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Parcel 018-1046-50-100 01/12/2007 02:59 PM
PAGE 1 OF 1
Alt. Parcel 21.29.17.326A-20 018 - 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 - SATHER, ROBERT D
ROBERT D SATHER
877 170TH ST
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 871 170TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 2.258 Plat: 4271-CSM 16/4271 018/02
SEC 21 T29N R17W PT NW NW & SW NW BEING Block/Condo Bldg: LOT 02
CSM 16/4271 LOT 2 2.258AC
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
21-29N-17W SW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
09/18/2006 834712 WD
02/18/2005 787853 2752/477 QC
03/28/2002 674852 16/4271 CSM
03/28/2002 674851 1863/038 QC
2006 SUMMARY Bill Fair Market Value: Assessed with:
172329 194,900
Valuations: Last Changed: 06/30/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.258 26,800 123,200 150,000 NO
Totals for 2006:
General Property 2.258 26,800 123,200 150,000
Woodland 0.000 0 0
Totals for 2005:
General Property 2.258 26,800 123,200 150,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 09/2712005 Batch 05-20
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
7
OWNER v2 TOWNSHIP t1 AJ _SEC V T~ R -W
ADDRESSfiej, -d' ST. CROIX COUNTY, WISCONSIN.
r-
SUBDIVISION LOT LOT SIZE ft? 14c- rz -v-.v
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHO F.- THING WITHIN 100 FEET OF SYSTEM
All'
1, e, iL
/ o ft
1
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I di ate o th Arrow I
-C l! BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical ieferenLu point: /00 ' Slope at site:
SEPTIC TANK: Manufacturer: L__)e_e Ks Liquid Capacity: /000
Number of rings on cover : U't E Tank manhole cover elevation: {6
Tank Inlet Elevation: ~9 1/« Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cycle gallons; total capacity o:
distribution lines gallon: size of pump head;
gallon per minute horsepower ran name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device.
SEEPAGE PIT SIZE: Number o pits feet diameter
feet liquid depth _ seepage pit in epe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number c j' lines iufj width /,2' length,~1 the depth,,- 9 dr
SEEPAGE TRENCH: width length _
PERCOLATION RATE /_8 A REQUIRED' AREA AS BUILT 9(7D
INSPECTOR y
DATED- PLUMBER ON JOB
LICENSE NUMBER
rown4hi,p III ~Cr~St. Cho1X Cuunty loor
u'cutiun ~ u) Sec-ti,ongLLot 0 Subdi.vi4i-on
PTIC TANK
S4_ ze gattone Number o6 eompantmente
, e tanee Anam:. WeU Bui tdi.ng 12% eeope
Hi.ghwate4 _
1IMPING CHAMBER
size gatZona _ Pump Manu6aetu4e4. Mudet Numbers
OLDING TANK
Scze gattona. Numbek o6 Compantmente
Pumpers Ata4m Sy4tem
~iatance 64om: Wet.2 ,.5 Buitdi.ng J 12$ 4eupe__ _ T
Hi.ghwatea
13SORPTION SITE
Bed-12_,X - The.neh
q.tance 6&om: weZ j
Bui-.Ldi.ng t2$ dope
Hi.ghwaten
w} ORPTION SITE DIMENSIONS
.W- dth o6 tneneh 6t Req u.i hed aa.ea
Length oA each tine A 6t Depth o6 xoch beeuw tiee
NumbeA o6 eine4 Depth uA noch uveti tike /17 -1 To tae e.ength u6 Pi ne4 , 6.t Depth 06 tite beeow ynude 3Q _~.n
D-ie,tanee between tinee At Stope u6 .trench ~ .cn, pen 100 At
~
1 u 4 u~ aLo v"tptiurl 41eu
-~6t Type o6 Cu ve4. Pape.n un .6-thaw I,Numbv n u6' pi t,6 Gnavee ahound pit, ye4 nu
Out4idg diameters 6t Depth betow i.ntet - A,t
Totae ab4oKp.ti,on area 6t
.A&ea 4equi4e At
NSPECTED BV -
TITLE
11PROVED
- DATE 19 8
t OTEV - DATE
IASON FOR REJECTION
i ~ State and County State Permit #
PLB 67 C
''i-,
y Permit Application County Permit # d
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:
.4 -f - } 6 12 14A m M o,V 1:4
a v 5-
B. LOCATION: Section c-[_, T_~;k9N, R f-J& (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township 19MMOA-i
C. TYPE OF OCCUPANCY: "Commercial "Industrial `Other (specify) "Variance
Single family X Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY /000 Total gallons No. of tanks On/~
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New )Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X_Length go Width Depth ~Tile depth (top) No. of Lines 7~
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land ~ "~'o Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
1, 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 Soil Tester,
NAME i~We E' I~K J,-4-- C.S.T. # $J.--J' S and other information
obtained from i2 (owner/builder). p
Plumber's Signature MP/MPRSW# m/O ~7'~/ Phone # 7/5-~,
Plumber's Address a Z.
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.
,7, /08or 9 /5c? ,q ,ems S
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Do Not Write in Space Below /FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application -e J/ Fees Paid: State • e-t) Counnty Date -3' 51 - ^
Permit Issued/Rejects (date) Issuing Agent Name
LInspection Yes No State Valid# Date Recd
unty (white opy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
te (pink copy) 4. plumber (canary copy)
_ Revised Date 7/1 /78
EH 115 Rev. 9/78q\
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701 OG' s✓/j~O
.7
LOCATION: 1~ Section T A 7N,RZ* (or) W, Township orJ1At>~~ ~r
Lot No.__, Block No. - County
C S - 1 Subdivision Name
Owner's/Buyers Name:
Mailing Address:. RM mc~.~ c/ S
TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 -COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS Zf, -25 th -PERCOLATION TESTS /Z .V 16
SOIL MAP SHEET— --------.-NAME OF SOIL MAP UNIT
_ PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
NUM- DEPTH CHARACTER SOIL L SINCE HOLE HOLE AFTER INTERVAL RATE
MIN/IN
BER INCITES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
e if
P- Qt 0, 54^,Id 3~4~ /0 Pu /0
P- ft rltr l~ 7 s k!' 13
P-9 1 yi lI / Zll N N O
P- " 0 /0/1 ` 4) tr ,i 3 u 13
P- -5~ 40 °t t( D J ~l 0
v
P-,6
PEA-7.5e Q SA~~1 eve- L-
/ e ze 44 Loo e•e SXgc~ v e- L, OIL BORTESTS
ING TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES /
B- 17 1,ntxi~QZe -
B- t( ar
B- a Y
B- If
a "
B- lp ~a r
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the to ation 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. Indicate slope.
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1, the undersigend, 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) R,,3 Certification No.
Address 4-~ c,,,, , S
Name of installer if known tC f' G
Copy A -Local Authority CS r SignW~ture
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REPORT ON INSPECTION OF SANITARY PERMIT #
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
me, ress,ice a o. o ns a Ong Plumber Time of Inspection
7-3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BEN Permanent reference Point) escri e:
Elevation of vertical reference point: Slope at site:
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity:
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: # ft to well:
(7)DOSING TANK: Manufacturer: # of gallons:
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines gallon; size of pump head; gallon per minute ;
horsepower ; brand name of pump and model number
Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO
8 HOLDING TANK: Manufacturer o ga 11ons
;
construction ; depth to the cover ft; If septic tank is
being used are baffles removed? ❑ YES ❑ N0; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO;
Locking device on cover? ❑ YES ❑ N0; Diameter of vent and material ;
Distance from building to vent
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe-elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPAGE BED SIZE: ft width; ft length; tile depth;
li.neal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed ft.
11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft;
tile depth ft; ft to well; ft to ordinary high water mark of
lake or stream; ft to edge of slopes greater than 20% falling away toward lakes,
water courses or drainage ditches; elevation of tank discharge line entering seepage
trench ft.
(12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO
(13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO
DILHR-SBD-6095 N.05/80
Signature of Inspector: