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COMMERCIAL TESTING LABORATORY, INC.
Y
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
ST. CROIX ZONING REP3:T NO.2 15356/01 PAGE 1
ST. CROIX COUNTY REPORT DATE; 12/26/91
COLIRTHWSE DATE RECEIVED: 12/20/91
MDSON, WI 54016
ATTNI THOMAS C. NELSON
f 039,
OWNER! John 6 Margaret DeRos i er !l 1.~ ~i / _ ~ 5_
LOCATION*# 1048-192nd ve., Richmond (•Q ( / (P
COLLECTOR: ML. Jenkins
SOURCE OF SAMPLU Kitchen faucet
COLIFORM*# 0 /100 mi
INTERPRETATION: Bacteriologically SAFE
NITRATE-NS 5 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
9 1~
1:5)
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LAB TECHNICIANS Pam Gane `
WI Approved Lab No. 19 '
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d
Means "LESS THAN" Detectable Level Approved by!
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
T. CROIX COUNTY ZONING OFFICE
Ate, e St. Croix County Courthouse
L;y 911 4th Street
~`b Hudson, WI 54016
' x Telephone - (715)386-4680
The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
1~11 45 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 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: $ 25.00 xxx
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 *SEEIM.
(Determines if system is properly functioning at time of
inspection)
Property owner's name John L DeRosier and Margaret M. DeRosier
Property owner's address 104 - 192nd enue New-Richmond, WI 54017
Legal Description NE 1/4 of ' -sw 1/4 of Section 28 , T 31 N-R 18
Town of Lot Number 4 Subdivision Name
FIRE NUMBER 1048 LOCK BOX NUMBER
Color of house Realty sign`by house? If so, list firm:
ST r (715) 247-3541
--a mum ji _ ease send a certi icate o sep c.
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: Bank of Somerset
Telephone Number (715) 247-3348
REPORT TO BE SENT TO: Bank of Somerset ATTN: Kristen Dixon, P.O. Box 220, Somerset
_ WI 54025
closing d to
Signature
W~ - I a - C~ d - 9 ZzAlk t oajo
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EVALUATION OF SEWAGE DISPOSAL i WATER SUPPLY
BUYER: Martin C. and Susan-J-.- AustrencT
PROPERTY ADDRESS: 1048 - 192nd Avenue COUNTY OF: St. Croix
New Richmond, WI 54017
SEWAGE DISPOSAL SYSTEM
SEPTIC HOLDING TANK MOUND
SIZE OF TANK (GALLONS) SIZE* OF SEA EPAGE AREA (pa S t
AGE OF SYSTEM t1&- Q.~./i4 DOES TANK/FIELD HAVE A VENT?
LAST TIME TANK WAS PUMPED? SHOULD IT BE PUMPED NOW?
IS LIQUID EVIDENT IN VENT? YES NO X_ N/A
COMMENTS:
WATER SUPPLY SYSTEM
PRIVATE WELL i. SHARED WELL OTHER
WELL SPRING OTHER
HOW MANY FEET FROM WELL TO: DRAIN FIELD SEPTIC TANK
IS WELL LOCATED IN PIT? DOES WELL TERMINATE ABOVE GROUND?
IS A WATERTIGHT SEAL, CAP OR COVER PROVIDED?
DOES WATER DRAIN AWAY FROM WELL/SPRING?
IS WATER PRESSURE SUFFICIENT?
COMMENTS: _
l(/'GEt ,(~v~p'LLC7clbo
ON THIS DATE, INSPECTED THE Y AND SEWAGE
DISPOSAL SYSTE SS AND FOUND THAT THEY ARE:
NOT CAUSING ANY UNSANITARY CONDITIONS, ARE IN
SATISFACTORY CONDITION AND MEET STATE CODES
DO NOT MEET STATE CODES
OTHER
THIS REPORT COMPLETED BY&f&~APZ MlAiA) LICENSE # -4.;-L
D%G/
STATE OF
TITLE:
G44~ 0
` ~r A
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
_ ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, W154016
(715) 386-4680
Dec. 19, 1991
Kristen Dixon
Bank of Somerset
P.O. Box 220
Somerset, WI 54025
Dear Ms. Dixon:
An inspection of the septic system on the property of John &
Margaret DeRosier, located at 1048 192nd Ave., New Richmond, WI,
was conducted on Dec. 19, 1991. At the same time a water sample
was obtained for testing. The results of that test 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.
cerely, p
Mary J Jenkins
Assistant Zoning Administrator
cj
on
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407739'
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CERTIFIED SURVEY MAP
LOCATED IN PART OF THE NE 1/4 OF THE SW 1/4 OF SECTION 28, T31N, R18W,
TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN.
N FILED DEC 04 1055
4 OWNER
N M DEC I,1 1985
o RICHARD WIER ST. CR-0:X C':,JNTY
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= N 1/4 CORNER
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N S89052140"W ROAD 1315.88'
345.42' EASEMENT 345.42'
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this instrument drafted by Douglas Zahler job no. 85-13
Vo . 6 Page 1615