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Parcel 020-1139-00-000 06/09/2005 07:31 AM
PAGE 1 OF 1
Alt. Parcel 29.29.19.701 020 - 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
WARE TRUST, ROGER O & GLADYS F TTEES
ROGER O & GLADYS F TTEES WARE TRUST
750 GHERTY LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 750 GHERTY LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.598 Plat: 1979-GHERTY'S ADD
SEC 29 T29N R19W GHERTY'S ADD LOT 8 BLK Block/Condo Bldg: 3 LOT 8
3
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/26/1999 609300 1452/041 QC
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 2.598 33,000 203,400 236,400 NO
Totals for 2005:
General Property 2.598 33,000 203,400 236,400
Woodland 0.000 0 0
Totals for 2004:
General Property 2.598 33,000 203,400 236,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 112
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
rj
OWNER f, 'TOWNSHIP )/l SEC. T.:~ y N, RAW
ADDRESS., s ST. CROIX COUNTY WISCONSIN.
SUBDIVISION 6'h~ .s f,~~, LOT LOT IZE
PLAN VIEW ' k__
0
~
Distances & dimensions to meet requirements of H62.20 /961
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
• f4
I
1A case
I
- -7 _
1 , i,5 }car Ce p. -
O ~ I I I I~ II
7-Te
f .
rs `X ' Indicate North; Arrow
SCALE
SEPTIC TANK(S) Gam, MFGR. CONCRETE X STEEL
NO Jof 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 length- area 6
depth to top of pipe "
NUMBER OF SEEPAGE PITS Outside diameter total pit area
AGGREGATE 1
PERK RATE t f AREA 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 that
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 ,6f failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH S SYTEM.
INSPECTOR
DATED j(~
j I/ PLUMi3)ER ON JOB__.~~~
LICENSE NUMBER
REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.i.tany Penm.i•t
• State Septic
NAME ' Townah.ip S.~. Cno.ix County
L o ca.t.io g = /Section
SEPTIC TANK
Size / gattona. Numbers o6 Compa,%tmen.td
flibtance Fnom: G/e.Et r~7 12% of gneaten stope it
Bu.itd.ing it. Wettandd - ~ .
Highwaten - it.
DISPOSAL SYSTEM
c5 ' S 12$ oh gnea en s dope ~-t.
D•ibtance Fnom: Wett J'&
Buitding Wettand4 F •
Highwatet it.
FIELD DIMENSIONS:
Width of zneneh it. Depth oS nock betow ti.Ee .in.
Length of each tine c'~Gr 6t. Depth o6 nock oven Cite Z .in.
Number o6 tines 3 Depth o6 -t.ite below grade -,:?C-.in.
Totat teng,th o6 tined it. Stope o6 .tneneh 4--- in pen 100 it.
D"' ranee between tines I 6t. Depth to bedrock ~ •
Totat ab.eonbtion anea l ~'CI ~ 2 Depth to gtoundwaten it.
A 2
N-tiequi&ed anea it Type oj Coven- Papen ox S to aw
.
PIT DIMENSIONS:
Numbers o6 pits Gnavet around pits ye.a no
Out6 ide d.iameten St. Depth below .inlet it.
2
Totat abzonbt.ion anea it • A
Area nequined it2 rn
INSPECTED BY TITLE APPROVED DATE 19 ` J
REJECTED DATE 147
<i4
i
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
: P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: Section q?l, -P2-?N, R $ k(or/ )Township or Municipality f/CC NSd t/
Lot No. --Y_, Block No. County S~• ~~C~i X
Owner's Name: Subdivision Name
Mailing Address: [CdSdM
TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET _ SOIL TYPE 9)k
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- j~2
12 e he 1,~ 041~A
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST y~ c~(DEPTH TO BEDROCK IF OBSERVED)
-7 6
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 numb pr of square feet of absorption area
needed for building type and occupancy. :r •'1/"-e /brc. rc=,-
y ~ Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope. Sys,-/,-
'Ice, ~1
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1 /4 ti rIo ~
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I, the undersigned, 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 (print) AZ ~Jlf t` /11i ';1W Certification No. J'~
Address CC vi~rrS - O%
Name of installer if known
"`OPY A LOCAL 14llPHORliY CST Signature _
Qe
-W~ . . -qqq~
7 I State and County State Permit # - 17 7 6,
L - j6 Count Permit #
Permit Application Y
1l
for Private Domestic Sewage Systems County T C7'c
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:: JJ
~C}G Z✓ 1,vIC~" e G'~~ ><P Ile, ! k n l~ s tal k
B. LOCATI. N: .Sv % $ ?[LI"%, Section T N, R_1 (or) Lot# _ City
Subdivision Name, nearest road, lake or landmark Blk# Z. Village
- h of f !s /icl it J v i4- Township f~lcdso ex
;
C, TYPE OF O UPANCY: *Commercial "Industrial *Other (specify) *Variance
Single family k Duplex No. of Bedrooms No. of Persons_
D. SEPTIC TANK CAPACITY /t?UU Total gallons No. of tanks /
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete- Poured-in-Place Steel Fiberglass Other (specify)
New Installation X Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-PlaceOther (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area l sq. ft. 615'
New X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: X Length a310 Width DepthTile depth (top) Za No. of Lines -57
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land ~ 2.2 cr /A em la Distance from critical slope -7t'~
WATER SUPPLY: Private 19 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 -2 Z C kr, k t5 C.S.T. # SS - and other information
obtained from (owner/builder).
Plumber's Signature or,
MP/MPRSW# Phone #3A-6 - &I
Plumber's Address --?/d 141-C A 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 B to - FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application U Fes Paid: State County 1 Date 8C
Permit Issued/Rej ted (d te) L C7 Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (w to opy) 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