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HomeMy WebLinkAbout042-1038-10-110 n to 0 3 m n r~ m d `~1 v 741 v m \ 1 (n Z V~ Z p ? Z7 p ~1 • ~ m O v c o p~ N N jV N ►-0 ]rl N Q z 3 3 a m N OpD 7 CD p h c CD ~ o N O N !'S IV Q= 0 N ~ p O 7 (D N U7 O C) (D CD 3 0 o to (o o o p c ~ n ~ 7y (n D c e~ (D CD U) CL o m W rn V m ro n (D 3 p ~l (D rt C pw N) 0 rt ri (A UQ (a. ~ m F• " z _ 0 CO CO N cn o a 0 H. ~ rt H w ' w w~ ~ C z o O O o • ON z -0 N) CD - Z w < w z =r 3 (D 00 C,- m 9 o m I w O o (n r H D CD m m v r w s N ~ d (D~ 0 m cn N CL (D d\ z O z co z O rt 00 H H Z 0 O D a D W O N LTJ N 00 m m N • w Z Z m -o i CrJ CD N O " c (emu m ~f x rfi a 00 M n (D Z 5," (D z CD (p -4 to (D w C) in , 51 ~ 0 a i' (D In a r. p " W m N cn CD CD m (D r d z o 00 g rt 0 z w 3 m 4- H CD A w E 0 CD (CD X N Q w m d p O CD G T O O. N N C S O o N O a 0 (D V N a CD (fl a =r X, y N 0 0 a. p0 b CD m y N m f0 ~ n N O 7 N N ~ O ao_ °a I ~ 0 I o I CD Dro °o I o {G O a 0 0 a- Parcel 042-1038-10-110 12/1912006 05:02 PAGE 1 OF 1 F 1 Alt. Parcel 15.29.18.225A-10 042 - TOWN OF WARREN ST. CROIX COUNTY, WISCONSIN Current X 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 - MAIN, MARY L MARY L MAIN 988 HWY 65 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es . ' = Primary Type Dist # Description ` 988 HWY 65 SC 2422 ST CROIX CENTRAL SP 1700 WITC_ ` Legal Description: Acres: 7.000 Plat: N/A-NOT AVAILABLE SEC 15 T29N R18W PT NE NE LOT 3 OF CSM Block/Condo Bldg: 5/1357 EXC THE SLY 568.10' THEREOF EZ-U-1413/398 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 15-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 08/30/2001 655224 1709/482 WD 05/04/1998 578414 1320/311 WD 07/23/1997 890/177 07/23/1997 884/302 2006 SUMMARY Bill Fair Market Value: Assessed with: 149255 347,700 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.000 54,500 199,200 253,700 NO Totals for 2006: General Property 7.000 54,500 199,200 253,7000 Woodland 0.000 0 Totals for 2005: General Property 7.000 54,500 199,200 253,7000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 158 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges 00 Delinquent Charges 00 Total 15.00 A AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC./5 TjN-RW ADDRESS j ,,T&, 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 -7 V- yFi do i s, ; F"Z O jIn di at N r h rr w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: J cc Liquid Capacity : /pt"~''// SEPTIC TANK: Manufacturer: Number of rings on cover S Tank manhole cover elevation:la~ Tank Inlet Elevation: 5 Tank Outlet Elevation: PUMP CHAMBER , Manufacturer:_ _ Number of gallons Number of gala mpEset fo cycle gallons; Total capacity of distribution 1'n s g llon: size of pump head; gallon per mi~t horsepower ;brand name of pump and model num er _ Type of warning devic HOLD G NK: Manufacturer _ Number of gallons of manhole cover warning device SEEPAG P T SIZE; Number of pits feet diameter fee id depth seepage pit inlet pipe-elevation bo t o seepage pit elevation _ feet. SEEPA E BED SIZE: number of lines width_ /_t___length -sJ tile depth jl r SEEPAGE TRENCH: width length__~ PERCOLATION RATE___/ZL_ AREA REQUIRED AREA AS BUILT y/Llrl '7J'i INSPECTOR DATED__ PLUMBER ON JOB% LICENSE NUMBER-- 3_~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR`& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 12 CONVENTIONAL ❑ALTERNATIVE State PlanI -D. Number. a L1 Holding Tank El In-Ground Pressure El Mound I It ssigned ) NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER INSPECTION DATE. Marvin Risberg RR#1 , Roberts , WI l~,3._ BOO BENCH MARK (Permanent reference p-1) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NE NE, Section 15, T29N-R18W, Lot 4, Town of Warren Na- of Plumher. MP/MPRSW No.. County Sanitary Permit Number_ Henry Nechville 3258 St. Croix 43668 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING C VER PROVIDED: PROVIDErY I ❑`YES LINO ❑YtS LINO BEDDING. VENT D/ l// VENT 7TL/ HIC,H WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH /`11 ALARM.. FEET FROM / LINE. 7 JAIR INLE: ❑YES LINO 'YES' LINO NEAREST / - DOSING CHAMBER: MANUFACTURER BLIQUID CAPACITY :CO P~DEL PUMP. IPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDYELINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP ANN ROLS OPERATIONAL , NUMBER OF PROPERTY JWELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN LINE (AIR INLET PUMP ON AND OFF) FEET FROM - E~ YrES LINO NEAREST 10 SOIL ABSORPTION SYSTEM. Check the soil moisture atAhedqpth of p}dwing FORCE LENGTH JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, constr ction all cease until the soil is dry enough to continue.) MAIN i CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER NDIA ttp1T5 LIQUID TRENC-LIS MATERIAL DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER ELEV INLE I ELE END. PIPE$.. LINE. AIR INLET. 7 FEET FROM NEAREST--► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES LI NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES LINO ❑YES LINO DEPTH OVER TRENC H:BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. TRENCHES LATERAL SPACING. GRAVEL DEPTH BELOW PIPE BED/TRENCH . FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO ELEVATION AND DISTR. DISTR. PIPE DISTHIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.. DIA.. ELEV.. PIPES DIA,'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑ ❑YES NO YES LINO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE ❑YES LINO ❑YES LINO NEAREST /LI Sketch System on Retain in county file for audit. Reverse Side. ETI TLE DILHR SBD 6710 (R. 01/82) EATUR DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, ' FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 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: X Mailing Address: "c~fE Property Location: City, Village or Township: County: N, ~37 '/a ,NF'/aS /T NCR /S E (or W L~ r vvrs y 1~ 747 /1 Lot N/ufmber: Blk No.: SubdivisionNa e: Nearest Road, Lake or Landmark: State Plan I.D. Number: /41- (If assigned) TYPE OF BUILDING Number of blic* ❑ Variance* ❑ Other (specify) Bedrooms: ~ 1 or 2 Family *State Approval Required. 3 se"ivt TOTAL NUMBER PREFAB POURED-IN GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS NEW REPLACE- Opecify INSTALLATION MENT (Specify. SEPTIC TANK CAPACITY J G L~ .S HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: - 7 _ L KA-e cz_ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA -(Minutes per inctr►., PROPOSED (Square feet): El New [?~'heplacement ❑ Experimental ❑`fSeepage Bed ❑ Seepage Pit r ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): ovate ❑ Joint ❑ Public h" ft l- v " q / 5 A ~ I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP/ RSW Phone Number: c~ vt LLr ' Plumber's Addres ~ c Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Sanitary Permit Number: P APPROVED O:~ ❑ 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) t'urw - S t' C lUU Owner of Property- ! -AZ ✓//,y /J 6 ~i-~- - .Location of Property /V/Vr fit, Sectiuu_j= N R /•S W Township Mailing Address x Subdivision Name /U0 c U Yv^, o, L d3 Lot Number Previous Owner of Property Total Size of Parcel 6-.21 A C Date Parcel Was Created /)t Z Are all corners identifiable? /11---Yes No Include with this a lication one of the follow.ijj~_,: .Certified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION i I (We) certify that all statements on this tome are true to the bust of Illy (uur) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recor ed in the Office of the County Register of Deeds as Document No. QVile- ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an casement, 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 APPLICAULE) C:) DATE SIGNED DATE 51GNED t CERTIFIED SURVEY MAP PART OF THE SE 1/4 NE 1/4 & NE 1/4 NE I/4, SECTION 15, T 29 N - R 18 W WARREN TOWNSHIP ST. CROIX COUNTY OWNER: MARVIN RISBERG W1 SC. ROBERTS, WISC. uu 0- m r -J w0 a cs zz~ it u UNPLATTED LAND_ °~'O mo c\j 9SECTION LINE rf) - N 89° 43` 28" E 728-30' Nm s c S 89°43` 28" W II r_ ~w - z C.ICOUNTY SURVEY TOWN ROAD RIGHT OF WAY \ ~6`, 100.00' RE N W CO R. SEC. 15 u o MONUMENT, FOUND p~ R.R. SPIKE IN ¢f I ~ g=C. IS N L7062m,- - _ 111 V ';1HWY. 65 SET z Oz w N 3 z 0 z z C9 O m w t O W o Q M o LL 0 (tL~,~II _I zQl c~~ Z Z a W w a: c z al a x N 0 Q z 20 c z d d ~w n c o a zS a6°09'28 "W m S 86009'28"W 725.92` a n n z t- s= 65.00' 347.11` o O t z Li- o° 3 78.81 I 0 - II I z c Z 00 N o o z a d ~:z d- - v it m 0 a o 0 6 Z cO o I W Z er N _ Wom W w z N \ m c" z E w N oO oU I p C9 X;xfn O J c~ v o x r o I W 1 O a ul -J Llj N .0 O a r U - - = m a (D (D W I t,~ cv 0. m I U) 1 z Z N p _ LL ir Co m o Z N cf~ Lij x N ' z (n r") M Z II , ' 60' J X X O m I Ld ( I L, I 2f Etl 3 I I 1 I I 0b 1.0° O _ 0 O • o 60.00' L - S 89021'28"W LD CO K) _ I- w I- O cv N m 0 01 ci r~ - zl o 0 <I Q O O z J O 0 co m 1 LO' ' U O co m Q1:3 - cn JI w co 3 3 +z ziro " u w 3 zo N E 1/4 N E 1 /4 00 J o W SE 1/4 N E 1/4 Z W Z m Q z z W z ~ t9ao „ W m to S 89 3 2 48 W +I , u A yy qp0 J .r^' y a m "o 610.00' o r _ a s F C) Y< r 1, ` e O co to c\j Oo 0 'n a to 6 ' " Y Z u1 O I M N r; © a to F z - CV J N Q_ ~ r`. a > i W v v, m J 1 I L v= u cn PRIVATE S 89° 32` 48" W. M Q m 0 o o N W ai M I O N t~ 4l O r' y ) ~';3 `gym EASEMENT 610.00` i to M N 1° 00 m (J N O N N 0 W 1 _ C) N lei L 0 c' ° n cV p. o 90 r- 610.00` X100.00' S 890 32' 48" W ~~742. 50` f, UN PLATTED LANDS EAST 1/4 COR. 'OWNE'D IN '4 f. 3 I, 1l wi tin x aj vc rE;er_, registe red `tiscorisiri 1-.rd SurVeyor, 1,s:7°eby certify that by order of and Lander the o'r;nNrs directicn, listewhave aL1Z ~vyuC~ and T,''1a_np; tr_e ,~'ror,.~rt dl;scrib-'d. sho.,n~ have ^n this SL->-t is a true and cowrc'.ct re-resenta,tion of tae exterior boundaries of the surveyed, land and that I have C ? ^l i°d s«7'. t 1. t4:° of C'Raj)ter 236-34 o' th? t~l ? I:31i2 arld -Tyn,'1 r t in E. 11 : 1 HI:^TIL~ A Marcel of land located in the aE 1/4 111- 1/4 and t;!e HE 1/4 Ix 1 /A =3 ,tion 15, T 29 11 - h 18 `4, Warren Township, St. 0roix county, `41isc. C. u r . r cribed as f allows : C )z-,zancing at the Last one quarter corner of said Section 15, t~ ence 38} "along syi` .ast line of 6e-,t ti?1 15, 742,50 r}. J 21;v nt; `J 800 ' t 8 tt -w s 1 00 -F t t f _ 'he ^ r~%e T1 00o 32" W, 105.8.10 ft. Thence S 890 21' 2811 'd, 60.00 ft. Thence N 000 36' 28" E, 463.15 ft. hence S 86o 09' 28" `d, 65000 ft. T pence. N 010 10' 3211 'd; 376.28 ft. to the I'lOrth line of section 15. Thence N 890 43' 28" 728.30 ft. to the West line of S .T .H. 65. Thence S, 000 38' 32" E, along sai*l West line, 1891.11 .ft. and the point of beginning of this :jarce-l. Ft. more or less, or 28.161 acres This parcel contains 1,226,760 esq. .:;ore or-le-se including lands used for town road right of way. i DEPARTMENT OF REPORT ON SOIL BORINGS AND 5 INDUSTRY,, ;y B D~ S ~~P LABOR AND P. 79 HUMAN RELATIONS PERCOLATION TESTS 115 ONS ~MADIS ff, (H63.09(1) & Chapter 145.045) t.> 'i dJ LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVI NA ~5 '/a 1/4 /T z9 N/R If E (a Fib d~v 'M re COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:: 71 -C4a I Aobe;p S USE DATES OBSERVATIONS MADE - NO. BEDRMS.: COMMERCIAL DESCRIPTION: yy PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ❑New LYJReplace eft j f~ T RATING: S= Site suitable for system U= Site unsuitable for system SC, " 0 13V A6 74 _1lw COe7NVEjN TIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑U S ❑ U ZS ❑U ❑S KU ❑S 21U 0,0.11 11,,24%~ [under ercolation Tests are NOT required DESIGN RATE: I If an L y portion of the tested area is in the s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: i.j PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IN ' CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- l p' ` > i~,~~y ~f B 13NIv6Y. L i ~P3 Qa1 • G i f, 3.3 G~'~tl B- B 0.f, 40 6Y 5,'4 4, 7f ' 401e. 4S, 7 75 ' tl - .J , ,5 L 7cz Av, -G Y. -10 S A .2 B- / 33 C- y. /);,Sr- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- / 3 P- P- 2- 6, / z 7 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. 130 P f /3" , "-XC,4 i19T~a cJ t ~ G / ~S E,Y-4 C T t y SYSTEM ELEVATION fo. •7.2- F1 ZIP,/,n, -Ve~ 12 EU_r4Tic~ ~ a- Fr i C 7 f t E E e ~ 1. • I , I - I See , I E i R 6 E I I I 3 , ' s I, the undersigned, hereby certify that the soil tests reported on this 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 location of the tests are correct to the best of my knowledge and belief. NAME (print): "®MESITE TESTING Co. TESTS WERE COMPLETED ON: P-T 2- S~167 ADDRESS: a illb CERTIFICATION NUMBER: PHONE NUMBER (optional): DS"I WS' 54016 J^~ CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - v 1-1 m t ItJ 1 ~ i>a l $ ~mr_°• yap: nI .b ,s k d M,t_ .41fl rt u r un Cat ta..€3°., F.,€ C :~r) fA~d°ia;i 1.,o r i SI G<, S. i1 fB . 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X = ~E.PG /oCv-loNf = fj~A.V~ Atl9£~PED o,Q S~eIJEL 1%ee5 j Vt rlchl- ass 7 LE GE N D 6141hrid v /a o' o 29 -3 ~3 pp f~ x 1~ /10 e r- ° L' v fix; 4 r y o ~-7r l FDIC Iys7 Piq to ~i S ~ ~ q U ~o { ~ v CXi RCn 4 ~ I I ~ 6,, Ub w n,o " c W~ e I I ~ ~p ~ -r 7 o rv me $ LJ' o 7 In - - - - - N .r. ,r 1l