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HomeMy WebLinkAbout020-1024-70-000 all ° r° C (D ' c (D it g - ~ ~ l 1 r: n ~ O n m o v v o m~ Cn ° 5- 3 W A d d N O H CCDD O_ c 0 W CD N ~ d A z d N N O O lAl O 7 O co N :3 d p CD -0 A v D N n O O O O - CO _ 7 v 0 O rn 3 0 CD o n 0 CO N O Cn d C C D c N N a o o CD W CL CD CD I O o I _ o _ CL lz Q (D co CD c ' n r N N o c vo, 00 aD CL C) o O Q u •0 '0 !V • 41 E 3 fn fn . o m O CA ~ O CD CD (9 N L 90 CD Q N 07 N 4 3 m ~ N CD - d N I z z N z W O O o m D n o' CD N CD CD (n c CD N W ~ d 0 3 z CD -I fn O o o p z m a c _ N CL A a. W -0 m N cn (D " - z o 3 ;a o z g m ~C N ~ < CD ? W N a C CD O D -n CD c o a CD I I ~I p A A A O N N O O V A 0 b A O DQ < ti b O CD ~ y ' O L ' w Parcel 020-1024-70-000 01/02/2007 04:40 PM PAGE 1 OF 1 Alt. Parcel 15.29.19.107C 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 ALAN D KLINGSPORN O - KLINGSPORN, ALAN D 985 SCOTT RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 985 SCOTT RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.150 Plat: N/A-NOT AVAILABLE SEC 15 T29N R19W NE NE COM INT CEN LN Block/Condo Bldg: HWY & N LN SEC 15 GO S 610.75'TO POB E 250', S 200', W 250', N 200' POB Tract(s): (Sec-Twn-Rng 40 1/4 1601/4) 15-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 11/04/2005 811284 2923/35 QC 03/17/2005 789850 2766/281 WD 03/17/2005 789849 2766/280 WD 10/29/2003 745101 2445/241 LC more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 161174 181,200 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.150 53,800 118,900 172,700 NO Totals for 2006: General Property 1.150 53,800 118,900 172,700 Woodland 0.000 0 0 Totals for 2005: General Property 1.150 53,800 118,900 172,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 131 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 ADDRESS TOWNSHIP / Z -,.,I _SEC . TD'S' N R W 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 e I j -L_ i , f- i Tndi'rate North, Arrow SEPTIC TANK(S) 1~UV ,aAFGR. CONCRETE STEEL N07=6f 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 -24, ' area -z y depth to top of pipe -/ID NUMBER OF SEEPAGE PITS Outside-d ~iz;meter total pit area AGGREGATE PERK RATE 4 S5 / AREA REQUIRED 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 th~i 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 THI S INSPE DATED PLUMBER ON JOB LICENSE NUMBER----../ _5/_ s ~ 1 l ~ . ~ `c ~ {,v,l ~Ib P ~ 1 e.- 1, t, , REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM San 'c tarry Perm.(..t ~`J3 S.ta,te Sep-tie,,:p NAMEO Township St. Croix County 4~4~ 7 - - 1.uca:tion/~ ~f~~ Section Lot # Subdivi.6ion ,EPTIC TANK Size_ ZG-1?(' gatkon,5 Numbers o6 eompa4tment6 0~~,,tanee 61Lom: Wett Building _ 120 .scope Highwa.te,t PUMPING CHAMBER Size gat one .Pump M u6( u elk Model Number _ _ HOLDING TANK Size gattons N en o ompar.,tments Pumpers m 'Sy,s em Oi/s tanee. 6r.om: Weft Buitding 12% mope Highwa.ten. ABSORPTION SITE Bed T l• I)-('A tance 6aom: Wet ~Bui2ding f2% .6 tope Highwaten ABSORPTION SITE DIMENSIONS j width o6 trench ,t 1 g`ed area 6 Length o6 each .Stine At 'Dep-th o6 rock below -tile C2 in 4r Number. o6 tine Depth o6 Tock over. ,tile. 'Z _ in Totak Eeng-th, o6 tines 6t Depth o6 tiZe be.Eow grade 7~ i.n DiA tanee between tineb At Stope o6 -tneneh in. pen 100 At f tJ ~,uti aVJur-ptiun ar.eu r I 6-t Type o6 Coven: ,Pap or z t&aw i PIT DIMENSIONS C Numbe4 o6 pita tavet around pi t,5 yep no Outside diame-te)L 6t Depth below inlet 6t To,tat abb o4p.tion anew 6 Area ,Lequi4ed ~ INSPE t TITLE APPROVED . DATE 19 8 [:EJECTED DATE 19 8- -REASON FOR REJECTION i a i* i J S PIb. t-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health Section of Plumbing & Fire Protection Systems oil> ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises Street City County Master Plumber Address Owner Address ❑ County Permits ❑ Appropriate State Permits Type of Building: ❑ Public ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer ❑ Conventional Soil Absorption System ❑ Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH: : i F k _ s - - - - - - E , - 4- w f i : , i , s E , E I~ t E E F i I _ - 1 r ; ~ ~ ~ _ ? sag. n _ ~ _ ~ t ~ i t a w w a , , , : . : i F i € _ . _ , € i : 4 -1- E i r j J , i i F e s e ❑SEE ATTACHED DISCUSSED WITH PLUMBER ( ) Yes ( ) No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party 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./v-'/4,W%4, Section -r,T42-f N,R&& (or) 1~1 jownship or Municipality il`1 Lot No. , Block No. County Subdivision Name Owner's%Buyers Name: /u + A_.r Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms - COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT X ALTERNATE SYSTEM 9 OTHER DATES OBSERVATIONS MADE: SOIL BORINGS _-~S PERCOLATION TESTS SOIL MAP SHEET s NAME OF SOIL MAP UNIT L3xe~{^~i~i-S~^~ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RA rF_ NUM_ SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- / s~" Sep C©~ O A* v 0 3 r~ 1C~ ~ S P- e 0- 60r-r s /14 ! Y 1V0 -3 P- L') I, C Vo P- - ! P -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 C IF OBSERVED IN INCHES B- B-113-PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plathe location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy S~ ..Indicate scale or distances. Give horizo taI and verti I reference points. Indicate slope. S~g7. S ~/7l•~C'~ ~ /j .S i~LGit C ~ a " ~ ~ e ~ I P-e?NC s 13Di IF4. 07_ _ N Fx a w • a A/a ill, _ • fCi@e'~ d 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) i,u <!i`S l ~~~i S o _ic',v Certification No.~ Address s i S Ol Name of installer if known l CST Signature Copy A -Local Authority State and County State Permit # Y3 PLB 67 Permit Application County Permi # Z -Y. 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: r~ B. LOCATION: /✓G Section /,4 , T , - N, R / ~ (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms -3 No. of Persons .j D. SEPTIC TANK CAPACITY leoo 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 .x Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate ~'~~ss 7 Total Absorb Area ft. 6/5 `~iPrLrv~iN~, j New Replacement X Alternate (Specify) i Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: K Length -width Depth -J Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- 4=v 411r= l tz;:, 3 Distance from critical slope 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 Certified Soil Tester, NAME Ozagj C"~irr i ~rL C.S.T. # and other information obtained from ~aA, A e (owner/builder). Plumber's Signature MP/MPRSW# 3P3 Phone # 7/6' -3Y6 Plumber's Address /C> /4r '-l /e 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. 9 E . fi 3 e j x E 1 f E ~ 1 r 3 i e Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State County S-,,1'~ Date 9 7 4;& Permit Issued/Rejected (date) -1`J-~f.J Issuing Agent Name7 ~ _ ~f~~ J Inspection Yes_ X 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 REPORT ON INSPECTION OF SANITARY PERMIT # c~ (1) Name AndAddress of Permit Holder Person/Persons at Site (2 )Date of Inspection A-2/ ~,S 01 ----Name, Address-, License o installing Plumber Time of Inspection -(3)INSTALLATION CONSI T F: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BEN ermanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO ; 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ N0; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: ell) r~ f ,