HomeMy WebLinkAbout020-1141-10-000
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Parcel 020-1141-10-000 08/28/2006 03:09 PM
PAGE 1 OF 1
Alt. Parcel 19.29.19.722 020 - 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 - JOHNSON, DEAN & JO MARIE
DEAN & JO MARIE JOHNSON
895 AUDOBON CT
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 895 AUDUBON CT
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.345 Plat: 2167-MALLACOVE
SEC 19 T29N R19W MALLACOVE LOT 17 Block/Condo Bldg: LOT 17
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/08/2005 797053 2818/213 WD
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 1.345 61,400 245,000 306,400 NO
Totals for 2006:
General Property 1.345 61,400 245,000 306,400
Woodland 0.000 0 0
Totals for 2005:
General Property 1.345 61,400 245,000 306,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 105
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
. AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC I. T_ 'N, R,' W
ADDRESS ST. CROIX C iJNTY WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62,20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
G
t
E
i
9
ctf a e o th~ Arrow
I d-i~-
SCALE : I I
SEPTIC TANK(S) MFGR. CONCRETE STEEL
No. _67 rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. L NO.
GALLONS Per Cycle _
TRENCHES NO. of width length area
BED NO. of lines~ width length area
depth to top o pipe
NUMBER OF SEEPAGE PITS Outside iameter, total pit area
AGGREGATE
PERK RATE T 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 tha
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
fnanty wi 11 make PvPrv Pffnrf- r-„ rent-nr+n-inn
.v.~.... L ,i`u5 C J L-mi lure .
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM.
INSPECTOR
<.;
DATED PLUMBER ON JOB
LICENSE NUMBER
• REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
San~.tany Penm.itc*A3
S-ta,te Serpttc
9 49
SAME J Township S Cro.i-x County
u c a ti o n _N"Z___S e c--ti o n_lj_ L o ,t # T_ _S u b di vie 40 n
1PTIC TANK
SIt:ze. _galtons Numbers. o6 eompaktmen-tls
chance drum: LUef t Bui-fding 120 sEope
H4 ghwa,ter.
'LIMPING -CHAMBER 1
Size aUor` Pump Manu6actune.n Modet Numb e.~c
1OLDING TANK
Size gatfon.6 Numbers o6- Compaktments
Pumpe_n - Atarm
pi's tance. 6num: weU__,, ~:«ti~utn i z,o sk;a e.
Highwa.ten
6SORPTION SITE
Bed' Trencdh
X4'6 tance- {prom: We.EL Buieding.- f2% slope..__
Highwater
f:KSOKPTION SITE DIMENSIONS
Width oU tAench
_ _6,t R e q u.i-L e d area
Levngth o 6 each U n e 6t Depth o6 rock below .tiXe
Numbers oU l'e.6 Depth 0A 'Loch oven tl('fe
Total length o6 tinee_ % 6t Depth o6 tite below grade
Oils tanee between fines - 6t Stope o6 trench .cn. per 100 At
At rAUJr:/LrJ((.UVI ((r.e.a t Type o6 Cover: PUrJeh 0h /~~1CQW rr
" I
,'IT DIMENSIONS`
Number. o{ pity, Gravel arcound pit's _ yell--____- no
Out/side diame"ten Depth below inlet ~x
Toxat ab,6or,p-t.ion area -6
Area ne.qui/Led
N S P E C T E D TITLE
11PROVED DATE P 9
- - -
:f JECTED DATE 198
'FASON FOR REJECTION
I
REPORT ON INSPECTION OF SANITARY PERMIT # ~I l`f
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
Time of Inspection
ame, r,, License No. o ns a i rIg Plumber
/
(3)INSTALLATION CONSISTS 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:
(7)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 ❑ NO; 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 TREN H: 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.05,180
Signature of Inspector:
-EH -115 Rev. 9178
• REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: Section T. - ~N,R./,_(_ (or)_W, Township or Municipality
Lot No.t, Block No. County ~ %
ub ivlsion Name
Owner's/Buyers Name: -14' 11 441 1
Mailing Address: 1 7c y.1
TYPE OF OCCUPANCY: Residence V No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW_REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET t % l
NAME OF SOIL MAP UNIT Z AI I li, ! i
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 BOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
~ i
P-
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-
B- C
B
B- C' /"r 4
B_
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plaq the Yation 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. f-' J
pc sic,
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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 Adr-ninistrative Code, and that the data recorded and location of test holes :re correct to the best of my
knowledge and belief.
Name (print) / - ` Certification No.
Address
Name of installer if known
Copy A -Local Authority CS"' 6gr. s. •F
1
State and County State Permit #
KLB 67 1 11-41 q
r 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:
B. LOCATION: _Y4 '/4, Section T `Z N, R (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village -
Township~i C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms --1 No. of Persons
D. SEPTIC TANK CAPACITY /~f 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 7~',,=Total Absorb Area sq. ft.
New/'~_Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (t p) No. of Trenc~es
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 U 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 TeIer,
NAME C.S.T. and other information
obtained from (owner/builder).
Plumber's Signature
MP/MPRSW# Phone
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.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application a f10 Fees Paid: State/-/,O-Z) County '21 bi' Z D LZ /Q ~2
Permit Issued/Repe~n~ (date) L 1 ~ Q Issuing Agent Name
2~ t
Inspection Yes_ 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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