HomeMy WebLinkAbout018-1027-70-000
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Parcel 018-1027-70-000 03/15/2007 12:45 PM
PAGE 1 OF 1
Alt. Parcel 13.29.17.203B 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 - VANSOMEREN, ADRIAN P & RACHEL
ADRIAN P & RACHEL VANSOMEREN
2018 90TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 2018 90TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 8.030 Plat: N/A-NOT AVAILABLE
SEC 13 T29N R1 7W SW SW LOT 1 OF CERT Block/Condo Bldg:
SURVEY MAP IN VOL III PAGE 727 ORD 8.03A
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 27,300 141,600 168,900 NO
UNDEVELOPED G5 5.030 4,700 0 4,700 NO
PRODUCTIVE FORST LANDS G6 1.000 3,000 0 3,000 NO
Totals for 2007:
General Property 8.030 35,000 141,600 176,600
Woodland 0.000 0 0
Totals for 2006:
General Property 8.030 35,000 141,600 176,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 306
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
WNERn/;, TOWNS HIPL/. f ,
~D•~R~ 5 S nm vrt SEC. T~i N RAW
ST. CROIX COUNTY WISCONSIN.
SUBDIVISION LOT
, LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
fi
7, 9
r'
_ i
f
I di atte ozthi Arrow -f
SCALD . I ~ T
.a 0 r
SEPTIC TANK(S) MFGR. CONCRETE' STEEL
NO7 of rings on cover AI~nN Depth `
PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO.
GALLONS Per Cycle
TRENCHES NO. of width length area
BED NO. of lines width length ,<r>~ area u f
depth to top o pipe -
NUMBER OF SEEPAGE PITS outside diameter- total pit area
AGGREGATE j x'
'
PERK RATE - AREA REQUIRED AREA AS BUILT 1p"
Disclaimer: 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 possible to inspect at this point of construction. St. Croix County
assumes no liability for system operation. However, if failure is noted the
County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM.
INSPECTOR
DATED PLUMBER ON JO
LICENSE NUMBER 12? jJ '~oL Y
AS BUILT SANITARY SYSTEM REPORT
WQER , TOWNSHIP SEC. T N'- R W
0. ADDRESS , ST. CROIX COUNTY, WISCONSIN. T-
.-3DIVISION , LOT LOT SIZE
PI-A.11 VIEW
-Distances b dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t
1
i
S
7 i
Indicate North Arrow I I
- i S CALE~- ( i ~
tiPTIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
'r',NCHES NO. of width length area
no. of lines width length area -
depth to top of pipe
A=GATE
AREA B LT
RTjjTMD_t
%tRk: RATE A A
I,SC3aimer: The inspection of this system by St. Croix County does not imply complete
,awpliance with State Administrative Codes. There are other areas that it is riot possible
inspect at this point of construction. St. Croix County assumes no liability for
Stem operation. However, if failure is noted the County will make every effort to
,jtermine cause of failure.
AEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR.
DATED PLUMBER ON JOB
LICENSE M[BER
i _
1
REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
. Sanitatcy Pvw t04~-~_
• State Septic~ Ste-
NAME,,'~ Eownbhcp_' S~. Cnoix County
Locat.iox .5Section
SEPTIC TANK
Size _gattonb. Numbers o6 Compaxtmentz j
ViAtance Fxom: Wett 12% oa gxeatex tope 6t
Bu.itding 6t. Wettandb 6t•
Highwatex - 6t.
DISPOSAL SYSTEM
0
D.iztance Fxom: Wett St. 12% on gxeatex .6tope 6t.
Bu.itd.ing st. Wettands Ft.
• H.ighwatex~6t.
FIELD DIMENSIONS:
Width o6 txen ch 6t. Depth o6 xo ck b etow t.ite in.
Length o6 each tine 6t. Depth o6 xock oven tite .in.
Numbex of tinez Depth of t.ite below gxade in.
Totat Length o6:.t:inez jt. Stope o4 ttcench in pets 100 St.
.2ineg _ fit. Depth to bedxock fit.
D"' tance between
Totat ab.b oxbtio_n- •axea jt2 Depth to gxoundwatex St.
Requ.ixed axea it2 Type aj Coven.: Pape& ox Stxaw
PIT DIMENSIONS:
Numbex o6 pit, 6- axound pits ye.a no
Out6ide. d.iame.tet it. Depth below .inlet $t.
2
Tota. ab.6oxbtA.on a.nea 6t A
Axea xequixed 6t2 rn
INSPECTED BY TITLE
C
APPROVED , DATE 197.
REJECTED .DATA 197.
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
i~ P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: W4; j~''/4, Section T~/N, R I-" (or) W, Township or Municipality---- Xj- -It-4
Lot No. , Block No. County ) y F _L-------
~ ~ Subdi4ision Name
Owner's Name: •1, ~F{-k=~ l 1'°t" r
Mailing Address: t 1't, t< ( 3
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
I
EFFLUENT DISPOSAL SYSTEM: NEW C~ ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 7/" X44 7S PERCOLATION TESTS ~•l- ~
SOIL MAP SHEET - SOIL TYPE ~-__--__t__--.-_--__----_-------___--
i
PERCOLATION TESTS _
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE C
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P_ _7
SOIL BORING TESTS
r6.
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THI NESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBS RVED)
7
72 72-
if x,
7 Z-
V
745
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. 6,i-5 r( i01 7; "r IriA(~ Indicate scale
of distances. Give horizontal and vertical reference points. Indicate slope.
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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
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.
f
Name (print) 'spy 1, V Cgrtific tion No.
Address S /G
Name of installer if known
CST Signature.-
("-17,v_ e, IcC, t
6 7 i State and County State Permit #
PLB A, Permit Application County Permit
County
for Private Domestic Sewage Systems
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
l~~ I A n/ ° V Fj r~ Sa r» aee ~v ~J~z . (Jobl" I-A G R o S S e) 'FA 1, d w; nj , if-Air S
B. LOCATION: o5uJ i/4~7574/'/4, Section, T.-4 N, R_tg* (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township i4M MCIA.;~
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family X Duplex No. of Bedrooms No. of Persons
14 01Z 4
D. SEPTIC TANK CAPACITY al gallons No. of tanks 0/y4z
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 Total gallons Prefab concrete Poured-in-Place Other (Specify)
E, EFFLUENT DISPOSAL SYSTEM: Percolation Rate-~,-Total Absorb Area sq. ft.
New X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length 1 idth 42 r Depth .06 f Tile depth (top) o2 $Lzi No. of Lines U
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
1, 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,-11 -A Z L! j NAME T C.S.T. # J~`/4T and other information
obtained from P_ (owner/builder).
0
Plumber's Signatur MP/MPRSW# ~17 Phone # 7/-5r 6509(-337J0
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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ICY X
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application ' Fees Paid: State County Date,
Permit Issued/Rejected (date) Issuing Agent Name
Inspection Yes A No 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