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Parcel 020-1130-60-000 12/05/2005 05:08 PM
PAGE 1 OF 1
Alt. Parcel 17.29.19.621 020 - 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 - POSSEHL, RICK O & LONNA R
RICK O & LONNA R POSSEHL
489 PARK LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 489 PARK LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.900 Plat: 2274-PARK VIEW ESTATES 1ST ADD
SEC 17 T29N R1 9W PARK VIEW ESTATES 1 ST Block/Condo Bldg: LOT 40
ADD. LOT 40
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 807/84
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.900 67,100 170,500 237,600 NO 05
Totals for 2005:
General Property 1.900 67,100 170,500 237,600
Woodland 0.000 0 0
Totals for 2004:
General Property 1.900 34,800 153,600 188,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 208
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 ft c =?z TOWNSHIP SEC. TAN-RAW
ADDRESS i- ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION r r M<, °5 1--LOT ~ LOT SIZE Jr
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW 'EVERYTHING WITHIN 100 FEET OF SYSTEM
AF.
4 1_4
un~~
n
I di a e oath Arrow
SC Lk: = '','I t I J
BENCHMARK: (Permanent reference. Point) Describe:
Elevation of vertical reference point: Slope at site: J _
SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover_ Tan manhole cover elevation:j
sJ(;
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer:- Number of gallons
Number of gal. pump set or a cycle gallons; 'otaf
distribution lines gallon: size of pump head;
gallon per minute; - horsepower brand name of pump
and model number
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover---
`t'ype of warning device
SEr;l'AC~E PIT SIZE: ~ _umT~er of pits ee -diameter
feet liquid depth seepage pit inlet pipe-elevation_
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines_ ? wi tt jj le~tgth_7 the depth3
SEEPAGE TRENCH: width length _
PERCOLATION RATE L}- - A REQUIRED ! ' ;ARE AS BUILT INSPECTOR
DATED PLUMBER 0 OB
-
LICENSE NUMBER_
Rf, f PORT CF 7NSP( MON [NDIVlVUA[ StWAGL SYSTEM
S a yr i t o l+_ y I' e it rn i t 113
Star( S(' pt" c14/"
St. C '(n r x r r r vi l i
NAM f ((r(n Ali 4'f,)
,Ooe
Iirt'r(~(0 VI S ('Ct.i() VI/7 1(rt b
17- S 1tb(1(.V,ld((~vl --ew tod
ti( I [C "TANK
tir o gaPCovis Numbeh oAy compan_tme.n.to
0
Drhtancc rom: We
H.i.ghwa to n
PUMPING CHAMBER
S.i ze ga£('opi 6 Pump Manu(~actunen Mode. Number(_
HOLDING TANK
Si:'e q(T ('onh Number( o(I Compantme.vntb
P(rRipe h AQalim S(Ibtem
0(Atav1 ce (nc•in: wee(' 6uti.Qd~v(y------ !,Pope -
H i-9 It or at e n.
ABSORPTION SITE
br
Bed- 1 rreVic
D<~tancc ,(om: weep _G__ Bu4",fdi n~ f 11 A61ve-
ff~gItwateit
ABSORPTION SITE DIMENSIONS
wi dth (r ( 0(eneh ~t Requi ice- d a hea l
~7/ ivr
[.cogth oA e-aeh (.ine _6 Depth oA rLock bed- ow ti, 0,
Numbers o6 Depth oA goeh ovet tli.Pe Z iv
JotaP Pevrclth of 4'i.nca 6t Depth o6 tifee, be.Pow gnade_ in
F~'.~.. 70
~.6tanc( he tw(_en P.rn(h - t ~`f'4 , ~ Al
f aP abaonnt-<-av( anea ~t Type of Coveh.: Papeh n a t>(aw
r~ v
L Tl DIMENSIONS
N u Rib c >r t% G~(a v e P an o u n (E +.t5 yeA
Outh.i(lc (I ame,ten 6t De-pth be.('aw 4" vi c t
TotaP ab!)orrpti_an ahca
INSPECTED BY TITLE
h
APPROVED DATE 19
RI( it CTED DATE
I:(ASON Loll' U JLCTION
Ilk
.~h
t • ~ pV ~
State Permit
PLB 6 7 State and County
If: w Permit Application County Permi #
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:
Al L_ _
B. LOCATION: /a .-'/4, Section LZ, TN, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPAN Y: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY 100a 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. EFFLUEN DISPOSAL SYSTEM: Percolation Rate Total Absorb Area ~LL sq. ft.
New 4/ Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width ~pth Tile depth~(top)7_ No. of Tre es
Seepage Bed: Length 34- _Width Depth` Tile depth (top)- No. of Lines
Seepage Pit: Inside dia~eter Liquid Depth No. of Seepage Pits
Percent slope of land h'7a Distance from critical slope
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 Ce tified Soil Tester, r d
NAME R~1~ /1 j S C.S.T. # ~ 7 5 7 nd other information
obtained from (owner/buil
Plumber's Signature NAP/VPRSW#/OP~15 ~L Phone #~.'~7- 3 3
Plumber's Address lVet-- to v7 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 BelowG FOR COUNTY AND STATE DEPARTMENT USE ONLY p J
Date of Application Fees Paid: State County / . Da
Permit Issued/Rejected (date) le 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 7/1 /78 ,
F H - 11 J Rev. 908
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701 `t
r0 w ~
r lam' ~ ~F/,''r~i
LOCATION :'/4Section 17 T.?N,R&(orl ownship or Municipality J l
Aid
n j rf~
Lot No. Block No. t County ;
ubdivision Name (,►F l .J
Owner's/Buyers Name:
Mailing Address: f rX7 , 4jl S • J ZCy 6 f ,I
Ou
TYPE OF OCCUPANCY: Residence X- No. of Bedrooms -3 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW x REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS a~ _PERCOLATIOM TESTIS I'D-02
SOIL MAP SHEET NAME OF SOIL MAP UNIT JA'
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
RATE
NUM- SINCE HOLE HOLE AFTER INTERVAL
MIN; IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- / #94, Sam ~e ~Zi o 3 to
P- d2 -9,q 11 Se re- / y o -3 y'x- y' /
P „2" e n S
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- Alcaie_ YLIt _30 1( k)4e- /is '30
B- 7 spa ry Os• f+ (i- 7 a
- W. Z2
B- 3 ar bt ca ct - X.- (Z J J
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian loca ion and square feet of suitable ar(
Indicate number of square feet of absorption area needed for building type and occupancy / °~J)ndicate scale or distar
Give horizontal and vertical reference points. Indicate slope.
A40 AS- Zd-Ite,4
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1 3 7-P Jlgme- /t4ro-4 ~
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1, 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. 1
Name (print) ' Certification No.~
Address e /J 't S
Name of installer if known s
Copy A -Local Authority CST Signature
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