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Parcel 020-1052-10-000 03/01/2006 12:32 PM
PAGE 1 OF 1
Alt. Parcel 20.29.19.195D 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 - SCHROEDER, HARRY F JR & KAREN E
HARRY F JR & KAREN E SCHROEDER
841 DORWIN RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 841 DORWIN RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.470 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R1 9W NE SE LOT 3 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 652/452
2005 SUMMARY Bill Fair Market Value: Assessed with:
91783 218,700
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.470 61,800 161,300 223,100 NO 05
Totals for 2005:
General Property 1.470 61,800 161,300 223,100
Woodland 0.000 0 0
Totals for 2004:
General Property 1.470 24,700 127,700 152,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 203
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
OWNER N 0 p TOWNSHIP 4✓h SEC.~G TZL[N-R W
ADDRESS H R0 h ~ ST. CROIX COUNTY, WISCONSIN
SUBDIVISION OT LOT SIZE
PLAN VIEW
Distances and dimL-:nsions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r
-F -F
147-
I di at N r h rr w
BENCHMARK: (Permanent reference Point) Describe:
/4k"j- w,l r^~ rtu
Elevation of vertical reference point: 0, 0 -Slope at site: - G 7l~
SEPTIC TANK: Manufacturer: Liquid Capacity:- L_
Number of rings on coves' :2~ Tank manhole cover elevation
Tank Inlet Elevation: ";I Tank Outlet Elevation:
PUMP CHAMBER 14-
Manufacturer: X A- Number of gallons-
Number of gal. pump set for a cycle /1- gallons; Total capacity of
distribution lines gallon: size of pump 141 head;
gallon per minute horsepower ;brand name of pump
and model number /V
Type of warning device
HOLDING 'PANIC: Manufacturer 1V Number of gallons
/
Elevation of manhole cover
Type of warning device -
SEEPAGE PIT SIZE;- Number of pits 4*_ feet diameter i
/7
feet liquid depth- seepage pit inlet pipe-elevation ~
bottom of seepage pit elevation `/feet
SEEPAGE BED SIZE: number of lines 3 width 7 length Mile depth
SEEPAGE TRENCH: width /V length- i~
PERCOLATION RA'Z'E AREA REQUIRED y AREA AS BUILT
INSPECTOR
DA'E'l,D - - - - - - - PLUMBER ON JOB S
/_7
LICENSE NUMBER ` y 3 Z
r- --4
_4
U
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Q Ql:
l)
FEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. BC1X 7969 PRIVATE SEWAGE SYSTEMS DIVISION
'
MADISON, WI 53707 BUREAU OF PLUMBING
Y~CONVENTIONAL ❑ALTERNATIVE State PlanLD.Number.
111 asslgnedl
E Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER' INSPECTION DATE:
Harry Schroder RR# 2, Box 340, Hudson, WI ~~3r
BENCH MARK (Permanent reference pmnt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELE V.. IcST REF. PT. ELEV.:
NE SE, Sec. 20 T29N-R19W, Town of Hudson
Name of Plumber. MP/MPRSW No. County Sanitary Permit Number:
Douglas Strohbeen 5432 St. Croix 38493
SEPTIC TANK/HOLDING TANK:
MANUFACTURER , - • LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER
WA / - qPROVIDED PROVIDED
`i/~/y/~/ ' v 9.5-11 0 Q OYES ONO OYES ONO
BEDDING: VENT DIA.: :VE:NM AI L. HIGH TE NUMBER OF ROAD PROPERTY WELL III UILDING. VEN~TE?`F
SH
ALA FEET FROM LI~ OYES O No NEAREST
DOSING C AM ER:
MANUFACTU ER. BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
OYES ONO EYES ONO EYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS R IONAL PROPERTY WELL BUILDING IVENT TO FRESIC
(DIFFERENCE BETWEEN UnT FROM LINE AIR INLET'
PUMP ON AND OFF) EYES ❑N EAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the dept of to n.g JTFN(,Trl 7TER MArERALANDMARKmG
or excavation. (If soil can be rolled into a wire, construction sha ase u F RCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE ACING C JINSIDE DIA ttPITS LIQUID
DIMENSIONS / TR E+rew._ MAT IAL PIT DEPT
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI PROPERTY WELL: BUILDING: VENT TO
PI Es RESH
eFLOw BO c vER E Ev IN E E v END. NUMBER OF
~j~, PIPE FEET FROM LI"E Q A,o 1 f► J7 S NEAREST-► W3 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-
OYES meets the criteria for medium sand. TIONS MEASURED.
O NO
SOIL COVER TEXTURE PEHMANLNT MARKERS OBSERVATION WELLS
OYES ONO OYES ONO
DEPTH OVER TRENCH; BED DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL. SODDEU SEEDED MULCHFD.
CENTER EDGES.
OYES ONO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TNROEOFNCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
:
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 MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
c PLANS.
DYES ONO J OYES ONO
COMMENTS: PEq MANENT MARKERS: OBSERVATION WELLS: /0 NU BER OF PROPERTY WELL. BUILDING.
FEMIT
FROM a"E'
0.9$ OYES ONO OYES ONO NEAREST
4 .r y.7q-7 G 9 3 .WG
4.778
Sketch System on in county file for audit.
Reverse Side.
(GNAT TITLE.
DILHR SBD 6710 (R. 01/82)
-I.. wlscons" APPLICATION FOR SANITARY PERMIT j~ 0 3
~ 13ILHR pig 67 ~ OUNTY
oERRRTmEnT ov ( ) UNIFORM SANITARY PERMIT #
- InOUSTRV,LRBOR6 HUTRn RELRTIOnS
-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
H47 r r 7 C_ ! rdd # Z 5-
PROPERTY LOCATION 4jr
Al yo%~
All 1/4.SA S 1-C', T,4N, R J~ Dr) W rower o 1~ L«(
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
Y/1 or 2 Family Number of Bedrooms. - ❑ Public (Specify):
THIS PERMIT IS FOR A:
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.
kSeepage 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
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity v()~+
I
Lift Pump Tank/Siphon Chamber
Holding Tank capacity 14
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
4 Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift P.m /Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
3 4, L~' ❑ Joint ❑ Public
Private
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signatt e: MP/MPRSW No.: Phone Number:
rf, L
1 `~V Z L i.~i/-E
Y'J~ l~5 - M~ ~3z (247,- 323
Plumber's Address: Name of Designer:
5-14- vi
COUNTY/ DEPARTMENT USE ONLY
Signat re of Issuing Agent: =Date: ❑ Disapproved
r
l 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
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.
a Ilf Ivl( IC I (JI APPLICATION SAFETY & BUILDINGS
, I'ivIt"( t r
FOR SANITARY DIVISION
1N1?lJST11Y, j 1 1'.0. BOX 7909
LA110ti1 /UVII 1'HIMII
HUMAN 10-AATIUN; ~ (I'L11 67) MAt_)ISON, VVI 53701
Attach puns for LI"lu Systen't of) paper nut Iuss than [IV x I 1 Illcltcs nr SIZU. Include 1 plAt p111t drat IS dinlun:,I1,IW1I uI d,,tvvn It) Scale. I lotizunlal
affd vertical taevation lefulence points IIlusl be ShuvVII. All applol,iiatu Supltltinu diSILMICuS 111(1 pflySILdI chall,:IdIISLIGS aN slaealied ill r:hapl A
FId33, WIS. Adltl. GOdu, rntlSt be Shown. An influx paur of each pa, 1u must 1.)u siultet_f, Soaiud artd 'I,tl'A by Ill(. dw, lyIarr_ If dt ;iuned by a Nlur:tcl
Plumber, Lhu date, denature and IIGUnse 11a.trnb01 Intl:~t be Nhovv11_ I lle umlerN copy of a luylblu Ie11u11;,I iul, „1 ih,: Sutl WA Iupu1 t In(.,st III:
inclu,.iud.
4 N t11iI y
I li IwIty Uwmrr: A,1,fI,
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k,
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i'ny,,ily I u, .,UuII l., Ny~,-M,fluyu-llr luvvuslufa. It ,
(o I vv
_ -
L.,I 1.,.. UII NuSu1xl,vlsiun N unu: Nblilu t Itoad, I okc I rn I~ 111, u PI uI I.U_ Nu, Le i
N-1 (1f assltlnull)
c` I I U l U U I L D LN G
NlImibw )I
~ Iauc]ruoins:
1'uhlir. Vallurtct; Ufh,:r (specily)
Family "Stalu Ap1,1uval 13,:quirud.
t
j IUII>l. NUiVVISI It I'M I All 1101--I11 U-IIV NI VV I I L I I AC I t) I I li t
L IIt.;LA:,ti i,
UAI L f]N UI 1 AIJI, (,UI, M It Pl A C L ,I L I I MI uV., l lit t_A l It,N MLN r (~i ;III
I'Ili 1-WIC NI 111-1IY
I I, lI I111 I, IVK C t AL I I Y_
I I 1 i'u vu' I AN1~1 ,II'I ION l.lifllVlnl I-i Af IQN IU I [ nlfst)fll f IONAI~t_A - r
n:r utclll 1'11C]Pt) I U (Stlu.aru It;utl Nr-vv HuIIl lzeilluill I Expl;rUnulltll epau,; laud LA Suupauu I'll
L'
h/timl t -
t ut nat lvc, ly Suepaue 1-1 ul101
r1 u.I ~yu,lt - - L)Vvncr S N ,me .a l,sted I'll Sofl 7 51 Hapol I III otilu( 01,11i p1w,unt uwIIL"1
1'11V.iW l 1 Jo111t UbIIC
~uo~:ISI,fnCd, hereby assume responsiht111y lot IIIStall1ttl,,lt AI the privtitu S("wayu systelll shown un fhu ailitched planN_
IIntl li ~VV N t, Ifl ume Numbui
N~ , I'
~
unu ,i I'I,IinL .I- ~Il~tlatwr-
__.._._._..._r...r -
t Y' J
A' u,f 1, ,\1)1111 s: f 1 t, SI
y \ I +1 ~ 1. 7 r t
COUNTY/DEPARTMENT USE ONLY
i..c. I I IU, ~S,ultary lumm Numbur -
AII'IiU vLCI _
,t ~ c, Lr t I I I 1
I h:uoul(Iu1 lhsul~plrlvol: -
V
r,n c;," ,lu r,uu, , Is) ul /1WIUm .A ✓,u l„1~16:
t,a11ye ill uvuner91111), hUlitilnu use of plLttnhtll i0:(IuIrOS a Salutary Permit I tanSlut FUInI I67 1) to b,: Stihnllttud to the (Aunty prior to i11-
:,t,111aUon. 1-dilura to culuply vvtll void thu sanitaly pullrtit.
i~I':I Ir1110 PION: IIIc County, Canary-HUrudA of I'Ilnldill ill, I'IIIk UvVI,uI, C1u1(t:1lld I'Iuluf,r.l
U+ atil li.ia;t IN 0 IM1)
Form - S `1' C 100
Owner of Property AIM
or-
Location of Property Gy
5eCt10R-j -,TN RjW
Township
i Mailing Address i~.t4--
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel Was Created
Are all corners identifiable? Yes No
Include with this a 22lication one of tile followiliji:
.Certified Survey Map
.Deed
.Land Contract, or
.Other hegal 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 recorded in the Office of the
County Register of Deeds as Document No. ~~RE / -2I ; 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. )
SIG ATURE OF OWNEA. SIGNATURE OF CO-OWNER (IF APPLIC LE)
T ,
DATE SIGNED'
DATE SIGNED
l
PARTMENT OF REPORT ON 'AIL BORI CGS AND SAFETY & BUILDINGS
JUSTRY, DIVISION
HOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7969
ON, WI 3707
,~J;~••)APJ RELATIONS
(H63.09(1) & Chapter 145.045)
'i 1(f j"!ON: SEC T ION:T t TOWNS HIPT1Vrtt~i'PY: LOT NO. JBJUK_ NO.TSUBDIVIS10N NAME:
/JR E-1
- -
UUNFY: OLVNER'S BUYER'S NAME: DIiAILING ADORESS
r
` C' ?o 1,
SE DATES OBSERVATIONS MADE
NO. BEDF COM)MER IAL DESCRIPTION: ~r~{' Pflq I S RIP IONS: N TESTS
L:Jflesidence " I:~INew ❑Replaca / g
i . ' JZ 1 V \ t<-I ; 1~ t-T~ t I 'J Y `4 . \ t r I- r T ti ;
SATING: S- Site suitable for systerrv U- Site unsuitable for system
J'JENTiQ(JhL MOUND: IN-GROUND-PRE~URE: SYSTEM-IN-FILL HOLDING TANK RECOMMENDED SYSTEM: (optional)
i F'7!, colation Tests are NOT re4aired DESIGN RATE: If an
y portion Of the tested area is in the
rr,er,s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
71
PROFILE DESCRIPTIONS
ISOANG~TOTAL PTH TO GROUNDWATER-INCH'S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH _Qf 0,',BER DEPTH IN, ELEVATION EST. HI HES TO BEDROCK tF OBSERVED
(SEE ABBRV. ON BACK.)
s
Cam.' l ht l-- PERCOLATION TESTS
TcST Dr_PI H L„ATER IN HOLE TEST TiMc Dfi ,P IN 4`JATEH LEVEL-11% ClIFS RATE 711'1_F 1U
~,!(:-R *'!!ffS f F(fRS4/tWNG INTERVAL--MIN. PERT G t PEriMCI
3 r r . _
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scalr> or distances. Describe what are tt.c hori-
Dr•tal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the drection and pe."nt.
ref land slope.
Q
STEM . ELEVATION .Y -27 z
I! 1' t- I 1 I 1
40,
_ 3
I r ra l f4d t • x I _ ! I - I _ l i " Z6- "T:. , g ( -
f ~ I C
F .C
i i Er.
tr-
f
JtI C-,,
14 to cJ! ~t i1 ~ fl~+ 1
C0InJ t rJ
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures ar,1 methods specified in the Wisconsin
wistrative Coda, and that the data recorded and the location of the tests are correct to the best of my knowledge a+xt be',ef.
`.-V'AF. (print : TESTS WERE COMPLETED ON:
7i3R SS: CERTIFiCATIONNUMBER: PHONE NUMIBER(upuonal)
w ~ r•~,,.. ~-t- -A.. 1 _ '7 C SIGNATURE:.
"STRISUTION: OriR°nal 3n,4 nno raspy to t_nrz+ Authority. Property Ow"'t, and Soil