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Pi 'Cel 02 54-80-000 08/28/2006 03:56 PM
PAGE 1 OF 1
AI:. ?arcel 9.201 B 020 - TOWN OF HUDSON
C. rent X ST. CROIX COUNTY, WISCONSIN
C Aion Date cal Date Map # Sales Area Application # Permit # Permit Type
00 0
Ta:: Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - MANN, RICHARD S & BARBARA
RIC iARD S & B/'.' 'A MANN
85' '-IWY 12
Hi ,ON WI 54
Di cts: SC = School SP = Special Property Address(es): Primary
T} Dist # [ +ion * 854 HWY 12
SC 2611 F N
SF 1700
Lc Descriptic Acres: 1.000 Plat: N/A-NOT AVAILABLE
T29N R T SE NE COM PT S LN Block/Condo Bldg:
Of NE INT JY TH W 209', N 209'
S TO PC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
21-29N-19W
N Parcel History:
Date Doc # Vol/Page Type
U fJl Pc`: Bill Fair Market Value: Assessed with:
0
V rations: Last Changed: 10/25/2005
-iption Class Acres Land Improve Total State Reason
R, ~ENTIAL G1 1.000 39,100 81,100 120,200 NO
iI Property 1.000 39,100 81,100 120,200
Woodland 0.000 0 0
for 20C
ral Prc,-erty 1.000 39,100 81,100 120,200
Woodland 0.000 0 0
Lc '.ery Crec Claim Count: 1 Certification Date: Batch 111
S:
;;ecial C . Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
DER 1A AII , TOWNSHIP ~UbSeAISEC. T~N, R / 9 W`
0. ADD ESS , ST. CROIX COUNTY, WISCONSIN.
3DIVIS ON , LOT LOT SIZE .
PLAN VIEW
-Distances S dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
f
- I
TAC
! ' + ! + i Vv ~C~'U3
_ I ;Indicate North.Arrow
I ( i SCALE : f r
,OPTIC TANK(S) POC,~O MFGR. CONCRETE__ STEEL
NO. of rings on cover Depth DRY WELL ItLNCHES NO. of _ width length area
no. of lines width length area
depth to to of pipe
P,GREGATE He 4~ KL C K
S i ~rl RATE j,C2 AREA REQUIRED AREA AS BUILT
kciaimer: The inspection of this system by St. Croix County does not imply complete
cms-pliance with State Administrative Codes. There are other areas that it is not possible
k,, inspect at this point of construction. St. Croix County assumes no liability for
,NiStem operation. However, if failure is noted the County will make every effort to
1e4ermine cause of failure.
,'BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
'-INSPECTOR
DATED PLU11,1BER ON JOB L fA_:
LICENSE NU11BER
z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.itaxy Pexm,it QOM
• e
State Sep-t.ic 7S
Township St. Cxoix County
NAME
Loca#.ion j~ Section
U
SEPTIC TANK
Size/ dQ 0 ga.Z.Zonz. Number o6 Compax.tmen.ts~_ j
Distance Fxom: Wet 12% on gxeatex s.Zope it
Bu.i.Zd.ingit. Wet.Zands 6.t.
H.ighwatex it. R
DISPOSAL SYSTEM .
Distance Fxom: We.Zt S 12% ox gxeatex s.Zope it.
Bu.i.Zd.ing it. W et.Zands Ft.
• H.ighwatex it.
FIELD DIMENSIONS: -
-Width o6 .txengh it. Depth o6 xo ck b et ow t.ite in.
Length os each t/ne 6z,,-"Depth o6 xack ovex .t.i.Ze .in.
Numbex o6 .Z.ine Depth of Cite be.Zow gxade in.
To#aZ Zength o~ ,ZiressSlope a6xench in pen 100 it.
Distance between .Z.ines j.t. Depth to b edxo ck it.
To.ta.Z abz oxbt.ion axea jt2 Depth to gxoundwatex ~ .
.,Requited axea it2 Type of Covet: Paper ox Stxaw
PIT DIMENSIONS:
Numbex o6 p.itz Gxavet axound pits yes no
Outside d.iametex it. Depth below .in.Zet , j it.
Tota.Z absoxbt.ion axea A
f~ rn
Area ~-equ.ixed it2
INSPECTED BY TITLE
fAPPROVED DATE
oet 1 .
REJECTED DATE 1971
HWJISSITE TESTING CO.
CCEPS RT. 0, ®'rIIEdL ROAD
p 5-41 17;
ups~~ 700) Sic%. Z l
G
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('o tiSd D~t-Tt v
~tol.
DOSE
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oiA= 7'0 • E H ' 115 Rev. 9/78 .1 s 7E-Aj
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: '/4, 1 '/4, Section 1/ T 1% N,R E (or) W, Township or Municipality ~UySd~cs
Lot No. , Block No. County Ceo/ x
/0, 11,4 ev ftVA/ Subdivision Name
Owner's/Buyers Name:
vys pis .
7-1 1~"X 2(
Mailing Address:
TYPE OF OCCUPANCY: Residence)( No. of Bedrooms COMMERCIAL
,9va1T/vim
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS f4A11Y 6! 1yfO PERCOLATION TESTS
SOIL MAP SHEET NAME OF SOIL MAP UNITY &-Z`0/ SALT I-OA14-1
PERCOLATION TESTS CS S0g5;rrf}f'
TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL
BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P- u14idE,i> IAI WED
P- +Cee4p w"'o-4 ~0 2 • 2 f~ /-dkk -sT A5e1.1fA L i t Ae6M /o
P- 2 L b ST. Sai o i o NT
P- o E.v / E6~iN (p . O /D
P-3 S74PAt>t s c/o w 3-. 4, =
P- vP£ CS - °
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- ®NE > /l) ",W- AN. s, / G „ Z/- 4A), 5 4) / -B,v L .
B- y Cs /z y w cs
B- /4, q Z
B- 3 NoNt 7 -ji ' 4//-
B- S" Ye/-Roe L, 51 .r C / w CS
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 5~/S ~`~'f/►L sis?E'y Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
D~Tf3Ur/I)9 /NE/I /NJ'/1)E ~ r'o Z ~ F.f'OM SEf 7~~C C'O(lt /P ,Z.
fI~E '7~D x
:3/57AA1CE5
eCv 725:45
~1f1N~/
~ ► yav~ d = sE,o~%c ~avE~ef ~21
3
r_ ry
No /-rE,tf LvE e1,---
I /N TFS 7 iP
94+ . ARE/ 7tivE/y
j fl-Ar .
My we//
0 13 yO ~7
4
j rnt Savd~ dot 4'a£
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 (Prir),).Aker `1 ZhR1 C1-,,A/ Certification No. ~Z ZI?2-
Address /t 0 N& "L Iey '
PA- IOS ~Xfi4U*7 *7NI ND 10,05'66)
Name of installer if known ~P
Copy A -Local Authority CST Signature /l R ~0► ~C'
State Permit #
PLB 67 State and County -
v County Per t # 1-5
Permit Application
• 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:
ltRo *,INAI hr101
B. LOCATION: 5Z- '/4 Nw Section ZL T 24 N, R-ly- E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
ZY Township ~(I .O v
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _I Duplex No. of Bedrooms 3), No. of Persons J-
D. SEPTIC TANK CAPACITY Zp:D72 Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete 41-C_ Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab oncrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rat 7~ Q Total Absorb Area t-sq. ft.
New Replacement Alternate (Specify) A0r7ffio~J 0~ l~iQ~tUtlf /p EX/3 j. SySTE~
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: XInside diameter Liquid Depth 3 No. of Seepage Pits
Percent slope of land 6-2-470 Distance from critical slope NDN~
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 Certified Soil Tester,
NAME /fohER7- 4101f ff7- C.S.T. # fso~`ra' and other information
obtained from 5d// T~ST~,Q- • &l /oehr (owner/builder).
7' Phone # 71 -3Jn6~1J>J y
Plumber's Signature ZZZ<-~ MP/M R # 0 & / . r
Plumber's Address 122 / N QE
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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PRYWCY T LAST j O
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.Sov~ LoT L,v,c
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application f4~1' Fees aid: State 4~, 6 0 Coun y. 24 eo Da
Permit Issued/ed (date) - Issuing Agent Name- -t~
Inspection Yes _ Y 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