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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner HELMUT & LIGITA LUTSEP ` LUTSEP, HELMUT & LIGITA 1337 AWATUKEE TR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1337 AWATUKEE TR SC 5432 SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 26 T30N R19W GL7 LOT 2 OF CSM 3/738 Block/Condo Bldg: EXC PT TO AWATUKEE TR Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1078/180 RD 2004 SUMMARY Bill Fair Market Value: Assessed with: 5354 432,400 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 260,000 165,400 425,400 NO Totals for 2004: General Property 3.000 260,000 165,400 425,400 Woodland 0.000 0 0 Totals for 2003: General Property 3.000 183,700 138,500 322,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 104 Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 640.48 Special Assessments Special Charges Delinquent Charges Total 640.48 0.00 0.00 Parcel 030-1073-70-000 03/23/2005 10:42 AM PAGE 1 OF 1 Alt. Parcel 26.30.19.256E 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 * LUTSEP, HELMUT & LIGITA HELMUT & LIGITA LUTSEP 1337 AWATUKEE TR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1337 AWATUKEE TR SC 5432 SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 26 T30N R19W GL 7 LOT 2 OF CSM 3/738 Block/Condo Bldg: EXC PT TO AWATUKEE TR Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1078/180 RD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 5354 432,400 Valuations: Last Changed: 07108/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 260,000 165,400 425,400 NO Totals for 2004: General Property 3.000 260,000 165,400 425,400 Woodland 0.000 0 0 Totals for 2003: General Property 3.000 183,700 138,500 322,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 104 Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 640.48 Special Assessments Special Charges Delinquent Charges Total 640.48 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT DER TOWNSHIP 0SEC. T . ADDRESS , ST. CROIX COUNTY, WISCONSIN. R W BDIVISION LOT LOT SIZE PLAN VIEW Distances S dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM FT- ' i i - t { - --j--{- I - I.rdicate North' Arrow SCALE . y 4'PTIC TANK(S)__L_ MFGR• C ► ~S CONCRETE STEEL NO. of rings on cover Depth DRY WELL (INCHES NO. of width length area no. of lines_ width length tr--i azeac depth to top of pipe GP.EGATE,~ Gl: RATE AREA REQUIRED AREA AS BUILT y " ,,claimer: The inspection of this system by St. Croix County does not imply complete o~,pliance with State Administrative Codes. There are other areas that it is not possibly: o inspect at this point of construction. St. Croix County assumes no liability for 15tem operation. However, if failure is noted the County will make every effort to i~ermine cause of failure. (EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. -'INSPECTOR j DATED PLUrMER ON JOB LICENSE NUMBER z REPORT OF IVSPECTION_INDIVIDUAL SEWAGE SYSTEM Sanitary Permit/~` • State Sept.ie_- e NAME--,__,T owndh.ip St. Cko.ix County Location. Section SEPTIC TANK - Size _ga.l.lons. Number o6 Compan.tment~s I - Distance Fxam: GJe.l.l St. 12% on gneaten. 6.lope St Bu.i.ld.ing Wetlands Highwatex _ it. DISPOSAL SYSTEM Distance From: Well it. .12% ox greaten. 6zope Bu.i.ld.ing it. Weteands Ft. H.ighwatex it. FIELD DIMENSIONS: Width o6 txench it. Depth o i xo ck b eZow kn Length o6 each Zi.ne_ it. Depth o6 xock oven t.i.le in. Numbex o j .roes Depth of t.i.le below gxade it. Total .length o4 Zine6 it. Slope ob txeneh in pen 100 fit. Distance between Una it. Depth to bedxock ~t• TotaE absoxbt.ioi- area 6t2 Depth to gxoundwatex - 6t. J t2 Kequ Type o6 Covet: Paper. ox Stxo.w ~.xed axea PIT DIMENSIONS: Numb vt o f pi t,GxaveZ axound piths yeas no Outside d.iametex it. Depth below .in.let 6t• 2 Total ab6oxbtion axea it z A 2 rn Axe.a Aequ.ixed ~t INSPECTED BY TITLE . . APPROVED ,DATE 197 REJECTED ,DATE 197_ 4 and County State Permit # PState ~L~6 7. Permit Application County Permit for Private Domestic Sewage Systems County f` ko X *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: Mc, . car)ra Mcs, L~At B. LOCATION: '/4 sr Section, T,23 N, R C1 (or) W Lot# City _ Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial _*Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons '7r" D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder YES X NO # of Bathrooms: Automatic Washer < YES NO Other (specify) E. SEPTIC TANK CAPACITY .YJ Total gallons No. of tanks ~N *Holding tank capacity Total gallons No. of tanks New Installation )C Addition Replacement- Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) _c.9 2) A 3) Total Absorb Area sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet----- Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length uJfh / Depth Tile Depth --11/-" No. of Linesd Seepage Pit: Inside diamet FJ Liquid Depth Tile Size Percent slope of land Distance from critical slope D I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified jo il Tester, NAME f C.S.T. #and other information obtained from - 0A.? C1 IQ (owner/builder). Plumber's Signature MP/MPRSW# - -Phone # -4%TZY Plumber's Address cd i.U PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with 1 H62.20, including well). 30 o ©v 1\ S 4.5 Iav~ 2 G Q L7 / S~ tic T 'r -5 IoX I N e ~ E------ice _ We//_~ Do Not Write in Space Below FOR DEPARTMENT USE ONLY Date of Application ,~7 - '/'Fees Paid: State (Q County Date Permit Issued/44joeted (date) ~ / - 'J J -Issuing Agent Namej ,r.Z, - Inspection Yes__X_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