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Home My WebLink About018-1011-60-000 o • I roc I d p o~ 0 I M N bq m m erg 0 SO p ~p O II N C a T O ~ Y I ~ I U m i ~ v I O 0) q (D I CL I o `c~ o a 4Ni c I Z a`~i > I o z > ° o L a z ° c c c c m c I U. c U. c 42 3 0€ 3 0N'€ ~o 16 I aci I M Cl) d u I E E z ° ° coFN-z am am c o I E z 4~ c c I y u o 42 o Z c c v~ H I s Y) o E c m E v D D:3 j Cl) I N N O N m 4) E 4) 0 (D IL c a `n ~ I a~ O ~ I Q ° ° F- z m z z z N z i r- 20 c n d CNI m CD co w .2 a l c CL Hd U co L 4) M E C O a a Y C C a .0 o N 0 = to N rn c c V1 w j o N I Z N a a2 0$ 3 2 I E z 1 0 00 •N Zaaa CL IL CL V IL w m I 3 Go co r-- A J V O rn rn O Z rn rn z a- } w - l0 m N N N 7 O O _ 0 0 O j m m rn ° m o m Q co O Q z cn m ~ E w a I~ a a ~ y 00 m N C O N C O E c O co V V Fo- a~i c c c a °o °o ~o C 000 C -6 1 N C m Y C 2 C = N~ p ° ~ E E V/ M a w ~~z av d o m~~I 0-4 m O 0) T d E a) ° M o 'w m E o 0 co o o o .E u I C14 M a) co • O Ir O O 2 00 M Z 2 I- z N O Z_ Z Z ►r !n I r € I U d € € a 0 ~ a Z~ 0 a~ I • a m d c m° c ~`iwv E 7 c+,' r B o I +1 A c°~aTe vUic°~ 031 w0 `Parcel 018-1011-60-000 12/20/2006 03:17 PM PAGE 1 OF 1 Alt. Parcel 06.29.17.86C-2 018 - 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 - ALBERT, LEILA LEILA ALBERT 2035 CTY RD J BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1517 CTY RD E SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.014 Plat: 0869-CSM 03/0869 SEC 06 T29N R17W NW NW LOT 2 OF CSM Block/Condo Bldg: LOT 2 3/690 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-29N-17W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 12/16/2003 749175 2474/478 WD 12/21/2001 665984 1797/114 AD 07/23/1997 931/285 07/23/1997 778/265 more 2006 SUMMARY Bill Fair Market Value: Assessed with: 171943 134,800 Valuations: Last Changed: 10/18/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.014 22,100 81,700 103,800 NO Totals for 2006: General Property 1.014 22,100 81,700 103,800 Woodland 0.000 0 0 Totals for 2005: General Property 1.014 22,100 81,700 103,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 09/27/2005 Batch 05-22 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 Parcel 018-1011-40-000 12/20/2006 03:15 PM ' PAGE 1 OF 1 Alt. Parcel 06.29.17.86C-1A 018 - TOWN OF HAMMOND Current 1*1 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 - MCFARLIN, MICHAEL M MICHAEL M MCFARLIN 1509 CTY RD E NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1509 CTY RD E SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.001 Plat: 0869-CSM 03/0869 SEC 06 T29N R17W PT NW NW LOT 3 OF CSM Block/Condo Bldg: LOT 3 3/869 (FORMERLY PT OF LOT 1 OF CSM III P 690) 2.134 AC EXC LOT 5 CSM 7/1920 (.366 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ACRE) BEING ADDED TO P86C-1 B 06-29N-17W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 03/08/2002 673025 1850/387 QC 07/23/1997 813/614 05/24/1993 499475 1010/527 WD 130228 160/034 WD 2006 SUMMARY Bill Fair Market Value: Assessed with: 171941 169,000 Valuations: Last Changed: 10/18/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.001 27,300 102,800 130,100 NO Totals for 2006: General Property 2.001 27,300 102,800 130,100 Woodland 0.000 0 0 Totals for 2005: General Property 2.001 27,300 102,800 130,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 126 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 • FORM NO. 985•A • NGMII~~r COnip.rry® V ~ ~ III ~,r~7. p Ly u LI j5 3 518 8 9 S! RVEY-- R RECORD CERTIFIED SURVEY MAP NW CORNER SECTION 6 T29N, R17 W RAILROAD SPIKE II ._J L---------- -I _ C OTTT~TTY TRUNK HTC~Tif~7AY Ail- ST - - - - - - - - - - 112 1 r~l N.S.P. Easement I° 863500 - - -265.691 t CV O - o Io p Southerly rig -b wayi,n IS ~FoPOINT OF BEGINNING LOT I In 1.01 a i --t 0 4-1 168.55' 3.366 acres ~ N •o LOT 'd ocA 4.159-acres oT34~ ac CJ 84.1' z 2 1 I EAST 1133.66' I~-- Easterly right- UNP TT L S v of-way line N~N oI U Affidavit to correct 592-71 W APPROVAL OF THIS MINOR SUBDIVISION LEGEND DOES NOT MEAN APPROVAL FOR ¢ BUILDING SITE OR SEPTIC SYSTEM; S o • 1" iron pipe found REFER TO H62.20. 0 N A P.K. nail found ca r +E-sExisting fence ~a o 1"x24" iron pipe weighing 1.68 lbs. lineal ft. set 3 4 APPROVEr SCALE IN FEET FILED ~ 0 100' 200' 300' 400 90201978 SEP 22 1978 c I"= 20d) JAA(ES O' CONNELL J R•Oftfer'f Geed' / ST. CROIX CL)' >Y Got, .r COMPREHENSIVE PARKS PLANNING Wl "t AND ZONING COQ Description A parcel of land located in the NW,-; of the NWT of Section 6, T29N, R17W, Town of Hammond, St. Croix County, Wisconsin, described as follows: Commencing at the NW corner of said Section 6- thence EAST (assumed bearing referenced to the Easterly line of that parcel recorded as the N254' of the W1126' of said Section 6, bearing N1o 11'40"W) 33.00'; thence SOo 01120"E 33.00' to the point of beginning; thence continuing SOo 01120"E 218.55' along the Easterly right-of-way line of an existing town road; thence EAST 1133.66'; thence Nl0 11'40"W 21.8.60'; thence WEST 1.129.19' along the Southerly right-of-way line of County Trunk Highway "E" to the point of beginning; Subject to a 50' easement to Northern States Power Company to erect, operate, repair and maintain an electric transmission or distribution line or system as shown on the attached map. I, James E. Rusch, registered Wisconsin land surveyor, do hereby certify that I have surveyed and mapped the above described property' that such plat is a true and correct representation of the exterior boundaries of the land surveyed: and that I have fu11 v n mnl; o•rl w;+t, +1his „rat.; Q; nne n•F' ,Sol 11110,100, n 1V)3 -00+ 'road ~i ano 1 ON 1 699 92Ed auznToA a 1r s!M ) aovd 3NMO A slle3 aaAla ' Ja?Taq pue 9L£l S u•pusgsaapun `@SpaTMoux Teuo?ssajoad jtuz jo gsaq aug og ~gunoo x?oao •gS :j aoueu?pao uo?s?A?pgnS aug pus sagngegS u?suoos?M aug jo +t~•g~Z aagdBuo yr ~L Zjo suo?s?Aoad aug ugzM pa?Tdwoo -[Tn3 aASu I gsug pue :palaAans pus-[ aug jo sa?aepunoq ao?aagxa aug jo uo?geguasaadaa goaaaoo pus anag e si gSTd eons geug :,~gaadoad paq?aosap aAoge aug paddew pus padaAans aASu I geug A y~/07~; j~J?gaao ~gaaaq op °a0jCanans pusT u?suoos?M paaags?Saa luosng •g saver `I saa?dxa uo?ss?umoo fiu u?suoos?M `.~gunoo aa?STO neg `o?Tgnd J~aeg N %9 5, m 'awes a a2a MOLLx3e us guauna sul 9LI?OSaaO3 a a noaxa O M uosaad a q4 o q cD ugp pT P g ugpg u ug q g u 1~ aw og caCu?A•d•W pawsu aAoge aug `6L6T ` jo dep s?ug aw aaojaq auiso j~TTeuosaad IT o `o v ~TS ( MMO TdI6"IO nVa 2 ~ v a SS ( NISNOOSIM d0 g,I,VZS w + CIO 0 -0~ ssaug?M ,`Dy o + °°-M 'p 100 dSN v,'t(D O 0 z G ssaug?M agSQ acgaags?u?ulpy `aCu?A'd'W ~ ~ (D O C ~ ' d ct N m n o C£ r• tv P o •~gaadoad paq?aosap u?aaau aug 3O a~isw Og as?sap .dew su91SSV ao ~ r• ej. Z saossaoons 94T `dSN uo?uM sasn aangnj ac guasaad due ugTM aaajaagui you saop asn p?SS Ou?p?AOad `xsTa uMO a?aug ge `saauMO pueT guaoeCpe aug Og SJeMaA?ap r, aOJ MLTH `N6zs `g uotgoaS `iMN aug Jo iMN aug jo ugaoN aug 30 0OS ugno5 b m CA 0 aug jo asn aug og saaaSe j~usdwoo aaMOd sagegS uaaugaON z < o :sMoTloj se paq?aosap sguawasaa p?Ss `,~uedwoo aaMod sagegS uaaugaoN jo ao?jjo aateTo ned lguawgasdaQ -n N G8M-3o-4LTDTH pus agSgsgTsag `aOgeags?u?wpV 'aCu?A'd'W 4 cg pagsagge se geTd m Z uMOus aAoge aug jo S pus t sgoT og guawassa ssaa2a-ssaa9u? ue ug?M aauga2os •2u?uu?Saq jc gu?od aug og ,£6•Sgg ISgM aouaug •,SL'89T M„z3,9+03N aouaug :,~T*+L9 ISVa aouaug :psoa uMog DUTgs?xa us JO au?T JNM-JO-41491a J~Taagssg aug 2UOIS ,SS*99T d„OZ,TOoOS Su?nu?guoo aouaug !Su?uu?9aq jo gu?od aug og ,OO*E9 g„OZ,TOoOS aouaug 00'e~ (M„O+l,TToTN Su?asaq cg uotgoaS p?SS JO ,93TT M aug JO ,+l3 N aug sa papacoaa Taoaed gsug jo au?T JCTaagsed aug og paouaaajaa 3u?aeaq pawnsse) SSVH aouaug !g uotgoaS p?Ss jo aauaoo MN aug ge Bu?ouaumloo :SmOTTOj se paq?aosap °u?suoos?M `J~gunoo x?oao 'gS °puowweg aug 3o iMN aug ui pagsool puST jo Taoaed V 3O uMOy `MLTd `N6zs `9 uo?goaS 3O 1 tMN NOISdIaDSd(I n11IWWC)0 `JNINOZ dN'I gTOtIS '?M `uospng 13S 1004 "lV3Nl"i/'S81 891 ONINNnd Saavd 3nISN3H3VdYl0: 9NIHJ13M 3dld NOaI bZ X .,l xo eo as n0 0 1Nfl 7 Xi0X100 is TZ~ g p d T o 60+ T •ouI csaaau?2ua suanagS 30N3d 9NI1SIX3 if It T ,,C t1ka ng •g saws ONnO:l 3dld N08I „1 • 6461 6 ` ON393'1 NVWHO'l 1 110 03 0 SVM 1N3 LSN1 SIH1 a3AOSddV 3N1-1 AVM cn0 Oob OOZ 001 0 - -d0-1H916 0631SV3 ( rnoo SONY-1 0311V'1dNn rnn 1333 NI 3~`dOS MN-MN I'99 1 £1'b18 iSV3 I Z * rl r r Z X08 8 Z I'L6£ £9'519 05'89 \0o00 N O Z;u M M ~ o No No y LN3A-*v "p2~ ° l Z n co m i S380V .00'I co °r ~a~+ o 1 m S H CO °m . I vz F C. 1-4 lo I Cjl ►N~.S380V 4912 0~I ~ of o0~s D m y .Ig _.....,r... f s m I nrn I 069 39Vd 3W OA NI 43o' 0o3a d`dW ~l3Aaf1S 031d11a30 m r I 28a 6'862 £b'L09 09'852 oss ~ONINN1938 NO 90'0 £6698 1S3M ~I JO iNlOd I ♦ 3N 1"i AVMai d0-1HJ18 HlnOS ~ J~'dMH~TFI ~Nfl2i1 TSNf10~ ~ X/T r---- J. ADDRESS TOVNSHIP,! g' yn _SEC. ~r N, R ST. CRO X COUNTY, WISCONSIN. `DIVISION , LOT LOT SIZ&6i- Arl¢n;Xr. - PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Gal Odd 'TIC TANK (S)NFGR. CONCRETE l' STEEL NO. of rings on cover _;;13 Depths' DRY WELL 'NCHES NO. m'f width length area J no. of lines Z width, length, area_,, 44A' depth to to of pipe R.EGATE/ZSP - -y RATE _~r AREA REQUIRED AREA AS BUILT~-q ,claimer: The inspection of this system by St. Croix County does not imply complete % =pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for ~ Aem operatics. However, if failure is noted the County will make every effort to ermine cause of failure. BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. r `INSPECTOR DATED. PLUMBER. ON JOB LICENSE NUIMBER F- REPORT OF IT1SPECTIO?l--INDIVIDUAL SEWAGE DISPOSAL SYSTEM SAnita_ry Permit r State Septic .A11 1E TOWNSHIP • t. Croi. ; County SRPTIC TA.m; ' "Size gallons . `l /7 umber j Compartments Distance From: Well "A~It. 12% or greater slope ft Building' ft, Wetlands ft 11ighw3ter ft. DISPOSAL SYSTE:1 Tile Field or Seepage Pit(s) Distance From: Well. ft. 12% or greater slope* ° ft Building Al ft. Wetlands f:. FIELD Hig1-iwater ~M ft, Total lengtAl of lines ft. Humber of lines ~ Length of each line ft. Distance between lines ft. Width of the trench Aft. Total absorption area sq, ft. Depth .of rock below the 2 in. Depth of rock over tile ~ in.. Cover _-nver.rock,,Depth of tide below grade in. Slope of trench in per 100 ft. Depth to Bedrock ~ ft. Depth to ground water eft. PITS . Number of nits Outside diameter ft. Depth below inlet ft. Gravel around pit: `yes no. .Total absorption area sq. ft. .Square feet of seepage trench bottom area required %:quare feet of seepage pit area required Inspected tiy: t 0 -Title':. s Approved , : Date "197 7 State and County State Permit # r U-~ PLB6- Permit Application County Permit # 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. L CATION: lYa'/a, Section { TAN, R/7 1-(or) W Lot# City_ Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family L.---'- Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher ~~ES NO Food Waste GrinderYES~b # of Bathrooms Automatic Washer ---YES NO Other (specify) E. SEPTIC TANK CAPACITY iIFT Total gallons No. of tanks Ts, *Holding tank capacity Total gallons No. of tanks New Installation C./ Addition Replacement _ Prefab Concrete 4--__ *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) -26 3) 3 Total Absorb Area /_~5~ sq. ft. New &--I Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 2 ' Width Z Depth ;~%z+! Tile Depth Zy No. of Lines 7 ' Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land 10 Distance from critical slope 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 Certi ' Soil Tester, NAME E C.S.T. # 7 Z_ l ry and other information obtained from (owner/iaiMer). _ - JR _e6_ 47W Plumber's Signature MP/MPRSW# r _7 Phone 42V G - 5 z/;PL aj Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). -78 4, `cam ° 41 Elk a ~a H 115 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 TEST LOCATION: '/4'/4, Section -L, TVIN, RLZE (or) W, Township o~ty Lot No. Block No. County ubdivi ion Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other REPLACEMENT EFFLUENT DISPOSAL SYSTEM: NEW ADDITION DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS %Z,Z.57 SOIL MAP SHEET SOIL TYPE 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 MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P/ Z Z_ No J, '3X 3 3 -:2, P_Z 4 7 l3, Jy~ 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) Zvi ii.z:5,k "~,0../ .S. B- -27 '7 - 7Z11 -k -57 9•S. 7z-~• d „ 70'15 :P, I z.~,- t s. 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. C,,4346 ~r• y/v~./Ab/F~ Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. r RY 8 v I tN V, Li I L_ Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 289332 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: NELSON, KEITH HA4MOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 018-1011-60-000 TANK INFORMATION ELEVATION DATA A9700147 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ai, i t to ROAD Dt Inlet Vent ke Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM I Loss Friction System TDH Ft TDH Lift Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION TypeO CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HAMMOND 06.29.17.86C-2,NW,NW 1517 CTY RD E LOT 2 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: L i Safety and Buildings Division ~•■~tnr,t SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. r • See reverse side for instructions for completing this application state sanitary Permit umber The information you provide may be used by other government agency programs ❑ Check it revisi n to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location X114 yl,✓ 1/4, S T , N, R/ ) E (or) 160 o,,5_16 ZZze/Aan Property Owner's Mailing Address Lot umber Block Number 617%, 10-1 City, State Zip Code Phone Number Subdivision Name or umber ~rv2i ~ ~ (7is> a-v 3 ~ d II. TYPE F BUILDIN : (check one) ❑ State Owned ❑ ity Nearest Road ❑ VIIIage Public 41 or 2 Family Dwelling - No. of bedrooms Town of > III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 17. '9 ' G r 2- ``ff'' 1 ❑ Apartment/ Condo )011 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5,.,,~Repair of an System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1201 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 1 Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Capacity . Total # of Prefab. Site INFORMATION ing Tanks Manufacturer's Name Concrete Con- Steel Fiberglass- Plastic App. New Existing Gallons strutted Tanks Tanks Septic Tank or Holding Tank KJ~ w ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibilit for installation of the onsite sewage system shown on the attached plans. P ber's Name: (Print) PI mb 's Si ature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address treet City, St te, Zip Code): / IX. COUNTY/ DEPARTMENT USE ONLY ~f ❑ Disapproved Sa itary Permit Fee (Indudes Groundwater EDate Issue Issuing Agent Signature (No Stamps) roved pp ❑ Owner Given Initial Surcharge Fee) g Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 06/94) DISTRIBUTION: original to County. One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11.inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Wisconsin Department of Industry, §O L AI EVALUATION Lal~r and Human Relations Page of Division of Safety and Buildings in of dance with s. Ik 3.09, Wis. Adm. Code _ h. Y „ County Attach complete site plan on paper not less than 8 1 2,~ 11 inclie,4 m'sfe Plan must include, but not limited to: vertical and horizontal rej~ierice point (BM), direct+etfS and O 1 percent slope, scale or dimensions, north arrow, an0 o-otion apAdistarice tb t"rest'Dada . # tl I a t O TION - Please PH t form , , by Date APPLICANT INFORMA 'vag-lw, s. 15. Personal information you provide may be used for secondary pu V11 Property Owner 9 ► Cj P erty Location `~l CA 4 Govt. Lot 1/4 W 1/4,S T Q9 N,R -7 E (or C VD Z~ Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1-7 co, R A, City State Zip Code Phone Number ❑ City ❑ Village [j4 Town Nearest Road \ &3-r s Di (7)5 )c~t)(.o-9Y8¢ ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Q Code derived daily flow 4 5 o gpd Recommended design loading rate bed, gpd/ft2 - -9 trench, gpd/ft2 Absorption area required (D U 3 bed, ft2 5 W • 5 trench, ft2 Maximum design loading rate gibed, gpd/ft2 88 trench, gpd/ft2 Recommended infiltration surface elevation(s) l to 0'? ft (as referred to site plan benchmark) Additional design/site considerations Parent material rQ Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 g Texture Consistence Boundary Roots I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 d-I DY 3~~ t, s.6 k rn r r a F J►y-as R`)J t_ lm bk m 15 t- cso ICF , Ground 3 5.3D 7 S Y m K try ( `J f s elev. 9~.a0ft. y 30 3 7. Y 3/ - SL „1 kFw^ va I of .S 5 -50 7 -S `5 9, '41 1' a- S m L c 8 Depth to limiting b so- eD -7,!S r, J , factor <AD in. -7 X, I t-o L . Remarks: t' I ETA v n~.~, o_* 4O S i Boring # Ground elev. ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. _Donf~A 716-a119-3 SO Address Date CST Number Z-7 a0bfi~ fi. St0.~' ra r ~c l.J 4D 54®C PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 7 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks:. SBDW-8330 (R. 08/95) Yklj I/ i I ! ! I r ' it ! I ~ I! l l l i! I I i l! i i I I I I ~ i~ tb c, II I I r , I V cn °t 'i o' 0 2 r j _~_1-TITT-iTT t- T------T-j i--_.. _ - _i-----i-j-I . J 41 I. ' I ! 1 I I I " ~ I I ! I I , IAM , I ~ I j- e ' I I I : I I ! i I ~ I , I I ~ I I i I j I I I : : I I I I I 1 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the v~ 4'C/'-a2 residence located at: Sec. T_e- N, R_Z7_W, Town of /err,/ri'Dr St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced A, 049 9 Did flow back occur from absorption system? Yes/ No (if no, skip next line. Approximate volume or length of time: s2kZr~ gallons minutes Capacity: /6f -VV Construction: Prefab Concrete- Steel Other Manufacturer (if known) : Age of Tank (if known) : (Si atur 41 (Name) Please Print (Tit e) (License Number) (Date Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I ce"rtify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baff e). Name Signature MP/MPRSi,~,~- STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Pa li /1,(i/Sail-, MAILING ADDRESS ljf~17 C7t; PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE A " PROPERTY LOCATION 1/4, 1/4, Section T__j:~? q~N-R~_W TOWN OF Ala dlrle> _Ycl ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP 5-:3. ~ VOLUME yam, PAGE 4C&3 LOT NUMBER - 7-Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has-been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: S C St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property ////~~<J Location of property 1/4 /j/~J 1/4, Section T" N-RAW Township Mailing address Address of site Subdivision name Lot no. Other homes on property? YesNo Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume 9~/ and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. ~iq G ignature o Applicant Co-Applicant ,5--is- ~;>7 Date of Signature Date of Signature y DOCUMENT No. WARRANTY DEED TNIa RIME RESER-. `°R RECpRpIN° °A- STATE BAR OF WISCONSIN FORM 2-1992. 478190 r kEGIS7ER5 OFFICE _----R~- 1 i ST. CROIX C. Sony ..a Rivard, an unmarried woman lil RDc'd. for f2new d this 22nd J! Y , 92 _ - 11 8 30 q • conveys and warrants to .._.Keith,-Nelson,...a...sngle_.man - _ RETURN TO . . . j _ . the following described real estate in ...County, - - ~ - - State of Wisconsin: ` Tax Parcel No:........-° III Lot 2 of Certified Survey Map filed September 22, 1978 recorded in Volume 3 of Certified Survey Maps at page 690 as Document No. 531889 being a part of Northwest Quarter of Northwest Quarter of Section 6, Township 29 North, Range 17 West. By acceptance of this,deed, Grantee agrees to assume all obligation under that certain mortgage to Farmers Home Administration recorded in Volume 586 at page 510 as Document No. 353950 as assigned by Document No. 432021 in Volume 796 at page 305. l This 1S homestead property. (is) (is not) Exception to warranties: municipal and zoning ordinances, easements, restrictions of record and mortgage recorded in Volume 639 at'page 197. 19.92._. da of Dated this _.....2.'.S. t- y January ......................................(SEAL) _._"AlC/.M~~:Et/aC/-..........................(SEAL) Sonj is Rivard ....................................(SEAL) ..(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. ST. CROIX County. authenticated this ........day of 19...... Personally came before me this ......I....... :day of .....JAIXV.4xY- ° 19.925_. the above $.qnJ.~a.,-R_~vard-,___a_.unmar~ie_d:;__~ ,•I 5!.9man ~o _ TITLE: MEMBER STATE BAR OF WISCONSIN _ - .Q• (If not . authorized by $ 700.00, Wis. State.) , to me known to be the arson t81}o executed the foregoing instrument and acknowledge the ila+ae,,,,,..••••P~ THIS INSTRUMENT WAS DRAFTED BY y'~a^I RFiM3NGTON,- L W': QFFICES.• My m-1s A i. t 1..tt., udittb A Rem> ton o~ ew..RschmanA«..~ 5.4.01.7 Notary Public County, 1 ._sta eoex..Irmo.. (Signatures may be authenticated or acknowledged. Both is permanent. ( P are not necessary. date: 19.........) .I •N,RMS of psrsolu sisoiae in say -E.1t, should be typed or printed below their si-I. res. STATE BAR OF WISCONS114 Wisconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 2 - 1982 Milwaukee. Wisconsin FORM NO. 985•A HCM.,Nr COnq.ry~ 351889, CERTIFIED SURVEY MAP NW CORNER SECTION 6 T29N, R17 W RAILROAD SPIKE 66 L ~ C,OiINTY_ TRLi_NK HTCHWA_Y "E" - WESI - 1129.191 ~Vw 4V I o N.S.P•__Easerilent-_ 863.50' _ ° - - _265.69' IN RR o •~9 POINT OF BEGINNING Southerly rigTi -bway,n1~U1 a ° u~l _P ~a I ~F168.55 ~ LOT I a crebb acres 0 ~ o ~ LOT ~ o "0 < cli Id u~ 00\ 59- s H a c Q) 1~ ~9i 874.13f z 2 59.5 z I i E-JI I EAST 1133.66' " io Easterly right- of-way line MPLATTED LANDS o•. ~ ao NW- (qW Affidavit to correct 592-71 I b z ~ N APPROVAL OF THIS MINOR SUBDIVISION Q) P LEGEND DOES NOT MEAN APPROVAL FOR BUILDING SITE OR SEPTIC SYSTEM; Id P4 o • 1" iron pipe found REFER TO H62.20. N 0 P.K. nail found r. +--,-Existing fence - 1"x24" iron pipe weighing 1.68 lbs. lineal ft. set APPROVE") SCALE IN FEET 01L 0 100200' 300' 400 2 0 1978 1"=Zoo' ST. CROIX C 4v COMPREHENSIVE AND ZOMNGPCOMR~M1ll8& INS Description A parcel of land located in the NW,-'~ of the NW-q1 of Section 6, T29N, R17W, Town of Hammond, St. Croix County, Wisconsin, described as follows: Commencing at the NW corner of said Section 6, thence EAST (assumed bearing referenced to the Easterly line of that parcel recorded as the N254' of the W1126' of said Section 6, bearing N1° 11'40"W) 33.00'; thence SO° 01120"E 33.00' to the point of beginning; thence continuing SO° 01120"E 218.55' along the Easterly right-of-way line of an existing town road; thence EAST 1133.66'; thence N1° 11'40"W 21.8.60'; thence WEST 1.129.19' along the Southerly right-of-way line of County Trunk Highway "E" to the point of beginning; Subject to a 50' easement to Northern States.Power Company to erect, operate, repair and maintain an electric transmission or distribution line or system as shown on the attached map. I, James E. Rusch, registered Wisconsin land surveyor, do hereby certify that I have surveyed and mapped the above described property: that such plat is a true and,correct representation of the exterior boundaries of