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HomeMy WebLinkAbout018-1066-50-100 0 3 o i 3 0 �.> O O E» <» � y � I m I V' t3 o o N C N U m au N Gj f6 o �C OD °+ C O OO 2 ca a). 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Number of feet from well: Number of feet from building: (Include distances on plot plan) . SOIL ABSORPTION SYSTEM Bed: ✓ Trench: Width: / 2 Length: 5V Number of Lines: 2 Area Built: YO Fill depth to top of pipe: .? ,/ if Number of feet from nearest property line: Front, O Side, O Rear,O Ft . Number of feet from well: f/rs�/„p//{ Number of feet from building: > /m0 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: 7 Plumber on job: License Number: 3�8' 3/84:mj Form - S T C - 104 ,. +r AS BUILT SANITARY SYSTEM REPORT OWNER � �,� 'r:U_ TOWNSHIP dtmaw d SEC. T a_%_N-RLZW ADDRESS 1195' ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW I Distances and dimensions to meet requirements of I•IHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM � wry/ F / I C/kON JI, op 17- 6 sY• ---I 67' INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Apne Proposed slope at site: o2 2 SEPTIC TANK: Manufacturer: 4tAoe s Liquid Capacity: 4,800 Number of rings used: �_ Tank manhole cover elevation: /m p,D ' Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side JQRear, O y/0p feet From nearest property line Front,0Side,O'Rear,O > lD0 feet Number of feet from: well building: (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LAWR&FMMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NF'!4,NEt,S30,T29N-R17W CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Numbar: Ilf assigned) Town of Hammond ❑Holding Tank El In-Ground Pressure El Mound HWY TT NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Richard Deiss Box 195 Hammond WI 54015 11"g 41:Od BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: David B. Fogerty i3289 St. Croix 92513 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO ❑YES -]NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: OYES ❑NO OYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODE L. PUMP/SIPHON MANUFACTURER: IWE]YES ARN,, GLABEL LOCKING COVER PROVIDED'. PROVIDED: ❑YES ❑NO ONO I ❑YES ONO GALLONS PER CYCLE: PUMP AND coN OLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRIES'. (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) I ❑YES ONO 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.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH; INOEOF DISTR.PIPE SPACING. COVER INSIDE DIA. #PITS LIQUID 1 BED/TRENCH ^ TRNCHES: MATERIAL: PIT DEPTH. DIMENSIONS (�f( GRAVEL DEPTH FILL DEPTH JOIST R.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING. V NT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET ELEV.END: PIPES. FEET FROM LINE. AIR INLET. NEAREST-► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ❑NO SOIL COVER TEXTURE R PERMANENT MAKERS OBSERVATION WELLS 1-1 YES ❑NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED CENTER. EDGES: DYES ONO ❑YES ONO 1:1 YES El NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.: ELEV.. DIA.: ELEV.: PIPES DA: ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS DYES ❑NO 1:1 YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPE FIT V WELL: BUILDING: FEET FROM LINE: ❑YES 1:1 NO ❑YES ❑NO NEAREST W � , Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: Zoning Administrator DILHR SBD 6710(R.01/82) 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 at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; IF 3. All revisions to this permit must be approved by the permit issuing authority. 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 in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed 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 description where the system is to be installed; li. Type of building or use served: If public is checked, indicate type of use (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 pe rmi t i s for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; 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 constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. 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 disapproved. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 forma -- --------------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. ThiE change in statutes was the ` result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater<-- included the creation of surcharges (fees) for a number of regulated practices which Wiscorsin`5 can effect groundwater. The surchart?,-� took effect on July 1, 1984. All of the water that buried reasurf3 is used in your building is returned tc the groundwater though your soil absorption o system or the disposal site used by your holding tank pumper. a The monies collected' thr ouvr these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(8.03/86) _ _ 1 DIL SANITARY PERMIT APPLICATION COST- In accord with ILHR 83.05,Wis.Adm. Code STAT SANITARY PERMIT# �asi3 -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 I�V/ I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. [FOR VARIANCE ❑YES VIJ NO PROPERTY OWNER PROPERTY LOCATION Richard Deiss NE '/4 NE '/4, S 30 T29 , N, R 17 E (or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME Box195 ----- -------- ----------------------- CITY,STATE ZIP CODE PHONE NUMBER 7n CITY NEAREST ROAD,tihl%OR IkAA "ov Hammond WI 154015 1 (796 2382 VILLAGE : HY TT /ja II. TYPE OF BUILDING OR USE SERVED: nee?— Number of Bedrooms if 1 or 2 Family 3 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 e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. FRI A Sanitary Permit was previously issued. Permit# 5?g 4 S 2 Date Issued 12-31-86 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. ®Conventional 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. ® Seepage Bed b. ❑seepage Trench c. ❑ See a e 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): 98.06 1 624 624 Feet 1;�Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons I Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 1,000 1 Weeks Concrete ❑x ❑ 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. Plumber's Name(Print): Plumb nature:(No Stamps) -W/MPRSW No.: Business Phone Number: David B. Fogerty 3289 715 749-3656 Plumber's Address(Street,City,State,Zip Coe: Name of Designer: Focferty H ts. Rd. Roberts WI 54023 D. B. Fogerty VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# David B. FOGERTY 3233 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: Focrertv Hcfts. Rd. Roberts WI 54023 749 3656 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) rcharge Fee Approved ❑ Owner a Given Determination al X00.00 Z �L� )� )� (� � Adverse Determination � 'f Q X. COMMENT /REASONS FOR APPROVAL: In l,' P(j�Pw� b,� a C . rtels�,� SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy T -- -au 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 inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property RC,L4 4, L"j, O`cl s S Location of Property NE _14, Section 3 , T 9--9 N-R /7 W Township 1 4 Cl kp. )-I-.a � d Mailing Address Address of Site /l�T far 3 1 G 4-. ri.,0h 01 �,t/ 5�4/U % 6- Subdivision Name : Lot Number Previous Owner of Property Total Size of Parcel g Gres Date Parcel was Created Are all corners and lot lines identifiable? L1� Yes No Is this property being developed for resale (spec house) ? Yes No Volume '74 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION I (We) eeAti6y that att statementd on this 6onm ane true to the best o6 my (oun) knowledge; that I (we) am (are) the owner(s) o6 the p topeAty du cA i,bed in this .in6oAmation 6oAm, by vahtue o6 a waAAanty deed neeonded in the 066.ice o6 the County Reg.i,bten o6 Deeds as Document No. q2.o 6 b 6 ; and that I (We) pneaentey own the proposed 6 to bon the sewage di.spo.s .dyes em (on I (we) have obtained an easement, to nun with the above dean bed pupenty, bon the eonstnucti.on o6 said dyetem, and the same has been duty neeonded in the 066.iee o6 the County RegiAten o6 Veeda, ae Doewnent No. ) , SIGNATURE 00,OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF,WISCONSIN FORM 2—1982 420M �i iEG15M5 OFFICE U4 VAG 1 ST. CROIX CM, W IS. ; Recd. for Record Nm 26th Mary Russell , a/k/a__Mary T. Russell , ---- . Dec. a single person day 0 3___A.O► 198 u ----------------------------------•---------------------•-------•--------------------------------------------- i f M. conveys and warrants to .._..Richard W. DeisS and Sherry S. • # __---.-Deiss_,-. husband__and-- wi-fe.,_._as- _surviy61shi mari-ta_l-_property_---------• __ - -- --------------- ------- i i --------------------------------------------------------------------------------------------____________ I RETURN TO ________• ' -------------------------------------------------------------------------------------------______-_--___-_-_-. - , �j the following described real estate in .......S.t.___CroiX_ County, j State of Wisconsin: Tax Parcel No- ------------------------------ A parcel of land located in the Northeast Quarter of the Northeast Quarter (NE4 of NE4 ) of Section Thirty ( 30) , Township Twenty-nine North (T29N) , Range Seventeen West (R17W) , more particularly described as Lot One ( 1) of Certified Survey Maps in Volume 6, page 1712 , as Document No. 417315 . I' (' I I Q FEE i This -__1S riot......... homestead property. (is not) it iException to warranties: easements and restrictions of record . I I i 4- i Dated this ---°UP --•------------------------ day of ------------ -----December-------•---------- ---------- 19.86.... i i �2-1�-'."_..`-----(SEAL) � ii -------- ------ ----------•-----------•--------------•-------------(SEAL) --------------- -------- -- ----- ���.--- - , Mar Russell_ ---------------------------------------------------------------- --------y---------------- ---------------------------- l i (SEAL)----------•---••-------------•-----•----------.(SEAL) ------- ------ --- ---------------------•-----.-.....------- ----- 1 * ------- ` AUTHENTICATION ACKNOWLEDGMENT Signature(s) ----------------------------------------------------------- STATE OF WISCONSIN ss. -------------------------------------------------------------------------------- St_..._CrO1X---------------County. authenticated this --------day of--------------------------- 19...... Personally came before me this ......day of --________December____.______, 19.86___ the above named ------------------------------------------------------------------------------- Mar Russe 11 a _k a Mar i -- T-.---Russell sse 11 ---------------------------- -- TITLE: MEMBER STATE BAR OF WISCONSIN ----- -------------- - -- - -- (If not, --------•--------------------------------------- -----•----- ---------- authorized by § 706.06, Wis. Stats.) to me known ��ik►� tt n _________.._ who executed the foregoi ipl6e wledge the same. THIS INSTRUMENT WAS DRAFTED BY a,'i�•• • • — — ---•-------- Thomas.-A. McCormack ----- ---- --- ----- _ r� L Ry= - by.�d S --------------------- ___-_---Baldwin-L-_WI 540Q2 Notary County, Wis. , 1 ---.•.*_--------- (Signatures may be authenticated or acknowledged. Both My Con'isnis�s �a ��rnt.( ,' not, state expiration i are not necessary.) date: a ••'��•��s`',, a�a. .RWi�aCA��'��� j{ _ *Names of persons signing in any capacity should be typed or printed below their signatures. �. H C Mille.Cm nanv� STATE BAR OF WISCONSIN .: r nn*, *7.. C#�. Nn. 1_ nil? H . • z y H a STC - 105 t4 a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z cy a OWNER/BUYER Qjc kkr-f - W. 1.D C-J-5 � ROUTE/BOX NUMBER 193 Fire Number .CITY/STATE Na h-, ti.a �-v� (,i/,. Z I S"4013- PROPERTY LOCATION: Nr7 // ;&, Section 30 T -L N, R�W, Town of T7gb„ rr, o Ad , 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 pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. yo E I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth , herein, as set by the Wisconsin Depart- b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date. / (� S I G N E D_ .,r,h.l✓� (,f/ jz� DATE �76 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. I INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 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 corrrmercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT EASED ON SOIL CONDITIONS; 0. PLEASE rise the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates,names,addresses, flood plain data, percolation test exemp- tion, it appropriate; 10. If t=-,e informal ion (such as flood plain, elevation)does not apply, place N.A. in the appropi iate box; 11. Sign the form and place your current address ar,d your certification number; 12, i�llake legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. i ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10„) BR - Bedrock cob CoblYe (3- 10”) SS - Sandsl.one (tr Gravel (under 3") LS - Limestone S - Sand HGW - Nigh Gio nndwater cs Coarse Sand Pere -. Pr rc:o(ation Rate med s - Medium Sand W ._ `v'te!1 is - Fine Sand Bldg Building Is - Loamy Sand > -.. Greater Than sl - Sandy Loam < - Less Than - Loarn Bn - Brown sii Silt Loam 81 - Black si Silt Gy - C3rwy c, -- Clay Loam Y - Yello"nl scl - Sandy Clay Loam R - Red s i c I - Silty Clay Loarn mot - M(it i`es w - Sandy Clay w! - twit{, sic - Silty Clay fff - fevv, fine, faint c Clay cc - ('1orrimon,coarse, l-t1 -- Pcat mrn - Many, medium m - Muck d - distinct p -- prominent HVVL - High vvater level, Six general soil textures sr"rface vvater for liquid waste disposal BM - Bench Mark V RP Verti c i Reference Point TO THE OWNER: is the first ,tap il�r_i,r,rF,:;�r �snitlry t�ermst. The cci.;r�ty or the Department rr�ay request ;'ui. tr.St =.) the field !7;'?4 t€. ' ,��Iort. .ssu,3 we. A €c rnpletu �c i of (or the private Jc: syslem o;j a ij-,rnlii at)plicatio i tnus' ?.f§ '{t h mtted to the appiopri,oe Kcal a?iih-riI, ii i Order to ,,,'r1fZ1 # ooi ir?t:. to c 5zip ;i"'y' }7£'}rr'o n .,t ';3e --I+A and p£isted piioi- m the start of wly cons"!uction. I 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY,. C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 537907 9 53707 HUMAN RELATIONS (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.:BLK.NO.: SUBDIVISION NAME: NE '/NE'/ 0 /T 29 N/R 17 E (or)W --- --- ----------------- Hammond COUNTY: OWNER'S f S-NA+AE: MAILING ADDRESS: St. Croix Richard Deiss Box 195, Hammond, WI 54015 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 New El Replace I 4/1V 1/19/87 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDINGTANK: RECOMM ENDED SYSTEM:(optional) ®S ❑U ©S ❑U ©S ❑U 12SOUIRISOU19ravity 12 x 52 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: n/a I Floodplain,indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- / ///, da,� /UIfX� > .6 / / rns ,L' .•, his B- > 00$ di, w 7 1/' , In B- B- $� / B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERI002 PER PERINCH P- / z ' i P- P- 3 3 3 P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the 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 98.06 i � � I e 3 a— t ! ! ----i � t , 3 A*ENDED .R PORT: The uild .t r) p inthe hie bsf T_ wi thout I refe n ing ----- T _ from �er' mark therbby� makin4 the primar� field � tkl - ystem1wnorha ] a roved usin .. _ i� t � c re the.-�. �,a���zn� o�E� �f �. ,.�� , E E , tN T e bor h i w r .re¢lug and perked-. i - NOTE Teste tnotl esi there i� a dislcrepency kbetwe0n bore hole elevations of 1 5 lore holes '2,1,,_4_ ,_dbub eehecke1d the me re ev to s as e rre tkr ow#reason for he I di ffe enee s .. _ _ 1 � 1 I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: David B. Fogerty 4/19/87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): Fogerty H ts. Rd. Roberts WI 54023 3 - DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — i 1 ti � 1 � o A � n N In C I X I fIl n i V V i i I Ii f i � I I I ' I DD o I b o � I e �. 4' �l lf. � I v I t b M i IIz ti I , , 1 ��_ � � ',''"\ � n �.' i r7 � `,' �� , �� -F `' � :_ --,�_ ��� i . I: • �- �, n �� I ; � �' !�� !� A' , I � '�9` �� � ' i i� I;�' I� i d ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) <= 425-8363 (RIVER FALLS) -'= HAMMOND, WI 54015 April 27, 1987 Ms. Vicki Smith Bureau of Plumbing 201 E. Washington Avenue P.O. Box 7969 Madison, WI 53707 Dear Vicki: Enclosed you will find permit No. 88459 which is being replaced by Permit No. 92513. The reason for the new permit is that when the footings were put in for the basement, they were put in further than what originally planned and the septic system had to be redesigned. Also, you sent a letter requesting how many bedrooms this system is, it is a 3 bedroom home. If you should have any questions regarding this matter, please feel free to give me a call. Sincerely, * O,A) Roxann Croes Administrative Secretary Q� Y E ocr E c9 w N F LID C «m 3 y C a C !�1 o �2 > a of m o 00 o na > m > a 0 E :° � . r � y m rn CQ o gE E N w d c, . 0 ` F = c o«— c a c �. Q• F- d EdN o _m Q oa ° dv > � � F w e rn c Cc Z 23 - dog > am Q � F N N > Z E NaU 3= a > - r V E n a o U m = E.- /Y' Ri: H M a O L.L W w E E EM O :� m y c am Lf) c 'c > oo aQ .� � � �, LL M r co C'D N « N — a1 N N ? C LA `.� E 3 O a3 O « " 0, ... N C V C U W c m« c H 3 E« d C =w oc v 0 .3 d E 2r „ � d � O W o f T a a) 0 m � N a E O U F- I a) m- >.a a c _ >o t ;? CL Q nN 0> o m >- CD d ° of �� 3c W Hd _ a ,r _ _ 2 om cm, cENd mo �. cc 0 > W C,O1 , w w C T d ; a, N'm 70 1 > m d C c E d Y �v W T tm ; c r d _. ro ,tea ~.° ~ o CL:~ cco U � m a ~ m Q ` a ° a z > 3 E ° W ^ � V Z mQ ao uHoa v� a> o ` wy , a Z w z O U z LL U) Z F- 0 O o W oU U U) z z cr D _> D LL � m o Q Z cr � W 00 � U) CLO cr Z o to U U Q F— _ 0 � J U U Q ~ Ir 0 C) m cr LL W J L U w m U) m >U) 0— X F- W O ~ N f+ m LL Ir ff ao CC co O p W co Z W Z � m Q U —� COO* 0 12— F— < _ O z = cc DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 796`5 BUREAU OF PLUMBING MADISON,WI 53707 ENCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (If assigned) El Holding Tank ❑In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Richard Deiss Box 195, Hammond, WI 54015 '1' 17 " X) BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: NE NE, Section 30, T29N-R17W, Town of Hammond Name of Plumber: MP/MPRSW No.: County: sanitary Permit Number: Dave Fogerty 13289 St. Croix 88459 SEPTIC TANK/HOLDING TANK: MANUFACTUR LIOUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.: IWARNING LABEL LOCKING COVER PROVIDED, PROVIDED: O ❑YES ONO DYES ONO BEDDING: VENT DIA.: V FEET FROM ENT MATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: 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: DYES ❑NO ❑YES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. IR NLOT RESH (DIFFERENCE BETWEEN FEET FROM LINe PUMP ON AND OFF) ❑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.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: TRENCHES DISTR.PIPE SPACING MATERIAL: INSIDE DIA #PITS LIOUID PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL. BUILDING. V NI LE FRESH BELOW PIPES-. ABOVE COVER. ELEV.INLET-ELEV.END: PIPES. FEET 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 R EVE RSESI DE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO OIL COVER TEXTURE JPIRMANENT MARKERS OBSERVATION WELLS DYES El NO 1 1:1 YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. S MULCHED CENTER: EDGES: YES NO ❑YES ❑NO 1DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. fSTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.'. ELEV.', DIA.. ELEV: PIPES A.: E LEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS ❑YES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY IWELL: BUILDING: FEET FROM LINE: 1 wI El YES 1:1 NO ❑YES ❑NO NEAREST U ? 51 / Sketch System on ,% Retain in county file for audit. Reverse Side. SIGNATURE: TIT LE. DILHRSBD6710(R.01/82) S 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 at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved.by the.permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (riumber of bed rooms, etc.), depth of system, or type of system-, 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be- submitted-to the county prior to installation; , 5. Private swage systems musf-be`properly maintained. The septic tank(s) should tDe {dumped by a I•icense'd 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: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (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 for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; 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 constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. 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 disapproved. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or.with cQmplete,dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form, ------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 198S, Wisconsin Act 410 was signed into 'aw. This legislation is more -M commonly known as the groundwater protection law. This change in statutes was the result of oJer'2 years of steady negotiation.and public debate. The groundwater-bi.l Ground at8f--" included the creation of surcharges (fees) for a number of regulated practices which Wiscon�in' can effect groundwater. The surcharca_ took effect on July 1, 1984. All of the water that buried reasree is used in your building is returned tc the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund admmis- tere(j by the Department of Natural Resources. These funds are used for monitoring ground- f eater, groundwater contamination investigations and establishment of standards. Groundxat� _ it's worth protecting. 3D-6398(R.03/86) l DILHF� SANITARY PERMIT APPLICATION Coy 9 1LH In accord with ILHR 83.05,Wis.Adm.Code TA SANITARY PERMIT STATE # –Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/z 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 ❑ NO PR ERTY OWNER PROPERTY LOCATION ,q ` s '/a '/4, S Jp T , N, R 7 E( PR PERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE7 ZIP CODE PHONE NUMBER CITY NEAREST ROAD, �.yJD LAGS LVTOWN OR J"w II. TYPE OF BUILDING OR USE SERVED: 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. [K New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ 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. LJ Conventional 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. Fkrseepage Bed b. ❑Seepage Trench C. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): ,—,/ 42 LKP ' ❑Joint ❑ Public • Feet rrvate VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or44ytd#mwWeyA El 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. .e Lumber's Name(Pr' t: umber's i nature:(No Stamps) MP/MPRSW No., Business Phone Number: c 3�a9 �6 er's d ess(Str e,Ci fate,Zip de): Name o esigner: VII . OIL T S INF iION ertifie it AMP CST# ST's ADDRES (Street,Ci ,S ate,Zip Co be) Phone Number: - 7"ff 1 UNTY/DE ARTME USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Sign re o s) XApproved ❑ Owner Given Initial Surcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INDUSTRY, OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY,' DIVISION LABOR HUMAN NDLATIONS PERCOLATION TESTS (115) '4 MADISON W 7969 (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP/�: OT NO.:BLK.NO.: SUBDIVISION NAME: �/E�/ /T N/R/ E c — — COUNTY: UYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERCIAL DESCRIPTION: �,/ PRO DESCRIPTIONS: A TESTS: PlAesidence 7 L'7 New ❑Replace 7 RATING:S-Site suitable for system U-Site unsuitable for system ON_VENTI❑N� . MOUND:�� Q� IN-GROUND-PRESSURE:SSTEM-IN-FILL HO_LDINGTANK:RE�MMEN�D SYSTEM:(optional) rL J].J� U S LrJ]�V, L��7,J` U / , _71 If Percolation Tests are NOT required DESIGN RATE: 4 I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGIT—EST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- > y' 7 8 B- 2 'V0. > e7 S ' S B- 3 71 11PA1 z > i ' w s B- �. 6 77 'ffr y d s B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD PER INCH P- S s 8 S Sr P- P- 27 1c, g— 2 P P- ✓ V / i i Z PLOT PLAN: Show locations of percolation 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 __--___ l i a 1..__._ -----.._. le r1l of. I i I 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. E print : TESTS WERE COMPLETED ON: AtPE�ESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): o L .J ST SI N URE: �6 6c Y- P I �� 5��03 \ i i DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 M.02/82) —OVER — I r I O I � I ► � � w44 � Its l vz : i � IN V � p D u � o n � o � o o � I r k— rN o y M i 4 �o 0 I o o � c ti i w 1 _ l y � i ti � l I i h Ak I .7/3fgG CERTIFIED SURVEY MAP LOCATED IN THE NE 1/4 OF THE NE 1/4 OF SECTION 309 T29N, R 17W,TOWN OF HAMMOND , ST. CROIX COUNTY, WISCONSIN. OWNED BY: MARY RUSSML RT 1 HAMMONDPWI 54015 **SEE SHEET 2 OF 2 FOR DESCRIPTION" 4b= SECTION CORNER AS NOTED. Ow SET 1 "X 24 " IRON PIPE WEIGHING 1.13 LOS . PER LINEAR FOOT. U NPLATTED LANDS NI/4 CORNER OF SECTION 30, NE CORNER OF SECTION 30, T29N, R17W.(2"IRON PIPE T29N,R17W.(COUNTY SET. SURVEY MONUMENT FOUND). NORTH LINE OF THE NE 1/4 C of EAST • T. H. EAST 400. 00 ' TT "' WEST 1480.60 °o, 8 in 743.00' _ M WEST 400.00' _M right-of-way line �. to to W• N N �• �'• � � � ^ W• a. Z. ^I N LOT I N (Ij J; Q• ai 2.50 ACRES 01 �• �: a• J; = N 108,900 SQ.FEET) N = Q• Z• Z. (2.20AC.TOR.O.W.LINE) H ..�• Q. O (95,700 SQ.FEET) .' O' Q.. J• WEST 4 00.00 UNPLATTED LANDS . . . . . . . . . . . . ... . . . . . . ... NOTE; BEARINGS ARE REFERENCED TO THE NORTH ,aN111NNp� LINE OFTHE NE 1/4 OF SECTION 30, T29N, R17W. �� yGONZNz (ASSUMED WEST) �' � I , JAMES M. �• - 1804 • S• 1804 $ Z SPRING VALLEY WIS. S S C A L E I = 100 11111 f JAMES M. WEBER S- 1804 0 ' 50' 100' 200' WEGERER,WEBER AND ASSOC. RIVER FALLS, W I. DATED W\%•1- SHEET I OF 2 . 88- 143 ) 1 1712- THIS INSTRUMENT DRAFTED BY Z),;, � Parcel #: 018-1066-50-100 08/14/2006 08:47 AM PAGE 1 OF 1 Alt.Parcel#: 30.29.17.452B 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-DEISS, RICHARD W&SHERRY S RICHARD W&SHERRY S DEISS 1573 CTY RD TT HAMMOND WI 54015 Districts: SC=School SP=Special Property Address(es): `=Primary Type Dist# Description * 1573 CTY RD TT SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.560 Plat: N/A-NOT AVAILABLE SEC 30 T29N R17W PT NE NE BEING LOT 1 Block/Condo Bldg: CSM 6/1712 2.50AC&PARC DESC; COM NE COR SEC 30;TH S 89'W 1143.00FT TO POB; Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH CONT S 89'W 168.61 FT;TH S00'E ALNG 30-29N-17W W LN 272.27 FT;TH N89'E 171.60 FT TO SW COR LOT 1 CSM 6/1712;TH N 00'W ALNG more Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1176/154 WD 07/23/1997 764/146 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.560 30,700 163,900 194,600 NO Totals for 2006: General Property 3.560 30,700 163,900 194,600 Woodland 0.000 0 0 Totals for 2005: General Property 3.560 30,700 163,900 194,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00