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Parcel 07.29.19.556 020 - 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 ROMAN, FRANK JR & MARJORIE FRANK JR & MARJORIE ROMAN 440 KRATTLEY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ° 440 KRATTLEY LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.110 Plat: 1925-EAGLE RIDGE SEC 07 T29N R19W EAGLE RIDGE LOT 27 Block/Condo Bldg: LOT 27 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 674/330 2004 SUMMARY Bill M Fair Market Value: Assessed with: 48645 253,600 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.110 40,700 155,500 196,200 NO Totals for 2004: General Property 2.110 40,700 155,500 196,200 Woodland 0.000 0 0 Totals for 2003: General Property 2.110 40,700 155,500 196,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 133 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 AS BUILT SANITARY SYSTEM REPORT 4 OWNER ~ Gi~j ✓~I TOWNSHIP Z7 u 'S'~:1 SEC. T_N-R W i ADDRESS r•^uK ~ p A- ST. CROIX COUNTY, WISCONSIN. SUBDIVISION i✓-~' LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WIT."N 100 FEET OF SYSTEM :TTI - -7' -4 I di at N r h rrc w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: S^ SEPTIC TANK: Manufacturer: ✓;r, Liquid Capacity: z/`` Number of rings on cover f Tank manhole cover elevation:_'CT Y / Tank Inlet Elevation: Tank Outlet Elevation: q 7;7 C PUMP CHAMBER / Manufacturer: Number of gallons J_ _ Number of gal. pump set for a cycle /L /I- gallons; Total capacity of distribution lines gallon: size of pump ti"//I- head; gallon per minute horsepower ;brand name of pump and model number It/ Type of warning device HOLDING TANK: Manufacturer AV A Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE;- ,/VI- Number of pits feet diameter 11-1-4-- feet liquid depth /V d: seepage pit inlet pipe-elevation -L/-J - bottom of seepage pit elevation /V /I-- feet. SEEPAGE BED SIZE: number of lines 2 width _~f f5' -length 2, -tile depth SEEPAGE "RENCH: width /V4 _ length ,/✓/f- PERCOLA'1wON RATE AREA REQUIRED : / AREA AS BUILT 671~i - INSPECTOR DATED PLUMBER ON JOB 2 ~ LICENSE NUMB y ~ r . 7 E N /'if 7 Ilk LL G c- J c - 5 << ~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ..O. BO & HLIMAN RELATIONS P PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 LXCONVENTIONAL ❑ALTERNATIVE State PillI -D.N,mber ❑ Holding Tank D In-Ground Pressure ❑ Mound (It assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Sam Miller Trout Brook Rd.,Hudson, WI BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. Orr ELEV.. NE SE, Sec.7,T29N-R19W,Lot 27 Eagle Ridge,Town of Hudson Name of Plumber: MP/MPR SW No. Sam tary Permit NumberDouglas Strohbeen 5432 T~~t . Croix 38534 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED s OYES ONO OYES ONO BEDDING: JV A.: VENT MATL: HIGH WATER NUMBER OF ROAD PROPERTY WELL. BUILDING. JVENTTOFRESH ALARM: LINE I ' AIR INLET. FEET FROM EYES ONO DY S EhJO NEAREST a C. I l1 rL__j DOSING CHAMBER: MANUFACTURER: BEDDING LIQUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER VIDED: PROVIDED: DYES ONO YES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROP~RT JWELL BUILDING (VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM THE AIR INLET PUMP ON AND OFF) OYES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH, IMATERIAL 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 11 DISTR. PIPE SPACING; COV EI INSIDE DIA nPITS DEPTH BED/TRENCH TRENCILIOUID HES 6 ~TH TRENCHES MATERIAL: PIT DEPTH. DIMENSIONS r GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BE LOW PIPES ABOVECOVER ELEV. INLET ELEV. END PIPES FEET FROM LINE / AIR( T 11' 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 N REVERSE SIDE. SHOW ELEVA- meets the criteria for me&um sand. IONS MEASURED. EYES ONO SOIL COVER TEXTURE PERMANENT MAR OBSERVATION WELLS OYESKER, ONO OYES ONO DEPTH OVER TRENCH BED JEITH OVER TRENCH BED DEPTH OF TOPSOIL: SODDED SEEDED MULCHED CENTER DGES OYES NG1 OYES 1:1 NO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH ]LENGTH IN 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.'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES O DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BFEET FROM LINE K? OYES ONO OYES ONO NEAREST L C Sketch System on Retain, fi county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD6710 (R. 01/82)._......x,-~ DEP RTMENT OF APPLICATION IItidD~TR'Y, FOR SANITARY SAFETY & BUILDINGS DIVISION LAQOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 81/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: i 5 e oil Al I P o u f rsu G7 c~Soh ~if!i S ~ f0te Property Location: CTownship: County: 4% 5CS 7 ~T 47N CR C q l Pjlwr) W Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. NuXer: ;L7_ l~G /C X/ AC vd ' L d k (If assigned) Al TYPE OF BUILDING Number of ❑ P lic* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY WCo0 11 HOLDING TANK CAPACITY 1+ LIFT PUMP TANK/SIPHON CHAMBER Al 4- MANUFACTURER: ITV 'Ci EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit 5' G ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Ej?01Frivate ❑ Joint ❑ Public - I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP/MPRSW No.: Phone Number: ~n~ los ~roLjGcc~ oC~~ A4P-3.7_ (;ZfZ 3133 Plumber's Address: Name of Designer: ,JvEtfilGijH7(~7G( Wl5 / 0~7 40 pu COUNTY/DEPARTMENT USE ONLY Isignatu a of Issuing en /mow FeejA Date: APPROVED Saniitttaary ermit Number: 9P-_1_ v`3 El DISAPPROVED yJ Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) r Form - S T C 100 Owner of Property i Location of Propertyk~7i _ Section -7 T N R J,K-~ Township f/~ Sf.~ yl Mailing Address ~ 22 !j,'//, f~2r A,5- /3 Y ` „Z Subdivision Name ff~/,L Lot Number Previous Owner of Property -LIZ) IF E_ ~LE 4 `_04- Total Size of Parcel Date Parcel was Created I- Are all corners identifiable? _Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other legal 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. 3-~ 19 I ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an casement, 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. 42) I SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) I , 73, DATE SIGNED DATE SIGNED J DEPART MENT OF REPORT ON SOIL BORINGS AN:L I~fAyFETY & BUILDINGS INDUS. raj, DIVISION LA )R AND CC P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (11J)'~' 71 M SON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/Mt'H+E}P*ttTY: LOT N04. . NO. B I Nq_ lY~ '/asp'/a 7 /T N/1101(or Aol5c5,.o 7` e_ COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: r / USE DATES OB NO. BEDRNIS.: COMMERCIAL DESCRIPTION: PROFILE DE T N • ERCOLATION TESTS: Residence /Z-/, .New ❑Replace 7-2 -2 7_,2cP_ aDF ~ "'I AP ~h O RATING: S= Site suitable for system U= Site unsuitable for system A MMTEN MA IN-GROUND-PRESSURE: ISYSTEM-1 -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optiona ) ❑U 0 $ ❑U ❑ $ ©U 9U 7i'01.4 B,.J' `X36•l If Percolation Tests are NOT required DESIGN RATE: If an / y portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /v PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER'^Ea CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPT 44-. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B l64 r,2' 4 c~ /J , 9 4A5- / • Sd., fie- /S 2- 9,1 Z 3 'S." CS s3 6// A1,6A -5,11/ 17 B- /0 h Cs 4- r, J~p il_ ~z r 3 B / ~oZ n S Br1 ; 6 vs/'/ (o Bn S B S r / 0dQ ` 2.3 B- PERCOLATION TESTS TEST DEPTH' WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER +S AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD PER INCH P- l 5!~' 0 3 3 P- CPO o? oZ Z 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. 1 12.1 /Ile ) 7'o ~a 0-_ ,P,%Jv)t N 09 SS F,(- /O C', Q' jig go,-es /qc-~4e), E n Qf f s c , ? Su: 4fi/e Rr eoq 1`s A7' y4 V -s ~ sla p F.~s7` 'oF E/~G-le ~~~G-~-. edl-de-5~1~ ~ . ~`r.~7e: ` Cwt ,+4►-~~,c~ /•v7'Cor.~ter ,d../'~ r .J Cu-~ 09rU-~ P3 1, 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.. /A`7, d - u 1 71) 1j4 r~iGO 2 71 /{fL>QK.learvl, NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBFQI~ntional): 1116 .9i~re /a/Je,~c~so, 1.c1; s , SdIG /S'9 7/S~3d'6 CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 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