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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner THOMAS R & BARBARA ROUGHTON ROUGHTON, THOMAS R & BARBARA 1554 HWY 12 HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1554 HWY 12 SC 2422 ST CROIX CENTRAL SP 1700 WITC / 7 Legal Description: Acres: 26.660 Plat: N/A-NOT AVAILABLE SEC 18 T29N R17W 26.66 AC W 2/3 OF SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: 56258 Use Value Assessment Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 22.160 2,300 0 2,300 NO UNDEVELOPED G5 0.500 50 0 50 NO OTHER G7 4.000 19,000 279,500 298,500 NO Totals for 2004: General Property 26.660 21,350 279,500 300,850 Woodland 0.000 0 0 Totals for 2003: General Property 26.660 21,600 277,900 299,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 131 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 Parcel 018-1041-40-000 03/25/2005 10:47 AM PAGE 1 OF 1 Alt. Parcel 18.29.17.287A 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): = Current Owner * ROUGHTON, THOMAS R & BARBARA THOMAS R & BARBARA ROUGHTON 1554 HWY 12 HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1554 HWY 12 SC 2422 ST CROIX CENTRAL SP 1700 WITC '5~'2 ~0 CV Legal Description: Acres: 26.660 Plat: N/A-NOT' AVAILABLE SEC 18 T29N R1 7W 26.66 AC W 2/3 OF SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: 56258 Use Value Assessment Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 22.160 2,300 0 2,300 NO UNDEVELOPED G5 0.500 50 0 50 NO OTHER G7 4.000 19,000 279,500 298,500 NO Totals for 2004: General Property 26.660 21,350 279,500 300,850 Woodland 0.000 0 0 Totals for 2003: General Property 26.660 21,600 277,900 299,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 131 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 Parcel 018-1041-20-000 03/25/2005 10:47 AM PAGE 1 OF 1 Alt. Parcel 18.29.17.286B 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): Current Owner ROUGHTON, THOMAS R & BARBARA THOMAS R & BARBARA ROUGHTON 1554 HWY 12 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: 13.330 Plat: N/A-NOT AVAILABLE SEC 18 T29N R17W 13.33 AC W 2/3 OF S 1/2 Block/Condo Bldg: NW SE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: 56256 Use Value Assessment Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 13.330 1,500 0 1,500 NO Totals for 2004: General Property 13.330 1,500 0 1,500 Woodland 0.000 0 0 Totals for 2003: General Property 13.330 1,600 0 1,600 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 H-AMMOND T .29 N.-R.17W 31 SEE PAGE 45 /N H1 MONO G/NE RO. 6 RK.s c, wer IL/Nf GK. 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Znc, i 00 ~ y C b ~ ~ F ~ [Yuen c.c. , /sb IJahm • 77i/NE KNOGG 9 4 • R ER qv y J /6o It 40 ,Pob t Heeb.».E c ©/968 R o d MaYO P 6/S/Inc~,Pev/979 y ~ ~ OR. SEE PAGE 19 cS . Cro.x L'ocrt S 1 E a O L REALTY E CO FARMS - BUSINESSES RESORTS - HOMES MOLLS ELECTRIC SHELDON O. SIEBOLD - Broker Harold Moll Hammond, Wisconsin PHONE: 796-2391 - Hammond, Wisconsin FARM - HOUSE - COMMERCIAL - INDUSTRIAL PHONE: 796-2698 t s6~~ ~14~✓131ri9drir~~4 . irea.c_r,ts of H£2.20 .S cQ4-1 ° ss y 5 ^ Yid 60 'A//X 4 s- 777- c of , an~pl Lines`_~_ wiCth l S 2 dep t o top (-"t i- ,"A REnUILFED imer; The ;.-rispection of th4',s em ow St. C ance with State Administrative Codes. There pest at this point of construction. St. Croix Count-r operation.'However, if failure is noted the Coun e cause of failure. s ON JOB - , - .3 • r ' • Z* REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itaxy Pexm.it State Septic NAME Towns hip ST. Cxoix County Location Section r SEPTIC TANK Size gattona. Numb en o6 Compartments I D,idtance Fxom: Wett so-( it. 12% ox gxeatex stope St Bu.itd.ing it. Wettands H.ighwatex - it. DISPOSAL SYSTEM Distance Fxom: Wet it. 12% ox greater scope 6t• Bu.itd.ing it. Wettands Ft. H.ighwatex it. FIELD DIMENSIONS: W Width o J- txench__j_6 it. Depth o6 xo ck b et ow t.ite~_.in Length o6 each tine it. Depth o6 rock oven t.ite -C-- in. Number of tines ~ Depth o4 t.ite betow grade a(e .in Totat .length o4 tines it. Stope o6 txench in pen 100 it. Distance between tines it. Depth to bedrock 5t• Totat abzoxbtion area jt2 Depth to g)Loundwaten- Requited area it 2 Type of Cove)L: Stxawl/ PIT DIMENSIONS: Number o6 pits ~ Gxavet around pits yes no Outside d.iamete it Depth below .inlet z Totat absoxbtion )tea it A 2 Axea xeq, "ned ` it rn INSPECTED 3 TIT .LE G--APPRO V,..FV: DATE 19 7/11W REJECTED , DATE 197. _ A 1\ 01 lt, 1 EH 1 15 Rev. 9/78 • REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:s '/4, Section /,TZ21N,R L1@ (or) W, Township or Marricil9eltty 4~L M''»C NC/ Lot No. , Block No. u ivlsion a e County 4f ego /,X, Owner's/Buyers Name: ej C-4 n/ Mailing Address: r" 9Z) C2 1-2 91 0 ? - TYPE OF OCCUPANCY: Residence X No. of Bedrooms -COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT-ALTERNATE SYSTEM p. OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET loo NAME0FSOILMAPUNIT_.__S C- LISA PERCOLATION TESTS TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES DEPTH CHARACTER OF SOIL RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/Ir BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- 0 5 N ~ r ~r 3 y P_ if P- 44 H'Q 15 ! XL A A- 2. ~I u ~I t~ tt tr -40 LL CAq P- 4 P O n <t << oz P- ,6 o 4't g s Y a ~y SOIL BORING TESTS 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- / A `t So ~ c SG f 4 rn mod " .S t ~ B- a t~ rl a v it o f B- 71 B- B- 113- 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 vi Indicate scale or distance; Give horizontal and vertical reference points. Indicate slope. ~G,t? e 5 rT- - . ~ n GO' I E c ~2L1 - ~ f a i 41 ev N e,, I Q a ~o$e_ Q~ I c:J i s. ( I. E ; i iP ~~~RJ LL" _ Q log c, n L e- 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. Na+ne (print) eT T Jc~/O.G c~f - Certification No. SAS"- S' Address 1 S Name of installer if known CST Signa ure _ Co A -Local Authority FOR State and County State Permit it PLB 67 • Permit Application County Permit # for Private Domestic Sewage Systems County ':5Y C o i x *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 1 o rv, IQ. 1~l o r ~r~ n/ /~R r~J n-~ o Kl c~ , (.lJ t S B. LOCATION: ~5&J'/i J/a~ '/4, Section , TL-23N, R / I:> (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township OAl41- C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms 3 No. of Persons zls~ D. SEPTIC TANK CAPACITY ®C7 © Total gallons No. of tanks (Re OPL4GeMel-I f) HOLDING TANK CAPACITY Total gallons No. of tanks C / F P00r2 Cone'. ) Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement ~ , Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place A Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area ~ sq. ft. New Replacement DG, Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: -Length cgi~ Width Depth ' Tile depth (top)_ =2~L' No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land O °S Distance from critical slope WATER SUPPLY: Private CK 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 oil Tester, NAME ✓c°,G C.S.T. # S5r-S"i4'~l and other information obtained from 262e- Z~ (owner/builder). Plumber's Signature MP/MPRSW# 49' y Phone #6.91 ~37X Plumber's F.ddress 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. _r e i Well - /,?D` Ar0m /J ra.i e w v i shed:l ppwc Way - - 11F- \ Z7 Z7 -~c> 40 e o Q \A ot 0 :f:) ca c, iLe Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application /6' 3 ! 1-761 Fees Paid: State County _ Date G C >11 Permit Issued/ d (date) 1_30 1;7 Y Issuing Agent Name - Inspection YesNo State 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 7/1 /78 r-_ - TRANSFER FORM T SANITARY PERMIT P L B 67- State Permit # / .Z Sanitary Permit # a c'" County S 7` C;_ 11 ;x Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: -'u.' '/4 _-5457 Section / 8 T V 9 N, R 1Z f (or) W Lot # -City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village Township B. TYPE of Occupancy: Commercial Industrial Other (Specify) Single Family k nuplex No. of Bedrooms 3 Variance C. SEPTIC TANK CAPACITY y W_6~2 Total gallons No. of tanks ©y~ 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/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area F/^Sy sq. ft. New Replacement-_ Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches Seepage Bed: ge -X Length -S" 2 " Width /,Depth 3~,Tile Depth(top)~?'/" No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land e~ i Distance from critical slope E. WATER SUPPLY: Private ❑Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. Name Name Address Address Zip Zip 1, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-1 15 prepared by the Certified Soil Tes nd/or any a _ ion of ests that may have been required. Plumber's Signature MP/MPRSW # Phone # -S 46- Plumber's Address d% G,rr~/`.✓ 1 Information obtained from (owner or agent) PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's ro pertv. If well has -not been drillee ndicate, s I Olf- kd I Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701 . AS BUILT SANITARY SYSTEM REPORT R . TOWNSHIP 10. V+ •_es.EC. ! - T "N, R1 W ADDRESS; ST. CROIX COUNTY, WISCONSIN. ,DIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7:7 9 1-71 A ~~aemle~°i.- > 3",- 1 Sx fir"„ 5 % 21 TIC TANK(S) MFGR. ( z C CONCRETE C---STEEL NO. of rings on cover f Depth DRY WELL INCHES NO. of width length area no. of lines _3_ width length - area _ depth to top of pipe -r UGATE _ t 3 ,K RATE `i" 7~1•`., AREA REQUIRED };:F 1 AREA AS BUILT .Claimer: The inspection of this system by St. Croix County does not imply complete % pliance with State Administrative Codes. There are other areas that it is not possible-j' ,inspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if failure is noted the County will make every effort to -ermine cause of failure. -:ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. "INSPECTOR DATED PLUMBER ON JOB _ ~LICENSE NUMBER .,,t 41 17 r Z' 4 u REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.i-tany Peiun.i.t State Septic NAME jlo4Y~ .S G %o' Township S~. C&o.ix County L o c a.t.i o m Section SEPTIC TANK Size /1 oa gattone. Numbe& o6 Compan.tmen.t4 I Di4.tance Fnom: Wett 0?d 6.t. 12% oh gr.ea.ten 4tope 6t Buitd.ing it. We.ttanda St. H.ighwa-ten - 6t, DISPOSAL SYSTEM D.i4.tance Fnom: Wet DO ~ 6t. 12% on gr.ea.ten 4tope it. Buitd.ing it. W etland4 Ft. H.ighwa.te, 6.t. FIELD DIMENSIONS: Width o 6 .then ch~ it. Depth o6 no ck b et ow..t.it e-Z2- in. Length o6 each tine 1, it. Depth o6 rock oven .t.ite ~ .in. Number.. o6 tin e4 3 Depth o6 -t.il.e below grade 3 in, To tat berg th o6 line4 Ca it. Stope o6 .trench in pen 100 it. D.i4.tance between .t.ine4 6t. Depth .to ' b edno ck ~ 6 t. Totat ab4onb.t.ion area 6.t2 Depth to gnoundwa.ter. Requ.i&ed area it2 Type o6 Cover.: Paper. on Straw PIT VIMENSIONS: Number o6 p.it Ghavet around pit.a yes no Out-6 ide d:iam .t n Depth below int e-t it. To.tat ab4 o t i area V 6t2 , z A Area 4e. cried 6.t2 rn INSPECTED TIT jff APPROVE DATE Z~ 197v REJECTED ,DATE 197 1, ~ State and County State Permit # PL'%R 67 Permit Application County Permit # for Private Domestic Sewage Systems County -L T o-r *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: c1 a -Ig a : iL a gA /c? A/ i N a. B. LOCATION: G'w '/4 _5'E '/4, Section T:2~4_N, R_ZZ E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township A1,1, .1,,A A . C. TYPE OF OCCUPANCY: *Commercial "Industrial *Other (specify) *Variance Single family _k_ Duplex No. of Bedrooms 10" -No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks / 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 Ra*te Total Absorb Area , sq. ft. New X Replacement Alternate (Specify) Seepage Trench~,~ ~ No. of Lineal Ft. Wih Depth Tile depth (top) No. of Trenches Seepage Bed:-1 _Length 43 'Width Depth Ar Tile depth (top) 3 No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land_ f ~n Distance from critical slope WATER SUPPLY: Private 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 Soil Tester, NAME A4 4- C.S.T. # 4"" and other information obtained from wne builder). Plumber's Signatur y. MP/MPRSW# +V15i' Phone Plumber's Address ✓P 174- - 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. ..t.~`" ..,cif ~~Z..N2l .,rc / sp ~ ,,t. ~ ~ ►S yl ~~t c~ s E .G' \ S ap7; • c, y`ccl~Vh ~E- ©rc L F w ^`r ~ ,r~ KS I~. _a. .y-•~Ufa-mtL J w n. _ ,n _sa a. aP v~y r r E 3 s \t e a ..x e iF /s'-~i ~m___. ..we. ,.v.. 74, f i .l Do Not Write in Space B low - FOR COUNTY AND STATE DEPARTMENT USE ON Y Date of Application ! l Fee' Paid: State / County atef C Permit Issued/Reject ( te) ! Issuing Agent Name ta 4-4444 Inspection Yes No State Valid# ate Rec'd r 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 7/1/78