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Parcel 020-1140-00-000 08i28i2006 02:43 PM
PAGE 1 OF 1
Alt. Parcel 19.29.19.711 020 - 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 - ROGERS, DAVID E & DAWN M
DAVID E & DAWN M ROGERS
349 AUDUBON LN
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 349 AUDUBON LA
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.099 Plat: 2167-MALLACOVE
SEC 19 T29N R19W MALLACOVE LOT 6 Block/Condo Bldg: LOT 6
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/18/2006 832559 WD
12/22/2004 783174 2720/92 WD
07/26/1999 607493 1444/416 QC
(C
07/23/1997 1191/546
mor
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 1.099 55,400 153,800 209,200 NO
Totals for 2006:
General Property 1.099 55,400 153,800 209,200
Woodland 0.000 0 0
Totals for 2005:
General Property 1.099 55,400 153,800 209,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
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• AS BUILT SANITARY SYSTEM REPORT
+►~ER„,~ ' , TOWNSHIP &SEC. T N, R W
.0. AD,)RESS , ST. CROIX COUNTY, WISCONSIN.
:BDIVISION , LOT LOT SIZE ,
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Indicate North;Arraw
SCALE : ~ ~ --i_-~-i.--~---~-! ~
TT A_
tPTIC TANK(S) MFGR. CONCRETE 1 STEEL
NO. of rings on cover Depth DRY WELL
tLNCHE5 NO. of width length area
no. of lines 7 width length area,
depth to top of pipe_ 3
' GREGATE
:.U RATE AREA REQUIRED AREA AS BUILT
t,sclaimer: The inspection of this system by St. Croix County does not imply complete
.*;pliance with State Administrative Codes. There are other areas that it is not possible
Q inspect at this point of construction. St. Croix County assumes no liability for
13tem operation. However, if failure is noted the County will make every effort to
,:,itermine cause of failure.
JEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
'INSPECTOR
DATED PLU1`1BER ON JOB
LICENSE NUMBER
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sani tahy Penmtt l /0
State Septic
~JAME Townsh.i St. Cto•ix County
Section Lot # Cj Subdivibion C,/ /io n ~i
()ca NyJ 4 ~W
.EPTIC TANK
Size gatZon.6 Numbers o6 eompattment6
<6 ranee 6tom: WeU Building 1,2% mope ~
H.ighwa-ten.
'UMPING CHAMBER
Size ga ,t ~mp Manusae,tunen• Model, Numbers
OLDING TANK
Size gaZZone Numbers 0 !Co". antments
Pumper. A at S
'<,stanee 64om: Well B .itding 120 slope_
H.ighwatet
{SORPTION SITE
Bed ^'X Tteneh
~ .6 tanee nom: Well Build.ing f2% .6 to pe
Highwatet
~~SORPTION SITE DIMENSIONS `
Width o6 trench / gt Requi. Led anew 6.t
Length o6 each Zine 6t Depth 06 tack below the in.
Number o6 f-ine.6. Depth o6 noek oven tile. L in
Total length o6 tine.6 l% 6t Depth o6 the below grade i n
D.t6tance between tine.6 .6t -Slope ob trench in. pet. 100 6t D
Tutiu' ab,6v..nption area 6t Type o6 Coven: Paper .6tnaw n'
IT DIMENSIONS"
Number o6 pits GtAveZ around pit.5 ye,5 no
Out.6 de diameter 6t 4pth below inlet 6t
Total ab.aonption area 'fit
Area tequited ~t
NS PE,CTED BY TITLE
.
,PPROVED DATE 198(
'(JECTED DATE 198
'FASON FOR REJECTION
l!
L'
,f 9
State Permit #
PLB -67 i State and County
I ~ A Permit Application County Perm
I for Private Domestic Sewage Systems County
I *DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
A4
B. LOCATION: Section, T N, R_ E (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 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 l Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. 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
WATER SUPPLY: Private IN 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 / I. / C.S.T. # F j and other information
obtained from (owner/builder).
Plumber's Signature / r MP/MPRSW# Phone e
Plumber's Address / F -
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 ST E DEP RTMENT USE 47 J-L) Date of Application
40 - ? Z^ Fees Paid: Stat rJ Cou ty Date
*2
Permit Issued/Rejected (date) Issuing Agent Name
Inspection Yes4__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
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H k15 Rev. 9/78 F r
REPORT ON SOIL BORINGS AND PERCOLATION TESTS VF&
• ~ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ? 80
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: 41/4, Ali'/4, Section_LL,T::L~N,R~E (or)&,Township or Municipality v
Lot No. , Block No. County s 01-4,,
- / C {
Owner's/Buyers Name: To k aloe,_ Z/ subdivision ame Mailing Address: 144 44
c L-c:" _51, ~ `l6/ 61
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW x` REPLACEMENT ALTERNATE SYSTEM OTHER
c
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS L GI^~
SOIL MAP SHEET) NAME OF SOIL MAP UNIT ~
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
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- ~~I ''r ~7` L 70~ ✓ ~J
i !i o "s
P-
7
P- i
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-
44 i 1 71 4;
B--" f~ lt' f Sl)y -o(,i•.s~ S
3/ r
B- 4
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 ndicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
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s, 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.
Nan:° (print) "x-e s ! (X / "f. SC//" Certification No. S~ Ay
Address / <i=N~~
Name of installer if known
Copy A - Local Authority CST Signature