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Parcel 030-1026-80-000 01/04/2006 12:34
PAGE 1 OF 1
F 1
Alt. Parcel 06.29.19.105C 030 - TOWN OF SAINT JOSEPH
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 - PETERSON, RICKY J & BECKY
RICKY J & BECKY PETERSON
1126 37TH ST
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1126 37TH ST
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 6 T29N R19W SW SE LOT 1 CSM 2/397 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
06-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
83336 235,000
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 91,200 122,500 213,700 NO
Totals for 2005:
General Property 3.000 91,200 122,500 213,700
Woodland 0.000 0 0
Totals for 2004:
General Property 3.000 91,200 122,500 213,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 115
Specials: I
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
_s
Form - S T C - 104
s
AS BUILT SANITARY SYSTEM REPORT
t-
OWNER TOWNSHIP
is ~n,~F,y SEC. T N-R_W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r
Oi"'-i ✓F w~ro y
'ex IS7zN - SSA. , 1
J`/'
~ ~ .rG..,T Jrivc.K
. .s_
V Erg5
k-7 7;-,
SX iE+b /lf._rI! 1
sei'lrc ilo:~1C
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used r
Elevation of vertical reference point:. 0r7 Proposed slope at site.
SEPTIC TANK: Manufacturer: n `%`~2
Liquid Capacity: Z~~,
Number :)f rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side o Rear, O I D o i feet
F;com nearest property line Front, Side,0 Rear, 0 V feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dim sions to septic tank)
SEE R;EV1 RSF STI)E
PUMP CHAMBER
Manufacturer: T Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, 0 Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width:! Length: 9 Number of Lines:
~J"'_ Area Built:
Fill depth to top of pipe: 3
Number of feet from nearest property line: Front, Side, O Rear, 0 Ft
Number of feet from well:
Number of feet from building: 4
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: ~ Plumber on job:
License Number :
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
0P.O.wB 7,969 BUREAU OF PLUMBING
MADISON, WI 53707
IX CONVENTIONAL ❑ALTERNATIVE St ate Plan I D. Number
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure D Mound
NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE.
Rick Peterson RR#2,Pine Ridge DR.,Hudson, WI f~0
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV..
NW SE, Sec. 6, T29N-R19W, Town of St. Joseph
Name of Plumber'. MP/MPRSW N... County Sanitary Permit Number.
A. Zappa 1614 St. Croix 43640
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. L10 CAPACITY. TANK INLET ELEV. . TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER
I / PROVIDED PROVIDED
O v 9 S. G 1 9 V DYES ENO DYES ENO
BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PR OP ERTV WELL'. BUILDING- VENT TO FRESH
-T
1!~ oo
ALARM FEET FROM ( N ut E 55' 141 AIR I~r
EYES NO ❑Y Ao NEAREST V V
DOSING C AMBER:
MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODE L. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ENO DYES ENO DYES ENO
GALLONS PER CYCLE:
PUMP ON AND OFF) PUMP ANDYES PE ANAL FEET FNUMBER OROM F PROPERTY WELL BUILDING I VENT LE FRESH
(DIFFERENCE BETWEEN - LINE AIR INLET.
=
N NEAREST
SOIL ABSORPTION SYSTEM. Check thesoil moistureat the depth of plowing LFNGT- DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
AIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF DISTR PIPE SPACING
NSIONS CO ER INSIUE DIA >t PITS LIQUID
BED/TRENCH & TRENCHES FRIA PIT DEPTH-
DIME
GRAVEL DEPT~ F ILI_ DEPTH 1111IT11. PIPE DISTR PIPE DISTR. PIPE MATERIAL . NO. DI R. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH
BELOW PIWISl.~ ABjj C VER. Et EV IcNILE i ELEV. END I PIPES LIN j JAIRINLET.
L Ej^ 0 I S D
\/\r A 'V y I " '71 '1 FEET FROM
NEAREST--s~Q V (p
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.
DYES NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
DYES ENO DYES NO
DEPTH OVER TRENCH; BED DEPTH OVFH TRENCH BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
EYES ENO DYES ENO DYES ENO
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.
E LEV.. ELEV.. DIA. ELEV.. PIPES. DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
DYES ENO DYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE.
H 1-93 DYES ENO DYES ENO NEAREST )I. I
nn 1
(1
o ~
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE:
DILHR SBD 6710 (R. 01/82) A
EZ=7,, ON wlsconsln APPLICATION FOR SANITARY PERMIT
3 I L H R COUNTY
J (PLB 67) UNIFORM SANITARY PERMIT #
TEnT
In OUSTRY, LRBOR 6 HUMRn RELRTIons 111111111
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
PROPERTY LOCATION CITY: _
k0-)1 /4St 1/4, S 6 , T~ N, R E (or W ~ owly OF: S ' " LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
Al -
TYPE OF BUILDING OR USE SERVED - - Q
41 or 2 Family Number of Bedrooms. ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
Sid Replacement Soil Absorption System ❑ Revision ❑ Privy
Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
-;N,Seepaye 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 e-Z:>
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: v G ,7 G L
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): PROPOS D (Square ~Feet :
?2 0 l 7 r / s-5 Private El Joint F-1 Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signatur MP/MPRSW No.: Phone Number:
• - _ 4 1 7~~ j°) -??6
14,
Plumber's Address: Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
t ~ ~ ) ❑ Disapproved
~r"c G~~ lI ~~1t CJ XApproved ❑ Owner Given Initial
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
i
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.
Form - S T C 100
Owner of Property f S O Yt
Location of Property Section T~-N R~W
Township S4- JoS~
Mailing Addre.bs
_ t 4~
Subdivision Name
Lot Number I _ -e r't' v e -1►~~(Q_~__ F.7 oRfl
Previous Ownur o.f Property--jo~'h SG~tw'~
"Total Size of- Parcul 3 Ar-ra$
Date Parcel Was Created_ J IhC\Q oz X977
Are all corners ident-if-fable? X yes No
Include with this application one of _the following:
.Certified Survey Map
. Deed
.Land Contract, or
Other Eegal Documr_nt 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 r corded in the Office of the
County fegister of Deeds as Document No. _iV-1Z q- ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an trasernent, 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....-34/ ZZO?
SIGNATUH F O E SIGNATURE OF CO-OWNER (IF APPLICABLE)
a
GATE S ED DATE SIGNED
r
IMPORTANT: BE SURE THAT THE DESCRIPTION COVERS YOUR 3cno V]
PROPERTY m p
IF PAYMENT IS MADE 6Y CHECK, TAX RECEIPT IS D A n
NOT VALID UNTIL CHECK HAS CLEARED ALL BANKS goo
SPECIAL >C
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THIS IS A MEMORANDUM TAX BILI_.AND NUT A TAX RECEIPT PRESENT
THS BILL WHEN PAYING TAXES OR ENCLOSE IT WITH YOUR CHECK
PLEASE PAY YOUR 1983 DOG TAX WHEN PAYING THIS BILL
{
DEPAR ,-MENT OF REPORT V SOIL. BORINGS AND SAFETY & BUILDINGS
INDUSTRY, REPORT L~L DIVISION
LABOR AND PERCOLATION TESTS (115) Za~~ ! L P.O. BOX 7969
HUMAN RELATIONS
MADISON,
WI 53707
SG (H63.0911) & Chapter 145.045)
SECTIOIN.T19` I. TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
VW E W)
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
sf Croix s . (k'So~l z ~~~.~•pb~ .~,P ~/~~so 4a~ s, syd,~
USE DATES OBSERVATIONS MADE
1\10.B DRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS:
Residence ❑New Replace p Z /O
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: JMOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
KS DU W IS L❑U ® S E] _LOS Qu ❑ S zu CoUdEviinv,~L e&rl) i cLv
zo sg. F> ate' x
If Percolation Tests are NOT rec aired DESIGN RATE:
~ If any portion - the se rfd ; in the 1
under s.1-163.09(5)(b), indicate: _ rl n_Wpi : n, ir'- , att F I•:vat on: 11--
PROFILE DESCRIPTIONS
IBORING TOTAL DEPTH TO GROUNDWATER-l ~ CHARACTER OF SOIL WITH -THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH I'W, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- • y, ' 13,V -9/, `,a,v. SL, . 7s 10A10. sc , , O .
B- 3.3 1 P lie- 13N.CS G~ .
40
B- -2 75' > 7,j .d'3" /,u9~y o' s-~o
/114. Q 13 42 -;,-a .S 13AJ. C 5 tom,`
B-
B 3 a 99- y1 - - o 67'4"-Y- SL► A12 ' 13A), -S
6_ - C:5 , '-'J oR. 5L J a-ez &d 6;e
~T. PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NPUM ER tai{=.ciES AFTER SWELLING INTERVAL-MIN. PERIOD i -PERIOD 2 ROD 33 ~ PER INCH
-T
P-
P- /
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable-so il 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 a.-,d percent
of land slope. &OTTOM Or /,~c0 S-101V4714-V SA,411 G-e
SYSTEM ELEVATION U~ E lt` vA eN OF 9_y Cfl CD Fr-
~ _ t
1 I ! }
E
I
N
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. t
f
i :
.
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,
NAME (print): TESTS WERE COMPLETED ON:
V/0- /raj
ADDR SS:
Fi j~ ~ CE IFICATtON NUMBER: PHONE NUMBER optional):
- E; L- R Vp o 41 &j 15. 'T yon s - 2 y JP 2 -
A) 1;
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DiLHR-SBD-3395 (R. 02/82) - OVER -
REPORT ON SOIL (30RINUS PERCOLATIoAl TEST5 11S
PLoT PL.AM PROTECT
DAT-E- 57.
HOMESITE TESTING CO.
R* r- 3, O'N EIL ROAD BOB 4
rah s~t~t~, Wis.. 54016 C5T SS- d2 y~Z
PROPDSED tiwse 1t)*sr LIE :z-;' r-T
PRo POSE O W L LL M vsr or 5o Fr G,Q trORE F~POH
,qc~ T£sT iq~PE'~S,
• = ,ewa wDE' P/Ts O = zx/s r ae, LL►E L L
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a67- 16L4eof- fED 13OX /j"Q(n `./O
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'pf-k so/ Z_ U
`r'P'_F`x) /1h v{~~ Fresh Air Inlets And Observation Pipe
So,, TE5TIAS5 By
I'IOMES,'TE TES ;NG ':G. Approved Vent Cap
RTJ' cluEi „ RO
HUDSON, WIS. ,4c.16 Minimum 12" Above
Final Grade
411 Cast Iron
y~-- Above Pipe
ro Final Grade Vent Pipe
Marsh Hay Or Synthetic Covering
min. 21t Aggregate
Over Pipe
Distribution Tee
Pipe -0 0 0 0 0 0
0 Perforated Pipe Below
Beneath Pipe 0 Coupling Terminating At
s [bottom Of System