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Parcel 020-1149-60-000 02/23/2006 10:04 AM
PAGE 1 OF 1
Alt. Parcel 33.29.19.804 020 - 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): O = Current Owner, C = Current Co-Owner
O - MOULTON, JAMES R & COLEEN M
JAMES R & COLEEN e00
593 PARTRIDGE CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 593 PARTRIDGE CIR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.800 Plat: 0215-COUNTRYSIDE VILLAGE
SEC 33 T29N R19W COUNTRYSIDE VILLAGE LOT Block/Condo Bldg: LOT 18
18
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-29N-19W
Notes: Parcel History:
Date Doc # ol/'age Type
07/23/1997 741/343 -
07/23/1997 5/1
2005 SUMMARY Bill Fair Market Value: Assessed with:
92672 255,600
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.800 78,200 182,500 260,700 NO 05
Totals for 2005:
General Property 2.800 78,200 182,500 260,700
Woodland 0.000 0 0
Totals for 2004:
General Property 2.800 34,000 150,900 184,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 134
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
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER - TOWNSHIP SEC._ T,,~N-R19 W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IZHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r
r NdGCS~
a
INDICATE NORTH ARROW
d .c"
BENCHMARK: Describe the vertical reference point used 70,
Elevation of vertical reference point: 7v? Proposed slope at site:
SEPTIC TANK: Manufacturer: ~aJ~,p z O IS Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: / Tank Outlet Elevation:
Number of feet from nearest Road: Front 10 Side, Rear, l 7~ feet
From nearest property line Front,O Side, Rear, O ^ feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank
GF.F. RRURRCR CTnV
POW
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
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, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Length: Number of Lines:_ Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Fron , O Side, Rear,0 Ft
Number of feet from well
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 O been used on any of the above soil
absorbtion sytems? (Check one).
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, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: ~s~ ~G Plumber on job:
License Number :
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR ~'SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
I BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
lanl.D.Number
gned)
CONVENTIONAL ❑ALTERNATIVE ;AATE
Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTIJames Moulton R. R., Somerset, WI 54025
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: FEE. PT. ELEV.: CST REF. PT. ELEV.
SE SE, Section 33, T29N-R19W, Town of Hudson,Lot 18, Countryside
Name of Plumber: MP/MPRSW No.. County. Sanna,y Perma Number:
Cal Powers, Jr. 1563 St. Croix 79184
SEPTIC TANK HOLDING TANK: p?
MANUFACTUR 11-rouib CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
YES ONO OYES ONO
BEDDING: IVENTDIA.. VENT MATT JHIGH WATER NUMBER OF ROAD. PROPERTY WELL. JBUI LDI NG. VENT TO FRESH
ALARM IFEET LINE. / AIR F
XYES ONO (1 a OYES LINO NEAR_ESTOM 7( (f / g~(~I
DOSING CHAMBER:
MANUFACTURER . BEDDING: LIQUID CAPACITY PUMP MODEL FP""'P; SIPHON MANU{ AC T IIHEH WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
OYES ONO OYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF °HOPERTV WELL BUILDING IVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM `INE AIR INLET'
PUMP ON AND OFF) OYES NO NEAREST-~
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing UI:,ME TER MATE RIAL 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:
BED/TRENCH WIDT/ H' LENGTH NO. OF 11111H PIPE SPACIN(; COVER INSIDE Uln -PITS LIQUID
$ f THE NC{ / RIAL' PIT DEPTH.
DIMENSIONS
GRn~'EL DEPTIi FILL DEPTH UST H. PIPF UISTH PIPE DISTR. PIPE MATERIAL N 5TH N PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIPES ABD COVER 11! 11' INLf I ELEV~yEND P UMBER OF
AIR INLET:
P FEET FROM LIN `y~ 2k
NEAREST --io_ t7
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-
OYES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PE HMANE NT MAHKE HS OBSEH VA TIO I WELLS
OYES ONO OYES ONO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DFPTH OF TOPSOIL SOOOFO SFE DFO MULCHED
CENTER EDGES
OYES. ONO OYES NO OYES DNO
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 PATEIA
NOD I STH IGISTR. PIPE UISTHIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV. CIA. ELEV. IPES DIA..
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING CHILLED CORRECTI.V RIAL VERTI
CAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ONO OYES ONO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PR OPERTV WELL.
BUILDING:
FEET FROM LINE.
OYES ONO OYES ONO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
is, NA E. TITLE.
DILHR SBD 6710 (R. 01/82) i
mwwmwiim~ wisconsin APPLICATION FOR SANITARY PERMIT , w4z DILHR COUNTY
(PLB 67)
1; -'Z~ x 00= OEPRPT OF UNIFORM SANITARY PERMIT #
InDUSTgV,V, LR LgBOq 6 MUTFin gELfiT10n5 -791"
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPE Y OWNER MAI DDRESS
PROPERTY LOCATION CTTT:
Wk-LAGE:
1/ 1/4, , N, R~~ (or)1( TOWN OF:
LOT NUMBER JBLOCK UMBER ISUBDIVI ION NAME NEA EST R AD, L KE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
,4 1 or 2 Family Number of Bedrooms: Public (Specify):
THIS PERMIT IS FOR A:
9 New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
9 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 Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of refab. Site Steel Fiberglass Plastic
Gallons Tanks CPoncrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
°Z ,LxJ Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibilit Ilation o th riv a sewage system shown on the attached plans.
Na of P umber IP Signat MP/MPRSW No.: Phone Number
~S
um is Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee- Date: ❑ Disapproved
-GG El Owner Given Initial
(.j C Approved Adverse Determination
Reason for isap " oval
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);
s<
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.
APPLICATION FOR SANITARY PERMIT
f'
ST 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
Location of Propertyw Section T,:~? N-R~ W
Townships /irSB /
.I 'rZ
Mailing Address
~~rrtPs L C' / 7
Address of Site
Subdivision Name
Lot Number ~Z4~
Previous Owner of Property
Total Size of parcel ".29/)
a p
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume 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, 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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPFRTy OWNER CERTIFICATION
I (We) ce ti.sy that aU statements on this Sonm ane true to the best o6 my (oun)
k,nowtedge; that 1 (we) am ( ahe ) the owneA (,s) o j the pnope t y de s c 4 i.bed in this
.i.nSoAmation Sonm, by viA tue os a waAAavity deed neconded in the 0jjice o6 the
County RegisteA oS Deedsas Document No. ; and that I (We) pnesentty
own the pnoposed site Son the sewage di~spoza sy~s em (o)L I (we) have obtained an
easement, to nun with the above deacti.bed pnopenty, San the cowstYucti.on os said
.system, and the same has been duty neconded in the 046ice o6 the County RegisteA o6
Deeds, as Document No. ) .
/,V]
IGN OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
5~-~-66
DATE SIGNED DATE SIGNED
POINT OF MATCH LINE - SHEET 2 SOUTH LINE OF SE 1/4 MATCH LINE -SHEET 2
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SEPTIC TANK MAINTENANCE AGREEMENT °
z
St. Croix County
e
9
H
~ CT7
OWNER/BUYER
ROUTE/BOX NUMBER Fire Number
.CITY/STATEh,~e~~CG~ Glf ZIP
1 Se c t i o n
PROPERTY LOCATION:< T N , R ~ W
Town of~~,g St. Croix County,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper mainntenanc con-
sists of pumping out the septic tank every three years 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. °
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
~d
the standards set forth, herein, as set by the Wisconsin Depart-
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 q
DATE ^ v
St. Croix County Zoning Office
P. 0. Box 98•
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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DEPORTMENT O.F REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969
IfIUMAN RELATIONS \ MADISON, WI 53707
(H63.0911) & Chapter 145.045)
LOCF.'ION: SECTION: TOWNSHTY: LOT NO.:BLK. SUBDIVISION NAME:
~Sl
~4 (or
COUNTY: OWN R'S/BU R'S NAME: DDRESS:
74
USE DATES OB ERVATIONS MADE
NO.BEDRM=COMMERC17D ESC RIPTION: rr~ IPROFILEDESCRIPTIONS: ER OLATIONTESTS:
Residence X New ❑ Replace
-ZZ
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTION1A'L: MOUND: IN-GROUN~`D-PRESIS'URE: SYSTEM-IN-F(ILLHOLDIIN`GTANK: RECOMMENDED SYSTEM :(o tional)
®S DU 1ZS J rY E]cJ N- Liu OJ 2u
If Percolation Tests are NOT required DESIG RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHia, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- > p
B-
B- e
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER I#OCTTn AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH
P- 1 A J6 ,
P-
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 their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. ;
SYSTEM ELEVATION 40~/
f E ~
. / ) [
3
tN
.
i
I, the undersigned, hereby certify that the soil tests reporte 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 prin TESTS WERE COMPLETED ON:
AD CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST NATURE:
j
14STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
r3-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - S - 6396 ,
To be a comp' accurate nail test, your report must inoluc.le:
2. whether this is a residence or corn n ject;
S: or commercial use planned;
4.
5. A - G IS SU[TAP I -,QA P self; TANK ONLY IF ALL
SOIL -IC
6, rg profil i ' completing tl plot plan;
7. 1 to scat =d. A
e elf rmanent;
t ~1 pla, te_it exernp-
10, n the appropriate box;
i 1. )ur ber;
a T FILED WITH THE
I )CAL AL -Y WITH J
'I TIN S FOR CERTIFIED SOIL TESTERS
tes and T
J
1s
Bn
Bl
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Y
Herat -
W/
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u,
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a - constructioi.
PAGE 'OF
CroSS SeeJtun o A Ze0 SyStern
~irlS //p
t~ h
Fresh Air Iniels And Observation Pipe
C)~_ Approved Vent Cap
Minimum 12" Above
Final Grade
I
20- 42" Above Pipe _ 4" Cast Iron
To Final Grade Vent Pipe
Marsh Hay Or Synthetic Covering
Min. 2" Aggregate
l Over Plpe
I Olstrlbution -Tee
Pipe 0 0 0 0 0
6" Aggregate a Perforated Pipe Below
Beneath Pipe
Coupling Terminating At
Bottom Of System
Pruposen ~Inr~~ 19ro c4.
za2 Ion
VLO
SOIL FILL
DISTRIBUTIOF.1 PIPE
APPROVED S4MNETIC COVER
"'MATER14 OR 9" OF STRAW
Z"oFA6GREGA~B OR MARSH HAy
(a0FAGGREGATE A
ELEV. OF 7•-5FEF-T---._
{
DIS-t"RiF3UTI0kj PIPE TO BE AT LEAST -_7~2 INCHES BELOW ORIGIMAL GRADE
AIJD AT LEAST20 INCHES BUT 1.10 MORE THAM 42 MICHES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXCAVAT160 ROM OWMAL 6KAOR WILL BE ~ INCHES
Mi (IMUM ®EPrtt OF FACAvATI®N FROM 0IRI41bAL 6949€ WILL BE _ INCHES
SIGAIED:
i
P
LICEAISE DUMBER:
I
I
DATE: ~2- C?-C ,
F
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