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HomeMy WebLinkAbout040-1133-70-000 1 o F o co~ I c m CD A ~o H d i 3_ x I _ ~ O • (n J z ° w cWn ° °C N CC) 0 o N a o J• 3 1 N N o r-y (D tJ**D z (D N A j CO m W N ° Ill G ca `Y N a a o c J v o 0 J `J° ° m o C, C: v 7 (D N O O co CA A w m U) D CD cQ o a m D J N W 3 CL om-. O O p co j CD CD co --i CL ~Z CD CD 0 r- C/) N W 00 00 GJ C7 (1) a C n 3 O O O J lr~r• o N~ fn N N~ m !_~N~ifV1 n 67 CT •fl (D O `G ! y o 0 (D m 1! n Z o J N C1 CL Z Z N N z 0 a W o v v o CL :3 CD CD `D H • N N CD SU 4 O N' C A N (D O O W ~ Q N CD 7 N z J N Oc K v d ? o. 1 z W W I M Fi (.n o z 0 3 A o U) N CD A A p> CD a p S d CD F 33c rn Ll -0 0) (D 0 - C N p N N cn Cn 0 N C~ CD 3 Q c Z Q CD CD O C1 X. O CD J N 5.0 (JD DO O CL < y CD O O C rn x J O b cc* w J m m mom a CL cc CD N 77 -0 gn v m a N n O 0 O I m m~ o 0 a CL a I o ' J Dq `D f0 w Q o *L 0 a ° Parcel 040-1133-70-000 12/28/2005 08:08 Ann PAGE 1 OF 1 Alt. Parcel 35.28.19.556E 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 - LARSON, EUGENE O & CAROL EUGENE O & CAROL LARSON 232 CTY RD SS RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.630 Plat: N/A-NOT AVAILABLE SEC 35 T28N R19W.63 AC IN NE SE W 160 Block/Condo Bldg: FT OFE747FTOFN 173 FT OF NE SE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 418/379 2005 SUMMARY Bill M Fair Market Value: Assessed with: 103095 198,600 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.500 30,000 161,200 191,200 NO Totals for 2005: General Property 0.500 30,000 161,200 191,200 Woodland 0.000 0 0 Totals for 2004: General Property 0.500 30,000 161,200 191,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount I I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I c L l 45 SOS ¢ I, . So► ' .1 { 12 OPP qj t 4 y * Soti.o r'~ a l halo D .E.. v t 44 V T Soar, i= . F 1 h 7~ A~.l ► ♦ c~r~ S1~b11 f 1 t. `I r V ` s5 1 . . 1 " 10 dl 1 'II ♦ , y r I, Sr•.r ^ S011p S rJ t' Z/e6 7♦~ aP4 a . 1 fiM ~ r. tt ' gt Nd Se's.., 3a 2 6 • / 1 1 a 1 j i I ,i AS BUILT SANITARY SYSTEM REPORT r OWNER iG'-~C~ 'f TOWNSHIP SEC `-S` )$-.R/~ W ADDRESS K' _ ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE _ PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM L n _,v i 1V1 n' ! ✓~'S U V~ LL u~-~ G 1S 1 ~ `A f ~Y I I di at N :)r h rr w BENCHMARK: (Permanent reference Point) Describe: c~ Elevation of vertical reference point: C Slope at site: _ 1 61 Liquid Capacity: K: Manufacturer: Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: -Tank Outlet Elevation:- PUMP CHAMBER Manufacturer: Number of gallons r0'..0 gallons; Total capacity of Number of gal pump set for a cycle_Zt' distribution lines __gallon: size of pump- g head; gallon per minute horsepower ,brand name of pump and model number _ J~ ,~T"C L /~1e S > Type of warning device /I K: Manufacturer---- Number of gallons llevation of manhole cover- t'ype of warning device-` S 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 7 tile depth SEE H: width _ length PERCOLATION RA'lECS, AREA REQUIRED 6C AREA AS BUILT - INSPECTOR - - - GEre G' LSbc~ ~KUrccc ~C~Sp.~ D % PLUMBER ON JOB DATE LICENSE NUMBER. 4, DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING t P.O. BOX ;+969 MADISON, WI 53707 CONVENTIONAL ❑ ALTERNATIVE State Plan I.D.Numben (if assigned) L11 Holding Tank El In-Ground Pressure ❑ Mound INSPECTION DATE NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: Eugene Larson RR# 1, Roberts, WI 30 REF. PT. ELEV.: CST REF. PL ELEV. BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN NE SE, Section 35, T28N-R19W, Town of Troy Nam, of Plumber MP/MPRSW No.. County'. Sanitary Permit Number. Roger Nelson 6379 St. Croix 38514 SEPTIC TANK/HOLDING TANK: _ MANUFACTUR LIQUID CAP ACITV. TANK INLET ELEV.. INK OU ET ELE V.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. i DYES ENO DYES ENO DING.~VENT TO FRESH V UMBER OF O OPERTY WELL BEDDING : V NT DIA.' ENT M HIGH E LINE. AIR INLET ALAI FEET FROM EYES ENO DYES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MA NUFACTUREI WARNING LABEL PROVIDED OVER PROVIDED DYES ENO DYES ENO OYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PR OPERTV WELL BUILDING JVENTTOFRESH LE LINE AIR INLET'. (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ENO NEAREST LEN(~~T 11 DIAMETER MATERIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: NSIDE DIA zPlrs LIQUID BED/TRENCH WIDTH LENGTH No OF DISTR PIPE SPACING CO DEPTH I l: 77 TRENCHES / 7 DIMENSIONS 7 NUMBER OF PROPERTY ELL BUILDING VENT TO FRES, GRAVEL DF PTH FILL DEP H DIST HPII DISTR PIPE DISTR. PIPE MATERIALLINE AI N ET BELO PIP AH 1v~ OyER LLEVV INI r E EvEND 7 FEET FROM 44 :)L)' ll ~lNEAREST 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 REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ENO PERMANENT MARKERS OBSERVATION WELLS SOIL COVER TEXTURE DYES ENO OYES ENO SODDED SEEDED MULCHED DEPTH OVER TRENCH: BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL CENTER EDGES. DYES ENO DYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. POEDISTR. DIATR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV.'. DIA. ELEV.' ELEVATION AND DISTRIBUTION COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY PLANS DYES ENO DYES ENO NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: LINE. FEET FROM DYES I] O DYES N NEAREST ~T ~ ~ u'~1 Y~ G~.~V Ut,.GO 11 f TY) C) q 1~ Sketch System on tain in unty file for audltI~4,A~ Reverse Side. SIGNA TITLE. DILHR SBD6710 (R. 01/82) / C 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 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. Property Owner: Mailing dress: c Property Location: eit4-iGi "q or Township: County: %515 %S33/T_.2, N/R ICI E (or b C /'~'dx Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: ~C L~AV T- I //~l ~ (If assigned) TYPE OF BUILDING Number of / Bedrooms: ❑ Public* ❑ Variance* ❑ Other (specify)* "~Li or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/ MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental Seepage Bed E] Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Watteer}Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): LEI-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: MPIWffqM No.: Phone Number: .01 3 Plumber's Address: Name f Designer: COUNTY/ DEPARTMENT USE ONLY Signatur of Issuing Agenl' Fe d Date: APPROVED Sanitary Permit Number: / r}' n A 1!? C ~l! 7-1 -Fn?3 ❑ DISAPPROVED t7 5/ 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.07181) J P, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFkTY U. NGS DI N INDUSTRY; LABOR AND g PERCOLATION TESTS (115) , `/MIAl l- l 7 HU'MAh! RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SU ISIOIIA /a /4 /T _ N/R E (or) W COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: Y 1 _ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: OResidence ❑New ❑Replace _ 1 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) QS❑U Q-S❑U EIS 11U OSEU OS❑U If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the 1 . under s.H63.09(5)(b), indicate: - Floodplain indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-ING44-ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I+j ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 71 B - - I B 1 f_ 1 'r J I- B- B B- T__ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER INCHES AFTER SWELLING INTERVAL-MIN- PERIOD t PERIOD 2 PERIOD 3 P- P- P- P- P- 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 yy ~ ~ ~1 •ob F k~ =sl `zs~ N_ ' 1tYt~ ~ try ~ j~ i , h j t I - t~ !rj 'su J) J C~,, - S ~ oi _ 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 COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SIGNATURE: n DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Si~~' ti ktaE R ( 3 ~ 3 a.... a if s,k..i.;ul f2i_€s cl, l.; r>i d€ c Cft_ €f. PCYi i€ v, t; Cei r.. e >o ph, a=east txoxi, As CO ~a c Cc)" its it''} i t ni _ n d I t a a 201', 1'urw - S T C 100 Owner of Property bl Q ' _ - i.. ar 0 V1 Location of Property Scctlun N lZ W Townahip Mailing Addreaa Ivlrq~r~.~rr. . Subdiviaian Name Lot Numbar Previuua Owner of Property Ct ra^ be r 1 ; A_Jcl. aK c.r ~I tw Total Size of Parcel ----~1 Date Parcel Waa Created Are all cornera identifiable? YcLi Nu III CIOde with thi6 dP 1)li C at iOLI One u1 ChC_f011uw-ilIL: Certified Survey Map Deed. .Land Contract, or .Other Cegal DOculucnt which duacribcs the pruperty PROPERTY OWNER CERTIFICATION (We) certity that all statements on this form aru true to the best of my (our) know1ud6vi; 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.-AP --23 5 ~ ; and that I (we) presently own the proposed site for the sewdyu disposal system (or 1 (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. .fir ~ .y. r`i !j <t _r SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICAaLE) DATE SIGNED DATE SIGNED ! PAGE OF PUMP CHAMBER CKOSS SECTIOM AKJD SPECIFICAY10KIS VENT CAP `i~~C.I. VENT PIPE WEATHER PKOOF APPROVED LOCKING 25~ FRCM DGOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 12°MIU. AIR IkITAKE GRADE I MIN. 'I 18" M I fJ . CONDUIT 18"MIAI. ~ INLET PROVIDE I - AIRTIGHT SEAL I I i I ` / API'RO`JED JOINT A I III wf I I I APPROVED JGIrJTS W/C.'L. PIPE I I W/C.I. PIPE LtrENDINC. 3' - I II ALARM EXTENDIMC, 3' QWTO SOLID r.IL- B I II ONTO SOLID SOIL. C I I ON I I I PUMP OFF D CONCRETE BLOCK - V RISER EXIT PERMInED C)QLy IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATI0QS EPTIC AWE) _ !r )SE TANKS MAUUFACTURER: hL NUMBER OF DOSES: -____-PER DAY i / lAAlK -,IZE i _ GALLOIJS DOSE VOLUME: C ALLO"S ALARM MANUFACTURER: _ 1JA;T > r - CAPACITIES: A= INCHES OR GALLONS MODILL LIUMBER: B=_ INCHES OK GALLOKJS SWITCH TYPE: _ G` 7- _ C= INCHES OR Z P( GALLONS PLIMI' MANIJFAC.TLJREK: D=1_S -INCHES OR C- GALL01..15 MUIiEL NUMBER: NOTE: PUMP AND ALARM ARE TO BE SWITCH TYPE: INSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE GPM VERTICAL DIFFER.EKICE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. _ FEET -H MINIMUM NETWORK SUPPLY PRESSURE • • . • , , • . . 2.5 FEET + --FEET OF FORCE MAIN X 1i oo Fr.FKICTIOIA FACTOR.. - FEET TOTAL DIJNAMIC HEAD FEET L"-- t~ , '1 /DZ F t IAJTERnIAL DIML"SIOMS OF TAUK: LENGTH _ J) ;WIDTH ~ ;LIQUID DEPTH _ Z- P ~ f v ~ \i~ l~ b V b b a ti ~r N C ~L Cd ~ y W i~ ask I L H/'1 N E ' t c 2 .c n o f o O T d T - N C T H m a~ `0 E E E E N Q L J w E c o 5 M 41? o m c v M CI h c ~ m • ~ E m "M C- w _ o E L ° U E a N°° m - U $ c h m m m ❑ w o` E.o ad o c o5 E E ~t NL O ~ c •E c m 00 tc72 3l > at o N c tp ~o h_a3 ~o~ p' ZZ~ 1 1 l'T 0r t Q N O w C M3 J C Malmo I-, R M 75 CL > rn C) Q $ =t5 d of ` W by V a M c0c Cia°, m cS 3c°, M 51 = 4) r rt o ''d W F - w n° u.Et v c d o d W 0 C/) Z 0 o W F I- U LMLJ CO cD J GICC p L > z z cr U- CE U U DU) ° ry o C © cr ti. oc C W ~ Z ! O C. U- o y M Uw w w 1 c, O CC LL 00 o 0° z o ~ m 010002, w ° m r:D D ~ o C/) r 'j,