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HomeMy WebLinkAbout018-1014-00-000 n ti O 3 'a n d `r1 C y C Im ° fD ~ m c=o n ~ v ~ v c U) :r N Z O00 O O ` 1 • D° 3° m c: Cn mi CD m 3 90 z v n 3 C V N p3j ? N y (n n ° o ` 1 ° j a o C) r ° m CD i H ° 0 cn 7~ 0) 3 ° O n o tr (A (A H 7 N Ln I O C• Dial a N) CD (o 77 I - (n D C n b Z o 7C ! m (a- CD m ° a :3 C/) co C: CL CD 0 > A m O m N) m It (I ` j = W H V Z co co co 0 r- (n Z rn ° co co 3 0 k .;j -rt 3 1 3 rn ° o o o Zf Z O O O n "ad~ ( 0 vi tin vii p III D r3 - r3. a v o o 7 (DD M Ln r C1 O CD m = co C~7 y ON N~ Q. ' W O i o =t z D 00 ° ~o W c nni O a ° o m H• CD N W m c° :3 Gi Z C m 1,/C-ll N rn W n cn Z Z Z `D Z m • ~ ~ ~ II q N O j A n v N CL A' V O rn 7 ~C C7 Z N v W M m co • m a X c z z Z CD p W ~ d m a m a ~ 0 0 3 m -n O o a CD m v m CL y I ~ y A A a I fi I A I w N O O I V I A ti • CD II DO A M w p 0 O a o CD Parcel 018-1014-00-000 01/23/2007 11:20 AM PAGE 1 OF 1 Alt. Parcel 07.29.17.101C 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 - THOEN, JASON E & LYNN M JASON E & LYNN M THOEN 1529 110TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1529 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.659 Plat: N/A-NOT AVAILABLE SEC 07 T29N R1 7W LOT 1 OF CSM 5/1313 Block/Condo Bldg: 670/534 1.659 AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 10/19/2006 836952 QC 07/23/1997 1139/88 WD 07/23/1997 670/534 2006 SUMMARY Bill Fair Market Value: Assessed with: 171969 213,300 Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.659 24,000 140,200 164,200 NO Totals for 2006: I' General Property 1.659 24,000 140,200 164,200 Woodland 0.000 0 0 Totals for 2005: General Property 1.659 24,000 140,200 164,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 222 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 AS BUILT SANITARY SYSTEM REPORT OWNER Z TOWNSHIP'. n✓ t~/ _ SEC. T iN-R W ADDttESS_ ST. CROIX COUNTY, WISCONSIN. ~_-''1r7~ SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions Co meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM W, L Lit I~ f, I I di. at N r h rrc w BENCHMARK: (Permanent reference Point) Describe; Elevation of vertical reference point: Slope at site SEPTIC 'L'ANK: Manufacturer: i q ~~'q / (Luid Capacity Number of rings on cover _ Tank manhole cover elevatiod- Joe__ Tank Inlet Elevation: Tank Outlet Elevation: 9A S _ PUMP CHAMBER / Manufacturer:- 1 f~ _ Number of gallons Number of gal. pump et for a cycle IV gallons; Total zc pacity of distribution lines; gallon: size of pump head; gallon per minute horsepower i1/;brand name of pump and model number ; - Type of warning device- A/_/ HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover'` ; r Type of warning d evice fr SEEPAGE PIT SIZE; Number of pits tr feet diameter feet liquid del' tI,__" NC 1";; seepage pit inlet pipe-elevation jT- bottom of seepage pi.t elevation P/ f feet. SEEPAGE BED SIZE: number of lines width le~ length the depth SEEPAGE TRENCH: width length( AREA AS BUILT:`; PERCOLATION RATE, AAA REQUIRED' I Z41 INSPECTOR PLUMBER ON JOB S/ r c ,C ,t 6 y LICENSE NUMBER- L DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. qOX 7469 • BUREAU OF PLUMBING MADISON, WI 53707 L CONVENTIONAL ❑ALTERNATIVE Seale 11- )D.Numb- (If assigned ❑ Holding Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER. ]ADDRESS OF PERMIT HOLDER INSPECTI N ATE Je Hietkema R. R. 1 Hammond, W1 BENCH MARK (Permanent reference pmnt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. NE NW Sec. 7 T29N-R17W, Taws aA Hammond Narne of Plumber. MP/MPRSW No.. County. Sanitary Permit Number. Stephen Aab 5184 St. C"Loix 38500 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ry LIQUID CAPACIT J I TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCIIIIIyffyy~~fffffN OVER T 9%,1-7 PROV ED: PRu C> ~ YES ENO Y S ENO BEDDING: VENT DIA.: VE T MATL. HIGH WATER NUMBER OF ROAD. PR OPERTV WELL. BUILDING. VENT TO FRESH C ALARM FEET FROM }LINE ~a AI INL{ DYES ENO DYES ENO NEAREST 1 DOSING CHAMBER: 1 -20 MANUFACTURER. BEDDING. JLIQUID CAPACITY PUMP MODEL 1PUMPISIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: DYES ENO DYES ENO DYES ENO 5 GALLONS PER CYCLE: PUMP AND cDNTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO F ESH AIR N (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) DYES ENO NEAREST__~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I FNGTR 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 1LENG~, INOOF IDISTR. PIP SPIA N(,. COVE 11111DI DIA ttpITS LIQUID BED/TRENCH TRENCHES RIA PIT DEPTH. DIMENSIONS U r GRAVEL DFPTH FILL DEPTH 4~1`Fli P E DISTRPIPE DISTR. PIPE MATERIALNOD RNUMBER OF PRO WELL fUILDINGVENT TO F BELOwpI ABOVEC vER EV INLET E V END PIPE FEET FROM a P AET- I NEAREST-s MOUND YSTEM: Mound site plowed perpendicular to slope Check t texture of th irl m I for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mou sy ems to M e tain t ON REVERSE SIDE. SHOW ELEVA- rrycet the riteria for a um san TIONS MEASURED. DYES ENO SOIL COVER TEXTURE PER ANENT MARKERS OBSERVATION WELLS I / / I/ DYES ENO DYES ENO DEPTH OVER TRENCH BID DEPTH OVER TRENCH 111D ZEPTH O TOPSOI SOUDW SEEDED MULCHED CENTER EDGES ES EN O DYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: j % WIDTH. LENGTH. w NO. OF LATERAL SPACING. AVEL DEPTH BELOW PI FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE NIFOLD MATERIAL NO. STR. ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.. CIA ELEV.' PIPE DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY/ r C ER M ER L VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES 1:1 O EYES ENO COMMENTS: PERMANENT MARKERS: j B ERVAT N WELLS: NUMBER OF PROPERTY WELL: BUILDING. il O FEET FROM LINE/ EYES EN DYES ❑N NEAREST k--- . / 00 ss s C, S Sketch System on aZncu file for audit. nty Reverse Side. /0/001r- 4' Q SI GNATUR TITLE. DI SBD 6710 (R. 01/82) ®ws`°"5'" ® APPLICATION FOR SANITARY PERMIT DILHR St. Croix -UNTY ~J (PLB 67) ® s~ERRRTmEnTOC UNIFORM SANITARY PERMIT rnDUSTRV. Lge°R 6 "UMRn RELRTI°n5 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8,4x 11 inches in size. -See reverse side for instructions for completiny this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Jett Hielkaaa Rt. 1, Hamnoad, WI PROPERTY LOCATION CITI4,: I3 1/4 NW 1/4, S 7 , T29, N, R 17 E (or) W TOWN oP" LOT•f,JUMBER BLOCK NUMBER SUBDIVISION NAME 11NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER T01.0 k(oad TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 L_] Public (Specify): THIS PERMIT IS FOR A: EXI New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision [ 1 Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. F 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity 00Z Lift Pump Tank/Siphorl Chamber Holding Tank capacity Manufacturer: Wieser~s CGasrete Protduets ISO* 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): 106 615. 64B PF] Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur MP/MPRSVV No.: Phone Number: Stephen L. Aaby 51€ 4 (715) 69~-2107 Plumber's Address: Name of Designer 124, Maia St.* Woodville, WI 5400 Stepkma L. Aaby COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Feel: Date: ❑ Disapproved 11-W j' y- ❑ Owner Given Initial CCCfff/// Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-3BD 6398 (R_ 5 82) DISTRIBUTION. Orginai to County, One Copy To, Bureau of Plumbing, Owner. Plumber Form - S T C 100 Owner of Property 'le-k SC 71 E Location of Property I-4, SectioT ;2 N R W Township Mailing Address_ Al Subdivision Name Lot Number Previous Owner of Property ,S rCG y9 ~/~'~J Total Size of Parcel C.,' S Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map .Deed nd Contract, or Other Zega~ocument 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 deed re ordd in the Office of the Count Register of Y Deeds as Document No. ;and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above 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. 4a,~'2~ 72-Z-1- SIGNATURE WNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION 707 LABOR AND PERCOLATION TESTS (115) MAD P.O. ISON, WI BOX 537969 HUMAN RELATIONS \ / 3707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: t /a /T ,'N/R,' E (or COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R R TONS: ER LA ION TESTS: Residence XNew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system [CONVENTIONAL: MOUND: T-N-G-RO(~ND-PRESSURE:ISYSTEM-IN-FILL HOLDING ]RECOMMENDED SYSTEM:(optional) I XS ❑U ~S ❑U 19S ❑U EIS XU ❑S ~U 2'x 36' 13, x' If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the hinder s.H63.09(5)(b), indicate: 0, 3 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GRQ QRQ UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION O VIED EST. I T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 477 11 p Ul h i t B- d l d 1.~.. 'Alo ME .7 ~d~~' mac ~j/ p ~ J L~Jfl17~ No IV B / (i © Q F ® L. Si4 e r 11/J, i L Z. Ii• A6/•L/ 'rx'k'C/ B- S hey. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES "T NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH w O 1.6 P- , C Gs i 1 2. 46 AN 0 ;M P- P- 1_P PLAN VIEW: 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 slop. cl SYSTEM ELEVATION 9 ~ ` T~ p ~ sa ~ l~ R-~-~~~~ K ~z ~ ~ t3.i71 s i l~ tJ' W~ _ J . - 10 TN 'S /d2~ - r33 r / ~nzx 1>~o4 ya Pi I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures mC,hods speci ied in the '.:-iscer ir, Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. AME (print): TESTS WERE COMPLETED ON:~ Z [ADDRESS: C ERTIFICATION NUMBER: PHONE NUMBER optional; 1 / C CST SIG ATU E: DISTRIBUTION: Original-Local Authority, 2nd pay;;-rture~" of Plumbing, 3rd page-Property Owner, 4th page-Sc;i; DILHR-SBD-6395 (N. 03/81) 0 TI 3Dsl I 1 (It JAL T S T.E . Pl ~v Toy C -361 Vi o-q Gb5E1z-vu~►n~ P P )r- z 6/y ji- A,