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HomeMy WebLinkAbout036-1067-30-000 0 Os f C ~ 0 A L/1 m CD ID Q 0 0 N v o o 00 CD Ef c o co ow • 3' 3 m a O (D N Oo X 7 N C Z a Z O p l/~1 CL y w O A 1 O b O (D O w w0 C:) CD O O C n 7 0 O a' H ~ O O ~~1 CD CD (n =r 7 y c D CL C) w co ij CD N) Z Ul (D 1 r n l Z co co n r N ^ N co N u a o T E-i 1 y r f r3. -q --I--q m CD cn m 9 Z _ o. N O A y CrJ d H O d ro 3 II 7 fD a a y N T y_, - zWZ O D a 00 `D C ) \ CD (a N \ a CD CD CD -A cn O A Z m O o . 0 t 0 iz z N a A O W m j m CL Z 0 3 Z 0 m -4 3 y I ~ CD A w F as CD a CL o 0 3 m c ao z 0 <D 0 ~ y CL 0 y 0 ~ CD CD A fi v 14 0 w o 0 ~ A 0 b e CD cAn O o 0 w 0 0 o C- ~ AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP=----SEC/1, -ltlW ADDRESS ST. CROIX COUNTY, WISCONSIN. .r ~C3L.C.G.r~ SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to eet requirements of H63 (lu WITHIN 100 FEET OF SYSTEM s 01 I di a e th Arrow SC L T BENCHMARK: (Permanent reference Point) Describe.,Sref4 spas- Elevation of vertical reference point. p®.®r Slope at site: - SEPTIC TANK: Manufacturer: A~an ,,Liquid Capacity: ~~Nu[nber of rings on cover ---manhole cover uleva-tLf i Tank Inlet Elevation: ' Tank Outlet. Elevatiun. PUMP CHAMBER Manufacturer: Number of gallons Number of gal . pump set for a cycTe _ gallons; total cap~►~, i c y of distribution lines gallon: size of pump`- head gallon per minute horsepower- _ Graniname of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallon; - Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number oF- pits feet diam=eter _ feet liquid dept seepage pit inlet pipe-elevation-, bottom of seapaKe pit evaHon feet. SEEPAGE BED SIZE: number of lines v~c~th~~ _lertbtl>~,~tile ~ieptg3 SEEPAGE TRENCH: w dth length PERCOLATIQN. RATS AIW--'f~EQUEDAREA kS BUILT INSPECTOR DATED 4 PLUMBER ON .TbB-__ LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS S..ABOR &t HUMAN RELATIONS DIVISION r.o, pox 7s'ss PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON, WI 53707 ELI CONVENTIONAL ❑ALTERNATIVE slate P1anl).o.N-1,11 III assigned ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound T NAME OF PERMIT HOLDER: AQ,OR ESS OF PERMIT HOLDER INSPECTIO D - ~ , BENCH MARK (Permanene ,feren,e point) DESCRIBE IF DIFFERENT FROM PLAN.i REF. PT. ELEV.'. CST REF. PT. ELEV. Na of Plumber. MP/MPRSW No County. Sanitary Permit Number SEPTIC TANK/HOLD JG TANK: SEPTIC A TAN LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER MANUFCTURER G. PROV ED'. PROVID D, f ~Q YES LINO NO c y\ IF . VENT DIA.. - VENT MATL 1HI(;H WATFRr / NUMBER OF ROAD. PROPERTY WELL BUILDI V O BEDDING'. Al I L c i ALARM FEET FRO M / LINE l ❑YES LINO ❑YES LINO NUMBER OF DOSING CHAMBER: MANUFACTURER BEDDING LIOUII)CAF'ACITV PUMP MODEL PUMP;SIPHON MA NUF ACTURER :jARING LABL LOCKING COER OVIDED: PROVIDED. ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLSOPERATIONAL NUMBER OF HoPLHrv wELL BUILDING J VENT LFFRESH (DIFFERENCE BETWEEN FEET FROM vF AIR INi PUMP ON AND OFF) ❑YES L_!NO NEAREST 0. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth ofplowing I.- II ulna,I,IH A1ArFHIALnNUMAHKmC, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVBEED/TRNTIEONANCH L Y_ST LIQUID EM: H DIMENSIONS vlOn ~ LIE Gnl No of DISrR PIP sPACIN:u T INSIDE Dln =Pits THE iertF / ro FkIAI PIT DEPTH - DEPTH UISTH PPF DISTH PIPE DISTR PIPF M TE IAL NO D NUMBER OF PROPER 7V WELL BUIL ING VENT TO FRESH ~;>u(c~veH EIFV INI r ELEV~JNI PIP FEET FROM LINE AIR ET '7~~/ ~uNEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope C ec the texture of the fill ma erial for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: ound systems make rta that it ON REVERSE SIDE. SHOW ELEVA- eets he criteria for medi sa d. TIONS MEASURED. ❑YES ❑ NO SOIL COVER TFxIUHF NT MARKERS OBSERVATION WFLLS ❑YES LINO _OYES LINO DEPTHOVIHTHLN(,H BFD DEPIHOVFH IHENCH BFI) DL PTH OF TOPSOIL S(lUI)FD SEEDED MULCHED cLN7FH IEDCLS LI NO ❑YE LINO ❑YES ~ NO YES PRESSURIZED DISTRIBUTION SYSTEM: rlb'I [)(H LFNC,IH NO. OF LATERAL SPACING GRAVEL DEPTH BEL WP(PF FI DEPTH ABOV :OVE BED/TRENCH TRENCHES DIMENSIONS GU"'AN[FUL PUMP MANIFOL I) DISTR_PIPE MANIFOLD MATERIAL NO DIST DISTR_PIPE DISTHIBUTI PIPEM ERIAL&~MAHKIN EV. ELEV. DIA ELEV. PIPES DIA ELEVATION AND - DISTRIBUTION Ii (LE SIZE HOLE SPACING OH I L L F D C(I HFCI LV JCOVER MATE L VEH C L LIFTCO RESPONDS TO APPROVED ItUFORMATION PL Is _ ❑YES ❑ NO - - ❑ YE ❑ NO COMMENDS: PERMANENT MARKERS: JOBSERVATION WELLS. MBERO PHOPERT WELL'. BUILDING. EET FROM LINE. ❑YES ~NO ❑YES NO NEARES C ~ 7 ( Z.. 1 ~ S I_ U Sketch System on ` _ county file for audit. Reverse Side. SIGN HE TITLE DILHR SBD 6110 (R. 01 /82) r QEPARtMFNT 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: Mails~l@ Address: t / n Z, 7- Pro erty Location: City, Village or Township: County: N/R /7 0 (or) Vy i Lot Nu ber: 'Blk No.: Subtlivision Na e: earest Road, Lake or Landmark: State Pla I.D. Number: ' (lf assigned) ..;Z tf 1-,4 1 f 1, + TYP OF BUILDI G ❑ Public* ❑ Variance* ❑ Other (specify)* ~ • ~p - lQ~p `7 ~~10 Number of 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 f r HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit 2 ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private 1:1 Joint El Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name-of Plumber: } Sign_ ure' ( MP/MPRSW No.: Phone Numbed; 1 ~'n . : ice- ~ K.-' c.;LYti.•,,.,- ~ ~11 - ~ _ Piumber's Address:' J,l Moesigner: f COUNTY/DEPARTMENT USE ONLY Si ature of Issuing Agent: Fee: Date: APPROVED Sanitary Permit Number: I El 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- st0ation. Failure to comply will void the sanitary permit. DiSTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber +LHR-SBD-6398 (N.03/81) Ee 7-1 L7 !,Q MiL~`S i z w~' I wi5. r i +Ypp+ P i 1 MoPLkIv do EH 115 Rev. 9/78 _ REPORT ON SOIL BORINGS AND PERCOLATION TESTS _ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION- NPV '/4," zf, Section '~f ,T &N,R 17E (or) W, Township or Municipality /a f~ PARtE~ rEy 45 'i.k. ov /97'(j PLAT. Le,- . Block No. County Subdivision a me TpM ~.~f~E r!r Owner's/Buyers Name: Mailing Address: J-;ArC & 400r ,.f # ZO /vLrW A;r-AAi-o !S "TES' yo,Y 7 eY' Q r, TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL /CflCIr EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYS NI OTHER DATES OBSERVATIONS MAD SOIL BORINGS SAP! • 4 ' 7f PERCOLATION TESTS T_ 3V / 71 SOIL MAP SHEET SCS ZO) NAME OF SOIL MAP UNIT S14, •~iV7~A D _ _ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE NUM INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- / y2 1a" BiV. SiL le . f. 3v Iz G ~o P- z J& F 8N P1 '0// /(lf "moo s/ 2y -0- Lo P- P- P- RED 51 !M447-AS 0vwr,4ia fiNF SAaD 9 RAJAJS SOIL BORING TESTS (E//, 1 Wi,iM Ajkj) ON fACeS OF I'EDS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK > NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES v. B- ND,vE 0 / 1~I~N S•~ /~pir/~N. L ")p• S/ /2 " Ep S .2 - C. B- Z 72. NONE > 72 rp e-,&&ASE SL . Ils- B- 3 ONE 7 ",w. Sal l " L/ AV. fl, I- SS R.Q- SL ~ i B- Y 8 NON E 22 " BN SR7 G2 ~ 0 R. S/ B- S 7Z NSNE ) 7Z 8„Rv s;L S „ 0.0f. s/' y B- 6 72- N0Wr > 7Z 20''13.). Sit , $1 " - /t!. S/ A 1--on PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.- Indicate number of square feet of absorption area needed for building type and occupancy /DO 'FOR 7-XC IC4 Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. //LS -At 8ED o z PIANS N07- rO SCA14 1)1S*;r,4114eJ '4cc vrp~TE7, m Taw,v Hi411 ROap pf-- EXIST/N~ rn BM y~' t7/~r ENT~ANC~ ~iVf° ~ TE/EP#0NE po% 4.7 PqWT€0 RELY, A &`F Biy: 77 m o PROMep WE ff a =/o 0 P_ .r a Q a PRO'. a = /3o,PE Nol/sE ~N v 4- 30 .4 = ELE f/, f~ eticE ~wTS 6~ `A/00 H • o /o c E j31L! !i E S /hioEs 6~ l 'd 5 L►sr bF ,jyW F- Q0 T P _ P; • 8 _ a.. _ hAeMArTS IVEi5 L . 110vSE- n (3~ _ 3o, z a , ~ yy t _r z RRO W )V t W/J _pay Roof 7s' zo% f of 131V Irv. a _rw I, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief`. Name (print) A006ER7" h T Certitication Noff-0.2 Address 871.3 U Ry 1141, e A,, 4-7/,s" _ Name of installer if known Copy A - Local Authority CST Signature Yl r 46~ r 0, 1 q 13 ,3 57 DEPARTMENT OF y'rt REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTF~Y, DIVISION LABOR AND 'F01itMtA11eV PERCOLATION TESTS (115) MADISP.O. BOX ON W 53707 HUMAN RELATIONS , ~ z~D J (H63.090) & Chapter 145.045) i LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOTNO.:BLK.NO.:SUBDIVISION NAME: N '/4 1/ 21 /T31 N/Rl1 E (or ST~9~'low' --------IV[ 000NTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: X7 13o,( USE 10 DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: T RCOLATION TESTS: Residence /f I1~ New ❑Replace I REF ~tpa~~ jJj -v RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: I ^ n If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROF. E DESCRIPTIONS Ft " BORING TOTAL DEPTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) r B- / 7.0 /00d 93 > fA.V,D~~ B- ZC~ 7o B-3 2.0 /®6•f > 7t 4'F eV16r14'4& 7ES>T v 7 v SSA ~r 7 B- /DO, 33-' B-3 6.0 y60.7 ~ ' - >7o B- PERCOLATION TESTS / ,tJ sA,tJP .5'IW710 TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN AFTER SWELLLIN INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- A 3. J' 4/ a / 1 ~Y 11 rr? L P- - ~j P- 3.37 ) Z. ( P- 3"1 W0-- P- 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 direction and percent of land slope. 1?o'7- dM of- Bev (!~fe,4V f,/041 S/1A~j GIE EX,4C 1 Y t: SYSTEM ELEVATION .3T Belo,,) 11"L AEf. Pi ~ i i rz, b /Vo r 9E 7-o e- r6l'5 Ae e4- 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): TESTS WERE COMPLETED ON: AU2, 2- ADDRESS: CERTIFICATION NUMBER: PHONE NUM ER(optional): H®ME T' ST[NQ► CO. =0.: , yew s T.31, OWEIL ROAD CST SIGNATURE: HUDSON, WIL, . 54)016 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - _S e >`3 U,,... a J;=vi . a UO€OP „E ! Win d" r. ,O f ills bb D 639P"' aura and d3(a ur n swi test, prow Th . use yi t Y.,7't must df?iaJ y iii €,a46 o .'u 7- her t1-, . is a i' 'c3 ns'.e or ,son3a',l# ...€a! pnzbjF 4ct': [ViiAXeMI1. NA1 n.amher of b3 &t,C.m m t;€:? n €;..mi a€ use jda"?nS1E,'i:l„ is this ra neLv o! r r l"fCaa'Taa r a ~ys -"€"l` f °],'€.,"s s,YST FRA ARE R UL l',"1) C_8;,,! 3A,`3F-1) 0INI SO(L C',o' D11TICHI S 1°1,_EAS = n ask,!" l!:Wa€i a:; shown hue for aJ` <<€ q poll chsc.ha,tions sul completing the plot plan; MAKE A L E..; TLE dl%3q,3m e's£;f,lfle?tely !{JLs§ ing yma tat 1()4;ations, U sawing to sal is pref gl"'.d, A 'TWe „ .«!e£ of b.'1=ti.,ai7ir`di£C and a,£rse.{_3e €,rLJca1iCa;3 FE4tm,^_fit,e P(,iinv dYe fat :°3sa( 4hflvItz,a7$d3F"? pErfPiaca?"tt1ttr mm hoe €_e Al 43pp miate boxes as to di-vs, rumn s, radW a,;, t hod 1:)ia€ ; Bala, Pe rcoiatiom test k?Xf'IYtp- if my, opf i ae_ hd € nWa,._ j,aH ,h, i:01-11,1 t i ai__, e,: vAianl don llet apoly, . a,,,_ !%A, ri k.e a,u l opri 3t; box; ~,tt, n we fr € wlct a3m ~ , z°, ~ ari€i , and your o t a v3 On nu,A3t3r; dal mm t . £ € ) B - isW We A SS smy ° . - a,u~e;' (u€a~a~~~ ` ~ Lalmst-~ Comm s %..ia P-c p" , tai. (sfa',aiaa;'i f Fine B Laa,_o ,.r, ii > - L Wtv - Sm Ay L own - Lu L>>m k3o B1 C g;,. Tay Cky Won t Ms SD Oy C; ay Wri; Soy Cw'/ _ , ?331 a? Many, r; o 'li°,°. r 44 "°'<laEC tseen, and . ea ,mb ,',t..r.?On aik y be :;ulrh€€'a:f:{ =}iv aq €a:> jaa k,.,a€ <.a, hon y """by _bla...'= a g: nd . The sv hnV .3e€n t nun he WNW C-C1 € p(stal Qor to the st<.a of any co w", r f 5 'REPORT ON SOIL 80RIN&S PERCOLAT'loN TES Pao T P L AM PROTECT Z. D. Al DATE- e z --,P3 w/ f ` HOia E51TE TESTING CO. r=i div roN, Wis...._. 54016 e57 S.S` d2 yC2 PROPOSED tioosE , osT LIB 2_; Fr o.4 Meec )~QoM ,g~L 7~sT i9~E` S. pRoPOSED WELL MVSr LIE" 50 r'r. cs,~e • = !3f}C.E'~fcd~" f'/T,~ Q = EXis r1w G-- z EL.4 Z PE.QG I06,4710,Vf 11,4,vp f 09,Cke,0 o,Q 540VEL 134eE5 T~/C f ang- Se-' ? tip Fr, 64o m A&p4 AD ~7- LEGEN D a o) H h E X/ST/AJ lueo yq W 3o 16 i P p x TG 1 Te6yla'k yt Ell -5e yv~ `jTA n l - C4~ 1nT - ~1Y1\ ~j rc.dC -..O ~ ~1 -411 - r offer c - c~ Parcel 036-1067-30-000 01/23/2007 09:30 AM PAGE 1 OF 1 Alt. Parcel 29.31.17.437C 036 - TOWN OF STANTON 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 - TESKE, THOMAS E THOMAS E TESKE 1575 200TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1575 200TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.480 Plat: N/A-NOT AVAILABLE SEC 29 T31 N R1 7W 3.48A N F= NNFF ~n_n _ Block/Condo Bldg: 1182.78'WOFNECOR,THS1105',WTOW LN NE NE, TH N TO NW COR NE NE, TH E TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB 29-31N-17W Notes: Parcel History: Date Doc # Vol/Pale Type 07/23/1997 / 739/09 07/23/1997 \ 651/52 2006 SUMMARY Bill Fair Market Value: Assessed with: 166892 185,000 Valuations: Last Changed: 05/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.480 22,000 133,700 155,700 NO Totals for 2006: General Property 3.480 22,000 133,700 155,700 Woodland 0.000 0 0 Totals for 2005: General Property 3.480 22,000 133,700 155,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 122 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00