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Parcel 020-1147-00-000 01/03/2007 11:05 AM
PAGE 1 OF 1
Alt. Parcel 26.29.19.779 020 - 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 - NYSETH, GENE L & VICTORIA
GENE L & VICTORIA NYSETH
757 MEADOW DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 757 MEADOW DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.237 Plat: 2077-HIGH MEADOWS
SEC 26 T29N R19W HIGH MEADOWS LOT 14 Block/Condo Bldg: LOT 14
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
162255 421,600
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.237 76,000 325,900 401,900 NO
Totals for 2006:
General Property 2.237 76,000 325,900 401,900
Woodland 0.000 0 0
Totals for 2005:
General Property 2.237 76,000 325,900 401,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 223
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
ER TOWNSHIP EC. T N, R W
ADDRESS , ST. CROIX COUNTY, WISCONSIN.
.'DIVISIONLOT LOT SIZE
PLAN VIEW
Distances & dimensions In meet requirements of H62.20
SHOW-EVERYTHING WITHIN 100 FEET OF SYSTEM
16,
P
t
TIC TANK(S) °,':-MFGR. Y CONCRETE-, STEEL
NO. of rings on cover Depth DRY WELL
INCHES NO. of width length area
no. of lines width length area
depth to top of pipe
32EGATE
:K RATE AREA REQUIRED AREA AS BUILT
.claimer: The inspection of this system by St. Croix County does not imply complete
?liance with State Administrative Codes. There are other areas that it is not possible i'
inspect at this point of construction. St. Croix County assumes no liability for
tem operation. However, if failure is noted the County will make every effort to
..ermine cause of failure.
_1SES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
"INSPECT------
DATED J+ / /1?f) PLUMBER ON JOB
r' LICENSE NUMBER
t
"YPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
San-i.;tan.y Pen.mit
t rI State Sep-ttie
NAME Township St. C&oix County
Loca,ttion Section. Lot # j Sub'divi.6 can
SEPTIC TANK '
Size gattons Number o6 co trip alLtments
Di6 tanee 6nom: weak Buitdting 1.2% zZope.
Htighwate,c
PUMPING CHAMBER
Size / 3„S l gat o nh_ _ : Pump Manu jaCtu&ek Model Numb eh /,57
HOLDING TANK
Size gaffons NMb. o menu
P u m p e. A e OiAtanee 6n.orn: Wett itd,i.ng_ 12% s ope_
Highwa.ten
ABSORPTION SITE
Bed T'r.ench.
Di., ,tan.ee ,6 Lom: WeU Bu.itdting 7.2% 6to,pe
Htigh.wa.teit
ABSORPTION SITE DIMENSIONS
--Width o6 .0Lench C~2 6t RequiiLed aftea Z,13 0 6t
Length o6 each tine_ J6x Depth o6 toek beeow :tile / 2 in
Numbers o6 ktines~ Depth o6 %oc ove& t.ite Z in
260
Totat teng:th o6 tine.s~ 6t Depth o6 tite betow grade _ in
Distance. between tines i~; 6:t Slope o6 trench in. pelt 100 6x
x_
Total absonpttion area ,3 6,t Type o6 Coven. Pape& on 6;t&aw
"PIT DIMENSIONS
Numb en o6 pits GtaveZ around ptita_______yeas
h
Outside d.i.ame-ten. 6t Depth: be.Eow tintet 6x
Totat ab6ottption aAea 6x
Area nequtihed r~ 6
INSPECT,- TITLE -
APPROVED DATE 19 8
REJECTED DATE _ 198_
REASON FOR REJECTION
i
REPORT ON INSPECTION OF SANITARY PERMIT # f
(1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection
Time of Inspection
ame, r ss, icense NO. o ns a ing Plumber
(3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System
BENCHMARK: (Permanent 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 ❑ NO; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ N0; Wired? ❑ YES ❑ N0;
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;
li.neal 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:
PLB 67 State and County State Permit #
Permit Application County Permit
for Private Domestic Sewage Systems County-If
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
rNl- NYs,FT/I KT z T;F&,T 'S)Zeer- NP Nvb6o r,
B. LOCATION: -:5 LO '/4 Section, TgJ_ N, R-Z ? E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
.r
/Vzk p04u-~ " Township tJ1?D-36N
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family ✓ Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY l~{ 'J&al gallons No. of tanks /
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete ✓ Poured-in-Place Steel Fiberglass Other (specify)
New Installation Ai Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate, e&1 /'-A~LTotal Absorb Area SZZI ~ ` M ft.
New ✓ Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: Length Widths Depth 30 -Vz ' Tile depth (top)s z ,~No. of Lines
Seepage Pit: Inside dLameter Liquid Depth No. of Seepage Pits
Percent slope of land-0 - S A -4Th N,E' Distance from critical slope
WATER SUPPLY: Private IP*Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner: 4-
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.S.T. #and other information
obtained from CO. 1 ay-SZY4 ovine uiIder).
Plumber's Signature _ Phone #~1Z~=
Plumber's Address
0&-ez - ~L~
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.
S,F
I
oo (2 44
} (,e To 5,1 A)K q
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONtjY
Date of Application -)Z-Fees Paid: State Coynty,,,-' Date. 75`
Permit Issued/Rejected (date)~ ° - Issuing Agent Name
Inspection YesNo 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
I
EH• 115 Rev. 9/78 7 1 • . REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701 ~Gy
~c ~7-1 goy`'
LOCATION: x, Section ,T_N,R E (or) W, Township or Municipality
I ~'Cr/1t /YZ,;0,,0Ky ~
Lot No. Block No. County
Subdivision ame
Owner's/Buy/erers. Name::/ Ja 104-- T,
~ 1/
__"T %/~l7Ls% /QO /~df -/f"lf~.tO~ GC7/s' .S~/C~/(cs
Mailing Address:
TYPE OF OCCUPANCY: Residence K No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT } ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS J~C3N C 23 NDF•1 PERCOLATION TESTS `TVAJE Z 3 f ~
SOIL MAP SHEET`Stl (~o NAME OF SOIL MAP UNIT
~`~CT-''¢'
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- 36) S MZ-rfS 91 7'0 30"' P-
P-
P- G"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- 72- NONE )72 9"4.14AM H'A't. 7 ,WZoav.s, _?2 A4•-13N Cs w
B- L 8 J4 NONE > 3 2 "JyN. L Q" p • C /Z "O~~L ~eG- sa " oP . 01e. ,r .
B- No~E >JV 31 9"l~!l~v. G :,o~P. is w c~ '9 ,,ee <f
B_ NaNt > 7 s' "XAJ. L 13' , v L (a ' O.P. L5 r, 41-6, S'' a~ CS
B- 72-- oN>~ > 7 3''RA,. s-1 / 7" V A). -(,-z- 11 ';:'A -1s 30'' .15r w
B- D,t9E > g3l 6 1 4. 110 G 2,1", r_.s w 11
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 _
te Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope.
• ~ //BIND % ta~Pw.ED
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132. /o/ 85
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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 met ds\
specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my L. ~pQ
knowledge and belief.
Name (print) r "O~=Rr Certification No. `5
Address -3 0141,61Z_ Name of installer if known
CST
Copy A-Local Authority S.;anature