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HomeMy WebLinkAbout018-1073-20-000 n In O ! 3 -0 0 C~ ~1 C F 3 ' 0 c A (D r: Cl) -1 j Z N 2 W cC O 3 N rn 0 'I 3 m 93 m o j V °V 1 N CL 3 0 d j W -U 0 N° r~ O o,m o Cn 3 N) 4 7 W O ro 3 N U) c A d CD C3) a ° cn Z D CD CD CL p N d 'o D 3 a_ p 5D 3 O r~ o i CD N 0 0 0 cn o c 1 a ~ a 0 0 0 M• z O O O lei Up -0 O n a c 3 (n N y A 0 v r. 3 O cn CD m V) :3 < CD (D CD CD 2) (A C p N 7 ~ d N N 0 D D o v O c a lV o' CD CD ~r ~ I W CD a CD Z c Z A O N C) N A z 7 p I 1 (n W oo - N W CD CD M G N Z i 0 v N 41 CD ? N 0 CD O p N d CD ° p 2 G •7-• X fll , p T o a T j g C In Z 3 :3 < o a (D . O 5- (D O c) (o CD N ° o O CD CL A N CD CD N 7 a b 0) C N qD U) 0 ° ~ q C p p CD 1 S m b N cu 0 3 CD o0 c A p tv A O O b C) CD O L Parcel 018-1073-20-000 12/19/2005 12:28 PM PAGE 1 OF 1 Alt. Parcel 33.29.17.510B 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 - PRATT, RONNIE & GLENDA RONNIE & GLENDA PRATT 1724 60TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1724 60TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 4.150 Plat: N/A-NOT AVAILABLE SEC 33 T29N R17W 4.15A IN S1/2 SW1/4 COM Block/Condo Bldg: SW COR SEC 33 TH E 973. 81' TO POB TH N 420 FT E 430 FT TH S 420 FT TH W 430 FT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TO POB EXC S 33 FT FOR RD 466/234 33-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/21/2003 731197 2323/211 EZ-U 07/23/1997 466/234 2005 SUMMARY Bill Fair Market Value: Assessed with: 90728 233,600 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.150 35,700 157,400 193,100 NO Totals for 2005: General Property 4.150 35,700 157,400 193,100 Woodland 0.000 0 0 Totals for 2004: General Property 4.150 35,700 157,400 193,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 207 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 D.I.L.H.R. Plb. 1-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Leroy Jansky i . Division of Health 13 E. Spruce Street Section of Plumbing & Fire Protection Systems Chippewa Falls, WI 54729 ON-SITE WASTE DISPOSAL INSPECTION REPORf15) 723-8786 Name of Premises Street City County Master Plumber Address Owner Address ❑ County Permits ❑ Appropriate State Permits Type of Building: ❑ Public ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer ❑ Conventional Soil Absorption System ❑ Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH: t P i p 3 ~ 1 € m , s s 4 ~ ~ # i ` 5 l I y" f _ , , s E , r L , € Y c x t 4 P i , 3 ° p 3 3 ' _ E ~ { a : r t s , s t , , e € s { E I € ° { S 3 s , € e ; , , € 3 ; € E f , , , € F , i ` , 1 , , , i a 7 i ~ ❑SEE ATTACHED DISCUSSED WITH PLUMBER ( 1 Yes ( 1 No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party i 1l'I1'011" 1 01 1N-1ICICIION INUIVIVU AL ~twAGL SYSIIM u rI .i t .z ~r rl ( n rn-i t s r~~ r pt.4 c _ ~ ~tq I (uw ki It i p ---S t . C n a .i, x C u u.VI tai/ 21 1,; a [r , l (v i i u vI I r.r a vI S W t I I' rI3 2 I't]C LANK ~.t ~ ~ yr(VPuIIn Nurri[,("< ('nmL,It'Ifni('vrt~ ~ W1, t{IIIVd(I IM111NG l'IIAMNI K Si c I~ Vufit p Mcivru1jc I 'Ii tlF<< M(iI,Iv k Nurn0 IUIN(, iANh r Si z(' i lc~k'(uv16 Nunn( c,I 0 I1 tit 1_ulit tin nt.ti _ I'it tit p'it Aeahrn SIIA tern ti-tapir(' ( ~rit ui: tuoef 6 ll<l'divtcl bkoC~r II ~ ,IIIW a.tc l; 0 RI1110N til II 1`;od I 1ti r~It tapir(' 0/Ir,Iit (UPef I;II(FdIVI~I 1,c - IIcIlit wa t('rI r';Oltl'I lON ti l l1. UIMI N') ION.ti ran ~'~1~~ W I tl Ii 'T;~„ri; > (l RPc~ar iii d ahea je t L,. l II O--N- -41--4-44r-e (t 1) e 1, t k'I a It. a c fz b c, u w t i_ e e r ri N n ai(, I~ 'I h V I ki (,A r,~~ CF07JU,; P 1J t4t U ~ n. U C I2 U V P /t t P ( VI i~(rIl' PcitLI -tit u v kiVh At 0optit I, ti. ci. bvfow yn_ade ter Il.iti'tavI('h 1)CtwV(l VI Y vieh h~ ~kv1>c o0 thVvlch 4,n. p eh 100 (~l a I taV n1,1un1)t40yi unV(i (t Iy11V of CUveIL F'avc Ulf 'sVIaw f 1 1) 1 M I N 1 ON VII m1,I>>I r,( p: ( I Ggavc~Y iznuu,vrd p A -yeb III, IIIt I(Ic if iafit Vto,I fT ~eprII bcfow tiYieu't (~-t I„tae a1) %I;!IIIt(0P it'Iec.( f-t i Ali (,it llk'4 I'1 C I 1 U 1;y I'~,(~VI Lr 0 A I f 198 ( II C I I I) VAT[ 19 A',I!N IOW I"I J[ C1 ION REPORT ON INSPECTION OF SANITARY PERMIT # (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection 1~~M►~UNI~r I Time of Inspection ame, ress, License No. o ns a ing Plumber Av! vhf `-rT 4Q I (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit Q Seepage Bed P~r~ar,~h ❑ Holding Tank ❑ Fi l l System (4)BENMTWFT~Vermanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: t To r~,ou~~D (6)SEPTIC TANK: Manufacturer: uj rsy , Liquid Capacity: ►zcxo GALS. 2oH D Tank Inlet Elevation: 4(o' y ~4 Tank Outlet E1 ev : 9C9 ' 3 # ft to lot or property line: > s' # ft to well > 2.5 ' MDOSING TANK: Manufacturer: WEEKS # of gallons: icy C,AUS 4 # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower Yz P r.: ; brand name of pump and model number f ) Is the warning device installed? ❑ YES ❑ NO Wired? ❑YES ❑ NO ; 8 HOLDING TANK: Manufacturer o gallons 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? C] YES ❑ N0; Wired? ❑YES ❑ N0; Locking device on cover? ❑ YES ❑ N0; 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: )U ft width; so ft length; OA tile depth; 1 i.neal feet tile; ft to residence; >s0 ft to wel l ; s ft to lot or property line; >5-o' ft to ordinary high water mark of lake or stream; >z o' 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 TRENCH: 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 lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? Q YES ❑ NO (13) Has system been installed in floodway? ❑ YES © NO Floodplain? ❑ YES ®NO DILHR-SBD-6095 N.05/80 Signature of Inspector: State of Wisconsin ` Department of Industry, Labor and Human Relations v SAFETY & BUILDINGS DIVISION Bureau of Plumbing, Platting & Fire Protection P.O. Box 7969 T0: Madison, WI 53707 Plan Identification No. Gentlemen: Re: The Bureau of Plumbing, Platting and Fire Protection 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 an site requirements specified in c h. H 3, Wis. Adm. 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 absorpt 'ioonsystem. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval con- tained in this letter. The licensed plumber responsible for the installation shall notify the county nspector when the installation of the system will commence so that the county inspector shall be able to inspect this instal- lation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. t I / I DILRH-SBD-6159 (N.7/80) in accord with ch. 145, Stats., and .h. ii 3# Wis. Ad m. C"cide, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. please rev'r oiw Code fcr 0.e requ i re tints of each code section noted The architect, professional engineer ls€ r ra or plumbing contractor shall keep one set of plans bearing ,~-e starip of approval of this department at the construction site. If the installation of this system. has not °~~nced within t years from. the date of this letter, this approval shall become void and new application s,e ode for approval of these plans before work may commence. i this approval, the Division of Safety and Buildings does not h i tse f 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 o der Lwh Tres or additions should con- ditions arise king this necessary This approval Is based on ch. H 63, Wis. gr in. renuil"e tints. 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 gill automatically void this acceptance ncerel y, s Sargent r'ea ,1":JFws ,DILHR-SBD-6227 (R.9/80) (PLB.106) Plan Identification No. Construction Inspection of Alternate Design Sewage Disposal Systems Wisconsin Department of Industry, Labor and Human Relations Bureau of Plumbing. Platting and Fire Protection Owner's Name Mailing Address A. Site Investigation at onset of construction 1. Name of Installer 2. County S ~Cr o, X InspectorTn i5o.,) 61jl~f.)~'_"-j Date 101211$c 3. Package # G 4. Preliminary onsite made by'-TT1Dr,,,_1' nq_" Date AD 31 5. Depth to limiting factor (50% unconsolidated rock or estimated ground water level) 6. Percolation rate I 7. County installation permit number ~2_ 1Co 8. Are percolation and soil boring holes evident? Yes 2 No 9. Is system located in area of soil tests? Yes__X_No 10. Is system located in area shown on state approved plans? Yes X No 11. Ground slope in area of system 12. Site data is correct as presented by C.S.T. and system designer? Yesy No B. Inspection of Construction 1. Disposal site plowed and properly prepared? Yes No 2. Disposal site conditions wet or damp? Wet Damp Dry 3• Type of fill material 4. Depth of fill (1' Minimum) I.~t 5. Is a crawler type tractor used? Yes No a. Blade Bucket 6. Has site been driven on by any vehicles? Yes---No If yes, explain I 7: T-reoc-h width as indicated on approved plans? Yes _ No 8. Trench spacing as indicated on* approved plans? Yes No 9. #atre- tr-cnc;h bot toms, been properly leveled? Yes No 10. 4-r-ene-h length 'and number as shown on approved plans? Yes.' No 11. Distribution piping proper diameter? Yes No Q. Holes in distribution piping properly sized? Yes No 13. Holes in distribution piping properly spaced? Yes k: No 14. Holes in distribution piping in a straight line? Yes No 15. Distribution. holes drilled straight into piping? Yes No 16. Depth of gravel below distribution piping ' 17. Depth of gravel above distribution piping 18. Thickness of marsh hay covering I I'! F f+L. 19. Permanent marker at end of each trench i' 20. Depth of fill over center of system 21. Depth of fill over outer trenches 22. Side slopes 23. Type of fill used above t-fenches 24. Depth of top soil 25. Seeded? Yes No If no, has mulch been placed over mound? Yes No C. Pumping Chamber 1. Diameter of inlet `t 2. Diameter of outlet '4 3" r-_r I 3. Head 4. Size of pump tank gallons 5. Draw down or gallons pumped per cycle 6. Manufacturer and type of pump same as that indicated on approved CIF' plans? Yes No x If no, indicate Mfg. and.Model I of pump used. 7. Quick disconnect provided? Yes No 2 a f f 8. Diameter of manhole 9. Height of manhole above finished grade - 10. Diameter of vent 11. Height of vent above finished grade 12. Pump tank located as shown on approved plansl Yes No D. Septic Tank 1. Properly installed? Yes ' No COMMENTS I~U~~Q Cf+gv~ ~ WAS MOVES -ro I~,r>~ l or., ( Al ` OCgilon~ D12ECTL-( SOUTH OF= SC(}rlL TAN{ IrJS,FA,o 61= FAST or- -TA"K, I, the undersigned, hereby certify that the questions were answered on the basis of my personal inspection or knowledge of the construction of this alternate system and further that all data and answers recorded on this form are correct and to the best of my knowledge and belief. A- 11 Name: n Signature: Title: WE HAVE INCLUDED TWO COPIES OF THIS FORM FOR COMPLETION BY YOUR OFFICE. WHEN INSPECTION OF CONSTRUCTION IS COMPLETE, ONE COMPLETED FORM SHALL BE RETURNED TO THIS OFFICE WITHIN TEN (10) DAYS AFTER YOUR FINAL INSPECTION OF THIS ALTERNATE SYSTEM. Date received by Bureau of Plumbing, Platting and Fire Protection 3 . EH 115 14 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: SE-'/4, S_h-'/4, Section 33-, T29N, RLZR.(or) W, Township or It%7;,X3P2aKX Hammond Lot No. , Block No. County St. Croix Subdivision Name Owner's Name: Ronald Pratt Mailing Address: Route # 1, Box 45 Ha mond, Wi scnnsi n 401 - TYPE OF OCCUPANCY: Residence xxx No. of Bedrooms 4 Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT xxx DATES OBSERVATIONS MADE: SOIL BORINGS Jul-)r 230 1979 PERCOLATION TESTS ~Jul_sZ_24, 1_97_2 SOIL MAP SHEET-__ #k 69 SOIL-TYPE Jew ett_si__loam_.__ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES, RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN,'!' P-1 16 See Bore Hole Data 23 No 30 3 ],/4 3 1/4 3 -346 9.4 P 2 16 See Bore Hole Data 23 No 30 5 1/8 5 1/8 5 1/$ 5.85 P-3 16 See Bore Hole Data 23 No 30 5 1/2 5 9/16 5 1,/2 5.45 slowest rate----- 9.41 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) &-it # 8"d]k Gy-Bn sil, 20" Bn sil, 6" Y-Bn sil 1 74 30 28 f-dis mott. & sm stones, 40" Y-Bn sil & B-Pit # 74 38 30 same as pit # 1 (exception - depth to 2 3 t # 45 36 &4 74 48 34 same as pit # 1 (exception - depth to 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. Mound SVstem - si zed aCCOYdincr tl indicate scale or distances. Give horizontal and vertical reference points. Indicate s pe. alternate sewage manual } I ; i I _i._- „ ('mac r, i.c~ U~ n a•,-,1~ Ici ti Y x KAN -'11 P 1 I ; ~k TI f 4 I I ~ 3 i 111 I I i ~ L1~ AC•1 /i t A iM< Amc } q. ,,y, t i I~ dz r- _u...a* S ( 4 tS1 c\' ~ {3 f I ~ , 1 ! III 111 n _ + 4% a c. a f ~ 11 t ~ I I ~ I , i ~ tN ' ~ 3 ~ ! 3 € I I f I i ( s i + I 1 , 3 ~ j:~r .y i LL• (alb 4 ,.~cl~Crcea~ we! -4 T- + i ; "IBC i i ~ f f , I f 3 I ~ I 7 , 1, 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. Name (print) Michael A. - _l §(-snn Certification No. 55 198- Address 108 South Cudd Ave, River Falls, Wi scc)ngi n 54022 Name of installer if known COPY A -LOCAL AUTHORITY CST Signature i ' s r , it Q CP - N O ll:, ~ `~I 8'J': ill -t-•" 0861 z a3nltDId a- ynnn~~~ { 7• gin: F N~ ~ ~ ~p= c N 011,;' 1 \ 1 03A 13 5iiiGiiflld Tll~ .10 4 F r, • 1 viii ~ « ~ ~+y1 ~ ~ , ,I State and County State Permit # 0 ~U w Permit Application County Permit # ! x for Private Domestic Sewage Systems County 420 'DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: gotjoqLd Rqn-{ + /74l/n M Q l)Q, L~ t ,s B. LOCATION: J5 ate'/q Section , Tol9 N, RJT V (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township l~mmei✓ r/ C. TYPE OF OCCUPANCY: Commercial "Industrial "Other (specify) `Variance Single family X Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY AR00 Total gallons No. of tanks 61VL° HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber rdp0fotal gallons Prefab concrete -Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate- i r Total Absorb Area sq. ft. New Replacement Alternate (Specify) 140 y/Jd I ivy Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diamgter Liquid Depth No. of Seepage Pits Percent slope of land- `1a Distance from critical slope 'v'VATER 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 S Tester, NAME ✓ f C.S.T. # .6"154 and other information obtained from Wn1~4G (owner/builder). Plumber's Signature MP/MPRSW# 11710 4429 Phone # `r/$~- 6 33710 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. E ,,.7 s 3 i - ( F a a ae E e- < t Do Not Write in Space d~s Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application L~ -ad Fees Paid: State County Date Z) /c Q Permit Issued/%jected (date) 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 2, state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 PIb 100a 12/78 Detach And-Return Upper State of Wisconsin DIVISON OF HEALTH Portion Of This Form With F SECTION OF PLUMBING ? AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: 1" S14r., Sec. >"rn of 71ammor SI„ 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. Providing one of the two catagories above is checked, remit correct fee in one payment. ❑ 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. 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. 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 ❑ 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. Sysi=rms In Fill (Fill must be placed prior to plan submission) Iii a filled (fill to extend 20' beyond edge of trench before side slope begin). d tvpa of fill. nsi'e report by county or district plumbing supervisor. fill has r~een in place. rr 1 State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH MAIL ADD*ESS: P. O. !O% 300 MADISON, WISCONSIN 53701 July 23, 1979 IN REPLY PLEASE REFER T0: '~%3550 Mormon Coulee Rd., Rm. 104 FCFri/Ff] ' a Crosse, Wisconsin 54601 - % JUL L 1979 ZONING Mr. Ron Pratt R. R. Box 245\ OFFICE f~\v Hammond, Wisconsin 54015 Dear Mr. Pratt: Re: Site evaluation; Mound; SE-14 SW-1, Section 33, T-29, R-17, Town of Hammond Enclosed is a copy of my inspection report of July 17, 1979. As you will note on the report, the only area I checked which is suitable for a mound installation to replace your present failed system is west of your house on the opposite side of the shelterbeit. Before the design plan can be made, however, percolation test results and slope detail of the area must be obtained. Mrs. Pratt informed me that the area located is on property not owned by you at this time. The design plan cannot be approved until you have either obtained ownership of the property or a binding easement for the installation. Mrs. Pratt indicated this would not be a problem, but you should be aware that it is a requirement. Should you obtain assistance in applying for Wisconsin Fund grant money, the mound plan would have to be approved prior to that application. You are aware that the Wisconsin Fund is non-retroactive. Feel free to contact me if you have any questions. Sincerely, James A. Sargent, Chief Section of Plumbing and Fire Protection Systems Dennis R. Sorenson On-site Waste Specialist DRS:jd cc: Plumbing Section, Madison Attn: Julie Peterson, Mound Program l.Wdrold C. Barber, Zoning Administrator, P. 0. Box 227, Hammond 54015 ^:.Aalttt Protection Systems ON-SITE WASTE DISPOSAL INSPECTION REPORT CpUrtty city Sheet Address e _ r ber q Address r~x D Appropriate State Permits Permits - C'' 1Y i e~ ~ i r Q _ff Single Family or Duplex ,ilding: ❑ Public TYPE OF TREATMENT SYSTEM 'tPROPRIATE BOX FOR VIOLATION ❑ Conventional Soil Absorption SYsta`l' g Sewer r ; ❑Conventional System in-fil'• Tank ; [R'Aiternate Mound Systet l Tank ❑ Holding Tank jc Bed ❑ Experimental System e Trench ❑ Seepage Pit 4CTUAL COMMENTS AND SKETCH ` 1X t -'r ?S - f A~ is J1 i 1 i a 1 I . 1 w 41 E ~ ~ fJ ~ t --i--~_~.± - (e••~g 11b~FZ`~( sit! ( i 0 "J i _ t r -t~-- 4----~- - - , AG-4' AT aq, i ~ ~ ! f 411t +1dE' i - IZN 11 ' ~ • TTACHED ,'D WITH PLlltV18R Yes I I No SIGNATURE (Voluntary) INSPECTION Signature of Inspector Pink • Plumber or Responsible Party Yr,.llow -local Inspector IN-SITE WASTE DISPOSAL Irib r r-6 I lun ncrun s City County' Q + ITT r + rY k Address Address` ; - r K t. :y Permits--',--), ❑ Appropriate State Permits 1.T Single Family or Duplex of Building: ❑ Public TYPE OF TREATMENT SYSTEM CK APPROPRIATE BOX FOR VIOLATION Wilding Sewer t1 ❑ Conventional Soil Absorption System 9 h t , t e►` ° D~- ~Conventional System-in-fill E;,Iding Tank eptic Tank 4 c e Lgf Alternate Mound System ' -oage Bed ❑ Holding Tank Pit ❑ Experimental System ,.aye Trench ❑ Seepage FACTUAL COMMENTS AND SKETCH: - ; T 17 i ` - ; i I . I 14b; 4-4- L 4-4 1 + - - - l I t Y9~ _ - } N~ ,1~ Ion d S + € r kire. " + - i IN _ - - ( i ! 1 - - A~ - I SEE ATTACHED }CUSSED WITH PLUA6iTF►R 01 Yes ( 1 No SIGNATURE (Voluntary) FE OF INSPECTION Signature of Inspeci :t: Local Inspector Pink - Plumber or Responsible Party 4rMSpfc:c.: A ss C OIX COUNTY ) ounie Pratt and Glenda Pratt, husband and wife, of Route 1, Hammond, Wis- being first duly sworn, deposes and says that they are the owners of u'}=' following described real estate: parcel of land located in the "out!: ialf of the Sout west Quarter (;'2 of S[•T') of Section Thirty-three (33), Township Twenty-nine (29) Qrth, of Range Seventeen(17) West, Town of Hammond, St. Croix Co isconsin, described as follows: Commencing at the Southwest corner f said Section Thirty-three (33); thence East, assured bearing .73.81 feet along the South line of said Section Thirty-three (33) ~o tie point of beginning; thence North 0° 30' :'ast 420.00 feet: three ast 430.00 feet; thence South 0° 30' West 420.00 feet: thence Wes'- 0' 1L'.ti "<,rrson, formerly Ruth ':cai~srr± a7 ac?tel.` fe--_Jjp, 17?1c- f.^,? 1.o;7in1 .,Cr;,-rit r,,., rc, 7 ,t<ac parcel of lar,(i located in the South +~a1.1 of tic ..~i Of S"'4) of Section Thirty-three (33), Township ijo,'ity'..P..'.,ae (2 crth, of Range Seventeen (17) West, Town of Hammond, St. Croix Couec isconsin, described as follows: Commencing at the Southwest corner < ,laid Section Thirty-three (33); thence Fast, assumed bearing; 773.:1 et along the South line o." said. Section Thirty-three (33) to the poi; beginning; thence Fast. assumed bearing 200 foet along the South said Section Thirty-three (33); thence .North 0* 30' East 200 feet w.',.ence West 200 feet; thence South 200 feet, more or less, to t.. o. beginning, except tt:- South 33 feet for town road easement: _ e last described real estate is 'rein-, purchased solely for t_le n.:r^osc if constructinc, a mound system for on-site wastewater disposal thereon, and ) t:'„ event the St. Croix County Zoning Administrator approves the purchase of e°.t estate, then an applicatioi, will be made to the proper agency for permit sion to construct a mound system for on-site wastewater disposal on estate, and that both said parcels of real estate are adjoining; part Affiants state that in the event said real estate is purchased t%crc will not be any buildinf7 'evelopment or construction of any family c-elling on said last described real estate, except the construction of a mound system for on- sit- wastewater disposal. i review this matter and if approved, consent to the purchase of said real estate for the construction of the round system for on- a wastewater spas 1. Dated August /3J 1979. Ronnie Pratt Glenda Pratt Subscribed and sworn to before me <y f ay of August, 1979. CSC 4-,-Y-1 .arold D. Olson rotary Public, It. Croix Co.. WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health Section of Plumbing & Fire Protection Systems ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises Street City County Master Plumber Address Owner Address ❑ County Permits _ ❑ Appropriate State Permits Type of Building: ❑ Public ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer ❑ Conventional Soil Absorption System Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH- a ut t r ti ~.._.s E , E - i~ E ~l - T Ji, ~ E t s E ~3 ` E ~Tfi Flu tai"f '114 J~CA,,, 3 v "e ' )a<~ i°Z lFg 1f»ri1 ti 1rw r t r~i~ 17 1 ~ 3 ~.--y lc~~csua ~~1~i' 'f t ° ~k t~....w.,. .a a : t k. y7 La Jaaw ~ T t E E E ° Lo -a E E E k~ a E 3 E k L `T vl i~ ~3.~V i ~ ° ~ ~ Y ~ ,tit . ~ r s rr 4.~. ~~.1_ rS!,._ ~ ~ _„t. ~.,x~! ~!m".~,:,,~ P 3 _ ❑SEE ATTACHED DISCUSSED WITH PLUMBER ( ) Yes ( ► No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector Yellow - Local Inspecto" Pink - Plumber or Responsible Party