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Parcel 020-1126-80-000 11/10/2005 09:31 AM
PAGE 1 OF 1
Alt. Parcel 17.29.19.584 020 - 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 - PETERSON, TERESA L
TERESA L PETERSON C - DAWSON EVELYN D
DAWSON EVELYN D
462 GREEN MILL LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 462 GREEN MILL LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.560 Plat: 2272-PARK VIEW ESTATES
SEC 17 T29N R1 9W PARK VIEW ESTATES LOT 3 Block/Condo Bldg: LOT 3
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/30/1998 582027 1336/059 WD
07/23/1997 686/480
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.560 59,800 124,300 184,100 NO 05
Totals for 2005:
General Property 1.560 59,800 124,300 184,100
Woodland 0.000 0 0
Totals for 2004:
General Property 1.560 30,900 112,300 143,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 120
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
.i' t
''NER• _ rL TOWNSHIP SEC._ TY N, RW
eO. ADDR SS f c. .r ST. CROIX COUNTY, WISCONSIN.
_iBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
:?TIC TANK(S) i MFGR. CONCRETE 1--_' STEEL
NO. of rings on cover- - Depth 'r DRY WELL
`.aNCHES NO. of width length area
no, of lines width length area-
depth to top of pipe
-~REGATE Az_
K RATE ' ,a ,/ps AREA REQUIRED AREA AS BUILT
_ciaimer: The inspection of this system by St. Croix County does not imply complete
_npliance 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.
-7ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
-'INSPECTOR
DATED PLUMBER ON JOB ' f
r i''u_C ft { }
LICENSE NUMBER
i
I
I
REPORT Or INSPECTI01_1--IidDIJIDUAL SE JAGE DISPOSAI, SYSTEM
S j Sanitary Permit
State Septic 1
TOWNSHIP
• t. Croix County
SE.PTIC TA IT',
Size gallons . `umber of Compartments ,
Distance From: We 11
~
@ FL= ft, 12% or greater slope ft.
: Building -_ft. Wetlands ft
Highwater ft.
DISPOSAL SYSTE11 Tile Field or Seepage Pit(s)
Distance From: Well ft. 12% or greater slope A
Building ft. Wetlands f:.
FIP,L_ - K Hip
'hwater f IF ft
, -
Total length of lines ~Q ft. !lumber of lines Length of
each line s 2 ft. Distance between lines rft. Width of the
trench iLtft. Total absorption area sq. ft. Depth
of rock below the in. Depth of rock over tile *X in. Cover
over.rock, . Depth of tile below grade JQ in. Slope of
trench in per 100 ft. Depth to Bedrock ....r~ ft. Depth to
ground water ft.
P
}lumber of pits uts d iarmeter ft. Depth below inlet
ft. Gravel aro d ~i : es no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
t;quare feet of se "nit a a re fired
Inspecte Title:
Approved Date 197.
Rejected , Date 197
EH 1 15
,y 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 TES S
LOCATION: /4, r;~ '/o, Section _,.r: ~ N, R6 E (or)(OTownship or Municipality
Lot No., Block No.~ County
ubdivision Name
Owner's Name: ~~tl , ~n` s~`~` t:f
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW AD ITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS ! PERCOLATION TESTS kn&) ~ ~'~,rz
SOIL MAP SHEET c -~P SOIL''TYPE 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
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
SL (C &m Nr I /\j E -A, 1 p- c,
P
D
SOIL BORING TESTS
I TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
G-
B 1 1 i rc " S,
''I_AN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
.dicate on the plan the location and square feet off uita le ar as. Indicate number of square feet of absorption area
needed for building type and occupancy. Indicate scale
;r distances. Give horizontal and vertical reference points. dicate slope.
' i
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33
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1, 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) Iru Certification No.
Address L- MI-L,54 -
Name of installer if known
CST Signature
l
COPY A - LOCAL AUTHORITY
State and County State Permit #
P L6 7 Permit Application County Per i # -
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: Y Section T j N, R17 E (or) W Lot# City
Subdiv' me, nearest road, lake or landmark Blk# Village
Township s
C. Y OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family L/CYDuplex No. of Bedrooms - No. of Persons
D. TYPE OF APPLIANCES:,Bishwasher YES NO Food Waste Grinder YES NO # of Bathrooms
Automatic Washer d/YES NO Other (specify)
E. SEPTIC TANK CAPACITY- Irra Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks /
New Installation Addition Replacement _ Prefab Concrete L/
*Poured in Place Steel Ot r (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolate otal Absorb Area sq. ft.
New_~ddition Replacement *Fill System
Seepage Trench: No. Lin. Feet r Width Depth Tile Depth No. of Trenches
Seepage Bed: Length WidthDepthTile DepthNo. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land _T Distance from critical slope
1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Adm' istrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Cert d So' ter,
NAME C.S.T. # Wand other information
X5
obtained fr i o ner/builder).
Plumber's nature /MPRSW# Phone'
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
1
1
Do Not Write in Space. to FOR DEPARTMENT USE ONLY Q l f
Date of Application' Fees Paid: State Coun Date
Permit Issue (date) D_lssuing Agent Name i✓
Inspection Yes No _ Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI F
2. state (pink copy) 4. plumber (canary copy)