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Parcel 020-1163-30-000 01/07/2005 PM
PAGE E 1 1 OF 1
Alt. Parcel M 12.29.20.942-944 020 - TOWN OF HUDSON
Current rX' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
BOWMAN, KENNETH R
KENNETH R BOWMAN
1071 EDGEWOOD CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1071 EDGEWOOD CIR
SC 2611 SCH D OF HUDSON
SP 1700 W ITC
Legal Description: Acres: 0.692 Plat: 1929-EDGEWOOD ESTATES
SEC 12 T29N R20W EDGEWOOD ESTATES LOTS Block/Condo Bldg: LOT 12
12, 13, & 14
-Twn-Rn 40 1 /4 160 1/4)
Tract(s): (Sec g 12-29N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 876/398
07/23/1997 704/346
2004 SUMMARY Bill Fair Market Value: Assessed with:
49023 258,700
Valuations: Last Changed: 10/26/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.010 32,200 167,900 200,100 NO
Totals for 2004:
General Property 1.010 32,200 167,900 200,100
Woodland 0.000 0 0
Totals for 2003:
General Property 1.010 32,200 167,900 200,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 206
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
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
F
OWNER TOWNSHIP SEC. T N-R
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
~S
aY '
INDICATE NORTH ARROW
19
BENCHMARK: Describe the vertical reference point used L,~} - Lee- ✓r4~_ S C- r)
Elevation of vertical reference point: f Proposed slope at site: / a.5
SEPTIC TANK: Manufacturer: _Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: X51 Tank Outlet Elevation:
Number of feet from nearest Road: Front,
Q Side, Rear, O feet
From nearest property line Front,OSide,,Rear,O feet
Number of feet from: well` building:
iL-/
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
i
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 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: ? Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.(
Number of feet from well: S.
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, 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 :
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABC;R.& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P DxBOX 79G*9 BUREAU OF PLUMBING
~MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan ID. Number
1/ assigned)
❑ Holding Tank El In-Ground Pressure ❑ Mound 1
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER. INSPECTION D VTE-.
B 8 H Devetopment 836 St. CtLoix Station N.Hud5on W1
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. RE'5. PT. ELEV.: CST REF. PT. ELEV..
SE NF, See.12, T29N-R20W, Twn. of Hudson,Lotz 13814,Edgewood Ebtate6
N.- of Plumber: MP/MPRSW N,, Coumy Sanitary Per- Number:
GI, tiam SchumakvL 6382 St. Cnoix 58856
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUID CAP ACITV. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
P V ED: PROVIDED..
~LA0. YES LINO ❑YES LINO
BEDDING. VENT DIA.. VENT MATL. HIGH WATER FNEAREST----*-
DOSING MBER OF ROAD: P : BUILDING. NT TO FRESH
ALARM ET FROM 1, LIIVAIER INLET.
❑YES NO L ) [:]YES LINO CHAMBER:
MANUFACTURER BEDDING. LIOUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER
WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY JWELL BUILDING I(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 FNGTH 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 D
E DIA -PITS LIQUID
DEPT
H
BED/TRENCH a TRENCHES MATERIAL IE17
DIMENSIONS v, •Z.
GRAVEL DFPTH FILL DEPTH DISTR PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COV EOV INLL~{ E E Q7 PIPES; FEET FROM LINE: AIR INLET.
/ Ti NEAREST ► i _l.; E: S )
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 NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES LINO ❑YES NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH,BED OF TOPSOIL P~YES SEEDED MULCHED
CENTER EDGES DEPTH LINO ❑YES LINO ❑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. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV. DIA.. ELEV.. PIPES. DIA.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATEF?IAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
❑YES LINO ❑YES LINO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
J
FEET FROM LINE.
Z
❑YES LINO ❑YESNO + NEAREST J
~cs, 2 rLd A 5 C LIIIZ C C , v v Lett, C` cr
Sketch System on my file for audit.
Reverse Side.
SIG TITLE.
DILHR SBD 6710 (R. 01/82)
wisconsin APPLICATION FOR SANITARY PERMIT
(~!®ILHR COUNTY
T
inDUS
1EnT ,LAOF
(PLB 67) UNIFORM SANITARY PERMIT #
npUSTRY
LRBOR 6 HUTgn RELgTIOnS 5'&_
~y~-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 4,3 A,
PROPERTY LOCATION CITY: r
r 1/4 r''1/4, S J2 , T , N, R. E (o W`\ OWN la rw z.~
LOT NUMBER JBLOC NUMBER SUBDIVISI N NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
L 1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
k 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 -
El 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 r t
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): PROPOSE quar Feet):
XPrivate ❑ 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:
Plumber's Address: Name of Designer:
4 X7 .2-
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
Owner Given Initial
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
• h
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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property
Location of Property j f 4 fG, Section T N - RC W
Township /yc'L'Svy~
Mailing Address
Subdivision Name
Lot Number
Previous Owner of. Property T t/-~ ✓ ~/i': f ~1 -
Total Size of Parcel
Date Parcel was Created ~L;&I
Are all corners and lot lines identifiable? ` Yes No
Is this property being developed for resale (spec house) ? f~ Yes No
Volume - and Page Number ~y S 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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) ee&ti)y that a.PL stalte.mentls on this Aonm cute tue to the best o{ my (ouA)
knowledge; that I (we) am (ane) the own.eh (,S) o{ the pnopen ty de/snibed in -thi/s
knAonmation Aon.m, by vi,ctue o~ a wvu arty deed neeonded in ,the. 06{ice o~ the
County Reg i s teh aA Deeds as Document Na. ?f ' ,Z , ; and that I (we)
pne,sentky own the phopolsed /site ion the 15ewage po at system (on 1 (we) have
obtained an eaheme.nt, to nun with the above d"c i.bed pnope,,gty, {ion the
con,stAuction oA scud /sy6te.m, and the Game, has been duty heconde.d in the 066ice
oA the County Regizten. o{ Deede, ass Document No. ~ y )
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
• H
G
y
S T C - 105 r
v
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County
d
v
OWNER/BUYER
ROUTE/BOX NUMBER Number _
CITY/STATE Z I P S '16'/
PROPERTY LOCATION: 4, 4, Section C~N, R_-ZC W,
Town of St. Croix County,
Subdivisionc ,'zCz Lot n umb e
>li'E~ ~ _-.X•
I
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,
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 m<Ly 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. H
0
E
L4
I/WE, the undersigned, have read the above requirements and agree u,
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- ~d
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.
S I G N E D
i
DA'Z'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.
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N -DEPARTMENT ENT OF SAFETY & BUILDINGS
REPORT ON SOIL BORINGS AND
LABOR AND
HUMAN` R
LATIONS PERCOLATION TESTS \1+`'/ DIVISION
P.O. BOX 7969
(H63.09(1) E{ Chapter 145.045) MADISON, lNl 53707
1 - o) 14
LOCATION: SECTION: OVJNSHIP/MUNICIPALITY: LOT NO.: 3LK. NO.: SUQDIVISfON NAM-E:
u~ Er7:=r
COUNTY: QWNEB'S/Q L'YEf~'S NAM E: ~ ~"~~`au
MAILING ADDRESS:
`T Cf=or}( ~i `t ~=lE 1 '
USE fJO. BEDRNS.: COMMERCIAL DESCRIPTION. DATES OBSERVATIONS MADE
?esidence PROS I L E DESCRIPTIONS: PER OL j"TION TESTS.
)V -1~New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
fJ
OfJVENTIOPJAL.: MOUND: -GROUNaPRE.SSURE: SYSTEM-IN-FILLHOLDIN GTANK: fJECONIMENDED SYSTEM.(optional)
S C'U_1 C~ S-~U CC'S ❑U ~ S 0
-L-11 S 9 U
' Tk C tJ c c w r~
it Percolation Tests are NOT required DESIGN RATE:
under s.H6309(5) (b), indicate: - ~ If any portion the tested area is the
Floadplain, indicate Floodplain elevation:
S ~L" E~cx-,L r f PROFILE DESCRIPTIONS I ( : ONCZ (~nl~ t'~1/
riORING TOTAL DEP"FH TO GfIOUNDWATEP INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
I_---
^dUrnBER~DEFTI! IN, ELEVATION _06SERVED_- EST. _M:HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK)
B- QA/L~ T~~~yJ
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B-
FEET PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATEH LEVEL-INCITES
NUMBER TE S
AFTERSWELLING INTERVAL-MIN, RATE MINUTES ELEV.
- PERIOD_t PEF'iIOD2 _ PER/IUD 3_ _ PER INCH
P I 2'7L t~_I rPIG - S _ _ ! 103,11
P. z.6Z I~10 t
P_ 3
I3//i. 7 f X3,3 z 01,
-OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable it areas. Indicate scale or distances. Describe what are the hori-
ntal and vertical elevation reference points and show their location on the blot plan. Show the surface elevation at all borings and the direction and percent
land slope. L•~, r~C 3~ ) CtVC~RTfd f Gam. ¢0 YSTEI ELEVATION Tnc:,~rl ~=u sau7H 7N OTC , TiZci.<_ Q xi rzc0 `/12cs
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W 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
tmistrotive Code, and that the data recorded and the location of the tests are correct to the best of my knoevladge and belief.
_ TESTS WERE COMPLETED ON:
Ess CERTIFICATION NUMBER: (PHONE NUMQER(optional):
7/5 0
CST SIGNATURE:
i11BUI ION: Original and one copy to Local Authority, Property Ov)ner and Soil Tester. ~"-SR - OVER
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