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Parcel 020-1146-70-000 05/26/2006 07:47 AM
PAGE 1 OF 1
Alt. Parcel 26.29.19.776 020 - 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 - BLIVEN, EDWIN & SUSAN
EDWIN & SUSAN BLIVEN
762 MEADOW DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 762 MEADOW DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.058 Plat: 2077-HIGH MEADOWS
SEC 26 T29N R1 9W HIGH MEADOWS LOT 11 Block/Condo Bldg: LOT 11
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 662/194
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.058 75,200 165,000 240,200 NO
Totals for 2006:
General Property 2.058 75,200 165,000 240,200
Woodland 0.000 0 0
Totals for 2005:
General Property 2.058 75,200 165,000 240,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 120
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER 1- /)z ° TOWNSHIP SEC.
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT Z, LOT SIZE
PLAN VIEW OZO 516- >o-- 601)
i
Distances and dimensions to meet requirements of H63
THING WITHIN 100 FEET OF SYSTEM
i
.1 A11-1 ia I
LIA,
r
IN,
it
JJA
w
t ,'r
i!
A
C ' I di a e o thI Arrow
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: Slope at site: 1
SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover : Taman manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cyc e gallons; total capacity o
distribution lines gallon: size o pump head;
gallon per minute horsepower ran name of pump
and model number ;
Type of warning evice
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device _
SEEPAGE PIT SIZE: Number o pits feediameter
feet liquid dept seepage pit inlpipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines '__wih le rgth__ _ the depth____
SEEPAGE TRENCH: width length
PERCOLATION RATE AREA REQUIRED- _ AREA AS BUILT
INSPECTOR
DATED PLUMBER ON JOB S sr,
LICENSE NUMBER
DEPAR''MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7965 BUREAU OF PLUMBING
MADISON, WI 53707
®CONVENTIONAL DALTERNATIVE State Plan LD. Number:
of a~oonWl
O Holding Tank D In-Ground Pressure D Mound
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER. INSPECTION DATE.
Ed Blieven 525 N. Lemon St., N. Hudson, WI
BENCH MARK IParmanent re1-- p-li DESCRIBE IF DIFFERENT FROM PLAN. High Meadows REF. PT. ELEV.: CST REF. PT. ELEV.
SE SW, Section 26, T29N-R19W, Hudson Township,Lotll
Name of Plumber-. MP/MPRSW No.. County: Sanna.Y Parmit Numb -
Anthony Zappa 1614 St. Croix 34814
SEPTIC TANK/HOLDING TANK:
MANUFACTURER 11-11oll CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV_ WARNING LA LO KIN
P O tDED, P VIQ1 ~)5 y YES NO YE ❑
BEDDING VENT DIA.: F T MATL., HIGH WA NUMBER OF ROAD: PROPERTY WELL BUILDING: VE`NTT7 RESH
i Z JALAR : FEET FROM E:7~ ~7 AIry1NL
DYES ONO S NO NEAREST ( l ~ti5_<.f rl
DOSING CHAMBER:
MANUFACTURER. MI G LIQUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LBEL LOCKING COVER
PROVIDED: PROVIDEDS ONO DYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AN C N R L OPERA ZONAL NUMBER OF PH OPERTY WELL BUILDING JVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I I NGTH OIAME TEH 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:
BED/TRENCH WIDTH ILENGTH NO DISTR PIPE SPACING JINSIII~ 11 -PIT$ UID
1 THE NCHE$ ~r ( .COVER AL;';' _ PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH 1115TH I F DISTR PIPE IDISTR. POPE MATERIAL NO D H NUMBER OF R Y WELL BUILDING. V NT TO FRESH
BELOW IPE SOVE COVER ELEV INLfI E L E V.IQNu 2 PIPEr$,L~ NUM ROM LINE I, luR INLET ,
FEET F - 3.-
1 ~O U "~.1 G. / - I NEAREST 1 tl I 0 Io
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-
DYES O NO meets the crite a f edium sand. TIONS MEASURED.
OIL COVER TEXTURE PERMANENT 7KERS OBSERVATION WELLS
❑YES NO DYES ONO
UE PTH OVER THFNCHIBED DEPTH OVER TRENCH/ D UEPTN OF TOPSOIL f SODDED EDED MULCHED
CLNTEH EDGES
DY AE
ES ❑ 'O ❑ /ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO OF LATEHAL SPACING rHAVEL DFPTH FI PIPF FILL D TH AB V COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR E JJIFUL HIAL' JNI[ OI STH III 1 OISTHIBUI ION PIPE MATERIAL & MARKING
P PES
DISTRIBUTION ELEV ELEV DIA ELEV PIP OMA
ELEVATION AND
INFORMATION HOLE SVF HOLE SPACING IDnILLE 1) CNOVI CI l V CgVFH MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
1~ES LJNO OYES ONO
COMMENTS: AEHMAN N MA K R r,, OBSERVATION WILLS- NUMBER OF PROPERTY WELL. BUILDING
t FEET FROM LINE
DYES LINO DYES INO/NEAREST-
3 52 ~1 -
Ll
Sketch System on etain in my file for audit.
Reverse Side. jc'
SIfiN~I
11
DILHR SBD 6710 (R. 01/82) l /
f
' DEPARTMENT OF APPLICATION Y
SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% 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:
-sT" /1/0/004C 111vV2s,1.~
Property Location: City, Village or Township: L County:
t5Z'- / a!' '/4S 26 /T -2~ NiR /Y E (or w /T I)/ ~>SG~,t S/. (ilp~~C
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
assigned)
TYPE OF BUILDING
~nq,~• / Number of
Public* ❑ Variance* ❑ Other (specify) 461 60Z - ~Mav~ 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 W1
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOS D (Square feet): New ❑ Replacement ❑ Experimental ~O Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
W
L. X ater Supply: FO- ner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: o.: Phone N
MP PRSW
umber:
Plumber's Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signatu a of Issuing Agent: Fee: Date: APPROVED Sanitary Permit Number: ca&uku
Gl + ❑
DISAPPROVED '3'.4140
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)
PETTY C;VSti
UNITED BUILDING CENTERS
-Yard No. Date
Paid to :
Paid by : Amount
For:
I--
Received Payment------
Form - s T c too
Owner of Property
Location of Property Section ,.2_~- ~N It l~ W
Township
Mailing Address
Subdivision Name _~j OCAJ C
Lot Number
~~r,
Previous Owner of Property
Total Size of Parcel q
Date Parcel Was Created_
Are all corners identifiable? Yes No
Include with this application one of tfie_fo_lLowil~:
.Certified Survey Map
.Deed
.Land Contract, or
.Other I;egal 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. C-e/C; 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.
eo-A v A .
l l ~1'V11 Y~ ~:t' ~~1C011
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED
DATE SIGNED
Y
{Uf1sTir.~, TESTS
' WISCONSIN DEPARTMENT OF HEAI_Tl-I :AID D SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCAT10N.x ._IT_ _ N, } =E (o r) W, Tovvii,n p or P,AunicipaIity
Lot No.~_. Block County _ - _ _
ubdlvisicio. dale
Owner's hi34-yers Name'
Mailing Address:
j,
TYPE OF OCCUPANCY,, ;No. o Sedroo -rs__ CO"lpr!i RCiAL
EFFLUENT DISPOSAL.S`r`STEM: NEW REPLACEPslENT - ALTERNATE SYSTEM _OTI-IER
DATES OBSERVATIONS ,ODE; SOIL 6ORlNGS_'_ /`_fPERCOLATION TESTS_
SOIL MAP SlycE id1E 0F : !L MA?
Px ; I TIG'd i'ESTS
CTEST~ t'O '~iS^1f1TER (N TEST TIME DROP !N Y `:;TER LEVEL, INCrs M, }~Tc_~
DE11i7i j C# = Z OF S 2'• 1_ ! 1.
SER INCHES THICKNESS !N INCHES 1S7 WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 tYtIN/fN
;s
„ r.
P
P`
SOIL E3(3Rl'NG TESTS _
. _ LacPTH TO GROUNDWATER, INCHES TEXTU E, M.O OF LING AND ND T? DEPt-i }i
TEST PTH TEXTURE, ti`OTT LING TO BEL~RUc'..'.
TES, TOTA L DE
NUMBER] INCHES OBSERVED ESTiMATeO 14IGHEST IF OBSERVED IN INCHES
_vr
B t t r -
157 F!f
q ,tahl.. co;l aat£aG.% lrrd;ca an ,I'• 'a2 'S tloca,;On an' oyuarc !c£t of uiinui8 r., ca5.
OI ~(\!-\(1 C~~j ff rihato r~orrn a#rnr't +n~tc Zil La.. re h c!-sand
C... ..L, V,.. .a.
Indicate- number of square feet of absorption area needed for building type and occupancy Indicate scale or taistances.
Give horizontal and vertical, reference points. Indicate slope. "
_ € wr r a l 7_1 _11
xaa. r a { r I
a a IT.
i " } 3 t ~ 1 ~ F 1 ~ a w,~-.:.a*-=,a..a•rr-..• ~ -.2
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f, the undersigend, hereby certify that dl'.,, soil costs reported on this form were made 'uy me in accord with the procedures and methods
specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my
knoviledge and
n S t d .i"
Certifica tiorr 1Jn._
Name (Printr• v
Address__
Name of I ns;aller , f knc.~vl~ --CST S~ 91,
sop C.: Prcporay{ 0- Ere:
2c
4P*WbI Al C~/Ell4 i/eti' X T /A-.2 - 79'
SAFETY & BUILDINGS
DEPARTMENT OF REPORT ON SOIL BORINGS AND
INDUSTRY, I~ R J /'1 DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
(H63.09(1) & Chapter 145.045) "1~7
LOCATION: SL SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
5r 1/ 1 z 6 /T21N/R11E or f~ 0,0$_0A
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
~FVF.A/
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: L-PR-0-FILE DESCRIPTIONS: PERCOLATI N TESTS:
Residence [New p
~V ❑Re lace ~/rT7r 2 S>
j~
13 RATING: S= Site suitable for system U= Site unsuitable for system
MIK ENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
S❑~ $ ❑U ENS [:]U ❑SDU ❑SQU ~os. (3EI>
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:'
PROF
I.~ E DESCRIPTIONS dJ,EJ~i T ,V~
61 -
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-I'Mt+4-ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH'hAL OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-f 70 -,76) 10_CSV-Sz, 43'145i 3,0 1
• 3' ' AV, o y r S rs -2.
B 6.0 /07r y )4r- > ,0 1617141v,J4 , ~33'OA1-5, •67° dR.is, js'c°s~ 6,R'
-3 6
B- / 70106, g der >7o ~~3',~N• 4, 10'4,e. SL) i 7S Ifs; 3. yz . s.
B-_5" 70 66•yy' 7 0 O.v A/. '11 .S'..,.QG,P.
/'GCC 5 f~/1f~CF fJ~d~T00AJ /,(1 ~"E£~. PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER +A1G"E.S AFTER SWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PER INCH
P- o 7 ~+Y a
P-
P- A-) -7. 76' 1 9
P-
P3 - 1107o, 7,
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 an7d' show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. ~T7oM 0f 13t'/i eCxe,4j147,V41 5A Lzt Z q7- /0 Q
y rT.
SYSTEM ELEVATION r. c'• y`c~y' I'dea-- U;jl..41
E ,
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TN
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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 reccoiJ1.p rrded and the location of the tests are correct to the best of my knowledge and belief.
faf .j x x
NAME (print): y gg ,~}gg TESTS WERE COMPLETED ON:
4 ~ Yu
ADDRESS:
w ? CERTIFICATION NUMBER: PHONE NUMBER(optional):
~ a sus -53-- Q l `10 2-
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
D!'_HR-SBD-6395 (R.0 /82) OVER -
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REPORT ON SOIL. (30RI3&S ~ PERCOLATI0iV TESTS 115-
PLO r
P L AM PROTECT y~sd,c1 41iS S7,61-1 .
HOMSSITE TESTING Co.
tIT-3, O'NEIL ROAD BOB A
"Uu~;ONI WIS.- 54016
N d 7- 02- le2-
PROPOSED HOUSE MUST l.lE 2~ FT oe 146tr FiQOM qy, TESr fj,QE~lS,
PROPOSED wea M vsr LIE 50 FT at tiDRE FiQDH ALL TEST ~,PE/}S,
= a~yoE' PirS EXisr/.~J (r u~E~~
PEQG ~oCgT"iDNf = yAN~ ~}tl9£~4E0 o,Q 5,4evEL -134ee5
® = *%Z V£OT%ChL &f£ReA)C F" Poi r d S U,PU~ y e u
Ran ~2 t i ,V -IF
Tv
ie~ f QA E G. CS I ' - /~l~ s T ~~4PkS ,Pv~ y ~ O• LlJ.
LE GE N D (51E'vi4170N oA I E S (-U r- +eA.)P_,_
/o'POW = /OCR, o ~r-
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16 -
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go,PE3 5fA7f fjY001!, SEi T1
s ~f 2~`l`7 c'4 r- /lvl,)sa,) 415
`G NED 2'~~cti c
elf
- Fresh Air Inlets And Observation Pipe
SOIL TESrIX~g By
HOMESITE TES !NG r:O• Approved Vent Cap
RT.-3, 0,uEiL iRco"'
HUDSON, WIS. 'V4016 Minimum 12" Above
Final Grade
/~+4 Xi,y U.~, of-
4" Cast Iron
Above Pipe Vent Pipe
io Final Grade
Marsh Hay Or Synthetic Covering
Min. 2" Aggregate
Over Pipe
Distribution Tee
Pipe 0 0 0 0 0
~o TTprt °F C
Aggregate 0 Perforated Pipe Below
Beneath Pipe
0 Coupling Terminating At
Ff Bottom Of System