HomeMy WebLinkAbout020-1061-50-000
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Parcel 020-1061-50-000 02/22/2005 01:05 PM
PAGE 1 OF 1
Alt. Parcel 23.29.19.232 020 - 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): Current Owner
* QUALLS, GALE H & ISABEL N
GALE H & ISABEL N QUALLS
759 HWY 12
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 759 HWY 12
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 39.620 Plat: N/A-NOT AVAILABLE
SEC 23 T29N R1 9W SW NE ALSO A STRIP OF Block/Condo Bldg:
LAND O _ HE EAST SIDE OF CSM 7/1878 IN
THE N Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page 1 Type
07/23/1997 897/401
2004 SUMMARY Bill M Fair Market Value: Assessed with:
48108 Use Value Assessment
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.620 2,300 0 2,300 NO
OTHER G7 2.000 33,000 136,300 169,300 NO
FEDERAL X1 1.000 0 0 0 NO
Totals for 2004:
General Property 39.620 35,300 136,300 171,600
Woodland 0.000 0 0
Totals for 2003:
General Property 39.620 35,400 136,300 171,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 119
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
001-WATER SPECIAL ASSESSMENT 0.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
r ~
AS BUILT SANITARY SYSTEM REPORT
OWNER I2 x 1. kl , ~S TOWNSHIP lk'6 eta SECd_~~ TAN-R_6W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION. a LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
o-w-Y-VEIRYTHING WITHIN 100 FEET OF SYSTEM
_1 7-
TZ /111"/ IX
1, - a
}
i
7
-
134
y.
Cc~` % G U \
I di 6a 4e o th Arrow I
BENCHMARK: (Permanent reference Point) Describe:
Elevation of'vertical reference point: /e' Slope at site: ~GU
SEPTIC TANK: Manufacturer: Liquid Capacity: i~
Number of rings on cover Tank manhole cover elevation:
Tank Inlet Elevation: 9/; 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 of 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 feet diameter
feet liquid dept seepage pit in et pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines j width ° _lerrgth A~~_the depth
SEEPAGE TRENCH: width len tl
PERCOLATION RATE % -AREA REQUIREDU AREA S BUILT
INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER
R1P0R1 0f INSP1CIION IN01VIVUAI SIWAGE SVSTtM
tiani raqrl Purr
S1att, Sertic /6
NAMI /~sr G~rV(ow VIA Grip_ (''11olx Co(iyrlit
I ~c((t[(I n rr i ov 1 o t M Su1) div,i_A i on
SI PTIC TANK
Si 1 e qaT eon,5 Numbers o6 eompan,tmen t6
V(s tance loom: W V f Bu~Pdrnc
Hi-ghwa ten
PUMPING CHAMBER
Si ze - - ---gaQi'on6 Pump ManuOc.tunon Model Numbe u
HOLDING TANK
Size gaPonA Numbv, oA CompantmentA
Pumpers _ Aeanm Sif btern,
Oi s tance loom: WvV Rui Pdiwq 121 6 Pope
E1ig1,w«ten
ABSORPTION SITE
Red TnencIt
Di6 tance_ loom: We tk Building ? ~ 176 A Eape-
Ilighwato n
ABSORPTION SITE DIMENSIONS
Width of trench -fit Requirred area _
1-Cogth oA each ('ine A.t Depth oA Aock below fife ~ ar
imbc11 o0 Cano5 _ Dc'pt1r ~ u A noch oven fife 112
~Vmtaf eength oA Ilin e6 A .t
Depth aA ttiPe below grade
, a n (e b P two P n 11wri s- - A irtirrG}r n~Rnr+rye t 'y~„e'n c h rr~n~rN T"'n' w"J'o p j
To taP ab5oup Non a a v a t TI
rK~
_f e o( Coven: Paps n on tnaru
PIT D'IMINSIONS
N"mben oA p.i to Gn_avet' Anon p~.fiA yeA vr'
OutAide diameterr At Depth befow i-nPet ail
Totaf ab6onption area At
W a nequine At
INSPECTED BV TITLE
APPROVED DATE 1L I ~ r. fi
Rt JECTED DA71
R1 ASON FOP RI 1ECT10N r^
State and County State Permit # r
PLB 67 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:
Us le
B. LOCATION: c5( '/'/4, Section T N, Rf (Fr) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family e'< Duplex No. of Bedrooms No. of Persons Z
D. SEPTIC TANK CAPACITY /o2,00 Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete •X Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement ~x
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area X12 f' sq. ft.
New Replacementtk-' Alternate (Specify)
Seepage Trench: No. of L'inal Ft. Width Depth Tile depth (top)T-No. of TrencLies
Seepage Bed: Length Width Depth `V2" Tile depth (top)~No. of Lines ~j'
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land -V r~ ` 2 ZE: Distance from critical slope
WATER SUPPLY: PrivateX 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 & _,&hES (_iI./IStBD{v7~S"~~- C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signature Phone
MP/MPRSW
Plumber's Address S j::ix
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.
3
f ,
m.. w. _ _ . , - m
. . .
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i
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT SE ONLY
Date of Application ~Q "ZZ FeesppP id: State County & D -lam - d
Permit Issued/f iecte* (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 7/1/78
7
199 15 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS %o
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
%e 3o 1~e~
LOCATION4', Section : ,_,1N,RZf* (or)rownship or Municipality a c F
Lot No. , Block No. N,
County •y ,
Gam/ ~/1 r
Owner's/Buyers Name: Subdivision Name
~ f[ Il/ttq.Il1 1.4 C ~-••''Mailing Address: RA d,St~ ~ 1/1 5 "4116
TYPE OF OCCUPANCY: Residence__~_(_No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW -REPLACEMENT ALTERNATE SYSTEM 17 OTHER _
DATES OBSERVATIONS MADE: SOIL BORINGS fi+~"~ Z PERCOLATION TESTS V 19
SOIL MAP SHEET S NAME OF SOIL MAP UNIT
_ _ PERCOLATION TESTS
TEST HOURS WATER IN TEST TIME
DEPTH CHARACTER OF SOIL DROP IN WATER LEVEL, INCHES
NUM
NUM- SINCE HOLE HOLE AFTER INTERVAL RAT>-
MIS:, IN
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PER71OD 1 PERIOD 2 PERIOD 3
P_ se e r2 ~p. AID J 3 -3
8 6, v 3 (o
P-3 Sew. re alA A, S .2 .7 i .
P-
P-
P- J3
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSE/RVED ESTIMATE(D~ HIGHEST IF OBSERVED IN INCHES
/
~ At .1 x
B- 2-
B-
B-
B-
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian the location and square feet of suitable areas.
Indicate numb r of square feet of absorption area needed for building type and occupancy ®cate scale or distances.
Give horizontind vertical reference poin/t~. Indicate sl
es 14-S ope. 4 / /
.
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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)- Zy~s v Certification No. S
/~f 9
Address "n
D,~t
&ze
` Name of installer if known _
Copy A -Local Authority CST Signature
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