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• 02/07/2005 01:04 PM
Marcel 020-1167-10-000
PAGE 10F1
Alt. Parcel 29.29.19.1032 020 - TOWN OF HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
MCCOY, DEWAYNE & DORI R
DEWAYNE & DORI R MCCOY
461 FRONTAGE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 461 FRONTAGE RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.420 Plat: 0211-COUNTRY VIEW
SEC 29 T29N R1 9W W1/2-SE1/4 LOT 1 - PLAT Block/Condo Bldg: LOT 1
OF COUNTRY VIEW EXC PT TO 1-94 (883/466)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/22/2000 628607 1536/483 WD
07/23/1997 1076/80 WD
07/23/1997 925/396
07/23/1997 883/466
more...
2004 SUMMARY Bill Fair Market Value: Assessed with:
49072 278,300
Valuations: Last Changed: 06/06/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.420 37,100 178,200 215,300 NO
Totals for 2004:
General Property 3.420 37,100 178,200 215,300
Woodland 0.000 0 0
Totals for 2003:
General Property 3.420 37,100 178,200 215,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch 131
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER J l Y- TOWNSHIP 4?S D e'1 SEC 02 ~j T N-RZW
ADDRESS e7~ ZQ'2 ST. CROIX COUNTY, WISCONSIN
SUBDIVISION ~~~,~y LOT LOT SIZE o2 . y ~q~ dr 5
PLAN VIEW 4rA-
L
7-1
Distances and dimensions to meet requirements of IIHR 83 ~
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
(U-4
psv
xso
15
yg' I~ m _ ~lS
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
i
Elevation of vertical reference point: DO.D
/ Proposed slope at site:
SEPTIC TANK: Manufacturer:
Wei S a, / Liquid Capacity: / Q
Number of rings used: Tank manhole cover elevation: ~J - 70
Tank Inlet Elevation: O Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side, Rear, O 1 7 4 o feet
From nearest property line : Front.0 Side,O Rear, O feet
Number of feet from: well building: /S l~ ~~iow F ~o✓'NW or/~ouS~
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE STnR
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, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: ~a h dcu"~~ / Trench
~
' ~~g 59?
Width: l $ Length: 3 ~ Number of Lines: Area Built:
r~
Fill depth to top of pipe: 2
Number of feet from nearest property line: Front, O Side, 0 Rear,0 It.
Number of feet from well: ( e,
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, 0 Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector.
Dated: Plumber on job:
License Number:
3/84:mj
OEM
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969
BUREAU OF PLUMBING
MADI£ON, WI 53707
`PTCONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number:
Ilf assigned)
Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECT N O E:
Sam Miller Rt. 1, Box 282, Hudson, WI 54016
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
SW SE, Section 29, T29N-R19W, Lot #1, Countryview, Town of Hudson
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Doug Strohbeen 5432 St. Croix 88396
SEPTIC TANK/HOLDING TANK:
MANUFACTURER n: LIQUID CAPACITY: TAN INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
Lt / ~•/D YES DNO DYES ❑NO
BEDDING: V T DIA.: VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING, JVENT TO FRESH
~i ALARM FEET FROM ` LIN/45 AIR INLET.
YES ❑NO DYES DNO NEAREST /
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL EPIROV COVER _
PROVIDED: D:
YES DNO DYES ❑NS❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WE LL VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowin=FRCE
LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (if soil can be rolled into a wire, construction shall cease untithe soil is dry enough to continue.) CONVENTIONAL SYSTEM:
INSIDE CIA #PITS LID
BED/TRENCH WIDTH LENGTH NO. OF 1777BR~4t,
~J 7RENCJ.FgB-. PIT DEPTH
DIMENSIONS t./I 4_/+y GRAVEL DEPTH FILL DEPTH DISTPIPE DISTR. PIPE TRPIPE PROPERTY WELL . BUILDING : V NT TO FRESH
BELOW PIPES: ABOVV~ COVER . ELEV. INLET . ELEV. END PIPES NMBER OF
ET FROM LINE A
IR IQUINLET MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
D YES ❑NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMAFN RKERS OBSERVATION WELLS
DEPTH OVER TRENCHDEPTOVER TRENCHBED D ❑ NO ❑ YES D NO
CENTERDEPTH OF TOPSOILSODDEDSEEDED
EDGESMULCHED
YES DYES DNO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TNO.OF RENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEV.. ELEV.: DIA.: ELEV.. PIPES DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DR
: ILLED CORRECTLY COVER MATERIAL
VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ❑NO DYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING:
NUMBER OF
FEET FROM LINE:
DYES ❑NO DYES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
MS19NAT E: ITITILE: /
DILHR SBD 6710 (R. 01/82),
L ,
s
DILHR SANITARY PERMIT APPLICATION CO WY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANIJARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLANK I.D. NUMBER
8% x 11 Inches in size.
-See reverse side for instructions for completing this application.
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOPETITION R VAR
FOR VARIANCE ❑ YES ❑ NO
PROPERTY OWNER PROPERTY LOCATION
&Lm K %..e SLO%Se S Tot , Kim Ic? E (or W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
CITY, STATE ZIP CODE PHONE NUMBER O CITY ( ~ NEAREST AD, LAKE OR LANDMARK
V
TOWN OR ILLAGE : v436 &CCI e- &0/t
11. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify):
III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable)
1. a. Aj New b. E1 Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1. a. X Conventional b. ❑ Alternative c. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. Seepage Bed b. ❑ seepage Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet) :
'--'3 I S 8 2. 3 Feet % Private ❑ Joint ❑ Public
TANK CAPACITY
in VI. Total # of Prefab. Site
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glFiber-
ass Plastic Appr•
Tanks Tanks structed
Septic Tank or Holding Tank X 14 J 4w .S ~ f Irl ❑ ❑
LEl El
ift Pump Tank/Si hon Chamber IBS❑J ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Sta ps) MP/MPRSW No.: Business Phone Number:
5~ r o a.c. 4f -5" Z (2'/7 )32-33
Plumber' Address (Street, City, State, Zip Code): Name of Designer:
to '-z' cuj le *G t s O 7- A/1 ;67- jo S .0010 0 VIII. SOIL TEST INFORMATION a.
Certified Soil Tester (CST) Name CST #
e San 115-199
CST's ADDRESS ( treet, City, State, Zip Code) Phone Number:
5401,6 3'41-s94'
IX. COUN /DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given initial *60 Surcharge Fee , p
Adverse Determination
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
, .
APPLICATION
TO THE APPLICANT:
1. This 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. A new permit may be needed
if there is a bhange in your building plans,' system location, estimated wastewater flow (number of'bed' '
rooms, etc.), depth of system, or type of system; , -
4. Changes fn ownersffip or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to lie-
submitted to the county prior to installation; .
5. Private-sbwage systems must be liroperly maintained. The"septic 'tank(s) should be-purmped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private, sewage systeFi, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 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 where the system is to be
installed;
ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 31 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete #2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in #1-6;
Vi. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. 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. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Departrrrent Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8'/2 x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to spate 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; dosing or pumping chambers; 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; dose 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.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and-public debate. The groundwater bill Groundyvater -
included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Treasure
is used in your building is returned to the groundwater through your soil absorption o ;
system or the disposal site used by your holding tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural R =.so_ rce These funds are used for monitoring ground 1
water, groundwater contaminations on estigat ons and establishment of standards. Groundwater,
it's worth protecting.
_ BD-6398 (R.03/86)
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
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
Location of Property S w 1% 5 14, Section 9 , T o29' N-R~
Township u~4a&
Mailing Address
t7 4 t1so~? ~i 5 _ -~~d /G
Address of Site Scri'~'ja 5; 44 r_> Cow/~ s. R cY L5M.61: t Ec~ ~ t o ti
Subdivision Name V,*
Lot Number /
Previous Owner of Property 9lcfav
Total Size of Parcel Z. 2s~ Aee-be 5
Date Parcel was Created 7/y
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) Yes No
Volume. and Page Number Jy( as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) centi6y that aft ztatement.6 on this 6o4m ahe true to the but o6 my (out)
knowledge; that I (we) am (are) the owner (,s) o6 the pnapeh ty dens n ibed in thi6
.in6onmation 6o4m, by vvttue a6 a waAAanty deed necanded in the 066ice o6 the
County Reg aster o Deeda ass Document No. ; and that I (we) pees entty
awn the pnopoaed site ban the dewage d,a pad 6 y,s em (on I (we) have obtained an
eabement, to nun with, the above de-scAi,bed pnopehty, ban the conatnuction o6 aai,d
.system, and the .same has been duty keconded in the 06jiee o6 the County Regi.6ten ob
Deeds, as Document No. 31 30 -
SIGNATURE 01? OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
R PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON, WI 53707
' (H63.09(1) & Chapter 145.045)
LOCATI N: S SECTION: TOWNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME:
sw V 1/ 9 /U`jN/Rlg1(or sou / Cow,- l~.erg
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
e/"Or` iS r lep- /mod a/, / /WN So L~c •S-
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: A New DESCRIPTIONS: PERCOLATION TESTS:
Residence ANew ❑ Replace
9_a -~i~ 9-a 76
SO, / mlofP ,Bx OL
RATING: S= Site suitable for system U= Site unsuitable for system C 6 Bk d - fg /~r~ ~ /ZX
O~('~NVEN IIONAL: MOUNAD: IN-GROUND-PRESSURE: SYSTEwM-IN-FILLHOLDING TANK: RE/COMMENDED SYSTEM: (optional)
NS au ®V au J ; HIV ~u _ CIS Nu 4.-0 , 'x3 r
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL/ ELEVATION DEPTH TO GROUNDWATER3 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPT Q OBSERVED EST. HjI~GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B l ~rb,
9bl
.q' /`~OACQ'° OrQ' ~b O S/ sS S ~3 .S .~o S
B- oZ 7.0' ,s-, 3' 114AI e 7,01
Bps ~h ~rl . .s' s
B-3 V 9C. Xhae- __7 6/ e9ITIA 40 6.2 9,4-Sl
B- Y 7,S_' .17' 6,I¢-- 7 5-
P 6 IS/, h / s
B- S 7, 0' 3,,.' /ld,-A 9, Q' 61SI, 110 09 6.#t S
B-
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 1p1GIs1E6 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R/ D 3 PER INCH
P_ , /Ia 6 6 b G 3
P-O2 C/ 0 oZ ~o L3
P-3 Aj, c ~3
P
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
17~ 1 ej. /0/ 4t
.i,, /ot,~r,k~~ lS,i f
Lt!
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/'",~tlart S di4r G T/ 4- ' a r
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I, the undersigned, hereby certify that the soil to 4ortec ►i Iis 1Wn we de by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded an ocation of thelests a rrect to the best of my knowledge and belief.
NAME (print►: TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional)-.::
Alk 5 6 - S
C ATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
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2. The us
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
d
a
OWNER/BUYER
ROUTE/BOX NUMBER /C 2 :g/ Fire Number"-
.CITY/STATE_~l49'So ZIP
PROPERTY LOCATION: 54/ Section 2-1 , T Z.~ N, R_z~~
Town of Ae .S0# , St. Croix County,
Subdiviaion4:&Z Aiw , 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 pumper. What you pit into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which 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 systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master 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
0
I/WE, the undersigned, have read the above requirements and agree iLn
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- b
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNE
DATE- Q~
St. Croix County Zoning Office
P.O. Box 98=
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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CMERCIAL TESTING LABORATORY, INC.
J514 Main Street, P.O. Box 526
Cojfax, Wisconsin 54730
715-962-3121
800 - 9621- 5227
czlk
ST. CROIX ZONING REPORT NOA 14152/01 PAGE 1
ST. CROIX COUNTY DATE* 11/22/91
COURTHOUSE DATE RE 11/21/91
HUDSON, WI 54016
ATTNS THOMAS C. NELSON
i4
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OWNER: Danielson Z!r Zr/ l~' / 2
LOCATION*# 461 Frontage Rd., Hudson I
COLLECTORS M. Jenkins
SOURCE OF SAMPLE: Outside faucet
COLIFORMS 0 /100 ml
INTERPRETATIONS Bacteriologically SAFE
NITRATE-NS 3 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
LAB TECHNICIANS Pam Cane
WI Approved Lab No. 19 c_a
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C Means "LESS THAN"
~ Detectable Leven Approved bY2
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
~eI ST. CROIX COUNTY ZONING OFFICE
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix Co. Zoning Office offers the service of septic and
water inspection to Lending Institution, Realty Firms, and
private individuals.
COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE
LOCATED.
Please provide the following information, enclose appropriate fee
made payable to ST. CROIX CO. ZONING, and mail, along with form
to the above address. Testing will be done as soon as possible
after fee and form are received. `
V
WATER TESTING FEE:$ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE:$175.00
(VOC'S)
SEPTIC SYSTEM INSPECTION FEE:$ 25.00
PROPERTY OWNERS NAME: el- Ir 0,01
PROPERTY OWNERS ADDRESS: 416? a~CITY: hltzljoe
Legal Description 5 CV _1/4, Se- 1/4, Sec. 2q , T 2f NZa--j
WTown oLot No . , SubdivisionFIRE NO. q&/ LOCK BOX NO.
Color of house Really sign? Ycs Firm: ZP7;a ca
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, 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:/,(ft
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Telephone No.
REPORT TO BE SENT TO: 200
o?w
CLOSING DATE:- A
Signature:
Y~ ST. CROIX COUNTY
WISCONSIN
^}t ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
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911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Nov. 20, 1991
Jim Dahlby
Edina Realty
700 2nd St.
Hudson, WI 54016
Dear Mr. Dahlby:
An inspection of the septic system on the property of Mr.
Danielson, located at 461 Frontage Rd., Hudson, WI, was conducted
on Nov. 20, 1991. A water sample was also 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.
'n ere Y,,
Ma . `Jenkins
Assistant Zoning Administrator
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