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Parcel 29.29.19.698 020 - 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): Current Owner GREG G GRIESE ' GRIESE, GREG G 734 GHERTY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 734 GHERTY LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.551 Plat: 1979-GHERTY'S ADD SEC 29 T29N R19W GHERTY'S ADD LOT 5 BLK Block/Condo Bldg: 3 LOT 5 3 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.551 32,800 128,100 160,900 NO Totals for 2005: General Property 2.551 32,800 128,100 160,900 Woodland 0.000 0 0 Totals for 2004: General Property 2.551 32,800 128,100 160,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 301 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 6► TOWNSHIP14Ub<ofi'v) SEC.zE T2q N, R/9W ADDRE,~,~__f~_ Un `>nres cg~i~ Ar ST. C OIXX0 T, NTY WISCONSIN. ~ 1j SUBDIVISION bCCTU~ LO LOT SIZE Distances & dimensions to meet requirementsWof H62.20 wlTHI4 LOO FEET OF SYSTEM G Trdi- 144 a e oath Arrow SCAL SEPTIC TANK(S) MFGR. . CONCRETE -STEEL N0. 67 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- `F~length _ c; area l dept to top o pipe NUMBER OF SEEPAGE PITS outside diameter total pit area AGGREGATE ~,yb PERK RATE ARE REQUIRED A I 7 AREA AS BUILT 2,0 Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas thn 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 THIS SYTEM. INSPECTOR DATED /d PLUMBER ON JOB LICENSE NUMBER REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM S ani ta,ky P eA mi t_-Z-691. State Septi NAME Town.ahi p , St. CAOix County Ioca.tion Sectionc2~_Lo.t H Subdivi,6ion (~FPTIC TANK Si ze r' gattonb NumbeA compaA.tmen" 04n.tanee 6AOm: Wet - 8u.itding 1.2% 6tope Highwa.teA i'LIMPING CHAMBER Size gat Z on4 P",*p.-Manu~aetu)L en Mode. Numbers HOLDING TANK C Size gatton,6 AfupdT,e~c""a~ CompaAtments _ PumpoL Ata4m System Di,stan ee. 64Om: wett Building 12% mope HighwateA ABSORPTION SITE Bed TAeneh 04_s,tanee 640m: Wett Building r2o .elope - Highwa.teA ABSORPTION 81TE DIMENSIONS Width o6 -tAeneh 6t RequiAed anea Length o6 each tine = 6t Depth 06 Aoc betow .tile Numbeh o6 Z-(.nu nnr+I To;ta.e Xenglth oii tinee % 6-t Depth o6 .tile below gAade O. ,5 tanee between ine,6 a 6t Stope o6 -tAench in. peA 100 At 1 uA,uL ubou~Lptiun aAea 6-t Type o4 CovvL:, Pape4 .6 tAaw PIT DIMENSIONS Numb en 6 pitb GAavet aAound pit.6 yep no ` Outside_ d.i.ame-teA bt `Depth below inte.t Totat ab.a onp-tio>n a~ a~ ~ AAea AequiAed 6t INSP-E-~_By TITLE APPROVED DATE f ' 19 8 REJECTED DATE 198 REASON FOR REJECTION , I i REPORT ON INSPECTION OF SANITARY PERMIT # X522 (1) ame an Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Time of Inspection -Name, ress, lcense NO. o ns a ing Plumber 3 INSTALLA S STS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BEN 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: (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 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: r State Permit # c,? 93 PLB 6 7 State and County 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: ti'6 '/4 NW '/4, Section 2 T:!~J N, R 1 (or) Lot# ity Subdivision Name, nearest road, lake or landmark Blk# 3 illage Ci~~~PT~' ~~~~~~d~ r~~~/~j~ ~~JC✓~ Township T~UP 10 A-1 C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family' Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY /0-6-0 Total gallons No. of tanks Z HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation N/ 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 s ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width2Y'_Depth z4 Tile depth (top) 32- "_No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits _ Percent slope of land /0 '1~2- /cl Distance from critical slope 1VATER SUPPLY: Private ;Z Joint El Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: 1, 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 a64hG,PT C.S.T. # 3 5 '~Z~ z and other information obtained from S r (owner/builder). Plumber's Signature ~'k~sf ` _ MP/MPRSW# Phone # Plumber's Address 72 OV p D l~U~~d.•v Cam:/ S - 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. NOT %o 3 v 1 ti E • a Refill _ 30ir m _ w E o y V y o v y y U q n o p o u' o a u o <-t pit _~Pi4VE~ o ~ Lo .V D I Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application - Ll Fees Paid: StatCounty U Permit Issued/Rejected (date) ~U Issuing Agent Name fy 1- Inspection Yes No State Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALT-11, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 r C~J ELI 115 Rev. 9/76 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: '/a, Section y T:tLN,RZZ E (or0W Township or Municipality Lot No.Block No. 3 _ 2'S /J' 6A9471'4 S j~PDi7tl'0 County 5v. &Z6K `SE ubd Islon ame Owner's/Buyers Name: © Mailing Address: G`D L..SML-ES/~/~ O/l~/~' ~•U/.r , TYPE OF OCCUPANCY: Residence-)( No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT -ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE:: SOIL BORINGS PERCOLATION TESTS q' / 4'_?o SOIL MAP SHEET 5~-_5 66 NAME OF SOIL MAP UNIT' /'ZeL , PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES NUM- SINCE HOLE HOLE AFTE INTERVAL RATE MIN/IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 6T 16&ai P_ cj~ C f, P- L% )e_dv L: /(/o NE P- Cad p-~,~ c P- i 6 yo 3 Naiv~E >6 P- /SEE 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- l /07 QA) " a• L 23 " ~.J • G "OAP' CS c•~ Ga-(- boy " A4 -,6,v cS B- 2 /0 "130o1j. 4. AR 4V ZS ~X"k" 5'2 B- 3 72- !VDT E 7 Z.- , A " se QN L s CS B- A//0,t3E > ~ / / "Cowix R_~ LS ? , 5-/3.v es B- 2- A/"6_ > ~ 2_ j ~ 4-- 4sf_ K 'aN LS B- A)0)Ue_ 7 ei'1Cr- JS CS PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the loca~on nd square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy 'Z ~ /j Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. = ~~E C~i4tji~ s7y4r1EL ~ .1~,'WyfrP) o R -TRAn1S1T~" 5`~'i ~/EtI~TIONs r G ~ u~ Q XZk 4 v, 4M J3 13 UP N 133 13y . 7Y ISN E c7 r 7_ r Q, 64& 3 B, tl{e 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. L Name (print),,~~~~T~~~ G~r u Certification No. Address 'e r 3 &UP~l!V 40 ,Z® p~/©~ • ~X~~1~~~//l~~/ Name of installer if known CST Si in_ - l 'f Copy A - Local Authority s ` • f y v~ ol~ 71 07 ~pnoS I w I ~ 11. ~ N a~ ' I ' I W Q~k O QC o I'z