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HomeMy WebLinkAbout018-1005-30-000 Q o ar o 03 °603~ ~ I o~ M' o ~ I h p C p~ O N O N N N o O O ~I L w O ti N M - n ~ I ~ U W V ~ O y C M N T 0 d o8 L 0) w w y?ma~ I c tz c2 o L m UmmC u o c n N E ¢ n aom ~ o I w j E n z I' O z a m M FN Z 0 O z U) FZ- r N Z E -o 2 Cl) c • ti ii (D c 0 O 0 z z w z y c (D 'a N N 0 v _ co d M b c ~n d O 0 ° c o a ~ N LO U) U) U U _ 0o Z°I •r~ ~ aaa v, FL o c CD C~, (D U) J V 0 0) 0) AV E ar Y O E :3 c c Q m c a N O O 4? d Q Z fn co ~rn O N ICI! fA (CID Lo O O 0 co _ ~N ea d~F- y ~agl LO (D ( d C N ICI M 0 o o $ o c a _ n a~i H c C ° of E °O° co 00 M O> O y U • ~ 0 0 2 I~ O Z C rd U) I I v y R a dt d L: a i +co.+ E ` 'c c 3 r A Vat IONti 0 Parcel 018-1005-30-000 11/10/2005 11:26 AM PAGE 1OF1 Alt. Parcel 03.29.17.34A 018 - TOWN OF HAMMOND Current _XST. 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 - LINDSTROM, JOHN A & KAREN P JOHN A & KAREN P LINDSTROM 1853 120TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1853 120TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 17.782 Plat: N/A-NOT AVAILABLE SEC 03 T29N R1 7W PT NW NE W 608FT EXC Block/Condo Bldg: NSP RNV & RD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-29N-17W NW NE~ 1114 Notes: Parcel History: Date Doc # Vol/Page ~ype~ 01/12/2004 751408 2590/470 QC 07/23/1997 1170/548 -1 QC 07/23/1997 877/51 7 A// 07/23/1997 771/96 -7-70 more more... 2005 SUMMARY Bill Fair Market Value: Assessed with: N Use Value Assessment Last Changed: 07/13/2004 Valuations: . Valuat Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 29,000 130,600 159,600 NO AGRICULTURAL G4 4.000 600 0 600 NO UNDEVELOPED G5 10.782 9,900 0 9,900 NO Totals for 2005: General Property 17.782 39,500 130,600 170,100 Woodland 0.000 0 0 Totals for 2004: General Property 17.782 39,500 130,600 170,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 137 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION ~MTADISON WI 53707 State Plan I.D. Number: NYY 4, NE 4 i Sec . 3 , T29-R17 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hammond El C Holding Tank ❑ In-Ground Pressure Mound ME RMIT HOLDER: ~ Box ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 1 Ave Hammond WI B RK ( rmanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT ELEV.:, CS EF. PT. ELEV.: Name o Plumber: MP/MPRSW No.: ( County: Sanitary Permit Number: Rinnnip- St Cr • 1,128780 SEPTIC TANK/HOLDING UTL ELEV.: WARNING LABEL LOCKING Cov? QET MANUFACTURER: LIQUID CAPACITY: TANK INLET EL TANK q' / PRO IDED: PROVIDED: Ar8 q/ YES ❑ NO ❑ YES NO BEDDING: V>=NTDIA.: VCNTfv1ATL.: HIGH WATER NUMBER OF ROAD: / PROPER S WELL: BUILDING: VENTT FRESH ALARM: LINE: I=ITi r r/- AIR INL / FEET FROM YES ❑ NO ❑ YES NO NEAREST "S~ ) : r` OSING CHAMBER(/9,/ MANUFACTURER: BEDDIN LIQUID CAPACITY: PUMP MODEL: PUMP/StP"O 'MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES ❑ NO ~J~t WEos OU ~S YES ❑ NO YES ❑ NO GALLONS PER CY LE: a PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FI~E~ (DIFFERENCE BETWEEN r T a v S FEET FROM LIME: 3P r~ / AIR INLET: LJ PUMP ON AND OFF c 0 0 E2-V'E_S ❑ NO NEAREST --ON- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN 3~ ( /~-5 the soil is dry enough to continue.) CONVENTIONAL SYSTEM: 115- S,Ito / 7 WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH: DIMENSI G L DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MAT PROPERTY WELL: B ESH ET FROM AIR INLET: BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FENEAREST MOUND SYSTEM: 3 , Y- l0 19 1/ f,, 5 NqN Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslopey: 5 mound systems to make certain that it ON REVERSE SIDE. SHOW ES El NO meets the criteria for medium sand. ELEVATIONS MEASURED. Y KSOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ~o ~j`' YES E] NO YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: i, EDGES: Ig 2 '19 . r/ r 6 ❑ YES NO YES ❑ NO YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: SEq/TRENCH I i TRENCHES: DIMENSIONS LJ ~5 " MANIFOLD PUMP 0. MANIF LD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: " ELEV.: DIA. ELEV.: PIPES: DIA.: , N ELEVATION AND (J ~ DISTRIBUTION D 4' vS i' d/ nk_ -U ` ~ ' ~ Zy t HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORK PONDS TO LAN INFORMATION a APPROVED[ 3~° VYES ❑ NO T G ES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPE WELL: LINE: BUILDING: COMMENTS: ET FROM XYES ❑ NO YES ❑ NO -111 11- m ' l , r-., l r' . l l ~z [ !M1 / , 1 1C (I y C c --A Sketch System on Retain in county file for audit. Reverse Side. SIGNAT RE: TITLE- SBD-6710 (R. 06/88) ~f DILHR SANITARY PERMIT APPLICATION COUNTY ~DILR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ Npvlous 8% X 11 inches in size. Check if viz on application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S90-00788 PROPERTY OWNER PROPERTY LOCATION Greg Myer NW Y4 NEY4, S 3 T 29, N, R 17 f (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Box 1853, 120 Avenue CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hammond, WI 54015 715 796-2316 : NEAREST ROAD III. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ CITY 12 WiN :Hammond Count Trunk T ❑ Public ❑ 1 or 2 Fam. Dwelling- # of bedrooms 3 PARCEL TAX NUMBER(S) (0 00,5,_ <zO III. BUILDING USE: (If building type is public, check all that apply) 3,29.17.34A & 3.29.17.35A 0 s 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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 in line A. Check line B if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑x Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 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 450 375 375 1.2 53 97.1 Feet 99.37 Feet VII. TANK CAPACITY Site INFORMATION in allons Total # of Prefab. Fiber- Exper. New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank 000 1000 Mi western reca t x F1 1 11 Lift Pump Tank/Si hon Chamber 750 750 1 Midwestern Preca t x F1 a F1 I LJ Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): (No Stamps MP/MPRSW No.: Business Phone Number: Bennie Helgeson Plumber' ignature: 3215 715 778-4425 - IV 10011 Plumber's Address (Street, City, State, Zip Code): Rt. 2, Spring Valley, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue ssuirlg Agent Signature (No Stamps) ;Approved ❑ Owner Given Initial Surcharge Fee) h~~~ ~ /I Adverse Determination V X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 & 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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. Vlll. 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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) M ' Y t~ O r V~ Ll' ~ a y ~ Ql ~ ~ W T f rt m a d o v W ~ L LL Q 0 Q M G~ S J oNS\ Page Of Cross Section Of A Mound Using A Trench For The Absorption Area El-eo, 17.1 Medium Sand Fill 6 -J1: 6 - " Topsoil D E►e.►. 9 7. l 3 E Plowed Layer 21~" Aggregate, ~~►S~~ B~low P' overed With D Ft. WLA tr a hetic Fabric .11 0Ylt, E 05 Ft. O Ft. ,S Ft. 11 ► ~ tIDNS F . 7 7 Ft. H 1, l1>S~" NNE !j N D t` ~SS~ i pENOS Plan View Of Mound Using A Trench For The Absorption Area 8 90., 7 d,8 Force Main ~ Distribution Pipe I Permanent Markers Observation Pipe W I _L I-- B K \ Trench Of " - W Aggregate I L A 5- "t. I j Ft. K Ft. W A.*), ~ Ft. B 7~9- Ft. J Ft. L $ Ft. License Signed:, Plumber: -3,)/f Date: 41-'j4o LAAnd LC i Ir 1~ti'a 4•-~~JSTA LL P~2HA1J ElJT HARY AT EuD OF E'M1 CH Lr.T'L-wXL '~uD tAP Q ' ~}t1Les w :.hT~'a OQ -BO" ro M CY~ t P JC / FR.Ori Tau H P `C\ PV C- LATcRJ~ LS 1J£1CT -Ib E1..~J ChP JtiS'S32.1BuT]p►J: PIPE SEW AGE SYSTEM P 3(~ . ~Fr. GNS1TE YEN. E~ p,T10v~ gR Hq ilaLc ~tAnc-raZ_._.... 4-u -7 -JAL- 1 Alp SIM Hq N gCPARZMENj ~qN of S hC~NC~ _ SEE COKKE o~ I-v3Le-vpJ pE _ 11JV , EI~V. pF IATG%A LS 9'7. 7 TTr pLF~cE I sT Ho -E E $ I=Ror1 TEE wi-rii 30 c.c-EED1AJG HDLG ~4T ~~o I JJ lEkx)N s ST 1-~OLE 'f0 ~E >JEX~" -THE L:+'vD C~tP- LAc 1 r r . PAr,F r;F UPf%P CHAME-t-R CR0-55 SEC?'!C!J ANO ZPECIFICA71011S VEUT CAP 4'.C. M. VEUT PIPE T WEATHERPROOF AP°ROVED LOCKIA'G DOOR, JUMCTIOU BOX MANHOLE COVER ~ 23' = ~0.^1 ~~t~ us~►-N ~..y,~ ~~(o.~l WIWDOW OR FRESH 12"MILL. I AIR INTAKE GRADE 4, MIN. 411 I I8 r~IU. COAJDUIT p \ 18 MIN. ~ S - E "OVIHpE INLET O►~ „ T SEAL ( c i APPROVED JOINT A APPROVED JCu I W/C.I. PIPE itiov e I II W C.I. PIPE EXTENDING 3' V0 I III ALARM EXTEUDIMC, 3' G ONTO SOLID SC O►JTO SOLID SOIL 0F I t1D12SjKY • Lr ° .~I. I. ` 0 DIrPP1~SN~E ON OF SAF I I aN a ~ COf~~ES~ ONCE ELEV. g b, 4 FT. gEfc I PUMP ` OFF D COLICRETE BLOCK lei.. 79 3s RISER EXIT PERMITTED OWLy IF AIJK MIUFACTURER HAS SUCH APPROVAL /ODD = SEPTIC E SPEC.IFfCATIOUS 90. 0 '150 =DOSE fj TANKS MAMUFACTURER: ~ id uye-s4erti LIP- S ~ IJUMBER OF DOSES: PER DAy TAWK SIZE: GAL.LOUS, DOSE VOLUME U ALARM MAMUFACTURER: C• r- I-r T" cS~ r S IAJCLUDIAIG 6ACKfLOW: 17 / GALLON MODEL AJUMBEK: A) J~ CAPACITIES: A= IUCHESOK mod GALLOAI SWITCH T`IPE:._ M/-P Ir rLl.1r F-lo aT _ BcIWCHES OR ?~7, GALLOU PUMP MANUFACTURER:1 ' Ga~IWCHESOR GALLOL+ MODEL NUMBER: W tn S- 14 D=I) INCHES OR 12 S~ GALLOL' SWITCH TYPE: dc it Lk t:4 MOTE: PUMP AMD ALARM ARE TO BE MIMIMUM DISCHARGE RATE ~.(~._GPK INSTALLED OAJ SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AND DISTRIBUTION PIPE.. ( FEET + MIAIIMUM AIETWORK SUPPLY PKESSURTT,~E/.. . , . 2.5 FEET FEET OF FORCE MAIM, X I F/po FLFRICTIOU FACTOR. :51 8 FEET = TOTAL DyWAMIC. HEAD = -25,14 FEET IIJTERMAL. DIMEMSIOMr. 0,F. TAQK: LEKI&TH ;WIDTH .;LIQUID DEPTH /0( SIGIJED: LICENSE NUMBER:°0~~- DATE: 4-2-yy INDUSTRY, 9~,.,~ 14• va vs ~asv r,a ~ v UIV WIu P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 H , gtR >sJ AT IONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSHIP O NQ.:BLK. : SUBDI I ION NAME: 6LM I- V~/ 1/ Xgej N/R 1 E (or 77 ~AT_ COUNTY: MAILING ADDRESS: e r ~x l853 /.20 , va arnwtondl (~i. 67y o/S" USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DES RI TION: W L'_~Residence 3 (f f~ ONew L'J~'Replace RATING: S- Site suitable for system U- Site unsuitable for system Q 6:3 ~r'C-~ b s l -k CONQVENTI E29 F~ItJ NA MOUNp:EIU IN-GROUND PRESS~IRE:S~STEM-IN-FIkL DI TANK:RAOMOMEyNg1EDSYST5-MX(optional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: V l Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH• ELEVATION OBSERVED EST. H TO BEDROCK IF OBSERVED (SEE ABBRV ON BACK.) , ~ 8 I Si is - ► M1r.~ o ° . 7, (3t s; (T..5 . y')-j S.) l.3 R S S, M~ arg. ~j 5 t I TS ; 3$'Lf 8,% S; l ,7~'Qn Si *FD ©t+~• ° B- 3 s, n 9s" -2 s .'756/ 5,'l Ts . Y' ,1 , 55'd,1 3 Sr1 FD or9.1t1o A/a .8'B/ 51 TS .~'-,8 5.'1 `'~'FFFo . Ho. i - i . 7' 61 :5,-( TS :S, ,l . lp"gA, 3,Y NFF'rrj A4 PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATTER NCH E FF NUMBER INCHES' AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D P- I L) C ly to 1<14 P_ 2 t< P_ 3' y P- P_ Y auh P= _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hor, zontal and vertical elevation reference points and show their location on the plot plan, show the surface elevation at all borings and the direction and percen of land slope. o~o,,~ ocY SYSTEM ELEVATION 77J Rocl Recd 7 r- I t erg cL - Id i.. ~ Inx VV ©(K "-r -fn Pa~9~ato ~ j I r , 1 _ I 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 the location of the tests are correct to the best of my knowledge and belief. NAME rint : TESTS WERE OMP ETED ON: e t ' I e 96 ADO SS:~ _ CERTIFICATION NUMBER: PHONE NUMBER (optional): r h o / CST SIGN RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10/83) - OVER - i 4 1 00 f Q. 7Z, - L i - "d . q vl _ -11 ~I • ~ s Ci ~s o _ - + -1---~ c ~ s ell H a r STC - 105 a SEPTIC TANK MAINTENANCE AGREEMENT p St. Croix County z d a H OWNER/BUYER Greg Myer - U 53 ROUTE/BOX NUMBER Box 1853, 120 Avenue Fire Number /Q CITY/STATE Hammond, WI ZIP 54015 PROPERTY LOCATION: NW 1, NE 14, Section 3 , T 29 N, R 17 __W• Town of Hammond St. Croix County, Subdivision Lot number _ I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into ` the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with rx. the standards set forth, herein, as set by the Wisconsin Depart- V ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED 1) ATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT ST 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 Greg Myer 1 Location of Property NW ~4 NE 14, Section 3 , T, 29 N-R_ 17 W Township Hammond Mailing Address Box 1853, 120 Avenue Hammond, WI 54015 Address of Site Subdivision Name 4:~Z/, Lot Number rf Previous Owner of Property Total Size of Parcel yl 1A /I Date Parcel was Created Are'all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes_ No dd r- Volume O~ 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION I (We) ceAti6y that aQ2 6tatement/s on this 6ohm ane thue to the but o6 my (oun) knowtedg e; that I (we) am (ane) the owneA (b) o6 the pno pent y dens eh ib ed in th,ie .i,nbotrmation 4oAm, by viAtue ob a wvftanty ~ed neconded in the 044iee o6 the County Regi.6teh o6 Deeds a/s Document No. and that I (We) ptuentty own the p.,.opoz ed Zito 6o, the sewage digs pob s y.6te ( on I (we) have obtained an ea8ement, to nun with the above desenibed pnopexty, 4ot the con6PLucti.on o6 za.id .ayatem, and the same has been duly teco&ded in the 04j.ice o6 the County Regizten 06 Deeds, Document No. 4ATI41U1;Q 0 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) A-L 12- DATE SIGNED DATE SIGNED ~0.rC~~ Iv uurrJ~~f`~ L x a- r ,r VIC . as Pavow ;A of the @But* of ......»....«+Aifr r..._... . ......q.,........».............,.. t"~~ lltr rt Mar t a aoevgrt, Myer .t...# sDa sad vil6, sod_ suz'ri t.arifiiI property . t 0 •G ~ es►u w ~~~~f t° iMeiM rte! edset is ._.Coec~ety, ` . ~ et * b twwlealOer eaned the "Pogpn4y") ; the we" 1/2 of the NE 1/4 of Section 3, Township 29 K w1i t Um" 11 West, St. Croix County, Wisconsin. s Parcel No_ Ibis deed to given in fulfillment of a certain land contract between the iintsd,February 28, 1987 and recorded March 3, 1987 in Volume 770 of Records, ti mil, Sectmtent No. 622889, in the St. Croix County Registry. Uts to not homestead property. &MMMAIM 7- land contract was executed a death of Joha J. iia3sit w.. Mre Satetes and not the Personal tepre"a tzonally, hereby ver ter# okl_'_U* s to good, indefeasibis, in fee s free and cl -of iwM f < Stet iems, or eumlrtsnci created by t act or default of the Wfr~ltluse - _y. 1i .*.viNtsictLwa* covenants of record and municipal roiitin~t ,e ke iMaslronty is Oven ender Section 860.09(2) of the V14co a6 v; - r bad ie the It y I _1L , • 1 ose~h F eh a may- 7r+ax ~ - wcaxVO aa>tt ' I ..»3- . •y•4. k ' __i ~~77 Outa amie 'T - outJe0mgsoted this ........day of , Per came before .........igId une 19........ the AM Von" ph .....Wal.... e E: NEXUR STATE BAR OF W1SC.. (If not. authori=d by 4 708.06, Wis. Ststs.) wn to be who exerabd the truce the tame. TMI MEN? WAS DRAFT ° Y~ - - II even { Ir -4m . - . expira~i • - t.11- thOV Sign .4 z ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE ` 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 April 18, 1990 Division of Safety and Building Bureau of Plumbing P.0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Greg Myer property, located NW4 of the NE4 of Section 3, T29N-Rl7W, Town of Hammond, St. Croix County, revealed suitable soils at a depth of 1.1' below which seasonable high ground water was noted. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerely, -1~6v-t-o Thomas C. Nelson Zoning Administrator TCN/ j rs