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HomeMy WebLinkAbout020-1210-30-000 o (1) cO p ° r ~ I 0 N ~I' I 'I I N I b~ `1. v .0 ~ I Fr v I Z .2 C 'O 7 U. C: co N '0 -0 Q O co W Z N Z O V~ £ O` Z a m ~O Z O I O Z c .U 2' r 70 cn _ O d Z c O CD Z N I- ~ C E T7 -o v cm ` N N 7 C~1~/1J m cl y CO a L _ C O U O N Q zr_ Z co Z 'p I N Z c N i O N T d .m i c i m a m O ID > N d i N O ` (D O m n N jam„ o N N N _o o ~*a d m `n O O O Z o •r.i a a a m S: a 7 O N 0) N N J U 'o rn 0) N rn rn N O N O O m am co _ O m Q O N c fV o 8 m 4 Y ? io o r) L) 3 - I U) a o O a c o c o ° O LO r- U m O ° .2 p : O N C C a- O O ,II L O' H N C N C a N O In N o Z v CO rn N o '0 E o Z o T H cn O ~ I ~ I ~rI ! E C CA R ~ x# c. 1 a • CK O. y U N t A 0 a 0 in V FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,g W TOWNSHIP u OZ/ SECTION_ T 0- N-R / 9 y ADDRESS &X ~ 2-- ST. CROIX COUNTY, WISCONSIN S O 'n IIJY" S f`D SUBDIVISION A4 jk-,& 4e LOT 3 LOT SIZE Z.D//¢L PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~yY3Z '7 J'p 4.- C 40' 14 0 v 7a Iy ILA c o h 1o-t I;w~ $-N\, Tor A r"' % 100.40 INDICATE NORTH ARROW BENCHMARK: Elevation and description :,__T Alternate benchmark ID S ~F d~aLk 3o,,j'*10" i' SEPTIC TANK:Manufacturer: Wt:,sar Liquid Cap. 000 od. Rings used: A Manhole cover elev:Final grade elev: Tank inlet elev.:-i..,4 Tank outlet elev.: ,g No. of feet from nearest road:Front Side , RearA_Ft. 13 From nearest prop. line:Front , Side, Rear Ft. 91 No. of feet from: Well k.. , Building: c; Y " (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE Z- ~ - . 't PUMP CHAMBER Manufacturer: /yA Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed:6oaTrench: Seepage Pit: Width: ~g r Length 44th Number of Lines: Area Built 7Z4O5*l77' Exist. Grade Elev. 7,2,0 Proposed Final Grade Elev. 7- 2, Fill depth to top of pipe: PTO. feet from nearest prop. line:Front , SideX , Rear Ft.7$~ No. feet from well: ? No. feet from building W7 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: DATE : PLUMBER ON JOB : LICENSE NUMBER: 3 y 6/90:cj wisc.4nsin-Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and .duman Relations Safety and Buildings Division INSPECTION REPORT Parway Add. St. Croix ATTACH TO PERMIT) Lot 3 Sanitary Permit No.: GENERAL INFORMATION NW T1, NE T1, ec.1 6, T29-Rl 9, MacDonald Rd. 1 491 69 Permit Holder's Name: ❑ City ❑ Village I3 Town of: State Plan ID No.: CST BM Elev : Insp. BM Elev.: BM Description: Parcel Tax No.: 1 d S Cf j y }ga' y 1205 a^ 'SF iw£f`' l~ .o TANK INFO[ RMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /00, Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 7 y6 q7, 79- TANK SETBACK INFORMATION St/ Ht Outlet 7.T;- q7, Y3 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ,2 L,1 NA Dt Bottom Dosing NA Header/Man. /0, 6; Tra.7 Aeration NA Dist. Pipe AS 14,11 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade q73 Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length EDia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width < LengthA/ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION TypeO Moe Number: System: /Oxa 7?/ 6 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 T xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No ❑ Yes ❑ No ,,COMMENTS: (Include code discrepancies, persons present, etc.) r r LA. `t L; r a U d.' .7 _y V ^\A Yf3 Plan revision requir~ld? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. EE I.HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY/ Z '&,f) Cull STATE SANITARY PERMI-Attach complete plans (to the county copy only) for the system, on paper not less than all 8% x 11 inches in size. ❑ Check if revision to prus application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S~'71 V'/a '/4, S /lo T , N, R E (or) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # o x ~-a'g Z 3 CITY, STYE ZIP CODE PHONE NUMBER SUBDIVISION NAME NUMBER ors fly DEG 3~G Z G 9 GJa . TYPE OF BUILDING: Check one) CITY NEAREST ROAD II ( ❑ State Owned Ra =N VILLAGE : 4 Se Q 6 ❑ Public N 1 or 2 Fam. Dwelling-# of bedrooms-3 PARCEL TAX NUMBER(b) III. BUILDING USE: (If building type is public, check all that apply) - s 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. M New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5.0 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 22 ❑ In-Ground 42 ❑ Pit Privy 12 N Seepage Trench 13 ❑ 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION S~ 611-S- 6119, 6) _ 3 `13.70 Feet ~7 3o Feet r/14 TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tans Tanks structed tic Tank or Holding Tank /000 Lift Pump Tank/Si hon Chamber Will. 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: u S' o1,b 2-9137- lumber' Address (Street, City, State, Zip Code): JX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Eats Issued =75 VPMAPdoStamps) 0( 1~ `Surcharge Fee) -•-vOL ~J Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: S0D4W8 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber 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 1/4, Section T Z'' N-R~ Township Mailing address k-7 Ie y so << Gti syOl b _ Address of site ~c Subdivision name-?,/A- ",Z All, Lot no.~ Other homes on property? yes No Previous owner of property Total size of parcel Z. Z7 ~~~`5 Date parcel was created Worv Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume 8Q(e and Page Number 5"~f7 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 & 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 my (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. f 3 SYS/ y and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No.5~3s8oe / Si ature of applicant Co-applicant q -r( Date of Signature Date of Signature y~ ~ `~l'!Oii[ t • 1'~ru` vY~~,Y~o }}.fi~b r~i ~~,a~ll~ .~~~~.-a.4r.~ d X iasae 1tw11and.".~iiiad• Ui art+= 1 •.z yt .•i.iww.......«.«...µ «..•....•.•......••H..•••H. aad VM"SMy a SM-J ...Xill,ase,;„a te„parapn. :N!~...H.•.M•+HMHN•sr•+• w.H....••• ..•.•.........H .0 .,.K F,:.•......w..... .H ..•..•.H... H. f~ , ......«...•........+w......• . A«1MN h - ih ~~'0•~ .i.~r~w•.«....HH..a~uw.•►....wH............................................................ w...• .«........H•w.... . • d! S dsserli>td H•3t. ......«.H.'•............. Nd esfab V aoa+,t>x........H.H .....oe~ty, r not Qwrtos of tha Northeast Quarter Of Section 16. Trams ip 21..«.... 1lc lwst, St. ' Cssia Countys Viaooosin acan Lots 1 tbromo oli4" m e d J soiraw file : , my 239Il84 is Vol. "S" t , pose 1447. Doo. No. eve sot to ':thm~'ftolasatlft of troteat:LVG Courasata dated tebsoary 13, `19839 the off,"', of the . s~ Nsiete! Of Deeds en ftbnwm 18, 1985 111 Vol. 706, tap I"' 1b. 31NOL Ste. to aoa-enoluolve easements of t'eootd for No of the 66 toot Peat Of 43 OL the aboa e wtioaed Certified SdsNy read Mop. ~ a d*!PfttItIQR FOODS t between tbs State of M1scOn M1 of cis Ift"oro" a" V001W F*rA doted September 13, 19790 oasies 2i, x'1 !7! L` Vol. "601"s s+eoos+ded. pose 6399 Doc. No. 360128 for the matatemsnoa of, f roe tietwea : do SY At of Si 4 of Seatift 9-29-19 and w At of U. As of ~ 4 K 7 f:~ 1y~ O. (rt (r'..ti FEE 4 10 k~«kr• M ~aeeattdss: ry ,~p~ ,A Atsd dds ' ..~1 » ' F" day of , lot ........(SZAL) ...~w `A- . ~ ssALi, ~ie,~,~0►• 4.y.,..~.....« ~pll+e.sletlae.lsi=S.. .~P ifs (8ZAL) t.... ate- ti y....° . . ...........(aIAL) . g t ern ANasNTICASZOx y; . ACKNOWLXDGMXws U) .....H..«.........H....H«...H........ arArs or w><aooxalx ~sotlsalei dds .day ....H...H Spa. ~~...................Couety. l Pe+sonsily ew" WON ns teril.a~l~a IoAA...•tbs a6sw~now" s~rratt rsnssie BTATZ BAIR OF WIXCOxeii~ iloxiazi~t..8laitnie..fsi Itil lac! s... (t An wi:::) t tthe n.... esseeuted the T"lS WSTIM"IDIT WAS MAFM w ttv ~MR 1~ t ~k MUM GPI f! ow ...............mat......... asra •st us:naaq) adtaowlsdgal. Both NMxetavy Cmasai.11 Public be is SXA. (;IrO1x . y. Wis. _ espinrtoe r dates 1 j0q at P~ le Mw - _ _ ' ..MeM, dwN M ts.••1 or nsln••at t+w,w llrM slrn.wi+u. '~Po4 aTAT8 aA1t Al wrts=m v i hOR.I Nt 1..9 bm~Wo G7d aMek G., low L F SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 'J w 11NER/BUYERS 0 ROUTE/BOX NUMBE Fire Number- CITY/STATE zip 5-4146 PROPERTY LOCATION:''', C, Section /)6 T o'VN, R /9 Town of AklSt. Croix County, Subdivision:~?kx Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licen's'ed' 's'ept'ic tank pumper. What you put into the system can a ect the .unction o, cne septic tank as a treat- ment-stage in the waste disposal system. St. Croix Count residents'-may be eligible to recieve a grant for a maximum of 607. of the cost.of replacement of a failing system, whic 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), t-he 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. y 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration.date. J SYGNE DATE -77 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016. 386-4680 Sign, date and return to the above address. E DEPARTMENT QF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS Ifv;D~ISTi~ti',' DIVISION LABOR AND 11c P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) SION NAME: TOCATION:~SECTION: TOWilu IP/~: LO717T ZAP, t~ w'/a 'f ~ %a I l ~ /Tz9 H/R 19 E (o W COUN TY: OWNER'S/Q' ` V-E ==A-ME: MAI LING ADDRESS: L'L USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL -DESCRIPTION: hh~-,~ PR FIL DESCRIPTIONS: PERCOLATION TESTS: -%Residence JNew ❑Replace I ©T ~r S ~5%0 G~eT 26 i99A ~a K U Sot G • ~r° - ILO~sA RATING: system m O ILS RATING: S= Site suitable for system U= Site unsuitable 'to, t& - ~A fCONVEN-T ONA : MOUND: ou INN-GR_S PQ URE: SYSTS I❑ULHODLDING A K: RECOMMENDED SYSTEM:(opti 1) L L-1 21 If Percolation Tests are NOT required DESIGN RATE- I If any portion of the tested area is in the under s. I LHR 83.09(5) (b), indicate: t._L11SS I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS QORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER'DEM-H tF4. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- X7.53 aON~ r S 2 ° ,eSL0 a ft t)e B (p, Z 1 C1O - t 4o NtC > /O.4 Z 2'' SOTS 2G ,CSC 23~ S e+e e.j 1 B- `).~7 or'jz > 8,)7 30~ ~s rs z°~a S,C "8a "iS 9k~ cs r B ! 1.~1Z 4b.7/ > 11.42 6"9QaS)C 14 A75 &YA'Crna B- 9. LQ 99 Z. , > 9.6? !d +BcSLTS I "$4~►Srt ''8e~ ritS 9'$QNc~TGc 6~JB.2.,~ M B- ~t~.c PERCOLATION TESTS TEST DE TH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER If< {i-5 AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD2 P R D PER INCH P_ I ►~o•~ 97.So 3 > > > < 3 LP I 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 v;rt;cal elevation referepce 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 r . k' I ' S I i I i I Q, I r I__ C A L;L -4 tN Qcy,o,N►aT~ I 1 r~ , , so - - -1- i 1-JA11 L4 I( I I I~~ 7a I ~ ~ I i.T I - - -ELL -+s Al ~ L0 I, the undersigned, hereby certify hat the soil tests reported on this fFrm wer® ade by)in acord with the procedures and methods specified in the Wisconsin Administrative Code, and that the ata recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): / TESTS WERE COMPLETED ON: Orr Z~ /99Q Ioptional): ADDRESS: CERTIFICATI N NUMBER: PHONE NUMBER h1C)ds~N 1 h~ 4z 3Fs6-d08d CST I ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R, 10/83) - OVER - J Y I I Q \ Q 0 Al M r '1 V ~ Z zt 4 N it iM NWi` it # ~ d (VI it i , d o S v ~ Q i o 03 d V) PQ a a~ -c ~n z a r4 o a r z vi a) - . ns ■ m ~ M 01 1tl ~ • 0 c co- ~ a ~ ~ p0 ~ 'J o1~ n-~ ul \n v) 14 ~,uba Lz,w V ~ r M J IVA)~ l,l O uj o., z . O LLJ F- 0 y fl) F- C7 1 r O l W 4 N C0 O F-- M N1 Z ( U.I f I I ~ 1 ci- f oz ~I 9 :3 U 1 z j U~ j l 2 1 d. Q l 1 a- I n o t+ f ! l m i1 t I I `t I J 1 j f ~ M I ~ I ~ I M 1 i w I l j 4 ~ I I I n_ 1 Z 1 m l O I i > 1 Rd' I t Z (,;7 ~ l to r- f I I ~ v yl p I I l ~ i. v I I 1 ~ I. ~ I td w, SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 22087 PAGE 1 07/07/92 St. Croix County Zoning DATE COLLECTED: 06/26/92 911 4th Street DATE RECEIVED: 06/29/92 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins SERCO SAMPLE NO: 55892 SAMPLE DESCRIPTION: Sam Miller 6/26/92 ANALYSIS: Bromodichloromethane, ug/L <0.2 Bromof orm, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethrane, ug/L (Ethyl chloride) <0.4 2-Chloroethylvinyl ether, ug/L <0.4 Chlorof orm, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 Dibromochloromethane, ug/L <0.4 (Chlorodibromomethane) 1,2-Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <0.5 1,1-Dichloroethane, ug/L <0.1 192-Dichloroethene, ug/L <0.2 (Ethylene dichloride) 1,1-Dichloroethene, ug/L <0.2 trans-112-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 cis-1,3-Dichloropropene, ug/L <1.5 trans-193-Dichloropropene, ug/L <0.9 < means "not detected at this level". 1 mg 1000 ug. Member SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NUs 22087 PAGE 2 07/07/92 SERCO SAMPLE N03 55892 SAMPLE DESCRIPTION: Sam Miller 6/26/92 ANALYSISs Methylene chloride, ug/4 <5.0 (Dichloromethane). 1919212-Tetrachloroethane, ug/L <0.2 Tetrachloroethene, ug/L <1.5 11191-Trichloroethane, ug/L <5.0 19192-Trichloroethane, ug/L <0.1 Trichlorofluoromethane, ug/L (Freon 11) <0.7 Vinyl chloride, ug/L <1.0 Benzene, ug/L <1.0 Ethylbenzene, ug/L <1.0 Toluene, ug/L <1.0 Trichloroethene, ug/L <0.4 This sample's analytical results ar below the U.S. EPA's SDWA Maximum Contaminant level of T/~30/91 for those requested compounds which are also on the SDWA MCL list. < means "not detected at this level". 1 mg 1000 ug. Member Arm sERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 22087 PAGE ,3 07/07/92 All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature will be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. erson Project Manager I < means "not detected at this level". 1 mg = 1000 ug. Member N ST. CROIX COUNTY ZONING OFFICE ~\0 LJ e-, St. Croix County Courthouse 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 gU this form ig essential &Q that $~g property. g_II DI 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: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 X (For VOC'S) SEPTIC SYSTEM INSPECTION FEE:. $25.00 (Determines if system is properly functioning at.-time of inspection) PROPERTY OWNER'S NAME: Sa, m PROP. ADDRESS: ZDA 0 2 9'2; CITY 4~ cS50 K ~ ~ Legal Description X1/4 of the &E~ 1/4 of Section T 2_j_N-Rj1_(~_ Town of Lot Number subdivision: .&,,t L4 jd.jji FIRE NUMBER L - Color of house&2(eeri Realty sign by house?.g,4-_If so, list firm: PLEASE INCLUDE, IF AT ALL. POSSIBLE, A NAP,i.e,COPY OF PLAT HOOK, 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: fc- wi A. //(T r c'do s'Z Telephone Number / 71-f 3YL- 749 REPORT TO BE SENT TO: CLOSING DATE: Signature : 44m