HomeMy WebLinkAbout038-1068-50-000 (2)
ocno K m 0
r~
m C7 `+1
3
v N O N
(D A:
lot
O
cn ~ = N Z n o !r
`C
S O W O m-4 00 00
3 3 0 (D m w
cfl oo ID
Q Z d ~ N A ~
C (D N ol 0 A
N IQ N W N < N "S
O (O
n p s (D O- (O O O
O co ;C (p p N
co (T IC: N O N Oc
O
~O N N A ~ O ~
~0 v N _n
iv In < D Q
° Im n N U) a
D co Q
rlj C: CD
:Et N ~3 Q ^ co O p
Op ~(D W O
~ 'CL 3
n r N
CD N
(W„ co e in N O L
z O O O
-u -u T
o C: CD 3
fA (n U1 N m
° m 3 v v v"
O
N N
N N (D
N D C
W fD - 0
< N C ~i
p 7
.N ~ Q
' 3
IQ
Z
'7 N N
Z W z O
D m o
Iv O n
v
h•
o (D CD
N
CD W CD N N
~f
C (D (D
W Q
3 7
~Z (D -i Cl)
o =3 Z (D
cn o _
n p A Z O
W Q O
Io
m v m ;
(D N z
Q' ~ A
o -
o Cl)
m
Z
(D A
N F
Q(nCD D
W W O Q
(D rn fl
o N p'
rn v c
N W W Z O
Q
O W (D
U1 O 3 N
W
(D Q
D Q T
n Q
Q 7 yC
O Q
W 3 n
CL
W 0 o-
m m
Q 7 T
a ~ N
O O O
33 N
~ O
a
R
ti
(D ?p a
eq O v
~ a
O (D
°
Parcel 038-1068-50-000 10/20/2006 11:42 AM
PAGE 1 OF 1
Alt. Parcel 16.31.18.292G 038 - TOWN OF STAR PRAIRIE
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 - MRDUTT, LANA
LANA MRDUTT C - HERZOG, DAVID
DAVID HERZOG
2104 CTY RD CC
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2104 CTY RD CC
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 2.060 Plat: N/A-NOT AVAILABLE
SEC 16 T31 N R1 8W SE SE TH S 307' OF E Block/Condo Bldg:
292' OF SE SE W OF CO HWY CC
EZ-IE-1207/356 EZ-IE-1214/314 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
EZ-UT-1226/285 16-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/27/2006 828331 LC
06/14/2005 797576 2822/092 PR
06/14/2005 797575 2822/090 TI
07/23/1997 700/60
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.060 14,400 63,600 78,000 NO
Totals for 2006:
General Property 2.060 14,400 63,600 78,000
Woodland 0.000 0 0
Totals for 2005:
General Property 2.060 14,400 63,600 78,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 104
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, SEC. T';' N-R~W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
S OW EVERYTHING WITHIN 100 FEET OF SYSTEM
FT
p
0' '41 4, - el A
y
4
I di ale No the Arrow
BENCHMARK: (Permanent reference Point) Describe : Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: ~L,',- 4-, ~2i
L,iquid Capacity:
Number of rings on cover Tank manhole cover elevat i
Tank Inlet Elevation: e~tz Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cyc e gallons; total capacity o
distribution lines gallon: size o pump head;
gallon per minute horsepower brand name of pump
and model number ;
Type of warning device
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 in et pipe-elevation-
bottom of seepage pit c, evation feet.
SEEPAGE BED SIZE: number of lines 4 width 42 lerigth.the depth
SEEPAGE.TRENCH: width length
PERCOLATION RATE {r`,. REA REQUIRED AREA AS BUILT
INSPECTOR _
DATED - i PLUMBER ON JOBS/
LICENSE NUMBER
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit-
State Septic /
EMI: I'0WNSHIP_~Ti% 0gy4Zt. Croix County
k)CATION Section ALot Subdivision
IJITIC TANK
Size y gallons Number of compartments-
istance from: Well Building 12% slope
Highwater
I IMPINC CHAMBER
-
Size gallons Pump Manufacture Model Number
IOLDING 'L'ANK
Size gallons lumber of Compartments
Pumper Alarfh System_
iistance from: Well Building 12% slope
Highwater---
IiSOKIIT}ON SITE
tied Trench
f :~t arnc(, f rom: Well d 9 Building 12% slope
Highwater j~
diSORPTION SITE DIMENSIONS
Width of trench ft Requires! a - ft.
Length of each line ft Depth of-"` crick below tile----/ -/in.
Number of lines Depth of ock over tile- in.
Total length of lines ft Depth of tile below grade____, t~ in.
Distance between lines ft Slope of trench-----in. per 100 ft.
l~ ft Type of Cover:
't'otal absortption area
- - -
I IT 1)1MENSIONS
Number of pits /,.eptli e1 around pits- -yes no
outside diameter I:t below inlet _ -___-ft
Total absorption area f. t:!
Area required ft rj•'-F
INSPECTED BY TlTLH
APPROVE D A'Z'E 198
RI..JEGTF.D 1) ATF 198
1-:ASON FOR RE.1ECClON
IJO
_l~
r
15EPARAIMENT 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% 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: City, Village or Township: County:
'/aS IT, NCR ) E (or) W
Lot Number: Blk No.: Subdivision Name: N barest 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
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): l~ New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench i
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
I
Q Private ❑ Joint ❑ Public i
I, the undersigned, hereby assume responsibility for installation of the . ate sewage system shown on the attached plans. f
Name of Plumber: Sign MP/MPRSW No.: Phone Number:
Plumber s Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Sig a re of Issuin Agent: Fee: Date: Sanitary Permit Number:
APPROVED
lvCa ` ❑ DISAPPROVED zzf4
Flason 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)
,DEPAirTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, c DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
COUNTY: OWNER'S/BUYER'S NAME: MA LING ADDRESS:
` l l ?
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: 15ROFILE TONS: ER LA ON TESTS:
4Residence ) EZNew ❑Replace I
RATING: S= Site suitable for system U= Site unsuitable for system )
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-I -FILLHOLDIN TANK: RECOMMENDED SYSTEM: (optional)
S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL 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.)
B- : f
c
1,2-3e< c.
B
A'-7 A,
7, 7, 2
PERCOLATION TESTS
~S2 . . - ~ L~'
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 PERIOD PER INCH
P-
P-, y
5
P- A_- Ah- 1Z Z
P
P_
2__
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 1 ,
- E
y.
i
p i
SI~P~
`f L1
N
W
j.. _ f
, .
I I
i, 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.
NAME (print): TESTS WERE COMPLETED ON:
ADDRES : CERTIFICATION NUMBER: PHONE NUMBER optional):
CST SI NATUR
C-
Heal Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
T
sz-
~f+tr/~YICZAIQ I
!!F
!
t,
3s'
....f.:..~ / ' 9 4
s
k)4
~
E .
,r