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Parcel 020-1144-40-000 12/06/2005 09:30 AM
PAGE I OF 1
Alt. Parcel 17.29.19.753 020 - 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 - GERZMEHLE, DENNIS & MARY
DENNIS & MARY GERZMEHLE
984 WERT RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 984 WERT RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.720 Plat: 2276-PARK VIEW ESTATES 2ND ADD
SEC 17 T29N R1 9W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 60
ADD LOT 60
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
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 1.720 63,300 171,800 235,100 NO 05
Totals for 2005:
General Property 1.720 63,300 171,800 235,100
Woodland 0.000 0 0
Totals for 2004: 'I
General Property 1.720 32,700 165,300 198,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 125
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
OWNER ' TOWNSHIP SEC. 1 -'N, R W
P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT " LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Ilk
i
L
i
i
I
i
I
i
1}, 4
M '
SEPTIC TANK(S) MFGR. - CONCRETE STEEL
NO. of rings on cover Depth ; DRY WELL
TRENCHES NO. of width length area
BED no. of lines I width ' length area
depth to top of pipe
AGGREGATE
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 r
. y _
DATED - PLUMBER ON JOB
LICENSE NUMBER
c
RFPOI,T OF I?ISPI;CTI0'.1--174DIVIDUAL SI TJAGE DISPOSAL SYSTEIi
Sanitary Pernit J~~~
r State Septic'
1V
. ~A: iE - 1 l `LAC TOVIN S H I P
t. Croi County
SEPTIC TA"K,
SiZe; gallons. "umber of Compartments ~
Distance From: r-Je11 n .r ft. 12% or greater slope ft.
t*
. 44
Building` ft. Wetlands ft
Highwater ft.
DISPOSAL SYSTL.i1 _Tile Field or Seepage Pit(s)
Distance From: Hell ft. 12% or greater slope ft
Building ft. Wetlands f:.
FIELD ;:llighwater f- t.
Total length of lines ft, !Number of lines r" Length of
each line eft, Distance between lines ft. Width of the
trench
~ft. Total absorption areaY ,.r sq. ft. Depth
of rock below tile in. Dp-pth of rock over tile ' . in. Cover
aver . rock,, `
Depth of tile below grade c- 4,/
in. e
BZopof
'
trench in e`er
00 ft. Depth to Bedrock - ft. Depth to
,round mater ft.
PITS
Dumber of pits Outside diameter ft. Depth below inlet
ft. Gravel around pit: ___yes no. Total absorption area
5 i sq. ft.
Square feet of seepage trench bottom area required .
;square feet of seepap nit area required -
Inspected by: - ` Title':
Approved Date 197.
Rejected Date 197.
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
LOCATIOSection ~_JN, R~1A'(or) ,Township or uni ii aIity a`~
S' A 1~ County S Ore
Lot No. , Block No. - 'L S' r
s~~ Subdivision Name
Owner's Name: 5 / n) /
Mailing Address: 1 ~ O f Q 0 /l /'f C~ . ~[1' ~f ~~'s • --tl-01,6
TYPE OF OCCUPANCY: Residence - K No. of Bedrooms -3 Other
EFFLUENT DISPOSAL SYSTEM: NEW X -ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS /0 `,It 2 u PER / CQLATION TESTS lU
SOIL MAP SHEET ~ IFT y / SOIL TYPE S A _f - ! -X
PERCOLATION TESTS
TEST DEPTH F SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
CHARACTER O
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
12-, 3
adt'
170 1 C-7 le 16L"re X2- I
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- Sy"
B Y
B- 6e j -5
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable a eas. Indicate numb pr of square feet of„ahsorption area
needed for building type and occupancy. s hYMdicate s le
or distances. Give horizontal and vertical refer nce gain &dicate slope. 5'Y5 ~e ~jjtFcT ~►u%
3 ~
,
JA
I I , I
! - -10 y "a
T___ _
_
NX-
i f ~ i i 1 I I '
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) t?.~s~-s ` .t fs.. Certification No.
Address 44)e/~id SeN" S S~C~~
Name of installer if knoNm _
CST Signature ,
PLI967 State and County State Permit #
Permit Application County P r it #
for Private Domestic Sewage Systems Coun -
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: Section T'' " N, R E (or) W Lot# C.,-City
Subdivision Name, nearest road, lake or landmark Blk# Village
} Township
if ~T ^ ✓vr
C. TYPE OF OCCUPAN Y: *Commercial *Industrial *Other (specify) *Variance
Single family Y Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES. Dishwasher _jYES NO Food Waste Grinder ES NO # of Bathrooms-m
Automatic Washer / YES NO Other (specify)
E, SEPTIC TANK CAPACITY Total gallons No. of tanks
Holding tank capacity Total gallons No. of tanks /
% ew Installation Addition Replacement Prefab Concrete
'Poured in Place Steel Other (specify)
c_FFLUEN DISPOSAL SYSTEM: Percolation Rate 1) yT 2►_T~3) _,`ZTotal Absorb Area sq. ft.
New Lel Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length ~ width Depth -Tile Depth_ 3 No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent- slope of land-5 `d 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 Cert~ ied Soil Tester, /'fj f1 L r
NAME C.S.T. # and other information
obtained from ` (owner/builder Z
Plumber's Signature 14 :y MP/M RSW# Phone # JtT 7 r 7 l
Plumber's Address'
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
7 2-
I ,LV
,
Do Not Write in Space Below F DEPARTMENT USE ONLY ~ ~d ~1-0
y
- "
Date of Application 3 Fees Paid: State Q r O OCounty szl - et Lq
-4, MA
Permit Issued/f} (date) --7 -Issuing Agent Name f
Inspection Yes_,y 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)
Revised Date 6/1 /76