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HomeMy WebLinkAbout020-1188-90-000 z a o m, C) V? Q Cq Q) Z O !V ~1 C C C N N c ~ a r I i ca o n t= ~ ~ I I C _O OUl- ~ C I O) N C X23 N ~ N a~ 'E 3 O c rn 3 C3 O LL O TJ ,n O) Q w ~ I I co ~ Z N rn Z _ EO O Z r co N W d m N I- Z c C7 O Z !!t U >p N d Z ~t <n I- - m E ~~yj•~ N N O OR n N .w C O o O O O • 1V (n s .N O O N a- ~ O E 4-".. o 0 ® - O N Q~ N N Z m z Z O O O E N E l N = ~J N f° E W N A Q L Y f9'. CO O d L' E _0 E O 00 cn U F- H H (.5 Ln d V) , a a CL CL o o 'U rn rn o v, -j U 7 rn O = Z N V t~MM1~ N N N C O O Ir 0 o = N 0 O cn Y 0. d N 3 Q 4) ~ O ^ N N r4,i .C OO O N C E `o E ® C C O O C N 0 0 o ~ o o ~ o 0 0 r ~ 0 0 1 - 0N N N 00 E E E a v N o ~ C - (h -.L L ~ r N M N ON C N H H C9 M: C:) N w ) N N N E E U ® i L: (L rr~~• CC A d .U N .O C o "1 .r E 7 i r FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER -':~;cAr`/ 4 //Q r-- TOWNSHIP ylcAAR SECTION /T-I-el N-R / W ADDRESS -07.7- 8'2- ST. CROIX COUNTY, WISCONSIN SUBDIVISIONS LOT / LOT SIZE O /1~1~sav L 3 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C S 3/ ( 3 k-1 7,b f t f{Oi ~Gln~j6- x 96 SYet. S P, It E N 3(' ~c :P,s Ar lufi ebi S CorK•J F- I!= tob,o i 1 +-T.Cn A N aav~ 3 ~ ~ I c T H "A" NOTIN ARROW BENCHMARK: Elevation and description: s?. r, ~-T- I; H F_j- Alternate benchmark3 v4 Venr4-;L19 =de.. SEPTIC TANK: Manufacturer: Wm,'SQr' Liquid Cap. Qp Rings used: 1 Manhole cover elev: ` Final grade elev: Tank inlet elev.: (o, 215 Tank outlet elev.: Cv 5 No. of feet from nearest road : Front , Side, Rear Ft. Z I(D t From nearest prop. line:Front , Side , Rear Y Ft. ':~11 i . 2-6- (Include of feet from: Well Building. (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE r r PUMP CHAMBER Manufacturer:/I/k 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: Q4"&%..j:,*.jPrench : - - Seepage Pit: Width: Length 3 57, Number of Lines:2_Area Built4S/87t;7T Exist. Grade Elev. Proposed Final Grade Elev._ FrS U Fill depth to top of pipe: No. feet from nearest prop. line:Front Side X Rear Ft .,V0 No. feet from well: FIZ No. feet from building 5`7 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 : ~J LICENSE NUMBER: ~ 6/90:cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABORA& HUMAN RELATIONS DIVISION ` P.O. BOX 7969 4CONVENTIONAL ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION METlSftrl 5ec . 16 ,T29 -R19 Sta P' Number: Town o f Huds on Lo t ~ El ALTERATIVE Holding Tank ❑ In-Ground Pressure ❑ Mound Co R A NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Box 282, Hudson WI 54016 IA107hr) BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM LAN: REF. PT. ELEV.: ST REEF. PT. EL t /1 Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Doug Strohbeen 5732 St. C ix 135526 SEPTIC TANK/ : y.13 Y0042hy It tr. Al. 4 " ? MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: •TANK OUTL WARNING LABEL LOCKING COVER W PROVIDED: PROVIDED: t{,~e~ L f q NO 7 YES ❑ NO ❑ YES BEDDING: VEPFT DI A.: Y~1Pr MATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T FRESH C'0' • ALARM: rFEET FROM LINE: [ t AIR INLET: 3 8~ ❑ YES NO / -+7 1 ❑ YES O EAREST > s 58 j ( C T DOSING CHAMBER: ' MANUFACTURER: BEDDIN!S~ ~~~MODEEELLPUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIO NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN T FROM LINE: AIR INLET: PUMP ON AND OFF) I ❑ YES ❑ NO NEA SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: R: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) / CONVENTIONAL SYSTEM 9, ' $ _qei, i oL v. = 147, WIDTH: LE O. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH r R TRENCHES: f MATERIAL: PI DEPTH: DIMENSIONS 3 (0 Co T ar GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATF~RIAL: NO. I TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INL T: ELEV. END: P cf "/Je..i~; ~(D PIPES: FEET FROM LINE:: / i AIR INLET: 7D ga y • e✓Z'SC%H ✓C- NEAREST 19 MOUND SYSTEM: 7 Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: 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 DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ES ❑ NO ❑ YES ❑ NO ❑ YES ❑ :NO~] PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELO FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DIS UTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST-1110. etain in county file for audit. Sketch System on Reverse Side. GN URE: TITLE: SBD-6710 (R. 06/88) 1 DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COON STATE SANITARY PER PAT # -Attach complete plans (to the county copy only) for the system, on paper not less than El cfii~~ n 8% x 11 inches in size. ; rev onto evious 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 SE%4-5&Y4,S Vll N,R E(<W:) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 60 f z z 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER GS_M. V,0 1. 7/3 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE 4 ~5oh 60 ~ . d~ ❑ Public F91 1 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NUMBER(b) I III. BUILDING USE: (If building type is public, check all that apply) 139 E 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 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. F New 2.E] Replacement 3. ❑ Replacement of 4.E] 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 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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 G /.S 4'1Y O. 7-,L- G z' 7 ;?.So Feet GM- 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 structed Septic Tank or Holdin Tank BOG(, C e F1 I El I Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu is Signature: (No stamps) MP/MP SW No.: Business Phone Number: Plumber' Address (Street, City, State, Zip Code): Ill C. Wl bl~ lIL7 U IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater 1:6 Issued Issuin Agent Signature (No Sta Approved ❑ Owner Given Initial Surcharge Fee) Q / Adverse Determination 45 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 INSTRUCTIONS , t 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. Vf1. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; close volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 4 4 APPLICATIONFOR 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 lot tesale by ownet/contcactoc,(spec house), then a second form should be retained and completed when the pcopecty is sold and submitted to this office with the appropriate deed recording. Owner of property S~-~ ~;//a-✓ 'c, Location of property !_i/4 /41 Section Township ria~sos~ Mailing address ,25'.-Z z9z- - Address of site . /o, 4om j ~~~H ~c ~so~ W SytJ /4 Subdivision name C' S•/'~• Yo% 3 YI&g 7,, . Lot number _ 3 Ptevlous owner of property Total also of parcel X e 5 Date parcel was created /o- z,- r--Ace all cotnece and lot lines Identifiable? x as o IS this property being developed tot resale fapec house)? as o Volume 6 9 g and Page Number _30z- as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION TITS FOLLOWINCt A WARRANTY DRI<D which Includes a DOCUMtNT NUMBER, VOLUME AND PAOR NVKSgR, and the SRAL OF THE REGISTER OF DEEDS. In addition, a cettlfled survey, it available, would be helpful so as to avoid delays of the reviewing process. It the deed description teferences to a Ceitifled Survey Map, the Cettitled Survey Map shall also be required. 7 PROPERTY OWNER CERTIFICATION tlve) rectify that all statements on this form are true to the best of my (out) knowledge) that I (we) am (ate) the ownerts) of the property described In this Intotmation torm, by virtue of a warranty deed cecotded In the office of the County Register of Deeds as Document No. ~g9 71/0 1 and that I (we) presently own the proposed alto for the sewage disposal system (at I (we) have obtained an easement, to run with the above described property, for the conettuction of 80d system, and the some has been duly recorded In the Office et-Abe County aeg t c of Deeds, as Document No. ? 9 7 / /a Signature of owner signature of co-owner (II Applicable) U I ate of elgnatute Date of Signature t _ -ll jY eft ~f 1J X K ; Y ~i of I s 1 v rot AJ Sy s Y i o c `AWOP-0000 Md tM t# ettM/ swoon", aMt. A * 'arr ttq of 4 " : #iQ i~ Wit, Vic, now Life in g A} . Christ AL) By-t- ' • lLaberr Willuid O. 8chults SEAL Hy~ lldll S_ ; , i . Noumea $ • yisier, MOO` AUTNtNTICATIOM tinsad y ' ACKNOMtLEOaME0 ---A" of, STATE of WISCONSIN - f. CMdx Cotrtl~r . "It . Personally career before tae, tbiti w T M the aboae no" ' ~ s'Crl1°t'ffi`~AS ~ 11S,Nf a>.thorisea by 3706:86, Ntiti Styx.) 5t ultz, NOLitlecl E. visor apd~_ This instrument was drafted by Acbert F. W1s11 to me known to be the per[on,, 522 Se. pond Street, P.O. Box 151 Htxl9M WI 5401 going instrument and ackatlglried~ei ` (Signatures may be authenticated or acknowledged, Both * .u4;ty are not necessary.) Notary Public St. Crraix My Commission is Cea1 permanent. (N soy ttwte date: --__Nay l.-_ s *Names of pera•ms signing in any capacity must be t _ Yped or printed below their signatures. wARRANTY ntar►-tifAT[ SAW OF e'It1CORM.M. FORM no. I-1997 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT w r. St. Croix County w OWNER/ BUYER Z4- o ROUTE/BOX NUMBER '80X Z. rL Fire Number d CITY/ STATE ZIP rt PROPERTY LOCATION: S'E k, SE k, Section T 79 N, R J LS? Town of56~ St. Croix County, Subdivision/. 5.~1, d/3Qs~7/3 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 licensed 'septic tank pumper. What you put into the system can affect the function 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, 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 systems 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. H I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with N the standards set forth, herein, as set by the Wisconsin Depart- z ment of Natural Resources. Certification form must be completed •d and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. L QE?ARTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JNDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 769 HUMAN RELATIONS 07 N WI 37 (ILHR 83.09(1) & Chapter 145) LOCATION: SSCTT0_N-.__ TOWNSHIP/Mk#mmiPOT NO.: BLK. NO.: SUBDIVISION NAME: sE s+_'/ /Tz9 N/R/9,8 (or V LaSON COUNTY: OWNER'S BUYER'S NAME: MAILING A DR . S, CRolx USE DATES OBSERVATIONS MADE I.w NO. BEDR COMMERCIAL DES TON: ES S: Residence LZNew ❑ Replace 7t~ 9 0 SOD S C .gyp sold RATING: S- Site suitable for system U- Site unsuitable for system TDU. MOUND: DU ING[YS E]U SCKS []U LHOLD r 1 ZS ING A K:RECOIVIU ENDED YSTEMa~lion A If Percolation Tests are NOT required DESIG RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: trdS5 r [F'oodplain, indicate Floodplain elevation: NA PROFILE DESCRIPTIONS BORING TA(,. DEPTH T R UNDWATER-INCHES HARACTER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH f ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- I x.33 >83/61& SITS Z6'8R,jSC 22 '6RNCSi4Q 1"BA.4 M S B- Z %,S$ / 7 oN > 8518 $LSLTS " a SC, 73'~BQti M B- 9.33 99.67 Nootc `9.33 n48~sc-tsl "g St 3 ' &-ASE*9'' cS044Z" Q,,,NS B- A ~O.17 '17.2 ->/6-17 lZ.. LS<rTS IZ" QNSL ~~RN ~IS~G~GZwBRsJ s B- > q.67 i2~$CSCT'S 13"6QNSC 3,''g~,MS~tG a"gQN~iS B- Uc_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER UIMM AFTERSWELLING INTERVAL-MIN. PERIOD 1. PERIOD2- PER INCH p. .-zo NONE /01.70 >Z > Z > Z < 3 P- Z 3.10 n1ON l[ 10010 3 > ~ > 2 > < 3 P_ Z-7-0 NoNlc 49.7 > >L > < P- P- ELM ATI Yu At RL 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 q7 ~y LA 1 : 1 ' p I 47- S v . 19- i "SCAC Ai - 1 - i I - - r_ i Ap~AQ LqT 1 ~1ICS c' - j I - - 260 f4 p ~ ab-~ _ _ _ _ f~ . ~Ma.~ 6-n 61Z S5 A r 4o-- CoRN is 2 - Eova lv _ /00 I, t e undersigned, hereby certify that the s it 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 recor d and the location of o the tests are correct to the best of my knowledge and belief. NAME print : ` TESTS WERE COMPLETED ON: Ao14sP-V ~O LJQS4N Jp31+~S0 u l UQP y1r4 MAY St 076 RS: CERTIF CATION UMBER: PHONE N BER(optionall: 07 Sr-c- 4 S7 CST SI URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBDG3951R.10/83) - OVER - S o,,r,.\ M I L. L E R C. S- M. Vo f. -7 3 .3 5'jfs'f~w. E lU = g7.Sv~ j fc 5 (T4~t ac'1fow, ~1V• X17. SO) Z~r r Zv' D r', Vd. way ~pkSa- 2.SXH~ X~ D 0 0 SOS do rI 0 ~ i ~ ss' o p Al tw r14.* 4- / 73-5 ~v~V 20' o;., lot- t,~A, -3. M . s KE i N !o" Wood ~a N~a ~os~ A+ lo-t v&a-✓ - E tu. = Ibb.Do 0 0 4 N 3 z 1- ~o 1 h l G✓tsT" lot I ~ e a.. /(I y, S' ~ `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.: 21505/01 PAGE 1 ST. CROIX COUNTY REPORT BATE: 4/24/92 COURTHOUSE LATE RECEIVED! 4/23/92 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Lon 6 Janna Gilbertson I LOCATION: 580 Cty Rd. At Hudson COLLECTOR! M. Jenkins DATE COLLECTED' 4-22-92 TIME COLLECTED. 2:04pm SOURCE OF SAMPLE: Kitchen faucet y DATE ANALYZED:4-23-92 TIME ANALYZED:2S00pm f COLIFORM: 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE--NS 6 ppm Above 10 ppm exceeds the recommended Pubtic Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane yOF.\NDEVEpDEry WI Approved Lab No. 19 i Ao S Means "LESS THAN" Detectable Level. Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 f Y1 ST. CROIX COUNTY ZONING OFFICE b v St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Of f ice of f ers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can .toe 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 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at.time of inspection) PROPERTY OWNER'S NAME : L_of,,J J RNN I L-P5 ErZT& 0AJ PROP. ADDRESS: A- CITY CL'-DsonJ Legal Description 1/4 of the 1/4 of Section , T N-BBL Town of Lot Number Subdivision: c M f © ;o-1~6- rr~ , FIRE NUMBER S~ LOCK BOX Color of house brVyAJ Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A KAP,i.e,COPY OF PLAT BOOR, 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: L011J r-N (~;'L-GEP-TsZ)0 Telephone Number Sco ` 8-7 9 9 REPORT TO BE SENT TO: M-e--r ~ l- (TAfJ tq Zo CrresTu Levi De_ -0 . B56 2-9 2_ sotj w CLOSING DA Signature ST. CROIX COUNTY WISCONSIN ZONING OFFICE I p M p N N B w rrrrb ST. CROIX COUNTY GOVERNMENT CENTER . 1101 Carmichael Road r Hudson, WI 54016-7710 (715) 386-4680 April 25, 1994 Mr. Roger Bevers l®Z / River Valley Abstract & Title Co. 206 Second Street OZ ~~3a-7b Hudson, Wisconsin 54016 131i C RE: Water Inspection Results for Lon and J`anpa. Gilbertson Address: 580 County Road A, Hudson, Wiscoris a,y, Dear Mr. Bevers: Per Sandy Lowry's request this date, enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions with regard to said report, please let me know. incer ly, J s K. Thom son Assistant Zoning Administrator mz Enclosure 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.S 60671/01 PAGE ~ ST.CROIX CTY GOV.CTR REPORT TIATES 4/21/94 1101 CARMICHAEL ROAD DATE RECEIVED# 4/20/94 HUDSON, WI 34016 ATTNS THOMAS C. NELSON . i I OWNERS Con 6 Janna Gilbertson LOCATION; 580 Co. Rd. A, Hudson COLLECTORS Jim Thompson DATE COLLECTED. 4-19-94 THE COLLECTEDS 10S00am ~ SOURCE OF ALES Kitchen faucet t ~ DATE ANALYZED:4-'2`3-94 Q! - TIME ANALYZED:2S00pm ~ ".COL I FORit, MFCC S 0 /100 ml INTERPRETATION'# Darteriotogically ';AF;-,' I itITRATE-NS ppm Above 10 ppm et~c-eeds the re,-ammended Public 13r i n}; i rtiWJ iter Standard. Coliform bacteria/100 ml Nitrate-Nitrogen, mg/'- i RESULT'S: FAX'D ON: 4121 f 9 LAB TECHNICIANS Pam Gate PHONED ON: y~.NDFVENOfN~ CALLE : WI Approved Lab No. 19 o ~ u 6 4A t means "LESS THAN" Detectable Level Approved by' o PROFESSIONAL LABORATORY SERVICES SINCE 1952 r ~ ~ ~ ~ ~ ~ G~- ,~.-~f .'z i A `9T ST. CROIX COUNTY WISCONSIN \"y - r r r ~ r r ~ rr ■ame ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road 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. Please 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 $15.00 Owner: L,lm Requested by: Z.,n Rea! EsJ-~ /7 fit„ t _ Address : Address:, 1.2,o l ✓.1~.4« ZIP Z I P.# 10 JG Telephone W: (71e,)4,;) 7997 Telephone W: ( 7157 3J4,-? Property address (Fire If & Street) : IS0 74- Location: h, Sec. , T N, R W, Town of Realty firm: 2w Lock Box Combo Closing Date: G TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: Is the dwelling currently occupied? ❑ Yes No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y ❑N Slow drainage from house. ❑Y ❑N Sewage Back-up into dwelling. ❑Y ❑N Sewage discharge to ground surface or road ditch. ❑Y ❑N 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: 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd ❑At-Grd ❑Mound Approx. size 'X ❑Gravity ❑Dose ❑Pressurized Ft.Z ❑Bed ❑Trench ❑Dry Well ❑Holding Tank ❑0utfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other Dose tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Locking cover ❑Warning label ❑Pump/Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: ❑House ❑Well ❑Prop. line ❑0ther ❑Ponding: ❑Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title _ ST. CROIX COUNTY WISCONSIN y o. L ZONING OFFICE M r N 11 r 11 ■ V o n ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 March 8, 1994 1*,C~ 1~fd azo- /0-3t~ --76-0e,'D Ms. Sandy Lowry 3~ Lowry Real Estate / 1201 Mayer Road Hudson, Wisconsin 54016 RE: Septic Inspection for Lon and Janna Gilbertson Address: 580 County Road A, Hudson, WI Dear Ms. Lowry: An inspection of the septic system on the property of Lon and Janna Gilbertson located at 580 County Road A, Hudson, Wisconsin, was conducted today, March 8, 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. Should you have any questions, please contact this office. S'ncerely, A" Mary J: Jenkins Assistant Zoning Administrator mz Po - YY ( m p*Q 4 1 r►,~. ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r r p r r r r,.. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road 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. Please 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 $15.00 Owner: pry J"rU (~Ie_13E;erz ,tip- Requested by: Address: S o C. D Address : 1z,0/ 050/J RAJ r ZIP S+ / ~Xvno wr ZIP 4vlS. ~ y Telephone N°: (7L5) 3 G 33 3 Telephone W: (7 1 7 N tea. - L/ - Property address (Fire N4) Street) : Location: h, Sec. Ile , T Z`fi N, R W, Town of -IDsoN La,r 3 of c-5M ;~/-7/ 3Ls/ (o/ -r ~k,/`1 Realty firm: Loc,v rz y Lock Box Combo: Closing Date: 4 Zy q `f TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: N Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: Age of septic system: 3 4 a- S. Septic tank last pumped by: Date: L'`sT s` Previous Owner's Name(s) : SPeA AA Have any of the following been observed? ❑Y IN Slow drainage from house. ❑Y Sewage Back-up into dwelling. ❑Y KN Sewage discharge to ground surface or road ditch. ❑Y IQN 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 u~uv~ 6K DATE: "3 Z 4- 1/94 s OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION t f IN J 1~ - TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes DNo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: E6,elow grd OAt-Grd ❑Mound Approx. size 'X OGravity ODose OPressurized Ft.: l}Sed OTrench ODry Well OHolding Tank 00utfall pip-e OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: ❑House'v Dwell DProp. line- ❑Other Dose tank Setbacks: ❑House Dwell OProp. line 00ther OLocking mp/Floats OAlaem OElec. wiring Soil Absorption System Setbacks: OHouse ❑well~ OProp. line l OOther J ❑Ponding: ODischarge: 'V General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N v; Inspector Title t f•- COM ERCIAL TESTING LABORATORY, INC. 544 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715.962-3121 800 - 962 - 5227 C k i ST. CROIX ZONING REPORT NO.** 15369/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 12/26/91 COURTHOUSE DATE RECEIVED. 12/19/91 HUDSON, WI 54016 ATTN THOMAS C. NELSON l! OWNER. David 6 Robyn Rorchart ,c~- LOCATIONt 780 Aldro Rd., Hudson LU 1 COLLECTORt J. Thompson SOME OF SAMPLE' Outside tap COLIFORMt 0 /100 ml INTERPRETATION' Bacteriologically SAFE NITRATE-Nt 5 ppm Above 10 ppm exceeds the recommended Public Dri* ing Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L Cqj 1p ~ , N LAB TECHNICIANt Pam Gane r'qZ BUJ 20 C WI Approved Lab No. 19 002 C,c v, ti d,.MOVrN°~ i r Y < Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 06-1 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse b 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`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 (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOC' S ) 02 SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) G a-r+ 3ZL Property owner's name C1~.tS1 -L i'lRd. 1JY• / Property owner's address AI -0 all-C J M I W I. s-4c lto Legal Description 1/4 of the 1/4 of Section , T N-R Town of Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? If so, list firm: 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 re uestin sgrvices, , ~rst I~Ct Q Telephone Number KW t~ 30 1 Se.c-cN--ff S lJ REPORT TO BE SENT TO: t z n ~~l-i ~ C` fM l~S - S4 oI Closing date Signature ST. CROIX COUNTY r WISCONSIN OW, ZONING OFFICE aa,~ ST. CROIX COUNTY COURTHOUSE -rn 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Dec. 18, 1991 Doreen White First National Bank/Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. White: An inspection of the septic system on the property of David & Robyn Borchart, located at 780 Aldro Lane, Hudson, WI, was conducted on Dec. 18, 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. Sincerely, J s K. Thompson ssistant Zoning Administrator cj (D (D O p, ri .c~. 0 i 0 CD 0 CD 3 >v O 3 3 N o o ~73 oNO o I"f1 = r -4 2 . y N r`7. ID -A -A 0 0 -4 CD v t t o 0 0 -p Cos 0 0 ce - f CO o a o W (D 9 r-3 ° con N 3 ' > > 0 3 0 0 = H O C~7 y N„ ° o 0 ~O rat' m (D CD CL N O C~1 -n (A N a a o 7d a) CD U) o a a r+~ O O O(D N N Q 14 • I Q+ A N 0 C(o (o c O CO 0. y O r, U) C • h~ 1 O 1 j o o c 3 6 C') o ~ Q fD o 00 , p, r3 0<' 0 0 0 . t-4 cn o"'o JE o o Q N ai N o I,'II 00 a 111 rn rn o O iv O _ m (n E m y ~ k~ N oC z 3 N N o y D co 0 p CD N N • .1 CA U) N SOU F N C O N SD W O (D O a 3 0 'o CD oz m :3 A Z 3 n 0 v a A 0 m N ONO W ~ CL o z 0 3 a O ' z m y z j SD A W li O N Q O o O G 0 m m C 0 z a 0 (63 CD ' N W. y 0 O y N ~ a ON O 3-3 4 N w CD p (SU fi 3 co CD I y N O O V A 0 ~b pQ O CD r, 69 O O O (D ya 0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDl,1S~l-RY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNS IP/M40#tet11t : OTNO.:BLK-NO.: SUBDIVISIO NAME: Nr- 1/ NC 1/ ze /T Z9 N/R/9 E la) u LS6N rse I~AR_ Ir,~s COUNTY: MAILING ADDRESS:. I S; C~ot~ R UILI-S h&qs 5@4 C 714 LA (A llutL&"% USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION p TESTS: I _,a Residence ~I,,, New ❑Replace 6 /99~ SG (9 Sd)(s 01LZ N a®r RATING: S= Site suitable for system U= Site unsuitable for system c (~(I' ✓ ROUND-PRESSU Iona N-FIEL CZSTIOONAL: V MMS EJU ING~S E1URE:S2S IEA I THO EISGC~JU TANK:IR If Percolation Tests are NOT required DESIGN ATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: 11_ / I Floodplain, indicate Floodplain elevation: NA txc_ r PROFILE DESCRIPTIONS BORING TOT DEPTH TO ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEZAhf, ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 13- 13- 33 95.7 olvt > 8.33 ~~"gcc > '8P N 43~BQNc~~Gt~ 2 oa 9 .~9 oN~ > 9.00 /3 aLLT:, i 3a,~1. ?r e ►N1S 44 JRRNC B- .00 93.29 NONIC >9,66 rz~$i~-rs ~g~$aNL 2a_8,R,015 S 5 f3a~,:: ~(GR B- R-83 93.g4 tN.' >8.f~3 '$`L15 IC9 4L Z4" 89,,j 11"1'5 SG~$eN<__`ntG B- ~ .06 44 .ss Nc~Nc > 4.08 s 8«Ts B- ict " $twC~~G2 L PERCOLATION TESTS Z~E TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER MOWS AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D2 PERIOD PER INCH P- 3-7S NvAc 95.7 > > > < P- Z 3,3f NONC 9S.3S > ? > Z <3 P- 3 7.v~ IN NLf 94,'55 >Z > 2 >2 < P- P- I_E4 AT I n A-) Q C. P- PLOT PLAN: Show locations f percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation ref ence 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 ELEVATIO q Z.00 B 3 t I 7 . t I a . & s DoTQN~Q; I /S I I _ 1 I I, the undersigned, hereby certify that the soil tests repor d on t 's 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 local n of tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: /.1QQ : y ,a 50 ~ o sr, u ,f ~Nc~ ~a c. S aF~T 8~ i2 cs 199v ADDRESS: W) CERTIFICATION NUMBER: PHONE NUMBER (optional): 07 S~COAJA SIT gods6N vV I S U/~ ~.a4 SKI-46F10 CST SI TURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 2 ILHR•SBD-6395 (R. 10/83) OVER -