYSTEM ELEVATION 3 , E 3 ; 3 EE I I i = 1 1 F ( t t " f 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)' il TESTS WERE COMPLETED ON: C - C~ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ell 12 ✓~0 i -lot t CST SIGNATURE L DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D!I_I IR-SBD-6395 (R. 02/82) OVER - #tv, Fl~ _R w L9~.,S PLEAS" f#4K 6',. ~ it F t s r t (31~Y'.s ~ 's .ate tv% 4 # :Et in; n i." a, l f' ~ ey i t ~ ~1 J - ~ i Flt