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Parcel 020-1023-40-000 07/14/2006 05:15 PM
- PAGE 1 OF 1
Alt. Parcel M 14.29.19.104G 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 - RELF, WILLIAM J & LINDA K
WILLIAM J & LINDA K RELF
772 HOLDEN LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 772 HOLDEN LA
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 5.050 Plat: N/A-NOT AVAILABLE
SEC 14 T29N R1 9W PT NW 1/2 NW SE COM E Block/Condo Bldg:
1/4 COR TH WILY 1304.32 FT TO POB: TH S
620.56 FT; WILY 353 FT; NLY 620.49 FT; TH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
ELY 353 FT TO POB 14-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 802/433
07/23/1997 798/335
07/23/1997 724/313
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 5.030 73,000 146,200 219,200 NO
Totals for 2006:
General Property 5.030 73,000 146,200 219,200
Woodland 0.000 0 0
Totals for 2005:
General Property 5.030 73,000 146,200 219,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 218
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1983.44
S88 °55 W
353.00 353.00
P. 0. B . P. O B
1
I
II
1
I'
1 3 ' ~ 12 1
' 5.03 ACRES rn' 0 5 03 ACRES -1 o
N lfl
~ i to N
(,J; 0
tD o
. z i;-
,Z
NW 1/4 - SE 1/4 1
I
i
NORTHERLY RIGHT-OF-WAY L~If~E OF PROPOSE
353.00 353.00 19 8 8,
CENTERLINE OF PROPOED -TOWN ROAD
►7. 84'
, -
34700
347.00
T I
f w
AS BUILT SANITARY SYSTEM REPORT
OWNER Je / _~s u TOWNSHIP /r L~SEC . -Rl yW
~ ST. CROIX COUNTY, WISCONSIN.
ADDRESS f
SUBDIVISION Q LOT LOT SIZE
r
PfAN VIEW
Distances and dimensions to meet requirements of H63
hLEVE_RYTHING WITHIN 100 FEET OF SY EM
VT1
L/ I f GI . I i
I
t
r
N )1
l
-71 fIAA
4- -
a e o rrow
SCIALt :
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: r'~i-✓ Slope at site:
SEPTIC TANK: Manufacturer: L) Liquid Capacity: 41
Number of rings on cover _ _Tank manhole cover elevati- on: Y
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 device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device
feet iameter
SEEPAGE PIT SIZE: Number o its
feet liquid dept seepage pit in epipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines , width /J' lengthslCthe depth,
SEEPAGE TRENCH: width length _
PERCOLATION RATE -AREA REQUIRED AREA AS BUILT:
INSPECTOR
--__Y_,~K _
DATED PLUMBER ON JOB
LICENSE NUMBER
N't VOKI.. Of IN_ IV[CTION - INDIVIDUAL tiI_WAGL' SYtiIt M
14 0.
Towne h4.
Sec.t-iQn Lot N
5ubdiviei on
/WI-
I I , ' I A N K
1 - gafZ.vne Number oh camr~antmenXe
r"iwc { nom: 0lelk t-~ ~3utii'd~ n
_ /4__._ _ 12 0 x o p v. -
Ifi.ghwa te.n
,A41 IN(; 011AMBER
- gatton4. _ -Pump Manu6a"ctu4e4 Model Numbe.ti
11) I NG 'TANK ,
ya.Qlon4 Numbelc ob Compan.tme.n,te
A t a t(m S y,6 .t e m
f, n►1r:"~'"""`(>;ip"x l f3 rx ~ d c n 1 2 o e 1 a p e
9
Highwa-tek
ION tiITE
~-X Tn,en.ch
t,hum: (oo e 8uilding --l2`o sYope
Highwa-ten
:(4TIION SITE DIMENSIONS
W,(d.th oA -tne,nch Requi.n.ed a><ea ~J"'
Length oA each tine tt At Depth o6. nook be Paw tie
v.
Numbest (14 l.i.neb'~ Depth o A koeh oveh ,t-i ee Z ~ v
1 t~rY leny.th 04 tinee At Depth o 6 -t-4 tv be.Pow gnude
I~ I1rv,rr be twe. en Iine.e
-At Sl.ope o A xlie.nch 2-1 <n . i.,v n 100
t
I r , I' rr n <i n. p c, n u n e a _-At
b -t Ty p e u A C 0 v e. 4: V a p v n a t, wv
r' I I) I M I NS I O NS Nnwl,r~r „A pits ~ Oltavee ah(Yunf{ to yes nu
n,
di amete n At Depth b exuw to f,c -t
i 1,il' 41)tiolip,tion alqea_ 6t
q At
I't' X 1 1 U 6V TITLU
DATE-_ / _ 19 b
I:1 7I C-I LD DATE 19 n
I:I ASON I-OR REJECTION
l
jJE.PARTMENT OF APPLICATION
INDUSTRY, FOR SANITARY SAFETY & BUILDINGS
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'/2 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: WQ I
erty Location: City, 1I age or JQZuLjbjU_ County:
,%_V 'XS /'/iT N, R /Y E (or s`,
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
L PIG (If assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required. C:
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
AZrI
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: "Q
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): [N~New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit
1 (0 5/y ❑ Alternative (specify) ❑ Seepage Trench
C•
Water Supply: Owner'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 tuber: Signat MP/MPRSW No,: Phone Number:
Plumbef's dress: ) Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Sign tur of Issuing Agent- Fee: Date: _
APPROVED Sanitary Permit Number:
9
O
a ~f ±Gt ~S' ❑ DISAPPROVED I
eason for Disapproval:
i
Alternate course(s) of Action Available:
I
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to ;si-
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)
~J (Zo - 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES Oy ~S',~/✓ J;
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATI'ON~C',, Section ~,T.22N,13/7_9 (or) ownship or Municipality
Lot No. Block No. /Q e-v 1-Y County SA ~/-Dix
ubdi sio Name
Owner's/Buyers Name: 'e G
Mailing Address: 4~20 $I S c O
TYPE OF OCCUPANCY: ResidenceZK No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM / OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS 4-y2 a /-Q0Z PERCOLATION TESTS SOIL MAP SHEET SCE NAME OF SOIL MAP UNIT RZCa~ A946-- Ae%-CIL 440-e-
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE
I`'UM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
(SAP A.-le 4X4 "470
P_2. j" Sew o r 1
P-3 ee-
r~ 2i O
•
-3 C,
P_-
P_
P_
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B_ Z ft" e- r" _ "1l ` 6o " A4Pd S
B_ f1l"
6/.c ts l) `tom ~^i rye, (l`
~/,c[~L 7 it
B- ! `f /~GCXC 4r-- 7 ( A (fa of D s`s~ / 'r S ' e
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian the loc "on and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy iglr 4r d0 p" Ind' ate scale or distances.
Give horizontal and vertical reference point§olndicate slope. Sic W44
rT,~}
e_ /X1141-c'es ,45
17
I' /\40-
-con
E,(, = /CO-'S ~ N
d
) - V1,
Dr, I! 164 99
14 kr
A A 5, 09--44
AX Z d,K,4 Ds
I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures an specified in the Wisconsin Administrative Code, and
that the data recorded and location of test holes are correct to the best of my
knowledge and belief.
Name (print) ce %s Certification No.
Address i G -rte d!
Name of installer if known
Copy A -Local Authority CST Signature _6 I_
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