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HomeMy WebLinkAbout020-1012-80-000 n w O g m 0 d _1 O d f r fu O ce 3 3 o U) m o m o 0 Q a 0 o cn `C' ~ A 3 O co - : N N\ CD N m ? co O C O CO cnn r N N 2 j O V D Q O (D °o °o CD O Q 0 D o cn m w cn c n. :3 o A7 3 3 N O O ~1 w Cl) _D a w Ln m cci CD U) a v W c CD m 3 d o o O CD 00 O L O O ~ nr cn O ( m CO 2 n r Cl) y CO m c Q m o ~i c o v . A A O O O O °OC-) 3 yya4~ CD N N v 3 v v O O .ZJ !9 o ° m O O 0 C _0 N 1~~i1 cn cn O 01 13 QD !V Q CD N N 0 3 m - a ~ CD N N z z z co O o v O D n o : h. 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U1 CD 0 0 O a- 0 j N O O O C(D CD U7 U1 7 D) V (n CD O' N ~ 7 A a N N 00 o D D D O (D h • c w CD Z CD -I N o N A Z CD A n A z O tD ~ ~ o. 1 O Z ao v m N \ _ o Z . 00 3 a x 0 m o ~l c==~ CD C) co :E w CL r: 10C 3 C a m0 0 o N N ] C Z 7 a CD CD m -4 3 ` _ s1 cod 4 v O ~w 3 :CI b p 0 m 0 0- 0 DECD z v Q a N =r m o 0- 0 m a ~ 0 r DQ A O O O 0 14 COM,,IERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 -962 -5227 CIZA: FAX - 715 - 962 - 4030 G --ER REPORT DATE: 7/08/93 i CARMICHAEL ROAD DATE RECEIVED: 7/01/93 ATIONS 1051 Tann,~' .,jLLECTOR: M, Jenk i, PATE COLLECTEDS 6-3i! TIME COLLECTED*# 2:0,' MCE OF SAMPLE 44 ~I DATE ANALYZED17-01- TIME ANALYZED** 2200p,: COLIFORM,WCCt 0 4 r_ INTERPRETATION, $ac#e+± NITRATE-N: 3 pp, Above 10, ` r\ TECHNICIAN: Pam Lane C OF.INDEVENOEHT. ; oved Lab No. J O O i OO PROFESSIONAL LABORATORY SERVICES SINCE 1952 FF W 'r j T IV _ y ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE r cO(aRTH STREET • HUDSON, VYr' 4016 _ r- 5) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 ❑ Septic $25.00 X Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: L k O C ~f 4 dX/l NT Requested by:,451,6',~f Rc/ vz- 16 r/F_ Address: je5-/ T,.~,~.f y Lifter- Address: "'Ce 5T City & State: SL -v City & St. Zip Code: Zip Code: 5 z16 Telephone N°: (7/5`) 7~ *.)Cc Telephone N°: (713-) 3~t1 3 Property address (Fire N° & Street) : jc, T_W v v C, G~fti~ I~~pS~,v Location: ;,5,--- Sec. , TN, R W, Town of yvOSc~ St. Croix Co., WI. Tax ID W Parcel ID N2 House color: Realty Lock Box Combo: Water sample tap location: j,v 51 p, r' e TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied? P(Yes ❑ No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced by: Date: Previous Owner's Name(s): J4 Kp C. #4,FX ~ /7- Have any of the following been observed? ❑Y ❑N Slow drainage from house. ❑Y ❑N Sewage Back-up into dwelling. ❑Y ❑N Sewage discharge to ground surface, `b road ditch or body of water. ❑Y ❑N Slow drainage from the dwelling. Jr 1) ❑Y ❑N Foul odors. - 14 Co, /A, Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. -IV 4 ?l~ z DATE : 9~ OWNERS SIGNATURE: J OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN r j, TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? []Yes []No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: []Below grd ❑At-Grd []Mound Approx. size 'X []Gravity []Dose []Pressurized Ft.2 []Bed []Trench []Dry Well []Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES []Other []Unknown Septic tank Setbacks: []House []Well []Prop. line []Other Dose tank Setbacks: []House []Well []Prop. line []Other []Locking cover []Warning label []Pump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: []House []Well []Prop. line []Other ❑Ponding: []Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title I I I • S N LAND SURVEYING* HUDSON , WISCONSIN 54016 (715) 386-2007 Noins Lloyd C . Albright Address Box 5483, Tanney Lane, Hudson, Wi. 54016 Description A parcel of land located in part of the NE 1/4 of the SE 1/4 of Section 11, T29N, R19W, further described in Vol. 649, Page 396. PLAT DRAWING N This is not a complete Land Survey W E underground elec. S Vol. 645, Page 583 S890-301-0011W 1278.32' 1.23.481 o 761x241 underground (D ° w ° M -O (d house E garage M M -t O M i \ O C" T O w ° Lr) r. M ; C O O (V O I \ - - O co N N W I - 83.01 3 Cl) 361x14' metal shed C ` ° -1 I S89 o-30'-00"W ° _I O N M O N89 e-30'-0011E 560.80' z 38.08' M I n I O ° O N O M M N890-301-00"E 722.70' The location of improvements on this drawing are approximate and.are based on a visual inspection of the premises. The lot dimensions are taken from recorded plats and deeds of county records. This drawing is for informational purposes only and should NOT be used as a complete Land Survey Lloyd C. Albright has agreed to waive the minimum standards of AE-5 Map No. 87-01-17 Drawn By A.N. 01/20/87 Scale 1-"=100' a Parcel 020-1012-80-000 12/02/2005 10:36 AM PAGE 1 OF 1 Alt. Parcel 11.29.19.57A 020 - TOWN OF 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 LLOYD C & DIANE L ALBRIGHT O - ALBRIGHT, LLOYD C & DIANE L 1051 TANNEY LN HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1051 TANNEY LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 11 T29N RI 9W NLY PT NE SE BEG E 1/4 Block/Condo Bldg: COR TH S 826.49 FT S 89 DEG W 722.770 E LN CSM IN VOL 3 P 722 ORD; N TO NE COR Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) CSM; W 560 FT MOL; N TO NW COR; ELY TO 11-29N-19W POB EXC PARCEL DESC 1031/455& INC PT ROW AS IN QC-1299-344 Notes: Parcel History: Date Doc # Vol/Page Type 02/24/1998 573699 1299/344 QC 07/23/1997 1031/455 QC 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 75,000 111,500 186,500 NO 05 PRODUCTIVE FORST LANDS G6 16.930 104,300 0 104,300 NO 05 Totals for 2005: General Property 18.930 179,300 111,500 290,800 Woodland 0.000 0 0 Totals for 2004: General Property 18.930 111,700 94,500 206,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 130 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 AS :BUILT SANITARY SYSTEM REPORT s TOWNSHIP SEC. T_N-R W r' I I : ` : ~tC ST. CROIX COUNTY, WISCONSIN. i.~l',!?IVfSION LOT LOT SIZE PLAN VIEW and dimensions to meet requirements of H63 _ "OW-EVERYTHING WITHIN 100 FEET OF SYSTEM P I r. as , ~ Y Cv GCA' ITT - vs. , r rrt . ~ - - ; I di a e 140 th Arrow 1( fi fl r e E ,Yl-~-~cC, ..30 C.c~! 11;r•'t'_ v1ARK: (Permanent reference Point) Describe: ~ 1-11 of' vc,r-! ical reference point: Slope at site:- "I _ IC TANK: Ma.nu.fa.cturer: `t Liquid Capacity: ,11„_-'r of rings on cover Tan manhole cover elevation: f' rnk Inlet Elevation: y> Tank Outlet Elevation: (;IIAV4, BER iiiuI_r_a.cturer_ : Number of gallons 4AIIII)er of gal. pump set or a cycre gallons; total capacity d i s I ri_buti_on. lines gallon: size of pump head- I I_on per minute ; horsepower ran name of pump and model number 'T'ype of. warning device 1101)ING TANK: Manufacturer Number of gallons I31_evat_i_on of manhole cover Type of warning device - tTiameter Sl;li,l'AGE PIT SIZE: -Num er o pits ee- Ceet liquid depth seepage pit in eft pipe-elevation hottom of seepage pit e evati_on feet. I',!'.i'AC F; BED SIZE: number of lines wic th le-igth _s/-'tile depth 2`.)" 13NC}i . width length I'!,:RCOLATION RATE ____AREA REQUIRED c~,.54 AREA I ro I;f1`I'I:I~ PLUMBER ON J B LICENSE NUMBER y Z ' REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM ♦ Sanitary Permit awQ State Septic /"/Z_ NAME _`L'0WNSHIP St. Croix County LOCATION /F Xe ----.-Sect ion/,/-_Lot Subdivision SEPTIC TANK 05 Size. gallons Number of compartments Distance from: Well Building 12% slope Highwater PUMPING CHAMBER N-L C-t /S/~Pi Size gallop,fManufacturer Model Number HOLD 1=NG TANK Size a -10, mber of Compartments v- Pumper r _ Alarm System Distance from; 11 Building 12% slope- Q Highwate = 1 - - - - - ABSORPTI.N SITE c1 Bed _ Trench s~ Distance from: Well Building 12% slope Highwater ABSORPTION SITE DIMENSIONS Width of trench ft Required area ft rf Length of each line S ft Depth of rock below tile. in. .r Number of lines Depth of rock over the in Total length of lines L' ft Depth of tile below grade -JV- in. Distance between lines"- ft Slope of trench---in. per 100 ft Total absortptfion area ft Type of Cover: PIT DIMENSIONS Number of pits Gravel around pits yes.. no Outside diameter. f.t Depth below inlet it Total- absorption lea ft Area required 1NSPE' ` B~. 7'1.'I'LE APPROVED DATE ~ 198 r - - - - - - - - - _ _ ~L - - RE.1ECTED 1.) ATE 198 REASON FOR T mTnN ru J Aoa- n- -0 DE, F APPLICATION SAFETY & BUILDINGS NDUSTRl FOR SANITARY DIVISION 4 LABOR ANG PERMIT P.O. BOX 7969 HUMAN REL4TIONS (PLB 67) MADISON, WI 53707 i Attach plans for the system on paper not less than 81/2 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. The owners copy or a legible reproduction of the soil test report must be included. Property.10ner: f Mailing Address: Property Locatio Ci , Village or Townshio: County: t/a y'/aS I /T N/R (or) 011 ~S r` ~i; ~c 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: 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 x HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: ~s EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ 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. Namepf Plumber: Signat~, MP/MPRSW No.: Phone Number: Plu ber Address: i' Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signa re f Issuing g t: Fe/e: Date: Sanitary Permits Number: APPROVED t£' 3to 4/ ❑ DISAPPROVED R ason 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) ~ 1 E , ~ Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 c LOCAT1IQN.- 1445 ~'/4, Section To2N,RdI0(or)&Township or Municipality SAN ' a~~_r y4F ~0.O yes . 6 . County .Sly Ci'D lC Lot No.J Block No. Owner's/Buyers Name: / Ito Y j ^ /D//^, 16- 14bubdivision Name Mailing Address: Y1 70 t~ /C L -r-/. -mod CQIY C TYPE OF OCCUPANCY: Residence---4 No. of Bedrooms --3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEWXREPLLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS ( l A PERCOLATION TESTS d o SOIL MAP SHEET__ NAME OF SOIL MAP UNIT C L A C PERCOLATION TESTS BL<r yr~ ICJ PX TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHE RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- S..ea Ovt 7/ ko 3 n P- I/J' _fee P- P- J SOIL BORING TESTS TEST TOTAL DEPTH EPTH TO OU W T R, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK SR;VED ST _ TED HIGHEST IF OBSERVED IN INCHES B- 7 1;2 " A' d " AW, 1200-5-e S 7 a a Si,~S F O -._s_ S B- B- L G 14,A I e- 7 ; cc, r L B- A101a e- "t-5- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the I cation and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Ar cad 0' / Indicate scale or distances. Give horizo/ntpll and ver9cal ref ren/ce points. Indicate slope. X Co /-je Igo 1 T P'erc R ,~o : 30' s 17 3t? ~ © f'er~5 d ~ ~ 20 ~o uJ Q p 4r 41 lo 7,j -61o 0 16 le 2 b S/o e S~~ yes f1 ` 'l 2 r e :&s ao'xSJ' 4 g C~~ ` ~/U g `f EL = ' _ g B L rZ,,z l03, s a 1 -3 G'L. = /07' k- F-4 = ldc~ e.., . ~ er* /o t; k"iae- Guru er rt s brl. c- /00 I, the undersigend, hereby certify that the soil tests reported on this form were made by ¢ in ac~ad-Wtih ro res and methods specified in the Wisconsin Administrative Code, and that the data recorded and location est ho ? ov t best of my knowledge and belief. Name (print) Certifica Address v Name of installer if known Copy A - Local Authority CST Signat ` f s 3 1 17 - , 1 71 :a 1 ?MCI