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HomeMy WebLinkAbout040-1204-50-000 n cn O E -0 n C7 f_ m M o 3 ^ `3 v v D \ 1 3 O n 2 o Z ° w~ cNn ~C• N 7 f(D fD CJO N 0" \ O- (A Z N (O. CC) N o CO C 0 O O O A N (D 0 0 ` \1 CL 0 N O •d O 3 VI D rc) v C 0 m oD m a ° (D CD (a CD Z m a C 0 0 ;7 -4 C n w w a 3 O j (D 00 N) r co co 00 00 O c t4 H N CD C/) rt n 5 ~ G~ m v N. (D cn v v v p oZ O O O W u' n °o ~ N N N v ~O d o y 0 CX (D A 00 rC Zl _ (D p U lD Yj N N 3 m N (D w a a a ' r N N D O r 1 Z W Z d N • CD CD co (1) v a ~7 -1o cn 1 W CD 0. Co C (D CD (D 1 I- I co a W I a 7 (a ~1 t=] Z (D ~ cn N F~ - O , Z (D (n C " ~a 0 ~i CL F! a tT1 0 M N Ot O O W ~ R' oD CD (1) d b a z x G 3 n c Z N w a o 3 m °OC N < A car N ca CD CL D ~I ~ m a x v 9~ O CD O T EO m m C X CL OZ d Cl) U7 (D N N CD A N CD Q O II ~ A I N I ~ b 3 CD s 0 0 C) z o I (Q A CD O (n A O_ W hQ a 0 CD O rya O i ti Parcel 040-1204-50-000 12/14/2005 09:42 AM 4 PAGE 1 OF 1 Alt. Parcel 25.28.20.951 040 - 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 - DODGE, JULIE C JULIE C DODGE 170A DELANDER DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 170 DELANDER DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.462 Plat: 2332-PLAINVIEW ACRES SEC 25 T28N R20W 3.462A PLAINVIEW ACRES Block/Condo Bldg: LOT 05 LOT 5 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 02/20/2004 754757 2513/265 EZ-1 06/24/2002 682501 1915/330 WD 07/06/1999 606282 1439/509 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 103636 244,900 Valuations: Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.462 55,700 180,000 235,700 NO Totals for 2005: General Property 3.462 55,700 180,000 235,700 Woodland 0.000 0 0 Totals for 2004: General Property 3.462 55,700 180,300 236,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 08/22/2005 Batch 05-1 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT SEC.,; 55V3N-R '7W OWNER )q6?,OV TOWNSHIP Tr-oX ADDRESS SfT. CROIX COUNTY, WISCONSIN ~i/tea "fir tom,- SUBDIVIS10N ~gyryc ~leT ~t, LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r Z2 11idic at N r h rrc w BENCHMARK: (Permanent reference Point) Descriue: c Elevation of vertical reference point: l da Slope at site:--- SEPTIC TANK: Manufacturer:- (/(~2e--'/f s Liquid Capacity _7 Number of rings on cover Tank manhole cover elevation: d Tank Inlet Elevation: /OS Tank 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 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 $ S tile depth 2 SEEPAGE TRENCH: width length- _ PERCOLATION RATE AREA REQUIREll AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB /J LICENSE NUMBER v "bEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 3707 1Z CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: If assigned) ❑ Holding Tank D In-Ground Pressure 1:1 Mound NAME OF PERMIT HOLDER: 7DDRESs OF PERMIT HOLDER: INSPECTION DATE: / Randy Stillings 366 LakeJaneTrail, Lake Elmo, MN BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST R F. PT. ELEV. SE4 NE-4, Section 25 T18N-R20W, Troy Township Name of Plumber: MPRSW No.: County: Sanitary Permit Number: Richard Hopkins 1059 St. Croix 34798 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA EL LOCKING COVER PROVIDED: PROVIDED: Q I w r` DYES NO DYES ❑NO BEDDING: VENT DI VE ATL.: HIGH W NUMBER OF ROAD: PROPERTY WE BUILDING: VENTT ESN / ALAR EET FROM LINE: AI I f I In~ ~T DYES NO S NEAREST ~L' DOSING C AMBER: MANUFACTURER. BEDDING: LIQUID CAPACI7V PUMP MODEL. PUMP/S TON MANUFACT ER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ONO DYES ❑NO GALLONS PER CYCLE: PUMPANDCONTROLS OPERATIONAL., V(JhfiB PROPERTY WELL BUILDING: V NTTOFRESH (DIFFERENCE BETWEEN F M LINE AIR INLET PUMP ON AND OFF) DYES ❑ NEARE SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FO LENf.TH JOIAME TER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH. NO. OF DISTR. PIPE SPXIING. JINSIDE DIA *PITS LIQUID BED/TRENCH TRENCHES / EHIAL PIT DEPTH DIMENSIONS rw GRAVEL DEPTH FILL DEPTH UISTH PI f DISTR. PIPE ISTR. PIP MATERIAL . NO. 1 NUMBER OF ROE TY WEL : BUILDING. V NJ TO FRESH BELOW PIPE - ABOVE COVER ELEV. INLF7 ESL EEV. END' / PIP s FEET FROM LINE AER ET NEAREST a / / MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PRO DE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to rnake certain that it OJ4, EVERSE SIDE. SHOW ELEVA- meets the criteria for,medium sand. TI#NS MEASURED. DYES ❑NO E SOIL COVER TEXTURE 9 PERMANENT MARKERS- OBSERVATION WELLS DYES 'ONO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED =OP SOIL SODDED. SE ED MULCHED. CENTER EDGES / ~-I DYES 1:1NO YES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF Lla. ERAL SPACING GRAVEL DEPTH BE PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MA HIAL NO. OISTH ` DISTR. I DISTHIBUI ION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.. DA ELEV. PIPES DIA: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DIt LLL CONHECILY COVFR MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES LL/ 1 DYES ONO COMMENTS: PERMANENT M iq ER OBSERVATION WELLS. o NUMBER OF L fOEPERTY WELL: BUILDING: FEET FROM DYES LINO DYES ❑N NEAREST C} i Io7 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURF'" LE DILHRSBD6710(R.01/82) ~y' DEPA'I;TMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & BUILDINGS LABOR AND PERMIT DIVISION HUMAN RELATIONS P.O. BOX 7969 (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8Yz 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: L:= Address: r Of * '9 Property cation: A4 , / / L¢ t t ~!t9*IFegrer Township: unty .jam /a A1F%S,.2.5_1T NiR -L20 (or) W ` Lot Number: Blk No:: Subdivi ' n Name: d 'rte Nearest Road, L e or Landmark: State Plan I.D. Number L ! Ca L~ (if assigned) TYPE OF BUILDING CgLI -7 Number of El Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 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 ~lJU HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: % EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed 1:1 Seepage Pit 3~ ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑Public ~,y 4Name ndersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. f Plumber: Signa e: ~►P/MPRSW No.: Phone Number: . r's Address: (//ri )V4 / Name of Designer: $Ya. COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ;1 t1 ' ,pr 6w APPROVED Sanitary Permit Number: 3 ❑ DISAPPROVED 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) .))SPAR' MENT OF REPORT ON SOIL BORINGS ,Q SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (11 P.O. BOX 7969 HQMAN'RELATIONS MAbISON, WI 53707 (H63.090) & Chapter 145.045) - eoy~~' ~r LOCATION: SECTION. TOWNSHIP/MUNICIPALITY: LOT N ! K. N DIV ON NA' E: 1/4 w' /T' N/R 9yE (o r,~a ~9iuv%w ;s COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: Ss-Oy ,S .40 51141; ! j 93C~C~ Gyf~l'E JA,c1~ T,Pyli / U.v USE DATES OBSERVATIONS MADE NO. BEDRNIS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: XResidence 3 N4_ New ❑Replace Q 27 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) C013- S19 Ff ©S DU F IS MU C J S ❑U ❑ S DU ❑ S ®U uffA)Adv,#/ WfAJA6P /00 Ix `a If Percolation Tests are NOT required DESIGN RATE: ~~J•~r I If any portion of the tested area is in the under s.H63.09(5)(b), indicate:R Floodplain, indicate Floodplain elevation: 615S4.f/ Am ~ 94,,,S• 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.) B /1 l) /0l, y6 ff 7io- >i1~? /r„~~ 4s o, Gs (7 00 ' pk& -Qv B- B- /6D >/6ro SG, y--/3✓• ~s s„0 s w. jy ylF (a ",A&' .-fie - 13,) . S PO /0/ 30 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH P- P_ Jk_ 4CWJ) 1 c 10 .P n ~41~L~ S'e.5' P- C S i / G /r-o 1/f__57 P_ -3 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. 1,21,6D RoTTOM S44t 4 eT/- y - 3, y. 2- fT de /otu' V~~,Pj/CAL /PE ~PEIXE SYSTEM ELEVATION po/N' P ~tv'~7iQ,v of 9Cn, n~ fr /E(lA-Tra '0 a":- 7'0P 13M c+4 VOrk t SfE i /QG 4 FT' 0'e- Rep P'IpAr. M 1100se, Af I/ST ar 4T 9~ a' y7 '4*eox - V sr sjr~s. 3y N btvST Gi r Ar GfT 273~7 135 F- \e4 E ; _ E C UL' CVA 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 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): TESTS WERE COMPLET D ON: /-Ma _2114k c h7- 6C/-L7 1 ?,f 3' ADDRESS: CEgTIFICATION NUMBER: PHONE NUMBER (optional): %S ' SIGNATU E: tzrf. g i of 's' i C~ i . a F N . Jl~l "1.+.l fir., E ' tir ~~.is fJ C," , tSY. t' , .Ft£:•~,€., 1r ,tz, E i.3. cEI iO; i iu ~i. ,r r i E.,.4.3= iris . ,.a , alt=. r°p ~..i.v~~34rt~` Ee' i F;S, } <<. _ J ~3 .s. fa_ , c <k~ [ t. y ..,E .3 . r 4 E t3, F ~ S, L p+ i 'n 1 ~p " .13' r sa . =iSG t t Via. >`j C, 0 ?i. r V ~ VI) F _2 ~'G ~ 0;?0 e.1 1 ✓ / 1 5 it rLx ~ r 76 in !Y-4 U) ~ r 4 515 n x @ y C 4 er Si,