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COMMERCIAL TESTING LABORATORY, INC.
514,,Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715- 962 -3121
800 - 962 - 5227
FAX - 715 - 962 - 4030
ST, CROIX ZONING REPORT NO.'# 39743/01 PAGE 1
ST. CROIX COUNTY REPORT DATE! 4/19/93
COURTHOUSE LATE RECEIVED'# 4/16/93
HUDSON, WI 54016
ATTN'# THOMAS C. NELSON
OWNER'# John Myers
i,
LOCATION. 604 Old Mill Rd., Burkhardt
COLLECTOR: M. Jenkins
DATE COLLECTEI4 4 -14 -93
TIME COLLECTED'# 24'00pm
SOURCE OF SAMPLE'# Kitchen faucet
DATE ANALYZED:4 -16-93
TIME ANALYZED +11'#00am
COLIFORM'# 0 /100 ml
INTERPRETATION'# Bacteriologically SAFE
NITRATE -N'# 7 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard, -_
Conform Bacteria /100 ml
Nitrate- Nitrogen, mg /L
O�
0 ot,,r1OEVENpEH� LAB TECHNICIAN! Pam Gaspe
E
Z WI Approved Lab No. 19
Means "LESS THAN" Detectable Level Approved by'#
PROFESSIONAL LABORATORY SERVICES SINCE 1952
., ro ST. CROIX COUNTY ZONING OFFICE
-- r 6) 93 St. Croix County Courthouse
�`rN14'�"'v`�"y 911 4th Street
vrO�r Hudson, WI 54016
Telephone - (715)386 -4680
The St. Croix County Zoning Office offers the service of septic
} and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form ia essential aQ that tag property can Dg
n located
J 4 f.` Please provide the following information, enclose appropriate
� fee made payable to St. Croix County Zoning Office, and mail,
�� v along with form to the above address. Testing will be done as
soon as possible after fee and form are received.,
fAt
&WATER TESTING--------------------- - - - - -- -FEE: $ 35.00
F (For nitrates and coliform bacteria)
ATER TESTING FEE: $185.00
(For VOC'S)
I� SEPTIC SYSTEM INSPECTION ----------------- FEE: $25.00
(Determines if system is properly functioning at,"time of
inspection) \
{ PROPERTY OWNER'S NAME: ca 1n N M yea` s
PROP. ADDRESS: 6 O 0A 1� d - CITY __\�
✓ Legal Description SW 1/4 of the SC 1/4 of Section I , T ZI_ -R
Town of 13 Q,k� a.,d1 Lot Number Subdivision:
FIRE NUMBER LOCK BOX NUMBER 03D / / � l l �
Color of house Av,.1 ealty sign by house? NO If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK
WITH LOCATION SHOWN AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: 1 7 Pnorh M; Ner
Telephone Number G�z- 43cA -7676
REPORT TO BE SENT TO:
\GZ7 L
CLOSING DATE: how ! 1
Signature
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ST. CROIX COUNTY
�-Y WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
- — - -_ _ - (715) 386 -4680
April 15, 1993
Timothy Miner
1627 Linson Circle
Stillwater, MN 55082
Dear Mr. Miner:
An inspection of the septic system on the property of John D.
Myers, located at 604 Old Mill Rd., Burkhardt, WI was conducted on
April 14, 1993. At the same time a water sample was obtained for
testing. The results of that testing will be sent to you as soon
as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
Should you have any questions, please contact his office.
Si erely,
Mary J. Jenkins
Assistant Zoning Administrator
cj
U 2589P 363 7I,y.9io I
EXISTING SEPTIC KATHLEEN H. YALSH
SYSTEM AFFIDAVIT REGISTER OF DEEDS
Document Number ST. CROIX GO., NI
RECEIVED FOR RECORD
Name & Return Address ox � ; i•., h � N � 06/04/2004 11: 45Alt
60y old AFFIDAVIT
k� (JS �N wi S ►6 EXEWT #
REC FEE: 13.00
L..G O��' 1 (�I� U - 1111.1 0 Vi �SSN TRANS FEE:
T COPY FEE:
Parcel I.D. Number CC FEE:
PAGES: 2
The existing septic system which serves the dwelling being added on to must be verified by
an acceptable soil report or be inspected by a licensed soil tester for compliance with high
groundwater and /or bedrock separation requirements as set forth in s. COMM Chapter 83.10 (2)
WI. Adm. Code. The results of that inspection must be made available to this office. If the
existing septic system meets these minimum requirements, and is properly functioning, an
addition may.be added to the dwelling without updating that system. This addition must not,
however, encroach upon the required septic system setbacks as setforth in s. COMM 83.10 (1).
Property Owner (s)
Property Mailing Address: 6 Oti O\A •1� Z d.
s�'j
Property Legal Description: Lot # CSM /Subdivision .
S1.' %, SE V., Sec. -1 , T 1 1 N -R f � W, Town of
I, as the owner of the above described property, hereby affirm that the septic system serving
this dwelling meets the above referenced state private sewage system codes. I realize that
this addition may cause the existing septic system to become undersized for a dwelling of the
resulting size, and I will make this information available to ny future parties interested
in purchasing this property.
Signed: v' Notary Public Subscribed and
sworn to before me on this date:
Date: � ` u» y. OoY
My commission expir 3w"' ALS�
County Approva �•
Date r
,`2- 4 J `
August 27, 1999
Ellen Montgomery
604 Old Mill Road
Hudson, WI 54016
RE: House addition, Town of St. Joseph, St. Croix County
Dear Ms. Montgomery:
You have requested the Zoning Office to review your remodeling/addition project for compliance with the state sanitary
code (COMM 83). When remodeling or adding onto a dwelling you are required to examine whether or not the
construction involves an increase of wastewater.
I have reviewed your house plans that you submitted to this office for compliance with the state sanitary code. As I
understand the addition, you presently have 1,664 square feet of total living area and your addition is to include 212
square feet of living area. The proposed construction equals a 13% increase in the total living area and does not include a
bedroom. You have indicated that the proposed addition will include an entryway, larger kitchen area, and a larger
bedroom.
Section 83.055 (3)(b)(2) states: Increased wastewater load in dwellings results from an increase in the number
of bedrooms from construction of any addition or remodeling which exceeds 25% of the total gross area of the
existing dwelling unit.
Since the construction/remodeling does not exceed the 25% standard as stated in the code section above. The septic
system does not have to be evaluated to obtain a building permit. You have been granted a variance from the state to
allow the house addition to be constructed approximately 4.3 feet from an existing septic tank.
As a reminder, to prolong the life of the system, remember to have the septic tank pumped once every three years or
when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as
fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the
dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the
prolonged life of this system may be dependent upon proper maintenance of the system.
The addition shall comply with all applicable setback standards. Please contact the township to obtain a building
permit.
Should you have any questions, please contact this office.
Sincerely,
Rod Eslinger
Zoning Specialist
r
Wisconsin Departrnent of Cornmerae SOIL EVALUATION REPORT Page / of ✓? `
Division of Safe(yand Bungs
in accordance with Comm 85. Wis. Adm. Code c+-z—
Attach complete site plan on paper not less than 81/2 x 11 � County
include, but not tir *W to: vertical and horizontal reference par D Parcel I.D. . io ll . 7 • 07V
percent slope. sole or dimensions. north arrow. and loco . and distance to nearest road. .3 0
Please print all lnformad F E g 2 0 20 0 4 oar Pbrsonal UrrannaWn Yeu PW W WW be used for eeco dWy (Privacy law. a. 15.04 (1) (m))•
Pmp" Owner
ST ZONI FF CE 1/4 ,51 1/4 s T Z N R / I 4 (or) W
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❑ Replacement ❑ Pub or owvner W - Des.U:
Patel material Flood Play elevation if applicable 1 t!
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sod Rafe
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C ST None F"se P" o ?�G,BR i milt .1107 — 2'z4 S 3-7
Address UlD 6L ASSOCl Date Evaluation conducted Telephone Number
Private Sewage Consultants -TAO t 5 • .2oo 715'-7 3Yy2.
Spring Valley, WI 54767
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i
Effluent #1 = BOD > 30 < 220 mYL TSS >30 IM "V& " Effluent IQ = BOD,:S 30 mg& and TSS < 30 mg&
The Department of Contmerce is an equa opportunity service provider and employer. if you need assistance to access servtces or
need material in an alternate format, please contact the department at 608 -266 -31 or TTY 608 - 8777.
sea. -ea�o p<.a,�aoy
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Document Number Document Title
St. Croix County
Occupancy Affidavit
Name — (Owner) Typed or printed
being duly sworn , states, under oath, that:
1. He/she is the owner /part owner of the following parcel of land located in St.
Croix County, Wisconsin, recorded in Volume ) 03 1 Page [_ Document
Number St. Croix County egister of Deeds Office: Recording Area
Name and Return Address
A parcel of land located in the K of the S6 -% of Section 3 ,
T N — R W, Town of S7 S it PX , St. Croix
County, Wisconsin, being duly described as follows (include lot no. and
subdivision/CSM or detailed legal description):
70 - OCO
Parcel Identification Number (PIN)
As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a
2. bedroom home, or a design flow of -00 gpd. The design flow is calculated by a suming 150 gpd for 2
individuals per bedroom. There are currently _,2_ occupants Irving in this residence; occupants are permitted
based on the design flow. Therefore the septic system serving this residence is code compliant. However, I
understand that if there are intentions to exceed the number of permitted occupants, the system will need to be
modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make
this information available to any future parties interested in purchasing this property.
Dated this day of
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF WISCONSIN )
)u•
authenticated this day of St. Croix County. )
Personally came before me this day of
the above named
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and admovAedge the same.
authorized by § 706.06. Wis. Slats.)
THIS INSTRUMENT WAS DRAFTED BY
Notary Public, State of Wisconsin
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. If not, state expiration date:
may Date:
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE"
This 1rAwnutlton axat be oorriplated by sL m&W d0=KW name A return and EW #Y Mq*1 dl. OUW kLtmwdon such as the
ti&m douses, leagaf dew pdon. eta. may be plawd on Ws "p of the document or maybe placed on additlo W Pty Of"
document. UgW Use of M cover page adds one page to your document and 5100 to the mcomkgln. *Uowa h Statutes,
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently serving
the - 7 - 11;�7 In II 2F4F residence located at: SeJ %, S65- Y.,
Sec. 3 , T N, R_J� _W, Town of 5 , St. Croix
County, Wisconsin. Upon inspection, I certify that I have found the tank and
baffles to be in good condition, and it appears to be functioning properly.
Last time serviced 5 k ryl&ht�, 2 -0 03
Did flow back occur from absorption system? Yes No no, skip next
line.
Approximate volume or length of time: gallons minutes
Capacity: QQ
Construction: Prefanc ete V Steel Other
Manufacturer (if known)
Age of Tank (if known) :
(Signature) (Name) Please Print
(Title) (License Number)
(Date)
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or
licensed disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank condition, I
certify that the tank, to the best of my knowledge, will conform to the
requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over
outlet baffle).
Name Signature
MP /MPRS
v s