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HomeMy WebLinkAbout038-1122-90-000 0cnp 3v0 C7 r~ o m f C v ! c C; m 3 II ~ ~ w O cn g = = n z ~ ~1. j~ 3 y N N C O N T Wppp CO N O O ~ Q 7 O O N N N ° a a m .y l^l V N a W W N N N. N C 1 O 0 c: CD CD CD 0) 04 o 6 7 N 7 = O fi C .r C ' d O Fu, Ii a cn D ~a 3 CD (fl N N a W `D 3 w V 3 a ~ o o~ I CD ONO -4 ° CD co co 0 00 00 CD cn 0 3 c o v o O O O 3 r' v o ~ ~ CD < z n 3 C6 N cn " D 5;. o N m vv~ o e~ ~ = ~ ~ I co m N 7 3 ~ GNJ7 ' N N z zca z 0 D CD o O a o `CD cn ` N (D N y O CD W d n 3 5 Z CD N O ~i O ? Z (D cn C 0 a ? z 7 cn W O 0o v m CD Z 'o a C/) c w (D ? W y N (D ? Q C C t/ 0 [A O O C S OZ a O C CO N N CD ;U A I N O A 1 O i O fi A O ~ O V N n1 V ~ A O b w m o p C) a Parcel 038-1122-90-000 01/17/2007 12:48 PM PAGE 1 OF 1 Alt. Parcel 30.31.18.510C 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 - BELISLE, GERALD W & DIANE L GERALD W & DIANE L BELISLE 1033 GENESEE ST WAUKESHA WI 53186 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 16.125 Plat: N/A-NOT AVAILABLE SEC 30 T31 N R1 8W PT SE SW 16.12 AC LOT 1 Block/Condo Bldg: OF CSM 5/1259 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1002/515 WD 07/23/1997 896/137 07/23/1997 661/435 2006 SUMMARY Bill M Fair Market Value: Assessed with: 175752 Use Value Assessment Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 14,000 5,600 19,600 NO AGRICULTURAL G4 13.630 600 0 600 NO UNDEVELOPED G5 0.500 50 0 50 NO Totals for 2006: General Property 16.130 14,650 5,600 20,250 Woodland 0.000 0 0 Totals for 2005: General Property 16.130 14,650 5,600 20,250 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i AS BUILT SANITARY SYSTEM REPORT 1 OWNER - TOWNSHIP s,~ t SEC .,.~T!IN -RfW ir/ ~.m ham- ADDRESS ST. CROIX COUNTY, WISCONSIN. Col '"J 0 SUBDIVISION LOT J LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 THING WITHIN 100 FEET OF SYSTEM S I di -.a e o th Arrow I SC L i BENCHMARK: (Permanent reference Point)' Describe.: ~~~Xf ~•6 ~•s~ Elevation of vertical reference point: ,/L:~ f Slope at site: SEPTIC TANK: Manufacturer: j ' Liquid Capacity: Number of rings on cover Tank manhole cover elevatio - j Tank Inlet Elevation: Tank Outlet Elevation: n PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower ran 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 eet diameter feet liquid dept seepage pit in etpipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines wi EF- lerigth&_Ltile depths; SEEPAGE TRENCH: wid h len tl , PERCOLATION RATE._' REA REQUIRED REA A BUILT , INSPECTOR r r DATED t PLUMBER 07-JOT LICENSE NUMBER- _ z REPORT OF INSPECTION - INDIVIDUAL SI?WACI? SYST kM n~ Sanitary i'~rmiL 0r/ State Se1) Lic`/ NAME 'rOWNSHLP St. Croi_x1 Count LOCATION _ Section30 Lot # Subdivision SEPTIC TANK Size gallons Number of compartments Distance from: Well /00 Building f% 12% slope Highwater PUMPING CHAMBER Size gallons Pump Manufacturer Model Number ITOLDING TANK Size.-------gallons Number of Compartment Pumper Alarm System Distance from: Well Building 12% slope Highwater ABSORPTION SITE Bed" Trench Distan from: Well , Building 12% slope 511 Highwater ABSORPTION SITE DIMENSIONS mss. Width of trench j ft Required area . ✓ ft. Length of each line ft Depth of rock below tile ` in. Number of lines Depth of rock over tile ill. I Total length of lines -A c~ ft Depth of tile below grade in. Distance between lines ft Slope of trench -2--t 11. per 100 ft Total absortptlion areal ft Type of Cover: PIT DIMENSIONS Number of pits Gravel around pits yes no Outside diameter ft Depth below inlet- Totalabsorption area ft Area require ft LNSPECTED BY i TITLE APPROVED W/65 DATE 198/ REJECTED DA'T'E 1.98 REASON FOR REJECTION State and County State Permit # F'.LB 67 Permit Application County Per 2 for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. 0V1(NER OF PROPERTY Mailing Address: B. LOCATION: --SZ,_'/a Section T, R (or) gyp( Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village_ Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons J D. SEPTIC TANK CAPACITY A Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete _,X Poured-in-Peace Steel Fiberglass Other (specify) New Installation Replacement A Lift Pump Tank or Siphon Chamber--Total gallons Prefab concrete Poured-in-PlaceOther (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate.Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: x Length Width JV, Depth .S~l Tile depth (top) No. of Lines c`2 Seepage Pit: Inside diameter. Liquid Depth No. of Seepage Pits Percent slope of land- 4.2 5-6 Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, I Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Cer ied Soil Tes er, NAME ~jU„f C.S.T. # and other information obtained from f,IA X' (owner/builder). Plumber's Signature N)P/MPRSW# Phone Plumber's Address 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. , M _n. 3 tea- ~ I a jj 3 s , n r y e e m e w. e Hw a m.. ,i .m. .ems m . 1 a~ c E 3 a ~ r . , e~ _ . m. tea., a . E. " ~ y Fem. j . ~ v g_. s, m ern ~ «..n. . m _ a ~.m m ' ..e . . a~ w...r m.. t e > e a' mow. s.. 4-..«M- I , =y 3 Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ON(_Y Date of Application a--" Fees Paid: State /~/0"o county Da Permit Issued/ReOcTed (date) to - Issuing Agent Name Inspection YesNo State Valid# Date Recd 1. county (whi e copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. Plumber (canary copy) Revised Date 7/1/78 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN[3'USTF§Y~ CC DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME: N/R (or) W COUNTY: OWN R'S BUYER'S NAME: A IN ADDRESS: / ,ly C USE DATES BSERVATIONS MADE NO. Residence ~ BEDRMS.: 1COMMERCIAL DESCRIPTION: ❑New YReplace. PROFILE D ONS: ER LA ION TESTS: 17-17-9/ Z2 ~IL RATING: S= Site suitable for system U= Site unsuitable for system A119 --f PV )11 - AJ.14 , , 1 CONVENTIONAL: MOUND: IfV-GROUND-PRESSURE: SYSTEM-IN--FILL HOLDING TANK: REC MMENDED SYSTE :(optional) oS ou [--Is ou oS ou os ou ES ou If Percolation Tests are NOT required DESIGN RATE: [SYSTEM EL 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.) B- B- B- I In B- 1 - F PERCOLATION TESTS \ 49,F~I /G. 98l ; TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCH R MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 1003 R !NCH P- / T I -,'Amon A6 P- _3 z 7 3 3 P- , 916 P- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale 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 ELEVATIONS E , E X _ )dale x~c 6_ Abe a a ; i E : E 4,1C •s a ; a a E a 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 rintTESTS WERE COMPLETED ON: ADDRE CERTIFICATION NUMBER: PHONE NUMBER optional): CS SIGNAT E: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. C% DILHR-SBD-6395 IN. 03/81) S s 1Ylj 4,rc 30 r3lI/, elg k/ nr~sEr 11 .Szyw APp/"o'• $0. O J/arC J.1 i TU i i i r~r C C/oo©" r f fIONSE IJ