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F Parcel 020-1159-90-000 02/14/2006 01:07
PAGE 1 OF 1
F 1
Alt. Parcel 16.29.19.914 020 - TOWN OF HUDSON
Current 1X_I 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 - FRYE, THOMAS J & KAREN B
THOMAS J & KAREN B FRYE
557 SPURLINE CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 557 SPURLINE CIR
SC 2611 SCH D OF HUDSON p
SP 1700 WITC T,•S 2 Z 2Li
~.D
Legal Description: Acres: 2.080 Plat: 2216-NORTH LINE STATION II
SEC 16 T29N R19W NORTH LINE STATION II Block/Condo Bldg: LOT 23
LOT 23
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/12/2002 702047 2078/388 QC
07/23/1997 983/404 WD-~
07/23/1997
07/23/1997 e-T44/14P a
2005 SUMMARY Bill Fair Market Value.~k Assessed with:'
92779 259,600 >
Valuations: Last Changed: 10/25/20(5V
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.080 69,300 195,500 264,800 NO 05
1, aTS 13 ~s~ Ill 'z
Totals for 2005: 3I~0 7
General Property 2.080 69,300 195,500 264,800
Woodland 0.000 0 0
Totals for 2004:
General Property 2.080 48,200 117,100 165,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 205
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
AS BUILT SANITARY SYSTEM REPORT
OWNER iyi ~Ii ~~d✓ TOWNSHIP !/sear
SECTION-& a N-R l f e
ADDRESS GoK*ZCZ ST. CROIX COUNTY, WISCONSIN
-~kcra kJt®/L,
SUBDIVISION LOT SIZE a, Z rL,
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _
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INDICATE NORTH ARROW
BENCHMARK: Elevation and description: %Ti~~ /~/✓l~rw, =/ado - t9.4p.0
Alternate benchmark
SEPTIC TANK:Manufacturer:a/wsa✓' Liquid Cap.
Rings used: 1 Manhole cover &,00 Final grade elev: 5-
,
Tank inlet elev.:9. 2 - Tank outlet elev.:
No. of feet from nearest,road:Front , Side, Rear Ft.-1iD"
From nearest prop. line:Front , Side , Rear,_Ft. ~y
No. of feet from: Well -S? , Building: -37"
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
s
c ~f
.E r
PUMP CHAMBER
Manufacturer: _w A Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front-, Side_, Rear-Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed:~enyshX...~/ Trench:--- Seepage Pit:
Width: /f Length L~ Number of Lines:---:~_Area Built7?- SS ?I-
Exist. Grade Elev.6,`/d Proposed Final Grade Elev. 7,3
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , ReaVY-_Ft.//d"
No. feet from well: 7S' No. feet from building S
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE: PLUMBER ON JOB:-
LICENSE NUMBER-,'
6/90:cj
rLOCATION: HUDSON 16.29.19.914,SE,NE, SPURLINE CIRCLE, LOT.23
isca",in Npartmentof Industry, PRIVATE SEWAGE SYSTEM County:
01 or and Human Relations INSPECTION REPORT ST. CROIX
Sa4ety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL'iNFORMATION 149322
hermit Holder's Name: ❑ City ❑ Villages] Town of: State Plan ID No.:
MILLER SAM E HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
C.8 a5 /-~d nCN n 020115990000
TANK INFORMATION ELEVATION DATA A9200168 ~v Z
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark d, 4,
Dosi-n g 4- 9 ? 9 r
Aeration Bldg. Sewer
Holding St/ /Inlet '9,17 VIP
TANK SETBACK INFORMATION St/Outlet 9a,QS
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
D g NA Header FAgaw
Aeration NA Dist. Pipe d, Us 9d,S~~
Holding Bot. System j
PUMP/ SIPHON INFORMATION Final Grade 3 y
Manufact Demander ' r-op';1_ (010 9~166
Mo el Number GPM d, S,T 5, 8 r Z
TDH Lift Loss Syste TDH Ft
Forcemain Length Dia. Fi Dist. To Wef~
SOIL ABSORPTION SYSTEM
BED/TRENCH width , Length r No. Of Trenches p No. Pits Inside Dia. Liquid Depth
DIMENSIONS Sld DIMENSIONS
LEACHI Manu adurer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type Of C CHAMBER o e Num er:
System: 7/C' (off 76 114 OR UNIT
DISTRIBUTION SYSTEM
Header / M*1%4QkI_ Distribution Pipe(s), ,r x Hole Size x Hole Spacing Vent To Air Intake
Length L? Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over 0 xx Depth Of xx Seeded/ Sodded xx Mule red
Bed /Trench Center Z -15-6 Bed /Trench Edges C/~ Ja Topsoil C] Yes ❑ No ❑ Yes,' ❑ No
COMMENTS: (Include code discrep ties, persons present, etc.) )
Plan revision required? ❑ Yes [~]-Pd6 P q
Use other side for additional information.
SBD-6710 (R 05/91) Date Inripector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: '
i
SANITARY PERMIT APPLICATION
[~rDILHA In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ Q'3~ Z
8'r4 X 11 inches in size. Ch &/k i rev sion to 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 PROPERTY LOCATION
S G.~ F_ t/4 G'/4, S T , N, R E (Or
PROPERTY OWNER'S MAILING ADDRESS LOT # Z 3 BLOCK
'Boy `*2,f Z__ 1
FR~
CITY, ST E ZIP CODE PHONE NUMBER SUB IVI ION NAME OR CSM NUMB
o .-L 9 ✓ A %tic -s a. i ° all%
II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State owned VILLAGE ; SO '1 1 _ U✓ rC~ ek
❑ Public 1 or 2 Fam. Dwelling-# of bedrooms3 PARCEL A N R )
III. BUILDING USE: (If building type is public, check all that apply) 9 r
0 L0 59-
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 n Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
140 System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 12. 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
O 0 X0 b& Z 4 . Z Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank 100 W ct S 2 -"-I I I . E1__ F1 I R
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
o 5r1_oL6t..r, ,1/1 -f~~2 X1-1 3A-33
lumber' Address (Street, City, State, Zip Code):
0 f) d 4- (A /V # ft- Ri r ` h /jt f W is 5- `L6 17
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing Agent Signature (No Stamps)
Approved F-1 Owner Given initial Surcharge Fee) t = -1101 9
$ Adverse D termin tion V
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS r
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 tine permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SPI) 6395) 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. Compete 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 8% 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.
SBD-6398 (R.11/88)
1 i
S T C - 100
4
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 a,,,
Location of property 1/4 WE 1/4,, Section N-R /f W
Township _J/Vu C- a
Mailing address n Y # Z R' -x,
1`fk~sa . "i
L S%~
Address of site
Znt"' Z
Subdivision name Aet7-k w CL__ %f`,~~, Lot no.-c;-
Other homes on property? yes.. No
Previous owner of property G n p ~1- ,(a q
Total size of parcel 2, 2 3 04 C-
Date parcel was created _4& Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) Yes No
Volume V -~3 and Page Number S 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 No. ~f ,9(12 8 , 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. ±Z - 24 9,-k
Signature of a
p' nt Co-applicant
Date of Signature Date of Signature
FAI
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER-
ADDRESS: FIRE NO:
LOCATION: -5,C_1141 A/E 1/4, SEC. / 4 T Z f N-R2
TOWN OF: I~u IS/ p ST. • CROIX COUNTY_
SUBDIVISION:
Sf f H LOT NO. J 3
Improper use and maintenance of your septic system co`~ild 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 prior 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
expiration date.
SIGNED:4T-r n.~
DATE:-
St.
Croix County Zoning office
911 4th St.
Hudson, WI 54016
DEP TRYQ11 OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
`INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS \ / MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION / SECTIO% O/l E (or TYINJHIP/M NICIPALITY: OT NO::BLK. O.: SU DIVISI N NAME:
~ ,q S
COUNTY: OW ER' R S AM MAI LING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCI L DESCRIPTION: PROFILE S: TESTS:
Residence ®New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GRO IND•PRESS : S M-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
ES ❑U CAS ❑U ®S ❑U ❑S ®U ❑S [OU
If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: S Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH M, ELEVATION OBSERVED EST. E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
7,S 7~
B- .
7/ 9 A117AIAr
7 / s 3 is
A/, 0 > -32 L~~SzS
B3 9? 7 > 7 3 - r -
BG
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER LNG IeS AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD 2 0133 PER INCH
P. -5",6 A49 IV
P- 3 ( 3
P-31
P-
P-
P`-
PLOT PLAN: 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 thej>'~Fation on the plot 1atr surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
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a _._...3_ l 1, the undersigned, 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 the location of the tests are correct to the best of my knowledge and belief.
NAME 1 int):
TESTS WERE COMPLETED ON:
J JU Z
AD S CER IFIC T1 N UMBER: PHONE NUMBER (optional):
3 - / - ' -
STS TU
0tGT SiGUTI *N: Original aid -ie copy to Local Authority, Propel,y Owner and )oil Tester.
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REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1
11/()5/92 14:40 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/ 6/92 AREA: JT
Activity: A9200168 11/ 6/92 Type: CONVSEPT Status: PENDING Constr:
Address: HUDSON 16.29.19.914,SE,NE, SPURLINE CIRCLE, LOT 23
Parcel: 020-1159-90-000 Occ: Use:
Description: 149322
Applicant: MILLER, SAM E Phone:
Owner: MILLER, SAM E Phone:
Contractor: STROHBEEN, DOUG Phone:
Inspection Request Information.....
Requestor: STROHBEEN, DOUG Phone:
Req Time: 11:11 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION