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HomeMy WebLinkAbout040-1103-70-000 n cn O K v 0 y C) 3 m CD v C/) T a O 2 u o W rn rn A i ;!+a • c v w v O W N r CD 0 (D CD CO D A w 1 NO -0 Q cr O A p O O 0) W O A ~y O !fie W 7 N O N (D ri d (D z i C a i W W Q O O d 0 C) O CD rn m a n r N N (h O c PI+ C9 O ;a o N v v h. O O O z o c i N 3 Q i to fn !n m w CD v v _v - N N Qo w d ~ N 4' m cD m D A _ o 0 ~y y N N O W N C 77 :3 CD a cl K Z Z Cn Z Q D (D o D sv ~ m F ~ N C CD w co n n --j Cp O O A Z CD U. zt ; K A Z 4 O_ O Z -i N co D m N O) tD fD CO CL z A o Z N z (D A N N y`> N fn CC (D (D G C-) a O N Z TI CO N c CD - 7 C a. O Z -6 - O N N } t17 U. 7 O a ~ W ? 7 ~ r p> O -o co 3 N CD CD a v v n ~ A w 0 b Q a O(D tv T O O N V O ~ N O ^Q _ CD iw 1 0 O t O 2 C) Q- Parcel 040-1103-70-000 03/19/2007 01:58 PM PAGE 1 OF 1 Alt. Parcel 26.28.19.404B 040 - TOWN OF TROY 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 - HANTEN BROADCASTING CO HANTEN BROADCASTING CO 178 RADIO RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description " 178 RADIO RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 4.590 Plat: N/A-NOT AVAILABLE SEC 26 T28N R19W 4.59 AC IN NE NW COM SE Block/Condo Bldg: COR NE NW, TH N ALG E LN 400 FT, W 500 FT, S 400 FT, TH E ALG S LN 500 FT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB 26-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 4.500 55,000 255,400 310,400 NO Totals for 2007: General Property 4.500 55,000 255,400 310,400 Woodland 0.000 0 0 Totals for 2006: General Property 4.50J 55,000 255,400 310,400 Woodland 0.00J 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form t;lb 67 Wisconsin State Board APPLICATION FOR PERMIT of Health for PURCHASE OR INSTALLATION OF A SEPTIC TANK (Sec. 144.03, Wis. Stats.) A. OWNER OF PROPERTY Name Address Street, City, Zip Code B. LOCATION OF PROPERTY WHERE SEPTIC TANK IS TO BE INSTALLED P Check 1. _ City Mail address 7 - County one: 2. Village Town Give license number held: C. INSTALLER Wisconsin Restricted Licensed Sewer Plumber Services Nam Address i j 2 ? D. SPECIFICATIONS OF SEPTIC TANK Size in gallons: Check one 1. 500 gal. 4. _ 1,500 gal. 7. ` 4,000 gal. 2. ° 750 gal. 5. 2,000 gal. 8. 5,000 gal 3. 1,000 gal. 6. _ 3,000 gal. 9. Dover 5,000 gal. give capacity Materials: t . t Prefab concrete 2. Poured concrete 3. Steel E. TYPE OF OCCUPANCY 1. Single family residence 3. Commercial establishment 2. Multiple family residence 4. Industrial establishment F. APPROXIMATE NUMBER OF PERSONS SERVED :DAILY G. PERCOLATION TEST MADE 1. Yes 2. _ No Date f- L By whom (To be completed by County Clerk) Date application is filed and fee paid Permit issued (date) Permit Number County Clerk Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. County Clerk will forward application, the fee of $1.00, and Copy (b) of the Permit (yellow copy) to the State Board of Health. Checks and money orders should be made payable to the Wis. State Board of Health. • ' ~✓U h 6~ Lit t tf~ J/ ~l 1109 Plb 60 NAME OF BUSINESS , LOCATIONZ' - 54zt W;'~'+~~' / Y)4/~/ S ~~Q street or highway ,~V;rcu..Lv city or township county OWNER 1y 41o4 Mailing address ARCHITECT OR ENGINEER Address PLUMBER.2&a Address 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building Addition if addition to existing building attach detail d memo for each. ( ) Restaurant or dining room . . . . Seating capacity (10 sq.ft./person) Motel ( ) Hotel ( ) Cottages Number of units: Regular Housekeeping 2 persons/unit 4 persons/unit TOTAL NUMBER OF UNITS Bar or cocktail lounge . . . . . Seating capacity (10 sq.ft./person) ( ) Nursing or retirement home . . . Number of beds Mobile home park . . . . . . . . Number of units - dependent - nondependent ( ) Service station . . . . . . . . Number of cars served (daily) School . Number of classrooms Meals served Yea_ No~ Showers provided YesNo ( ) Factory or office building . . . Number of persons (total all shifts) Residence . . . . . . . . . . . Number of bedrooms Other - specify 1?,4D /Q c.7+ TA 7~ It dR 4 T 2. Indicate whether or not the following facilities are connected: Food waste grinder . . . Yes No Dishwasher . . . . . Yes No~ Automatic clothes washer Yea- x_ No 3. Fill in the appropriate information for the following as indioated: Septic tank capacity planned 10 1 D Normal septic tank capacity required D d U ~~//v 50% increase for FWG or AN S -D septic tank capacity required Q0 s~ Percolation test results - ATTACH PERCOLATION TEST REPORT SHEST Seepage trench bottom area planned width , linear feet depth Seepage pit planned outside diameter ds~p?h be 4 low inYe , depth Seepage trench bottom area uir~ed 3,Zo 3~ , width linear feet p2~ Seepage pit required %P! outside diemete r depth below inlet 13 Signature of person completing form: STATE BOARD OF HEALTH, PLUMBING DIVISION P. 0. Box 309, Madison, Wisconsin 53701 Address: _~7j ,,r¢L1 S Approved: ~1 U c*•~~s~-l. Date Date►~ TRIS APPROVAL IS BASED ON STATE PLLINy'PING CODE REQUIREN ENTS AND DOES EXEMPT THE K T A LATIOIi riiC =i CI f'i, t' , . LAuE, TOVdtaSTiIP O CI I . i i' OR PERMIT REQUIREr Lll . ado - 3 - 76 -6eb Plb 60 NAME OF BUSINESS.' LOCATION street or highway city `r to~nshi county OWNER 4¢~ - Mailing address ARCHITECT OR ENGINEER Address PLUMBER_X~-.a!Address 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building'" _ Addition If addition to existing building attach detailed memo for each. Restaurant or dining room . . . . Seating capacity (10 sq.ft./person) O Motel O Hotel O Cotta-Zos Number of units: L lar Housokoepin.as 2 persons/unit 4 persona/unit TOTAL NUMBER OF UNITS O Bar or cocktail lounge . . . . Seating capacity (10 sq.ft./person) Nursing> or retir©m;,it home . . . Number of beds Mobilo home par}; . . . . . . . . Number of units - dopond<,:nt - nordepondcnt ( ) Service station . . . . . . . . Nur.3er of cars served (daily) ( ) School . Niuber of elaaarooms Meals served Yes- No~ Shoaors provided YesNo Factory or office building . . . 1%,mber of porsons (total all shifts) Residcnco . . . . . . P-ri.ber of be1roems r other - opceify 2. Indicate Va,tiDr or not the follo:ri.ng facilities r.re connected: Food w sto &rind3r . . . Yes No-X-1 DisYmasher . . . . . . . Yes_ No V Nom Autor.:ztio alotho3 i.=char Yes 8. Fill in th3 e;, rcpr^iato intor:: tier for th-) follc.rin,; as indicated: Septic tsrii arpscity plcnnod i,L.9~~ Normal soptic tan's capacity rcquirod ~J ti-a 5Cr' inomaaa for F°FG or k',I Total soptic tan'., capacity required ~If+ lj Percolation tost rcMults - ATT .ZH P F;OLA?1ON TF ST P--- OE SH~-77 S©epage trench bottom area p1rm3d width linear foot , depth Seepage pit plnnned outside diameter r ~q pth below inlet 1 depth Sovp~;e trcnah bottcn ar,,a required wid-rh linear feet Scope pit required t ~~2 i cutsido dis.~,,ster depth bolo:r inlot Signature of p^rson completing fora: STATE BOARD OF HEALTH, PLUMBING DIVISION P. 0. Box 309, Madison, Wisconsin 53701 Address: r fIt l Approved: - . Date Date; INIG CODE F LA,,E, TO';; ;o J^ 'M, UP, PE :20J t(EvUiw :;icilS. 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E O Cs, 3 W 3 ,-t E E E m m n co to o in m H C4 Cl) ~~1 GCAT OF INSr CTICN---INDIVIDUt_.L 713TriAAY T.t _ .Tivi-NT consists of -Septic tank. C'ther (Describe) _ ft. Building ft. -PTIC T IiJK : Distance from: - ell~ft. Lot Line y0 High watermark ft. 12% or greater slope ft. etland ft. Cistern ft. No. compartments Liryuid capacity, gal. 7FLUENT DIS='C` AL SY,ST,-; consists of -Tile field. ~eepage nit(s). Tile Field:Distance from: 'cell ft. Building ft. Lot line ft. Cistern ft. High watermark of water course ft. Slope 127, or gre Ater ft. ' etland ft. Total length of tile lines ft. lumber of lines . Length of each line ft. Distance between lines ft. :idth of trench in. Total effective absorption area of trench ',ottem sq. ft. Depth of filter material below the in. Depth of filter material over tile in. Cov-r over filtc r m-terial _ Depth of the below finished grade in. `dope of t.r(?nch bottom in.• per 100 ft. nth to bedrock ft. Depth tc ground water ft. seepage "its•Distance from 'ell ft. 2uildini7 ft. Lot line ft. Cistern ft. High watermark of water course ft. `-lope 12, or greater ft. etland ft. Humber of '-'its Cutside diameter ft. i) nth belot,,r inlet ft. Lining material Gravel around pit:_Yes. iqo. Tctal C-,scrption areYv, _ sq. ft. Souwre feet of seepage trench bottom area recu.ired Square feet of seepage pit area required j ~ re-construction Ins ection C? ? ' ' ` ' Date of Inspectio 196 Inspected by: 10 Title: Construction nectien Date ,1.9 Date ,19 Date ,19 ~.nT)roved Date 19 iejected _ Date ,19~ _iNIBIT NC. 5 1Q~0 fJ~^ County, Toim of unitary Permit ini?lica+1i.cn No.__ Cwner,l~ ~ ~Sanitary Permit Ne. roperty _,ddressI`/ z Land use Permit No. Street or Highway ii Septic Tanlc -rmit Ao._ ubdivision