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Parcel 030-1099-20-000 03/21/2005 03:49 PIN
PAGE 1 OF 1
Alt. Parcel 33.30.19.356B 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): = Current Owner
* JAEGER, PAUL & BARBARA
PAUL & BARBARA JAEGER
595 PERCH LAKE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 595 PERCH LAKE RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 4.580 Plat: N/A-NOT AVAILABLE
SEC 33 T30N R19W NE NE LOT 1 CSM 5/1284 Block/Condo Bldg:
ALSO COM NE COR N 89DEG W 537.31 FT -NW
COR LOT 1 CSM 5/1284 -POB N 89 DEG W 100 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
FT S 315.58 FT N 89DEG E 100.03 FT N 33-30N-19W
313.1 FT POB
Notes: Parcel History:
Date Doc # Vol/Page Type
11/07/2003 746124 2452/292 WD
11/07/2003 746123 2452/288 WD
07/23/1997 1095/303 QC
07/23/1997 900/02 more...
2004 SUMMARY Bill Fair Market Value: Assessed with:
5641 252,900
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.580 121,500 127,300 248,800 NO
Totals for 2004:
General Property 4.580 121,500 127,300 248,8000
Woodland 0.000 0
Totals for 2003:
General Property 4.580 55,600 99,700 155,3000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 115
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 ~SC~c'lfld" 'T'OWNSHIPS ~~SF SEC.3j `r3 I-R_&W
t
ADDRESS u ST. CROIX COUNTY, WISCONSIN.
030- 10,q ao-vo~l 3 10-B
SUBDIV] SION T} e-/!qL,5 L LOT LOT SIZE
PLAN VIEW
Distarncus and aimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
LA
1
i
I di at N r h rr w
BENCHMARK: (Permanent reference Point) Describe: 7L,/
~ Slo e site:
-
Elevation of vertical reference point at
--SEPTIC TANK: Manufacturer: Ve a= k 5-- Liquid Capacity: Dvz?
Number of. rings on cover Tank manhole cover elevation:
----?~t~
'l'ank Inlet Elevation: 9►'~~`'f ~ 'lank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number. oT: gallons_ -
Number of bal. 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
1Ievation of manhole cover-
Cype 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.
SEEPAGE BED SIZE: number of lines width length ✓r..~ the depth
r~
- -
SEEPAGE TRENCH: length
width
,t
PERGOLAT LON RATE AI.EA REQUIRED /S AREA AS BUILT
iN SPECTOR___„ -
D ATE ll PLUMBER ON JOB
- LICENSE NUMBER ; o
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR &.HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CICONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number
signed)
❑ Holding Tank El In-Ground Pressure El Mound (lf as
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Jeffrey K. Schottler R. R. 2, Hudson, WI x-30
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE V..
NE NE, Section 33, T30N-R19W, Lot 1, Town of St.Joseph
Na- of Plumber. MP/MPRSW N,, Count
V Sanitary Permit Number:
Richard Hopkins 1059 St. Croix 38506
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.'. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
J PROVIDED PROVIDED
A) k )-1 ES ❑NO DYES ❑NO
BEDDING. [tNT DIA.. Tr. HIGH WATER NUMBER OF ROAD: PROPERTY WELD BTO FRESH
ALARM. FEET FROM ~J i4/JV~ LINE/ ~~i/ AIR INLET.
DYES NO DYES ❑NO NEAREST -T/ r /
DOSING CHAMBER:
MANUFACTURER BEDDING . LIQUID CAPACITY PUMP MODEL P M ;SIPHON N! FACTURFH,/'~ WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
DYES ❑NO DYES ❑NO DYES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATI NAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE IAIR INLET:
PUMP ON AND OFF) DYES ❑ O / NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of pl ing LevcrH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORC
the soil is dry enough to continue.) MAI
CONVENTIONAL SYSTEM:
BED/TRENCH [BOVE ECOVEH NGTHNOOF DISTR PIP SPACING J INSIDE DIA -PITS LIQUID
TRENHESDEPTH
DIMENSIONS PIT
GRAVFL DEPTH RPIPDISTRPIPDISNODI NUMBER OF PROPERTY WELL UILDING VENT TO FRESH
BELOW PIPES INLET ELEVENDPIPE
LINE AIR LET/
FEET F
NEARESTO-s
MOON SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill mate al for PROVIDE A DIAG AM OFSYSTEM
and furrows thrown upslope: mound systems to make certain/that ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand! TIONS MEASURED.
DYES ❑NO
SOIL COVER TEXTURE PE tAN T MARKERS OBSERVATION WELLS
YES ❑NO DYES ❑NO
DEPTH OVER TRENCHBED DEPTH OVERTREH;BED DEPTH OF TOPSOIL SODDED f / SEEDED MULCHED
CENTER EDGES %
YE NO ES ❑NO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO. OF LATERAL SPACING: JGRAY DEPT BELOWN PIPE. FILL DEPTH ABOVE COVEH
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE JMMAT IAL NO. DISTR. IDISIR. PIPE DISTRIEUTION PIPE MATERIAL & MARKING
ELEV.'. ELEV.'. DIA. ELEV.'. ! PIPES. DI i'
ELEVATION AND
DISTRIBUTION i
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORHECTLV COV MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
> PLANS
DYES ❑ DYES ❑NO
COMMENTS: PERMANENT MARKERS: OB ERVATION WELLS: N BER OF PROPERTY WELL. BUILDING.
ET FROM LINE
❑ YES ❑ NO ❑ E ❑ NO NEAREST
Sketch System on e rri in county file for audit.
Reverse Side.
SIGNA RE. JTITLE: '
DILHR SBD 6710 (R. 01/82)
DEPARTMENT OF APPLICATION
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: Ma Address:
c` 02
Property ation r Township: County:
l/ C % L='/aS 33 ~T D NCR / If (or) W D S T /pro '
Lot Number: Blkr:
JS 61 4, bdivision Name: Nearest oad, 6ak4.e&-Laa6rnerk: State Plan I.D. Number:
/ (If assigned) i
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
M1 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 Q 7~_
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): C,R_New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
/ ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
KPrivate ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Na~f of Plumber: Si gnat NIP/MPRSW No.: Phone Number:
111~c,~igro q
Plumbe ' Address: Name f Des, ner:
I,
COUNTY/DEPARTMENT USE ONLY
Sign ture of Issuing A 7nt. Fee: ®p Date: APPROVED Sanitary Permit ~Number: 11/1 wg3 ❑ DISAPPROVED
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)
Form - S T C 100
Owner of Property~,._'/•
Location of Property _4Section 33 T N R
-2
AW
Township-~f
Mailing Address __..Z "J
Subdivision Nan)e7~, e e l G~
Lot Nun)ber
Previous Owner of Property /jam
Total Size of Parcel
Date Parcel Was Created_ ..j
Are all corners identifiable? l Yes No
Include with this application one of the followiu :
L-Certified Survey Map
:Deed
.Land Contract, or
.OCher Legal DOCUlllent 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. ,5" and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an oasement, 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.
1
5JU T E O OW ER SIGNATURE OF CO-OWNER (IF APPLICA61_E)
u 1 f U n
DAT SIGNED DATE SIGNED
RY, T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
RY, DIVISION
INDUS-1
-LABOR AND P.O. BOX 7969
• ROMAN RELATIONS PERCOLATION TESTS (115 MADISON, WI 53707
(H63.09(1) & Chapter 145.045)
'LOCATION SECTION TOWNS HIP/MWwe~•tlY: LOT NO.:BLK. NO. SUBDIVISION NAME:
/J I
/X - L ,/OWNBk~Y1•Pt/
E: lor)W MAILING ADDRESS:
CO TY /
USE DATES OBSERVATIONS MADE G - G S
NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~1~' PROFILE DESCRIPTIONS: PER OLATION TESTS:
Residence J~ tpJVew U Replace L 1 z,
- ~j
RATING: S= Site suitable for system U= Site unsuitable for system
(CONVENTIONAL: MOUND: jiN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
NS ❑ U I z S ❑ U S ❑ u S MUj E] S Ku
- reQuired DESIGN RATE:
If Percolation Tests are NOT
I If any pOfilOn of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplam, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER D&94*i;lN. ELEVATION OBSERVED EST. iIGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
;5
t c a -
'B-
PERCOLATION TESTS
TEST DEPT WATER IN HOLE TEST TIME DROP IN WATER LEVELES 4-) S RATE MINUTES
INUMBER -JIMMOM AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PERIOD 3 PER INCH
r r7 ~htr t
P- IAt,
N 5-
P
I
,LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
mtal 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
,I land slope.
SYSTEM ELEVATION
L
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TN
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t
CJ t~-3s -)p
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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
/Wininistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
E Iprintl: TESTS WERE COMPLETED ON:
CERTIFICATION NUMBER: PHONE NUMBER (optional):
_VZ CST~NATURE: s
,d one copy to Local Authority, Property Owner and Soil Tester.
_/tit) OVER -
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