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Parcel 020-1022-80-200 06/29/2005 11:19 AM
PAGE 1 OF 1
Alt. Parcel M 14.29.19.104A-20 020 - 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
* BROOKS, MICHAEL R
MICHAEL R BROOKS FOSTER HEATHER A
FOSTER HEATHER A
929 LA BARGE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 929 LABARGE RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.900 Plat: 1521-CSM 16/4337 020/02
SEC 14 T29N R19W PT NW SE BEING CSM Block/Condo Bldg: LOT 02
16/4337 LOT 2 2.900AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-29N-19W NW SE
Notes: Parcel History:
Date Doc # Vol/Page Type
09/05/2002 689305 1968/311 WD
07/23/2002 684731 1614337 CSM
09/25/2000 630504 1545/253 QC
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/05/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.900 45,400 116,400 161,800 NO
Totals for 2005:
General Property 2.900 45,400 116,400 161,800
Woodland 0.000 0 0
Totals for 2004:
General Property 2.900 45,400 116,400 161,800
Woodland 0.000 0 0
I
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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AS BUILT SANITARY SYSTEM REPORT
OWNER, ~i► - , 5 s TOWNSHIP W",/S.j J%j SEC :t/ Tf I N, RILIW
P.O,:* ADDRESS ST. CROIX COUNTY, WISCONSIN
7 o . ( ~ tic
SUBDIVISION LOT LOT SIZE 5
L 67-
PLAN VIEW
Gl a
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100FEET OF SYSTEM
r ~
.)R jvle~A 193
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- ;p
a
x
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3
9
3
SEPTIC- TANK(S) MFGR. k,5 C~ CONCRETE x' STEEL
NO. rings on cover -?me_ Depth DRY WELL
TRENCHES No. of width ' length area _
BED no. of lines width lend- area
depth topes of pipe
AGGREGATE
c_
11-
PERK RATE AREA REQUIRED .?,?C 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-of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSPECTOR
DATED - J " 7." PLUMBER ON JOB
LICENSE
L
.
,
RFPOI;T OF ITISPi;C1'IO?1--I DIJIDUAL SL74ACE BISPOSAI, SYSTEH
Sanitary Permit
State geptic
"AME T&INSHIP
t. Croix County
SP.DTIC TA'?K
• ize gallons. %lumber of Compartments /
Distance From: Well ~ ft, 12% or greater slope ft
Building: ft
Wetlands
Highwater ft.
DISPOSAL •SYSTLiq Tile Field or
~ Seepage Pit(s)
Distance From: Well
ft, 12% or greater slope ft
Building 4
ft. Wetlands f
FIELD
r,ighwater ft,
Total length of lines-ft, dumber of lines Length of
each line ft. Distance between lines ft. Width of the
trench ~ft. Total absorption area s
q• ft, DeP ~
t..
of rock below file in, Dp-pth of rock over the in. Cover
Over .rock, Depth of tile below grade in. Slope of
trench in per 100 ft. Depth to Bedrock ft, Depth to
ground water ft.
PITS
Number of pits Outpid d'.ameter ft. Depth below inlet
ft. Gravel around fit `yes no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
,,quare feet of_-s6epag.e nit area required
.r
Inspected by;
/ Title:
Approved Date`." 197
Rejected Date 197`.
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 /
SG
LOCATION --V-1/4, A ~/4, Section THIN, R a &(or) W, Township or Municipality I:U
Lot No. , Block o. County Ck x
Subdivision Name
Owner's Name: A
Mailing Address: U SO r
TYPE OF OCCUPANCY: Residence X No. of Bedrooms U Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT, /
DATES OBSERVATIONS MADE: SOIL BORINGS _ PERCOLATION TESTS ~SO ^ 7P
SOIL MAP SHEET., SOIL TYPE U rv o rYI
PERCOLATION TESTS
r HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES
'TEST DEPTH RATE
CHARACTER OF SOIL
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
3ER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
O
r
~P-/ 9$ Te sar`y Aaa~~ l 5eAP~r
P 3er, $ „ I ~ rI /L
IP-3 13 ?P it rr l
U 3 !S
L~ 0, ( H if
_ - - - -
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
7 - op S6 !L Or' 5 , y j-M 0/9-V q C, a rr
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/ ( It, 6 ! f /i r
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S n ! y ! /
j - / y / 6 ! ri rr rJ O
3 ! <I / r r O I/ n b ri
rr ! l! ff 6
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of uit vie a. Indicate um er of_~guar feet of absorption area
needed for building type and occupancy. Indicate scale
cr distances. Give horizontal and vertical reference points. Indicate slope.
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40 3,.0
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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) ZE:,v e / f' ,1 Certification No.
Address e e' '
Name of installer if known
CST Signature
COPY A - LOCAL AUTI-:O's?ITY -
g State and County State Permit #
-Z~7-
Permit Application County Permit - 7.1
• for Private Domestic Sewage Systems County
s
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: '/4 ' '/4, Section T N, R & (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township U S
L-'z • ` ; , y fit-` ~ -
C TYPE O~ OCC ANCY: /-Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms 1~ v No. of Persons a
D. TYPE OF APPLIANCES: Dishwasher A YES NO Food Waste Grinder YES NO # of Bathrooms--6-1V e
Automatic Washer 7C YES NO Other (specify)
E. SEPTIC TANK CAPACITY/000 Total gallons No. of tanks _ onl e-
'Holding tank capacity_ Total gallons No. of tanks
New Installation -Addition _ Replacement Prefab Concrete X
*Poured in Place -Steel Other (specify)
EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area 33d sq. ft.
Newer Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet /l4 Width l Depth -:?I Depth o No. of Trenches ' o
Seepage Bed: Length Width Depth Tile Depth No. of Lines
n
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land D°~~T f2°Jo Distance from critical slope
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 it Tester, LL
NAME ✓eR e ~T O W1 C.S.T. # 5-i4t/ and other information
obtained from u~ e2. (owner/builder).,/c/ p
Plumber's Signature MP/MPRSW# ZT009 Phone #60 1 7~
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
I PAC e A-
\ '50,04
1 ° SLo~ ,T c" -5
1 a0 %
4
0)~ \ d 6 yy t~ A i)o TI e1- ~ SS, FRO M We 00 e
1,4)VK o r n1 F o Cv e- 4
eA r L4 75"
W
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Do Not Write in Space Below FOR DEPARTMENT USE ONLY C _
Date of Application r _ Fees Paid: State L~ r ; County 2 7. Date.,
Permit Issued/Ra}eciad (date) ~-Issuing Agent Name (1-,- 4) CL l'._>
Inspection Yes _No Valid# Date Rec'd~
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)