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Parcel 161-1049-80-000 03/27/2006 08:37 AM
PAGE 1 OF 1
Alt. Parcel 13.29.20.5088 161 - VILLAGE OF NORTH HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
ARKADI KASK 0 - KASK, ARKADI
201 HELEN ST N
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1005 RIVERSIDE DR N
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 0055-VIL OF N H ASSESSORS PLAT
S 220' OF E 100' OF OL 68 EXC P508L VIL Block/Condo Bldg:
NH
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
13-29N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 695/101
2005 SUMMARY Bill Fair Market Value: Assessed with:
108236 55,400
Valuations: Last Changed: 05/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 54,200 0 54,200 NO
Totals for 2005:
General Property 0.000 54,200 0 54,200
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 27,500 0 27,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
~ I
s
Perm ~f,
Sanitary
r State Septic
n
',F°TIC TA':
_,izegallons. 'lumber
ce •rell ft. 12% or great _
;uilding > GI ft- . t•:etlands
'iighwater ,~71C ft.
DISPOSAL SYSTL:1 `Tile Field or Seepage
Distance From: Well
-,.ft. 12% or greater slope a
1 uildin.. /~L1 ft. Wetlands _ y
FIELD Kighwater << ft.
Fetal length of lines ~C ft. Number of lines LengL'i of
eac3i 1 a,nc ,/C ft. Distance between lines ft. Width of
trench ft. Total absorption area sq. ft. Dept:
o,F rock below tile in. Dp-pth of rock over the in. Co~vcr
.over. rock,&,(i Depth of tile below grade 2 in. Slope of
trench in ner 100 ft. Depth to Bedrock _ft. Depth to
ground water - £t.
PITS
'Dumber of pits ` I;tsic:e (Ilam~_ter ft. Depth bclow inle`
ft. Gravel a-roupit;! des no. Total absorption area
ft.
Square feet of seci ; ~;e . ~crical i)ot Lu:; r€ cjuireci
".quare feet of seepage 1)1 *rea required
111snected by ' ~,~1 ll 1 r;. , Title.
,proved Date ; 1971- .
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
REPORT ON SOIL BORINGS AND PERCOLATION TESTS f
LOCATION: :'/4, _=/4, Section TAN, R E (or)IV, Township or Municipality
Lot No. , Block No. County `j (2 iP.,(X
ision I
Subdig'
Owner's Name:
`77
1
Mailing Address: C ~ s
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS __-PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS I L-10Q•f
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 C 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
ill y
-9A 1~, C~ j
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- 65
C)b ft,'
- ,7
IT, &z A
PL N VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable area . Indicate n mbe r of square fe t of absorption area
needed for building type and occupancy.At'S na - its Indicate scale
or distances. Give horizontal and vertical reference points. M ate slope.
I ,
it.
ZT
L f-1 Via
1 kc i 1 I ! ; fi_ )I
,
. - - 4
- - - _ <
the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
Ji methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
he best of my knowledge and belief. _
~ t
print) r t' n Certification No. Z
TIC;141 AL 5~ al,
staller if known
• i
CST Signature
'°,I.JTHORITY _
PLB67 State and County State
Permit Application County Per
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: /Section T 44 ?N, R_ E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms -No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES !/-NO Food Waste Grinder YES VO # of Bathrooms_.2
Automatic Washer 4__ *ES NO Other (specify)
E. SEPTIC TANK CAPACITY T t I gallons No. of tanks
*Holding tank capacity } otal Ions No. of tanks
New Installation / ition Replacement Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOS. SY TEM: Percolation e 1) 2) 3) Total Absorb Area _ sq. ft.
New Addition R placement *Fill System
Seepage Trench: No. Lin, Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length 7Width Depth Tile Depth No. of Lines
Seepage Pit: Inside iameter 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
by the Certifi Soil a er,
NAME C.S.T. #l~nd other information ~ov obtained fro (owner/builder).
Plumber's Signatur M
VIP/PRSW# 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).
s
zi
w
Y'
10,
Do Not Write in Space Below FOR DEPARTMENT {{US NLY~.
Date of Application Fees Paid: Sta 1 Count Date
Permit Issued/2e'~ - (date) Issuing Agent Name 1 • e
Inspection 4ite No Valid# Date Recd
1. county copy) 3, owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2, state (pink copy) 4. plumber (canary copy)