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Parcel 020-1019-50-000 12/20/2005 08:24 AM
PAGE 1 OF 1
Alt. Parcel M 14.29.19.926 020 - 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
DAVID J & JEAN C ROSE O - ROSE, DAVID J & JEAN C
998 TANNEY LN
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 998 TANNEY LN
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 5.025 Plat: N/A-NOT AVAILABLE
SEC 14 T29N R19W NW NE LOT 1 OF CSM Block/Condo Bldg:
3/768
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill l=air Market Value: Assessed with:
91501 247,800
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.025 87,200 165,500 252,700 NO 05
Totals for 2005:
General Property 5.025 87,200 165,500 252,700
Woodland 0.000 0 0
Totals for 2004:
General Property 5.025 58,000 138,800 196,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
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
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP 771 d S-0 r) SEC. N TMN-R /9W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
b` Fl
~jU~Q~ ~it✓~/y.
SUBDIVISION IJ'76 LOT f7
LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SH0W__E_VEE._YTHING WITHIN 100 FEET OF SYSTEM
cz~v
E
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1 ~ • N
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C
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I di a e o thl Arrow ~I
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: /dc,/ Slope at site:'3-5 ~c
SEPTIC TANK: Manufacturer: ~ - c Lcir-Cjz , Liquid Capacity:
Number of rings on cover Al -SL 7~ Tan manhole cover elevation: e4iol 't"
Tank Inlet Elevation:Tank Outlet Elevation: 93`>"
PUMP CHAMBER
Manufacturer: _.LL /A Number of gallons
Number of gal. pump set or a cycle gallons; total capacity o
distribution lines gallon: size of pump head;
gallon per minute horsepower bran 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: Number o pits feet diameter
feet liquid dept seepage pit in etpipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines ~2_ width le-1 leqgth5e tile depth 39//
SEEPAGE TRENCH: width length
PERCOLATION RATE > o AREA REQUIRED E- RE AS -~UILT;~,,
INSPECTOR _
DATED /,'i PLUMBER ON JOBS-~,~~ct'
LICENSE NUMBERA- z
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f ~L ` `tl t Cc Tic c t~ c~ 5 ~G~c Cc~cy
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This agreement, ma,~ and entered on this day of ,
19 by end het.,,-aen the township of C-LJ.::ewa C(.)unth,
Wisconsin.
WHEREAS: An application has been made for a sanitation sys'em on the
following described property:
h h, section T n' a W
Lot Block Name of Subdivision
WHEREAS: The owner agrees to install a holding tank for septic tank
purposes.
NOW, THEREFORE: For and in consideration of the issuance by the Town-
ship of of a permit for the above premises, the
pznrties do hereby agree and bind themselves as follows:
1. Owner agrees that they will conform to all rules any' z-egulaticns
pertaixiarng to a holding tank system. They agree that anytime
said township deems it necessary to maintain this tank, the
owners shall have same maintained in 24 hours, or townships will
have said work done and charged to owners and place same on
their tax bill as a special charge. Pumping is included as
normal maintenance.
2. The townships reserve the right to assess a bond if they desire
to cover any possible maintenance charge in the sum of $ _
IT IS UNDERSTOOD that this agreement shall be binding on the owners,
their heirs and assigns.
IN WITNESS WHEREOF, the parties have hereunto set their hands and
seals the day and year first above written.
SIGNED: Name of town official
Address
SIGNED: Name of owner or developer
Address
STATE OF WISCOrTSIN)
SS:
COUNTY OF CHIPPEWA)
Subscribed and sworn before me this day of _19
SIGNED: Notary Public, Chippewa County, WI
My commission expires
RLPORT OF INSPECTION INDIVIDUAL St WAGE SVSItM
Savti ta~lIj PenIII i t Q~j
State Septtc /
AME- Town.ehtipSt. Cnof x C'oun tl1
cation- ~&AA Sec-tian~Lu-t # _Subdivie4an
1PTIC TANK
Si z e gatto n.a Numb e4 o6 co mpaA.tmen-te
,(htanee 640m: , Wet.L Bu4.Eding ,-1 , 12% 6tope ~
Highwa-teA A NJ")
LIMPING CHAMBER
Si ze gatxon.4 . .Pump Manu6actunLoi. ~Mudz.i Nunib,~-,,_
OLDING TANK ,
Stize gat on.e NumbeA o6 Com,pa4tment,6
PumpeA L AxaAm Sye.tem_
ie -tance. 64om: Wett Buitding._._._.____ 12`o 6. ope------
Highwa.teA
NSOPPTION SITE
Bed TAeneh
(,stance 6Aom: Wet.E Buieding_12% 6tope_,--
Highwate4
-
t;SORPTION SITE DIMENSIONS
w.idt6i o( tAench -5.t Req uli Aed aAea_ ( t
Length u6 each .E.i.ne. ff 6t Depth o6 Aoch befow ttee
Numbe_ii u6 U'ne-6 Depth u6 Aock oven tike
Tutak feng.th o6 tine,6 ' 6t Depth o6 tite below g.nade
- - -
D,i.aLance between tinee `Y. ~.t Stope u6 -tAe.neh ,i.rl. pen 100 6t ?
1 04 ,.t ubo 04ld iun anew ,6.t Type o6 Coven: Papers oh, tnuw
~.7 I T%`DI MENS I ONS
, r
Number ()6 pi.t,6- GAavet around pita yel __nu
Ou.te4de d.iame-teA6-t Depth below n('et - ----6t
Tutat abaoAp-tion aAea 6-t
Anea nequilLed 4 6t
NS PECTED By,rC" TITLE
PROVED . DATE_ _L - f-- - 19 8
'I JE CTED DATE 198
'1 ASON FOR REJECTION
REPORT ON INSPECTION OF SANITARY PERMIT #
(1) Dame and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
ame, ress ice s o.~o ns a ing Plumber Ti rfie of Inspection
-
3 NSTALLATIQ CONSISTS OF:
I Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit Seepage Bed ❑ Holding Tank ❑ Fill System
(4)BENCHMARK: (Permanent reference of nt escri be ~)/7~ ,
Elevation of vertical reference point: /'Z-j Slope at site: y
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity lQD B
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: /DO "Y # ft to well:
(7)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 ❑ N0;
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: 12,- ft width; .f:2 ft length; tile depth;
?A_1 i.neal feet ti 1 e; _,J~ft to resi dence; a ft to wel l ; 00 ft to lot or
property line; ft to ordinary high water mark of lake or stream; _A),4 ft to ecg-
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? ZYES ❑ NO
(13) Has system been installed in floodway? ❑ YES NO Floodplain? ❑ YES RNO
DILHR-SBD-6095 N.05/80
Signature of Inspector:
{ioc+~cn~
PLB'67 State and County State Permit #
a !i 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:
Dcz J c c A 1-.
B. LOCATION: /Q AE Section , T_ZYN, R_L_2+--(w) W Lot# _I City
Subdivision Name, -nearest road, lake or landmark Blk# Village
Township
1
C. TYPE OF O PgNCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY /g 8)00- Total gallons No. of tanks r
HOLDING TANK CAPACITY Oil X4 Total gallons No. of tanks
Prefab concrete L/~ Poured-in-Place Steel Fiberglass Other (specify)
New Installation lz Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENj DISPOSAL SYSTEM: Percolation Rate Total Absorb Area~LS~-1E sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length- 6712' Width J Z ' Depth 0 Tile depth (top) '24-j if No. of Lines
Seepage Pit: /Inside ameter Liquid Depth No. of Seepage Pits
Percent slope of land-2- Distance from critical slope Zfl
11
WATER SUPPLY: Private 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 C.S.T. # ~$5- and other information
obtained from builder).
Plumber's Signature i? } fMPRSW# z Phone #56-:
Plumber's Address Z
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 Fees Paid: State G}C) County D e
Permit Issued/R i cted (date) Issuing Agent Name
Inspection YesNo 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 7/1 /78
EH 115 Rev.'9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: Y4, n)a Y4, Section 11 J29 N,R_&4,W W, Township or Municipality! /1- 9 yx
Lot No. , Block No. c9~ =r. D 3 1>a C_0 71c, t7 County a S C r` 11 ,
bubdivl~ Name
Owner's/Buyers Name: ~ s '
Mailing Address: l//
TYPE OF OCCUPANCY: Residence-JC/No. of Bedrooms 3 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS SZO A;;:~1. PERCOLATION TESTS IV A&
SOIL MAP SHEET NAME OF SOIL MAP UNIT
PERCOLATION TESTS Q CL f e
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME 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
P `
P- i S 0.~ C.Li lr ` 3
P- x
P_ Ct
P- ofoor
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
B- t) 7 of ! t/~~ + i1116 /
AP, > /d t, lr ~ ~
B- I
B- II ! _ 1 S I'
B- fyc I~ - IOC--" 2t)~~ ci
C4Q B- CSC > t a L) AL J9 -A
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on t plan the location an square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy C= 2,A Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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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) F _ • Certification No. 7
Address LLf,
Name of installer if known S. cz s'
Copy A -Local Authority CST Signature ~~M
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SYKORA BROS. CONSTRUCTION
NAME :
ADDRESS
WEEK ENDING
Fours Job Description Started Dinner Quit Mileage
Total
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