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HomeMy WebLinkAbout040-1197-80-000 o cn p K v 0 d _1 O d F C i O fD 3 o 3 co a .a y 0' 2. c"D v v # a 1 0 0 w w Q c n y !7 fll N O Q • CSD '3 C N N N N 0-4 a- z CL -,j 00 IV co (D 3 O W v N N T7 * - J ~S ` \1 N Q O O O = 0 p C (OD .7 N n O. O N O O O 3 N Cl) °o p O m Co -G D (D U~ N N fl. T 7 w C s7. C O O O- 3 U N D O O o r cn in co 00 _ fn O z 0 0 0 0 C> W = _ `f n cn cn cn ° o v < 3 cn s o' m m ~ aO ° 41. ~ m ~ ~ rn a :"fl O -Oi N !V O C C N Z W Z o D n :F Q ~y o' o m m o . N N N N i m C (gyp (D. d co 7 (D -1 cn O O A Z fOY Q A Z O 3 ~ ~ A W - m N W O t z 0 3 a O z 3 N W D o_ n ~ o - ~ a o a cD m m A fi 4 ti N O O a A ti b N O a o O a° a C:) (D C:) CL Parcel 040-1197-80-000 07/18/2006 10:13 AM PAGE 1OF1 Alt. Parcel 4.28.19.902 040 - TOWN OF TROY 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 FLOYD L & FRANCES A FOSLIEN O - FOSLIEN, FL.OYD L & FRANCES A 567 HIGH RIDGE DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 567 HIGH RIDGE DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 7.480 Plat: 2081-HIGH RIDGE COURT 1ST ADD SEC 4 T28N R19W 7.48A HIGH RIDGE COURT Block/Condo Bldg: LOT 30 1 ST ADD LOT 30 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 753/484 07/23/1997 636/368 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.400 84,700 297,700 382,400 NO Totals for 2006: General Property 7.400 84,700 29.7,700 382,400 Woodland 0.000 0 0 Totals for 2005: General Property 7.400 84,700 297,700 382,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 308 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 AS BUILT SANITARY SYSTEM REPORT OWNER f- I p,,,j' TOWNSHIP - p - -SEC. T=o~,_N-R_' ' W ADDRESS -i+;~~ (V6, ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT x LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM c. I AV' x f I .tr r. l ' e C i ~r l t I I di at N r h rr w BENCHMARK: (Permanent reference Point) Describe:,c" ' A r Qe~i kt~E Goy.:,„pe Elevation of vertical reference point: Slope at site: ~a SEPTIC TANK: Manufacturer: Liquid Capacity: JJ7i Number of rings on cover j Tank manhole cover elevation`C ~7~4 Tank Inlet Elevation: 9031 Tank Outlet Elevation: M. PUMP CHAMBER Manufacturer: Number of gallons " Number of gal. pump set for a cycle gallons; Total capacity of distribution lines x!93 gallon: size of pump 24~ head; gallon per minute ; horsepower_ ;brand name of pump and model number _J. i1 r l Type of warning device J_. HOLDING TANK: Manufacturer Y\,;0 Number of gallons r` { Elevation of manhole cover JVt Type of warning device SEEPAGE PIT SIZE; Number of pits /;r. feet diameteril feet liquid depth rj seepage pit inlet pipe-elevation r"'L bottom of seepage pit elevation 1 feet. SEEPAGE BED SIZE: number of lines width length y z tile depthl, SEEPAGE TRENCH: width__ /j _ length__ PERCOLATION RkTE ~i AREA REQUIRED AREA AS BUILT INSPECTOR DATED St PLUMBER ON JOB Cap / Prti LICENSE NUMBER 5pgc,033 J DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HI~MAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O..ROX 7969 BUREAU OF PLUMBING MADISON, WI 53707 CXCONVENTIONAL ❑ALTERNATIVE State Plan I D. Number f assigned) L1 Holding Tank El In-Ground Pressure El Mound (I NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER. INSPECTION DATE. Floyd Foslein 12811 N. 62nd, Stillwater, MN BENCH MARK (Permanent reference po,nt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. SE NE, Section 4, T28N-R19W, Troy Township, LOT 30,HIGHRID E Name of Plumber: MP/MPRSW No. Sanitary Permit NumberEugene Grove 5569 Ts~'ty- Croix 34827 SEPTIC TANK/HOLD NG TANK: " MANUFACTURER LIQUID CAPAGhY. TANK INLET ELEV.. TA! K OUTLET ELE6: WARNING LABEL LOC ' NG O ER '/(J/J ) PROVIDED: PRO D ❑YES ❑NO ES ❑NO BEDDING. VENT DI VENT MAT HIGH WAT NUMBER OF OAD: PROPERTY WE,L.L IBUILD_IpIG: VESFEET FROM j ~~jLI~J A❑YES ❑NO ES ❑NO NEAREST ` DOSING CHAMBER: C%_' c5 MANUFA TURER BEDDING. JLIQUID CAPACITY PUMP M(O EL. PUM /SIPHON MANUFACTL.RER WA W LABEL LOCKING COVER /',f W E DP OV EDZ4-7~ ❑YES ❑NO '1RIC G//~ ❑NO YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. UMBER OF PROPERTY WELL BUI ~nk G IV ENT TO FRESH (DIFFERENCE BETWEEN r FEET FROM LINE AIR INLET PUMP ON AND OFF) L_ ES ❑NO _ NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at th? depth of plowing LE c TH FORCE DIAMETER MATERIAL AND M K G or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDT $LENGTH JNOOF DISTR. PIPE SPACING COV ! INSIDE DIA -PITS LIQUID BED/TRENCH THE NCCES MATT, IfA DIMENSIONS ` PIT DEPT"' GRAVEL DEPTIf• FILL EPTH DISTH PIPE DISTR. PIPE DISTR. PIPE ATERIAL NO.DIS R. NUMBER OF PROPERTY WELL BUI LDIN ENT TO FRESH '2 BELOW PIPES," ABDV {AVER. &E V. INLET 'LEY END PIPES NUM FROM ,LINE,. IR LE (l FEET •i!r ! j NEAREST ~L^ 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 R RSE SIDE. SHOW ELEVA- meets the criteria for mediu sand. TI MEASURED. ❑YES ❑NO ~ SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ✓d' ❑YES NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER THENCH,'BED pEPTH OF TOPSOIL. IDDED 17ED. MULCHED. CENTER EDGES. ❑YES NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF L/} ERA SPACING. GRAVEL DEPTH LOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DIS R. PIPE ANIFOLD M ERIAL N IS H. DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8, MARKING ELEV.. ELEV. DIA. E V.-. PES'. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED OR CTLV COVER MATER( VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ES AN ❑YES ❑NO COMMENTS: PERMANENT MARKER VI O RVATION WELLS: NUMBER OF PROP ERTV WELL: BUILDING: ~7 FEET FROM LINE ❑ YES ❑ NO ❑ YES ❑ Lo NEAREST O , M1I LA( C Sk tch System on Vain in county file for audit. Reverse Side. SIGNATURE TITLE. DILHR SBD 6710 (R. 01/82) 1 DEPARTMENT 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 81/2 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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: City, Village Township.. County: 5~C '/a/y„~'/aS Jtf, NCR/ (or)W Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: .a - (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 2~-1 or 2 Family *State Approval Required. 5 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY CCU ; HOLDING TANK CAPACITY A LIFT PUMP TANK/SIPHON CHAMBER `7 - A- - MANUFACTURER: 4 g- I EFFLUENT DISPOSAL SYSTEM ,e ,G= ' Ey PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): 2"New ❑ Replacement ❑ Experimental [J Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) /j,tf ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): P Pri ate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private se 9e system shown on the attached plans. Name of Plumber: Signature: MP/MPf'4MNo.: Phone Number: Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of_IssuiingAge Fee: Date: t~ 7Sanitary Permit Number: APPROVED 6 `O r D SAPPROVED ~T r3 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 (N.03/81) a Form - S `1' C 100 Owner of Property /4c'y0 f.. 9" IF &C A-:- S Location of Property_ 4, Sectiou_ ,'1'~ N it 0 W Township r2c) _ Mailing; Address '66 X 43 12F 2 ~UD5- ei"V OJ /5-G C).clf Subdivision Name 1116i! 10/.De-Z 6""'Cr /S, /~np/ri,Oy Lot Number SG Previous Owner of Property __4 '~-rF /AJC , Total Size of Parcel Date Parcel Was Created Are all corners identifiable? 'KYes 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 (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 dried regorded,(n 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 drgly recorded in the Office of the County Register of Deeds, as Document No. SIGNATUR . OF OWNER SIGNA rURE OF CO.OWNL-R (IF APPLICABLE) DATE SIGNED DATE SIGNED •DEPARTMENT OF ~ BUILDINGS INDOSTRY REPORT ON SOIL BORINGS AN Y & BUILD DIVISION LABIJR AND PERCOLATION TESTS (115) .O. BOX 7969 q N, WI 7969 HUMAN RELATIONS 53707 2C: LOCATION: SECTION: TOWNSHIP/ LOT NO.: IIIX NO.: SLIM) )VIS A WWWW 4- W OUNTY: OWNER' YER'S NAME: MAILING ADDRESS: ' 'LYE L.C1 i 1~ G LC / AI IlZbll fJ . 6 Z `4-" USE DATES OBSER ISMS NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: R IONS: PERCOLATION TESTS: XResidence 3 New ❑Replace ~ i ~/z.~Tf~/ 7 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDSYSTEM: (optional) L"S ❑U ❑S ❑U 0S ❑U ❑S ❑U ❑S ❑U C ni~lClUir it~t,A.~ SYSTEM EL If Percolation Tests are NOT required DESIGN RATE: If any portion of the lot is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: FA6 '7L~ PROFILE DESCRIPTIONS It`",C'~c'~ e/, BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) _ L I~ Sd1_'4Y iv= Ir S4n/ia °z7 ° CLa+~ ve t.1<M B- L 94- 90,0 vN J J - o&Ia 7 15 -4 44-, ~ ( r-H 6 o,ios, 40 9 B Lr 3©; L_~ 3e)) 5L- L- .Ti-f G g, /6; SIC,, 8; Y C'c..A r CU !J 7 f B 5►Lr, Z-19 J P>111 S 1rl &I s/ 31/ 51/ 7 /V.0t jc `7 a~ F B- C) wl > e o 5" t 64 0-,/ ' L PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIODS PERINCH p- A( vpq N. q % $•Ya. % V6 Amv '51i P- P- P- PLAN VIEW: Show locations of percolation tests, soil it- rings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points a%*I ow their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION 65-, et, 5 . i _ p.__ _a. _ a , _e.. a-...._ ----d--.. 4., , ® 4-O S.00 CJ~_D 47 0 t )IIJ LTfG a ~ ~ , tol+ Opp y~~ Z 'Ts~ + C t7 L T7 0,/ i , , 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. NAM, (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): f SIGNATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) _ /°3,/✓j. $ NGtf 5~'.!'el CoK~ITT~'(f15~u9~'1 E /c~,~n~ r^• /1EF, i_ i -:r 75& ~oflL• Pun+`r'TRN~t" 7 L~ r 41[3 3 26