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• Parcel 020-1159-20-000 10/11/2005 10:39 AM
PAGE 1 OF 1
Alt. Parcel 20.29.19.899 020 - 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
0- MACDONALD, MICHAEL S & CYNTHIA L
MICHAEL S & CYNTHIA L MACDONALD
496 MAUD CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 496 MAUD CIR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.280 Plat: 2320-PINE GROVE HEIGHTS ADD
SEC 20 T29N R19W PINEGROVE HEIGHTS ADD Block/Condo Bldg: LOT 06
LOT 6
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
20-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/30/2002 680358 1900/501 WD
07/23/1997 989/452 WD
07/23/1997 913/124
07/23/1997 880/579
more...
2005 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/27/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.280 22,800 111,200 134,000 NO
I
Totals for 2005:
General Property 1.280 22,800 111,200 134,000
Woodland 0.000 0 0
Totals for 2004:
General Property 1.280 22,800 111,200 134,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form-STC- 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP y/,_,4y,_ SEC. T C N-RW
ADDRESS al,fFt, ST`. CROIX COUNTY, WISCONSIN
SUBDIVISION L~T , LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IZIIR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
e~
ti~
1 `'may
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used ~d ~,.4_
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: { s Liquid Capacity: C'
ap
Number of rings used: / Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side feet
Rear, Off'
,.From nearest property line Front 10 Side 0Rear, O
feet
1t
Number of feet from: well
building: 14
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
L SEE REVERSE SIDE
1r
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. -
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Length: Number of Lines: -.21_ Area Built:
Fill depth to top of pipe: hr's"
Number of feet from nearest property line: Front, O Side, Rear, 0 lot
Number of feet from well:
Number of feet from building: ,
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: _ Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:.
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: -
Dated:
$2 f/ Plumber on job: License Number: .i
4-/
3/84:mj
bfPARTME{NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O: BOX 7969, BUREAU OF PLUMBING
MADISON, WI 53707
)(MCONVENTIONAL OALTERNATIVE Stale Plan l.D.NYmber:
F V O Holding Tank O In-Ground Pressure ❑ Mound (11 @sWed) -
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
B&uee; Btcavi tnen 1208 Wis Con in St. , N. Hub on, W1
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
NB SE, Section 20,T29N-R19G1, Town of Hudson, Lot#6, Dick Stout Sub.
:Name of PlUrrWO MP/MPRSW No. County: nile+y Permit Number:
Witt am Schumaketc 6382 St. Ctc.oix 58932
SEPTIC TANK/HOLDING TANK:
( MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: ARNING LA LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ONO
'BEDDING: VENT DIA.: VENT MATL.: HI H W NUMBER OF ROAD: PROPERTYELL: BUILDING: IVENT TO FRESH
ALARM FEET FROM . LINE: - AIR INLET:
❑YES ONO ❑YES ONO NEAREST
DOSING CHAMBER: I
MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER: WARNING LABEL ILOCKIGCOVER
NPROVIDED: PROVIDED:
❑YES ONO ❑YES ONO ❑YES ONO
GALLONS PER CYCLE: PUM AN N L PERA IONAL: NUMBER OF PROPERTY WELL , BUILDING. VENTTOFRESH
tDIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF) OYES ❑NO 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 until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH. LENGTH : N DISTR. PIPE SPACING COVER INSIDE DIA *PITS ILIOUID
BED/TRENCH TRENCHES MATERIAL: PIT DEPTH
DIMENSIONS
CIIAVIL DEPTH FILL DEPTH UIS i 1 F DISTR. PIPE IDISTR. 1 MA IAL: NO. DISTR. NUMBER OF OPERTY WELL BUILDING: V NT TO FRESH
BELOW PIPES ROVE COVER. ELEV INLE 1 ELEV. ENU PIPES FEET FROM LINE. AIR INLET.
NEAREST
;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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑ j
NO
IL COVER TEXTURE PERMANENT MARKE S OBSERVATION WELLS
❑YES ONO OYES ONO
DEPTH OVER TRENCHIBED DEPTH OVERT N H! EO DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER EDGES
OYES ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE ILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUM MANOLD IFDISTR. PIPE MANIFOLD MATERIAL JWDISTH DISTR. 1 DISTHIBU I ION PIPE MATERIAL 6 MARKING
I ELEV. ELEV. DELEV. PIPES DIA.:
I ELEVATION AND
DISTRIBUTION
I INFORMATION HOLE SIZE HOLE SPACING ILLEU fIHHECI LY IFUVIR MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
S_ UNO OYES ONO
COMMENTS: EHMA N OBSERVATION WELLS, NUMBER OF PROPERTY WELL: BUILDING:
/ FEET FROM LINE
DYES I-INO DYES 17-1 NO
_ NEAREST
Sketch System on `
Retain in county file for audit.
Reverse Side.
SIfiNATUNF I LE
ALHR SBD 6710 (R. 01 /82)
wisconsin APPLICATION FOR SANITARY PERMIT
DILHR (PLB OUNTY
iTUNIFORM SANITARY PERMIT #
II~lOUSTFIV, LRBOR 6 MUTQn RELRTIOns
ST
-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
PROPERTY LOCATIO CITY:
1/4 5~ 1/4, S , T'79 N, R . E (orCV TOWN Fe 1( ! I
LOT NUMBER BLOCK NUMBER I-SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
.,4L .I• `i 'day _
TYPE OF BUILDING OR USE SERVED
X 1 or 2 Family Number of Bedrooms: .7 ❑ Public (Specify):
THIS PERMIT IS FOR A:
~d 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.
5. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of 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):
:7 - 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:
t,.. ~ .r
Plumber's Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee:
Date: ❑ Disapproved
/Q a - Dom, f5- Approved El Owner Given Initial
Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
)ILHR-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.
s sewage THE OWNER. This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private 9e 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
M 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 this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property Z'2,;'"cec e ~ <zc
Location of Property _L & Section T N - R W
Township
Mailing Address
7 7
Subdivision Name
Lot Number 671 T T ~----7
Previous Owner of Property 6 Al, xe
Total Size of Parcel
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 r' and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
Land Contract , ( `7 ~L-LG~ ~C4
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) eeAti.4y that att etatement~s on this 4on.m ane true to the best of my (ocvc)
knowledge; that 1 (we) am (cute) the ownen.(.s) o6 the pnopenty de.6c4i.bed in th.ivs
in6oAmati,on 4oAm, by vic tue o4 a wa4Aanty deed Aeeotded in the 064ice o4 the
County Regi6tten. oA Deeds as Document No. ' ?,E rl q 05 ; and that I (we)
pAede.ntty own the phopo6ed zite AoA the dizpos-aT-system (ot I (we) have
obtained an ea6ement, to Aun with the above de6cAibed pAopeA.ty, 6oA the
eon.6 tAueti.on o6 said 6 ystem, and the .6ame ha6 been duty AeeoAded in the 066ice
o{ the County RegisteA o4 Deeds az Document No.
SIGNATURE OF OWNERiLQ2~t. f SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
u,
Y
STC - 105 r
v
SEPTIC TANK MAINTENANCE AGREEMENT H
0
St. Croix County z
H
OWNER/BUYER z,' -e' es'
ROUTE/BOX NUMBER,244ZZS ~I-OV Fire Number
CITY/STATE ZIP 611
PROPERTY LOCATION:. ~4~ Section_ T2-1N, R W, `
Town of GAL 'd A/ St. Croix County,
Subdivision% Li-15Lot 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, i
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- ro
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County `honing Office within 30 days
of the three year expiration date.
SIGNED ~ i2t~Ls Z
• D A'f E
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.
X X-
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DEPARTMENT OF REPORT ON SOIL BORINGS SAFETY & BUILDINGS
INDUSTRY,
LABOR AND$ ` • PERCOLATION TESTS ( 8 DIVISION
w P.O. BOX 7969
HUMAN RELATIONS ~ MADISON, WI 53707
i (H63.090) & Chapter 145.045) C
LOC I01`": SECTION: TOWNSHIP/ffl 0 1d1C11 AI!I;PY: NO.:BL I A
XX 1/ g1/ o?o /T~`IN/R/9~(or) so•v ~b~M~.rf
COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS:
Owx cccQ may- 02d~' ~~s. !.cdS `s. i"Yolf.
USE D ERV ADE
rrte~.. NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR S: PERCOLATION TESTS:
7~usesidence 3 New ❑Replace
Soy / /~iRP She
RATING: S= Site suitable for system U= Site unsuitable for system S r S /
CONVENTIONAL: MOUND: JIG TANK: RECOMMENDED SYSTEM: (optional)
XS ❑U ®S ❑U MS ❑U ❑S MU IDS XU
Iation Tests are NOT required DESIGN RATE: If an
1 y portion of the tested area is in the
indicate: Floodplain, indicate Floodplain elevation:
PR FIDE DESCRIPTIONS
c
BORING TOTljL ELEVATION DEPTH TO GROUNDWATE CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH FM' OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-/ Al > r
We >
.7 7014.9'Ah A S/+
7 61 CS
B- 7•.s' ld ' atc~ 7 / , wvv • ~h . Sah -S~-f r, S: S CS
B- Alame. ;
*-gn, I+ C5 iatd
7.,S-" lo,2.~ itld~~ . S' l . S b s+ F. 2, l SA
s , 3 s
B-
PERCOLATION TESTS
TEST DEPTH? WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER H*;I-IE6 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P_ y.S' z 3
P- o 4 3
_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. AZ Z •S~1 ~j , q1 1 vhJ 3. 6' i es ii(, = lOa. 9
SYSTEM ELEVATION
r
,
09
N
4- e'5
N, > p
T ;001
r
M• ~k Ab -~--r9
,s
~ _ .
0-1
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accd with the procedures and methods spe ifid in 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):
(o ~A><lrG~ a c~ moo/ /5- 386
CST ATURE:
"c
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
6
D I LH R-SB D-6395 (R. 02/82) - OVER -
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INSTRUCTION- -6395
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