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HomeMy WebLinkAbout018-1006-30-200 o o o 0 0 o~ c p 0 I I o ati p I I N L c 0 0~ I o in ,p o cf0i obi ~ a ai (D t 3 I I o °00 Z o z z c p m ° m U. c O« LL C 3 Nin 3 ¢ w in Q I I z y z tl) 3 C z d d ~d d M~v~i ! am \a o o _ c 0 z z i0 w U) z c o o o 4' Q z p z E 'p 0) M -p 01 M 4) m N 0. U1 \ N U) U ~ I M~ c c n L t a r t c O ~ c O o (~D ¢ w o Q y_ z~z o zF-z o N _ Z _ cc Z M j d N C C', m E c m m A c U N Ua d N O N d o m p 0 mecca ~nGCa E UNI Z N> o N N U) v O N N N cLi 'E O EL E-L U) 16 5 •N ~aaa aaa N a c p to o 0) rn rn rn m p~ rn } N J V E a 0) I S p N ~ ~ m ~ N 0 C1 O CD Q m C a ~Q co y C CL .G y _m N 'C to d O N O 'O d QI } fn m ...ter 'p d Q } fA m O N U) a y y O O V! C E 410 Y1 C 10 N O = N E pL 20 ua°o V m n o c (D N 0 p M (D c N y N O r O N to N N O r- ~ N Z, D L O O E O d N W C N M M N CY) 0 4 oo M C w 7 to u m rn p w co m y • 0 0 2 O N O z C d' g fA N O z C Cn V - € y EL a a • ee E .2 ! d d d m= ~w c A _1 A ciao 0 inci oinc~ -01 C) Q o Ii o ° I o ~ O °v) '0 5c c o r. cn 0 3~ co -aocn e~ ~c 3 o coo° o c O y 9t y O N U p O ' 0) y C04 N p) ` I N C H f0 ,V C ~x ~ N v ( p N N CO ~ O N N O ~ a _C C z 3 C L O 7 as O C LL C C w ~ m _ p N N -0 cs EU~~ o w 2 p h Q a ac. Cl) Z E U) o v z ~ y 0 m N a M ~ U) O Z V c m Z d c !A F- r O N c E rn 'D 4) cc N a N N u) c: CD U) O O O • N O O Q. ) .C (0 N N C C O t, 6 0 O O 2 Q N N N Z H Z Z O 4 4 O co c D Cl) N co N M d N N (0 i LO ~ G O a E z N 't H H H 2 U 1 0 0 0 d •~V a a a a c r~ O o CO E rn rn CO v E °2 co '0 O _N N M > > o o E =3 Q c ~ r -o „ y ~ O N N N O C M C 3: 00 ° O E O N _ O U F- C O N p 0 0 a o O \ L M 'It ~o p Y 01 C -p N N V r,: c ° O N c N N n.l a0 N E CD 7 L' 'O L M M • ~a M co c0 p~ U) CO O U 0 0 2 O N O N Cn Rl a y a ~ rr• w L v 7 _ j A U as 0 in U ST. CROIX COUNTY TONING DEI'ARTMENT AS BUILT SANI'T'ARY REPORT ~ . Owner Address _116Tle rQU~ y S rt'3 City/State a~ Legal Description: Lot 2. Block Subdivision/CSM # Sec. 3 , TAN-R jW, Town of A:'~ d PIN # b - /61~~i~L-ZOO SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC yj/ Setback from: House IS"' Well /,OtP/L 1:5-1 Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: G®..~ Width S Length ? 5- Number of Trenches Z_ Setback from: House o ` Well LOi~ P/L /5'' Vent to fresh air intake ELEVATIONS: Description of benchmark Elevation _ZOV- Description of alternate benchmark Elevation Building Sewer ST/HT Inlet 3. ST Outlet--- , PC Inlet PC Bottom Header/Manifold 42 " Top of ST/PC Manhole Cover a'l Distribution Lines O 92,21-, ) Bottom of System Final Grade ( ) ur° aGa ( ) ( ) Date of installation / ~Permit number aWOY~2- State plan number Plumber's signature License number 027y4d Date Inspector *V. Ad ✓ -(V/ &"K) `Tall . Gt j / 14%, 9.1; / ~v< ('ompktc plot plan a •k NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW f G oA r 5 r~~ o~ O \ ~o e2~Sk7-T 77e,4- INDICATE 3 NORTH ARROW nL. nsi nDepartmentofIndustry, PRIVATE SEWAGE SYSTEM County: and Human Relations INSPECTION REPORT ST. CROIX • Safety' nd Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299032 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: ALTON, JOHN HAMMOND CST BM Elev.: Insp. BM Elev.: BM escnption: Parcel Tax No.: 0 O 1 OC ~1,~ ~1~--+c t Io~ 018-1006-30-200 TANK INFORMATION ELEVATION DATA A9700350 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r r Ben q, 1.1 Dosing rd! P 7 Aeration Bldg. Sewer 7 57 5'"5 Holding - Inlet g5.,3L TANK SETBACK INFORMATION s~ St/ Outlet 1143 TANKTO P/L WELL BLDG. Airlntake ROAD Dt Inlet Septi a NA Dt Bottom Dosing NA Header/Man. S Aeration r--~ ^ NA Dist. Pipe Holding •y Bot. System I l? 1-W ictl-33 '2/ PUMP/ SIPHON INFORMATION Final Grade Cf "S' Manufacturer Demand S ,$(o Model Number GPM TDH Lift riction, System-., TDH e--Ft Forcemain Length / Dia. Dist. To Well/ Fii SOIL, B TION SYSTEM BED THE CH idth5-1 Length No. Of Trenches PIT No. Of Pit Inside Dina. _ Liquid Depth DIME DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Typ CHAMBER Model Number: S O y t OR UNIT I el DISTRIBUTION SYSTEM Header / Manifold Distribution Pi e(s , x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing O T ?A7 ( O 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.) LOCATION: HAMMOND 3.29.17,SW,SW 1812 110TH AVENUE LOT 2 C ~ T5 Ire~a~~ ~ God ! ~ ,~~inf IM~~( RI' I o toalt a h a V~-&(f n1-3 S 5 w► ~ "a~ ~i[1 f Cs f I ~es`f ~ ' ~1 ► Plan revlsl1~~ofl req#Xed? ~ No p~C, 1 Use other side for additional information. ~J p! ( UW SBD-6710 (R 05/91) Date Inspector's ignature , 1 ert- No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i , Safety and Buildings Division ~ISCOnsin SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. k-0i O • See reverse side for instructions for completing this application State Sanitar Permit Number ~6 3 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location 174 SG) 1/4 5,ej 1/4,S T Ta2g ,N,Rt? E(or)4!P Property Owner's Mailing Address Lot Number y Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number , P" In 04w gt 4J r~ s / S- ( ) c " aV 510 Jor I1. TYPE BUILDING: (check one) ❑ State Owned ❑ Icy Nearest Road ❑ Village r Public 1 or 2 Family Dwelling - No. of bedrooms Town of .c-ns l~- d ref zea -e- III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) O1 ~l = l BOA & o 2~c 1 ❑ Apartment/ Condo 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. 51 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ®.Seepage Trench 22 ❑ fn-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4_ Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ff, yQ Elevation 115- ;7,5-d 2, Z e Feet G '9 Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete - Con- Steel glass Plastic App New Existing structed T nks Tanks Septic Tank or Holding Tank /af400 1' ;..`jzje ` "Jev LEI ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No Stamps) N PRSWNo.: Business Phone Number: d. _17 131 7, a &I Ro Plumber's Ac dress (Street, City, State, Zip Code): l d 7 ~ c( J~ ~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) )J_Approved ❑ Owner Given initial d1a• D'D 9 1~1 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) DISTRIBUTION: original to County. One copy To: Safety & Buildings Division, Owner, Plumber ,1 AV INSTRUCTIONS t 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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: 1. 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. 2 4 N f~o~6s~~L r i rlv rrt-~'J ~ ~ ~ ~D ~y I ~atp~P~ ~ IJ ?Z X ~ Wisconsjn Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page l of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than k ip Fjes it Plan must County include, but not limited to: vertical and horizo nce point (dM)„ditp ion and j 7 percent slope, scale or dimensions, north ar vJ Arid loca,n t~ distance to earest road. Parcel I.D. # elt- so APPLICANT INFORMATION - PI Prft" all ormation Reviewed by Date Personal information you provide may be used f ndary pu T os s (PrivQV6 s 15.0411) (m)). - Property Owner r,UtVTY o Property Location ( } ~ti 'C9~lf.NC~OFFfOE Govt. Lot 1/4,S ,3 T ; 2 N,R / E (or)C'• ' Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number El City ❑ Village ® Town Nearest Road [&New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow e-l 6_6' gpd Recommended design loading rate 4 bed, gpdhF trench, gpd/ft2 Absorption area required C Ca bed, ft2 trench, ft 2 Maximum design loading rate r _5 bed, gpd/ft2_,_4~' trench, gpd/ft2 Recommended infiltration surface elevation(s) /J' A5 yGr~~ ~,~ft (as referred to site plan benchmark) Additional design/site considerations Parent material 5"f c G'lrl Ll',r l 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 ❑-S ❑ U Qs ❑ U [as ❑ U ❑ S JX] U ❑ S Q 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 6-16 MYA;21~2 6 /_1 N"rv r- -5- o-3aio C~ Fubk Ground 3 6, yd ,~P f' 5 d ht' S" b elev. G r C S l r Y. 9y,~At. yd-2.' 7. S- VIP Depth to limiting ; factor Remarks: Boring # ,Z 2 6 /0 GP Y - ~ 7N 56 K h? fs! G ~ F • , , S Ground elev. Depth to limiting factor min. Remarks: CST Name (Please Print) Signature Telephone No. z' 4 Address Date CST Number 17 6~ / r PROPERTY OWNER r-t/T SOIL DESCRIPTION REPORT Page ~Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots QPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench :C, 1,4V ,.%o y S / ! 5b y Ih v~r S `t ; Ground $ r~ 6 ~S 5 f r J , „ ~p elev. Depth to limiting factor Remarks: Boring # / 6 nay /6 L .Z 1#714 1r! /0~r y y- v !~Z sf / 1 sb m F~ ~s f 3 ya , ~r ,BPS' G s l ! F ~S Ground elev. Depth to limiting factor `TL- in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # f O-ty D .Z a I1na,b/f 1y! C f o~ S ly ~l~ i' S 1 5 b k ~J1 der C- S' ; Ground glev. 7G,G gift. Depth to , limiting factor Kin. Remarks: Boring # Ground elev. tt. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) Aa 7-,2 ~y3 OF l c v e to T /1/owsC 5 a3 e`o . ~ ~ v Q~ w b 4 v .ry g3: y~°5 Wr /la Tti ~ U - 564503 CERTIFIED SURVEY MAP Located in part of the Southwest Quarter of the Southwest Quarter of Section 3, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. Prepared for and at the request of: OWNER: John Dalton 1794 110th Avenue r Hammond, WI 54015 Drafted by. Kristi A. Eylandt F1~Ep 2 2 7 1997 ► TOTAL AREA LOT f: 4A OTHLEMH WALM 3 49,970 50. FT. R~Register ot oft Crotx Co 1.15 ACRES AREA EXCLUDING R.0. W.: 43, 700 SO. FT. Cr 1.00 ACRES UNPLATTED LANDS OF OWNER S 88'59'09" E 380.00' i 190.00' i i 190.00' 1 N TOTAL AREA Z Z I WELL o f 49,970 SO. FT. tip iz o 0 1 1.15 ACRES c M Q n I> O o ; AREA EXCL D ROW: ed~ I0 jD o HOUSE U' rv 43,700 SO. FT. 9 10 Im 11110 C4 ow 1.00 ACRES 0 I io o I; jr- M O' 0 jrn Ir IZ o O 00 ,BIZ I' LOT 7 N 1 L!0 OT 2 W W W I W N o a o f ROW SOUTH 1 4 CORNER p i ° o ° 110th A ve 0 0 0 17 SEC. 3-29-17 - - 190 00, --1i _ _ - 190.00' --t~ 1 (FND 1 " P.) S 88-59-09- E`` , - - - - - - - - t- /I - - - - - ~~----S 88'59'09" E 380.00' - . ' 190.00' \ 190.00, -A 190.00' 6,-1811.19' 110th Ave c~",- N 88'59'09" W 380.00' --------S 88 59'09" E 2646.0_8'---_----- G! _ 110th AVENUE _ SOUTHWEST CORNER R.O. W. 110th Ave-IT 3-29-17 SOUTH LINE OF THE SOUTHWEST 114 OF SECTION 3 (CONCRETE NAIL) UNPLATTED LANDS V46a"I GO a IV S" R/b/9 -2 1~r RONALD F. JOHNSON 5-1186 NOTE: The parcel(s) shown on this map is/are subject to State, County and AMERY, Township laws, rules and regulations ( i.e. wetlands, minimum lot size, access W151~ to parcel, etc.). Before purchasing or developing any parcel, contact the St. 0 ~q 1 Croix County Zoning Office and the appropriate Town Board for advice. SU R-J ~ X44660 LEGEND 4 County Section Corner Monument i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~d l _t,' ;da/ 1-"f -kl MAILING ADDRESS / l D 7!1 r~ G PROPERTY ADDRESS 4, & D n/ zg L I. (location of septic system) Please obtain from the Planning Dept. CITY/STATE ) PROPERTY LOCATION ~ 1/4, 1/4, Section T_,2 Y _N-R_/~W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION GS ~r LOT NUMBER CERTIFIED SURVEY MAP J^C M1, VOLUME PAGE33 J~; LOT NUMBER 2-- Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in. operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: L DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property 114 1/4, Section W33, T. fN-R_! 2 W Township- Mailing address Qy lld' a /de- '4d G S Address of site 1.2 l0 71 4 kx av' I(G~' Subdivision name C Z433 3 Lot no. other homes on property? Yes__ _No Previous owner of property Total size of property 7,! ~ . Total size of parcel _ _ fa J.-< Date parcel was created F/3 2 9 7 Are all corners and lot lines identifiable? !JZ Yes No Is this property being developed for (spec house) ? Yes ' <_No Volume Y yr and Page Number _~Sy as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner (s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. .2LyL/ , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. S nature of Applicant Co-Applicant Date of ignature Date of Signature S € f ; ; DOCUMENT NO. :VOL 348 FA 6E454 This Indenture, ma& by halter G. Knipfel and Janie Knipfol, his , A ~.'hilri K. F',kell M3nnt:sota " grantor 5_of ' HenwHpin County, XV&ejHXi~e he-rcLy cnn\e v~ ,,nel 1~,:uraut.; to JOhn•J, ~ uiton end Carolyn G. Dalton, husband an(I vji_i'o !Oin't t~~ t 7 grantee of Jas(z in ;torl for the sum of One ,ollr?r 1.00) and other good and waluable ccii.>l~ie i. on the following tract of larel in 0t. Cl'oiX County, State of Wisconsin; tc,~o-th.~_rds (~/3) intorest in the Southwest Quart:ar of Sect-ion Tile-ce (3) ; Fast one-Imlf of the Sout i-e<~, st Quarter of Section Pour lall in 'Po1,,jns1lip ?.9 'Ic,rt;; R,,n;-e 17 '.:teat., subject to public hiF;htiJay and a~ol^ line, e°'. setttent,r;. r E ~ i, 477 ~ I' 1 i -j A f t r Yi IN WITNESS \;III;REOF, the ;aid grantor Shat Ve hereunto set theil° hand r and s(,li thi; d,yof Aril A. D.,I9 7L/ QLGI~(J ~G K~C~ ,i (S SIGNED AND SEALED IN PRESENCE OF t , ~I,lt t,r)1'_ 1}s Krtii~t'etl. ` 1 n~ Jane hnij)Col :'l~ihna h. r'skell l.~`SE:vL) STATE OF WISCONSIN, SS. FIt • C'?'J1X ('aunty. _ DOCUMEINT NO. This Indenture, Nlade by Iicrbert P.I. 11ni_p9'el and Ilesto 'r,,ni_pf'el~ A12b :d `~T1 ~ 11 1 trIIae iota grantor S of C 1i2~3 ~sl ]ti Ramsey County, 1~+~~i4YFtt hc•rehl' conc~ ~ ~ .,ncl NN a, rants to on d Cr,"rotYn G. ton ; , nzsD~.nd ~~nu . ['r _i 1c;na-1;: I,rnu ;t^ tee S ofJa.,i.1Y1rtOYl (.uuu 1, for the n,n of c Dol1~;r ('";L OC:) and otti. r P:ood a.td va aablt the follossing tr,wt of land in Cr01X t'ounty, St,it(' of Wiscow,in; 7n~,-•t-k:i~~<1 (1_~~3) int~~t~F~:~t in the :_>~~it}~tae.,t rLc~1~• )ti r'i a-o ; l.a:.t; one-fi,, ' f „lie tt- ~,.,t <~tt,cr Ot' ,cction Four 00 all ill ~'C' wt,r,, c I'l, ':Jest, to puhli n 1,_1- .r~cl 1,;;1c 1.inca t;a^el~u~nts. ~ M IN 41.7.'TNESS 1VUEREOF, thi- sni,j gr,:ntur -1 ha Vo herrunto get tLlEi -VanJ and d.,y of _ -u 11 A. D., 19 Y1. / SIGNED AND SEALED IN I'I ESL•NCE OF Ij, 04S~.rn L0 C4'9'-0",_ scattsin DeparUrrent of Industry, S L AND SITE EVALUATION REPORT Page of Labor " Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 5,f- Cvo ' Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION G ,l Ac f J h GOVT. LOT S d/f S V 1/4,S T N,R Q (oo PROP RTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # '17 4 D l}VIC b y -L CITY, STATE ZIP CODE PHONE NUxxBER ❑CITY ❑VILLAGE TOWN NEAREST ROAD on j ( /Sl 77~Z rtN++a~ /otti v Cn N New Construction Use Residential I Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 300 gpd _ Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 500 trench, ft2 Maximum design loading rate bed, gpd/ft2-trench, gpd/ft2 sw' - 's "r- Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) S' Additional design /site considerations 5%~of ~br 3 ` tj Parent material t-• r s S el Flood plain elevation, if applicable E'~a-ft S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U a Unsuitable for system ® S ❑ U I S❑ U as ❑ U ®S ❑ U ❑ S U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence gy Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trendh p+.{ 77l ` 2 I F C 0.7 0-~ qq F(F SYR 8/x 0 Ground 3 S2~lS f~ 6 Rear Merr`L-C 0.7 d I eft. `>t 7S p 7-SYR 0.7 04 Depth to limiting factor - ' > 90 Remarks: •^/tl.zs,i I ~_voc%__ _ Boring # d- 0-0 vY 313 ~~~4 0 s 0,6 2 o4l we 0,T701S . k X~- b cs F 3 5z-7 ~ I U ~ 6 ,S Tor near- 7 '01 f Ground D FIC- 5Y9 31'L L C~I~ ~S 0'~ ~'0 J_f ~Il of ft. 71 to ~I1 6 oor o Depth to limiting factor Remarks: Y i h trier+t ir„ f V-0 c (a CST Name:-P ease Print _ Phone W ewer S~y 9QF"a ddress: A/ 3C 51 C cllfww~ C'/' 5 I/ v Signature: Date: CST Number: cs m s /ipz PROPE'RTYOWNER SOIL DESCRIPTION REPORT Page -)--Of S PARCEL I.D. #r Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 : < t 0- to z s• ab c- 5 F °•S 0.6 z Falk I C- l a o,e Ground 3 57 -70 '7s r 9 q l~ ss h1 I r e; s G 90 elev. ,73,7 1 70 - gd 7 7>Z s4 F - o o s Depth to limiting factor D Remarks: Boring# 1 0-7 I0YR q1~- ~v- Q S-: 04 .3 9- S ~,s r z Ft~ as_ 10 Ground elev. s 7" ~6 YR ---r I C S 0-7 Sl V ft. Depth to limiting factor Remarks: Boring# 1 0-10 OYe S~' 2 v►~ I+, 0•5- 0C 15-3 !o-~l 10Y ly I ~q64 0,7 0, 3 0-73 l0Y 6 6 j w, 4 ds C 0-7 o,g Ground I elev. 310 Ib R 16 u~ ~l oIS 0,7 `AP JL'_ ft. i Depth to - limiting factor Remarks:', n+evnaLr+.,..t~ ack Boring # I ©IZ 'CYR C. 5 2•F bLf i 06 6 I z- 3 srR y b' ~ P~,J" b Polo$b~ s t s I F o a Y-4 V0, C? 0,7 :6 Ground L~ , n elev. ~"S~ •S - S ~ ~ C S l~ 9L, L ft. Depth to Ilmltlnq 1.~----- _lL„(~ _ -1.,._ L-._ 1t~ 1~►t 1 .r..- fay, z 11 Remarks: SBD-8330(R.05/92), ~V: WisCbnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 3 of -5- LaboPand Human Relations Division 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 Sr CvO~•r 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 nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION (n GOVT. LOTS t S W 1/4,S 3 T Z N,R 7 `g( W Oil k'] PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # I I f D k Ve her CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE IFOWN NEAREST ROAD f`km,".-d 4SC0 11 ! (715-) 7cfg X442-tigs4mo -1 0/ 1 6(] New Construction Use Residential / Number of bedrooms Addition to existing building j) Replacement ( ] Public or commercial describe Code derived daily flow 3o c gpd Recommended design loading rate bed, gpd/ft2 • 6 trench, gpd/ft2 Absorption area required bed, ft2 SO() trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 5-('- o ft (as referred to site plan benchmark) Additional design / site considerations - _ s%zr,, at- . S oar rRrc- Parent material Lo C5 f, s Flood plain elevation, if applicable All/} ft S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U - Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon In.r~ Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh, Consfsben~ Boundary Roots Bed Trerx~ rm, ia- Y6 to yr Ground DY c' 1 ti~Fv° w 62 elev. ffy'j f I. C. V q4 Depth to limiting factor 1--T Remarks: Boring # I Ground elev. Depth to limiting factor Remarks: CST Nam -Please Print Phone: S O dress: C Signature: ^ _ - Date: CST Number: G - 12f j f'1 - 1 p 2 i t`~J\ 206TOSS - HJSS .4a4-5gaM ua»y aDn-4EI 'x!OJ:D'~S Jo A:: Uno3 puoww'OH JO UmOi MLIa N621 S :)aS t7/Z MS Jo t/Z 3S 'paAan.Ans aq 01 -A:.jado,Ad uo om4- jo -puO!S :~saM 'uo~,pq >io'uf' .4o j :.joda~j 1!oS pu-o u-o-~d q olcl -all p C_ NIL 00 p Q- ui t' L oy N u O W~ ~ O M S L C ,04 1 L cu c: 4 0 O q 9 r `~2 O U S OJ > m I.- g IL E-- N V) CX) Y ~ 4 9 Poo T ~`C © 0 2 o L~ N C ,Y 0' S 41 d _ ~ U C4 6WW L ~ O 3p Gu a U ~M10--0 fa J ill 10 a ° i CS ~ v p t C~J o ~ o p I ~ tU O Q`s M al L) L R7 t~ ~ 0 n V-, c ~.5~ OIL OI CU Cj H +y X ~ DI L 0 L p~ °-s out o ~ LA -5 op I d o I LL c 68 0 t o L L -P d LA 4 cu Q A t L 4-V { { EL Qj t -Q:5 4-1 c -Y O 0 0 d • , Wisconsin Department of Industry, S I L AND SITE EVALUATION REPORT Page of Labor 'and Human Relations Division of Safety & Buildings in 4cord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S~- Cvo 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 nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 2 Jack ~ Its GOVT. LOT S 1 Z %t L,/ 1/4,S 3 T 9 N,R 7 x(or PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # f q 110 vetidt CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE NOT, OWN NEAREST ROAD HcAon P-o-d ~L"54 r I s OL y6 ;--LL rri•~rhe-, (Uth dy, to c,,- New Construction Ilse [ ] Residential / Number of bedrooms 3 [ ) Addition to existing building j j Replacement [ ] Public or commercial describe Code rived daily; flow .`i gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 416. - Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 0-6 trench, gpd/ft2 Recommended 01111ra ion surface elevation(s) 3o" d can tvc ti, h ft (as referred to site plan benchmark) Additional design / site considerations hlo h c Parent material v (Sri --Flood plain elevation, if applicable N A ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRFSSURE GRADE SYSTEM IN FILL HOLDING ANK U = Unsuitable fors stem INS ❑ li ®S ❑ U INS ❑ U ~ S El u ❑ S K U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence BoLncl3y Roots -Bed Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. T t ar , , f I,I rR 3 ( c n Ground t / ! l CS a ''4 ,n,, iI i 6~ 5 - - 1_- -_U_ l) elev f J 5 Y k l~. eft. ..,T Depth to PA.~r~ - --"J ,S limiting El factor 7. tT r ,rr, f u,rrt,i d C Remarks: X k'' h S r-t r;~„ rfc, } Boring # I Ground elev. 7 L ft. Dopth to limiting f;5t r 3 - CST Name:-Please Print t(~~ Phone. Address: jnature. Date: CST Number: l~ CS - Df o2 OROPEAP'OWNER 7a~h f _ SOIL DESCRIPTION REPORT Page Z of S^ -PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench F= I d s rz s 12- r,ej Ground ) 't 3 5.3 Yl' 3,,e t 7o C S v~, 7.4 elev. 2.3 ft. ~fp . 711 C Y P S S ~i h vv-1 4~ - 02 67,r Depth to limiting - factor > 7 'N, y;nt~ f rv,t(rl! - _ Remarks: Boring # I f, elk, 'I Ground - - c r r r,5 ' L s I C' 7 elev. 90.7 t ~~h 1 ft. Depth to limiting factor - - - - - - - - 7 1- Remarks: Boring # 1 Q l? 3 3 1 c. I f o d 41 l f _ Ground - Y'- ~ L elev. Depth to limiting factor Boring # l~ 11 i 3 ~3 I c - Ground a r k~v ctrk, r,, S f^1_ elev. . L$I._ ft M 7/ Depth to hw 5--- limiling 1 factor Remarks: SBD 8330(R.05/92 L~0ct_ n ~ c ° ° C+s~ 5 ~0 it p QUi o_ pQ Q o fl CL jo n~Q no r bbd v X W C4 ° ~oN~O n --j I 3 cc: 0 ~ 0 IT o v r D fU s rt ~ o . I 4 00 -6 A Plot Plan Sort Report Por Jack Dalton, West Sight of two South 1/2 Southwest 1/4 sec3 T29N R17W Town of Hammonol St,Croix County Bruce A Webster CSTM-5501902 0 ~8s a1p~s ~uB n p ct "5 n O Q P O ~ a ct C 't7 ~ ~ 3 s oR~ Q~s SL to 77 A v o O ° ~ x n Z iTJ o~ ~LA o ~ Q S RO n m N II Parcel 018-1006-30-200 11/10/2005 10:31 PAGE 1 OF I F Alt. Parcel 03.29.17.43C 018 - TOWN OF HAMMOND 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 - DALTON, JOHN J & CAROLYN G JOHN J & CAROLYN G DALTON HAMM ND WI 54015 L6T/•J`S,~/tx~✓'~~ Districts: SC = School SP = S ecial Property Address(es): Primary Type Dist # Description " 1812 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.000 Plat: 3338-CSM 12/3338 SEC 03 T29N R17W SW SW BEING LOT 2 CSM Block/Condo Bldg: LOT 2 12/3338 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/18/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 16,000 40,900 56,900 NO Totals for 2005: General Property 1.000 16,000 40,900 56,900 Woodland 0.000 0 0 Totals for 2004: General Property 1.000 16,000 40,900 56,900 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