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Parcel 020-1145-40-000 10/11/2005 08:10 AM
PAGE 1 OF 1
Alt. Parcel 17.29.19.763 020 - 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 - HANSON, WM & DELPHA
WM & DELPHA HANSON
975 WERT RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 975 WERT RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.560 Plat: 2276-PARK VIEW ESTATES 2ND ADD
SEC 17 T29N R1 9W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 70
ADD LOT 70
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 659/289
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/26/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.560 30,900 174,900 205,800 NO
Totals for 2005:
General Property 1.560 30,900 174,900 205,800
Woodland 0.000 0 0
Totals for 2004:
General Property 1.560 30,900 174,900 205,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 111
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEI4 REPORT
OVER -5, q am lnr , TOIMSHIP `Yua°'s SEC. -7_ T Z (N, R ~W
10DW SS ST. CROIX COUNTY,s~WISCONSIN.
?DIVISION LOT 7 v LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
T SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Indicate Worth Arrow'
fi - -fi--t-- - - f - - ~--1 - - - - _
c I ! i I ( ; SCALE .
c;PTIC TANK(S) 1060 )'M GR. r ? s PN CONCRETE t/ STEEL
NO. of rings on cover Depth DRY WELL
'tIENCHES NO. of width length_ area
no. of lines 2 width- ,2 length 57_ area~~
depth to top of pipe 10
r'
~G P,EGATE
RATE AREA REQUIRED j AREA AS BUILT G
kr,glaimer: The inspection of this system by St. Croix County does not imply complete
.oioliance with State Administrative Codes. There are other areas that it is not possible
`,o inspect at this point of construction. St. Croix County assumes no liability for
jStem operation. However, if failure is noted the County will make every effort to
,,:ermine cause of failure.
(GASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
-INSPECTOR:
DATED j % r PLU; fBER ON JOB X)
LICENSE NU11BER /41
r
z
REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.i.tar y Penm.i.t
• State SPp~cr.
NAME___~ S$. iownship C A o i x County
Location `5Ce LL Xl1: Section
SEPTIC TANK 521~
Size ' ="z= gattons. Numbers o6 CompaAtmen-ts
Distance FAOm: Wet L : 6t. 120 on gAeateA zZope 6t
Bu•itd.ing 6.t. Wettands ~ .
H.ighwatet _ 6 .
DISPOSAL SYSTEM
Distance FAom: Wet 12% on greaten stope 6 .
Bu.itd.ing 6 Wettands Ft.
H•ighwateA 6t.
FIELD DIMENSIONS:
Width o6 ttench 6t. Depth o' Ao ch. b etow t.ite in.
Length o6 each tine el 6t. Depth o6 rock oven tite in.
Numbers o6 tines Depth o6 t.ite below grade in.
TotaZ tength o6 tines ~ 6t. Stope o6 tAe.nch in pen 100 6t.
Distance between .roes 6t. Depth to bednoch 6t.
AFotat absorbtion area-"2 6t2 Depth to groundwateA 6t.
e, or Stna.w
Required area 6t 2 Type o6 ~ Coven: Pap.
-
PIT DIMENSIONS:
Number o6 pits GAavet around pits yes no
Outside diameteA 6. 1 `I-Depth below .inlet _6t.
Totat absonbtion at ea 6t A
2 ~
Area nequiAed 6t
r
INSPECTED BY TITLE
APPROVED DATE Z-2 c 19 7 j
~r
REJECTED DATE 197
r\l
--EH 115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS 1- _l
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES r``<
' P.O. BOX 309, MADISON, WISCONSIN 53701 1t1~1
JtiL
s / Z4NI~G
LOCATION:4 `7 T~ .+1 `N,R~ ~ ~ or)(ownshipor Municipality
/u /a,Section ,
Lot No.~, Block No. County S xore! IC
Subdivision Name
Owner's/Buyers Name: -5_ P
Mailing Address: 6L1 _V, SI-Vel6l
TYPE OF OCCUPANCY: Residence x No. of Bedrooms 3 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS ~0 ` 2 9
SOIL M1 AP SWEET _ A 17
NAME OF SOIL MAP UNIT Y ~9'~~' ► ~cGR~'L
PERCOLATION TESTS
DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
IESf NUM- SINCE HOLE HOLE AFTER INTERVAL
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
I P- ffp° l/~ ~r/O .Z-
P- e Lire avl-,4 ;;2 7
P- care O -SAY S~ /
P-
P-
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 y-~ IF OBSERVED IN INCHES
B / /S` / J :2 i~ s• .y2 u s C U/jrf"~ .5. . 3d- B- oZ G ~ IIG " / y" S "~S oc 4'" s 'U fey S
+CS,2S"S 36" 6, cs-rc? -S
fell
B- e- e
57cl- Ale
B_ e,y /Ya 7L3 396 SA eC ~re° S
S4, -S
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location a_od square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy 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) A 0e 17-S Certitication No. SS~ ~s
Address
Name of installer if known J~
Copy A nat: trams ` y .N
-Local Authority CST Siy
PLR 67 State and County State Permit
of Permit Application County PerrOi
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:
B. LOCATION: Section ~T T N, R E (or) l Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. 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 or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT, DISPOSAL SYSTEM: Percolation Rate- - Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of ~ineal Ft. Width epth Tile depth (t5 r)A) No. of Trenches
Seepage Bed: Length Width Depth Tile depth (top)-~_No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
1, 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. # and other information
obtained from (owner/builder).
Plumber's Signature.. . ~ MP/MPRSW# Phone
Plumber's Address
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 County Date 1
Permit Issued-/ Rejected (date) Issuing Agent Name
Inspection Yes No State 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 7/1/78