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HomeMy WebLinkAbout018-1016-20-000 nv,O mvn °c 3 n 3 o n1. (D v # \ 1 c~D 74 I ~ 0 n 3 N N N o o~ v w m m o o n o n n n m A j 30 ° rn v O C v co co m p- 00 C p O CD CD (D N ~ O o c (D o o u o 0 y °z 7 0o C N_ N O r~ ~1 m I ~ cn ~ D A 4 co CD co CD cn CL D N W c c Q 3 O j 'I c;wcn o CD Z co co ~ Q c C7 U] ~ J I N • • ~ !ti v 3 H o O O O o t~l (D cn rt ca (n C" 0 ° rt n ~ v d o v F . fD tLj 2 (D = o m d ' N W 00 t G7 3 y cn n _ CD - rn ( O 7 4 n A (D 4- t.at 1 ~ I o z co z o Q 0 CD CD "Ni CD En N. c (D (D 1 F~ 1 z CD (D A Z fN9 W p c ,n.. H H is n A 2 0 Cl) 0 N) v n G) 3 Z a. o Z co T N) o W (D Z rn U) L n (D O 3 A 1l " C C~C n 3 zz p W g a m ° ; M 00 1 d a I v_ n ~ 0 3 v c I =3 Z d ° o_ CD 0 N m a A ' A S A N i lv tv O O V ' A N OWo <n O O C * o a o a Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP .yyn SEC. T N-RAW ADDRESS ST. CROIX COUNTY, WISCONSIN • SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t I q INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used /.flp Elevation of vertical reference point: 11-2 V Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: O Tank manhole cover elevation: ~J z Tank Inlet Elevation: Tank Outlet Elevation: 7 7 Number of feet from nearest Road: Front 0 Side,o Rear, O feet From nearest property line Front,0 Side,0 Rear,.0 feet Number of feet from: well building: r (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER s Manufacturer: Taiquid Capacity: Pump Model: Pumpt.3phon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switchvation: Gallons per cycle: Alarm Manuf turer: Alarm Switch Type: Number-of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width 2 Length: Number of Lines: Area Built: Fill depth to top of pipe: 6 Number of feet from nearest property line: Fron~t,,~ O Side, Q Rear,O Ft ./Q Number of feet from well: i Number of feet from building: ~J (Include distances on plot plan). SEEPAGE PIT Size: N~nber of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built : ~ , Has eXOnsytems-? p box O or distribution box O been used on any of the above soil absor(Check one). HOLDING TANK Manufacturer: Capacity: Number of rings ud: Elevation of bottom of tank: Elevation of,![~nlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: / Inspector: Dated : Plumber on j ob : License Number : 3/84:mj COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 1 CROIX i;i3 NTl REPORT UA',E« 11111/`i., COURTHOUSE 70"r PFCEIVED1 HUDSON, WI 5401r. 6- 6rzli 13, I i ION: 1083-160 . ammf, f _ECTOR: M. Jenki,;: SOURCE OF SAMPLE' {;itches ?a,;. 'OLIFORM. 4 /144 mi ;NTERPRETATION: Bacteriologically SAFE Ib ppm :ove 14 ppm exceeds the recommended Public Drinking Water Standard. oIMADEDENO. ` l~ P u D D 'I~a !i. i-t:iJ-y 1Y9iC' :itH LL ll. I-.GCVI_1. rr'.i h..O veu A PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~1 ST. CROIX COUNTY ZONING OFFICE ,I> St. Croix County Courthouse 1 p~✓ 911 4th Street t UUU 11 (~J Hudson, WI 54016 Telephone - (715) >ervice of septic realty Firms, and property can be L, use appropriate l V ( A '.ce, and mail, ~ gill be done as JA,IC 5.00 02 5 S 7.00 aLD.00 a S. c~ a ~g ~rot-cm is properly functioning at time of 74~" Inspection) ~38G s~sv~ Property owner's name Property owner's address 1 0 $ 3 - off' S~ - rCLtwt w+~u-~ a SLO Legal Description N W 1/4 of the yUVJ 1/4 of Section , T?g_N-R 17 Town of Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: ~U►~ eC~ ki Telephone Number -S$(o -S S L Y REPORT TO BE SENT TO: ~~lt E- i rs I~C~ t~j Uv~ Closing date 11- 0 - Signature '14 HAMMOND T29N.-R.17W 31 .1,`` SEE PAGE 45 I O 'ir ~ - n wares w,.er E N 3 rs6 co. ti ,urnr/n tar • er ee Eiro/t: n H • 11j~*~r '3 tiWi/Aon~' y a ~ O.tp Thou t 41 oir// d¢ Harve Cwrsfrznce F Srorh /no'E v U ~.d n • ~a re~ n .z9.s • Goo Hi/die 5O /NE f Su uy N Geoiyius er' kb ,j / W /ry Cj / 9S S °.9 - S l h k 0 y V cvn 254 r°o st (TuncL H Ni /ke rKZ U ® a for/o qs h a F Sd. S an,e r _4 ~ - Lquist ywc' Pan,eAt St Eu ene chm~ e sr/~kr p T 40 r O 1 ,4 ,Y ,X 2S0 .Ptvra/d /l/ 5 /779 Uean 7 /~o s R Yh `'Sa'n t C/a/~ 7 . ; I sco/xsin </on0/M ~7¢cobson /5 7 Caroyn No/an Core. r,r. q de son3 Ne/son aj, '1 Farm Lrev N de soNW Farm John J3 Sammy L. 's s ~4R Fain,y Trccr/ ~0;; I t,y C `y iron: M9mt Co. ¢0 a~ -~Da/ton Morrow i c/S95 i1a o<c,;,~< chars ~C~ ~~1ii • 200 ° Z F ,Qu<h Fran- a~ /9/s/ t~ 83BS A/10 USHNELL ,Pusrnar I, 4 Tos,~son p Dv cry v 3 1 no n/ o r~ ~ <rz a atimk ~k y Tohn d I¢ bny e 40 y U y.C Ka / f D. j R/chord9 U C 9o so• -a/d ~Q oieu Fion lC /eo a Ivord Farms, ?1.C d ` Kafhe.,nc Str¢ 64.48 lne. Q'i F °y c/ ferf BO vo Eis/n9e~ eta/ C5 W, ti n `C tl r6 0 Q °~d t i('ana /d f • iTa ~~~cs N ,rra/d r o0 kKa Goaktne Fran O era/d%nc n f~~ • E/horn ry Sr 1.Bcrr, cc 63 Bo Frank e/ss L.wiseM MT Bo dO v.eje C'a <a.na„ McNe/% CTahn v Kar/ S Roxanne r • Farms //Prno LJ3 16 Curre// /Pober r Theo Che vaoer ~c F,~ W'~ ,Po er /'39 dole r° E , //o / p 9 rl/e/ on co Ti c (L/fe BO a41~~J F e e 'k~.y~ ; f BarGa/'a 7 m u rYs N /e \ry ~ 9.3: ~ e c7ie.> ws ~ ~ ebc,Eer v b ~ 7homp.son 2.71 zz8 v r~ a~ `2 Rro ,3/2.S ~ athey 4o e a. /BS p 26777 Zrene ah& • Y S ~O ,5. io 2 ~MdfOr/ ~ too O t`o V Fern B//Cardiyn E/ WA/7 9er Gera/ .r~~Q STa a6s7a4B b aor !/,e ~~.d1s - °5 - a~a- d Veran,ca Z a is t .,a d f Nov Farg1 3B 97 Da/lorY d07 b4- heron/co., K a N7 mt q nc /0753 Fa~.>s J~c Kam,/eK 2 /eo • L.:,d~~..;•t i Ca o ° y 7s 634 rzo Kusi/ek P' . l M¢ry K 74./ Donald S I i s kins V p$ nB rss 732.2 „B Haw Nax .ja d py°a rrrra 7e/6 3~ glaA SD 1 u E/ho~ B[ e d / Boy R / 7Marce//¢ N 14& 07 L7bhn 7' ,Po er- R Lana f Duane v sf ' p K o:rr/ar, Jaj~ J~ to F e ,Nord Lewis 140 NK ' ~C y fS n, Lnc• ^d 14 a //ace b V d0 /091 <)ln0/d /`/eri~e G'/' f Q efa/ CFC c 2 qr~ d Un iV KKPl'irl,~ Y9 s 3 ~c.SardE ,cs6s/ Ho%~ °v a hb/,{: _ W 4 7ss_~¢ 7Y y of ~W Ka rhr • fanny. y l7 /2 • F 3a0 `9 w .y/-/a//e : Z 200 t Farms, Six e v Q W 5 ds as a • 6 • W .Pusmar Farms, ua/° Lorn `s d r o.man re~en y h f IJ~a ~a yy U nveeny lU Inc. Duane 8 Le,.v. da 4o aro/yn f son, Snc. CY~y 5 " yrer,, f Lor 8 E e/f C 157 na LD < o h 7r s6 a Da//on Bo rnomon 49S 1 i7a..et U gO y NerberF Gessin er h Lewis Sather Turner b ~ir~ 0 //s •'~rc chv . t7iz'9 O C'or..~e// Fam// Tut/• C C htl e~e- 19 Thomas • 3 O /sd J` 0 /ink, aWebb v[, s Bnrbara \vJU e>b/ /co o-~ iz° v _ Pa///f toll" Tr F00' ,7s6 as i>.5o. /42 p 0O/' / Do/ores - /9nnabe/% V tl~ •tIr'ian L j ` R Nov Fo /53 v~ KFarmch Ramber Nose h C.tl"CO~s tis /gzs Pa t Uy C rd /boson 9 P ° y Do/arcs q F~ 0 r47 /34.32 C~C Snc. /3 /44.04- Do,hme/7 Ford 6 Yo W2 7 L 20 0 / `GnN SS B3 \ F • s Q ha /2 (i:///s Farm, a. 1 y • F a~ ca yo l C. y~ rber d co I nc 0 1/7 / .P~ -se// 8^! ~y aHA MV Far:/e/ ~ 'V WeJnveen CZ Q morn _Z- _Z- ice f, " n nneths 37 1 /ss l hd n r0. esses /06 i v g ~nci nn,, /63 erne f Y.22 s FW` 13~ VAnson C~h/ar{ h~w~ G/JS~L /e Sh. r/ay s " /2 OKa efe L✓7/4m,Jc e fChnsfian Kew-,p,ch 9J~ sz M c.rne//cT r%Sb 24 0 7366 13 ~ CF ~ d ey ,Evan Nan on ' i an Earn r a. Ken- y ✓a.na.sH F D ^ L N~-9 .~~c4 e 5 Hans n ds ie sa W/N t~noo, / PORT y Lo y haw~ns, n~ ti /bo Coyer F /e,en L e1n/ 0 d ao F US Syrus F e s~ e Jean say E 7/ v 2 l n v 2 LeSfruae Qo Peter- e. A D h orN ,1 • 54~ 79 d3 N, Bo , e1a/ B I'1 ' N son sse/r! • m S o? k o ,t7obbe y.U Boe PCUne/a Sco# l . • r ✓ 0 rh he •f-~je 9e✓er~ llun3 "fors- lC~ Ken-.Pich m a r ,a TR t` o ~f. t salty 4o 40 n en q U Fa m Inc sa6/ r', BRo tl BO Gardne.- q/" s J'$ BO v y .ASas .Tot/ erman so Moh T hn o, $ O Ch /20 own-s/o De<lz rrr~ 'da3irr //3 /r SC NIC / fie, re ti v roc. b~ch Bo ,r e /?onnr T°F/nn W, p _rnc - Gerfrudes Jar,as obr~e Il 97dJ 4.yr Bernard L L,5'/e s NF Lo y Ec/yene Nyland C a R fh Are-e- /o 115.79 zBree3e ! Lew/s t J r,c /lersre/7 f'~icrson 6 etOJ/~ `•n•• z#.57 w y rn7 - C~~.e~.E.~..F .1. arfc ven <zoo na aao T 4o W u~ Loc. Z I Farm Inc. F~ WY x er rRen 15B 73 Ken-/P.ch 155 69 Dc%r-Cs ore C a U 0 4 c Este 1/e Farm, Z~<. L We Ow o 0 j 177,2 y Eo Kaymond F, to KL zy e s/, s rd //¢em • s R E-R r~i,ni y~qV ~ ~ ¢o o w~ ~ tsh~ran ` • • 5~ • fub/s, Znc. 3 a ©/99/ floc ord 777 1600 SEE PAGE /9 O2 AVE O Cro:,. Cc~-.pry /ws. 7S4 1500 1700 ~Y 1800 1900 2000 2100 4 Arctic Glass & Window outlet 01WERSOPI EXC#;VHTIHG FACTORY OUTLET WINDOWS Bulldozing - Grading - Backhoe Work DOORS - PATIO DOORS Dump Truck Service - Snow Removal SUNROOM GLASS ' Estimates Given - Site Work 1-94 at County Road T~ 684-2124 Hammond, Wisconsin 54015 oR cHU 684.2510 (715) 796-2292 or (800) 657-4656 HIGHWAY 12 EAST - BALDWIN DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 )U] CONVENTIONAL ❑ALTERNATIVE State Plan ID Number f assigned) E:1 Holding Tank ❑ In-Ground Pressure ❑ Mound (l NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTI N DATE Greg Hawkins 710 Hillcrest,Apt.#11, Baldwin, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. Pt. EL V.: JCST REF. IT, ELEV NW NW, Section 8, T29N-R17W, Town of Hammond Name of Plumber. JMI/MPRSW No. County Sanitary Permit Number. Gary L. Steel 3254 St. Croix 58904 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELEV.. WARNING LABEL LOCKING CO ER PROVIDED: PROM D ~7_. 5-2 17 YES ❑ NO S ❑ NO BEDDING: JV VENT MATL. HIGH WATER NUMBER OF ROAD. PROPERTY WELL- BUILDING. VENT TO FRESH J ALARM FEET FROM L1 E f / AIR INLET -51 ❑YES NO 1. ❑YES NO NEAREST Y DOSING CfiAMBER: MANUFACTURER BE DOI NG. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY JWELL 1BUILDINC,. JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 FNG TH JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH NO. OF IDISTR PIPE SPACING; COVER INSIDE DIA i PITS LIQUID BED/TRENCH TRENDIES MATk+F ML PIT DEPTH DIMENSIONS L G BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH DISTR PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO DIj R NUMBER OF PROPERTY WELL BE LOW PIPFS ABOVE COVER ELEV. INLET ELEV END 7 PIPESY LINE- / ) AIR INLET' r a5f • J ! G NEARESTO-► f MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMA EN MARKERS OBSERVATION WELLS ❑Y - ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED [DEPTH OF TOPSOIL SODDED N S MULCHED CENTER EDGES ' YES O YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SP LNG JJRAVEL: DEPTH BELOW TIFF FILL DEPTH ABOVE COVER DIMENSIONS RDISTRIBUTION PIPE MATERIAL & MARKING DIST MANIFOLD PUMP MANIFOLD DISTR. PI E MA CIF /D MATERIALfPIOES ELEVATION AND ELEVELEVDIAELEV . DIA.: / l DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPE RTV J WELL 7LDING. FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST I 4 + C? r'. L Sketch System on Retain in county file for audit. Reverse Side. - SIGNATURE JTR SBD 6710 (R. 01/82) :.r osin APP LICATION FOR SANITARY PERMIT 31 L H R p1 G COUNTY aaTmEnT OV (r LB V7) UNIFORM SANITARY PERMIT # STRY,LASORGHUMRn RELRTlOns -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP TY OWNER MAILING ADDRESS PROPERTY LOCATION OQ1/4 i) 0/4, S 93 , TAC1, N, R / 70(or) W Tow Q/ LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME ]NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER yt1 nJ $3- 1 / o TYPE OF BUILDING OR USE SERVED '0610 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy El Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed &Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 1112) f`7 ~J-1, Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation f the private sewage system shown on the attached plans. Name of tuber (Print): Signature: A+}P/MPRSW No.: Phone Number: Plumber's Add ss: Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial XApproved Adverse Determination iQ Aeukykl Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber i INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398• To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION VOR SANITARY PERMIT S 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 e~?11-101=no Location of Property %N/ J4 Section -t T 00 N - R W Township ~ MdN Mailing Address T2T-. I Subdivision Name p Q~I 0~ 'pf ulz 7 Lot Number Previous Owner of Property ~•p.MES (-VWki~ N S Total Size of Parcel ~G Ile) c-iz, Date Parcel was Created I U - Ab A Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume and Page Number VIA as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoi/d delays of the reviewing process. If the deed description references to a Certified Survey Map, the the. Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (A) c_e.ntiny that ate 6tatementA on tka loom ate_ ttue to the befit of my (out) kn.ow.eedge; that I (we.) am (ate) the owner (A) of the pnopenty deAc''Libed in thii ,i,nf onmcLtion foam, by vihtue of a wa)u arty deed neeonded in the Office of the. County Regi6telr of "Deeds Document No. and that I (we.) phe6entey own the phopoded Aite lot the sewage. spka.L' Aystem (ah 1 (we) have obtained an ea.Aeme.nt, to nun with the above de6coi.be.d pnopenty, for the conAtmucti,on of da-i,d bydtem, and the Game hay, bee. duty neeoaded in the Office of the County Regi6teh of Deeds, aA Document No. 12, d 1~ SIGN RE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) )n'T' S?-GNET) DATE SIGNE!) H , V1 y r y H SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County d j , OWNER/BUYER -~a M .1 i 1I'O1jTI,'/BOX NUM.BrR_ Fire Number .CI'T'Y/ STA'T'T P ~ PR OPl?IZ'1'Y LOCAT TON: Section 1 1 71, N, R W, Town of- St . Croix County, Sul)divis i_on Lot number I Improper use (Ind mainten.; ce of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment 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 1-980, with the requirement that owners of all ne_w systems_ agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- 1'ying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approx=imately 30 days prior to three year expiration.. H 0 T/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal- system in accordance with x the standards set_ forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of t`to +_1,ree year_ expiration date. SIGNED ~ I DATE St. Croix County Zoning Office P.O. Box 227 Flammond, W1 5401-5 j 715-796-2239 S tn, date and rettirn to above address. . v r N x N m N N CD (D X3. CD C N 3 O CD O O a n n O 0 O Z C ~ 1 _O c c (o (p T~ii o m U 0 C CD 0 CD O m a (D m 0 O' la yN N C O 00 • W p (D (D O cp W co (y m (D Co 0. N i _ m m v v (D A O m a O O co O W O T to 0 W O 3- c - c c _N^ N W c l< Q' c O o 0 c S (n N N 0- o a CD S' ` in coo, -a D < m Q A (D C Q O A ^ O CA o" 0 D c n m L/ c - 9 2 O a- ..0CD CL - m o (mn fO 5 5 CL cr y O CD w C N y m Al o a U) ~ m, m CD -5*~-~ D Z o CLM 0 3 ~ m m Za •1 CD 0 U:) cr a,D ~ ~C0) CD n (n v. a w En w O 0 a N 0 CD F N v, w w C 171 t CDccn CD = 00OL m CD _ = 0 a (O w Q 0) t y 0 (n o -E ai I m ("D C t° o umi m v 0 a c cr0 c mCL w (D S !7 -l o 171 Q ao aaact) av c co cr 3 * co 1 (/1 (Q ? O c CD 3 co CD 0 C G) co < CD a 0 m o (o a O n m 0 2 Q m c CD m aC a ?C (Dw .-.n Fv3 0~ 000 V m av a v 3 CD 0 (CD y 3 a 0< 3 1 (0 - w v 0 1 Z DEPARTMEN'T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/M+44W4R "TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: /a~ ~/4 /Tj N/R 7 L(or) W , x-, COUNTY- OWNER'S/&W4-&=S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: esidence New ❑Replace - / RATING: S= Site suitable for system U= Site unsuitable for system 107flDnAtOgRi IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑U ❑U []S (U OS'QU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER 9EP~H-1N, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- IV& A, '75 ~z o8 ✓ , B- 3 ~77 ell 17 0-0 75 B-Z K5. ~PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD( PERIOD2 PERIOD3 PERINCH P- P- P- P_ J P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION a N ~~xt T 0 ~ t _ I D I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: //-/-3--0C4 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN TU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER l • 4 r 6 .B _ S E€€a s a e 4- a J= a 1 3` f 3 'r4 .xi -",1 Y ..,.s., t55~1 {F'}"c. {1~.~~ 7(r7 H('''ID :..f i 3 i +~~i E.P { z w... ..,$9...a s CFA~". S~~v -.s. ~a..13-~F f~EE use a- rti ~ . ui", t , . w, rc descl LET i 1. i.3 a ,n =ocmin n,;. ,.=iat;~'~ ~ to .st[ Fc~ ,F Ei _ =.h t. s c, .__n I:S,,. 3. t xc., t. e I f`; 6aI s, C, €i€e iC, ~s`-4t€ t f, xr as "Ci` at is 7. Ek-,!, Ad_ " 4,, r ^ s-r1 ,I. i" € & : i>« P~c S,and "ai r C t.. 6 5 ; ' p1/ t~/~ rrJ rJ S 83 X2 17I7 OL/Y \ W' O y jr- ~•,rr~ 7-R 9 Parcel 018-1016-20-000 01/22/2007 08:29 AM PAGE 1 OF 1 Alt. Parcel 08.29.17.118B 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, GREGORY G & SUSAN GREGORY G & SUSAN HAWKINS 1083 160TH ST HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1083 160TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.108 Plat: N/A-NOT AVAILABLE SEC 08 T29N R17W 2.108 AC IN NW NW LOT 1 Block/Condo Bldg: OF CSM 5/1464 700/38 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 700/37 2006 SUMMARY Bill Fair Market Value: Assessed with: 171994 211,400 Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.108 27,600 135,100 162,700 NO Totals for 2006: General Property 2.108 27,600 135,100 162,700 Woodland 0.000 0 0 Totals for 2005: General Property 2.108 27,600 135,100 162,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 207 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 I`