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HomeMy WebLinkAbout030-2038-80-000 0 <n O g-0 0 C7 v F ' a Lo~ 'm 0, 0 a) CD CD 1 N) 0 v o y cD CD CD cQ N N O O O N '.S 0 (n O_ O N w C IN 0 CO A N to O C_ s A 0 (b O N) 0 ° (n : O 7 O C7 O CD r N O N N ~ 7 O O o O m (D CD (O CD U) O_ N N Li O -0 D C: CD E ::r 3 O N (OD U) O A A (D lot 2 CD (D Cc 2: 0 r- N o 00 00 C) o N s 0 3 v v v ? d z O O O o t~l =I A a D a4 - ~vvo o O (D .O. L D. N A O O - O 7 M N N CD O O 3 CO z N zco z o O D o_ j s ~ o m CD N N ~ O C G co N. _ (D w C d a 7 z Cp ~ 1 (n O Q A Z n O. A Z O <Z W CNIi CD CD < O Q Z 3 O ! Z N N z m o CD D 3tjo°~ m T i i N~ - N N C C0.7CD N o a I(p O CD 0 y (D 0- d (D CD O C) o N i ~ v ~x v a D rn o rn1(D (D 0 e a= ti i / 1 ~ N ti v o o ~n a A 4 O ~ V A O 0 ~ (n o c v o n Parcel 030-2038-80-000 04/15/2005 03:12 PM PAGE 1 OF 1 Alt. Parcel 25.30.20.482C 030 - TOWN OF SAINT JOSEPH 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 PRESCOTT, JEFFREY M & CONNIE JEFFREY M & CONNIE PRESCOTT 1397 20TH ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1397 20TH ST SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE SEC 25 T30N R20W NW NW LOT 1 OF CSM Block/Condo Bldg: 4/1009 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 620/54 2004 SUMMARY Bill Fair Market Value: Assessed with: 6048 306,300 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 78,700 139,200 217,900 NO PRODUCTIVE FORST LANC G6 7.000 83,400 0 83,400 NO Totals for 2004: General Property 10.000 162,100 139,200 301,300 Woodland 0.000 0 0 Totals for 2003: General Property 10.000 95,200 109,100 204,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 123 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 ADDRESS TOWNSHIP SEC. 2 T ~ N, R ~W -___r. ; ST. CROIX CITY WISCONSIN. SUBDIVISION _ LOT LOT SIZE YK L11 PLAN VIEW Distances dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I w I di a e otth Arrow SCALE: i SEPTIC TANK(S) MFGR. CONCRETE STEEL No. of rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. ~MODEL NO. GALLONS Per Cycle TRENCHES NO. of width - ~ length area BED NO. of lines width length area depth to top o pipe NUMBER OF SEEPAGE PITS outside di meter total pit area AGGREGATE PERK RATE RE REQUIRED AREA AS BUILT Disclaimer: The inspection of this system by St. Croix C6,unty does not imply complete compliance with State Administrative Codes. There are other areas tha! it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER _ REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanit,74y Pe.hmit State Sept.ic NAME TownshipV St. ChOtix County Loc k4n, ~Sectiond Lot # S bdivision SEPTIC TANK Stize/j.j gaUon5 Numb etc o{ e0mpahmen6 / D~.,5tanee Ahom: Wef Building ~ 120 /scope Highwateh PUMPING CHAMBER r Size ga tons _ Pump Mav, u(~aetun'eh Mode.E Numbeh HOLDING TANK Size ga,E.fons Number of Compahtme.nt5 i Pumpers. A.2a m S y's,tem Di6tanee Ahom: (deft Buifding 12% !slope Highwateh / ABSORPTION SITE -2- 1 Bed L Thench. D, 15 tanee~ AhOm: Wett Building - 12% stope Highwateh ABSORPTION SITE DIMENSIONS Width oA theneh At Requtihed anea Length oA each /tine. At Depth OA hock beEow Cite in Numbeh 06 Une)s Depth 06 hock oven tote in Totat length 06 fine./s At Depth oA tite below ghade 3(- tin Di6 Lance between fine./s _At S Eope 06 theneh in. peh 100 At Tota. ab6o4ption anea At Type oA Cove_h: Papeh ote /,,thaw R' PIT DIMENSIONS Numbeh 06 Pit/5 Ghavee abound pith ye/s RZ& -41 Out,6ide diameteh At Depth below time/ A Totat absohption anea At Ahe.a he.quihed At INSPECTED BY TITLE APPROVED DATE ! 1 198.. REJECTED DATE 198 REASON FOR REJECTION REPORT ON INSPECTION OF SANITARY PERMIT # ~ 'V (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection me, ress, icense NO. o ns a ing plumber Time of Inspection c/ ° _ c7 G~/ 5tG E-/ 3 I STALLfATI N; CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BENCHMARK: (Permanent re Terence 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: (7)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 ❑ NO; 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 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 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: . TRANSFER FORM PLB 67- T SANITARY PERMIT State Permit # Sanitary Permi # County - ~ tL1 8 d ~V 7 Sin Sanitary Permit Transfer Date Original Permit Issuance Date y A. Property Location: '/4 i i. , Section T c N, R . ,'_G; . E (orCW, Lot # -City Subdivision Name, Nearest Road, Lake or Landmark BILK # Village Township B. TYPE of Occupancy: Commercial Industrial Other (Specify) Single Family Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY / -L Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab Concrete X Poured-in-place Steel Fiberglass Other(Specify) New Installation Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate . . -a. 'Total Absorb Area sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches Seepage Bed: X Length LAY Width ' Depth ? Tile Depth(top) 9C No. of lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land A, I . Distance from critical slope E. WATER SUPPLY: M Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. 7 Name `i=/= i~ / /jam S C T i Name Address /i Z_ -Z Address Zip Zip I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared by the Certified Soil Tester and/or any additional soi , tests that may have been required. r' . r Plumber's Signature ~j:' 47 MP/MPRSW # j~ t Phone # f%` L- Plumber's Address "Information obtained from (owner or a nt PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's ro ert If well has qt been drille 1 ~ I I i - ILI } i I ~ f 3 4 Signature of Issuing Agent s - 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green (copy) P.O. BOX 309, MADISON WI 5370 PLB 67 State and County State Permit # f J O V Permit Application County Permit # for Private Domestic Sewage Systems County T" 'crn/ *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 30-.?,D ~ 3~c "'.(.P U~Sc~~,fS . 57 L/&-/ 6 S0,-1 B. LOCATION: !eft-) '/4 A)W '/4, Section Lj-, T30N, R&~_ E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# (1 Village RC k,. ui rct 0011 LC-; Ps Township 5>` C. TYPE OF OCCUPANCY: *Commercial "'Industrial *Other (specify) *Variance Single family _/Y\ Duplex No. of Bedrooms 3 No. of Persons D. SEPTIC TANK CAPACITY /000 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) - E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate fW Total Absorb Area -~r7 sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of ineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: X Length Width Depth d Tile depth (top)3No. of Lines -3 Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land /12'" 15Distance from critical slope 2 S WATER SUPPLY: Private CY 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 Tester, NAME ZVI:74t C'~/_ C.S.T. # SS _~Ly and other information obtained from G (owner/builder). MP/MPRSW# Plumber's Signature s Phone # Plumber's Address Z QL~ b cf4k ' 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. .N _ e 5 k a 3 6 Fill ~~top E S C z5 g ~u~ - - - _ _ _ F COVER :r w /z' w~ R Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: Statej',~ County Date Permit Issued/Re}acLed.._(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 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 PH 115 Rev. 9/78 ! v r- REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES rs P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: ~~'/4, N a, Section ~ ,T,.LN,R~E (or) W, Township or Municipality f s r n Lot No. , Block No. County Subdivision Name Owner's/Buyers Name: dgE A4~ "I -f C_ Mailing Address: D 11) f y0~ (~~J\f TYPE OF OCCUPANCY: Residence _Z{ No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL. SYSTEM: NEW X R~E,P~LACEM{ENT C,Q ALTERNATE SYSTEM- DATES OBSERVATIONS MADE: SOIL BORINGS TJ 7,19 1 j O PERCOLATION TESTS 2 C ZZ?o SOIL MAP SHEET 565Y - NAME OF SOIL MAP UNIT e ll PERCOLATION TESTS C#-e T.a-le TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES ^'UM- DEPTH CHARACTER OF SOIL RATE SINCE HOLE HOLE AFTER INTERVAL BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- 5kqc if 4 ,f TeR 0,0 &-,'A- P_ P-Z 12 72 ' p P- °7 fr v lp- / 2- 741,4- 14S I/n~ 7i 6 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- 72 tiovE- > -7 "AtOAI - L ~~.6.) . L y' o. SZ 2 - ? ar w w B- 3 d I t > 10k WQV. 4 s "o G ~ e5 ~cG 3~'" ._et - CS B- PA)E_ > 12e) b':Pe .,L L 'AP. C fS °cS w 71„ -/3,v . cS B- 7Z 'VOA/ " "de.5d 23'0. Ji/ O'U /c a ~OH,~ro 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 615, .Indicate scale or distances.-.r Give horizontal and vertical reference points. Indicate slope. L s. TP 3'01?114r sy.•v 00 M 46 asps 3 " - ; a 1b _7 , -A N, N , P0 P p,~lL G~ 4 ./3/x'1. it 1611f i~e F' 19 f r w ZG ~v s/b~El`~ n E a - E ~9 tow a b GlfiR/~/G-_rp r rvfx~~ 13S 13,,(-1 /its AWOX. 3YO ' 5,,1Y ao /Fe4,0, 14 kv 1,04K &11 00A95 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 (priw)'&~ni ~r Certification No. ,7 7~CJZ y~~~ Address )e4 3 (')'A~ F,1 IL- 9 1 Lj2 SOA,' LOOS .Name of installer if known Z4M~ ~~C©SJ~SI~.t~ ~~S Copy A -Local Authority CST Signature EH 115 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!9/ '/4,''6) '/4, Section -4 ,T~bN,R1-0E (or) W, Township or Municipality Aefi `a - Lot No. , Block No. County ;n Subdivision Name Owner's/Buyers Name: AO-1 U Mailing Address:, e0l S TYPE OF OCCUPANCY: Residence X No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REP'LLACEMENT -ALTERNATE SYSTEM -OTHER DATES OBSERVATIONS MADE: SOIL BORINGS ZMa PERCOLATION ~~TEST S-_~ SOIL MAP SHEET SC S y~ NAME OF SOIL MAP UNIT (1//^~ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES ` RATE NUM- MINI l~ SINCE HOLE BER INCHES THICKNESS IN INCHES 1 T WETTED HOLE IN M NU ES 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, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- B- B- B- B- B- 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 Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. ,o~ j~~%• 11414 _ ~LN 1103 7t~ y- 13,1 133 k • N 12S_ A-7 E } , ZA, _Z) 14 = a t n e , 1 j 1, 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) -411121c 171 Certification No. Address ~L-- Name of installer if known Copy A -Local Authority CST. Signature s t OD ~ o I _ (Ti IV\ f I V1% r~ - r s~ S PIP !b1 -A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health Section of Plumbing & Fire Protection Systems ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises Street City County Master Plumber Address Owner Address ❑ County Permits _ ❑ Appropriate State Permits Type of Building: ❑ Public ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer ❑ Conventional Soil Absorption System ❑ Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH: a € , f ~ _ w 1 a _ t ti r x_ _f _ r t€ - - , E r i 3 E j € 3 , i € e e ._.w. a .e _ e Tm '.o _ A. I , tt 1 f1 ~ / ~ C ',sue-e-... 4. m~~.. -hm # . , e € g i , .e.. m e a m m m f > . q _e.... ~ . xn.e {.-.e- - a e m _ _ , s € - w s a r I , F } € 3 { € 7 i I a , g € E s , , r F E E , j. ° s € j f t _ Imm ❑ SEE ATTACHED DISCUSSED WITH PLUMBER ( ) Yes ( ► No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector Yellow Local Inspector Pink - Plumber or Responsible Party i