HomeMy WebLinkAbout042-1009-10-000
n N O 3 v n d r~
7 O
co ~1
0
z p t
m m
C/) p~j O N vNi O Z (o A O v A N•
O CD 7 3 Q CCDD N
N -0 CD tA\
CL c: L-,
CO
3 CD W] co O C 1
O NF w 0 ~ N 0 ~ O CD
0 r CD = n CD CD s N O A~ ~O1
3 7 N O CD
N
CA
I y
(O CD N G A
I T W S
Cl o o D I
O m V
w
CD o\ !`i
CD (D a,
N jo W CD N 0 C
N I ~ Q
o
Z O O O r
W -o AO < N Z
a -3 - - Cl) w D
o- v v_v o tQ
o CO 'D N w
o v ~r
f m
fu I (P
T 00
C
tJ
3 p
N
CL 3
Z Y
o y co a O
O 7
CD ID @
(n
CD N N
~
G CD N
CD
w a
CD 1 (n
Z
O A Z co
N B A .n.
v n A (j
I Q.
Z A
W -0 m
M z
c " X
D U)
3 m
N Z
CD
co
N co a
as a
a _
N N c
~ - 3
o z a
O
N
O
li O
O y
N Cp
H
A
i N O
T
7 A
F
O ti
a
i N tv
X O
Cn O
(P I V
A
O
O 7Q O
O O O
bb
O 0-
ti
Parcel 042-1009-10-000 01/16/2007 01:44 PM
PAGE 1 OF 1
Alt. Parcel 04.29.18.61 A2 042 - TOWN OF WARREN
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 - RAPP, ROBERT J & ROXANNE
ROBERT J & ROXANNE RAPP
1196 114TH AVE
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1196 114TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 4.320 Plat: N/A-NOT AVAILABLE
SEC 4 T29N R18W PT NE SE LOT 2 CSM VOL Block/Condo Bldg:
3/880 ORD INCLUDING R/W
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
04-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
148976 295,800
Valuations: Last Changed: 11/20/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.320 46,500 169,300 215,800 NO
Totals for 2006:
General Property 4.320 46,500 169,300 215,800
Woodland 0.000 0 0
Totals for 2005:
General Property 4.320 46,500 169,300 215,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 302
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
4
AS BUILT SANITARY SYSTEM REPORT
J
TOWNSHIP W /t rZdC/Y SEC. T,2^-Fl W
->7 ( PST. CROIX COUNTY, WISCONSIN.
I VISION LOT LOC~SI -CA
PLAN VIEW D istances and dimensions to meet requir ments of H63 ICE
EVE$YTHING WITHI 100 FEET OF SYSTi
t
\i
.71
Y..... T-. '
i a e No th Arrow
---r--; C- ,~J
scul
J
61,;i4't,11MARK: (Permanent reference Point) Describe:
1,1~viti_on of vertical reference point:_ ~ Slope at site: ld',
'TIC TANK: Manufacturer : _.___L&L, k-- Liquid Capacity:
A :oiiwr Of rings on cover ---Tank manhole cover elevation
' allk Inlet. Elevation: Tank Outlet El evat_iun Lo~%
CAI 1BER
Curer [Number of gallons _
,,iw T of gal. pump :yet for -a cycle--- allons, total capacity o~-
t ril-ution -lines -gallon size of pump_,_ ___-----_-head,
Ioir per minute horsepower- brand name of pump
! 1110d e l number
1w of warning device
i1u:J0i NG TANK: Manufacturer Number of gallons _
hlevation of manhole cover
't'ype of warning dev' ce
, .'i PAGE PIT SIZE: j` um er o pits _ eef~t diameter
-
feet: liquid depth seepage pit inlet pipe-elevation-
i'lo t om of seepage pit elevation- feet. i
BL:D SIZE: number of lines__2 --width / length tile depth,
'i'RL:IdCI-I: width _ _ length-
f-- - _
i Ord RATE__j1gj~-.AREA REQUIRED _6 ' AREA AS -BUILT__ i~
INSPECTOR
~f~,~ PLUMBER ON JOB -
/ LICENSE NUMBER~L
I
A'IITW1 01 1N'IV[CIION IN UIV IUUAI ')'iWAGI IIM
';IYII (('l)( I'r'inii 1
S ( (I ( c 1 v 1) ( ( )
NA 1I_ I ow r(API 4
- p-4 - S.l. ('nip t i, iln it
jr-06joC I4Lri N S Svvt4.on Lot N ti(Iblliv~A(()PI
VI I I' I A N K
S(ze aYYunA Naml)c'n
u~ c Ornpan trnen to
O)r) l)Fri : Wit, YY 1iucfd4.n(1 1 ~n ~YOr)v
114 qhwa tell
PoMl'INI• CIIAMRI R
- gaftonA Pump ManuAactunvn Mdet NurnhvIt
I I) I N(; TANK
S( ze gaffonA Number u(t Comp gtmvY(tA
►'lln(1,v IF AKanm SyA to
t(Irlvv (nom: wefI Liu4P 4nq 12~; n4upv
H4.q hwaten
AIi0111)I ION SITU
Itr(I Tnvnch
tar(vv Arum: We-Pf ~
Bu4 Ldi n
H4 ghwa to n
)L4350kYI ION NI If DIMENSIONS
[e( lit It 41A french- ~j - 6t Reyu, tied area
vn)Itll (.6 each ('4ne 6t Depth 1( no eh 1) vfou, t4Pv
Nil rill) vIt (I ~ Y<ne6 Depth oA hock uvvIt t~YI, (v(
I,t)IP YvY(rltll nl( Knee t Depth OA teee 6vPuw (Dade ,r(
I)(~tairlc' 1) vtween YineA At Sfopv O~ t1vneIF 4YI. I)vn 100 At
I„',1+)(A)IJ.) UYI anv.l ~t Type o Covvn: ar)v11 (lh AtIt aW
PfT- U1M1 NCIONS
N14101I)v1( 416 Gnavvf' anUund p( tti IIvA r(
014 t~ ( dv di ameten A l
,--ht Depth he row i nt'vt
I(taY it 1,AoIptton ahea
i
A n ell i v ,j (1 4 h e d ~ t
N I* I C 11 4) _Wt
1111KOVI U DA 11.
19 h
'I II C I I V DATL
I9h
A A";11N 100 RI 1LCTI0N
I
PLB 67 State and County State Permit # 1
e k Permit Application County Permit #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
IV61A 4Z - xo A er 17- C A
B. LOCATION: r Section T~N, R E
(or) Lot# City A y d, .S' y,t/ k// s' f
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
D. SEPTIC TANK CAPACITY !~d e e' Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete - 11Ci Poured-in-Place Steel Fiberglass Other (specify
New Installation _A' 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 sq. ft.
New ,-Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Wjdth Depth Tile depth (top) No. of Trenches
Seepage Bed: -4 Length ~42211 - Width / Z Depth -~4Tile depth (top)~_No. of Lines -2
Seepage Pit: Inside dia eter Liquid Depth No. of Seepage Pits
Percent slope of land 'Ie 5 Distance from critical slope )7 .tr[
WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal ❑ ) e
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,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester, L,L~ I A e, e N) V /'?,P
NAME /1 C.S.T. # .S -5 -,?,Y" Tnd other information
obtained from (owner/builder).
Plumber's Signature MP MPRSW# / 1 4 9 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.
E
_ b.~_ as
E 3
2
'
_ a . . „sue. _ .c p, a .s.. S
i
F - e _ e m i
3
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: / State County _GZ DayQ -4Z
Permit Issued/Rutted (date) 5-- 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
2. state (pink copy) 4, plumber (canary copy)
Revised Date 7/1/78
- E H t 115 Rev. 9178
` REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: '/4, '/4, Section ,T_N,R_E (or) W, Township or Municipality
Lot No. , Block No. County
ubdivision Name
Owner's/Buyers Name:
Mailing Address: - '
TYPE OF OCCUPANCY: Residence / No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS - - PERCOLATION TESTS
SOIL MAP SHEET_.____,_--___-___-.__-.. NAME OF SOIL MAP UNIT -
PERCOLATION TESTS
TEST DEPTH ~CHARACTER 'OFJSOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
f 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- _
P-
P-
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-
B-
B-
B-
B-
3-
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 ar eV~fl q ilding type and occupancy Indicate scale or distances.
Give horizontal and vertical reference points plicate s pe
~~l Fr.~~vF[1 C, 2 3979
i
/V.
- L7 ZONING OR iCE
{
-~u..
£ E _
Jai L~✓ ~ ~ s
J
L
~+~`C3 ILy~ f )L 1 ✓ri~~v CAS ~Ud~t ..L
77
j w . _
t c . /4-1
r\ 4
,
a
}
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) Certitication No.
Address T
.Name of installer if known
Copy A - Local Authority CST Signature.
,4
12
16 f~
lD ,~~N LJ
X1414
/
7'S
-s ,
r
~n