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Parcel 018-1004-30-000 12/20/2005 03:44 PM
PAGE 1 OF 1
Alt. Parcel 02.29.17.26B 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
TOM J & RITA K KASINSKAS O - KASINSKAS, TOM J & RITA K
1134 192ND ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1134 192ND ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 9.580 Plat: N/A-NOT AVAILABLE
SEC 02 T29N R1 7W 9.58A NW SW LOT 1 OF Block/Condo Bldg:
CERT SURVEY MAP IN VOL III PAGE 788
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
89981 181,600
Valuations: Last Changed: 07/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.500 28,900 107,200 136,100 NO
UNDEVELOPED G5 2.000 1,800 0 1,800 NO
PRODUCTIVE FORST LANDS G6 5.080 12,200 0 12,200 NO
Totals for 2005:
General Property 9.580 42,900 107,200 150,100
Woodland 0.000 0 0
Totals for 2004:
General Property 9.580 42,900 107,200 150,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 132
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
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BULIDINGS
LABOR & HUMAN RELATIONS ALTERNATIVE PRIVATE
P.O.'BOX Z-40 SEWAGE SYSTEMS BUREAU OF PLUMBING
MADISON, WI 537,,07 Mound ❑ Pressure Distribution
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: PLAN ID NUMBER:
t
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
SEPTIC TANK:
MANUFACTU1RER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.:PROPERTY LINE: WELL: BUILDING.
DOSING CHAMBER:
MANUFACTURER: LIQUID CAPACITY: PUMP MODEL PUMP MANUFACTURER: WARNING LABEL LOCKING COVER
P OV,IDED. PROVIDED.
YES ❑ NO ❑ YES ❑ NO
GALLON PER CYCLE PUM P AND CONTROLS OPERATION AL: NUMB "RF PROPERTY WELL.
BUILDING: VENT TO FRESH
DIFFERENCE BETWEEN
Tj LINE: AIR INLET
ROM
PUMP ON AND OFF ❑ YES ❑ NO NEAREST w,,~,~n l
SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction
shall cease until the soil is dry enough to continue.)
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM
and furrows thrown upslope: mound systems to make certain that it
meets the criteria for medium sand. OF SYSTEM. SHOW
YES ❑ NO ELEVATIONS MEASURED.
DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO.OF SPACING CENTER : LENGTH: DIAMETER: MATERIA AND MARKING;
rJlTRENC#i TRENCH ES: TO CENTER: 1"}~ v
E?IIbIE#S Cl~1SS /
M. MANIFOLD: PUMP: MANIFOLD PIPE MATER AL AND MARKING NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
DIA-,
PIPES- _f DIA.~+
E iTlAT1 11T C
HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY. DEPTH OF GRAVEL OVER PIPES: VERTICAL LIFT CORRESPONDS TO APPROVED
YES ❑ NO JJ PLANS
c_ YES ❑ NO
SOIL COVER:
TEXTURE.
L
DEPTH OVER THEN CH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED: SEEDED. MULCHED.
CENTER
: EDGES.
❑ YES El NO ❑ YES ❑ NO ❑ YES ❑ NO
COMMENTS:
1 1 t; , t 10 IGNATURE: ill LE.
DILHR-SBD-6227 (R. 05/81) S
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
i
Sanitary Permit_
f
State Septic d~
AME TOWNSHIP St. Croix County
OCATIOkS S41 Sectionozo-Lot # Subdivision
EPTIC TANK
Size gallons Number of compartments
Distance from: Well Building_ ! - 12% slope_
Highwater
'LIMPING CHAMBER
Size
_j hi gallons Pump Manufacturer-------------,------- Model Number
iOLDING TANK
Size gallons Number of Compartments
Pumper_ Alarm System
.)istance from: Well Building 12% slope
Highwater
,BSORPTION SITE
Bed Trench
)istance from: Well Building - 12% slope
Highwater
.BSORPTION SITE DIMENSIONS
Width of trench _ ft Required area ft.
Length of each line ft Depth of rock below tile in.
Number of lines Depth of rock over tile in.
Total length of lines ft Depth of tile below grade in.
Distance between lines ft Slope of trench in. per 100 ft.
Total absortptton area ft Type of Cover:
f'IT DIMENSIONS
Number of pits _ Gravel around pits_-yes no
Outside diameter ft Depth below inlet ft
Total absorption area ft
Area required by _ ft
INSPECTED BY TITLE
APPROVED DATE 198
itEJECTED DATE 198
REASON FOR REJECTION
OEPARTVENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, , DIVISION
LABOR AND P.O. BOX HUMAN REJLATIONS PERCOLATION TESTS (115) MADISON WI 53707
LOCATION: SEC49TION: --79N/p ~I W TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
COUNTY: OWNER'S BUYER'S NAME: MUSE DATES OBSERVA MAP
NO. BEDRMS.: COMMERCIAL DESCRIPTION: R -_.J. R N TESTS:
Residence 2 New ❑Replace ,
,
RATING: S= Site suitable for system U= Site unsuitable for system 'f
CONVENTIONAL: JMD: 1N-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMEND ~ YSTE 6Vtio dLj
as ou s au as ou os au as ❑u of G
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V.
If any portion of the lot is in the _ under s.H63.09(5)(b), indicate: ' `
Floodplain, indicate Floodplain elevati I G i
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.)
B- / ry H
01 C'/ ~ .
B- -72
r / ff i~ rt p a tr « <r rr~7Z 4
B- 3 7A
B- ° )C/ ~.e.---
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT 1 PERIOD PER1093 PER INCH
P_ I D Z Z L oZ 0
P- u O O
P- 7 319
P-
P-
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.
SYSTEM ELEVATION /57
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative 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:
✓e..~~- oL~l '2 7,
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
- 14 5E iS 6 ~~-337
C IG URE:
I
Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester,
. 03/81)
boa.
PLB State and County State Permit #o
67 # Zf3
I Permit Application County Perm t
for Private Domestic Sewage Systems County fi;
*DENOTES STATE APPROVAL REQUIRED /
Date Approval Received from State if Required 2/ C ys y State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
/4 S i✓5 !S R S li3 c~r.Je rv r W r S
B. LOCATION: e J '/4 S " '/a, Section T,21 N, R/7 JP (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township AmmoNal
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _X Duplex No. of Bedrooms
1'5 No. of Persons_ 77
D. SEPTIC TANK CAPACITY /QQC~ Total gallons No. of tanks (Ji✓
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation X Replacement
Lift Pump Tank or Siphon Chamber X Total gallons Prefab concrete pfd Poured-in-Place Other (Specify)
- r'
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate--- Total Absorb Ara esq. ft. E 7
New. X Replacement Alternate (Specify) m D cJN C/ ✓S f~° M
Seepage Trench: No. of Lineal Ft. p~ ~Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X Length -Width Depth eifdk' Tile depth (top) No. of Lines 3
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of Ian( I Distance from critical slope- 7C
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified So Tester,
NAME t/ e,' f C.S.T. # S"O`~
~ and other information
obtained fromN (owner/builder).
Plumber's Signature P/MPRSW# ~'f P S~~;P9 Phone #7/5' YY -337F
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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o Not Write in Space Below r FOR COUNTY AND STATE DEPARTMENT U 5E ONLY
of Application - 9~ Fees Paid: State dv County J ~~z Dat
Issued/ d (date) Issuing Agent Name
Yes No State Valid# Date Recd
to copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
Y) 4. plumber (canary copy)
Revised Date 7/1 /78
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WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTLCTION
POST OFFICE BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of ~ r v ;
Location NW 1/4 of 1/4 S 2 T 29 R U xv44 W
Tuwn or Municipality Hammond Street Address R.R. 1
-Hammond W-I 54015
1-d No. Block Subdivision
I wTowner' s Name: Thomas Kos inskas
application for this site is to serve a:
❑ new constructinn use.
❑ replacement system use.
i, 1,; a NEW CONSTRUCTION USE, the alternative private sewage system is to be
1(h d (is:
X❑ part of the 3%/5% limitation. This is numbe 9r-04-2 of the applications
made through this office.
❑ one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
r an individual lot for which a sanitary permit was issued but was later
ruled unsuitable due to new or changed soil criteria established by
the department.
C~a lot that meets the site criteria for a conventional private sewage system.
REPLACEMENT SYSTEM USE, the mound is replacing:
a tailing conventional soil absorption system.
I _-~r holding tank that was installed and in use prior to February 1, 1980.
7
L j, privy that was installed and in use prior to February 1, 1980.
e
li+y that the above information is true and accurate to the best of_W -knowledge.
Sign~tet"- -
1~ ► _ Date jql 29 1981
hl iH (M.n8o)
~U
State of Wisconsin \ Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
-1 Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Plan Identification Number
Re:
PRIVATE SEWAGE SYSTEM ONLY-
The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private
sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by
and received for
approval on
The soil and site evaluation was conducted by
The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of
The proposed system is for a
Wastes from the building will discharge to a -gallon capacity septic tank which will discharge to a -gallon capacity
pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will
discharge through a -inch diameter pipe to the soil absorption system.
It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of
approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation
of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this
approval and shall follow the directions or orders issued by the appropriate local or state authorities.
In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with
the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional
engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at
the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall
become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the
Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight,
construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions
arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the
permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void
this acceptance.
cc: OWS
By:
County
Other
Enclosures
DI LHR-SBD-61 59 (R. 7/81) mes Sargent, B erector
r
Plb*100a 12'18
Detach And Return Upper State of Wisconsin
~I DIVISON OF HEALTH
Portion Of This Form With SECTION OF PLUMBING
AND FIRE PROTECTION SYSTEMS
Any Return Correspondence MAIL ADDRESS: P.O. BOX 309
MADISON, WISCONSIN 53701
608-266-3815
DATE: PROJECT:
r
PLAN ID. # J
DETACH HERE
PROJECT NAME PLAN ID. #
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the plan review fee required is $
❑ Plan accepted for review. Fee received is $
Fee is being returned because of ❑ Overpayment ❑ Underpayment.
Providing one of the two catagories above is checked, remit correct fee in one payment.
a.~
❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance.
❑ Plans being returned.
❑ Additional information required. SEE BELOW.
1. Plan Submission
❑ Additional information shall be submitted in triplicate unless specifically noted.
❑ Plans not clear, legible or permanent.
❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2) (a) Wisconsin Administrative Code.
❑ Affidavit enclosed.
11. Alternate sewage Disposal Systems (Mound Systems)
❑ PLB 108 (Application for use of an alternate system).
❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution
❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate.
111. Private Sewage Disposal Systems
❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides.
❑ Elevation of permanent reference point (benchmark).
❑ Location of area suitable for replacement system - provide soil test data.
❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc.
❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast.
❑ Construction detail and cross-section of soil absorption system.
❑ Soil boring and percolation test on EH 115 completed by certifiedsoil tester (1 copy).
❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed.
❑ Deed restriction required (1 copy).
IV. Holding Tanks
❑ Profile of holding tank,
❑ Holding tank agreement signed by owner and local unit of government (sample enclosed).
❑ Reason for installing holding tank soil test or statement from county (1 copy).
V. Lift Pump
[J Calculations for total lift pump discharge, head and gallons pumped per cycle.
Size, length & depth of force main.
Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM.
❑ Cross section of lift pump tank showing pump(s) or siphon(s).
VI, Systems In Fill (Fill must be placed prior to plan submission)
dotal aiea filled !fill to extend 20' beyond edge of trench before side slope begin).
Depth and type of fill.
Copy of onsite report by county or district plumbing supervisor.
Length of tim« fill has been in place.
'T. CR0I X COUNTY
r~ ~ ~ ;la aT ' r -
W1 s c O N S I N
l ~.I
"Aff
11AMMONP, WI 401
~~~~vl+11) V- i(l, I')ti
ISsiI~Iwln, WI ~h(lfl:
U l~ i r r`9 r. K u r; i i r 1( r> :
I leave: 11 heell, c:ti 1 1 4, 41 L1w I i nn I i n:,llc ~ C iun
n your, acw r 5ystcm.
I'lie. 11011;c c yin 1100 Ilct ~l~ i ~_cl unt. I I t lin t ( i ii;i I
lu~;l e("L._Il-) leas 1)e,on d~.~IIc
I I yo ii. IIavc ~lny (Iuc, i mI I~1 crI e (cc ( f i I
c I) tac~ L Int.' -
yllUrS t ru.1 y,
Thomas C. Nc 1 : 4) 11
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