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Home My WebLink About018-2021-02-001tWisconsin,Department of Commerce PRIVATE SEWAGE SYSTEM Safety~nd Build~ly Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). ermit Holder's Name: City Village X Township Hammond Hills Estates, LLC Hammond, Town of :ST BM Elev: Insp. BM Elev: BM Description: /0~ 'ANK INFORMATION • ..c ~ ELEVATION DATA TYPE MANUFACTURER ~ ~n I CAPACITY Septic v l~c,~- ~; ~k,,, Z Dosing Aeration ..~--._...___._~ Holding TANK SETBACK INFORMATION TANK TO G P/L~ Gp - - WELL BLDG. Vent to Air Intake ROAD Septic d ~ ~ Z ,~ ~ ~ ~ __._ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Num TDH Lit Friction Loss System He TDH Ft Forcemain Len Dist. to Well county: St. Croix Sanitary Permit No: 506351 0 State Plan ID No: Parcel Tax No: I Y-~.a~~- oz~v Section/Town/Range/Map No: 08.29.17. STATION BS HI FS ELEV. Benchmark 2 ••7 /OZ•? ~~ Alt. B~VI ~~ Z'~ ~~ Bldg. Sewer + ~~i ~ ~ SUHt Inlet L iq 1 9'I 'T St/Ht Outlet ~ ! 1 9 ~ • Dt Inlet ~• ~ Dt Bottom Header/Man. ~• G / Dist. Pipe ~' ~•~ 9Z s Bot. System o ~10~ ~ .5 °~ ~' sz Final Grade 3.8 9~.7 St Cover(('''' ~^ T'i l ~+1. ~A • 3 /~ ~ ~ ~ ~' ~g ~/ i ,~,1 SOIL ABSORPTION SYSTEM BEDITRENCH Width ~ Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. _ Liquid epth DIMENSIONS ~ ~~ ~+ Z ~ `~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer //~'~ n ~t"~• ~ q l a..~d~ INFORMATION Type Of System: ',1 fit! / ~ ~ ~ /~ UNIT . Model Number: u rIICTCIQI ITIIf1A1 CVCTGM . f.. ~rl.-- 23 t23 = ~ d,~ Header/Manifo~ ~~ Distribution ~ x Hole Size x Hole Spacing Vent to Air tak~'1~ Zh 1~(~O 7 Pipe(s) acin th ~ Di ~ S L ~ Dia_ Length p g a eng Cd'lll f`/'1\/GR .. o.....,~...,. e..~-...,,~ nnr.. .... Mnnn`I nr et.rrarlo Svstams Only Depth Over Depth Over ~ ~ xx Depth of xx 5eeded/Sodded xx Mulched Bed/Trench Center ~• ~ "'1 ... '" T Bed/Trench Edges \ Topsoil ~ Yes ~. No 1 Yes ~j No 1 COMMENTS: (Include code discrepencies, persons present, etc.} Inspection #1: / / Location: Hammond, W 54015 (SE 1/ SW 1/4 8 T29N R17W) Hammond Hills Estates Lot 2 1.) Alt BM Description = ~ u "~"' " "`~' - 1 \ DI.-1.........~. Inn#L. - 7 Inspection #2: / / Parcel No: 08.29.17. Y i eommerCewl.gov Safety and Buildings Division City ~~/ - 201 W. Washington Ave., P.O. Box 7162 ~ r9 l~ ~ Madison, 707- 162 ermit Number (to be fined in by CoJ Sanitary ~~ P Sanitary Permit Applicati~ bmission of this form to the appropriate govle d i Ad C State Transaction Number //.~[" e, su tn o s. In accordance with s. Comm 83.21(2), W unit is required prior to obtaining a sanitary permit. Note: Application forms for stato-owned POWTS are Project Address if different than mail' ad 1 submitted to the Deparanent of Commerce. Personal information you provide tray be for secondary ~ ~ ! es in acwrdance with the Priv Law, s. 15. 1 rn , Stats. I. lication Information -Please Print All Information ~ ~ _ t ~ Parcel # Proper'y Owner's Nat>ste e~ t rS ~~ ~ ~ ~ Propttty s Mailing Address. ` ~ ~ ~~ ProI~Y L-O-Cet1On - t Ci State t ' Z-P Code ix N y., J W ya Section ~ / S • ~ / O/ ~ N; R ~tE r W l ' y) ~ ~ ~ dype of Building (check sIl that app II. S "vision Name or 2 Family Dwelling - Number of Bedrooms ~ / . ~~ ~ ^ public/Comtnercial -Describe Use -~ City of CSM Number ^ Village of ~~ ~G + ^ State Owned -Describe Use "~ own of ~ bo on liae A. Complete line B If applicable) TII. Type of Permit: (Check o o `~• a ystem . _' ^ Replacement System ^ Treatment/Holding Tack Replacement Only ^ Other Modification m Existing System{explain) List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of Phunber ^ Permit Transfer to New Owner ~ ~•~ ~ ,~- , Before Expiration YV. T e of POWTS S stemlCom oneatlDevice: Check all that a l G -Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ~Dispersat Component (expiaur) ^ Pretreatment Devi {sin} V. Dis rsaUTreatment Area Information: a Required ( Dispersal sed (sf) re Design Flow (gpd)/' Design Sof it APPlicati Rate(gpdsf) Dispe ate! A- ~ ~" Sys &levation ~~ r , ~ ~ . J~ v ~ ~ vv VZ. Tank Info Capacity in Qallons Total Gallons # of Units Manufacturer ~ ~ ~~;; .R ° New Tanks ~ fixisti Tanks T ~ Lt/ ~ ~ ~ v7 w ~ Pn Septic or Holding Tank ~ _ _ . Dosing Chamber VII. Responsibili Statement- I, the undersigned, asanme respo ty for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si MP/NIPRS Number Basilicas Phone Number ~~ ,. Plumber's Address (Street, City, State, Zip e) ~/ ` v VIII. Coun 1De artrnent IJse Onl Permit Fee Date Iss Issuing A e t Signature ~~PProved I S~1 $ ~~D' ~ LL -7 ~d ~ / 0 Given Reason nial 7 IX. Condit~~sons for Disapproval S, B J ~ ~~ f A~~ ~ /: M„1,,J 1. Septic tank,. effluent filter and f ~ / dispersal cell must all he services !maintained t,,) a~ ~.: ~ Wlor.: I~~- ~ • as per management plan provided by phtmber. 2. All setback tequker--eMs must be maintained ~ •~. _ .. _....~. _ __ _ __._. __ _____ _-..-... x.... a n . t t h.nf..e in M• Aciaca W ¢ompiea• piaas wr su• •r•s•w •uv .....w.............-..y .. ~ - .. SBD-6398 (R 01107) Valid thtu 01/09 . P T PLAN PRUJECT Oeverina Homes LLC/ Hammon ADDRESS P.O. Box 179 New Richmond Wi 54017 S E 1/ 4 SW 1/ 4 S 8 /T 29 R 7 W TOWN Hammond COUNTY ST. CROIX 9/29/07 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUND SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all setbacks required by SYSTEM ELEVATION 91.8/91.7 5' below grade WDNR 101st. Ave Plans Designed Using Conventional Powts Manual Version 2.0 3 0' Pro Bec Hoy 0 S 3~ Vent >6" of Cover 12" 4' Long Quick4 Standard Leaching Cham with 20.0 ft2 ~~eeaa ~o' 5.8ft^2/pair o ncPcaps Grade at System Elevation 30' B-3 K} 45' e 30' _ ^, 10' j J ~ B-1 0 !7 Vents ~B-2 2-3' X 90' Cells with >3' spacing Scale is 1" = 40' unless otherwise Please note: survey was not complete at the time of testing, noted installer must check all setbacks prior to installation. ~~~~ 120' ~ r'""~ h; S 3 ~ ~ ~ y a F; t t o~~ ~~ new 428' Property Line ,,~,,~ B.M. 218' Property Line PRbJECT Oeverina Homes LLC/ Hamn SE 1/4 SW 1/4S 8 /T 29 )T PLAN ADDRESS P.O. Box 179 New Richmond Wi 54017 ~ 17 w TOwN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 ~ DATE9/29/07 BEDROOM 3 CONVENTIONAL XXX IN-GROUND SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all setbacks required by SYSTEM ELEVATION 91.8/91.7 5' below grade WDNR 101st. Ave Plans Designed Using Conventional Powts Manual Version 2.0 30' S' Pro 3 Bedroom House 30' Bn 45' 0% Slope 30' 10' B-1 45' > 6" of Cover 4' Long 12" 1 A )) Vent Quick4 Standard-W Leaching Chamber with 20.0 ft2 of Area 5.8ft^2/pair of end caps Grade at System Elevation Scale is 1" = 40' unless otherwise noted Vents 2-3' X 90' Cells with >3' spacing Please note: survey was not complete at the time of testing, installer must check all setbacks prior to installation. 120' 428' Property Line .M. 218' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT ... Page of Division of Safety and Buildings in acx-,uraancz wiu~ ~.wnrn oa, YYIb. rwlll. VVNC County ~~~ ~ .~ Plan must lete site plan on paper not less than S 112 x 11 inches in size Attach com ~' . p indude, but not limited to: vertical and horizontal reference point (BM), direction and per( I,p, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print al! information. Revi by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.114 (1) (m)). y 7 /d ~ r Property Owner ¢ Property Location g ~ D ~ ~ ~~ ~'~ /"! Govt. Lot 5~ 114 `j 114 T ~ ~ N R [ E ( W P rty owners Ma' Address Lot # Block # or CSM# . N a m e ~ ~ ~ ~ City fate P Code Phone Number ^ City ^ Village Town Nearest Road New Construction Use Residential / Number of bedrooms .~ _ Code derived design flow rate ~ GPD I ^ Replacement ^ Pu is or commerdal - _ _____ __ __ Parent material !3 ~~ n eleva ' if applicable ~e~~/.~ ft. ~ / ~2;~J~-`-' reeorrrrtiorts: ,,t JUN 1 2~~'l f' ~- - System ~~ • r~i i i~ # ~n9 // ~~ Pit Ground surface elev. ~~ ' ~ ft. Depth to limiting factor ~ ~ in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture 5tnrchue Consistence Boundary Roots GP D/ft? _ - in. Munsep (2u. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-~3 , 31 ~s 2 13-y ~ . y~ s----- ~~ ~ , 1 nn ~`•~D w1 d Boring # ~ ~~ ,~ Pit Ground surface elev. ~ ~ ft. Depth to limiting factor / ~. ~ tc~tion Rate Horizon Depth Dominant Redox Desaiption Texture Structure Consistence Boundary Roots GP DIfF in. Mtmsep Qu. Sz. CoM. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 7~.~ ~ yr ~'`- - ~ . n .s ~ • Effluent #1 = BOD > 30 < 220 ng1L and TSS >30 < 150 'Effluent #2 = BOD < 30 rrxyL and T55 < 3t) mglL C~ [ ~~ prinU Si a CST Number Bird Plumbing, Inc. Shaun Bird / 226900 Address Date Evaluation Conducted ~~ Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ _~_ „ ~ 715-246-4516 Property Owner ._ ~1 .,____ ~. ^. Boring rPlarcel 1D # ~/ 7 ~7 i~ Page of ~, __....a .. ~ Pit Ground surface e~ev.~_ ft. DepTn m t+rrutu~g rasa ~ _ a'. tion Texture Stricture Consistence Boundary Roots x Descri R d l Sa'1 nation Rate GPD/fF Horinon Dept- in. or Dominant Co Mansell p e o Du. Sz. Cort. Cola Gr. Sz. Sh. •Eff#1 •Etf#2 -Z. - ~j -----= e ~' Boring # ^ Borings Pit Ground surface elev.'! L ft. Depth m limiting factor ~ in. ~ ~~ ~e ~iortZOn Depth Dominant Color Redox Desaiption Texture Sure Consistence Boundary Roots GPDlfP in. Mansell Qu. Sz Cont Cda Gr. Sz Sh. •Efl#1 `Eff#2 ~ ®~ ~ } /V r r2n~inn ~f ^ BOrirg U - o U Pit vrouna sunaoe @lev. n. ~,~a~ w ~amm~y ~auv~ ~. Texture Struc6ure Consistence. Botu~dary Roots th Dominant Redox Desafption hl i ') Sod Rate GPD/ft? or zon ep m. Mansell . Qu. Sz. Cont. Cobs Gr. Sz Sh. •Etf#1 `EtT#2 t~ 'Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mglL • Effluent #2 =BODE _< 30 rnglL and:TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or - need. material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. saoa3w (R.~oo) . n Soil Test Plot Plan Project Name Oevering Homes LLC Sha i t ~~ Address P.O. Box 179 ~, New Richmond Wi 54017 C M #226900 Lot 2 Subdivision Hammond Hills Estates Date 6/2/07 SE 1/4 S W 1/4S $ T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 91.8/91.7 *HRPSame as Benchmark 101st. Ave Please note: survey was not complete at the time of testing, installer must check all setbacks prior to installation. Scale is 1" = 40' unless otherwise noted B-3 45' 0% Slope 30' 45' B-2 n* I ,B.M. 218' Provertv Line 120' 10' B-1 428' Property Line ~'-'`7~ ' 2.41 A c . ~ °_ ~ ~ ~"' ~ ~ ~i i " % C.B. 26240 S.F. I ~' s2 \~~ ,( /", ,/ / / '// ~ ~ C.B. 0.60 Ac. ~ ~ S" . / /, / N - ~ : L4 T 7 ' /i i : ~~i / I ~ ~ '800, ; / ~ ~= / ; /i " ~ ~sB 6 104329 S. F. ~~ ,' / I - 3 // ~ i / ' / . ~/i , / ~--_ 2.40 Ac. `~B 6 .3 -~ // ~/" ~, / ~~ C.B. 62592 S.F_ ~ ~~ ~_.+~~~' / /'~ . ~ 7 ~ C.B. 1.44 Ac. ~ ~' 7 ~.i /~ ~ ,. / /~%~ / i ;. / // //" N 89'3!'18" W 206.5' ~~ C °_ ~ 8' N 89'34'18" W 206.5' 6`~ ` ti ' ' ' ~' \~` ~- t` ~, 6 ~~ ,~ :,:. 126.7' ~ 79.8' 91 ' 6 ~ ~~~~.. ~,h O9' "5 _ -- -- \ -- --- - _ ---~ ~ `Z ~ ~ Z ~ ~~ 0 ~ ~W ~ ~ I .~ i ~, ~ LOT 1 ~~- LOT sB4i ~ LOT 3 ~ I SZ' ~` ~~ ~~ 96621 s.F. ~ e y 96595~S.F. / /N 69475 S. F. ~~ ~ 78023 S.F. N \ ~~" 2.22 Ac. ,l/. 2.22 Ac. / ~~' ;1.59 Ac. ~!~ I 1.79 ~. ~`\ C.B. 46030 S.F. ~J' ~ ` ~ 2 C.B. 1.06 Ac. ~/ / / I ~ \ ~~ ~' 287.2' ~ 250.0' ' _ 2 ' 249.6' - - ,.~. - _ ___ __------ ---N-$954'~6"-W-~~r3:fi~--------------~ ~~~~---E _UNPL_A_TTED_L_ANDS s ~/4 co~^ -~- - sEC s LOT 1 OWNED_~Y OTHERS T29N I ------- AG. RESIDENTIAL R"'" P !_ A T ------------ I ----------- OPERTY OF HEI AND MAY NOT BE USED OR COPIED WITHOUT PRIOR WRITTEN CONSENT. ~ ST. C120IX COYINTY SEPTIC TANK MAINANCE AGR:I'sEMENT O'GVNERSHIP GEg'I`1FTCATION FORM ~~~~r~ ow~~rBuy~r -----~ Mailing Address „~~ /~ Nei D~ c f Prop ~ a parnonoat for new construction.} ~~:- , ~~ ~ ~ - (Vcsification rcqurred from Planning ~ ~ ~ -l ~ 16 ~ S~ - City/State Parcel Identification Number ~ LEGAL DESCRIPTZ4N Q C' ~/f" ~ ~r/a , Sec. U . T ~N R~~, Town of Progeny Location ~.~ /a ,~ ~ , . ~ ~ , , . ~~ _ ~ , ~ .~r _, Lot # SUbt~1VISlOn ~" In- °'~`~• ^ Volume ~ Page~# Certified Survey Map # .--- i ~ c7 ~ ~ ~ , 'Volume _-~---= I''age # - Warrauty'Deed # O Spec house yes no Lot lines identifiable yes no ~Iaa~.~..,.~...~.....------ failure to httndlc wastas. ~Pa Tnrproper use and maiatenan~ of your septic system could result in its pr ~~ by a licaosed P~P~ ~t y°u put into maintenance consists of pumping out the septic tank every three years or sooner, s ~~ maintenance the system can affect the function of the septic tank as a treatment stage in the waste disposal Osdinsaca. responsibilities ate specified in §Comm. 8352(1) add is Chapter 12 - St. Croix County Sanitary ,: Planning 8t Zoning DeparnYretit a certificarion form. signed by the .~ prop~y owner agrees to submit to St. Croix Countyl~~ or a Iicxaased Pumper v~Y~g that (l) ~ on site owner and by a master plumber, journeyman plumber, restricted p and PumpinS (if necessary. the saP~ tank ~ wastewater disposal system is in proper operating condition and/or (2) after inspection less than 1/3 full of sludge. ~ s stem with the urrements and agree to maintain the pnvate sewage disposal Y Uwc, the rtndersigned have read the above zeq ~ and ~~ ~p~cnt of Natural Resources. State of wiscoasin- standards set forth, herein, as set by the Dcparement of Commerce letcd and returned to the St. Croix County Punning & Certification stating that your septic system has been maintained must be comp . ~~ Department within 3Q days of the three year expiration daft. _ 3/we am/an the owner(s) of the Uwe ceTfifi' that all statements on this form are true to the best otfermof Deeds Office. ! ~ 02 ~~~ Pro described above, by virtue of a warranty deed recorded in Regis DATE SIGNATURE APPLICANT(S) 8i Zoning Ikpstt-*~` esented may result in the sanitary permit being revoked by the Planning ~~* Any information that is misrepr cation a recorded warranty decd from the Register of Deeds Office and a copy of the ccmf' xtd swn'e5' ~P if Irzclude with this apPli reference is made in the wsaantY deed: {REV. 48J0~? State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number ~ Document Name THIS DEED, made between D&B Equipment, LLC A Wisconsin Limited Liability Company ("Grantor," whether one or more), and Hammond Hills Estates Development LLC ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See Attached PINS: part of the following parcels 018-1016-50-000; 018-1017-00-000; 018-1017-30-000; 018-1017-40-000; 018-1017-50-000; 018-1017-50-001 (1111111111 IIIII 611111111 11111 1111 111111 Ili1 till * 8 5 0 4 1 8 2 850418 KATNtEEN li. WALSH REGISTER OF DEEDS ST. CROIX CD., WI RECEIVED FOR RECORD 05/11/2007 03:15PM WARRANTY DEED EXEMPT A REC FEE: 13.00 TRANS FEE: 1333.20 PAGES: 2 Recording Area Name and Return Address Assured Title, LLC 1810 Crest View Drive, #1B Hudson, WI 54016 Parcel Identification Number (P[N) This IS NOT homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements, Restrictions, and Rights of Way of Record Dated ~ ~ ~ ~~ - f * Ronald C. Bonte, Member * Steven M. Dalton, Member (SEAL) (SEAL) AUT r `~Cjy ACKNOWLEDGMENT Signature(s) ~ 0 STATE OF WISCONSIN ) ,k } ss. authenticated on ~ St. Croix COUNTY ) * p~gL.IC 2 * Personally came before me on ~'~ ~ ~ ~' TITLE: MEMBER STA the above-named Ronald C. Bonte and Steven .Dalton as the Members of D ui m L ((f not, t me ow be a per (s) wh executed the foregoing authorized by Wis. Stat. § 706.06) in trument ac oWleda d the e. THIS INSTRUMENT DRAFTED BY: Richard K.Y. Lau - Redmon Law Chartered Notary Public, State 2217 Vine St., Ste. 204 -- Hudson, WI 54016 My Commission (is d (Si natures ma be authenticated or acknowl g Y edged. Both are not necessary.) NOTE: THIS lS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WLSCONSIN FORM NO.1-2003 * Type name below signatures. 1 of 2 ~ M ~ -- r r ~ " ~ ~ r r R . ~ i O ~ ~ N ~ ^+~ ~ " ~ • ~ ~ ~ ^ ~iA arr 1 l f 7 •- - ,, ZTd Wdbi:Oi b00Z tri '~aQ zBZtt£SSTL: '~1 Xdd ~'7~ S3~JOH ~iI213f1~: WOZl.~ FRQhI ~ : OEVER I NG !-MMES LLC FAX N0. :7155311282 v `~ a ~' i Dec. 14 2004 10:14PM P11 J "" ~~ awrA ~~ _._____..-- --- .~..~...~.. ..r. _. ~~ i 1 1 ~ • .1 ~ ~ * ~ ` .- _ R +I a a i~Q'O E sir s~+ 44 ~ ~~ ; Fp ~~ ~ ~~ + ~i ~ R 6 a r ~~ ~ N i ~ ~ 1 1 1 N ~ ~~ '~ ~~ " z ~ ~-~'~