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Parcel 161-1052-90-050 02/23/2006 10:27 AM
PAGE 1 OF 1
Alt. Parcel 13.29.20.511 B-05 161 - VILLAGE OF NORTH HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
06/07/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - O'CONNOR, JAMES C & PHYLLIS R
JAMES C & PHYLLIS R O'CONNOR
1212 RIVERSIDE DR N
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1212 RIVERSIDE DR N
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 0055-VIL OF N H ASSESSORS PLAT
S 65' OF N 75' OF OL 71 ALSO BEGIN E LN Block/Condo Bldg:
RD 75'S OF N LN OL 71 THS87DEGE
97.8'S ON LAKE 110' S 12 DEG W 20'N 59 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG W 141' TH N 23 DEG W 70' TO POB EXC 13-29N-20W
N 10 FT OL 71 DESC IN 2590/561
Notes: Parcel History:
Date Doc # Vol/Page Type
06/07/2004 765136 2590/561 QC
06/07/2004 765135 2590/559 AFF
07/23/1997 1097/528 WD
07/23/1997 589/303
2005 SUMMARY Bill Fair Market Value: Assessed with:
108263 499,600
Valuations: Last Changed: 07/28/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 295,700 193,200 488,900 NO
Totals for 2005:
General Property 0.000 295,700 193,200 488,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 1011412005 Batch 05-33
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1
t
AS BUILT SANITARY SYSTEM REPORT
OWNER- TOWNSHIP- dry SEC. 7qN-RAW
ADDRESS oJf~` ~ 5 - _ ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE__
PLAN VIEW
Distances and dimensions to meet requirements of H63
low- EVERYTHING WITHIN 100 FEET OF SYSTEM
p -
- TIFF,
- -
Fft f - 4' ° to -
Q
~ , r F
c9j
di n e Ott- rrow
;Ck
r4tt4z -1 ~ 9 r ~ <y e'en
BENCHMARK: (Permanent reference Point.) Describe: rte." P-//Ilf i 161<00I6 yr-
i4 r7,4 OF rhol`lfe-
1?tevat.ion of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer: WI I' a-)O-~> Liquid Capacity: -;o
Ntimber of' rings on cover Tan manhole cover eI evat iorn 7
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
lumber of gal. pump set for a cyr~e gallons; tot~tT cap c i t y o
distribution lines gaL1.on: size of pump_ _ head
gallon per minute_ _ horsepower_ brand name of- pump
and model number _ J
Type of warning evice
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover- _ _
11
ly e of warning device
SI?EPA E FIT SIZE: --1~umFier oT tts Teet_ diame t-er
feet- liquid depth_ seepage pit inT-j pipe-elevation
bottom of seepage pit e evation feet-
SI?E.PAGE BED SIZE: number of lines widths le sgtl1,~ file depth 3~
_
SEEPAGE TRENCH: width_ length
1'1?RCOLATION RATE - REA REQUIRED_ fL_(~' _AREA AS 13UILT_
INSPECTOR
UA`'1?U - PLUMBER ON JOBv~
LICENSE NUMBER
r K
RLPORT OF IN, IVLCTI9N - INVIVIVUA1. ti1WAGC SYSIIM ~ u
tiarnl (afirt Vv'irni
(a rcSv 4 4 c
c TowvnAh4,p -S.t. Cx Count II
SC,-- Se,c.t.ion Lut M Subdivibx.on
I [AN K
C ' Cd. 0"A ` Numbeh o corn ,av,tme.n.tA
r,,~ ~rrum: We.X'f 4J ? Rukfd` ng- 1`! Yc,.re
r
N.ighwaten
,,11' 1 N(; CHAMBER
' fda~ one _ 4~,mp ManuAdetu)ten. Modex Numbers
01 V I NG TANK
ti~fr' 9iaAtana 1llr bek o6 Compantmentd
I'„rnl,~ h lttr Sote.m
% t,avrrc Oomr Wets t3uiQd~nc~_ 12$ el?.ope
d:
Mighwate~
is :1?I,'I'1 IoN ITE ~
Thowoh
_
11~ cl6iwa (e h
i' I I N ti I It D I MI NS IONS
M l ~ ~s
lrl, o~ thench At Re u4,red anea A
I ckii1 th o A each l..i.ne_ 4/ At Depth „A hack beYow tcPe ~4 n
Nrrrribcft oA 14.*le6~ Depth oA naek oven -t.e4'e 'Z1
I,trY Yen ~,nee
9.th a 6 46.t Depth uh .tite. below grade.
ranee between tineb
~,..,.~..,..At ♦t4pe a6 thench~ I- in. pe.n 100 At
-
1 , toe abe an.p.t.ion ake.a At Type afi Caveh: Pareic an e.tnaw
i
I'ImINtiIOV I; '
v..„,l ~r ~act6 GKaveY aA. nd pate yeA no
r ,,Ic do:ameten _At Depth below nYet t
i r,rI' ubAonpt.ion anew e At
-
A „ ec1uia.ed At
I'I ('111) tiV L ~
T I T L E
i ' V 1 1)
_ DATE 198/
'1iII I' DATE 198
A, ~~N I OK' IZI:JECTION
PLB, 67 State and County State Permit #
Permit Application County Permit # S1
X
for Private Domestic Sewage Systems Co u nt y
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
d I Cpi~it ooe Z 11~ ~P f ~ mop-+4, o ps-c,v i 5 i°C~~ Cv
B. LOCATION: Section 12 T N, R20 E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village'" HU17~~z1J
Township
C. TYPE OF OCCUPANCY: *Commercial S!/ *Industrial *Other (specify) *Variance
Single family X- Duplex No. of Bedrooms No. of Persons,2
D. SEPTIC TANK CAPACITY /c'ZV Total gallons No. of tanks j
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement Ix
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
- - -
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate y' Total Absorb Ares -17
sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed:_ _X. -Length 2" Width /2~-' Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal Y
Owners name as listed on EH 115 if other than present owner:
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 /PGb'E--'T' Z(/b Ile /I C.S.T. # _53 "02743
and other information
obtained from 250/4 7-57 74 Q (owner/builder). 7/Jz
Plumber's Signature ij t P/M / e Phone #
~SW #
Plumber's Address 7L 2- /VO C~ J, !1 PJ A-) e 7 -5 .
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
P~ (drew e /
nl ~ 0~6ER~,~
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.
61~ 4,9
ti
° o o v a u ' ~E
V1 it 10
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application- Fees Paid: State- !5 -,-,C County` Date
Permit Issued/Re}eeted (date) Issuing Agent Name
Inspection Yes No State 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 7/
gda
•DEFArTMENT OF REPORT ON SOIL BORINGS AND SAFE
4NDUSTRY, ti
LABOR AND PERCOLATION TESTS ( / 1151
P.O.
HUMAN RELATIONS ` MADISON, WI
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
5E 1/3~/a I ~ /T N/R z0 E (orl W A16R OvPse).Aj
OWNER'S BUYER'S NAME: MAILING ADDRESS:
5 F c,po~X JAMIE-,< C) '6'0A4v0.2 T'. 4101
USE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE
Residence 2 R TONS: ER LA ON TESTS:
❑ New Replace Z
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IfV-GROUNDPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
®s ❑u s ❑u ys ❑u EIS ®u a s au~~~~,~~~~~
If Percolation ~Te,ts are NOT requiDESIGAEIf any portion of the lot is in the
under s.H63.0)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPT
NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
13-
B 2 G Ole,
s
B- 3 ~s/
s_
B-
.t. p
1~.
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN.
PERIOD 1 PERIOD 2 PERI D
P Z r4 j
P-
P_ 21 P- ` 2-
P-
P-
PLAN
VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hor
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and pence
of land slop, &-h` 4 C' 0,e111v1_?e0 -k L/--- SYSTEM ELEVATION ~e%40 131'Y l1
O + I ,
Y'P'~ ~QJl~1i:
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L-
r-
94
dp 13
A/ M
49
h
13,
a
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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 methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print►:
T TESTS WERE COMP ETED O
ADDRESS: ,l /C v6 Cd ~A _ / 2 ' /Aj
CERTIFICATION N
UMBER: P ONE NUMBER optional!:
P2 -
i2l
CST SIr'W~!
I ~f C
DISTRIBUT
ION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
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