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Parcel 020-1052-80-000 01/07/2005 05:12 PM
PAGE 1 OF 1
Alt. Parcel 20.29.19.197B 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): * = Current Owner
ROSSING, DEAN E & VICKI J
DEAN E & VICKI J ROSSING
453 JACOBS LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 453 JACOBS LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 12.000 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R19W PRT SW SE S OF H/W EXC Block/Condo Bldg:
E 8 RIDS
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 658/513
2004 SUMMARY Bill Fair Market Value: Assessed with:
48015 275,900
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 12.000 70,000 143,400 213,400 NO
Totals for 2004:
General Property 12.000 70,000 143,400 213,400
Woodland 0.000 0 0
Totals for 2003:
General Property 12.000 70,000 143,400 213,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 305
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
001-WATER SPECIAL ASSESSMENT 0.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
Form - S T C - 104
J AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP 0 SEC._^_,f) T4~N-R,/5- W
ADDRESS Me , , ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE C
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
60
l~
~21
d~
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: ` Proposed slope at site:
~ c- ~c S f
SEPTIC TANK: Manufacturer: C'/ f,iquid Capacity:
Number of rings used: ~ Tank manhole cover elevation:
Tank Inlet Elevation: L4, Tank Outlet Elevation:
Number of feet from nearest Road: Front, O Side,O Rear , l feet
From nearest property line : Front,0 Side,n Rear, O sa a feet
Number of feet from: well 76~ building: ,26
(Include this information of the a ove plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
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f
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:
l
Width: Length:--' Number of Lines: Area Built: ~1 r~
Fill depth to top of pipe: oC
Number of feet from nearest property line: Front, Side, O Rear,O Ft `
Number of feet from well: d
Number of feet from building: G~(~
(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).
z ~
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:
C
Dated: Plumber on job:
License Number:/
3/84:mj
t
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR &7HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
PLO. BOX '969 BUREAU OF PLUMBING
MADISON, WI 53707
® CONVENTIONAL ❑ ALTERNATIVE State Plan I D Number.
n
❑ Holding Tank E] In-Ground Pressure ❑ Mound (if assig ed)
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE.
Dean Rossing RR, Hudson, WI 9~~ ~+5/ 3 ,~7t
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. IT. ELEV.: CST REF. IT EV
SW SE, Section 20, T29N-R19W, Town of Hudson
Name of Plumber. rP/MPRSW No F~,.y Sanitary Permit NumberByron Bird, Jr. 3318 Croix 54990
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV. . TANK OUTLET E~EV. WARNING LABEL LOCKING COVER
P 1DED'. PROVIDED
1~G-~ ~~i.~~ ~Z (~'1 YES ❑NO ❑YES -]NO
BEDDING'. VENT DIA.. VENj MATL.. HIGH 1(JATER NUMBER OF ROAD: PROPERTY WELL BUILDING. JVENTTOFRESH'
ALARM. LINE AIR INLET.
❑ YES ❑ NO FEET FROM 1 - '
Y S ❑ NO NEAREST
DOSING CHAMBER: '
MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PR OPE RTV WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLENGTH 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:
BED/TRENCH WIDTH LENGTH NPIPE SPACING COVE~~~' NSIUE DIA #PITS LIQUID
MA y'IAL:.;r % " DEPTH.
DIMENSIONS PIT
/ / 1
GRAVEL DEPTH FILI. DEPTH DISTR PIPF DISTR. PIPE DISTR. PIPE ATERIAL. NO DI TH'• NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPES/ ABPVy COVER ELEV. INLET ELEV. END PIPE LINE. AIR IN1.6T.
<i rn r 1 ; - w 1 FEET FROM -7
1 ! NEAR EST-s ` mil` C
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 R VERSE SIDE. SHOW ELEVA-
❑YES NO meets the criteria for medium sand. TI MEASURED.
❑
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES / O ❑YES ❑NO
1111PTH OVER TRENCH BED DEPTH OVER TRENCH.BFD UE PTH OF TOPSOIL ISO D y ED MULCHED
CENTER
❑YES ❑NO ,TED ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LEN NO. OF LATERAL SPACING. GRAVEL DEPTH BELOV~1 IPE FILL DEPTH ABOVE COVEH
BED/TRENCH TRENCHES f
DIMENSIONS '
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERI IN O. DISTR. JD~STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVELEVELEV. PIPESDA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY OVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
❑YES ❑NO C ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS'. NUMBER OF PROPERTY WELL . BUILDING'.
FEET FROM LINE
+ i ❑YES ❑NO ❑YES ❑NO NEAREST
y. ' ' J ,
f ~
1
Sketch System on y ) I Retain in county file for audit.
Reverse Side. !
SIGNATURE. TI TLE.
DILHR SBD 6710 (R. 01/82)
wlsEOnsln APPLICATION FOR SANITARY PERMIT
DILHR COUNTY
M OERRFmmEnTOF (PLB 67) UNIFORM SANITARY PERMIT #
In OUSTRY, LRBOR 6 HUMRn RELRTIOns
~y X90
-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
PROPERTX OWNER ? MAILING ADDRESS
"or
PROPERTY LOCATION
V CITY:
VI AGE:
_X C 1/4 ? 1/4, S .,:PC" N, R/`/ E (or _W_ "OF: Z Y'~_ 7 e_/~ e le
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME rEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED o as - dOs a 8"~~
1 or 2 Family Number of Bedrooms:
Y ~ ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
j 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 s',f ' i
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):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of.1lumber (Print): Signature: 7 r„ P/MPRSW No.: Phone Number:
.I
-4 C-L-711
Plu er` Address: % Name of Designer
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
~-o p ❑ Owner Given Initial
11147U 6- kApproved 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
4
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 + J • 5 s-,/ 'V
Location of Property -S W~4 `4, Section ~i T - R W
Township / 6L ds,oA2 -
Mailing Address
p Subdivision Name
Lot Number
Previous Owner of. Property ~O SS i C
Total Size of Parcel Z2
Date Parcel was Created ! lr'GJ 1 /G lo[
7
Are all corners and lot lines identifiable? Yes N-
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
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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPFRTV OWNER CERTIFICATION
I (We) eejtt~()y that aU statements on this ~otm ante PLue to the beet oA my (ofo)
knowledge; that 1 (we) am (ahe.) the owneA(s) oA the pnopvLty de6nibed in ,tk s
inAonmatton 4wm, by viAtue o{ a waAAanty deed neconded in the 06y )ice ob .the.
County Regi,6teA oA Deeds as Document No. R-L7 ; and that I (we)
pnesen-Cy own the pnopoAed site {oA the sewage posa. -system (on I (we) have
obtained an e"eme.nt, to nun with. the above descAi,bed ptopeAty, {ion the.
eo"tAuction o6 said System, and the same has been du.-y n.econde_d in the 0~ ic.e
oA the County Regis-tet oA Deeds, as Document No.
wI! R
~p ~ SIGNATURE OF CO-OWNER (IF APPLICABLE)
SIGNATURE OF OWNER
ep-'12 If' w1) %-Jy
DATE SIGNED DATE SIGNED
I, Dean Rossing, owner of the property located at
Route 1, Box 206, Hudson, Wisconsin, Township of Hudson,
do hereby agree that the existing; old farm house located
on the above stated property will be either moved or torn
down by July 31, 1983, in compliance with the St. Croix
County Zoning office's request as per August 28, 1984,
telephone conversation with Tom Nelson. The above mentioned
house is to be removed because o_E a new house and septic
system to be built in the area near the old house.
Dean E. Rossing
U-) C
H
y
STC - 105 rr-
y
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
c7
OWNER/BUYER0_1000 g7 rW , Cr tai Ss~il/~ CH"
~
ROUTE/BOX NUMBER -Fire Number .?-7-
CITY/ STATE
_N, R__ W,
PROPERTY LOCATION: ~;j5 14, Section C q
I
Town of St. Croix County,
~Oubdivision_ Lot number- _
Improper use and maintenance of your septic system could result in
I
its premature failure to handle wastes. Proper maintenance con- t
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
I
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. Ho
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- b
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. I(`
SIGNED
DATE 2-~`r~7 - G
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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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
LABOR AND' PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 7969
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP MU ICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME:
C NTY• { OW H'S/BUY"!=R'S NAME: r LIN ADDRESS: ,
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DES RIPTION: PROFI E D SCRIPTION~: PE COLATION TESTS:
17,11 &eside tee ❑New Xeplace
f 1A 49
RATING: S= Site suitable for system U= Site unsuitable for system
rCONVENTIONAL: MOUNjc`D:_y IN-GROUNNL)-PRES'S' URE: SYSTE~`M-IN-FIILLHOLD N-G((TANK: R COMMENDEDSYSTE (opt 1)
~J ®S~u OS ®U EIS ~IU
y portion of the tested area is in the
Ists re NOT rei red DESIGN RA LF'loodplain, an
5)(b), indicate: indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
~l
ZTALI 2, 0", z
r JJ ~j J p p `
B- rC nlt~ ICS yZ ' 6 ;;I,,
~Z 2Y Z 149A.' -54 (9 '41,
B- S" 72
"'3 A8475,0'1 IIAA14 07, d3-7F 4 1-aw-5 doe 3_1
B-
Ft' 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
P_ 0 2
P- ' ;kd G 2-
P-
P-
PLOT PLAN: Show locations of percola Zests, soil bori s and the dimensions of s itable soil areas. Indicates or ~~`es ri e t are the hori-
zontal and vertical elevation reference poi is and show their location on the plot plan. Show the surface elevation at all on s ?the direc ion and percent
of land slope.
.00
SYSTEM ELEVATION (15rcp't ~_G
`Q %
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a tp A - u '
IZJ
a
70 It
t` r
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P i
% I, the undersigned, hereby certify that the soil tests reporte n orm were rt1~Fg by me in accord with the procedures and methods specified i AC;isconsin
Administrative Code, and that the data rec rded and the loci n a tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Fig, j 1 _q4
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ADDRESS:-- CERTIFI ATIO N B R: PHONE NUMBER (optional):
CS I RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) OVER -
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+ PROJECT &a n ADDRESS ~c l 5 c, '
S 1 /4~ 1 /4/ j/T~yN/ICY TOWN COUNTY _5;
BEDROOM jL CLASS PERC_ L_
CONVENTIONAL4 CONVENTIONAL LIFT- MOUND_ HOLDING TANK-
IN-GROUND PRESSURE
SEPTIC TANK SIZE D~ LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION EA 4.3 6' ERC RATE ED SIZE 1-2
PLUMBER ISCENSE NO._ZlZ_-?_~DATE
ilk, loci'
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