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Parcel 018-1 12/21/2006 09:21 AM
060-80-000
PAGE 1 OF 1
Alt. Parcel 26.29.17.413A 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 - FERN, DUANE M & DAWN D
DUANE M & DAWN D FERN
716 200TH ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 5.830 Plat: N/A-NOT AVAILABLE
SEC 26 T29N R17W 5.83 AC E 264' OF S Block/Condo Bldg:
962' OF SE SE
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/15/1978 579/272 WD
2006 SUMMARY Bill M Fair Market Value: Assessed with:
172475 128,500
Valuations: Last Changed: 10/22/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 26,000 68,100 94,100 NO
PRODUCTIVE FORST LANDS G6 3.830 4,800 0 4,800 NO
Totals for 2006:
General Property 5.830 30,800 68,100 98,900
Woodland 0.000 0 0
Totals for 2005:
General Property 5.830 30,800 68,100 98,900
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
• AS BUILT SANITARY SYSTEM REPORT
^.'N ER TOWNSHIPt/g I AlSEC. )_41_ T_LN, R_IZ_W
.0. ADDRESS L,, , ST. CROIX COUNTY, WISCONSIN.
'IBDIVISION LOT LOT SIZE ;l f,,,,, c
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
de
lie 64, y-
tom" S~A3C `Tf{~ivCyrS
,,"<r 0V T
i
:PTIC TANK( G't'' LMFGR. c } c y CONCRETE X STEEL
NO. of rings on cover Depth I- DRY WELL
'.ENCHES NO. of width ~ lengthy area f
`.D no. of lines width length ti area
,,depth to top of pipe
GREGATE
::RK RATE Z, m, _ AREA REQUIRED _ AREA AS BUILT % .
sciaimer: The inspection of this system by St. Croix County does not imply complete
'mpliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
stem operation. However, if failure is noted the County will make every effort to
termine cause of failure.
.EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECTOR i
DATED /C' rf 7 S' PLUMBER ON JOB ,ft = f - l w~
LICENSE NUMBER.
I - i
E
' 9
R,P0P,T OF IJISPrCTION--I7IDIVIDUAL SEI`IAGE DISPOSAI, S1'STE11
Sanitary Permit ?f~
t
l z e Septic
1E TOWNSHIP
_9 F.- _C _r 0-1 County
SEPTIC TA'.71
Size f~ gallons. `umber of Compartments .
Distance From: Well ft. 12% or greater slope
f 1.
Building` ft. Wetlands ft
Iiighwater ft.
DISPOSAL SYSTEM Tile Field or Seepage Pit(s)
Distance From: i1ell ft. 12% or greater slope' ft
Building; ft. Wetlands ~ f
FIELD i,ighwater ft.
Total length of lines ft. Humber of lines Length of
each line eft. Distance between lines ft. Width of the
trench -ft. Total absorption area sq. ft. Dept::
of roc's, below tile in. DP-pth of rock over tile in. Cover
i. r
aver . rock", . Depth of tile below grade ;n. Slope of
trench in ner 100 ft. Depth to Bedrock ft. Depth to
',round water ft.
PITS
Number of pits Outside diameter ft. Depth below inlet
ft. Gravel around pit: yes no. Total absorption area
__s q . ft.
.Square feet of seepage trench bottom area required
:square feet of seepage nit area required
Inspected by: Title':.
Approved Date 197
Rejected Date 197.
, p~ ~ spy .
I-k
EHy115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: ? Y4, : '/4, Section -fit= , T4N, R ZEW W, Township orQNbr*miW~ ff~ A4~aa'
Lot No. , Block No. County
Subdivision Name
Owner's Name: 24(, A/ & re z? N
Mailing Address: 7 C/ L, JAI
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT X
DATES OBSERVATIONS MADE: SOIL BORINGS ~,l/ 7 - PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P
P-
110,
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B-
B-
aZ
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
or distances. Give horizontal and vertical reference points. Indic a lope.
44
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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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) &9 /f / e SA l Certification No._ % ` J _
Address fi R / 6L of A/ Lie n C, ( V
Name of installer if known 0'¢4 e- S MY ;7-&
COPY A -LOCAL AUTHORITY CST Signature ~ ~ ~
P LB67 State and County State Permit #
Permit Application County Perm t #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
A/-/Y : RN 1 i WI.y Vic.
B. LOCATION: Y4 s Y,, Section 2&' , T 2Z N, R / fir) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township ,4Ai d rsNd
C. TYPE OF OCCUPANCY * Co
: mmercial *Industrial *Other (specify) *Variance
Single family _ Duplex No. of Bedrooms .3 No. of Persons
D. TYPE OF APPLIANCES: Dishwasher ( YES NO Food Waste Grinder_~(_YES NO # of Bathrooms-
Automatic Washer RYES NO Other (specify)
E. SEPTIC TANK CAPACITY-/07-V7- _Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement Pre t
'Poured in Place Steel Other (specify)
EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) ,6- Total Absorb Area l sq. ft.
.dew ' Addition Replacement X *Fill System ,
Seepage Trench: No. Lin. Feet p O Width Depth Tile Depth - No. of Trenches 1;2.
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land jar Distance from critical slope So
i, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
"visconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester, r
NAME C.S.T. # 17 G ~ and other information
obtained from 12L~,Ame= v (owner/builder).
Plumber's Signature MP/MPRSW# jffj~-,e~~ Phone #,,26JV
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
I H62.20, including well).
i D00 r+~ ~Pr~:c r4wK
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Do Not Write in Space Below FOR DEPARTMENT USE ONLY
Date of Application Fees Paid: State (J ~l~ County Date Permit Issued/Refected (date) Issuing Agent Name
Inspection Yey~' No Valid# Date Recd _
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1 /76