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Parcel 018-1079-70-000 07/26/2006 10:20 AM
PAGE 1 OF 1
Alt. Parcel 36.29.17.552F 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 - HENDRICKSON, DALE L & CHLOE
DALE L & CHLOE HENDRICKSON
2049 CTY RD J
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 2049 CTY RD J
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC y
Legal Description: Acres: 1.610 Plat: N/A-NOT AVAILABLE
SEC 36 T29N R17W 1.61A NE NW BEG N1/4 Block/Condo Bldg:
COR TH W 163', S 429', TH E 163', TH N
TO POB 584/343 AKA LOT 1 CSM 7/1897 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
36-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 584/343
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/22/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.610 24,800 74,200 99,000 NO
Totals for 2006:
General Property 1.610 24,800 74,200 99,000
Woodland 0.000 0 0
Totals for 2005:
General Property 1.610 24,800 74,200 99,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS ALTERYE IVE PRIVATE DIVISION
P.O. BO,IC7969~ SEW SYSTEMS BUREAU OF PLUMBING
MADISON, WI _-3707 Mound ressure Distribution
NAME OF PERMIT HOLDER: ADDH ESS OF P[HMIT HOL EH: INSPt CI ION OAT F. PLAN ID NUMBF R:
Sc~ n
N i 1 3 7 9 L 7V 4~?L/y1_~ z - 3 S
BENC MARK (Parmanent reference point) DESCRIBE IL DIFFERENT FHO PL Al HEI P k. ELF V.. CST III[ PT. LLEV
SEPTIC TANK:
MANUFACTURER LIQUID CAPACITY: T ELEV.: TANK OUTLET ELEV(UMB,E."R OF JP WELLBUILDINGET FROM t
DOSING CHAMBER:
MANUFAC URE " LIQUID CAPACITY: PUMP MODEL. PUMP MfANUFACTURER: WARNING LABEL IVN GC OVER
L A.f, 12- f PROVIDED: DED:
❑ YES NO YES ❑ NO
GALLON PER CYCLE PUMP AND CONTROLS OPERATIONAL NEi ~I PROPERTY WELL JBUILDING IV ENT TO FRESH
DIFFERENCE BETWEEN FEET FFIC~M LINFj1 / ` / AIR INLET
PUMP ON AND OFF YES ❑ NO [NEARJE4 ((l r d
i
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 OF SYSTEM. SHOW
El YES meets the criteria for medium sand. ELEVATIONS MEASURED. i
F-1 NO
DISTRIBUTION SYSTEM:
f WIDTH LENGTH: NO.OF SPACING CENTER - LENGTH: DIAMETER: MATERIAL AND MARKING.
BEDITREtVGH TRENCHES: TO CENTER I FO~RCr
DIMENSIONS
MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE M ERIAL & MARKING:
DIA.: PIPES: DIA.:
-Lf VATt Z
HOLE $I HOLE SPACING: D IL D CORRECTLY: DEPTH OF GRAVEL OVER PIPES: VERTICAL LIFT.CORRESPONDS TO APPROVED
Il / YES ❑ NO PLANS:
L
Z~l YES ❑ NO
SOIL COVER:
TEXTURE:
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDE U: SEEDED: MULCHED'.
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
COMMENTS:
SIGNATUR
DILHR-SBD-6227 (R. 05/81)
y RFIPORT OF INSPECTION - INDTV1DUA1. SEWA(J? SYST M
Sanitary Permit. /9q.0
.
State Sept is 11f13
b1-~' TOWNS111P St. Croix (:wtinLy
NAMI?IDITA
6, LC
LOCATION Ale ~ Sectior~~ I_.ot Subdivision
tiEP'1'tC 'T'ANK
Size gallons Number of compartments
Distance from: Well Building t2% slope
Highwater
I'UMI'1_NC CHAMBER
Size gallons Pump Manufacturer Model Number
HOLDINC TANK
Size gallons Number of Compartments
Pumper Alarm System
Di-stance from: Well BuiIdi- rig l2% slope
Highwater
ABSORPT ION SI'Z'E
Bed Trench
1) i stance f rOrll: Well Building 12'1 slope
Highwater
ABSORPTION SITE DIMENSIONS
Width of trench it Required area It.
Length of each line ft Depth of rock below tile i.n.
Number of lines Depth of rock over file in.
'T'otal. length of lines ft Depth of tile below grade in.
Distance between tines itt Slope of trench in. per 1.00 ft
Total absortptIoii area f t `I'ypc ul Covc'r:
PIT DIMENSIONS
Number of pits Cravel. around piLs yeas no
Outside diameter ft Depth below inlet ft
'T'otal absorption area ft t_j
Area required ft
I NSPFCA :D RY T1'l'LIli P q
uVl';il DATE I98
~PPIt
m
I i ! F: I i I) ATE 198
K
PLB 6 7 State and County State Permit #
Permit Application County Permit #
for Private Domestic Sewage Systems County 0 it
*DENOTES STATE APPROVAL REQUIRED 9- 9- If/
/ c p
Date Approval Received from State if Required State Plan I.D. # 63 d C1
A. OWNER OF PROPERTY Malin Address:
V/9 i9 L t~t r> L~ S
B. LOCATION: /11F '/4 N4j1/4, Section TL N, R % e) (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township An7ml4,t~~~
C. TYPE OF OCCUPANCY: "Commercial *Industrial `Other (specify) *Variance
Single family X Duplex No. of Bedrooms No. of Persons 3
D. SEPTIC TANK CAPACITY 1600 Total gallons No. of tanks rAjHOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete i!< Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement X
Lift Pump Tank or Siphon Chamber e,' 0 Total gallons Prefab concrete X_ Poured-in-Place Other (Specify)
-
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area 75- sq. ft.
New Replacement- X Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X' Length- 5!~( Width2 ' Depth / " Tile depth (top) No. of Lines Tea
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- -,;2 7i> Distance from critical slope
WATER SUPPLY: Private ❑ Joint W 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 oil Tester,
NAME
C.S.T. # ~5-- and other information
obtained from
(owner/builder).
Plumber's Signature MP/MPRSW# A:~ Phone #7/ 4*V 57Y
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.
i
~ I E
C WC
71
t w
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application - d y-F/ Fees Paid: State / V, (,K) County D 7
Permit Issued/Rtlected (date) Issuing Agent Name . /
Inspection Yes No State Valid# Date Rec'd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 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 PROTECTION
POST OFFICE BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an..Alternative Private Sewage System
In the County of
Location /VE 1/4 W(-"* ) 1/4 S J6 T a N, R /7 S (or) W
Town or M~~y 9A Street Address
Lot No. Block Subdivision _
'Landowner's Name : Doql-e.
The application for this site is to serve a:
❑ new construction use.
19 replacement: system use.
If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be
included as:
❑ part of the 3%/5% limitation. This is number of the applications
M made through this office.
❑ one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
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. '
❑ a lot that meets the site criteria for a conventional private sewage system.
If this a REPLACEMENT SYSTEM USE, the mound is replacing:
a failing conventional soil absorption system.
❑ a holding tank that was installed and in n
use prior e r or
to
February 1 198
p 0.
❑ a privy that was installed and in use prior to February 1, 1980.
I certify that the above information is true and accurate to the best of my knowledge.
Name use e,-- SOL 4f`" Signature
~ U
Title M P Date 3 7~ f ~11/~E
DILHR-S$D- 6158 (P.7/80) 5 1981
PL"BIND SECTIOPI
WORKSHEET NIiLSSURL DISIKIBUIIUN NPWORK DL',IGN
PROM] M,~ G 5 i9a1
PLUMBING
SECT1c;i1
Design a pressure distribution network for a bedroom home. The site
characterisitics are:
Depth of groundwater or bedrock in.
Landslope a %
Percolation rate ,j min./in.
Distance from dose chamber to distribution system 9 5 ft.
Elevation difference between pump and distribution system ft.
Step 1. ESTIMATE WASTEWATER LOAD
Step 2. SIZE THE ABSORPTION AREA
A) Aren rvijtiirod '
9) Select length C) Width is nnD) I will use a manifold.
Step 3. SIZE DISTRIBUTION PIPES
A) Hole size I will use is _ in.
B) Hole spacing I will use is in.
C) Lateral length is ft.
D) Lateral size in.
Step 4. DISTRIBUTION PIPE DISCHARGE RATE
Step SIIL MANIFOLD
A) Manifold length
B) Number of distribution pipes = `t-
C) Manifold diameter in
Step 6. SIZE THE FORCE MAIN
A) System discharge rate Z/
B) Force main diameter
C) Friction loss will be ft./100 ft.
Step 7. TOTAL DYNAMIC HEAD
A) Vertical lift 4 ft.
B) Friction loss ft.
s
C) TDH ft.
Step 8. SELECT A PUMP
Step Y. DOSE CHAMBER SIZE
L c) G--
Step Step 10. DOSE VOLUME
4~ cD ~,4 L C 6
~s
~b
Q
~5-5
State of Wisconsin ` Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
Bureau of Plumbing
P.O. Box 7969
1
CA~'~ Madison, WI 53707
Plan Identification Number
L_ J
Re: u e.,
PRIVATE SEWAGE SYSTEM ONLY- (N(~ \JL `~~QN1
,C e "34 Z t'j o-v1 W
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
EUts R"~v and received for
approval on
The soil and site evaluation was conducted by
The site meets the soil and site requirements pecified in chapter H 63, Wisconsin Administrative Code, for the u e of
The proposed system is for a - c~Co~ r1 t +V
Wastes from the building will discharge to a_Y~1~L allon capacity septic tank which will discharge to a ~Sb1-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
County By
Other
Enclosures /01 CA%%y -C~1LC/
DIL_HR-SBD-6159 (R. 7/81) mes Sargent, B (rector
State of Wisconsin ` Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
m a~mo~~~~ 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-6159 IR. 7/81) mes Sargent, B erector
- W"010"_
a 12/78
Detach And Return Upper State of Wisconsin
DIVISON OF HEALTH
Portion Of This Form With SECTION OF PLUMBING
tit AND FIRE PROTECTION SYSTEMS
Any Return Correspondence MAIL ADDRESS: P.O. BOX 309
MADISON, WISCONSIN 53701
608-266-3815
DATE:
PROJECT:
errnative Syscela
NWh, Sec.
PLAN ID. #
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. 8 9
Providing one of the two catagories above is checked, remit correct fee in one payment. 10
RECEIVED
❑ AUG 241981
No fee has been remitted. Plans submitted with no fees will be held in abeyance.
ZONING
❑ Plans being returned.' OFFICE
Additional information required. SEE BELOW.
I. 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.
II. 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.
I II. 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 certified soil 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
❑ 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)
❑ Total area 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 time fill has been in place.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
' INDUSTRY, a DIVISION
LABOR AN P.O. BOX 76
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
LOCATION: SECTION: TOWNSHIP/MU ICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
~ /Ta`N/p 1\J 1 lor)W ~MMD~
COUNTY: OWNER'S BUYER'S NAME- MAILING ADDRE S:
d7 ~iRc7/X (t, eNC1R1G K S AJ AL,46V,r61 (~e S
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: DESCRIPTIONS: PERCOLATION TESTS:
K Residence 3 ❑ New Replace I ~1 e ~3 _ G~ _ z/.~
RATING: S= Site suitable for system U= Site unsuitable for system / O T
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
oS ❑u oS ❑u ['ZZ'S ❑u oS au aS ❑u
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V.
I If any portion of the lot is in the
under s.H63.09(5)(b), indicate: I` 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.)
B- C3 0
> 16
B- Mo 4L/,-7 5~/,sx fs g j'sc 7'o 52F " nz, f-
B fur I~ S 5f~.n PC,A vs e a 1--
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERI D PER INCH
P f d .5"
P- Q I-V
P
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 96 (It) If
c ov&;4y /
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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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
A L 4 (,j I - 1.1 /6~- 6 89(- 3 3 7
TURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester,
DILHR-SBD-6395 (N. 03/81)