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Parcel 020-1138-10-000 04/22/2005 03:26
~ PAGE 1 OF 1
F 1
Alt. Parcel 29.29.19.692 020 - 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): Current Owner
BRATHAL, DANIEL A & JACQUE
DANIEL A & JACQUE BRATHAL
768 GHERTY LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 768 GHERTY LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.526 Plat: 1979-GHERTY'S ADD
SEC 29 T29N R19W GHERTY'S ADD LOT 7 BLK Block/Condo Bldg: 2 LOT 7
2
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2004 SUMMARY Bill Fair Market Value: Assessed with:
48780 323,300
Valuations: Last Changed: 10/26/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.526 32,700 217,400 250,100 NO
Totals for 2004:
General Property 2.526 32,700 217,400 250,100
Woodland 0.000 0 0
Totals for 2003:
General Property 2.526 32,700 217,400 250,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 116
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
r
AS BUILT SAN I-TARY SYSTL:M REPORT
~i~/Y/ TllAL TOWNSWIP 'k2YN-It/~W
UWN1':k ei 1r A
ALllktL SS CRO k X COUNTY, W 1 SI;uN:~ 1N
SUBDIVISION e &g='s? 1 V LOT 2-. LOT 1'Gl
PLAN V I LW
Distances and diMendiona to n►eeL L_UgU1rtruu:nLL; u1: 1163
VIMTH1NG WITHIN 100 OF SY:;'I'I-.M _
V
1_ L I -A/
P
`r'lrhArrc,w
Ell Itdi etle ca
1.-
SCIALE:
BENCHMARK. (Permanent reference Point) Deucribe. /1gilVr Rr~N
:----_.-jG' - - 1,u1 e at
Llevaation of vaerticaj.refa3rencrr 1)0111L
SEPTIC TANK: Manufacturer; GL!1G'S_!'i~S Li (Iuid Caj),tC 1 y jevr-r
Number of rings on cover Tank tai<ankole ct,vcr c it-va i i 0i,
Tank Inlet Elevation: Tulik Out lct l~l_,vaj I,t,
PUMI' CI AMBL R
M"nufac Curer : Ncuubc i (A !
Number of gal. pump set or it cycle_-- l;a llutts , t ut,il .il, , I I Y O
dia t_ribution 11nda hu 1 lull. s i zu (if pump
Kallon per minute horaupowcC hI1111 11<11,E ')I I)WHI)
and wade 1 nuntbar
Type of warning dev
HOLDING TANK: Manutacturet ut };.11 hm, ,
Elevat ton of utarthole
'l' yl,e c)1 War-ll n8 device
-
qtr r o;t' 1' i, t I c,L. I (11,011,
SUPA 'E Y I T S L"LE Nut
feet Liquid d~sptla _ cseellaLcC It 11►lct I1.JW L'LCv,,! A.kl,
aeapag -p1t elevat 1 oit
`3LLE: number ut 1 Meta w<<II I,
Sf~:t? A Al,t o 1iEhf
SI'.i:l'AGk. kENCkk WidL11 luttbt.l,
PLRLULA'l AN RATk ___~_AREA REQUIRED kEA A , 1W .
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LAB~ZUR & HUMAN RELATIONS DIVISION
PRIVATE SEWAGE SYSTEMS
P.O. BOX 7969 1 BUREAU OF PLUMBING
MADISON, WI 53707 t
.
C CONVENTIONAL ❑ALTERNATIVE State PlanID.Number
(
Holding Tank ❑ In-Ground Pressure 1:1 Mound
NAME OF PERMIT HOLD R: ADDRESS OF PERMITrHO LDER: INSPECTION DATE
H
L
BENCH MARK (Permanent reference Fount) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.
Name of Plumber MP 1PRSW No. County: Samtary Permit Number.
LI,L'
SEPTIC TANK/HOLDING TANK:
MANUFACTURER / LIQUID CAPACITY: TANK IYLE TANK OUTLET ELEV. WARNING LABEL LOCI~hRJG OV
PFrk~O---V~IIO ED. PR OY/IDE D"
j _ /V. L_.1YES ENO ~YES ./6 NO
BEDDING: VENT CIA VENT MAT L.: HIGH WA R + NUMBER PROPERTY WELLUILDING VENT TO FRESH
) ALAR/ LINE AR IiVLEIFEET FR
YES ENO NE
ARESTOl k
DOSING CHAMBER: _
MANUFACTURER BEDDING. LIQUID (;APAFITY PUMP MODEL PUMP,SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
EYES ENO EYES ENO DYES ENO
GALLONS PER CYCLE: PUMP AND CON TROLS OPERATIONAL: NUMBER OF PH(1PERTY WELL BUILDING.( VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM NE AIR"LET
PUMP ON AND OFF) EYES ENO ~NEAREST-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing t r-TH - r 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: _
WIDTH: LE NGTH NO. OF DISTR. PIPE SPACING COVER INSIDE DIA az PITS LIQUID
BED/TRENCH TRENCHES / MAI, I.L. PIT DEPTH'.
DIMENSIONS J S v a~' 2_
ENT TO FRESH
GHA\FI. DFPTH FI LL DEPTH IDIST11 PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO D i!FT R NUMBER OF u~PHNOPeERTV WELL. BUILDING: AIR
c{vPIPFS ABO ECOVER ELEV INLFr ELEti_END PIPES FEET FROM II ~NyET_
NEAREST--1
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 stems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets e criteria for medium sand. TIONS MEASURED.
EYES ENO.
SOIL COVER. TEXTURE PERMANENT MARKERS: OBSERVATION WELLS
EYES ENO EYES NO
Lit PI H OVER TRENCH BED DEPTH OVER TRENCH;BED EPTH OF TOPSOIL SODDED JSEEDED MULCHED.
CFNIFH EDGES _
EYES ENO EYES 1:1 NO EYES NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH NO. OF LATERA-L 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
F I_E V.. ELEV. DIA. ELEV. - PIPES. DIA.'.
ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED
HOLE SIZE HOLE SPACING DRILLED COHRECT LY COVER MATE RIAL.
PLANS
TION
ff~t DYES ❑(N4 DYES ENO
F IPROPELLBUILDING
ER O
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: INU'B
ET FROM LINE❑ YES ❑ NO ❑ YES ❑ NO EAREST--
V
r.
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE.
DILHR SBD 6710 (R. 01/82)
P LB67 State and County State Permit #
Permit Application County Permit # -
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: / _%_hll- Y4, Section Tom'/ N, R_/L Wor) W Lot# _-City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township yli d fl w
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance _
Single family A_ Duplex No. of Bedrooms 7 No. of Persons 2
D TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms-✓_
Automatic Washer _,__YES NO Other (specify)
EPTIC TANK CAPACITY 141*-"7-c Total gallons No. of tanks _ /
`;-folding tank capacity Total gallons No. of tanks-
-~w Installation _A Addition- Replacement Prefab Concrete i1
Poured in Place Steel Other (specify)
FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) _7 2) 7 3) Total Absorb Area sq.
lew~ Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet 1,-y) Width ' Depth--:?,/ Tile Depth ~2- No. of Trenches
+ epage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land 12 Distance from critical slope
i, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
'aavisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME C.S.T. # / 7~(f and other information
obtained from (owner/builder).
Plumber's Signature MPI # h`l j< Phone #;-/-S-7'/J'
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
1
Do Not Write in Space Below FOR DEPARTMENT WSE ONLY
Date of Application Fees Paid: State ( y~ County Dat
- r ,
Permit IssuedfRejECted (date) I ~J_)--- -Issuing Agent Name
Inspection Yes No Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revised Date 6/1 /76
1
r r
Smith Plumbing & Heating PHONE (715) 265-4838
Al f,,~ r,¢ f rfO,L c/ GLENWOOD CITY, WISCONSIN 54013
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