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• FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER FLCL,CA Ag, TOWNSHIP sl~
SECTION~T 36 N-R_LLW .
ADDRESS__ Z ST. CROIX COUNTY, WISCONSIN
SUBDIVISION__AV
LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
s4 '
r b
EY
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: (60 o
Alternate benchmark idD-di S;A;,.G dzc hd"SP-
SEPTIC TANK: Manufacturer: L&AI&S Liquid Cap. PQDqa,j
Rings used: Y manhole cover elev: Final grade elev:
r~ 5
Tank inlet elev.: ~~C°~ Tank o Pt et elev.:
No. of feet from nearest road:Front , Side , Rear Ft.
From nearest prop. line:Front__&_, Side , Rear Ft. ? /aa"
No. of feet from: Well n(-Sjv, , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: i" 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: ...E Length '7-,5"- Number of Lines: Z Area Built 5-0
Exist. Grade Elev.--j
.Q S.0 Proposed aFinal Grade Elev. ld ( C(
Fill depth to top of pipe: `3G `e
No. feet from nearest prop. line:Fr+ont-k, Side , Rear Ft.Zd~
No. feet from well:o feet from building
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' d 1r s~ w
DATE: PLUMBER ON JOB: c
u rQ~
LICENSE NUMBER: AtPkS'*3--LG Z
6/90:cj
c ~ cry
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations
Saf0ty INSPECTION REPORT St. Croix
Safety and Buildings Division Lot 4 Sanitary Permit No.:
GENERAL INFORMATION SW-4, N144, ~.'°~~6H1T~P 1M . watukee Tr. 149079
Permit Holder's Name: ❑ City [I Village f] Town of: State Plan ID No.:
Richard LaCasse St. Joseph
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
1OP33 -A ' /100,60
Dosing
f
Aeration Bldg. Sewer
Holding St/*k Inlet
TANK SETBACK INFORMATION St/-Outlet 4.! 1 u oz'i
Vent
TANKTO P/L WELL BLDG. AirIto ntake ROAD tit Inlet
Air
Septic y~l NA i_t Bottom
D NA Header /-P %ft
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manuf Demand S .7- ~ r
Model Number GPM
I Loss Friction Syste TDH Ft
TDH Lift
Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION DIM N I N
LEACHING Manu a durer:
SYSTEM TO P / L BLDG WELL LAKE /STREAM
SETBACK
r Mo Num er:
INFORMATION TypeO n I CHAMBER
System: u 20 so. 2 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, persons pr sent, etc.) =7-
e- C1
s~ 3 - 101
as ~s
rL 9
1
I
C~ CC~~~ 99 ~ l ice'
Ale- CU-I#
Plan revision required? ❑ Yes 2"`N*'0
a S. /
Use other side for additional information.
SBD-6710(R 05/91) Date Inspedor'sSignatu a Cert. No.
SANITARY PERMIT APPLICATION COUN
TOiLHR In accord with ILiiR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than ~VQD7 4t
8% x 11 inches in size. ❑ Chlk if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION P EASE P NT OR TION.
A F.0
PROPERTY OWNER LbUAAJL PROPERTY LOCATION
S") t/4 tjd~ Y4, S 2 T,30 , N, R /q E (o W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
90' ass
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
~t Co BIZ ~o-aso3
11. TYPE OF BUILDING: Check one CITY ~ NEAREST ROAD
( ) ❑ State Owned ❑ VILLAGE s
; S-F, 30
w
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms 3 AR EL AX NUM ER( )
III. BUILDING USE: (If building type is public, check all that apply) V,3V O
1 ❑ Apt/Condo V w
20 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. 9 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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
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) *I caloea" ELEVATION
760 7SO 140 to - 530 '0`L0W(-%jW /O5d Feet
VII. TANK CAPACITY Site
INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper.
New xistin Gallons Tanks Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank ~d ~Or7O l
Lift Pump Tank/Si hon Chamber
Vill. RESPONSIBILITY STATEMENT
1, 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) M PRS o.: Business Phone Number:
O; L . S -W=_ 3zrZ- 7tS g68-4Wig
Plumber's Address (S et, City, State, Zip Code
Z KW &YL -75- 64--72-4
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sani ee (Includes Groundwater Date Issued Issui ant signature (No Stamps)
er Given Initial Surcharge Fee)
16-0-qd pproved ❑ Own
Q (21
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 8 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 __Erct a _y N ,
Location of Property 50 k 10CL)~k, Section Z(o , T N-R~- W
Township
y
Nailing Address 3
Address of Site
~ i~•1, 5 - II
Subdivision Base
.Lot Number 4
Previous Owner of Property ~,rv_ o Q T~D~~ d to
Total Size of Parcel
Date Parcel was Created Z. l4
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? x_ Yes 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) cutU6y that atCt, ~tatementJS on thus orcm ahe thue to the beAt o6 my (oun)
h"r-wtedge; that I (wel am (ane) the ownen(a1 o6 the phopenty dezcAi•bed in thiA
in6olmati,on 6o4m, by viAtue o6 a waAAanty deed kecokded in the 066-ice o6 the
Count Re iAteA o
Deeds Document No. ; and that I (We) pneeent,Cy
ocun -t1~e pRopoaed bite bon the aewage di,5pos aya em (on I (we) have obtained an
easement, td*nun with the above dmcAibed pn.operrty, 60A the conatnuction o6 said
a ystem and the eame has
been, duty necohd¢d .in the 066.Lc¢ 06 the County Re at¢~c o
fltcde, ab Oocla,+ent No. 9i 6
SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
DOCUMENT No. STATE BAR OF WISCONSIN FORM 11-19&9 THIS ErACL RESERVED rOR RECORDING DATA
M LAND CONTRACT
470335 Individual and Corporate
TO BE USED FOR ALL TRANSACTIONS WHERE OVER
$25,000 IS FINANCED AND IN OTHER NON-CONSUMER
ACT TRANSACTIONS
pA0 REGISTER'S OFFICE
Contract, by and between Ri.q uA...0 ....SJolut,..axld....... ST. CROIX CO., W)
Janet P. Stout_,___husband__and__Wj_.e___$u V, .y.Q ~hj,R Poc'd for Re.0rd
.....ill? a~...Rro_Rel„;y.$ ("Vendor", i! 1 W~ O 4091 '
w 1v
whether one or more) and.....13d . of Ali 11:15 A. M
~y1 1
("Purchaser", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- Regisfer of Deeds i
formance of this contract by Purchaser, the following property, together with the i
rents, profits, fixtures and other appurtenant interests (all called the "Property"),
in........ t__..CrAix County, State of Wisconsin: RETURN TO
Located in part of Govt. Lots 6 and 7 of
Section 26, T30N, R19W, Town of St. Joseph,
further described as Lot 4 o Certified Survey
'QBS -Map recorded in Vol. 8 ~w ge 2 3 (a~ PZU ax Parcel No
tf,y as Document # 1{ 'g p aR Res Of
W , -
This ........18 riot homestead property.
(is) (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at1353. AWatukee Tr. , -_HudSOWi".
the sum of $._.25_t 000 . in the following manner: (a) I1.Rae......................... .
at the execution of this Contract; and (b) the balance of $_2.5.,.A.QQ...QA together with interest from I
lfi on the balance outstanding from time to time at the rate of......... (.10 t,ell....... per cent per annum j'
until paid in full, as follows: Monthly payments of interest only in the maount of
$208.33 with the first payment due on October 1, 1991, and payments
due on the first day of each and every month thereafter until August
31, 1994, when the entire principal balance and any accrued interest
are due in full.
Provided, however, the entire outstanding balance shall be paid in full on or before the............. 31st day of
AUCIU S t 19-24.. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of .....1 Q. % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after June..l.......... 1 199.1... (OR)
there may be no prepayment of principal without permission of Vendor.*
In the event of an
~i y prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated
II as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except: security interest in property to Bank St. Croix.
Seller whall provide purchaser with abstract at closing or upon
request.
Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall be entitle to take possession of the Property on............ June 1.1 , 19 91
'Cross Out One.
NCMInerCarrgy® STATE. BAR OF WISCON91N
• ^ FORM No. 11 - 1982 Stock NO. 13017
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ut lins;op g ;o Juana aq1 ui (q) ao alsp anp pat;foods ay1 Butmollo; 9Rep --09-•-• ;o potaad i .1o; sanutluoo gatgm lsaaalut
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. • • _ •
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.
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1314 ay1 Xq ;n- a o 8u9i ~Ru10
ldam 'saaus.1quxnoue pug suatl 11s ;o avelo pus asa; 'Rlaadoad eq1 ;o 'aldmte 99; u? 'pa9Q Alug.1aNb s 'jontIoand oql
01 a9ntlap Pus oln09x8 'pu10utap 110 Ines .1opu8A 'pat;toods eAogv .1auuvm aql ul pus setu?1 9q1 IN pauuo;Gad Alln; eq Ilsge
suotl?Puoo TIN pus ptsd AIIn; aq llsgs 9R9uout to4lo pus 199.191ui tlltes Botad esegoand oqJ es100 ul ;gq; 900aSv aopuaA
•Rl.1ado.1d aqJ Suf129jj8 suotlvInBez pus seousutp.1o 'smel Ili gJtm Rldtuoa ol
pug ';agaluo0 stgl ;o ustl 9ql o; .1opedns suati uto.1; asa; Rlaido.1d 9141 daeil 01 'atgda.1 pus uo1Jtpuo0 algsluvual pooe ut
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18aolsaa of pat?ddv aq
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01 9sol 10 93T;011 BATS Ahdtuoad Ilvgs .1asegoand -aopuaA gJtm p9;tsodep eg Tlvgs Rlaado.1d aq1 out.1anoo satotiod its ;o
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•luatuAvd gans Sutmoqs eldta0a.1 pusutap uo aopuaA 01 asntlap 01 pus 4! ut
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This instrument drafted by Fran Bleskacek Job No. 78-52-190
i
Vol. 8 Page 2367
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3u00,00o08N 3„ES,Zho00N ,6O*TEZ M I TZ h9 l Z,1ZoM ntO,LTo6L 100,191 T - 1Q
ONIHV39 ONIHV38 H19N31 H19N31 9NIUV39 31ONV H19N31 'ON
1N39NV1 1N39NV1 38V OHOHO 0VOH0 1VHIN33 sniovb 3AHnO
STO - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 'a I
c4. cam- G Ca 5s
ROUTE/BOX NUMBER C/o FIRE NO.
CITY/STATE__)4A -a ZIP 6yd 6(0
PROPERTY LOCATION: Sct) 1/4 ►~1 W /4, Section T30 N, RAW,
Town of ~p SPA , St. Croix County,
Subdivision , Lot No.
Improper use and maintenance of your septic system could result in its premature
failure to handle wastes. Proper maintenance consists of pumping out the septic
tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER.
What you put into the system can affect the function of the septic tank as a
treatment stage in the waste disposal system.
St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of
$3000 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 SYSTEMS agree to keep their
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master plumber, journeyman plumber,
restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and (2) after
inspection and pumping (if necessary), 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.
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 Department 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. %
SIGNED
DATE 7~z
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY; DIVISION
LABOR AND P.O. BOX 7969
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: WNSHI P/I?LTYLOT NO.: BLK. NO.: SUBDIVISION NAME:
SW ~ NW ~ 26 ~T 30 N~R 19~drt . joseph 4 /a Pine Grove
COUNTY: OWNER'S Shoot& E: MAILINGADD
RESS: St. Croix Richard fa (7,v, sse_ x '
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESC IPTIONS: ER OLATION TESTS:
~Redence 3 n/a New ❑Replace 11-2-90 n/a
RATING: S= Site suitable for system U= Site unsuitable for system
r ONVENTIONAL: MOUND: eN-GROUND-PRESSURE:ISYS-rEM-IN-FILLIHOLDIN(i TANK: RECOMMENDED SYSTEM:(optional)
Q S ❑U H S ® S ❑U ❑ S EU ❑ S f~] U split level trenches
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: class 2 Floodplain, indicate Floodplain elevation: n/a
decimal' 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. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 16.82 105.55 none >6.82 .58bl.1. .58bn.sil. 1.33bn.s.1. 4.33 bn.l.s.
B 2 17.25 105.50 none >7.25 .92bl.1. .83bn.sil. 3.75bn.l.s.&9r. 1.75bn.s.1.
B 3 6.67 103.00 none >6.67 .67bl.1. 1.67bn.c.s.&gr. 4.33bn.s.1.
4 6.58 101.06 none >6.58 .75bl.1. 1.00bn.c.s.&gr. 3.58bn.s. n. .s.
B-
B- 5 6.41 100.97 none >6.41 .83bl.1. 1.25bn.sil. 1.83bn.c.s.&gr. 2.50bn.s.l.
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RAPER IINCH NUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R
P-
P-
P- see ffe-sign rate
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. 102.00=upper trench
SYSTEM ELEVATION 99.50=lower trench
3
4-1
d3 rrr~ .
E
~ i
-Ab
3
s,
N
E o
t
3
3
ell
Z
7~77
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.
NAME (print): TESTS Jf R CQI~IPLETED ON:
Gary L. Steel jj yU
PHONE NUMBER (optional):
ADDRESS: CERTT15/,>TION NUMBER1711~-246-6200
1554 200th. Ave., New Richmond, Wi. 54017 LLLL tt55 CST SIG T RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
e-- Ici
G..,,r t J e M ~R S ~Z t z
Sw Y~, N uJ t'y0 I sec. z~ ~ 3o N ~ R ~ R W
Ta~~sa a~ S~, ~a shy Sv5 C~a r x Ca~
~o
3 ~~M
i I 8.3 P,NA
/ I I b Q G~ rs t 61
uoer
i
ga! ;s 7~a~, aS- _ Joao co"a.-mac.)
A-6 c • tom, a'd s ~y , z ~,o~.~
5' A -75'
cl C)
• COIriMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
FAX-715-962-4030
lqql a -T~
ST. CROIX ZONING REPORT NO.S 39362/01 RAGE 1
ST. CROIX COUNTY REPORT DATE; 4/13/93
COURTHOUSE DATE RECEIVED4 4/08/93
HUDSON, WI 54016
ATTN S THOMAS C e NELSON
1
i
OWNERS Dan 6 Mary Kay Penn ings
LOCATIONS 1378 Awatukee Trait, Hudson
COLLECTORS M+ Jenkins
DATE COLLECTED: 4-07-93
TIME COLLECTED: 2S30pm
SOURCE OF SAMPLE: Kitchen faucet
DATE ANALYZEW 4-08-93
TIME ANALYZEDS12S00pm
l COLIFORM(S 0 /100 ml
INTERPRETATION#+ Bacteriologically SAFE
NITRATE-NS 7 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
a 1`
0 (r,
of "~`"E"~fN, LAB TECHNICIANS Pam Gane
WI Approved Lab No. 19
I'
Means "LESS THAN" Detectable Level Approved by/ ~
PROFESSIONAL LABORATORY SERVICES SINCE 1952
r X11 ~ ~
~e -j0277-3
oas- ST. CROIX COUNTY ZONING OFFICE
911 4th Street
Ai}` 0 Hudson, WI 54016
co
Telephone - (715)386-4680
_ St. Croix Co. Zoning Office offers the service of septic and
~g90- 51 er inspection to Lending Institution, Realty Firms, and
private individuals.
COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN HE
III ~ LOCATED.
Please provide the following information, enclose appropriate fee
,~,P 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: $ 35.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $185.0-0
(VOC'S) /
SEPTIC SYSTEM INSPECTION FEE:$ 25.00
PROPERTY OWNERS NAME: _ Ca )'n -1 r y /~'a y pr nr, i" qS
PROPERTY OWNERS ADDRESS : 1378' A-ok iso T. CITY: Ilu d-r6m
Legal Description NE 1/4, SW 1/4, Sec.4_, T 3o N-R /9 W,
Town of S-/. 7-osev~ e4s-lpa. t .,Lot No. , Subd i 1
-
FIRE NO. /37 F SCdKOB70X NO.
Color of house Qrown Realty sign? rs Firm: 6-
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 : ~/irh a~/~y 4 '2
Telephone No. - 3
REPORT TO BE SENT TO: 7/ u-<14
f,
CLOSING DATE: i• O/
Signature:
r 1
M
ST. CROIX COUNTY
a WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
April 7, 1993
Jim Dahlby
Edina Realty
700 - 2nd St.
Hudson, WI 54016
Dear Mr. Dahlby:
An inspection of the septic system on the property of Dan & Mary
Kay Pennings, located at 1378 Awatukee Trail, Hudson, WI was
conducted on April 7, 1993. At the same time a water sample was
obtained for testing. The results of that testing will be sent to
you as soon as we receive them back from the laboratory.
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.
Should you have any questions, please contact his office.
Si cerely,
Mary J. Jenkins
Assistant Zoning Administrator
cj