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HomeMy WebLinkAbout017-1035-50-000 r n N O m v n d _1 o f c d o cD o H' cCDD m a v I d n 3 3 Cl) cn oo o -i 2 0 w o • o m n o o w rn (SD 3 0 m g v ?7 Q N z d N 1 3 O N Q O Co o y ~ U,Wi ° n O N "S CD 0 =3 CD (D cu CD (D 0 3 3 N O v = O O C N O (n < D ~p a 2 CD cn m co a N _ o W 0 ~ O O N (D p 8 8 3 t~ z o co co 3 m CO o o c \r v v v z O O O c o' a m 3 v v _v m O ICil CD N 9o ~i CD I v 'O !V (D ~ N I O N (D CL N N z r~ :3 z-iz 0 D j m O 0 o S !r m CD U) O 0 73 O N Q) CD (a 0- n w m m I 3 ~ z m fn O O O A Z n co C n A z O m o_ O 3 o. (n -I co - * ~ rn a z 3 C (D A a W ~ CD O aQa~ D 3 a (D (n d (D (D N O N Q C ~ ~ O - G CD (D O_ ill C I. 0 o n o o S o CD m o ° N ❑ N N w , m w N 0 (D C (O S a y (D a N N C 77 Q 7 co a o ~ ~ o o Yo a S D m O S O N N CD N N O ~ N O 0 N S "0 Ili _ C N O O 7 d. (COD a ~ a 0 A CD d0 b A o O y~ O s. ' Parcel 018-1035-50-000 10/12/2006 04:14 PM PAGE 1 OF 1 Alt. Parcel 16.29.17.251C 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 - BLOK, MARSHALL & SHARON MARSHALL & SHARON BLOK 1722 HWY 12 HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1722 HWY 12 SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 10.790 Plat: N/A-NOT AVAILABLE SEC 16 T29N R17W SW SW E 40 RDS OF S 44 Block/Condo Bldg: RDS OF SW SW EXC HWY PROJ 8949-03-22 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1191/603 WD 07/23/1997 810/405 07/23/1997 518/427 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 30,500 110,900 141,400 NO AGRICULTURAL G4 7.500 1,000 0 1,000 NO UNDEVELOPED G5 0.290 50 0 50 NO Totals for 2006: General Property 10.790 31,550 110,900 142,450 Woodland 0.000 0 0 Totals for 2005: General Property 10.790 31,550 110,900 142,450 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 208 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 018-1035-30-000 10/12/2006 04:14 PM PAGE 1 OF 1 Alt. Parcel 16.29.17.251A 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 - BLOK, MARSHALL & SHARON MARSHALL & SHARON BLOK 1722 HWY 12 HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 9.000 Plat: N/A-NOT AVAILABLE SEC 16 T29N R17W 9 AC E 1/2 SW SW EXC S Block/Condo Bldg: 44 RIDS Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 810/402 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 9.000 1,000 0 1,000 NO Totals for 2006: General Property 9.000 1,000 0 1,000 Woodland 0.000 0 0 Totals for 2005: General Property 9.000 1,000 0 1,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANIMAY SYSTEl"I REPORT OWNER TO NSHIPI7~r,"o.,,W _SEC./,6_ TcV il, R/7W P.O:,ADDRLSS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE ~ ~cee-s a~~~c.~ ~Z Sub f . PLAT zE.1 Distances & dimensions to meet requirements of 1162.20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM (r o ceW i ~e, SEPTIC- TANK(S) 000 MFGR. 5C /--I CONCRETE X STEEL N0. o.- rings on cover wo Depth DRY WELL po TRENCHES No. of width length area BED no. of lines w v _ width length area 9160 a'- depth to top of pipe AGGREGATE 1 " Z~v Y I e f olio PERK RATE AREA REQUIRED 2j~ S' AREA AS BUILT !tee DISCLAIIER: The inspection of this system by St, Croix County does not imply complete compliance with State Administrative Codes- There are other areas that it is not nossible to inspect at this point of construction. St. Croi.:: _ _ 11 (2 1 S • t"IOl:eci t:i:.~ ~,Citlilt: j :1.1.1 every el"LOi:tt t0 ca L:se OL t:ailure. GIZI;ASES AINT' OILS SHOULD NOT BE DISPOSED THI:OUGH THIS SYSTEM. INSPECTOR P)K.IED 1-/?'- 79 PLUMB .R ON JOB z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM ' San.i.tvL y Pe lun i' ' State S e p:ti c_LZL NAME -fit c =C' ~ " a ownAhip $t. Cto.ix County Location Section ~ SEPTIC TANK. S^i.ze(-('~c gatZon6. Number o6 Compattment6 j Distance Fnom: WeZZ S 12% on gteatet 6Zope 6z Bu.it.d.ing ' 6t. Wet ands 6t• H.ighwatet bt. DISPOSAL SVSTE~4 Distance Ftom: WeU 6t. 12% of gteatet stope 6t. Bu.iZd.ing 6.t. WetZandz Ft. H.ighwatet 6t. FIELD DIMENSIONS: Width o6 ttench_~ 6.t. Depth o6 no ck below t.ite in. Length o,~ each Une 6t. Depth o6 tock over tite in. Number o~ Unels _ Depth o6 ,t.iZe. below glade .in. .To.taZ Length o6 Zina 6t. Slope o6 trench in pe.t 100 't. D.i.s to ke between Z ine/s6t. Depth to b edto ck ~ . I'ota.2 c?bsotb.tion area;/ ~ r- 62 Depth to gtoundwaetc u•t. 2 Requited area St Type o6 Covet: PapvL of St)Law PIT DIMENSIONS: Numbet o6 pits GtaveZ around p.it.s ye/s no Out,s.ide d.iametet 6t. Depth below inte:t 6t. 2 Total: ab.sotbtion area bt A 2 Atea tequ.ited INSPIECTED BY_y TITLE L _ a APPROVED " ,DATE 197 REJECTED DATE 197 EH 115 Rev. 9/78 ' REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:':~Y4,St.✓'/4, Section )6_,TxVN,R_aP (or) W,,Township or Municipality 11,9 Lot No- , Block No. County 157f' pdivision Name Owner's/Buyers Name: S A ~t. Mailing Address: eyw nj we 04J TYPE OF OCCUPANCY: Residence -No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT- X ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 7 L - 7? PERCOLATION TESTS Z'7^ 77 SOIL MAP SHEET NAME OF SOIL MAP UNIT O'C' PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- SINCE HOLE HOLE AFTER INTERVAL BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN y P- /V!J .0 t/ P_ S 2 r, ~ u a rf ap o~T o Y S 1 P- 3 a o 3o P_ It /0" Ma 30 P- ~ 116 o " o C) L 12- P- ~o 16 n t r O r, G o~ s1 `f O SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES rr ~b r B- rY tl (f it /16 r/ t~ 6 _2 C B- tr (I t t Y a /v V B- 't t' tr t/ 6 7-2 rr ~t 0 rt O ° tr q B- 7-T2 7- ZN M N a !r t~' f 5714 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Qs rZy r Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. r~-~+pk F-/Q4,~4 qJ4 { Ilfepltafe 1iel o o 171 o of ~at' R_ 7 _ iel ) v t _ 98 too Houses I o-rekMo/Es c E 111o/es v - a~ W 12 I Not to Sca lE I, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. Name (print) Z, W,4 Certification No. Address Name of installer if known Copy A - Local Authority CST Signature State and County State Permit # PLB 67 , 11 1 W Permit Application County Per for Private Domestic Sewage Systems County "DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: Sb) % Section , T N, R_ZZY (or) OW Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township aM/72047 C. TYPE OF OCCUPANCY: `Commercial 'Industrial `Other (specify) `Variance Single family x Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY 2000 Total gallons No. of tanks G A-* (t. HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete- Y Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement X Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate ! Total Absorb Area sq. ft. New Replacement oK Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: k_Length r?0 t Width 42' Depth ;?4y Tile depth (top) No. of Lines 7--w0 Seepage Pit: K Inside dia eterXY" Liquid Depth 94~ 't No. of Seepage Pits ©NePercent slope of land- °fa Distance from critical slope WATER SUPPLY: Private 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 Soil Tester, NAME ✓e- ' C.S.T. # ~j j - and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# /W - 4114? Phone # &J94 .33 7~ 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. 4' ferna, a~e -El &--/c L7 13 I U? 0 o _ -j ~z f ~A RN _v _ L7 17 o . Se~pa~e p i f 3 Sep ;6 a anQ - E L~j Jac w M 0 ACrk 10/65 , 99 ~ a _ 130re /~0/6s ws . c' /1101 fi S co /e Do Not Write in Spac Below FOR COUNTY AND STATE DEPARTMENT USE NLY Date of Application -/9 C~ - Fees Paid: State County C' Date Permit Issued/R d (date) - Issuing Agent Name Inspection YesNo State Valid# Date Recd 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