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HomeMy WebLinkAbout018-1020-50-000 0 c 0 ° 2 � T $ O f/ o § E ' m » e ] % \ ' \B0\ °w L § / 2 ; 7 B \ \ § E . _ C �:a ■ E m z / 2 % 0 0 11 E a o E c: §c i E 0C D a w CD \ § § 0 § « $ w ¥; n r ■ @ CO S I' 9 & § 3 : / T"a M 3 jj E "w. 2 2/ o 0 o g " \ § 0 ( § § § / § \ j \ 7 CD OF \.� CD 7 �� } — z .. / o > > o � - � _ CD � w f } 7 , � � � ■ a 0 § ) 0 .. z / § 5 i \ 2 I 2 z » \ CD / . � k . 0 . I £ n 0 CL / o � $ � K � A . � . � » \ o . » eg � < § \ / 8 , Parcel #: 018 - 1020 -50 -000 05/22/2006 05:04 PM PAGE 1 OF 1 Alt. Parcel #: 10.29.17.154A 018 - TOWN OF HAMMOND Current �XI 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 PATRICK T & DEBRA L HAMMOND O - HAMMOND, PATRICK T & DEBRA L PO BOX 413 HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 18.037 Plat: N/A -NOT AVAILABLE SEC 10 T29N R1 7W NW SW EXC PT TO HWY & Block/Condo Bldg: EXC CSM 10/2934 NKA LOT 3 CSM 10/2934 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 10- 29N -17W Notes: Parcel History: Date Doc # Vol /Page Type 06/29/2001 649849 1671/297 WD 05/11/1998 578843 1322/218 WD 07/29/1997 1254/163 WD 07/2311997 1116/203 WD more 2006 SUMMARY Bill #: Fair Market Value: Assessed with 0 Valuations Last Changed: 08/24/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 26,000 178,200 204,200 NO UNDEVELOPED G5 16.037 14,400 0 14,400 NO Totals for 2006: General Property 18.037 40,400 178,200 218,600 Woodland 0.000 0 0 Totals for 2005: General Property 18.037 40,400 178,200 218,600 Woodland 0.000 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 f 0 4 . 1 J fi11 -C'O ti p b C U� .- 1995 JUL 1 21995 IV � NTY 529911 O RD CEP T I E I ED SUP V E Y MA P Located in the Northwest quarter of the Southwest quarter and the Southwest q)-uatter of the Northwest quarter of Section 10, T29N,R17W, Town of Hammond, St. Croix County, Wisconsin. Owned by: Hank Fogelberg NW corner 275 192nd Street Section 10 I North line of the SW 1 /4 of the NW 1 /4 Star Prairie, Wi. (P. K. nail set) — — 15 �Unplatgd L�r ' S 89'50'08 "E 1269.83' co l I 45 4 I I m w LEGEND I " 790.164 Square Feet(18. 140Ac. a z J W Section corner U_ m N monument I It��v v ° ° Drainage course �_ Z • 1" x 24" iron I 3 a S 89'59'28 0E w 3 0 pipe weighing ao 1266. 15' 1 // w o 1.6 8 lb s./ lin . 0 Lo �, x f z ft. set. la , I p5� o w JI olo • z _ ° o ° ° -- Fence line dz z ; �' ®T 2 v Z �I ` I v 787, 883 Square Feet (18.087 Ac.) a ei J I I (L �I c co 1 :N89 1•E , m W ? rte\ . II i 45.00' i East -West 1/4 Section line W1/4 Corner h N 82621489 "E 3924 53 I Section 10 ►`5 a� :posnt of beginning (B. K. nail set) w E1 /4 Cor?Ler I L _ ° o Sec. 10 I� o , a ®�- J7 (Berntsen cap) U I : 785,696 Square Feet (18.037 Ac.) ` I_ o v S 82-48 .16" Z i 10 z N$9 °54'15 "W �. w 65.00 �' v 10.00' . �% v CU Z I N fc _ (� Bearings referenced rn 00 $ I to the West line of I S 89'5'30 "E z a w o the NW 1/4 of Sec. 0 1086.30' ° zl J 10, assumed I o ;� 1 3: OT 4 o �W = 882,094 Square Feet (20.250 Ac,) m = aI O AN „_ �.II� v n ;ra : J I �I I10 Lo ° 'o °� w =I J 1 l of o `° z omprehensive Plaru:;:. Vi I z z Zoning and I South line of the NW 1/4 of the SW 1/4 w Parks Committe3 1 456 55' I If not recordew.i I N 89' 38' 06 "W 1250.15' within 30 days �6( i Unplatted Lands 4 approval dato i SCALE IN FEET I = 300 '0130 % CWhe r SUM00A 10 d 75 150' 300 600 900' (Berntsen cap) Drafted by: JAG 495 -2412 ' V VOLUME 10 PAGE 2934 I � _ Wisconsin Department Commerce SEWAGE / Safety and Buildings Di PRIVATE S AGE SYSTEM oust yS <54A sion CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar . Personal information you provice may be used for secondary purposes [Privacy L${pr, s.15.04 (1)(m)). L Pgrt;tgIder' M TR ICK ®iAj )[iDge E] Town of: tate Plan ID No.: CST BM Elev. Insp. BM Elev.: BM Description: Parcel - — — LJUU TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic rZ j O nchmark d%' �U0 v 0 Dosing j d 4 2. ZG 5 Aeration Bldg. Sewe z Holdin io /Ht Inlet Z 3. Z TANK SETBACK INFORMATION S et TANK TO P / L WELL BLDG. Air i to ntake ROAD_ et Air Septic 7 5 -,0, 7Ss 2 �" / �- NA eVaottom Dosing > 5 0 NA Header / Man. 9r yf! Aeration N Dist. Pipe (p . !o . 22 95;2. Holding sot. System �.�6 �'• Z 9f/, yY PUMP/ SIPHON INFORMATION Final Grade Manufacturer c D Model Number �V �3 V �v GPM 2 TDH Lift Lriction +•� Syetem� S TDHZoAFt oss Forcemain Length1bS Dia. H7I/ Dist.ToWell (,✓t SOIL ABSORPTION SYSTEMS p� (-� -�- g 4� = (. (, s cam' BE TRENCH Width J- I Length / No. Of Trenches PIT No. i s nsi a ia. uid Depth EN I N a I I DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O 11 CHAMBER Mod Number: System: 5� OR UNIT DISTRIBUTION SYSTEM Header / Mold � Distribution Pipe(s) / � J x H Size x Hole , Spacing Vent To Air Intake v Length Dia. p Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 1Z /� vlG�(A�f LOCA HAM 10.29.17.154A,NW 1041 COUNTY ROA�D?�— LOT 3 s � V Tloxn l�l`fC f1 f Z S 8t IOtk`�15r.n �Pw C�'�nok 5rr' kK S S%AV NG ter r e& Akw flAe re tAey r .� •� �,, ins . g = 3 r cc '-E Plan revision required? ❑ Yes �$, No Use other side for additional information. SBD -6710 (R.3/97) Date 1 re Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i r s F ° em.:., ,.. ,...,.. .. �... ,..... « .. ... ....... .e. .....,. ,_.gym ., r..> . ma. , ..... . ._ .,,...., m s m., _.f ,.. ...._ rz ,,... .._ . .,.... ..._ .. >.._ _ �. _... M_ S E y.. s _. , i � 4 F � 3 a _ f s 3 E E E 5 . A. , �. s� . € S w. t E f ate_. . an.,., ,.... m .. F n` 1 f 3 ..,,, �,. _ a .._-.. .d .S- .... -. ., e f t z E f r' a µ B i 3 .., ., .& ...n �:. °.. .. ,......� e......... '� { ...,e, �, . .. .°.., .... . -- .. .... .... <.q .� .. 3 ,.. .. € e, .,m.�... ........e ......y e ! 3 i E t 3 } m _..,,m �. .,. .®.,.�. i i e y d F ¢ � v a 3 4 E m, ash. �m em Aam�,. a E l g _ v � 4 F s E E m r V isconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ft, , • See reverse side for instructions for completing this application State Sanitary Per t Number Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION X57 Property Owner Name �/ Property Location y- 'C' S /Q ix /a, S T �7 P f , N, R 1 1 (or W Property Owner's Mailing Address Lot Number Block Number P U Sax 3Sz- 3 1 / City, State Zip Code Phone Number Subdivision Name or CSM Number Q mrnor�_ I d" • .S o 5 (7iS 52 '?q /a )796- 11. TYPE OF BUILDING: (check one) El State Owned O it � / Nearest Road El Public 1 or 2 Family Dwelling - No. of bedrooms ° Town of 7l'Rr>I/� a C III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) I �. Za - n. 1 5 , 4 ,A 1 ❑ Apartment/ Condo 1 0 /$ — /oZ0- SD— n0o 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1..M New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System System Tank Only_________ Existing System _ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 jgMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -ln -Fill VI. ABS PTION SYSTEM INFORMATION: 1. G P IIons Per Ty 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (s q. ft.) (Gals/day /sq. ft.) (Min. /inch) / Elevation 7- -3 '7S —779 4 6 96 'ZZ Feet Feet VII' U NK/ Ca aut in gallon Total # Of Prefab. Site Fiber- Plastic Exper. IN MATION Gallons Tanks Manufacturers Name Concrete con Steel glass App. New Existing structed T nks Tanks Septic Tank or Holding Tank IZ5 / ZS" O n ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 750 7 O ��' ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (NoStamps) MP /MPRSWNo.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): / l ozd r, S - SR IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit F e surcharge Fee) (i ncludes Groundwater ate Issued Is g Agent Signa re (No Stamps) Approved [ Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber INSTRUCTIONS • 1. A sanitary permit is valid foftwo (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the _ Wisconsin Administrative Code will be applicable. -3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation -5. Onsite sewage systems must be properly maintained.' The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 - 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity.of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. it Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 isconsin G. Thompson, Governor D epart m ent of Commerce William J. McCoshen, Secretary September 01, 1998 CUST ID No.6306 ATTN.• POWTS INSPECTOR BOLDTS PLUMBING AND HEATING INC 820 MAIN ST PO BOX 87 BALDWIN WI 54002 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 09/01/2000 Identification Numbers Transaction ID No. 134050 Site ID No. 157712 SITE: Please refer to both identification. numbers, Site ID: 157712 above, in all correspondence with the agency,',' St. Croix County, Town of Hammond NWI /4, SW1 /4, S10, T29N, R17W Pat Lalley FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 417442 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, N DATE RECEIVED 08/31/1998 FEE REQUIRED $ 180.00 RD M SWIM, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JSWIM @COMMERCE.STATE. WI.US B®LDT's �V L L JOWAALIF A PLUMBING do N A nm INC. "Serving You For 40 Years" 820 Main Street Baldwin, WI 54002 (715) 684 -3378 Fax (715) 684 -3144 Page -Z-of 8 Date: % 9 Mound System For A -3 bedroom Residence Located in the L 1 /4 of the 1 /4 of Section 16 ? , TLqN, R(IW, Town of llQ m ln o n d , f C'�o j'X County, Wisconsin. i RECEIVED Index AUG 3 1 1998 SAFETY & bLUUO- U►V. Page 1 of 8 Title Sheet Page 2 of 8 Plan View Cross Section Page 3 of 8 Distribution Pipe Layout Page 4 of 8 Pump Chamber Paige 5 of 8 Pump Performance Curve P.0 N T,S. Page 6 of 8 Soil Evaluation Report Co l'I dItIoli ally Page 7 of 8 Site Plot Plan Page 8 of 8 Mound System Plot Plan �4?1Eti1 Ol= CC;MPPEt.G�NGS AYlu 9 � i ( `� Prepared For: � 711 - �7 - 00,6 Prepared By: Dale Hudson Certified Soil Tester / Master Plumber #220863 Page z ofs-- Cross Section Of A Mound Using A Trench For-The Absorption Area AST - fj — _ H Medium Sand Fill � 1 ° F 6" Topsoil 3 E U Trench Of ?" - 211" Aggregate, Plowed Layer 6" Below Pipe, Covered With D /,o Ft. Straw, Marsh Hay Or Synthetic Fabric E /. Z Ft. r, / Ft. F • 7r Ft. H /,_�r Ft. Plan View Of Mound Using A Trench For The Absorption Area Force Main Fi l .Distribution Pipe � Permanent Markers -Observation Pipe W B L K I \Trench Of - 22" Aggregate L — — A `f Ft. ,1 -i. 7, /d Ft. K /o Ft. W 2 Ft. Z 2 S Ft. 3. // Ft. L 1 / License Signed: Number: .22o,?53 Date: Distribution Pipe Detail For Two Lateral Network Holes Located On Bottom Are Equally Spaced PVC Force 'Ha Pv c F ee p e, I�o 'Y X X PVC Distribution Pipe P P X * Last Hole Should Be Next To End Cap i P 4 11, Ft. Hole Diameter Inch X `l ? Inches Lateral Diameter / / Inches) Y Y Q Inches Force Main Diameter Z-- Inches Of Holes /Pipe 12— Invert Elevation Of Laterals 9 4,7 Ft. Signed: License Number: Z 208 53 Date: Page 7 Of S COMBINATION SEPTIC TANK /PUMP CHAMBER 4" CI Vent Pipe with (No Scale) Approved Cap, +25' ,Approved Locking Manhole Cover From Buildings With Warning Label Attached Weatherproof — Warning Label Junction Box Vent Cap 12 Minimum h Final Grade—,, 6" Minimum 4" Minimum 6" Ma ximum Quick 4" C.I. ----- Disconnect 18" Minimum { Insp. Pipe-- - I 1/4" Weep Hole Baffles I Approved Joint i A 4 w /C.I. Pipe Extending 3' Alarm & B Approved Joint Onto Solid Soil On 6; w /C.I. Pipe I C Extending 3' Z_ ' Onto Solid Soi - Off D Conc. Block 3" of Bedding Under Tank Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/ of Doses: //2.5 Gallons Volume of Backflow:....... + /'SI.7lo Gallons Tank Manufacturer: Total Dose Volume:........ /Z � Gallons Tank Si ze -Septi c /Pump : 12 501750 Ga 1 ons Alarm Manufacturer: 11<� 1--112 c f� Model Number: 110 Capacities: A Z � , O i nches or / 8-6 Ga11ons Switch Type: /Y) d V - c c. + B 7 7 Z 7 inches or 30.6 Z Gallons Pump Manufac • o ('41 + C ,3 / inches or/ 7.Z3 Gallons Model Number: E y -3 11 + D / i nches or ,r -7 Gallons Minimum Discharge Rate: 'Z,o M Total ..... = _ 11q inches or Kp, Gallons Vertical Difference Between Pump Off and Distribution Pipe: /6•- Feet 0-6.5 Minimum Required Supply Pressure: ......................... 2.5 Feet 1 - Feet of Force Main x / %3/ Friction Factor /100 Feet: + /,-3/ ----- feet Z Inch Diameter Force Main Total Dynamic Head: ... j ,3I Feet Internal Tank Dimensions: Length /5/ Wi dth Liquid Depth Signature �`' /� License Number r Date 8- - ® - i Is son INS MESON Ron UP nommon MOMMEM ■i1m►s■■■■ ■r ■ ■ ■■■■r■■��■■■■ON �. gjIm• RO qtA' N 0, o ���� ■i � M a e WOMEN 0 NONE MMh7m BERS.- MN00� EMOMIMMORMSMAKIRROMME D sil •, MEN ■ ■fit ■. ■ ■ ■■ ■ ■■■■ ■ ■■■ ■■■■■■MM■■■■■■ MEMO ■■■NONE ■■■■■■■►■■■■ HIM ■■■■■■■■■■ NO ■ ■MM EMOa■■nOW■ ■■ ■ ■■ ,■■■■■■ ►a■■■■■\■■■■■i ■ ■ ■■ ■■■■■■■■■■� ■■ ■■tea ■ ■■■■ ■■■ Wisconsin Department of Commerce SOIL AND SITE EVALUATION ` Division of Safety and Buildings Page 46 of $ Bureau of Integrated Service's in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches In size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and s7. C e-o r X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all Inf" Matlon. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location �� 16? I �L' Govt. Lot N G(/ 1 /4 c_ ,d 1 /4,S &,> T 29 ,N,R 7 (Or - Property Owner's Mailing Address Lot # I Block# Subd. Name or CSM# Al9 for city State Zip Code Phone Number ❑city ❑ Village ,1SI Town Nearest Road 1(7/-5)7 9 ,i� New Construction Use: ,® Residential / Number of bedrooms -3 Addition tang building V ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 0 gpd Recommended design loading rate `- 5 bed, gpd/ft 'jp trench, gpd/ft Absorption area required bed, ft 3 trench, ft / Maximum design loading rate -t5-- bed, gpd/1'1 gpd/ft Recommended infiltration surface elevation(s) 91,51, ZZ It (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I ❑ S ,®U I BS ❑ U ❑ S ,9? U [- C U ❑ S 1 U ❑ S _[N' U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 13 f o -q IOy� y en s. Zrri /'>? ,r c o Ground -Z5 ,5'• V c e- � r r Z>�56 /�✓�'�. / t o5 , („ I I 9 `f .5'9 CZd 75 ✓r'r •5' Depth to limiting factor �in. Remarks: Boring # % 0-10 o 3 /' o s% zms GW L 613 � 5 -Z7 ' , 55 5 `I Ground 7- ..5 X ' CZd 7 YR -- ✓ • � ,'�� elev. 9 5•ZO Depth to limiting facto6i Z2 in. Remarks: CST Name (Please Print) Signature Telephone No. �I r_ a sort. 7/5'- o r oe8 '3 37,? Address 1 j Date CST Number Inc e5 / i),' ,^_ c�[ LEZq 6.40 • « 1 r �� � �� ♦ / �-G'T�Il�l�.�� ®ITT / /l® © % � A W 190 P A . .M - =� WA mm I M F �__-� • 1 1 l o Nrl / t _ DO ✓y1 N'10 n GJ. 7/5 -79 - 88`g N Lo �z9 N R 17w v 13M Z = A0 /.7z , B � - 96 •y� 13Z — 95.2 2 3� aZ O �N N II3 — 9/ 3$ B3 0 //y � ?y Sy. Y C_ 95 7-VI - T47- -� P r o� • Pr cJ P ; Pro o e l � 0 0 NDU�C tjp�O9e Hop 1 � Scale, _.1,,,� raw►^- �� � • �> � .. � � y � ' � A P; ri f�. l b 1�a � a � L ox 3SZ Sec,, /o 7i5 _796 - s:t� nom. N+J% Y -z9 N K 17w $ ICI '� I = /oo • a' CM O Z = /Dh p 7Z ' B 13Z - 95-Zo" B4 zH' 9/ , 76 38 B3 9 BI E---- Not Sea IG �•�= ��i I 154 I. 3� L3 � 1546 RM Z Na; � a P P efs R z7 E. �P /csr zzog:�3 1 I ofd Oro/ II Wisco Department of Commerce ;SOt AN SITE EVALUATION g Division of Safety and Buildings Page of Bureau of Integrated Services a ccord a �ance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not les �th�d 8 1/2 x size. Plan must County L Include, but not limited to: vertical and ho Jal reference point (BM), direction and �T • �'o X percent slope, scale or dimensions, north la rro ` , an aid d is tan ce to nearest road. Parcel I.D. # APPLICANT INFORMATION - PI sejpri�4ifW0tmafiolh Rev' wed by Date Personal information you provide may be used for s :rY,purPo §es ( , (1) (m)). q /v Property Owner J / , C �- \" Property Location n Govt. Lot A&() 1 /4_c t'G� 1 /4,S /�� T 2 7 N,R /Z 4 (Or Property Owners Mailing Address Lot j B Subd. Name or CSM� City State Zip Code Phone Number ❑ City ❑ Village , Town Nearest Road 0 New Construction use: ® Residential / Number of bedrooms 3 Addition to e xi ting building Mme"/ El Replacement ❑ Public or commercial - Describe: Code derived daily flow 50 gpd Recommended design loading rate 5 bed, gpd/ft trench, gpd/ft Absorption area required bed, ft .3 trench, ft i Maximum design loading rate • bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 94 , 27— ft (as referred to site plan benchmark) Additional design/site considerations Parent material -'� Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank u= unsuitable for system ❑ S ,® u ,R S❑ u ❑ S .Nr u I ❑ s CR u ❑ S P U ❑ S EN-11 SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Boundary Roots <; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground — 3 - L 5 , ,� > `{ P, `' Y r' 2'V- -S,6 1- V4 r elev. /� 9 •Y20 ft. `f 7 _5_1 W ' C2-,/ 7� 8 S/' Zrnsb / 11 j Depth to limiting factor Remarks: Boring # G_ 1.1 / In 1/1( 0 u.) _7 15-Z 7 �5 Yk 54 Ground L7-3 •5 >) Gro/ 7 � Z.yn P9 ✓-r • 5' ,'ra elev. •ZD ft. Depth to limiting factor/, 42 —in. Remarks: CST Name (Please Print) Signature Telephone No. 71S'- 4;�P - 33 7f Address q Date CST Number J��'r -- �f; �l�v �'�. lf,�'�Z- 7-9-9 o s" PROPERTY OWNER SOIL DESCRIPTION REPORT ' Page of PARCEL I.D.1 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench El at °'9 /",) YX 3 &e " s.' � � 19-21 y Ground 3 `' y 7�y� s �,� -�- •�; 9 7, y 7 I- 5w Depth to limiting Remarks: Boring # Ground elev. ft. ; Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground , elev. ft. Depth to limiting factor in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) o� P•o• 13ox 30Z sew. /0 ?iS -76 sw' /y Tz9 N 9 17w of I314%*Z = /D /,7Z $ � • 96.yo " 95•Zo a D � 91.76 " 38 � n 0 8 ,�• 9 0 zy' BI 1 I 3� aM * Z f "� C orr e.r a AIP14CST' ZZofs3 P � � EP, z ofd' Ord Cy' I � o A' 1�' ox -3S "' /D �p �7' Q ►'�'I rY1p ►'!Gt �� I • r O J I 715 - 796- N Lo s-wi v B M BM'Z = /0 /P7Z 13Z - 95.20' z 3' a2 ,2H 133 - 9 ' 3$ d �o F S�. P �• 9s �a Prop • ' Idv/ I 0 P rof. M P rc� C��� Nousc Go�oge� BI F No, 1 Scale, �3 . I coptl.,r a. a No . E7. P. z MP165r Zzag�3 �5 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer I a �,-• , "G ,�� �� Mailing Address P-e9- oX 35 Property Address /D � �� y • j�� (Verification required from Planning Department for new construction) City/State ygrr� ' , Parcel Identification Number Oy8 - le:00 - 50 - ooa LEGAL DESCRIPTION Property Location NW y,, - W j, Sec. /o , T29 29N -R �2 W, Town of 1 1 ay 91np Subdivision NA Lot # 3 Certified Survey Map # 5 Z 9 q / a Volume A2 �? . Page # Warranty Deed # -5� 7 L fi' 4` 3 Volume /3ZZ . Page # Spec House ❑ yes JR1 no Lot lines identifiable yes ❑. no SYSTEM . IMAINTENANCE Improperuse and mamzwanceof ymscptic systemcould resalt is its pnmat fOure to handle wastes. Propermaiatenanoe consists of pumping out the septic tank every three yean; or sooner if needed by a licensed pumper. What you put into &e system can affect &e f ni ction of the septic bmk a treatment stage in the waste T Property owner agrees to submit to St Crone Zoning Department a ca6flcation fo signed by flue owner and by a maste rPhimbe4 , ]Oumeymanplumber. restdctedphmrberor a licensed puaq=verdymg that (I) the on -site wastewaterdisposal system u m Pmper operating condition and/or (2) after Ica and pumping (if nooessary), the septic tank is less than W Full of sludge. Ve. the understood have read the above roquh ments and ague to maintain the private sewage disposal system wi& the standards set forth, herein, as set by &e Department of Commence and the Department of Natural statin tha Your Septic Resources, State of Wisco�in.. Certification system has been maim mast be completed and rodzrned to the SL Croix County Zoning Office within 30 days of flee three year "Puau date. SIGNATURE APPLICANT DATE . OWNER - CERTIFICATION I (we) certify that all statements on this form am true to the best of my (our) knowledge. I (we) am (are) &e owner(s) of the Property described above, virtue of a warranty deed rocorded in Register of Deeds Office. 1/�2LS�)D� � - ;>'�' I SIGNATURE APPLI / A ;� DATE «s « «s Any information that is mis reseatodma result in the sanitary s «ss «« - r'eP Y tary Permit being revoked by the Zoning Department «« Include with this application: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 2 - 1982 517SS-113 11 WARRANTY DEED DOCUMENT NO. David D. luem and Marci J Drink- -a&4-jnt ten rite 'A/! convev- and war to Patrick J. Lalley an Marla K. Lalley MAY I 1 1998 .husband —and —wife —as survivorship marital propetcy— 9:30 A0 �5 T HIS SPACE RESE R VED FOR RECORDING DATA 11-r* AND RETURN ADDRESS the following described real estate in St. cioix County. State of Wisconsin: it 018-1020-50-000 F%F IDENTIFICATION NUMBER Part of the NWV4 of SWV4 of Section 10, Township 29 North, Range 17 West. St. Croix County. Wisconsin described as follows: Lot 3 of Certified Survey Map filed June 8, 1995 in Vol. "10", page 2934. as Document No. 529910- SL Croix County, Wisconsin. $ 4SFER This is not homestead property. (is not) Exception to warranties: Easements, restrictions and rights-of-way of reect Dated this day of May A.D., 19 98 (SEAL) (SEAL) Ii David D. Juen (SEAL) (SEAL) Marci I- Drinkwine AUTHENTICATION ACKNOWLEDGMENT Signatu re(s) State of W ss 9t. Croix County. authenticated this day of 19 Personally c=w before me this — day of May 199 8 _ , the above named David D. Juen and Marci J. Drinkwine, TITLE: MEMBER STATE BAR OF WISCONSIN single pens as joint tenants (if not, Brenda Poulin it authorized by §70o.06, Wis. Stats.) Notary Public tome ki, n J who executed the foregoing Z State of Wisconsin P in d ackmc- stru"7 /I THIS INSTRUMENT WAS DRAFTED BY -�"ed be pers h;tme, At',nmey Kristina 06tland Zmhda Pauli n Hudson W154016 Notary Public, St. Croix County, Wis. (Signatures may be authenticated or acknowledged. Both are n( My commission - s re-Tri.inent. (If not, state expiration date: necessary.) 11 / 19 20qq_ 1 of persons signing In any capaily should be iyped or printed below %*sr svgs iuses 'TA FF Itill OrWIV YIKCOn5.1 L---c,31 81.r* Co 1,c Wisconsin Department of industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 -Labor arxi Human Relations _nivisir,i of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix I not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to ne; rdst read. 018- 1020 -50 APPLICANT INFORMATION- PLEASE FtINf;.., 1. a k v ION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Hank Fogelberg * GOVT. LOT NW 1/4 SW 1/4,S 10 T 29 N,R17 Wor) W PROPERTY OWNERS MA!I_ING ADDRESS — r LOT # BLOCK # SUBD. NAME OR CSM # 275 192nd. na csm pending CITY, STATE ZIP UM ❑CITY ❑VILLAGE ®GOWN NEAREST ROAD Star Prarie, WI. 540 8'03 Hammond Co. Rd. #T (x)cNew Construction Use Residen • r 3 (] Addition to existing building I ] Replacement (] Public or co d Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/ft trench, gpd/111 Absorption area required 375 bed, ft2 375 trench, ft Maximum design loading rate . 4 bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 100.2 ft (as referred to site plan benchmark) Additional design / site considerations contour line a, el. 99.2 Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system I❑ S QQ IM S ❑ U I ❑ S 0 ❑ S RldU I ❑ S tRU ❑ S MU SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture I Structure ConsistencelBounday Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends 1 0 -10 10yr4/3 none 1 2msbk mfr gw if .5 .6 1 4 <.«i 2 10 -32 7.5yr4/4 none scl 2msbk mfr 9V i f .4 .5 3 32 -41 7.5yr4/4 7.5yr5/2 scl 2msbk mfr gw na .4 .5 Ground 2p 7.5 r5 /6 elev. 4 41 -60 10 r5/4 c2 99.6 Y p 7.5yr5/8 sicl M -- na na npp Depth to limiting factor 32" Remarks: Boring # 1 0 -11 10yr3 /3 none 1 2msbk mfr qw if .5 .6 v 4.4 2 2 11 -26 7.5yr4/4 none scl 2msbk mfr gw if .4 .5 3 26 -60 7.5yr4/6 t2p 7.5yr5/2 scl 2msbk mfr na na .4 € .5 Ground 7.5 r5 8 elev. 99.6 §. Depth to limiting factor 26 " Remarks: CST Name:— Please Print Gary L. Steel Phone. 715- 246 -6200 Address: 1554 200 h. ave. , Nipy Richmond, WI. 54017 Signature: Date: CST Number: 4 -6 -95 cstm 0 PROPERTY OWNER Hank Fogelberg SOIL DESCRIPTION REPORT Page 2 c= 3 PARCEL I.D. # 018 - 1020 -50 r Boring # Horizon+ Depth I Dominant Color I Mottles Texture I Structure Consistence JBotrdary I Roots ed Dft in. Munsell + Du. Sz. ConL Color Gr. Sz. Sh. T2 "3i' 1 0 -10 10yr4 /3 none 1 2msbk mfr gw 2f .5 .6 2 10 -20 7.5yr4/4 none scl 2mssbk mfr gw 1f .4 1 .5 Ground 3 20 -31 7.5yr4/4 none scl 2msbk mfr gw na .4 elev. 7.5yr45 2 9 4 31 -47 7.5yr4/4 c2p 7.5yr4/6 scl 2msbk mfr na na .4 �.5 Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor 7-1 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor r Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Hank Fogelberg 1554 200th Ave. CSTM2298 WIWI S10- T29N -R17W New Richmond, WI 54017 MPRSW 3254 town of Harrmiond (715) 246 -6200 N 1 " =40' BM.= top of 1" steel pipe C el. 100' Coe � Dr ` PA 0 LW ID z r Gary L. Steel 4 -6 -95 1 1 1995 ap p 9 , a.4 5 y99io C ER T I F I ED SURVEY MAP Located in the Northwest quarter of the Southwest quarter and the Southwest 4- )uaz�ter of the Northwest quarter of Section 10, T29N,R17W, Town of Hammond, St, Croix County, Wisconsin. Owned by: Hank Fogelberg NW corner 275 192nd Street Section 10 I North line of the SW 1/4 of the NW 1/4 Star Prairie, W i. (P. K. nail set) I - - 15 Unplatted Len S 89'50'08 "E 1259.83' c I I 45' \ V W o OT 1 W LEGEND I N . a 790,164 Square Feet(18. 140Ac. N . z W J IM�to m I- Section corner IN U_ m (V monument I c v o a CU I� Drainage course �_ z • 1" x 24" iron 3 a S 89'59'28 "E w 3 0 pipe weighing I CD CO 1266.15' / P, In NI 1.68 lbs. / lin. U' / 7.7' W 01 z ft . set. I N N o <I loo :z 0 0 0 0 l - Fence line ; °IO W WI ti� z Z §_(9 T 2 Iq N z I 1 787,883 Square Feet (18.087 Ac.) �1 to t a zl :N89 °51109 "�E w of i 45.00' 1 East -West 1/4 Section line I N 89. 51'09 "E 3924.53' WI Corner 1262.48' Section 10 ►`� 41 :point of beginning 1 - W. K. nail set) w g g E /4 Covaei ° o Sec. 10 1 I7 o : Y ® � 3 (Berntsen cap) I o* a m LO mil o 785,696 Square Feet (18.037 Ac.) Q� I O Q . N S 8 0 48' Id Z [� - Z N$9 °54'15 "W W s5.00 7' (Di ZiIITI 10.00' . v iv 3 N v c0 N d � / 0 °m Bearings reference � ° I to the West line of I �' S 89 z 3 W a the NW 1/4 of Sec. 1 0 1086.30 v ° zl <I 10, assumed I o 0 m a o !L ®// `�` of W �W a _ X 882,094 Square Feet (20.250 Ac.) N = c1 JUV r 0 zl Fin o �; W � j�lol °� ° Z 0110 ° J V�Iz z South line of the NW 1/4 of the SW 1/4 W I4$ 55' I . N 89'38'06 "W 1250.15' Unplatted Lands :° ;ti �',, :1. 1 I = 300 ' + SCALE IN FEET /, ,► 1 fiW Cc�i+t�er S'giti'o*i 10 d 75 150' 300' 600' 900' (Berntsen cap) Drafted by: DWG 495 -2412 VOLUME 10 PAGE 2934