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Bach added information from Sanitary Maintenance Card and added pumping information 05/04/06. MIGRATED ON: 09/04/2015 *No data found for Notices, Violations i tit • AS BUILT SANITARY SYSTEM REPORT rK TOWNSHIP SEC. T N, R r W ;1• ADDRESS ST. CROIX COUNTY, WISCONSIN. 3DIVISION i- ? LOT LOT SIZE . PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i c f • A 1 ' TIC TANK(S) MFGR. CONCRETE STEEL NO. of rings on cover ; Depth DRY WELL "CHES NO. of width length area no. of lines width length area depth to top of pipe REGATE /f RATE I ri , AREA REQUIRED AREA AS BUILT claimer: The inspection of this system by St. Croix County does not imply complete % )liance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if failure is noted the County will make every effort to ermine cause of failure. :rISES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. i~ DATED PLUMBER ON JOB LICENSE NUMBER REPORT Of INSPECTION - INDIVIDUAL SEWAGE SVSTfM Savi4, tarry 1'clrfn i State Sept2c___1_- -%S--C ` _Town5h i-p~ ~ St. Cnu (,x Cuuvr ty cation=SLc) IVF -Secti.an 2 Lot # Subd4Iv.i,5 1an. :EPTIC TANK S i ze - gad fovr/s Numbers. o6 compahtrnentA - i 5-tanee ILO M: W Bu.ttd.Eng 12% 6 Pope. HEghwate"L 'LIMPING CHAMBER Size ga('PanS_- Pump ManuAactune"L Modef Numb iol-VING TANK Size ga fons Numbe.te o~ Compa"Ltmevrt6 Pumpers Atan-rp. -Syltem - i_n tanee Anan1: BuiVding 126 Pope. H Egh.uate n-_ r li 0RPT10N SITE B e d T n_ e n e h ti Lance A"Lom: (Ve_2P - i Buitding j r2 o s Pope HEghwateA N0RPTION SITE DIMENSIONS Width o{ tnench G At Requ4ne.d a"Lea -------fit LevrAth oA cacti One- S At Depth aA "Loch befow ,t.ike l <n Niimben oA Yi.vte-a v De.pth oA n.aeh oven ti.fe TotaP fe-ngth oA Une.6 At Depth oA tiV,e. be-Vow gnade, D<htanoe between P,ine.h At SEope oA trench .i.n. p(? n - 100 -6t 1. I o 4 A t b 5 0)(,pt,(-UYr. aAe.a 'f nY A t Type oA Coven: Pape"L o"L 6 t"Law IT DIMENSIONS 1 Numbeh oA pi,t5 _ G"Lavvf a"Loured p4te yes nu O(l t6l de d1 ameten At Depth beeow -nk-et At To-tat' ab,~o"Lption a"Lea At A~Lca nequti"Led At INSPECTED - TITLE 11 PROVf0 - DATE 1981' ItCTED DATE 1 9 8 'I ASON fOR Rf J1:CTION i' PLB 67 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: Les: Johnson 4218 45th Ave. S., PIinneapolis, Minn 55406 B. LOCATION: Stv v, NE Section j, T2 N, R-12 E (or) (W) Lot# City Son Na e, neare t ro d, lake or landmark Blk# Village MM Deve lopment on south side o~ Township Hudson city "N", j mile east of Hwy 35 C. TYPE OF OCCUPANCY: "Commercial *Industrial *Other (specify) *Variance Single family x Duplex No. of Bedrooms 3 No. of Persons 3 D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks 1 HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete x Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-PlaceOther (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate miri Total Absorb Area 04- sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width De th Tile depth (top) No. of Trenches Seepage Bed: X Length_ 36 Width 1d Depth Tile depth (top)3211 No. of Lines j Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 6 to 10 Distance from critical slope None WATER SUPPLY: Private 1-9 Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: 1, the undersigned, do hereby certify that the information I ave reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the of luent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME Dennis P. Christopherson /S.T. # 55"1599 and other information obtained from Builder (owner/builder). Plumber's Signature MP/MPRSW# 5164 Phone # 598 -2107 Plumber's Address BOX r Woodville, Wi PLAN VIEW: Provide sketch below of system (include direc ion of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate r dimension location of all wells on the property or neighbors property. If well has not been drilled please i dicate. 44 .2 E . e r E - E e 3 E 2 e i E e . ~ . sue. ..e e . i .ej-..., ..W. _ Do Not Write in Space P-h low FOR COUNTY AND STATE D PARTMENT USE ONLY Date of Application ,'1( 76-[ i Fes Paid: State l County Date 6 A~ Permit Issued/ eje ted (c l&) j G Issuing Agent Name Insn-ction Yes No State Valid# Date Recd inty ( ite copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 (pin copy) 4, plumber (canary copy) Revised Date 7/1 /78 f EH lla Rev. 9/78 9/ 10 r REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES _ RE~,EIv~o P.O. BOX 309, MADISON, WISCONSIN 53701 Co I o~v 3 1jHCi ZOti1NG ~ J~ Township or Mynicipality -C LOCATIONS Y4, v'/4, Section T~ QI,RL ~ (or) o~~~~ ~,4-! p v6 c,OM o~- O~ o cc ~ +i Lot No. , Block No. Et-de o- C sf y Jf-'County 5-A Owner's/Buyers Name: A/ Subdivision Name ) f1 Mailing Address: Y,z~ ~/p_!Z ~ dale, -Q, /1-*A U it'?,;aa• S-5-1,0"- TYPE OF OCCUPANCY: Residence X_No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW -~REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 4-12-- SO O PERCOLATION TESTS QQ/0~~ - [4y ~2 SOIL MAP SHEET tc~ NAME OF SOIL MAP UNIT RX 6~: ~4- ~ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 ,4 aC) 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 Q 13- 7 B- 3 7 ro,r , ~S Ste" ~~~cS B_ rr e „ « J t' S '5 "rAd S 13- S7 ;7A;" S-0 B- -7 `r (rte / b2 ec t~ PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian tljg location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy do Indicate scale or distances. Give horizontal and vertica%eference p 'nts. Indicate slope. Sup j~,0~s~e Arw Nc S S'~ ate. s .¢s .Z,~ ~<<~ ~l X c tr N CFA L~ ~ 1 PE~~ i a d F = to 7' f5s jFZ = !o6' D O A (c.-,7'~ 4 © o n 9reA 6 D ee cs eo~ E~ l ~o • ~r~`~rY s'>% ire 1 w/a,-A.~ l ~r~ t I, the undersigend, 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) ,clr s r s leis Certification No. ~ A TIT Address Z/2(, Uj.s, Name of installer if known - e opy A - Local Authority CST Signature ' -v w kj~ M11 ~ . n r O ~ b -1 N OQ 1~4 ~ .ill ~e Rol NA1100.01004 o"i 0-1 a~.~S a ~~t }r~it~ A,18 11 ,n a`, gf ,i P M,'~"fi~4 7r` e w ° iqi• s M9>~ a 4! '~}"''v'Mr"1y~!'~{!t~Sre NMh rr~ ~+NR+^°r`"u i.,z SP""'*P^'~in r~, , r. `E°.ttOM"++' >f~ ~'t~`4rf~i'~ F~' ~i~ I,~•rk'•±~lN1.i~ •ir~, r. 6i ;i rt r"`~.i' ~i' i l ~h'i+~~'~t~~t'S• ,!7,a~~ , i I rrVb~!C,IV1p~i}3 ~f q't Po"~"q~•f4N'.~t,'~~i~1~ iu 'r{~,•''.:r d,~ ~gla'a~~,h~~iitph;~Pi{~1t ~t~i~~7fi~l ' - I~'t w t REPORT ON INSPECTION OF SANITARY PERMIT # (1) Name and Address of Permit Holder Person/Persons at site (2 )Date of Inspection Time of Inspection tt a Address, License No. o ns a ing Plumber 3 IN ALLATION CONS TS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System (4)BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO ; 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ N0; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liqu4 ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slob greater than seepage pit inlet pipe-elevation ft; bottom c` seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth.; 1 i.neal feet tile; ft to residence; ft to well; Ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TREN H: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO "'_ILHR-SBD-6095 N.05/80 Signature of Inspector: REPORT ON INSPECTION OF SANITARY PERMIT # (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Time of Inspection Name ress License No. o ins-tan in9 Plumber > (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO ; 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: Parcel 020-1096-10-000 09/18/2006 05:08 PM PAGE 1 OF 1 Alt. Parcel 33.29.19.388F3 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 - PORTER, DAVID M & VICKIE A DAVID M & VICKIE A PORTER 659 BRADHURST DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 659 BRADHURST DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.270 Plat: N/A-NOT AVAILABLE SEC 33 T29N R19W SW NE LOT 3 CERT SURVEY Block/Condo Bldg: MAP IN VOL 5/1220 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 01/30/2003 707694 2126/66 EZ 10/30/2000 632677 1554/583 WD 07/23/1997 790/10 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 3.270 76,600 215,400 292,000 NO Totals for 2006: General Property 3.270 76,600 215,400 292,000 Woodland 0.000 0 0 Totals for 2005: General Property 3.270 76,600 215,400 292,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 114 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r Parcel 020-1096-10-000 03/21/2006 12:19 PM PAGE 1OF1 Alt. Parcel 33.29.19.388F3 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 - PORTER, DAVID M & VICKIE A DAVID M & VICKIE A PORTER 659 BRADHURST DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 659 BRADHURST DR r Z'V► SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.270 Plat: N/A-NOT AVAILABLE SEC 33 T29N R19W SW NE LOT 3 CERT SURVEY Block/Condo Bldg: MAP IN VOL 5/1220 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W 5P__Id' -1bj6-' ~ 'i 6-~ wP Co ZO- l ~l vc7-- typo Notes: Parcel History: Date Doc # Vol/Page Type 01/30/2003 707694 2126/66 EZ 10/30/2000 632677 1554/58 r< O N WD 0712371997 790/10 Cj?, nJ tc- -711'7K7 2005 SUMMARY Bill Fair Market Value: Assessed with: 92157 286,300 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.270 76,600 215,400 292,000 NO 05 Totals for 2005: General Property 3.270 76,600 215,400 292,000 Woodland 0.000 0 0 Totals for 2004: General Property 3.270 47,600 167,000 214,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 114 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 Parcel 034-1062-50-100 09/15/2006 05:24 PM - PAGE 1 OF 1 Alt. Parcel 28.29.15.429F 034 - TOWN OF SPRINGFIELD 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 - WHITE, ROBERT & LINDA ROBERT & LINDA WHITE 2944 HWY 12 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 2944 HWY 12 SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 0.450 Plat: N/A-NOT AVAILABLE SEC 28 T29N R1 5W .45A PAR 100 X 150 FT Block/Condo Bldg: SW COR SE SW ALSO THAT PT OF ABANDONED INDEPENDENCE STREET Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 28-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/12/2000 6262930 1526/78 ROAD 04/05/1999 600489 .___1-415L95 WD 07/23/1997 1119/76 2006 SUMMARY Bill Fair Market Value: Assessed with: J y 0 l~ lL4--1 ~N~ Valuations: Last Changed: 06/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.450 2,850 34,950/ 37,800 NO Totals for 2006: General Property 0.450 2,850 34,950 37,800 Woodland 0.000 0 0 Totals for 2005: General Property 0.450 2,850 34,950 37,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00