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Parcel 020-1144-60-000 10/11/2005 03:37 PM
PAGE 1 OF 1
Alt. Parcel 17.29.19.755 020 - 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 - DIRKS, JON J & MELISSA R
JON J & MELISSA R DIRKS
974 WERT RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description 974 WERT RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.710 Plat: 2276-PARK VIEW ESTATES 2ND ADD
SEC 17 T29N R1 9W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 62
ADD LOT 62 P755 1.71A
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/13/1999 603120 1426/304 WD
07/23/1997 697/587
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 04/29/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.710 32,600 176,100 208,700 NO
Totals for 2005:
General Property 1.710 32,600 176,100 208,700
Woodland 0.000 0 0
Totals for 2004:
General Property 1.710 32,600 176,100 208,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
I
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Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
Jef 'tit 5,1,n,~ TOWNSHIP '0 SEC. T ~-N-R -W
ADDRESS I~w~s'o~V ST. CROIX COUNTY, WISCONSIN
s
SUBDIVISION,'. LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I11IR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
iirr a
T- ~
r
-71
- -
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: 10-'d
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: o~ Y Tank Outlet Elevation:
Number of feet from nearest Road: Front Side Rear n
> > ~J feet
From nearest property line Front,0 Side,0 Rear, O feet
Number of feet from: well :Ila
J~p , building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
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: K Trench:
Width: / Length: 2 4~' Number of Lines: ~ Area Built:
Fill depth to top of pipe: 22 r°
Number of feet from nearest property line: Front, O Side, Rear,0 Pt.
Number of feet from well: S'4
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, Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
I
Inspector'
Plumber on job: ~T
Dated: 02 G
License Number :
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.`BOX-7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number.
(if assigned)
E] Holding Tank ❑ In-Ground Pressure ❑ Mound (
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INS Ak'(5-6cll
ON DATE
Je4b AndeJusavc 1631 Wahd Av H (jn, (UI 3-~a4•°OpS ~v3a
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV..
SW NE, Sec.17, T29N-R19W, Town v4 Hudsn Lot#62, P kv,irew E.6tate6
Name of Plumber: MP/MPRSW No. Co ty Sanitary Permit Number:
~►~,.~?,iam Schumaketr 6382 S ChG(X &943
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
I 1~ PROVIDED: PROVIDEPROVIDE[? I .,lJ AYES ONO 10yK ONO
BEDDING: VENT DIA VENT MATL HIGH WATER NUMBER OF ROAD: , ROPERTY WELL BUILDING: VENT TO FRESH
ALARM FEET FROM r j. LINE 1~ I IAIR INLET:
DYES NO L_ OYES O NEAREST P
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING. JVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) DYES ONO NEAREST 10
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Erd(,TH 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: JNO.OF DISTR. PIPE SPACING: COQ( INSIDE DIA.. #PITS. LIQUID
BED/TRENCH TRENCHES ( MZCT R~~Ay~+~ PIT DEPTH.
DIMENSIONS 7 Co ~~J
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE / DISTR. PIPE MATER4f, NO. DI ST•~ NUMBER OF PROPERTY WELL BUILDING: VENTTO FRESH
BELOW PIPE ABOVE COVER: `LEY. INLET ELEV. Etyp.I j PIPES: FEET FROM uNE/ y / S AIR INLET:
NEAREST-;; (J
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
DYES O meets the criteria for medium sand. TIONS MEASURED.
NO
SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS.
DYES ONO DYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED. MULCHED.
CENTER. EDGES:
DYES ONO DYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
''NIDTH: 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. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION F
INFORMATION (HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
OYES ONO OYES ONO
BUI
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: LDING:
sl l FEET FROM LINE:
DYES ONO OYES ONO NEAREST
J `rum
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,tern on t Retain in county file for audit.
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SIG TITLE.
6710 (R. 01/82)~~
NOR
wlsconsln APPLICATION FOR SANITARY PERMIT
~LDILHR COUNTY
(PLB 67) UNIFORM SANITARY PERMIT OEPRRTTEnT OF
InOUSTRV,LRBOq 6MUTRn RELRTIOnS 5Y 9Yls
-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
PROPERTY OWNER _ MAILING ADDRESS
j
PROPERTY LOCATION eff"'.
1/4 1/4, S , T2 N, R E (or TOWN OF:
LOT NUM ER BLOCK NUMBER SUBDIVISION_NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
Ix !
TYPE OF BUILDING OR USE SERVED^ O
fp~4_1 or 2 Family Number of Bedrooms: 3 Public (Specify):
THIS PERMIT IS FOR A:
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.
Seepage Bed ❑ Seepage Trench Cl Seepage Pit ❑ Holding Tank
L~ 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 R ; t;>
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete 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):
/Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: MP/MPRSW No.: Phone-Number:
C•.
txZia a ~Z.. >7 (it ;7 ) J Imo
Plumber's Address: Name of Desi ner:
ef -e.
COUNTY/DEPARTMENT USE ONLY
Signat re of Issuing Agent: Fee: Daate:) ❑ Disapproved
Q 1AApproved El Owner Given Initial
Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBO-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 y•
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.
APPLICATION FOR SANITARY PERMIT
S T C - 100
I
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/contractpr.,("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 Z
1.7N Location of Property Section Z% T j N - R W
Township
Mailing Address
V
Subdivision Name
Lot Number ,
Previous Owner of Property /v,~ 1_-
Total Size of Parcel A~
Date Parcel was Created
Are all corners and lot lines identifiable? Z/" Yes No
Is this property being developed for resale (spec house) ? Yes i% No
Volume and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3., Other recordings filed with the Register of Deeds Office
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 the Certified Survey Map shall also be required.
PROPERTy OWNER CERTIFICATION
I (We) cma6 y that aU 6 to temen s on .thiA bonm ace tAue to the beat o6 my ( our )
knowte.dge; that I (we) am (ane) the owner(s) o6 the property descA bed in this
injonmati.on Jonm, by vi tue o6 a wa4Aa.nty deed %econded in the Oj6ice of the
County RegisteA o6 Deeds as Document No. 3 ,9g ; and that I (we)
pus entty own the pnopos ed site jon the sewage pos system (on I (we) have
obtained an easement, to nun with the above descAibed ptopexty, 6o,% the
construc ti on of said system, and the same had been duty tecotded in the Ojb.ice
o6 the County Reg.idten o6 Deeds, as Document No.
SI ; ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
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SEPTIC TANK MAINTENANCE AGREEMENT H
St. Croix County z
d
OWNER/BUYER
ROUTE/BOX NUMBER, Fire Number
CITY/STATE ZIP
PROPERTY LOCATION: 7(~✓ X14, Section, T J N, RAW,
Town of St. Croix County,
Subdivisionr~' Lot number
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.
0
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- hd
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.
4
SIGNED C~
DATE
St. Croix County Zoning Office
P.O. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUST*; DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
LOCATI./'/ SECTION: lo TOWNSHIP/ LOTNO.:BLK.NO.:SUBDIVISIONNAME:
•W '/4 i ip 1 1 / hi s o a! 16X ¢s
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
s w Te FF R1.Ad4_spw b 3 / A✓✓wd &ef k-)e5, S o16
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL D SCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS:
Residence ? / ♦ New ❑ Replace I 9 1_, if J Sa, / A*II P r B _ /
RATING: S= Site suitable for system U= Site unsuitable for system C. s-Tf ~ ,ply Q
IN-GROUND Pa URE: SYSTEM-I N- FILL HO FLDING T : AN RECOMMENDED SYSTEM: (optional)
CO2S. IMNSOUND:
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: N Floodplain, indicate Floodplain elevation: ' /9
PR FI E DESCRIPTIONS
BORING TOTAL/ DEPTH TO GROUNDWATER ifd@"4!S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH4-N, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
it"
s
B- o~u~ 7 ,v~ #41 48n $ns , 3.
r y- Sot e -s
AAA/s/, /,dt 7 ns y 6 o/s>
B- oZ .d 4,4.4 e- 7 rO n CS
B- / . v ' r D 7 BI S/, Graf -V . /fin /s'0 / Sh -S
C _5 "0
q . of
B- . N'aJcce 2.3 64 s A S RA C S Ire / ,rs/4
Ile
B-,()' / .a vAte. T .D 7,6/5 /j A O n CS *14%, 04m W ten
O
B-
PERCOLATION TESTS
TEST DEPTHJ. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 4P004FS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
,oa 5,161 G
P-
P- .t ` 0 3 3 3 3
P- o < 3
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
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I, the undersigned, hereby certify that the soil tests reported on this form were mac( n accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests ar ° f my knowledge and belief.
NAME (print): _ TS WERE COMPLETED ON:
n
F G
ADDRESS: VA MTVIFICATION NUMBER: PHONE NUMBERIopptional): &At IC1
ATU 11 :
DISTRIBUTION: Original and one copy to Local Authority, Property Owner ands
DILHR-SBD-6395 (R. 02/82) - OVER -
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