The URL can be used to link to this page

Home My WebLink About018-1049-10-000 O CA N C 1 (D ID v c m 3 3 3 " 3 0 y o f 0 0) 2 N O N o ° CO m = Z N i N O ° to N III N N O- ~ ~ o (7 r ~ D 3 Z m m w '-c m n m a) co 3 o .`7 00 o a = N O J A o n)( Co m N m co > > co O 1 N Q n) (n O7 N r D) N r a w CD h 7 O ] N n O O O C CD CD M ] (D 7 O W O a 0 f C. 7 N tl( 8 7 ° O w y N a v U) D a m a Z D C m CD (D N N C. O (fl D N G R CD s W s CD r- n o o D CL o D C) m j a O ` O o a 2 - 2 v o) co A co 3 3 O A 00 0 3 I'. N r 7 , !r -a -V T m I o O 00 ~ co o cn < N) Z aQ C) p cn cn cn 41 a N N N A o D m 3 cr -0 D CD R Q -0 o 0 o o CD ("D CD CD CC N 3 d 3 ° D CD n. - z l~l ° z OJ z z m z 0 D m o D (D o v O a O a CD m m m y • N CD N ( -Ci ((D f(pU N. C CD (CD C CD N W (D Q (D 0 o 3 7 (D (D -1 fn z o m ~ N in ~ ? Z C1 o j , Y v n o. A O o Z ~ N W W CD m rv CL a z 0 3 0 3 a z z I w F w CD .A I CL a o s 0. N. o ~ om o T ~ 3 o=i c 3 m c 3 _ > C 0 o a ° o a CD 'n m < CD LI7 N 4) N N CD N a Q-0 c 0 Q A CD N Q 0 x fi (a n N N I N N °o V I o 0 00 ob a CD CD A rn O O o o m o CD a' 0 Q- 0 0- ~ z ri Form - S 1' C - 104 'QFf, w AS BUILT SANITARY SYSTEM REPORT ~..U1N TOWNSHIPSEC. J~ I' % N-R J W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f~ra: n ~•cl r , ~ saco~af Sep~~ Y2-~ 12 I-In uS"( INDICATE NORTH ARROW 7 BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: J /c? SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: P'7Z & Tank Outlet Elevation: -CJ Number of feet from nearest Road: Front, 0Side 10 Rear, O 2 --!5o feet From nearest property Iiiie Front, 0Side, ®Rear, 0 feet Number of feet from: well f building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE RI?VERSF S 1 I)[? PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Si on Man factulie Pump Size Elevation of inlet: Bot-om of `an elevation: Pump off switch elevation: Gal6dns er cycle: Alarm Manufacturer Alarm Switch Type: Number of feet from nearest property line Fror~f, O Side, O Rear, Ft. i Number of feet from wel' Number of feet from buildi g: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X~ Trench: Width: Length: 7 ,C, Number of Lines: Area Built: Fill depth to top of pipe: U i Number of feet from nearest property line: Front, O Side, O Rear, Ft.lp Number of feet from well: ZZO Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of its: AD'aieter: Liquid depth: B ttom of seepage evation: Area Built: Has either a drop box O or distrib ion box been ~ed on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: #ea apac It Number, of rings used: of tom of tank: V4 Elevation of inlet: Number of feet from nearest p operty line: Front, O Side, O Rear, O Ft. Number of feet from well Number of feet from b i diiy, Number of feet from nea est oad: Alarm Manufacturer: j Inspector: Dated: Plumber on job: License Number: 3 / 8 4 : ITIj 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 CUCONVENTIONAL ❑ALTERNATIVE state Plan LD. N-ber (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Leon Hawkins Hammond, WI _ A 1 ~•~G~~r7 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NW NW, Section 22, T29N-R17W, Town of Hammond Na- of Plumber. MP/MPRSW N<,. County Sanitary Permit Number. Everett Boldt 4489 St. Croix 49473 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELEV.: WARNING LABEL LOCKING ROVE / - PFlpV I D: PIR . C.~ 41, ( G"Z Lj ES ❑ NO ❑ ❑ NO BEDDING: VENT DIA.. VENT MATE. HIGH WATER NUMBER OF ROAD: PROPERTY i' WELL'. BUILDING. VENT TO FRESH ALARM FEET FROM - LINE. AIR INLET EYES NO EYES ENO NEAREST V DOSING CH MBER: QUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFAC ER WART IDJG LABEL LOCKING COVER MANUFACTURER. 7ING LI EDPROVIDEDS NO EYES ENO DYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. N r P ERT WELL JBUILDING IV ENT TO FRESH (DIFFERENCE BETWEEN F ET F JOIF M L NE AIR INLET PUMP ON AND OFF) EYES ENO NA E SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LeN DIAMETER 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 LENGT NO. OF DISTR PIP SPACING COVE - INSIUE DIA zPITS LIQUID BED/TRENCH TREN- IA E, PIT DEPTH DIMENSIONS J / l GRAVEL DEPTH FILL DEPTH IDISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. D R ,NUMBER OF PR OP ERTV WELL. BUILDING. VENT TO FRESH BELOW IPES ABOVE COVER ELEV INILE i EI EN q 7n PIP LINE ter, AIR INLET I FEET FR V~' ~1 QC /C NEARESTO--► ('1 Qri r YSTEM: MOUNDS 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 REVER E. SHOW ELEVA- meets the criteria for medium s nd. TIONS M SUR D. EYES ENO SOIL COVER TEXTURE ffMANINIMARKERS OBSERV TION WELLS ❑Y S El O YES ENO DEPTH OVER TRENCH BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL ISODDE SEEDED MULCHED CENTER EDGES. Y S ❑ O YES ❑N ❑Y S ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO. OF LATERAL SPACING. GRAY LDEPT BELOW PIPE. FILL DEPT ABO COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE M . IN0DI ELEVATION AND TR. IPIPE D I BUTI N PIPE MATERIAL 8. MARKINGELEV.ELEVDIAELEV.PIPESDISTRIBUTION VERT INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY C VER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED EYES ENO EYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATI N ELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO YES ❑ NO NEAREST 0 `06 I 1 V 4, jqo'5 Sketch System on ly file for audit. Reverse Side. SIG TITLE V y DILHR SBD 6710 (R. 01/82) ! C 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 ®CONVENTIONAL ❑ALTERNATIVE state Plan I.D. Namber (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HO L" ADDRESS F PERMIT HOLDER:INS PEC CAT B NCH-MARK Werman t reference point) DESCRIBE IF DIFFERENT FROM PLAN. R T. ELEV.: C REF. PT. ELEV.. NW NW, Section 22, T29N-R17W, Town of Hammond Name of Plumber. MP/MPRSW N,, Coun[y Sanitary Permit Number_ Everett Bol.dt 4489 St. Croix 49419 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLE ELEV.. WARNIN LOCKING COVER PROVIDED YES ❑NO ❑YES ❑NO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD. PR OPERTV WELL. BUILDING: VENT TO FRESH ALARM FEET FROM LINE AIR INLET. ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: 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 WELL BUILDING IVENTTOFRESH. (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 LENGTH DIAMETEH 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 DISTR. PIPE SPACING COVER INSIDE CIA -PITS LIQUID BED/TRENCH TRENCHES MATERIALS PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILI. DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL NOES NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER E. EV. INLET ELEV. END. PIPES FEET FROM LINE. AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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 PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH 'BED DEPTH OV ER TRENCTEED DEPTH OF TOPSOIL SODDED SEEDED MULCHED. CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF EDISTR RAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD . PIPE MAN IFOLD MATERIAL NODISTRJDISRPIPE DISTRIBUTION PIPE MATERIAL & MARKINGELEVELEVDIA.'. PIPES CIA.: ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS To APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING : COMMENTS: : FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST __ILL: Sketch System on Retain in county file for audit. Reverse Side. TITLE, SIGNATURE DILHR SBD6710 (R. 01/82) - uA$`°"'" APPLICATION FOR SANITARY PERMIT V ILHR J~, CRO, X COUNTY _A °F (~'g 67) UNIFORM SANITARY PERMIT 1/1? j4 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/z x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT I A'` PROPERTY OWNER MAILI G ADDRESS 1 R+ N.O Ad ~/9W ~ 1 d M s " W Gv , S PROPERTY LOCATION CITY: ' NG''~1/41~ i/4, S A 791 N, R/~ VILLAGE: {Or? TOWN OF: Aja2d I►I { LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ~ N TYPE OF BUILDING OR USE SERVED 019_14)Y9_10 -0 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement Repair Cl Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ' 9 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 Q Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ~5 a at Gg e-4 e. 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 Feetl: PROPOSED (Square Feet): 1;6' 4o Private ❑ Joint ❑ Public t, the undersigned, hereby assume responsibility for ins tion of the private sewage system shown on the attached plans. Name of Plumber (Print): S' MPIMPRSW No.: Phone Number: Plumb ress: Name of Designer: A L, d w C.~ r' r r'ER e.f 4 a L d f COUNTY/DEPARTMENT USE ONLY Signature Qf Issuing'Agent: Fee: Date: ❑ Disapproved r W t l G' F~ d~ 7 f u Approved ❑ Owner Given Initial Adverse Determination 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 Wisconsin APPLICATION FOR SANITARY PERMIT t DILHR 0'e6,X COUNTY 0 OEPRRT'R1EnTOF (PLB 67) ~Ooq vY # U 11111111 1nousTRV,LRSORSRUmenRELRT1Ons t UNIFORM SANITARY PERMIT -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILI G ADDRESS C;o N AicJ /(l A,'-S / i9 m M oov d (,j > S PROPERTY LOCATION? /7 CITY: N01/4 Nkl~ /4, S A A , T , N, R VILLAGE: / (OC) VII TOWN OF d n1 LOT NUMBER BLOCK NUMBER ISUBDIVISION NAME NEAREST ROAD,LLAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X 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 Q oHe- Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: We &_,es a o G,e e4 e- 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 -1(Square Feet): / J!" ( °S -1/ Itsl Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for ins ation of the private sewage system shown on the attached plans. Name of Plumber (Print): S n ✓ MP/MPRSW No.: Phone Number: Plumb ress: Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Disapproved / 6t /J c ❑ Owner Given Initial / / xApproved Adverse Determination 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 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. Form - T C 1 00 ` r Owner Of Property e0A/ A Location of Property //W OV,,Jk, Section_ N K /;7 W Town ahip_ NAM M et Mailing Address 44rnni) I-J, S " Subdivision Nam* Lot Number Previous Owner of Property cY, e-v Total Size of Parcel 9, S /qe,a ~ Data Parcel Was Created '~Z/- '?U Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map V!Da e d .Land Contract, or .Other i:egal Document which describes the property 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 dead recorded in the Office of the County Register of Deeds as Document NoT zl_W 4- ; and that 1 (we) presently own the proposed site for the se. a ja disposal system (or I (we) have obtained an easement, to run with the abuve 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. SIQNATU2QE Of OWNQH SIQNATUNE OF CO-OWNER OF APPLICABLE) ~ DATE SIQNED ~ DATE SIQNEU DEPARTMENT OF REPORT ON SOIL BORINGS AND ETY & BUILDINGS INDUSTRY, t DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.045) , LOCATION: ~ 4 SECTION: aa /T~ N/p/ * (or)W TOWNSHIP LOT^O.:BL~iNO,: SU DIVISI~ NAME: COUNTY: OWN/ER'S/BUYER'SnN ME: ~fJ/ MAmILIN aADDRESS: /-V/R ,1f 1/1t 'Y/ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: X New DESCRIPTIONS: PERCOLATION ;71 I~Residence ~1 ~JVew ❑Replace I 1/_ FJO J RATING: S= Site suitable for system U= Site unsuitable for system t d CO®STI❑U. M~S.RU IN-GROUNDPRRE:SY~S I®ULH❑SG®~:RECOj)(1MO~Ye/V 1 OiciAoCl) If Percolation Tests are NOT required DESIGN RATE: I 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 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) gj" IF( B- 7r',- 5 5,1-m /9' P74 SAIA 4 1? B oS C[?,d f 9„~, ~l / r It rr rt C fI 1 1 B- 3 It - u n c~ it f l /..F q ~ K B- PERCOLATION TESTS F t• TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I 8 AFTERSWELLING INTERVAL-MIN. PERIOD( PERIOD2 PERIOD3 PER INCH P- 1Q 8 1 P- ,o' tl r P- 3 P- d o r ~ 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 91, ~ fl { E i ) I , 3 E x , a m e......_.. - 3 r... _ ---r- I v i I t 1 j ~ I _ ~ N , , , t , _ t { I f [ 1 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: LVee.,e~~ ~~df / Ere ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): jE~',9 L 4,-j lw ~'S o 5's 7/ 99 7S TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DIL.HR-SBD-6395 (R. 02/82) - OVER - 1 _i s . s 3,' tj ..i as c. .>>s~ nurmer f : ._r s r •r, 1- 1TH SvE=A cULAD as V s_,._O N. H CIAO PEON,,;: nNSP use Most A E,. .,n E K . ~ - ~ vv Any sm al we "a_ > ,.Um., :.:::i com,,E,:° r5y To Ito P plan: . .K A 3_ =rte. annuomy kn su, n_ a. y'rh a. r.o a woo . pa u. ..ci. ; e~ 9k n ~ . t alO C r > F M < Won os l t ~ 1 , c; ,ts, T 01n, r_w3 E. icy .a NO nl::nE,}` fn"r „ y e An b `s rg" € e tm.s e „ .0my Cow, E Lis: ~ ~ <f t3 i k1m,v fit "MtW VW A 3v 1 1 N T- 6- 19 f i Y! Awl F 00 * SAvJCd 11r, v ~ f , i St-~~ cl ~ goo I ap ~ ~ /000 CtqL L A+ 7-V c,aRue~ Pd~ + ep~,~' I ' 4 Azad eve 6 of 301-.-- .30 SAW e4 C, F F ~ IS p- 1~ I jlk,r~~ 'a eas4 99. ► pBr~-4 - c 13-1 a '0 vel Ape, R f~ h 13- q 8-5 7- - 55 ROr- Lj"4c A `f L4 0 A ,pea ~~'c e L f = z O ~ O U C Z co CIO* Cn 0 m p z co o m 3o ~o O 71 C= Now O m x cn 0 00 m Now -n O r r m o ~ n ~ C7 ~p m Cl) N U) O O Q C ■ yc z Go C C 0 C Z c < v 00 m o m Z 71 U) zz I o1 ■ O U O z m C ■ m ~ V j o b ? a ~ o N ~F o~ D~ Z 7 Q 3 - D om~ C l o T L n O o 1\ p ro ° -1 -1 ~ 17 MC) M D ow m C m N S~ s~ ° 30 , ~ and ~D (7 °m me - 'om m aD roc = n m? - o a 3? ~ D 3 0 ; M E ~MM 3 o m cDU c ~ a ~7 W n 1 0M ._.m:E S m < cc D O ? 7 m cCn v ~ ~ ~ 1 C O o 3 3 3 ` cn 3 C7 < m v o N 3 fl z m ° O- S m N a c N N O C D °a o N. o < a m ° o Z z N a " N a m to UC3 m cm < amo m ° D D m ma o ~3 m~ -1 4' C) ; m m v3 C.~ D D < m < D D m O 3 O D d D D 0 D f D m 3 o ° S Ca ST. CROI X COUNTY WI SC 0 N S I N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 May 4, 1984 State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Attn: Carolyn Haag Dear Carolyn: Sanitary permit 4149419 on Leon Hawkins has been rescinded as the house had to be moved back. A new permit, number 49473 was issued today to the same property owner. Should you have any questions regarding this subject, please feel free to contact me. Sincerely, 4a'~4 Mary J. Jenkins Secretary Attachment DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 1-iUMAN RELATIONS MADISON, WI 53707 3707 (H63.090) & Chapter 145.045) L, ATION SE TION: g TOWNSHIP/MUNICIPALITY: /T/NO.:BLK. NO.:SUBDIVISION NAME: Al&) 1 4 .2.~ /T 1 ?71~/R 1,7 ~Ior) / t Y1➢i'l9tl /y ';A COUNTY: O NER'S BUY R S ~NAME: MAILING ADDRESS: / USE ATES OBSERVATIONS MADE t__ I a NO. ;RMS. : COMM AL DESCRIPTION: I _ DESCRIPTIONS: PERCOLATION TESTS: ®Residence New ❑Replace _7S~ r RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-G D-PRESSURE: S ST -IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) u os ou as au ~s a os ou 0s au n ,a If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the ,n under s.H63.09(5)(b), indicate: A// Floodplain, indicate Floodplain elevation:/ PROFILE DESCRIPTIONS BORING TOTAL P T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED 1 HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- -70 B-2 52 r B-3 1~ B_ J4 B- t.~' GVJ ~.O PERCOLATION TESTS 1551 DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV -IN H S RATE MINUTES NUMBER RgGHE6 AFTER SWELLING INTERVAL-MIN. PERIODt PERIOD P PER INCH P- l 3, 5 P- 3, 5 P- P_ 2- 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 ELEVA r i0N 7-, f T- t ~ I ~ I 1 j c. 4 ' E ~ i i 7 t` E I I l , ~ I a -11 J-1 ~ I I 3 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) elf e 14 D L TESTS WERE >COMPL ED ONE:[ 7 i/ ADDRESS: CERTIFICATION NUn~BER: PHONE NUMBER (optional): 1 TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Ov,.,ner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - '14 Al 4,-, s ' 7-1 L o Rti.v k ~ D 4d .5, j 1 s ! f _.f r, _ F'. P e r F 1 4 a. DAA r ~ i... AID In, 97 4 ~y r- ~ , Parcel 018-1049-10-000 01/22/2007 08:30 AM PAGE 1 OF 1 Alt. Parcel 22.29.17.341 B 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, LEON S & ILENE O LEON S & ILENE O HAWKINS 1819 90TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 1819 90TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 9.500 Plat: N/A-NOT AVAILABLE SEC 22 T29N R17W 9.5 AC IN NW NW LOT 2 Block/Condo Bldg: OF CERT SURVEY MAP IN VOL IV PG 1013 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1164/82 QC 2006 SUMMARY Bill Fair Market Value: Assessed with: 172358 Use Value Assessment Valuations: Last Changed: 06/30/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.500 32,000 175,900 207,900 NO AGRICULTURAL G4 6.000 600 0 600 NO Totals for 2006: General Property 9.500 32,600 175,900 208,500 Woodland 0.000 0 0 Totals for 2005: General Property 9.500 32,600 175,900 208,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 114 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 N N ^4, N N \ lJ TJ 41 0 O 0 ° 4.1 9 --I 1.1 U N O U] x w -4 4-1 r~ w W r~ ° o z i ~ O 33 N O ~O H Z H H o H -zr 00 I -i J N d H 1 o, w H ro a a 3 , ca + 3 H O G ~4 -W W v ~ rzi o Q Z (1) H o Fzi w a~i ccd o a co o