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Parcel 020-1010-40-000 01/03/2007 02:20 PM
PAGE 1OF 1
Alt. Parcel 10.29.19.44B 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 - STORER, ALLEN F & BARBARA J
ALLEN F & BARBARA J STORER
1033 SCOTT RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1033 SCOTT RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.400 Plat: N/A-NOT AVAILABLE
SEC 10 T29N R1 9W NE SE LOT 1 OF CERT Block/Condo Bldg:
SURVEY MAP IN VOL III P651 ORD
Tract(s): (Sec; Twn-Rng 40 1/4 160 1/4)
10-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/16/1998 591707 1377/405 WD
07/23/1997 981/156 TI
07/23/1997 783/362
2006 SUMMARY Bill Fair Market Value: Assessed with:
161050 246,000
Valuations: Last Changed: 05/30/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.400 80,600 153,900 234,500 NO 05
Totals for 2006:
General Property 3.400 80,600 153,900 234,500
Woodland 0.000 0 0
Totals for 2005:
General Property 3.400 80,600 138,900 219,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 211
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER ✓~r ,;J e
L U 4 ~ V TOWNSHIP SEC.//,' _ T,,)--N , R4;~W
ADDRESS%/',r g ST. CRO X COUNTY WISCONSIN.
SUBDIVISION - LOT LOT SIZE
PLAN VIEW 1-G
Distances & dimensions to meet requirements of H62.20 G p V Z~
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4 -
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Ir~di-Gate North. Arrow
~ ~ ~ I SCALE
SEPTIC TANK(S) _MFGR. _ CONCRETE STEEL
NO. of rings on cover / Depth
PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO.
GALLONS Per_Cycle
TRENCHES NO. of width length_ area
BED NO. of lines width + length--5,z area / 1Rt~
depth to top of pipe
NUMBER OF SEEPAGE PITS Outside diameter total pit area
AGGREGATE V ~ ;I n ,,14~ z!~.
PERK RATE S AREA REQUIRED- f f! _ AREA AS BUILT
Disclaimer: The inspection of this system by St. Croix County does not imply
complete compliance with State Administrative Codes. There are other areas that
it is not possible to inspect at this point of construction. St. Croix County
assumes no liability for system operation. However, if failure is noted the
County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH ~T--- IN TOR )
DATED ~PLUMI3T?R ON JOB
P - LICENSE NUMBER__-A 0L = - - -
Z ,
REPORT OF INSPECTION INDIVIDUAL SELVAGE SYS7EM
r Sanitahy Pexmit ~
` State Septic_~ _
NAME Township St. Cxo.ix County
Location Section
SEPTIC TANK I",~ u
I
Size G % ga.ttonb. ~lumben o6 Compatc.tmen.tb_
Distance Fxom: Wett 6t. 12% on gtr.eatex scope - it
Bu.itd.ing ~C it. We.ttandb_ 6t.
f
DISPOSAL SYSTEM Highwatex - 6t.
.
Distance Fxom: Wet~~` ~i St• 12% ox gtceatex dQope it.
Bu.itd.ing s wettands_ Ft.
• H.ighwatex it.
FIELD DIMENSIONS:
width o6' txen ch_ IZ, it. Depth o6 xo ck b et ow t it e__/z in. ~
Length of each tine ~ it. Depth o6 xoch oven Cite Z in.
Numbex of tines Depth of tiZe below gtcade,--,'-,/ .in.
Totat teng.th os tines ~ L it. Stope og txench in pets 100 it.
Distance between tines 4, t. Depth to b edxo ck St.
Totat abzoxbtion axe Sz2 Depth to gxoundwaten. it.
Requited axea it2 Type of Cove x: Papetc~'x Stxaw
PIT DIMENSIONS:
Numbex o6 pits / GxaveZ axound p.it~s yeb no
Outside d.iameteA Depth below .inZet it.
2
Tazat aba oxbz n a ea it
A
Axea tce cx 6t2
7
INSPECTED ! ~2 TITLE
APPROV DATE 19'7(
_ -
REJ TED ,DATE 197
EH 1 15
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS /
LOCATION:: Y4, '/4, Section L4-', T~N, R OE (or) W, Township or Municipality u So h-
Lot No. Block No. _-de~ L',PA I ft s County -rte. 11(
~C Subdivision Name
Owner's Name: _ i1
Mailing Address: -
2-TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW cl ADDITION REPLACEMENT j
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOI L TYPE Z 7
PERCOLATION TESTS
TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IACTERN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-1 33
P-5 A'
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)
B 7 z l~/ - p r C - r^
3 7 _ - 'r
B__ r
PLAN VIEW (Locate percolationtests,soiI bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitab area . I irate number s uare feet of a~•sf rptio area
needed for building type and occupancy. scale
or distances. Give horizontal and vertical reference points. 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) C_ /I 4 /e'-Zlr ;'h Certification No. 1 y J
Address w ~i ` 1 ~'h L' J1 r
Name of installer if known
=r>✓~-~!~~~~ ti,~n~
COPY A -LOCAL AUTHORITY CST Signature
i_ State and County State Permit # /
PLB-67 Al Permit Application County PerrrlIt-
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:
..Sso 31
z-, Z
B. LOCATION: S t- '/4 /7/4' '/a, Section / T ` N, R E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
/ - Township
If,- / / f Az
C. TYPE OF OC PANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons_
D. SEPTIC TANK CAPACITY LrT~ 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 5 Total Absorb Area 415 sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: e-,;2 V Length j•2 J Width 7_ Depth __3~ Tile depth (top) ..12 ' No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land ;7_ Distance from critical slope
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 Certi ed oil Te/s/,ler,
NAME tai,, Gf/ C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signature - t~~ tJ I~IP/MPRSW# Phone #-'~'y
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.
IF,
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application / Fees Paid: State ! L - ounty , Date . - - -2 t.\
~
Permit Issued/Re,'eL (date) Issuing Agent Name; ` cam
Inspection YesNo 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
Ea, 1,15
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
«s` - DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: '/4, Section , TN, R E (or) W, Township or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
SINCE INCHES THICKNESS IN INCHES HOLE HOLE AFTER INTERVAL
MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-
P-
P-
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)
B-
B-
B-
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. _ Indicate scale
or distances. Give horizontal and vertical reference points. 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) Certification No.
Address
Name of installer if known
CST Signature
COPY C -PROPERTY OWNER