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HomeMy WebLinkAbout161-1021-70-000 0 tnoK -0 0 d o c o v a~ CD v v' st c E CD 3 o v 0 o co a c w m • zr c: O N N 1 ICI CD co 0) 0 CD N r~ Q. Z d z CD :3 o CD N) o o cn x H C1 C) a 0 Q (D Z co V 0 co O W G U, ~ C c CD ! o A7 G Q N ri ? o o~ o . r H• co N (n N = o o O Ch 0) rt O U) y^ C N I a W G N n G G] (D D~ a a co C f1 G -0 W r a c 7~ N H 3 O m m a M rt c o o s m rt w (D E n rn o o CD Q eQ ~o v, r4 z co cD o r N 0 CO CO z cn O C C~ ~0 (q O O I O rt p N N C 3 G 00 ON N "wA • o o 0 Y G CrJ 0 H. ON ° r-3 m G p7 n~ T). CD H 00 y a N _ o: z co z O CD o 4 T (D cn Z m o F O c CD M rt W a rt n 3 z CD s -I cn p Z ID .a a A C Z Cl) O Ip -0 m N W G CD (D Z 0 3 ~ o cr z o 3 m 0 N (D W ~ S N d (D a C n G T N 3 N C 3 a z M o_ CD ~ m v a ~ I 0 ° i c Q m o z m I N ti m ~ w a N N ~ O A 0 b ~ 40 A O ` 0 Parcel 161-1021-70-000 06/23/2006 11:54 AM PAGE 1 OF 1 Alt. Parcel 13.29.20.398.399.400 161 - VILLAGE OF NORTH HUDSON 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 - WITT, BRENDA A BRENDA A WITT C - LARSON DAVID W LARSON DAVID W 627 GALAHAD RD N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 627 GALAHAD RD N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 02/35-LAKESIDE ADDN 1910 LOTS 4,5,& 6 ALL IN BLK 3 LAKESIDE ADD Block/Condo Bldg: VIL NH Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 03/30/2004 758138 2537/466 WD 03/16/2004 756706 2527/149 LC 08/19/2002 687427 1951/616 WD 03/05/1999 598910 1408/449 WD more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/22/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 80,000 169,700 249,700 NO 02 Totals for 2006: General Property 0.000 80,000 169,700 249,700 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 80,000 165,000 245,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 219 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 L AS BUILT SANITARY SYSTEM REPORT V 1 IIA6- Or- OWNER C R I S C"?l/_ ST 4 F soAJ TOWNSHIP Ait, roc b`, r/j SEC /pTXIN-RZOW ADDRESS 2-A lb ST. CROIX COUNTY, WISCONSIN. H u D Sory , c~I ~s Si~~~ 6 r SUBDIVISIONZ-Aki 1 G £ AU, LOT 5 ~ (o LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 EV "THING WITHIN 100 FEET OF SYSTEM G ' s I di a e o th A ro SC L~: - - SUCHMARK: (Permanent reference Point) Describe: ~`ORz O V 0-r . ~F PT T-b S f o ^v ~s R Elevation of vertical reference point: JC30. O Slope at site: Qn)v rL SEPTIC TANK: Manufacturer:bi r L„Sr AfS Liquid Capacity: I WO 619 blumber 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 cycle gallons; total capacity o distribution lines_ gallon: size o pump head; gallon per minute horsepower ran name of pump and model number ; Type of warning Te ce HOLDING TANK: Manufacturer Number of gallons Elevation of manhole.cgver Typpe of warning device UEPAGE PIT SIZE: - Number o pits eet diameter ;.Vfeet liquid dipt i-~ seepage pit in e pipe-elevation bottom of seepage pit E: eeva ion feet. SEEPAGE BEDt SIZE: number of lines_.3_width length3,51 tile depth SEEPAGE TRENCH: width length PERCOLATION RATE 3 -AREA REQUIRED ~ TREAS BUILT- Cotes i INSPECTOR GATED PLUMBER ON JOB r~ . LICENSE NUMBER r DF_"ANTUE.'JT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LAZ.^R,& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ACONVENTIONAL ❑ALTERNATIVE State Plan LD. Numbe (lf assigned) E] Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: C. M BENCH >MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV V C_ Name of Plumber. MPIMPRSW No.. Cou my Sanitary Permit Number. ;EPfICI ANK/HOLDING TANK: MANUFACTURER. ILIOUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROFED. PROVIDED: DYES ❑NO ❑YES ❑NO BEDDING. VENT CIA.. VENT MATL.. JHIGH WATER NUMBER OF ROAD: [IFINE DELITY JIVE LL. BUILDING J VENTTO FRESH G ALARM FEET FROM / AIR INLET YES ❑NO C ❑ 'E N NEAREST f 1-S 15- S DOSING CHAMBER: MANUFACTURER r`: / BE DD LIQUID CAPACII Y PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED'. Y S No DYES EINO DYES ONO GALLONS•'PE n 'C LE. PUMP AND CONTROLS OPERATIONAL NUMBER OF PR (iPERTV WELL BUILDING VENT FRESH (DIFFE NC ETWEEN FEET FROM NE AIR INLET . PUMP ON AN FF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing tIA^.1-TER IMATERIAL ANDMAHKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: _ WIDTH LENGTH [TRE . OF DISTR. PIPE SPA IN(; COVER INSIDE CIA -PIFS LIQUID BEd/TRENCH r ~k ~a r, CHES Mp,., 'rAL: PIT DEPTH. DIMENSIONS (;W-" FPTIi F It. t. DEPTH jDi1T1 PIPE DISTRN DID NUMBER OF PROPERTY WELL BUILDINGVENT TO FRESH BF I''A I 1 ABOVE COVER EEV. INLEr ELEV ENE _ PIPE LINES AIR I ET ET F NEARESTO--s-~ MOUND SYSTEM: Mound site plowed perpendicular to slope Check th texq,d e of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: ` mound ystems ?to make certain that it ON REVERSE SIDE. SHOW ELEVA- /meets e criteri' !qx.aaedium sand. TIONS MEASURED. ❑YES ❑NO ' SOIL COVER. TEXTURE i ~ PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH'ED ('JD TH FTOPSOIL SODDED SEEDED MULCHED CENTER EDGES ❑ ❑ ❑YES ❑NO ❑YES ❑N YES NO O PRESSURIZED DISTRIBUTION SYSTEM: / WIDTH. LENGTH NO OF LATEI L SPACIN GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENSy+ES DIMENSIONS f MANIFOLD PUMP MFjNI OLD D TR PIP ANIFOLD MATERIAL INODISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV. D(A. EV. PIPES'. DtA.'. ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACI D L7 C RECT COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS _ Y NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST- Sketch System on oun file for audit. Reverse Side. " IGNATURE TITLE DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION ,LABORAND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/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: NGU %Nk),IS 13 iT 29 NiR 20 E (or) W ,Vla 7y 110VS0-t! 57{ < Lot Number: Blk No:: Subdivision Name: p 7 Nearest Road, Lake or Landmark: State Plan I. D. Number: 2-1 ,9~' a0yX (If assigned) TYPE OF BUILDING F~/~ ,V17 Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 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 Qatf J( HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: E- 'e- &AMEv OG EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOS D (Square feet): IX New ❑ Replacement ❑ Experimental ^ Seepage Bed ❑ Seepage Pit AOx 3- ❑ Alternative (specify) ❑ Seepage Trench Water Supply: 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. Name of Plumber: Signat MP/MPRSW No.: Phone Number: Plumber's Address: Name of Designer: 'I Zz- 1y0A yD~ j!~ /t/DrP - U~sp v ~v/S COUNTY/DEPARTMENT USE ONLY 1igna re of 1 g Aggnt: Fee:: Date: APPROVED Sanitary Permit Number: L~ U/ G J , ~oZ62 ❑ DISAPPROVED r J eason 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) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, 1 c DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7969 ON WI 53707 HUMAN' RELATIONS (H63.09(1) & Chapter 145.045) LOCATI ~N: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.T5U BDIuI~% nr ru /a 1/ l3 /T29 N/R 6E (or) W •vo nc~o rc COU NTY: OWNER'S/BUYER,s NAME: MAILIN ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 .4New ❑Replace S_:? ~Q-~~-- s c 1~uhao low,-,y SA~~ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-Fl LLHOLDING TANK: RECOMMENDED SYSTEM:(optional) M S ❑ U ~ ~ ❑ U ®S ❑ U ❑ S ®U ❑ S ©U t9T/d v,9 L N4IW F ELD 61.7 s- F7-, If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area 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. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B NO. B- z op 97 30 ~Cr > ' y _f 13~. s, d' V 'v e 3o Fr - p5" 9" I3AI B B- 0 mfo D v 6~.~ S eJ. S w'^ s ~ J .1 CI ' " N • to, jCQC PERCOLATION TESTS TEST DEPTH WAT IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFT SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PER D 3 PER INCH P- 41Y 710- U 's 2 P- P_ Z /gyp 2 ' P- P- 7 (o. U/0 PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- P11PLOT ff"Tt 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. /3ea'TIOM OF ReP LiE E-X#M y .t/- 9a , `16 Fl- SYSTEM ELEVATION 7 U,6 -xf lPef faT. a w W A C% i s' W ~C J „ . v 3 3 E z. _ s e J3. oe d~ , Ai 4f- LOT yokz Am = Ncv zorl&v 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)P/~h~ / (OI /hk c h P-2_0-?2-- ADDRESS: WERE C? 2-- DON: ADDRESS: M CERTIFICATION NUMBER: PHONE NUMBER (optional): 3 - - - iC;ST SIGNATUP,E: / i ` E J; _ _ 'V ` PILOT and CRO55 SEC710 N PIA NS 13 ti Al~a.i'~7 vM .S-7 Ii MiVitivM/J' 20" - - f Sou~ LvT G,ur - SUiL rfsi i5 vZInT Q G 'a Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade a k 4" Cost Iron ?(2 Above Pipe '----F; J Vent III i Pipe i o Final Grade Morsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee 0 Pipe 0 0 0 0 0 A ggregate Beneath Pipe Pertoroted Pipe 6elow r ~EJ Coupling Terminatki, y~ ✓ ,y% Bottom Of System sviL rs - -