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PAGE 1 OF 1
F 1
Alt. Parcel 11.29.19.57C 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 - SHIPLEY, JEAN R
JEAN R SHIPLEY
1045 TANNEY LN
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1045 TANNEY LN
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.220 Plat: N/A-NOT AVAILABLE
SEC 11 T29N R1 9W NE SE LOT 1 C.S.M. V Block/Condo Bldg:
III P722 ORD 613/167
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
11-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/19/1999 608865 1450/159 QC
07/23/1997 613/167
2006 SUMMARY Bill Fair Market Value: Assessed with:
161069 230,400
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.220 79,900 139,700 219,600 NO
Totals for 2006:
General Property 3.220 79,900 139,700 219,600
Woodland 0.000 0 0
Totals for 2005:
General Property 3.220 79,900 139,700 219,600
Woodland 0.000 0 0
I
Lottery Credit: Claim Count: 1 Certification Date: Batch 219
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 1~ rl jf' =1 TOWNSHIP,,;_ ,i SEC.
Ir T ?N R, W
ADDRESS ST. CROIX COUNTY WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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I di ate oXthj Arrouq
S CALL : I- ` {c `~-I I I I
SEPTIC TANK(S) MFGR. CONCRETE STEEL
No 67 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 area 6,t r..
depth to top o7 pipe
NUMBER OF SEEPAGE PITS Outside diameter total pit area
AGGREGATE
PERK RATE AREA REQUIRED AREA AS BUILT
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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 THIS SYTEM.
INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER,
Z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.itany Pe4tni t4..Z.
State SPpt.ic,_~9
NAME D/Yl /C° rowneh.ip ~Q~sdh St. Cno.ix County
Locat.tox Section
SEPTIC TANK
S.ize(~j gattona. Number o6 Compa,%tment,6_ I
Vii Lance Fnom: W e t t J_Z) 6t. 12$ on gxeatex a.Lope it
Bu.itd.ing it. We.ttandb
DISPOSAL SYSTEM Highwa.ten
DiA tance Fnom: we.te 12% on gxeaten etope 6t.
Buitd.ing 6t, Wet.tande Ft.
H.ighwatex J 6t.
FIELD DIMENSIONS:
. Width o6' .trench ~ Z it. Depth o6 hock below. tite-L--in.
Length o6 each tine it. Depth o6 hock ovei tite in.
Numbex.06 t.ineA Depth o6 t.ite below gnadej__~Lin.
Total teng-th o6 Q.inee~0"L it. Stope o6 trench ,7,, .in- pen 100 6.t.
DiAtance between tinee.t. Depth to'bednock- 6t.
Totat abb onbtion anew 4 6t2 Depth to gnoundwaten~6t.
2
Requited area it Type 06 Coven: Papen 'on Straw
PIT DIMENSIONS:
Mumbex o6 p.itz Gxavet around p.ite yeb no
Outaide d.iamete ' 6 depth beCow Intel 6t.
Tota.t ab4o4btion area 6.t2. z
Axea xequiAed 6t2 rn
INSPECTED B TITLE_
APPROVED . ► DATE ? .;.3 121 .
REJECTED ,DATE -197-.
(A
01
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PLB-67 State and County State Permit
Permit Application County Permit #
for Private Domestic Sewage Systems Y
6111
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: Section f L, T Z `iN, R/ CJ E (or) Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township /yC yc/; t't.7
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) "Variance
Single family _ Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY 1000) Total gallons No. of tanks /
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete- ~C_ Poured-in-Place Steel Fiberglass Other (specify)
New Installation - 4t 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_X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length S- Z-~ Width 1 2- Depth L/0 Tile depth (top) Z`nf No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- /CJ .2c, (1_ Distance from critical slope
WATER SUPPLY: Private Q 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 C#4L-t,,,kn . t "t _ C.S.T. # S 3 / and other information
obtained from C;L ,n 0vv e uilder).
Plumber's Signature MP/MPRSW# L76 3 Phone # Lv~ 5 3
Plumber's Address i
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. Ci r)
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application f 5~'-Fees Paid: State /5' dv Cou ty Date
Permit Issued/Rejected (date) Issuing Agent Name l fi s Cr~t'2/
Inspection Yes_A___No 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
EH, 115 Nev. 9/78
• - REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: ''/o, Section T_iN,R=E (or) N~ Township or Municipality /
Lot No. , Block No. County
Subdivision Name
Owner's/Buyers Name: / 1 1 i ` : c Y
MailingAddress:_ 1, X TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS S- to PERCOLATION TESTS 4Z`-3
SOIL MAP SHEET `5197~7te
NAME OF SOIL MAP UNIT
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 AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- Z
P-
P_
P_
P_
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- T5 Z Y
B- Q -6-7 -z ti L~r` Ly-7 U 7 -5
B- c/ U ? i c- L i 2 ay L-CjL', -2 Lf
y L_ 6, AZ_ b 7 -K
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 1-3L 4g?Si`;1L-'' 70A4V 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) f~ ""'k-> rr~c t r~''~ Certification No. /
Address C On tl yJ, c S
Name of installer if known
Copy A -Local Authority