Loading...
HomeMy WebLinkAbout008-2000-20-000 n Cl) Q j v n c = 3 I m ° v co °O ~l• o o m v o 0 1j N 7 co O N O O cn ! N N Q Np tU N m ° n C) C) O H n S 0 W v O Oo W (Ji 3 :E W O ( V 7 N C A O C » N CL Q O ~ (y ~r Y 1 ? (D O N a m V L r ~ N ((DD W 0 -4 OV O ' C\~\ N N O 7 C) ~,-.-A C" (mil Cti O O CD "*Mat 00 co ri fi't` C\ N N a N! Q \ D. < G G < c -p U) (n cn > N) N) cy. * CD { j T h O O (D .(D+ N !V ~ ~`G7 U7 7 fl1 L ? Cl) zco z (D o rte) p N !'r • CDo Cl) (D N C N CD \ l/Q d z m ~ ~ cn O ~ ! p Z <D a. i~ C m ~ W W M iv rn CL z z c, o e m 3 rn N z W I s D N (D Q 0 - - 77 0 m a3. o a v I m o N ' ~ I n I a c ~ Q I y b I ~ ' m o~ CD a n o I ~ tv O O i a A O_ "1j dQ ti 69 0 ti ° b dw~ /~//o AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC TJN-RW ADDRESS A Jr," - E COUNTY', WISCONSII4 i SUBDIVISION LOT OT S ~g'.~~`,~G ie) PLAN VIEW Distances and dimensions to meet requirements of H63 0 F. Y RING WITHI `F, ET 9F SYSTEM J _ I di a e o th Arrow SCAL: - - BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Irrf r" Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cyc e gallons; total capacity o distribution lines gallon:. sizes pump head; gallon per minute horsepower ran 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 o pits feet diameter feet liquid dept seepage pit in et pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number cf lines width length tile depth SEEPAGE TRENCH: width length . - PERCOLATION RATE AREA REQUIRED _AREA AS BtJ.II- DATED Rh BER ON JOB LICENSE NUMBER - , - i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS 2j C) DIVISION P.O.JSOX 7969 ^ BUREAU OF PLUMBING MADISON, WI 53707 A ~ 310 I~CONVENTIONAL El ALTERNATIVE StatePlanl).D.Number . Ilf assigned ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound N E OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE )n L j BENCH A.~rRKr (Permanem reference romt) DESCRIBE IF DIFFERENT FROM PLAN } REF. PT. ELEV.: CST REF. PT ELEV . t.r / L„~..Al F_ a i NX ame of Plumber. MP/MPRSW No_. County Sanitary Permit Number_ ^ - SEPTIC TANK/HOLDING TANK: Z. d fT/{ MANUFACTURER. LIQUID CAP ACITV. TANK INLET ELEV.. TANK OUT T L V WARNING LABEL LOCKING CO R Q~ 1 PROV ED: PROV D " 2~ e YES ENO NO WELL. BUILDING. VENT O FRESH ' J J I BEDDING: VENT DIA VENT MAT L. HIGH WAT 'I NUMBER OF ROAD: 1PROPERTY A 'ARM LINE'. AIR INLET. FEET FROM YES ENO ❑ E NO NEAREST 1 1s OSING CHAMBER: MANUFACTURER ED G. / QUID CAPACI TV PUMP MODEL PUMPi SIPHON MANUFACTURER WPRAORVNI IN BEL IDEDB: ES O E N YES ENO GALLONS PER CYC. PUMP AND CONTROLS OPERATIONAL. NUMBER OF I'H(iF'E RTV LL' ILDING (VENT TO FRE SH (DIFFERENCE BET' E N FEET FROM LINT AIR INLET PUMP ON AND OF EYES ENO NEAREST10 SOIL ONI" SYSTEM. C eck the soil moisture at the depth of plowing vr, I1~ I Ar,F TF IMAITHIALAND MARKING or excavation. (If soii can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: zl- LENGTH NO. OF DISTR PIPE SPA IN( COVER - INSID I SPITS. LIQUID BED/TRENCH WIDTH c" TRENC s roi AL; _ PIT DEPTH DIMENSIONS L+ ~Z, C'RAVF I 011"H FILL DEPTH ID ISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. R NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BF L"N I'1;'/~. ABOVE COVER ELEV LET ELE END PIPE FEET F (LINE. AIR INLET'. ( 1/ ROM NEAREST--s MOUND SYSTEM: Mound site plowed perpendicular to slope Check the V'tomake tf the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systcertain that it ON REVER SE SIDE. SHOW ELEVA- meets the crm sand. TIONS MEASURED. EYES ENO SOIL .'OVER. TEXTURE PERMANENT MARKERS. OBSERVATION WELLS EYES ENO EYES ENO DEPTH OVER TRENCH. BED DEPTH OVER TRENCH RED DEPTH OF TUPSOI L. SODDED SEEDED MULCHED CENTER EDGES EYES ENO OYES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH LENGTH NO. OF LATERALSPACING. GR VEL DEPTH BELOW", PE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MA%IFOLD PUMP MANIFOLD DISTR PIPE MANIF LD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING EV. ELEV. DIA. ELEV. PIP ELEVATION AND El ES DIA.'. DISTRIBUTION 11111 E SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIA L VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS OYES ENO EYES ONO COMMENTS: PERMANENT MARKERS: OBSERVA ION WELLS: NUMBER OF (PROPE: BUI LDING: FEET FROM LINE OYES ENO YES ENO NEAREST-a►j_ '2 P41 1,( 2 101-, (tom 07 j ( t z_ t Z. ~0 to-ZI3 Sketch System on tax in county file for audit. Reverse Side. $161CA'tUR TITLE. DILHR SBD 6710 (R.01/82) APPLICATION DEPARTMENT OF TY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT n~~~IEU "r .0. BOX 7969 HUMAN RELATIONS (PL13 67) 3 laoj32NIA ON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that 14i pensionoiladrawn.' cale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and ph Fharacteristics4 ` cified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated LFig fieskgrrE ~f esigned by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproductl soil test report must be included. Property ner: Mailing Address: ' mF' a?of / L S / Property ocation: 1 .ViUaWor Township: ounty: S 36, T~9 Ni R or) W'Q i- O f -27-, eo Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 19-f 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: t )j e' EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA ENevv (Minutes per inch): PROPOSED (Square feet)❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit 5 2 / / v 'A lternative (specify) ~~eepage Trench Water Supply,:? GP Co Owner's Name as Listed on Soil Test Report (if other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na of Plumber: Signat ^e: MP/MPRSW No.: Phone Number: cis I~•e fl e s6 3D / 5- 0? PI ber's Address: Name of Designer: 1jedleie 5/ e 1 o--`- COUNTY/DEPARTMENT USE ONLY Signat a of Issuing Agent: Fee: Dat APPROVED [Sanitary Permit Number: DISAPPROVED I 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 (N.03/81) ~C ! ' I DEPARTMENT OF REPORT ON SOIL BORINGS ANDSA&T 1J NGS 4DION INDUSTRY, yy LABOR D PERCOLATION TESTS (115) B 969 HUMAN REATIONS ~UNM~ISO~N W707 ~ 10NING L\tVISIONWAIMAE: LOCATION: SECTIION:T p p TOWNS HIP/f* Jam; LOT NO.: BLK. NO.: S M COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: 5~- C OI X a- e__ IJLJ©o~t.L~ot a~ll~ AldrA- v ,h S USE DATES OBS RVATIONS MADE NO. BEDRMS.: ICOMMER(-,!AL DESCRIPTION: [PROFILE TONS: 1PERCOLATION TESTS: ~JResidence 9 ew ❑Replace 1 RATING: S= Site suitable for system U= Site unsuitable for system CONVEfyTI-]U MOUND: IN-GROUND-PRESSURE: ISYSTEM-1N-FILL HORSGTANK: REC© M'E,N~~ YST0 h: ;tional Bs [ If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V, u If any portion of the lot is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / p / B n C)rn (J e- >60 is 8111G7 s,/ B- 2 16~ 7. $ 1( a u ai / is /4" C-y S, 1-16 B-,3 60 3 " (3I -Si/ Is 9"" "-p s./ 49 6, 5,'l 9/ 5,15 /dy44'Al S,1/ B 61 oil s B-,5 f~ I ( 7 ! Y 5/ -!S-; s 1.2 ~y 41y "-A s, ''G-y B- (P3 .It ` l 3" gl S,1 is 141 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER D1 PERIOD2 PERIOD3 PERINCH P- t - 1 i 45-3 - P P- P- _ PLAN VIEW: 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 slop. qp. ~0 % ~-e r~► t ~s SYSTEM ELEVATION L~o:~ er 'l-re 99, 9 3 30 Pt?'- r Q pp pp 151 -e 0 ov ye't' 6 . t 3 S 'P Tl ~ro~Ctsc e i c_c' 1 e. sj , el, 4 i, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME( pr" t): E COMPLETED ON: h'V1 VZ l ' C' S 4~ TEST7111-2 ZIRET CERTI ICATION NUMBER: PHONE NUMBER optional): 3C~ ~?7~ - a Wt i (J 1 CST SIGN T RE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 IN. 03/81) Parcel 008-2000-20-000 12/06/2006 04:52 PM PAGE 1 OF 1 Alt. Parcel 36.28.16.537B&540C 008 - TOWN OF EAU GALLE 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 CATHERINE O WOODWORTH O - WOODWORTH, CATHERINE O 2686 BOSTON RD WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 2686 BOSTON RD SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 27.000 Plat: N/A-NOT AVAILABLE SEC 36 T28N R16W PT OF E1/2 OF NE1/4 COM Block/Condo Bldg: NE COR SEC 36 TH N 86 DEG W ALG N LN NE1/4 661.17' TO POB; TH S 1659.91 FT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) NLY R/W COULEE RD,TH S 61 DEG W 137.51' 36-28N-16W TH S 68 DEG W 341.51'TH S 63 DEG W 251. 56' TO W LN OF E1/2 NE1/4 TH N ALG E LN more... Notes: Parcel History: Date Doc # Vol/Page Type 02/12/2002 670903 1834/395 CAFF 06/05/2001 647345 1653/38 QC 07/23/1997 642/131 2006 SUMMARY Bill Fair Market Value: Assessed with: 171561 243,700 Valuations: Last Changed: 10/11/2000 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 22,500 112,700 135,200 NO PRODUCTIVE FORST LANDS G6 25.000 25,600 0 25,600 NO Totals for 2006: General Property 27.000 48,100 112,700 160,800 Woodland 0.000 0 0 Totals for 2005: General Property 27.000 48,100 112,700 160,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 513 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 192.00 Special Assessments Special Charges Delinquent Charges Total 192.00 0.00 0.00