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Home My WebLink About020-1270-50-000 C o (D o N^ li 0 d O 0. CC0 ~ I h 0 N M N N f6 aNi I N (D t o U c z S U. 0 3 p O O N Cl) 3 z E Nrn z = o LL V p z r _ rn > a m N N O C z O U O Z c v O .e _ d z c fq l- O O Z c E a ~ ~ M I 7 CL N hV _ c CL m Q ~ U C p _ p Q z°mz Z N ° M co a as =3 0 E N C LA r) a) c C) N M W N O C> Q C a L O N N N V I.. LO O O " N 0 0 0 z o • rv c a M a v, (L ° fA J U II, O O N I = rn rn ~~\l 0 N O } N CK N CO E 3 O O O (L N co N v L' c0 7 O O = N C 'i~~++ C 'I. N O C C O Tr N M O I' co O a IV) (n s Q CL O y N lam,/ O O~ O~ (0 c O O Q~ Cp C N C V L L '0O (D 0 co 0) 0 00 m 0) O N O 00 - 7 H F- m E E u • y O N Z r O s U O i xc ° L: a r • a m .2 m E c rw e~ O ; R "~1 A 0 a g O V "ca j - Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT `OWNER' ....;TOWNSHIP SEC. 'Z) l T Z" ?N-R 49 a 037 ADDRESS ®k Z_- ST. CROIX COUNTY, WISCONSIN ES 3, z ff G .~T. . SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions.to meet requirements of ILRR~831 ' SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM . is 9- 1P r I v 4'~ . g r 'T 7 r t l' - l')OPINDICATE NORTH ARROW ..tom. _ _ _ BENCHNARKs Describe the vertical reference point used .7.o 0 0 SEl Elevation of vertical reference point: /DD.o Proposed elope at site: SEPTIC TANK: Manufacturer:'4Le1 is4✓ Liquid Capacity: /ODO '•"-Number of rings used: _ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ' Number of feet from nearest Road: Front ,0 Side, Rear, 0 Z feet • From nearest* property line Front10Side10Rear,(D zS feet Number of feet from: well building. i (Include this information of..the above plot plan)( 2 reference dimensions to septic tany• SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: .Number of feet from nearest property line:'. Front, OSide, ORear,Q Ft._._ 'Number of feet from well: Number of feet from building:_ (Include distances on plot plan). 1Z, SOIL ABSORPTION : SYSTEM : Bead :h a ~Trench: Z Width: I/ ~ Length: ~!_-'Number of Lines:_. Area Built: Fill depth to top of pipe:_ t z Number of feet f om nearest property line: Front, Side, Rear, It. O O O ,Number.of feet from well: q) r of feet from well: q► Sr N 'ber of feet from building:_2Z7 l (Include di ances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (C}eck one). HOLDING TANK Manufacturer: Capacity: Number of'.rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. ..Number of feet from well: i Number of feet from building: Number of feet from nearest road: I Alarm Manufacturer: I Inspector:. ' Dated : Plumber.on job: t License Number: t 3/84 :m* j W7 l1EPARTtAENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION 5 State Plan I.D. Number: ec. 4, 21, T 2 9-R19 (If assigned) 4 J, P- Town of Hudson-Lot 4 CONVENTIONAL ❑ ALTERATIVE Harbor View Rd . Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: _ - ' Sam Miller Box 282, Hudson WI CX 26 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL T REF. PT. EL Name of Plumber: MP/MPRS o.: County: Sanitary Permit Number: Doug Strohbeen 5432 St. C-ix x-,& - 128884 SEPTIC TANK : d o ✓ev- G ;'O' MANUFACTURER: LIQUID CA ITY: TANK INLET EL Or- ITANKOUTLETrL-EV.: WARNING LABEL LOCKING COVE P,RRO,VIDD PROVIDED: 610e) qa-Y. 9 , G5~YES ❑ NO ❑ YES L~NO BEDDING: VEM~DIA.: MATL.: HIGH WATER 1 UMBER OF ROAD: PROPERTY WELL: If BUILDING: VENT TO FRESH C' ALARM: /t FEET FROM LINE: I , AIR IN ET ❑ YES tJ IVU Ca ❑ YES NO NEAREST ~ O MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS ATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST 11- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE TH: DIAMETER: MATERIALANDMARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO OF DISTR. PIPE PACING: COVER INSIDE DIA.: # PITS: ID i TRENC ES: MATERIAL DEP -44 DIMENSIONS 8 36 ";a i GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FR BELOW PIPES: ABO E COV R: ELEV. INLET: EL V. E PIPES: LINE: / AIR IN^LErT: si 2 1Y% ZE11 9-7 o - I C t/G NFEET FR EARESOT IO ~o(J 62 MOUND SYSTEM: 3 , Mound site plowed perpendICU ar to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope to e: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO rDEPT H O VER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOP SODDED: SEEDED: MULCHED: NTER: EDGES: 7SS1 ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL TH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. TR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DI ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: R MATERIAL: VERTICAL ESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO COVE ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO N I.oYI'"~ Lla• C Cd / I ~ ~7i ) ✓ CL k l/ Sketch System on in in county file for audit. Reverse Side. SIGNATU nTL SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION CILHR In accord with ILHR 83.05, Wis. Adm. Code COU STATE SANITARY PERMIT Attach complete plans (to the county copy only) for the system, on paper not less than 1 bQ.fjn 8% x 11 inches in size. ❑ Check f r21A6n to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEA E PRINT AIL INFORMATION. PROPERTY OWNER PROPERTY LOCATION So IM, IlaL, Sw t/a Lu t/4, S 2 / T Z9, N, R /9 E (ora PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # to * asz CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER saw w= s /fe 3?4 a7 (p9 Saco b S LaKCS. h II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ V ILLAGE s o t~ r1 at ]o or v%~ w e 4OWN OF -E ]Public 9 1 or 2 Fam. Dwelling-# of bedrooms!-- AR LTAX UMB RO III. BUILDING USE: (If building type is public, check all that apply) O _ 02 SO 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. W New 2. ❑ Replacement 3.E] Replacement of 4. ❑ 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 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 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 ¢So (0 15' (,y$ D.-] Z 3 9')15"0 Feet /ad•Sa Feet 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 strutted Se tic Tank or Holdin Tank Y ~Od O tela-~ Sa- 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: ~`k5 Stro"as.r. F Z Z07 3 2, 3 3 Plumbers Address (Street, City, State, Zip Code): Q-or 3 q,• '-'R ;cL "o.- WC S'`/O 1 -7 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date slue Issui Agent Signat a No Std / Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber APPLICATION FOR SANITARY PERMIT STC - 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 _4&3-W., YArA i Location of Property :S N l.U ~L, Section -Z T Zq N-R / 9 W Township H u,d,sa vj Nailing Address 790x .*Z$ Z __li~d_son wI syc/L Address of Site _Lo"ti'~ ~l y k 4ober V;, iZoa~ Subdivision Name Sacobs Lo. r, I%otg Lot Number 14 L/ Previous Owner of Property ra.~t=L-<x Total Size of Parcel 3. 2 pca.r s Date Parcel was Created - 2 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? X Yes No Volume.90S' and Page Number q(62- 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) centi.6y that att Atatemen .6 on thi6 6on.m ane tAue to the best o6 my (owc) hnowtedge; that 1 (we) am (are) the owner (,s) o6 the pnopen ty des cA i.bed in .thi.6 .in6oAmati.on 6onm, by viAtue o6 a wa Aawty deed Aeconded in the 066.ice o6 the County Regis,ten o6 Deeds as Document No. 4-34"t V7 ; and that I (We) puzentCy own the pnopoeed site bon the 6ewage duspo.s system (on 1 (we) have obtained an easement, to nun with the above dea ch ibed pnopeAty, bon the con.b-thuction o6 aa,id dy,6tem, and the tame has been duty teco&ded in the 066.ice o6 the County Reg.ia.ten o6 Ueeda, ab Doewnent No. 4 3 s i -1 J. SIGNATURES Olt/OWNEER° Q SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED WARRANTY DEED ••I,s :r,.x ecscnrcn roe etcl'ntrr«„ n•rA STATE ItAlt OF WISCONSIN F0KJ1 2-1992 4'o"1154:17 REGISTER'S OFFICE • ne-Nl: f: ST. CROIX CO., WI ? Virginia M. Ilonson, a single woman Reed for Record MAR 12 '968 « comet, an,l la,.rrlntr; to Sam E. Miller. ' a Single man 8:00 A M 0 C4_-41& ;of Dos& the folloaainc li-eville•I real eetate in St, Croix Mate of \\•Itcon+in: C,nlra), Tax Parcel No:...... West Half (W'j) of the SOUthWest Quarter (SWI4) ttl Section Twenty-one (21), Township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin except that part South of the I,ublic highway and except Lots 5, 6, 7, and 8 of Certified Survey Map n Vol. 6, Page 1747, Doc. No, 419479. That part of the West Half (W') of the Northwest Quarter (NW's) of Section Twenty-one (21), 'township Twenty-nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin lying South of the right of way of the Chicago, St. Paul, Minneapolis and Omaha Railway Company. .CKAN511h~ FEE? This is not hornrelr•ad pnq,erh:. #aak 0.q not) t:aselllsnCS of record and of record, if any, projective covenants and restrictions aZ) S r 14lted this dac .rf1 ill rt lr ' / . 11 ,88 E A I . ► U<-,~-a,tic. aJ~fJ ~52st~d t'/ t E,\I,1 • Virginia M. Manson INEAto ISEA1.► AUTHENTICATION ACKNOWLEDGMENT Signature(e) STATE, OF WISCONSIN, ~ ss. authenticated this day of ru 'k C•ounh•, 19 Peminnll} came before me this flay of Mn ` 19 88 the ahnt'e earned Virginia M. Ilanson TITLE.: NIENIRPR STATE ItAlt nF \VISCONSf\ (If not, authorized by § iOr.Or, Will, Slab.) . to me t.rrrra'rl to he the tar►ron ecrl•utcd the r lie forevoiti • trument :tat ni'knnn•leI T••'i INSTRUMENT WAS DRAFTED nY '1' the :,atnt•, L91s.A. Hurray, Heywood, Car[ S Murray u . 1'.0."ltox 229, 1{udsi,rt, WI... 54(116 1 If nnl (Sienntures erny he Authenticated or arknlna•lyd;;ed. Both a''rtn• u111ir P ,~4 j (i. are not nerraanry) ,nrti! n ' ('nuntp, tr ,ute1~,• ~lafe c•:n'r:ItiNN "Nooles er p.rvm •ilrninx in any to,.,, it,' o.-,,.1 t. WARRANTY DEED CTA'IF, RAn of R1SCr)\!•1Y F L- SEPTIC TANK MAINTENANCE AGREVIENT St. Croix County ~ OIMER/BUYER SQ. wA' ~~1'~ Ila.✓ r' 0 - z Z Fire Number_ ROUTE/BOX NUMBER oX g 0 CITY/ STATE 14 ZIP 5-Y61 G r* I o 5 0'►1 UJ PROPERTY LOCATION:'', lVlvk, Section?./ T_~N, R~ Town of s. n St. Croix County, Subdivision?ac.ob s La64i n9 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 licensed 'sept'ic tank pumper. What you put into the system can a ect the .unct on o, th_ peptic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents'•M~2 be eligible to recieve a grant for a maximum of 607. 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 thew .sys't'em s 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. 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. SIGN j DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016. 386-4680 Sign, date and return to the above address. DE?AS-DgENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ' MZUSTRY, DIVISION LABOR AND 7969 PERCOLATION TESTS (115) MADISONP.O., WI BOX 53707 3707 HUMAN RELATIONS • . . ULHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNS IP/~: LOT NO.:. NO.: SUBDIVISION NAME: "q I/ Nw I /T`zq N/R/1 E (o W / pso 4 ~~cc~~3s ~A•., I ~ COUNTY: OWWNER'S/9+66-NAfIQE: A LING AD RESS: • , Sr CRb~x JdM MILLe-k Freav, 401'->5 Ad 4so"j W/ 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FI DE IPTIONS: PERCOL 10 TESTS: Residence N rF EKNew _ _ ❑Replace / ~j 9 V / Z z 96 RATING: S= Site suitable for system U= Site unsuitable for system j~ Viz K ~Q,& CQNVENTIOE1NAL: M®f 0: EA IN-G ROUNDPRESSURE: SYSTEM-IN❑-FILLHO~LDINGTANK]RECOMMr40ENDEDV&k[TSYST16NEM.(ALopt' q ~ll- 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: CL'Q'S ! iFloodplain, indicate Floodplain elevation: NA le,( 7 PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHM ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) e ► ~;a 02.0/ >8.56 _(N -IT5 B- Z G.Si /63-cZ /V ~7•LICLTS O"O~rf M~~. _/6`8,91-4M:5-f6R N, > 9. r LTS p~t?RuM G Q ZS $eNCSiG~ B- > 8.0 6"~cc-~ '8 Msfc.>e Bg~L~.~~+sG~ B 3.~7 ii )z./L o" x.67 ►2"6~~T✓ 92''BQ14 ivrs_~Ge B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IBS AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 4c tt~z -00 3 > Z > > < 3 P- 2 ":,.7 ~ .1 C' 3 >Z > >'Z < P- 320 Nc+ I' 166 .7 >Z > >Z 3 P- P- _ dTte A~<. 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 9-7.'S3 g-5 ` 9 , I Z~~ A~TLRN1~~~ <°A` 4 SG4Ltt 1 ® Q c ~ ► ~ r 1 1- 30' -3 Z6' z I ~ - - - -~-_•'-s a-z 7:~( ~CN~~MAP.~.- IoP c~R 6•,SQUa4,a' \ ~ 3D' - - CLEF W'S' t eN 101 • CXj I ~ I, 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. NAM (print): TESTS WERE COMPLE ED ON: I Ae -v 3014 s(a.., o NNSoN ~c~12vE~~lN4 ► 2 z► 90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): aU&<,4r,4 3 g4 3 CST SIGN URE: 60 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - I 1 _ Z I -P ~ I IC IiI 1 J ~ ~ II I I I I . s --l l I sal t ~ tI l I hi all C? I~ ll~ ~ ( 1 I I I I n m I 1) ~ I 1 O h I II Ili i rri I 1 m I ~ 1 Y I p ~i r-- I .r ~ ; y. I I 1 1 • 'CI 1 I '_'fl ;I `O I l I i I fTi I I ~ f~1 ` ( 1 l I ~ I( II! III ' I I C~ C) I I --~---Orp•~ L? a~ I I II l r I 1 II 1 D I 1 ; - 1 ~ I 1 1 1 O l 1 l (T] l ~ ~ ~ I III • ~ I ~ I I Iii ,Ps I lrY ! I V V7Y ( I ^p t Z I I c~ J O , I C v 1 III ( ~ O j I ~1 O'.,. I 11 1 I 1 'U r^ i t . (Tl I ` ( ~ G+ II O~ i 1' rl o lI L4 ,d I I I ~ m l w rri TV <T 0 C O O -1 7` OZ I rrl 0 Z Z7 !tl O In I l ON, N ¢ U\ A V til 0 t ■ a LA S~ P o P N r, P Do - o 1` P P r 0 R1 ^ s P 1~ o o ` 1o 5 m P t - e 0 b 0\ ~ ~l H N ~ J t P W 1 t a 4 r r 04 ' ob col o P ~ ~ ~ ~ A t o n / -C z I- in t o R x A .Q i w 1.0 r- ins , N SA •w i t EasT /df 73 ~~iyi Sct(z 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.t 31566/01 PAGE i ST. CROIX COUNTY REPORT DATES 10/29/92 COURTHOUSE DATE RECEIVEDi 10/28/92 HUDSON, WI 54016 ATTNS THOMAS C. NELSON l 2(6 i (DINERS Char Les h Audrey Barr LOCATION: 842 Harbor View Rd., Hudson COLLECTORS M. Jenkins DATE COLLECTERS 10-27-92 TIME COLLECTORS 3S30pm SOURCE OF SAMPLES Outside Faucet DATE ANAL.YZEDSI0-28-92 TIME ANALYZEDS2S00pm COLIFORMS 0 /100 ml INTERPRETATIONS Bacteriolvgicaliy SAFE NITRATE-NS 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. 10` Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L F sT Go2 . ~ 1 04" C119, of 19 LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 { Means "LESS THAN" Detectable Level Approved-by: 10/19/92 10:25 '0715 386 4628 _ S.C. CQ OUSE Q002 ..1 ST. C MIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th-Street Hudson, Wt 54016 1 Telephone - (715)386--4680 The st. Croix County Zoning Office offers the service of septic p`Z and water inspections to Lending Institutions, Realty Firms, and private individuals. Comoletion 2t this form J' essential &q that =2 Bro eert-v„ 21 ta - 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_'__ X~ (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOCIS) SEPTIC SYSTEM INSPECTION ----FEE:- $25.00 (Determines if system is properly functionin% at -.'time of inspection) PROPERTY OWNER'S NAME: le-,v V "Leg )AXA/L4 PROP. ADDPM_Q:1" 2 WA rhU/- l~j ew ~ C:ITY S _ y Legal DescriptJ on 1/4 of the 1/4 of Section , T N Town of 4L d s O h Lot Number ~Subdivision : , 1337 FIRE ER LocR Box BB~t Gs1 G - 1 X70 Color of house Realty sign by house?-/ ; If so, list firm: PLEASE CLUDE, IF AT ALL , A , f . COP OF PLi1P • HOOK, WITH LOCATION SHOWN., AND a COPY F 9= LISTING 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 cuff, malting access to the hoiue necessary. if this is -the case, please make proper. arrangements with this office to ensure time when entry may be gained. Firm or individual requestin services: i`f I- 1r" Telephone Number Z, & REPORT TO BE SENT -TO: CLOSING D T : Signature i CDMRCIAL TESTING LABORATORY, INC. 514 Wtreet, P.O. Box 526 Colfanconsin 54730 715 - X3121 Boo- 2227 STX ZONING REPORT NO. 08986/01 PAGE i SIX COMITY REPORT DATE: 8/07/91 USE DATE RECEIVED: 8/06/91 MI 54016 AVIAS C. NELSON i OWNER*, Charles 6 Audrey Barr LOCATION. 842 Harbor View, Hudson COLLECTOR'# M. Jenkins SOLIRCE OF SAMPLE: Kitchen faucet i k COLIFORM: 0 /100 ml INTERPRETATION: Bacteriologically SAFE G NITRATE-N: 6 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Icteria/100 ml trogen, mg/L LAB TECHNICIAN: Pam Gave WI Approved Lab No. _19 < Means "LESS THAN" Detectable Level Approved by: p PROFESSIONAL LABORATORY SERVICES SINCE 1952 O\ ST. CROIX COUNTY ZONING OFFICE 911 4th Street f 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. WATER TESTING FEE:$ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE:$175.00 (VOC'S) SEPTIC.SYSTEM INSPECTION FEE:$ 25.00 PROPERTY OWNERS NAME: (AES A VL~ AAkk PROPERTY OWNERS ADDRESS : W b6boO, 01W -CITY: 4()V 6 T ):!A1; Legal Desc ption 1/4, 1/4, Sec. , T N-R W Town ofVIO~D/l~- Lot No. Subdivision S 1~1-1--'7 a/U ,QvCT LOCK BOX NO. FIRE NO. Color of house Realty sign? Firm: (i KKK -EOAK 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 individua g~jequestin services: f5~7-,ol~cll4 Telephone No. 5V REPORT TO BE SENT TO: V-:5 I CLOSING DATE: a-07- Y( Signature: zff5~~ 4--7 700 Lu -~Tq1 ST. CROIX COUNTY ZONING OFFICE 911 4th Street D / Hudson, WI 54016 O 0 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 FORK 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. WATER TESTING FEE:$ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION FEE:$ 25.00 VVVV PROPERTY OWNERS NAME: La 15 it PROPERTY OWNERS ADDRESS : AMOCITY: r SO IR c yS e~ Legal Desc tion 1/4, x_1/4, Sec., T _;3o N-RAW, Town of ri_ ~Jp s4 E-,Lot No._ ` Subdivision FIRE NO. 71 LOCK BOX NO. Color of house / Realty sign? Ves Firm: a 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: Telephone No. $ REPORT TO BE SENT TO: CLOSING DATE: Signature: ST. CROIX COUNTY WISCONSIN ZONING OFFICE 5T. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Oct. 28, 1991 Jim Dahlby Edina Realty 700 2nd St. Hudson, WI 54016 Dear Mr. Dahlby: An inspection of the septic system on the property of LaCosse located at 1378 Awatukee Trail, Somerset, WI, was conducted on Oct. 28, 1991. This system was inspected at the time it was installed which was on July 26, 1991. 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. ~ erely, to Mar . rnkins Assistant Zoning Administrator cj n» O 3 m p d o 3 n 3 t•+A 3 CD m n • c CD fD m .o ~ O -z 3 3 c CD Cp d iV O r.. (D -I -I (D W O (D =r 3 I^~r O- N 3 3 N a N `D 0 ° CD Q~ 3 o O 0 N CD co 2 W O R O O O O n A7 CJl C 7 N 7 v p 3 ° v o ° to ° O S N N C N M o o (Z N a W CD C O o 3 rn N ; i ~ o N CO O co 3: r- CA C N O C CL a ~~r ° tv O O O cn n IE 0 3 N N N ° o a- CT vvc~, Q CD D (D N v 7 CD N O N W N) l= O D a a N N~ j 0 CD O O CD w > • O 7 CD N l~,ll C fD N a O P Z tD C =3 p Z O a z 7 (n -C N 00 N ° 0 A 3 z CD A W = D 3 m n s ca. CD as o 3D'`, v " r CD z o - n o = N m o N (D ~q e n» N A, 3 1 CD O M V CT R I b o. Z. V A O 'b I(D ~0 0 C) s ~ - ST. CROIX COUNTY 97 WISCONSIN ZONING OFFICE 1 1 I y M R R M - Nosed ST, CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road =x .:,,ter Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. outside water lines are often turned off during winter months, making access to the home necessary. PPlease make arrangements with this office to insure that entry can be gained. Water (VOC's) $185.00 Septic $50.00 Water (Nitrate & Bacteria) 45.00 Nitrate & Bacteria retest $7.5.00 QOv W*ACL6Al/ Owner: 4, p, Requested by:D KEA/ 1AREl r Address: 4z- ,~f.~.?60~ icW ~D Address: 6 9!x' ~ a*.D60A1 Z I P-TI/O Ik 5 ZIP Telephone No: (7/5) l.~ Co Telephone N°: (7zs Property address (Fire NQ & street) Location--k, z, Sec- , T N, R w, Town of 1110,0-64 orv . Be r% ¢G- Realty firm: Lock Box Combo: 3,1L Closing Date: O Z t0Z0-1270-50- 00(0 2/..29'• /9. /3~~- TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: V-yve Is the dwelling currently occupied? es 0 No If vacant, date last occupied: /s Age of septic system: ' Septic tank last pumped by: - A mate: Previous owner's Name(s): Have any of the following been observed? DY @V Slow drainage from house. OY (tk~ sewage Back-up into dwelling. pY Sewage discharge to ground surface or road ditch. Y Foul odors. ti~ 11 they ents relative to system operation: o R I-p if` hat the above information is complete and true to the bred of knowledge. v OWNERS SIGNATU , DATE:;ey~ Be J } I~( U~~ PiV1 fII'JfJ: YY11VV1V 1v 3 f1 1 t1L11I 1t1 ( 1J) OJ'J 000 i! OWNERS DRAWING OF HOUSE & SEPTIC SYSTE LOCATION 1 N iy 14 Ir 1~.~ -17 s e~~sr~~ ~r -17 TO BE COMPLETED BY INSPECTION AGENCY System design &/oir permit on file? OYes ONo Soil series per SCS Soil Survey: sheet # Type of sail-absorption s stem: OBelow grd OAt-Grd OMound Approx. size 'K OGravity ODose OPressurized ♦V Ft. ❑$ed OTrench ODry Well Molding 'l'ank OOuti:all pipe OBSERVED DEFICIENCIES 00ther OUnknown $e tic tank Setbacks:ClHouse OWell OProp. line 00ther Dose tank Setbacks: ❑House Owell OProp. line OOther OLocking cover ~OWarning labelC1Pump/Floats OAlarm OElec, wiring_ Soil Absor Lion System Setbacks: Mouse OWell_' OProp. I ine 00ther nPonding: ODischarge:~ General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N I Inspector Title ST. CROIX COUNTY WISCONSIN ZONING OFFICE 1 N s • NOUN, ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, WI 540 1 6-771 0 (715) 386-4680 _y April 18, 1997 Ken Urbik 9401 South St. Louis Ave. Evergreen Park, IL 60805 RE: Septic Inspection, 842 Harbor View Rd., located in SW34,NW4I Sec.21, T.29N., R.19W., Tn. of Hudson, St. Croix Co., WI. Dear Mr. Urbik: An inspection of the septic system which serves the home at the above described property was conducted on April 14, 1997. 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 be pumped once every three years as the prolonged life of this system may be dependent upon proper maintenance. I have enclosed a copy of the septic system inspection report completed by this office at the time this system was installed. I have also enclosed a copy of the As-Built report that shows the location of the system as it was installed. I collected a water sample at the same time and submitted it to Commercial Testing Laboratories for analysis of bacterial or nitrate contamination. The test results are also enclosed. Should you have any questions, please do not hesitate to contact me at (715) 386-4680. incerely, es Thompson Assistant Zoning Administrator enc. cc: file 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 County Zoning Office Cust.No: 78900 Report No: 37693 StCroix Cty Gov.Ctr Date Reported: 4122/97 1101 Carmichael Road Hudson WI 54016 Date Received: 4117197 OWNER: Charles A. Barr LOCATION: 842 Harbor View Rd., Hudson COLLECTOR: Jim Thompson DATE COLLECTED: 4114197 TIME COLLECTED: 2:30pm SOURCE OF SAMPLE: kitchen tap DATE ANALYZED: 4117197 TIME ANALYZED: 2:00pm COLIFORM,MFCC:0 4110orrl INTERPRETATION: Bacteriologically Safe NITRATE-N: 5.5 ppm Above 10ppm exceeds the recommended Public Drinking Water Standard i11 ~ E E~vEO RENO Lab Technician: Pam Gane wl roved Lab No. 19 ao APR ,1 X997 App r,170 ST coU Means zCN►NQ'O ' LESS THAN Detectable Level 1 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 71067 Page 1 of 3 04/22/97 St. Croix County Zoning DATE COLLECTED: 04/14/97 1101 Carmichael DATE RECEIVED: 04/15/97 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins SERCO SAMPLE NO: 34467 SAMPLE DESCRIPTION: Barr ANALYSIS: Dichlorodifluoromethane, ug/L (Freon 12) <2.0 Chloromethane, ug/L (Methyl chloride) <3.5 Vinyl chloride, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.7 Chloroethane, ug/L (Ethyl chloride) <0.6 Trichlorofluoromethane, ug/L (Freon 11) <1.0 1,1-Dichloroethene, ug/L <0.1 Methylene chloride, ug/L <3.0 (Dichloromethane) trans-1,2-Dichloroethene, ug/L <0.2 1,1-Dichloroethane, ug/L <0.3 2,2-Dichloropropane, ug/L <0.5 cis-1,2-Dichloroethene, ug/L <0.2 Chloroform, ug/L <0.5 Bromochloromethane, ug/L <0.3 1,1,1-Trichloroethane, ug/L <0.3 1,1-Dichloropropene, ug/L <0.2 Carbon tetrachloride, ug/L <0.2 1,2-Dichloroethane, ug/L <0.1 (Ethylene dichloride) E~J / Trichloroethene, ug/L <0.4 RECE~V 1,2-Dichloropropane, ug/L <0.1 Bromodichloromethane, ug/L <0.2 APR 2 Dibromomethane, ug/L <0.3 ST r` cis-1,3-Dichloropropene, ug/L <0.1 i, trans-1,3-Dichloropropene, ug/L <0.2 1 1,1,2-Trichloroethane, ug/L <0.2 < means "not detected at this level". 1 mg = 1000 ug. ~~gP 'ham.#`e SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 71067 Page 2 of 3 04/22/97 SERCO SAMPLE NO: 34467 SAMPLE DESCRIPTION: Barr ANALYSIS: 1,3-Dichloropropane, ug/L <0.5 Tetrachloroethene, ug/L <0.3 Dibromochloromethane, ug/L <0.3 1,2-Dibromoethane, ug/L <0.4 (Ethylene dibromide) 1,1,1,2-Tetrachloroethane, ug/L <0.1 Bromoform, ug/L <2.0 1,1,2,2-Tetrachloroethane, ug/L <0.3 1,2,3-Trichloropropane, ug/L <0.5 1,2-Dibromo-3-chloropropane, ug/L <0.5 Hexachlorobutadiene, ug/L <0.3 Benzene, ug/L <0.2 Toluene, ug/L <0.5 Chlorobenzene, ug/L <0.2 Ethylbenzene, ug/L <0.5 Total Xylene, ug/L <0.5 Styrene, ug/L <0.5 Isopropylbenzene, ug/L, (Cumene) <0.2 n-Propylbenzene, ug/L <0.2 Bromobenzene, ug/L <0.2 1,3,5-Trimethylbenzene, ug/L <0.2 (Mesitylene) 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 tert-Butylbenzene, ug/L <0.5 1,2,4-Trimethylbenzene, ug/L <0.4 sec-Butylbenzene, ug/L <0.4 4-Isopropyltoluene, ug/L <0.4 (p-Isopropyltoluene) 1,3-Dichlorobenzene, ug/L <0.2 (m-Dichlorobenzene) < means "not detected at this level". 1 mg = 1000 ug. 1 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 71067 Page 3 of 3 04/22/97 SERCO SAMPLE NO: 34467 SAMPLE DESCRIPTION: Barr ANALYSIS: 1,4-Dichlorobenzene, ug/L <0.5 (p-Dichlorobenzene) n-Butylbenzene, ug/L <0.4 1,2-Dichlorobenzene, ug/L <0.2 (o-Dichlorobenzene) 1,2,4-Trichlorobenzene, ucj/L <0.2 NaPhthalene, ug/L, (volatile method) <0.5 1,2,3-Trichlorobenzene, ug/L <0.2 This sample's analytical results are below the U.S. EPA's SDWA Maximum Contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL List. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature may 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, Carol Davy Project Manager < means "not detected at this level". 1 mg = 1000 ug.