HomeMy WebLinkAbout020-1101-00-000
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Parcel 020-1101-00-000 05/13/2005 10:47 AM
PAGE 1 OF 1
Alt. Parcel 34.29.19.403F 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
TERWILLIGER, F EDWARD & JANICE
F EDWARD & JANICE TERWILLIGER
659 BAKER RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 659 BAKER RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.950 Plat: N/A-NOT AVAILABLE
SEC 34 T29N R19W NW NE COM N1/4 COR SEC Block/Condo Bldg:
34 TH S 1290.81' TH E 643.47 FT TO POB
N384' TH E 3405TH S 384' TH W 340.5' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TO POB EXC PT TO COUNTY FOR RD 34-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1004/455 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.950 45,700 97,400 143,100 NO
Totals for 2005:
General Property 2.950 45,700 97,400 143,100
Woodland 0.000 0 0
Totals for 2004:
General Property 2.950 45,700 97,400 143,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 306
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
`r.NER ) t t~ r., i !1 , TOWNSHIP%d)wYti' SEC. T~N, R~ W
a. ADDRESS , ST. CROIX COUNTY, WISCONSIN. L~ ~'.?BDIVISION M LOT 'LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4
a
V
c- i
W y vj
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a
57
_ 1 1
C i ~1~~
, (S ~j 64- t`
f
o,-ti~ yn 0/_ ( s ~
,TIC TANK (S) MFGR. CONCRETE ` STEEL N44m~ v
NO. of rings on cover Depth DRY WELL ~t S,
'ENCHES NO. of width length area i-~
_D no. of lines width; length . ! area
depth to top of pipe f
,37REGATE
:ca RATE AREA REQUIRED AREA AS BUILT
~claimer: The inspection of this system by St. Croix County does not imply complete
:pliance 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
tem operation. However, if failure is noted the County will make every effort to
-ermine cause of failure.
'BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
t
INSPECTOR- `
DATED PLUMBER ON JOB E y t~ ; a ,
LICENSE NUMBER
L
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
SanitvLy Pv mit-J,7
Tj State Septic/,eNAME CTowns hip St. Croix County
--r
Laca pan % o6 'a, Sectiov►3y~N,R19W
SEPTIC TANK
Size gattonz. Number o6 CompaA,tmentz
Distance FAOm: WeU 12% oA gtceateA 6Zope 6t
Building It. wetZands ~ .
HighwateA 6t.
DISPOSAL SYSTEM
Di6tance FAOm: Wets 12% oA gtcea;teA 6tope 6t.
Building - 6t. Wettands Ft.
HighwatvL ~ .
FIELD DIMENSIONS:
Width o6 ttr.ench 6t. Depth o6 Koch below tale in.
Length o6 each tine 6t. Depth o4 Aock ovetc .tile in.
NumbeA o6 Unez Depth o6 tite below grade in.
Totat tength o6 Zinets 6t. Stope o4 tAench in pen 100 6t.
Distance between tines 6t. Depth to bedrock. 6t.
TataZ ab,s otcbtion aAea 6t2 Depth to gtcoundwatetc 6t.
Requi. Led aAea 2
PIT DIMENSIONS:
NumbeA o6 pits GAaveZ vLound pith yeas no
Outside diameteA 6t. Depth b eZow inZet 6z.
2
Tatat abzotcbtion aAea 6t z
A
AAea Aequi&ed 6t2 rn
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
y~~ / REPORT ON SOIL BORINGS AND PERCOLATION TES S,f
LOCATION: A&d_ 4, SectionJY, TaYN, R Jy& (or)t&?ownship or Mu icipality
3i/~~1.~C~'t /5~.~i•~r r`X
County -S~
Lot No. Block No ;a't '4
/ / / ,L-srCC Sub vision Name
Owner's Name: ~/GZ K-
MailingAddress: & d2(t_c at CL i ).c s Z ~1 ~s
~
S.~
TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS A-1_3 SOIL MAP SHEET L/-43/ SOIL TYPE
?~yCi't
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
12-
S4~
P_ el
C5 1:
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)
5k S
2- Ic It6k, Z6 ts, /Y 54
B_ 3 7y
~9 + tv~i. S ~v /~1tY°rs S•G
B- /J^ l /lL~ili 7 / ' 'i (JS// ~G~1/ (ti/' G1 5G 1'i/~iCif%~ /3 S~/
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate nurr}ber square feet of absorption area
needed for building type and occupancy. 2 J-c-o `mot lh wi to-Ale- 1':::o- Indicate s le
or distances. Give horizontal and vertical refer ts. Indicate slope. f y s /c,,,~11~
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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 an belief.
/Uil-5 4t
Name (print) Certification No.
Address
Name of installer if known
CST Signature
OPY A -LOCAL AUTHORITY
-PLB67 State and County State Permit # ice? !44
Permit Application County Permit # 379
for Private Domestic Sewage Systems County 7
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address::
cc " lee.
rLa
I -la 14 l C., a w S'~lc•l,E
B. LOCATION:'/4 Section _ T N, R ~(or) Lot# --City
Subdivision Name, nearest road, lake or landmark Blk# Village
_ Township /j/ccr~$.Jw
C. TYPE OF OCCUPANC`i': `Commercial *Industrial *Other (specify) *Variance
Single family _A Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher _X_ YES NO Food Waste GrinderYES_X-NO # of Bathrooms-/-
Automatic Washer /YES NO Other (specify)
E. SEPTIC TANK CAPACITY 42 C G Total gallons No. of tanks
'Holding tank capacity Total gallons No. of tanks
New Installation ~ -Addition Replacement _ Prefab Concrete X
Poured in Place Steel Other (specify)
=r FLUENT DISPOSAL SYSTEM: Percolation Rate 1) ,y 2)_ 73) Total Absorb Area 9 sq. ft.
"Jew Addition Replacement *Fill System AoCCcrc
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
`seepage Bed: Length Width Depth " Tile Depth " No. of Lines 3
Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land /c Distance from critical slope r
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 C tified Soil ster
NAME r"'s 'Al -'C.S.T. # S and other information
obtained from owner/builder .
Plumber's Signature MP/MPRS it Phone #7/,- gge- 6~3
Plumber's Address
i
rPLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
I /ul,
T
/00
d
® (~r. 0 gkQ vA~v
fi
S c. T
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INV
Do Not Write in Space Be w FOR DEPARTMENT USE ONLY
Date of ication Fee Paid: State- _4 County Date Permit Issue . ejected ( ate i -Issuing Agent Name
Inspection Yes No. Valid# Date Recd
1. county (w ite 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 J
~ ~ State and County State Permit #
C Permit Application County Permit #
for Private Domestic Sewage Systems County
I
*DENOTES STATE APPROVAL REQUIRED
4 Date Approval Received from State if Required State Plan I.D. #
I
A. OWNER OF PROPERTY Mailing Address:
L A' L)
0 12-7 CIc c rZ~ cc// s ~ t
B. LOCATION: 4-0 '/a ltlg:~ '/4, Section T04 N, R_L~ E (or) Ca Lot# 4:_ City
Subdivision Name, nearest road, lake or landmark Blk# Village
41 l , C-T l 5 6 A K C < 1,4 Tf Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) `Variance
Single family Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY ( Z C, C, Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete- Poured-in-Place Steel Fiberglass Other (specify)
New Installation ~C Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width epth Tile depth (tog No. of Trenches
z
Seepage Bed: Length TKI WidthDepth ~ Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land' /!%r Distance from critical slope z
WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
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 Soil Tester, L/
NAME Ar,"- / 5 C.S.T. # _5 z" y~f and other information
obtained from f caner/builder).
Plumber's Signature ~1~C 4 r~ rte, MP/MPRSW# /6 cf Phone #
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application Fees Paid: State County Date
Permit Issued/Rejected (date) Issuing Agent Name
Inspection Yes No State 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)
Revised Date 7/1 /78
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