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HomeMy WebLinkAbout040-1182-10-000 r DEPARTMENT OF _ SAFETY & BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 7969 HUMA14 RELATIONS ' (H63.09(1) & Chapter 145.045) LOCATION: SECTION: *TOWNSHIP/I.1-1,1-1111 LOT NO.:BLK. I SUBDIVISI N NAME: eq ,-k" SE 1/4AY4 36 /T,2BN/R/`/ E (or T ~ I7 Dana e- P COUNTY: OWNER'S/B YER'S NAME: AILING ADDRESS: s . C ~ % r 'r~cl 1 art t~sc~r~ R T s 13, vx /1'1 CJ~~~E'r, ~l~ ~ Pr. f~, `v~r f e~l~~r's USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: XResidence A✓A XNew ❑Replace Ail XIY 4uef &I RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) NS ❑U OS ❑u ©S ❑U ❑S ©u ❑S DU eenve-,ih-0,114/ ~X 573~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the N!~ under s.H63.09(5)(b), indicate: V,4, lFloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH44, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- >1 10.6 _s 16 ,:Xed t ki4 ;7~~ Sal B- -2 7.. ~.1 9C), Al N nn e - > 7 (,Z ~l2 , 3 > lnl red 9„ v a1,-le _c&, A 30 -4; k Sd B- -3 00 YG1, J7 NoAe- `xej I3~ f",k Sd B 87-5-1 B- J 6,10 S7,6,1 /1/dne- 6,/O ~ /'P 3../0 `n1r=(e Al Wl,le sd B- 7, Cpl ,S'~',5~2 Nc.aC T~,l I /.3s i7s;1, ~2" 3s;~►,X~d F,~~r; • '~`I., PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER +He",E3' AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PER INCH P- 41, -Al C~ I j ~lr /10 /0 P- 9 3,0 Mb/) e/0 P- P- P- 'rests- Qan , r ,a 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. N SYSTEM ELEVATION 1~~• 3 C~uK d rr ve 7 -1 Sen,k l a _ z2Y 0 0 ,14. ; s t/=~ ✓er'j. ,F har-7 rec 4- ,39 rn,4J leoel a4L 400- 4- I3%.rA 7' e _110IExe- ~v,0r,ht'f.S_ .Se~' b~ Dit.Wr^ J, 35-1 1 '39 i p= - B wa ~S J o I Q 2 /fir-~a ! p ( d __-per'rolal1?n Tesf" 5 X WY sec 3 Sr a I, the un ersigned, hereby certify that the soil tests reported o form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the t of e, are correct to the best of my knowledge and belief. ~a NAME (print): TESTS WERE COMPLETED ON: ell- ADDRESS: g CERTIFICATION NUMBER: PHONE NUMBER (optional): ,57 )C,.,y 1.2 r 6'y'.?~ 7 low IV CST IG ATURE: Cn DISTRIBUTION: Original and one copy to Local Authorit E# ner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - -YL, aY d eacC fr< €u 5t is t 'Ct £ ,+.Yl t-.ll's t{4.,(3a',. Cl ,1 1 ~._4, X s,:~i c,€ 3fa; i.~F. 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N Da s Igrasn, +1ss.afonf 444hr+. tit ohs? va arxard :"rra# ha¢,err.l .Aonh alt Ip =`df17s, a rarpare+,»rt, Who a+tlaertad -#ha •ft!rdlge,r,y +nia'r,.,narl+, trYad fe me , O N•?I'.s9'3s,w /d7.:t .+It. rr L9 j iuos u t.. .o #e ba svah I'r'oi,don* o•s♦ gal.:stani CsVar of 41 4,41 ctslpaa.f¢,yn,_'Ind p LA.-, o.~k„owtadyad th!#' dray aerOGVfs.d ¢he ferIs I a#vtj ,h Yir'r✓M.q •s• avdh Iff,cara Nt6'S4Jdt,!_+9e.d4 as #ho asad of Jwd corparu}rnvr•by:.ia 1104j,"o +ys, t...... htD: ~Ali o c C G S o, c b ~v j V~ U GJl ril h. \lY w o N LA C f`1 C ~ 91 (Z~ C Q ST. CROI X COUNTY , r WI SC0 N S I N ;x51 { ZONING OFFICE 796-2239 HAMMOND, WI 54015 September 21, 1984 Ray W. Shen R. R. 3 MiUtown, W1 54858 Dean Mn. Shvm: We have been holding the Sanitary Inspection Sheet for the following system(s): Mad Fengws on SE% NA14, Section 36 T2 8N-R 19(V, Tows o6 Tu y Lot 17, Danate PanLk Please turn the As-Built into this office as soon as possible, so that we may complete our file. If you have any questions, please feel free to contact this office. Yours truly _ Thomas C. Nelson Assistant Zoning Administrator sl ForLII C 100 Owner of Property - 0C lkS .Location of Property , Section T, N Townshipl=~q Mailing Address Subdivision Nam Lot Nuruber_ 1 Previous Owner of Property -k}&I Total Size of Parcel Date Parcel was Created/))/ ~j Are all corners identifiable? ✓ Yes No Include with this application one of the following.. .Certified Survey Map .Deed .Land Contract, or .Other Vagal 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 1 (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed r__ orded in the Office of the County Register of Deeds as Document No. x ; 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 been4uly recorded in the Office of the County Register of Deeds, as Document No. '7 i 1 SIGNATURE Of OWNER SIGNATURE Q i~WNER (IF PLICABLE) DATE SIGNED uATE IGNED APPLICATION FOR SANITARY PERMIT (PLB67) 1 it ' &L:± OLIN oc`.saaT' sEnT of UNIFORM SANITARY PERMI Kw~.~sTwv,~,aooa6~xwrxanwcuaT~s -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS &a 'S 61 s ✓1 r ,5 z PROPERTY LOCATION CITY: ~ E 1 /4 d 1 /4, S 3 , T2Y, N, R E (or) W TOWN E 0 L4 LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LA E OR LANDMARK STATE PLAN I.D. NUME a-Ir O/F U -e- TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. 3 ❑ 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. --;KSeepaye 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: />'tt IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic 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): C/Jrivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur MP/MPRSW No. Phone Number4 C./ : C,v1 is h tFl_ 3~ 3 (~as► 3 a F r P um Address: M Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: 4~ / ems' ❑ Disapproved l,t~G~:(sZ ~c-mil ❑ Owner Given Initial / Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-5398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING`: LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION Y.O. BOX 79 MADI BUREAU OF PLUMBING :;ON, WI 53707 CONVENTIONAL ❑ ALTERNATIVE State Plan I.D Number ❑ Holding Tank [I] In-Ground Pressure 1:1 Mound (If assigned) NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER. INSPECTION DATE. Brad Ferguson RR#5,Box 129,Oakridge Dr.,River Falls #67-0 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV SE NW, Section 36, T28N-R19W, Lot 17,Danate Park,Town of Troy Name of Plumber. MP/MPRSW No.. County Sanitary Permit Number. Ray W. Shern 4343 St. Croix 43711 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV WARNING LABEL LOC INC COVER P Q O P OV OED: PRO Il 1f `,U C7 d' L YES ENO I ENO BEDDING: VENT DIA.. VENT MAT L. HIGH WATER IN UMBER OF ROAD. PR~~~tttOpppPERTY WELL BUILDING: JVENT TO FRESH &JAI ALARM. FEET FROM LI~y,E AIR INLET'. EYES O EYES ENO NEAREST S G DOSING CHAMBER: MANUFACTURER. 7INGS LIQUID CAPACITY PUMP MODEL MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDEDEENO EYES ENO EYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL . NUMBER OF PROPERTY WELL. BUILDING.I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM "E AIR INLET PUMP ON AND OFF) EYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE NciTH °IAMETER 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: BED/TRENCH WIDTH LEND TH INO OF DISTR PIPE SPACING COVER INSIDE CIA =PITS LIOUID TRENCHES , MAT H AL PIT DEPTH. DIMENSIONS (0 ) GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. ISTR NUMBER OF PROPERTY WELL. BUILDING: VERNRESH BELOW PIP AROVE COV R EL~V~N LE„i ELE Jl PIPES FEET FROM LINE AIIT NL TO F ET. (L1]VVJ17~ 88 NEAREST- 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- E YES ENO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS EYES ENO EYES ENO DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED C ENTER EDGES DEPTH OF TOPSOIL SODDED SEEDED MULCHED EYES NO EYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH 7LENGTH IN OOCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUI ION PIPE MATERIAL & MARKING ELEV.. ELEV.. DIA. ELEV.. PIPES. DIA ELEVATION AND [DISTRIBU1ION INFORMATION HOLE SIZE HOLE SPACING DHILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPHOVED PLANS EYES ENO EYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE' )0 OYES ENO EYES 22 /ENO NEAREST tip. , , C".~ ~ zf 1I /x/27 Sketch System on Retain i county file for audit. Reverse Side. _ SIGNATURE. TITLE: i' DILHR SBD 6710 (R. 01/82) Parcel 040-1182-10-000 11/04/2005 05:17 PM PAGE 1 OF 1 Alt. Parcel 36.28.19.733 040 - 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 - FERGUSON, ROBERT B & NANCY ROBERT B & NANCY FERGUSON 69 OAK RIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 69 OAK RIDGE DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.428 Plat: 03/58-DANATE PARK SEC 36 T28N R19W LOT 17 EXC W 31 FT FOR Block/Condo Bldg: LOT 17 RD & EXC E 14 FT DANATE PARK Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 671/270 07/23/1997 562/65 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.428 44,000 210,800 254,800 NO I Totals for 2005: General Property 0.428 44,000 210,800 254,800 Woodland 0.000 0 0 Totals for 2004: General Property 0.428 44,000 210,800 254,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 145 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0 cn p i9 -0 0 d ro `+1 A~ 0 U) z= 0 ° w CCDD m A `C m o N a a• CD CL CD a . 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