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Parcel 020-1051-70-000 03/24/2006 12:33 PM
PAGE 1 OF 1
Alt. Parcel M 20.29.19.1931 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): 0 = Current Owner, C = Current Co-Owner
0 - PITTMAN, RONALD & DEBORAH
RONALD & DEBORAH PITTMAN
823 NORTHVIEW DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 823 NORTHVIEW DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 5.760 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R19W E1/2 OF SW 1/4 LOT 1 Block/Condo Bldg:
CSM 5/1317
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 674/249
2005 SUMMARY Bill M Fair Market Value: Assessed with:
91780 231,100
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.760 91,600 144,100 235,700 NO 05
Totals for 2005:
General Property 5.760 91,600 144,100 235,700
Woodland 0.000 0 0
Totals for 2004:
General Property 5.760 62,600 123,000 185,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 105
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
w s
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER 'YOWNSHIP SEC. { T r1 N-R W
r
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
X -3/ 7
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3
J
yy
/Q
. I
D
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: ~Q to Proposed slope at site:
SEPTIC TANK: Manufacturer :~~iquid Capacity: Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, (D Side,0 Rear, 0 0 feet
d
From nearest property 1_ine. Front,0 Side,0 Rear, ® feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
dip
PUMP CHAMBER
Z ~
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, Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: f 35 Trench:
Width: Length: 3 Number of Lines: Area Built: ~j
Fill depth to top of pipe:
9
Number of feet from nearest property line: Front, O Side, O Rear, Ft
Number of feet from well:
Number of feet from building: ~j
(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, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:_
Dated.
Plumber on job: License Number: 3/
3/84:mj
r-
• DEPAR'"MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
L.AROR ri HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
5UCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (I1 assigned)
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DA E.
Ronald Pittman 304 St. Cttoix, N. Hudson, W1 9 C;1e --8y
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: JCST REF. PT. ELEV.
SW SW, Section 20, T29N-R19W, Town o6 Hudson /O`YJ
Na- of Plumber: IMPIMPRSW No.. County Sanitary Permit Number
Thom" A. Wang 3231 St. Cnoix 58855
01
SEPTIC TANK/HOLDING TANK: 7
MANUFACTUREFj. LIQUID CAPACITY . TANK INLET ELEV.'. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED
T! 77 / YES LINO ❑YES LINO
BEDDING'. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: JPROPERTY WELL: BUILDING. VENTTO FRESH
s1 ALARM FEET FROM 1 LINE AIR INLET
YES NO / ❑YES LINO NEAREST /00 BUS
DOSING CHAMBER:
QUID CAPACITY JPUMP MODEL PUMP/SIPHON MANUFACTURERWARING LABEL LOCKING COVER
MANUFACTURER. 7ING
LI
PROVDEDPROVIDEDS LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY [11E LL JBUILDING. I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES LINO 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 NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA npITS LIQUID
BED/TRENCH TRENys / N44~Llr RIA L PIT DEPTH
DIMENSIONS
GRAVEL DFPTH FIL DEPT H DISTR . PIPF DISTR. PIPE DISTR. PIPE MATERIAL. N TR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPES ABOLVE COVER. EL INLET ELEV. E D. PI FEET FROM LINE J /vv AIR INLET
NEAREST
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-
meets the criteria for medium sand. PIONS MEASURED.
❑YES LINO
SOIL COVER TEXTURE PERMANENT MARKERS. JOBSERVATION WELLS
❑YES LINO ❑YES LINO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED = 1 TOPSOIL ]7E SEEDED MULCHED
CENTER EDGES
YES NO ❑YES NO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. IDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV. DIA. ELEV.. PIPES. DIA.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
❑YES LINO ❑YES LINO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'.
FEET FROM '
❑YES LINO ❑YES LINO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
.
S N T//yyE TITLE
DI LHR SBD 6710 (R. 01 /82) G'L
y
E-Consin APPLICATION FOR SANITARY PERMIT
(PLB 67) COUNTY
DILHR
UNIFORM SANITARY PERMIT #
US USTRY, Y, LR BOR 6 HUTRn RELF1TIOn5 -5- t°y 915-
-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
PROP TY OWNER MAILING ADDRES
14 ~J% yo ~i 3,~~
C-11 0 to Pt
PROPERTY LOCATION CITY: /
501/4 S &.1/4, S To~4 N, R ' E (or)CW Vow hmod s-6I'J
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME AREST R -LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED Co - 1051 -
X 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.
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 0
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: A;dw,037 Pr 01 4 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):
0 6 /F K 5 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) Signa re: MP/MPRSW No.: Phone Number:
Plumber's Address- `r Name of Designer-
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ~y~/ , ❑ Disapproved
7`t9 / ❑ Owner Given Initial
'Alt" Q ~ ~f ~ 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
r
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 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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
AO 1A
Owner of Property F6& 1n / 6&L
of Property 6J ~4, Section T Q N - R W
Township bh,~>0/1 _
Mailing Address
Subdivision Name
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
I (We) ceh icy that aXX 6 a.temen-ts on this {onm ane tAue to the be5-t o A my (ouh )
fznowTedge; that I (we.) am (ahe) the owneA (,5) o{ the, pnopenty d"e-)Yibed in this
J* .mation Kon.m, by viv,tue o{ a waAAanty deed necanded tin the. OAOice. oA the
County Re.gi6ten o{ De_ed.5 ass Document No. ' and that I (we)
Y),eAent.ey own ,the, pnopo6ed site {)on the, 6ewage c~pohWP /,y6tem (on I (we) have
ob,ta,i.ne.d an eahe.ment, to hun. with. ,the above d"cltibed pnopenty, ion the
con,6tAuctc on o{ 6aid .5 y6 tem, and the tame h" been duX neeonded in the OAOice
oA the County Regi/5te_n o{) Dee.d,~, aA Document No.
SIGNATURE OF OW ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
I)A`I' . S. 1 C, D DATE SIGNED
H
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S T C - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT
0
St. Croix County
c~
OWNER/BUYER
a~r• f'✓1~1 _
i
Fire Number,
ROUTE/BOX NUMBER f
CITY/STATE-All A ~,c~14S LIP
PROPERTY LOCATION: Section- T N, R_"_-_W,
Town ofGf(1 ~(f? _ St. Croix County,
Subdivision Lot number
I
Improper use dnd maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank uiner. 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. o
F
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- ~o
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date. Jll)
SIGNED ~
D ATE
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.
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DEPAI?TMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 79609
HUMAN RELATIONS
11) & Chapter 145.045)
LOCATION: SECTION: OWNSHIPJ U ICIPALITY: LOT NO.: BLK. NO. SUBDIVISION NAME:
~w 1/45J/ d /T N/R E (o l 4's'-~-'
C UNTY OW ER'S/BUY R'S N ME: MAILING ADDRESS:
d ` x S Card !1r
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PRO,F~LE EfCRIPTIONS: PERCCtOLATIO TESTS:
~~Residence - NNew ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYST M:(optional)
OS ❑U TO ❑U NS [:]U ❑S ®U ❑S ;SU dotl L).
[under Percolation Tests are NOT required DESIGN RATE:/~ \ If any portion of the tested area is in the
s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
4,56 0 >g'.5'6 oils/
B- a D~ x'9./7 ,75) 6;1 3/ yid 6n av6r
B- ' ..06 213 *33 6'1 S I S~ o v Bii Si Cyr
B ~bU /DAD > >.vo ,3~~C1 I~riS SIGH
Lo S B-
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 PERIOD 3 PER INCH
P- S O ~0 ry o~
P- C~ /c / e
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 9 . Dd
P, l•• ,Q =100
' rc Lec~ar._haSf
Std t t~S E for-nt^
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n leS
13 y
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rd d x
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[ t ~_4_..... _
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haW"e- o -3 tam,
"40, C0 l6 S I-.ane eT Y U &-1 o !d o k of glad S&kr
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: 4?
ADDRESS: / CERTIF T O NUMBER: P NE U BER(opt' nal):
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