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Parcel 20.29.19.195C 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): O = Current Owner, C = Current Co-Owner O - SCHNEEWIND, JON & JANET JON & JANET SCHNEEWIND 835 DORWIN RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 835 DORWIN RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.050 Plat: N/A-NOT AVAILABLE SEC 20 T29N R19W NE SE LOT 2 OF CSM Block/Condo Bldg: V5/1209 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 795/272 07/23/1997 728/01 07/23/1997 681/580 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21 /2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.050 30,300 119,300 149,600 NO Totals for 2005: General Property 2.050 30,300 119,300 149,6000 Woodland 0.000 0 Totals for 2004: General Property 2.050 30,300 119,300 149,6000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 308 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT i t OWNER- 1 9W_ /eS 1 TOWNSHIP rat SEC. ' `l': R rW ADDRESS f jr,'ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e ' Q i i t • 4 i ) is ~a. „y,..+..`. I di at N r h rr w BENCHMARK: (Permanent reference Point) Describe: ~ww ray r7 „i_. Elevation of vertical reference point:f -Slope at site: _ SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: _ Number of gallons Number of gal. pump set for a cycle -gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower ;brand name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons_ Elevation of manhole cover 't'ype of warning device_ _ SEEPAGE PIT SIZE;----- -----.--Number of pits_ feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation _ feet. I SEEPAGE BED SIZE: number of lines width length C the depth SEEPAGE TRENCH: widt _ length-- _ PERCOLATION RATE AREA REQUIRED / / AREA AS BUILT INSPECTOR DATED I - PLUMBER ON JOB ...~tics•~~~-rr , ~ - ~.tn. LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX X969 BUREAU OF PLUMBING MADISON, WI 53707 LtCONVENTIONAL ❑ALTERNATIVE State PlanLD.Number: ~ Ilt assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF Ply ;MIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Charles Taft 231 River, Hudson, WI -'3.70& BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT ELEV.. E SE, Sec 20,T29N-R19W,Lot2-Dick Stout Sub.Town of Hudson Name of Plumber: JMPIMPRSW No.. County Sanitary Perm, Number. Richard Hopkins 1059 St. Croix 38498 SEPTIC TANK/HOLDING TANK: MANUFACTURER. f LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED ❑YES LINO ❑YES LINO BEDDING: VENT PIA. VENT - ATL. HIGH WATER NUMBER OF ROAD 1P ROPERTY WELL. BUILDING. VENT TO FRESH J I / ALA RM. IFEET FROM - LIN LAIR INLET. ❑YES -fNO x3 t ESA/ N NEAREST DOSING CHAMBER: MANUFACTURER JBEDDING. LIQUID CAPACITY PUMP MODEL PUMP/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 IVENTTOFRFSH (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. W soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LE NG TH. NO. OF DISTR. PIPE SPACING. COVER IDIASt PITS LIQUID BED/TRENCH TR ENCHESMATERIAL: DEPTH: DIMENSIONS f TS f GRAVEL DFPTH FILL DEPTH DISTH PIPE DISTR. PIPE DISTR PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING'. VENT TO FRESH BELOW PIPES ABOPVE COVER INLEJ ELEV. END PI{IE FEET FROM ' LI ('A - a } A#& IN1,ET., f t,S~ NEAREST--------W- MOUND 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. TIONS MEASURED. ❑YES LINO' SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS / ❑YES LINO ❑YES LINO DEPTH OVER TRENCH.BED DEPTH OVFH TRENCHBED DE H OF TOPSOIL SOUDF ISEEDED MULCHED. CENTER EDGES. j` YES LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPT.AELO* PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: _ DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. JNPIP E DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEVELEVDIAELEVPIPDA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES NO ❑YES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING. FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Sketch System on Refa'in m'county file for audit. Reverse Side. JSIGNATURE'. _ TITLE. DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 a Attach plans for the system on paper not less than 8'/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: CA G e- i G i[ to p Property Location: s4y,_y1~ye~ Township: County: A/IC7- '/a $ F'/aS D 217 N /R / It (or) W Lot Number: Blk No.: Subdivision Name: Nearest oad, J aka nr I an.iari State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Z/4. Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: e- S EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New 1:1 Replacement ❑ Experimental Seepage Bed 1:1 Seepage Pit I , " O El Alternative (specify) El Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public S I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: 40'/MPRSW No.: Phone Number: Plumber's Aggress: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signa ure of Issuing ent: Fee: Date: f~ APPROVED Sanitary Per[mjit Number: VkAd& D ~O ❑ DISAPPROVED 7 O 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) Furor - S T C 100 Owner of Property cry, Location of Property _4.section v10 T vT~N R_Z,5; W Township Mailing Address vZJ % O!/ ~~Sbh Subdivision Name ~4/G Lot Number Previous Owner of Property Total Size of Parcel_ Date Parcel Was Created 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 (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 records in the Office d of the County Register of Deeds as Document No. 7 L3; ~ and that I (we) presently own the proposed site for the sewage disposal system (or I (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. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICA81-E) DATE SIGNED DATE SIGNED t 19 DEPARTMENT OF REPORT ON SOIL BORINGS TY & BUILDINGS INDUSTRY; , Cam/~ DIVISION LA9OR AND N-2Qlj/ P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (1 ) j~y/ 179 DISON, WI 53707 (H63.09(1) & Chapter 145.045) 'd O1c LOCATION: SECTION: WNSHIP/Q.-,e^eioiP o°4ei T `.4 LOT N K. NO.: UBDIVIS AM E: ©/Tv~gN/R` V (o TO a~ OA4 C;s s . ~aa9 COUNTY: OWN R'S/BUYER'S NAME: MAILING ADDRESS: S CK~ r`Rr s fi a USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATIO TESTS: Residence 3 e.~ ,New ❑Replace I /__/sue D3 6 RATING: S= Site suitable for system U= Site unsuitable for system e- CONVENTION1A'L: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING(TTAANK: RECOMMENDED SYSTEM: (optional) S ❑ U ®S ❑ U 9S ❑ U E] S 1:1 S l! U Cant v~wy d/1c~y / 9,-./ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: A/i PROo~FIV DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-44eftES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B B 6' /4/0,u e- 7 2.5' / 1911o / B (S__;0 15, , S',8•, 6 e d s B- 3 )S' Abu / 1 3 , S7~5 /9,1 "W e a/S B- !,,[<)Aie- 7 S ' a / X" / ? Brf /S 3 zft e S B PERCOLATION TESTS TEST DEPTH" WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 'HeHE-3 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ o I -_-3 P- ,3 . 3 r GU .2- G 3 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 y~ • 3 ,t/, E, A e, t- coy-'Uev- I ~..r.,sY1 s/«/ p t3,M 1 ";Ue- 7e •+cc.. ~o 5 r5 t-0r - Q m . %S l ~t ~ fJ e'-,- A.. le- /j• ,~a fi- C or,t,l2v~ ov . . 93 Top or 01 E ,23` I / pz 1!90.0 1~ I I a C_ C70? r. - A c,? F ) V ~-Y` fis C~ ~ ~G~~//1 /f ~ LIt rG /f4 C.W f'S . 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): /sy9 3 CST I ATURE: J - ~I -jo An ou q g'i,yV n ! i=*-~. t~ . [ 'fit , AD Pic . 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