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HomeMy WebLinkAbout018-1055-30-000 a Z, \ k \ _ _ � I � 2 � 52 \ 0 � } )] I W [ . CD 2 ) E2 . 2 7 k= .� ) or < 0v CL ± R © B . ® z' 2 z ) % \ / (L m § E z / 2 \ k k 7 t » & o { \ / r q o 5 � j { I � -� § (D ) � / � z ) z � .. k � 2 \ � ) k � ° CL E b § 0 0 a = 6 # � § k k k F \ ? z •� � � 2 a 0. t E � 5 0 � 2 j v / § } z _ _ § co - co ° » E D \ Of 1 % § k J ca z / i CM § 3 ° / o \ K ) E CO Cd 6 e c � § c ) { o % LO � n ` o � o ® / � $ 2 § k § ® o � £ _ . z z a = a . ■ c4 E � a — a % u \ k } ) \ o z / k / ) \ � « � � � L % } . o t IL$ - c� ° S v a 2 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 Plan SE�,SW'4,S24,T29N-R17W CONVENTIONAL ❑ALTERNATIVE fiitassigned)D .Number: $ Town of Hammond ❑Holding Tank ❑ In-Ground Pressure ❑Mound Hwy. 12 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Shawn Seifert Baldwin, WI 54002 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST FEE.PT.ELEV.: Name.Nanne.f Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Thomas A. Wang 3231 St. Croix 96016 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ❑NO DYES ❑NO BEDDING: VENT DIA.'. VENT MATL. HIGH WATER NUMBER ROAD: PROPERTY WELL. eU1LDING:IVENT TO FRESH ALARM: FEET FRE►M LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST. DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO ❑YES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING. VENTTOFRESH (DIFFERENCE BETWEEN OEItT FROM LINE AIR INLET: FROM PUMP ON AND OFF) I E]YES NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIPN CONVENTIONAL SYSTEM: WIDTH. LENGTH: NO.OF DISTR.PIPE SPACING. COVER JINSIDE DIA.. #PITS. LIQUID E �TRBN�Oy TRENCHES MATERIAL: PIT DEPTH: GRAVEL DEPTH FILL DEPTH IDISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. OE-st OF PROPERTY WE BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV.INLET.ELEV.END: PIPES. F4ET FROM, LINE. AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. 1:1 YES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS El YES 1:1 NO ❑YES F-1 NO DEPTH OVER TRENCHT DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED: CENTER EDGES: ❑YES ❑NO ❑YES ❑NO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: .WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: . Oft �� °p. TRENCHES: °MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO,DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.- ELEV.: DIA.. ELEV. PIPES. DIA.: yy��T #'tt A l �[ tBUTIO�Ny irI � Tl� HOLE SIZE- HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED dF X11.7 PLANS. ❑YES ONO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS N �ER' ' ' PROPERTY WELL: BUILDING: FEAT i LINE: ❑YES 0 N ❑YES ❑NO NSA Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710(R.01/82) Zoning Administrator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and it 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 au'iority. A new permit may be needed` if there is a change in your building plans, system location, estimated wastewater flow (number of bed- 'rooms, etc.), depth of system, or type of system; 4. Changes ira ownership or plumber requires a Sanitary Permit Transfer Renewal Form (SBD 6399) to be submitted to the codhty prior to installation; 5. Private sewage systems must be properly maintained. The septic tank s) should be pumped by a licensed ` s pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. - To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal descriftion where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of us� (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling-, III. Purpose of application: Check only one in ##1. Complete##2 if permit is 'or tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system typ( . Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #'-6; VI. Tank information: Fill in the capacity of every new and/or existing tank list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site con: tructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Cl-eck experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license r umber with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application t)rm. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is ( isapproved. Complete plans and specifications not smaller than 8'/z x 11 inches m ist be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with c)mplete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewer ;; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; s)il absorption systems; replacement system areas; and the location of the building served; B) horizontal an f vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; eleve Lion differences; friction loss;pump performance curve; pump model and pump manufacturer; D) cross se(tion of the soil absorption system if required by the county; E) soil.test,data on a 115 form. e ----------------------------------------------------- ------—-------—-----------------°-------'------------------ ----------------------♦ I GROUNDWATER SURCHARGE E On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislati)n is more commonly known as the groundwater protection law. This change in statutt s was the result of over 2 years of steady negotiation and public debate. The ground%,ater bill Ground at r included the creation of surcharges (fees) for a number of regulated practi( es which Wisco i1 i' can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ieSUrQ is used in your building is returned to the groundwater through your soil at sorption u system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the ground,rater fund adminis- tered by the Department of Natural Resources. These funds are used for m)nitoring ground- t water, groundwater contamination investigations and establishment of star Jards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY EZ: ILHR In accord with ILHR 83.05,Wis.Adm.Code 5T gRvle � �*� STATE SANITARY PERMIT# 960142 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 15W.] NO PROPERTY OWNER PROPERTY LOCATION ' c j,1; '/4, S TV , N, R E (or WC PROPERTY OWNER'S MAILING ADDRESS LOT NU BER _ BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER CITY ST LAKE OR LANDMARK ❑ VILLAGE: 1%1 offs 15�TOWN OFO II. TYPE OF BUILDING OR USE SERVED: Cd Number of Bedrooms if 1 or 2 Family. OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of eA Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a.Xconventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ See a e Bed b. ❑Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet ❑Private ❑Joint ❑ Public CAPACITY VI. TANK in allons Total #of Prefab. Site Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xisting Gallons Tanks Concrete strutted glass App. Tanks I Tanks Septic Tank or Holding Tank EJ ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumbe 's Name(Print): Plumb ignature:(No Stamps) MP/MPRSW No.: Business Phone Number: Am� � "-,q � 3� Plumber's Address(Street, State,Zip Co e): Name of Designer: to Vlll. SOIL TEST INFORMA71ON Certifi d oil Tester(CST)Name CST# WA 1,i PL /t/'�//y 97,66 CST's AD RE S(Street, i ,St at ,Zip ode) Phone Number: t fx er 1 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved El owner Given Initial S rcharge Fee n I Adverse Determination Uv •U — z�2 X. CT BENTS/ ASONS FOR/DISAPPROVAL: _ SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequaoies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractpr, ("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 ro ert 5 P Y f P � �. Location of Propertyr, '� ' 1y, Section �, T N - R __ W Township r;Awnl �1�1( . Mailing Address Subdivision Name Lot Number - Previous Owner of Property - Total Size of ParcelC Date Parcel was Created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract .� 3. • Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) eenti6y that att statements on thiA 6onm ace true to the but o6 my (ouM knowte.dge; that I (we) am (ace) the owner(s) o6 the pnopeAty deacAibed in th.i,a .in6o4mation 6onm, by viAtue o6 a wannanty deed eojed in the 066.ice o6 the County Regdten o6 Deeda as Document No. l and that I (we) i pnea entty own the pno pos ed .6 to bon the sewage pas system (on I (we) have obtained an easement, to nun with the above de,6cAibed pnopenty, bon the conatnucti.on o6 sa.id system, an the same has been dut ne�nded in the 066ice o6 the-County RegiAt Dee Document No. f 1 . SIGNAT RE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 1�0 9 � DATE SIGN DATE SIGNED DOCUMENT No. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA y (i QUIT 'CLAIM DEED 41.13 — :_-:_ ' -...._- REGISTERS OFFICE . ST. CROIX CO., WIS. �I Marion P. DeJong__and__Susan H. DeJong,__husband Recd. for Record this 30 ii ay Of April A.D. 19.2 6 and wife I •-----•. •--•••....................••. ---••••-•-•-•-•-••-•••••----•---••••......--- •-•--•••... ••---•--•- 8:30 A A7� quit-claims to ... arren L._ VanRanst__and Linda VanRanst,__ _--- husband and wife, _ as9int tenants, and Sean M -- --- Siefert and Christine R Siefert, husband and wife i ---------- 1100w of 0­- the following described real estate in .....St..__Croix......................... County, - --- - --------� ` � State of Wisconsin: • RETURN TO I i Tax Parcel No: .............................. A parcel of land located in the SW-4 of the SE-1g of Section 24-29-17, Town of Hammond, St. Croix County, Wisconsin, described as follows: Ccmmencing at the S4 corner of j said Section 24; thence East (assumed bearing referenced to the South line of said 4 SE4) 66.01 feet along said S line; thence NO°58120" W 33.00 feet to the point of beginning; thence N0 158120"W 397.04 feet; thence S88 121E 638.60 feet; thence S43°251W 89.41 feet; thence°S3°48'E 312.66 feet; thence W223.32 feet along the Nly right-of-way of U.S. Highway 1112"; thence N7.00 feet along said right-of-way line; thence W 300.00 feet along said right-of-way line; thence S 7.00 feet along said ii right-of-way line; thence W 67.50 feet along said right-of-way line to the point i� of beginning. Subject to a pole line easement as recorded in Volume 1133711, Page I 468. The purpose of this deed is to release that certain reservation of access as more II fully described in that certain Warranty Deed from Marion P. DeJong and Susan H. DeJong, husband and wife, to Warren L. VanRanst and Linda VanRanst, husband and wife I as joint tenants dated December 22, 1977, and recorded in the Office of the Register l of Deeds for St. Croix County , Wisconsin on December 28, 1977, in Volume 567 of Records, at Page 203, as Document No. 345654. II �3I 1 i WNW I i s not p This ........... . . ............... homestead property. + }� (is not) 44— �I Dated this ................................................ day of ../YtQTd— ..........., 19. 86__. (SEAL) /O /GG!�' f .. -.. (SEAL) ------- ......................................... -•---••-•--- ► ..Marion._P.__DeJong-••---. (SEAL) -LL�c? ?J.. -c. ..............(SEAL) ij Susan H. DeJong-------------------- ------------- --•------------•----- •--••-------•-•-------•-----------••-------- --------------• - l II i AUTHENTICATION ACKNOWLEDGMENT Signature TATE OF WISCONSIN es) �I -----------------------------------------------------------------------------•-- 1 i St• Croix--------------County. authenticated this --------day of 1 1 9 19....._ rsonal came before me this ____day of If � C!-! 19.86 the above named ---------- --------- ! --------------------------------------------------•----------------------------- Marion P. DeJon and Susan H. DeJon ,. -------------•------- -- ----------------------------- !� TITLE: MEMBER STATE BAR OF WISCONSIN - i ii (If not- --------------------------------•--------------------------- .................................................. .1�".:».G--°-------- authorized by § 706.06, Wis. Stats.) S:_.,y`. ' to me known to be t erson .._ who exdcute4 the foreg 'ng instrument and knovale�ige \ galYl� �i THIS INSTRUMENT WAS DRAFTED BY -- Thomas A. McCormack Y`I� -------------------------------------------------------------------------------- � --------- -- _ ---- j Baldwin, WI 54002 Notary Public' ' Wis. - - -- - -- - --- - -- -•- - .- - -•- --- -- _C(a[ Courtrj!, j (Signatures may be authenticated or acknowledged. Both My Commission f -is permanent.(If .not,..state"kxglration Ii are not necessary.) date: I.!__X.l{-L;Ill �--•-_---•• 1 1��= •) i , 1� 1 *Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN H.C.MdlerC n%WV� FORM No. 3—1982 Stock No. 13003 Mu..0 M .sen.ln I� H H a S T C ­ 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St . Croix County z d ,+1 a /BUYER_- - ROUTE/BOX NUMBEK Fire Number CITY/STATE._ Gt� _Cc.) ¢ � -'( z 1 e4 f PROPERTY LOCATION : -) 14, 54 Section 2 rr77 Z�, T 2 , N , R Z z W, Town o ^&Al �___ St . Croix County , Subdivision Lot number• 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 i 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 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depa lv ment of Natural Resources . Certification form must be comp ted and returned to the St . Croix County Zon ' Office w in 3 days of the three year expiration date . SIGN G � DATE k2 ,! 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 . w .. INSTRUCTIONS FOR COMPLETING FORM 115 - SRD -6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; . Complete the suitability rating boxes. A SITE IS SUITABLE FORA HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descri;>tions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locatio:is, Drawing to scale is preferred. A separate sheet may be used if desired; S, Make sure your benchmark and vertical elevation reference point ar�clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, floor! plain data, percolation test exemp- tion,if appropriate; 10, If the information (such as flood plain,elevation)does not apply, pace N.A.in the appropriate box; 1 1, Sign the form and place your current address and your eertificatior- number; 12= Make legible copies and distribute as required. ALL SOIL TE �;TS MUST BE FILED WITH THE LOCAL. AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Sy mbols st - Stone (over 10") BR Bed ock cols Cobble (3- 10") SS — Sandstone gr Gravel (under 3") LS — Lim istone *s — Sand HG1N — Higl Groundwater cs - Coarse Sand Perc Percolation Rate coed s — !Medium Sand W — Wel fs - Fine Sand Bldg - Bui'�linq Is — Loamy Sand > - Gre.iter Than 4sl — Sandy Loam < — Les_ Than 'I — Loarn Brit Bro=wn *sil — Silt Loarrr BI Blaz k si — Silt Gy — Grar 4cl - Clay Loam Y - Yelow sci - Sandy Clay Loam R — Re( sicl — Silty Clay Loam niot — Mo ties sc - Sandy Clay wr' - wit', sic — Silty Clay fff fever fine, faint �c --- Clav cc - con mon, coarse pt — Peat nim — Mai y, medium rn Muck d — (list nct p --- prominent HWL — Hig i water level, Six general soil textures sr-rfacc water for liquid waste disposal BM — Bet ch >'4'lark VRP — Vet i ical Reference Point TO THE O WNER- This soil test report is the first step in securing a sanitary permit.The r:ounty or the Department may request verification of this soil test it) the field prior to permit issuance. A complete set of plans for the private sewage system and a permit: application must be subrnitted to tne, tr«rrpropriate local authority in order to obtain a tic°nnait. The sanitary permit muse be obta ned and posted prior to the start of any construction. J DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 F+UMAN RELATIONS BOX 76 11)&Chapter 145.045) pt LOCATION: SECT N: TOWNS NICIPALITY: L NO.: SUBDIVISION NAME: /� TJ H/R E co C UNT OW E 'S BUYER'SSN�ME� p `� MA ING DRESS: ` I U Q f X Q .J E' �C r 4 ' USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI lrE E��IP IONS: ER TION TESTS: [WResidence ❑New ❑Replace (/! d RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: - PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOM ENDED SYSTEM:(optional) ®S ❑U �S 11111,11112,11:111OUND- LSDU OS 2U F]S �U e If Percolation Tests are NOT required DESIGN RATE: I If any y portion of the tested area is in the under s.H63 indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- B- B- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER1003 PER PER INCH P- P- P- P-_ P- P- PLOT PLAN: Show locations of ercolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- 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 percent of land slope. SYSTEM ELEVATION 3 �• s w Ii € — e I • , . j _.. _.,._j ..... ,._(.,,,. �... ... .... v a D E L L• i Ie1'© H - -_. Sa ee� r ey _D _I O ! I Dr - I,the undersigned, hereby certify that the soil tes s repot ed 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 to ation of the tests are correct to the best of my knowledge and belief. NAME (pri t): TESTS WERE CO M ETED O : 'l 10 �Q� 4 ?0 F9 ADD ESS: t CERTIFICA O NUMBE : PHONE NUMBER(optiona0 CST SIG RE: � DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — L • r i _.. �' � __ __. - _ - - 4 -f�G? l - Neff _ Slott's 110 X10,'tew ' 7� - - � - r 1J ! J•l i �v 11 - �r - ;des t d r tt w, l( - w Parcel #: 018-1055-30-000 10/12/2006 04:40 PM PAGE 1 OF 1 Alt. Parcel#: 24.29.17.381 C 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-PARIZEK, PEDER A&TASHIA L PEDER A&TASHIA L PARIZEK 2054 HWY 12 BALDWIN WI 54002 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *2054 HWY 12 SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC dol Legal Description: Acres: 5.680 Plat: N/A-NOT AVAILABLE SEC 24 T29N R17W PT SW SE BEING LOT 1 Block/Condo Bldg: CSM 2/545 5.68AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-17W Notes: Parcel History: Date Doc# Vol/Page Type 09/30/2004 775799 2666/384 WD 08/27/1998 585954 1352/212 QC 07/23/1997 1132/445 QC 07/23/1997 941/186 more 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 27,300 69,600 96,900 NO UNDEVELOPED G5 3.680 3,400 0 3,400 NO Totals for 2006: General Property 5.680 30,700 69,600 100,300 Woodland 0.000 0 0 Totals for 2005: General Property 5.680 30,700 69,600 100,300 Woodland 0.000 0 0 ii Lottery Credit: Claim Count: 1 Certification Date: Batch#: 130 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00