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Parcel 030-1031-60-000 01i04i2006 01:01
PAGE 1 OF 1
F 1
Alt. Parcel 08.29.19.111 F 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 - KONDRASUK, ROBERT L & ANGELA
ROBERT L & ANGELA KONDRASUK
469 NELSON FARM LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 469 NELSON FARM LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 5.030 Plat: N/A-NOT AVAILABLE
SEC 8 T29N R19W PARCEL KNOWN AS #6 AS Block/Condo Bldg:
DESC IN 592/524
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
83379 399,800
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.030 181,800 181,800 363,600 NO
II
Totals for 2005: II
General Property 5.030 181,800 181,800 363,600
Woodland 0.000 0 0
Totals for 2004: IIGeneral Property 5.030 181,800 181,800 363,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 304
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
b .~q
OWNER
- TC I N -R W
34 k, 6 W7 - - TOWNSHIP- SEC.
ADDRESS ST. CROIX COUNTY, WISCONSIN.
Cts
SUBDIVISIONn-v~_ LO'T'_ L0I' SIZE ,(Q
PLAN VIEW
Distanc_us and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
~J
zv _
- ro
J u
C I di at N r h rr w
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: _S1ope at site
SEPTIC TANK: Manufacturer: s' C~} liquid Capacity:
Number of rings on cover Tank manhole cover elevatio :mar/
'l'ank Inlet Elevation: Tank Outlet Elevation: f7-iLz-
PUMP CHAMBER
Manufacturer: Number of gallons
. Z&
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 ~ 7,A4 Number of gallons
Elevation of manhole cover
't'ype of warning d v ce_
SEEPAGE PIT SIZE;! Number of pits feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width length~j _tile depth
SEEPAGE 'T'RENCH: length
PERCOLATION RATE AREA REQUIRED (0(5 AREA AS BUILT
INSPECTOR _
DATEll PLUMBER ON JOB
LICENSE NUMBER-
14C ~D
DEPARTMENT'OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.Q. BOX 7969 BUREAU OF PLUMBING
t MADI`4N, VtI 53707
11CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number
` (lf assigned)
❑ Holding Tank El In-Ground Pressure El Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE.
Robert Kondrusak 8th St., River Falls Y-41-93
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. Town O , o s e p REF. PT. ELEV.. CST REF. PT. ELEV.
Ne Ne, Section 8, T29N-R19W, Lot 6,Orville Shettle Sub.
Name of Plumber JMPIMPRSW No. County. Samtary Permit Number_
John Sykora, III 3212 St. Croix 38486
SEPTIC TANK/HOLDING TANK: _
MANUFACTURER'. LIQUID CAPACITY . TANK INLET ELEV.. TANK OUTLET a WARNING LABEL JL6 5 P O DED PR
C' j YES ❑ NO NO
BEDDING. VDIA VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO F E
t ALARM FEET FROM S
)Il LI" „ AIR E
❑YES O NEAREST / 5z' V '7
DOSING CHAMBER:
MANUFACTURER BE DD ING. LIQUID CAPACITY PUMP MODE P . WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP ANDCOVr oPE ATION NUMBER OF PROPERTY wELL JBUILDING IVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LI"E AIR INLET
PUMP ON AND OFF) ❑Y NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the d Pofpto ing EN(;TI{ DIAMETER MATERIAL AND MARKING
FO CE
or excavation, (if soil can be rolled into a wire, construct Io all cease until M IN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH NGTH. NO. OF DISTR. PIPE SPACING COy F. JINSIDE DIA. -PITS LIQUID
BED/TRENCH TREN,"EL M RIAL PIT DEPTH
DIMENSIONS a
GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FR
BELOW PIPES ABOVE COVER ELE V.J; L_EI ELv. .D/~ P
_7 FEET FROM LIN AIN~//L~T
7J S !//7 NEAREST !
MOUND SYSTEM:
Mound site plowed perpendicular to slope Chet, he texture of the fill m erial for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mou stems to make cer in that it ON REVERSE SIDE. SHOW ELEVA-
me the criteria for mediu sand. TIONS MEASURED.
❑YES ❑NO / -
SOIL COVER TEXTURE 1PIRMANINT OBSERVATION WELLS
❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED VTH OF TOPS IL 7DDED MULCHED
CENTER EDGES
YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO.oF LATERA SPACING. GRAVEL DEPTH BELOILL DEPTH ABOVE COVERBED/TRENCH TREN ES
DIMENSIONS
MANIFOLD PUM P MA OLD DISTRP PE MANIFOLD MATERIALNISTRIBU TION PIPE MATERIAL & MARKING
ELEVELEVDI ELEPELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING D LLED CORRECTLY COVER MATERIAL P VERTICAL LIFT CORRESPONDS TO APPROVED
LANS
❑YES NO ❑YES ❑NO
BUILDING.
COMMENTS: PERMANENT M KERS: OBSERVATION WELLS: NUMBER OF LROEERTY WELL
S ❑YES ❑NO ❑YES ❑NO NEARESOM
3_O 8.61
S ~
8.0 Z 0 93-13
Sketch System on Re in in county file for audit.
Reverse Side. 7IT_e.
SIGNATURE t
DILHR SBD 6710 (R. 01/82)~ r
DEPARTMENT OF APPLICATION 0 an" 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. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address: I
ryc t
6ov f, L!
Property Location: BH -,ADT tege-erTownship: County:
~.'/oS ~TZ NCR A E ( r) S Y~ Y.~ o'
Lot Number: Blk No.: Neares/Road, Lake or Landmark: State Plan I.D. Number:
G 1 =~~d 7 ~l~l 5 ` e (lf assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* 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:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
;-2 L4 ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public -C- 41,L"
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature:,.
AAP/MPRSW No.: Phone Number:
0 Ai
,T1111i., V,
Plumber's Address: Name of Designer:
7
COUNTY/ DEPARTMENT USE ONLY
Signa re of Issuing Agent: Fee1: /s s Date: L.~ Sanitary Permit Number: APPROVED 127 ❑ 'DISAPPROVED
eJtJ
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 (N,03/81)
Furw - 5 T C 100
Owner Of P r u p e r t Y a lc c~ o~~Y ~cr_ 5~1~-.
.Lucution of Property_ 1; Ale ~4, SuctiU11 8 'LAN It W
-1
TowLi ehip 1: Jo - Y
y, c
Mailing Addrext3_V:P rt✓~_ r~ s
Subdivieion Naule I'
Lac Nuuibar
Praviuuu Owner of Property-_ v_`
Total Size of Parcel
04te Parcel wary Created
Are 411 curnera ideliLitiable? Yes No
include W1Llt-Lill cs_yLjltc_iCl_uu olie ut OIL lull.uwli :
Certified Survey Mali
Ueed
Land Cuntract, ar
Other Legal DULULUellt Wkich dascribe~j rile prul.urty
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this town ire 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 Hegister of Deeds as Document N L i ; 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, end the same has been duly recorded in the Office
of the County Regmar of Deeds, a5 Docurent No.
51UNATURE OF OWNER sINA r NE Oi CU UWN (If APPLICAfILt)
IJATE SIUNEO O i z SIGNED
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
t11D1.;,';"RY, C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
• (1463.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.:
/Tc-XI N/R/I E
COldN~ 'S/BUYER'S NAME: MAILIN ADDRESS:
LAW ITHIrilli-ri DATES O SERVATIONS MADE
_yy~~rrp' O. B COMMERCIAL DESCRIPTION: PROFILE DESCR~~IIPTIONS: PERCOLATION TESTS:
~0 esi2fPr'i
10 7 ~ rv' A New ❑ Replace /C ~ rJ
''1
1 F~(~~.
P9 Y : S=QS~t~uitable f lem U= Site unsuitable for system
C ZONAL: MO -f IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDSYSTEM: (optional)
❑U [A$ ❑U DU []S QU
If Percolation Tests are NOT required DESIGN RATE- If an
A, y portion of the tested area is in the
under s.H63.09(5)(b), indicate: fy Floodplain, indicate Floodplain elevation:
CL! `!7 PROFILE DESCRIPTIONS
G-'iC . vrAtn
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH.LN. ELEV
9P5 54- ATI N OBSERVED EST. HIGHEST TO EDROCK IF OBS VED ( EE 86 V. ON BACK.)
B ~'tLl , v/~ N 4 ~~•-~i s l /4t ' s ( ,~~4Y s 6
G. 6
t
99-
(oho y G. 6 2 /,25 t .S
B
41" .V7'
PERCOLATION TESTS
TEST *kAfATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER TERSWELLING INTERVAL-MIN. PERIODI PERIOD2 PERIOD3 PERINCH
P P_ y
P-
P_
P_
2..
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn
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 22 I8 It ' 9Z-CF -6-1 N v b° s 96 _f e l Z
~G fit,
47-GEN 12
'r 4
-M
VA c6ir Vt -Z U-:
16 f -to AW,-
s
Lo Y"
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Cb~ ~EJ Cj 46 ii 0C
lei
a SS~.cw~-~~ ~ leJ,.._~f~b[.?l,d1 4r' lQd •D . J"s'f ~ N
- 9
j 1 7
dt 4 ,
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:
?s-
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
z s c5 ~Y~
t,~<< 7Z 7i6
CST ~ TU :
t\~
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
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