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Parcel 020-1145-10-000 1oio7i2oo5 10:43 AM
PAGE 10F1
Alt. Parcel 17.29.19.760 020 - 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 - WILLSON, M W YOUNG,& LARRY & FERN
M W YOUNG,& LARRY & FERN WILLSON
960 WERT RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 960 WERT RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.370 Plat: 2276-PARK VIEW ESTATES 2ND ADD
SEC 17 T29N R1 9W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 67
ADD LOT 67 960 WERT RD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1173/482 QC
07/23/1997 1098/579 LC
07/23/1997 1091/280 SD
07/23/1997 911/18
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/26/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.370 28,600 126,200 154,800 NO
Totals for 2005:
General Property 1.370 28,600 126,200 154,800
Woodland 0.000 0 0
Totals for 2004:
General Property 1.370 28,600 126,200 154,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 134
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form -STC-104
0 AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP l`►'u~s~/~ SEC. T 2 9 N-R W
ADDRESS !'ff, ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOTLOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
J
8•
I
11061se,
R
I p
f
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: /OO-D Proposed slope at site: ,2 pie
SEPTIC TANK: Manufacturer:- Liquid Capacity: O61!5) 47/-?
Number of rings used:
nub Tank manhole cover elevation: 5;79
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front 10 Side 0 Rear, ® ,2/Q feet
From nearest property line Front 10 Side 10 Rear, O /0Q' feet
Number of feet from: well , building: f~
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER 4
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Ma fa ure • Pump Size
Elevation of inlet: B om of elevation:
Pump off switch elevation: Gal ns'per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: ~S Trench
Width: /2 / Length: Number of Lines: Area Built: Co~7 D
Fill depth to top of pipe:
Number of feet from nearest property line: ~~Fr//ont, (D Side, O Rear, 0rt .
Number of feet from well: Ailed 1"e l zQ
Number of feet from building: '70
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Di eter:
Liquid depth: Bottom of epag pit a evation:
Area Built:
Has either a drop box O or distribut n bo b n u led on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Eleva 'on of bot of tank:
Elevation of inlet:
Number of feet from nearest prop/ry in ro , O Side, O Rear, Ft.
Number of feet m 11:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector
Dated: Plumber on j ob : /YUCYS~rI
License Number: Z
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. 136A 7969 BUREAU OF PLUMBING
MADISON, WI 53707 r~/,,
:
LXCONVENTIONAL DALTERNATIVE IS,,,, Plan l.D.Number
D Holding Tank El In-Ground Pressure D Mound (if assigned)
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTAON DATE
Vetcnon Waxon R. R. 1, Hudson, W1 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: IFIfF. PT. LEV.: CST REF. PT. ELEV.:
SW NF, Section 17, T29N-R19W, Town ob Hudson, Lot#67, Pcftk View II
Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number:
Date F. Hudson 6629 St. cAoix 69644
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TA I ET E TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
67 DYES ENO EYES ENO
/ JAHILGH
BEDDING: VENT DIA.: VENT MATL. WATER NUMBER-OF ROAD: IPROPERTY WELL: BUILDING. ENT TO FRESH
AIR INLET:
ARM. FEET FROM LINE„ IV
DYES ENO " DYES ENO NEAREST G~ Li
DOSING CHAMBER:
MANUFACTURER: BEDDING. LIQUID CAPACITY PUMP MODEL. JPUMP/SIPHON MANUFACT'+RgR rAFIN.I
' , LABEL LOCKING COVER
I
/1 ROVIDED: PROVIDED:
DYES ENO DYES ENO DYES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: M F PROPERTY WELL. BUILDING .IV ENT TO FRESH
(DIFFERENCE BETWEEN EIA O LINE AIR INLET:
PUMP ON AND OFF) DYES NO NEA EST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 tNC,TFI 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:
BED/TRENCH WIDTH: LENGTH JNO~OF JDISTR. PIPE SPACING. COVER DE DIA *PITS LIQUID
TR NICHES. MATERIAL: 'I PIT --DEPTH:
DIMENSIONS Cam/
GRAVEL DEPTH FILL DEPTH DISTR. PIP DISTR. PIPE DISTR PIPE MATERIAL NO. DIS TR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
BELOW PIPES. ABU OVER
ILEI ~ T. E V. ENp. PIPES. FEET FROM LINE / AIR 14LET
NEAREST--i. ` \J
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-
D YES NO meets the criteria for medium sand. TIONS MEASURED.
E
SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS
DYES ENO DYES ENO
DEPTH OVER TRENCHBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED: MULCHED:
CENTER. EDGES.
DYES ENO DYES ENO DYES ENO
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: INC. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV.: DIA, ELEV.: PIPES. DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
DYES ENO DYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑ YES 1:1 NO ❑ YES El NO NEAREST
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Sketch System on R my file for audit.
Reverse Side.
SIGNATURE. TITLE
~A
DILHR SBD 6710 (R. 01/82)
unscons,n APPLICATION FOR SANITARY PERMIT
D 1 L H R (PLB 67) COUNTY
1n0US RYLR 0R UNIFORM SANITARY PERMIT #
~flOUST.LgB6 MUmF7r1RELQT10r75
(Vg6,yy
-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
If' r!G1 J1 f $f~// c~ e 'f
PROPERTY LOCATION - / /
51,01 /4 E/ 1/4, S T N, R f A (or W TOWN OF: fy~~r/sors7
LOT NUMBER BLOCK NUMBER SUBDIVISION /NAME NEAREST ROAD, LAKE OR LL NDMARK STATE PLAN I.D. NUMBER
X1,4 I TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: ❑ Public (Specify):
i
THIS PERMIT IS FOR A:
X 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.
Seepaye Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny Tank
1 System-,16-Fill ❑ In-Ground Pressure ❑ VaOlt 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: Ze~ae
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound In-Ground Pressure
Total #o Prefab. Site Steel Fiberglass Plastic
Gallons 'I'an oncrete nstructed
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: MPJMPRSW No.: Phone Number:
42o-rN.., 44::; Z9 (715 574 337
Plumber's Address: Name of Designer:
Ha I,, I
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee:: Date: ❑ Disapproved
Approver! ❑ Owner Given Initial
Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
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APPLICATION FOR SANITARY PERMIT
I
S T 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 ttiis office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - = - - - - - - - - - - - - - -
Owner of Property l~ ✓I~ rJ l X Q j~
Location of Property 5&1) ~4- N, Section / 7 , T Z9 N - R W
Township /7'ia/YSD 1d'
Mailing Address
Subdivision Name
Lot Number
Previous Owner of Property
p i
Total Size of Parcel ,200 X < 9
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 6 d~ and Page Number_ 2/ 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) eenti_6y that aU .6tatement6 on this 4onm o e cue to the best o6 my (ouA)
knowledge; that I (we) am (are) the owner. (s) o~ the pnopenty de,6Ch ibed in -t6i
in6on.mati.on JoAm, by vi tue of a waA&anty deed recorded in the Oj6.iee of the
County RegisjeA o4 Deeds as Document No. / ; and that I (we)
pn.es entty om, the i 4 .s e.d s % t^ ' - +1 " ~ n 0 ~Os at s qs te m ton I (we) have
obtained an Basement, to nun with the above desc/,'be;'. ;,-.copenty, bon the
eonsttueti,on o{ said system, and the same has been duty AecoAded in the 04jice
o6 the Country Regii ten o~ Deeds, as Document No.
SIGNATURE 01' OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED ^T
• H
` H
a
ST C- 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
d
OWNER/BUYER O i%
ROUTE/BOX NUMBER -Fire Number
CITY/STATE ✓~~o.~', ZIP
PROPERTY LOCATION: S6) ;L, 1L, Section , T N, R/'5?_W,
Town of $ t. Croix County,
Subdivision/',^J~ Lot number 41~,7
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. H
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- u
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.
S I G N E D
DATE
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.
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WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES Ica
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALT~ s,
P.O. BOX 309 i
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
T2 N, 1311(or)t Township or Municipality `
LOCATION: '!a, ''/4, Section
r'Pc~J eS County cd.`X
Lot No. , Block No. u ision (dame
Owner's Name: /1 /i x
~OX / ~c Sou l~s Ja'sSys ~ ;
Mailing Address: A 2s ,
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW _ ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS' 7 PERCOLATION TESTS /S 'Zg" 7
SOIL MAP SHEET ✓ SOIL TYPE ,5./y 1414.,
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
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P e. D r e. Pllf-11-9 f Z° a _3 I~p
P- fiat,
S~ oYe. '
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO 1reP OC V, 8 RyED)
Q 'r fit t A'° 7 plea ~r ` ~~~j I t N S~~ 7o7 S r/ h,
rl, 73
AIOAt C- -7 49r2f
B- pia, ,`lo w ? p6 / X475, t.z • SL ? „ .s c~ r,
o,u 0-- 7 o" 5+6,-.
/,21(7
j 01 13
PLAN VIEW (Locate percolationtests,soil bore holes and suitable sail areas.)
Indicate on the plan the location and squar feet of suitable areas. ! dica a nu ber of square feet of absorption area
needed for building type and occupancy. ZS-A" , S-00 loicate scale
or distances. Give horizontal and vertical refere a points. Indicate slope.y r /~'eP/~lCC-7;
1 15 7"
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F. 131y I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and elief.
Name (print) 4 ( 4 , Certification No. Address So4✓ ( t a
Name of installer if known
CST Signatur
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