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HomeMy WebLinkAbout018-1017-80-000 C 1 j m A 13 0 3 o v o ° rn v ° co • CD 3 0 i 3 m 0D o a z E: :z CD 0 m co a I 3 C) Oft CL m m m a co 12 CD -0 0 CD i~ 3 O 77 7 ° r l~l y ° O C !a (0 0 p m rn C D C a CD C a ~ W CD ;o 3 3 p o o a ''I i 00 cn z 5 o CD ° O o r u) w co o 03 C/) 0 Q x V -0 -N z 0 0 0 0 ca a 3 v rr3- v 0 3 0 O m » M to o N N , m C co co ID 3..~~ :3 CD Q z ° N zcaz o v O D ° CD 0 D N l~1~ co v c c. c m CD n a 3 z CD cn N (D c 9 a p C) o' z N co w v m ° M CD C z j' 3 m ~ CCD a w w 'I m co a 3 CD CL ° N 0' - a v -n C z d Q o c. m 0 N S 7 a 4 (D N CL A A N W N O I O V A I h Q vy f O 0 ti O a °O i r ' A11, 1.1' ~ tN 1 I'AI(Y SYSTI-:M 1\ EPORT WNIs'}t---~CI.__i' Q-r - I'OWNSlilPLC. N-R17 W ADUI:L.`;S ~211~CY11~!~ j ~C/LS_- ST. CROIX COUNTY, WISCONSIN. f8 SIII',U ~V 1 S 1~)N IfI LOT LOT SIZE PLAN VIEW ta1)C and (1i11)C11S-1011 I_u It eeL. requirements of 1163 ~UOW FVERYTHING WITHIN 100 FEET OF SYSTEM _ l7 T-- ~0 ev ti, --y- Indi at N r h rrc w I.NCIIMAR.K: (Permanent reference Point) Describe: p~ . O f /~oUSC 1%1evat.fon of vertical reference point: ) Slope at site: 5010 S1,PTIC 'T'ANK: Mit nUIit CIure r: e~ S Liquid Capacity i Number ul mi cover Tank manhole cover elevationg7 ? i'~:tnfc lul.et I.IcvaLi_un:- I'auk Outlet Elevation: I PUMP CHAMBER Manutacturer: _ --Number of gallons Number of gal. pump set I I it cycle ~ gallons; Dotal capacity of di_Str, i_YbutiC 1 Ines A -111m-t size of prn p- head; rL.lon per mi_nute burs ;brand name of pump an.cl model- number Type of warning device- HOLD.I.NC TANK: Manufacturer - Number of gallons 1,'l-evation of manhole cover Type (-)I- warning device SEI,.'PAG1,. P -T SIZE; Number of p Lts-&4- feet diameter feet liquid do pth _ _ seepage pit -inlet pipe-elevation bottom of Seepage. ])it (Levation feet. SE1sPAGE K1s1) S IZI," number of width-- -length the depth Z_V . VF P A _ L C 11t1,NCII: width 5 7ZI21 length AREA AS BULL1 `~J O I V1,C011AT_LUN R AE AREA 1~EQU IRED 95 1_NS11 ECTOR _ DATED PLUMI3P'K ON IOB 1~Q~e ,SOs'I _ LICENSE NUMBER f? -3 _ l~ ry r - / rid, l:i ~ ~%..f~'`/• ~ 73,3 P,'pe z lev 7c Tee 93.3 p'nt~s 93,3' _111~encA .Z - 11'31 = 9~ `f~ P/,Pe Z_/dv, io,5110 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION IP.O. BOX 7969 BUREAU OF PLUMBING MADISON, W1 53707 IX CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER. INSPECT ON DATE. Pat Strand Hammond, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NE NE, Section 9, T29N-R17W, Town of Hammond Name of Plumber. MP/MPRSW No.. County Sanitary Permit Number Everett Boldt 4489 St. Croix 43678 77~ SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WA NI G LABEL LOCKIN OV / Q PR ED PROVI D -C~'~ ~tT92' , / ✓ }YES ❑NO NO BEDDING VENT DI A.. VENT MATL.. HIGH WATER UMBER OF / i ROAD. PROPERTY WELL / BUILD( G. VEN OFRESH ALARM EET FROM LINE f AIR NLET ❑YES NO ❑YE NO NEAREST DOSING CQ~MHAMBER:: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEY.UIL.I.G LOCKING COVER / PROVIDED PROVIDED ❑YES ❑NO 1 ❑YES ❑❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER, F PROPERTY JIVELL . IV ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO INEARE,16T SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILINI;TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cea's`e until FORCE the soil is dry enough to continue.) 4 MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF IDISTR PIPE SPACI ~G COV J ~W ~r INSIDE DIA #PITS LIQUID cryc~ 1 DEPTH DIMENSIONS IT rR C~ Es r„~ ""zi ~A4 PIT GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR PIPE DISTR. PIPE M ERIAL O. DI V R NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESN BELOW PIPES ABOVE C V R E N N PIPES LI E INLET. FEET FROM 1•s°" NEAREST--r /r 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 o njake certain-that it ON REVERSE SIDE. SHOW ELEVA- meets the criter for edium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE JPM ARKERS JOBSERVATION WELLS ES ❑NO ❑YES ❑NO DEPTH OVER TRENCH; BED DEPT' OVER TRENCH,BED DEPTH OF TOP, IL ]SO DDED SEEDED MULCHED CENTER JED.E'S .d 1' ❑YE ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH IDTH LENGTH TREONCH ES ATERAI,SP CING GRAVEL DE H BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. IPE MANIFOLD ATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING /M I ELEV. ELEV.' DIA. j ELE PIPES DIA.: ELEVATION AND } DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER ROPERTY LL: BUILDING: FEET FRLINE: ❑ YES ❑ NO ❑ YES ❑ NO NSketch S ystem on Retain in county file for audit. Reverse Side. [ DILHR IGNATURETITLESBD 6710 (R. 01/82) NA ,r " w~ F ® wesconsin APPLICATION FOR SANITARY PERMIT LLL®I L H R 3~f CRU / K_ COUNTY ~J (PLB 67) UNIFORM SANITARY PERMIT # oErz~TrnEnT of . / 1n0U9TRV•LA8QR & HurnRnamLATKx-w ~~J (r~' 'fl -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8%x 11 inches in size. See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS t~~'R ~►v ~a~ d L~f s PROPERTY LOCATION rye: 1 /4 M 61 /4, S 9 , Tr-2y N, R /7 1~ (a TO F: m m v n-1 d • LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER N IV A- - ' L' 'j k r, TYPE OF BUILDING OR USE SERVED . 1 or 2 Family Number of Bedrooms. Public (Specify): THIS PERMIT IS FOR A. ❑ 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. Seepage Bed CK 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 0A_)1o X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 'Ue- ie-S 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): CP yZ 4 1 © _ "5~0a YPrivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for i allation of the private sewage system shown on the attached plans. Name mber (Print): ignat MP/MPRSW No.: Phone Number: o Ste) " 37 Plumber' ess: Name of D igner. s~ A~ WOE t S 1/+ oCc COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: rl~ ate: Disapproved ❑ Owner Given Initial J' X Approved 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 ' Form - S T C 100 Owner of Property Location of Property" !U SectionT N RW Township Mailing Address Subdivision Name Lot Number Previous Owner of Property L Total Size of Parcel Date Parcel Was Created Are all corners identifiable? Yes No R Include with this application one of the following: .Certified Survey Map ,,D-a e d .Lan Contract, or .Other Legal 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 deed recorded in the Office of the County Register of Deeds as Document No. ; and that I (we) presently owls the proposed site for the sewage disposal system (or 1 (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 County Register Deeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) C ' J DATE $IG ED DATE SIGNED -4 " DEPARTMENT OF REPORT ON SOIL BORINGS A SAFETY & BUILDINGS ~ I / 71, INDUSTRY, DIVISION LABOR AND ~j i P.O. BOX 7969 PERCOLATION TESTS (11 ) HUMAN RELATIONS / N ~ DISON, WI 53707 (H63.090) & Chapter 145.045) rl+ A LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT ' BLK. S ISO ' ME: ~IlE'/ '/a 9 /THIN/Rr7E(a W ~,.yoNv ~'MF COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: V-6olK 12A r :5' AV A) A USE DATE T- E NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL q~ PERCOLATION TESTS: AResidence ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for system y~{~~ / • FT ~D/P T/F7G~-f1G~it Jt CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) -7;WV ©s 1:1U os ❑u os ou ❑s EA EIS au /,;vc- ~D,f r vfL, . If any portion of the tested area is in the A If Percolation Tests are NOT re ft::r E SIGN RATE: under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: ,G`1~~•-- PROFILE DESCRIPTIONS W /-°l-. BORING TOTAL DEPTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH pT'ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 22 4, - G C}p B eR s J Qe. 7*4. s B 0 -'At 'f t S 67 q C • ~3 ' /3U -ls s/'L 6 7 ' 13,v Sc.. 2. ojo ' die-/3.,j . B 2-- js Ls L7~•6?/ 4 /`46O e- e_4 B D 1 s 9,s V / S~ 137V-6y, SQL . & 7 ' AV •j/ L ~ .,P~ el*P T4 e3 B-`3 9~ 36 y~ -412 a. - ' 10 kl~te r B PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH ,Z Z/ P- P- Z ~2- fir' y P- P_ 3.0 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 point~/s77 and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. /3%' 170 7r,, C,,a, 6, 1,141-1dtl 5 .4/~t SYSTEM ELEVATION '7Z~~uc Es. rv VSe!W_ . /.N, 6~v Td. X/~v z ".._7Tor~~tL S/ GL..- FQ'. E ~J ~ l 1 3 i CM r1a 0 o F x F( • c~ FT X Tr • 67 AFV/*r . E 1 . 13 T E 3 !J € } t I I 1, 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): RTJ, O'NEIL ROAD =0 2- y Z 2 ,pa S- CST GNATURE: H16DSON, W IS. 54016 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - LE„x Asa SP tr -1 3TeIt Maly ;`:aaTaie MaMe`'t fh s , ti u esid.. t c or corn itoal projecq NIAX 11 U M riurnher of bodroonns or c(onrnei oia! s Planned, CxOM€.f Meb We nMabdoy r_ hnq box*. A E : S IS SCIA . ABLE FOR A HOLDING TANK ONLY IF ALL OT-HER SYMEMS ARE RULED OUT BASU) ON SAL CONOMONS; PLEASE ve Are abb _LulEbons shown here for 'au, E£, g hr file dE f 11pikim wid Cmrnp1t' ing the plot plan; TH l<z A LI.GMLE £§k 'ts amp k ely f a„ kg Me- Mt 02hons u'34t1kig to wale & land£,Sre",W A ME, sx, ,i3w ut= c1"t 7awk ,"d Str M 3b M._€.n Ek^ie€"1 ce YA.^.ti:-iH Ei€ ccri; ahc§v1rn, a3`hi <Et ;J-t"nnu:E-em; i# Q A! a{<St prate N)xes as -ti) date. !"mt'rt s, addr esws, M);,ci vd a€n ow4 hi.t,.£dw n 3,€ o s?mm-ip- "n it arqw0p; Me: ;re h;;c)tmwk { uch m , Kul CFlr Aq el ?aii(:n) des not <eIJP'IV r31)t:[', `'tl.f`a°+.I the a&:=poprime sn the fotrn and place y cur , ;.u e t add £ S.. and ymi r[ t4 Ka7An norni,,,e ; Gi i re[ tur £ i 3") LS LEastmi ,,avo E+alp Cal r~w :uwace, Cause SOW P-"~rocdatlon ' Loamy Sam! Close- 1han WV 6 =,`rE < Loss T! ni 1. €>s(£°3 Eft & G y <.,y Lo trig y I My My €M (A', Clov, it Minci ;3 l' 0 ~ni„ L - F gh vv% sy.T'in and a I3. €n"Y`-i: ee-gs {C.1[ ti ' S€9£ t<<7.£ I P .M arywayTon .:,cal v REPOR PLOT PLAM PROTEG I 17• D. .tau - GD~fT STi '~4.y1~ DPI rf 742 ///toy T A) HdOMESITE TESTING CO. VT-3, ©'NEkL FIOAD BOB UJ ;J1 C1, . r- UU i+t` Nj WIS. 54016 C5T' ~S~ d2 y~'Z PRtopo5£D. moosE mom Lie .2'r Fr• o,~ ~dA'E ~~oar AFL ~~~'sT ~rP¢'AS. PROPOSED WELL M vsr Li E- go¢T. . =13,4 yaF f'iTs = ExdrlV U- WS-44 Aeve- /OC#rlowf #,4,Vp 40f ElftlO O e 54odrL /3orF5 • ° 2 . M VEPriCAL er1clR CA)e - Poi T Tc~; r Tt~ I k Pfau s-e-y~,~ ~,v T ,Ux % ski S Ti v 7-0 LEGEND yar f'r A/0,4 V t t L 5 ~TF ya t~_4 a ire . `f1j N d yJR~~ II ~ - JJ 3 Py X P3 x f d'O ~r'tl 2~f v /3/ of woo E WE; /fwd 12-- V-~ h~ a i I.r FS~~ ' Houle ~ 4.1 o k r s' P, rA M 4 ~ o vl sa v ° yt'^ n err r cr _ oc' in V) V) v 1 V N t i C Parcel ID18-1017-80-000 01/23/2007 11:43 AM PAGE 1 OF 1 Alt. Parcel 09.29.17.129 018 - 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 - STRAND, PATRICK D PATRICK D STRAND PO BOX 244 HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 170TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 09 T29N R17W 40A NE1/4-NE1/4 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 172013 Use Value Assessment Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.500 3,800 / 0 3,800 NO UNDEVELOPED G5 1.500 100 0 100 NO OTHER G7 2.000 19,500 97,200 116,700 NO Totals for 2006: General Property 40.000 23,400 97,200 120,600 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 23,400 97,200 120,600 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 STRAND, PAT NE NE, SECTION 9 Hammond, WI r T29N-R17W, Town of Hammond San.Permit#43678 10-5-83 E. Boldt Conventional, Replacement R.Ulbricht INSTALLED 10-28-83 kc9l