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COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121
800 - 962 - 5227
i
ST. CROIX ZONING REPORT NO.S 37527/01 PAGE 1
ST. CROIX COUNTY REPORT DATES 12/28/89
COURTHOUSE DATE RECEIVED*# 12/22/89
HUDSON, WI 54016
ATTNS THOMAS C. NELSON
/1 / ' � � o
OWNER S V i ncet Gin v J�v
LOCATIONS 171 Riverview Acres Rd., Hudson 3 3D. 2-b , Job' J
COLLECTOR: St. Croix Zoning
SOURCE OF SAMPLES Bathroom faucet
COLIFORMS 0 /100 mt
INTERPRETATIONS Bacteriologically SAFE
NITRATE—NS 2 ppm
Under 10 ppm is safe for human consumption.
COLIFORM + NITRATE
r
i
LAB TECHNICIANS Pam Gane
WI Approved Lab No. 19
tyOF.\NDEDENOEN�9
o { Means "LESS THAN" Detectable Level Approved byi
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
13
\ ST. IROIX COUNTY ZONING OFFICE
St Croix County Courthouse
911 4th Street
Hudson, WI 54016
7T ephone - (715)386-4680
The St.`y\-Croix unty Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
CouR1Eation of this for s 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: $175.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at time of
inspection) l
Property owner's name '-►ce-:� G �"
Property owner's address
Legal Description 1/4 of the 1/4 of Section , T N-R
Town of Lot Number Subdivision Name
FIRS NUMBER w�LQCX BOX NUMBER
Color of house Realty sign by house? If so, list firm:
Ser M-,
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: ��hce M -
Telephone Number W- t-12- 233 -0,7/0 Y- -c o 7
REPORT TO BE SENT TO: I l v v.n
h WT
Closing date
Signature
l V, lie HI)s
S C- 4),�o
c'let
3S
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� 33 - 0°tI D
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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
+ ty' ST.CROIX COUNTY COURTHOUSE
- 911 FOURTH STREET • HUDSON,WI 54016
(715)386-4680
i
December 22 , 1989
Vincent Gin
171 Riverview Acres Rd.
Hudson, WI 54016
Dear Mr. Gin:
An on site investigation of the septic system on the property of
Vincent Gin, 171 Riverview Aacres Rd. Hudson WI. was conducted on
December 21, 1989. At the same time I also obtained a water
sample and submited it to the laboratory for testing. The
results of that testing will be sent to you as soon as we recieve
them back from the laboratory.
At the time of the inspection, the sanitary system appeared to be
functioning properly for the existing use. 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 is totally dependent upon
proper maintenance of this system.
Should you have any questions regarding this subject, please feel
free to contact this office.
Sincerely,
; �K�
Mary ins
Assistant Zoning Administrator
TCN:cj
I�'4
1
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
i
0,, sF
TO BE COMPLETED BY INSPECTION PGENCY
System design &/or permit on file? ❑Yes o
Soil series per SCS Soil Survey: sheet #
Type of soil absorDtion system: -low grd OAt-Grd OMound
Approx. size F OGravity ❑Dose� ❑Pressurized
Ft.2 ❑Bed OTrench Mdry Well ?
Molding Tank OOutfall pipe
OBSERVED DEFICIENCIES OOther OUnknown
Septic tank
P ,/ "� —
Setbacks: OHouse ❑Welly/�°❑Prop. line ❑Other
ank
Setbacks: OHouse ❑Well ❑Prop. line ❑Other
❑Locking cover OWarning label ❑Pump/Floats "
OAlarm OElec. wiring
Soil Absorption Syste!6p�;6Discha
Setbacks: OHouse Prop. line her
❑Ponding: _ �rq�'
General comments: 1
INSPECTORS SKETCH OF SY TE LOCATION
N
Inspecto 7-f- 1
Title
Yte-
T. CROIX COUNTY
?�r co RECEIVED WISCONSIN
M 8 1 19,33 ZONING OFFICE
CROIX COUNTY COURTHOUSE
` C;0iY'T y URTH STREET • HUDSON,WI 54016
(715)386-4680
SEPTIC INSPECTION / WATE2 TEST REQUEST FORM
Specify desired test(s) & remit appropriate fee with application.
Outside water lines are often turned off during winter months,
making access to the home necessary. Please make arrangements with
this office to insure a time when entry can be gained.
❑ Water (VOC's) $185. 00 V Septic $25. 00
Water (Nitrate & Bacteria) $35. 00 (visual inspection)
Owner: t C e Requested by: V ✓i(-e
Address: I ? 1 Address:
City & State: V)T City & St. ,
Zip Code: S-Li o 1 6 Zip Code:
Telephone N°: (11S) Telephone N4: ( )
Property a%dgss (Fire N2 & Street) : 7 Location: ;, Sec. , T N, R a D W, Towd of
St. Croix Co. , WI. Tax ID N2 Parcel ID N4
House color: Realty firm: Lock Box Combo:
Water sample tap location:
TO BE COMPLETED BY PROPERTY OWNER
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Is the dwelling currently occupied? V Yes ❑ No
If vacant, date last occupied:
Septic system installed by: c. Year: I L17 S
Septic tank last serviced by: -L r C111 tc.-, Date: i C19 2-
Previous Owner's Name(s) : AA V e
Have any of the following been observed?
❑Y KIN Slow drainage from house.
❑Y ON Sewage Back-up into dwelling.
❑Y LAN Sewage discharge to ground surface,
road ditch or body of water.
❑Y I)3N Slow drainage from the dwelling.
❑Y JIN Foul odors.
Other comments relative to system operation:
I certify that the above information y/compl and true to the
best of my knowledge.
OWNERS SIGNATURE: C DATE �5
�COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121
800 - 962 - 5227
FAX - 715 - 962 - 4030
x
ST. CROIX ZONING REPORT NO*** 42655/01 PAGE 1
ST. CROIX COUNTY REPORT DATE+ 6110/93
C"THOLISE DATE RECEIVED: 6/04/93
HUDSON, WI 54016
ATTN: THOMAS C. NELSON
,
f
OWNERS Vincent Gin
LOCATION*# 171 Riverview Acres Rd., Hudson
r
COLLECTOR** Jim Thompson
DATE COLLECTED*# 6-02-93
TIME COLLECTED: 12*#30pm
SOURCE OF SAMPLE. Kitchen faucet
DATE ANALYZED*#6-04-93
TIMtE ANALYZED*#11.00am
COLIFORNI 0 /100 ML
INTERPRETATIONS Bacterioiogically SAFE
NITRATE-NS 3 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Co�Liform Bacteria/100 mL
Nitrate-Nitrogen, mg/L
RECEIVED N
P� JUN 1 4 '1993
ST CROIX co
COUNTY
t ZONINGOPFICE
LAB TECHNICIANS Pam Gane
Qf.1NDEVFNpEHr 9
WI Approved Lab No. 19
d SA <
Means "LESS THAN" Detectable Level Approved by*#
® PROFESSIONAL LABORATORY SERVICES SINCE 1952