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Parcel 020-1144-50-000 12/06/2005 09:30 AM
PAGE 1 OF 1
Alt. Parcel M 17.29.19.754 020 - 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
STEPHEN D & PATRICIA TRS COX O - COX, STEPHEN D & PATRICIA TRS
978 WERT RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 978 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 61
ADD LOT 61
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/29/2002 669592 1824/505 QC
07/23/1997 686/309
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 63,300 170,800 234,100 NO 05
Totals for 2005:
General Property 1.720 63,300 170,800 234,100
Woodland 0.000 0 0
Totals for 2004:
General Property 1.720 32,700 162,500 195,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 214
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
:TER , TOWNSHIP SEC. T N, R W
ADDRESS ST. CROIX COUNTY, WISCONSIN.
:3DIVISION LOT LOT SIZE "
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t
i
E
1
1
TIP; TANK(S)_ MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
`iCHES NO. of width length area
no. of lines width length area
depth to top of pipe
''REGATE
_K RATE AREA REQUIRED AREA AS BUILT
ciaimer: The inspection of this system by St. Croix County does not imply complete /
)liance with State Administrative Codes. There are other areas that it is not possible i
inspect at this point of construction. St. Croix County assumes no liability for
tem operation. However, if failure is noted t'--: County will make every effort to
ermine cause of failure.
-ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
INSPECTOR
DATED PLUMBER ON JOB
LICENSE NU1103ER
• 9
Z♦
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitahy PeAmc A;'Y
/ State Septic ~ '
~
NAME Vitt Township / St. C&oix County
I V Laca ivy a~ Sectiov/% T7 N,Gl
SEPTIC TANK
Size / 70 gattons. NumbeA o6 CompaAtmentIs
Distance PAOm: wet it. 12% oA gtc.eatvL slope it
Buitd.ing it. We.ttands b~.
HighwateA it.
DISPOSAL SYSTEM
Distance EAOm: Wets 12% oA gneatetc stope it.
Bu.itd.ing Z' i it. Wettandls Pt.
HighwateA it.
FIELD DIMENSIONS:
Width o4 tAench / Z it. Depth o6 Aock below Cite in.
Length a4 each tine it. Depth a6 Aock oven Cite ' in.
Numbet of .roes Depth o4 tite betow gtcade /'L in.
Totat Length ob Zines it. Stope o6 ttench _ in pen 100 it.
Distance between tine,5 t. it. Depth to b edtr.o ck b .
Tatat absotcbtion atcea 6t2 Depth to gtcoundwatetc it.
Requited atcea it2
PIT DIMENSIONS:
Numbetc of pitz GAavet aAound pits yes no
Outside d,iame'~A it. Depth b etow inX e-t it.
2
Tatat ab~sotcbtion tea it
z
` 2 ~
AAea Aeq uite~d m
f' INSPECTED By TITL~
-1 11 /
APPROVED , DATE 19 7
REJECTED DATE 197
a
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 i
LOCATION:: '/a, ~'/a, Section -7, T~N, R 4 E (or) W, Township or Municipality 2/ L C/5 r
Lot No. 1.1 Block No. e I C ~ County / ~L ► y
f ubdivision Name
Owner's Name: ire
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms j Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS- 7 PERCOLATION TESTS Sri' - rrs - 7
SOIL MAP SHEET' SO ILTYPE PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
CHAR
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
Pi4 F `f- !y ' E~r / ?2 3 Id '
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)
- 5 Ldp _ i-
2 l 12S T -,Z
B-. 1-
` i > c S'
B
7- ` 7 7 L~'•^
PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.)
Y ~ Indicate on the plan the location and square feet of suitable areas. Indicate number of s are feet of absorptt"°n_arrea
1 needed for building type and occupancy. ernbica'te sca
or distances. Give horizontal and vertical reference point ate slope.
i
t f I 1 , I
I i 1 E
- - - - -
I S ` -
T '
T i 'I
i f i I 3 }
I i wi{ I- I
AVI
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) ' ` r / Certification No. t1-
6f j,
Address L z . ti i a~ r~ / 4-
Name of installer if known
fi CST SignatureF
OPY A - LOCAL AUTHORIT-r.
State and County State Permit # C'
PLB67 Permit Application County Per for Private Domestic Sewage Systems County
"h -
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
1-3
B. LOCATION: ,y'/4, Section ) T r, N, R 1 E (or) W Lot# -City
Subdivision Name, nearest road, lake or landmark Blk# Village
~R { 1Jr- l F Is T' A TL S Township
~1~-C-1- 1 C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family y Duplex _No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher L," YES NO Food Waste Grinder ./YES NO # of Bathrooms -3
Automatic Washer J~YES NO Other (specify)
E. SEPTIC TANK CAPACITY U Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks /
New Installation Addition Replacement _ Prefab Concrete v
*Poured in Place Steel Other (specify)
F. EFFLUEI)LT DISPOSAL SYSTEM: Percolation Rate 1) 2)~3) y- Total Absorb Area (S sq. ft.
New Addition _ Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile 9epth No. of Trenches _
Seepage Bed: Length = Width Depth y r Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land 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
i by the Certified Soil Tester, ,
NAME C.S.T. # ~j and other information
obtained from (owner/builder)
.
Plumber's Signature IVIP/MPRSW# 41 ~ 7 'hone # 7
Plumber's Address u~ . c: /1 /
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
.t
H62.20, including well).
i
i
P
3
f - Try
F4 A
iv q 1
Do Not Write in Spa Below --,FOR DEPARTMENT USE ONLY L
Date of Application Fees Paid State Lam' C untyF Date
Permit Issued/Rejected (date) _issuing Agent Name - ^ /
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) -