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• Parcel 020-1123-80-000 05/26/2005 11:48 AM
PAGE 1 OF 1
Alt. Parcel 07.29.19.555 020 - TOWN OF HUDSON
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
* KIEFER, STEVEN & CAROL
STEVEN & CAROL KIEFER
441 KRATTLEY LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 441 KRATTLEY LN
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.920 Plat: 1925-EAGLE RIDGE
SEC 07 T29N R19W EAGLE RIDGE LOT 26 Block/Condo Bldg: LOT 26
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
07-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/24/2001 643511 1623/545 WD
07/23/1997 1174/545 WD
07/23/1997 826/519
07/23/1997 705/504
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/26/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.920 45,500 261,100 306,600 NO
Totals for 2005:
General Property 2.920 45,500 261,100 306,600
Woodland 0.000 0 0
Totals for 2004:
General Property 2.920 45,500 261,100 306,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 540
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r /
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
P.O. 7969
Madison, WI
Wisconsin in accord with ILHR 83 -05, Wis. Adm. Code MadBox
WI 53707-7969
Department of Commerce
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. state sanitary Permit Number
• See reverse side for instructions for completing this application
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)). State Plan I:D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N
Property Owner Name Property Location T N, R I c? E (Or)/
t i4 t i4, S
Property Owner's Mailing Address Lot Number Block Number
1432 Z Al.
City, State Zip Code P e Number Subdivision Name or CSM Number
Nearest Road
IF . -TYPE F B ILDING: (check one) E] State Owned i'l
~JP Z.r ill age
Tax Number(s)
Public 1 or 2 Famil Dwellin - No. of bedrooms on of Ill. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 E] Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Restaurant/Bar/Dining
/ Car Wash
Merchandise: Sales/ Repairs 11 C1 4 E] Church /School 8 E] Mobile Home Park 12 C] Service Station
5 El Hotel / Motel 9 E] Office/ Factory 13 Other. specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
New 2. Replacement 3. E] Replacement of 4_ E] Reconnection of 5. Q Repair of an
A) System E] System _ TankOnl _ Existing System Existing System
--Y -
B) Q A Sanitary Permit was previously issued Permit Number r Date Issued'-/-
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ['Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank
12 ❑ Seepage Trench 22 In-Ground Pressure 42 Pit Privy
43 E] Vault Privy
13 ❑ Seepage Pit
14 Q System-In-Fill
V1. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc_ Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
C, 413 ro 7 8 Z Feet 4 Feet
in lloaccts Total # of r Prefab. Site Fiber- Plastic Exper.
VII. TANK Caa
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass App
New 'Existing structed
Tanks Tank ❑
Y Septic Tank or Holding Tank 1
El El
Lift Pump Tank /Siphon Chamber -L4 El 0 ❑ El
VIII. RESPONSIBILITY STATEMENT
"to
- I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.,
uM /MPRSWNo.. Business Phone Number:
Pluipber's Name: (Print) Pl s um er's A< dress (Street, City, State, Zip Code):
1 7 ® G
COUNTY/DEPA TMENTUSEONLY
Disapproved Sanitary Permit Fee dudes Groundwater ate Issued Issuing Agent Signature (No tamps)
❑ surcharge Fee)
Approved ❑ Owner Given Initial'
Adverse Determination
,..CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL:
DISTRIBUTION: Original to County, One copy Tor Safety & Buildings Division, Owner; Plumber
SBD•6398;(R.11/96)
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this pe-mit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to t)e submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3151.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
,manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber isto fill in name, license number with appropriatepr(?fix.(e.g_ MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the --ounty. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution bt:•xes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss,- pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.