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Parcel 020-1019-60-000 09/27i2006 10:55 AM
PAGE 1 OF 1
Alt. Parcel 14.29.19.92C 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 - SUTTER, STEVEN M & COLLEEN R
STEVEN M & COLLEEN R SUTTER
994 TANNEY LN
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 994 TANNEY LN
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 5.025 Plat: N/A-NOT AVAILABLE
SEC 14 T29N R19W NW NE LOT 2 OF CSM Block/Condo Bldg:
3/768 693/619
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 953/450
07/23/1997 804/201
07/23/1997 789/395
07/23/1997 730/421
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 5.025 87,200 159,400 246,600 NO
Totals for 2006:
General Property 5.025 87,200 159,400 246,600
Woodland 0.000 0 0
Totals for 2005:
General Property 5.025 87,200 159,400 246,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 118
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
0' IMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227 cz:w
i1Ei''Oii'I DATE' SIlJf~t:
COURTHOUSE DATE RECEIVED. 3/11`92
HUDSON, WI 34{?lr
nT'rN' T4iOi1AC C. NE1,330N
,WNER. Edward A & Deborah Pomast
OCATION. 994 Tanney Lane, Hudson
COLLECTOR. M. Jenkins
:'ATE COLLECTED! 3-10--92
DATE ANALYZED.3-11-92
,IME ANALYZED:2200pm
"OLIFORMI 0 /100 mi.
I~iF'F:~I'ATi03~. ?a~. 'a_s a•~ , ~ i.b ';ARE
ove 10 ppm exceeds ?he recommended rliaitc
prinking Water Standard.
(D ~ CO C
CMG cr
~_AA
s' ~ u
SAE TECHNICIAN' Pam Cane .\NDEGENDf
WI Approved Lab No. 19
o
A
d~ Sq
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY ZONING OFFICE
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix Co. Zoning office offers the service of septic and
water inspection to Lending Institution, Realty Firms, and
private individuals.
COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE
LOCATED.
Please provide the following information, enclose appropriate fee
made payable to ST. CROIX CO. ZONING, and mail, along with form
to the above address. Testing will be done as soon as possible
after fee and form are received.
WATER TESTING FEE:$ 25.00
(For nitrates and coliform bacteria)
WATER TESTING--------------------------------FEE 175 00 X,
(VOC'S)
SEPTIC SYSTEM INSPECTION FEE:$ 25.00
~(,,s''t ~~~Y\;1-1
PROPERTY OWNERS NAME:
PROPERTY OWNERS ADDRESS: ~`I ~?CITY:
Legal Description 1/4, .1/4, Sec. W , T 2 N-R j9 W,
Town of lly~ac~ , Loot: No . J* 3 , Subdivision
FIRE NO. LO(,BOX NO
Color of house ~ ;cr.,~•t~ Realty sign? ~yp_ Firm: f.l /p
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e., COPY OF PLAT
BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill.
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: 6L1v_')at , r. '6~0-:.
Telephone No.'(r ? r
REPORT TO BE SENT TO CLOSING DATE:
Signature: ~,LcQ tyrLK.
7JSERCO Laboratories
1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636.7176
LABORATORY ANALYSIS REPORT NO: 20791 PAGE 1
03/24/92
Commercial Testing Laboratory DATE COLLECTED: 03/10/92
514 Main St. Box 526 DATE RECEIVED: 03/12/92
Colfax, WI 54730 COLLECTED BY : CLIENT
DELIVERED BY : CLIENT
SAMPLE TYPE WATER
Attn: Pamela Gane
St. Ci;oix .Zoning Office
SERCO SAMPLE NO: 1444$ on, WI 54016
SAMPLE DESCRIPTION: Pomasl
1351
ANALYSIS:
Bromodichloromethane, ug/L <0.2
Bromoform, ug/L <0.5
Bromomethane, ug/L (Methyl bromide) <1.0
Carbon tetrachloride, ug/L <0.2
Chlorobenzene, ug/L <1.0
Chloroethane, ug/L (Ethyl chloride) <0.4
2-Chloroethylvinyl ether, ug/L <0.4
Chloroform, ug/L <0.5
Chloromethane, ug/L (Methyl chloride) <0.6
Dibromochloromethane, ug/L <0.4
(Chlorodibromomethane)
1,2-Dichlorobenzene, ug/L <1.0
(o-Dichlorobenzene)
1,3-Dichlorobenzene, ug/L <1.0
(m-Dichlorobenzene)
1,4-Dichlorobenzene, ug/L <1.0
(p-Dichlorobenzene)
1,1-Dichloroethane, ug/L <0.1
1,2-Dichloroethane, ug/L <0.2
(Ethylene dichloride)
1,1-Dichloroethene, ug/L <0.2
trans-1,2-Dichloroethene, ug/L <0.1
1,2-Dichloropropane, ug/L <0.1
cis-1,3-Dichloropropene, ug/L <1.5
trans-1,3-Dichloropropene, ug/L <0.9
Methylene chloride, ug/L <5.0
(Dichloromethane)
< means "not detected at this level". 1 mg 1000 ug.
7JSERCO Laboratories
1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178
LABORATORY ANALYSIS REPORT NO: 20791 PAGE 2
03/24/92
I
SERCO SAMPLE NO: 19462
SAMPLE DESCRIPTION: Pomasl
1351
ANALYSIS:
191,2,2-Tetrachloroethane, ug/L <0.2
1,1,1-Trichloroethane, ug/L <5.0
1,1,2-Trichloroethane, ug/L <0.1
Trichloroethene, ug/L <0.4
Trichlorofluoromethane, ug/L (Freon 11) <0.7
Vinyl chloride, ug/L <1.0
Tetrachloroethene, ug/L <1.5
Benzene, ug/L <1.0
Ethylbenzene, ug/L <1.0
Toluene, ug/L <1/.0
This sample's analytical results are ~a~ t below the U.S. EPA's
SDWA Maximum Contaminant level of i/30/91 for those requested
compounds which are also on the SDWA MCL list.
All analyses were performed using EPA or other accepted methodologies.
Samples that may be of an environmentally hazardous nature will be
returned to you. Other samples will be stored for 30 days from the
date of this report, then disposed of by SERCO Laboratories. Please
contact me if other arrangements are needed. This report may not be
reproduced, except in its entirety, without prior written approval
from SERCO Laboratories.
Report submitted by,
L~~YNJCN-
Diane J. Anderson
Project Manager
< means "not detected at this level". 1 mg = 1000 ug.
Mpmbe•
Eorm`,- S T C - 104
• AS BUILT SANITARY SYSTEM REPORT !
OWNER TOWNSHIP SEC. T N-R_W
ADDRESS ST. CROIX COUNTY, WISCONSIN
/~Up So~v W i' S _
SUBDIVISION ('SM NY. 3 LOT Z LOT SIZE
76k
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
OW w{ If
3
~ ar
a 'O
1 U
12 ~
-O
171
n
INDICATE NORTH ARROW
jA,v,v~ y G N
BENCHMAJM: Describe the vertical reference point used /V LOT moA) - ~I1
Elevation of vertical reference point: Q r Proposed slope at site:
SEPTIC TANK: M:.nufacturer: Liquid Capacity:
Number of r_ngs used: 3 Tank manhole cover elevation:
Tank Inlet llevation: Tank Outlet Elevation:
Number of fEet from nearest Road: Front, Side, 0 Rear, 0 32-1 feet
From nearest property line Front, 0Side,klq~J'N Rear,0 _ ~o Feet
Number of feet from: well ' J building: /
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERS[,: 51DE
PUMP CHAMBER
Manufacturer: Liqui apacity:
Pump Mo Pump/Sipt Manufacturer: Pump Size
Elevation of inlet. Bottom of tank elevation:
Pump off switch eleva on: Gallons per cycle:
Alarm Manufactu r: Alarm Switch Type:
Number of eet from nearest property line: ontSide, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORBTION SYSTEM
Bed: Trench:
~ l
Width: 4 / Length: 36 ~ Number of Lines: -3 Area Built:
Fill depth to top of pipe: M,4P'A( 0,A1 ~j
Number of feet from nearest property line: Front, O Side, 0 Rear, O Ft. Z /
Number of feet from well: /6& •S PT
Number of feet from building: 72.E
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits- Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either drop box O or distribution box ui 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, 0 Rear, 0 Ft.
Number of feet Irom well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
~
HOMESITE SEPTIC PLUMBING CO.
License Nuinber : RT- 3UNEII RD HUDSON- MS_ 544.16
ROBERT ULBRICHT
WIS. MASTER PLUMBER LIC. NO. 3307 MAR&
MINN. INSTALLER & DESIGNER LIC. NO. 00663
3/84:mj
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form 1a essential g.Q that jthg Rroperty can bg
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.
WATER TESTING----------------------------FEE: $ 35.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $185.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at time of
inspection) ~6 n0~~1
PROPERTY OWNER'S NAME: r 1
PROP. ADDRESS:- ` RIA kck~ V\ A~ CITY V ~
Legal Desch}p ion 1/4 of he 1/4 of Section ,L, T N-R
Town of Lot Number Subdivision: c.
FIRE NUMBER N LOCK JOX NUMBER
Color of house CDWN Realty sign by house?_~3() If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual re esting services: EU f0 m4sl
Telephone Number . a(o
REPORT TO BE SENT TO: .i nn h 1
CLOSING DATE.,-
signature
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
May 21, 1992
Ed Pomasl
994 Tanney Lane
Hudson, WI 54016
Dear Mr. Pomasl:
An inspection of the septic system on the property of Ed Pomasl,
located at 994 Tanney Lane, Hudson, WI was conducted on May 20,
1992.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
sin rely,
1 ,
..yam . Mary_,J.: 7ehkihs
Assistant Zoning Administrator
cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969
BUREAU OF PLUMBING
MADISON, 01 53707
.X CONVENTIONAL ❑ALTERNATIVE state PlanLD.Number
(lf assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTION DATE.
Hudwa h, Inc. 1509 Cou.~ee Rd., Hudson, WI -/-~'y 36)
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT. ELEV.
NW NE, Section 14, T29N-Rl9W, Lot #2, Town of Hudson
Name of Plumber. MP/MPRSW N,, County Sanitary Permit Number:
RobeAt Utb/,ticht 3307 St. CtLoix 49441
SEPTIC TANK/HOLDING TANK:
NLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
MANUFACTURER. LIQUID CAPACITYENEA
{ P OV ED PROVIDE
W 1 O o "7 I I 7~ YES ONO NO
BEDDING. VENT D(_IA.. VEN MMATL. HIGH MATER OF ROAD: PROPERTY WELL. BUILDING. 1VENT TO FRESH
( ALARM. M ^ I LINE. / AIR INLET.
OYES O OYES ONO J\
DOSING CHAMBER:
MAN
UFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
OYES ONO OYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. A NUMB PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET ROM LINE AIR INLET
PUMP ON AND OFF) OYES ONO NE EST
SOIL ABSORPTION SYSTEM. Check thesoil 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 FO E
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING; COVER JINSIDE DIA -PITS LIQUID
TRENCHES i MAT RIAL PIT DEPTH.
DIMENSIONS J I
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. ISTR NUMBER OF PR OPERTV WELL. BUILDING. VENT TO FRESH
BELOW PIPS ` ABOVE COVER ELE V.INLET ELEV. END PIP I LINE. AIR INLET.
(L f qq _7 -"7 FEET FROM -t ~L~~7 7
IJ~, I:~ I L (7 1 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-
OYES meets the criteria for medium sand. TIONS MEASURED.
O NO
SOIL COVER TEXTURE PERM NT ARKERS; OBSERVATION WELLS
r -
Y S ONO DYES ONO
DEPTH OVER TRENCH 'BED DEPTH OVER TRENCH; BED DEPTH O -TOPSOIL S DUE
CENTER E DGES SEEDED MULCHED
OYES /NO OYES DNO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO. OF LATERAL SP CING. G AVEL DEPTH BE W PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. IN O DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV.. DIA. ELF V. PIPES DIA.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑Y S ONO OYES ONO
COMMENTS: PERMANENT MARKE,R~ 0 OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE.
. ❑ YES-,,,, O NO O YES O NO NEAREST
~1 I 3.4 5
12
17
l
o ~
Sketch System on f,etain in county file for audit.
Reverse Side.
SIGNATUR,k - TITLE.
DILHR SBD 6710 (R. 01/82)
wlsconsln APPLICATION FOR SANITARY PERMIT
~COUNTY
(PLB 67)
OEaRRr
mEnr of UNIFORM SANITARY PERMIT #
InOUSTRV,LRBOP6HUMAn RELRTIOnS
-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 A
I MAILING ADDRESS
lfGJilcie,ei- ^ we `i c 1E r-
~U •Ur~SG ~lJ~ S - SyU~(-
PROPERTY LOCATION @i+j :
ki,) 1 /4 t 1/4, S T jfl N, R E (or)CW To~' W oF:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
7,_ C
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Z 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 /(rD
Lift Pump Tank/Siphon Chamber 4
Holding Tank capacity 1~14-
Manufacturer: ltJ i JE ! GUC4 - , 7-5 ""e f fiS ("OUCit. e_ it.d S
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):
i
Yk 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: W/MPRSW No.: Phone Number:
'613 'T zYz%3% / /17- (33CI ,7 ( 715)
Plumber's Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
J r
Owner Given Initial
y /G' 7 UU 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.
i APPLICATION FOR SANITARY PERMIT
sTc - loo
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/contractgk,("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
Location of Property ylt) ~4 N ' Section T Z N- R (WILL
Township _ -5 6-4-)
Mailing Address j f' "r5/'61
Subdivision Name 76 ~l
Lot Number
2
Previous Owner of Property`
Total Size of Parcel ✓ - G 2- 4'e-a S
Date Parcel was Created
Are all corners and lot lines identifiable? !1 Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume d 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 d(_ed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) eeht 6y that aU statements on tki,6 6onm cute t ue to the best o~ my (out)
h.nowtedge; 4hat I (we) am (ane) the ownet(,S) o6 the ptopettty debet,i.bed in -thZ6
insotmation 6onm, by virtue o6 a wattanty deed teeonded in the 066ice the
County Regi4 ten o ~ Deeds as Document No. .311__ 7Z ; and that I qi~Le )
paaentty ouin the proposed /site Got the sewage diSpoa e /system (ot I (we) have
obtained an ears emeki t, to nun with the above deg cAibed ptopehty, 6ot the,
constltuctior,. o6 baid system, and the same hais been duky teeotded in the 066ice
o4 the County Registet o6 Deeds, as Document No. ) .
C' I
•T
SIGNATURE GF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
l
CERTIFIED SURVEY MAP
NW 1/4 - NE 1/4 - SEC. 14 T-29-N t R- 19-W
g: I I
5d 50' NE
CO. I
SEC
SEE. !#89°-04'-23"E 666.55' I S890-04'-23N~
r , LINE 644 34' , 1322.86 L,--SEC.
2._21- I AI NE 407
790
N 1/4 COR° I q
CO. MON.
SEC I~ 9 LOT I
r.f J,~xF r r. N W
5.025 A. Q' 1
( EAST LINE
day ay;,. c° I NW1/4-HEI/4 w~
~~Y ~ p• . ~ o i I I
~ i
$ Yl ~ 4 4 1 ~N!/
13
a N 89°-06'- 32 E 666. 55' 1 3s(
64 3.9 5'
- 2 3.20' I 1
. 0 I I c~
~NQVP PNpS =
V " I QI
-
LOT 2
N w
ni I$( g0 E I/
aNO 5.025 A. m I r p(
q, I N I OpP~- ~ANIDS• E
' S t'
81EARINGIS, ASSUME-p - 0
uOCP-0~~O9"E ALO"G aI
T ktE.' EAST4 LINE OFD THE
N 89°-08,-38 E 666.53 1 MI
HE /4•4SEC.,14 _
642-3 24 18' -I i CENTERLINE
- I I (SO0°-I I' 33"E }
'141'PROVED~; 1 TANNEY LANE
LOT 3 I -I
z N 5.025 A. W w
F a 21 7j(,~~ (may w ° ( I;.
m a. 1 11✓
N ~O O i 0
..rya 'I
ST. CRQIX GOIJNTY
w
Ct3w► Nt FAWA /MAl 0,41 i
I 1
AMID UW4100 Cp^Wlj N690- 10', 45" IF. 666.55'
641 3'4' 'S 16
APPROVAL OF THIS MINOR SUBD1VI510 W LOT 4
I I
DOES NOT MEAN APPROVAL FOR m 5.025 A. m o1
BUILDING SITE OR SEPTIC ~Y.,TEM. y Aao 900 0 I
REFE4 TO H62.20.
pp U
M j 0 S89°- 21'-05"W 640.51'
S890-12'-52"W 666.55' -L_ _
LEGEND
- SOUTH LINE CENTERLINE
0-- I* 'X 24 IRON PIPE SET, NW 1/4 - NE 1/4 (S89°- 21'-05"W)
WEIGHING 1.68 LOS./ LIN. FT. McCUTCHEN ROAD
200,- -loo' 50' 0 200' sa`' ~GpvV ~
SCALE IN FEET = GENIE C.
SHAFFER
S+1315
¢ HUDSON
WIS. llb
TH15 INSTRUMENT WAS <
C;".tti'It'i :A~ a~ctJ :I ,Nx DRAFTED BY E.R_P_ y/*
j% /V4 $L]R`~
ST, CttJT~c l:~U ~`l Y, Jy i. JOB NO. -t8 - 110 +I~1RR881<~N
r
R C 3 r r ~n a,~y sacgmrox, ~ zpz ap;~n~