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Parcel 161-1094-30-000 01/09/2006 12:01 PM
PAGE 1 OF 1
Alt. Parcel 13.29.20.746 161 - VILLAGE OF NORTH 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 - FINCH, ANNE T
ANNE T FINCH
270 STATION CIRCLE N
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 270 STATION CIR N
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 04/38-ST CROIX STATION 1977
ST CROIX STATION LOT 22 VIL NH Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-29N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/06/2003 745980 2451/345 QC
06/19/1998 581390 1333/336 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
108579 289,900
Valuations: Last Changed: 05/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 112,000 171,700 283,700 NO
Totals for 2005:
General Property 0.000 112,000 171,700 283,700
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 70,000 117,900 187,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 113
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIPSEC . T N-R, CW
ADDRESSG ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION ti ~ra iyc ~I~~' LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
TnLEVERYTHING WITHIN 100 FEET OF SYSTEM
! l r~ f e-
- i
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V"
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I. di ate Jo th Arr-,
S C~LE - i f -
BENCHMARK: (Permanent reference Point) Describe: `e h~ c4k +rce
Elevation of vertical reference point: 16-C Slope at site:
SEPTIC TANK: Manufacturer: L''e~ r Liquid Capacity: > oy _
Number of rings on cover Tank manhole cover elevation:'*_
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cycle 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
SEEPAGE PIT SIZE: um er o pits eet iameter
feet liquid dept seepage pit in et pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines a_3 width i ' length the depth
SEEPAGE TRENCH: width length
PERCOLATION RATE 0- i REA REQUIRED Ya AREA AS BUILT
INSPECTOR
DATED PLUMBER ON JOB /tzK-
LICENSE NUMBER 3
~0c)
REPORT OV INSPECTION - INOIVIDCIA1_ SLWAGL SYSTEM
S t a t e S p a~.i_ c
A II ~i... Township _St. Clro i x County
c t<nvr Z A?_4LL2 Se.c-tion4L Lot M_,,P^Z --Subdivis i.an.1g9k
I I'I IC TANK
r gat tonb Numbers o6 cornpa k tmen•te
trvrrrAhnm: We.P.t_ _ Buitd,i.n9- --I~-~ 12o bko,r>e.--
Highwa•tet
'11MVING CHAMBER
S t Z egatto n.. ..Pump Manu 6ae.tuten. Mo de.t Numb e.t
(01DING TANK
Si zegattonb Numbers o6 CompaA.tme.nts
I'umpen Atatm System
•1 taV) Ce 6nom: weak Buitding___ 12% stops
Highwa.tet
~I tioRPTWN SITE
lied Thowt,
t c yr r C ~r u m: W e ft- B u (ling-----,- ---~-12'-
W a p e----- -
H i ybra..te n
/ON SITE "DIMENSIONS
tv~'d th o A .th.ench ~At Requ.i.he d atea_
l eve Ith oA each tine. At Depth oA hock below tife _tn
Nurrrberi o6 . +i-ee Depth, oA tack ove.A ti. e. in
Total tength o6 tines At Depth o6 .cite b etow gnade. in
D.ie-tance between tines At hope oA tte.nch in. pen 100 6,t
ro-taf abeotp•tion area At Type oA Covet: Papet oA e.thaa
I 1 1) 1 MI NS 10NS
Nrrmheh oA ptt~5 GA vef atoun.d p.ti,tn yes nu
de diam e. tte.n + At depth betow inl'e-t A.t
(rl(' obsoAption area 6,t
A,reo ~regaited At
NtilXI C EEO BY TITLE
I'hUVI U DATE 198
II CIl h DATE 198
'I AtiON I oR REJECTION
1 ~
PLB 67 State and County State Permit #
4 `
of 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:
6~Iva.'Ir k-1 J
e'
B. LOCATION: .j 1,&2 % -11 J % Section , T 2R N, R
(or) 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 c3
D. SEPTIC TANK CAPACITY la~VZ-~ Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate' Absorb Area sq. ft.
New 'N'
Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: A- Length- Z Y Depth ~_Tile depth (top) No. of Lines 43
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- f 511 fj Distance from critical slope
WATER SUPPLY: Privateer Joint ❑ Community ❑ Municipal ❑
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 D ~ C.S.T. # 5j and other information
obtained from ~tJ (owner/builder).,
Plumber's Signature MP MPRSW# r3~ Phone #
Plumber's Address v
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.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application -c) 7 Fees Paid: State , L-% Count r'l-ti) Date < r _ 'f
_Y
Permit Issued/Rejet•ted (date) .5-- Issuing Agent NameV' ,✓l o
Inspection Yes 4_No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, Wl 53701
2. state (pink copy) 4, plumber (canary copy)
~ Revised Date 7/1/78
61,
E.H.115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVI iLJ ~ R r?1-
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HE L j
P.O. BOX 309 O 6' G I
lie
MADISON,-WISCONSIN 53701/y6'
) REPORT ON SOIL BORINGS AND PERCOLATION TESTS'
LOCATION_5_W%,- w0_%, Section` ON, ~ 0(or~'fownship or Municipality 1/'l~ of dSo y
Z
Lot No.,?o7-,, Block No. •S C ~9~'d.~ County
Owner's Name: _-c ubdivision Name
f~+ ct JJ _
Mailing Address: Qy lYudScs~t,. 44-lt_r Slredlfl
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X -ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS_ r'! 4 V ER OLATION T STS
SOI L MAP SHEET SOI L TYPE QIs_
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN I NCHSOILES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-1
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B_ ~o'r .*t 7 Grr /1 7►-s~ yr. S4 a-6 / 1f Gr
? ~i`r o 7S J+~.t" S;C G-r. 3ySe'Y" S•~/Gr.
B- G 6t j ~~'WC 4ts 7 ~~ta `t< BLS/ O`'~ a~~'~' ~ia~ y} H S~V-h~
PLAN VIEW (Locate percolation tests,soil bore holes and suitablesoil areas.)
Indicate on the plan the location and square feet off suitable areas. Indicate nu ber f square feet of absorption area
needed for building type and occupancy. A0 d 41 Ind' ate scale
or distances. Give horizontal and vertical reference points. Indicate slope. AV, f)Lx a... v- ~
fs ~.s° ~ ~ E ; ~ I 9 f
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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) Certification No. ss 15_?f
Address--1-e~tl etlrl r
Name of installer if known
CST Signature ^ '
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