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' i FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER '~,Q,,, /ZS TOWNSHIP Sf ~JO SSG)
SECTION ZIT 30 N-R W
ADDRESSZ ~pc R4A0 ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT__Z_LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~oac~
r ~PJ
O
I3
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: 4it.16-Q ~L1d (6
Alternate benchmark
SEPTIC TANK: Manuf acturer : I jje -L Liquid Cap. jZ06
i
Rings used: a Manh cover~elev: Final grade elev:
Tank inlet elev.: Tank c tYet elev.:
No. of feet from nearest road:Front(1Side Rear Ft. }
From nearest prop. line:Front Side, Rear Ft.
te ~a
No. of feet from: Well F7" 18` , 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 Building
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepage Pit:
Width: __5 Length, /00 Number of Lines: Z. Area Built /06d
cl
Exist. Grade Elev. Proposed Final Grade Elev. fob
Fill depth to top of pipe: No. feet from nearest prop. line:Front
, Side, Rear Ft.~
No. feet from well: Cv~ No. feet from building Z(o` S~
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 cif PLUMBER ON JOB:.
LICENSE NUMBER: ~'~z1 Z
6/90:cj
did
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Hyman Relations INSPECTION REPORT St . Croix
Saf4ty and Bui+dings Division
. - (ATTACH TO PERMIT) Lot 1 Sanitary Permit No-:
GENERAL INFORMATION SW4fNW%,Sec.26,T30-R19,Awatukee Tr. 149073
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
Richard Stout St. Joseph
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA 71
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ~s3 0 `
D .0 / . 6. /w, „ . 3
Aeration Bldg. Sewer
Holding St/ Ht Inlet (o~'~ Q/.$$
TANK SETBACK INFORMATION St/ Ht Outlet
J9 /_0
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic } 1 / /T NA Dt Bottom
1( C) AO
osing NA Header/ Man.
i
Aeration NA Dist. Pipe
Holding Bot. System 99
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand S. _r 30''
Model Number GPM
TDH Lift Friction System TDH Ft
Loss Forcemain Length Dia. I f Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width s Length I No. Of Trenches plT- o,Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM
INFORMATION Type Of Q~Oh / CHAMBER Mo um er:
System: re-nA'~ oZ~ Co - OR UNIT
DISTRIBUTION SYSTEM
Header4 Manifold r~ Distribution Pipe(s)' x Hole Size x Hole Spacing Vent To Air Intake
Length -12-L Dia. Length 9Z 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 discre ancies, persons present, etc.) p
C~ _ D
~
in 7e
~ 4 7, Q~ IK-&
V2n-re0sio Ir' uired7 ❑ Yev o J
Use other side for additional information. 91 ' 1'1` o /
SBD-6710 (R 05191) - l.-ar - Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER: •
C'r~2 ~rnz - F' -W
- ~ a
Qr~S'~-tea 7~
SANITARY PERMIT '
. PILHR ' TRANSFER/RENEWAL COUNTY
UNIFORM R
(PLB 67-T)
PERMIT RENEWAL DATE:
PERMIT TR FER DATE: ORIGINAL PERMIT ISS ANCE DATE: STATE PLAN I.D. NUMBER:
PROPERTY LOCATION: -
'/a~S CITY:
LOT NUMBER: BLOCK NUMB N'R E (or) W VILLAGE:
z ON NAME: TOWN
NEARE T ROAD, LAKE OR LANDMARK:
A L--
PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED):
NAM SANITARY PERMIT TRANSFERRED TO:
SIGNATURE:
NAME:
ADDRESS: ) PHONE NUMBER:
PHONE NUMBER: AD RE S: 1
lL - 7
the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been property.
PLUMBER'S SIGNATURE: Y n approved for this
PREVIOUS PLUMBER'S NAME IF CHANGED):
PLUMBER'S ADDRESS:
PREVIOUS PLUMBER'S gppRESS:
MP/MPRSW NUMBER:
PHONE NUMBER: MP/MPRSW NUMBER:
1 1 PHONE NUMBER:
SIGN URE OF ISSUI G ( )
ENT: DATE APPROVED:
DISTRIBUTION: Original -County
DILHR-SBD-6399 R. Copy - Bureau of Plumbing
5/82 Copy Owner
~ILHR - SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUN
TATE S NIT Y PERMI
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑
8% x 11 inches in size. oeck f revision o pr vious 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
e;~ 0 . d4 I ) $(t) %4 t4U)Y4, S 2(o T 3N, R /9 E (or W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
s417U w,l tsqAll- c /
w
II. TYPE OF BUILDING: (Check one) 1:1 State Owned ❑
L:I CITY 5d JQWN OF: 4w6z VILLAGE : ~ NEAREST ROAD
wKe.&_
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms -4*/-- PARCEL TAX NUMBER( S)
III. BUILDING USE: (If building type is public, check all that apply) 030- 167q-6-6-166
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. ® New 2. ❑ Replacement 3. ❑ 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 300 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) *A7 99 Z ELEVATION
~0 !Od O /6d p /0 < *XO *Z W id Feet /DZ 7 Feet
VII. TANK CAPACITY Site
oNewistin gallons Total #of Prefab. Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
structed
Se tic Tank or Holdin Tank /Zoo
Lift Pump Tank/Si hon Chamber El LEI El E]
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plu er's Signature: (No Stamps) M /MPRSW o.: Business Phone Number:
Plumber's Address ( et, City, State, Zip Code):
e2LL Z o o z
IX. COUNTY/DEPARTMENT USE ONLY
X ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuin gent signature (No Stamps
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
9TC-100
This application form is to be completed in full and signed by the OVnet(s) of
the property being developed. Any Inadequacies will only result in delays of
the permit Issuance. -Should this development be intended lot tesali by
owner/conttactot,(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.
Ovnec of property -R-;&,IfA n s4)xg±
Location of property x•1/4 --1/4, Section T_.~'a-LCLV
Township S
'Y' o
Walling address -
~S~ o,',o
Address of site _ '2-
Subdivision new* ,E;ho- Groy/ •
Lot number
previous owner of property , 6Q~ was Y--
Total also of parcel cC y`e
Date patrol was created /z2LQ /
Are all corners and lot lines Identifiable? -w. as o
is this property being developed for resale ('spec house)? x as
YolasN and Page Number as recorded with the Register of Deeds.
www - rw - w w w- w- w w w w w w- w r w w w w r w w w w w w w w w ww ww r - w
INCLUDE --w-www-
WITH THI9 APPLICATION THE FOLLOWINGt
A WARRANTY 0220 which Includes a DOCUMENT NUMBER, VOLUMti AND PAGE NUMIZR, and
the eRAL OF THE REGISTER OF DEED9. In addition, a cettliled survey, 11
available, would be helpful so as to avoid delays of the reviewing process. it
the deed description references to a Ceitlfled survey Map, the Cattifled survey
Map shall also be requited.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge= that t (we) am (ate) the ownerts) of the ptopertr described In
this Information form, by virtue of a warranty deed recorded In the Office of
the County Reglatet of Deeds as Document No. ) and that I (We)
Presently own the proposed alto for the sewage disposal system lot 2 (we) have
obtained an easement, to tun with the above described property, lot the
construction at said pystsm, and the same has been duly recorded in the Office
of thDe~ ~Cognnty~Reg• ter [ Deeds, as Document No.
Sl9nstute of Owner Signature of Co-owner ti Applicable)
('7 19)
Date o[ signature Date of Signature
Unplatted Lands
West line of the NW} of Section 26
S0004215311W 7 $000 215311W
1304,601 1304.601 _
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S09005 101 'IN
497.051
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11~g VnPlatted N
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a cn n
65
t~ o. s,• - ~•~y
' 1:1 I :a iN s <•19;y.t; ~(,r i•, yCL'..Z }r..
baat~ r-0 6 A Z rt N L~1:~377{{ ~
to Ca f.00 O N' ~ X 0 F•3
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sa n: o rt.
rrJ r tJ~ m v e,'fn~~7:n , a . co a
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Bearings are-referenced to the west line of the NW}
of Section 26, assumed to bear S00 42 53 W.
0
W
instrument drafted b Fran 8leskacek Job No. 78-52-19'0
by
's
i,7
THIS SPACE RESERVED FOR RECORDING DATA
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-19
WARRANTY DEED
REGISTER'S OFFICE
4 0395 9 PA~`464
Richard 0. Stout and Janet P. Stout, husband ST. CROIX CO., WI
Recd for Record
and wife survivorship marital property,
:0 419
at 23 M
conveys and warrants to Daniel L Young and Jody L. v &_M t
Young, husband and wife, $*'~Reolster of Deeds
RETURN TO
the following described real estate in St. Croix County,
State of Wisconsin:
Located in part of the SW~, of the NA of Section Tax Parcel No:
26, T30N, R19W, Town of St. Joseph, more fully described as follows:
Lot 1 of Certified Survey Map recorded in the St. Croix County
Register of Deeds' Office on June 11, 1991, in Vol. 8, page 2368
as Document #470294, along with a 66' wide private road easement
as shown on CSM, Vol.6,' page 1523 and CSM, Vol. 3, page 738.
The roadway shown on this map is a private roadway. Any maintenance
costs of the private roadway shall be shared pro-rata by the adjoining
property owners.
7Sll Q 0
This is riot homestead property.
(is) (is not)
Exception to Warranties:
-
Dated this 13th day of June '1991
(SEAL) (SEAL)
• Richard O. Stout Janet P. Stout
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
St. Croix County.
authenticated this day of 19 Personally came before me this 13th day of
June , 19 91 the above named
Righard 0. StOUt and Janet P.
Stout
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the persons-~,,•who,f3xecuted the
authorized by § 706.06, Wis. Stats.) f g ing inst ument and ack led Or)a
THIS INSTRUNYp(T W S DRA Y
Janet~tou
.t3=
UV i V ` K ya
Z .~is
WI 54016 ita
113udson, Notary Public I^Gounty;/Uis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanents (If Rat, stem e01taflon
are not necessary.) J
date: Pl LI
SB2 NTF 0021
'Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0208
Form No 2 - 1982
STC - 105
t (A
SEPTIC TANK MAINTENANCE AGREEMENT w
St. Croix County
r
OWNE /BUYER ~.~Cr=vt ~n v. o
ROUTE /BOX NUMBER Fire Number
2 O t7
M
CITY/STATE Hiid,SeSt~ ZIP o
PROPERTY LOCATION:'- SW Section2(,, T 30 N, R IL W,
Town of Td-5 e* St. Croix County,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Prover maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a 1icens'ed'septic tank pumper. What you put into
the system can a ect the .uncti.on o the septic tank as a treat-
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' phew 'sys'tems 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
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart-
ment of Natural oStCeCroixeCountyaZoningo0fficetwithinm30edays
and returned to the
of the three year expiration date..,,
SIGNED F A"
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
DEPARTPAL?jT OF REPORT ON SOIL BORINGS AND Y64 SAFETY & BUILDINGS
INDUSTRY y PERCOLATION TESTS DIVISION
' LABOR AND (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
(ILHR 83.090) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ LO O.:BLK. NO.: SUBDIVISION NAME:
SW 1 NW 1/4 26 /T 30 N/R19f(or) W St. Joseph 1 n/a Pine Grove
COON"iY: OWNER'S BCDOE 9&ME: MAILING ADDRESS:
St. Croix Richard Stout R.R.#2, Box340, dson, Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: PERCOLATION TESTS:
[jResidence 3 n/a fr New ❑Replace 11-2-90 n/a
RATING: S= Site suitable for system U= Site unsuitable for system
r ONVENTIONAL: MOUND: IN-GROUND-PR U E: S ST M-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
S ❑U CijS EJU ® S [:]U ❑ S QU ❑ S )F~jU step down trench
F rcolation Tests are NOT required DESIG N RATE: If any portion of the tested area is in the
er s. ILHR 83.091511b1, indicate: C1aSS 2 Il Floodplain, indicate Floodplain elevation: n/a
deciaml' PROFILE DESCRIPTIONS page 42 OnC2
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH= ELEVATION OBSERVED EST. HIGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B_ 1 6.91 102.70 none >6.91 .75bl.1. 1.08bn.sil. 2.58bn.l.s.&gr. 2.50bn.s.l.
B 2 6.74 102.90 none >6.74 .58bl.1. 1.08bn.sil. 2.33bn.c.s.&gr. 2.75bn.s.l.
B 3 6.66 101.60 none >6.66 .50bl.1. .58bn.l.s. 3.00bn.l.s. 2.58bn.c.s.&gr.
4 6.59 99.77 none >6.59 .92bl.1. .67bn.sil. 1.67bn.l.s. 3.33bn.s.1.
B- _
B_ 5 6.83 99.80 none >6.83 .83bl.1. 3.00bn.sil. 1.33bn.c.s.&gr. 1.67bn.s.l.
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE IES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD PERIOD 2 PERIOD TER INCH
P-
P-
P-
P Se esl ra e
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. 99.20=upper trench
SYSTEM ELEVATION 98.10=lower trench
V. V 1 /
I r~ I ~ t I ~ ~ 1 I ~ ~ ~ ~ ' jloI
10
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f 1 I ~ 1 1 '
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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 WERE COMPLETED ON:
Gary L. Steel 11-2-90
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave., New Richmond, Wi. 54017 2298 7 -246=6200
CST SIGN E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILIiR-SBD-6395 (R. 10/83) - OVER -
Loy- I
Sw Y.4 , Sec.. ~o y -r-sc'Il ' 19Q
---ra~,n, a~- `tea- set vYY~ G'aK C
4if z s
wl- C~_
~.ZC.F- ND /Zoo-
c1
A BM a"~F / s $ "K lad'
mss: ~1~,✓ : too d~
&ar hl 4
~ ~ p~~d`~ek ~ ~ Q fi+ex ~ araa
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aid der se~fjacrts d;s~s
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G ~a 5 s 3~-c d'~ Cam, bC~
10 ST. CROIX COUNTY
WISCONSIN
r p p ■ ■ rorti ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
_ (715) 386-4680
March 31, 1994
Ms. Jenny Olson
Century 21
706 19th Street South
Hudson, Wisconsin 54016
RE: Water results for Dan Young
Address: 1363 Awatokee Trail, Hudson, Wisconsin 54016
Dear Ms. Olson:
Enclosed is the original water test results from Commercial Testing
Laboratory, Inc. for a water inspection of the above property. If
you have any questions with regard to said report, please let me
know.
ncerely,
1^ 11
Mary J. Jenkins
Assistant Zoning Administrator
js
Enclosure
i
-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 REPORT NO.' 59289/01 PAGE 1
ST.CROIX CTY GOV.CTR REPORT TATE' 3/28/94
1101 CARMICHAEL ROAD DATE RECEIVED' 3/24/94
HUDSON, WI 54016
ATTN' THOMAS C. NELSON
OWNER' Dan Young
LOCATION' 1363 Awatukee Trail, Hudson
COLLECTOR; M. Jenkins
DATE COLLECTED' 3-23-94
TIME COLLECTED' 2'00pm
SOURCE OF SAMPLE' Outside faucet
DATE ANALYZED443-24--94
TIME ANALYZEA'2:00pm
COLIFORM,MFCC' 0 /100 Sul
INTERPRETATION' Bacteriologically SAFE
NITRATE-N' 7 ppm
Above 10 pPm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
p£~
< MAR 3 1 1994 ~-J
00
LAB TECHNICIAN' Pam Gane TQRU)C
Coui4TV CU
f.WDEPEN lG
WI Approved Lab No. 19 Y•rE[~
{ Means "LESS THAN" Detectable Level Approved by:
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY
oaf'-, WISCONSIN
ZONING OFFICE
■ x r a ■ x ■ ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
AIN. Hudson, WI 54016-7710
_ (715) 386-4680
March 23, 1994
Ms. Jenny Olson
Century 21
706 19th Street South
Hudson, Wisconsin 54016
RE: Septic Inspection for Dan Young
Address: 1363 Awatokee Trail, Hudson, Wisconsin
Dear Ms. Olson:
An inspection of the septic system on the property of Dan Young
located at 1363 Awatokee Trial, Hudson, Wisconsin, was conducted
today, March 23, 1994.
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.
Also, water samples were taken. Once we receive the results, we
will forward the same on to you.
Should you have any questions, please do not hesitate in contacting
this office.
Sincerely,
Mary Jenkins
Assistant Zoning Administrator
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ST. CROIX COUNTY
n WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
13
(715) 386-4680
- -
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I~31 V4
F SEPTIC INSPECTION / WATER TEST REQUEST FORM
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. Please make arrangements with
this office to insure a time when entry can be gained.
~'Op 1
❑ Water (VOC's) $185.00 e-septic ~-5-99-
WWater (Nitrate & Bacteria) $35-:@0 (Visual inspection)
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Owner: c~~cr t Requested by: _TE(,vOq Qlsojn~
Address: I?,(r 3 LA-TZ)( L FLAIL Address: G f vT t ~So
City & State: I-h?nSotJ IA) I City & St. i"IU(~So , L31
Zip Code: _~pl ( a _ Zip Code: D10
Telephone N°: (°?I~ 5Ljct' -!Eic;L-12_ Telephone N°: (]L5) 3&X0-b2_0-7
Property address (Fire N2 & Street) : )~Cp 3 ~ t ict ` RZA I,--
Location: s, Sec. alp , T 30 N, R I`t W, Town of ST SoSe-PH
St. Croix Co., WI. Tax ID NQ o3o_ Io-Iy ..Parcel I N4
50-100 075 ID
House color: Realty firm: 0-Z.I L ck Box Combo: iZL4~-1
Water sample tap location:
TO BE COMPLETED BY PROPERTY OWNER
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS
Is the dwelling currently occupied? Vyes 0 No
If vacant, date last occupied:
Septic system installed by: Year:
Septic tank last serviced by: -t Date: =
Previous Owner's Name(s):
Have any 91 the following been observed?
❑Y ~ / Slow drainage from house.
❑Y LIN/ Sewage Back-up into dwelling.
❑Y LJN Sewage discharge to ground surface,
road ditch or body of water.
❑Y m Slow drainage from the dwelling..
❑Y 6; Foul odors.
Other comments relative to system operation:
I .certify that the above information is complete and true to the
best of my knowledge. \
OWNERS SIGNATURE: DATE:
'I
.OIL,
t
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
IN
TO BE COMPLETED BY INSPECTION AGENCY
System design Vor permit on file? ❑Yes ❑No
soil series per SCS Soil Survey: sheet #
Type of soil absorption system: EfBelow grd ❑At-Grd ❑Mound
Approx. size 'X ❑Gravity ❑Dose ❑Pressurized
-r Ft .2 ❑Bed _ ❑Trench ❑Dry -Well
❑Holding Tank ❑Outfall_pipe
OBSERVED DEFICIENCIES ❑Other ❑Unknown
Septic tank -
Setbacks: ❑House ❑Well y ❑Prop. line J ❑Other
Dose tank
Setbacks: ❑House `OWel-l ❑Prop.'line ❑Other
❑Locking cove ~nincf lab Pump/Floats
❑Alarm Elec. wiring
Soil Absorption System
Setbacks: OHouse ✓ Dwell ❑Prop. line t) ❑Other
❑Ponding• ❑Di ch •
General comments:
CJW~
INSPECTORS SKETCH OF SYSTEM LOCATION
N
Inspector
Title
lY
~ L
Coniuryt
S
' 21-0 Y
Premier Group
70619th Street South
Hudson, Wisconsin 54016
(715) 386-8207
(612) 436-8433
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. L#
13 Uk
Fire # Dist nr,
L]KE NEW - ON 4.3 ACRES! Addr Ci
Sec Twsp C
Immaculate four bedroom, two bath home is just Ext Vin 1 Yr Blt 1991 Ht Pro . FA Style Ranch W/O
like new and ready for your family. Energy TFF Tax Yr t
Lot Size SMFL
efficiency and low maintenance make this home 4.3 Ac 1312 1664 $2399.69
Practically perfect for today's busy families. A L C D Approx Rm Size 2 # Baths (J WT Sch Somerset
well designed floor plan features spacious rooms, LR 1 C 15x15 (xJM6 BB -
open kitchen with snack bar and lovely dining DR 1 C 12.3x11.2 (x) Dwshr ( Disp. U20-test on file
area. Main floor laundry, large master bedroom Kit 1 V B 10x12.4 [x) Refrig [ R&0 ()Yes ()No
suite with private bath and walk-in closet. The FR L Unf in. [x) WS 1 R (x) 0 Avg Ht S
lower level walkout offers plenty of storage MB L C B 18x11.4 C. Wtr (J C. Swr. Avg Util S
spaces and future family room with sliding glass BR 1 C B 13.1x11.4 (x Well [ Septic Poss Date Jan . 1, 1994
doors that lead to the large wooded back yard. gR 1 C B 12.5x11.4 Frplcs [ C. Air Bsmt full walk-out
All this and more set on 4.3 acres with lovely
countryside views. BR 1 C B 11.4x9.9 [XJ Gar2 (A GDO (x) Deck [_L patio
LDR _17 8x5 Rec Rm J Ldr UFFI (J Y [ IN UKN
N-495R Legal/Disclosure Legal on file.
6" wall construction. Energy efficient. Tempstar
gas FA furnace. Central AC, low taint- vinyl exterior.
2.8 Lister Jenny Olson Ph 386-2554
PRICE: $119,900 Mr Century 21 Premier Grou # C21 HUD Ph 386-8207
DIRECTIONS: I-94 Exit #4. Follow Hwy 12 North to
Cty Rd A. Continue North and East on Cty A. At
intersection with Cty Rd E, go straight (Bass Lake
Road), left on I32nd,_right on Awatukee Trail.
Information is considered accurate but we accept no liability for error. Listing may
be changed or withdrawn without notice.
loud ■ous;+c
OPPORTUNITY
Each Office Is Independently Owned And Operated REALTOR'
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Vol. 8 Page 2368
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This instrument drafted by Fran Bleskaceki Job No. 78-52-190
Vol. 8 Page 2368