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Parcel 020-1028-70-000 03/14/2006 04:02 PM
PAGE 1 OF 1
Alt. Parcel 16.29.19.127A 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 - ROTHE, CLARENCE O & VERGIL (LE)
CLARENCE O & VERGIL (LE) ROTHE C - BECKMAN D & ROTHE D & S
BECKMAN D & ROTHE D & S
660 PERCH LAKE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 528 MCCUTCHEON RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 36.640 Plat: N/A-NOT AVAILABLE
SEC 16 T29N R19W NE NW EXC CSM 2/400 & Block/Condo Bldg:
EXC PARCEL AS DESC IN 882/534 (ADDED TO
CSM 2/400) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
16-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/08/2001 644915 1634/589 WD
07/23/1997 882/534
2005 SUMMARY Bill Fair Market Value: Assessed with:
91585 Use Value Assessment
Last Changed: 10/25/2005
Valuations:
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 33.510 3,300 0 3,300 NO 05
UNDEVELOPED G5 1.130 100 0 100 NO
OTHER G7 2.000 57,000 114,500 171,500 NO 05
I
i
Totals for 2005:
General Property 36.640 60,400 114,500 174,900
0
Woodland 0.000 0
Totals for 2004:
General Property 36.640 35,600 85,000 120,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 207
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
:'NER/1 AC_P N lu r~'1.' , TOWNSHIP SEC. T~ N, RL LW
.0. AiJDRES~ + $ T. CROIX COUNTY, WISCONSIN
~ ~ ,ri yam( •
:3DIVISION , LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
A '
OPTIC TANK(S) NCC; MFGR. l~j c e S er CONCRETE 2 STEEL
NO. of rings on cover__ Depths/- DRY WELL
" NCHES NO. of width length area
;D no. of lines widthlength area
depth to top of pipe 3Itl
'GREGATE /f0
♦RFC RATE = ~1 AREA REQUIRED
/AREA AS BUILT sciaimer: The inspection of this system by St. Croix County does not imply complete
.mpliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
'stem operation. However, if failure is noted the County will make every effort to
termine cause of failure.
EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
~'INSPECTop,
DATED PLUMBER ON JOB
LICENSE NUMBER
z ,
RCPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitary PeAmit---X'
~
State Septic
NAME ' Townbhtip ' St. CALoix County
Location,,, % obi'. Section./ T_N, R W
SEPTIC TANK
Size. Z gattonz. NuuumpyJ_b~ ers ob CompaAtments
Distance FAom: Wet /d 0 6t. 12% oh greaten ztope bt
Buitding~21 (D bt. Wettand~5 bt.
HighwatvL bt.
DISPOSAL SYSTEM
r
Di6tance FAom: WeU / o` G bt. 12% oA gneateA 6tope,,--- bt.
Buitding66bt. WetZands Ft.
d ( H.i..ghwateA ' bt.
FIELD DIMENSIONS:
3 Width ob tAench~L bt. Depth o6 Aoch. betow tite in.
Length ob each Zine t. Depth ob Aock oven tite in.
NumbeA ob tine/s 3 Depth ob tiZe betow gAade-' kn.
Totat Zength ob tine6 j bt. Stope ob tAench in pen 100 bt.
Di,s Lance between Zine/s [p bt. Depth to b edno ck bt.
Totat absoAbtion area ( bt2 Depth to vtoundwateA
RequiAed area (D 1 6t2
i'
PIT DIMENSIONS:
Numbers ob pi GAavet around pitz ye/s no
Outside diam tehc bt. Depth below inlet bt.
/ 2
Total abz f ,)cb;o area bt z
A
AAea Aequk&ed bt rn
40~
INSPECTED '
TITLE "2/f
APPROVED DATE -2,
19 7.
REJECTED , DATE 197
0
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 TE,S}S /
LOCATION: A'/j,~%, Section/` , T*N, R J2 (or)6jownship or Municipality Mu dS
County
Lot No. , Block N S X
SA]bdivision Name
Owner's Name:
j3r
Mailing Address-
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 7,20'7PERCOLATION TESTS '.1 z-7
SOIL MAP SHEET SOIL TYPE Z -
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- of ' S^
/
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)
B- 9
B-
B Gs►.t'L, L .r ~..Y
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of suitable areas. Indicate-number f square feet of absorption area
needed for building type and occupancy. •~G•~' r Sc<. e Indicate scale
or distances. Give horizontal and vertical referenc Qints ndi slope.
I t
7-t
r lt'/ 1 ;;1.01r i
IbIl
oil
it N
10 1
iS
_ }}I f S r f z ~ { i 1
# ~ I ~ S t I I i I 1 t i t i f
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 eli f~. /
f 6 ! - S
Name (print) " '-1 VCertification No."
Address
Name of installer if known
CST Si atZ
-
A -LOCAL AUTHORITY gn
CO
State and County State Permit #
PLB67 Permit Application County Per t # 1 _ 4
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: _&C-_114 Section T' N, RZ (or) aot# City
Subdivision Name, nearest road, lake or landmark Blk#_ Village
Township ci SL'
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family . Duplex No. of Bedrooms ,3 No. of Persons _3
D. TYPE OF APPLIANCES: Dishwasher
_K_ YES NO Food Waste GrinderYES_,X_NO # of Bathrooms
Automatic Washer ( YES NO Other (specify)
E. SEPTIC TANK CAPACITY ~M"O Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation -Addition _ Replacement _1K _ Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) t,7- 2) - 3) __Total Absorb Area sq. ft.
New Addition _ Replacement X *Fill System ~(S-Fz ci'ai""61
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length,36 Width Depth " Tile Depth ~~•r _No. of Lines _
v
Seepage Pit: Inside diam ter Liquid Depth Tile Size
Percent slope of land e?` ` - S~rf-lX 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 Ce 'fied Soil T ster, _ _
NAME<i C.S.T. # and other information
obtained Fromm 1-e'o"&(- cry. owne
Plumber's Signature RSW#Phone #T~~ =~$6 3~Z3
Plumber's Address ~PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well). /
Al
t r c<~Y~~u 5/1.
~v 1
C~• 1`y' /
Do Not Write in Spac Below- F R DEPARTMENT USE ONLY
Date of Application ` Fee Paid- State el ~ C nt Date
Permit Issued/Re*"- (date) - U Issuing Agent Name 2J
Inspection Yes\/ No 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) Revise,'.-