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Parcel #: 018 - 1072 -60 -000 12113/2006 02:52 PM ► 4 ,
PAGE 1 OF 1
Alt. Parcel #: 33.29.17.505 018 - 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
DANIEL P & CAROL A BODISH O - BODISH, DANIEL P & CAROL A
1727 CTY RD J
HAMMOND WI 54015
Districts: SC = School SP = Special perty Addres s " = Primary
Type Dist # Description " 1727 CTY RD J
SC 2422 ST CROIX CENTRAL
SP 1700 WITC X I s J
Legal Description: Acres: 10.000 Plat: 3555 -CSM 13/3555
SEC 33 T29N R1 7W PT NE NW & ! LHE ING Block/Condo Bldg: LOT 1
LOT 1 CSM 13/3555 1 .0O CC
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
33- 29N -17W
Notes: Parcel History:
,,yy Date Doc # Vol /Page Type
04/15/1999 601344 1419/053
l � � 07/23/1997 1006/84 LC LC
07/2311997 956/96
J 07/23/1997 441/462
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
172600 Use Value Assessment
Valuations Last Changed: 08/24/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 7.000 700 0 700 NO
OTHER G7 3.000 16,000 115,400 131,400 NO
Totals for 2006:
General Property 10.000 16,700 115,400 132,100
Woodland 0.000 0 0
Totals for 2005:
General Property 10.000 16,700 115,400 132,100
Woodland 0.000 0 0
Lottery Credit Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
010 - GARBAGE SPECIAL ASSESSMENT 60.00
Special Assessments Special Charges Delinquent Charges
Total 60.00 0.00 0.00
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y 8T CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitarY�rtrU LL ut�g .:
Personal information you provice may be used for secondary purposes (Privacy L Y, s.15.04 (1)(m)).
GARDNER, GEORGE Ih �V�llage Town of: State Plan ID No.:
CST BM Elev - :- Insp. BM Elev.: BM Description: lVU Parcel TdiV- 1072 -80 -000
TANK INFORMATION ELEVATION DATA A9800419
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St / Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet
Air
Septic " NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I N
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION TypeO CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HAMMOND 33.29.17.507,SE,NW 1727 COUNTY ROAD J
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
Y
I
Safety. and Buildings Division
Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue
I n accord with ILHR 83.05, Wis. Adm. Code P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size.
• See reverse side for instructions for completing this application State anitary Permit Number
.3 2- 02, Z, !o
Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)]_ State Plan I.D. Nub
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Property Owner Name Property Location
r mac; 1/4 - 14, S v T-, 0r , N, R� 7 E (or
Pro erty O ner's Mailing Address Lot Number Block Number
/ C c(
City, State Zip Code Phone Number Subdivision Name or CSM Number
1 F BUILDING: p V illa ge (check one) ❑ State Owned Nearest Road
/1 �
Lj Public 1 or 2 Family Dwelling - No. of bedrooms a Town OF c
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 107d,
1 E] Apartment/ Condo 6 ir - -
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 ❑ New 2, ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of T S .#tepair of an
System ________System Tank Only __ Existing System __ ExlstingSystem
B) ❑ A Sanitary Permit was previously issued. Permit Number ate Issued
V. TYPE OF SYSTEM: (Check only one) &ZAft"
Non - Pressurized Distribution Pressurized Distribution Experimental Other
1 IbSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
(�1 IS 9[_ ,c/ Feet - 2,;�.2-Feet
acct
VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanksl Tank
tic Tank ng Tan +^ Q /O ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 10 - ❑ ❑ ❑ 1 ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility fby in tallation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Pe: (No Stamps) MP /MPRSW No.: Business Phone Number:
Plumber's Address ( ree , City, State, Zip Code)•
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issui A Signature (No Stamps)
Approved ❑ CIA Surcharge Fee)
Owner Given Initial p Q
Adve Determin 160
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
1 SBD- 6398 (R.11/97) ,DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber -
T
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently serving
the e- � r ,�,,�� residence located at:
Sec . R Town of - ,,,,, St . Croix
County, Wisconsin. Upon inspection, I certify that I have found the tank and
baffles to be in good condition, and it appears to be functioning properly.
Last time serviced �&
Did flow back occur from absorption system? Yes No (if no, skip next
line.
Approximate volume or length of time: ,:Z� o J gallons minutes
Capacity: f2Q
Construction: Prefab Concrete Steel Other
Manufacturer (if known):
Age of Tank (if known):
(Name) Plea e print
(Title) (License umber)
(Date)
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or
licensed disposer (NR 113 Wisconsin Administrative Code)
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank condition, I
certify that the tank, to the best of my knowledge, will conform to the
requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over
outlet baffle) .
Name - Signature
MP /MPRS �
W isconsin Department of Commerce ..S AND SITE EVALUATION
Division of Safety and Buildings -- — Page of
Bureau of Integrated Services �.
g �� -, r�r�c�th S. ILHR 83.09, Wis. Adm. Code
�d� County
Attach complete site plan on paper not les th4ty 1/2 �1 tttenas in si(e,. t1an must
include, but not limited to: vertical and h ri"bMal refer �' jh1 M), dkaction and 5St. l /
.' Rn
percent slope, scale or dimensions, nort h• arrow, and location an distancs to ri p arest road.
Parcel I.D. #
fC2 - 107 -g0
APPLICANT INFORMATION - Please print all0# 19 tion.; ,( Review d by Date
Personal information you provide may be used for! econdarAt�}yi 6� (1ydvacy Lai; . 4 .tM (1) (m)). �? r
Property Owner Property Location
t .
Govt. Lot J 1/4 N W1 /4,S 33 T QCC ,N,R E (or) CS>
Property O er's Mailing Address - Lot # Block# Subd. Name or CSM#
1 ? C,+Y R 9 I
City State Zip Code Phone Number
❑ City Village ® Town Nearest Road
a w 'r I 501S 1('71V
❑ New Construction Use: ® Residential / Number of bedrooms �_ Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow oQ gpd Recommended design loading rate . - bed, gpd/ft - - trench, gpd /ft
Absorption area required - 55 -7 . a bed, ft O trench, ft Maximum design loading rate
g
p, �1 g g _ bed, gpd /ft trench, gpd /ft
Reeemmvnded infiltration surface elevation(s) I I , y �n ft (as referred to site plan benchmark)
prt5eri-
Additional design/site considerations _
Parent material , _ _________. Flood plain elevation, if applicable tt
S = Suitable for system Conventional Mound In- Ground Pressure AT Grade System in Fill Holding Tank
U = Unsuitable for system ® S ❑ U ®S ❑ U [.�A S❑ U I WS ❑ U I CIS R U ❑ S 21U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 / _ 5
cQ 1 7-aS 1040/3 — L
rs
Ground �j 5.3 7•
elev.
S - 51 R
Depth to
limiting 5 7 O _ 0 y 5 t R! M fa t r fatr ;
in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to ---
limiting
factor
in. Remarks:
CST Name (Please Print) Signature Telephone No.
eL, 2i - ay8 -35V8
Address Date CST Number
X7 to �"" 6+. 5 +c ' V- - q, g as 12
:5 0 ;I A4
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.N
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
i
Ground
elev. ,
ft.
Depth to
limiting
factor
in.
Remarks:
Boring #
I ,
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
n.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
n.
Depth to
limiting
factor
' Remarks:
SBD- 8a','.11 fR. 07/96)
• e LOwq� } Pay-
SE�Iy� Sp-c., 33, .a9N, R
IDo
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address
(Verification required from Planning Department for new construction)
City /State ��.,mr,. -,r1 Parcel Identification Number /"2
LEGAL DESCRIPTION
Property Location 5 y, %<, Sec - L , T aN -R Town of
Subdivision Lot #
Certified Survey Map # Volume . page #
Warranty Deed # r,?� /g9, Volume Page #
Spec house ❑ yes ,l no Lot lines ideatifiable ❑ yes ❑_ no
SYSTEM= MAINMANCE
consists of�pmuwaad=iat=noeofyoc wpticsyst= couldresaltiaitsptematarcfailunetoLandlewast�es .Propermaiabeaanx
can affect function of die SePtic � e � � � or ¢ by 9 P� What you pat iao do system
septic tank - as -a treatmeatstage in the Waste disposal'"Stem.
11 0 PAY owner agrom to wbmif to St Croix Zoning Dgmt=nt i outiHcatioa form, signed by tine ewnec and by a
u = d=pkmbc4jOa1neymanpkmbcr. restrictedpinmberoralicensedpumper verifying thit(1)fireoa-site*rastevatm( sposalsystem
Pr OP condition andlor (2) after inspection and pumping (if accessary), the septic -tank is less .don In full of "sludge.
Uwe, the h=ia a d have c D the above fC
forth, haeia it emeats and agnoe to maintain tiro private sewage disposal system with the standards
.'a set 6Y ffi,e Department of Commerce tad the Dcpattrneat of Natural
Stating Resources. State Of Wiscomin.- Certlocad
that YOur septic q9cm has boon maintained mast be completed and nhrrnad to the SL Croix Coy Zo Office within p
days of the three year expiration date.
SIGNATURE F PUCANT ! ��
A'IE
OWNER. CERTIFICATION
the I (we) certify brat all statcmeats on this form are true to the best of my (our) knowledge. I (we) am (are) the owaer(s) of
Toperw described above, by virtue of a ty deal recorded in Register of Deeds Office.
SIGNA PI;ICANT 1 / T
DATE
« « « « «« Any informatioa that is mis- represented may result in the sanitary perniit being revoked by the Zoning Department « «s « «f
•« Include with this application: a stamped warranty, deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
p ipp----— - -
F
ILED
NOV 1 Z 1998 ® e FEB 9 a
KATHLEEN H. WALSH
2 pepio of Deeds
StCrolxCo.,VVi to ST. CROIX COUNTY
591.443' ` SURVEYOR'S RECORD
V '
CERTIFIED SURVEY MAP
George Gardner
Part of the Northeast 114 of the Northwest 114 and the Northwest 114 of the Northwest 114 of Section 33,
Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin.
UNPLATTED LANDS
NORTHWEST CORNER N R/W C.T H. "✓ " C. T. H. ",I
SECT /ON 33, T. 2911(, R, /7W. , --- "'— — —
O O
\ � I N89" ,'SB "W . SB9 ° 58'58 "E 379.20 h N89 °58'58 "W NORTH 114 CORNER
— SECT /ON 33, r 29 N., R. 17 W.
in 1208.07' '27' 2 4.26 /020.9/'
l\ SB9 °50'45 "E 283.14' _
S'LY R/W N. L INE NW 114 SEC. 33
C.T. H. "J" l00`
B_U ser4 _CK_
_ I — N 89 °58_'58" 2608. IB' _
- -
Na
MQ)
SEP
b l r \�AREAjt /� V
j BEARINGS ARE REFERENCED
TO THE NORTH LINE OF THE
SHED i H NORTHWEST I /4, SECTION
N Z 29 N., R. /7 W., ASSUMED AS
Q I
SHED GARAGE d N 89 ° 58 ' 58 " W,
41 � I
BARN , WF4
! VAR /OUS
n SHEDS
I
QI
N I N
'r'' W 1 LOT 1 Owner's Address:
'k, �� ;; <r. ., 1727 C.T.H. "J"
vj I W Hammond, WI 54015
3 I 11 SCALE IN FEET / " = 150'
CONTAINS 435,607 SO. FT. b
J I N I OR /0. DDO AC.
$ A 0 75 150 225 300 375
h
14 26,537 SO. FT. OR 9.792 M
M ( AC. EXCLUDING RIGHT OFWAY) '°o LEGEND
0
O ' b SET I "X24"IRON PIPE (M /N. WT.
L13LB. IL. F.)
, COUNTY SURVEYOR'S MONUMENT -
' FOUND BERNTSEN NAIL
ft riotr'Ef'�7ft1 +'�Q ���jC0/VS/�����
stp Vt{1; 3U �f11'h ui 2 2 �) , v /
lU _ } V ,�
approvEt ,S,tI511 (:, Ill 2 Vf O i
? 2i ' LX E -FRI E_I)IG�
ft, f� E % •
,!!,, ,,.r•;+ u,� J ' " W PHY a ac
713
N I ALLS, ,:' ,
WISC.
. .... . ....
N 89 1 58'58 " W 379.20' .� I..R� 0 •'S �Q� i,,
UNPLATTED 1 LANDS �'•'s����
urence W. Murphy
Registered Land Surveyor
Revised October 9, 1998
THIS INSTRUMENT DRAFTED BY JERALD L. LARSON SHEET / OF 2
w
Vol. 13 Page 3555
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