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HomeMy WebLinkAbout020-1139-20-000 V c O O 3 y o C r1 C w 3 7 A 3 K .7► M (D (D O ( p DZ NaN,. cl) C ON `C • (D d A (D Q d N r.r (D D 3 O N N 7 (D NO n ~ ..y m P cD W O (D A N N D ° V O O O N O °O ' ~ W ° Cr C " D ° o W ° O O d = CD Cn D CD (D ] N N M r v W v - m C) CL D O (D -7 a- (D (D CD O 0 r- En U) ~D co 7 en 0 G vvvA z o O O 0' ~'E 3 ai CO o I f q v v v CD N CD n A SU - N Q N 3 m a (D o I z lam] Z co Z O v 10 D a CD 0 tr o N• 7 O Cn Z7 ° En D (D N C CD N _ N I CJ ~ Q a 3 z 0 ~ y O N C A w n pnj d A G 7 O D C M N N co T CO (D (D Q Z ~ A Z1 Z O N Z CD A W F d N O (D d C1 _ G C, o C1 N T U)j~ N C O 0 N N Z a O 0 pp CD (D (D d 0 s (D p O D O 7k c O N COO CD LU (N _ N Cl1 -0 CD O D. A ,a o~ W- CD N CD N D N ~ O N X O I N - A ~ O CD CD 0? O ~ A EA ~ Ca ° a O i y O 'mil Parcel 020-1139-20-000 05/31/2005 10:36 AM PAGE 1 OF 1 Alt. Parcel 29.29.19.703 020 - 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): Current Owner SABIN, TIMOTHY O TIMOTHY O SABIN 773 GHERTY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 773 GHERTY LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.432 Plat: 1979-GHERTY'S ADD SEC 29 T29N R19W GHERTY'S ADD LOT 2 BILK Block/Condo Bldg: 4 LOT 2 4 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 752/305 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 2.432 32,200 183,300 215,500 NO Totals for 2005: General Property 2.432 32,200 183,300 215,500 Woodland 0.000 0 0 Totals for 2004: General Property 2.432 32,200 183,300 215,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 145 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 L/ t • AS BUILT SANITARY SYSTEM REPORT _~d It SEC. - ~ N-RdW OWNER S ,~,913i~ TOWNSHIP - 4_1C ADDRESS ? ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 THING WITHIN 00 FEET OF SYSTEM TT A X1 I di a e o th Arrow SC L u~ BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: /fif1 ' Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover : Tan manhole cover elev t cq1 ;s' Tank Inlet Elevation:` Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cyc e gallons; total capacity 0- distribution lines gallon: size o pump head; gallon per minute horsepower bran 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 iameter feet liquid dept seepage pit in e-t pipe-elevation bottom of seepage p-it evation feet. SEEPAGE BED SIZE: number of lines widh:_lerigth,5._tile depth SEEPAGE TRENCH: w'dt length PERCOLATION RATE _ AREA REQUIRED~/.S REA AS BUILT _ INSPECTOR DATED f PLUMBER ON JOB LICENSE NUMBER L /2 'REPORT,OF INSPECTION - INDIVIDUAL SLWAGE SYSTEM + Sartitahy Penin 4.t State Sepxtic 004, A Townahip~ St. CLO-(X County cation S cL N.4!j Sec,tionz??q Lot #,7,-Subdivi.6ion~ IPTIC. TANK St ze gattone Numbers oA eompa4tment6_ _ r ,i,5 tanc.e 64Om: Wett Build' 12 o 6Xupe-_- HighwateL UMPING CHAMBER Size gat one_ pump Manu6ac~uLe4- Mudex Numbers - OLDING TANK Size gattona NumbeL o6 Com,paL.tment~s PumpeL 1 AxaLm Syetem ,(,stanee 64Om: Wett Buitding` HighwateL 601ORPTION SITE Bed T)Lench . r ~ tan co 64om Wekt Building 12% e.Eope _ - - HighwateL (;SORPTION SITE DIMENSIONS W.i d-th o 6 tLench At Req u4 Led anea t Levnyth oA each eine At Depth o6 no eh below title cry Number oA fineb Depth uA Loch oven tixe Tu tak X eng-th u6 Zinee At Depth o6 •tif-e below glade-----__ Di,stance between Zinee At S.Eope o6 tneneh 4.n. pen 100 6t ~ L) 1.,1 'Ab150 4IJ.t4,un aLeu.--- 4t Tii nn if DIMENSIONS Numbers u6 pits GLavet a4ound p~•ts yea-_----_nu i Outa4 de d.i.ameteL At Depth below kn(et - _-^6x Tutat absoLption anea At An-ea nequiLed At NsPLCTED BV TITLE r" - - I'1 ROVED DATE ' 19 k I JI CTED DATE 19 8 tASON FOR REJECTION REPORT ON INSPECTION OF SANITARY PERMIT (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Time of Inspection a ress, License No. o Install Ong Plumber- (3 )INSTALLATION CONSIS S OF: ❑ SepticyTank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BEN Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ N0; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth-. ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of Make or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑YES ❑ NO~ (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: ' ~sovwiaal 7 State and County State Permit # ` # PLB 6 v v, 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: B. LOCATION. - , % Al Section T. N, R~ E (or) W Lo # City Subdivision Name, nearest road, lake or landmark Blk# 1 Village Township L:4, iv, C. TYPE OF OCCU ANCY: 'Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks j HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation ~x Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-PlaceOther (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Areal / sq. ft. NewXReplacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width_ Depth Tile depth (top) No. of Trenches Seepage Bed:-1 -Length _WidthZ Depth ',"-I Tile depth (top) ")-xJ No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private 5< 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, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil esterr,, NAME C.S.T. # S~ ! and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# Phone #t7(` r 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. , i Mrv i E : t } Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State County r/ FYI Date Permit Issued/Rejected (date) 7 -c~6 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 Rev. 9/78 EH .115 DEPORT ON SOIL BORINGS AND PERCOLATION TESTS l` ~y r n^ , CO,NSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES t?j~ dG r!~~ JUL P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION4~r 11-AW'/a Section ? ,Ta / N,RL_L_j6(or ownship or Municipality F~ 0 , Lot NoCounty .Block Igo ubdivision Name 7 +Owner's/Buyers Name: Mailing Address:az !i?, reE~t!/(l #Ve' f4Vl~'(f 1-i,,tow, TYPE OF OCCUPANCY: Residence x No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT -ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS oa -'PO PERCOLATION TESTS_ © - SOIL MAP SHEET 66 NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RAT' NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL i BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 ,t1~o ~c a A P- Se e Ore P- y ee r . o 3 P- " cl/e y Q ^ r0 0 P- ~ 3 yL P- r SOK BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER -INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES/ B- Y~ B- /IA. /W 4e- t. it ) ,I "546e /B- y is ' ,6or rc p2G G r B- 7 Of 3~9 /V e_ 113- 6 Alove- 3r 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 area needed for building type and occupancy O Indicate scale or distances. Give horizontal and vertical referece points. Indicate slope. ~~W e A 49 Ilety "'It I~ IBS I G1►,, A 6; r Q ~ 00 Of ge Q,rae- 71 r ' /f ~ N .~YS 4r ~s3 6 _ 13 3' - Ivy' 3 7 t, 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)..~L~'~ Certification No. Address U Name of installer if known Copy A -Local Authority CST Signa J 1 t f fvt' ~c 0 iJ r1.1 a r~f~~ D,E'PARTIYIENT 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'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. H izontal and vertical elevation reference points must be shownn-NI appropriate separating distance and physical characteristics as specif' in hapter H-63, Wis. Adm. Code, must be shown. An ' x page or ch page mustRbe signed, sealed nd dated by the des' ner. If Igne by Master Plumber, the date, signature and license n tuber must be own. The Hers (Npy le le reproductio of hero st report must be included. 7ZII L., Property Owner: ailing Address: Property Location:' City, illage o o nshi County: f t/a 1/aS /T 1 NCR C (or) W Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) L TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: C, 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): Z New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit - - ❑ Alternative (specify) ❑ Seepage Trench /L S Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Z Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the pri to sewage system shown on the attached plans. ~a Na of Plumber: / Signature MP/MPRSW No.: Phone Number: Plumber's Address: Name of Designer: LI 9 COUNTY/DEPARTMENT USE ONLY , Date: tats? APPROVED Sanitary Permit Number: S' nature/of Issuing Agent: Fee: L p7 ~oL ~d ❑ DISAPPROVED R s for Disapproval: MM tom' Y'- 1 r"r/ hQ 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 DII.HR-SBD-6398 (N.03/81) INA l'Y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUDUST~iY c DIVISION P.O. BO LABQR AND PERC i 06 TESTS (115) MADISON W 7969 HUMAN RELATIONS • . Np.: SUBDIVISION NAME: __2 S LOCATION: SECTION: (or) W TOW SHI / LI LOT NO.:BLK,`( COUNTY: 'S /BUYER'S NAME: _ MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I R~TCg~S TONS: [PERCOLATION TESTS: g Residence ? X New ❑ Replace. Il RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ZS ou as ❑u os au os ❑u ❑s ❑u 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- j 27 9 , B 7 B-_ B- B- 42s B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ 15 P-_2 :6 P P- P- P- PLAN 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 o IGw+Gi.a, a J` /.:cam 4(Al f SPY" ~r... _ 94 41/'rv a t 3 G 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): I TESTS WERE COMPLETED ON: ADD S: CERTIFICATION NUMBER: PHONE NUMBER optional): a , CSTCVNATUKE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) e, v / u,oso~' G I ~u I ~ f4 yq I G i4 i i I ug 1 I