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HomeMy WebLinkAbout040-1007-40-000 ' n N 0 -0 o r- a) O C7 v1 d # < O 3 - 3 O w C . n 2 N z m o a ° ~T C O N W V < `OG N Q ~I tD 7 O_ O tD m N 00 f, CD rn 3 W O C) O ^ 1 N (1 N 61 \ 1 N s O r W o , C N Z = n z o D o O :3 ° cn o 5" F CD sn N v O Q) (n (D iD (C] (D N O. N U N W C C O O C~ C) 3 O OD N Q !I D ("(4~I CD -4 -4 N (D (D d N O C Oo w O a' ~Y O O O c: E Q c N can N CD a N _~f Q C, m 0 p n ~7 ~ N w A N O .3 C L ICI X CD CO ~Q N :OE D z z co z O D m o O a 3 Z m m !r N CD CD N ( N C CD CD O W ~ SZ 2 3 7 Z = -1 y O z fCD 7 A z O v n I O~ I z N w (D (D m 00 (D (D C z 0 z N z W N N N. m c 5 z a m o c N (D n 0 a N CD- 3 fi o_ n N O O O A V O tp W ,r.9 O c„ o g e o a . L~ Y420 y . RFPOP,T OF ITISPECTION--I:dDIJIDTJAL SETJAGE DISPOSAL SYSTEii Sanitary Permit: State Septic l ~z TO II`SHIp_~ A rl t. Croix County ~r SEPTIC TAM" t / size gallons. `umber of Co nart:nents - Distance From: 'dell 12% or greater slope ft. Building z z ft. Wetlands f~ ILighwater ft, DISPOSAL SYST:1 Tile Field or Seepage Pit(s) Distance From: i1eli ft. 12% or greater slope- ft Building; ft. Wetlands f:. FIELD 'Iiighwater ft. Total length of lines -7-4--ft. Number of lines Length of each line ~ft. Distance between lines ft. Width of the trench f-,ft. Total absorption area sq. ft. Depth of rock below tale AZ-in. Dp-pth of rock over tile 2. in. Cover nver.rock., Depth of tile below grade L' in. Slope of trench n ; r 11_ 0Q ft. Depth to Bedrock ft. Depth to ground water ft. PITS "lumber of pits Outside di et ft. Depth below . inlet ft. Gravel around p' no. Total absorption area sq. ft. Square feet of seepage trench bottom area required. , Wquare feet of seepage nit a requir d Inspecte tI e: . Approved Date 197j r TY Rejected Date 197 S4 14 SZ~k tate and County State Permit # P L 13 6 7 Permit Application County Per for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPER Y Mailing Address: !T , B. LOCATION: 6s/'/a,&, Se on T 'N, R E (or) W Lot# City Subdivision ame, n crest road, lake or landmark Blk# Village Township C. PE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES Dishwasher YES NO Food Waste Grinder YES/ISO # of Bathrooms- Automatic Washer ~S :110 Other (specify) E. SEPTIC TANK CAPACITY ? ! Total gallons No. of tanks _ *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New /----A' ddition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width Depth ~~'Tile Depth No. of Lines _ Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land / L3 Distance from critical slope 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 5561 -ester, L NAME Zr C.S.T. # l-T and other information obtained from 4 6".1f (owner/builder). Plumber's Signature MP/MPRS # g!Z Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). A. ~ I f L I Do Not Write in Spa a Below' AR DEPARTMENT USf_ ?N?~Yourit Date of Application Fees P ' State CDat d ~P Permit IssuedLBajectI -'date) " / _Issuing Agent Name Inspection Yes No Valid# Date Recd 1. county (whit copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADI N, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1 /76 i Plb 67 r ~ State and County State Permit # Permit Application County Permit 'r 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: L t A ©y ' 0 -l ~c _ 19 v DSoti c t1, B. LOCATION: Af /4 Yo, Section TN, R (or) W Lot# 5 Z City _ Subdivision Name, nearest road, lake or landmark Blk# Village _ J (PICO (X C1,jAd S Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family _ Duplex No. of Bedrooms _r No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms_Z Automatic Washer X_ YES NO Other (specify) E. SEPTIC TANK CAPACITY / 00 0 Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) [j4 2)__-[JA3) j-,_"Total Absorb Area - sq. ft. New A Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length Width Depth Tile Depth No. of Lines -2-Seepage Pit: Inside diameter ~TLI_iquicl Depth-_S_ Tile Size Percent slope of land Q u- Q. If Distance from critical slope A) 0 vU e' 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 4A)- --/-/0 zu;-f C' fop C.S.T. # and other information obtained from (owner/Iad-le r). Plumber's Signature r ~ c MP/MPRSW# Phone #j~(~ - PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). L AP, 0 ALL ,ff V A~ ` X63 ACPe:~ ISO s> _ 100-4 Cj (.Alfom; _ __7 i 'r f < < < t f ~ . 3 Do Not Write in Space Below FOR DEPARTMENT USE ONLY Date of Application Fees Paid: State County Date Permit Issued/Reed- (date) Issuing Agent Name l r Inspection Yes_ No Valid# Date Rec'd 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 3/1/75 EH 115 (11-74) WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES • . DIVISION nF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 • MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: '/4, _1/4, Section T_N, R E (or) W, Township or Municipality Lot No. , Block No. County Subdivision Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET - SOI L TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 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 reference point. Indicate slope. t N I, the undersigned, 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) Signature Certification No. Name of installer if known Copy C - Local Authority 16, Parcel 040-1007-40-000 07/21/2006 09:14 AM PAGE 1 OF 2 Alt. Parcel 03.28.19.37A 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 - COFFEY, HAROLD E & ANDREA BARLOW HAROLD E & ANDREA BARLOW COFFEY 587 GILBERT RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 587 GILBERT RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 5.030 Plat: N/A-NOT AVAILABLE SEC 3 T28N R19W 5.03 AC IN NE NW LOT 52 Block/Condo Bldg: OF CERT SURVEY MAP IN VOL I PAGE 102 ORD Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 03-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/01/2004 764475 2586/013 EZ-1 07/30/1999 607767 1445/471 WD 07/23/1997 1117/248 QC 07/23/1997 593/509 more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 71,500 223,500 295,000 NO Totals for 2006: General Property 5.000 71,500 223,500 295,000 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 71,500 223,500 295,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 515 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1007-40-000 07/21/2006 09:14 AM PAGE 2OF2 I Parcel History: cont. 07/23/1997 549/94 I ( tot -au 7 4 (Jf 56 30 r`4Ly' t r,. i1~t 0 Qu OD op 3 .r 4v 'u te. w 0:" JID VA "Awm IQ f Yc / J = V. 9 r,< r Jr 7 Ago, N ~ INS ry hd r f too S' J 1. rt f . n.. ^1 m . 82° 50' W z S ZR2-3g ' \ TOWN ROAD PROPOSED 1. ~ ' f 1 j } I i f ' ttf ~~~i rY s { f WIN W, WTI Wt xx Too gin 4 " f. 1.C a) 4 x/ } CIP) 3 lot 9 T3 r ~5. a D Ton-, 05 >il if <i tt lk rr ` 4 1-0 Sam 7- a: r ifig yia { X Ins. 14 \ i S 82°50 W 282.33 TOWN ROAD