HomeMy WebLinkAbout020-1113-00-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Y~ 1 M R n N
ADDRES kAjtj
SUBDIVISION / CSM#o LOT # N
SECTION . T a r N-R a. U W, Town of 1Ur-,3 ; w
ST. CROIX COUNTY, WISCONSIq;~SF
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM T l
o~ 12e lv G n-Q I
Sk7S~
boo 9A). N-ew 1nP)L
!3'
191
y~~ r., o ~rz~ ~P lls
Vr. i i Q
J
N
V
V
A/
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this-form.
Provide 2 dimensions to center of septic tank manhole cover.
rT
BENCHMARK: 0 P JN W OcJp % J I ! J G ~,a L~ R t~ Ir ' ''tiA T•~~ !V b vW
~lev, = !J0.0
ALTERNATE BM:
~lS~h cal a TpNI` (c)oo 9rl SEPTIC TANK / PUMP CHAMBER / HOLDING .TANK INFORMATION
+fed~e~ pw Manufacturer: 22 S Liquid Capacity: 800 NQLO 10009il ~Id
'IbNl~ 860~~ h Setback from: Well6~ev- 5O~ House 4 Other
Pump: Pant usurer Model# Size
Float--sepeT-a$ion Gallons/cycle:
i
Alarm ca n
-:SOIL ABSORPTION SYSTEM
Width: Length Number of trenches a
Distance & Direction to nearest prop. line: Qye (L
Setback fr m: well: ay eR S~~ House Other
~ull ~uN VAIv< New Ty~Ar.
9 g5
915(v 014 TwN1t TN lkfi- 4a.ao au1'kfi
g~ ELEVATIONS
0I17 Sy,-io~. NeW /V2W CoVetc
Building Sewer ST Inlet; • a5 ST outlet
PC inlet PC bottom Pump Off
y Header/Manifold Bottom of system Of.toV
3-40-Existing Grade Final grade U0
DATE OF INSTALLATION: Io a
)1 r ^
PLUMBER ON JOB:
LICENSE NUMBER: 3 ~~u
INSPECTOR:
3/93:jt
L04`M10Xpar P$0Aus1r? • 29.20.4 IVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
o.:
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary lrm 01001157
Permit Holder's Name: ❑ City ❑ Village 1-_l Town of: State P an I Na.:
I v.: nsp. B ev.: Description: I~ Parcel Tax No.:
/ Gd a
020-1113-00-000
TANK INFORMATION ELEVATION DATA A9300263
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic S are- J ~j Benchmark
Dosing
Aeration ° 5 S' ' g 2S 9~~
i
Holdin St/)#( Inlet , ~
TANK SETBACK INFORMATION St/ 6butlet 9/ Off'
Ventto
TANKTO P/L WELL BLDG. Aiirlntake ROAD Dt Inlet
Septic NA Dt Bottom
Dosing NA Headerkfiffi3D. 9
Aeration Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
M nufacturer Demand TOP
Cad<~- s qG~
4!Z=I,ff /0
Model Number GPM
TDH FS ,tion System TDH F
Forcemain Length Dia. I f Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 7s DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEAC Ma rer:
SETBACK
INFORMATION Type o C H_4A Moe Number:
System: -ttyi1 -611 UNIT
DISTRIBUTION SYSTEM
Header / ~o Distribution Pipe(s) x Hole Size x Hole Spa=ToAr Length ~ Dia. Length 7x~ Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst
Depth Over Depth Over xx Dept xx Seeded / Sodded Bed /Trench Center Bed /Trench
Edges Topsoil ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) _
LOCATION:: HUDSO 12.29.20 458F
Plan revision required? ❑ Yes No
Use other side for additional information. 116
1
SBD-6710 (R 05/91)` a e Inspector's Signature Cert. No.
R~ , Q- , - ,
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
w;
i
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
O I Y,
1:1 STATEPtNi #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8'f~ x 11 inches in size. k revisiont
previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER ff II 1 PROPERTY LOCATION
Jim, P_ E. 4, /eritio- 1. od ea 1KI'/4 ,5 '/a, S a? T o~9N, R vZ E (or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
/40342 35A)
N
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
550/ -
11. TYPE OF BUILDING: Check one CITY ZEST ROAD _
( ) ❑ State Owned ❑ VILLAGE : 30 y(f 3S
❑ Public 1 or 2 Fam. Dwellings of bedrooms J PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
20 Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.0 New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only'one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. 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
x REQ ED~s\q. ft.) PROPOSED ►'~(sq. ft.) (Gals/ y/sq. ft.) (Min. in h) Q ELEVATION
(000 v ! v • I Q S^b Feet V Feet
VII. TANK CAPACITY y Site
in allons Total # o F~ Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tank anufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Ta structed
Septic Tank or Holdin Tank M 01111 A F] [71
)
Q
Lift Pump Tank/Si hon Chamber C U b ~ i
El El 1:1 1 1:1 1 0
5) 7 ~4
VIII. RESPONSIBILITY STATEMENT =D' -I- Will P * (,Q I W- 1, 1-~0U 9 A) )d N LONG CRT MaN u
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. W Q~
Plumber's Name (Print): Plumber's Signature: No Stamps) MP/MPRSW No.: Business Phone Number:
I r IQJ O ~S O CJ
Plumber's Address (Street, City, State, Zip Code):
IX. CO TY/DE ARTME T USE ONLY
❑ Disapproved Sa i ry Permit Fee (Includes Groundwater Date Issued Issuing ent S nature ( Stem
Approved El Owner Given Initial yjrl~ G~ Surcharge Pee)
Adverse Determination
oo~
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber
i
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
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 & Buildings Division, 608-266-3815.
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.
II. 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 in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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 is to fill in name, license number with appropriate prefix (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 e'h x 11 inches must be submitted to the county. 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 boxes; 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, ground-
water contamination investigations and establishment of standards.
I
SBD-6398 (R.11/88)
P. Q. L C 7 L CST H ► : h' 0 SS . 5 E C ~ 1.I .~.?.I\i.
N A M E T e a /ea,►i ..N..A M E JR~t esdumees~ e.r 45 0 C A QLf~I ion nJ I.C )..:.-N E S_E
PLO T~ M A P
Wei(
88, k .?S„
Q f~ 7o F a ~ Qoop W;4w
W~w~a~ ~Le~1-1ra~.~1 SOS' ~
G3
~ ao D~~~e411
0)",u 1v
6oori c GNa d S
FRESH AIP INLI'TS AND OBSERVA` IOU PIKE
CROSS SECTION
Approved Vent Cap
Minimum 12" Above I ~irA~ G~pg~
Final Grasie---` _
4" Est Iron
Above Pipe Vent Pipe
To Final Grade
Marsh Hay Or Synthetic Covcri.ng
Min. 2" Aygreglol i
Over Pipe
i
Dis tribu l'ion~ Tee i
Pipe I
Q ,U Aggregate Ver-f.oral:ed Pipe Lelow
1 aS 1 Dencath Pipe ---Coupling Terminating P .
Rbt• tom. of System,
i
Wisconsin an ent Ind~uay,
and H fiun+unta rielati oons SOIL AND SITE EVALUATION
Labor
DivDivision of Safety a euildinos in accord with IL.HR 83.05, Wis. Adm.REPORT Pape of
Code
COUNTY
ST c~Po /'X
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or J.PARCEL I.D. If .
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATIO14
T1114-1 / -/D&/ N6 GOVT. LOT NIu • 1/4 Z 114 !z T-27 NA Zo E ( iY
PROPERTY OWNER'S MAULING ADDRESS LOT 8 ~ SUED. NAME OR CSM /
/o h`w . 35 •
CITY, STATE ZIP CODE PHONE NUMBER ❑CI?Y QVILLAGE DOWN
NEAREST ROAD
,f/a. ffvf~-ro.•~ Gc>/S. 5y01G (7/51) 3.06 - 3P3z f #,0X'0 v &;W/.
as'
I I New Construction Use ~,CI Residential i Number of bedrooms y ( I Addition b wdsfing buildiflg
Pa Replacement I) Public or commercial describe
Code derived daily flow ~iOO gpd Recommended design loading rate -!_bad, gpoltt . trench, gpd/ft2
Absorption area required gibed, ry2 75 d trench, ft2 Maximum design loading rate bed, gp~+.llt2 1 ~Ir;r , gpoltt2
Recommended infilration surface elevation(s) 5-~- P 3 h (as referred U site p'= benanmarW
Additional design / site oix>sid ons S rr N9'~~0 ~v ~~•~FS
Parent material S~ s I E.y Gd -tom Flood plain eleve-,icn, if applicable
S a SUitabl !or System CONVENTIONAL MOUND 14-GROUND PRESSURE AT-WOE I SYSTEM IN rILL I'.U! DWG TANK
U a Unsultabb for system, I WS ❑ U aS O U 0 S 13 U OS O U t M$ ED ❑ S f~ U
Y
SOIL DESCRIPTION REPORT ;
Boring # Horizon Depth ' Dominant Color Mottles Texture Structure Consistence ftnd3y Roots GPD/ft
in. Munsell . Qu. Sz. Cont Color Gr. Sz. •S,t. Bed Tie 6
D /O /D 3 3 S/ 2,4", 7 n0vA es 2 .5 .G.
73 Q_j.9e 16y1f Y16 51 2,,w
3d CS r 0
Ground Bi
93 slow. G 9a ~s Yle S/ S cD,,,., '7
W
Depth to
u U. ✓ S Aa <o s
limiting
factor
> qD
Remarks:
Boring #
14 o-i /o yre 313 s4t- 2--- , s G
y_ /o. ye 6
Ground
elev. 114 7, ie 51-e
ft
9y
E-
Depth to - - -
limiting
factor ,i
Remarks:
CST Name:-Please Print ~ol3E~% ZlG,E3iPi'GGs7'- Phone: 71f - 3 AG'
ress: 'ors p%vEiG ~D. ffvD,fo.~ Gv/s', SS/O~G //~j c51~1 y`/~2
Signature: Date: CST Number:
PY
"This test site APPRO CO,
for a conventtoneJ septto`$Ystem.
PROPERTY OWNER 10AA)6' SOIL DESCRIPTION REPORT p 2-
.3
PARCEI.I.D.8____/'93 4 3/ 5 -j l+U Ds O v
Depth Dominant Color Mottles Struowe Qp n2
Boring # Her'aon . Texture Cor>sistenoe Bound, V Roots Bed ►erx~
In., Munsell Qu. Sz. Cont. Color Gr. Sz.°$h.
1101f "I
/3, "26 0Yi2 y y 5/ + S,bt fIZ ' Z1F . S . G
Ground ~2 3 /D Y/~ ~Y ~S , , F2- • ?
elev.
Depth to O C s. .A
Inviting
factor
r
Remarks: 5oi /S 10 ~o Gw 0 6X0 1Pie y tJ , 1/
Boring # T'
7~ > razz -X-C- S_ 4
Ground
elev.
It. -
Depth to
_ v
Imiing
factor
Remarks:
Boring #
Ground
elev.
fc
Depth to
limiting
(actor
Remarks:
Boring #
Ground
elev.
fL
Depth to
limiting
factor
Remarks:
eon oo'mio ncw^%
i
7
3/ o0
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is
Id - 73M =
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95.35 wi;vLi~w
c,fsl:u 6- ~fT
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADDRESS: _FIRE NO: 4f
LOCATION:/ W1 1/4, Z- _1/4, SEC. -4,2 T_2_1_N-R_2_~2_`W,
TOWN OF: 41 /`7 ST. CROIX COUNTY
SUBDIVISION: LOT NO.
Improper use and maintenance of your septic system could result
in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or
sooner, if needed, by a licensed septic tank pumper. What you
put into the system can affect the function of the septic tank as
a treatment stage in the waste disposal system:
St. Croix County residents may be eligible to receive a grant to
help with the cost of the replacement of a failing system, which
was in operation prior to July 1, 1978. St Croix County accepted
this program in August of 1980, with the requirement that owners
of all new systems agree to keep their system properly
maintained.
The property owner agrees to submit to the St. Croix County
Zoning a certification form, signed by the owner and by a master
plumber, journeyman plumber, restricted plumber or a licensed
pumper verifying that (1) the on-site wastewater disposal system
is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification from will be sent approximately
30 days Fricr to three year expiration.
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system-in accordance with
the standards set forth, herein, as set by the Wisconsin DNR.
Certification form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expire, ion date.
SIGNED
DATE:
St. Croix Co-onty Zoning Office
911 4th St.
Hudson, WI 54016
S T C - 100
This application form is to be completed in full and signed by
the owner(s) of the property being developed. Any inadequacies
will only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor,(spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property A4 22-
e n L .9 7
Location of property,~'~1/4 X1/4, Section TN-R,2.C_W
Township
Mailing address 1j~
Address of site
Subdivision name Lot no.
Other homes on property? yes X No
Previous owner of property jpj _ -7-
Total size of parcel y ,Q f~ -e
r
Date parcel was created ._A f A
Are all corners and lot lines identifiable? _ X Yes No
Is this property being developed for (spec house)? Yes No
Volume 1511A and Page Number as recorded. with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available', :would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I(we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of
the property described in this information form, by virtue of a
warranty deed recorded in the office of the county Register of
Deeds as Document and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
recorded in the office of County Register of deeds as Document
No.
7 9~ /
'S-iof applicant Co-a' 1 cant ~1(
PP
D to o signature Date of Signature
]HIS SPACE RESERVED FOR RECORDMG DATA
THIS INDENTURE, Made by West Hart and Hannah E. REGISTERS OFFICE
Hart, his wife,
ST. CROIX CO.. WIS.
Recd for Record this_5t1__
grantors of St . Croix County, Wisconsin, hereby conveys and warrants day of___19 65
to Jimmie E. Malean and Katherine L. Malean,
husband and wife as joint tenants, at_-_ _____n, M.
Re St r o Beds
grantees RETURN TO
of Croix St - unttv Wisconsin, for the sum of
- Eighteen Hundred and no 100 (C 1800.00 Dollars, Heywood and Hayes
the following tract of land in St. Croix County, State of Wisconsin;
A parcel of land located in the Northwest Quarter (NW4) of the
Southeast Quarter (SE4) of Section Twelve (12), Township
Twenty-nine (29) North, Range Twenty (20) West, further described
as follows: From the Southwest corner of said Northwest Quarter
(NW1) of the Southeast Quarter (SE4) go East along the South line
of said Northwest Quarter (NIY4) of the Southeast Quarter (SE4)
a distance of 332.7 feet to the West right-of-way line of State
Trunk Highway 35; thence North 30° 48' East along said right-of-way
line a distance of 300.0 feet to the POINT OF BEGINNING for the
parcel to be conveyed herein; thence North 30° 48' East along
said right-of-way line a distance of 404.0 feet, thence North
84° 57' West a distance of 698.8 feet, thence South 00° 55' West
along the West line of said Northwest Quarter (NW4) of the
Southeast Quarter (SE4) a distance of 115.6 feet, thence
South 59° 12' East a distance of 572.0 feet to the point of
beginning; containing 3.4 acres.
Y.
V M' I N
1 I I
IN WITNESS WHEREOF, the said grantor S have hereunto set the it hand S and seal s this 5th
day of March , A. D., 19 65.
SIGNE ND SEALED IN PRESENCE OF -~~~~Y (SEAL)
/WEST HART,
v Z f~2 _ C~ L- ~t (SEAL)
JOHN D. HEYWOOD HANNAH E. HART
(SEAL)
Carol McDaniel
(SEAL)
STATE OF WISCONSIN,
St. Croix ss.
County.
Personally came before me, this 5th day of March , A. D., 19--6-5.
the above named West Hart and Hannah E. Hart, his wife,
i
to me known to be the person S who executed the foregoing..instiument and acknowledged same.
r
NOTARY- JOHN D . HEYWOOD
SEAL
This instrument drafted by Notary Public St. Croix County, Wis.
HEYWOOD AND HAYES, Hudson, Wisconsin Mycommission i (Is) permanent.
(SZtlon 59.51 (1) of the Wisconsin Statutes provides that all instruments to be recorded shall have plainly printed or typewritten thereon the
nsmea of the grantors, grantees, witnesses and notary).
WARRANTY DEED-STATE OF WISCONSIN, FORM NO. 9VOL 412 PA 93 M. C. MILLER CO., MILWAUKEE
d Department of Industry,
Labor SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
onion of eatery s Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
c ~Po x
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but -5'7-.
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # .
dimenstoned north arrow, and location and distance to nearest road. 6'b - -
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY ATE
PROPERTY OWNER: PROPERTY LOCATION
T/1/41 14-10 iVll=-- GOVT. LOT Nw 1/4 <6- 1/4,S iZ T - 2T ,N,R 1-0 E
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAM "O CSM #
/03 6 h`u, . 3-S
C)TY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE EFOWN EAREST ROAD r
,f/o. ffvf~ fa-~ . Cc>/ S Sya/G (-715-) 9JA6 - 9,r_32-
~f vOS`o.✓ 1 j40 . 3.5 J
New Construction Use Residential / Number of bedrooms [ ] Addition to existing building
Pa Replacement Public or commercial describe
Code derived daily flow gpd Recommended design loading rate bed, gpdM2-' ~~-trench, gpoltt2
Absorption area required gibed, ft2 75 19 trench, ft2 Maximum design loading rate / bed, gpd/ft2 ' a trertch, gpd/R2
Recommended infiltration surface elevation(s) 5 3 It (as referred to site plan benchmark)
Additional design / site cortsi 'ons sV,I', O w 7K Lti e-4,f
Parent material , Go AA mot.,-i Flood plain elevation, if applicable tip- tt
0
S = Suitable for system CONVENTIONAL. MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for s stem [l S ❑ U as ❑ U MS ❑ U ® S ❑ U IDS []U ❑ S R )u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourtd3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench
O= a /D R '3/3 S/ 2,4m, 4,e iYi&gfR e5 2A" . 5 .G
0 '51 2, "V". 64e '-w7w
yx 116
Ground 73L -/OV Y16 15 U lw, ye -Mt CS
Depth to cif u U- / s A:> '<o v s i
limiting
txto~
i
i
Remarks:
Boring # S/ 2. w,, slo t` vf/2 e5- 1 S • G
Ground
elev. SX
5y. /s ft.
5~1v U r ~d 29Ve E'
Depth to
limiting ~•rs1~ -rte C:-4 0,1u
e--
tam ~i
Remarks:
CST Name:-Please Print 1'?o13Ej'f 21kwQ el CGS.- Phone: 71f_- - Uc _ PIP-5
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Parcel 020-1113-00-000 01/12/2005 10:31 AM
PAGE 1 OF 1
Alt. Parcel 12.29.20.458F 020 - TOWN OF HUDSON
Current 0 ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* MALEAN, JIMMIE & KATHERINE
JIMMIE & KATHERINE MALEAN
1036 HWY 35
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1036 HWY 35
SC 2611 SCH D OF HUDSON
SP 1700 W ITC Legal Description: Acres: 3.400 Plat: N/A-NOT AVAILABLE
CEC 12 T29N R20W NW SE SW COR GO E Block/Condo Bldg:
332.7'W RM HWY 35,N30 DEG E300' TO POB
N 30 DEG E 404'N 84DEG W 698.8'S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
115.6' S 59DEG E 572 FT TO POB 12-29N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
2004 SUMMARY Bill Fair Market Value: Assessed with:
48543 227,900
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.400 48,400 127,900 176,300 NO
Totals for 2004:
General Property 3.400 48,400 127,900 176,3000
Woodland 0.000 0
Totals for 2003:
General Property 3.400 48,400 127,900 176,3000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 217
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00