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HomeMy WebLinkAbout020-1128-50-000 0(n0 gvn v ~1 m :E r m 0 cD m ' ' ° 3 T ~ m c • 'U CD 1 0) CD 3 3 - O n d O IN p O N C V NO `C CD (7 3 O a N O ~~]/11 ~ a 0 z n y (O O (O c (D to to ? (O N O ^ oN Cl 0 o 0 0 o con \ 1 CD CD ' O 3 Q O 3 - ° a to o O (n (n I N W a c c - o o m 3 O m (n 'm (D o o m 0 r (n co j (n o c z o 0 0 ° (n 0 O v s ~ of co ~ ~ aQ v v v O (D (D .~i <D y O Ci O (D F U) m N Oc .r y 1, Q w .t N z y y z co Z O y (D o a~ O o CD (n y 70 (n m m c 0 (o C CD N O W ~ O_ Q 7 O O O A Z CD U O f7 A Z O v a C o W m co V a Z G z 3 m (O y z (D W F O Q O ~ - v C iD- D1 > T OZ Q y O (D ~ 7 ~p F N CL ~ N 'C X nU'i O " o o- t ti N O O H Z O O DO V o O `D O ° o_ Parcel 020-1128-50-000 10/12/2005 04:53 PM PAGE 1 OF 1 Alt. Parcel 17.29.19.600 020 - 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 LOWELL R IVERSON O - IVERSON, LOWELL R 460 PARK LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 460 PARK LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.650 Plat: 2274-PARK VIEW ESTATES 1ST ADD SEC 17 T29N R19W PARK VIEW ESTATES 1ST Block/Condo Bldg: LOT 19 ADD LOT 19 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.650 35,500 173,000 208,500 NO Totals for 2005: General Property 1.650 35,500 173,000 208,500 Woodland 0.000 0 0 Totals for 2004: General Property 1.650 35,500 173,000 208,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY. SYSTEM REPORT OWNER TOWNSHIP 14 u J 5 SEC.LZ T %-RC G ADDRESS r J 2- ST. CROIX COUNTY, WISCONSIN. + SUBDIVISION (OZ VV 6-T l LOT SIZE PLAN VIEW I)istances and dimensions to meet requirements of H63 OW_EVERYTHLNG WITHIN 100 FEET OF SYSTEM _ th Arrow S C L . ~ - BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point ` Slope at site: SEPTIC TANK: Manufacturer : t"~11 i " Liquid Capacity: Number of rings on cover ? - Talc. manhole cover elevation: Tank Inlet Elevation: - Tank Out. let Elevation: PUMP CHAMBER Manufacturer: Number of gallons _ Number of gal. pump set for ai cy-c~e__ gallons ; total capacity o distribution lines gallon: size pump_ head; gallon per minute horsepower__ _ brand name of pump and model number 'T'ype of warning c e ice - - HOLDING TANK: Manufacturer. Number of gallons Elevation of manhole cover Type of warning device _ SEEPAGE PIT SIZE: - Num-der of pits feet diameter feet: liquid depth-- seepage pit in ee.t pipe-elevation _ bottom of seepage pit elevation _ feet. SEEPAGE BED SIZE: number of lines with j _leogtt-i /Mile depth 3 t SEEPAGE' 'FRENCH: width lengra _ PERCOLATION RATE c 57A REQUIRED 41 (5 AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB z LICENSE: NUMBER /ti~ y` ~ 3 - ~ v l G/'r 17 1 .i N'll"ORT Of INSPECTION INVIVIOUAL. SIWAGE SYSTIM S a yr i t a )r i I I' c >t rn i t ti to I yC S c' p t c. c _ _ 7~~ - t+ _ --(ownAh-ip_ _ _ _S-t. C~wix Countrl , ,r t i ovt Sec.t%onL7 to l- N f Subd4 v~ 5 i on 1,CI IC IANK Z°' ' g(iff,nz Numbers o6 compatitrrtent~t ti t~tHf, (~nt,m; Weef 8u4i.Yd~.nc 1'lo bko,,e Il,i_ghwa.ten ~i1MVING CIIAMRFR v-t AL,i',~_~ "`~`f`~ i zt' gaf Pum Manu ac.tu.nen r it M o d e N u m b e rs ii'I PING TANK i;4'' c _ 9ak.Qonb umbers o Compa tImcvtt~5 Purnl.,en - ~aAm ~ Atem s titvt,~c' fnom: GIe.QP Gu~kdi.n Ito h('ope - Hi itwaten /L~.f ~ ti tl I' "r 10 N ~ ITF h~~ (G` 3 'r t~rrrr~c {nom: IUCCP Rrat('dtinll J2 l'n ~c ~ Hi'iIhwate~t r ~?I'Pl ION SITE_ DIMENSIONS - - - - - W i d th o 4 to e n c Gt '-i"- (~t RF yut~E d area ~ I en<=lth o4 each fine Dc nth a n0ch, be (o _ ~ ~ 'K (t w t.cXe ~ in Numbers o(~ ki.yteti__ - _ Depth oA kaeh oven t.i.fe (n fotaf ken ,th o f .ne.e 9 ~ _ ~ De~.th o>S ~t.FX-e be~aw grade i n Vietance be-twe.e.n e.~neb__ __At ~Xope o~ tnench_ -__-~-n, pen 100 At fo~tae abAonp.t.ion anea_ - At Type oA Coven: Papor. on s thaw I I V I MI N'; IONS Nrtrtrbcn oA pits GnaveP around pith yeas no 0o t;ti irlc dia"Ie-ten - -t Depth beeow ind'et ~t I t~tf abAonption area -'fit A'rcrt hcquined N'I - _ ~~I VAII _ 19X, r I t i' I I I~ / Cat vnrf ~ ~ _ _ _ - 1yh l';i'N Itll•' L.'I It,CIION ~J t-----__.. ~ 1 ~ 1, IC I.1 -PL'B 67 State and County State Permit # Permit Application County Permi # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF] PROPEI L/ RTY / Mailing Add/dress: L 1x/1 B. LOCATION: tV'/4 Section 1_7, T ` N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township (ir S"L r7 C. TYPE OF OCCUPAjVCY: *Commercial *Industrial *Other (specify)*Variance Single family 7 Duplex No. of Bedrooms No. of Persons ~i D. SEPTIC TANK CAPACITY 0 Total gallons No. of tanks r* HOLDING TANK CAPA~~TY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation to Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area-t-~sq. ft. New l•~ Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (to No. No. of Trenches Seepage Bed: Length ~ 2--- Width[ 2- Depth Tile depth (top).. No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits_ Percent slope of land-- Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ _ Owners name as listed on EH 115 if other than present owner: 1, 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 Soil Tester, C NAME .1 ~ y :/G h "--rs(' yl C.S.T. # - J`Z and other information obtained from u i (owner/builder . Plumber's Signature CID M Phone # '4- A/P 1 117 Plumber's Address w ✓ h 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. r r i E i • R .d. y ..a. , e -.,.m.. sm.«,. . e.. y. r d»-=tea e..,........-. t t s ~ e Do Not Write in Space Below /FOR COUNTY AND STATE DEPARTMENT SE ONLY Date of Application ~ ~14/ Fees Paid: State 141, "-Tp Coun y Date -09/ Permit Issued/ +efecvrd (date) Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 (Pink copy) 4. Plumber (canary copy) Revised Date 7/1 /78 15 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:N SectionT21N,RZ_'_D(o,)(J,2Iownship or Municipality 17 14 <<"1 e~'~r X Lot No.Block No. kc: ~ - County '57/( J Subdivision ame Owner's/Buyers Name, I-O W e l / _C11,eo'S0N Mailing Address: k / 0~®x v27jl ,V,.G SC1N uj,'S, _ry01 TYPE OF OCCUPANCY: Residence-,No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEWX-REPLACEMENT -ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 9-13- F0 PERCOLATION TESTS SOIL MAP SHEET__Sd NAME OF SOIL MAP UNIT _ PERCOLATION TESTS TEST DEPTH _ CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RArF_ NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER/ 1ST WETTED SWELLING IN MINUTES PERIOD I PERIOD 2 PERIOD 3 P- I Se 2 Aa- e Z c 3 co P- Z " e'L /ire 2 A16 3 P-, " .See 161're- © v o I co 6 Ar P- P P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- Ir Q e 7 476 v " C'o~►S e SZ it 54 60-, B- 3 a 7 6 r,T l 4, F " CaArs¢ SSG/r. 1,2 /0 B- 9t PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy .'J 00 Indicate scale or distances. Give horizonta,l ~fd vertical eferen~Je po nts. Indicate slope.- I e /01 '-eisf r~? - r`S~t~c~S mss' SfrJ~t , : e v1 9 aZA °la~~ jQ ~j(2reS f © p@r~ cS 63 I~ t aA 3 I 1~30' \ % IN o fl ~ pert Al luQ.s f i AJ ~,'ST e,~, v- F,1-403' 96 C-4zlo-W Arm ~.a s 1111P,4,,4 2-0(XSO` MC e 00w~ ~Ad! W'AS- /7 N V r S~4 /00 I, the undersigend hereby certify that the soil tests reported on this for re maj>~" cc ith the procedures and methods specified in the Wisconsin Administrative Code, and that the data record dyaid lo~ Kopf t hot re correct to the best of my f knowledge and belief. Name (print) , I fi6~ No. U W ss r Address e6l .461,e. Name of installer if known Copy A -Local Authority CST Signature -~-^-h r, 1 1 ~ `s1 r~ _All h y C ~`vl f: ~J (c~ l i ~ .i` ~ s Wisconsin Department of Industry, PLB-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing, Platting & Fire Protection Name o remises Date an No. Street City oun y Sanitary Permit Master Plumber irm Name dress Journeyman Plumber Address Owner Address - - - - - - - - - - - - - iscusse with Signature ( )See Attached. DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. On-Site Waste Specialist : White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner