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Parcel 020-1136-10-000 08i29i2006 08:31 AM
PAGE 1 OF 1
Alt. Parcel 20.29.19.671 020 - TOWN OF HUDSON
Current Xl 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 - FRANCEL, MARK E & LINDA M
MARK E & LINDA M FRANCEL
423 VALLEY VIEW RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 423 VALLEYVIEW RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.570 Plat: 2624-WILLOW RIDGE 2ND ADD
SEC 20 T29N R19W WILLOW RIDGE 2ND ADD Block/Condo Bldg: LOT 62
LOT 62 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
20-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/01/2002 685718 1939/266 WD
07/23/1997 713/78
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.570 66,700 165,900 232,600 NO
Totals for 2006:
General Property 1.570 66,700 165,900 232,600
Woodland 0.000 0 0
Totals for 2005:
General Property 1.570 66,700 165,900 232,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 211
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form - STC
AS BUILT SANITARY SYSTEM REPORT
i w
OWNER N A I J. K
{ e j Se j TOWNSHIP SEC. T Q 4 N-RJ9 1,
ADDRESS 5t. (-ROIL S_ ST. CROIX COUNTY, WISCONSIN
•
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IhI1R 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Dun,
Y3'\
4
so
10
• 10 ~ raC
i~ INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used eI~' OIVU
15
Elevation of vertical reference point: 100 Proposed slope at site:
SEPTIC TANK: Manufacturer: Qe 3 _____Liquid Capacity:
Number of rings used: Tank rnanhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,0Side 0Rear, ~ feet
. From nearest property line Frorrt,OSide,~Rear, 0 q5 feet
Number of feet, from: well huildiug: a o
(Include this information of the above plot plan)( Z reference dimensions to septic tank)
SEE REVERSE SIDE
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:TTaM woa3 aaa3 3o aagwnN
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:aaTuT 3o uoTaunaTg
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DEPARTMENT OF INDUSTRY,
LABOR & HUMAN RELATIONS INSPECTION REPORT FOR SAFE & BUILDINGS P.O. BOX 7903 PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 MBING
10 44 OXONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER:
INSPECTION DATE:
Virgin i,a BeAte. is en St. C&oix Heights, Hud6on., WT
vC
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN
NW NW, Sec. 20, T29N-R19W, Town, of Hud6on ,Lot#62, GliUow Ridge REF. PT. ELEV.: CST REF. PT. ELEV
Name of Plumber: MP/MPRSW No.
County: Sanitary Permit Number:
Richa,td Hopkins 1059 ST. C&oix 58939
SEPTIC TANK/HOLDI TANK:
MANUFACTUR R: LIOIyID APACITV: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL
LOCKIN OVER
PR ED: PROVID
BEDDING: J VENT DI VENT MA L.: HIGH WATER YES ❑NO ❑ O
ALARM NUMBER OF ROAD: PROPERTY WELL: BUILDIN VENT TO FR SH
FEET FROM / LINE , AIR INLET:
❑YES ❑NO ❑YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIOUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER.
WARNING LABEL LOCKING COVER
❑YES ❑NO PROVIDED: PROVIDED:
GALLONS PER CYCLE: PUMP AND CONTRO LS OPERATIONAL: Ttb ❑NO ❑YES ❑NO
(DIFFERENCE BETWEEN N MB OF PR OPERTV WELL BUILDING: VENT TO FRESH
E R LINE. AIR INLET:
PUMP ON AND OFF) ❑YES ❑NO REST
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 until F RCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF DISTR PIPE SPACING COVER
TRENCHES. INSIDE DIA.: #PITS. LIQUID
DIMENSIONS Jl ~0 TNO~Dl L' PIT DEPTHGRAVEL DEPTH ILL DEPTH DISTRPIPE DISTR. PIPE DISTR. PIPE MATERIALRBELOW PIPEABOVE COVER. ELEVINLETELEV. END2
NUMBER OF PROPE RTV WELL: BUILDINNT TO FIRE H
~y FEET FROM LIN < AIR NLE
/ 2- / s 7J 3 Z
MOUND SYSTEM: NEAREST
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrownUpSlope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE.
PERMANENT OBSERVATION WELLS.
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH YES No El YES El NO
CENTER. OF TOPSOIL: SOD ED: EDGES EEDED: MULCHED:
:
Y ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LAT RAL S ACING G L DEPTH BELOW PIP
TRENCHES: FILL DEPTH ABOVE COVER:
DIMENSIONS
MANIFOLD PUMP MANIFOLD IS
. :
ELEV. ELEV. . PIPE ANIFOLD MATERIAL: O. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND DIA.: E V.: PIPES: DIA.:
DISTRIBUTION
ff O RMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COV R MATRIAL
- VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENTMARKERS: OBSERVATION WELLS INUMBE
: PROPERTY WELL: BUILDING:
n R OF
+KV FROM LINE:
❑YES ❑NO ❑YES ❑NO FEET
NEAREST
t~- cr. 9
r
~,y3 1b.~z
.,I $ la~ 1l
Sketch System on
Reverse Side Retain in coidnty file for audit.
.
SIGN TITLE:
DILHR SBD 6710 (R. 01/82)
uuisconsin APPLICATION FOR SANITARY PERMIT
~ DILHR st. c~aI►
(PLB 67) UNIFORM SANITARY PERM.
MMMdMqM OEPfiSTRV, LfRBOR 6 MUMRn RELRTIOns
SO 93
9
-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 WNER MAILING ADDRESS
.4 R-ro, St. c6n( He'lAks iuukm U1 S%L
PROPERTY. L A ION CITY:
41 1/4#~✓1/4, S , TZq N, R Q~E (o VI AGE: PU
LOT NUMBER BLOCK NUMBER SUBDIVISION NA E NEA EST ROAD, LAKE OR LA DMARK STATE PLAN I.D. NUMBER
WII (ow LIZ r A e d
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): CONVQraI ! GI`Jr' SoI Gb ui~)j 114 w S sem
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.
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 # K'e A 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: lOj
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.
Na of Plumber (Print): Sign re: - /MPRSW No.: Phone Number:
y : I I &"'4~ 4g2 rzio ~ 1 (17/ f ) 11111~ I'WA
PI tuber's dress: = Na of D igner:
0& 7
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
g7 Disapproved
W."'4 f} &,&/, '0? p~ ❑ Owner Given Initial
/ l Q Approved 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
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 PERMIT
S ' I' 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 114 y12 /?1 Ze4e. 7etI P' -
Location of Propert ~1~-~Section o~ O , T N - R,12 W
Township "5e
Mailing Address 4?
Subdivision Name I (/Zl
Lot Number
Previous Owner of Property
Total Size of Parcel
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 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
1 (We) eeAti.6y tat aU 6ta,temen.t6 on .tkis 6ohm ah.e true to the best o6 my (ouh)
knowledge; Aa.t I (we) am (ane-) the owns (h) 06 the pnoneh ty deauLi.bed in .th.i's
.in6oamation i6o4m, by vi tue o6 a way ari.ty deed lceco/cded in ,the 066.ice o6 the
County Regiz ten o6 " Deeds ark Document No . and that I (we)
pnebentey oun the phopobed .6 to 6on the sewage Lpo.6a hy.3,tem (on I (we) have
obtained an easement, ':to /.un With the above descvLibed ptope&ty, 6on the
con,6tAuctior, o6 6a. d system, and the scune h" been du.ey necmded in the 066-ice
o6 the Couni y Reg • .ten o6 Deeds, a.a Document No.
SIGNATURE OF OWNER SIGNATURE OF CO-014NER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
Jw iusr
O
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SEPTIC TANK MAINTENANCE l1C REE'MENT Ho
St. Croix County
d
Y
/ BUYER / r • qf' l' /A /•W/ lf1~' ~/l~l G ~d'C~
ROUTE/BOX NUMBER Ste- Fire Number
CITY/SPATE 1Fi~ rd S ~y~-r~~• LIP
PROPERTY LOCATLON:'ot/!-" SectionOJ'1' Ay _0 , !t_Lq_W,
Town of St. Croix County,
S u b d i v i s i o Lot number (o~
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 evury three years or sooner,
if needed, by a licensed septic tank hum.her. What. you put into
the system can affect the function of the .5L'1)tic tank as a treat -
ment stage in the waste disposal system.
St. Croix County residents m_ay be eligible to receive a brunt 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 1380, with the requirement ttiat
owners of all new s stems agree to keep their systems properly
maintainud. The property owner agrees to submit to 5t. 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. a
0
E i
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 sit 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 Off' within 30 days
of the three year expiration date.
SICNED
DATh but
o~
St Cijoix C_,unty Zoning Office
P.O. hox 98
Hammord, W1 54015
715-7S'6-2239 or 715-425-8363
Sign, date and return to above address.
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•
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, .
DIVISION
LABOR AND PERCOLATION TESTS,115) P.O. BOX 7969
HUMAN RE! ~iTl(~NS ~ C flr MADISON, WI 53707
(H63.090) & Chapter 145.045) /E' ja
D'ATT -0 N: SFCTION: OW SHIP/MUNICIPALITY: LOT N BLK. rSU)BDIV;ISIe ON NA
1/4L a /T 9N/R)gE(o W (,~dtSO< ? 'd e~
OUNTY: OWNER'YNIDI ER'S NAME:
MING ADDRESS:
IAIL. Y,
l , C&~6f1 I)] bi
USE Q(~ C DATES 013SERVATIONS MADE
NR NO. BEDRMS.: CM I vERCIAL DESCRIPTION: PROFI E DESCRIPTIONSPER COLATION TESTS:
esidence Af ❑
'
New ( tL` ` U J ] 1 a "Op.D
RATING: S= Site suitable for system U= Site unsuitable for system
C N ENTIONAL: MOUND: IN-GROUND-PRESSURE: IYSSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) 1
f of MU Conve-n-H ng.1
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: Floodplain, indicate Floodplairr elevation: A) I
11 PROFILE DESCRIPTIONS --ff
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
r Y,5 . B 1 M0
fi
B 8 y7.3 None i 1P "r) it; C, r,
q.
B- 3 1 1~~1 hJ on
13- A
B'~/ r .at13NSI ~(4 3 CK_
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOI.E TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t______ c>ERioD 2 PERT~D 3 PER INCH
ii.V 51
_ N R 3 Za
P- 4
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-
7nr•.tal 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, a
SYSTEM ELEVATION
_ rA I
~ p f { I} + f!' r ~ 1
31a~ 1-kloe , 0n:~~h'.~ d~
Y'
61
Pro 'I 10d
/0
I
• tV tom. ~ ~ i ,r i I I I r
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: +b J CERTIFICATION NUMBER: PHON - NUMBER (opt i"ZT
0 S~ H Ud Sbh- W 5k-10 V C, G I r i6_j A 699
CST A J
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DISTRIBUTION: o, iginal and one copy to Local Authority, Property Owner and Soil (P.. 02132) OVER
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100
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FRESH AIR INLETS AND OBSERVATION PIPE
CROSS SECTION
L_-1 Approver:? Vent Cap
!
Minimum 12" Above h1~X,
_ F; na1 ,rid / 03
urn
mpX~ j
' 4" Cast Iron
t{ Above Pipe Vent- ;Pipe
To Final Grade--
Marsh Hay Or Synthetic Covering
Min. 2" Aggregate
Over Pipe ~
Distribution
Tee
_ Pipe
Aggregate (p Perforated Pipe Below
Beneath Pipe <Coupling Terminating At
W-5
Bottom of System