HomeMy WebLinkAbout038-1065-40-000
m a n
0 C7 r~
c o
cl)
m m •a •
•D c
Z
~ O
m W
n d O w 0 O O co O (D
a z Q CD 41.
y cc
1y N W N Zl ` l
N CTI
11
0 9 n a (D : m CO
o O
C C CD (7 d N
O (7 00 k
~,y 7 N 8 O 0~1
0 03 r- (D -
r'I' CD CD CD N N O. N V
w ° o
N•
tD a ° D
CD (D
Z rt O a co w° a 00 Co CD o r- cn
(n w v
00 C o O O O o
rt1 fD ON H .r u) N o D `i
c) m M00 CD
m N (n
S o~ v m (D
m v
'm F m o m
_ < Dl N _
7 v W
ZI CD N)
z
QQ F- O 3 N
w u-I z
1 ° z00z 0
W O H O D° (D 0
I-ti W LT1 a.
I-~ : O N •
rt Z ` CD c
D C N
N
W 7~ c D
O
V O
C) n F W N d
rd Z (D (D
O C1 m O A C~
C
CL
(D
9. C O
ri
O z ---I
N
W * m
(D CD
CL z
o _ ,
o :-t z ao
N z ~ ~
(D
A
w
CL D
CD Q
v a ~
O Z T
3 O C
Q
O
7 Z
O
C
O N
O_ Zy
N
A
O A
7
N
n ~
S O-
(D ^a~
N
i O
N
O
I O
a
A
ti
0
E» O
O :E ti
O (D a
O ` ti ^^7ll
Parcel 038-1065-40-000 02/02/2006 08:30 AM
PAGE 1 OF 1
Alt. Parcel 16.31.18.282C 038 - TOWN OF STAR PRAIRIE
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
RANDY C & COLLEEN M POTTING O -POTTING, RANDY C & COLLEEN M
1039 220TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1039 220TH AVE
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 7.000 Plat: N/A-NOT AVAILABLE
SEC 16 T31 N R1 8W 5 AC NW NW THAT PART OF Block/Condo Bldg:
LOT 1 OF CSM 5/1322 ALSO LOT 2 OF CSM
6/1781 ASSESS WITH P281C Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
16-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page' Type
07/23/1997 774/47
07/23/1997 672/353
2005 SUMMARY Bill Fair Market Value: Assessed with:
119109 244,200
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.000 63,000 177,000 240,000 NO
Totals for 2005:
General Property 7.000 63,000 177,000 240,000
Woodland 0.000 0 0
Totals for 2004:
General Property 7.000 63,000 177,000 240,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 126
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
~I
OWNER Aunt TOWNSHIP y~~~J SEC.CIN-RYW
ADDRESS-;t~) _ ST. CROIX COUNTY, WISCONSIN.
-4-~ 14462~~40 ~L~*
SUBDIVISION LOT LOT SIZE
PLAN VIEW I
Distances and dimensions to meet requirelments of H63
SHOW EVERYTHING WITHIN ovFEET OF SYSTEM
,i
r
I
I
I r w
BENCHMARK: (Permanent reference Point) Describe: Elevation
O
of vertical reference point: Zjo.O Slope at site:
SEPTIC TANK: Manufacturer: iyJ,6,';A,&,✓jcsz Liquid Capacity: LB1~9A
Number of rings on cover Tank manhole cover elevation:
_ Tank Inlet Elevation: 7S,q Tank Outlet Elevation:],(
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle40 gallons; Total opacity of
distribution lines gall n: size ofp mp- head;
gallon per minute horsep wer 3 ;brand name of pump
and model number - _ ;
Type of warning device
HOLDING "TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines _ width length 6 the depth
SEEPAGE TRENCH: width _ I~ngth
PERCOLATION RATE AREA REQUIRED _0/6 AREA AS BUILT
INSPECTOR
DATED PLUMBER O JOB
LICENSE NUMBER
.r
I
,IC a o
ti
j
`L
tay
r
DEPARTMt-NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.P. BOX A)69 BUREAU OF PLUMBING
MADISON, WI 53707
❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
[If assigned)
El Holding Tank ❑ In-Ground Pressure El Mound I
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
.2.-"2
Randy Potting RR#2, New Richmond 9-/-0
a _OF
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PL ELEV..
NE NW, Sec. 16, T31N-R18W, Lot 1,Town of Star Prairie
Name of Plumber. MP/MPRSW No. County. Sanitary Permit Number.
Cal Powers 1563 St. Croix 38546
SEPTIC TANK/HOLDING TANK:
MANUFA URER. LIQUID CAPACITY. TANK INLET ELEV.. ITANK OUTLET ELEV.. WARNING LABEL 1LOCKING COVER
t r PROVIDED PROVIDED
~(~O ✓ - V• AYES LINO ❑YES LINO
BEDDING. VENT DIA.. VENT MATL HIGH WATE NUMBER OF ROAD. PROPERTY WELL. BUILDING. VENT TO FRESH
n a ALARM FEET FROM L'NE I LAIR IC7,SLE
AYES LINO l~pL ❑YES NO
NEAREST pC /N) (J I p
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAP ACI TV 111111 MODE 11IM1,1IP N MANUF TU ER WARNING LABEL LOCKING COVER
j~ PROVIDED: PROVIDED
YES LINO " 2u YES LINO ❑YES LINO
GALLONS PER CY E: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY JWELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN ` LINE AIR IN r
FEET FROM ~Q AA Sy
PUMP ON AND OFF) YES LINO NEAREST W IV
SOIL ABSORPTION SYSTEM. Check the s i oisture at the depth of plowing FNGTH DIAMETER MATERIAL AND MARKwG
or excavation. (If soil can be rolled into a ire, construction shaill cea e until FORCE r
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM: - I
WIDTH LENGTH NO. OF DISTR. P E ACING. COVER [INSIDE DIA -PITS LIQUID
BED/TRENCH / TRENCHES ~FP St RIAL PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FIL_ DEPTH IDISTH PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. TR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
HFLOW PIPF' ABOVE COVER ELE E i EL END PIP I LINE. ` AIR I LE
FEET EAREST-
Il/Y_ - N
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 JPERMANENT MARKERS OBSERVATION WELLS
❑YES LINO ❑YES LINO
DEPTH OVER TRENCH BED DEPTH OVFR TRENCHBED DEPTH OE TOPSOIL. SODDED SEEDED MULCHED.
\`'{p 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 HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES LINO ❑YES LINO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY fILL. BUILDING.
FEET FROM LINE:
❑YES LINO ❑YES LINO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
AT RE TITLE:
DILHR SBD 6710 (R.01/82)
wlsconsln APPLICATION FOR SANITARY PERMIT 1/~~ ~fL
DILHR (PCB s"' Cf~/ COUNTY
oERRRTmEnTOF UNIFORM SANITARY PERMIT #
® :nOUSTRV,LROOR 6 umRn RELFITIOns
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PRO RTY OWNER MAKING ADDREI''S
PR ERTY OCA ION tTY:
W+--LAGE:
1 /4 /d 1/4, S / T_~' , N, R (or) W TOWN OF:
LOT NUMBER BLOCK NUMBER ISUBDIVI'SION NAME NEAREST ROAD, LAKE OR LANDMARK STATE P V10 I.D. NUMBER
'Yel
TYPE OF BUILDING OR USE SERVED /
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 ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity F
Lift Pump Tank/Siphon Chamber i h
Holding Tank capacity
Manufacturer: / .r
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
r Cr ® Private Joint ❑ Public
I, the undersigned, hereby assume responsibility for installatim of the private sewage system shown on the attached plans.
Naq.if of Plumber (Print): i SMP/MPRSW No.: Phone Number:
Plumber' Address: / J Name of Designer
- :
C J cif'-,n 1.7 COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: _ ❑ Disapproved
(/r /c ❑ Owner Given Initial
V/w'
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
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.
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
Vent Cap Weather Proof
Junction Box Approved Locking
Manhole Cover
12" Min
4" C.I.
Vent Pipe Final ,
' Grade 4" Minn
Conduit
18 Min ~ 18''
' III j
Inlet
i IP
Approved
Joint w/ Approved
C.I. A Joints w/
Pipe C . I . Pipe
Extending Extending
3 Onto Alarm 3' Onto
Solid On B Solid
Ground ' Ground
C
Pump Off
[r-
Concrete Block D
SPECIFICATIONS
TANK PUMP
Manufacturer Manufacturer:
- ,
Tanis Material: y~- Model Number:
Tank Size: _ Gallons Switch Type
Total Dynamic Head: FT
CAPACITIES Pump Discharge Rate_ GPM
Total Daily Effluent: Gallons
A = " or Gallons Number of Doses:
Per Day
B = " or Gallons Dose Volume: Gallons
'
C -J? or Gallons Notes: 1. See pump curve for
D = or Gallons additional performance
Total Tank information.
Capacity Required Gallons 2. Pump and alarm are to be
installed on separate circuits
ALARM as per ILHR 16.19 WAC.
Manufacturer: SIGNED:
Model Number:- )L7, LICENSE NUMBER
Switch Type ,~!DATE : / - 3 cv -
Model 3870 Submersible Effluent Pumps
140
120
~A
by
's
3 100 yA
0
LL
L 80
d
u y7$
c h!A
o hY
7o
m 60 J y A
H ~Yp
1
40 ~py05 i7 N P
WPM03,'h H.P.
20 WP03, 1h H.P.
i
0 20 40 60 80 100 120
Capacity - Gallons PerMinute
\ Max. Wt.
H.P. Order No. Vo1L Phase Amps RPM Shcas (tbs.)
WPO311E
WPM0311E 115 9.4
1750 56
W PO312E
WPM0312E 230 im 4.7
W PHO511 E 115 ~g-g _ 7
WPH0512E 230 8.0
60
WPHO532E 208/230 34
WPHO534E 460 3~
1.7
WPH0712E 230 10 9.0
1•'i WPH0732E 208/230 5.4
460 3m
WPH0734E 2.7
WPH1012E 230 10 11.6 3450 70
1 WPH1032E 208/230 30 6.4
WPH1034E 460 3.2
WPH1512E 230 10 13.3
r,. WPH1532E 208/230 92
lh WPHIS34E 460 3m 80
4.6
WPHH1512E 230 10 13.3
WPHH1532E 208/230 92 30 WPHH1534E 460 46
SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE.
3
i' ;FfTMENT OF REPORT ON SOIL B033INGS AND SAFETY St BUILDINGS
Ii4I~USTRY,, DIVISION
0,10; AND PERCOLATION TEST'S (115) P.O. BOX 7969
;,UMAN RELATIONS t MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
i :.TTO rJ SECTION: OWNSHIP/MUNICIPALITY: OT NO. f3LK NO SUaDI VISION NAME:
r 4N14 ~_/T3I ti/ E( ► ST A~ =k>-~ 1 .Ir= I rJ%1 L' S• m'
C~3l;NTV: OWNER' UYE~S NAME: M A I L I N ADDRESS: /
.A n f`'r 3-~c7-t't 1 ,.1 c F Z r_\t-I tc_i. N'• ~k'j ~~t(~ 1dDl
DATES OBSERVATIONS MADE
i 1MO.tfEORMS COMM~R~IAL~-SZrRIPTFON: PROWLa ESC~TpfiZS 1S.AA N ES Si
~Rssidrnce j New ❑Replace 3 -Z 3
IiA f ING: S- Site suitable for system U- Site unsuitable for system _
t U(Vt N'(I(~~iNAI_: C,10UND: IN•GHHOLINaPRESIS'URE: SY YSTEM-I1N~-1F 11'LL HOLDING TA'N1K RECOMMENDED SYSTEtvl:(oplional)
LEIS !_A ~ O S ❑ U L Y 1 S U C_`.1 S uU ❑ S ~ U I N- C Z J ~.J 1% _ 1;'P-- E-~ 'd f _e=
lif Pe,cnlauon Tests are NOT .e uirad rDESIGN RATE:
Q ( If Inv ruon of inn resred area ,s in the
j,nder s.Hii3.091b)1~~), indicate:, Findicate Floodplain elevation:
I ~Gf~''~'~f•-• SAIL..: P.a~~K- I l PROFILE DESCRIPTIONS Il..r~.y
a <7~
ii'oRING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COL R, TEXTURE, AND DEPTH
ht~Eq 9(;pQLot. ELEVATION 8 ERVED S . HI H- ' TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.)
l a' / .56 a L L, • 2,.4.0'?,., S' ' L 1.3 i t ..,1 ~ L. j 1.00' 8 N
L~" n Q °'tS'3i
O/J G 8 • ~Q ! • I 2 , Mew 5 w +2 05' " ,~x csrs 3N S 2.50P_"j Mme:
• 30' ;XIL L-; 4 S i L ~ ! • (0 7 ~ i34 S L_ j . 8 3t P.+na M3
J`j'4 f~c~N~ y lo,g W ~R. ~N rna~
C , •SD' aV. L j ~•oo' 67' a4
;E- ~j.o~ )q+SL ~dnll~ y o).Ua LS Erg 3,%~' r I.3' F,,., ;
f--
f •SO' u~ irk Z,ot3' 6•v c;L~ I.g3' za R,,,i L w/6rZ 7
N~Nr > 0, 75 D5' F«~~r°~ 2oB1~ e>N ~s
Sn' I'aL L' 2.83' 1j,v S,Lj •~7' FAN L.fS w Cs•fZ •7S' g
I v. 75' U7 ~J OrJ E Cj, 7 S r CS w G^r2. ' D' BN - S 7
PERCOLATION TESTS-- N UM6M ~~=~PQ"J~ `N go~•~
DEPTH WATER IN HOLE TEST TIME - DROP IN WATER L VEL-INCHES RATE f. ojuTES
~J PkR INCR
dUVIBcH tNCHtES AFTER SWELLING INTERVAL-MIN. FlIOQ j PE R100 2
Y_ -7
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances- Describe what are the h
rontal and venical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and per
of landslopo. `L.WOO S~• 1`T. SU('Tf~Pa!^C
S`rSTEM ELEVATION
.1 t.
C' _SLo
O i I
01 _A
1jr, 0e.
-1--- -
I
1
< < IQ'U I '!o I I i f r _ '
I ► I t i vyt
,
L i i I i I ~ a I,. ,y I• I fly. - I
PSI f ' •
1, the Undersigned, hereby certify that the soil tests reported on this form were rnada by me in accord.Xvith the procedures and methods specified in the Wiscons
fld.n m-.tretive Codu• acd that the data recorder) and the location of the tests are correct to the best knoujletlga and belief.
~~7 1E Iprint TESTS IVFHE CUMPLETFO UNt
1 _
- 7'
\,fi t- ~ E. C 4-4
_SS f . rlf flf I( ~71O,V NUMdE 1 I, tf:) 1 WU tc4~ttlnyuun+
L,1 U/}IG,NA f URE:
i,f ~.f (~Ita,17 t(!'1' n::'t nil 9n••nn±rrltl in 1 tM-•1 Awh')r,(v. PrnpP,!y OWn•!r mil r',u Tcsrvl.
1 _
a~ r"~~ry;~~J~~ see 73/~✓,~i~'h/
/1 ~`l~lriII.J~ v7~fT ®flf~~'~i• _ r
i
1
i
as am
164 9th t
w,
T_
S y
cfsT ew