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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner HANSON, MARILYN A MARILYN A HANSON 1368 HAGGERTY ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1368 HAGGERTY ST SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.000 Plat: 2111-HOULTON SEC 27 T30N R20W LOT 9 BLK 7 VIL HOULTON Block/Condo Bldg: 7 LOT 9 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: 6196 118,900 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 50,000 67,000 117,000 NO Totals for 2004: General Property 1.000 50,000 67,000 117,000 Woodland 0.000 0 0 Totals for 2003: General Property 1.000 28,200 54,000 82,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 306 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT ---.Tt' -SEC. ` 7>(N-R~ ,41 OWN ERC- '/'/I Ncjl75C!~~ T OWNSHIP 4?7- ADDRESS_ 7- ST. CROIX COUNTY, WISCONSIN. SUBDIVISION t'•LLici Ci= f~G~L i~ LOT q LOT SIZE PLAN VIEW Distances and dimensions to meet requi i i_«<( ~it ~0 RH) ;r SHOW EVERYTHING WITHIN i,J:'C 0 t- Y S f ' a 3 5 - - r - rr 1% `1w iGl mho t7 Ii di at N r h rrc w _ c - 4 BENCHMARK: (Permanent reference Point) Describe: 'r-IT O/z i t- 5 1`e J~ Elevation of vertical reference point: Slope at site: SEP'T'IC TANK: Manufacturer: LVe,`SC?r Liquid Capacity: ~00c Number of rings on cover 'T'ank manhole cover elevation: Tank Inlet Elevation `l'ank Outlet Elevation: - - e-- PUMP CHAMBER Manufacturer:- 'v z~C k Number of gallons Number of gal, pump set for a cycle Cj~ gallons; Total capacity of distribution lines gallon: size of pump y head; - - gallon per minute 7_ horsepower '-f iL ;brand name of pump and model number ~7c e! } 't'ype of warning device 5j i.<Lri-c HOLDING TANK: Manufacturer 41-1 Nuiiiber of gallons__ Elevation of manhole cover ; Type of warning device SEEPAGE PIT SIZE;___,,t Number of pits feet diameter feet liquid depth seepage pit inlet pipe-elevation - _ bottom of seepage pit elevation_ _ _ feet. SEEPAGE BED SIZE: number of lines tr width- -length `4&-tile depth x3G. SEEPAGE TRENCH: width,~r~` _ length- _ PERCOLATION RATECG,;.,< _ AREA REQUIRED AREA AS BUIL`T'?` c - - - - INSPECTOR DA`Z'ED PLUMBER ON JOB LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7960. % BUREAU OF PLUMBING MAD',ZON, WI 53707 U CONVENTIONAL EALTERNATIVE Sta,e Plan I.D. N,mber. (I1 assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE. MwLityn Hauon R. R. 1, Box 654, Houton, W1 54082 q/)v BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV. NW NE, Section 27, T30N-R20W, V.iUage o4 Houton Na- of Plumber- IMP/MPRSW No. County Sanitary Permit Number. Paul Cudd 2739 St. Cuix 54933 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.'. TANK OUTLET ELEV.. JWARNING LABEL LOCKING COVER f v,, PROVIDED. PROVIDED 1Lj DYES ENO DYES ENO BEDDING. VENT DIA.: VENT MATL.. HIGH WATER NUMBS OF ROAD: PROPERTY WELL. BUILDING VENT TO FRESH 3 r r ALARM FEET FROM LINE ` / R INLET ❑ YES NO * 1 ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURI~R BEDDING. 11-11111111 CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER i P O DED: PROVID D. DYES NO y YES ENO ES ENO GALLONS PER CYCLE: IPUMPANOCONrRO1-soPERAnoNA1- MBER OF PaoPERTV` wELL BuILDI G VENT TO FRESH (DIFFERENCE BETWEEN EET FROM L1 ] _C `alAlttyuL _~j PUMP ON AND OFF) DYES ENO NEAREST C7( L~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 FN(,TH 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." LE GTE. NO.OF IDISTR. PIPE SPACING COVR JIN11111 DIA &PITS LIOUID BED/TRENCH 3 ND OF CRIES 1AL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL D PTH DIST PIPE DISI"R. PIPE DISTR. PIPE MATERIAL. NO. IS NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. LFT ELEV. D. PIPES LINE. AIR INLET. FEET F L ~Yj G`W' 2_ Z-C NEARESTO-s ~D 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- D meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ENO DYES ENO DEPTH OVER TRENCH BED DEPTH OVER TRENCH.' BED TH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DEP . DYES ENO DYES ENO DYES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.. CIA ELEV. PIPES. DIA.'. DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. EYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL. JBIJILDING: FEET FROM LINE ❑ YES ❑ NO ❑ YES E NO NEAREST -7 I.IC, SCI 5./4 1,50 i SketcpSxste n Retain in coun file6or audit. ' Rev Side. SIGNATURE. I LE DILHR SBD 6710 (R. 01/82) l~~r` sue'"" - wisconsin APPLICATION FOR SANITARY PERMIT DJ L H R St. Croix COUNTY (PLB 67) = 1]EPRRTTEnT OF UNIFORM SANITARY PERMIT # - InOUSTRV, LABOR 6 HUTRn RELRTIons !5-,q 9 3.3 -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 Marilyn Hanson Rt. 1, Box 654, HOU.lton, WI 54082 PROPERTY LOCATION NXXX NW 11,VE 1/4, S 27 T 30, N R 20XY44 W vILXLKAXGEX,. Houlton LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 9 7 Haggerty Street ry TYPE OF BUILDING OR USE SERVED • /W , 0,50 .-aa57d iX 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ® Tank Replacement ❑ Repair LN Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X1 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 1000 1 X Lift Pump Tank/3=XXCXi ixr SR Pump 750 1 X Holding Tank capacity Manufacturer: Weiser 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): Class 2 945, 96o ® Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility sewage s wn on the attached plans. Name of Plumber (Print): Si a re: MP/MPRSW No.: Phone Number: Paul R. Cudd 2739 (715) X25-2049 Plumber's Address: of Designer: Rt. 5, Box 364, River Falls, WI 54022 Art Wegerer (576) COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved / 4u /J ~/40 ~ p Approved El Owner Given Initial / L7 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. uAsconsa" SANITARY PERMIT (~IDILHR County naisTR%,LFAeaac►~wEs GROUNDWATER SURCHARGE Sanitary Permit No. _6-Al- 9 On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground >Aitt Signature of Issuing Agent: Groundwater Fee: Date: WiscO I`S DILHR SBD-7289 (N. 05/84) p FU rIII C 100 Owner of Property r~,~ z rr► 1 1 viJ~ 1't-- Ho 1~7 -'c L% ~ .Location of Property_ IV W N :t, Section_ T ` LN ll_aLW Township Mailing Address'} Cn C !~.~t ,~<~~I~) ` J+ Subdivision Name Lot Number_ q Previous Owner of Property_ A e- ~G l<Ae Total Size of Parcel_ l~f Date Parcel Was Created Are all corners identifiable? Yes No Include- wh it i it it;ktl)_L ~ ti ,,t tut, uuc uS I'll,: tullowtu~, .Certified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION i I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No'3511260 ;and that I (we) presently own the proposed site for the sewage disposal system (or 1 (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ) LUL-n SIGNATURE 004OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 7/---, / k-- DATE SIGNED DATE SIGNED SSanOgr. of uznla_t PUP alPP `U9,TS f988-Si.4-StL Jo 6CZZ-93L-S1L TO YS TM `P tounuPil 86 x0l 'O-d O l5 0Dt Il0 911-"UOZ A71Un(tJ xtOil `t ~1 , ~L• V( a'TN0I ) ~~1 a l (ap uoT l ezTdxa ~n , C aa.ztl l aye JO s CPp OF (ITt lTM aO_TJTO ~uTItOJ ,Chinn- xToz) l5 atil of pauznl,az pup Pa laTditto a aq lsnut utJOi uOT aPOCirazaO •saOJnOsPN TPJnlrm So lUa111 w -1JPdaQ UTSUOOS IM aril Cq las sP `UTaJ ai{ `t{IJOj las sPJPPUPIS aql x tllTM aoUPpaoOOP UT utals" TPSO`'dsTp 091?Mas al PtTJd atil UTPIUTMu Ol U aaJ9P PUP SluaRtaJTnbaJ anOqu atTl pPaJ -Aril 1pau9TsJapun ayl IM/T 7 0 ~.a •uotlPJTdxa zPaX amyl of JOT-1d SXPP of. l~TalPUiTxoJddr luas aq TTTM mJOX UoT3POT3ilJa-) mnOS PUP a9PnTs 3o TTn3 £/T UPgI ssaT sT xuPl. aTidas aya `(CzPSSa -oau 3T) 9uTdiund pus uoTlOadSUT JagJP (Z) PUP uoTITpuOO 9uTlPJadO JadOZd UT ST utals,ts TPsOdstp JalPMalsPM alTs-uo atil (T) 7Pt11 9UTAJ -T-10A zadutnd pasUaOTT P zO zagmnTd Pal7TJlsaz `zagmnTd uPtuCauznoC JagntnTd Jaisn,ut v, Cq pun zauMO ayl XCI pau9Ts `tuznl uOT -IPOTJTlJaD H 'utao7, C1l]nn7 xTO_r~ is 07 1T111g1`1s saaJ lP JauMo XlJadOJd •pauTP7uTeni CTJadoJd SIt ta1SCs JTayl daa-4 of ;4 )-i r gitta_1SA'Mnu TTP 3O sJauMO lPtil luamaJTnhaJ agl tilTM `086T 3o 1sn~nV !IT mP1901d sTtll PaldaooP ,tauno0 XTOJD 'IS 8L6T `T ~TnC Ol JoTJd UOTlPJ11to LIT sPM yJTgM `mats Cs 9uTTTP3 P 3O lUau(aZ)PTdaJ 3o lsoo ayl Io 09 j0 tuna-rxvut P Jot lUnJ9 P Onra:TaT nl PlgT99TTa aq ~rIM sluapTs~J &luno0 xTOJO l5 •ucalsSs TPSOdsTp PIS" a11:1 UT a9Pls luam -lPaJl P sn. 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