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HomeMy WebLinkAbout040-1064-40-000 O _ O to m Lo~ S a 3 r. c co 3 1a3i o m v, o co 0 rn °C • m 3 o m 0 ~ Co 0) z CA) ° r- [3- d M pWj N N w O p C O n j CD CD , O n C/1 CD (D 0 O O O O N• O n 0 O o f, C O x tan H w °o f C (D W C Q y c V rt r"i rrJ F'• N Co W C O S1' . O N 0 3 O N a m \ p H :D' d m n w a t~ w w ° FJ oo F~ Z z co o cD CO W n r y H F'• Z I N O C In S-. F-h Z H d ' ~ ^ Q `.Z w H t-h Cn ? m d z O O O . 1 d 2) r w• -0 G C° l o S r• In = O co d ra, rn w C ` I e~ to W d (1 C. 00 f~ a A rn w w h a I N z CO z CD 0 H H Z O D a ,w O N M o• C E Oo CD m ~I. Z Z 0 to ~1 CD v aQ o - c CD CD x M '•v w a J G m H (D z CD co -1 y rt (D e rt o ? 2 CD Ili rt O z \ 1 .`C F ~V v a A y. O -a r p o M N tr 00 r ON a 3 N z o z o N z A CD w i a ~ .N7. m a I ~ iv a ~ m o o - 5,3 w T c j o o a CD m v to 3 a r. ~ I 0 A CD X A O i ~k A N CL CL ~ N CD O 0 O V ~ A A tv CD ~0 V v) O ° O O g CD i b Parcel 040-1064-40-000 01/24/2007 04:18 PM PAGE 1 OF 1 Alt. Parcel 16.28.19.240D 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 O - RUST, MATTHEW H & SHERYL L MATTHEW H & SHERYL L RUST 369 N GLOVER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 369 N GLOVER RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.960 Plat: N/A-NOT AVAILABLE SEC 16 T28N R19W 2.96 A IN E 1/2 NE 1//4 Block/Condo Bldg: LOT 3 OF CERT SURVEY MAP IN VOL III PAGE796 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 12/04/1997 569410 1280/523 WD 07/23/1997 872/442 C: 2006 SUMMARY Bill Fair Market Value: Assessed with: 158217 290,300 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.960 60,500 204,300 264,800 NO I Totals for 2006: General Property 2.960 60,500 204,300 264,800 Woodland 0.000 0 0 Totals for 2005: General Property 2.960 60,500 204,300 264,800 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 (~i l .S ilL7' TOWNSHIP C) SEC. `1 7N-R/~J W/ ~ ADORES thee)`z-ir_ J~' ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT .3 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 `~t fl1g~t' SHOW EVERYTHING WITHIN 100 FIE=F OF SYSTEM r "toy, t l S I di at N r h rrc w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: 140 .--Slope at SEPTIC TANK: Manufacturer: &jk I,rt k Liquid Capacity: Number of rings on cover : Oro Tank manhole cover elevation Tank Inlet Elevation: 'lank Outlet Elevation:- PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle_____gallons; Total capacity of distribution lines, gallon: size of pump- head; gallon per minute horsepower__-______ ;brand name of pump and model number- Type of warning 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 elevaL~j,1 feet. SEEPAGE BED SIZE: number of lines width--J1-__-length 3 the deptl SEEPAGE TRENCH: width _ _ length__ PERCOLATION RATE _ AREA REQUIRED- _ AREA AS BUILT INSPECTOR ` DAT ED ~ ► ~ Ct PLUMBER ON JO - LICENSE NUMBER - J J -DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7'469 PRIVATE SEWAGE SYSTEMS DIVISION MrxDISON, WI E.3707 BUREAU OF PLUMBING ` CONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (Ifassigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dennis Schultz 1003 Birchcliff Dr.,River Falls,WI p_ 3 ~'~7;jC> BENCH MARK (Permanent reference I DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. NE NE, Section 16, TJQN-Rjgw, Troy Township - Lot No. 3 Name of PlumperMP/MPRSW No.: County: Sanitary Permit Number'. Otis K. Huset 3111 St. Croix 38453 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.'. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: nYES ONO DYES NO BEDDING: PENT DIA.'. V€NZ-MATL.: HIGH WATER NUMBER OF ROAD: 1PROPERTY WELL: BUILDING: JVENTTOFRESH ALARM: FEET FROM LINE: / AIR INLET OYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER REDDING: LIOUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO OYES ONO DYES ONO GALLONS ~R CYCLE: F11P AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING (VENT TO FRESH (DIFFERENCL'^QETWEEN FEET FROM LINE AIR INLET PUMP ON AND 6P-F) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER JMATERIAL AND 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: BED/TRH WIDTH LENGTH NO OF rR PIPE SPACING COVER NSIUE DIA is PITS LIQUID TRENCHES: MATERIAL' JI 1 DIMENSIONS ! PIT DEPTH GRAVEL DEPTH FILL DEPTH DISTR. PI PF DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLFT ELEV. END: PIPES FEET LINE: t AIR INLET. FROM NEAREST-s 6 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows throwrvupslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES; NO SOIL COVER TEXTUWE PERMANENT MARKERS JOBSERVATION WELLS _ DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH,'BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTHt LENGTH No. OF LATERAL SPACING: JGRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH"^ : TRENCHES DIMENSIONS MANJFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL: NO. DISTR. JD:STRPIPE DISTHIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.ELEVDIAELEVPIPESDA. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: DYES ONO DYES ONO NEAREST e • PsC, of • v rt ~ t Sketch System on Retain in county file for audit. Reverse Side. SIGN T TITLE. DILHR SBD 6710 (R. 01/82) SAL c-o DEPARTMENT OF APPLICATION IN FOR SANITARY SAFETY & BUILDINGS DUST1iY, DIVISION LABOR AND PERMIT D 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 61? l s . SC A U G r ~ C tt Fir QR . I?UIE R_ fl+ L G erty Loca pon: City, Village or Township: County: 'at/aS 1$ NCR E (or ~'D ESir' o5'O/?L Lot Number: Blk/JNo': Subdivision Name: 711 earest Road, Lake or Landmark: State Plan I.D. Number: 7o LJJAf k01+0 (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. Z TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY Gt Q l HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New 1:1 Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ~~j g ~J~ ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public ~Ej(%(f✓,SV 7- I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber. Signature: MP/MPRSW No.: Phone Number: TS tJS~7(77Si Plumber's Addres : Name of Designer: Co AI.1 T i~/, t1 S (/s. Sua z OTis vs~T COUNTY/DEPARTMENT USE ONLY Signatu of Issuing Agent: Fee: Q O Date: Sanitary Permit Number: APPROVED C1 ❑ DISAPPROVED S 3 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 'I' C 100 Owner of Property - Location of Property` Z.~ > Section r' Ti' - Township Mailing Address Subdivision Name 7- Lot Number 7- ' Previous Owner of Property Total Size of Parcel - ';;L~ Date Parcel Was Created i Are all corners identifiable? l/ Yes No Include wit11 thi.___applic_(tion one of tl(e followin I-,: .Certified Survey Map .Deed Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION l 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) 62 l`I 0 DATE SIGNED DATE SIGN., t l DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS I1'~USTJtY DIVISION LABOR AND P.O. BOX 7969 HUMAI~ RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: MUNICIPALITY: LOT NO.: BLK. NOSUBDIVISION NAME: ~,a E *'OWNSHIP -70 COUNTY: OWNER'S/BUYER'S NAME: M ILING ADDRESS: USE DATES OBSERVATIONS MADE N0. BCOMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: XJResidence New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLMEI INGTANK:RECOMMENDEDSYSTEM: (optional) S El U ~ S 0U ® S 0U ❑ S ©U S ®U If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate:r T Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 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.) i ~ET B B- - - / % Cj Fes- B- __V PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD 3 PER INCH P_ P_ 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. / f°.~_,.• T~ .nom _ SYSTEM ELEVATION E 3 _ ! I ( 3 ~ V` 3 E E f E _ Tom`-►.., n _ _ _ S 3 F F _ a a : E E I 3 I, the undersigned, hereby certify that the soil tests reported on this form were made by mein accord with the procedures and methods specified in the Wisconsi - 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): TESTS WERE COMPLETED ON: G_~ :~vc •i~E- fir./ c:Jf~=r~=~ r'% f _ . , ~ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CS SIG TURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Teste^ / DILHR-SBD-6395 (R. 02/82) - OVER - R` or ,E ~ us,? ,i,~....P y IIE %CSt 1"~i~C73""$ f1l*`ht Ei"?E;[134~4': Uazc cC,'at"ly i£S'.Uatt@. h"t iS r, , esjdf,,,-wk, or C;?79T n ,Gihi YJ o,jecf,; . F i,~i ~1 y.` IT ur3'.,tw' £1T ,a€-,fro € fnS .;r CJ n I C i a us'e at1ne€ F;Eb _ ie o;' t 1 , i Pay ,~,tUiC'r i '1i°?-;. x,'YS D"A'~. k7.'_€..s; i E Pa ' lbw (N a :F' it E~-j ~`,.I s-r' xa ~.ta e.. ?~:e~: _ ASE=,ht i € or'-' €or rr11:i I t4t,:2 h, CicF~€„ire C3, a5 and ££anlf)it tinq "h Not C'= 'f KE A LF'.; RL djagyiarn accurzit:'Iy locating your t„st C ss:i`tew Sher ° e',.iy' !;t' L?,.,°, 3i- desii"e£,, "UrC, oL'€Y' hwii(thi"t"aik and vo, F :,d of vc;1ion p~t„{ur Plt.{'3 ~)t"iE ,z rY clo U,YSy Sht7t-vn and are ~Wrn§ail,o;f tl vi=ta a dl `Cif. C, nli ~c3t ov,-i`+ its 'i is Fws, wirnes, ad 1 ~oLi~! F~laF3 d hJ 3, g~eiiyQiat. on '1~£'tY p- bpi tlSrF I • rv t,t Fr plc::%ti t. 1.F<.abc a d %'W" Et-k tai „y„ L~ 6 o tfj E . ~.~ox, sr'T .3 , 1iv1, r - i~~tt,ta~>~ e , if,dur Sat£ h£ 1 'Fti } i nu d i a y 1'Fi k? s L.ezy r;(; F 477 h i' toTIif, 9 ~iE.,4l 11, [F3Lic. - atnon of ties SoJ l (e -4,t F° it) CYe t k ;SSUJ , e. to t ~i~i. i L,° ;t • SAFETY & BUILDINGS PORT ON SOIL BORINGS AND 7t)N tSEi'AFc , Ir.~ AT OF RE P.O. BOX BOX 796$ iNDU-STRY, PERCOLATION 1 ESTS (115) MADISON, WI 53707 LABOR AND HUMAN RELATIONS 11-163.090 & Chapter '145.0461 OT N tJC StlBDt il: I ION Afvi ~ l WNSHI MUNICIPALITY: G LOCA N: COUNTY, E R' N n , .v,•-, ✓ ~ f r DATES OSSERV}1T!ONS MAUic USE 086018ae 4.~- .r,~ .mil y RATING: S Site suitable for sYStern U. Site urouitsWe for sYatern x3 r O~ ~ ~ NVENTI NA :MOUND: IN GROUND 5YST -FILL OLDiNG TANK: RECOMME°JDED SYS7Ero~l) r` _ i ,r'71 10 i s au s c u s e a s s If Percolation Tests are NOT required DESIGN RATE: if anYportion of the, tested area is jh FloodPiain, indicate Floodplain eln,, ' under s.H63.09(5) (b), indicate:. PROFILE DESCRIPTIONS XTURE AND DEP H P HT R U ATER-IN HE A AC E OF S IL WITH ICKNESS, C L R. BORING TOTAL ELEVATION BSERVED TO BEDR IF OBSERVED t EE pBfDRV. ON BACKS NUMBER 1) 1PJ„ , B_ -7 =!)-7 w 1~ z rr a~'t •s j~ i'7 44- PERCOLATION TESTS ; ilr^--"w Jt1 i PER "NCH r pEPTH WATER tN HOLE TE T TIM - Nt.IptBER INCHES AFTER RWELLING INTERVAL MIN. P P hori" PV. n and naa. the Describe w'~st direction are and I+ the mrt ' of rcolation fasts, soil borings rind tita dimensions of suitaV;e Loihe l erase. surface indicate elevation acal a alt or dis boritengs PLOP PLAN: Show Iocat'lons P8 zcntai and vertical elevation reference points and show their location on the plot plan. Sttnw of land slope. .i...-• ~ i ; ~ ~.IG'•• 'ti.-. /try.'. _ h.`i-..•r:• r~. ~ ~ SYSTEM ELEVATION { T i ' `C..~~...' ' .,<'r~7+,~'`,e~.-,r ,•-•s:-c.~~!{•-'q•' i t i '!;;.i I ; } I r r_ t ~ i i ....Y., ..1 . ~ { } s ~ -«.w........,. ids ? ,~i ~ r k /nr All, { { , _ w t ` ~ i i t I.V 4 ? ~ ~ g . ~ `.~~k .~t i ~ . . . ~.•----t - t,~; 1 v {i I~ 1 J . t f~ fl e by me in accord with the procedures and methods specified In tho Wfscwnsln I the undersigned, hereby certify that the soil tests reported on this form•were mad y the best of Administrative Code, and that the data recorded and the location of the tests are correct to my knoyvle~fge and belief, , TESTS WERE1COMPLETED ON: NAME sprint iIRh6TION NUJ 9E : HO II NUM6ERTt;J;►ittsral); 5-- o ;a , 1 / 1 j j 1 1 CERTIFIED SURVEY MAP R.1253D0 I Thex lots am located east of Glover Road. a6 SCALE IN FEET W1\ a a •JNi~r. \ 2 1 0 O q0 200 Ts9~0 09'P Sol-C) n3~ Sr 4GYT lfV rp ap ~ sp'Qt tiea ~.,r \ SOLD `rte ~s \ f9~ \ \ Z 2 P<r o vP I PPS % qy \ _ NW-NE NNE-NE . P t\ 9 \ SW-NE I SE-NE _9ir,- _O 3s 'fly cp 'f ~ e0 9y O9 O S 9,900.00 < \ LEGEND 1 p= `ti~pE'~ 'TO~ \ q P O 9OF 0 f %2! IRON RPE WEIGMNG 4\ ay, ~°'OE LrS PILINEAL FOOT Z VL n bj t COUNTY SECTION CORNER \ N 9,9D0.00 \ MONUMENT, FOUND P9\ to ,yb~F.S PL i \ ti~ 05 ,Ey I NOTE: \ tN'~61 v' LOTS 1 AND 2 ARE 0a 1 HEREBY RESTRICTED TO ONE COMMON i DRIV$MAY. COTS 3 ~y NaQ P I AND 4 ARE ALSO a a \ HEREBY RESTRICTED (~"p \ ZN TO ONE COMMON py i DRIVEWAY. A\ tp v~ a W0: Northeaster) RM line YA POD T a North rly "PROVED w(Mmme J sps R/N Ina WWr u a na3 NNNOq ~=t6T 00' M e"+s. N87' 32200" APR 26 A 1 F. ~N. . DOES M`A NOT MEAN "KOV,u ST.C- C_. ~r ro ft N'2 SEP(IC SY.tEy 00 6t°00'f0° Et/N CORNER SECTION wh - CO//~IM~a Nis waver i4 T29N~R19WW Ar 101i am"n _ III t I