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Parcel 018-1036-50-000 01/19/2007 03:28 PM
PAGE 1 OF 1
Alt. Parcel 16.29.17.255 018 - 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 - LEWIS, DUANE L & LORNA D
DUANE L & LORNA D LEWIS
1667 HWY 12
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1667 HWY 12
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 16 T29N R1 7W 40 AC SW SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
172220 Use Value Assessment
Valuations: Last Changed: 07/14/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.000 4,100 0 4,100 NO
UNDEVELOPED G5 1.000 100 0 100 NO
OTHER G7 2.000 26,000 127,100 153,100 NO
Totals for 2006:
General Property 40.000 30,200 127,100 157,300
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 30,200 127,100 157,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 145
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
OWNER Duane Lewis TOWNSHIP Hammond SEC. _1_&_~~N-R1ZW
ADDRESS Hammond WI 54015 ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
ERYTHING WITHIN 100 FEET OF SYSTEM
L t
ILI
- - _
c
J
I di a e o thl Arrow I
- t _ ~ cif - - _ _
SCALE . 1
BENCHMARK: (Permanent reference Point) Describe:
/ d
Elevation of vertical reference point: S1oPe at site:
SEPTIC TANK: Manufacturer: K-' Liquid Capacity: ~ -
Number of rings on cover t Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer Number of gallons _ _
Number of ga pump set for a cycle gallons; tot--- ate- capacity
distributi 1 es gallon: size of pump _ head;
gallon p minut horsepower ; brand name of pump
and mo el number
Type f warning device
HOLDING TA Manufacturer Number of gallons
Elevatio of manhole cover
f e o wa ning device
p T---
SEEPAGE PI S ZE: um er o pits ee ter
feet liqVi d depth seepage pit inlet pipe-elevation
botto o eepage pit elevation feet.
SEEPAGE BED SIZE: number of lines 1-2-- widthi le ~gthtile depth,
SEEPAGE TRENCH: width length
PERCOLATION RATE AREA REQUIRED-~- AREA AS BUILT
INSPECTOR
DATED- PLUMBER ON JOB__ -
LICENSE NUMBER
y C? Y ":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
CONVENTIONAL ❑ALTERNATIVE State Plan l)D. Namibia,
(
❑ olding Tank ❑ In-Ground Pressure ❑ Mound If assigned
NAME O JERM1T HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
~ r
BE CH MARK (Permanent re erenc.. point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PL ELEV.
I v3.25
MP/MPRSW No County. Sanitary Permit Number.
Name of Plu
33
i ~_6 y / 2
SEPTIC TANK/HOLDING TANK: S ° -7
MANUFACTURER . LIOU10 CAP ACITV. TANK INLET ELEV.. rTANK ELEV. WARNING LABEL LOCKING COVER
r 1< C' / S PROVIDED: PROVIDED
.~J KYES ONO DYE 'IN
BEDDING. VENT DIA.. VENT MATL HIGH WATER NUMBER OF ROAD. PROPERTY WELL: fILD111VENT TO FRESH
ALARM FEET FROM AIRI L
YES ODYES ONO NEAREST 11
SING CHAMBER:
MANUFACTURER BE DOING: IQUID CA ACITN P MODEL PUMPtSIP ION MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
OYES ✓ `r DYES ONO OYES ONO
GALLONS PER CYCLE: PAND CONTROLS OPERATIONAL. NUMBER OF PHOPE RTV WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM uNE AIR INLET
PUMP ON AND OFF) EYES ONO INE _AREST-~
SOIL ABSORPTION SYSTEM. Check the soil moisture atthedepthofplowing lr,'FTER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until L FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF JDISTR. PIPE SPACING; COVEH INSIDE DIA 'SPIT LIQUID
BED/TRENCH I Z U TRENCHES MATERIAI PIT DEPTH
DIMENSIONS .
(,J,-F OF I'T11 FIt . L. DEPTH DISTR_PIPF DISTH PIPE DISTR. PIPE. MATERIAL. NO. STR NUMBER OF PROPERTY WELL. BUILDING. VENTTO FRESH
BF 1 "(V PIPI s ABOVE COVER ELEV 1NLer ELEV END PIPES FEET FROM uN~ 0~ 77 AIR '
Z LO 9~ Z NEAREST---s_1 GI
MOUND SYSTEM: CDC-` 0'3
Mound site plowed perp ndicular to sl pe Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
and furrows thrown 770N
meets the criteria for medium sand. TIONS MEASURED.
DYES SOIL .`OVER. TEXTUHE PERMANENT MARKERS. OBSERVATION WF ILLS
DYES ONO DYES ONO
DEPTH OVER TRENCH .B IDUPTF/ )VFR IRENCH/e DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER FDG
DYES NO DYES NO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
CI.N G` GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
SPA
WID rll LENGTH NO. OF LA7.1';
BED/TRENCH TRENCHE
DIMENSIONS
PUMP MANIF /E TR PE ANIFO ED MATERIAL'. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
MANI
ELEV. ELEV. DIA. V # PIPES DIA._
ELEVATION AND
[DISTRIBUTION
HOLE SIZE HOLE SPACING:' /L LF-, ' CO ECT COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS
f
_ _ ES NO DYES ONO
COMMENTS: PERMANEN ARKERS. OBSERVATION WELLS: TNFUEET MBER OF PROPERTY WELL: BUILDINGFROM uNE❑ YES ❑ NO ❑ YES ❑ NO EAREST
s p 4tt w E A cam, ,
I
Sketch System on Retain in county file for audit.
Reverse Side.
SIGN ATI,,,{k3E""" TITLE jjj
DILHR SBD 6710 (R. 01/82)
REPORT OF INSPECTION - INDIVIDUAL SlWAGE SVSft M
San.~,Will PcAm( t
Slate Sptic Sia33
w A M I (ri~!L~ ~ S T o w n s h p-- C n u i x C u vl 111
location S _ Section/4~ Lo-t # SubdU_v4,5-i_ovl
`;I PTIC TANK
St ze gak.~on.6 NumbeA o{ eompaAtment.3
Ui6tavi ce AIovn: weff_ Bit Ifd'i.ng - 12 5fo.e
H.('. ghwa teA
PUMPING CHAMBER
Size gaUons _ Pump ManuAae.tuAeA Mudek NumbeA
HOLDING TANK
Size ga fon6 Numbers oAj CompaAtmevn-t,s
Pumpvq keaAm ~yh.te.m
Dt,S-tanee {nom: Weft Bui -Ed.iny 12o hkopc
H.i.ghwa.tcA
ABSORPTION SITE
Bed TA evnch
1) 5 tavnce AAOm: Glee 8u,ikding- t2° A Rope -
H4.ghwa.teA
ABSORPTION SITE DIMENSIONS
W4dth o6 tit, eneh t Rc(Iii cd aACa At
Length oA e-aeh E-ine Ayt Depth oA lwcfz bcl'ow t(Xc IVI
NumbcA (YA kEnee Depth oA Aoch ovl'A t (ec <n
It tae fenq.th 0A Q4_neIS At Depth oA ttXe bcCow (I a(1c (YI
D~-Stay?cc between P.ineA 61 Skope (IA thevi ch gyn. L~n 100 1
1,<< i111~unp-1-(UVI a 1 a -_61 Typc oij CUVefl : PapeA on n t~l(m)
I'll DIMENSIONS
NumbeA oAj p~tb GAave( aAound pc t5 yc~ no
Out64de- d.('amete)t 6-t Depth below inYct -Ait
IotaE absoAp-tion aAea - -{~t
Anca AequiAed 6T
INSPECTED BV TIILI
APPROVED DATE 198
RE JE CTED DATE 19 8
REASON FOR REJECTION
I
SAFETY & BUILDINGS
QEPARTMENT OF APPLICATION
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address:
Property Location: Ci y, Village Township: ou :
'/4S /vz`; N/R /'7 f(or) W
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
- A (If assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY a
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: f -
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ?-Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
if - c Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
17~%Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: M /MPRSW No.: Phone Number:
PlumbPsAd'dreg: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signat a of Issuing Age t: Fee: Date: 13 APPROVED Sanitary Permit Number:
❑ DISAPPROVED
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
DEPARtMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY',.
DIVISION
L LABOR P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
LOCATION: SECTION: OWNSHIP MUNICIPALITY: =NOIBLK. NO.: SUBDIVISION NAME:
Tom; NRi7fior) W -
COJUN Y: WNER'S BUYER'S NAME: MAILING ADDRESS:
7
=J / (Airtrn Lo is USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: R TONS: PERCOLATION TESTS:
Residence ❑New XReplace I s s =v5 _
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
InS ❑U LNS ❑U ❑U ❑S U ❑S U eloe4i~_'1_12~1~1),-"-l
F ercolation Tests are NOT re uired DESIGN RATE: SYSTEM EL V.
4 I If any portion of the lot is in the
er s.H63.09(5)(b), indicate: ~ a_'~ Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /6 _4
S .C.
B-3 Joel
~ ! .s
'v~` /L_ .1 G1 r _5 ` ~ Q "',04,4 14'*Wll 4 ~
.m.
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER I HES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P_ d
P_ C0 i IC5
_j pbu
P-
P-
P-
PLAN VIEW: Show locations of percolation tests _soil t rlny"nd the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points sfiovv then on on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slop. .d
SYSTEM ELEVATION
F
ax-
i
r" J-1
r
A.
~N
,
c~4 ; 4114-
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): 4 TESTS WERE COMPLETED ON:
ri 2- s
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
-7 Z -c
CST SIGN RE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 IN. 03/81)
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