HomeMy WebLinkAbout018-1083-18-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
569509
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
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 Parcel Tax No:
Diaz, Thomas&Angela I Hammond, Town of 018-1083-18-000
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No:
a a�1G a J f— S"11 16.29.17.590
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER stwy CAPACITY STATION BS HI FS ELEV.
Septic �;c Benchmark
614. /Z 50
, /6G.
110 I/aat Aga- Alt. BM W o
O.3 /,d` •
Aeration Bldg. Sewer
8.a8 95,E
Holding St/Ht Inlet
TANK SETBACK INFORMATION SUHt Outlet .Ifo > 9 7,$
TANK TO w/L WELL BLDG. InlfzrNe ROAD Dt Inlet `
5 of Septic 7 1 CIO /415 Dt Bottom �,_
Dosing Header/Man. 14612 74,Z
Aeration Dist. Pipe 949 •Z
Holding Bot.System
PUMP/SIPHON INFORMATION /, 3 q5; .
/
Manufacturer Demand St Cover
GPM )
Model Nu r Ail 5
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width I Lengt No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 y ? -�
SETBACK SYSTEM TO L,P/L tJ BLD,GI e WELL LAKE/STREAM LEACHING Manufacturer r
INFORMATION CHAMBER OR
( k,�
Type f System: l r �� //X /�Z UNIT Model Number:
it Aj-
DISTRIBUTION SYSTEM ZO X 3 JON S
Header/Manifold ) Distributi ` x Hole Size x Hole Sp is nF g Vent to Air Int
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 �.�5 Bed/Trench Edges �� Topsoil 1*_ 1 n Yes No
°' es No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / /
Location: 1737 97th Ave Ha 54015(SW 1/4 NW 1/4 16 T29N R17W) heasant Hills Lot 18 Parcel No: 16.29.17.590
1.)Alt BM Description= G : .,S /Z3GlC� O v`
2.)Bldg sewer length=
-amount of cover /0��i f, $0 .t 4-_,3�-- 5 1i
l 60K:Q�>►�hQ.�J�� Gv�E.0 flr� ✓�C�!/ v
Plan revision Required? Yes o
Use other side for additional information.
SBD-6710(R.3/97) Date Inepctors J
Cert.No
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Safety and Buildings Division 5 77 d, �d
201 W. Box 7162 Sanitary Permit Number(to be ed in by Co.)
$p1�
i 162 j
►� g TON
t Application State Traosamon Number
In accordance with SPS 3832 JCode,submission of this form to the appropriate governmental unit /
is required prier to obtaining permit Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety f9d essional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s.15.04(1)(m,Stats. 277 L A lication Information—Please Print All Information 3 x,7 4F_
Property Owner's Name Parcel#
0-,, rzo'ca.
Property Owner's Mailing Address Property Location
�/�3 Govt Lam ,
City,State Ap Code Phone Number S - ;/Z j4. Section
d
II.Type Building(check all that apply) Lot# T N; R E
or 2 Family Dwelling-Number of Bedrooms / Subdivision Name
14j BI #/ �' G
❑Public/Commercial-Describe Use ❑City of
OJtik�
❑State Owned-Describe Use CSM Number ❑Village of
own of o�ta
D �� 5 T
III.Type of Permit: (Check onlA one boa on line A. Complete line B if applicable) "�Ae—
A ❑New System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain)
B. ❑Permit Renewal t Kmnit Revision ❑Change of Plumber [I Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
I V.
ape of POWTS System/Component/Device: Check all that apply) u- �C 5
Non-Pressurized In-Ground ❑Pressurized In-Ground ❑A-Grade ❑Mound>24 in.of suitable soil Mound<24 in.of suitable soil
❑Holding Tank 0 Oder Dispersal Component(explain) ❑Pretreatment Device(explain)
V.DispersaVrreatipent Area Information:
Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(st) Dispersal Area Proposed(s System Elevation -
®U
VL Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units o v v
New Taoks Tanks o i' o ° m
Existing I'VAL, �d lG �z A.U 0, i; 11.0 a
Septic or Holding Tank / ✓L r f
Dosing climb r
VII.Responsibility Statement-1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print)A/ PI Si MP/MPRS Number Business Phone Number
Plumber's Address(Street,City,State, ' Code)
" sa
oan /De artment Use Only Z,�
proved ❑ Permit Fee Date Is Issuing Signattue
en Reason for Denial Io �Z
rWDL Condi> � lReasons for Disapproval
is Septic tank,effluent filter and
dispersal cell must all be services/maintained
at per frianegement plan provided by plumbw.
�, xxgub�a�ls.mustl,�e�.rrisiM+lt�f
Attach to complete plans for the system and submit to the County only on paper not less than 8 is z 11 inches in size
SRD-6398(R. 11/11)
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Q a 14L
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zi -41
4 �\
T7 19 �� ,
1
Sol Absotptlo Cross Segdon
ft
r,w lOT 0.00 ft
C Schedule 40 Final Grade
rwc Vent PlPe 96.50
WO VeM Cap ft
Leaching 95.50
ft
�J System ElevaMon
3.00 ft 6.00 ft ft
Soli A sonmtlon System Plan View
ft
3.00 ft
6.00 ft Leaching Trench 1
Chambers
- w 4•Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber SRggjffSMLonq
Manufacturer And Model_Lr?Tt Qk,.,c LL FFTc h�a.
EISA Rating 20.00 s9 ft per chamber Soil Application Rate 0.50 gpd/sq ft
600.0 gpd Design Flow+ 0.50 Soil Application Rate 20.00 EISA= 60.00 Chambers
3 rows of 20.00 chambers each.
- II
Page of
RECEIVED
' �"!�•�
� % SOIL EV%Yyj?�,REPORT
#1205
UU , k W 1 of 4
p i Depaf nt of-69%ty-ancl-PSfessional Services
Division of Safety and Buildings T�,�,P1 Keith E.Stoner
in accordance. �i�JNI-TY' �j ��ode
Attach complete site Ian on r not less than 8%x 11 inches in size. Plan muOPMEN County
P P Pape St.Croix
include,but not limited to:vertical and horizontal reference point(BM),direction and
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.
018-1083-18-000
Please print all Information. R Date
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m))- 0 wan, ZL
Property Owner Property Location
Thomas G. Diaz Govt.Lot SEIM,NW1/4,S16,T29N, R17W
Property Owner's Mailing Address Lot# I Block# I Subd.Name or CSM#
1946 Washington Ave.South 18 Pheasant Hills Sub.
City State Zip Code Phone Number ❑ City ❑Village ® Town Nearest Road
Stillwater MN 1 55082 1 Hammond 1 1737 97Th Ave.
❑New Construction Use: ® Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD
❑Replacement ❑ Public or commercial-Describe:
Parent material Outwash Plains Flood plain elevation,if applicable Na ft.
General comments Propose 3 dispersal cells Tx 82'using a.5 S4R.Center upslope cell over the—100.50'contour w/a S.E.of 95.00'.Center middle
and recommendations: cell over the 99.70'contour w/a S.E.of 94.70'.Center lower cell over the 99.20'contour w/a S.E.of 94.20'.
[K]Boring# ❑Boring
®Pit Ground surface elev. 98.95 ft. Depth to limiting factor >108 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Pt2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. •Eff#1 `EfW
1 0-9 10YR3/2 sil 2msbk mvfr Cs 3f-m 0.6 0.8
2 9-22 10YR4/4 d 2msbk mvfr gs 3f-m 0.4 0.6
3 22-32 7.5YR4/4 Is Osg ml gs 2f-m 1 0.7 1.6
4 32-46 5YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0
5 46-52 10YR6/4 s Osg ml gs if 0.7 1.6
6 52-108 10YR6/4 s Osg I ml T -- — 0.7 1.6
#3 with bands of 5YR4/4 sl #5 with 1-2 inch bands of 5YR4/4 sandy loam
2]
F Boring# ❑Boring
®Pit Ground surface elev. 101.05 ft. Depth to limiting factor >116 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/fF
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. •Eff#1 'Efl#2
1 0-12 10YR3/2 sit 2msbk mvfr Cs 3f-m 0.6 0.8
2 12-27 10YR4/4 Sid 2msbk mvfr gs 3f-m 0.4 0.6
3 27-39 7.5YR4/4 Is Osg ml gs 2f-m 0.7 1.6
4 39-116 10YR6/4 s OSg ml --- 2f-m 0.7 1.6
#4 wbands of coarse sand and sandy loam up to 2"thick
Effluent#1=BOD5>30<220 mg/L and TSS>30<150 mg/L Trnt#2=BOD5<-30 mg/L and TSS<_30 mg/L
CST Name(Please Print) Signature: CST Number
Keith E.Stoner A��Ztt&; 224059
Address Keith E.Stoner Date Evaluation Conducted Telephone Number
23220 Wood Creek rd.Siren,WI 54872 5/1512014 715-653-2324
SBD4330(K 11/11)
Property Owner Thomas G. Diaz Parcel ID# 018-1083-18-000 Page__.Z_of 4
❑Boring
F31 Boring# Pit Ground surface elev. 101.15 ft. Depth to limiting factor >115 in.
® Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#t *Eff#2
1 0-12 10YR3/2 sil 2msbk mvfr Cs 3f-m 0.6 0.8
2 12-34 10YR4/4 d 2msbk mvfr gs 3f-m 0.4 0.6
3 34-44 7.5YR4/4 Is/Ifs Osg ml gs 2f-m 0.5 1.0
4 44-82 10YR6/4 sl 2msbk mvfr gs 2f-m 0.6 1.0
5 82-115 7.5YR5/4 gr cos/s Osg ml gs if 0.7 1.6
I
#5 w/Bands of cus and pea gravel
F 4 ❑Boring
Boring# pn Ground surface eiev. 101.95 ft. Depth to limiting factor >121 in.
® Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-8 10YR3/2 sil 2msbk mvfr cs 3f-m 0.6 0.8
2 8-20 10YR4/4 sd 2msbk mvfr gs 3f-m 0.4 0.6
3 20-32 10YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0
4 32-48 5YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0
5 48-80 10YR6/4 s Osg ml gs if 0.7 1.6
6 80-121 7.5YR5/4 gr s/cos Osg ml -- --- 0.7 1.6
❑Boring
Fs-] Boring# ph Ground surface elev. 99.05 ft. Depth to limiting factor >108 in.
® Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *042
1 0-9 10YR3/2 sil 2msbk mvfr Cs 3f-m 0.6 0.8
2 9-26 i0YR4/4 sd 2msbk mvfr gs 3f-m 0.4 0.6
3 26-40 7.5YR4/4 Is Osg ml gs 2f-m 0.7 1.6
4 40-46 5YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0
5 46-76 10YR6/4 s 059 ml gs if 0.7 1.6
6 76-108 7.5YR5/4 gr s/cos Osg ml -- --- 0.7 1.6
*Effluent#1 =BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L
The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay.
s.n..o�+nm_..m++...♦ Y.3N.C �Mwnr
Property Owner Thomas G. Diaz parcel ID# 018-1083-18-000 Page__3__Of 4
F ❑Boring
6 Boring# Pit Ground surface elev. 101.50 ft. Depth to limiting factor >115 in.
® Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#t *10#2
1 0-10 10YR3/2 A 2msbk mvfr Cs 3f-m 0.6 0.8
2 10-25 10YR4/4 cl 2msbk mvfr gs 3f-m 0.4 0.6
3 25-42 7.5YR4/4 Is Osg ml gs 2f-m 0.7 1.6
4 42-57 5YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0
5 57-94 10YR6/4 s Osg ml gs if 0.7 1.6
6 94115 7.5YR5/4 gr s/cos Osg ml -- - 0.7 1.6
F 7] ❑Boring
Boring# pit Ground surface elev. 98.05 ft. Depth to limiting factor >90 in.
® Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#t *EfW2
1 0-8 10YR3/2 A 2msbk mvfr Cs 3f-m 0.6 0.8
2 8-29 10YR4/4 d 2msbk mvfr gs 3f-m 0.4 0.6
3 29-41 7.5YR4/4 sl 2msbk mvfr gs 2f-m 0.6 1.0
4 41-62 5YR4/4 s Osg ml gs 2f-m 0.7 1.6
5 62-68 5YR4/4 sl 2msbk mvfr gs if 0.6 1.0
6 68-76 10YR6/4 gr s/cos Osg ml gs --- 0.7 1.6
7 76-90 7.5YR5/4 gr s/cos Osg ml --- -- 0.7 1.6
❑Boring
FIBoring# Pit Ground surface elev. ft. Depth to limiting factor
❑ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *602
*Effluent#1=BODS>30-S220 mg/L and TSS>30<150 mgA- *Effluent#2=BODS<-30 mg/L and TSS<_30 mg/L
The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay.
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County
Safety and Buildings Division
201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be ffiled in by Co.)
Madison,WI 53707-7162
State Transaction Number
it Application
In accordance with SPS 383. Wis. Code,submission of this form to the appropriate governmental unit
is required prior to obtaining i permit. Note:Application forms for state-owned pQWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide aF j''1`; d for secondary
purposes in accordance with the Privacy Law,s. 15.04 1 m,Stats. /
I. �7 U
Application Information— lease Print All Informs.
Property Owner's Name �. eA Ate O ' Parcel# 10
on, �
Property Owner's Maiamg Xddress O�� Property Location �j 1
J �a ``/4 / '0FCO� Govt.Lot ✓�� 1
City,State Code Phone Number QOM 0 ''/, (.QJ/,, Section 1(�
�-e F/* c le on �(6•
.Ty of Building(check all that apply) Lot# Tz N; R E d
or 2 Family Dwelling—Number of Bedrooms ` X Subdivision Name
El Qka d �le,� p��v._
Public/Commercial—Describe Use ❑City of fly
T
CSM Number ❑Village of
❑State Owned—Describe Use '
YXfown of� c7 X21 G�Lo
3 1.✓ as C lam...Le-5
III.Type of Permit: (Check onlylone box on tine A. Co le line B if appy
APVY
A' ew System ❑Replacement System ❑Tr tmen olding T liii�e ement Only ❑Other Modification to Existing System(explain)
B. El Permit Renewal El Permit Revision ❑ Chan f ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner L 4,.M f _ Du . 4
IV.T of POWTS System/Component/Device: Check all t a 1 s a, r mil" (, , '.)
Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil
❑Holding Tank 11 Other Dispersal Component(explain) ❑Pretreatment Device(explain) / 0('
V.Dis ersaUTreat nt Area Information:
Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation
60 �S a&5 /a Gsb
VI.Tank Info Capacity in Total #of lyt�nufa turer/-
Gallons Gallons Units ��Z�_Yu�4ee " °
New Tanks Foisting Tanks ) ;U V] in VJ
Septic olding Tank / �J
Dosing Chamber
VIL Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plum Si a MP/MPRS Number Business Phone Number
Plumber's Address(Street,City, fate,Zip Code)
V .Coun /De artment Use Only
Approved [sappZe. Perk, Fee Date Issu d Issuing ent Signatur
Reason for vial $ /75 °° Z
IX.Condit90bE1d j1; 1dMfrfieasons for Disapproval AA
1 Septic tank,effluent fifter and
dispersal cell must all be servlces/maintained �� L /
as per management plan provided by plumber. w 1.�� 2j r! I C wL Yv
2. o setback requirements must be maintained
as per apoicaWe code/ordinances: ylJ. Z rw o w ra .
Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size
SBD-6398(R. 11/11)
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Tipmas Diaz Sewer
Owner's Name: Thomas Diaz
Owner's Address: 2183 Barclay
Maplewood Mn.
Legal Description: SW 1/4 NW 1/4 Sec 16 T29N R17W
Township: Hammond
County: St. Croix
Subdivision Name: Pheasant Hills
Lot Number. 18
Parcel ID Number: 018-1083-18-000
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing&Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test&House Plans
Designer/Plumber. Keith Knudtson License Number: 648443
Date: 11/12/2013 Phone Number (651)470-1737
Signature
,&— V,- //,
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01).
Page 1
�= ..
5 >1
s l _5
KNUDTSON PLUMBING&
CONTRACTING,LLC-' �S
927150TH ST.648447MPRS
ROBERTS,WI 54023-8525
CELL 651-470-1737
� otoe
L-f> f
0 `
I �
Soll AWiy on System Cif fiction
104.00 ft
103.30 ft
4'Sdodule 40 p� Final Grade
PVC Vent Pipe 1 1.00
With Vent Cap ft
Leaching
Chamber
System Elevation
3.00 ft 3.00 ft ft
t v�
V�
Soil Absorpidon System Plan V12W ?j C
ft
60.00 ft
t
3.00 ft Leaching Trench 1
M" Chambers
11111111111 I 4'Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leachina Chamber Sasctticadons
Manufacturer And Mode! ����l a, ( �;cJ�z A4 S LtJ.J lqJ-A>
EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.50 gpd/sq ft
600.0 gpd Design Flow ., 0.50 Soil Application Rate 20.00 EISA= 60.00 Chambers
3 rows of 20.00 chambers each.
Page of
+ ai1#ers"
_ z
EFFLUENT FILTER
x-525 Filter is rated for
'10,000'GPD (gallons per day) 1/76°Filtration Slots AWm
it.one of the largest filters Imw_�
itsz class. It has 525 linear feet- f
%Y F
filtration slots. Like the � A-%Is PVC
Kok PL-122,the Polylok
-E25 has an automatic shut
ball installed with every fitter.
: Ier2 the fitter is removed for
nmg,the ball will float up and
uararity shut off the system so
effluent won't leave the tank. sgtRaavis
)o c►fher filter on the market can
FbadwSkft e`that claim. \� 10.= `°"w
toaoo coo
Pi_-525 Maintenance: �40� _---
The PL-525 Effluent Filter should
operate efficiently for several years
der normal conditions before --
€equiiing cleaning. It is recom-
-mended that the filter be cleaned """
eery time the tank is pumped or
v least every three years. if the
-- nstalled filter contains an optional
4•-
alarm the owner will be notified g
by an alarm when the filter needs g _ ,
servicing. Servicing should be
done by a certified septic tank ILK GwDaftW
purnper or installer. .
Amrmk 90-M
U.S.Patent No#6,015,488
1.Locate the outlet of the S,srT,saa
septic tank. =
2. Remove tank cover and pump
tank if necessary. PL-525 installation: 3. Glue the fitter housing to
3.Do not use plumbing when the 4" or 6" outlet pipe. If t
filter is removed. Ideal for residential and com- the fitter is not centered
mercial waste flows up to under the access opening
4. Pull PL-525 out of the housing. 10,000 Gallons Per Day (GPD), use a Polylok Extend & "
5. Hose off filter over the septic Lok or piece of pipe to *.a
tank. Make sure all solids fall 1. Locate the outlet of the center fitter. See page
back into septic tank_ septic tank. 19-21 for Extend & Lok
i
6. Insert the filter cartridge back 2. Remove the tank cover and
information.
into the housing making sure pump tank if necessary. 4. Insert the PL-525 fitter
the filter is property aligned into its housing.
and completely inserted. 5. Replace and secure the
septic tank cover.
7. Replace septic tank cover.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page
FILE INFORMATION SYSTEM SPECIFICATIONS _
Ov ner 4, ,� [� ,. Septic Tank Capacity /Z�O gal ❑ NA
Permit# —— — Septic Tank Manufacturer fief ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer J o k ❑ NA
Number of Bedrooms !� ❑ NA Effluent Fitter Model ❑ NA
Number of Public Facility Units �8 V Pump Tank Capacity gal *-NA
Estimated flow(average) J160 al/day Pump Tank Manufacturer �1QA
Design flow (peak), (Estimated x 1.5) 6to gal/day Pump Manufacturer XNA
Soil Application Rate 6-7 al/day/ft2 Pump Model xlqA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit A
Fats, Oil & Grease (FOG) s30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODS) X20 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other:
Pretreated Efflumit Quality Monthly average Disgersal Cell(s) 5;A-(k.W bo.ck-4 ❑ NA
Biochemical Oxygen Demand (BOD5) G30 mg/L in-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑At-Grade ❑Mound
Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size sin dia. ❑ NA
Other. ❑ NA
Other: ❑ NA Other: ❑ NA
'Values typical for domestic wastewater and septic tank effluent. O ❑ NA
MAINTENANCE SCHEDULE
Service Event ServiCe Frequency
inspect condition of tank(s) At least once every: 3 ❑ r ears) ) (Maximum 3 years) ❑ NA
years)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑year(s)
{Maximum 3 years) ❑ NA
Clean effluent fitter At least once every: J nth(sl ❑ NA
I years)
Inspect pump, pump controls & alarm At least once every: p month(s)
Y A
Rush laterals and pressure test At least once every: ears) NA
Y
fir' At least once every: ❑ month(s) I-] NA❑year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cells) shall be visually inspected to check the effluent Levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page Z of y
START LiiP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tanks) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal call(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
n
tv aluati a o r g
e/ nk
�Dre- N57RClG?Z DtJ
b ear _ - �fl�-1t81?F� I�1�1�✓ Ca
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name i-4+�--,pe-,- Name
Phone &5 j_ 4-76— 3 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Q C.V-e/' J GL .' Name ST Ck-D( U 20AIlXV
Phone 6 Phone —7(S— 3 a / — (o 8D
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)OM(f) and 83.54(1), (2) &(3),Wisconsin Administrative Code.
l
-2, of
y
START UP AND OPERATION Page
#Fcw new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tanks) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POW I S 10aintainer to assist in manually operating the pump controls to
restore nominal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POW T S fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
i All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After.pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed.as a last resort to replace the failed POWTS.
afuati L i is a o ing�ank
e at fZt�}-1 r5 rrzz.' /�/,�1✓ �AI5TR0C'-a D
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMMENTS
E
POWTS INSTALLER POWTS MAINTAINER
Name � -� �� '` blame
Phone &5141176— -? Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name I p t.A l-e i' S a .'� Name s-� Q{ V
Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) &(3),Wisconsin Administrative Code.
PROPERTY OWNER: Bonte,Ron SOIL DESCRIPTION REPORT 3
PARCEL 1.104 Page of
•„t Certif,jSoil of sting
Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr. Sz.Sh. BedTrench
3 1 0-4 7.5YR 3/2 - s1 2 m gr mvfr cs if .5 .6
2 4-11 7.5YR 3/2 - sl 2 f sbk mvfr cs if .5 .6
Ground
elev 3 11-28 7.5YR 4/4 - sl 2 m sbk mvfr cw if .5 .6
104.2 ft 4 28-42 7.5YR 4/4 - is 1 m sbk ds cw - .7 .8
Depth to 5 42-55 7.5YR 4/4 - Imcos 0 sg dl gw - .7 .8
limiting
factor 6 55-65 10YR 6/4 - s 0 sg dl - - .7 .8
>65'
Remarks: consicierawe gr a co in norizon ;some gr&co to norizon
4 1 0-3 7.5YR 3/2 - sl 2 m gr mvfr cs if .5 .6
2 3-8 7.5YR 3/2 - sl 2 f sbk mvfr gs if .5 .6
Ground
elev 3 8-28 7.5YR 4/4 - sl 2 m sbk mvfr cs if .5 .6
103.3 ft 4 28-43 7.5YR 4/4 - Is 1 m sbk ds cs - .7 .8
Depth to 5 43-62 7.5YR 4/4 - imcos 0 sg dl - - .7 .8
limiting
factor
>62.
Remarks: cons. era a gr&coo in norizon
5 1 0-5 7.5YR 3/2 - sl 2 m gr mvfr cs if .5 .6
2 5-10 7.5YR 3/2 - sl 2 f sbk mvfr cs if .5 .6
Ground
elev 3 10-20 7.5YR 4/3 - sl 2 m sbk mvfr gs if .5 .6
102.5 ft 4 20-32 7.5YR 4/4 - sl 2 m sbk mvfr cw - .5 .6
Depth to 5 32-56 7.5YR 4/4 - is 1 m sbk ds cs - .7 .8
limiting
factor 6 56-64 7.5YR 4/4 - s 0 sg dl - - 7 8
>64
Remarks: some gr&Cob below
Ground
elev
Depth to
limiting
factor
Remarks:
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Tomas Diaz
Mailing Address 2183 Barclay St. _ wo
Property Address 1737 97th Ave. ,
(Verification required from Planning&Zo g Department for new construction.)
City/State Hammond Wi. Parcel Identification Number 018-1 083-18-000
LEGAL DESCRIPTION
Property Location SW ,/4, NW y4, Sec. 16 ,T 29 N R 1 7 W,Town of Hammond
Subdivision Plat: Pheasant H ills , Lot# 18
Certified Survey Map# Volume ,Page
/` /S 20/3
`Warranty Deed# / 3() 7 ( efore 2 07)Volume ,Page#
Spec house Dyes[]+ no Lot lines identifiable 0yes[]no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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 a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in§SPS.383.52(1)and in Chapter 12 St.Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&Zoning Department a-certification form,signed by the
owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site
wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that our septic system has been maintained must be completed and returned to the St.Croix
County Planning&Zoning Department wi to 30 days of the three year expiration date.
I/we certify that al statements i this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the
property described above,by virtue of a arranty deed recorded in Register of Deeds Office.
dumber of bedrooms 4
(PRO
—��
SIG URE OF APPLICANTS) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
i
reference is made in the warranty deed.
(REV.04112)
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State Bar of Wisconsin Form 1-2003 $ Tx64 38997 6
WARRANTY DEED 982309
BETH PABST
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED,made between Eagle Valleygankt N.A. 07/15/20134:25 PM
EXEMPT#: N/A
("Grantor,"whether one or more), REC FEE: 30.00
and Thomas G.Diaz and Angela la M. Diaz Husband and Wife
TRANS FEE: 105.00
PAGES: 2
("Grantee,"whether one or more).
Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area
estate,together with the rents,profits, fixtures and other appurtenant interests, in
ST CROIX County,State of Wisconsin("Property")(if more space is Name and Return Address
needed,please attach addendum):
File- 781
Lot 18,Plat of Pheasant Hills,Town of Hammond,St.Croix County, Ak--104 319' �t�vTl le wI 5503
Wisconsin.
018a083-I8-000
Parcel Identification Number(PIN)
This is not homestead property.
(is)(is not)
Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except:,
Easements,restrictions and rights-of-way of record,if any.
Date June 20 2013
Eagle Valley Bank,N.A.
V4 -�ao--�.0-�--�_ (SEAL)
(SEAL)
* Cheryl A. Barwin,VP Controller
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF MINNESOTA )
ss.
authenticated on WASHINGTON COUNTY )
0M
* Personally came before me on June 20,2013 ,
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Cheryl A.Barwin,VP Controller of
Eagle Valley Bank N.A.
(If not, to me known to be the person(s) o ex ed the foregoing
authorized by Wis. Stat. §706.06) in strum ent cknowled a t�
THIS INSTRUMENT DRAFTED BY: '
'* Lorri .DeMars
Fran Iverson ` Nota Public,S'a o
1200 Hosford St. Suite 201 Hudson WI 54016 M ommission ermanent)(expires: 1/31/2015 )
(Signatures may be authenticat or acknowledged. Both are not necessary.)
NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO.1-2003
*
Type
of below signatures.
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�- w scorfsrtVspart'ment of Comme OIL AND SITE EVALUATION Page I of 3
Division of afety and Buildings r�RIGIN�ccord with Comm 83.05,Wis.Adm. Code
Certified Soil Testing
Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must Count
include,but not limited to:vertical and horizontal refer�nOb-pofnt�M),direction and y St. Croix
percent slope,scale ordimemsions,north arrgvr,'and location and distance to nearest road.
Parcell.D.#
APPLICANT INFORMATION- P4as6 print all informatio -C-41-I(,� 3
Personal information you provide may be used4or secondary�uiposes(P6 acy Law,S:\5.04(1)(m)). Reviewed By Date
Property Owner P perty Location
Bo on O�,�n r r ;" G t.Lot SE 1/4 NW 1/4 S 16 T 29 17 W
Property Owner's Mailing Address ` t# Block# Subd.Name or CSM# , S
1011 170th St. �t' 18 Pheasant Hills
City State Zf Code PhoneNumber y �]Village ®Town Nearest Road j 7 7
Hammond WI 5WQ15,: 715-796-5240 Iaarnmond 444T1--&t.
Z New Construction Use: Z Residential/-NURlber of bedrooms 3 ❑Addition to exist ipg building
Replacement Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate -5 bed,gpd/ftz •6 trench,gpd/ftz
Absorption area required 900 bed,ft2 750 trench,ftz Maximum design loading rate -5 bed,gpd/ftz •6 trench,gpd/ft2
Recommended infiltration surface elevation(s) 24"below contours ft(as referred to site plan benchmar
Additional design/site considerations install 2-5'x 75'shallow trenches on contours for 3 br
Parent material till Flood plai n elevation,if applicable NA ft
S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U=Unsuitable for system Z L] U ® S ❑U ® S ❑ U ® S ❑ U ❑ S Z ❑ S Z U
Horizon Depth Dominant Color Mottles Texture Structure Consistent Boundary Roots GPD/ft2
Boring# in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. ry Bed Trench
23 '
1 0-10 7.5YR 2.5/1 - sl 2 f-m sbk dsh cs if .5 .6
2 10-20 l OYR 4/4 - sl 2 m sbk mfr gs if .5 .6
Ground 3 20-27 7.5YR 4/4 - sl 2 in sbk mfr cw if .5 .6
elev
104.2 ft 4 27-47 7.5YR 4/4 - is 0 sg dl cs - .7 .8
Depth to 5 47-77 10YR 5/4 - cos 0 sg dl - - .7 .8
limiting
factor
>77^
Remarks: horizon 4 has gr,cob&occasional st;considerable gr in horizon 5
2 1 0-3 7.5YR 3/2 - sl 2 m gr mvfr cs if .5 .6
2 3-8 7.5YR 3/2 - sl 2 f sbk mvfr cs if .5 .6
Ground 3 8-29 7.5YR 4/4 - sl 2 in sbk mvfr cw if .5 .6
elev
103.0 ft 4 29-46 7.5YR 4/4 - Is 1 in sbk ds cw - .7 .8
Depth to 5 ;t 46-62 7.5YR 4/4 - 1 Imcos 0 sg dl - - .7 .8
limiting ' t
factor
>62' )
Remarks: considerable gr&cob in horizon 5
CST Name(Please Print) Signature: Telephone No.
Henry F.Grote _ 715-665-2681
Address Certified Soil esting Date CST Number Ref#
P.O Box 57,Knapp,WI 54749 4/16/2000 222774 1063
PROPERTY OWNER: Bonte,Ron SOIL DESCRIPTION REPORT
PARCEL LD.# PCert fed SSooi�fedng
Depth Dominant Color Mottles Structure GPD/ft2
Horizon in. Munsell Qu. Sz.Cont.Color Texture Gr.Sz.Sh. onsistence Boundary Roots Bed Trench
3 1 0-4 7.5YR 3/2 - sl 2 m gr mvfr cs if .5 .6
2 4-11 7.5YR 3/2 - sl 2 f sbk mvfr cs if .5 .6
Ground
elev 3 11-28 7.5YR 4/4 - sl 2 m sbk mvfr cw if .5 .6
104.2 ft 4 28-42 7.5YR 4/4 - is 1 m sbk ds cw - .7 .8
Depth to 5 42-55 7.5YR 4/4 - lmcos 0 sg dl gw - .7 .8
limiting
factor 6 55-65 10YR 6/4 - s 0 sg dl - - .7 .8
>65"
Remarks: consiaerable gr&cob m onzon ;some gr&con in Horizon
4 1 0-3 7.5YR 3/2 - sl 2 m gr mvfr cs if .5 .6
2 3-8 7.5YR 3/2 - sl 2 f sbk mvfr gs if .5 .6
Ground
elev 3 8-28 7.5YR 4/4 - sl 2 m sbk mvfr cs if .5 .6
103.3 ft 4 28-43 7.5YR 4/4 - Is 1 m sbk ds cs - .7 .8
Depth to 5 43-62 7.5YR 4/4 - lmcos 0 sg dl - - .7 .8
limiting
factor
>62•
Remarks: cons. era a gr&cob in Forizon
1
5 1 0-5 7.5YR 3/2 - sl 2 m gr mvfr cs if .5 .6
2 5-10 7.5YR 3/2 - sl 2 f sbk mvfr cs if .5 .6
Ground
elev 3 10-20 7.5YR 4/3 - sl 2 m sbk mvfr gs if .5 .6
102.5 ft 4 20-32 7.5YR 4/4 - sl 2 m sbk mvfr cw - .5 .6
Depth to 5 32-56 7.5YR 4/4 - is 1 m sbk ds cs - .7 .8
limiting
factor 6 56-64 7.5YR 4/4 - s 0 sg dl
>64 - - 7 8
Remarks: some gr&co Mow
,6
Ground
elev
Depth to
limiting
factor
Remarks:
4
Patcel #: 018-1083-18-000 02/19/2008 03:52 PM
PAGE 1 OF 1
Alt. Parcel#: 16.29.17.590 018-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-ANDERSON,WILLIAM C&KELLY L
WILLIAM C&KELLY L ANDERSON
302 WILDWOOD CIR
ROBERTS WI 54023
Districts: SC= School SP=Special Property Address(es): '=Primary
Type Dist# Description 1737 97TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 3.570 Plat: 07-086-PHEASANT HILLS 2000
SEC 16 T29N R17W PT SE NW PHEASANT HILLS Block/Condo Bldg: LOT 18
LOT 18 3.570AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-17W SE NW
Notes: Parcel History:
Date Doc# Vol/Page Type
11/23/2004 780712 2701/240 WD
01/31/2001 637734 1581/282 WD
05/05/2000 622544 7/86 PLAT
2008 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/22/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.570 33,800 0 33,800 NO
Totals for 2008:
General Property 3.570 33,800 0 33,800
Woodland
0.000 0 0
Totals for 2007:
General Property 3.570 33,800 0 33,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch#:
Specials:
User Special Code Category Amount
II
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i