HomeMy WebLinkAbout018-1021-50-000
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Parcel 018-1021-50-000 01/12/2007 01:02 PM
PAGE 1 OF 1
Alt. Parcel 10.29.17.160 018 - 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 - KUEBKER, RICHARD F & ROSEMARIE
RICHARD F & ROSEMARIE KUEBKER
1880 CTY RD E
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 10 T29N R1 7W SE SE 40A Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
10-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/26/2003 750104 2481/047 WD
07/06/2000 625958 1524/430 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
172051 Use Value Assessment
Valuations: Last Changed: 08/24/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 20.000 2,500 0 2,500 NO
UNDEVELOPED G5 18.000 14,900 0 14,900 NO
OTHER G7 2.000 13,000 83,100 96,100 NO
Totals for 2006:
General Property 40.000 30,400 83,100 113,500
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 30,400 83,100 113,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 09/26/2005 Batch 05-18
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
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REPORT OF INSPECTION - INUIVIOUAL SLWAGt SVSILM
Suytd ta~lq 1,e~lrn t
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1. 40 ( x I.UUYI It
SC . S-4!~rSe.c.t..c.avtll:~- Lo-t M Sub div .cetion
N n Q/~ ~d a-/ 57`ob U
yaYYortb Nurnbeit o6 cornpalt tmen.t4
(I corn: WeY buitdiny 12% 4Yope`__---
N4,ghwa.te4
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yatton4 Pump Manu6a:c-ta4en MudeY Nurnbelt
i ANK
yaZton4 Numbe.A o6 Compan.tmert-t4
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i I I U I MI NS I ONS
n the nt h- -fix RC.gti,( ed a4ea t
eac-h tcolc Depth u6 Hoch beYow t 4 f o Ycne.A 4 Ue.pth o6 Hoch uve)l ttev
~ c rt11 tit 06 Y,(.ne4 Depth o6 ti& beYuw ,j,ladv Sri
Irctween Y6te4 6t SYope u 6 tn.enc it. t r~ . il+ I t7U 6 i .
llt "1llCl on a lfeU _.-6't Type. 116 CoveA': / rpape>t wl ~t'i i1HJ
i, ri.t6 Gaave.e anound p4 to
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State and County State Permit #
PLB 67 Permit Application County Per
for Private Domestic Sewage Systems County v~
s
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
7<L) e~ w. /-1A m m v o') W S
B. LOCATION: Section /0 , T,~L9 N, R 76 (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township r
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _)i( Duplex No. of Bedrooms No. of Persons_
D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks 0A,1
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement X
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area--123L-sq. ft.
New Replacement X Alternate (Specify)
Seepage Trench: No. of Lin eal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X Length- S0 Width 2_Depth cl 6 "r Tile depth (top) No. of Lines 642 0
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified S it Tester,
NAME L=►>E' p' 4 Ztk4e74 C.S.T. # •~S- S ~ and other information
obtained from ec1Ne (owner/builder). C
Plumber's Signature 61 MP/MPRSW# nMP- 141 / Phone #715 -,6 FV-r-TS 7-f
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Do Not Write in Space Belgw FOR COUNTY AND STARTMENT USE ONLY
Date of Application G ' Fees Paid: State Co ty zf Date
Permit Issued/&
eja4 sd (date) Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (w it 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 7/1/78
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
.!NDUSTRY, DIVISION
LABOR P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON W 53707
LO~ TI 'j S 4 S ~ ®O~Ta N/R / ~(or) W TOWNS UN~~ALITY: LOT NO.: BLK. NO.: S ~ ION NAME:
COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS:
S+ CRO/>< R u e K~,e m m oNgl ~ S i
USE DATE tQ SER O
NO. BEDRMS.: COMMERCIAL DESCRIPTION: T N TESTS:
~~Residence ❑New %Replace ~~fgi j.
J rF
✓°3..
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMEND
(~lS ❑U ❑S ❑1, ❑S ❑U ❑S ❑U ❑s ❑U
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL
I If any portion of the lot is in the
under s.H63.09(5)(b), indicate: I` 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. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- L3 q7 19
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 PERIOD PER INCH
P- / .3 "
if
P- /11/0 10 3 r
P- 341 4-1
P-
P-
P-
PLAN VIEW: 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 slop.
SYSTEM ELEVATION 94-4 ;Loo, 4aQes -
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C OUXIJ-y ;Q,U AJ Ex . _,s
i, 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 : TESTS WERE COMPLETED ON:
_,~e c®74-/- oL- f- 7- .0-/ - k/
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
C SI URE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 IN. 03/81)