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HomeMy WebLinkAbout032-2017-50-000 n CA p K-0 0 d r~ O m c O `r1 M a M v n c M CD m 3 - O m' CO ° a w n 3° N 00 CL E: N CL ~ O7 0) N S ~ U7 C n m O :E C7 O ~O~yy 3 0 ' = ° ~ 7 N O O ~ CD Ln m to ~ D a CD (n CL 00 C:) (D C: n z_ ~ S r\ O O O~ < Fw~ N) CD CL CD 00 00 !^,n ~ N N N O C 00 00 3 .r v J O ~ 000 z - cr' v v v v o o N v cNr, SJ ~ ~ N co :3 (D N = 3 00 z co D O n rN ° m y 70 1 N lei CD a) ~ a (}1 G (D CD -4 l Z CD (n --I (n ~i n ~ A Z O (1 03 -0 * o a z Z C =5 e 3 a IF " o z ° 3 m N ;o (D p O ` D 3 CL CD o - m c o a (D A I O a A ' N O O a A O_ GQ W O W I EA 0 ~ b O (D yb O . y O S ~ I Parcel 032-2017-50-000 11/16/2006 01:09 PM PAGE 1 OF 1 Alt. Parcel M 5.30.19.535C 032 - TOWN OF SOMERSET 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 - BOUCHER, CHARLENE M RIVARD CHARLENE M RIVARD BOUCHER 515 180TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 515 180TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 5.200 Plat: N/A-NOT AVAILABLE SEC 5 T30N R19W PART OF NW 1/4 OF NE 1/4 Block/Condo Bldg: LOT 1 CSM VOL 4/1188 5.20ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 533/274 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.200 59,000 83,000 142,000 NO Totals for 2006: General Property 5.200 59,000 83,000 142,000 Woodland 0.000 0 0 Totals for 2005: General Property 5.200 59,000 83,000 142,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/19/2005 Batch 05-35 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 t i AS BUILT SAIV LTARY SYS 1 LM 11L1'0R'1 I'UWNSHII' 'L:79N-R/7 ~d OWNI AUL)I,LLSS ✓i ST. CRO lX COUNTY, W 1 :;(;UN:~ 1 IV SUBDIVISION L T S 1'Z1: - w r_I- P LAN V I LW 03,) C-) Imo - o-Dilitancee and dimenuiona t0 Illeet 1'c:ckulreulc:l1LL, Of 1163 .L:V CTHING Wl'1'HIN 100 1_El"'t' 01' sY:)'I'I:M - L 11(tt atie otrh~ Arrow I SCIAL~. ~ i ~ J BENCHMARK: (Permanent reference Polnc) Describe: Elevation of vertica trtia- ~,.reference E,oinc: SIu at 5itC 1 SEPTIC TANK: Manufacturer. LlyuiJ Cal,ac i t y lluLtber of rings on cover r►k ulanhule cOvuc IL, iuu ~.5' Tank Inlet Elevation: 'funk Uut Itt Llt.,vat tun , PUMI' CHAMBER Manufacturer : Nulut,e t „t p;a I I oils Number of Bal. puu►p set for a cyc•l.le_ 8aI lu,lb , total c: ,1p 1~ i i y uF diatribution lined hUIloll. Lj u of pull►p ht.,Id, gallon per minute hordupuwel bralu uau,C ut l,uiup and model number _ Type of warning device HOLDING TANK. Manufacturer Nuluher of t;ak luu:, Elevation of manhole cover '['y ,e ut warni.nK device SLE112'E' PIT SIZE. Number of pit:; fCU cli lw. L•1 feel liquid dept.ll cteepa~e pit 1-ulet p.t-pr elevat lui~ ~r hot t ou, of deepaKe plt_ elevat l_un leer • With 11 ~A Sk?1:k'Al~l~ :U SLZE; 11L,111her U1 I.llwb SLk.NAui- ~i w,,ldth --Lei i6Lll , Y)rRC a1..P.' aN }A'rk.~' / r ARY A [tLQUIYtI:D Akl]': Al~ lill ! t c; //6;i-i r4/JG~ m c~ UFi A I DEPARTMENT-OF INDUSTRY, INSPECTION REPORT FOR ny SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS? DIVISION P.O. BOX 7269 / Q BUREAU OF PLUMBING MADISON, WI 53707 YJCONVENTIONAL ❑ALTERNATIVE State Plan I.E.Number: 61~, (If assigned) ❑ Holding Tank [:1 In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER . ADDRESS OF PERMIT HOLDER'. INSPECTION D E. BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. E EV.: CST REF. PT ELEV I i (A DF, x C Ill` 1(1 IL, 1 ❑f l~Q Na me rrnf Plumber `L MP/MPRSW No.. County. Sanitary Permit Number. "4 i, i SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER V- GG / / IC PROVIDED. PROVIDED'. < ~ ❑YES ❑NO ❑YES ❑NO BEDDING. VENT CIA.. VENT MATL HIGH WA R ~NEARES UMBER OF ROAD P PERTY WELL. BTO FRESH ALARM EET FROM. e. / LIN 'L AIR INLET YES ❑ NO ~r ❑ YES ❑ NO T J DOSING CHAMBER: MANUFACTURER BEDDING JLIQUID CAPACITY PUMP MODEL JPUMP,SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED'. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: 7D M P A ND CONTROLS OPERATIONAL NUMBER OF ~'I2(1PEHTV WELL JBUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE AIR INLET PUMP ON AND OFF) ❑YES ❑NO ]NEAREST-3► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing TER MATERIAL AND MARKING; or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: `WIDTH LENGTH NO. OF IDISTR PIPE SPACING COVf H INSIUE Dln Sz PITS LIQUID BED/TRENCH TRENCHES Mnr HIAI iPIT DEPTH'. DIMENSIONS 14- GHAVFI OEPTi FILL DEPTH 1111ST11. PIP DISTR. PIPE DISTR. PIPE MATERIAL NO TH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH - BE Lf1W PIPh S ABOVE COVER ELEV tNLF f ELEV_ END PI S i FEET FROM LINE AIR INLET j ©j J O~ 5. I-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 .`OVER. TEXTURE PERMANENT MARKERS. OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH; BEL) JDEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO 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 DISTHIBUTION PIPE MATERIAL & MARKING ELEV. ELEV. CIA. ELEV. PIPES. DIA.. ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLAN'S ❑YES ❑NO _E _ ❑YES ❑NO PROPERTY WELL: BUILDING. COMM PERMANENT MARKERS. OBSERVATION WELLS NUMBER OF NTS : FEET FROM uNE Sketch System on Retain in county file for audit. Reverse Side. oll SI ATU E: TITLE. D I L H R S B D 6710 (R. 01/82) J ~ DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/z 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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: a or Township: County: , Alk t/ '/4S ` /T N/R (or) W / a of Number: Blk No.: Subdivision Name: Neare t Road, Lake or Landmark: State Ian 1.15. Number: (If assigned) TYPE OF BUILDIN Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: ZI 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: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Q Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit r ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as, Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public ate sewage system shown on the attached plans. I, the undersigned, hereby assume responsibility for installation of th prI Name of Plumber: / j Signat MP/MPRSW No.: Phone Number: _X 00 Plumb Address: Name of, Designer: COUNTY/DEPARTMENT USE ONLY Permit Number: Signature of Issuing Age _ Fee: Date: E .APPROVED y; , _ APPROVED C7 l ❑ DISAPPROVED J' f-Wqt c 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) DEPARTMENT O-F REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION -AN P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: A/ WI or) LINTY: OWNER'S BUYER'S NA 7,4t: AILIN ADDRESS: USE DATES OBSERVATIONS MADE ]7EIEDRMS.: COMMER IAL D-ESCRIPTION: R F DESCRIPTIONS: 1PERCOLATION TESTS: [Residence ❑New Replace I ; RATING: S= Site suitable for system U= Site unsuitable for system L' 4 M-IN-FlL OLDIIA`NNG TANK: RECOMMEND D SYSTEM:(optional) CONVENTION'AIL: MOUND: ''II IN-GROUND-PRESIIS''UR E: SYS AA\\ S EU ix S ❑V [z.S ❑V EIS ~V ®V V rz If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. I If any portion of the lot is in the under s.H63.09(5)(b), indicate: I` 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.) d B- ^ Sa3 r~' o 4 B i~ 9 Z// 4j - i B- B- B- _I~n- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 PERT D PER INCH P s ) P- 1 eI44 446 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. SYSTEM ELEVATION ' u _ i, - E a • _ . ,a e 1, 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. NAM f~rint): TESTS WERE COMPLETED ON: b 4~ A DDR CER FICATI N UMBE . HONE NUM ER optional): C T S T E: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) ICI