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HomeMy WebLinkAbout020-1063-60-000 (2) 1 y Q o C ~ m N O 4' O w a ~ I y c I ac0_ y 0 c j 004) a N N N C l Co cm N M ;r. CL O E cov O c Z •c y a m a._ v ~ ~ u o dva3 3 v mw4)- E- N'C MD Q 5> a m 1 o I z y z y rn E W °o z :!t V 0 CL m N H L o I o z c m z ~ ~ ~ o to H m Zz Cl) NN c ~ I y ~ a 0 t o C m I ZmD Z c ai C E N > d ~ a o C N d Goa ~ ~ Q O O N U) M E E Z- > X000 a u. z a a a ; IL OP* o ~ M J V y rn rn } O c~ v o N S N O _ O N 04 LO a ELO a~i m c a o O Q Z U) 0 4) Q O's ~a a m ' ~ I ° c ~l o n 00 E O Co E N It n E Lo 0) M a 0 0 co A ~ ~ O C V O O C c 'n V O O O M y y a n N c3i ~O O Cl) 2 2 0 Z c 4d (n ti m m a 3 a L: a. 4-, E c c C, A ciao ov~ico • Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT r^ OWNER TOWNSHIP SEC. Z T _=2- N-R l~ W ADDRESS 144 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE c~~2, T i PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i ~D S o INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: lp~, oo~ c ~ati~ Proposed slope at site: SEPTIC TANK: Manufacturer:o G~l Liquid Capacity: Number of rings used: Cam- Tank manhole cover elevation: 1~ 59 7, ? Tank Inlet Elevation: 9 7cr_ Tank Outlet Elevation: fJ J Number of feet from nearest Road: Front,O Side 0 Rear, O feet .From nearest-property line Front 10 Side,O Rear, O > -5-z) feet Number of feet from: well J'= building: 12 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: ' Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ✓ Trench: Width: jZ Length: Number of Lines: 2- Area Built:d y~ Fill depth to top of pipe: 4 Number of feet from nearest property line: Front, aside, O Rear, 0 It Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 5-11) 11f1-1 Plumber on job: ~ License Number: 3/84:mj ' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION SJ"R~ ' "i] ff73-R18 lot 1 State Plan I. Number: Town of Hudson ❑ CONVENTIONAL ❑ ALTERATIVE TT ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Tom Hanson RBox 168 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFE ENT FROM PLAN: F. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: David Fogerty 3289 St. Croix 135431 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER r7 PROVIDED: PROVIDED: ' u U Sb ! . J E; fE NO ❑ YES _Ld, O BEDDING: E NT IA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY PL BUILDING: VENT TO FRESH / (7 ALARM: EET FROM LINE: AIR INLET: ❑ YES ,M 0 l L_ ❑ YES UNO EAREST - 0 o o > 50 Z DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODE PU SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND 0 VTROS S P RATI NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH PUMP ON AND OFF EEN ❑ ❑ 0 NFEET EAREST LINE: AIR INLET: SOIL ABSORPTION SYSTEM. Check the soil moisture at th depth of IOWIn FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, constructions ell ce a urftil MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PI E SPACING: COVER INSIDE DIA.: PITS: LIQUID TRENCHES: MA RIAL: PIT I DEPT16o DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N DIS NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELO PIPES: AB V COVE ELEV. INLET: ELEV. END: _ PIPES: LI AIR INLE / 2t } FEET FROM CC /Q NEAREST J MOUND SYSTEM: 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 PTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: DE ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST y CAI I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Pei SBD-6710 (R. 06/88)x'-~ ; V A ~ 1V I P -r 71MLHA SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY 43 44,3 Z STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous 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 n fl3 % SF- S 2-.3 T.29 , N, R E (or P OPERTY OW ER'S MAILING ADDRESS LOT # BLOCK # o e"'I l CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER l .tS 5T ~ ~/,r II. TYPE OF BUILD71,0ir (Check one) CITY NEAREST ROAD ❑ State Owned O ILLAGE ❑ Public 2 Fam. Dwelling-# of bedrooms PARCEL Ax Nu III. BUILDING USE: (If building type is public, check all that apply) z 0 _ ro 6 3 - lQ~ 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. TYPPE OOF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. RNew 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-Pre urized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION i Feet 10.3-f Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank / *x Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum is Name (Print): Plum is Signature:fNo Sta ) r *WMPRSW No.: Business Phone Number: e f), - ? q 3 s6 bar's Add7(Street, Ci ,State, Zi Cod t G 2 fa13 . C NTY/ EPA T ENT U ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) 'Approved ❑ Owner Given Initial i Surcharge Fee) Aver D rmin tion ` ONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: ormerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber t INSTRUCTIONS 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 focal 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. ll. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. 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. VII. 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. VIII. 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; (Jose 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. Se0 SBD-6398 (R.11/88) r a h w w I r V i I IN. 11 ii it 1 ~ 8 1 ~ ~ Ph i M a v H~ y N ti N m M N ~ C M ~Nt i '0'° S& 0 LL Co y "^ARTMENT of REPORT ON SOIL BORINGS AND SAFETY & BUILDING 'INDUSTRY, DIVISIO WMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 537C (1-163.090) & Chapter 145.045) i LOCATION: OWNSHIP/IVNiP1i6FY; OT NO,: BLK. NO.: SUBDIVISI N NAME: E- 1/41;61/4 Z3 /T N/R~, E (40 - COU Y WNE NAME: t I /i. , k' p at / Z USE DATES OBSERVATIONS MADE F~_,/ NO. B COMMERCIAL DESCRIPTIONS: PERCOLATIM S7S: (JResidence S IL"JNew ❑Replace RATING: S- Site suitable for system U- Site unsuitable for system YSTEM ONVENT❑AL: ME4S ❑U IN-GROUNDQU ~ - N-FILL OLDING TQANK: RECOMMENDED SYSTEM:loptionat) , OUND: IfLPercolation Tests are NOT required DESIGN RATE: ~J LIff aaniyy portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodptain elevation: + PROFILE DESCRIPTIONS BORING TOTAL ELEVATION H R U ATER-INCHE CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTI NUMBER DEPTH IN, OBSERV TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) • B- 0 A/OLrt Y .7'1't/f_ F„Ir a ! K• v B- p 2 rs 17 4, > - B. i 0. / ,f r S ~u~ / P ' h w w ct r r / C. B' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME -DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER INCH P- 2 c 3 P_ P_ 3 .73 3 P- P- .27 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 h 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 per of land slope. SYSTEM ELEVATION i i -S AF Al,r40c//O stA aT' S i I i o 1 'b b r IN, V J o Its : ry \ 1 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT ~ St. Croix County OWNER/ BUYER ROUTE/BOX NUMBER ~ Fire Plumber 2 Zyl ~ tv CITY/;.. STATE f'(,& " ~0LS ZIP 2Z M M PROPERTY LOCATION:. S 4, Section ~L3 , T Z q N, R W, CS61 VJL Z. Town of1G~ St. Croix County, ~ ~ ~UUZ zq Subdivision 1~eY U ''l f/°~x Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed 'septic tank um er. What you put into the system can a ect t e .unction 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, whi-c- 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 o to maintain the private sewage disposal system in accordance with 9 the standards set forth, herein, as set by the Wisconsin Depart- ~ ment of Natural Resources. Certification form must be completed ro and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED"A (.tA lk-L-- j L DATE 2,T ( t j St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. APPLICATIONFOR SANITARY PERMIT 8TC- 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 got resale by owner/contractot,lspec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property 4- A fL 1/+1/4, Section Z •3 T•Rw Location of property Township 1.4 .D96 `L Mailing address fl Ak l~ Address of site 1010 g e i-QCiL `4 T lubdiv/slop name j) &4-t Lot number 2 C y! 3 g 2 2 G ZIu ~2~ ~?ZS 7 ,faiu ez t~ P~ i Previous owner of property „ Total also of parcel Date patcol was created 9 Are all corners and lot lines identifiable? =_Yes o Is this property being developed for resale (spec house)? as 0 Volume =and Page Number as as recorded with the Register of Deeds. iNCLUDE WITH THIS APPLICATION THE FOLLOWINGS A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PACE NUMBER, and the BEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if avallable, would be helpful so as to avoid delays of the reviewing process. If the deed deacrlptlon references to a CeitIlled survey map, the Certified 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 ( (we) am (are) the owner(s) of the property described In this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. = and that I (We) Presently own the proposed alto for the sewage disposal system (or I (we) have obtained an easement, to run with the above 'described property, for the co tructi of said system, and the same has been duly recorded in the Office e 2108tVto gletar of Deeds, as Document No. 1. ~ ( V t e Cou 7-- of Owner Signature of Co-Owner (If Applicable) Date of signature Date of Signature l Ilj THIS SPACE RESERVED FOR RECORDING DATA i; DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 } WARRANTY DEED 451899 REGISTER'S OFFICE This Deed, made between Norman__ C Mears....... j ST. CROIX CO., WI xes i-dent__.Qf__ Mnneso_ta___and__ Frank __LaPlante-_ S~P2 81989 j Wi_scczne_in..................... , Grantor, 01 8:15 A M and ------------------------Thomas _W.__Hanson -4 HUSBAI~ID.~i1lLl.WIFE.- SZIF~IIP.I'PAI. IItOPEE2TY-------•--•-•---.....---•-- Register of Deeds Grantee, I• Witnesseth, That the said Grantor, for a valuable consideration...... N , conveys to Grantee the following described real estate in i RETURN TO County, State of Wisconsin: Part of the Southeast Quarter of the Tag Parcel No: -92-0-:1-06-3--6-1 . i Southeast Quarter of Section 23, Township 29 North, Range 19 West, described as Lot 1 of the Certified Survey Map in Vol. 2, Page 541, Document no. 346224, part of Fox Valley 1st Addition-together with and subject to any other easements, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend anv such other recorded encumbrances beyond the term established by law therefor. ii rRp'NSO FEE i it This 1S_ nOt_ • homestead property. II (~W) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; ! And..... grantors - - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except as noted above. and will warrant and defend the same. Dated this 2CztY1 Se tember 89 day of • p-- ~I O?/~--1 (SEAL) (SEAL) II ~_Norman C. Mears * Frank LaPl me ~..7...--- •------•-------------•---------(SEAL) U7 G (SEAL) i, * * lorence... LaPlante . ~i i! I! AUTHENTICATION ACKNOWLEDGMENT i Signature(s) of Norman C. ,Mears, STATE OF WISCONSIN Frank LaPlante and Florence ss. ---_•••------..County. ~ authenticated thi d of Septembe_r___ 19__89 Personally came before me this ---_-day of 19_..---_. the above named I * Hugh F. Gwin N/A i i' TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 3 706.06, Wis. Stats.) ~I to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Atty. Hugh F. Gwin, Gwin & Gwin 430 Second St., Hudson, WI 54016 Notary Public County, Wis. My Commission is permanent. if not state expiration (Signatures may be authenticated or acknowledged. Both ~i are not necessary.) date: 19-_-_-._-.) *Names of persons signing in any capacity should be typed or printed bellow their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1-1982 Milwaukee, Wis. ST. CROIX COUNTY * . WISCONSIN ZONING OFFICE 1 M M II N p ■ rrrri ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 24, 1996 Linda M. Harwell 815 Bradley Drive Hudson, WI 54016 RE: Water Test Sample for Linda M. Harwell for property located at 815 Bradley Drive, Hudson, Wisconsin Dear Ms. Harwell: Please find enclosed the water test results of the sample taken from the above referenced address on May 15, 1996. If you have any questions regarding these results or if we can be of further assistance, please give our office a call. in rely, ames K. Thompso Assistant Zoning Administrator St. Croix County, Wisconsin db Enclosure cc: Dale Johnson Western Wisconsin R.E. Co. 235 Cedar Drive West Hudson, WI 54016 C (0 ~J' P-1 y T.T." ST. CROIX COUNTY WISCONSIN ZONIN ICE N I N O N M _ vivo ST. CROIX COU CENTER - - 1 ichae 115*16-77 c~ 15) loft0 Q(p SEPTIC INSPECTION / WATER TEST RE ST 1M*,S 1936 v0 T CRax ti CkNJNTY Please specify desired test(s) & remit ap jqV FFrCP- th h application. Outside water lines are often u had,-o, ing winter months, making access to the home neces sary.".i1 1e make arrangements with this office to insure that entry car-be gained. ❑ Water (VOC's) $185.00 U Septic 50.00, Water (Nitrate & Bacteria)~4--SO-,, ❑ Nitrate & Bacteria retest $15.00 Owner: LINDA M. HARWELL Requested by: DALE JOHNSON, WESTERN WI. Address: 81 Bradley Dr. Address: 235 CEDAR DR. W. •E. CO. HUDSON. WI ZIP 54016 HUDSON, WI ZIP 54016 Telephone W:(715) 386-5432 Telephone W:( 715 549-6058 Property address (Fire If & Street) : 81 5 RRAT)T,F.Y 1)RTVF., TnWN OF HUDSON Location: Sec. T N, R W, Town of urrnSnN (CORNER OF BADLANDS ROAD & BRADLEY DRIVE) Realty firm: WESTERN WLock Box C mbo: S-I-G C R.E. CO. i -rr ~Si2 CSC e SS OZa-1063-60-40 is tieec~~ a3 g q. 19.2958 TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: 0,-ts-14e,' 6 4 Ewl1y Is the dwelling currently occupied? Yes 0 No If vacant, date last occupied: N/A. Age of septic system: SIX YEARS Septic tank last pumped by: OWNERS Date: 6-93 Previous Owner's Name(s) : Have any of the following been observed? ❑Y ~QN 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: WORKING FINE! I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: ATE: 5-2-96 IN A M. HARWELL 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION I P /3 Ro CA TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: MB6fow grd 0At-Grd ❑Mound Approx. size /a ' X Ste' MG'1{vity ❑Dose ❑Pressurized Ft. 2 OB6d ❑Trench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES 00ther ❑Unknown Septic tank Setbacks: ❑House C7\- OWell~ OProp. line OK ❑Other Dose tank Setbacks: ❑House❑Well-❑Prop. line 7 ❑Other OLocking cover_dA,-_ ❑Warning label - OPump/Floats OAlarm ❑Elec. wiring Soil Absorption System Setbacks: OHouse~ OWell~-7< ❑Prop. line ? 00ther)4 C ❑Ponding: ODischarge:Y\.-,~ General comments : INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r r r r■ rrrri ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 I May 16 1996 Linda M. Harwell 815 Bradley Drive Hudson, WI 54016 RE: Septic Inspection for Linda M. Harwell for property located at 815 Bradley Drive, Hudson, Wisconsin Dear Ms. Harwell: An inspection of the septic system serving the Linda Harwell property located at 815 Bradley Drive, Hudson, Wisconsin was conducted on May 15, 1996. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this system was based upon a surface inspection and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not detectable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. A water sample was taken at the same time which was submitted for analysis. Once we receive the results, we will forward same on to you. Should you have any questions, please give our office a call. Sin erely, ames K. omps n Assistant Zoning Administrator db cc: Dale Johnson Western Wisconsin R.E. Co. 235 Cedar Drive West Hudson, WI 54016 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* *4 17482/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE! 5/21/96 1101 CARMICHAEL ROAD DATE RECEIVED: 5/17/96 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNER: Linda M. Harwell LOCATIONS 815 Bradley flr., Hudson COLLECTORS Jim Thompson DATE COLLECTODS 5-15-96 TIME COLLECTEDS 2200pm SOURCE OF SAMPLES DATE ANALYZED25-17-96 TIME ANALYZED212200pm COLIFORM,MFCCS 0 /100 m{ INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 2.0 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. i Cotiform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Gane pq WI Approved Lab No. 19 ST ;OUN Y q, a ;~iilJGOFFIGE 1 Q Means "LESS THAN" Detectable Level Approved byt PROFESSIONAL LABORATORY SERVICES SINCE 1952 -OfMMERCIAL 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 ZONING REPORT NO.S 41649/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 5/24/93 COURTHOUSE DATE RECEIVED* 5/19/93 HUDSON, WI 54016 _ ATTNS THOMAS C. NELSON 1 OWNER. George & Karen Bunnell 1 , LOCATION? 815 Bradley Drivel Hudson' COLLECTOR: M. Jenkins DATE COLLECTED! 5-18-93 TIME COLLECTEDS 10:30am SOURCE OF SAMPLES Kitchen faucet DATE ANALYZED15-19-93 TIME ANALYZEM2200pm COLIFORMS 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 2 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, m9ll sA 1> - A6 o4.woEOFN,Etir LAB TECHNICIANS Pam Gane f t r~ 01 WI Approved Lab No. 19~ Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~0) ST. CROIX COUNTY ZONING OFFICE ~y,,~r St . Croix County Courthouse ® I:1 911 4th Street Hudson, WI 54016 C ~UiVTY : \ ZC~1y!f\G C)FFfC Telephone - (715)386-4680 9 t 1 Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion o this of 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: $ 35.00 35- (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) _ SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 25 (Determines if system is properly functioning at-time of inspection) PROPERTY OWNER'S NAME : V eO 1?jz& 4, 6-y a+--- )q it Y) h e, ] PROP. ADDRESS: f Y; Q-yF sy~ Legal Desc iption 1/4 of tAie 1/4 of Section , T N-R Town of d5~-~ Lot Number Subdivision: 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./,' n Firm or individual requesting se vices: .fan W"I&tt (:WfiiC 1 Z~ Telephone Number ZD REPORT TO BFSENT TO: 'Z D tk ST s o-r~ CLOSING DATE: Signature MINNESOTA --`7ATE s s n s _ $ -`i 3~a rg 3_ I 200 1 _ yl Z N 1 0o Jjbi),1 I N -4 p N .°n P r N 4 4 N M N N N n n n 1 w N v n n s C C~OQ[y'D(b ,J 1 yq y ~ p Rvev. 300 ~^n ~3 I i j i s 1~4, n 4° n X88=8~° + RutneR°^ 400 N N n u u n I ---1 N + - .t0 ° T tOVTTI pI1YKNA[l A ARM At ~ to n S+ bQ+ q{n r! fj~ ` \ d O z ..ACJl',)'~ 1 MAVEN DII. t s I " g 3 .i • m SAN }AM U; R[[NtR1AR RD _ now" N0 r At 1 O I Y 0I RO I r t •i pJ < ° o o n i N Q a i rik W { N Q Q° T XL $ I Q 0O0A t N r[RT g m I T 3 3^ t s 0 M[IL N RD. ^ - ~yiT' . u S • % a I DDAMIN "K.A UC - ^i F M~ A in[R• s I w V H m N n u w N N u M w u n I N COUNTRY VIEW AD. OG L~SIL LA. t MAN P ! l L ' 500 AILY AD. 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CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 19, 1993 Don Waalen Century 21 706 19th Street Hudson, WI 54016 Dear Mr. Waalen: An inspection of the septic system on the property of George & Karen Bunnell, located at 815 Bradley Drive, Hudson, WI was conducted on May 18, 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. cerely, Mary J. Jenkins Assistant Zoning Administrator js