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020-1045-20-000
sin D`apartment of Commerce PRIVATE SEWAGE SYSTEM safety and Building Division ` INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Wantz, David B. Hudson, Town of CST BM Elev: Insp. BM Elev: /Z BM Description: Q m Y~ I I G5 TANK INFORMATION /1 TYPE MANUFACTURER ~ Ny CAPACITY Septic Ir ~! ~ i ~QQd Aeration ~ ~ /~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 3 , / ~ $ 5 5d / °~~ 3v ~8" ' ~ 5d' - Aeration ~e,5 Holding _ PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift F ~ction Loss Syste d TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 515185 0 State Plan ID No: Parcel Tax No: 020-1045-20-000 Sectionlrown/Range/Map No: 19.29.19.177E STATION BS HI FS ELEV. Benchmark 2 ` ~ pQ /~~ AItS~ Ga~~~ ~' ~, ~ 9G ,7S Bldg. Sewer E~ ~ s~-~ SUHt Inlet ~ I y SUHt Outlet Dt Inlet ~~ 9 3. y Dt Bottom ~ ~ Header/Man. Dist. Pipe / D I 7 / a ~ ~~~ Bot. System G 7i Final Grade 9D ' ~'~ Z. C9~ St Cover ~ ~ 'L LJ ~~ ~G J j 90.1 ~ ~ ~ , f 1/0 / /•~ BED/TRENCH Width Length No. Of i~renches PI7 DIMENSIONS No. Of Pits Inside Dia. Liquid epth DIMENSIONS j v / E (/ ~-' Z. I /e,ti \ ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~. ~, INFORMATION CHA OR ~ ~ Type Of System: / h UN T Model Number: Go~t~t~-~`d IZ+ V V ~~ ~ ~' D~ DISTRIBUTION SYSTEM G.. A J--- Header/Manifold ~/ h Distribution Pipe(s) \ h Di i S x Hoie Size x Hole Spacing \ Vent to Air nta z~, Dia Lengt Lengt pac ng a SOIL COVER `n` ~O`"~" x Pressures Svwtems Only xx Mnund Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/S°~ded xx Mulched Bed/Trench Center ~` O C Bed/Trench Edges Topsoil \ \~ _ ~ es ~ No ~ a es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /, Location: 329 Baer Rd. Hudson, WI 54016 (SE /4 N 1/4 19 TI29N R19W) N~1A Lot 2 1.) Alt BM Description = Sd'-, ~a~1~2-b~ (nJeP~(e5 ~vv,~c," ~-d ~ ~a,~ 2.) Bldg sewer length = `n ~,~/e Ez- ~j _ ~~~ - amount of cover - ~~~ ~ ~ G LSO -t /ySJ~a'~C~L-- n, -VK ----- Plan revision Required? ~ Yes No ~" i ~ ~ ~~ Use other side for additional information. _ ~ (_ __ ____ .__ _ __ __ ____.__ _ - __ Date Insepctor's Signa re SBD-6710 (R.3/97) Inspection #2: / /. I ~~3 a~ Parcel No: 19.29.19.177E C d iJ ~.., O1'l. S~~ G... Qlr~~/~ trJ - - - - ~ r - -- i i Cert. No. ~ 3 Z d~ !'AID ~lac~ pp,~,~py Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 , ,~ . ~_ ~~ Madison, wt 53707-7162 Sanitary 1~ ~ u~ (to be filled in by Co.) Sanitary Permit Application StateTransactie, nj\i~unb~ -" , J1~n'' submission of this form to the appropriate governmental Adm Code Wi 83 21 2 ~ ~ , s. . ( ), In accordance with s. Comm unit is requil'ed Prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address} submitted to' the Deparmuxrt of Cotmneree. Personal information you provide tray be used for secondary in accordance with the Priv Law, s. 15. 1 m Stets. ' D ~ s ~. /~ t ct 1 r on L A lication Information -Please Print All Info Parcel # Property Owner's Noma ~/ ,. r Owi~er•s Mailag Address ti ~ ~ ~ ~ - - ~ 1 RnpeKy roe.tren / ~ ^ \ ~7.. L ~' ~^ `''~ i_ ~ / ~ ~ 5 i " SEE Govt. Lot t Ci St Zip Code ~ %., Suction J ~'/. e ty, a ~ , 7 /,~rcle o E r ,`[ T ~_ N; R [ t l il th k h il ii Lot # 7 _ y ~ a app ec a ng (c T](. Type of ~]Bu t Subdivision Name r 2 Family Dwelling - Number of Bedroo Block ~~ ~C ^ public/Cornmencial-Describe Use ^ City of ^ state Owned -Describe Use CSM Number ~a ( I ^ Village of ~ ~ „/ ~• f~ f T r own o III. Type of Permit: (Check only on x on line A. Complete lin e B if app e) A' ^ New System lacement System ^ Treatment/llolding Tank Replacement Only ^ Other Modification m Existing System (explain) B. ^ Pernrit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner '~ ` ~ a~- IV. T ~ POWTS S terdCom onentlDevice: Check all that a 1 t Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grads ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ~,~, ^ Holding Tank ^ Other Dtspersal Component (explain) ^ Pretreatment Device (explain) V. Dis reatment Area Wormation: ` 3C'. Design Flow (gpd)/ Design Soil Appli on Rate(gpdsf) Dispersal Area Required (s Dispersal At+ea Proposed (sf) System Elevation ~ ~k7 VI. Tank Info Capacity in Gallons Total Gallons # of Units Manufacturer g .c~ L~ New Tanks &xisting Tanks ~ ~ ~/~ `$ ~ ~~ a ._- Septic or Holding Taok ii d ~~ /r Dosing Chamber VII. Responsibility Statement- I, the undersigned, assn esponsibility for installatton of the PORTS shown on the attached Plans. Plumber's Name (Print) Plum gnature MP/IvfPRS Number Business Phone Number Phumber's Address (Street, City, S te, Zip Code ~.c// S ~ VIIL oun rtment Use nl ^ F Permit ce Date Iss d Issuing Signature Approved ' ~~ ~ 7 G $ y S ~4 ~~ y n Reason for tla ^ rp / ~ IX. Conditt~~~gasons for Disapproval pp T. Septic tank, effluentfilter and ,3, al y b~t3~ a-p ~ od dispersal ceti must all be services /maintained ` ~ O / v~~ n r ~ L u S' e~ ' as pl'b \ /J T' ~ b as per management plan-provided by plumber. ~ J 2 RN setback fequirements must be maintained ~'"iCtgeii to complete bha Wr the system ha enhma m the c:oaaay eery oa paper aer asss wn a ,is : s a 5~ l.od- ~.; ,..ten w-~--b~,. v~,'~~ Prtto r SBD-6398'. (R 01/07) Valid thtu 01109 ins ~"4 ~~~ ~ t~ PLO LAN PROJECT David Wantz RESS 3 9 Baer Drive Hudson Wi 54016 S E 1 / 4 NW 1 / 4 S 19 /T 29 19 TOwN St. Joseph COUNTY ST. CROIX 10/27/09 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUN P ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/261 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 ,BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEST Filter --~_ ^ BOREHOLE O WELL * H. R. P. Same as Benchmark Well is to meet all setbacks required by Baer Drive SYSTEM ELEVATION 83.0/81.0 4' below grade low side of cell WDNR 96.2' 23.8' System is to be installed on a 25% slope or 2-3' x 68' cells less with>3' spacing 65' 5' B-2 ~ 25%Slopi 35' B-3 10' ~, Vent 60 DW 1 ~' A boring test is to be done next to drywell if valve is installed Property Line 45' Line to be insulated under driveway Weeks ST / 5 T Valve if possible 10' 10' B.M. Existing 3 Bedroom house 110' Well ~ >6" Cover 12" 4' Long Property Line Plans Designed Using Conventional Powts Manual Version 2.0 Quick4 Standard-W Leaching Chamber with 20.0 ft2 of Area 5.8ft^2/pair of end caps -Grade at System Elevation COPY PROJECT David Wantz RESS 329 Baer Drive Hudson Wi 54016 SE 1/a NW 1/as 19 /T 29 ~ 19 TOWN St. Joseph COUNTY ST.CROIX r MPRS Shaun Bird 226900 DATE 10/27/09 BEDROOM 3 CONVENTIONAL XXX IN-GROUN ~P ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/261 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 ,BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEST Filter ^ BOREHOLE ~ WELL * H. R. P. Same as Benchmark Well is to meet all setbacks re uired b SYSTEM ELEVATION 83.0/81.0 4' below grade iow side of cell WDNR ~ y Baer Drive 96.2' 23.8' System is to be installed on a 25% slope or 2-3' x 68' cells less with>3' spacing 65, B-3 10' 5' B-2 ~ 25%Slope 5 Plans Designed Using Conventional Powts Manual Version 2.0 0 ' 45' Line to be 60 insulated under driveway D W Weeks 5T 10' S ' `- Valve if possible T A boring test is to 10' be done next to 10' drywell if valve is installed B.M. Existing 3 Bedroom house 110' Property Line Well ~ Vent Cover 4' Long 12" Quick4 Standard-W Leaching Chamber with 20.0 ft2 of Area 5.8ft^2/pair of end caps -Grade at System Elevation Property Line .. ~~~ i~ "x ~ SOIL EVALUATION REPORT Wisconsin Department of Commerce Division of Safety and Buildings in ~cenrrlanra wi4h C:nmm RF Wic Aram Cnria 2185 Page 1 of 4 A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8%Z x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . 02 1045-20-000 Please print all information. Rev' ed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1 J (m)J. ~/ Q Property Owner ~E~s`~1VE Property Location David B. & Jean M. Wantz Govt. I_ot SE 1/4 NW /4 S 19 T 29 N R 19 W Property Owner's Mailing Address NOV 0 3 2009 Lot # Block # Subd. Name or CSM# 329 Baer Dr. 2 CSM Vol. City Stat Zip:Code~ hc~ ipFr~p~~r J City ~ Village ~ Town Nea rest Road ~ Hudson ~ WI ~~~~ 715) 381-1773 St.Joseph J New Construction Use: yf Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ,J Public or commercial -Describe: Parent material Glacial OutWash Flood plain elevation, if applicable Na General comments and recommendations: Soil suitable for conventional POWTS with 0.7 gpd/sq/ft/ loading rate. Recommended installing two trenches at elevations = 82.00' & 80.00'. Boring # J Boring ~f Pit Ground Surface elev. 87.03 ft. Depth to limiting factor ' ~ 04~~ in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GP D/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr2/2 none I 2fgr mvfr cs 2fm,1 c 0.6 0.8 2 5-25 10yr4/4 none Ifs Osg ml cs 2fmc 0.5 1.0 3 25-40 7.5yr4/6 none Ifs Osg dl gw 2fm,1c 0.5 1.0 4 40-58 7.5yr4/6 none s Osg dl gw 1 fm 0.7 1.6 5 58-104 10yr5/4 none gr s Osg dl - - 0.7 1.6 d eva~at n below 80" completed by use of hand auger. Boring # !~ Boring Pit Ground Surface elev. 84.00 ft. Depth to limiting factor ~90~~ in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ttz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr2/2 none I 2fgr mvfr cs 2fm,1c 0.6 0.8 2 4-21 10yr4/4 none Ifs Osg ml cs 2fmc 0.5 1.0 3 21-35 7.5yr4/6 none ifs Osg dl gw 2fm,1c 0.5 1.0 4 35-45 7.5yr4/6 none s Osg dl gw 1fm 0.7 1.6 5 45-90 10yr5/4 none / gr s Osg dl - - 0.7 1.6 of luation completed by use of hand auger. * Effluent #1 = BOD F> 30 < 220 mg/L an~l TSS >30 < 1 ~ mg/L _ * Effluent #2 =BODE <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur . c;5 i Number James K. Thompson ~---~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/29/2009 715-248-7767 Property Owner David B. & Jean M. Waniz Parcel ID # 020-1045-20-000 Page 2 of 4 Boring # ~ Boring J Pit Ground Surface elev. 83.25 ft. Depth to limiting factor >gg" in. Soil application Rate Horizon Depth Dominant Coior Redox Descripfion Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 1 0-5 10yr2/2 none I 2fgr mvfr cs 2fm,1 c 0.6 0.8 2 5-23 10yr4/4 none Ifs Osg ml cs 2fmc 0.5 1.0 3 23-36 7.5yr4/6 none Ifs Osg dl gw 2fm,1c 0.5 1.0 4 36-50 7.5yr4/6 none s Osg dl gw 1fm 0.7 1.6 5 50-88 10yr5/4 none gr s Osg dl - - 0.7 1.6 Soil evaluation completed by use of hand auger. Boring # -:~ Boring ,~ Pit Ground Surface elev. ft. Depth to limiting factor , j !~ in. Soil application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell 4u. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0- D ~ ~ ----~ S ~ b K c,~/ /~ Boring # ~ Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stnucture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) A.C.E. Shc & Site Evaluatrons PROPERTY OWNER: David B. & lean M. Wantz SOIL AND SITE EVALUATION 2185 Page 3 of a PARCEL I.D.# 020-1045-20-000 A.C.E. Soil & Site Evaluations REPORT MEMO Slope across system area ranges from 23% - 32%. Area must be cut prior to system installation to reduce slopes to less than 25%. Finished grade to be less than 25% upon completion of installation. Lot line locations have been determined by compas bearings. Exact lot line locations should be determined prior to system design and installation. <. . /oca-~ed~rn/IerE. s~ • ~;/evQ/ua~o~~~ ~J~o;/eva.P. byh~da~cr (/ ~~ 5 : / _" ~'e~'~1/~ .C~rv~~~~ u~-E~ N 329~er~. ,~uoCfon, c.~/• 5~0~6 ,~a~z cs„~ /~ i ~..~ ~P. /9~, T ~'.~~n, st , crop ~., ~/ ~.bpts,/ IDC'I. if O.'20 -/Of~S-.ZO -Q~ g~'~ Z ;Ygbb .s~A~>r I D . ZZe ~ from off' ~d~ r+q /jssu.~~ eke = ia~.cn,, ZZ.S~ `j~ol P~. ~ ~• ~ ~,~er' 1~~~/e ~'\ ,~ ~w~~~-X' Certified Survey .:a~? ~eir:U ir,,~ the .~E4 Ed'Td~ Sec 19,T~2a:3.R-19-'7. ~t.Croix Counter, :lisconsin T~a,~..:~la:~~. FIL~p ~ ocT 81968 aaro r~ ~ Reg, d ~ N b Crohf ~ r: ~~~ Nthe, .t P~ ~ fir' ~ 9 ~ t, , r o,F R~ ~ r'~''~, ~''0 ' 4` Zo. ~ r '~ ~ ~. c •~ o h~ .~ rwS.O ~. 1DSq~t ~~ ~M a~ z ~~ a '~' ~ ~ Nf ~et ~ S~ o N ,~pt 3 Z Lot 2 ~2a's~E og ~ . i~~g• °e v ~s 3'~ ° 3 {a p ° + v i~• o ao +w+ N ~ Z Let A d L S is 4 7;,_ ss' w Sao ~t t j in. ' ~~ r 1Z~~'36"~~fy,t ~'"e ~'`F ~~ oq'K't Corn~encin~ at tare uorth~^rest corner of • s~~~F-l~ti'+ of aec.19,T-2a-,J.R-19-;"T. t.ience So~_tt~~l far ~5S'•3d~_y,~~ '_t3>7.R3 feet, theme 3,13p1t3'a. for F4.E~ feet ~~•o ,3e to t.r~~. °lace of Be;;in.rin (D.).~.},*_,},once'..5"+~47'y S~ • °g for 173 f ~ fe,.t, ~ .~3 eet, taence .?. I~o~~C' L. f. or ..">5~ .3-^: tliance 5.~°2<t'"-. °or N2G.71 feet, 5.73°55"?T.for 1:i4.~ feet, t:zence ;.~~3~OF3'',"d. for 1~4.5~ feet, t.ence 5.66~c~9'3G""'. for ?75.0 feet, thence ~:.Ool~~'~:. for 254.E feet to t:ae ''lZCe of I ca~tify tl~at t'rre dravrin~ t}Preon is 3 tr+.ze s:zc~ co~~.~'c~,~~m~t~,~4f the land lane? surveyed, r.:.1,~~ed s.nt? descriti~ed and done=~f,.t*~~* ~.~iir tion of Xen~.ll 7uilders ry ~tic~ard Ken~.ll and th~.t I ~~ f~,ill~~~'•~~, lied =.~itr tyre rroviGior~s of Sec. °:~~.~:~4 of t~yre '.Jisco~r~~3 ~e.trztes~ this m3ttc,r. ~' Jf~. .~.~~:...~ Y.enall 3uilciprs, `a; Richard ;~enall "'~~,..,, ••'• . Tovrn Board, To+r=n of Iatdson, St.Croix Count;, '"3isco_zsin ;~esolveci ~t_at the a.boee Certified ;:sc in the ':L;;P:'1;, iec.1J,T-~9-i?. R-19-°~. To~ti1 of ?ILIC?SOi1, en:~ztl Bui~.r.;ers z~J, Rica~rd Ken~.ll, o4~=r!er is 'rlereby s~. ;r~, ove,.c; by said. Toi;rcl Bo~.rc1. ST. CROIX COUN'T'Y SEPTIC TANK NL~~ITEN.ANCE AG . AND O~i~!1ERSI~ CER'T'IFICATION OwnerBuyex Mailing Address Fmperty Atidxess City/Stat~c iJ I 3~~ ~ ~ ~ r . ~~~- ~. (Verificxtioon required Eronn Piamning & Zooiag Dept Parcel Identification Nut b F cr,pL, DESCA~ON pro Location ~~ '~. , %+ ,Sec. ~,~, T ~ ~ N perry Subdivision Certifiied Survey Map # ~ ~ 3 y ~ ' ~ warxanty Dees # ~ ~ S~ .~ J , v~ ~~ ~ ~YST„_Eb;~ i:~~": T"=•NNAN['E AND OWNED CE TIFICATIUN Improper use and ~ y'~ she systxma could result in ib poeu comsisb of p~maapin$ cut the septic teak eveay three y~ ~' soom~r, if the system can affect the of Sae septic tank as a treatm~at stage in the wash reaponsa'bilities are specified im §Comooo. 83.52(1} and is C~aptar I2 - St. t~oiix Coi 'The pro~party owner agrees do sabmiR to St GYoix County Planaia8 ~ Zoni owner and by a nosst~a phmobe~ ~ phmaber, restricted phunbdr or a licoa wastewarodc disposal sysbetn is is pzop~ oP~B O°~tioa aad/oz (2) aifier iraspec~ lc~s than 1/3 full of ahidge: Uwe, the uand~ecsi$oaed~ have xead the above roqu and agrco .tn mair ~~~ sa g~ , ss set by she D of Con~crce sad the Depmeta t.,crtification stating float Your septic sysbaai has been maiaffiinod crust be complete Zo~aiA.g Department wxtimm 30 days of tifeo 1~ year espaatieu date. 1/we rectify that all staff oa this form are taue to the nest of ~f Dd .rev descn'bed above, by virtue of a waaanty deed recorded in R~~r .~ far nsw oo~stcnc~ton-) Town of ..fJ~ `-~ - _, Lot # ~' 1. page # ~ ~ J ~ . L/ Page # intone faulu:e m lvmedle wasoes- PzoPa' xded, bq a lioemised p~uaoper• ~ yo`r' ~ ~O ~' ~ rty Saai~y $ Depar'bment a cetafication fozm, signed by the ~ p~npe~r veocitping that (i}the om site m and pumpia8 (if may). ~ ~c ~k is ~ ~ ~yye disposal syso~m with the at of Natural Resources. ~~ of Wisconsin. and retuned ~ $te SL Qroia Coutxty Plaamng & Uwe ardare the owaer{s) of the Office. ~~ ~'~ D.A,TE *•*Amy iafonnation that is zaisreprosenoed may resntt in the sanitary permit being Iaci+ule with this application s rocorded wa~unty deed $om the Register of Deeds m~eaee is made is the vvammat3- deed. d by the Paamoing & Zoning Dept ~`** and a cagy of the oertifiod sairvey ~ ~ (REV. 0$l05~ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK `T'his is to certify th~Jat I have inspected the septic tank presently serving the • ~u.v-«t' L{/cc /]'f~" residence located at: •~~ ; , L~ ~ , Section ~, TZ~' N , R W , Town o f ~f ..~ c?5~~~/ Upon inspection, I certify that I have f ound the tank and baffles to be in good condition, and it appears to be functioning properly. %~ast time serviced: ~ o~ ~1 i~id flow back occur from absorption system? Yes ~ No (If no, skip next line) Approximate volume or length of time: gallons minutes ~apacity: Construction: Prefab Concrete_~ Steel Other r;anufacturer: (If known) : ~ ~.,~',-~~~,-~~ Age of T/~,~'~(If known).: ~..~0~{~~ (~'i ture ) Tit e / ~~~ ( ) Date c u ~ I~j ~ _r. (Name) Please print ~ ~ 6~O7~ - (License Number) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code ) Plumber (applying for sanitary permit) Certification: Ir, accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, W' Adm. Code (except for inspection openin over outlet baffle). q Name rv ,, ~~ S ' ature MP MPRS 2 ~~l ~n~ rx ~ 1~ c. ign / Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan Option #1. If system fails, determine cause of failure, use alternate area and install new system in tested, replacement area. ption #2. Inst~l system at a lower elevation, by removing chambers, removing biomat, and install,.r#w system. Opton#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 _ - _ ` , DOGUIviEN7 NO. ~~ STA. TE BAR OF WISCONl9IN FO1iM 1-1888 WARRA'AlTl/ DEAD T 'i9~ dl made hetyveen THEODORE J T.AGEfi a:ld hh~~ DDe~Q ..... ---- - -•- ----..... 4IKRT L- L~GL~K,'husband and w3.fe ----•- ~ an~orst ---- ~ (~rranGOr, and DAVID B WANTZ gnd J~ M,_-WriNT2, _~u~1~~~?~?_an~_Ka;€~__-• as survivorshiZs-marital•prA-gertYs_ _.-.---•_----------_••-•_-_ -----•-•----------_-•-°---•---°---------->-._------•--------~-•-----------------•---------------~ Grantee, Witne~sethr TS'lati the said Grantor, for a valuable ¢onaiderat;on_____- of_- ~1x~y_-si,.x _ Thp~g~n~, 5~yexi_ 1T~andxe_d_.and_.n,al.1.RQ__.L~66„ZQi2_C -= conveys to Grantee the following described real eatato"zn --:_:_SL..::GTO~._..__.__. :.County, State of Wisconsin: Tfif6 BPACC REBCRYeo ROR RKCORDiNO A%1Sa _-~ _ ; R~ld fort Rete:d I FEB Z xF i~y3 ~, .. 10:20 ' A. IVI~ _~ '~ -..~'' ~~ c ReBisteroi Oteda RL'TllRR TO ~l ~_ _ _. ~E I~ _ Taz Parcel No: - --------- -~------------------- ~! Part of the SF 1/4 of tie NW l/4. of Section 19, Township 29 Noith, Range 19 West, St. Croix County, Wisconsin described as followst Lot 2 of Certified Survey Map ~~ ~ - ,_ ~_ ._ ~~ f2ad O~tobe~ 8, `1968 ~n Vol.. ^1':,- Page' .o~ }~ `~ ~i I~ TOGETHER WITI•I AND SUBJECT TO 20 foot right of way, ~:enterline described as follows: I` Commencing €st l`7[,T corner of said SE.ll4 of NW 1/4; thence South 927.83 feet; th~nee O r _ n -c - 178.8 feet; then~£y; tt;snce 136!a.°4'~;'E -or. -Sly =lines ~ef Ces:nty TrLn1t_liigl?way "A", !~ ~~ ce N74°40'E on said Sly line 356:84 feet to NE corner of Lot 4 ~' of'Certified Survey Map, page 36 and place of beginning; r_hence ST4°40'W on said it S_1_ v_ ' Line 23.4. feet; thence S46°55 °inl 64. V feet; thence- SwoiO"w '05.3 feet, ihCata:e ~~ ~~ S68°10'W 272.0 fast to Ely,. line of Lot 3 of said Certified Survey Map, Pdge 36. ~~ - = R~ . ~ ii !~. ~,~ ~. ! ~ ~ i,>, I '~ _. bom~eatead This" _,_ .~.&_ - _ Property. (is) (ia not) -- ~ Together with all" and pings±lar the hereditamente and appurtenances thereunto belonging; ~ Theodore J -ha es and ikk_ L:._ r-~g~r------- _ - - - - - •------ - - -- ---------- --- And '~ -------- --•---- ~ --•---•-----~-- - - -- - warrants tha', the title is good, indefeasible in See simple 'and- free and clear of encumbrances except easement•a, ~eservat:Lons restrictions .and. rights-of-way of retard, if .any, - __... _ - _ and grill wassani_ sd-defe d -ths- sar..e. - -- Dated-this a~•~cz~.-•------- ---------- day of --_ -...~ebruary-• 19-93 -• _ rt _ ~ Theodo sex ~~ --•- -------- -- ----•-• --•;-- ----• •---- --------- ------:_._(SEAL) ----,/,..~t.~Z'7t'~tt..~--- -• -~ -- -~~~~a!/--~-__(SEAL) _ * ------ --°--•--• °------- --------- - -------------- --••----- . _ Vikki • 7 .:. Lager----------- ..R~or-*erQr-a+c AFT81~N~~~~~]~Qi~f?"¢~+-dry ACANO'QVLEDG~M1aSN'T '~~~ ~ °°~A~'i °';, STATE OF ~VISGONSII3 ------ ----- -- ~ --------------- - n~ _ St. Croix ses. ---- ~'t=t ~ --- .County. antb,enticated this ,._ __..7~__.- {~ ~. fi-~ .; _, y9______ Personally came. before me this _... .___.__day of • .p t,~ ~y ~.. ~ ~,~ ~„ Febrtsary_.. -__., 19___ ~3 the above named --_ - ~ ef~`°'~a~s6p9°•~a~•-~+a --- Theodore J La£;er .and Vikki L Lager, _ ~ ,~ ee`6bry"~s C~ ~~t~r'oc~~°~ ---husband and-wife----------- ----------- - ~--.'- --- --° c-~" -- -"' _----_ x.'132: r-_--_ -'iLO~ _ ------- ~-- ~~ TITLE . MEMBER, 3TA~E BAB-L7~~7f1~`OV 1vu~II~_ , ` . _ ' ' ---- _ (Lf not --- ---- - ------ --- ---• •------ ---------°--- - authorized by ~ 706.06, Wis. StatsJ ----•- - ------- -------° -- ------ ---- - --- --...-- ---°-- nil , . - to me L-nown to be the person __.g___.___ who ezecuted the = ,..- fore strament and acknowledge the same. - THt8 t1Y8TRUMENT WA$'ORAFTED BY - - ---Atty-__Robext W- -M~'ge - - - - - -- `--_------ -- - ~If;JDGE,--~'81~TE1~ & ),7'fAfDEEN,_ $.C- --- --- -- - - Hudson WZ X4016_•_____--°------- Nota y blic S-t~Ctnix-___.___•---____Coun ,Wis. • •--_-°- (Signatures may be-:authenticated or acknowledged. Both My ommtssfon ie pe manent. (lf not,. state eapiralltjon are not necessary.)-- date. ~O ~~ - 199./.._.) -J~ ~Name6 of persons BtRelait in any e3.Dacit7 BhoWd be typed or prtn4d below their aiaaatures. -~~ - WA2iRANT! DEED - - _. _.. -. .~. _.. ~.._ _.__--_~~ __.. _..- S.~c: °.__°.,•_ 8?A~/6 3,AM Vi" „3SLV3~ri3A - wn'•`u .e.. w.: 80AMNe a - t88Y - 2S~IwauYee. Wb. ~ . ' nNO 3vn C7 r- I e ~ ~ ~ ~ 3 ^? v1 !~ ~ ~ ~ 1 ~ ~ C ~~ ~r ~ ~ ~ # ~ `\ r I 1 ~ ~ ~ ~ \ ) 4 I :i ~ O CA 3 Z S V~ Z O K7 ~ '~,, C O N ~1 • 3 W. O G7 C .pi CT 07 [1 IV Q rv 00 C ~ ~ Cl ~ y v C 7 C' O ~ H l ~ Q O1 p ~ N p! ~ -I ~ (n N irk! ` 1\ O C l o ~ cD 1 a' (D ~ ~ n ~ ? p v p ~ ~ R A7 O r Cl O . W~ O O 0 0 ~ ; N ~' 0 d ( ~ I ~ C tD ' !l wi _~ m c~ o W a '.~ , ~ v I ~ ~ oA. I O ~~ I i. ~ ~ ~ W o z v ~~ y ~ i ~ ~ o O O O ca v I N ~ ~ ~ m ', < N Z t ~ cnulv~?! ' p D d Q ~ v o ~ o ~ j ~ ~ ~ ~1 m 1 ~o ( N O !~i w ' ~ ~ CA N ~ CA ~, ~ [1 7 w ~ Z 0 0 ~ O D ~ o ~ m ~ ~• ~ ~ c ly,~ I ~ C N a ~/ y I ~,, ~ n m ~ ~ ~ N A 2 A p N C i ~ •T ~ a ~' ~ ~ o. .. ~ ~ m ~ ~ m ~ 2 G ~ ? ~ p :. Z I y 0 ~ ~ Z N I ~~ D ~ `~ a ~ I a~ ~ ~ I o ~ z a N p .. o~ m n~ o _. ~' p~ ~ ~ y ~ I ° y ~ Q C N ~~ I °- I m `r I v ~, ~" o ~ '~ o a I a ~ o b ~ I m ~ro H ~ O ti c~ ti Parcel #: 020-1045-20-000 07/11/2006 05:01 PM PAGE10F1 Alt. Parcel #: 19.29.19.177E 020 -TOWN OF HUDSON Current !LX~ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -WANTZ, DAVID B & JEAN M DAVID B & JEAN M WANTZ 329 CTY RD A HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description "' 329 CTY RD A SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description; Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 19 T29N R19W PT SE NW LOT 2 OF CERT SURVEY MAP AS SHOWN I Block/Condo Bldg: IN V P36 EXC PT TO CO HWY .0013AC AS IN 650/226 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 19-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1005/153 QC 07/23/1997 994/289 WD 07/2/1 .997 789/67 ~~~ b (~ ~ 3 7flill^ CI IMMARV Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 53,000 122,600 175,600 NO Totals for 2006: General Property 1.000 53,000 122,600 175,600 Woodland 0.000 0 0 Totals for 2005: General Property 1.000 53,000 122,600 175,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 121 Specials: User Special Code Category Amount ~~ Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 '~ Wiaoonsin Department of Health and Sooial Servioes Plb. {{67 jf)/69 Division of Health PERMIT APPLICATION for PRIVATE DOMESTIC SEWAGE SYSTEMS A. 04fNER OF PROPERTY TYPE OR USE HLACK INK Name ~ Address (Streets City 21p Code) L~ ~l,' ~ l t ,_~S ~ rc~~ ' County B. LOCATION OF PROPERTY WHERr: SYSTEM WILL BE CONSTRUCTED OR EXTENDED ~ • Cheek One: J i ~.t~..~ ~'; ,~~/f W~ A S ^~ ~ ``~~ ~ . ~~ ~~ ~ L pE T;ONs CITY VI(1.AGE LEG /} ~ ~"'%~~ ~~r,~ ~"~~ ~ .S'r'C L7 ~-LS~~f' ~( TOWNSHIP ~ ~ j , ~UbS~ar _ ~ 3 a Cf" C p / REQUIRE FOR THIS hOAK? ~ NO (~ ~L ~ / 36 S CAL RMI E . I LO PE T D Y S PERMIT NUMB R D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION ~ REPLACEMENT ADDITION MATERIALSs Prefab Concrete Poured in Place Steel Other NL@'IDER OF TANKS TO BE INSTALLEDs E• TYPE OF OCCUPANCY • Cheek Ones One or Two Family Residence ~ Commercial Industrial Other /// Z Specify A b b d N f P t d ~ C um er o ersons o ccommo ate __ ~ Number of Bedrooms e F. 7~ NO Automatic Clothes Washer ~~ YES NO APPLIANCES, ETCs Food Waste Grinder YES _ NO Automatic Potato Peeler YES ~~ NO Dishwasher YES ~ ~ Other (Specify) • G. EFFLUENT DISPOSAL SYSTEM NEW ~ EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Beds Length Width Depth Tils Size No. Lines j Sespage Pit: Inside diameter __ ~iquid Depth PERCOLATION TES T Test Depth Character of Soil Hours Water Test Time Dro in Water Level Inches Minutes. Number Inches Thialaresa in Inohes Since Hole in Hole Interval Second to Next to •Last To Fall 1st Wetted Ovorni ht in Minutes Last Period Last Peri Period One Inch Example - 0 36N To Soil 10" Cla 26" 25 es or no 30 1 2 1 2 1 2 60 ~ G•t :c'C ~_~ C~ ,, ~ ~L J~iC pc~ • y f ~, ~ y ~ ~ ~ ~, ` • ~ f~ J• ~ ~ ~~ ~ ~ '"f RECORD DATA FROM MINIMUM OF 3 TEST HOLES ompute size of absorption area _n accord with H 62.20 Wia. Administrative Code. SOIL BORINGS -Minimum 36" Below Pro osed Abso tion S stem oring Total Depth Depth to Ground Water Depth to Bedrock _ umber Inohes served Estimated Observed Estimated Character of Soil with Thickness i,n Inches xample ~ - 0 72° 72" Black To Soil 12"• Cla 18"• Sand 18"• Gravel 24" z- ' ~ ~Z . ~~' Sv~~ ~ '' ~~r ~~rG~'i%~~j'~~ ~ Y z- l-'' ~1 zf~. ~`~- r , c L , r ~ ~,~' ~L r ,1 S RECORD DATA FROM MINIMUM QF 3 BORE HOLR6 r y SERCO Laboratories ~ 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 63ti-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 30544 PAGE l of 1 02/22/93 St. Croix County Zoning DATE COLLECTED: 02/19/93 911 4th Street DATE RECEIVED: 02/19/93 Hudson, WI 54016 COLLECTED BY CLIENT DELIVERED BY CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: Lager 329 TY RD A SERCO SAMPLE N0: 17463 SAMPLE DESCRIPTION: LAGER KITCHEN ANALYSIS: ---------------------------------------- -------- Nitrates, mg/L as N 3.7 Total Coliform Bacteria Absent This sample's analytical results are below the U.S.E.P.A.'s SDWA maximum contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL list. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, ~ L%E~~i1.a~ Diane J. nderson . Project Manager -~ ~ ~ j1Q y t- '>. < means "not detected at this level". Y `'~~' `. ~J ,.~..\ 1 mg = 10 0 0 ug ~, 5~ `~;~U~ ~ ~~ MEMBER ~' COMMERCIAL TESTING LABORATORY, INC. 514`Mait~ Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - b227 ..FAX - 715 - 962 - 4030 ~7. GROIx.ZONING REI:`ORT NO.S 37004/01 ST.' CRQIX COttNTY REF'[3RT DATE: 2/iB/93 COURTHOUSE DATE RECEIVED: "/15/93 HUDSON, Wi 540ib ATTNS THOf4AJ C. NELSQN cn cry ~ ~ o~~ : ~ S i?~ cam..- - ~; -- '~ y L L ~' ~; OIJI~RS Ted Lager " LOCATION: 329 C#y Rd. "A", Nudson COLLECTOR: S# . Croix Zoning ~ DATE COLLECTED'. '?-i1-93 /.?- ThfE COLLECTED: i0S03am ;~ SIXIRCE t1F' SAhIPLE: Kitchen faucet :-,'•,i ,; DATE ANALYZED.?-15-93 ~' i TII~ ANALYZED:Z:OOpm `t `~ COLIr"ORM: 0 /10{i,mt ~ f' ~~ INTERPRETATION: AacteriaEogicakiy,~;,,?SAFE l v; t ..NITRATE-NS ~ ~~~ 5~;pPm %`~ Above 10 pP~,?RCeeds the recoa~mended Public Dr i nF: i n9 ~Jdater Starniard. _., 1. *NOTE: Sample exceeds holding time. ~ 9 ~~ Conform Bacteriai100 tal ~ Nitrate-Nitrogen, mgfL t'"~ ~+ ,..Of.~NDEiFND fNr ~yF ~op 4 A dW~b..'~ •`4 PAt~ i ". _ LAB TECHNICIANS Fain Gas-e.. pHONE~' 0~`k~ - 2 WI Approved Lab No. 19 CALL.~F(; _--------- ( I'{eans "LESS THAN" I~tectable Lpvel Approved by2 PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~SERCO Laboratories 1937 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 30471 02/18/93 St. Croix County Zoning DATE COLLECTED: 911 4th Street DATE RECEIVED: Hudson, WI 54016 COLLECTED BY DELIVERED BY SAMPLE TYPE Attn: Mary J. Jenkins CLIENT'S ID: Century 21 - Lager 5ERC0 SAMPLE NO: PAGE 1 of 3 02/11/93 02/11/93 CLIENT CLIENT DRINKING WATER 13913 SAMPLE DESCRIPTION: Lager Sample of ANALYSIS: -- -- ----------------------- 2/11/93 ---- -------- ------ -- - Benzene, ug/L <1.0 Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tert-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) Dibromochloromethane, ug/L 1,2-Dibromo-3-chloropropane, ug/L 1,2-Dibromo.ethane, ug/L (Ethylene dibromide) Dibromomethane, ug/L 1,2-Dichlorobenzene, ug/L (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L (m-Dichlorobenzene) 1,4-Dichlorobenzene, ug/L (p-Dichlorobenzene) < means "not detected at this level". 8 <0.2 ~ , `i1 <0.4 cn. rss ~ ~ < 1.2 ~ is ~ ~ ~ t ~ <0.2 o i 0 ~ ~ co^ ~ ~ T ` <0.2 ~S m ~ ~. <1.0 <1.0 d "•, 1 mg = 1000 ug. ~' ~.,v4. ~~ MFMRFR N J SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 30471 PAGE 2 of 3 02/18/93 SERCO SAMPLE NO: 13913 SAMPLE DESCRIPTION: Lager Sample of ANALYSIS: 2/11/93 Dichlorodifluoromethane, ug/L (Freon 12) <0.5 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1,1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 trans-l,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropene, ug/L <1.5 trans-l,3-Dichloropropene, ug/L <0.9 Ethylbenzene, ug/L <1.0 Hexachlorobutadiene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <0.2 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethene, ug/L <0.2 Toluene, ug/L <1.0 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 1,1,2-Trichloroethane, ug/L <0.1 a,~.~, ,. < means "not detected at this level". 1 mg = 1000 ug. /`,~-~..`~~ ~~8. MFMRFR SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Piwne (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 30471 PAGE 3-of 3 02/18/93 SERCO-SAMPLE NO: SAMPLE DESCRIPTION: ANALYSIS: Trichloroethene, ug/L Trichlorofluoromethane, ug/L (Freon il) 1,2,3-Trichloropropane, ug/L 1,2,4-Trimethylbenzene, ug/L 1,3,5-Trimethylbenzene, ug/L (Mesitylene) Vinyl chloride, ug/L Total Xylene, ug/L 13913 Lager Sample of 2j11/93 <0.4 <0.7 <0.2 <0.2 <0.3 <1.0 <1.0 This sample's analytical results are below the U.S. EPA's SDWA Maximum contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL list. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report .may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, ~~~~~ ~~~~V' Diane J. nderson Project Manager d.°w~~"`*.. < means "not detected at this level". 1 mg = 1000 ug. ~``~ {`Y MEMBER t ~~-~~ ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 a° U~ 0 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion o~ this form is essential so t at the property can ~e located. PROPERTY OWNER' S NAME : ~ ~` - CQCQS oZ ¢?/~L ~.LC 7~PCX- ~~i.~.mC,~S". (~f} T~~) - /Y~ 0%1~/ _ ~ ?O 7Z7~'i PROP. ADDRESS: 3Z~i L~cTLtnt7J RCl~ ~ CITY N7~ ~ ~ Legal Description 1/4 of the 1/4 of ,Section ~~, T Town of Lot Number Subdlvlsion: ~ '~ nn 02G - - d~ , l~~L FIRE ER 3°~~ K BOX NUMBER ~.J F~ LC~n'2hlYx~1'1 Color of house Realty sign by house? C~~If so, list firm: - ~ - ~T~ Please provide the following information, enclose appropriate fee made payable to St. Croix Caunty Zoning Office, and mail, along with form to the above address. Testing will be done as soon as_ ...possi-ble -after _fee_-and fort _ are--r~ceiuerl- P. \/ WATER TESTING- ----~-=-~--~---------------FEE: $ 35..00 l~ (For nit tes and coliform bacteria) G ~~ ( For VOC' S ) -------------- -----------.. _ ___- ----- `~. SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly ~unct~ning at .time of ~.y~ PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,i.e,COPY OF PLAT HOOK, 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: ~n~{~='dl ~O'1/PI' C7fbcr~7 Telephone Number REPORT TO BE SENT TO: ~i~nC,P ®!SFY? '- r~tzcr'v c?l m~el' ~rr~ro® CLOSING DATE: of/o~la~~.~ Signature Parcel #: 020-1045-20-000 Alt. Parcel #: 19.29.19.177E 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 =Current Owner, C =Current Co-Owner O -WANTZ, DAVID B & JEAN M DAVID B & JEAN M WANTZ 329 BAER DR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 329 BAER DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 19 T29N R19W PT SE NW LOT 2 OF CERT RVEY AP S H N Block/Condo Bldg: SU M A S OW IN V I P36 EXC PT TO CO HWY .0013AC AS IN 650/226 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 19-29N-19W Notes: Parcel History: Date Doc # VollPage Type 07/23/1997 1005/153 OC 07/23/1997 994/289 WD 07/23/1997 789/67 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 53,000 122,600 175,600 NO Totals for 2009: General Property 1.000 53,000 122,600 175,600 Woodland 0.000 0 0 Totals for 2008: General Property 1.000 53,000 122,600 175,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 121 10/14/2009 07:47 AM PAGE10F1 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ o h v ry' 4 rrj ti a Q N N ~-, i y O O '~~' •~ O N }~ V .ti ~i O ~-~ ~ V ~ w C H •O ~ •~ c~ ~ww ~ _1 A v ~ w ~ ~ z rn N H Z c C7 O Z ~ .~ ~ ~ V N }Z- ~- m a E f0 N O O N m a t~ J U o 0 o c N O ~ ~ r ~ ~ ai y N -p 0 ON N = ~ a a o ~ ~ c v a ~ ~ o° OI ~ 64 ~~ I I m I I I I I I ,o o Z c i c L o Q 3 `~ m I ~ ~ Z ~ a I £ _ o O ~ a m v I n _ ~ a ~ °~ c ~, ~ ~ ~ N c I ~ U ~ ~ N N ~ ~ a .a U ~ x ~ N ~ 3 0 ~ N y j y ~ O .N Qj C C t0 O O O ` ~ _ .~ fp f6 N ~ C' . .. O ~ cZS w w O I Z S Z O°~ Z O Z d ~ ~ ~ I _ ~ ~ .. ~ ~ - Y o a r1 N d ~ N ~ i ~ 0 O d 9 v a v~ i o O O O ~ a a a ~ ~ a = a I > ~ N N Z 6 ~ N O ~ ~ ~ ~ f6 ~ ~ N O ' O O a E N m C m ~ G d ~ O _07 N d Q A !n Q 10 ~ 3 N I O U C `o a m ~ ~ o >` U N f0 d ~ O a I a ~ o .E ~ ~ N ~ o o C a N N ~ y c a~ c c °~ v rn I ~, a v ~ a~ ~ ~ ~ c ~ ~ ~ ~ ~ ~ + 7 + G t J ch o Z `~ Z~ L (n ~ a d ~n.~ I c °: ~ 3 :a p O u~ U I . ~~~ ~'~~ Premier Group 70619th Street South Hudson, Wisconsin 54016 (715)386-8207 (612)436-8433 MARKETED BY: J ENNY OLSON O: 715-386-8207 H: 715-386-2554 ADDRESS: 329 COUNTY RD A HUDSON, WI PRICE: $66,700 ~~ _ ~, _ a ~;,1„ ,, ~ - F "°"a ' - Sys °~~ ~ o~ s y =„ ~^'~v ' ... ]~ M-""542 R PFt2CEC7 TO SELL ! ! Neat three bedroom, 1 3/4 bath home on lovely wooded lot. Finished lower level family room with cedar walls and lovely brick fireplace. Newer carpeting throughout and new roof. All appliances included. Great buy! $66,700 ROOM SIZES SQUARE FEET MAIN LEVEL: 960 FEATURES TOTAL FINISHED FOOTAGE: 1760 LR 1 14.9 X 15.8 DR 1 9.4 X 8.6 BEDROOMS 3 KIT: 1 11.9 X 8.1 BATHS 1 3/4 FR L 22.7 X 14.1 FIREPLACE: YES, FR MB 1 12.11X 11.5 EXTERIOR MASONITE BR 1 11.5 X 9.3 GARAGE SINGLE ATTD BR L 14.9 X 10.10 LOT SIZE 3/4 ACRE TAXE5 $1578.21 (1992} YR BUILT 1969 NAT GAS H/W HEAT NEW WALL A/C '92 NEW ROOF, FASCIA & GUTTERS - 1992 **QUICK OCCUPANCY AVAILABLE** ,; y.QIREG~~ONS: County Rd A - east of Hudson, past Strawberry Drive Street is off to the Right and uphill. (3rd house in #329).;" Information is considered accurate but we accept no liability for error. listings may be changed or withdrawn without notice. Amery • Baldwin • Balsam Lake • Hudson • New Richmond • River Falls • St. Croix Falls • Somerset Each Office Is Independently Owned And Operated paae~adp puy pauw+p ~(~luapuadapu~ s~ aoi~/0 4oa3 ,:~ ~asaauaoS • s~~E~ x~a0 ~3S • s~~a~ Dania • puouiyoia MaN .uospnH . a~e~ wes~eg . uiMp~eB • ~(~awy 1661 M3N 2~3.12~a '8 2~3NSdM ~OOd~2~IHM 1N3W3Sd8 NI a3Z332~d 1S3H0 S~OO1S 2~b'8 ( HON3S '8 S2~Ib'HO `3~8b'1) 13S 3113NIa SNIb12~f10 ~~b N3~0 aNb' 3JNd2~ S`dJ 3aOWN3~l a01'dN30I2~d3a 32~OWN3~ 3~Y/M02~OIW 6861 M3N-~i3HSdMHSIa 32i0WN3~1 =a34f1~ONI lON SW31I ~a3af1~ONI SW31I 2661 S2i311f1J aN'd `dIOSbd 2~b'C130 2661 d002~ M3N 2~31d3H 2~31b'M SdJ NO~~b'J 05 1d3H 2~31`dM lOH SdJ ~H2if11dN S~~b"M 3NId ~1110N~1 aNb' 30t/~d3LiId ~i0I2~8 .1~3~0~ H1IM W002~ J.~IWdd SfIOIO`ddS W002~ JNI~I`l NI JNI~I30 C~31~(1'd~ 'd3~1`d JNINIQ 31b'~Idd3S bb'8 ?!0`dNS H1IM N3HOlI~! ~3~3~ 2i3M0~ aN`d~ NidW 6861 13dd'`d0 M3N ~3WOH NMOl ~O 3043 lb JNI113S a3C]OOM 3~i0`d t~/S JNI113S IM-NOSaf1H `b d`dOa Jl1Nf100 6Z£ 133HS 32~fllb3d ££1~8-9£~ ~Z19) LOZ8-98£ (5lL) g~Otig wsuoosiM'uospnH y~noS ~aa~3S y~6190L dnoa~ aaiwaad ®~ 1~t i' .•~~Ta .~ ~; /~~ b /~ Le: ti: ieci St:rvey Wa,•~ being ::'~ tl~e 3E, r{1ff~ 3~;; 1'~,T-4y::.:t-1~~-''!. :' SL.Croix County, ':/i:~c~:~s! n SE`;J.7+ Sec.19 } T2~J;~.A19:Y. ~Ih a~ 'c .M Rai <V . y~ ~ ~ F~~~~ 0~~ s`.l~ t ~i".~"~Y"' ;ommencin3 at t:~e t:orthrrest corner o~ a' t~~~~-Nw of 3ec.19,T-29_!~l.F-19..;x. thence South for .r i~P~•;o•*, '•9?,7.83 feet, thence S.13•1'a~E. for 64.63 feet ~L •>N to Lb~q, Place of Heglnr~ing (°. ).fl. ),thence tJ.6•1o47'E ~;~• •~ fir 178.8 feel, thence ::. i~r9(r';,. for :55fi.t34 feet, z t:isnce S.0'24 ~A. for 226.71 feEt, 5.73.55'~I. for 13..6 feat, thence 3.6808'.'. for. 124.59 feet, thonee S.66o69~30~ ~;7. for °75,0 feet, thence N.0.15'E. fvr 254•.: feet to the°l+tce of E3e~inning (P.O.H.) I caetify Lhat the dre.wirg Hereon is g true and c • ~ lend land survey.od, mapped and described anc: don of Kensll builders by Richard Kensll and th1L I v+itlt the provisions of Sec. 2;16.34 of a :'/isro t'.iis matter. ~~ • r.nncio .^.t •~ 4 oc~,~,•~~.~,~,~* •Vt Lhe ~;/,.•t?~~••.~1 Lion ~; • °i.i 11; ''•~'~, lie .~~~~~ L~uxe..~~?~ J ~ ti ~ ~•. Kensll 3uilders, b Ricli•~rd itenal '`~•. ••' ...... •• ~ ~~ f~ ~~ `~ Toxn ©oarc, Town of IJudson, ~t.~roix Cuunt;-, '.71sco,~sin i .yy ,~ ~} ~,~ h ~ . ~ ~ Resolved yltat Llto above Certified t:aP i:~ ;:,~ ;::;~!.;7;; Sec.19,T-Z9-i'. `'+ ~ ~e~4 S, R•1`~-.7. To~~c~ of i{udso-1 Kensll 9ui~ders 1,•~ Ric:ilyd Y.en111, owner ~~~~„~ ~ ?'~~ 19 °~i1e eti~ ' T ,/R a;~~rov by gai~i .o-in Hoard. r ~~ ~; _. ~.. • ~.,;~~ .i~ ~ ~~ Torrn Chairman ante 4 ~.. ~ I at>rbiff t.".at' Lhe fore~oir:~; is x co-~• of 'tcs~~lutio^ adoote~: ° ,"r` , ~. by tae Town Board of the Town of !'ud;.~:,,:;t.:rnix C•~u: t,; ,'71sco^si n ~~.; r- ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 February 12, 1993 Jenny Olson Century 21 Premier Group 706 - 19th St. S Hudson, WI 54016 Dear Ms. Olson: An inspection of the septic system on the property of Ted Lager, located at 329 Co. Rd. A, Hudson, WI was conducted on Feb. 11, 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 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. Sincerely, • Mary J. Jenkins Assistant Zoning Administrator cj 02/22/93 08:19 FAX 612 636 7178 SERCO LAB. -~-~-~ S.C. CO CRTHOUSE C~J001 J SERCO Laboratories St. Paul. Minnesota 1931 West County Road C2 ~'~ ~- St. Paul, Minnesota 56113 :~ : ` ~~~ Phone: {612) 636-7573 PAX (612) 636-7178 ~: 1 ! c^ ~: ~ ~ s~co Laboratories Nu`m~ber of Pages (including cover sheet) Please deliver ~nanediately Rum off. ~, _~ ~~ .~ N .__f O : - - CX7 Z C~ COf ~~ ~, ~ i ~ Z O~~ 4' ~ " i S' cm -~ -. ~ ~ cw . ,. ~ ti E If you do not receive all of the gages, please call (612)636-7173 as soon as passible. When Quality and Serv;ce Count 02122/93 08:20 FAX 612 636 7178 SERCO LAB SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 63&7178 -~-~~ S. C. CO CRTHOUSE [~j 002 LABORATORY ANALYSIS REPORT NO: 30544 02/22/93 St. Croix County Zoning DATE COLLECTED: 911 4th Street DATE RECEIVED: Hudson, WI 54016 COLLECTED BY DELIVERED BY SAMPLE TYPE Attn: Mary J. Jenkins CLIENT'S ID: Lager 329 CTY RD A SERCO SAMPLE NO: 17463 SAMPLE DESCRIPTION: LAGER KITCHEN ANALYSIS: ---------------------------------------- -------- Nitrates, mg/L as N 3.7 Total Coliform Bacteria Absent PAGE 1 of 1 02/19/93 02/19/93 CLIENT CLIENT DRINKING WATER This sample's analytical results are below the U.S.E.P.A.'s SDWA maximum contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL list. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 3o days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, L%E~wJ ..~ Diane J. nderson Project Manager ww .. < means "not detected at this level" . 1 mg = 1000 ug. ~,~, _~. 02/18/93 16:02 x'$71:5 962 ,4030 ' CQMMERCIAL TESTING LAB~RAT~RY, INC. 514 Main Street, P.O. Box 526 Celtax, Wisconsin 5473Q 715 - 962.3121 aoo • ssa • s227 FAX - 715 - 962 - 4030 ST. t~IX Zu1lIt~,Y~ 51'. {~2S3IX 1~15#T i C1:lll~Tt H!!i}S0~li idI ATTi`tS Ti~OT'tP~$ C. I~I.SOtd Gotijorm SaCtes'saf144 aL ~litrate-~(ifra9en~ m4lL 54{liw COMM. TEST LAB -r-,-r S.C. CO CRTHOUSE (7{002 ~'~?; t~0. i 3'7044141 T D1'f1=« ?1113/93 Di~7'ar {~CEIL1EDi ~J15/93 ;-41;e'F~et Ted user >_~:ATIOPi: 3~'? Ct~+ Rd. »A,,. Hudson ~;U.ECTt7Rt Sty Groix Zoning ~,TE COC.LECTErJ: 2-1!-•93 TIi'~ CAI.LECTQ; SG.43aa S (~ SAi~t.ir; hltchrn faneat DATE. ftidAL72EG:2-193 i1~ A~ALYZ>~:2S4tSpe CpLIFp~'t; 0 1100 m! I~'T~iFRETATI0P1. 5.aetar i a ios i ca ! ly piIT~ATE--t~l: S RPm Above 10 paa lx:aeds the reco~uoeMied Public 11r i nk r 1-9 !,rater standard • i~~/ Y' +FIrbTE: $arop to rxcezd$ ha td i na t i ae. ~~ <~C~ ~% N ~ CZ ~ ~ cc ~~c ~-~ cS~ O ~ o~~~o ~~ .S `~ ~ E ~ ~~ i N r AESUt_l~ °s: _~.~._. LAB TECI~iICIA~(S Pas ~'3;1E FAX'D Uiv; _~ ~8 ~.~.,,.~' PHONED ~-~J. 4{I ApproveC Lab t<n. 1~ DALL~~St . - ---. ~ < Miearrs "LESS TfiA>~" IrEtectable Lave! €~Proved byi n r~~~~rCC.I/1•IAI i wanQelYtav fiFRVIC:ES S1NDE 1952 02/18/93 14:07 FA% 612 636 7178 SERCO LAB. SERCO Laboratories ~-~-~ S. C. CO CRTHOUSE [~ 001 St. Paul. Minnesota 1931 West County Road C2 f~:~. St. Paul, Minnesota 55113 f ~~ Phone: (612) 636.7173 FAX (612) 636-7178 ~ ~° I]A'I'E: ~: Ft~+S: FZ2C~i: Nuanber of Pages (includi~ Dauer sheet) Please deliver ~ ~~ ~ ~tely ~~ / - G `~ p ~~~ a~~~ ~~~ ~~~~ ~ ~ ~ ~ ~. ,~ ~ ~ - ~ . ~~ ~~.. ~~- tea- a-- ~~~ ~~~~/u%~~ r,~at~ tid C'-- ,Cry . o/ ~~~ .~ ,~ r~o~~ r ~ ~- ~7v,-~~~ ~O ~Ze v~ ~ C~~s~~~~ Gu's~ J ~ U~ If you do not ive all of the pages, please call (612}63 7173 soon as ~S ~ ~ ~ ~~ yew ~~ ~'~ `~ ~`~ y,. ~~~ rn ~~~ When Quality a d ervrce Count 02/18/93 14:08 FAX 612 636 7178 SERCO LAB SERCU Laboratories ~-~-~ S.C. CO CRTHOUSE 0002 1931 West County Feed C2. St. Pavl. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7176 LABORATORY ANALYSIS REPORT NO: 30471 02/18/93 St. Croix County Zoning DATE COLLECTED: 911 4th Street DATE RECEIVED: Hudson, WI 54016 COLLECTED BY DELIVERED BY SAMPLE TYPE . Attn: Mary J. Jenkins CLIENT'S ID: Century 21 - Lager SERCO SAMPLE NO: 13913 SAMPLE DESCRIPTION: Lager Sample of ANALYSIS: 2/11/93 ---------------------------------------- -------- Benzene, ug/L <1.0 Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L (Methyl bromide} <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tent-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ugiL (Ethyl chloride) <0.4 Chloroform, ugJL <0.5 Chloromethane, ugJL (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 Dibromochloromethane, ug/L <0.4 1,2-Dibromo-3-chloropropane, ug/L <1.2 1,2-Dibromoethane, ug/L <0.2 (Ethylene dibromide) Dibromomethane, ug/L <0.2 1,2-Dichlorobenzene, ug/L <1.0 {o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) PAGE 1 of 3 02/11/93 02/11/93 CLIENT CLIENT DRINKING WATER 'A < means "not detected at this level". 1 mg = 1000 ug. '~ 02/18/93 14:10 FAX 612 636 7178 SERCO LAB SERC~ Laboratories -~-,-~ S.C. CO CRTHOUSE I~j003 1931 Waet County Raad C2. St. Paul, Minnesota 55113 Phone (612) 636-7173 FAX (612) 836-7178 LABORATORY ANALYSIS REPORT NO: 30471 PAGE 2 of 3 02/18/93 SERCO SAMPLE N0: 13913 SAMPLE DESCRIPTION: Lager Sample of ANALYSIS: 2/11/93 Dichlorodifluoromethane, ug/L (Freon 12) <0.5 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ugJL <0.2 (Ethylene dichloride) 1,1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 trans-l,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1;3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropene, ug/L <1.5 trans-l,3-Dichloropropene, ug/L <0.9 Ethylbenzene, ugiL <1.0 Hexachlorobutadiene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <0.2 n-Propylbenzene, ugJL <0.4 Styrene, ugJL <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethene, ug/L <0.2 Toluene, ug/L <1.0 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 1,1,2-Trichloroethane, ug/L <0.1 ~~. .,.~ < means "not detected at this level" . 1 mg = 1000 ug. !';~ •,;,- ~~ ,~: 02/18/93 14:11 FAX 612 636 7178 SERCO LAB r SERCQ Laboratories 1931 Wast County Roatl C2. St. Paul. Minnesota 55113 Phane (612) 638-7173 FAX {612163&7178 a~~ S.C. CO CRTHOUSE 0004 LABORATORY ANALYSIS REPORT NO: 30471 PAGE 3 of 3 02J18/93 SERCO SAMPLE NO: 13913 SAMPLE DESCRIPTION: Lager Sample of ANALYSIS: 2/11/93 ---------------------------------------- -------- Trichloroethene, ug/L <0.4 Trichlorofluoromethane, ug/L (Freon il) <0.7 1,2,3-Trichloropropane, ug/L <0.2 1,2,4-Trimethylbenzene, ug/L <0.2 1,3,5-Trimethylbenzene, ug/L <0.3 (Mesitylene) Vinyl chloride, ug/L <i.o Total Xylene, ug/L <1.0 This samples analytical results are below the U.S. EPAjs SDWA Maximum contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL list. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. nderson Project Manager e` ~, . < means "not detected at this level" . 1 mg = 1000 ug. -~, .• ~, ~~~~~ '-',. ._-, + :: ,- ,, ..<. ..,. - i - M . .+ f. I~ the undersigned, hereby certify that the percolation tests reported on this forn xere made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3)~ Wisconsin Administrative Code, and that the data recorded and location of test holes are aorrea~` to i the best of my knowledge and belief. ~A /'`~~ /~~ ..~---~ 9 ~i l t il' 4L NAME ,? ~ ~ ~G~- 1 TITLE .t_ (Type Print) REGISTRATION N0. or M//ASTER PLC.lC'1IDER LICENSE No. ~ . ADDRESS ~ ~ ..-, fL/ lID• (I~ ~~~ DATE ^~~ f ,C - -SIGNATURE - ~C ~-' ~~ • ~ .. - MASTER PLUM3F.'R F.Ai{ING AP l~ICATION ~ ,` J MP Signatures ~ + License Numbers 1, MP RSW ' !F (To be Co/mpleted by Issuing_Agent) Date of Application ~ ~Z ° ` ~ / ~~~ Fee Paid ~ / ~ ~~ Parmlt Issued (date) Cam' ` ` ~l ` Permit Number ~ /~s / -Agent (name) \ ~'~--~ For: ~-~1cr ~ ~t~..t~ eta. a C it C oun ToKn Vi 1 e ty, g ~ Y. ~? s ~Z •~~~-~~f/ QZ ~Z-~ - (Specify) Note: The application cannot be considered for Piling until all of the above questions are ans-rered and the fee paid. Agents xill forward application, the fee o4 $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Divisicn of Health. Do not xrita in space below - FOA DEPARTMENT USE ONLY DATE RECEIVED ACCEPTED BY RETURNED (Initials) (Date) See Corres. FEE RECEIVED VALID. N0. P£At1IT N0. Yes or No) . REVIEWED BY APPROVED 'DATE ~ ~ ' (initials) (Yes or No) COMMENTS: _ -_ _ __ _ \ •. ;, , ~. . . 1 ~1 ~ ~~ ~~~~~ Y:- Certified Survey ,;;al, bei~::~r ink` the :~E4 ~~1?1'J-~ Sec 19,T-•29iJ.R-19-'"J. ~t.Croix County, "lisconsin :~~~1.Cor 29~~4 0' ~E;~i.J~v~~ SeC.l9 T ~I ^ • I{ .~ .~ p, o• yr` .~ ~ F1L~D O CT 81968 DAVID iK!/ Reg. fly Q~ CroiX /~ S~Q J %~ t C / i-n. . Iron ~ ~ ~~ ~~~ o9`R'i "' Comn~enci~,z`; ~.t fife ~orthti~~est corner of 5~~~;E-b?bl of Sec.]9,?'_~`~-;1.~t-19-':'1. t'.-fence Soy-~tl-i far ~SS'~g~'r ~ --9`?7.,~?3 feet, tYLenne 5.13~19'E. for ~'~ i.6': feet b°D9~3a~~ tO the, °1-a.ce of Beinriin (". ).F?. ),±1_,ence "..~;%I:v47~B SL~• °9 for 1 ~3.~3 feet, thence '?. "4°40'L. .for 356.34 feet, thence S.(D~24'',~r. forN2G.71 feet, 5.73~55'irJ.for 134.6 feet, thence $.~~3°03'''J. for 124..x° feet, thence 5.66~~9'30"',";'. for ?75.0 feet, thence P•1.0~15'E. for 254.3 feet to the ?lace of Be~ir.nir~~; (!F.O.B. ) I cap+~ify that the drav~in; hereon is a tr!ie and cor.~~'c~;~~~i~`p;,•Qf tree land land surveyed, i~;a~:>,~ed and described and don~:'bJ,.•tn•P -.clir``a tiOn of Kenall :builders by Ric'zard Kenall anti ttz~,t I ,~,.~~~ f~.ll~r•'•.~~,- lied ~r~ith the provisioizs of Sec. 2;~6..~4 of e :"Jisco}~~~?1~' S_;~.tu~es t i i i s matter . •~~~-i LGIZ ~ :..• z~.~~ ~' rZ a nd o G y o,•1~~~.~y ~ _~ ,~ ~ ena11 Builders, bT,~Ricliard i{ena .~ ~~ 4 ~~I T0;^Irl ;3Oard, TO~idn Of :~lldSO?`l, ~t.CrU1.X COUnt~t, •:R~ISCO:ISln resolved ~tiat the above Certified ;;;ap in tyre i1L~r~r~~ Cec.19,T-29-2~'. ~ R-19-'" . TOVJrl of :iudson, Kenall Bui ~.ders bar Ri c:iard Ken~.ll, owner v is he eby ap~rov by said Tovan Board. ~