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HomeMy WebLinkAbout042-1083-60-000 n co p 3 v n C7 r_ c d F c 1; O co v1 3 = a 3 c v 3 d m n O 3 At O N O 00 . (D N N CRT o 3 m y ctOO m m Z O. n> a o °7 0 m --I ~~3~°W= ~po ~ ° n CD n f o00 0 0 m 3 o o o o o coo 0 0 0 CA m C a C D a o .H CD Cn n o 9 m W D /q 3 = co rn m r ~ c C) m o00 co cn r N ~j. t~ rl ~p ~ W W ~ cn ~ C oo =i O O 3 l~~ii1 _ V-4 CJ] v -Q ` . n O cA fA f/1 w m a M CD Ch r { . m Gt 'yo Ro CD a' C d r: :3 <D _ a 00 z N N ' f- ZD co OZ 0 I N 0. P W D m m m • C y ( 1 CD ~ C: CD N Q w C ill Z Z ~ tp '.I -1 N Z (D ~ N fT1 0. ` Q n CL A o' Z --I N O W m oo w o to n O FF (n m C. Q w m W N ° w D CL Q o' ~ c I oz a cD U) i a y A I A A ti N O O V A O~ b A CD 6p O O * r W O O L yb ~ 'r y Parcel 042-1083-60-000 01/18/2007 04:36 PM PAGE 1 OF 1 Alt. Parcel 30.29.18.468C 042 - TOWN OF WARREN 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 - BEAR, WILLIAM A & BARBARA J WILLIAM A & BARBARA J BEAR 930 70TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 930 70TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 23.500 Plat: N/A-NOT AVAILABLE SEC 30 T29N R18W 23.5A THAT PT OF NE SW Block/Condo Bldg: LYING WLY OF A LN COM 3186.4 FT N 89 DEG W OF SE COR SEC 30, TH N 0 DEG ETON LN Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) SW1/4 ASM'T INCLUDES 042-1083-95 & 30-29N-18W 042-1084-10 Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1012/430 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: 149742 Use Value Assessment Valuations: Last Changed: 06/22/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 25,000 176,300 201,300 NO AGRICULTURAL G4 43.500 5,500 0 5,500 NO UNDEVELOPED G5 0.500 100 0 100 NO AGRICULTURAL FOREST G5M 11.000 14,900 0 14,900 NO Totals for 2006: General Property 57.000 45,500 176,300 221,800 Woodland 0.000 0 0 Totals for 2005: General Property 57.000 45,500 176,300 221,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 R ` AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 4? SEC.~~TL6?N-RW ADDRESS! 7 ST. CROIX COUNTY, WISCONSIN. SUBDIVISION }r LOT LOT SIZE ,411 j PLAN VIEW Distances and dimensions to meet requirements of 1163 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM L 06 q 1O. Indicate N r h rr w BENCHMARK: (Permanent reference Poiat) Describe: Limon .11 Elevation of vertical reference point: e~02IC7 -Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: O~ Number of rings on cover Two --Tank manhole cover elevation: 103-477 Tank Inlet Elevation: %q•? _ Tank Outlet Elevation:Q PUMP CHAMBER Manufacturer: u ber of gallons_ Number of gal. pump se for a cycle --gallons- Total capacity of 212- distribution lines gallon: size of p mp head; gallon per minute ; horsepower`- ;brand name of pump apd model number ; Type of warning device HOLDING TANK: Manufacturer - Number of gallons kh E~evation 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 rvo width1~ length tile depth SEEPAGE TRENCH: width length PERCOLATION RATE AREA REQUIRED 27 AREA AS BUILT,! G~SS~ht~~ INSPECTOR _ DATED PLUMBER ON JOB SOn LICENSE NUMBER `i' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.n BOX 79'69 BUREAU OF PLUMBING MADISON, WI 53707 C CONVENTIONAL El ALTER NATIVE State Plan l.D. Number (it assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTI N DATE. EtWin Stewl Woodvitte WJ ~-CJ_y,3 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. CST REF. PT. E V. NF SW Section 30, T29N-R78WU Town a Watcnen Name of Plumber. rPRSW No.. County Sanitary Permit Number. Fvenett Bo2dt 4489 St. CtLoix 38499 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY- TANK INLET ELEV.. TANK OUTLET ELE V.. WARNING LABEL IL OCKI G C q 1 f~ ~t PR DED PROD E U I YES ONO JYES/ONO BEDDING: JVVENT MAT HIGH WATER NUMBER OF ROAD: PROPERTYBI LDING. VEN T F SAI N ALARM j} DYES NO OYES NO FRESTOM a~~ LINE ~~~,JWELL 6. 3 V DOSING CHAMBER: MANUFACTURER BE DOING. LIQUID CAPACITY PUMP MOD PUMP, HON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED'. DYES LINO OYES ONO DYES ONO GALLONS PER CYCLE: P MP AND CO OL OPERATIONFy NUMB OF PROPERTY NELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET ROM NE IAIRINLET PUMP ON AND OFF) YES ❑ N REST SOIL ABSORPTION SYSTEM. Ch ck e so I mo tureat t edepth f plowing r~, DIAMETER JMATIRIA; AND tinRKINC, or excavation. (If soil can be rol d to a re construe ion shall cease until F RCE the soil is dry enough to contin ) M CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIP PAC ( COVER JINS1111 DIA sPITS LIQ THENES MATERIAL: PIT - DEPTH DIMENSIONS (J - GRAVFL DEPTH IFILL DEP H DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY _ WELL. BUILDING: VENT TO FRESH BELOW PIPE$^_ AB I, VJR ELQV N ELEV END. PIPE FEET FROM I / AIR INLETIIIIIIII~ C L~ s I 4 '/C-' S ..2 11 ; ~ G v NEAREST-►i 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- DYES O NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED IS11DID MULCHED CENTER EDGES. DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV. DIA. ELEV.. PIPES DIA.'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING L FEET FROM LINE DYES ONO DYES ONO NEAREST ti I 61z q is 0 CC)f Sketch System on Retai nn file for audit. Reverse Side. SIGNATURE ITLE D I L H R S B D 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 N HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 81/2 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: Property Location: City, Village or Township: County: t/4s4d/4s 3O T 9 N i R (or w ~ ct s'e S C- i Lot Number: Blk No Subdivision Name: A .1 Nearest Road, Lake or Landmark: State Plan I.D. Number: A , .-~i (if assigned) TYPE OF BUILDING / Number of ❑ Public* ❑ Variance* ❑ Other (specify)*C~~ Q~p~ - S o ~Q Bedrooms: [Y 1 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/SIPHON CHAMBER MANUFACTURER: Oa c e EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA rte i (Minutes per inch): PROPOSED (Square feet): lei New ❑ Replacement ❑ Experimental LEI Seepage Bed ❑ Seepage Pit LBs~ 7';&?.,? p ❑ Alternative (specify) ❑ Seepage Trench Water Supply: o Owner's Name as Listed on Soil Test Report (If other than present owner): Private 1:_1 Joint ❑Public I, the undersigned, hereby assume responsibility for inst ation of the private sewage system shown on the attached plans. Name of Plumber: ig MP/MPRSW No.: Phone Number: v~ze4f d~G~t P S5 lo, 33 Plu dress: Name of Designer: /'4L w/w ~cS COUNTY/ DEPARTMENT USE ONLY Signatur of Issuing ~l D/ate:Y3 APPROVED Sanitary Per[m~it Number: DISAPPROVED 0_7 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 T C 100 Owner of Property 1- L LA.-J 7 5 e-+ Location of Property lyIE 4 ~uJ 4i Section 30 T Q9 N R /Y W.. Township_ G aIgfq ei✓ Mailing Address C.l~ooeei/C~ j~, s Subdivision Name Lot Number Previous Owner of Property W 5 lZ/Qe e- Total Size of Parcel Jr7 /7C,,,2e S Date Parcel Was Created Are all corners identifiable? _ Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (Url 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.3-Z y IS; 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) 2L DATE SIGNED DATE SIGNED DEPARTMENT OFt,/~REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 IJUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION:l~ SECTION: TOWNSHI LOT NO.: BILK. NO.: SUBDIVISIION NAME: N~ '/4 1/4 3o /T.29N/1118tor144-b4d Rerv NA Na A"A COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: d 4 , C R 0 i x C 1. L-dw'dw S~T eB i~.1 A i. `V - &),o o civ I Ile Ltd/' .S' . USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence /y' 4 )4New 1:1 Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:( optional) ®S ❑U ®S ❑U ®S DU 0S ®U ElS XIU A If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: /VA N A, lFloodplain, indicate Floodplain elevation: IVA F PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ^ ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 09 - q B- ! 6.4 9:.•a~. Hotq-e- m~6 7 AtYL 5'/C ..3 4'995- S,47 r- s~ B- cP 6, 16/ Iq g 0-1 a )14 ..1 41 Sr 4. S~ 3 - V' e5q- R © / B-3 6.18'99,018 ,r ./67' D4 ;5 s34 9W 51-, 6"3 0-~ R B-4 6.1 9 8, a o 6 7 &V 5-t 5' o ' as ' 900 A0 B- '34 6L 6: 4 (F-T gi 4.1 B- .r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER HIONOW AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- 3. a ' NO 3 0 3 3 P- A. cd P- 10-4 o .j P- lvq+epeSee ac/ wA in/ 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 directiyn percent of land slope. LD SYSTEM ELEVATION q5. 6 ,~evt~ e .S'7 4cees ! ~~F 5 t.v'/ oN Kcj P5 P ell 49 Ile ~fao r ,~-._,~~a 1~ rv~ ~4 PR© w 14 ►°use 4l /loo, o~ ~(-,o o qo rJ K e Al e- Q - 0R+e t e CI~~ ~0 ° pq i4 _ Snit big APbeA SC, A 4, el G-1j saN DRIVe oa I, t e 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): TESTS WERE COMPLETED ON: L~v eR e C1 6 - 9- F3 ADDRESS: ' CERTIFICATION NUMBER: PHONE NUMBER (optional): 14 5q / 5- 7c P S TURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - I' o 'd ilk .+~f`., 5 i YY7 fix, . 3 zc'e ' tz ~ iit,v, ~ot In g, xU f C' < ,.a t11, 1,'j o-~-(_' E .i r1 , tiw s rn `mr`q F~t~:' d 1~3P ';I{3 id_ gs s .:i,~ {{,rt. 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