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HomeMy WebLinkAbout018-1033-90-000 n ~ w a as ~ y O Q ~ c ~` ~ -G p N ~ ~ N ~ =~ a ~ N C ~ ~ 7 N . .~ ~ 7 A ~ ~ ib O O 7 ~ `' ' ~ ~ m - ci: c ~ ~ o O ~ i. Z O m ~ N ~ C (D a ~ ~ _ ~ 3 !° a ~ 0 ~ m O 3 (D e m m 7 ~o a ~ m n N Q Q' O ,C. ~ N n Z N ~ ~ ~1 N fD ~ Q ~ A ~ CJ7 N n ~_ m ti y O C a s v m s m m m O 3 CA En O O ~ O ~- o N p ',I 3 ~ n e m c ~ ~ c p p ~D 'O - ~ ~ `-° 3 ~ m ~* .. .~ M ~, ~ O A ~ ', = O rn ~ m v W W ~ y ~ N N 7 O 7 V W . ~ j (O ~ ,' O n 'i O W O 7 N `~ ' 1 7 O ~, C ~ 1 ', ' O C1 ~ N a a o '! .. ~ _ ~ ~_ ~ P ~ ~ ~ i N N Q '', I 0 O ~ G ~ 7~ C n C I, y 3 , ,• .. Q N { '9 ~ '. O O O o N In fn ~ ' ~ ~ ~ v o I ~ ~ ~ o Q 3 .' ~ ~ c I m °- y 3 .. D D o c a CD N N 3 N ? ~ ~ y w c ' i p 2 ~ ~ ~ A 3 Q ~ m N ~ A O O ~ -' Z c 3 c =~ A z ~ ~ m ~ vC < N ~ A ~ W I T C 3 a A F x a e w ti 0 A_ N Q O ~ O lv ~` V ti onsin Department of Commerce PRIVATE SEWAGE SYSTEM aty and Building Division . I ' ~ ~ ~~ INSPECTION REPORT GENERAL INFORMATION ~ (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Peterson, Nanc Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: ~t~ (~ I'~ } G5 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic , w) 5 Dosing Goy. Asa t ~' Holding .~--~'.' TANK SETBACK INFORMATION TANK TO / P/L J WELL BLDG. Vent to Air Intake ROAD Septic / / ~L t ~L -' Dosing ~~ t ,t i~ /V i ..~Z f -7Z `-~ Aeration Holding PUMP/SIPHON INFORMATION ~ Manufacturer Demand ~t ~ 5 GPM Model Number ~~~ ~ ~~,Z~ TDH Lift ~ Friction Loss System Head TDH 6t Forcemain Length i Dia. ~~ Dist. to well ~s SOIL ABSORPTION SYSTEM County: St. CrOIX Sanitary Permit No: 479302 0 State Plan ID No: Parcel Tax No: 018-1033-90-000 Section/Town/Range/Map No: 16.29.17.241 B STATION BS HI FS ELEV. Benchmark ,/ T • Z. / U~/. Z, / Ub Alt. BM ~~ °!5 a/~Z ~ Z5 Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet 7,SS ~~ (~5 Dt Bottom ~-.z5 X2,95 Header/Man. Z ~ ~5 /a ~ ~ 7 5 Dist. Pipe 2 .+}5 ~~ i1 ~ 7j Bot. System ~~ ~~~ ~ Final Grade '1C (~ `IS /b .75 St Cover ..1,55 /D2- Z5 BED/TRENCH Width ~ Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (~ 5 ~ ~ ~-~ ~- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ~ Type tem: u 7l -"1'G ~ ~/~ ~ ~~ - l~ N UNIT Model Number: O . DISTRIBUTION SYSTEM 50~+~ Header/Ma ' ~~ ~~ Distribution ~ f, ~~ Pipe(s) ~ ~ x Hole Size rt 6 x Hole Spacing,' V~to Air Intake u th Dia Len t ~ th ' Dia Spacing Len 3 g g SOIL COVER r Pressure Svstems ~nlv xx Mound Or At-Grade Svstems Only Depth Over Bed/Trench Center / / ~ Depth Over Bed/Trench Edges \ \ xx Depth of Topsoil ( ~.. xx Seeded/Sodded N xx Mulched , No ~ ~ ~ \\\ 1 , Yes j ,_j o ~.; s ~, I~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /~ / / ~ ! d5 Inspection #2: ! / Location: 982 County Ro T Hammond, WI 54015 (NE 1/4 NE 1/4 16 T29N R17W) metes & bounds Lot ~ P~a~cel 16.2 7.2418 1.) Alt BM Description = [~, ~ w'S ~"- ~ rYU~ tt h 2.) Bldg sewer length = I ~~ ' I P/v~'`J ~ ' -amount of cover = ~~tl S`~~. P l~w-5 ~~ ~DJ -~ ~~~.. ~0 5~a.c~`n. ~- 3~{ die' ~ - ~• ~ ~ Plan revision Required? ~ .! Yes ~~' to L_ /~ -T~ ~ ~~ i --- _ --- --- -- --~ 19~~_ ~ --- 1 Use other sidE for additional mformat~on. ~ ~ ~-~ ' Date Insepctor' ignature Cert. No. ' SBD-6710 (R.3/97) •.ti . • ~~ _~` 7663151 ~~ ~ ~~~ ~~~ ~ ~~ 0~ S~eib~cy Permit ~ ~ ! L s'/ Y~/~ - ~'' I~ wowdwilAC~o~wp21.r1r1t'114~ cwK l~+t;,,,,~~IS:MC~•ldA) ~,ee~..a~r.se~eNx~~r~•~ • q~a. ~, iQd ~ .iUL ~ ~ 2005 Gt ~~ 1633 ~ ~6 --6r~~: . ~ a ~~~~ ~~.t~~s a~r~' S ~ . %~201X L~'~S~1Y' ' ~~ C ~ ~ ZONINGf~FFICE (d£ y~~~ ~ ~' ~~ e3ade+~ /'-1~-u-tsnoyc ~ arMnta~llfl .lhi _ ! a- N'1rMii~~ b r~ D 1 ar~llwiproMrllirlt-~.radwr. 3 ~ ,,,~ .. A. Cl'Ii~~K'h~tlalMOr~O~b' aO~rM~a6~t 6~w owarr <tNir.at wit At4rN~ O t~elMM~rlPllw C] . O11r.-~aawhdU~+~+ ~Ktr~.taiwb M,~7t~~tuN~ D1w+>ta~s~+lM~ '~ wriilMMr © cw.rk O tis O ~ !~/, v? °a~ -~ ~ . ~ ~ ~l s v 75~ ~l s-r/ a (oD . a~» cww~aee a"" cw~ arr.. ~ .R p~ U ~-S•c.. oC !/ ''U t . ~. ~~ lir~~dM1la~~iwrrr>Y !~ st~~ ~ ~3 ~ s~' 1s~ G~ - s~~ 6 `~ ~ ~ ~ ~ 0 ~~ ~~ ~ S~~ ~? 1 ~ a a O o~wrrO>wa ~ ~~ >ix.c.rr~...anr S~~ -. YSTEM OWNER: 3 ~,~ ~3,,:~~~ 1 eptic tank, effluent filter and 1/~ ~~6Yrt/'"'"' dispersal cell must all be serviced /maintained ,.~ ~ ~~ s a er man ent Ian rovided by plumber. ~ ~P.~- ,~ a~ 2. All setback requirements must a marn arne L~~~v4,~,c.eG~ a~ . _ as perapplicable code/ordinances. 7l ~ ~~~~~ ~ ~ SBD-1395 {R.Oi1~03) ..~..___~.__..___.._ ~___.,__ ___._~..~.e~_... _._..__l NlN ;~ N~Y~ S l6 t29N~P~? 4/ tv4.~ v~ l-~Arttmand S~,C~ojr~~~ w A 1 ya ~"= ,6~ c~ ~-f~ ~r~ , ~~ ~~ P"t~~G ~°~~ ~~ ~' a ,.,~. ~, y a k ~t d ~l~ti k J -3 ~; n ` ~°. n ~~ •~'- ~-~ ~ _. i ~ '_-~ ! ~ ,.~.z ~~~~ ~ !~~ ~'~ ~~, ~ ~~F ~, } ,, ~~ ~,, ~ ~~ ... '~ °~ ~~~ ~ ~ ~~~ ~ ~ ~ f ,~~, 5~°F~ h ry ~ ~f`j ~. - a ~ ~,~ ~ ~ ~ ;,• ~ ~~ ~ ~~~ ~ ~~f ~~- 1 d p~ ~, :~ ~. E.- ___- -_.__ ____ .. ~ f~~ ~ .}1 ~! . GI~~f' ~ G~ ~ f L ~~~ ~ ~ a ~ R f ~ 7 r,l ~ 5 ; ~ ~,. ~'~~ 7~ x G.~3 C e.LG i~Re~w' a y 7'~e. 1~'1P ~~ 3~?s ~"C.~ F coriimerc~.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 06, 2005 OUST ID No.223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/06/2007 Identification Numbers Transaction ID No. 1151444 SITE: Site ID No. 701032 Nancy Petersen Please refer to both identification numbers, County Road T above, in all corres ondence with the a enc . Town of Hammond St Croix County NEl/4, NE1/4, S16, T29N, R17W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1026720 Maintenance required; 450 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/Ol) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) • Per manual cited .above, limited activities are allowed in the area I S feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shal{ be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat Cone APP DEPARTME~ OF ~ ~ SEE CORR JOE STANG Page 2 7/6/2005 • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state slats 101.12(2}, nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shalt provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS: Sincerely, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 prn Monday -Friday cbratz@commerce. s late. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 . MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Petersen 3 bedroom mound Owner's Name: Nancy Petersen Owner's Address: 976 C.T.H. T Hammond, W;sC. 54015 Legal Description: NE 1/4 NE 1/4 S 16 T 29 N R 17 W Township: Hammond County: St. Criox Subdivision Name: Lot Number. Block Number. Parcel I.D. Number: 018-1033-90-000 ~ECI~~~nsaction Na.: JUN 2 9 2005 Page 1 Page 2 SAFETY & BUILDINGS Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Designer: Joe Date: 06/: Signature: Index and title Data entry Mound drawings Lateral and dose tank System maintenance specifications jn~l1~ Management and contingency plan Pump curve and specifications Plot Plan ~~ ~ Oh°~°~~c~ ~~ •~cs Soil Evaluation Report 'OND ~~_ ONCE , License Number: 223475 Phone Number: (715) 684-5166 Designed Pursuant to the Mound omponent Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01!81) Version 4.01 (R. 09104) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fiN (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-s~uu soil tr~tment fa fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) cdiform of <= 36 ind~es. 450.00 Design Flow (gpd) 5.00 Site Slope (~) 99.40 Contour Line Elevation (ft) 16.00 Depth to Limiting Factor (in) 0.40 In-situ Soii Application Rate (gpolftz) Distribution Cell Information 70.00 Dispersal Cell Length Along Contour (ft) = 6.43 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest int in the distribution Y Pressure Disribution Information neiwork? Enter Y or N (core) a Center or End Manifold 3.22 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.50 Estimated Orifice Spacing (ft) = 11.25 ftz/orifice 2.00 Forcemain Diameter (in) 50.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Pump Tank Elevation (ft) Enter Y or N Z~ 3.25 System ead (ft) x 1.3 8.16 Forcemain Drainback (gat) d 7~ ~ 8.57 Vertical Lift (ft) 62.93 5x Void Volume (gaq ~'~ ~~ 0.76 Friction Loss (ft) 71.09 Minimum Dose Volume (gaq ~~ 12.57 Total Dynamic Head (ft) 26.21 System Demand (gpm) Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Manifold Diameter Selection in. dia. o ions choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) Treatment Tank Infonmation 650.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capaaty (gal) 38.00 Total Working Liquid Depth (in) Wieser Manufacturer 17.E galrn (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacityy (gal) Zabel Filter Manufacturer 17. Dose Tank Volume (gal/in) A100 Filter Model Number Wieser Manufacturer Project: Petersen 3 bedroom mound Page 2 of 9 Mound Plan View 1_ 1/10 B •' ' •observation Pipe 'Q' K : • ••tl.•••y••: • .•vs~s••.L:~:~:•at: •~. • eye • Y~.1p.•.••.• :~,• .•+.~:~.• . ~. •L.~.• . . .~1' ' L• L~•. ~~. ~'. ~ti ~'.••.•• 5 •. ~4•.•.•^..•'. . . .•L~~. o' .•'. 1• :•, ~•®• ::~'Lsy:S~SaS~ti~'L~ :~•. ~L~L:~,::.;,.~y=•.:*y,'~.~; a:~•S.n :.• ~.• ~~y;~ ~; ~j. .r.: •:;:•: •: •r•: •: •: •. •r•: •: •: •:•: •.••. •:•: •:;. • . •:•. L_.r . 1 l_ i L _ _- Mound Component Dimensions A 6.43 ft E 23.86 in B 70.00 ft F 9.50 in D 20.00 in G 0.50 ft 450.10 (ft2) Dispersal Cell Area 6.43 (gpd/ft) Linear Loading Rate -t -~ _I -1 H 1.00 ft K 10.86 ft I 11.58 ft L 91.71 ft J 7.72 ft W 25.72 ft 1260.41 (ft2) Basal Area Available ~ 7.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.86 (ft) . Jf/F/{~ F 101.07 (ft)--- Dispersal Cell :~ ..• Elevation ,...- ...• ~ ~I H E : .D ~ ~ p~~i c~i ~ - 101.57 (ft) Lateral Invert Shading Key Q _ Topsoil Cap Q "':' Subsoil Cap ASTM C33 Sand ®Tilled Layer Q :~:~:: Aggregate 5.0 % Site Slope a 115 ft c a o w ~ ~ ~ 0.5 ft ~ o (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Petersen 3 bedroom mound Page 3 of 9 End Connection Lateral Layout Diagram star cant awr tM P ~ =Turn-up wf ball xaive or cleanoutplug AA laterals are Warttrcal I!c-~(~~ Holes dried on the bottom of the lateral equaU9 spaced Force mkt oortneotiat tria tee or cross to marrrfold at arty point Lxerals ~ foroa main of f'vC Sch 40 [per COhAM Table 84.30-b7 Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head Orifice Diameter 0.188 in ,~ Orifice Spacing (~ y ~~ 3~.8~1 ft Or~ces per lateral 20 Orifice Density 11.25 ftz/orifice Manifold Length 3.22 ft Manifold Diameter 1.50 in Forcemain Velocity 2.68 ft/sec Dose Tank information ,gt,~h,,,,&,,;r,g label and k>cldng device and smiled watertight Eledricai as per NEC 300 arrd -~--- Cornm 16.28 WAC ~ 4 in. min. Drscottrtect i~ Tank component is properly vented ~ :: ~- ARemate outlet ktcatiort Weser Ca cit 850.00 Volume 17. Manufacturer Gallons gal~nch ~- A B C D Forcemain diameter ~ 2 in. Dimension Inches Gallons A 19.83 339.37 B 2.00 34.22 C 4.15 71.09 D 12.00 205.32 Total 37.99 650.00 3" tank. Alarm Manuafadurer SJE-Rhombus Controls Alarm Model Number Tank Alert 1 Pump Manufacturer Goulds Pump Model Number 3887 EP05 ~~ Pump Must Deliver 26.21 gpm at 12.57 ft TDH Weep hole or artti- siphon device vaticn ft 93.00 D~k elevation (ft) 92.00 Project: Petersen 3 bedroom mound Page 4 of 9 Mound Svstem Maintenance and Operation Specifications Service Provider's Name Joe Stang --] Phone 715-684-5166 POWTS Regulator's Name St. Criox County Zoning Phone 715-386-4680 Svs,~m Flow and Load Parameters Design Flow- Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450.1 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freouency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins d and/or service once eve 3 ears Should ins and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for pondin and see a e once eve 3 ears 9Aiscellaneous Construc>4ion arld Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished •~~~~~~~~~~~"• •~~~~~~~~~~~~~• Grade ` , 6-8" Diameter Lawn _~. Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Petersen 3 bedroom mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code This system shah be operated in accordance with Comm82-84 Wis. Adm. Cade, and shall maintained in accordance w~h its' compon~t manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.8 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting- No one should ever enter a septic or pump tank since dangerous gases may be prceertt that could cease death. Septic arxf pump tank abandonment shall be in acxordamce wiflt Comm 83.33, Wis. Adm. Code when the tanks are no kx~ger used as POWTS components. Septic or pump tank manhole risers, aa~ess risers and carers shoukt be inspeded for watertightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the c~mpldion of aervkre. Any opening deemed unsound, defecXitre, or subject to failure must be r~laced. F~ceed access openings greater than 8-inches in diameter shall be secured by an etfec~ive k~ci~g devise to prevent accidental or unawt#xxized entry into a tank or c;orrtpatertt. Septic Tanlr The septic tank shah be maintained by ~ individual certlfled in service septic tanks urxkr s. 281.48, Stags. The cwrtbertts of the septic tank shall be disposed of in aaadance with NR 113, Wis. Adm. Code. The oper~irtg condition of the septic tank and artist faker shall be assessed at left once every 3 years by inspection. The outlet Taker sh~l be dearted as necessary to ensure pt»per operation. The ftter cartridge should not be rerrtoved artless provisions are made to retain sdids in the tank that may skwgh off the taker when removed from ks enclosure. If the fdGer is equipped wkh an arm, the fNter shall be serviced ii the alarm ~ acrtivated cartinuouay. Intermittent taker atarrrts may indicate surge fkrws or an impertdirtg continuous slam. The septlc tank sf~k have its contents rerrtoved whin the volume of skxlge and sccar- in the tank exceeds t t3 the liquid vobaste of the tank. 0 the catterrts of the tank are not removed at tfte time of a triennial assessrna-t, maintenance personnel shah advise the owner of when the next service needs to be performed to maintain kare than maximum scwnt and sludge axurrt~iort in the tank. The addikort of baiogk~l or chemicbl addfives to enltartce septic tank perfomtanae is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pcatto Tank The pump (dosing) tank shag be inspected at least once every 3 years. AN switches, alarrrts, and pumps shah be tested to verify proper operaflort. If an effluent tiller is installed within the tank k shall be inspected and serviced as necessary. Mound and jme Distributioatsystem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimbler, and ttte nwurtd steak be seeded and mulched as necessary to prevent erosion and to provide some protecUat iron frost pertblration. Traffic ( than for vegetative mairttertance) ott the mound is not recromrrtertded since sok c~rr>pacrtiort may hinder aeration of the infikrative surface within the mound and snow compaction in the winter wiq promote frost penetration. Cokl weather ittatallatiorts (October-February) dictate that the mound be h~vNlr muk~ted as protection from freezing. Influent quakly ktto the mound system may not exceed 220 mglL BOD5,150 mglL TSS, and 30 mglL FOG for septic tank effkterrt or 30 mglL BODs, 30 mglL TSS, 10 mglL FOG, and 104cfuM00 mL for higfdy treated etflttent. lnikiertt flow may not exceed matdrrtum design flow specified in the pemtk for th~ installation. The pressure distribution system ie provided wkh a flushing poirrt at the end of each , and k is recommended that each lathrel be flushed of acxumufal<ed soflds at least once every 18 months. When a pressure test i$ pertomted k should be compared to the irtkFal test vAten the system was installed to determine if orifice cbgging has occurred and if orifice cieanittg is required to maintain equal distribution within the dispersal oak. Observation pipes vrkFtin the dispersal cell shad be cdtecfaed for effluent pending. Pondatg tevNs steak be reported to the owner, and any levels above 6 inches considered as an impending hydreuNe failure requiring additlatal, more frequent nwrtkoring. Sr2t~~]f Plan If the septic tank or any of its componeMa become defective the tank or c:orrtportent shah be repaired or replaced to keep the system in proper operating corMitlat. If the dosing tonic, pump, pump cxrrdrols, alarm or related vuirirtg becomes defective the defective cbrnportertt(s) shall be imntediatehr repaired or replaced wkh a canportent of the same or equal . If the mound comportertt fails to accept wastewater or begins to discrttarge wastewater fo the ground surface, k wiN be repatred or replaced in its' present kx~ion by irxx+assatg basal area if toe Iceloige acorns or by rerrtaving bidogiceky clogged absorption and dispersal media. and related piping, and replacing said comportertts as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the r~rrre and telephone number of your local POWTS regulator and service provider. Project: Petersen 3 bedroom mound Page 6 of 9 ;e~ 9T9bTE8STl=NO:Ld :Od, 66: LT '~1l1-tf~-ve GOULt1S PUMPS ~gi~el's~bl~ EPtl4 EPt~ ~~ MMMO~ 111 ~ ,~. r~ ~ ~x~ EiAtnent systerraa "~a,~"'a • Oawaleriip • >:uiN s~hmetpnd is high ao I> tug tranaim: Npr~wM~feapi rl~ ~,le~~ttart;~r. r ~ 101NlT p A6B~Clf trSiiliO ~ ~saM~,modatilal tcx~- eM is `t:" or "~":) • scapni~r 'V,'rnaoainawm. • ~ ua ro-soc~t. • That t~eecl~ np a st tear. rff it-P'G • Madranigl ca~bon- t~ttWMt ~ • ~~ i~~o~ • ~ ~ser~ • ~ ~~rg '~ EPg4 a4 tf~, 1ptp5~Of ~D . 6Q H~, rt$~~5,yy0{{,,,, t t~ ~ ~{l~ ~ t aSfiP, 116 V. 60l~ t~tl bunt irl oyplo8,d w~h • t~oruaroorts: Ot tc~ IellQft1.18~13 S,(InW wig ih[ee primp fvoria~y y~SJ'tW w~h tl~ree pry t~~~ Dw9 ~ cs+a ~ >. +ssaoo6rowas fenw,-. aooo w~ purnp outve~nes tar ma~ntat salt gnwtton. serrr~ alw<~rsosrn ter. ,c ~ . ~ .-. r..__. 8 f ......~.,.,~.. s 3 .. .4 ..~. ..,.. ~. • ..,,. f 4 .~«. .... a... ^ ...... ~ .. .`.. y ~_ c3`b ' ~- ~' o s i 6 8,` w 't2 ,~, CAPbttart- Goulds Pumas C." ~. , ~ ~c ~ % ~ 1TT indus~s ~ ~' ~ ~, n .- •~~ ~ ~~~ ~ ~ MLA` )-~arr-m~hG~ ~/~' S'~o~s- l NJ~ ~ N~YK S 1t t2yN~,7 ~ d ~ t v a.+~ o-~ 1'~/.im N1an d S~',Caa+'~ ~~~ ~' ~c. ~ t ~l~ ks~ ~ ~i h ' ~pGU ' ~.l ~~ 4~~'~~V -~ '., 4~ ~ `v .~ p ~"° ~ ,~~. ~~ 3 oV ~ ~~ ~ ~ L ~~~~~ h ~ \ o~ ~~ R ~. o~ X99 M ~ '~ .~ g- ~ /~ ~. ~ ~ W . per. ~r ~ "Y o ~~ ~ s,, \. l 1•,, ~~u v ~~tN ~ /~ 'S" `~,~ti a7~ ~:.,.~~11 ,,~ i Q t ~a X G,~l3 C ~L~ I~~~k, Q~ ~'~~St~a~ ~-2y-vs 06/22/05 {~'ED 10:45 FAX 715 3$6 46$6 v ~ ,~' _ 501 EVALU REPORT ilVisCOnsin Department of Gomme pivisi0n o(Safely antl Buildings p~~+ ,~,{~ ~ ce ithGbi~rrt}8~1~4-d4rf. Cad fr rn a ~ Counry Att2Ch tAmplele Site plan Dri paper not less than $ 7!2 71 inches in 5 Q~, P) 51 inGude, but npl limited t0: Vefllgl and horizontal raters pol~+1),~irc~cld Paree~r .i.D~~ O ~~ ~~~ ri ~~ ~ Q~C~ percent slope, soots or dimensions, norm arrow, and to lion a[rd di8t8nce to n@arr35t ro d. d ST. CRUIX COtlta'i'Y Reviewed. by Date Please print alt inform tiorr. ~O[WiNG OFFICE Person~llnlormallan y0U Rrovi4e m8y Dr: USbd for secontlary P ~ Property Qwner Property LOCatlon ~~ ~ ~~~~Ir.S ~ /~ Govt. t_o[ J~ ~ 7!a ~y14 S ~ jv T ~~ N R j E (or Property Qwners Maili Q ~r ~ ~ , ~ ~,. „ Lot ;~ l3lack # Sutxi. Plame or CSM# ~7~ Ciry graze Zip Code Phone Number ^,~ iCiry ^ Village ~7awn tVearest Road ~~v~avLCtetioL U~ ,BYO/5 { 14i ) 79t/c~~51`Z~ ~a C.,T t-f ~'~'~ `" r;Pt~ ~ew Construction Use: esldential 1 Number of bedrdams _„ ~_ t;ode derived design flow race ~ ^ ReplaCem@n[ 11 ^ Pub1iC Or COmmerCial - t]pscribe: ,r f ~ ParQnt material 1~ 'd"~ ~ ~ [S U~PY . ., flood Plain elevation it 8paiit~ate fV Cener3t Comments ~ Jr~ , ~ ~ 7~" ~ ~~ L arld recommendations: ~~~r -~ o.ti [ D ~~ Gt.~'- ~~; L~ ,~ y poring Boring # l'.~ Pit Ground surface elev. ~ Horizon Depth DornlnantColor Redox DesGiption in. Munsell Ru. Sz. Cont. Color 7~ ~ ~ t ~ ~~ ~ S ~- ~ •S ~` ~I-c~c~ `l. Dep[tl to limiting 1eCtor ~~ in• Soil Texture Structure Consistence 6aundary Roots Gr. Sz. Sh, ff •Ef~i1 ~- y ___._ „! c _~ ~ ' t c„~ ! u f ~ - [~ [ U ~' ~7 Soring boring # n / ~~. ~ Depth Ea limiting factor ~,1 ~> -- in. L_7 Plc DrOUnd surface elev. ~ (t. Horizon pepth Dominant Color Radox Oestxiption 'texture Structure Consistence Boundary Roots in. Munsall Qu. Sz. Cent. Color {3r. Sz. Sh. f " c5 f n~t~ ~ J~ ' U et N?'t ~" Ir ~J f V ~• ~._-_ i ' Effluent #1 = > 30 ~ 220 mglL and TSS X30 4150 CST e {Please Print) Signatl Address ~~ a a ~ ~7~ f~ ~~~ . ~~ r,~ 1~~~ 06-22-05 12:46 TO: ~~~ G C=~ 4~ X001 Paps ~ of •EfCI~ :, .~. .~ 'tµft#1 " Efeuant #2 = BOD ~ 30 and 7S8 { ~ +riid~ CST PM.vitber rEvaluation Conducted Telephone Number FROM:715 386 46$6 P01 48/22/a5 WED 14:16 FA% 715 338 4688 ?roperly Owner _„_ G ~~'e.7-e 1"~ ~'~ Parcel ~~ q O ate,,, ~ ~~ ..~~ ., Pape .__ of ~,~, t~aaa '~) wit txound surface elev. / o ` 7 tt. DePln to unuung rdaor r f - m• horizon Depth ppMirlantCotor RedoxOasmPtion. Texwre Swqure Consist®nce 8ourxttuy FtOOt6 in. AAunseY Qu. Sz. Cont. Cdor Gr. Sz. Sh. gDp tlort C3P ~~~ `E1~C1 (/ .,~ t`O ~( intia D S~ i ~ :t ~ S~ t t G t.e~ ! o f _ ~` Q . S ~ ~ PY ~ " {C •~ 1 t ...~ r ~,t~o- ~e o- r~ ~,b" . - _ - .® ^ Pit Ground suriaca elev. _,,,,_,,,,,, _„_, 8. Depth to tirnitirt~g factor an. lor Rettox Destxiption Texture Swcture Consistence 8ourdary ROOtt+ inant C i th D H D S4ii ication fZada GPO/1F or zon ep in, p om MurtseU Ou. Sz. Cont. Color Gr. Sz. Sh. '~~ ' `~ _ ~ ^ -.~ _----~ -- D Pit C3rouna sunace elev. ,~,,,-.,._,,,-_. rt. uepui ro ixr„ar~g ~.,a K.. tiolt Textur® SbvcWr9 Citif1518t1iYiG8 Botstd8ryt tuts Sai tioriton O irraot tbtot Redox Dtt Bt D soft ~'~ .. op _,,Jt1._ om __ Mwts~ell •- p , --...Qu. Sz, Cant. Oolar Gr. Sz. Sh. 'Ett~f1 ' EfBrreat ift = 9OD~ > 3a t 22U mg/L and TSS X30 ~ 9 5D mgl6 ' Efttueni #2 = BODE ~ 30 m~glL and 7SS : 31? 1F'IQft. 7'he Department of Commerce is an equal opportunity service provider and employer. If you naed assistance to access serrices Ot; nod material in an alternate format, pleas contact ti-e department at b08-2b6-3151 or TTY 608-264-8777. - sxr~uutROVOw Z0d 989b 98S S TL : I^IO2i.3 ~~ --~-~ ~'? .~ ~ ~ r4 c 7~ - ro ~ .~ ~ . .~ _ ~ - ~ \ ~..~ ~ ~ ~ ~, i r ..~ ;. ~ ~~ ~ ~~ ~ o o ~ ~ a ~ ° ~ ~ ~. ~ ~ ~ Q ~ p~ ~ ~~~ ~ ~ ~ ~ ~' r \ ~ ~ ~ ~, -, w r'i ,' 7~ ~ ~ ~'c' ~ zr)o~ ~~ ~.~ ~~ l~ s 4 _~ ~a r ~~ O .p 9!/ ~-i~ A S ~ ~ ~ ~ F r~ ~" ~ -Y! T ~ ~ `0 `1 d [!~ ~ ~~ ~~ ~ ~~ _ _ ~ ] ~~ l/~ r ~ ~ I ~ - ~ .. 989 98~ 5iL ~8d 9fi~0i Q~~4i ~UiZZ%"~3D :OZ 91~: ZT SO-ZZ-90 mme7L~ i~ SOIL EVALUAT REPORT Page_L___of~ Vklisconsici Department of Co ~/~ m~• Division of Safety and Buildings ~ LJ (~ ~n~~+ in a ce ith C6f?i4r+'85i Cod County lc~~ Attach complete site plan on paper not less than 8 1/2 11 inches in s z Plan m~uust ~" inGude, but not limited to: vertigl and horizontal retere ce poi~(~n),`,r~ir ct~l;9~d Parcel LDD ~ ~j _~ x'33 ~ 90 ' ooe~ percent slope, scale or dimensions, north arrow, and to lion and distance to nearest ro d. Please print all inform t/OnST. CROIX COUfJTI' evia y Dat ZONING OFFICE ~ ~ ~~ ~ Personal information you provide maybe used for secondary p ~ Property Ow,, n/Ier Property Lo'ca1 lion J /V~h e ~~~-~Ir'-.S Govt. Lot JV ~ 114. ~1/4 S (~o T ~9 N R ~ ~ E (~ Property Owner's Maili g A dress ,\ „ Lot # Blo'k # Subd. Name or CSM# q~~ ~.T N. -~ d• .s C;ty State Zip Code Phone Number ^ City ^ Villag [Town 7~eafest Road ~-{~l.v~ntMo~r~ ~,1~ ~•YO/s' ( I~) 79~~~~`l ~ I"~c3Lt~v. G\ T H t~-(" t, ` ~o~ Goo ~ew Construction Use: esidential / Number of bedrooms __~ Code derived design flow rate ^ Replacement ^ Public or commercial~--~D-esclribe: ~~ R Parent material ~ 8cS ~~ 6 UPv- / il/ _ __ __ Floocf Plain elevation if applicaole ~Q/~ General comments L~.S~ ~ ~~~ ~s' ~ ~~~~. ~ t~1^ ~O`~ Sa~"~ C.,L/tf~FG-- ai` recommendations: ~ ~p E~5 -e~ o ~. C d K. ~ o t.ew- 9 9; 4/ Q!r Q c..l in ~, S y S r-QVL. ,~le~ . / U ~~ D `7 U Boring Boring # S, ft. L'~ Pit Ground surface elev. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color ' ~' ~ l o `(12 ~ "' v `~.•- ~ '~ . s` Y1zi S ~, S a--a s Wit- ©~.~.~. Depth to limiting factor ~-~ in. "exture Structure Consistence Boundary Roots Gr. Sz. Sh. fF - \ ~ ,. e ~1 >e >c vv.S~. I~ l_cl li =1~ e sb~ tt ~, l~•F S S - L~ l b ~ '~i t ~~c sbk ~n~ ~' ^ Boring 3=J Boring # Ground surface elev. ~~~~ 3 ft. Depth to limiting ( °~ I Pit Horizon Depth Dominant Color Redox Description Texture Structure in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 b~~ I©yl~~ Sal ~~ Ak -1(v ~y c ~ w, ~ blt f"~ t._t.G'1 .e • Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 < 150 mg/L CST e (Please Print) Signature ., ~ ~ ~ ~ ( .P SOS ~~.~ Address V / . ~.-~ ___~ ~ca,___- in. t ~'~ (,~ S i v tr w ,..C', r ~ 6 // Effluent #2 = BO Roots - _ GPD/fF •Eff#1 'Eff#2 ` S~ t V . ~ `Eff#1 30 mgll. and TSS _< 30 tttg CST Numt~er ~~~2~~ s Evaluation Conducted Z ~-~°'~s Pn~ .\•\'\N TMM/\\ Property Owner _ h ~ ti `e_~~ ~`S ~~ Parcel ID # Page of II J~ vv = ~ Ground surface elev. 7 a t Y ft• Depth to limiting factor [ ( tn• Soil A ligtion Rate n ti i D Texture Structure Consistence Boundary Roots GP D/f! Horizon Depth in. Dominant Color Munsell escr p o Redox t1u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfftE2 ( ~ -~ ~©~lR ~ ~ O ~.~o S ~ to a o Y ~ s~~~ ~ C ~ w,S~k c. K. tt ~i- G~ ~°~ / i -~ ,~ ' , i r~ e tea- e r c>`.~ ~6`' -~ o~.;~~ ~ ^ Boring -- -~ -- pit Ground surface elev. ___ t. ep o imi i ~ Soil A liCation Rate tion i D Texture Structure Consistence Boundary Roots GPD/ff' Horizon Depth in. Dominant Color Munsell p escr Redox Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etif#2 -~ _ n Boring ~w ~~.y ., ^ Pit Ground surface elev. Soil ication Rate ti i Texture Structure Consistence Boundary Roots GP O Horizon Depth in. Dominant Color Munsell on p Redox Descr Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =BODE > 30 < 220 mg/L and TSS >30 < 150 mgiL 'Effluent #2 =BODE _< 30 mg/L and TSS _< 30 mglL 'I'Ite Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services Ot need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. siin.as~o te.o~rool z _ ~, ~ ~ ~ ~ 4- ) 11. c S I ~ ~ ~ ~ ...~ -~- ~ .~ ~ I~ ~~ o ~ ~ ~ ~ -S , 1L- T -~ L v ~ ~ ~ ~ ~~ ~ ~ ~ ~ d ~ ~ ~ i ~ , 4 ~~ J~~ d ~ '~ a ~ ~ ~\jy ~°~ ~ a~ ~~ ~ ~~ \ ~~ % °b~~ \ ~ Q ~ o ~ ~ ~/ ~ ~ ~~, a ~~ =~ ~ Z \ ~` I `~I ~. °~ ~ 0 ~~ D ~ ~ ~ a ~ y O ~ 7 ~ ~' a "~ ~ -~G 1 i ~ ~ o ~L ~ ~ ~ ~" l,~ d Q 0 r~l L --1 ~ T cr %'/~ OwnerBuy .~ ST CRUX CQUN'1'X SEPTIC TANK I\ZA,INTE2~tANs:E AGREEMEI`IT ARID OWNERSHIP CERTJFICATION FORM lvl~ling Address ~ 7 ~v C ~` t ~ _.__ _ n Property Address ~ a'" ~ ~,..~ ~ f {Verificatiaa requited from Flanri epa-tment for x-ew corsstruction) CitylState ~ l ~vli ~~ ~/ ~l F~rce1 TdetaCifiaation Number _~ l ~ i ECxAL DESCRIP"T'TQI~t / Location (J L~ 1/+, tl~~ Y~, Sec, l ~ T~N_g~l ~,_W, Town o£ ~~/ ~~ `1't a'x Property Subdavisiv~ ~~ ~ ~s~~~ Certifred Survey Map # , Volume /~~, --= Page # ~ - C ~ ~ ~ ~ Volume ~ b ~, Page # ~ Zy r~va~anty ~~~ ~ .~-.....-~ - Spec house t~ yes ~ o Lot li~rtes idanti~iable maces G no ~,YS'I.'>EM MA.II,T"xEi~FA1~CE Improper ase and maintenance of your septic system could result in its ptcmatuna failure t4 handle wastes. Fropar maintenance camsists of pw:npin$ out the septic tank every three years wr sooner, if needed lay a licensed pumper. What yott put into the systetu ,eon affect the function of the septic tank as a treatment stage in the waste disposal system, 'Che property owner agrees to submit to St. G7oix 2oxting Dcp3rtnieant a certification,farm, signed by the owner an~1 by a. rnsster plumber, journeyman: plumber, restctcted plumber or a license*.d parr~er verx£y~g float {1) tl~e on-site wastewater disposal system %s In proper operating condition axtdlor (2} after inspection and purngistg {if necessary}, the septic tack is less than 113 full of sludge. Uwe, the undersigned have toad the above regniseraeats and agree to maintain the priv-atc sewage disposal systersx with the standards set forth, herein, as set by the ~rcpacttneat of Comtnercc and the Department of Natural Resources, State of Wisco>ssin. Certification stating that your septic system has been rnaintained must be completed and returned to the St. Croix County honing 4t'1'ice witb~i~a 30 days o£the ree year expiration date, ~ f~ o~ G 4F Al?pLICAI~l7 DA'l'E QW, KEIt. CERT'~~CAT'~ON T (we) certify that all statements on this form are true to the best of trry (our)laiowledge. 1 lwe) am {are) the ownezts} of the property described above, by virtue of a warranty deed reaanled in Register of Deeds Uffice. ~a~o ~ $T{s 'I'T3P.I? OF t1PPLlCANT DATE be ent. *"~*«* ***+'~* .~r~y infomxation that is mis~represcntcd may result ion the sanitary permit being revoked by the 2.oniug paxtin ** [ttelude with tWs application: a stamped warranty deed from the Tegister of Deeds office a copy of the certified stuvey axap if rafercncc is made in the warranty deed T@d =QI SZ:94 S9-ZZ-90 Parcel #: 018-1033-90-000 07/~ 1/2005 01:49 PM PAGE 1 OF 1 Alt. Parcel #: 16.2r3'.17.241 B 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): * =Current Owner *PETERSEN, NANCY M NANCY M PETERSEN 976 CTY RD T HAMMOND WI 54015 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 4.500 Plat: N/A-NOT AVAILABLE SEC 16 T29N R17W 4.5AC S 19 RDS OF E 38 Block/Condo Bldg: RDS OF NE NE Tract(s): (Sec-Twn-Rng 401/4 1601/4) L P ( ~ca~S ®7 ~. 30 ~OjS O~.S~~ 16-29N-17W ~~ ~ ~ S Notes: Parcet History: Date Doc # Vol/Page Type // 05/13/2002 678846 07/23/1997 494/4 1 ~ ~ Yl 1 q 2 ~e~'s~ 9nn~ c1 1MMeRV Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/22/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 4.000 500 0 500 NO UNDEVELOPED G5 0.500 50 0 50 NO Totals for 2005: General Property 4.500 550 Woodland 0.000 0 Totals for 2004: General Property 4.500 550 Woodland 0.000 0 0 550 0 0 550 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 'l T° Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #:.'018-1034-40-000 07/11/2005 01:51 PM PAGE 1 OF 1 Alt. Parcel #: 16.29:17.2446 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): * =Current Owner *PETERSEN, NANCY M NANCY M PETERSEN 976 CTY RD T HAMMOND WI 54015 Districts: SC =School SP =Special Property Address s): * =Primary Type Dist # Description " 976 CTY RD T ~~~ `Z,~'~. SP 1700 WITCROIX CENTRAL , / l~~ ~ v ~o~~-~a-~r~~ Legal Description: Acres: 7.360 Plat: N/A-NOT AVAILABLE SEC 16 T29N R17W 7.36AC N 31 RDS OF E 38 Block/Condo Bldg: RDS OF SE NE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 05/13/2002 678846 1889/320 WD 07/23/1997 494/421 07/23/1997 456/37 ~nn~ c~ ~nnnneQV Bill #: Fair Market Value: Assessed with: ---- - Use Value Assessment Valuations: Last Changed: 10/22/2004 Description Class Acres Land Improve ,, Total State Reason RESIDENTIAL G1 3.360 33,100 117,500 150,600 NO AGRICULTURAL G4 4.000 500 0 500 NO Totals for 2005: General Property 7.360 33,600 117,500 151,100 Woodland 0.000 0 0 Totals for 2004: General Property 7.360 33,600 117,500 151,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 220 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U 1889P 32p , ~ I ~ STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number Il WARR,ANTY DEED This Deed, made between Kenneth J. Peterson and Marian E. Peterson, husband and wife Grantor, and Nancy M. Petersen, a single person Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, Slate of Wisconsin (ifmore space is needed, please attach addendum): Recording Area X7884.6 REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 05-13-2002 3:40 PK iIARRi1NTY DEED EXEMPT iF REC FEE : 11.00 TRANS FEE: 767.40 CERT COPY FEE: PAGES: 1 )I Name and Return Address The South 19 Rods of the East 38 Rods of the NE'/. of NE'/. and the North ~ ~~~ ~~~C~ ) 31 Rods of the East 38 Rods of the SE'/. of the NE'/,, all in Section 16, J Township 29 North, Range 17 West, St. Croix County, Wisconsin. J~a ~~ `n y-~~~~}(,~ ~ ~1~~ "G~~.i . m~ ; ~~101 018-1034-40-000; 018-1033-90-000 Parce] Identification Number (PIN) This is homestead property. (is) i~~lon Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. ~t Dated this .~~ day of Aprit 2002 • Kenneth J. Peterson -~~~ `,t + + Marian E. Petersen AUTHENTICATION _ Signature(s) =80RAH A. STAYBERG .~fyPU~7TIC 3tE-t7f~VT5~6Tf~~`n T authenticated th s~_day of - , + - ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. C.i1f`D~ I ~( County ) Personally came before me this ,~ a2- day of April 2002 the above named Kenneth J. Peterson and Marian E. Peterson, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing instru t and acknowledge a sa authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY + r Attorney Kristine l7gland otary Public, State of W' cousin udson, WI 54016 My Commis ion i n/e'nt. (If no tate e ~ ation date: (Signatures may 6e authenticated or acknowledged. Both are not necessary.) ~-f~s •) Names of persons signing in any capacity must be typed or printed below their signature. M/am,etwn vroraaiorab company. Fond a~ Lac. Nn eooass-zozt WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 NE COR. SEC. 16 AVENUE 241 ~ '- ' ~.. 3 ~_ 1324.53' _ ~ ', I S 1 ~ ~ ~ ~ (~ 829.23 450.21 ' LOT 3 C. S. M, I ~ / 39 I -- ~_-_r'~ ~- LOT 2 ~ ~,5. VOrL. ~ 6,. PAGE 1714 g ~,, I N ~ i - ~ 241 A- 20 I `/ ~ • 127. s a' 44995' u;~ 38 RODS iG•S X ,~y~~{') 241 A - I o ~-~; M ~ Il ~" - M ~~~ ~ ~; g n N ~ 418 ~~ ~ ~ 494/421 j • ~..~s~,,, ~~,..,~~e~, ~ - _ _ ~oo.2s' _ ~g }-- , ~> / I '~\ ~: G~_ _ - - - 30.00 ~ ~ 260.00 W ~ 260.00' 112.09 ~ I ;~ ~~~P ~rf~ ~ r~~~/z.~~ ~~8a~~~ ~~ ~ 2448 I ~'~~ o ~ i 494/421 ~.~~°n 1~.,) ~. uc.~ r .~ ~`~~ Irv ~,> 1 I ~ ~q N F)I ~~ ~, 56 i' 54 I 55 N ~ ~ 38 -Rt7DS;= ~~d~ ~ , co -7 2 O co 7 2 ~ ~ ~\ 214.33 ~;`~ r 368.23 I 719 ' ~ . ' `° 0 a~~a% -'4'zs p_~ ~~.~~_- d~ ~~;o,~o,~ ~ \ 722 ,. `, ,~>:~; /~,{, ~ ~