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HomeMy WebLinkAbout020-1040-92-000 r ~ i 1F..yy G C 7 3 w 0 V ~1 7 N C .r A (D r D) CD :i O (A 3 2 y Z O V A 2~ 0 n 07 0 ~y DI N O C~ C (O N ~C • (D 7 O (CD (D ? CD j N N CL Z Q` 41 V Q (O o `w3 0 (D D) 57 pWj y G) ? 0 -0 CD ° O (D D) ° V N CD (D O m 3 ° ° n N O CJ U] O H C ' 0m 00 p G ~ S'7 c I-d a t + o (D CIO - CD (a m o asCW 'J -0 CD I o o v o N. O rt m rt H ~C L Y CL z4z v a o CID m< o r co) co c, 3 0 z C C) 'a M -V ~ 0 0 0 0 W C v H (gyp d j to co co a m v v O D N Z 3 (D 0 CD rt o ° Ix (D 01 N Q tom" ro (D Ln CL I U) Z M ` w 1 =7 D a 0°! 0 o C) 0. cn 00 ° y O I trJ M. t-h v (D (D W (p O. x E m a 3 7 Z co -1 to rF in p A ? COY a a 0• ~i C A rt r. Fl F n W T m rt (D (D Z ° Z co M D A C4 CL > w a 3 3 n'7 c Q o ° (D I a I ~ A I y I ~ ti I ti 0 0 a O O (D 6Q Oho O 0O O rC ~ L Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER AllP 11X5- ~`C R~`~ / TOWNSHIP TT UI~fO/s/ SEC. ~ T _YN-R / W~ ADDRESS/'J!" ~~y• ST. CROIX COUNTY, WISCONSIN ~j''~°d SUBDIVISION -"LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM pvp 0,J do/ l3 ci4N gyp 5 f ~z x-52 ~LoT 3 WmM 30 3o S - - - - 6 - - - - - - - - le r ski ao `d GJGIr / r y 5 7rA4 of ENo or 1itoi1111'aGD d~ST f/E,/D~jQ 7 y,)AR AhIM1,6 73op`~ E,v9s : 9a . 9 ~ ao~, E.vf~s : I ~OI~EiPFt~ -7o INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 1iV CK fj~P~ Elevation of vertical reference point: Proposed slope at site: y .S /a vela f SEPTIC TANK: Manufacturer: CONG~,[~~. ~~o~ Liquid Capacity: Number of rings used: l Tank manhole cover elevation: 16 . i Tank Inlet Elevation: / ,C)L Tank Outlet Elevation: 73. 7r ' Number of feet from nearest Road: o Front,Q Side,O Rear, 092-, cQ,,A, feet EAST .From nearest property line Front, oSide ,ORear, 0 (0 feet Number of feet from: well, building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER Manufacturer: Liquid C city: Pump Model: Pump/Siphon nufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevat n: Gallons per cycle: Alarm Manufactu Alarm Switch Type: Number of eet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Q3 Width: 12- Lenith: 52 , Number of Lines: 2- Area Built: Fill depth to top of pipe: y'." 2 ell, Number of feet from nearest property line: Front, O Side, © Rear,0 Ft./_57 Number of feet from well: Jul Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: om of seepage pit elevation: Area Built: Has either a drop ox O or distribution box O been used on any of the above soil absorbtion s ems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings use Elevation of bottom of tank: Elevation o nlet: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: 0 Inspector: Dated. Plumber on job: License Number: HOMESITE SEpTIC PLUMBING Co RT. 3 O'NEIL RD., HUDSON, WIS, 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO, 3307M.p.R& 3/84 •mj MINN. INSTALLER & DESIGNER LK MO. ®06 3 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOn & HUM&N RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BO.X 7969 BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE Plan I D. Number: (I 1 assigned ) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER! JADDRESS OF PERMIT HOLDER: INSPEC ION DA E: i Jerry Millen Rt. 5, Cty Rd. A, Hudson, WI r7 Q BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. R6. PT. EV.: CST REF, PT. ELEV.. SW NE Section 19, T29N-R19W, Town of Hudson Name of Plumber: JMPIMPRSW Nn.. Cnunty Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 79147 SEPTIC TANK/HOLDING TANK: 49 /1/, 7P IMANUF OR EP: LIQUID CAPACITY' T NK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL JLOCKING COVER 17 ( PROVIDED. PROVIDED: L/~ r YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MAT[ J HIGH WATER NUMBE OF ROAD: PROPERT WELL: BUILDING: VENT TO FRESH ALARM FEET FROM - jLINr AIR INLE YES ❑NO ❑YES ❑NO NEARE_ST A6 C' SING CHAMBER: MANUFACTURER JBEDDING. LIQUID CAPACITY PUMP MODEL jP11MP,SIPHON MANUF ACTUFtE[i WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PH OPEHTV WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM INE AIR INLET' PUMP ON AND OFF) ❑YES ❑NO NEAREST-_ 0.1 1 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 11,1AME TER MATT HIAE AND MAHKIN6 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: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPr CIN(; COVER NSI T DIA PITS LIQUID THES / / M 1AL: PIT DEPTH. DIMENSIONS _7 I (f/~ ,HIv',JLL DEPIH FILL DEPTH UISTH PIP[ DISTH PIPE DISTR. PE. MATERIAL STH NUMBER OF PPERTY WELL BUILDING: VENT TO FRESH BELOW PIP 5 ABOVE VER ELE INLE f EL V ENU . AIR NLET: FEET FROM 7U NEAREST_ ~ MOUND S YSTEM: 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- ❑ YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE [1111MANI N! MA[tK[HS 013SERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH HEU DEPTH OF TOPSOIL SQDD[ D SEEDED MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING IGHAVE IT DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS STR MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL N0 171 PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVELEVDIAELEVPIPEA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY IWELL: BUILDING: FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in unty file for audit. Reverse Side. SI NAT TITLE DILHR SBD 6710 (R. 01/82) i, wlstonsln APPLICATION FOR SANITARY PERMIT ~~DILHR s'- 64°/X (PLB 67) COUNTY DEaawrmEnr0V UNIFORM SANITARY PERMIT # InDUSTRV, LRBOR 6 HUTRn RELRTIOnS 2 521,Y,.9 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PA ERT~jY OWR• ~cs~ ~i//N MAILING ADDRESS PROPERTY LOCATION q t~ s~1/4/vE1/4, S ~i . T2/, N, R/9 E (o ill TOWN OF: 11vOfo,4~/ GcJ% S . LOT NUMBER BLOCK NUMBER SUBDIVISION NAM NEAREST ROAD, STATE PLAN I.D. NUMBER AV- TYPE OF BUILDING OR USE SERVED y~ 1 or 2 Family Number of Bedrooms: J ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy r Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 4 4910,11! 1,E eA,1 440 .moo IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PRROI SED (Square Feet): 13 601-100- W /l -Z , & Private ❑ Joint ❑ Public f, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): HOMESITE 9EPTIC PLUMISIN (nature: RgP¢MPRSW No.: Phone Number: p p RT. 30'NEII RD., HUDSON, WIS 54016 , 3,?0 2 (711 A(O t1~4 Plumber's Address: Name of Designer: 1AMS. MASTER PLUMBER LIC. NO. 3307 MAR.S. COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: P e: ❑ Disapproved El Owner Given Initial QApproved Adverse Determination Reason for D pp Wl~~ Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. HOMESITE SEPTIC PLUK18ING CO. Nfi. I O'NEIL RD., HUDSON, WIS. 54016 APPLICATION FOR SANITARY PERMIT ROBERT ULBRICHT VAI MASTER PLUMBER LIC. NO. 3301 M.P.R.S. S T C - 100 ADMIN. INSTALLER & DESIGNER LIC. NO. 00663 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 SLt/ ;4 Section , T N-R W Township !7 UPS4i✓ Mailing Address 114u!l• Address of Site ~j Subdivision Name Lot Number Previous Owner of Property A14AW Total Size of ;Parcel Of Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes No Volume/ and Page Number 31 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, 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eerW6y that att statements on this SoAm a1[e trcue to the best as my (outs) knowledge; that I (we) am (atce) the owneA(.6) o6 the prcopeAty de6c abed in this insoAmation Sorrm, by viAtue o6 a wat&anty deed teco&ded in the Ossiee o6 the County RegisteA o6 Deeds" Document No. S ; and that I (We) pnesentty own the p&opobed site Son the sewage digspoz System (art I (we) have obtained an easement, to nun with the above deschibed pupertty, Sore the construction o6 said .system, and the same has been duty %eco&ded in the Ossiee o6 the County RegisteA o6 Deeds, as Document No. SIGNATURE OF OWNER G SIGNATURE C WNER (IF APPLICABLE) DATE SIGNED DA SIGNED C. H z HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD., HUDSON: WIS. 54016 >a ROBERT ULBRICHT S T C - 105 VWI& MASTER PLUMBER LIC. NO. 3307 MARS. r a H INSTALLER & DESIGNER L1C. NO, 00663 SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z r~ /4 9 494 /V ~ ROUTE/BOX NUMBER 1- Fire Number CITY/STATE i~/'U~SyN ~A's - ZIP _47Y0 Z 2_. ~ PROPERTY LOCATION. .5a) IVA6", 14, Section T 2-f N, If p~ Town of QJ Q~ St. Croix County, ~v Subdivision umber Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank.is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. y 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ro ment 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 ` ~o ~c1Ln Y rest Q~c,,,~ ~~'•1 DATE (14A ~L 30. lc1~~o ` St. Croix County Zoning Office P.O. Box 9&' Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. . y c Lo r m 7D m O c W cD ? w (DC C N 3 O p cD ~ ! I p 7 a3 =0 C) w w' w c 3 3 ccocD cocD ~ ~p o ? D 10 a N a o~ C =Dr Cl) -4 F O cn F ~ u c7 CD 7 CD 0 w-0 o N° CD a 0 A i n gym- :3 >'co nRr >j co (00 0 > > o woO = ~c w c ol< S, 5v c3oBL o w wrt cn m w w cn j CD _p p a N to D < (N Q 'o 0-0 w N ccDn D c c~D Q W o° 0= S. o QoF c wciw ~ocD or.afDMw O a oNto m?vw w c CO) m (n ~wN' Z n F ° o O w m CD CD a~-ic0o Z o am0 3CDCDm a D ° owFo?$ R1 co -i ID a. ~ c cr W (D =r :3 M a =r ao N o aN 0 F m F C tTl CD . ? vara S~ ~m 3c 0 l< a o 0. c o -1 w0 rn C: ° m N w w ao F ccn cc aw o f11 Q0 CCD Q~'F a=r0 C cn < =r CD t~ ° c 3 n ~.(A°c oCD M0 3 0 o a ~Nw a o ca c (D c p: ac 3 0 cD o o 3 o °•J Cl a o ~3 to -w Z V DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (11J) MADISOP.O. BOX 7969 HUMAN RELATIONS N WI 3707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME: sw '1. 1/ 'If /TZ9 N/R/7 E (o ► trvDsov COUNTY: OWNER'Sf'BteftR'S NAME: MAILING ADDRESS: _4-CiPoI /;,J Rr.~ ,yvE2ro,J cc~;-t. ,S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL DESC IP IONS: PER LATION TESTS: K Residence ❑New Replace 3 7T ,4/,e%/ i181fioew S/ i986 RATING: S= Site suitable for system U= Site unsuitable for system s' S7 ~i'+.~+E~ f % /v~~%t~ ' " E~o~ ~O ~ ti~ •Si4 uQ_S CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-1 -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) oS OU aS OU . NS OU OS aU OS au 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: CL~ SS S- Floodplain, indicate Floodplain elevation: __1 I PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- f730 > 90 • SSt' Jr. o. JW..Z 5' cav A . 7.33 ~~l,✓ CS t. /15 B- Z d•7 ! 3'x/0. j rS' 1.31 /,3N . J O .sF.v c S p ,r B-3 d • ~ /C~. 3C ~Zo- y~~ ~ • s' o4 6a. rov.e IS lo• SS 40 CS B- 0 , B- B- PERCOLATION TESTS i l trJt TEST DEPTH. WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ E.PCO.w •t&T l,V P- cS s~'° T s. P- 2- L I P- S Z .t/ I ;v v7T4S 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 their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION fT I [ ~ , F i ~ ~ I s r 'Cro 7. Wit//.rest,, v~.a C~t ~a . nal S ° Y's ~L~ • .S'Efwtr~ i i LZ ~ ~ . K 3 f ~ t r vexi ~t'tf r•. _ _ _ rP>~ - l ~_4r till ' R,e~,f. dF Bz . y >wFs ' ti ttAe undersigned, hereby certify that the soil tests reported on this form were made by me in accord w' the procedures and methods specified in the isconsin inistrative Code, and that the data recorded and the location of the, tests. are correct to the best of my knowledge and belief. (print): TESTS WERE COMPLETED ON: C HOMESITE 3fPTIC PLUMBING CO. 00ei N, WI& 6016 ESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ROBERT UIBfiICNT SS'. b2 y~Z_. 3,P~ -~/~S H". INSTALLER & DESIGNER LIC. N0.06 CST SIGNATURE: is- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. t. , 'r DILHR-SBD-6395 (R. 02/82) - OVER - - L .ACTIONS FOR OMP S - 5395 a p sail test, YOUr rep t 2. Cher t1 Ut y IF A[ L a prop iate box; WITH T r~ T "L TESTERS cc Mill T _tl i PL B (7 MOT and CROSS SECTION PIANS Sj5fTE A,P,P~afO CE'~T ~D . P o i2' ~ ~ S /s 'x S1~`~f'~t~ ~ 3 BaaQ~H . t~ • 1 , • r- SZ- B ~ 8 • _ ~s ~ . ~4o /o wed ~ for O ,s TP , 40 HOANESITE I SEPTIC PLUMBING CO. 7 RT. 3 O'NEIL RD., HUDSON, M& 54016 c ROBERT ULBRICHT SCA 1 G MINN. INOTAUR & DESIGNER LIC. NO. OW 1 - .2o ijjG Fresh Air Inlets And Observation Pipe SoiL TESTINy By 140MESITE TESTING r--G• RT-A OwEiL Rco► Approved Vent Cap HUDSON, WIS• 4,4016 Minimum 12" Above ~o ojev -1-1P1W1Aa0Q- Final Grade A441MV,y fem. /0 YL " Above Pipe 4" Cast Iron To Final Grade Vent Pipe Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 s Aggregate Beneath o Perforated Pipe Below Pipe q / Q~ o Coupling Terminating At 0 Bottom Of System A • Parcel 020-1040-92-000 08/25/2006 10:26 Alt. Parcel 19.29.19.172 1/2 E PAGE 1 OF Current X 020 - TOWN OF HUDSO Creation Date Historical Date Map # ST. CROIX COUNTY, WISCONSIN p Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner TIM ANDERSON O - ANDERSON, TIM 351 BAER DR HUDSON WI 54016 Districts: SC = School SP = Special Type Dist # Description Property Address(es): * Primary * 351 BAER DR ry SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: SEC 19 T29N R19W PT SW NE COM N LN RR Block/Condo Bld 0983 Plat: N/A-NOT Bld AVAILABLE R/W 620' SWLY FROM E LN, TH N 37DEG W g: 350' POB CONT 170 FT TO HWY A SW- LY ON HWY 205' TH S 37DEG E 170' NELY-POB EXC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) .020 AC EZ-1-1172/187 19-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 12/14/1998 593758 1387/003 QC 07/23/1997 ;/(184/336 Wp 07/23/1997 670/ ~Irl J l~ 2006 SUMMARY Bill Fair Market Value: Asse with: 0 Valuations: Description Last Changed: 10/25/2005 Class Acres Land RESIDENTIAL G1 Improve Total State Reason 0.983 51,900 156,000 207,900 NO Totals for 2006: General Property 0.983 51,900 Woodland 0.000 156,000 207,900 0 0 Totals for 2005: General Property 0.983 51,900 156,000 207,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00