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Parcel 020-1128-70-000 10/11/2005 07:57 AM
PAGE 1 OF 1
Alt. Parcel 17.29.19.602 020 - 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 - MEYER, KURT R & DENISE K
KURT R & DENISE K MEYER
452 PARK LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 452 PARK LN
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.650 Plat: 2274-PARK VIEW ESTATES 1ST ADD
SEC 17 T29N R1 9W PARK VIEW ESTATES 1 ST Block/Condo Bldg: LOT 21
ADD. LOT 21
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/15/2003 721550 2242/413 WD
1198/041 WD
920/175
911/525
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.650 35,500 172,100 207,600 NO
III
I
Totals for 2005:
General Property 1.650 35,500 172,100 207,600
Woodland 0.000 0 0
I
Totals for 2004:
General Property 1.650 35,500 172,100 207,600
Woodland 0.000 0 0
Lottery Credit: Batch M 523
Claim Count: 1 Certification Date:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
",?NER , TOWNSHIP SEC. TAN, RZf W
.0. ADDVSS a / T. , ST. CROIX COUNTY, WISCONSIN.
LOT LOT SIZE
PLAN VIEW
-Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
L
tye
142 (t' I .
1'✓/*A
I
?TIC TANK(S)_~- MFGR.CONCRETE_'~L STEEL
NO. of rings on cover Depth DRY WELL
.ENCHES NO. of width_~ length area -i
;D no. of lines j` width length area
I d'rpth to top of pipe
1GREGATE -
K RATE AREA REQUIRED' AREA AS BUILT
sciaimer: The inspection of this system by St. Croix County does not imply complete
mpliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
-stem operation. However, if failure is noted the County will make every effort to
'.termine cause of failure.
:EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
s
"INSPECTOR i
DATED PLUMBER ON JOB 5
LICENSE NUMBER ~j fj
REPORT OF INSr-CTION INDIVIDUAL SEWAGE SYSTEM
` San.itaAy PejLm.it
• . State Septic-, - ,
t ~
NAME i ownship CC St. C'to ix Cou.aty
Locat.ioK Section
SEPTIC TANK
S.izegaUonz. Numb en o6 CampaAmens
Diz tanee PAOm: WeZZ 6t. 12% an greateA slope` it
Bu.iZd-ing it. WetZands __6t.
H ighwazeA ~ .
DISPOSAL SYSTEM
Distance EAom: WeU 120 on greaxeA IsZope it.
Bu.iZd.ing it. WetZands Ft.
HighwateA - it.
FIELD DIMENSIONS:
W.id•th o6 tAench 5 it. Depth ob Aock below t.ite ~ Z- .in.
Length o6 each Zine it. Depth o6 Aock oveA liZe ~ in.
NumboL o6 Zine.s v~ Depth of tiZe below grade_ .in.
TotaZ Zength o6 lanes' > 2 it. Slope o6 tAench in peA 100 it.
Distance bettveen Zine/s- it. Depth to beduch. ~ •
Tota.L ab~s arbtion area ~t2 Depth to gtoundcvatea 5.t.
Requ-i..Aed area it 2 Type o Coven: PapeA o,% StAaw
~i
PIT DIMENSIONS:
Number, o6 pigs G4aveZ an.ound pits yeas no
Outside diameteA it. *epth below .inte.t it.
2
TozaZ ab6orbtion area it
2 ~
AAea AequiAed_
INSPECTED BY TITLE • /
APPROVED DATE ' 197f/.
REJECTED DATE 197.
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
y REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: Section/2-, T 1, R 174 (or) W, Township or Municipality 1 9 46a t~
Lot No. Block No. of- <_County
` ~ S4b~livision Name
Owner's Name: ol~~<1 6
Mailing Address: tr r,~4 d e q TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW k<~~ ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 79! PERCOLATION TESTS 3'
SOIL MAP SHEET SOI L TYPE 090-q-4 a ~ Ze d
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IERN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-! 3~ s
ors
P_9
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) Z 2, • 11-5 P -
5; 17, y
B
B S 1 , f yy G.~
17
PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.)
Indicate on the plan the location and square f~ of suitable reas. IndicaAe number of aree f-e`et of absoorrpti area
needed for building type and occupancy. - r1~0 ~SitPcale
or distances. Give horizontal and vertical reference poi s. Indicate slope.
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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) D Certification N' '141 gZ& 1;
Address
Name of installer if known
CST Signature ~ 9,r
A LOCAL ALI 1 HOR ,6J
.e
PState -L ~ 6 7 and County State Permit #
Permit Application County Permit # - <
1-11 IT
for Private Domestic Sewage Systems County ~T
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: F Y4 Ao!~F '/4, Section , T2;Xy N, R % `I E (or) W Lot# , City
Subdivision Name, nearest road, lake or landmark Blk# Village
6 Z-:~, Township i~cr5pti
C. TYPE OF OCCUPANCY: *Commercial 'Industrial *Other (specify) *Variance
Single family' Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES' ishwasher [r ES NO Food Waste Grinder YES [.10 # of Bathrooms 2-
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY 07~ Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation b~ Addition Replacement Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUEJ~Y DISPOSAL SYSTEM: Percolation Rate 1) :`J 2) . 573) ; S Total Absorb Area sq. ft.
New ~ Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Vro ~ Width Depth 3j~ „ Tile Depth ;2L No. of Lines 3
Seepage Pit: Inside diameter Liquid Depth Tile Size y
Percent slope of land !3 ^ Distance from critical slope
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 Ceed Soil Tester,
NAME rti ' e- ! Y . 9 / /7 } C.S.T. # 3 and other information
obtained from (owner/builder).
#
Plumber's Signature MP/MPRSW# f -s one
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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aN e
~'I D a p
u
Do Not Write in Space Bel w FOR DEPARTMENT USE ONLY
Date of Application f' Fes Paid: State County Date
Permit Issued/RnNo (dale) S Issuing Age Name c %
Inspection Yes Valid# Date Rec d
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 6/1 /76
TRANSFER FORM
SANITARY PERMIT
G State Permit # PLB 67-T p
1,0_4 Sanitary Permit... # 4
~ a
} r 1v County - o
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location: ' ~ice'/,, Se,action T N,R E (or) W Lot # - ity
Subdivision Name, fC~U~~~(J }"fL~ -Nearest Road, Lake or Landmark BLK # Village-
T(
wnship r./
B. TYPE of Occupancy:: Commercial Industrial Other (Specify)
Single Family Duplex No. of Bedrooms Variance
C. SEPTIC TANK CAPACITY J__ti:521!_ Total gallons No. of tanks
HOLDING TANK CAPACJ Y Total gallons No. of tanks
Prefab Concrete Poured-in-place Steel Fiberglass Other(Specify)
New Installation Replacement
LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other (Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
} rf New R lacement Alternate (Specify) ;
Seepage Trench:- No.Lineal Ft. r Width ~_Depth ile Depth(top)2No. Trenches
Seepage Bed:___ Length Width Depth Tile Depth(top) No. of Lines
Seepage Pit: Inside d.ameter Liquid Depth No. Seepage Pits
Percent slope of land Distance from critical slope
E. WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal
Present Sq tary Permit Holder Phone No. Sanitary Permit Transfe red To: Phone No. _
!/F
Name ) e
Nam
Address ,~j'~
Address
Zip -Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20,, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Testeryd/or any addittiiiggnal soil ~tests _that may have been required.
Plumber's Signature
L~2/G✓_/~,~/.~-r~~ MP/11b"#L" Phone
Plumber's Address r le14- c'7 'r-f ze,
Information obtained from (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
'l has of be
en _rille~asetdjt~,_-
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Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green Icopy) P.O. BOX 309, MADISON WI 53701
TRANSFER FORM
PLB SANITARY PERMIT
67-T to State Permit #
Sanitary Permit #
County
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location: Section T -N, R E (or) W Lot # -City
Subdivision Name, Nearest Road, Lake or Landmark BILK # Village
Township
B. TYPE of Occupancy: Commercial Industrial _ Other (Specify)
Single Family Duplex No. of Bedrooms Variance
C. SEPTIC TANK CAPACITY 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/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other(Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 'Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches
Seepage Bed: Length Width Depth -Tile Depth(top) .No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits
Percent slope of land Distance from critical slope
E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No.
Name Name
Address Address
Zip Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20., Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Tester and/or any additional soil tests that may have been required.
Plumber's Signature MP/MPRSW # Phone # -
Plumber's Address
Information obtained from (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor's property. If well has not been drille
E
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Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701
• TRANSFER FORM
PLB 67SANITARY - T PERMIT
State Permit #
Sanitary Permit #
County
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location: '/4 Section T N, R E (or) W Lot # -City
Subdivision Name, Nearest Road, Lake or Landmark BILK # Village
Township
B. TYPE of Occupancy:. Commercial Industrial Other (Specify)
Single Family Duplex No. of Bedrooms Variance
C. SEPTIC TANK CAPACITY 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/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other(Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 'Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches
Seepage Bed: Length Width Depth Tile Depth(top) .No. of Lines
Seepage Pit: Inside o.ameter Liquid Depth No. Seepage Pits
Percent slope of land Distance from critical slope
E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No.
Name Name
Address Address
Zip Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20., Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Tester and/or any additional soil tests that may have been required.
Plumber's Signature MP/MPRSW # Phone # -
Plumber's Address
Information obtained from (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor s ro ert . If well has not been grilled pleas indicate,_-
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Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green (copy) P.O. BOX 309, MADISON WI 53701
' TRANSFER FORM
" SANITARY PERMIT
PLB 67-T State Permit #
Sanitary Permit #
County
Sanitary Permit Transfer Date Original Permit Issuance Date
A. Property Location: '/4 '/4, Section , T N,R E (or) W Lot # -City
Subdivision Name, Nearest Road, Lake or Landmark BILK # Village
Townshi p
B. TYPE of Occupancy:.Commercial Industrial Other (Specify)
Single Family Duplex No. of Bedrooms Variance
C. SEPTIC TANK CAPACITY Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab Concrete Poured-in-place Steel Fi:berglass Other(Specify)
New Installation Replacement
LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify)
D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches
Seepage Bed: Length Width Depth Tile Depth(top) No. of Lines
Seepage Pit: Inside o,ameter Liquid Depth No. Seepage Pits
Percent slope of land Distance from critical slope
E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal
Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No.
Name Name
Address Address
ZiP Zip
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared
by the Certified Soil Tester and/or any additional soil tests that may have been required.
Plumber's Signature MP/MPRSW # Phone # -
Plumber's Address
Information obtained from (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh-
bor sproperty! If Well has not been dnl_lec(,_~~e ~ j dicate,
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Signature of Issuing Agent
1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701