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Parcel 020-1140-70-000 08/28/2006 08:20 AM
PAGE 1 OF 1
Alt. Parcel 19.29.19.718 020 - 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 - ANDERSON, ROGER O & JEAN
ROGER O & JEAN ANDERSON
360 AUDUBON LA
HUDSON WI 54016
Districts: SC = School SP Special Property Address(es): Primary
Type Dist # Description 360 AUDUBON LA
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Ac es: 1.207 Plat: 2167-MALLACOVE
SEC 19 T29N R19W MALLACOVE LOT 1 Block/Condo Bldg: LOT 13
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.207 57,800 227,300 285,100 NO
Totals for 2006:
General Property 1.207 57,800 227,300 285,100
Woodland 0.000 0 0
Totals for 2005:
General Property 1.207 57,800 227,300 285,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 136
Specials:
User Special Code Category Amount
pecial Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
NER TOWNSPIP SEC. T N, R W
0. ADDRESS y. , ST. CROIX COUNTY, WISCONSIN. °
3DIVISION LOT LOT SIZE ,
PLAN VIEW
Distances b dimensions to meet requirements of H62.20
SHOW EVERYTH NC WITHIN 100 FEET OF SYSTEM
If I I +
~ I I ! I I ( I '
I I ( I ~
i--j-- } - ; - i
I I 11. (Indicate North Arrow j
1 S CALF . ~t - -
VTIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
rNCHES NO. of width len th area
no. of lines_ width ten th w area
depth to top of pipe
631 ELATE
RATE AREA REQUIRED AREA AS BUILT
ciaiLier: The inspection of this system by St. Croix County does not imply complete
a_-pliance with State Administrative Codes. "here 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
termLine cause of failure.
STASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM:
w,
IZ~SPECTOR r
DATED PL ON JOB
LI ENSE NLTfBER
I
Z ,
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Saytitaty Permit _ State N,1MF.
i outnbhip Cna x County r
9
IS e c.ti o n
Location SEPTIC; TANK 1
Size gatt.on.s. Num en o6 CompvLtmen-ts i
D.c,dtanee Ftom: Wett_ .5 it. 120 oA gteateA stope -
Bu.itd.i ng 6t. W ettands ~ .
H.ighwatet ..7 it.
DISPOSAL SYSTEM
D.id.tanee FAOm: Wett. 120 oA gteatet stope
Bu-itd.ing it. W e.ttands Ft.
HighwatvL 6x.
FIELD DIMENSIONS:
WA:ldth o6 .ttench it. Depth o6 tock below t.ite_
Length o6 each tine ` it. Depth o6 tock oven. t.ite ~ in.
Numb et o6 tine3 Depth o6 t.ite below gtade.-~O.in.
To.tat Lengtih o6 tines_ t.t. Slope o6 -tneneh_ in peA 100 6t.
Distance bet.veen tines t. Depth to bed,toc ~✓j 6~.
i
Tout absorb ion aAZa °u 6z Dept, to gtou;ldwa et
Requited area r~ Type o6 Cove,L: PapvL ~6t SV%aw
PIT dIMENSIONS:
NumbeA o6 pits Gtavet around pits yes_ no
Outz ide d,iamete,;.Q Depth below .~nte.t 6,t.
r
1
Total ablsotbt.ion area ~";t z
7-
1
AAe.a/Aequ.ined 6t m
B y`r✓ L~,{..!_ `n TITLE ` y
INSPECTED
APPROVED , DATE 197
REJECTED DATE 197
I
EH' 115 Rev. 9/78 ,
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: f 1/4 ; LC! SO._~
Section T_N,R-L/E (or) W, Township or Municipality 1
Lot No. Block No. County 5T" 61CI_101X
ubdiwsian Name
Af,e ~I-
A-'
Owner's/Buyers Name: S6
Mailing Address: 1030
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEWKREPLACEMEGNT ALTERNATE SYSTEM -OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS , / y
SOIL MAP SKEET-- 5._________-__NAME OF SOIL MAP UNIT ~4f~ _ NE~p S
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- 1 8 " N. /3A, SA,vp -2-4, NOW. /o
P L 3 6 13A) 'v'
,8,l S,4,vv -2,151Drv45- /0 7
P- 3 Ae 16 Ay. /I Z-6 4A., -V,4. A, I D 4 4&
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 IF OBSERVED IN INCHES
B- 22-
J? 8AA 'S;j1j 0, S.
B- > 7 /ono 3 _ rc ,!{,v.
B- 2 _2- It'InIvC > 7:2 13,v 2.2
> AV is 2 L S
f 9A -26
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy Ti745'~h .Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope^ _ r _ - _
0 W41
% AW N,07- 70
'Yo ' NO rt Srve's o4 ccv^7,=__
13 olf
~ n~ 3d' d j LiE NaRvA d ~ /BERG
jej. 0 4- 'i6 Ig of 1007?,-1o
ly ^ 04x- -rit°EE wiA
x NO t;
Of, • r✓ ~y /ins f~ ~iw~~ p Gf' _
Y3` y3
g . M N a TE'
6
t CPC ~
. '411 f'
/00
66 # No 141E,15-0
13 E s
/0~
E(~c?~'il GtFNE
Al
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. ~j
Name (print) ~1hx11( ~ 7- Certitication No. J
Address a-) 0 u /EL LL LJP50,_-,~ l)is
Name of installer if known
CST Si r!awra.._~-
Copy A -Local Authority g
State and County State Permit # f 1
PLB 67
Permit Application County Permit #
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:
E& %-<I, X06 4ti6.U /030 icy 5+- /UQ -{u osow,cJL
B. LOCATION: Section ~ T~ N, R E (or)s W^Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
144 14 do VE Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family_ Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY /00t? 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-PlaceOther (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New-X-Replacement Alternate (Specify)
Seepage Trenches---No. of neal It. Width Depth Tile depth (top) 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
i
WATER SUPPLY: Private X 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 ified Soil Tester,
NAME L C.S.T. # - Z 02nd other information
obtained from (offer/builder).
Plumber's Signatures P/MPRSW# 1161, Phone -Zjjsf
Plumber's Address •L ,
.11
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.
1
{low.:~
~ 3 3
t
F
s I
_ .e . e
t
E
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State /c" ! Coun Date
Permit Issued/mod (date) Issuing Agent Name////` ,1" e 2
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