Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1165-82-000
A N O n CO) O E m n d CD m n Q cn~ z CD U) z~ z orn~ = o =r m ° o OD m 0 m o v O CD c No `c • (D 3 3 CD (D OD (D 7 N (D (D v y N Fy OD ~l a m o ur W a= ° (n W r_ 6 C CD m y v l (AF m a) CL OL n ODD n O f0 O O=p ° N r'3 Q OD O N Vt O 7 p I 5i D W ° C. cn D cn z D (n l< . ~1. CD cQ y W a n l O (n O O. n q: 73 CD c CD CL 0 0 CD C: CL CD i U\Nl O N CD fl. O N CD 00 00 P 0 (a cn CA cn C I .9 O 000 °I O 000°_ N N C rrS -D Ch Cl) Ch (1) v v 0 v o v 0 5- (n CR O O A) -0 '0 CD (D . (D F =r m N N - O 01 a a Q d .3i D z y z zooz ° N O D a 0 D z W o Q 3 O o ° o s C~ b (D CD ° m ° ~ CD Cl) CD (n M. CD m c CAD CD O N (ND a w a a 3 5 a 3 z ? (O z CD (G fn O O O A z m (n c cn c v a 0 CL A ~Z 3 (WD m CD m a a z I c 3 I c~ I a n O fn a co CA Z H z m w w 0) M y ~ Q no a CD c O ° o Q C (p O. -p a o Q j ::r 21 - Cn CD CD m ° ° 3 CACD CL N W ° °z a ;r "NNOF0 m CD CA W O C1 O ~T D) D) 7' 1 ft a. -p 9 *0 O a O O O O N ° o ° O ° 3 CD i 3 &~i OD O Aa' . W O O rC :E =r CD =r 0) CL x y < N a) n. CD n d 7 F 0 n O• CL y O O Z O. O y n 7 O S C 3 ° N o• m ti 0 d Imo 7 (D a y A CD o ° D CD dQ v o O O o0 °O_ ti 3 a WERT, BRIAN Nil SE, Section 17 R-,: 5 ' '74f J~ecky C,rCle, T29N-R19W, Town o6 Hudson Hudlson, Wl 54016 Lot #98, Pcucbiew Best. San.PeAmit#69678 9-25-85 R. Hopkiu Conventionat, New i Parcel 020-1165-82-000 10/07/2005 11:57 AM PAGE 1 OF 1 Alt. Parcel 17.29.19.1015 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 - TREMBLE, JOHN S & HOLLY-JEAN N JOHN S & HOLLY-JEAN N TREMBLE 942 BECKY CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description ' 942 BECKY CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.496 Plat: 2284-PARK VIEW ESTATES 4TH ADD SEC 17 T29N R1 9W PARK VIEW ESTATES 4TH Block/Condo Bldg: LOT 98 ADD LOT 98 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1096/115 WD 07/23/1997 711/619 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.498 30,200 233,000 263,200 NO Totals for 2005: General Property 1.498 30,200 233,000 263,200 Woodland 0.000 0 0 Totals for 2004: General Property 1.498 30,200 233,000 263,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 131 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, I INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P,O, BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 63707 BUREAU OF PLUMBING QkONVENTIONAL ❑ALTERNATIVE Stntn Plnn LD. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound of nasignnd] NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER, B ~ •n WiE✓„~. INSPECTION DATE BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF 77 t NW SE, Section 17, T29N-R19W, Town of Hudson, Lot #98,PaAkview Eyt. . PT. ELEV. CST REF PT ELEV Name of Plumber, ~n t MP/MPRSW No.. Cnunly . Richatcd Ho}clkin,s Sanitary Permit Number Yl 1059 St. Cnoix 69678 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. BEDDING. VENT DIA.: VENT MATT HIGH WATER ❑YES LINO ❑YES LINO ALARM NUMBER OF ROAD. PROPERTY WELL Y ES N O ❑ : BUILDING: FEET FROM LINE IVENTTOFRFSH AIR INLET: ❑ LIYES LINO NEAREST _ DOSING CHAMBER: MANUFAC TURER. BEDDING'. LIQUID CAPACI TV PUMP MODEL 1PUMP,11PHON MANUF ACT UFtEH WARNING LABEL LOCK I NG COVER ❑YES LINO PROVIDED PROVIDED: GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL ❑YES LINO ❑YES LINO (DIFFERENCE BETWEEN NUMBER OF PHGPEHrv WELL BUILDING IvENTroFRESH FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES LINO _ NEAREST--. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing N+,IH D1nMFTEIf "tATERIALANDMAHKING 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 DISTH PIPE SPACING COVEH - TRENCHES r7A -PITS E DIMENSIONS MATERIAL PIT GH.4VEL ULP IH FILL DEPTH UISTH. PIPE UISTH PIPE DISTR. PIPE MATERIAL NO I STH NUMBER OF BE LOW PIPES ABOVE COVER EL' V. INLFT ELE V.ENU PROPERTY :V-VLL BUILDING. VEPIPES FEET FROM LINE AINEAREST- 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- ❑YES LINO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PEH"1ANf NT MAHKEHs UbSEH~ATION WELLS DEPTH OV EH TRENCH BED DEPTH OVFH TRENCH HEU UFPTH OF TOPS(11L SOUI)F I) ❑YES LINO ❑YES LINO CENTER EDGES SEE UFU MULCHED ❑YES. LINO ❑YES D. ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH MOTH ENG TH NO OF LATE HAL SPACING (iNAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIF OLU DISTR. PIPE MANIFOLD MATERIAL NO UISTH UISTH. PIPE UISTRIBU iION PIPE MATERIAL & MARKING ELEV.. ELEV.'. CIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HO LE SIZE HOLE SPACING DH I LLE D CORRECT L V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO _ ❑YES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. PROPERTY WELL. BUILDING: NUMBER OF FROM INE: ❑YES LINO ❑YES LINO FEET L NEAREST- Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) wlsconsln APPLICATION FOR SANITARY PERMIT L_.; . ILHR /,y'.L COUNTY PEPPRTmEnT OF (pLB 67) UNIFORM SANITARY PERMIT # InOUSTRV.LRBOR 6WUMRn RELRT1On5. la 24 ZY" -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 PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION CITY: V I G E; (1~ I ~A/4/6~ 1/4, S17 . T®/, N, R/ E (or) W.,1 OWN o : 1 11.1: LO~: NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER St I BOO A 1J TYPE OF BUILDING OR USE SERVED Z 1 or 2 Family Number of Bedrooms: Public (Specify): 3-1 THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair iJ Replacement Soil Absorption System ❑ Revision ❑ Privy El Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. K Seepaye Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank '71 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 ! ( 1 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 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): PROPOSED (Square Feet): ~r y ~y 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): L/ r Signa re: JMPIMPRSW No. Phone Number: Plumber's Ad/drr ss:: / v Na~e _of/Designer- COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: D I LH R -SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber ` DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION HUMAN REDATIONS PERCOLATION TESTS (11J) MADP.O. BOX WI 53707 (H63.09(1) & Chapter 145.045) L AT ON: SECTION: TOWN IP/ NICIPALITY: LOT NO.: BLK. NO.: SUB VI ION NAME: I /a l /T 29N/R17E (or t~ 1~les CO V: OWN S BUYER'S NAME: LLING ADDRESS: C USE DATES OBSERVATIONS MADE NO. BEDRMS.: COM E IAL DESCRIPTION] ,~,~y PROFIL D SCRIPTIONS: PTIO TESTS: Residence ,J/~iVew U'~ RATING: S= Site suitable for system U= Site unsuitable for system C NVENTIONAL: MOUND: IN-GROUND-P RE: SYSTEM-IN-FJ,LLHO ❑LDING TANK: I ENDED SYSTE (opti all SS ❑UU j01 ❑U S ❑U S (/NU S JQ~jj 1J~ /C~fJ Vl a »k7 If Percolation Tests are NOT req it SIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(bl, indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST, HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) za~ 1?) al 10 B- /01 99W, 6js;/ I ~ 71' an V, 7 75 6h z, i B- f0 q,~3, /0 , ~ A' 84 / 433 7.1s''9., s, f 4 1. B- 5 6j, fl/ 93 6, /7 6, PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD2 PERIO 3 PER INCH P- P- z e ~t P- P-_ / "t P- 71 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 93,36 I i . i E t i E i I 0011 1-1 1 i - tM I IN t E 3 k 3 . 3 i k 3 E t 3 ~ t q I 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 the location of the tests are correct to the best of my knowledge and belief. NAME ( r t): ' r TESTS WER CO PLETED ON: e s > ADDRESS: j CERTIFI ATI N NUMBER: PHONE NUMBER (optional): CST SIGN TU ZL~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORD 115 - S BD - 5595 m To be a complete qnd urate soil test, your report must include: 1. Complete legal de 2. The use section must :e whether this is r ,r cial project; 3. MAXIMUM numL 'cial use r 4. Is this a or o'cr r 5. Con A SITE IS SUIT,4.E C)I DING TANK ONLY IF ALL 0 7 OUT BASED ON SOIL 6. Pk N s° own here for writing pi ornpleting the plot plan; 7, v i ating your ~atio)s. i scale is prefern- i. A it at, e. and are pe ' as load & colation test e> -,p- :e; 14 ;rtion (such as fl )d plain, e _wation) does n lace N.A. it )riate box; 11. Sit t' ) =i and place y -ent arl ` s --rd your certs numbers 12. My copies anc! I' +te as d. ALL SC TESTS MUST BE -ICED WITH THE LOCPL OftITYWITH' 1DA -MPLETION. -VIATION FOR CERTIFIED SOIL, TESTERS Textures ols st r 1 n„~ cob rye cgr - i =der 3") S. d sl- m -I "si _ s *c,' y . sc - _ ` sic S(t x cc rT)r i i n cl p I-fWL - 1, Six cge s : fo 'waste B- v nce Point TO t a" Tlrep or t' - I f ate'. „r to DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDU,STRb"q. DIVISION LABO,J AND PERCOLATION TESTS (115) P.O. BOX 7969 ,HUMAN RELATIONS \ / MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: "/a '/a /T N/R E (or) W COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ❑Residence ❑New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑S ❑U ❑S ❑u ❑S ❑U ❑S ❑u ❑S ❑U If Percolation Tests are NOT required DESIGN RATE: Ir fan y portion of the tested area is in the under s.H63.09(5) (b), indicate: loodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSE VED EST. HIGHEST TO BEDROCK IF BSERVED (S E B RV.ON BACK. > eat . s J, y B- 1 00 04 VV Xow4, 3" &xroo t O!K Zoli, 1,112'16.,gut 3'&, 5 B- B- -ft-d B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERIOD2 PERT D3 PER INCH P- P- 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 e 3 F a - t i z 3 3 [ 3 i , i r 1 E r f N , i E E i , , t a ~ r t - _ J__ f i __j 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DI LHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a cc--' a ~rnsir soil test, your report n-iu: 1. Complete iuya 2. The use sectic whether this is Or commercial project; 3. MAXIMUM nui commercial use 4, Is this a new c 5. :oI e A IS F„ -19 A HOLDING TANK ONLY IF Al L vc°, - "N -)ITION ; riptions a :I completing the . .1 diagram 7g your t ations. UrE to scale is pre I n riled it rr-rk aitu y it are cl€ is boxes as food ply, t,, ' exe 0- prol ia' 10. 'r>rmation (such as flood plain, e. a ~tion) does not apply, place N.A. it ~ appropriate box; 11. orm air; ;'a( your current ad( and your certification numbe- 12. 7 s -i distribute _ d. ALL SOIL TESTS ML"7 -ED WITH THE ` IIN I - OMPLETION. i CERTIFIED SOIL. TESTERS St Ktures tlth€, E st - - < 11 ock col 1c") F ne gr - Eder 3") _ Li stone +s- }°GW-I- Cs - F - ~e mecl ! - Cf Is -n *si 5 5c' - L )arn R sicl `.im r"fit si 1Y7 n1 ril UN d p - }'{Wia.. Si it fc E v TO 0 I w it may test, "r ity in )nStrUCt . 1. DEPAFi+M,l:NTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 370 HUMAN RELATIONS (1-163.090) & Chapter 145.045) 4~ y 1 LOCAT_I ; - SE TION TAN R IqE ( W TOWNSHIP/M HIP/MUNICIPALITY: LOT NO.: BLK NO.rp~7Vr~ / ~ AME: T / / f~ 1 ~7y8 R / 061; - 7 ) 9/ ) CO N Y: OWNE R'S BUYER'S NAME* MAILI G ADDRESS: UroI a, We. r S DATES OBSERVATIONS MADE USE N] I I U PR F E ONS: R CA N TS: IL D ND.BEDRMS : COMMER DESCRtPTlO p e esidence New ❑Reptac 3 RATING: S= Site suitable for system U= Site unsuitable for system [AS ENTIO~NAL: MOU D:❑~ IN-GROUND-PQ URE:SYQEM-INiOC C rl~s If Percolation Tests are NOT required DESIGN E: O 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 PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION °BSERVED EST, GHE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) I&IS Li Pia 1,C)ZIM 51) B- •75 n s>rg.: ~,Ig~ Mgr 1,~''~I' s~ -161Bn J B-'3 ~~,9 i I,ya' gl sl 1 t33'v11-SI) TAS•'Bns ~r• B- y I'l t lcQ,y 9 f'y~, ~1 ~SI~ , 33' ,gn SI ~4~~5`~~ 5 B- 5 1 It~o~~4 B- l O~bs ~ ` gi sly I,g3'6n sl ~,~7'~;n fir. PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME + DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL.-MIN. ! --F; ,inns P .^D FcR PER INCH P_ ' P_ i r P- P- _ Zt3 P- P_ JA0AIJA s S f ro 1k ow 4 o t k rt PLOT PLAN: Show locations of percolation tests, soil bdttngs and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and sh o tion on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope, - SYSTEM. ELEVATION It, ep Am qxr t..._. _~'(-..-.....1. 7I '0 r-~ eon _411 I v ) LEL 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 the location of the tests are correct to the best of my knowledge and belief, NAM (print : TESTS WERE COMPETED ON: 1-1 ' ha I ~ ~ ~ 's ADO SS: of CERTIFICATION I/NUMBER: PHONE rnNUMBER ((optional): 1) ll 1 y ! W r ti7 CS NA DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Be L. 67 PL CST A U E C ~j- I Iii PR%OJEC T P L U M H L I~ lv A ME L L 0 CAT 10 N _ _ I ► C N 5 E://- P _ L U I-- - \!I A P ~frc /v i i FRESH AI1: :CPLIT,US AND OBSERVATION .PIQ1; CPIOSS) SECTION rl j Approve('! Vent Cap Min imum 12 Above , Final 4" Cast Iron Above Pipe Vent Pipe To Final Grade-.__- r Marsh Hay Or Synthetic Coveri lig Min. 2" Agg.i-egl-iI Over Pipe _ - Distribution Tee Pipe bc~~},T-.; of Aggregate Perforated Pipe Below Beneath Pipe 4---- -CoLq)1.'_ng Terminating At Bottom of System r- y ~o m ' df CD a 0 9 v ~ ~~w ~ e cCwwN~~ c m m a(D CD - ° '113 $ .0 ° apo w o = CD ° CO g CD w 0 CD CL 00 n coo~3.•a c( DL o o m ° w to 0 0 0 > > O 3oC cc ° 0 3 o ao c0 =r. r. -~~wwv, 0 w (D o Wo am y CO M c ° (a a 0 C ~ v 0 n ° ~2 ° w = o m ao ~CL ..►m~ 0 Saa? y C m ° y N m w 0 (a 5Df-- Z a w CD -1 3 Ca (D (D O amA 3CDmm?G. D (D -w O co N N as w +?C ~ O =r CO (A c =rmc vac WWCf C I~TI (D C =r 0 0. (D o ~ow(D _ a`° ~-..o co cY° a O O (~D C A N y C cro o.Of CO) CCCF L7 a w Q) m _ o R1 ow 0 a$m aaaCD (a (A =r cp - o ~o c %.((D m 3 ( a ' C CD ~s ; ba aw CI. ,m -Imc aCa oc~w0 0 o °,3 ~.s am o o 3 m o ° a 0 < CO CD 00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT + s ' r OWNER TOWNSHIP`, ~i SEC. T N-R ADDRESS 0j, 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 S (3 AR00m N K ~f 101 f 000 37t ,tea q1 f4l t i W sf 500 + Wood ~RS~P INDICATE NORTH ARROW t BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: J Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: ~Q a Number of rings used: ~j Tank manhole cover-elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front ,O Side Rear, Q feet From nearest property line Front,OSide,ORear,O feet Number of feet from: well 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 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Ib _ Length: 3(0 Number of Lines: Area Built:(OU y 31 t! Fill depth to top of pipe: Number of feet from nearest property line: Front, ® Side, O Rear,0 Ft.~ Number of feet from well: 7 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: s Dated: Plumber on j ob : 1 ! f i,License Number: S q 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number : O Holding Tank O In-Ground Pressure ❑ Mound III assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Brian Wert R. R. 5, Hudson, WI 54016 ~~3D45 30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.: NW SE, Section 17,T29N-R19W, Town of Hudson,Lot#98,Park View Estates Name of Plumber: MP/MPR SW No. County Sanitary Permit Number: Richard Hopkins 1059 St. Croix 64884 SEPTIC TANK/HOLDING TANK: MANUFACTURER: TANK INLET ELEV.: TANK OUTLET ELEV.: WAR NING LABEL LOCKING COVER , VI DPROVIDED7 YES ONO OYES ONO BEDDING: VENTDIA.: VENT MATL.im UMBER TY WELL: BUILDING: IVENTTO H L EET FRO0 7 0 AIR I rOYES NO EAREST DOSING CHAMBER: EGALLONSPER R. 7YIN G LIQUID CAPACITYPUMMODELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER PROVIDEDPRVIDED: ES ONO OYES ONO OYES ONO CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELLBUILDINGVENTTOFRESH CE BETWEEN FEET FROM uNE AIR INLET ND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire, construction shall cease unti=FRCE the soil is dry enough to continue.) CONVENTIONAL SYSTEM: W BED/TRENCH IDTH QQ LENGTH NO OF DISTR. PIPE SPACING: COVER INSIDE DIA #PITS QUID DIMENSIONS ( if 3 TRENCHES ) MA~ PIT PTH: 1 GRAVEL DEPT FILL D TH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. D TR. NUMBER OF PROPERTY WELL rj_BELOW PIPS: ABO C ELEVINLETELF E r C' PIPE LINE 4 Z.f FEET FROM INLET: NEAREST-~ / J MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROV DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it REV SE SIDE. SHOW ELEVA- meets the criteria for me sand. TIONS EASURED. OYES ONO SOIL COVER TEXTURE. PERMANEN OBSERVATION WE LLS. DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED ES ❑,NO ❑ YES ❑ NO CENTER. DEPTH OF TOPSOIL. SODDED: SEEDEDF MULCHED EDGES. OYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA ELEV. PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: OYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: 2 OYES ONO DYES ONO NEAREST 01 7t7 Sketch System on Ret ' in county file for audit. Reverse Side. SIGNATU TITLE: DILHR SBD 6710 (R. 01/82) w+sconsin APPLICATION FOR SANITARY PERMIT DILHR COU14TY - OEPQRTmEnTOF (PLB 67) InOU5TRY, LRBOR 6 HUTgn gELRTlOnS UNIFORM SANITARY PERMIT # lo'dl '9FAl -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 PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATIONQ , CITY: Al WK/4 !J~ 114, S l 7 , T , N. R/ E (o wW VOWN OE: O LO NUMBER BLOCK NUMBER SUBDIVISION NAM NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER I A - oa TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): ( r N 3 THIS PERMIT IS FOR A: ,New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF ,T~,cH, IS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. K 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 Conc ete Constructed Steel Fiberglass Plastic Septic Tank Capacity e 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: 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): T na re: D7lP1MPRSW No.: Phone Number: Plum er's Addr s: p a = h , ✓ Na e of Designee F I a COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ,,C ❑ Disapproved ~f 'en AO ❑ Owner Given Initial ' Approved Adverse Determination eason 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 l y 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. APPLICATION FOR SANITARY PUMIT S 11, 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 f issuance. Should th.lo dovelttpmool- 'bt! lulu odod for.resale by owner/contractgz, ("spec`*,". house"), ,:hen a 60P(tn(l 1111,11 IJ111I 111 III- ii~l iliiod and completed when the property is so ].d aud Iitihutlttell III I lihs nl.l h,o i,1111i 11111 1tppt1111raiat.e deed recording. - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property :;„r.t ion T N - R W Township Mailing Address Subdivision Name A_"I(21Z26~ Lot Number _ Previous Owner of Propor:ty Total Size of Parcua. Date Parcel was Creill..oi Are all corners and '10L i anea idUnt 1 L I,tb l.e'; Yes No Is this property being developed for resale (spec house) ? Yes No Volume aivi 11age Number as recorded with the Register of Deeds INCLOOE WITH THIS AI'PLII;ATION ONE OF THE FOLLOWING: 1. Warranty Dood 2. Land Contract. 3. Other recordiugti 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) cmtt6y that aP 6.tatemen-ta on taws 6oaurl ane t'Aue to the best o6 my (ouA) hnow2edge; Bia.t I (we) `am (alte-) .tlte oo'ju (6) o6 the pnopenty ducvci.bed in this ,tvn6oAmati.on 16onm, by viAtue o6 a wcvvtcut.ty d ed neco/tded in the 066ice o6 .the County Regiz teA o6 Deeds a6 Document No. V0 and that I (we) plte6en,ey oun the pnopo6ed 6-i,te bon the 5etoage dapasa by6tem (on 1 (we) have obtained an easemert-t:, to n.un with the above de,sc/Li.bed pn.opeA.ty, bo& the corvst4ucti.or o6 6a. d 6y6.tem, and .tire same Ita,s been duQ AecoAded in the 066.ice 06 the County Reg.is-teA o6 Deeds, a6 Uoctune.mt No. SIGNAI'UtE (I, OWNER SIGNAT RE OF CO-OWNER (IF APPLICABLE) DATE LGNED OATS SIGNED I ERMOTT AGENCY. 600 Third Street HUDSON, WISCONSIN 5401'6 Phone 386-5151 Twin City Toll Free 436-5755• UNPLATIEQ 6q~lQ~ I PARK - W- G R E - N_ - --S89015'1 M I_ L L - MO„UMENTEO Ed 6 IPA w g xi 3z r"10 -7 $ I Qj wl _PARK_ I VIEW I 1 I _ESITATES 1 ~l ?i ~ ~w 79 80 I I 1i r`°° o: b l ~-p I I I w ICI al M r°'~ ~p p ~ppy~ 01 t- 1p`... ' O (RECORDED AS ~7p7 L2 W Z ~O 8 O a 6lZi 40"r 1 ' r h 104 p 1.067 ACRES z 8 I ' (4„W 1~1 46.493 SQ FT + ro' ''.7G7 1J rY F too y 75.00'- - - - - - - - - - - - -408:00~ - - - - - - - - - - - - - 75.f I '14"W 300.04 ` 01 y 105 ' co O 1.216 ACM I 8 : 103 ; $ m MOTI SQ FT. . a 98 rf N N Ib 1.067 ACRES 1498 ACRES hb 46 ' I i 46.493 50. FT 65257 S0. FT i z Neli`15'14"E 300.00' m D ' r9SWIV14"A Od 99 21 iV~wa sa 6m6et 2 1.1969ACRES 15000' - 1 i I~ 1.196 ACRES =1 NBMM~ x2.166 S0. FT. 32.097 SQ. FT. 15000 o - - - '8 8 102 ° % 'Ia'n 1.067 ACRES ~ rn - 46.495 So. FT S 2 9'22"E ry82.31'1$• 200.46 201.43' 10 6 S 89`1514" W_ 300.00' :8 1 N 1.078 ACRES N 46,940 SO. FT. »ra:'oa'`~ 'T _ 11 •eu~ee'aN Lu "3 3' ,g 101 8 ;8 100 ~7-.7~~•~;: ?`J 7•,~.~• 96 Iri I.054 ACRES 1e~ 1.036 ACRES ~j 1.034 ACRD ~In 45,895 SO.FT. 45.140 SQ. FT. I+fttVV 46.062 SQ FT. _ - 1Y~ -yyp M ~N J~ .d' o~~• ~O b.a' S89.15'14"W - - 300.00 - - y 246.00' « = o I mZ `.F - - - - l _`f - - 24600'---- N899 SW15'14 W 546.00' 15'14"E 150.00' - - - " m y,-e BROOKWOOD •-"-se9h5'Id'w N891'I WE --293:29 - -------243.00x----- - -i56.00T--- 15600x_.. 67.01' `G -=--1411.04'•-- ``q`'r 107 .g 108 $ 1109 110 1210 ACRES 1L- 1.071 ACRES 11,074 ACRES 1.074 AGRS ~O a2.697 S0. FT. rn ; 46.631 30. FT. .795 SQ FT. 46.765 S0. FT. V s E N89°I514 E 243.00:' I b 1 .oo' 156.00' - 'Y o►b~- - -s 89'19'14"w 4 I - - - - N89°15'14 E 'ARIA VIEW ESTATES FOURTH ADDITION. k Rural. Subdivision Located in the NE-SW and NW-SE, Section 17,T29N, R19W, Town of Hudson, St. Croix County,-Wisconsin - - - - "W n ST-WEST 01WtTE71 SECTON Lee-A- N89 - - y, I ~ I ° R Q75 ESECTIOM THIRD I ~Q AOD11410N $2 I $ 84 CCJJ -I---- $I N a I a 9 Cli b I Z N 8905240 W 412.00' K--PQNt OF 1~.,1 s9 r 0 BEGINIIMIG , 5 JrO5„W S89°15'14"W i 579 46 Y, A ~1 - 75 36,744! - 0b g 87 +sa ACRES g. 70440 6Q FT. pl ti 7 1 ~ ~1 1 N 1 + 93 g . 1.373 ACRES mp' t , b ; 94 59.754 so. FT O ' O 8 88 11 OI O M ef. : 10 ' 1.153 ACRES 107 dr1vs+M a ampl 92 0 1.606 ACRES i. 5 90.246 SQ FT 1.166 ACRES i I Q 9 70.040 SQ FT ~t I 90.762 SO. FT. m Ci 0 . i - - 1ff ! ' u ' d 1'14"W N~Idl3"E 3 w 1 206.00' ~------i 205.77 207 to , ! 208.00 ip ' g Yo I f I -A 3 b ' co 90 M 8 89 H ;N 95 s»zrw• '`J_ e7•rr~e" 91 8; I.o1e ACRES b g 1.005 ACRES i H lV 1.021 ACRES I 1.019 ACRES N' w ! 44.356 SQ FT N 45.g5 S0. FT 44.460 60. FT Ab ® .D 44.363 90. R. _ O • It y!, r' b. V) oa 249.87 24981 °j%• I+ - 20¢.02'- - - oN a 493.87 N8995 14 E N89'IS 14 E 412.04 - - - - - - DRIVE S89'15'14"W IN 5 -T------- T 6.0or 1 412 76' ' °i 1b~ 206A2 206.02 .ill ` i 1 ~ 1 1 R4 ' t _ _ 1 1 m 1 1 111 Ci 1 N 1 N g 112 ;p 113 fA 1.074 RES ! yl ~t0 1.031 ACRES 61 1.051 AtlF! 9 46.795. FT, 44.906 S0. FT. a N 44.906 SQ F7. O U T L OT I ' ...412 04... 6.771 ACRES q'_ A~1 O 294.941 $0. 206 Q H b WWQ N89*15'I4"E 478 15600 n ' 9 ir7 V IN n= i U) 3OCr 400, 66.00' 0 IM.gIN.®1 Z LEGEND SECTION CORNER MOILMEN; BERN'M OAP 0 2"x3d' IRON PFE vvEIO m 3C' FT SET. ALL OTHER LOT f ~b. OOIiJERS ARE STAKED WITH x2d' IRON PIPE WEIC6•N L~ L/Utl1' • 2" IRON PIPE FOUIO - - - a I" IRON PIPE FOUNI) 920. UTILITY EASEL IN; 10' IN WIDTH NOTE: ALL PIPES ARE ROUND, DIAMETER GIVEN i 7 SCONSIN REAL-ESTATE TRANSFER RETURN GRANTOR: Wisconsin De artment of Revenue Name D1lkZMLJJLoL_ Lill J111iiii 7 GRANTEE: ga Name Social Security Number Social Security Number Full Address New address if property transferred was residence Full Address nt Numme o 34 JWK 2" Rt. 50 am L"4t W 5"U it Is grantor related to grantee? Relationship includes, marriage, blood relative, partner, lessee-lessor, [N Yes* ❑ No Name and address to which tax bills should be sent if not the same as above co-owner, parent corporation or joint owner. *If yes, explain how related Grantor is Individual ❑Partnershi ❑ Corporation ❑ Other Grantee is 3 Individual Telephone: Grantor ( ) _ ❑Partnershi ❑Corporation ❑ Other PART 1-PROPERTY TRANSFERRED Tele hone: Grantee Check proper box and enter name of municipality and county Street address of property transferred include road name and /or fire number. City ❑ Village Town S r is County po Legal Description (Fill in complete legal description in space below or if metes and bounds description attach 3 copies of it as shown on the instrument of conveyance. If certified survey map number is used in description list town, range, section and acres.) Lot No. Blk No. Section Town Range Plat Name Property Parcel Number 111111111tvi" not 1 11111111111111 RIM M_ atift 1110 2M of nefta PART 11- PHYSICAL DESCRIPTION AND INTENDED USE 1. Kind of Property b. Residential Units, if any 2. Princi al Intended Use a. ~ Land Only 3. Land Area and Type Estimated y El One Family a. Residential d. ❑ Agricultural a. Lot size x ❑ ❑ New Construction ❑ 2 and 3 units b. ❑ Commercial e. ❑ Recreational b. JAW " Total Acres ❑ Building Previously Used ❑ 4 or more units ❑ Solar Design c c• El Industrial f. El Other (Explain) El Rental Tillable Acres ❑ El Earth Sheltered Home 2• W.T.L. Acres ❑ ' Condominium 3• F.C.:Acres El PART III -TRANSFER (Answer as many as apply) c Ft. of Water Frontage ❑ 1. ® Sale 2. ❑ Gift 3. ❑ Exchange 4. ❑ Other transfer (Explain) 5. Ownership interest transferred ® Full ❑ Other (Explain) 6• ❑ Deed in satisfaction otland contract'= What was the to df Ahe orig"al land Cant ict? 7. Amount of mortgage assumed b grantee? $ 8. Does the rancor retain an or the following rights: PART IV COMPUTATION OF FEE OR STATEMENT OF EXEMPTION ❑ Life estate ❑ Easement 1. Total value of REAL ESTATE transferred (purchase price, etc. rounded to next even hundred. Do not include personal property) $ ir00 2. Value of personal property transferred but excluded from line 1 3. Value of tax exempt property (solar, wind, waste treatment, mfg. M&E, other) included in line 1 $ 4. TRANSFER EXEMPTION NUMBER of exempt for Reasons 1-13 (see instruction) Sec. 77.25. ( ~ ) 5. Fee - thirty cents per one hundred dollars of value (line 1 times.003) Make check payable to Register of Deeds PART V - CERTIFICATION The transfer must be reported regardless of the Grantor's state of residence. Information on this return will be used to administer Wisconsin Income and Fran- chise Tax Laws and the Wisconsin Real Estate Transfer Law. We declare under penalty of law, that this return (Including any accompanying schedule) has been examined by us and to the best of our knowledge and belief it is true correct and com lete. Signa to of Grantor 7A7; Date SIGN Print of Type Agent's Name HERE Signature of Grantee or Agent Date Print of Type Agent's Name If Signed By Agent Agent Address Phone Document No. Vol. (Reel) Page (Image) Date Recorded Date and Kind of Conveyance ) LEA VE TH/S Parcel Number AREA 19 19 Code: County Tax District Assm't Dist BLANK L L A B C D E F I I 1 Office 2 Field 3 Use 4 Reject T T Ratio Consideration P&500 (R. 5-84) School District No. PROPERTY OWNERS COPY INSTRUCTIONS -xemt A complete return is required for all coon v77 n (1),(2);(4a and (17) of thesWPconsihsStatutesl,(See below )pUpon completion, submit all parts of Ns for pm from the fee for reasons stated at Sect intact to the Register of Deeds with the instrument of conveyance. if a fee is due make check payable to Register of Deeds. f GRANTOR: Usually the former owner of the property. (Seller if property transferred by sale.) GRANTEE: The new owner of the property (the purchaser when property transferred by sale) Indicate whether or not grantor and grantee are related by blood, marriage, lessee-lessor, co-owner, parent corporation or joint owner. If yes is checked, explain how related. if more than 1 grantee-explain relationship for each. Enter the name and address to which tax bills are to be sent PART I - PROPERTY TRANSFERRED Enter the name of the county and the municipality in which the transferred property is located and check whether it is a city, village, or town. Enter the street address of the property transferred. If rural property, give the fire number if known. The legal description is the legally accepted statement which identifies the location and boundaries of this property and can be found on the instrument of conveyance (deed, etc.). Enter the full legal description or attach three copies of the legal description as it appears on the instrument of conveyance to the front of this form. Also enter the town, range and section in which property is located. Enter the property parcel number opposite the space provided. The number can most readily be obtained from the property tax bill at the time taxes are ascertained for proration purposes. PART 11 - PHYSICAL DESCRIPTION AND INTENDED USE OF PROPERTY Item 'l a: Check all boxes that best describe property. One box must be checked. Item 11b. Check only one box. (!f "Land Only" is checked, in 1.a. omit this item.) Item 1c Check if property is to be rented. If non-rentai leave blank. Item 2: Check only one box which best describes intended use. If (2a) is checked answer (1b). If (f.) is checked please explain. Item 3a: Enter lot size. !f unknown, enter estimated size and check box. Item 3b: Enter total acres. If unknown, enter estimated total acreage and check box. Item 3bl: Enter number of tillable acres, if none leave blank. If unknown, enter estimated acres and check box. Item 3b2: Enter number of acres under woodland tax contract, if none leave blank. Check box if estimated. Item 3bT Enter number of acres under forest crop contract, if none leave blank. Check box if estimated. Item 3c: Enter number of feet of water frontage. If unknown, enter estimated footage and check box. If none leave blank. Note: Owners of forest crop land are required by law to notify the Department of Natural Resources of transfer of ownership. PART III - TRANSFER Check the appropriate boxes (1 through 8) to show how the property was acquired, i.e., by Sale, Gift, or Exchange and what property interests were retained or transferred. If Other (4 or 5) is checked, please explain in space provided. If (6) is checked L.C. date must be entered. In (7) show the amount of mortgage assumed by the buyer, if none leave blank. PART 1V - COMPUTATION OF FEE On Line 1 enter the full actual consideration paid or to be paid' (rounded to the next even hundred) for Real Estate including the amount of any lien or liens thereon. DO NOT include consideration for personal property such as household furniture, farm machinery, boats, etc. Incase of a Gift, nominal consideration or Exchange of property, enter the estimated current fair market value (the price which could ordinarily be obtained for the property at a sale in an open market between a willing buyer and willing seller), On Line 1 if the value does not end in even hundreds (i.e. $11,520) for computational purposes round to next even hundred (i.e., $11,600). On Line 2 show the value of personal property purchased but excluded from Line 1. On Line 3 show the value of real estate included in Line 1 but exempt from property tax. This value is not exempt from a transfer fee and must be included in Line 1. On Line 4 enter Transfer Exemption Number (1-13) if this transfer is exempt. See Exemptions Below. Also if this is an original land contract (no fee is imposed until satisfied) enter the words "Original LC." on this line and state value on line 1. Also state value on line 1 for Exemption No. 8. Online 5 enter the amount of fee if none of the exemptions apply to the transfer. The fee is based upon a rate of 30¢ per $100 on Line 1. Fees for deeds Prior to Dec. 17, 1971 No Fee executed in fulfillment of an original land contract dated: $100 Dec. 17, 1971- Aug. 31, 1981 10¢ per Sept. 1, 1981 or thereafter 30¢ per $100 PART V - CERTIFICATION The transfer must be reported regardless of the grantor's state of residence. Information on this return will be used to administer Wisconsin income tax laws and transfer fee law. This return must have both signatures. If agent is signing for grantor, then agent's name, address and phone number must be completed. (print or type). SECTION 77.25 - EXEMPTIONS FROM FEE The fees imposed by this subchapter do not apply to a conveyance: **(1) Prior to the effective date of this subchapter (October 1, 1969). **(2) To (and from*) the United States or to this state or to any instrumentality, agency or, subdivision of either (3) Which, executed for nominal inadequate, or no consideration, confirms, corrects or reforms a conveyance previously recorded. **(4) On sale for delinquent taxes or assessments. (5) On partition. (6) Pursuant to mergers or corporations. (7) By a subsidiary corporation to its parent for no consideration, nominal consideration or in sole consideration or cancellation, surrender or transfer of capital stock between parent and subsidiary corporation. (8) Between husband and wife or parent and child for nominal or no consideration. (Value on tine 1 must be stated.) (9) Between agent and principal or trustee and beneficiary without acutal consideration. (10) Solely in order to provide or release security for a debt or obligation except as required by s. 77.22(2)(6). **(11) By will, descent or survivorship. (12) Pursuant to or in lieu of condemnation. (13) Of real estate having a value of $100 or less. *Per Wis. Adm. Code section Tax 15.05(2). -Exemption numbers 1,2, 4 and 11 are also exempt from a return. ri • S 'r C - 165 ~ . r Sli_P'r 1C TANK MAINTENANCE AGRL1:;•f1 N'1' - c~ St, Croix County Q i f W N L It / 1i U Y 1: I~~~~--~ _ - - - - - - - ROU'1 E/ 1SOX NUMBER Fire Number CITY/STATE l I, PROPERTY 1.UCAT] oN : , `-a, SeCt i o~1f_._ R W , Town ofi St. Croix County, Subdivision l.ut numbur_~_. Improper USU and maintenance of your sv i,L it. system could rL•sulL in its premature failure to handle wastea. Proper ntaint'enatice coilsi:;ts of pumping out the septic tank eVVry three years or souuer, if needed, by a li-Ccnsed S_cl)Lic tank puml)Vr. What you put inru Lite sy iL cm can of f e :L t11V Iunct fun of Lite -;optic tank as a treat Iuerit stage to the waste disposal system. St. Croix-Cuunty residents maj he eligible to receive a grant for ai maxia►uin of 6l)% of Lite cost of repl,aceme-rnL of a fail.i►ii, systelu, which was in operation prior to July 1, 1978. Sr. Croix: County asccepLed this program in August of 1980, with the requirement that: owners of all new s agree to keep Chris systemsproperly mai- ntainud. The property owner agCCeS Cu submit to St. Croix County Lulling a certification form, signed by Lite owner and by a master plumber, journeyman plumber, rest c•ic Led `plumber or a licensed pUlliper Veri- fying that (1) the -on- site wastewater dispusal SySLetii is in proper uperat ing condition and (2) after inspucL ion and pumping (if r,ec- essary), the septic tank is less than 1/3 full of Sludge and scum. Certification form will be sent a,ppruximately 30 days prior to three year expiration. 0 I/WE, the undersigned, havtt read the above requirements and agree' to maintain the private sewage disposal system in accordance with x, r-~ the standards set forth, hurei.n, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be t ompleted and returned Lu.the St. Croix County 'l.uning Office within 30 days of the three year expiration date. SICNEL) s DATE. St. Croix County Zoning Office P.O. liox Ila►uuu it d, WI 54015 715-196-2239 or 715-425-8363 Sign, date and return to above address. O N y _ \ Y O G 41 W~ C 7 (?p C C N 3 ~ N N O. 7< <0 n f) fD O O ~ M O ~ '0 ~ 7' S LU 3 co .CY O C O N w~ 7CW 2 3 C tQ (Q 'a a =r CD 'a CIL CD cn $ A aD0 o° SID co 0 (D c 4- Ca L (a co CD , cD ? M O ? co n i q r A3Q o0 , cmOD CA) o m s o w o`° _ > > o _3°c° <c co W C Q' O :E 7 w w y w N ~ ° ° a~ ~o m Coo.m c~ A o < N Q ( Ch G .ON. 0 n D W A n 0 (C Al O fD a O Cc 0 a 0 O co m 0NCD N~-00) W C N 00) o a ID :E :3 Co CD M 0 =r M Cl. 0 3~MM 0. N A D -I o (D w to ID C, a o CD w w sw a ac ~ ~ ~ f ~ ~ 0 30o v,m.0)t a IT1 CDy= Q. M, M ~mCD o n 0 A O CD 0 a O f 0 C C CL 0 o tTi ao am A 0 CL G) 0-1 r - 3 W0IA m O c O N n 0 D d C cO 0 M C Cu a C a NO OO ;~y°tc RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, - DIVISION LABOR AND ' P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION:` SECTION: TOWNSHI M 1,C~tPALITY: LOT NO.:BLK. NO.: S~P IVJSIOI~J,, NAM ~S '1459/4 /T !/R )JE ( ) W 1 [R I/`f 1Y! 7 COLIN Y: OWNER'S BUY R'S NAME- 1"'V, ADD ESS: 6'.t1r6ix Rpian Wert s Helofso - USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCI L DESCRIPTION: PROFILE DES IPTIDNS: PER 0 AATTIION $TS Residence !1 New ❑Replace 6711 F (o I~ ''lh [LNA : RATING: S= Site suitable for system U= Site unsuitable for system t) CO ENIIONAL: MOUND: IN-GROUNDPRESSUR_E:SYSTEM-IN-FILL HOLDING TANK: ECOMMENDEDSYSTEM:(option1) ❑u I INS ❑t I' NS E1U ❑ S ❑ S e +10r) If Perc:s.H:63.09(5)(b), n Tests are NOT required DESIGN RATE: If an O y portion of the tested area is in the under indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, A NUMBER AND DEPTH DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- q9.9 ~ t 1~y ' 15 i j 1.331 $ns1, 6-AS-/ 6n,5 i B- H 91 )C0,'43' > 9 1-4A`,g1 ) -S,) , 3:3` gn 111/7"35161, 5 ~ l t B- q pa,bS l,'i sly I r3jh ~f f~~l 7'Irl fir. PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R *PER INCH j I-11 P- r / P- s P- P- i S Sid r ~ O ~C G . " ow Ir o br 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 3 VM* 1AP Coe ~ . _ _ _ _ _ phi b6 3 } , , sec" \ 30 3 I 3 ( : € I i .p . J__ L__ _ 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 the location of the tests are correct to the best of my knowledge and belief. NAM (pr ffil int : TESTS WERE COMPLETED ON: C GLe r Ij!T 5, ADD SS: CERTIFI AT ON NUMBER: PHONE NUMBER (optional): o v~ !~Q cat y 3 -c~ CS NA ,ry DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - L .s. W INSTRUCTIONS FOR o 7 E. -T1 OR 116 - SBD - 6396 4 r To be a crimp' to and accurate soil test, you st include: L 1. Complete iption; 2. The use sectic cler ly ether this is a residence I project; 3,I MUM n imercial use planned; 4 a -e m TANK ONLY I ALL 5 . A SITE I; S_ITABLE OR A l 'T BAS} ON SO'"_ . IC 6 d n; 7. A Inent; 9 > `ation test exemp- ld , d .„J eppi.ol.,....,le box; q $ C F€ d le al L ML_ 1`.. THE LOCAL AUTHORITY WITHIN LETION. y d Ves,cn j~Qhs _CQnf. ` l , SS'lg 9a1nsj , Gil very tv7t%l-s ok' 6 lo©- 'OL/f _ . m o-1- ' I e S ark r o m`a na I-A- _ a (I 6Q _ ~c~c-h Cc~l ar c har~~_ ~)O_ S a c om';0( 'eft fir. L3 a : my or to be i"wair MEN `7 #Y y P B. L: G P L OT A H 1) I O E C T i 0 (\I )SS b ROJE PLUM f) _ I~ `'`N•A M E. `BF '~P s We N A M E y L O CAT 10 N _._K. L I C E N IS E -f / ja ~~nTE ~s- k/1 A P _ P -1- . LO 8~- X04 L # Road 8~1 v~ y Q. = T p~~N Q x i' ~rN s calLNeR o LBO ~aaa~gl 6 Qi i P) lie, i • FRESH AIR LHTE"PS -AND OBSERVATITF PIPE CROSS SECTION Approved Vent Cap Minimum 12" Above ~7 { Final ,raja T~. 9lslR 1 ~tzr I .d 41' Cast Iron Above Pipe ` Vent Pipe To Final Grade I i Marsh Hay Or Synthetic Covering Min. 2" Ag g r_ e cI',a Over Pipe _ - Distr. ibution ~1 l Iii- ^ f ^ Tee Pipe Mow, 1-31 Aggregate PerloraL-ed Pipe Below Beniath Pipe 4-- Coup]. i.ng Terminating At Bot.torn of system