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HomeMy WebLinkAbout020-1134-80-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT F OWNER ! N~ ~q0/V S y y N~~~ U, ~ w P~ ~ a ADDRE t d w')11ow ' R Z SUBDIVISION / CSM# W', 1 1 LOT # SECTION DO T A N-R 11 W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4g-a - TN 3 Bvr-oo►-ti otj New pomp, OkT Of0 Vv Bu 0 41 s' rnpa 1C S ter. y• ~ l S o a ei c N T INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 ~uV• V BENCHMARK : 0 14 SO-t ry.\ Top of V e P; 1~k 15b V. ALTERNATE BM: USINS OID SEPTIC TANK/ PUMP CHAMBER / HOLDING.TANK INFORMATION ~gF1 C Manufacturer: W6 S~P Liquid Capacity: Q (ANk ~ ~ Setback from: Well' House Other Pump: Manu a Model# Size Float seperation a cycle: Alarm ion s ti ~fi ~ s e one ~c s.7 - , 79 Ioooc~ 5eef+ c TANr III IS cov ef- £Uv 10 5"~ 14 1Q.00 0 ':SOIL ABSORPTION SYSTEM N 18. 98.6 I Width: g Length 3(o N e es Distance & Direction to nearest prop. line: 3 a } Setback from: well: House 5 Other ELEVATIONS Building Sewer ST Inlet; N 7 9• s f ST outlet . a5 p!, i nl of ` ¢}A} nttmn (lff ea er ani o 0 o Existing Grade Final grade . 1~ DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 3 q INSPECTOR: 3/93:jt 6 I I1A Q ,;[Q*;rtr>~WAfQXst4P . 29.19 . P914At WW WOO County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division .91- CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 193491 Permit Holder's Name: ❑ City ❑ Village [}Town of: State Plan ID No.: e Insp. BM E ev.: BM Description: Parcel Tax No.: 020-1134-80-000 TANK INFORMATION ELEVATION DATA A9300149 )J,)/7 3 : ~ pIS TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ,,ff Septic v r Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet q..,: Vent TANKTO P/L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic 7.~ T` NA Dt Bottom i Dosing NA Header /Man. Aeration NA Dist. Pipe y~ Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade ~,'`f Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C, / DIMENSIONS SYSTEM TCIP / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER model Number: System: ?T OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. h Length Dia. ~ Spacing to SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 20.29.19.658 (NORTH VIEW PASS) 4'-7eb I I t ! ~ Plan revision required? ❑ Yes ❑ No , r .e i Use other side for additional Information. 71771 c SBD-6710 (R 05/91) 1Sate ' Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i ~ILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code ~ vww~,v 5 t, CKU j STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than lg~~ 8% x 11 inches in size. ❑ Check i3f revision to/evious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP TY OWNER PROPERTY LOCATION t~) N d- M-e -eis 01J W '/a '/a, S o T , N, R 19 E (or W / PROLP. RTY OW 1S MO lT D )ASS S LOT # L f g BLOCK # r W Ar/\`,, CI , STATE ZIP CODE PHONE NUMBER SUBDIVI,sION~ NAME OR CSM M ER v,D or is 0( t 1 b "A W i Now II. TYPE OF BUILDING: Check one CITY NEA EST O D , ( ) State Owned ❑ VILLAGE ~(AR~61Jl O r ~W 10 S ❑ Public NJ or 2 Fam. Dwelling-# of bedrooms..Z_ PARCEL T NUM ER( ) III. BUILDING USE: (If building type is public, check all that apply) ( - 0 - f 80 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. NUieplacement 3. ❑ Replacement of 4.E] Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 El Mound 30 El Specify Type 41 El Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE RE U RED (sq. ft.) PR CPOSE(sq. ft.) (Gals/day/sq. ft.) (Min./inch) C] '7 /ELEVATQN _go I J~ 3 C -7 .7 1 7. ,S Feet I ~ V ~ Q" Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab Con- Steel Fiber- Plastic Exper. INFORMATION New Astin Gallons Tanks oncr a structed glass App. Tanks Tanks Septic Tank or Holdin Tank (QO U Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plug's Name (Print): Plu ber's Sign e: (No Stamps) MP/MPRSW No.: Bu ' as Phone Number: SO u rnt-e U 1D Plumber's Address (Stre City State, Zip Code 11048 MI zt; are Y~ , N 4 DD ~ IX. COUNTY/DEPARTMENT USE ONLY M❑ Disapproved Sanitaryrmit Fee (includes Groundwater Date Issue Issuing Agent Signature (No Stamps) Surcharge Fee) Approved E] Owner Given Initial ` Q) 6 Adverse Determin lion Igo 4P TJ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11188) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber i INSTRUCTIONS . 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a.Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation.. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper;whenever necessary, usually every.2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safe~'ty &,Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property 1/4 AIT1/4, Section , T~N-R~W Township v Mailing address L U^~L~ mss, U Address of site Subdivision name_ `,(e, LC._DeJ A -Lot no. Other homes on property? es yes--_k/ --,k/ No Previous owner of property ~1_ ci S ~ Total size of parcel Date parcel was created Are all corners and lot lines identifiable?_ Yes No Is this property being developed for (spec house)? Yes k"No volume and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, & THE SEAL OF THE REGISTER OF pDE S. I addition, a certified survey, if available, ;would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I we am the owner() the property described in this information form, by virtue sof oa warranty deed recorded in the office of the county Register of Deeds as Document No. ~7 :,lepo own the and that I (we) presently proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, construction of said system, and the same has een duly recorded in the ffice of County Register of deeds as Document No. signatu e of applicant Co-applicant Date f Date of Signature • . ' • DOCUMENT NO. STATE BAR OF WISCONSIN FORM I-1882 THIS SPACE RESEMVEO FOR RIECORWDdo DATA WARRANTY DEED 452003 ;VW. S,52PAr 4 l -9 REGISTER'S OFFICE This Deed, between .Douglas C,_..Sun.det.._and---- ST. CROIX CO., WI Roxanne E. Sundet,...h.usband.and.wife : Reed for Record OCT 001989 - - Grantor, at ii:2s A..M and Kevin G. Heaton and Margaret. S_.-Heaton,- husband and wife as survivorship marital i property . - - ReofDisdi" . Grantee, Witnesseth, That the said Grantor, for a valuable consideration . RETURN TO conveys to Grantee the fullowin[ escribed real estate in St • _CLQ1X-. ii County, State of Wisconsin: Lot Forty Nine (49), Willow Ridge Second Addition to the Town of Hudson. Tax Parcel No: IV FEE i This is - homestead property. (is) (is nut) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Douglas .C.,.Sund.et..and Roxanne E.. Sundet__ imple and free and clear of encumbrances except warrants that the title is good, indefeasible in fee simple, easements and rights-of-way of record, if any, and will warrant and defend the same. Dated this 29th...... day of - September 19.$9 (SEAL) - (SEAL) 9 p l a C. ' r u t (SEAL) (SEAL) • Roxanne-E. Sundet _ AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ` S.........CO-lX County. authenticated this ........day of_ . 19 Personally came before me this 29th__day of ep.tember...... 19.9.. the above named - Doug.las..C--.Sundet -and • . R.Q.xa,n TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 706.06, Wis. Stals.)S to me know to be the person $ who executed the forego ) ;trument an,l aVo, ed ge the me. THIS IN.3TRUMENT WAS DRAFTED~As . ~ y C. L. Ga.ylord.,__Atto-Xft - l- i Tamara K. re- River st Falls WI 54G2.~. Q. C,ta Public St. Croix Count}. iSi,naturt-> may he authenticated or ft rulu'lyd ~S. CfLh; -NI" ('nnunis,ion is perman(nt..0f not, state expiration are not r.eee.aary•) , ( C N date: 12-22- 19 91) •Names of person; ;ixning in any capaci,.y sh-1A be t)'t^-1;•nnt•-1 hl- th,.r ~I frnar likit No 1 ` - 1 ~`)yi '1` Stock No. 13001 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER / p - - ADDRESS: FIRE N0: LOCATION: 1/4, !V~ 1/4, SEC. o_T--c2MN-R__,~LW, TOWN OF:. S~/y ST. CROIX COUNTY SUBDIVISION: 1/!~ / LL17v✓ //~6 I - LOT NO. / Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: ay residents may be eligible to receive a grant to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix county accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in pr+-,per operating condition and (2) after inspection and pumping ;of necessary), the septic tank is less than 1/3 full of sludge nc scum. Certification from will be _gent approximately 30 dav:~ pr or to three year expiration. I. /WEtx=.:; ties s-.-signed have read the above requirements and agree r, ~ j.r: the private sewage disposal system in accordance with ~r• ~ set fu,rth, herein, as set by the Wisconsin DNR. ° crm must be completed and returned to the St. Cr_-cix County Z,:,ni ng officer within 30 days of the three: year SIGNED: f' DATE : St. Croix Cou):ty Zoning Office 911 4th. St. Hudson, 14!" 5401.6 Wisconsin Department Industry, , Labor and Human n Relations SOIL AND SITE EVALUATION REPORT Page -/-of oivision of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but - not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPE TY OWNER: jj~ PROPERTY LOCATION , ~ N_e 00 GOVT. LOTS W 1/4Nh 1/4,S 2.0T Zq N,R /9 b(odi PR RT Y OW~~} I EEi~SR DING ADD e L~ PA J LOT # 8 K # S BO-, N F OR 14 _V1 0 CITY, A E ZIPrCODE PHO E UMBER []CITY []VILLAGE OWN ES ROAQ S L N ~ti . _ J ( Soy-- C '-e , P IVA [ ] New Construction Use,[adj Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow S0 gpd Recommended design loading rate r 7 bed, gpd/ft2 trench, gpd1ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 4 trench, gpdAt2 Recommended infiltration surface elevation(s) 92 75 It (as referred to site plan benchmark) Additional design / site consi ations Parent material S¢C.b S, pn elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FlLL HOLDING TANK U = Unsuitable fors stem I us u El S 'G )ffs O U ❑ S ,@'U S IgU O S 'B'U SOIL DESCRIPTION REPORT Borin # Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Bou day Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 7, S Bed rer~ L /s k y r aw A/ S 7 V1 %_25r' 7. i5 Q Wt./ 2 BL` A'► M tr G w k Ground 3 S S Y ®S ~c / - , 7 / elev. ft. Depth to limiting factor , Remarks: Boring # / 7, AA- aL4j 13 2. 31z- 3sbl( i~ dt,4 'a(-) Ground 3 9 3L.. 7 ~y~ y 2 f-r C w S. IaA f 32-O" 7 5 s elev. t Depth to limiting lac r„ Remarks: CST Name. Please Print Phone: 15 3 p'~ 6 Y 3 Address: 070 4-, y s A/ sor Signature: D e: CST Number: W, /V/e ~ z~i3 oo~~y~ I IVII ncrvn I Page of PARCEL I.D. If Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed n'~ch a S~ z or- 3 bk j7 -All -"A~ 7- 21, 1 Ground 7-L -elev. T ift;. Depth to limiting factor L Remarks: Boring # Ground elev. ft. Depth to limiting facto + T . . Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: .Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) 70 37 Zo \ r7 8`'J~VJIv 5. ~ s CL 00, r _ P. Q.L. 7 PLOTA1~, ► c i_' 0 S' S 5 E C T-) P oi cc -F E3 1 r„ t L 0 CA I O N V.... ov V)r akc DCEN S E-./- 3 U 1) AT 3 0 l MAP __-mow PL o r ° 53 rA► lei S fi ys Pte., 1 _?0' 63 _ G8 V1 - S' = QeNa~ 14R 1. Top A ~N.?(o e~p E; A)?-j w o Pipet Ibb. n ya, o-apox gat P;s ~ ~ paJp u~' I~~'1 Wt l 1 r S~Vfl C_ 71 cottmx)o C, Y, FRESH All'. INLETS AND OBSERVATION I'IVE C110S.'.3 SECTION Approved Vent Car) Minimum 12" Above Final 4" Cast Iran Above Pipe To Final Gradr Marsh Hay Or Synthetic Covering Min. 2" Aygre(j';i1 ' Over Pipe Dis tribu lion Tee Pipe I Aggregate V Pea.Forated Pipe i'.c beneath Pipe r, g 7S -Cou ling Teams i n . Qo~pr,ti~ .._.1.~. Bottom Al SY 4 F '67 '0 Is-cl R .6, L, PLOTA N I I DLUM- ~r 'Fr AR' l ~ ~j~tCbD~ 7, (.O40 r, rwl lei Sys f Q,,~ WWI P)P, Not t ► ~dJ~ ; ~~~1 GJt I l r 7/1 fax 11 Su rl ' R p N~tU}t~ 1 1S FRESfi ' 11I1: IfdLETS AND OBSERVATION PI.PE C1205', SECTION Approu.ed Vent Cap Minimum 12" Above \ ba , 03 Final Gr 4" Cast Iron Above Pipe : °~e'~in `?ape To Final Grade` Marsh [lay Or Synthetic Covering Min. 2" Agcjr.acj't►lo Over pipe Dis.trlbu tiott Tee Pipe Aggregate Perforated Pipe r, g 7Dcncath Pipe Go~,pl. i.ng Termi Qo Oi^+ l2C f~ o f 5 y s t e ir, 5: Parcel 020-1134-80-000 08i29/2007 08:36 AM PAGE 1 OF 1 Alt. Parcel 20.29.19.658 020 -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 - HEATON, KEVIN G & MARGARET S KEVIN G & MARGARET S HEATON 424 NORTHVIEW PASS HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 424 NORTHVIEW PASS SC 2611 HUDSON A SP 1700 WITC , Cr. /'V,V Legal Description: Acres: 1.540 Plat: 2624-WILLOW RIDGE 2ND ADD SEC 20 T29N R19W WILLOW RIDGE 2ND ADD Block/Condo Bldg: LOT 49 LOT 49 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: _ Date -13'05-6-f -Tot/Page Type 07/2 997 852/468 4 2007 SUMMARY Bill Fair Market alue: Assessed with: Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.540 66,000 159,300 225,300 NO Totals for 2007: General Property 1.540 66,000 159,300 225,300 Woodland 0.000 0 0 Totals for 2006: General Property 1.540 66,000 159,300 225,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 214 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisc6nsin 54730 715 -90kg - 3121 800 - 962 - 8378 (WI) f 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 32125/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 6/03/89 COURTHOUSE DATE RECEIVED: 8/01/89 HUDSON, WI 54016 ATTN: THOMAS C. NELSON L 1 :*~K-~ i!~ OWNER. LOCATION: 424 Northview Pass, Hudson, WI COLLECTOR: Nary Jenkins - St. Croix County Courthouse SOURCE OF SAMPLE: Outside Faucet COLIFORM: 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-N: 3 ppm Under 10 ppm is safe for human consumption. COLIFORM + NITRATE 1 LAB TECHNICIAN: Pam bane WI Approved Lab No. 19 ~•.WpEV(NOEN o+. I < Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 r w ST. CROIX COUNTY WISCONSIN r ' .v ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 August 1, 1989 Douglas Sunlet 424 Northview Pass Hudson, WI 54016 Dear Mr. Sunlet, An inspection of the septic system on the Douglas Sunlet property located in the Town of Hudson was conducted. At the time of the 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 gears. Therefore, the prolonged life of this system is totally dependent upon proper of the S'r_t4~ . Should you have any question: regarding this subject, please feel free to contact this office. Sincerely, ~zzal~ Thomas C. Nelson Zoning Administrator TCN:sa 4 S9 ST. CROIX COUNTY ZONING OFFICE g R St. Croix County Courthouse ~w 911 4th Street 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 is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's names - ° Property owner's address 72 Legal Description 1/4 of the 1/4 of Section , T N-R Town of Lot Number Subdivision Name FIRE NUMBER ~.Z y LOCK BOX NUMBER WA- Color of house Realty sign by house?,-;,,v if so, list firm: 0 mx_4~1 PLEAS INCLUDE, IF AT ALL PO ISLE, A MAP,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 re uesting services: ~lJF2' Telephone Number a - .1 REPORT TO BE SENT TO: ° Closing date Signature • N~ GE/r/o LLC)W 9 (0 ~OF THE SW 114 OF BE It N., R. 19 W- rl-: nam ore m oGt«►•pna M ►hn p.ol th .erpr!1 ►e Ser► T~~.IS. 0.1 7!A 71 t1; W t ;.,Is, 0~••1 H GS el -e' 2Y. th, 216 20 0* Wn Atm- 01~N(t11%hr' ''r ~4fr. rt Stall /4f t': T~ C,nd,od 14.% y~'~.UNPLATTLO LAN08. C/ ,,r'C jor ~ e~•ewrwur innw~r► a • S~ ~ O 40 0 l r. . V1 ..pp477 9 y ,g0 g r ` 0 6 ~ ~illav~r ~ I J at 05V JO'l '004M L Q 2 ti _ _ - of y► to it • ~ 1 N .900 00 ier4 w \Z s 409 . • • %00 00 ,rte Mt1 / Ji Qp00 1 b -PAR 3. ",.,r~"~ t t S¢ a '19 i1.., l Jl/D'o t. 1r • y.r• ,M S9 IV -do I