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HomeMy WebLinkAbout022-1048-20-000 n u1 O 3 -0 0 r m 3 3 m ID v CD -0 4t v m A 3 = l ] 3 O V N ~C C N CD C, CO \ d (D CD N co O 1 m m 0 j a N o yO J~J N CL O :3 N r'3 N) 0 0 -0 0 (D C O CD 6 d d O 3 o D N W O 0 1~~1 U) co CD CD (C CD (n a o ;L cn Cp CL CD 0 N N 7v z co m a n r cn Cl~j ° co co to o c N N Q O O O T l\l O 0 0 0 thil • N M/~ c v_ V y a9 ~1 tiai~ 3 ~ CD o CD v v 0 CD =3 a, po (D N 3 y N d n ~ N N Z „ ~ z z -D O D D N ~ C 1. O~ N N !NI ( CD (D O F c w ~ (n a 3 7C ° z CD ~ N ° CL a z CD J ; n A Z O C) 7 O ~ CC _ co A < ONO V CL 3 z 0 z N z CD A (a 7 CD C1 CD c- 'O O CD Z) - Z 'a CZ O D) m v m o ~ Ar c 3 ~ a O C O N 0 p sv CL N O O a ' A I O_ N 0 H CD O N 00 CD ti Parcel 022-1048-20-000 07/26/2006 12:21 PM PAGE 1 OF 1 Alt. Parcel 17.28.18.P258A 022 - TOWN OF KINNICKINNIC 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 - SCHMIDT, MICHAEL A & SUSAN M MICHAEL A & SUSAN M SCHMIDT 384 N LIBERTY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 384 N LIBERTY RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 35.000 Plat: N/A-NOT AVAILABLE SEC 17 T28N R18W NW NE 447/ 517 EXC CSM Block/Condo Bldg: 6/1757 ASSM'T INC 022-1048-20-100 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 767/599 07/23/1997 767/597 07/23/1997 447/517 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 60,000 129,000 189,000 NO AGRICULTURAL G4 22.000 2,800 0 2,800 NO AGRICULTURAL FOREST G5M 15.000 36,000 0 36,000 NO Totals for 2006: General Property 40.000 98,800 129,000 227,800 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 98,800 129,000 227,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1048-20-100 07/26/2006 12:23 PM PAGE 1 OF 1 Alt. Parcel 17.28.18.258B 022 - TOWN OF KINNICKINNIC 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 - SCHMIDT, MICHAEL A & SUSAN M MICHAEL A & SUSAN M SCHMIDT 384 N LIBERTY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: 1757-CSM 06/1757 SEC 17 T28N R1 8W NW NE 5 AC LOT 1 CSM Block/Condo Bldg: LOT 01 6/1757 ASSESSED W/022-1048-20(258A) EXC PT TO NORTH LIBERTY RD Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 17-28N-18W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 04/01/2003 715477 2190/535 RD 07/23/1997 910/58 07/23/1997 767/599 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/02/2004 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 o 9 nl. m m I 0 cn 31 = v z D 7 N. n N N O ~ ~ 3 0 v N CD ~D 00 n o \ c 3 CZD W N W C N ° p ~o r~ CO O p m CD V cNn co ° O c» v0 W o 3 3 N w 0 D oo O N N 07 ~ r~ ~l~l m (n D m a o CD U) N ul s C CD C: 3 O N m ~l ~r m ~ CD Z8 ;p r N w CD 00 N N n N O c !v o O O O ~ tv 0 o N 0 CL - can vii u~i v n I CD Q M 0 0 m m D v Q° = m o 0 N 3 y N O CD CL a - N z z z m 0 0 O D D N C c h CD M. ' N CD CD n c W CD ~ a 3 z CD cn Z3 n p Z CD - Z O Dom' j, O 0 W (D 0 CL , - z , 3 a °o z m z CD w ~ I D CL I o ~ I v ~ z Q O CD cn I I ~ A I a I I ~o I I N O a A I ti 0 O CD CD 0p A A EA O v W a 0 o ° y O a v ° c 3 " 3 f9. 3 ° ° 0 ° ,a CD w CD I ~ n' Q Cn 2 Z o D! _T o ~1 • m o o~ N o Fj °C SrJ1 3 C pj IV N ICI CD O !D N > N N v n' A Z O- N (D po O M po 41 N Q NO v N O 7 N co O O 7 (CD CD Q n O o CD co Ul U7 C Q 0 3 to w g D o p' co 0 co o m c o v u> D Z CD (C1 CD N d N W = W 3 CL O O i O A O 0 N N N a cn O c ~y < I o O O O T' I ~ n. ~ N t~J) Uri ~ m v v - N ° v m v a 90 C (D N N O CD 61 N a z N I Z 0 D D O N N 5r C N • O D M. 0 co N Q 7 w ~ ~ I O 0 CD =3 a I ,p Z CD N ~a 2 v A z a. W -0 P CL z a ~ O fT z ~ 3 m N Z CD W D CL a o - o a N A" y R' I I N N O O o~ A o (D d0 N s9 O I ° CL ~ AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ~.r r Sr T,4fN-R,~2W ADDRESS ST. CROIX COUNTY, WISCONSIN. i UL LOT LOT SIZE SUBDIVISION PLAN VIEW Distances and dimensions to meet requirements of H63 SHOM THING WITHIN 100 FEET OF SY-STEM 00 WON iftikft *#AW "I 1 t I di a e oith Arrow I-T L L --jSC BE11CHMARK: (Permanent reference Point) Describe: ~51 Elevation of vertical reference point: Slope at site: G SEPTIC TANK: Manufacturer:4/ ~ Liquid Capacity:/,9e;-,0 Number of rings on cover Tank manhole cover elevation:' Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons 't. Number of gal. pump set or a cycle gallons; tota capacity distribution lines gallon: siz pump head; gallon per'minute horsepowe' ran name of pump and model number Type of warning evi e 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 inlet pipe-elevation bottom of seepage pit elevation _ feet. SEEPAGE BED SIZE: number of lines wiAtlength _tile depth _ SEEPAGE TRENCH: width len th PERCOLATION RATE_ ' AREA R QUIREDJ~Z n. EA BUi~T C2 INSPECTOR DATED PLUMBER ON ;J - LICENSE NUMB 5 DEPAI°TrMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS F~, trYL~ DIVISION P.O. BOX 796'9 BUREAU OF PLUMB ING MAdISON,'WI 53707 ~ N1 CONVENTIONAL ❑ ALTERNATIVE r-state Plan l.D Number, Ilf ass,gned) ❑ Holding Tank OK In-Ground Pressure ❑ Moun NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. } BENCH MARK (Permanent reference point) CRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. n w n 7 n A i t IN,,,,, of Plumber. MP/MPRSW No.. County Sanitary Permit Number. ?a L I C U Ak. i 1) ~ I t -1 SEPTIC TANK/HOLDING TANK: 6~ I MANUFACTURER LIQUID CAPACITY. TANK INLET ELE V.. JTANK OUTLET ELEV. 5PNI LOCKING O ER PROVID t . O ❑ O B EDDINGVENT DIA.ENT MAT LHIGH WATER NUMBER OF ROAD PR OP ERTV BUILDI G IVlENTI O FRESH ALARMFEET FROM LI;E) AR LET. ❑YES ❑NO ❑YES ❑NO NEAREST_ DOSING CHAMBER: MANUFACTURER BEDDING. LIGUID CAPACITY JPUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. YES ❑NO 7 YES ❑NO ❑YES ❑NO GALLONS PER CYCL PUMP AND CONTROLS OPERATIONAL. NUMBER OF PHOPERTV WELL BUILDING IVENTTO FHESH LINE - AIR INLET. (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) YES ❑NO _ NEAREST SolL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ~ I ~ nin ','[TER MATERIAL AND MARKING FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN 3 the soil is dry enough to continue.) CONVENTIONAL SYSTEM: _ WIDTH LENGTH NO. OF pISTR. PIPE SPACING COVEH INSIDE DIA. ITS. LIQUID BED/TRENCH TRENCHES MATERIAL PIT DEPTH DIMENSIONS 1--__(HA+C IMF I'T li FILL DEPTH DISTH PIPF DISTH PIPE DISTR. PIPE MATERIAL: NO _DISTR. NUMBER OF PROPERTY WELL. BUILDING- VENT TO FRESH E+' I.( v I It F ABOVE COVER Et. EV INLF I ELEV. END PIPE S. FEET FROM LINE AIR INLET ` 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER. TEXTURE PERMANENT MARKERS OBSEHVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVFH THENCH,BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED. CFNTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: _ _ PLA WIDTH LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PE. FILL DEPTH ABOVE COVER. BED/TRENCH ft TRENCHES: (,4 DIMENSIONS + A+.ANIF OLD PUMP I ;I -j MANIFOLD DISTR PIPE MANIFOLD MATERIAL. N0. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. El FV /('fcl ELEV. DIA. t-7 ELEV. / PIPES CIA + ELEVATION AND ``pp/it 4 5 /-!tF C) DISTRIBUTION SI?C HO AC NG DRILLED CORRECTLY COVER MATER L VERTICAL LIFT CORR SPON DS TO APPROVED FORMATION IN , ` - ~ nIs YES ❑NO ES ❑NO COMMENT-S: PERMANENT MARKERS OBSERVATION WELLS NUMBER OF P EATY WELL IBUILDING FEET FROM~~ 1 ES ❑ NO YES ❑ NO NEAREST- Gru (,I 1. C, Sketch System on Retain+n,county file for audit Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) PLB 6 7 State and County State Permit # a~ Permit Application County Permit # for Private Domestic Sewage Systems County - co y *DENOTES STATE APPROVAL REQUIRED q Date Approval Received from State if Required D • IS J2 State Plan I.D. # A. OWNER OF PROPERTY Mailiny Address: t ' B. LOCATION: / Section T N, R (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township y C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY ~,j2gW Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel _ Fiberglass Other (specify) New Installation Replacement A•-~ Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete A-Poured-in-Place Other (Specify) E, EFFLUENT DISPOSAL SYSTEM: Percolation Rate A total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench, No. of L,i~nye/al Ft. Width -Depth Tile depth top)• No. of Trenches Length ,~Width__Depth_ Tile depth (top) ~No. of Lines Seepage it: Inside d ameter Liquid Depth _No. of Seepage Pits Percent slope of landG Distance from critical slope tNATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soi Teste , NAME C.S.T. # / and other information obtained from (owner/builder). Plumber's Signature' - Phone'`C%~ MPRSW# Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. i ~ . F E t E E E I I q. , E E Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application c~)O- Fees Paid: State_ County Date !K,2, Permit Issued/Rte ooze . (date) Issuing Agent Name /L-) , I-Lbk Inspection Yes No State Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 7-: L F 0 RC:) `~s "-=TTc -I fi' I,,) C> Rev ~ ~ Z LOSI: TED Try HE THE k) El//y0F SECTION ! 7 T N , R 1 ~_W T ^.t OF i~`S.l`: ^~'i~ 1 t r~• `s` LO 1\T}IuVOAiS~T\ Pk. GE 1 of 7 TITLE S EEi' PAGE 2 of 7 WORKSHEET PAGE 3 of 7 PLOT PLAN P.kGE 4 of 7 PLAN VIEW-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE IATOUT A GE 6 of 7 DOSE Cl-TA BER ?-AGE 7 of 7 PUYLP PERFOR-MkNCE CUFATE rF HED FOR t ,t PREPARED BY KC-ZEL, k' CZ R is Ar.D f.SSO IATLS X21 NGRTE Kk.IN ST ~.ET ` r I E fi F k L.,.S , i~Z . 5 4 0 2 2 J C 4M"k*, Ca 0 /V n • CHARLES KOZEL e ~ , ~r aw * E-09415 RIVER FALLS, a 4 •-•-'j J, - s~ ,o WI_S~. " ~ 40. e~oe ax i's ~rrz~ ~'`s~o PLOT PLO 'l tl- t Scale 1 i -ZCD cX»~►JG f 0 ~ of I SL; - SS j ~ _ } 44. X ~v ~ p~ X114 R y t POP NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install cast iron pipe 3' onto undisturbed soil both sides of each tank. 3. Install permanent markers at end of each lateral._( required) 4. Install 4" observation pipe with approved cap_ ( required) 5. Septic tank to be \z)oD gallon capacity as mGnufactured by ` 6. bench Mark- Elevation ouS , N-bt, sE t II I 1 ir'n 1; L . 1060 G^&"A.. , get ~ry 96_~ 1a6 s 9So. l LLP-\W 1J °L►JC i~ r-i S 6 `9r n liv, NOTES 1. Elevations sown are existing ground.elevations unless otherwise noted.. 2. Install cast iron pipe P onto undisturbed soil both sides of each tank. 3. Install permanent markers at end of each lateral. ( required) 4. Install 4" observation pipe with approved cap. ( Z required) 5. Septic tank to be o© gallon capacity as manufactured by 6 Wench Mark- Elevation T o 0 F iDi~G C'~ t }ou s C ,