HomeMy WebLinkAbout020-1034-00-000
St. Croix
ADAM J ELLEFSEN Municipality: TOWN OF HUDSON
959 PRIESTER LN Permit Number 12911
HUDSON Parcel Number: 020103400000
WI 54016
Alt Parcel Number: 17.29.19.146-0
Site Address: 959 PRIESTER LN
Components
Component Manufacturer Description Last Next Status Schedule
Service Service
Conventional Bed - Seepage Bed - Seepage 06103/2015 0610312018 Current 36
Drainfield
Septic. Tank Septic Tank 06103!2015 06;0312018 Current 36
Maintenance History
Service Date Maintenance Name Gallons Pumped
05122!2007 Not Available 0
08109;2011 Not Available 0
10105;2012 Not Available 0
061012015 Not Available 0
Notes
Date Text
714!1776 12.00:00 AM OTHER REQUIREMENTS: pumper reported new owner as Adam Ellefsen, abut may be
son-in-law living at house while Williams' move into a condo it Hudson
ADDITIONAL NOTES- No as-huilt, nothing completed on inspection report so may have
been installed at a later time0 Near Willow River
MIGRATED ON 09104;2015
`No data found for Notices, Violations
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Rr-.P0RT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM San.itaty Pe,Lmit
State Septic.."
NAM r ownsh.ip ,St. CAOi x County
- Locatio4 Section
SEPTIC TANK
Size gaUons. Numbe,t o6 CompaAtments
Distance F&om: Wett. it. 12% arc grtea.tn s,ope. _6t
Buit.d,ing it. WetZands 6t•
H.ighwateA 6t.
DISPOSAL SYSTEM
Distance FAcm: WeZZ it. 12% oA gAeateA 5Repe 6t•
Bu.itd.ing it. Wet.-ands Ft.
N.ighwateA it.
FIELD DIMENSIONS:
W id-th o6 tAer.ch 6t. Depth o6 t-ock be c:u tiie .in.
Length o6 each eine 6t. Depth o6 ,Loch overt t.iZe .in.
NumbeA o6 Unes Depth o6 below g fade .in.
Total .length o6 Ui,ies 6t. Slope o6 tAeneh in pert 100 6t.
Distance between Une-s 6t. Depth tie be.dn.oeh 6t.
Totat abscr-,bt-ion aAea 6t2 Depth to q.'Loundwale•'t_ 6.t.
Requited area it 2 Type o6 Covet: Papzn oA St-l.aw
PIT DIMENSIONS:
NumbeA c^ pits Grtave.E abound pits yes no
Out,b.ide d.iameteA it. Depth b ex o,,,j ~ niet 6t.
2
Totat. abso•t.btion arcea 6.t
AAea Aequi,7ed 6t2 rn
INSPECTED BY TITLE
APPROVED DATE 197.
REJECTED DATE 197`
i
EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ti > RFCc tI~
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH ~(rrf~
P.O. BOX 309 AU 2~) 1979 ) Z
MADISON, WISCONSIN 53701 ZONING
REPORT ON SOIL BORINGS AND PERCOLATION TES S F`` v OFFICE 1 `
I i)Ca l ION_ /r~~;'. Sec'ion! , T4N, R116 (orl62rownship or Municipality cL SOA/ i - i
Lot No. Block No. Cu,a«.1 ~Zf,3-S&? 7 GAG SYf &65-//County s1
Subdivision Name Ile Owner's Name:
%I i i I ing Address: iL [.(./r 11, Syy/ j(
TYPE OF OCCUPANCY: Residence _ No. of Bedrooms -7 Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT -
~ATES OBSERVATIONS MADE: SOIL BORINGS-__g'/y.7- _ PPERCOLATTIONTEESTS -~y-7,~/-
SOIL N4AP SHEET SOIL TYPE /t') 1~ P/4, ~l~~ eIa d~%t2y S9 /a al
PERCOLATION TESTS
TEST DcPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CH SOIL SINCE HOLE HOLE AFTER INTERVAL
BUM- INCHES THICKNESS ESS IN INCHES GER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P 312-
See gere- 41
~m 44 /l0 6 See
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
.UMBER INCHES OBSERVED ESTIMATED HIGHEST y (DEPTH TO BEDROCK IF OBSERVED)
I', 34"' SIC
.7V 1.2 S4 Z_ tS 3 y" S yy" S /,z " s frt~-.
- - ALIAJ 4e-- -7 f-1, ;Ix
4 rVr2r 7 [ I ~S s,L ,20 •s 5-
1: LAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet f suitable areas. IndicatS number of square feet of absorption area
r :r,ded for building type and occupancy. .2 De+O A r Su. 7dh e.---e4 Far Indicate scaII~
u distances. Give horizontal and vertical reference points. Indicate slope. s y s * IQ~~iAre~Me*e!',
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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 Administrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and belief.
Name (print) -~eru.~(•`S 1,2 r Certification No.
Address ./7/6
Name of installer if known _
CST Signature
OPY A -LOCAL AUTHORITY
. r State and County State Permit # 20&'
PLB67 Permit Application County Per 't #
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: 5&ZS Q Section T_59S N, Rd- (ur)Lot# City
Suhdivision Name, nearest road, lake or landmark Blk# Village
1, Township AlIJy 'L
C. TYPE OF OCCUPANCY: Commercial "Industri I 'Other (specify) 'Variance
Single family Duplex No. of Bedrooms No. of Persons 3
_ I D. TYPE OF APPLIANCES: Dishwasher YES X NO Food Waste Grinder YES,. NO # of Bathrooms
Automatic Washer _,X__YES NO Other (specify)
E. SEPTIC TANK CAPACITY_po0 __Total gallons No. of tanks
`Holding tank capacity Total gallons No. of tanks
New Installation X Addition Replacement- Prefab Concrete er
'Poured in Place Steel Other (specify)
F EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) l 2) 3) ,j Total Absorb Area yQ sq. ft.
New X_ Addition Replacement 'Fill System _ /f ~~'~cr:rel
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length 3 ~ ' Width Depth A/F Tile Depth ,3," No. of Lines 9
Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope
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 Soil Tester,
NAME 1,1,e 07 4 )`.S ? C'1rrS C.S.T. # and other information
obtained from L)4 owner/builder). - Plumber's Signature_ ( MP/MPRSW#~ Phone # 7
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including
, !well). 'VU Scale - .1.IS Atrtces 45 ~L tdi c o-k d
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Do Not Write in Sp Below FOR DEPARTMENT USE ONLY
Date of Application Fees Paid: State_ Cou ty Date
Permit Issued/RvionmV (date) Issuing gent Name - ~ a
Inspection Yes ~i 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
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Parcel 020-1034-00-000 07r11l2130~3 0348 PM
PAGE IOF 1
Alt. Parcel 17.29.19.146-0 020 - TO'vVN OF I IUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Curren- Ov:ner. C = Current Co-Ovrrer
DUANE J & JOANNE 1 WILLIAMS O - WILLIAMS, DUANE J & JOANNE 1
959 PRIESTER LA
HUDSON W1,54016
Districts: SC = School SP - Special Property Address(es): Primary
Type Dist # Description ' 959 PRIESTER LN
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.300 Plat: NSA-NOT AVAILABLE
SEC 17 T29N R19W SW NW BEGIN WV4 COR TH Block/Condo Bldg:
N 44' TO CL TN RD N54DEG E ON CL316 FT
S63DEG E 90.4 FT S 63 DEG E284' S 88 DEG Tract(s): (Sec-Twn-Rng 40 114 160 114)
W ON S LN SW NW 546.E TO POB 17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07123/1997 1185i5C0 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10x25?2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.3C0 52,900 155,000 207.900 NO
Totals for 2006:
General Property 1.300 52,900 155,000 207,900
Woodland 0,000 0 0
Totals for 2005:
General Property 1.300 52,900 155.000 207,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 204
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00