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HomeMy WebLinkAbout018-1015-90-000M~isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr01, Safely aid Buifdir+g Division Sanitary Permit No: INSPECTION REPORT 506245 GENcRAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Pr-rsonai information yor.i provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Ulferts Famil Trust Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: / ~ 4 . U /OD.- O ,Ot~. ~ r4 riinTl~wl nnTn \IY f~ IIYr VEC1Y1F111V IY TYPE MANUFACTURER CAPACITY Septic j ~/l.~/~ ~ Q~ ~~`Gi Dosing ~.^M ~ 6 , - ` l ~C,~ J Aeration ~ ~~ ~ ~'~o ~ r Holding TANK SETBACK INFORMATION TANK TO P/L WW~- BLDG. Vent to Air Intake ROAD Septic ~ 2 ~ i ( ~ G ~~ w/~ . Dosing -~3 fit., 7~/ Aeration ~~ Holding hI IMP151PHnN INFORMATION Manufacturer ~~ ~'~ Demand GPM 4Model Number ry~ '7~~ iTDi l_iiJ,L~ ,,~~ Fr~tion o ~ ISys ~ M ~ Dead v/ T~~ ~~ Ft For, emain Leng ~ Uia. Zee Dist to well ~ ~ to~~' ~~ SOIL ABSORPTION SYSTEM t3EDlTRENCH Width ~ Length ~ DIMENSIONS ~D /IQ SETBACK SYSTEM TO INFORMATION Type f System: DISTRIBUTION SY TEM Meader/Manifo d _ istributio II. ~ ~~. Pipe(s) ,Length Dia ~ null /~/1\/rO Of Trenches r--- Parcel Tax No: ` 018-1015-90-000 SectionlTownlRangelMap No: 08.29.17.116 LL.LYP'~44V 4~ v~ ra STATION BS HI FS ELE`: 13./~ ~/03.(oi .la~~ Ui Benchmark Alt. BM Bldg. Sewer j o ~'v ~ . ~ ~ Z. ~ St/Ht Inlet l,r~ „ Gn ~ ~/ ~ ~ St/Ht Outl 7 nle Sot m - _ ~~/7 G ~d r/Man. Z ~, Dist. Pipe-~ ~r~ "'~-- b Bot. System ~~ Final Grade ~ / _ / ~ ~ StCover~~~~f~~ - Z rM 2 3 Q~ v rl-K ~ T / B~L-D7G WELL LAKE/STREAM x Hole Size ~ A ~/3 z i a_2 ~~ Spacing _ fit, ~ ~ / • 0.5 s/eh~ ! D l- D S , ~~ 4 1 /OG'~ O \ /D ~ /~. d :lo ~ I ~~'o 4CH1 Manufacturer R OR UNI Model Number: Hole Spacing 2y+' c llnly ,u,~S - 3~S ~ ~ /. //t_~o Air/~lnt~a~ke_ /,, / C "7p `fn~UL~I~R n :~ ~. !.~'~ s Depth Over Depth Over xx Depth of ~~ kx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil !~ w 0 (~1~ yrs Nr, Yc~s X10 , n T ''7 /'1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~ ~ / h (/~~_ Inspection #2:_ T~ / ~' /~1 Location: 1070 170th Street Hammond, WI 54015 (SE 1/4 NE 1/4 8 T29N R17W) 40 acr~es,,L,_o/t ~~~`"' ,,'~,.,,,APar. ce~No: 08.29.1 1.) Att BM Description = r't ~`'~" ~'`~~'~ Yict'~ f ~-ash-~~~/~' 2.) Bldg sewer length = ~ ~ ~~ ~ - amount of cover = / ~~y~ ~ ~~ (~ i/'~-'; °" 'Ian revision Required? Yes No ~~ i ~ ~y ! ~~~~^ ~ other side for additional information. i ___!-_~ ~ ---- -- - ---- --- -~ Date Insepctor's Sig ariue 6710 (R.3/97) it Commerce.wil.gov Safety and Bu' ~ s Di n County ~ - / ~ i Ill 201 W. Washington Ave., O. Bo 2 ,( Q - 1't ~ i-1 ~+ ~ Madison, WI 53707- Sanitary Permit Number (to be filled in by Co.) Departmerrt o! Commerce U l _ ~ (~/ Sanitary Permit Applic do ~~ Stat~Transacti /n~Nu ~L Wis. Adm. Code, submission of this in accordance with s. Comm. 83.21(2) orm to the appropriate governmental t~ , unit is required prior to obtaining a sanitary permit. Note: Application fotnu fgrl ~t~~e~1P~TS are Project Address (if different than mailing address) submined to the Department of Commerce. Personal iitfomiation you rovide a b us d or secondary ' n u ses in accordance with the Privac Law, s. ! 5.04(1 (np , Stats. ~(JI /~ CO TY a ~ ~~~WWW1 ~~~^^~~~"' I. A lication Information -Please Print All Information UN ST. CROIX Na a Property Ow ne r's _ Parcel # / / / W ~ l ~ Ql.~ Property Owner's Mailing ddress Property Location / I /! ~ 1 / J ~, C~ •~ ' Govt. Lot ( City, t e Zip Code Phone Number ~ y~~~ll~ y,, Section ~ !.E r~ (' le one T2 ( N; R~E rW II. Type of Building (check a that apply) Lot # e 1 or 2 Family Dw lling- Num~`r~Bedrooms _ _ __ ~' Subdivision Name ~ j O ~Z~ { 81C- ~ T7r(-~ I~f Block# (/ -- ^ Public/Commercial -Describe Use ' ~~ ^ Ciry of ^ State Oamed -Describe Use CSM Number ,,,~- ^ Village of own of - III. Type of Permit: (Check only one box on tine A. Complete line B if applicable) `~' S stem y ^ Replacement System ', ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner fV. T e of POWTS S stem/Com onent/Device:<' Check ail 'at a i` ' ^ Non-Pressurized In-Ground ^ Pressurized In-Ground At-Grade ^ Mound > 24 in. ofsuitabie soil ^ Mound < 24 in of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Devic (explain) V. Dis ersal/I'reatment Area Information: Desi n Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) Systems m E1ev_ ario~ s-~-- . v VI. Tank Info Capacity in Total # of anufacturer ~ Gallons Gallons Units ~ R V V ~' y '~ New Tanks Existing Tanks ~ c V :; ~ ~ .~ = m o. U rn ~, rn ii". C7 iY Septic or Holding Tank '. Z Dosing Chamber I r. VII. Responsibility Statement- a undersigned, assu responsibility for installation ofthe POWTS shown on the attached plans. Plumber' Name (Print} Plumber' ignature MP/MPRS Number Business Phone Number ~z~ ~ 7iJ Plumber's Address (Str e et, City, State, Zip Code) .-------- ~ Q p (.~./ J VI unt /De artraen Use OnI pproved ^ Disapproved Permit Fee ~ .' Date Issued ~ Issu' Agent S V ^ Owner Given Reason for Denial ~ ~ ~~~ 0 w Ii~~ IX. Conditions of ApprovaUReasons for Disapproval ~ /'~ _ ~y~, s-~~~e- t~ ,~ GFj ~f~~ ill ~ ~~ ~ YSTEM OWNER: / ~~.~_ ~~,ff 1 / 1~/}/~wcaF", f ~ Septic tank, effluent filter and ~~ ~(ir~ ~ ~~~J dispersal cell must all be serviced /maintained /`' as per management plan provided by plumber. -' Att ch o can I t plans for the system and submit to the County only on paper not less than 8 1rz x t t mcnes to size as per applicable codePorc~lnar>rce~. SBD-6398 (R. 01/07) Valid thru 01/09 PLOT PLAN PROJECT' ~Ulfertt's Familv Trust ADDRESS 1011 170th St. Hammond Wi 54016 SE 114 NE 1/4S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 100.0' BEDROOM 4 CONVENTIONAL AT-GRADE XX)C CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .55 ABSORPTION AREA 1 100 # of chambers none ,BENCHMARK V.R.P. Top of grade at stake with flag ASSUME ELEVATION 100° Filter BEST GF10-8 ^ BOREHOLE O WELL ~ H. R. P. Same as Benchmark Fence Line Scale = 1 /4" = 10' 40 Acre Parcel Qom, Tank_as_t~be properly bedded - - - and provide acith lockdown " ~ ,- covers w approb~d warning ? ~~~~~ -~~-~ labels /~ ~ ~~ ~ 170th ~ ell is~ meet all ~ St. setbacks found in Comm. 4 Bedroom ~;~ ~( _ House ~ S ~r ~-lls. ~~ ~ I ~' ~ ~~ I , ~~ -B S~ ~a 1 S' below syste remain ~y~i urbe i~ ~v ~ *~ ~~ Huffcutt Combo ~~ ,System is to ~ installed along the contours B - 2 100' rE Fence Line 98' AIt.B.M. 1320' Property Line 8% Slope f ig is to be done to ` run-off away from ~ ~~.-~~ D~~ 3a3~f 6~^~` 200' To south lot line B-1~ p~5~~ a,~ . B. M. commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 22, 2007 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING 1NC 1008 192 ND AVE NEW RICHMOND WI ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA ' 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/22/2009 Identification Numbers Transaction ID No. 1404905 SITE• Site ID No. 689402 Ulferts Family Trust Please refer to both identification numbers, 1070 170TH Street above, in all corres ondeuce with the a enc... Town of Hammond St Croix County SE1/4, NE1/4, S8, T29N, R17W FOR: Description: At-Grade / Four Bedioom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1136044 Maintenance required; 600 GPD Flow rate; 44 in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible. for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Deparment per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component azea. Soil compaction, excavation, vehiculaz traffic and other similar activities that impact the treatment and dispersal are prohibited. COI • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption ~ ©~ azea. chs. NR 811 & 812c ~~" • 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. SEE CC • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated - county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAUN R BIItD Page 2 6/2212007 • Comm 83 22('n A coQy of the approved plans specifications and this letter shall be on-site durine construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All pernuts required by the state or the local municipality shall be obtained prior to commencement of construction/instaliation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this .letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~ ~~~ rle B Cha s L ratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 6/2/07 sqF ~~ o~ Fo ~~~~ zoos U~~~~~ Gs Owner: Ulfert's Family Trust Location:SEi/4 NE1/4 S 8 T29 N,R17W Hammond 1070 170th St. System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N.03/07) Pressure Distrubution Manual Version 2.0 SBD 10706-p (N.01 /01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contig 9-11. Soil test Shaun Bird Signature License number 'ional~y ~~V~~ OF COM r ~s ~SPONDEN PLOT PLAN PROJECT Ulfertt's Familv Trust ADDRESS 1011 170th St. Hammond Wi 54016 SE 1/4 NE 1/4S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 100.0' 4 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .55 ABSORPTION AREA 1100 # of chambers none ,BENCHMARK V.R.P. Top of grade at stake with flag ASSUME ELEVATION 100' Filter BEST GF10-8 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark Fence Line I I Scale = 1 /4" = 10' 40 Acre Parcel Well is to meet all setbacks found in Comm. 83 Tank is to be properly bedded and provided with lockdown covers with approved warning labels 4 Bedroom House 170th St. Area 15' below system is to remain undisturbed Huffcutt Combo Tank Grading is to be done to ,System is to divert run-off away from installed along the contours B - 2 system 100' B.M.* Fence Line 98' I AIt.B.M. 1320' Property Line 8% Slope B _ 1 ^ 200' To south lot line B. M. ~~ n a it ~... ~ ` ~' ~~v~'+'~ ~- r ~ ~ ~ = l~ ~~- . €. = ~ ~- v~~~~.i. 5'I~BiLi~~b ~`~.}St~'V ~~-~ ~~ ~~ ~ s - v~" -~ ~is~~~vi~s~ ~,g~erai ~.~ witl+ a $3.szs p$:ss ssati ~eoss S+ectian of ~iisc~essia A't-$r~~ S~.~gl~ ~ysargtiaa Area ozz a S~.ogiag ~i~e F~age ~~ g~ s~~f~u~~c~a Pi Fe €~s~~ i 3 ~~rr la~era3 ~el~rk . - A~cesf . t . ., . ! Last ~~e $i~tt~d 8e t~ex#: To ~~~ ~-~~€~ -~P ~~o~r~ Q ~. P~'~ carte ~ai~ ^~}`~"~ ~- €~3tG 'l~~strsbatson i~pe :~ ~ P .` ~~ a ~~~eter ~ ~ ,~~. 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Ate artcs eva~ C3 .II y,~c[s) pt Least arses every ~ 1 I3 sj Q NA ~ ledt+t atsce every ~ ~ s) Q ILIA qt Least acrce evecY C7 rna~ f3 y~~s} Q NA qt 3east ar-ss~ e~tenf Q ~~ f1 ~} £3 NA qt least flrxce event . ~~ ~ ~~°f~~ ruu~~ ~'RUC'~'[aN5 ~ ~~ ~ maw by ~~av~dual~~s fcssP~ POtt~TS~ srs ~r+ a4~d R s ~ idet~f becK uP ~ pier; Maw' ~ snk ~ ~~tse tira~ucn$ aft ~ v~' ~D c ~ ~ e at ~e dsspe~ aati{s) s2~ , 33se fir. ~ on the g stttfSOie- of ef~uent nn the ~ tt,e Borst 'rn tfis ~ t~ asxi to cneck~ ~d~~~ me'lmma~abs ~~ ~ ~ttte iSti~ ~m°~ i~IR ~, a tam age ar:d sc,~rn in anY tank e41s~s ° ~ c~ ~ ~,~th YYhett 3be ~ ~ fired ~F & ~~cing Op~~. ~, ~zs: i W #~m€r~ Coda- ~ r2e~ g(~'S ~~~ ~tt~ g~ Pt7V~'~ of P~ se~~ ~' ~ ~ ~~~.' ~ tn~~ ~€~12 months or ~~ ~ of crjm~~ a€anY be ~ ~ ~ ~ reguiabor~t a~litat'~Y ~ ~~ ~ . ,~ ~fP /~ Op~Tit3iit D the tf~ fani~s} ~ ihs P S ~~ - aye ST Fotttewo~. ~ s~ c~~ P and/or damage ~e ~" ~:s~ that ~ the by a septage servfcirt~ P~ . Q #hC ~- } 1. .... ~x~~ ~, . ~ - arms ~~ ~- ~s~~~~ ~~~~'a ~ ~ ~ ~o ~ avoid ids saw ~ ~ aan~. ~ sX PO'St~l~'S ~ m ~ merge c~ . to me e~rent ~P °~ ~ ~~ ~~~~ ~ass~ ~~, i3~rurt~mrso~c~z~~~' ~~~~ ~~~~~ • ~~~~~~ ` ~~~ ~ ~ ssss, ~ codes 9s ix'oi~' sat~ty ~eci arxd ifze aband~ ~ ~ ~° ~bcs and ~ shy ~ a~ ~ dssposad of br $ '~ ~~ .. ~ ~~~ and be ~ rem°'s'ss~ flr ~' ~"°~~ ~s.e~ sya~e ~~~ CA~~ P~~ ~ ~ ~ f~~3 m,~ures have been, or' ~sftsst ~ ` ~ a code if fist PO~tN'~ taEs and of s n~soE . ~ ~ art e~rafua~ arm ~a3/ be u~~ '~~~~ ~d ~nP and sha~ci ~ . Ttie ~~ area shy be pc~at~ed s-~ krt lames aad ~- Fa~nre fa • ~ ~ b'Y~ ~ u3 ~ need tar a ~ scte~avaiua~ ~ a . pcnmact tiro n~ ~ ~ must t:c~~l3' ~ ttse rules in efE~ ~ ~ ~ ~' ~i~em~'st ~" •~~ ble•dua is setback ar;d/or ~~ ~ ~ , L` ~~ fio ~ tse ~ as a last aesflrE acs repiac+e~ ~ c£ Sse ~ a ~.~ bo ider~ a suitable reD~ #f tto ssp~'+~ arse is a~raEebde rd -~ sfie tzar rat e+ra'ltsa~°~ ~ ~~ a y~lsle rege~ ~' ~/ ~,e+r ~ ~~rtta'~ ~~lheb~sf tiO~ sod ~ s`~ resay be n~o~~ . ~~~ ~~y~ons of sud; sy must rA~IY rvKh ~` sssiesin e~~~4itsae. ccflfFA ~;,t~fGS 1~ttAY GO~~ ~~'~`' ~~'~ ~ ~~CiIIrC['OXY~,F~t. ~ #~ ~4i~'D ~~ TfiF,A3'1~ TR~ATM~ T1iAlfC u3~fD~R A11Y t~ DF.~tTi~ ~"Y ~ ~GT.~ Ems` g D~ A TA1~tIC ~Y $E Bi~~-T [3R RESULT R•OFA ~Di13O1~tAt. i:0E~1~ ~ _ Pons ~ ~ s~~ , ,,~.,~ ~e , c~.i . Pine -7l .r- ~~- ~s SfP'~'J~E ~~ ~-- ~~ ~tlQns 'j J ~~ • ~. aoa,rasd~a ' ~ als~s ~ tee: ~d s~5at'f~. C1~~ R~ re~d~ fbs o~~s d~ arx ~~~. _ ,. ~~t~~. ST. CROTX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer G~- ~~-f'.~7 T~4 ~/ Mailing Address Property Address City/State LEGAL DESCRIPTION ' ~/~ / /~ Property Locations 1/4 , ~'/4 ,Sec. ~, T ~ /`A N R/ W, Town of, ~ ~r,~a.~.yJC Subdivision C7 S~(~ (Verification require from Planning & Zoning Department for new construction.) Parcel identification Number ~/~ ~o~S--9d-~xsd Certified Survey Map # Warranty Deed # S ~~Jd~ Volume Z - ,Page ~ Volume ~ /~ ~ ,Page Spec house yes ~~ ~ Lot lines identifiable ye no CA Lot # '"- . col Improper use and maintenance of youzj septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septicitank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.520) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit t' St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman pl~imber, restricted plumber or a licensed pumper verifying that (1) the oa-site wastewater disposal system is in proper operatipg condition and/or {2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, heroin, as set by the Dep ent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system been maintained must be completed and returned to the St. Croi~c County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this ~orm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms Ts T ~~/~-. Trkr~c~. OF PLICANT(S) ***Any information that is misrepresented Include with this application a recorded reference is made in the warranty deed. ~i~oi~ ~ DATE result in the sanitary permit being revoked by the Planning & Zoning Department. *** deed from the Register of Deeds Office and a copy of the certified survey map if (REV. OS/O5~ 1 <, . l 2091 Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than SY: x 1 inches i ~~r r~a~(;E_ p St. Croix include, but not limited to: vertical and horizontal refers percent slope, scale or dimemslons, north arrow, and location and distance to nearest road. Parcel I.D. ~ t g ,,- , ~ l~~ _Q £, ~- t9 a O Please print al! information. ReV wed B ~ Dat Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Ulferts Family Trust Govt. Lot SE 1M NE 1/4 S 8 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # ubd. Name or CSM# 1011 170th St. ~V~ o~ -~,~ l/c(. GiZ%'~I~Q/ City State Zip Code Phone Number i City ; " Village Town Ne rest oad ~ ~~(L Hammond ~ WI 54015 715-760-1126 Hammond ~~'~ ~QTh St. '' ~~~~~~~~r~~'~~~~ Wisconsin Department of Commerc ~~~ Sf~~EV~4,LI~~TION EPORT Division of Safety and Buildings accord nce with Comm 85, Wis. Adm. ode x Coun ~i New Construction Use: / Residential / Number of bedrooms 4 Code derived design flow rate 600 Replacement ; Public orcommercial -Describe: Parent material loess over till Flood plain elevation, if applicable General comments and recommendations: install 7.5' x 136' effective (9.5' x 136' overall) at-grade system w/ laterals following 100.0 contour GPD NA Boring # Boring Pit Ground Surface elev. 97.7 ft. Depth to limiting factor 44 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Mussel! Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-13 10YR 3/3 - sil 3 f sbk dsh cs 1f/m .6 ,8 2 13-25 10YR 4/4 - sil 2 m sbk dsh gs 1 m .6 .8 3 25-34 10YR 4/6 - sl 1 m sbk mfr gw 1 m .4 .7 4 34-44 7.5YR 4/4 - sl 1 c sbk mfr gs 1 m .4 .7 5 44-60 7.5YR 4/4 f2f 7.5YR 5/3 s! 0 m mfr - - .2 .6 occasional gy si coats on peds 13-34" Boring #~~ Boring Pit Ground Surface elev. 100.6 ft. Depth to limiting factor 48 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIftt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10YR 3/2 - sil 2 f sbk ds gs 1 m .6 .8 2 9-16 10YR 3/2 - sil 2 m sbk mvfr cs 1 m .6 .8 3 16-31 10YR 3/4 - sil 3 m sbk dsh gs 1 m .6 .8 4 31-48 7.5YR 4/6 - sl 1 m-c sbk mfr cs 1 m .4 .7 5 48-70 7.5YR 4/6 f2f 7.5YR 5/8,5/3 sl 0 m mfr - - .2 .6 common gy si coats on peds 16-31" ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` EfFluentt #2 = s _ mg/L and TSS _< 30 mgr CST Name (Please Print) Signatur : CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 8/23/2004 715-233-0398 ,Parcel #: 018-1015-90-000 04/09/2007 09:25 AM PAGE 1 OF 1 Alt. Parcel #: 08.29.17.116 018 -TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Ma # Sales Area A lication # Permit # Permit T e p p pp Y 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -ULFERTS FAMILY TRUST, KARL M &KATHARINA G KARL M & KATHARINA G ULFERTS FAMILY TRUST 1011 170TH ST 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: 40.000 Plat: N/A-NOT AVAILABLE SEC 08 T29N R17W 40A SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 08/18/1998 585304 1349/401 LC 07/23/1997 1147/24 QC 07/23/1997 1147/22 QC 07/23/1997 1105/436 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment ~/alUatlOllS: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 26,000 39,100 65,100 NO AGRICULTURAL G4 31.000 4,000 0 4,000 NO UNDEVELOPED G5 4.000 3,700 0 3,700 NO AGRICULTURAL FOREST G5M 3.000 4,500 0 4,500 NO Totals for 2007: General Property 40.000 38,200 39,100 77,300 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 38,200 39,100 77,300 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 Tota I 0.00 0.00 0.00 - - ~`'= 77' .,. ____ { y ^~JiTY'^i fi*_br7i DES -._ ----- e ~~~~'i ~ ~; (~ r ~ ii ,,~ x ~ ~ te. ~ 5te.r_ 7~. t33sar::n ~._ La~$sioa G. 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ST~Tr~TE 7 ~ . 21 i i ) .7 ~ . ~~~Jaiti i. ~J'. ~ Le~ -rya ~+~ ~~3 3 0 P~; c~# ~!'r:! ~ Crreri lawa.e .y..rr Zw, L+~v r'4. 8{ts(L3S r RiL+D3I:ry F(J!~?,F~ d'~$tCl~!€{, Bt'ii.,ES +fi. rt:RllBG£R, S.%. 219 ~10:-tF1 .(~~;, Skr~dt. ~'. r. t3a~: 13c~ F.=g~i~ c:o~Fnr.y 010-9PS-0000; 010-X10-OOV0; U10-507-0000 Sc. L"raix Ctni7'oty 002-102G-80; OOL-1025-~i0; c':1$-1013-30; 013-2010-30; 018-1013-~U; 02.8-201.3-50; 013-101.8-a0; 018-1.018-70; U18-101!8-80; ~a:ce' 1deRCa.Eecscfaca F?tExFser Ci?E'!7F Oi8-it=18-90; 0?8-1015_fiU; 018-1015-7~s; x,118-1025-80~ U18-1025-9Q; ~1$-IrJarl-UU uA2:~ :fi .~G tv `f.•J'.Fett~llr r~3 ti~1e5`. t7'd[rav e;;.s _ }{f}^'l, da~~ ~;.: s?+.g^,sr. 2998. s~.t,: IiCF~~E6'si 7<CATIOt+ . ~ / S w , .~ ,~ ~ j r, h _ ~- -KAr3 !7. OlEerts ~ ~'- { L Y, `~ ~ ~. ~~.. ~; {~ ~ ~ ~ ~ .,~7a1,; Rac6rcina G. OlEerts ~~ ._uctattor C-S ~! sac6 04. Ol Eorte and _ at srlna G. ~IFprta _ au'hentic ~t. s _ da~o.`' Augrest, 1993. S ~ ~ ~. .~.___~ _4eo A. BesYac ~-. '[. ~=.E: li~iosE~ .:^,kSE Ei;F. Vr" W~SC'ONSE7+ •. ~ ` riot . __- _ _- r314 ~;~r.;.ZP:'. 7rj J'~5.~~, H%i3. SCaCn-Y TSLS ENSTRQF°.Ei~ fi!hS DRhEp'i"66`i BY: ,eo A- Beekac, t+tearaey ar-_i. P~4;'rK, ~gLES G ~R:1F:vcP., S.C. ~3 t;~rth ;5:._-r Str??-, Q. O. Eax 138 7ti+leS !a`cis~. :•I: Wg313 Ac7urow[.sDC;t~rr, sTF;~oe o~ s•:?sco:asu t SS. C~II,fFiTi Personally came b2. ore me this _ duy o€ [o me knoom r,o be the person(s) mho e:cecut~d the :aceuoing instrument and acknuulledge are s-+me. D7utarv Pblic _ __ _ Count/, 41,,. c.nr I[f G4f, ezoirat:cn GiatE: ,~ . ~y~ ~ f EX~lB1~ "~fi"` REal Estate (St. Croix Cou*?ty, Wisconsin3 t~ortt~east Quarter (Nl 1J4) of section. £ignt ;8), To•~nship T~vef:t~= ?•line (~'~) hiorth, Raitige Seventeen (17) L,"rest. k.~iD; west NaIE (i~F 1/~) of Section Caine (9D , To~rnship `t'wea~ty Nine (~9) Ncsrc3t, P<ange Se:rentee.n (17} t~~est, EatCl'PT Co~aencing at the Southeast sorrier of said West ~:alf o4: Section 9; thence tdo~-th on guar--ter sectio~a line 341.8 feet; thence ~~82aW 34J.0 feet; thence S52`'W 3?0.0 feet: thence S3Q~S"3 17~3<0 feet: ttaei~ce SSSe4~- ?v3.7 feel tC3 section like; ~heit~C~e East Z:Ti se~tiG?: ~ ine 798.78 ^eet to Place of Beginning. A.t~a~; South naiE o~ South;~est Quarter of Soutt±west Quarte•:: (S 1/2 of S4-° ljd of S4~ 1~4) of Section ~"welve (1~} ; And No*thwest Quarter of Northwest Quarter (NW 1/d of N~ 1/4} of Section Thirteen (13); r?11 ira Township `~rentlr NinF: ('?9) North, Range Si~cteen (? ~) west. Rea]. Estate (Pepin. County, (~isronsin) t,ot Five (5) , Block T~.~o (2) , Klarps~ Sui~di+rision +to Town of Pepin, Pepin County, wisconsin. AI~iD; Lot 4, flock 4 of the Klampe Subdivision in the Town o€ Pedint Pepin %ou.~ncy, iv;.:::;ur~si.ri AND Part of ?~et ? , r3lock 5, i'irst Addition to K'sampe Subdivisio;~, described as follows: Corttnencirg at the Southeast corner of said L,ot, which is t~,e Point of Beginning; 'thence ?forth 4GQ8' East, 135 feet; thence South d3 52' East, 91.40 feet; thence South 8014' West, 163.43 Feet. to the Point cf Beginning. I.c~cated in Government ;mot 2 of Section `t'wenty-One r21) , Township T'~renty-three (23) Nc;rth, Range Fifteen (15) Flest, all in TCw'?v afi PErIPl, Pepin Coun~y, Wisconsin.