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HomeMy WebLinkAbout020-1138-20-000 0 0 ic v 0 r~ G ~3 ~ v' c N O 0 CA C: Zo N) (D 3 m N (D N~ Q r. m~ C2- 9 z n O .y N Q O O p m 0 1 O n 3 W p O 3 ] CD 7 N V O Q~1 Cn -4 C N ~ lei Q d N w C/) D a = CD ? m a 3 a m o w O = 7D r) C) _ m m CD- ~ co co c cn Q- (n 0 3 vvvg h. D E co ry O. C/) (D O O N 7 0 ~ N 7 07 ? Q CD w Q N fD - 0. N a z zco z O D Q CD 0 = FD -T C/) a "IwA ~ CD N N CD v = W z N y z p Z CD _ C j A n m a A G O Z N (D 03T m~ o z 3 a Z * 00 N z C W N 0 x~ L D 0 S w N n a~~Q a L 01 -n CM) (I D c cn =3 a > CL z a d N a N M ~p O p~ L m 3 N N co Q c N C. m m W -N 0 7 Z ti p N o C A o: ~0 ` m =r (n m N N FD- 0 a M o co v O o S 0 p~ z A V O ~ A ti 69 O O :E CD C v o I Parcel 020-1138-20-000 06/09/2005 07:29 AM PAGE 1 OF 1 Alt. Parcel M 29.29.19.693 020 - 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 NELSON, CLARK E & KARI L CLARK E & KARI L NELSON 772 GHERTY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 772 GHERTY LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.668 Plat: 1979-GHERTY'S ADD SEC 29 T29N R19W GHERTY'S ADD LOT 8 BLK Block/Condo Bldg: 2 LOT 8 2 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/04/1998 578416 1320/318 WD 07/23/1997 853/56 07/23/1997 725/615 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.668 33,400 185,700 219,100 NO Totals for 2005: General Property 2.668 33,400 185,700 219,100 Woodland 0.000 0 0 Totals for 2004: General Property 2.668 33,400 185,700 219,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 310 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 V- 1 ~j~/ --2c) z-~l~.C13 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00+ (Determines if system is properly functioning at time of inspection) Property owner's name J~ > ✓ / t.f ~ eL V? 7-1 Property owner's address Legal Description 1/4 of the 1/4 of Section , T N-R Town of Lot Number Subdivision Name h-er*ji FIRE NUMBER LACK BOX NUMBER Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number i REPORT TO BE SENT TO: G' rf?H ~.e?<7[" Lt . 7. L( 7 ( f~L'e ~7 c;J 5-1 Closing date Signature VIL s AS BUILT SANITARY SYSTEM REPORT a~ OWNER TOWNSHIP: u _t _EC. `z~T .N-R• "iW ADDRESS ST. CROIX COUNTY, WISCONSIN. L SUBDIVISION Y; e 2 / , ~:n~-- LOT- LOT SIZE PAN VIEW ~ Distances and dimensions to meet requirements of H63 Dim EVERYTHING WITHIN 100 FEET OF SYSTEM a y I di a "e--oath Arrow I SC L'- - I f ~-t - fi--. BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point:- Slope at site: `41'PTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover Tansmanhole cover elevation: 77-'- Inlet Elevation: Tank Outlet Elevation: PUMP CLAMBER Manufacturer: Number of gallons Number of,gal. pump set or a cyc e gallons; total capacity o distribution lines gallon: size oT 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- oF-pits eet iameter feet liquid dept seepage pit in et pipe-elevation bottom of seepage pit ereva,tion feet. _ . SEEPAGE BED SIZE: number of lines wi th leogth_~? =tile depth" SEEPAGE TRENCH: width length PERCOLATION RATE I?„ AREA REQUIRED AREA AS BUILT- INSPECTOR - - DATI'D _ PLUMBER ON JOB - LICENSE NUMBER t"p w • VI f'ORT Of IN, IPf CT [ON - [NOLVIVUAI SIWAGt SVS.HM Savli f-aAy I'c~(mi 7 St(It S~rl.~ric /07ro NAi1lI / To(A)vlab(i1,~-- - St. Cif ('nr(vltit I <~a 4oVl 5~~ti~,w ~~I of N (bd V.i.biov( Sl PTIC TANK Si.v el~e_ gr~4Number( (,camY~rzn m(~nt w` t)(b takicc (I ~(oto We PC ~ B(14 Cd(VIC ~ 1 120 4 ors(, N4"'q aten PUMP[NG CHAMBER r Si c gaE -Crwb f umLr' c(v is a Ie M(IdvN(Imbv I HOLD [NG TANK' c gaev(Ivlmbcr( (I tit a.ntmevitb PUtorle1r a,rn Vah tancc A1(oto : We CC - - u.ti1'd-(vi g 12 ~eop Highwa ten ABSORPTION SITE Bed I ?IChcIt Di a tav(cc (Pt nto : We CC 6(44 ed.tn'q 12' 6 Corc It iqit (A)afv~( 3 - i. ABSORI'-EION S [TE DIMFNS IONS - W("dth o thvv(ch Rcy((ii(vd a~(va ~ - I cvl( ttl vacd( VVie 1 D('K't[i nA' l(och b('('ou1 t4'.Cc_ N(nto bcit (r( C ( P C Vcptit of Koch ('vv)( tiec ((I To ta4' Cc_vi gth o C4_vrv! - - --~r- 6.t Vcnth o6 tied bveow ad(l (vl D ~ # a vi c v h c t (4) v c n F i via. 0 0 ( { 4 TotaE ab5rhr~t(ov( (a?ICa - (t T(q)v of C((vcr(: Pa !,tI(a(41 PIT VIMf NSIONS Number( f pi_ 0 11vC a)ro((vnd yeti vr' 0 (1 th4dc diato etv7 Pepth below 4viec ~t T(I taE abhoIf r)t<(Iki a~Ica f,t A r e a h_ v q r (i- (v 1NS'PECTE'DY6S~ " z TITLE L J APPROVED DATE R[ _1E CTED GATE 19 K'I ASON FOR RI _fI CTION i P LB State and County State Permit # 67 Permit Application County Pe Na ~j 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: Tom Esser Menomonie. Wise 54751 B. LOCATION: NE NW Section T_ N, R_ E (or) W Lot# City Hu sons Subdivision Name, Gherty Add. nearest road, lake or landmark Blk# 2 Village Township &st Hudson C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms No. of Persons 5 D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks 1 HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) - 64d E. EFFLUENT DISPOSAL SYSTEM: Percolation Ratemin Total Absorb Area sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of meal Ft. Width Depth Tile depth (to Seepage Bed: X Length 3~ No, of Trenches Width Depth 2Tile depth (top) No. of Lines j Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 10% Distance from critical slope n e 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 Stephen L. ABby 1o6 C.S.T. # 4 and other information obtained from (owner/builder). Plumber's Signature, MP/MPRSW# MP 5184 Phone # 696 -2407 Plumber's Address Box 254 Woodville, 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. PLFAS8 R ER TO ATTACH& DRAWINGS. s : E i ~--a v a 3 , _ _ , , e e _ _ m e 3 a r e _t E , Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State er-c Co ty 6}- Date Permit IssueTcoy) (date)Issuing Agent Name Inspection YState Valid# Date Recd 1. county ( y) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pin4. plumber (canary copy) Revised Date 7/1/78 DEPNT OF REPORT ON SOIL BORINGS AND l 1 7 p`FETY & B ~ VISION .INDUSTRY, LABOR AND . PERCOLATION TESTS (115) P.O. BOX 7969 HUMA'N RELATIONS !n M N, WI 53707 LOCATION: SECTION: 20 TOWNSHIP/MUNICIPALITY: LOT NO.:B i4O.: SUP V1J4 NAM NS i/4 NW4 29 /T29 N/R ijE (ojW) West Part Hudson, `+di g t~ COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Tom Esser Menomonie, Wise 54751 `l USE DATES OBS V, !ONS MAQE: A ION TESTS: PIT PCL NO. BEDRMS.: COMMERCIAL DESCRIPTION: IROFILE F2 D ®Residence 3 ®New ❑Replace /16/61 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ~s ❑u ❑s ❑u ❑s ❑u ❑s ❑u ❑s ❑u t If Percolation Tests are NOT required DESIGN RATE:SYSTEM ELEV. If any portion of the lot is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST_ TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 84" None None 6" t.s. 30" is 48" es B- 2 84" None None 6" T.s. 30" is 48" es, B- 3 84" None None 10" t.s. 15" is 59" as B- 4 64" None None 10" t.s. 18" is 56" es B- 5 84" None None 8" t.s. 24" 1s 50" Cs B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ 1 0" No 10 2 -5 5 5 P- 2 No 10 2 -54 -5 -5 5 P- 3 36 No 10 2 P- 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 hori- 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 percent of land slop. SYSTEM ELEVATION 76' ol~_.._ A C--o_ JeFr'. a 40* x'0:8... tN Sc -r s ri `~,..y yon w~ 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): TESTS WERE COMPLETED ON: Stephen L. Aaby 1/16/61 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): Box 254, Woodville, A 1406 1698-2407 CVSI AT ..F: / .51 r DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) r ' yoijdA-* sq© 4Lu ' I I ~ i I + • j-., t f + i ~ R O ~ I rrl 'a r II S No i I i i I i 3~~~~~ooory~ (/•q o(, 7 s J ►►oS~n~.~ trc! -V /-."g ~N,~3ser~-~--4 3 x.1.S