HomeMy WebLinkAbout018-1028-60-000
n y O K T 0 r~
O m f c w O r `°1
o o 3
~ m o ~ m .a a;
m w CD
3*
w j N w N nr
O
C (D _ O
IM O w ~O O Q N
N
O' 7 Q D O O
J ~ O
0 7 O C•
_ d C (O O~ lV
O
Z w m fl vv
D O u O.
I~ C
C
jJ N
O O
O
m CO CO
O O C
O O 3
D tV
g V w n~y Z
10 y•
CA Ti
(D
N N
CL
a. E v q (D
M
(D C
O i m N A O
y O
m
z
z m z Q
D (D O V
O a l N
I° m m (D ~.ti •
CD (n
N N N N
(D
_ (D
W
z
z (D
(o N o ~ ~
Imo' C z o
n O
w ~
to
--i j
W M N W
(D (D (D
O ~ z
A ~
O -
O
N ~
(D A
co
w
O
(D
v rn iD 3
7 N -O ry (D
N
O 00 D
N w ~ O T
in N C
X cn 7
v (D N o Q
A -O O
D- n ~ U
(D v w
CD- 73
ti
71
(D
O
O
y
cn w ?
w
O
(D
O 7 •J'
~ T N
N ~ O
I
O d
p ,C !v
m ba 14..
En Q ~ N
o r
Parcel 018-1028-60-000
03/15/2007 12:34 PM
Alt. Parcel 13.29.17.2088 PAGE 1 OF 1
Current X 018 -TOWN OF HAMMOND
Creation Date Historical Date Map # ST. CROIX COUNTY, WISCONSIN
p Sales Area Application # Permit # Permit Type
00 0
Tax Address:
Ow~n : O =Current Owner, C =Current Co Owner
DOUGLAS W & BETTY A VANSOMEREN O OMEREN,DOUGLAS W & BETTY A
2098 90TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description " 2098 90TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
SEC 13 T29N R1 7W 8A IN SE SE COM SE COR ck/Condo Bldg:
Legal Description: Acres: 8.TDatee t: N/A-NOT AVAILABLE
SEC 13 TH W 22 RDS N 20 RDS W 8 RIDS TH N
28 RDS TH E 30 RDS TH S 48 RDS TO POB
505/27 ct(s): (Sec-Twn Rng 40 1/4 160 1/4)
29N-17W
Notes:
cel History:
Doc # Vol/Page Type
07/23/1997 1189/111 WD
07/23/1997 583,/567 LC
07/23/1997 505/27
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 23,400 107,500 130,900 NO
UNDEVELOPED G5 6.000 5,300
0 5,300 NO
Totals for 2007:
General Property 8.000 28,700 107,500 136,200
Woodland 0.000 0 0
Totals for 2006:
General Property 8.000 28,700 107,500 136,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 132
Specials:
User Special Code
Category Amount
Total Special Assessments Special Charges Delinquent Charges
0.00 0.00
0.00
03/15/2007 12:31 PM
Parcel 018-1005-10-100 PAGE 1 OF 1
018 - TOWN OF HAMMOND
It. Parcel 2.29.17.32B ST. CROIX COUNTY, WISCONSIN
Current X Application # Permit # Permit Type
Creation Date Historical Date Map # Sales Area App
00 0
Owner(s): O = Current Owner, C = Current Co-Owner
Tax Address: O SCRIBNER, STEPHEN L & BARBARA J
STEPHEN L & BARBARA J SCRIBNER
1982 110TH AVE
BALDWIN WI 54002
= Primary
Districts: SC =School SP =Special Property Address(es): Type Dist # Description
1982 110TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 2.270 Plat: N/A-NOT AVAILABLE
Block/Condo Bldg:
SEC 2 T29N R17W PT OF SE SE 1.14AC LOT 1
CSM 6/1640 & PARC DESC AS COM SE COR SEC
2; TH W ALNG S LN 807.6FT TO POB; TH N Tract(s): (Sec Twn-Rng 40 1/4 160 1/4)
275FT; TH E 180FT; TH S 275FT;TH W 180FT 02-29N-17W
TO POB (LSAO)
Parcel History:
Notes: Date Doc # Vol/Page Type
02/05/2003 708308 2131/249 WD
07/23/1997 1217/488 WD
07/23/1997 1217/487 WD
07/23/1997 752/601
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Last Changed: 10/18/2001
Valuations: Total State Reason
Class Acres Land Improve
Description
RESIDENTIAL G1 2.270 28,200 185,800 214,000 N
Totals for 2007: General Property 2.270 28,200 185,800 214,000 Woodland 0.000 0 0
Totals for 2006: General Property 2.270 28,200 185,800 214,000 Woodland 0,000 0 0
Batch 102
Lottery Credit: Claim Count: 1 Certification Date:
Specials: Amount
Category
User Special Code
Special Assessments Special Charges Delinquent Charges
00
0.00 0.00
Total
RI PORT OI INSPICTION - INVIV IOU AL St. WAGE SYSTEM
saytt,.t-"zny Pcit In
i
state. Sep -t _,e
M I F o w vi h it i.
St. C n u ,(,x C u u vi -t y
~~I~a ttoyt
.L°Z. -Subd~,v4_~4, 0 yl
P1 IC [ANK
;r z c gaI'euvib Nuiitben. o~ eurnpantrnen.b
l.tvlcc f itutn: Wcef A I3ii,' ed.iytq 11 ,
H4 gliwat
±I'ING t'IIAMI3I h
"t' gal'(t,yt4 Pump ,bla"vtu(ac-tune~ Mudcf Numbe!t
;iN~, tANh
t
t
ga"('Yuv~n
Il l' III iJ l.1 1 l I" YI I J
I 'urn I.~ e ~t A a rr rn S y %t t o rn -
IUl't1'I' 00M: Wv e4' nq
h(t i. _Yd,c_vl~I_. a E't,r:)v
ll-igbtwc~.te~i
o1"111I(1N SI II
tld Titevtcft
(It vlc c riuin: lUe.-Ik it d.ivi
q I
_ ~ ~ .E. Cl p e
III yit wate~r -
T ION SITI - OIMCNSIONS
LCD I -It (I -tit eviah Requ_("lied an.ea 7 I
- -
O e p th o 6 n_o c fz b e- f ow N1 e -z.__, a ;1
Nit nibo~t oh k,t11 e6 DepNt o nue_fa uveit .t-Tke 2_._.._
I u1ae Y(yt it o e4yt(6 Mep"th o~j t~.~Le be.eaw grade-
UI r, tavtt~e 1) etiueen ('i.neA (It SXope of n i:)en 100
Iut!tY i[lo oit.pt.Fon area
Type aA Cave_~L: Papeh uit 's -thaw
11 OIMINSIONS
Nambeit c) pl;t5 Ghav(,X ahound ytu
I
Clu t!, i de d-i ame tv I t t I) e pt4t bekow cn ee-t
Iu (Z abAohp i.oyt ahea
A,tt'(t n(-tlIt (it d
- fi -t
PI C I 1 I) 6v
~I'I'IlOVCD
I II CTCD 'OAT t 19
'I ASON FOR RI JI CT ION -
r
REPORT ON INSPECTION OF SANITARY PERMIT #
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
ame, ress, License o. OT Installing Plumber Time of Inspection
3 INSTALLATION CONSI TS OF: ❑ Septic Tank ❑ Seepage Trench Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
(4)BENUHMARK: (Permanent re erence oint escri e:
Elevation of vertical reference point: Slope at site:
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity:
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: # ft to well:
(7)DOSING TANK: Manufacturer: # of gallons: _
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines gallon; size of pump head; gallon per minute
horsepower ; brand name of pump and model number
Is the warning device installed? ❑ YES ❑ NO Wired? ❑ Y.ES ❑ NO
8 HOLDING TANK. Manufacturer o g_57-on T
construction ; depth to the cover ft; If septic tank is
being used are baffles removed? ❑ YES ❑ NO; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO;
Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material
Distance from building to vent '
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe-elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPAGE BED SIZE: ft width; ft length; tile depth;
lineal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed ft.
,11 SEEPAGE TREN H: Total length of seepage trench ft; width ft;
tile depth ft; ft to well; ft to ordinary high water mark of
lake or stream; ft to edge of slopes greater than 20% falling away toward lakes3
water courses or drainage ditches; elevation of tank discharge lint' entering seepage
trench ft.
(12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO
(13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80
Signature of Inspector:
State and County State Permit # ~
PLB 6 7 G _
r Permit Application County Permit # -QR
for Private Domestic Sewage Systems County Z5_7L- C~P~ ' 1 x
DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY e Mailing Address:
/cam C~ U R S Y ro c i'►~ 12 e it,1
B. LOCATION: is _ y S F y. Seaton T~7 !2N
, RL _7 4b (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township q~,y1r1~~
C. TYPE OF OCCUPANCY: "Commercial Industrial `Other (specify) "Variance
Single family -~L_ Duplex No. of Bedrooms_ S? No. of Person s
D. SEPTIC TANK CAPACITY Total gallons No. of tanks -0 i1,
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete 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- G - -
-
Total Absorb Area _ sq. ft.
New Replacement --L\ Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X_Length- r _Width /a z Depth zr Tile depth
Seepage Pit: Inside diameter (top) No. of Lines_r
r, Liquid Depth No. of Seepage Pits
Percent slope of land- C2 c- Z--) Distance from critical slope
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 I Tester,
NAME C.S.T. #
and other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# MP -545 % Phone # ~/~j fj~yl -~3
Plumber's Address ;'i7 S
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.
E
e a c ke-
E
r.
e
n
. E
E
3
a
I
i
A w..
i
Do Not Write in Space elow FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application .1 Fes Paid: State/X,L+L) County e-d Date
Permit Issued/Rejected date) / i Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
"state (pink copy) 4. plumber
(canary copy)
Revised Date 7/1 /78
E H 1115 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:i:~K_ '/41C%, Section 13 ,Tja_jA,R_/_7o(or) W, Township or qty m/"eiAJ d
Lot No. , Block No. County ~T C,4o~ A
ubdivisio , ame
Owner's/Buyers Name: 000 jZ;j~
ii -isjo . arF e~ h~
Mailing Address: ct`• Z A~,c~ 1 ~iS
TYPE OF OCCUPANCY: Residence-__2-__No. of Bedrooms 3 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
'TES OBSERVATIONS MADE:: SOIL BORINGS /40 - ?Q PERCOLATION TESTS- :2p' - S-6
IM,,AP -NAME OF SOIL MAP UNIT__ 4
PERCOLATION TESTS
HOURS WATER IN TESTTIME
NUM- DEPTH CHARACTER OF SOIL DROP IN WATER LEVEL, INCHES
INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL RATE
BER 1ST WETTED SWELLING IN MINUTES PERIOD I PERIOD 2 PERIOD 3 MIN,'!!
P- /
40 / s• rc
/C.
P-
-Z -Z P- Q r/ Q
r / / T
f) r ~ ~ C1
6
P_
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES OBSERVED ESTIMATED HIGHEST TEXTURE, MOTTLING AND DEPTH TO BEDROCK
IF OBSERVED IN INCHES
B- 01
B- a
i1
B-
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the locatio and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy Indicatwe ~Cale or distances.
Give horizontal and vertical reference points. Indicate slope. /VO R k4
C,5 S
C s~-~
C3
~ ~ -/d
1z
Bold Few c e
E
3/0t h. (-;e d A0z j:~
e~
4
.63 6z
3
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) _ ✓
4e- - R /c-~ d L c~~ Certification No.
Address CAJ / '
.Name of installer if known e- p L
Copy A -Local Authority CST Signatur
Ir-
~ o
v 1
CA3
~Tj
t
° -
t~ ~ n
Q3 r, AL.
110
f I
3
Zj o ~ D 0 U
a N