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HomeMy WebLinkAbout018-1094-28-000 n ~ ~ fD < O <n Ca t ~O d 0^ O (dp b ~ N W t S C O ~ ~ (D 7 N °~ ~ v 3 `~ W ~ 30°J C ~ n 3 a i ~ m U? A w cz~ ~ ~ o W ~ o ~r ~ == Z 0 N CD a c m O. ~ ~D n ~ c ~ ~ a d ~ N N a Z z 3 o_ ~ o =~ ~ ~, O N 0~. ~ 7 O O O ~ D7 7 O ~ (D C m rn ti V O ~ Q o ~ a orn o ~ o' ~c ~ v N ~ O O N ~ n N N N O O CD C O' O. N O 7 O_ W O W O O 0 ~ ~u~o ~~~ °c ° f ~ ° r' 3 3 O T N ~j f~D 'C A7 ~ ~ d lD A 3 = ~ ~ ~ ;: ~ .. ~ ... .. ~ o J 2 ', S v ~ ~ N N N Yr O N !'Y '~. O. ~ FS ~ 00 OD ~ N N w 7 O C m c o ~ ~ m ~ ~ p, rn a .. ~ ', o ° 0 0o S '', oo~o a o °o rn n o c 0 0 = ',~ ~ '•' a v •• ~ G < G O ''. 3 v o v m ~ CI V p Z11 0~1 N ~ 7 ~ ~ ''. A 7 .. Z -i Z D m ~ ~ ~ s ~ N .Z1 m O C n ~ 7~ N (D V ~- ~ ~ ~ ~, ' ~ -' -i ~n O A Z n ~ ~ p 2 O a .. ~ 3 IZN~ W ~ m m -~ z 0 3 A ~ c =~ z 4 m ~ N f~D ~ O p~ n (D N ~_ c a ',I i Z O '~ 'I A 6p A ti Parcel #: 018-1094-28-000 oai2si2oos 09:31 AM PAGE 1 OF 1 Alt. Parcel #: 17.29.17.768 018 -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 -HAWKINS, WILLIAM E WILLIAM E HAWKINS 976 170TH ST HAMMOND WI 54015 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ~ 976 170TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 19.640 Plat: 09-002-PRAIRIE RUN LOTS 1/35 018-02 20SEC 17 T29N R17W PT NW NE & SE NE Block/Condo Bldg: LOT 28 PRAIRIE RUN LOT 28 19.640AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-17W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 04/15/2002 676384 9/02 PLAT 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/19/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 26,000 59,200 85,200 NO AGRICULTURAL G4 7.000 800 0 800 NO UNDEVELOPED G5 10.640 9,400 0 9,400 NO Totals for 2008: General Property 19.640 36,200 59,200 95,400 Woodland 0.000 0 0 Totals for 2007: General Property 19.640 36,200 59,200 95,400 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 /* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT} Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Hawkins, Williams Hammond Township CST BM Elev.:. Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~,. ~~ ~ JD~I Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~ ~S' .~-~` -~. (~ ~ r NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION facturer D nd Model Number _~--~°'""~ GPM TDH Lift Lrlction S stem TDH Ft orcemain Length Dia. Dist. SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No.: 374926 State Plan ID No.: Parcel Tax No.: 018-1036-70-000 STATION BS HI FS ELEV_ Benchmark ~./4) 2.35 ab O Alt. BM Idg. Sew or. y ~ ~ Q•Z( 9 3. /`~ St/Ht Inlet ~ ~S Sr St / Ht Outlet (P - gp ~(, gyp' Dt Inlet Dt Bottom ~~ Dist. Pipe ~ ~' Bot. System $ 't~ ~, too 9° ~ y ~ ' O. O Final Grade -~r~ar~e3 ~{ 50 9`f o o' St cover Z-go GjS. gip' B'~#37 R N Width , I Length r No. Of tenches PIT f Pits Inside Dia. iquid Depth DIMEN 5 4 g ~ DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ufacturer: SETBACK CHA l M INFORMATION Type O -~L/ C t "' r of 3 .~~ UNIT er: o e ,B r System: ~ l0+ Z DISTRIBUTION SYSTEM Header /Manifold u Di L th ~ ~ Distribution Pipe(s) r rt r th (P S Di n in L S 1~ x Hole Size - -- - x Hole Spaci Vent To Air Intake r 7 ~~ eng _ a. g g pac e a. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded J Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: (D / o~ Inspection #2: ~--/ Location: 976 170th Avenue, Hammonc}, WI 54015 (NE 1/4 NE 1/4 17 T 9N R17W) - 172917257 1.) Alt BM Description = ~- {°~G0•'"~ S""~-- ~""'# "'" ~""`'-" ~°'"'"N°'"4~' 2.) Bldg sewer length = p,~,~,~d ~ r ~ 3 ~ ,-ew.Jf t'" -amount of cover = 7 ~w ~C ~-~ ~ ~ r ~~( 3~ IS ~ roc, ~,s~v~P~~s R...~ ~.,.R,AI~.kr~i, ~ Sz lD~~•0 S ~ /csr; so ~'~~ Plan r~vl~s on required? I ^ Yes No - Use other side for additio I infor `~tion. 1Z Z°I ~ 5 S~ ~} ~ lop t••lleerr Date Inspector's Signature Cert. No. SB 6710 (R.3/97) ` Sanitary Permit Application ( Safety Bc Buiidmgs Ufvtston In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Avc. PO Box 7302 `~ SiCOIl51I~ See reverse side for instructions for completing this application oses ur ~ d d f Madison. Wi 53707.730" . gapartment of commerce p an p or secon Personal information you provide ma}~ be use [Privacy Lav`~, s. 15.04(1)(m)] (Submit completed Corm to county if r state owner Attach com f ete lens (to the county co - only) for the s~~stem, on than 8 .112 x i I inches in size. Coun ~ vi u ap li a~ ~ State Sanitary Permit Number ^ Check if nevi ~ State Plan 1. D. Number S~CY r` 1 ~ 2 is ~ ~ I. A lication information -Please Print all Information ~ cation: . ~' ner Name r '° Property Ow erty Location / 1/4 ' ll4. S /? T N. l~ or rs of fng dyes _:.4 HlockNumber ,Et( umber %7 l7~ ~~ r ST CROtX ~s ~ ~~ ,{ l~U GE-CY~ S Zip Code Phon u r .Ot~1NG OFFICE ivision Name or CSA4 Number II Type of Building: (check one) ~`'`- `' 3 ^ Cfty ^ Village ^ 1 or 2 Family Dwelling - No: of Bedrooms: Town of D public/Cotttmercial (describe use}; !S( rh o'" d O State-owned III Type of Permit: {Check only one box on line A. Check box on line B if applicable) Nearest Road ~7rJ T/ ~v~- A) 1. D New System 2. J~eplacement 3. D Replacement of 4. D Addition to Parcel Tax Number(s) S stem TankOnl Existin S stem al -le3G-~ro-Boo .29 .2S B) Permit Number Date Issued D A Sanit Permit was reviousl issued jV. Type of POWT System: (Check all that apply) Non-pressurized In-ground ^ Mound D Sand Filter ^ Constructed Wetland ^ Pressurized In-ground D Holding Tank O Single Pass D Drip Line D At-grade O Aerobic Treatment Unit O Recirculating D Other: V Dis ersaUTreatment Area inforrnatioa: Z S" " 1. Design Flow (gpd) 2. DispersalArca 3. Dispersal Area 4. Soil Application 3. Percolation Rate 6. System Elevation 7. Final Grade '1 ~ Elevation Required Proposed Rate (Gals.ldaylsq. ft.) (Min.linch} T/ Q~, $ VI Taak Capacitytn Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks O D ^ D S:! ' ~~ c. ~, Od ~ ~ ~ yam, ~Wes7`'~ y.rJ © D D VII Responsibility Statement the undersi ed assume res onsibilit fcr installation of the POWTS sho the attached laps. Plumber's Name (print} Plumber's Signature (no stamps)• M PRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) sc ate' d ~. ~ r- l6 VIII Coupty/Department Use Onfy D Disapproved Sanitary Permit Fee (includes Groundwater Date Issued issuing Agent Signature (No stamps) [Approved D Owner Given Initial Adverse Surcharge Fee) ~ ~ Z Od ~-- ~ Determination Z Z,S U .. lIX. Conditions of Approval /Re/ason/s for Disapproval: ~'/o oe(P /~'%" ~~'^` `' ~ ~ksyrS~ew. t~/v2Tein~- ~/S`iaG~ De 30~-S~r~~t~w oi~"'~na~9raC/~P, ~ tr/Y{r ~i ~ bYtQri/I Tar/H~l~ //~+/ {~14/N G~ ~ C'r141'Cv S /[ C ort~ rHln G("(~ast S. ~ e X r 5 ~•`,,. f SY s 1 r nti ~p J[ 4 KF~ tiO~a h Pd i1 et CGO r~iL~i c'C W r~~ ~U w. nt ~~ • 33 ~ w<// spa. /~ ,~~ > sa ' ~~m~ s~`of,'c S~,s {<..~ SBD-6398 (R 07!00) --I~.~., . _... ~c+,l~" dam' r o~d~~~~'~'o,d ia~: v s ~~ xG~.~r~~~~ /~~ r° ~ ~>~'~ ~ ~,~ G°~~ v Y 4 ~ ~° v~~ ~r ~,a"'' P` by ~(o Boa e 4 5~~ b~ ~:'~"~,~ i,~~dpe ~ ~ r~ ~~~ ti ~~ s,' r~~ unacurisin urtpar rnant Ot tJOmmerC9 SOIL AND SITE EVALUATION ' Divisidn of Safety and Buildings Page / of eu>~u of Integrated Services in accordance with s. ILHR 83A9, Wis. Adm. Code Attach complete site plan on paper not less than 8 tl2 x 11 inches in size. Plan must """'' include, but not ilmited to: vertical and horizontal reference point {BM}, direction and ,j ~~• r percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INfORMATtON -Please pr/nt a!I lnformaflon. Reviewed by Date Personal irdormation you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1 } {m}}. ~ Z, D~ Pro/pe/rty Ow/ner Property Location ~,/~ I~ ~ ~l • `ice ~-~c~ uw l~ •` ~ Govt. Lot ,~~ i/4~~ 1/4,S /? T ~' q .N,R 17 E {off Property Owner's Mailing Address Lot # Block# Subd. Name ar CSM# I 2~ Q C/~ S City State Zip Cade Phone Number ^ City ^ Village ~0] Yawn Nearest Road ^ New Construction Use: 'Replacement ®Residential 1 Number of bedrooms -_,~--•••- Addition to existing building ^ Public or commercial • Describe: Code derived dally flow ~ gpd Recommended design loading rate e 7 bed, gpd/tt2~trench, gpd/Ft2 Absorption area required G y3 -,.-bed, ft2 5L 3 trench, ft 2 Maximum design loading rate ~ ~ bed, gpd/ft2 ~ ~ trench, gpd/fiz Recommended infiltration surface elevations} T / 9% • ~ ~ ft (as referred to site plan benchmark) Additional deaigNsite considerations Parent material Plood plain elevation, if applicable ft S = Suitable or system U = unsuitable for system L~ s ^ u ~ s ^ u (mss ^ u ®s ^ u ^ s ®, u ^ s ~ u [3oring # g~ / ita~~u- GrounrJ .57ft. Depth to limiting factor 9.z. in. Boring # ,N;k , ~, ~~ .~,~~.' t Ground elev. 9Y~ft. Depth to limiting factor , ~(~,in. Remarks: CST Name (Please Print} Signature Telephone No. ~Jel~~`~t111 S~tiw~aye~ ,~.~ T/5-3~~-31a/ ~Addfess ~ Date CST Number I i~--~ it c,. _.,.~~~~~ ,.~/. ~ ~_. ,i >_l . ~-~~r// 5'/ail/~ ~ ~~7~'~l1 SOIL DESCRI PTION RE PORT Horizon Depth Dominant Color Mottles Structure i t C da B Roots P ~~ in. Mansell Du. Sz. Cont. Color Texture Gr, Sz. Sh. ence ons s ry oun ch ., ' 3 I• f 1I ~ H ? r ca~-4o•`fo ' ~v Remarks: 1 v-ly • , -- 5 ' ~ mu ~ ~ S ~ ~ , Ste', /y G S l hi f< <~ , 7/. ~ GP•~ PROPERTY OWNER /~tccJl;~~.tJS SCN4. DESCRIPTION REPQRT PARCEL I.D.# Boring # ~` Ground elev. ~<c~~t. Deptri to limiting factor ~_in. Baring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Page ~ of Horizon Depth Dominant Color mottles T Structure i t C B d t R 2 In. Munseli Qu. Sz. Cont. Color exture Gr. Sz. Sh. ons s ence oun ary oo s Bed .Trench p_ 6 3 -- S' .~ 1~a6if m ~ ~ e ~ ~ _ S~'~ a - ~ ~-s SPY ~ --- ~ 5 i ~ R C S ~ ~r- IS 3.~5' a2.Y 4o•9r)~ . ~y7,.e~ t o3. Remarks: Remarks: Horizon Depth Dominant Color Mottles T Structure i t C B d R t in. Munsell Qu. Sz. Cont. Color exture Gr. Sz. Sh. ons s ence oun ary oo s Bed ,Trench Depth to limiting faotor in. Boring # . dp... Ground elev. ft. Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R. 07196) ---~/~' ar ~ ~=yd Q~`~ o,y BOG. o ~"cad-~- / ~ ` y'G ~ ~~1a ~~ ~=~` ~o T -~ ~~ rgb.s~ l~ z 1 ~ d p y. ~ / t LcJcz~ /°~3 oF,3 TI Y f ~~ a~~ ~~ ~. OF ~c~ t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT •-AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ti,- l~ a ~ ~ ~~ ~`'''~ Mailing Address 9T /' f 7 d Th f~ ~ ~ ~'~`~ ~ ~ ~ '~y~ l ~ Property Address a yn +~ . (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION Property I-ocatioa ~_-'/•, .~ `/•, Sec. l ? , T a 9 N-R~Zw~ Town of ~ ~ ~ 6-~ d . Subdivision /02 d' '~ ~' e- -Lot # =. Certified Survey Map # ^"~- , Volume -,.Page # Warranty Deed # ~ 7 6'~ /~ , Volume /~ ~ ~ .Page # ~Y3~ Spec house ^ yes ®- no Lot lines identifiable ^ yes ~. no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handl~t you put int system consists of pumping out the septic tank e a ery three years or sooner, if needed by a licensed pumpe can affect the function of the septic tank as a treatment stage in the waste disposal system, The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a lumber, restricted lumber or a licensedpumper vertfyrng that (1) the on site wastewaterdisposal system msstCrplumber, journeymanp P the s tic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pumping (if necessary), ep Uwe, the undersigned have read the above requirements and agree to maintain the Private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of ~ g O ~ ~~u30 stating that your septic system has been maintained must be completed and returned to the St. Croix County days of the three year expiration date. G ~ ®® ~l cT l ~d ~s~~ • ~.~~t..,~ • ~ DATE SIGNATURE OF APPLICANT OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) o the ro erty described above, by virtue of a warranty deed recorded u~ Register of Deeds Office. pt ~ ~ ~~'~cfid DATE SIGNATURE OF APPLICANT artntent. ****** *ss*** Any information that is mis-represented may result in the sanityry permit being revoked by the Zoning Dep ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed .. DOCUMENT NO. QUIT CL71+tI DSSD Mary Christine Hawkins-POdboy, quit-claims to William E. Hawkins, the following described real estate in St. Croix County, State of Wiaconain: 'An undivided one-fourth (114) interest in the property more 'specifically described as: Worth Three Fourths of Northeast Quarter (N 3/4 of NS 1/4) of Section iSeventeen (17), Township Twenty Nine (291 North, Rarge Seventeen (17) West . ISt. Croix County, Wiaconain. f~ ~~~ REGISTER'S ~~F~(GE jT. CRGb: ~~?., Wl 5.4 ~'~ Vic- W.cvrd UEC 3 1 19y1 9:15A M ~..~• NAME AND RETURN ADCRESS TRA~ FER i ' Thia ie not homestead property. ' Dated this ~~ ~ ~ day of December, 1997. __~~~I~ , ~c c `1(L v{) ~~ c ~ ~ (SEAL ) -~''~c2 u Mary C iat ne Haw ins-Po y (SEAL) Signature(s) ADTSiN?ICA?ION ', authenticated *.his ` day of is` ' °ITLB: MSMBSR STATS BAR OP WISCONSIN ' (II not, ' authorize y 5706.06, Wis. State. rsls INSTRV~t? N71S DRAP?iD sy: Leo A. Beskar Rodli, Beskar, Boles a Krueger, S.C. P.O. Box 138 River Falle, WI 54022 ACAM STATE OP WISCONSIN (SHAL) (SBAI,1 ae. YIF: C~~ COUNTY 1 personally came before me this -~.'~ day of /~t•C~F.~'r7fj~~ 19~ the above named Mary st ne Naw na-PLO boy to me known to be the person(s) who executed the fore~~ i~struaient and acknowledge the same. •~~.' Notary wblt~l ~ T County, Wis. My eomniaai~on 1~~e s(If not, expiration date: .EGG D ) i ~'~~ , ~ ~S p~f®,~~` Rodli, Beskar, Boles & Krueger, S.C. 219 North Main PO BOX 138 River Falls, WI 54022 Parce I enti ieation Number PIN Y tq r