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HomeMy WebLinkAbout020-1137-30-000 Q o i II aai ° I 0 °va ~ ill o:o aci I ru E o o c o ~~~'vmv "a M. M.0 f60 tl a V O C .a v ;a .3 N O a' H x -0 f6 U Z fr OI r C L 3 m x c0 c H CU Mrn i, 4)cC14m Z ~~c00:3 L r C L L LL c > 0) LO C O U O c~ N c 0 > d N m a s ~+cD c 3 rn~ a a X f~ O N O- E ¢ cc (D 0, u (a . a a~ M M v 0) I ~ IA a) E Q Z w O Z d d rn w a co a) cli N H Z O Z C r 7 N Z C N H r C N I E ~ a o I N C N V1 N ~ N d L o aai ¢ O N ; ZmZ I I R o E E ~ ~ I a ¢ C - w N MO O N E E I cam x333 am 00 0 • w LO IL CL 0. m a z o U) y N U rn rn ~V 2 0 0 0 0 0 ° o 0 0 0 a O E~ N N N c O O m 7 a r N ('7 a J m 0) C 00 00 V C) 0 H c ►~l ° n ° `o E co ~n o0 o M ° cc) 0 > N c c a m °o °o 0 0 l iw M O H co Y Y c a N N N N v Q m x c c O a~ n . co a) (D r o y 00 41 7r- 1 r N Q N 'a Y 7 Z Z C N m y o0 ao t m co • N O N= W O Z N ,r' (n O V w E m € d o a v c -1 A L) (L ~;0 ma AS BUILT SAITITARY SYSTEM REPORT It OW14ER~~4 I Ei) TOWNSHIP- SECTION T a I N-R-13-W ADDRESS Q K Al.i2 ST. CROIX COUNTY, WISCONSIN SUBDIVISION (a LOT I. LOT SIZE PLAN 'VIEW SHOW EVERYTHIA N,", WITHI d 100 FEET OF SYSTEM 161kyU 13eo y9~ F D -BIRD ~C ItAN out C , to ( Q , to 6 Q .3 13enRvor-, H o r,%& INDICATE NORTH ARROW loa._Top o e~ ape oN Q )j BENCHMARK:Elevation and description: ~ 5.tsM 'j- Alternate benchmark 1000 SEPTIC TANK:Manufacturer: Use, olA InrJ~ Liquid Cap. Rings used:-3 Manhole cover elev: _ Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side__, Rear Ft. From nearest prop, line:Front_ , Side "X , Rear --Ft. No. of feet from: Well , Building:_ (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.:__pump off elev.; Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop, line: Front_,_,, Side_, Rear_Ft. Distance from: Well Sho 3,yv Building fleet; gv. v a SOIL ABS RPTION SYSTEM Bed• .-$I96,09 • Trench:U _Seepage Pit: Width:-J-S_Length 7 U~ Number of Lines: II cc~~ Area Built..7c-) o Exist. Grade Elev. Proposed Final Grade Elev. . L „ -.1S Fill depth to top of pipe: a ) - 7 a No. feet from nearest prop. line:Front Side' Rear ~ ~ ' ~ --~Ft._"` No. feet from well:~ ' No, feet from building a I HOLDING TANK Manufacturer: Capacity: No, of rings used:__Elevation of bottom tank: Elevation of inlet: No.,feet from nearest prop. line:Front_, Side Rear Ft._ No. feet from: Well building___., nearest road Alarm Manufacturer: INSPECTOR:' J DATE : PL UMBER ON JOB: LICENSE NUMBER : 3 v U ll 6/90:cj LOCATION: HUDSON 29.29.19.684,NE,NW,29,GHERTY LANE - )aC 12l ~~Sddt~~~ ^ 'LOT 1, ~8/G a Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 149318 Permit Holder's Name: ❑ City ❑ Village)p Town of: State Plan ID No.: EAKINS RAY I & WILMA HUDSON CST BM Elev.: Insp. BM Elev.: LBM Description: Parcel Tax No.: 03,E d 41 ku 020113730000 TANK INFORMATION ELEVATION DATA A9200164 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L- rat food ' Benchmark t Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic l 531 5 NA Dt Bottom Dosing NA Header/Man. 10 ~10 Aeration NA Dist. Pipe qp . C`j Holding Bot. System c 17 PUMP/ SIPHON INFORMATION Final Grade c Manufacturer Demand Model Number GPM Friction System TDH Ft TDH Lift I Loss ead -7 Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside D Liquid Depth 77 DIMENSIONS w DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuacturer: INFORMATION Type O CHAMBER Model Number: System: _1,, 7 Z_ OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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, pers ns present, etc.), ~l ~Gb ~s 31-0 Plan revision required? ❑ Yes ❑ No Use other side for additional information. 5 qy U~~ w>~% SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: J i i SANITARY PERMIT APPLICATION COUNTY ~ILHR In accord with ILHR 83.05, Wis. Adm. Code st cft )A • STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than , y 9 3 l S'% z x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. P ERTY OW R C , PROPERTY LOCATION C A n1S 1 I % 0 L) %4, S a. ~ TQ 9 , IV, R E (or) W PROPEM:V OWNE 'S M LING ADDRESS LOT # BLOCK # 8 AL 1 r] G e s` j L UM R SUBDIVISION NA OR CSM NU E CI, STATE ZIP CODE P -NR 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned ❑ VILLAGE M 40W I - uu,Qs iv, Y& L EL X NUM ER( ❑ Public ICI 1 or2 Fam. Dwelling-# of bedrooms PA 111. BUILDING USE: (If building type is public, check all that apply) oQn 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4.0 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 1130 Seepage Pit Pressure 43 ❑ Vault Privy 140 System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED sq. ft.) PROPOSED (sq. ft.) (Gals/da /sq. ft.) (Min./i h) Q Q `~7 QELEVATION Ce < C T~ 1 / Feet / 3 Feet 1-60 7p, 0 'o1C , VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1060 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. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ,-Tim u Ryfi 3 yb y 711 3$ L 16) Plumber's Address (Street, City, State, Zip Code): 1 NU 6 fG SVU1 G 1 (66 M~ G e n, L, , Y A) DS ~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Y, I^ A $ / S- / - 7 JU Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r 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 (SE0 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, Safety & 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. VIII. 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) APPLICATION FOR SANITARY PERMIT 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 Ray I. Eakins & Wilma I. Eakins as Joint Tenants Location of property AIE1/4 AJ 1/4, Section 9 , T_,:A_~N-Rj, W Township Township of Hudson Mailing address 778 Gherty Lane Hudson, WIs 54016 Address of site 778 Gherty Land Hudson WIs 54016 Subdivision name Gherty's Addition (located in E2 of NW-14 of Section 29-29-19 Lot number Lot 1 Block 1 Previous owner of property Lawrence P. Gherty & Geraldine M. Gherty 2.78 acres more or less Total size of parcel Date parcel was created Are all corners and lot lines identifiable? xx Yes No Is this property being developed for resale (spec house)? Yes XX 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, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In 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 y (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Signat a of Owner Signature of Co-Owner (If Applicable) APR. 1 5 1992 APR. 1 5 1992 Date of Signature Date of Signature /y t S Y~. rr- I name i Y. I ..yY _ a ~ r CA1l~I,11tlf ~ ~ lid in Tau =s + SUM ` ° ' ei° !N►t ~]►oe9 the fxmt of said Msre . F -1 $"mom sue,:. or f dw 41 TOM 00"m ON" MW'O rri~r ire. MLW' Pik, ~7 MiF7iw f .~A i.k1 to qN, eta r - PI ~r~. ~~i. ~cird3nt~4~''~" ~'~.wed .~fm~r. ry. t` .~ui~..r, . SEPTIC:. VJiK WAINTENA_NCE AGREEIIENT St. Croix County 014NER/BUYER Ray' T'. Eakins-and Wilma I. Eakins as Joint Tenants. O ROUTE/BOX NUMBER ''778 Gherty Lane Fire Number d CITY'/STATE Hudson, Wisconsin ZIP 54016 c PROPERTY LOCATION:_k,_AZ'~Jk, Sections, TAN, R /9 W Town of~ Hudson St, Croi~cbrooR tlv' Subdivision Gherty Addition Lot 41umberLot 1 improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out -he septic tank every three fears 5r esooner, .if needed, by a licens'ed' 's'ept'ic tank pumper. .7hat you out- ~.nto t:he system can a'if~ect the function of the septic tank as ct :reat.- ~ ment'stage in the waste disposal system. St. Croix County residents may be eligible to recieve a grant for a maximum of 60% of the cost.of 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 'sys't'ems agree to keep their system properly maintained. The property owner agrees to. submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- essary), the septic'.tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I/WE, the undersigned have read the above requirements and agree o to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.set by the Wisconsin Depart- :r ment of Natural Resources. Certification form must be completed .d' and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. 10 1 SIGNED 61, DATE APR. 1 5 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 19DUSTRsY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7969 ON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCA, ION: ' SECTION: OW SHIP/ LOT NO.: BLK. NO.: SUBDIVISION NAME: r /a ►J / Z /T2 N/R E 4y 4401!9')jo% G' COUNTY: OWN R'S BUYER'S NAME: MAILING ADDRESS: Croy>e A F 770 d 5~. L✓.` 0~6 DATES OBSERVATIONS MADE USE PROF NO.BEDRMS.: COMMERCI ESCRIPTI 11 1 D SC IPTIONS: PER CO TIO TESTS: ON: [*e!;,dece ew ~eplace RATING: S= Site suitable for system U= Site unsuitable for system NVENTII©AL: rMOUND:❑~ IN-GROUND-P URE:SYSTEM-IN-FILLHO~LDINGT,~-iV :RECOMyMYED,rEj~STE~optio~al) X's NS El If Percolation Tests are NOT required DESIGN RATE If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH LEVATION OBSERVED ST. HIGH EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) - i S s 13- z ~s tom 9 y2 ' •O A//5 csr4yr 83 T. CSC 2 B- x,43' 93 n > C, g3 ~ 1j 7'00 /S i, 33;0 ►e C!56.- c" "J6 y per. B- 3 ,S f2 .G7 B- B- B- PERCOLATION TESTS TEST DEPT ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER IUGW" AFTER S ELLING INTERVAL-MIN. PE IOD 1 2PER OD 2 P R 2 31 $3 'i 3 Z Od P-P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION d ~Hf J 2s E -o v pp 5,6 Esc Vex , _ _ TN I ~%s _ q- A Bar 7/, 1 r /..a 7 0~ Get A e7 w I -77 - - - 77-4;~~ ~ I E X C 1, 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS W RE CO PLETED ON: IGAOL V~h We /d ~S ADDRESS: CERTI ICATt N UMBER: PHONE NUMBER (optional): 1070 gw S Al M S o a, po 3~c~ Gg 3~ CST S G UygE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - i 11"TRL TIONS FOrl COMPLETING F`IM 115 SRO - 39 To be a + 'Curate, your report € ua 1. Complete le„ 2. The use sect." !,ally inc.,c e€ ie a r~~sider€~a ar comrnerc;ial projeet~ 3, MAXIMU€I1 n ; bedroom ^€~tercial use planned; 4. Is this a new, or ?ent sys 5. Complete the rating b -ITE IS SUITABLE FOR A F. 3 TANK ONLY IF ALL OTHER SYS, RULED C --D ON SOIL CONDITIONS; 3, PLEASE usr c.alas shoe r writing profile descriptions . completing the plot plan; 7. MAKE r'. L ern acc€ rtg your test locations, a scale is preferred, A separate if desir., 8, hake su€ b€ c €.;aiand v€>ri :aI ,;ra rr::fererace ~aoint are clean: liown, and are permanent; 9. Complete all appropriate boxes as to d narnes, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the informatio- (such as flood {Main, } does not apply, r-'a ° °.:n the appropriate box; 11 . Sign the form ar " lure your can er~t a your certification r' 12. Make legible cr d distribute, as re e,d. ALL SOIL. TEST, UST RE FILED WITH THE LOCAL AU- 'I FY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIF " ~L rE TEi S Sail Separates and Textures "ymbols st Stolle (over 10") Fah - Bedrock cots - Cc, ble (3 - 10") &mdstone gr - t ` (under 3) Limestone I , High Groundwater and - Percolation Rate rned s .I Sand W VVe11 t~s s, Gy ay --i Y SC iy Loarn R sicl Clay Loam rraot - I 1 y '=ay vv/ - arri'h so Clay few, fin , k p~ a _ Many, n distinct p prornine, r !AWL ...Nigh v, le€=.-1, Six ge ;r xtales su, atc «r x: sispe>sa€ Bend'; filertica! Point t TO THE OWNER; This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit, The sanitary permit must be obtained and posted prior to the start of any construction. 0 S'S 5 EC P B.1 6 7 PLOTA N h I LUM t N A M E ~1...M E J S r~_ ~>~Mec~ -r ENS E \T 10 M_9~ 1)AT u 9 _ . laS - pr of w ~j • ~ 4) i C, u ;SeY', i C ~ 7~ CL s ~i 163 r 3 s 63''i- ti ~D l~ ~~1 ~ 'j ~rJl Pi~ a(= Jr ~ = ~J6~'e- W e11 i s -f Pn.~ Ens` ~ Sys~~~ 7S Sep - LIN -o 7 n . n tit lkj- FRESH AI1: INLETS AND OBSERVATION PIPE CI;OSS SECTION .Approved Vent Cap Minimum 12" Above ~ 3 I / _ Final Grade i 4" Cast Iron Above Pipe "4 Vent Pipe To Final Grade E iMarsh [lay or Synthetic Covering Min. 2" Aggreyldl _ Over Pipe Distribution Tee Pipe _.._...._.I Aggregate Per-f.orated Pipe Below 3 or) 89 111encath Pipe mss- Coupling Terminating P Bottom of System REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 05/04/92 16:48 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/ 5/92 AREA: NJ Activity: A9200164 5/ 5/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 29.29.19.684,NE,NW,29,GHERTY LANE Parcel: 020-1137-30-000 Occ: Use: Description: 149318 Applicant: EAKINS, RAY I & WILMA Phone: Owner: EAKINS, RAY I & WILMA Phone: Contractor: BOUMEESTER, JIM Phone: 386-9020 Inspection Request Information..... Requestor: JIM BOUNEESTER Phone: Req Time: 13:30 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION I i I REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 05/04/92 16:48 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/ 5/92 AREA: MJ * * * * INSPECTION REQUEST SUMMARY Address Time Activity Type HUDSON 29.29.19.684,NE,NW,29,GHERTY LANE 13:05 A9200164 CONVSEP Item: 00012 FINAL INSPECTION Pam Quinn Pam Quinn From: Wednesday, May 16, 2012 10:44 AM Sent: bagency@sbcglobal.net To: ledbrownplumbingllc@att.net' Cc: FW: Message from "RNP15651F" Subject: 20120516103400833.pdf Attachments: ent is Mark Brown's proposed building sewer connection into the house so that a convenience will not require gory The attachm tics stem (shown in the as-built page). This wastewater will be discharged into the existing sep y umb requires m us, no new POWTS components will be involved, just Webs'te Plalnn nlg & Zlon ng POWTS daBa fro Wert ian sanitary 's i permit inspection. The entire 1992 permit has been scanned into the county archives, if you ever need to access it. -----Original Message----- From: Administrator Sent: Wednesday, May 16, 2012 9:34 AM To: Pam Quinn Subject: Message from "RNP15651F" This E-mail was sent from "RNP15651F" (MP 6001/LD360). Scan Date: 05.16.2012 10:34:00 (-0400) Queries to: administrator c co.saint-croix.wi.us 1 Ic, CJC~ tr n~D J r~ Z t COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 29746/01 PAGE 1 ST. CROIX COUNTY REPORT DATE. 9/25/92 COURTHOUSE DATE RECEIVED: 9/23/92 HUDSON, WI 54016 ATTN: THOMAS C. NELSON l OWNER: Ray 6 WILma Eakins LOCATION; 778 er y Lane, Hudson COLLECTOR: M. Jenkins DATE COLLECTED. 9-22-92 TIME COLLECTED*. 12:00pe SOURCE OF SAMPLE; Outside faucet DATE ANALYZEDI9-23-92 TIME ANALYZEDP2:00pm COLIFORM 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-NS { 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L 1'~0 11, LAB TECHNICIAN: Pam Gane w WI Approved Lab No. 19 < Means "LESS THAN" Detectable Level Approved by. (~'U ST. CROIX COUNTY ZONING OFFICE Y\ 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix Co. Zoning Office offers the service of septic and water inspection to Lending Institution, 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 CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. s WATER TESTING FEE: $ 35.00. (For nitrates and coliform bacteria) WATER TESTING FEE:$185.4n (VOC'S) SEPTIC SYSTEM INSPECTION FEE:$ 25.00 PROPERTY OWNERS NAME: 8004 aid W► I M a a k i n PROPERTY OWNERS ADDRESS : _77'7 $ Gh+e(4 Lo,eCITY : a Legal Desc iption,_1/4, 1/4, Sec. , T 711 N-R W Town of 4ucl.,on Lot No.l ado Subdivision 'S FIRE NO. -7-7V' LOCK BOX NO. 02,0 -1/ ,6y~ Color of house c-*-n: o Realty sign? "~e_S_Firm: c - PLEASE INCLUDE, IF AT ALL POSSIBLE, 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 requesting services: ,ham R rox /Teary Lela,, Telephone No. 3g-j6-R2_36 - , REPQRT fi3E SENT TO: e~ 700 ZA14 CLOSING DATE: Z. 9Z signature: