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HomeMy WebLinkAbout020-1005-60-000 3 C; a y O o c ryi a c o° ! w N c N '0 y O O O. C i ° fy ~ ~ a N C O N i+ ~ l9 N C Z N ILL O O ,FO 3 .2 ~ E~ E ¢ FO- o al M a E Z p Z m 04 W O. co 0 0 O 2 v c V ~ r 7 w d z 2 16 (A f- r lp z c -a O M N i c cD ~ to (D c c ago -C ° o y c O U N zco D o E Z 7 m E - ° ` co a ~a Y c N ° G C CL 421 cc E E N N N alb ~0 5 z N y G. d d N a c Co = a°o o°o fA U O O) Of ~ Z 2 ° 0 co m c a 0 ~ ~ d ¢ cn io co S ~1 0 0 p N C C~ o 3 5 c a o° O 1n F- N N . O C C O C O N y L OD O U) N E 7 O C L T 0 04 l6 .O iii 0 0 2 0 Z C f- +Sr- fn . L 0. E 'e d c _1 A ciao Oac0 v Parcel 020-1005-60-000 01/28/2005 03:48 PM PAGE 1 OF 1 Alt. Parcel M 07.29.19.12C 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 * JOHNSON, JEFFREY J & MADELINE D JEFFREY J & MADELINE D JOHNSON 1016 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1016 TROUT BROOK RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.230 Plat: N/A-NOT AVAILABLE SEC 07 T29N R19W PT SE SE BEGIN 626'N Block/Condo Bldg: OF SE COR SEC 7 TH W 312; TH N 312FT; TH E 312FTL TG S 312FT TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 47620 247,200 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.230 41,400 149,800 191,200 NO Totals for 2004: General Property 2.230 41,400 149,800 191,200 Woodland 0.000 0 0 Totals for 2003: General Property 2.230 41,400 149,800 191,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 111 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 t Form -8TC-104 AS BUILT SANITARY SYSTEM REPORT OWNER j TOWNSHIP ,~u SEC. T d f N-R W ADDRESS /D/V ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE ;7 PLAN VIEW DZ 1e0T-w0" Distances and dimensions to meet requirements of II-HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM V~ktU 3: Te . 9 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: Ste" SEPTIC TANK: Manufacturer: Liquid Capacity: /OGa Number of rings used: ;2-- Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,O Side0 Rear, feet ..From nearest-property line . ' Front 10Side, 72 ' feet Number of feet from: well l/ d building: (Include this information of the abov lot plan)( rnsios to septic tank • 1 11 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size w Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 1:2 Length: Number of Lines: Area Built: Fill depth to top of pipe: yQ Number of feet from nearest property line: Front, O Side, Q Rear,0 Ft. Number of feet from well: Q Vey /aa Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box ~J been used on any of the above soil absorbtion sytems? (Check one). ~J HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: r/' Plumber on job: License Number: 3/84:mj JEPAWI MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR a HUMAN RELATIONS DIVISION P.O. BOX*36s PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: Ton o4,f S7 , Hudson R19W ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned) Town NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: I P CTION DATE: 1016 Trout Brook Rd. Hudson, WI 54 N MARK (Permanent reference pointl DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE V.. Name of Plumber: MP/MPRSW N... Coumy: Sanitary Permit Number: 6382 St. Croix 128648 ,~illi.qm Schumaker i i SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL JLOCKING COVER r PROVIDED: PROVIDED: XXES ❑NO ❑YES .LINO BEDDING. VENT CIA.: VENT ATE. . HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM' FEET FROM rr~~ LINE S AIR INLET: ❑YES ~NO ❑YES O NEAREST ~1,~ Sa 110 DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. JPUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING. IVENTTOFRESH, (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing vcrH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR. PIPE SPACING. COVER J INSIDE DIA.'. .PITS: LIQUID BED/TRENCH TRENCHES MATERIAL PIT DEPTH: DIMENSIONS J GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI R. NUMBER OF PROPE RTV WELL BUILDING: VENT TO FRESH BELRW PIPES. ABOVE COVER: ELpEV. INLET ELEV. END: &I PIPES LI E AIR IN.ILET. II 1~,a3 glfUa v1q a NEARESTO--►~ cp~T MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED SEEDED. MULCHED. CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. J DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.. DIA.. ELEV.. PIPES: DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY: COVER MATERIAL. PLANS: LIFT CORRESPONDS TO APPROVED ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO -]YES ❑NO NEAREST 0 ~i Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: DILHR SBD6710 (R. 01/82) [ITLE E177EFUMLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 A ~ 144 Sid x 11 inches in size. ki revision to-previous appl [cation -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 Zt % S T , N, R e~e!E (o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ldj<< N-~ k-aA f CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ~ VILLAGE ,ON RF: RCEL X NUMB ❑ Public k1 or 2 Fam. Dwelling-# of bedrooms s.Z PA III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ 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) 1.0 New 2. ® Replacement 3. ❑ Replacement of 4.E1 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 420 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 4<!5V e v *7- Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank sG r7l -T Lift Pump Tank/Si hon Chamber El L1 I F-1 VIII. RESPONSIBILITY STATEMENT 1, 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) /MPRSW No.: Business Phone Number: urn ~c! ltov~ '~1 t Plumber's Address (Street, City, State, Zip Code): Q&- A, IX. COUNTY/DEPARTM NT USE ONLY V❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determinati n 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 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 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 05 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) . t ;r 4 gyp-._". r- ~t DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY„ DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7 ON W1 370 HUMAN RELf~TIONS. (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME: s~ 1/421/ - /T29 N/R/91 .0 4JAS COUNTY: OWNER'S 8UV Plt-NAWM: MA LIN ADDRESS: STCkOlx 3E F )(QNN ~:a /U! 1eo $eoot 4 IVIJ6Soh, W) 540/C USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: TROFILE p 1 NS: 1PERCOLATION/ ES S: Residence ❑New Replacern I a /y-" ~9/3 SHPT /9~9 Sons $~K FA&L 49 'JOr~ _ P,-4iNF /GLL RATING: S- Site suitable for system U- Site unsuitable for system C TDU . MEIS DU I-G2,S QU RE: SL"~J J -IN~1U HOLDING TANK: RE (2~VV&tiT 16AJ4f- - 0'e-, If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: t~e dSS / Floodplain, indicate Floodplain elevation: OVA T PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHIR ELEVATION OBSERVED S HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- C) A b o >e''08 /2"Boso-rs 3o'Dr; e M5 ~nC(76 B- Z 822~ 9';.98 /Vo>•_' X82' B- ~.?3 9Z•`-E~ 011 ?S B- B- /~STFi" oAr S 14OT- PPcta' B- Tb $u. < sob) Ur. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTERSWELLING INTERVAL-MIN. PERINCH P. 1 4.0v t4n'E 94,00 /0 4 114 d P. Z .9 6N~L 94.90 /C) Z Z z S z 60 rJor. iL Z -60 / 2 2 Z P- ~ P- P- [ e_td VAT I AT E QG 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 their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION ~Ef T,~yc:sr+,vti2K- `>W Co~NF fc LOS PF lQ),L 'SySTS; 61 ' ~TTOAI S7&A q6 o~~J ~~v4i (ate IUO.pO~H L ® iJOTf~ QLTH00411 4PCA 15 T/G SoiLTk'rTt i 0 t~e~srz_IN~: ZO . i. BECaUt O~ NUMt4~r? p` Co~i3~~r . ~ap..bF?LO4~, 1, the undersigned, h ertify that the soil tests rted nono this form were ade by me in accord with the procedures and methods specified in the Wisconsin Adm' ' ra ive Code, and that th+ data and th ocation of the tests are correct to the best of my knowledge and belief. NAME Aint): ~j TESTS WERE COMPLETED ON: Akvs\/ JOUNSDk, klos-lA 1 ~~/ln/l> /AUC ADDRESS: % CERTIFICATION NUMBER: PHONE NUMBER (optional): 407 Lt~~ OoJ~ ~T ~1_1L~'SdfV I^I r t~I ~ -t T CST SI NATUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBO-6395 (R. 02/82) - OVER - STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER it, J . FIRE NO. CITY/STATE GLCrl'F' ZIP al PROPERTY LOCATION: $ < 1/4 S- 1/4, Section TN, R1 W, Town of 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 ca 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 for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. C oix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner an by a master plumber, journeyman plumber, restricted plumber or a licen ed 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 f rm 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office / St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above ad ress a ~ APPLICATION FOR SANITARY PERMIT STC-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 Location of property S~- 114 -s-S _1/4, Section ,;7 T R1.~W Township r Mailing address Address of site 1&4-/C Subdivision name Lot number Previous owner of property O f12r~ o i Total size of parcel Date parcel was created IZZIL Are all corners and lot lines identifiable? as k No Is this property being deve oped for resale (spec house)? Yes ~Na Volume and Page Number 133 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which inclu es a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and 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. ROPERTY OWNER CERTIFICATION I(We) certify that all sta ements on this form are true to the best of my (our) knowledge; that I (we) m (are) the owner(s) of the property described in this Information form, b virtue of a warranty deed recorded in the Office of the County Register of Dee s as Document No. ~ '71-11.2 ; and that I (We) presently own the propose site for the sewage disposal system (or I (we) have obtained an easement, ,t run with the above described property, for the construction of said syste , and the same has been duly recorded In the Office of the County Register of Beds, as Document No. :K 2 yf_4 1. Si na e o Signature of Co-Owner (If Applicable) Date of Signature Date of signature ~ `i.US' .u`y. ,S'~,s~ 7 ti1 /'d y/ ~ ~ r G✓ ~~S w wcll~.s-• .e ~ T3 TN ?o /d wTjdr,.d "41 C/ ~Gna ~ S i~Gd !t/ sOle, 1L of `l y ti i / 3 4/, 3' V I'I 1 C) 3: 6 ~ ° o 0vg p M d RY O O O L O N y `O X L C 07 N ~ N N N N 21-- v 0 Y = O R C) E ai M2 t O N 7 N N ;a 3ai~t v w o_ 0 ID15 m v m S N E c LOOD aU o = N 7E La (D 0 c Z °~cc oL c z E m w_ k U. c o o LL O y cm cO 3 O O 3 ESQ € F. ~5 E 0 _0 o QF-'n~an E Q HE U 3 M a M N N _ Z rn W Z O C Z 4t d N 41 nC\l ~ am a co 0 C z O Z 2 2 ` Z fn FZ- rn N m c E E N N O N O N j d N = d N N V1 N 4-~ IL U) 2 a 2 O O N Q O N Q w Z co z Z co z _o V C C N -c° N E Z N 41 N E m T ~o 'o R .0 SL - co a co w U° co a c c ~ p y d O- O W N d (0 O C3 c a u, r c r o r a E i t r E- cL°i Q) LO 0 D 0 E EL EL cl) •~w oaaa °aaCL N N a ~i 0 = ao rn y 2 rn rn y o U) J U -p a) OOi co Z 5 ~ m O O 'O m O O a) :3 CO y c n p 'O co N p p 'O N N d Q (n 41 Q U) Q (D 7 w Co 7 w Op O G N C p tl) C E 9 C) a) =3 ti c v a p fo ~ N C 'O N W 0 O C O C~ c O y C p C O U .O 0 0 y U Z N -O C p N C M w U O C 3 a~ O C O L N L IS fDN L d0 0 U 'a O N O °7 04 Z H O N O • 6 O 0 2 Z C S " O V € €L W- L: a • c d d y c c c r`iv a E r A c°~IL OU) OmU Parcel 020-1005-60-000 04/22/2005 11:57 AM PAGE 1 OF 1 Alt. Parcel 07.29.19.12C 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 * JOHNSON, JEFFREY J & MADELINE D JEFFREY J & MADELINE D JOHNSON 1016 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1016 TROUT BROOK RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.230 Plat: N/A-NOT AVAILABLE SEC 07 T29N R19W PT SE SE BEGIN 626'N Block/Condo Bldg: OF SE COR SEC 7 TH W 312'; TH N 312FT; TH E 312FTL TG S 312FT TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 47620 247,200 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.230 41,400 149,800 191,200 NO Totals for 2004: General Property 2.230 41,400 149,800 191,200 Woodland 0.000 0 0 Totals for 2003: General Property 2.230 41,400 149,800 191,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 111 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT / 67. Z ` l q. ''D ER Je F. ~oAn` 50h , TOIINSHIPffwZ,_Q4 SEC. 7 Tag N. RAW ADDRESS IIIf 1r ST, , 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 ( tyoa ~ c, c/ i i ~6 Pe t. P'I r- ~ ~ i ~ ( r j I ~ ~ r ( i 1 - i Indicate No,%th Antcow `.,'TIC TANK(S)/00 MFGR.J-,y5 pre. CasT- CONCRETE X STEEL Seale NO. of rings on cover Depth DRY WELL 'vCHES NO. of width length area no. of lines width a y' length d 6' area G /sa ' depth to top of pipe 3y" SREGATE i " / AREA REQUIRED C15-P- RATE AREA AS BUILT ,,claimer: The inspection of this system by St. Croix County does not imply complete :ioliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for stem operation. However, if failure is noted the County will jdake every effort to :err,ane cause of failure. ,ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. "INSPECTOR DATED PLU;iBER ON JOB'4'ac LICENSE dI M .U1~ER r L *REP0RT OF INSPEC7ION-INDIVIDUAL SEWAGE SYSTEM M ~ Sanitaxy Pexmit---4- C State Septic ~ Township St. Cxoix County NAME / C Locati.on`~! % o~ = Section TEA, R~W SEPTIC TANK Size gattans. Numb ex a4 Campaxtmentz j Distance Fxom: Wett 4t. 12% ox gxeatex Est open ~V 4t Bu.Ltding ) 4.t. WetZands 4t. Highwaten 4t. -DISPOSAL SYSTEM .Distance Fxam: WeLb T bt. 12% ox gxeatex AZope,~ 4t. BuiZd.i.ngs~ 4t. Wettands - Ft. Highwatex bx. FIELD DIMENSIONS: WiRh o4 txench 4t. Depth o4 xo ck b eZow tiZe_Z in. Length ob each Zine 4t. Depth ab %ock ovex tiZe ~ in. Number: o4 tines ~ Depth a4 tiZe beZow grade 2~in. Totat .length o4 tines ~ bt. SZo pe o j .trench z^ in pen 100 4t. Distance between .roes 6t. Depth to bedxock 4t. Totat abboxbtion axea1;7-~14t2 Depth to gxoundwatexlll~ gt. Requited area 4t2 PIT DIMENSIONS: Number o4 pigs Gxavet axaund pits yed no Outside diameter t. Depth betow inlet 4t. Totat ab.aaxbtion ax a bt A Axea xequ~ red 4t2 rn INSPECTED By TITLE APPROVED ,DATE 1972. REJECTED DATE 197. N a r t~ E~H 115 I WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 , t ~.e~' Cc REPORT ON SOIL BORINGS AND PERCOLATION TES S ~SC LOCATION: : .?'/4,45L'/4, Section 0M, Rj6jI(or 111 township or Municipality County Lot No. , Block No. Subdivision Name Owner's Name: fF 21 O 4ALSO A/ / Mailing Address: ~I / S r a lka,, r-~ 1.tS S~yUt TYPE OF OCCUPANCY: Residence X- No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT ~j DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS y SOIL MAP SHEET o~FF'S~~ SOILTYPE err ~SCiSI 'S PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN BER P P-Z o 3' 3 / P See f d,~ z- /0 3 3 3'z 3/Z / SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED 'ESTIMATED HIGHEST ,yc ~r(DEPTH TO BEDROCK IF OBSERVED) ` B- P4 it A 7% 7 f6" A4awe 79- n s 3C- s w B- 6- 5' Lv B- S' 96N - s-PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of~~itable areas. Indicate nu b pf square feet of absorption area needed for building type and occupancy. ~L~ - . 5yN` Q Indicate tale c oints ndic a slope. Sys or distances. Give horizontal and vertical referen - o ~ o i ak. V4 014 o tN I. yA, Il z Co , i 16 e,6 o2 0,'A Z gt_ y I, the undersigned, hereby certify that the soil tests report d on this orm were made 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 an belief Name (print) Certification No. Address Name of installer if known CST Signature ` COPY A -LOCAL AUTHORITY X v f .s 1 ~ , _ , , <.; ~ ~ J•Y' r - ~ } :5 ~ t . ~ ~ 'g j ~ ,y • i i - jl i ~ ~ ' F s q i t' j y " t ~ t '".7 i _ i - i ,r 4 Try State and County State Permit # / d Per PLB67 Permit Application County for Private Domestic Sewage Systems County , i *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Adress:,/ AV- S . a1 AA c` 0 B. LOCATION: _jM_'/4 _S~ Section _7 , T9f N, R b (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder_YESjC_NO # of Bathrooms Automatic Washer _,X YES NO Other (specify) E. SEPTIC TANK CAPACITY IC'CI ® Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation X Addition Replacement _ Prefab Concrete X *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2)x_3) Total Absorb Area sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length- 0' Width Depth Tile Depth 6No. of Lines Tile Size Seepage Pit: Inside diameter iqui~l Depth Percent slope of land O 4 Distance from critical slope - Or s 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 Ce ' ied Soil T ter, NAME a k(tvt•h,i C.S.T. # and other information obtained from d r Plumber's Signature MP/MPRSW# Phone #711 3`32.3 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). • A~Psse 1 we- t.Pvf c ~ ~iyfe 6+~ = I+DV f 194 41A& 10 / tw ~ ` `off , _ cu( A r 316' Do Not Write in Sp elow/f FOR DEPARTMENT USE ONLY Date of Application - - [ Fees Paid: State Lo . ~ o n y~ Date Permit Issued/R~eled' (date) - Issuing Agent Nam Inspection Yes I Valid# Date Rec'd 1. county (whf* 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 6/1/76 . s ! 1° . ~ } • v • , j II i ~ ti - r ' ~t ~ a - ~ ~ .9 _ ; J ti i ?t l . \ f t• I . j ~ . ~ , ~ ~ ~t ~ f t ~ ~ .;r ' ~ f' r TRANSFER FORM PLBSANITARY ~ PERMIT 67~T State Permit #CJ 17 Sanitary Per i # County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: % Section T.2 '1 N,R / IF IV (or) W Lot # City Subdivision Name, Nearest Road, Lake or Landmark /BLK # Village TroKT B /-eo~ ke Township &A-4r~ B. TYPE of Occupancy:.Commercial Industrial Other (Specify) Single Family Duplex No. of Bedrooms 3 Variance C: SEPTIC TANK CAPACITY UT 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 X Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate- / 'Total Absorb Area GAS` sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches Seepage Bed: X Length 3 6 Width Depth yO1 Tile Depth(top) 3 O No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land Y X S- Distance from critical slope 3 O E. WATER SUPPLY: Pq Private D Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Phone No. Name "'S Y Name Ze {f J "Tam T ,ft Address =Ag r2 Address ZZa / / LT f'T, Zip l~4c~se r, ~`1 Zip S'yo/ I, 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-115 prepared by the Certified Soil Tester and//or any additional soil tests that may have been required. Plumber's Signature AOW410C. (.J041Z-6e MP/MPR- W Phone Plumber's Address/ ,Qo,t 3 ~7 / ©S'G el o A at ~c n 0 a O Information obtained from 4.t c! o h h .4 o 4m (owner c F-1110 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 Proper t . If well has not e icate. 3 ' a w f/e a N I o• S~ too0 A 2 5 0 G 0, 0 3i FE] 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 • . • TRANSFER FORM L B 6 7 T SANITARY PERMIT State Permit # 1111111111 0 Sanitary Permit # County jV Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: Section T N,R (or) W Lot # -City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village Township B. TYPE of Occupancy:. Commercial Industrial Other (Specify) Single Family Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY Total gallons No. of tanks r HOLDING TANK CAPACITY Total gallons No. of tanks Prefab Concrete Poured-in-place Steel Fiberglass Other(Specify) New Installation Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 'Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No.'Trenches Seepage Bed: Length Width Depth Tile Depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Saaiiy-Reithae~eo : Phone No, " Name r.- Name y Address Address Zip Zip I, 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-115 prepared by the Certified Soil Tester and/or any additional soil tests that may have been required. Plumber's Signature MP/MPRSW # Phone # Plumber's Address 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 ert . If well has t been r'I indicatp i . t t f . r S i Ali Signature of Issuing Agent 1. County (Yellowcopy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701'