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HomeMy WebLinkAbout020-1131-40-000 1 Q. O N O 03 v) m 0 4 0 h c O N Q T o O m N ~mg c N d O co D Z O n o O F O Y (0 0-1 x a c N (D ~ N ~ L N Y O 7 N n OU V 9) c 7 n O > C z N 0 L Q- U- c m ` N Q O m > O '0 00 Q O Oj Q N co 2 > z H ! E rn Z 00 v E 0) d co rn U) ! c ! o Z a c v o d Z ~ ! c ch H r ! IT c E N N ~ f6 O _~V O n c -0 N d 0 0 0 z m z i d N o E c d N A L }v~} N _ 0 N N ~i m n y y Q a L m 3 0 o E CL H ~ a N a a (L c E O N ° ° o N j moo } rn rn f*- M am V N O O O - N N N -0 E Z' 0 O :3 7 N N N co N O W O 3 a N a~ m m Q } co r 7 a~+ O O O ~ y C I. p Q C 7 e0 N LO O V (O O"• O N 0 Z N Q Q -D a 0 0 0 0 l N_ N N N O a> ~ H c m m c 0) ` N C r 0 N N O .O O O O C_ N M m O 7 L ~ N 7 L2 O N m `m u ! •~i 0 2 d Z N 2 2 U) r \ £ L a CL d y c r`1v E c c r A ci CL 0 Cl) 0 2013 Property Record I St Croix County, WI Assessed values not finalized until after Board of Review. Property information is valid as of JUL 06 2013 10:26PM . OWNER CO-OWNER(S) RICHARD M LEVEY 871 STRAWBERRY DR HUDSON, WI 54016 PROPERTY DESCRIPTION SEC 19 T29N R19W STRAWBERRY POINT LOT 5 EX S 125' OF W 60' PROPERTY INFORMATION ASSESS WITH P1 75C Property Address: Parcel ID: 020-1131-40-000 871 STRAWBERRY DR Alternate ID: 19.29.19.629A Municipality: TOWN OF HUDSON School Districts: SCH DIST OF HUDSON Other Districts: DEED INFORMATION WITC Volume Page Document # Section Town Range Qtr Qtr Section Qtr Section 2900 211 808128 19 29N 19W 896 96 467466 Lot: 5 894 425 466979 Block: 704 504 399361 Plat Name STRAWBERRYPOINT LAND VALUATION TAX INFORMATION Valuation Date: 20120717 Net Tax Before: .00 Code Acres Land Value Improvements Total Lottery Credit: .00 G1 1.220 628,900 512,400 1,141,300 First Dollar Credit: .00 1.220 628,900.00 512,400.00 1,141,300.00 Net Tax After: .00 Total Acres: 1.220 Amt. Due Amt. Paid Balance Assessment Ratio: .0000 Tax .00 .00 .00 Mill Rate: 0.000000000 Special Assmnt .00 .00 .00 Fair Market Value: 0.00 Special Chrg .00 .00 .00 Delinquent Chrg .00 .00 .00 Private Forest .00 .00 .00 INSTALLMENTS Woodland Tax .00 .00 .00 Managed Forest .00 .00 .00 Period End Date Amount Prop. Tax Interest .00 .00 Spec. Tax Interest .00 .00 Prop. Tax Penalty .00 .00 Spec. Tax Penalty .00 .00 Other Charges .00 .00 .00 TOTAL .00 .00 .00 Over-Payment .00 PAYMENT HISTORY (POSTED PAYMENTS) General Special Date Receipt # Source Type Amount Tax Status Assess. Status Interest Penalty Total J Parcel 020-1131-40-000 08/28/2006 03:27 PM PAGE 1 OF 1 Alt. Parcel 19.29.19.629A 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): O = Current Owner, C = Current Co-Owner RICHARD M & AMY Z LEVEY O - LEVEY, RICHARD M & AMY Z 871 STRAWBERRY DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Descri~!ion ' 871 STRAWBERRY DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.220 Plat: 2516-STRAWBERRY POINT SEC 19 T29N R19W ST :AWBERRY POINT LOT 5 Block/Condo Bldg: LOT 5 EX S 125' OF W 60' A::''-ESS WITH P175C Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 896/96 07/23/1997 894/425 07/23/1997 704/504 2005 SUMMAR Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/30/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.220 596,600 607,500 1,204,100 NO 05 To',- for :'.006: Gu: -al Property 1.220 596,600 607,500 1,204,100 Woodland 0.000 0 0 Totals for 2005: Go r._ al Property 1.220 596,600 588,800 1,185,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 202 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNE ADDRESS I ~ S TOWNSHIP ~Uo c~ SEC. P7 TZI h', R1q W ST. CROIX COUNTY WISCONSIN. ^©Sc~w t, _ SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 f\ . ~ er i c ' _ N -41 I di a e oath Arrow S CEi-- i SEPTIC TANK(S) /MFGR. c'S _CONCRETE STEEL rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. - -MODEL NO. GALLONS Per Cycle TRENCHES NO. of with length area BED NO. of lines 7 width 12, length area l k! depth to top of pipe /r NUMBER OF SEEPAGE PITS Outs' e diameter total pit area AGGREGATE LU R `7 IA ir- _b / z,, CSC` PERK RATE J~ AREA D _ A2- AREA AS BUILT Disclaimer: The inspection of this system by St. Croix C6,unty does not imply complete compliance with State Administrative Codes. There are other areas thi it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. Noweve if failure is noted the County will make every effort to determine cause of failure. CREASES AND OILS SHOULD NOT BE DISPOSED THROUGH HIS SYTEM. INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.i.taxy Pexm.i-t ! i State Septic NAME rownbh.ip S-~. Cno.ix County Location Section _ SEPTIC TANK Size gatton4. Numbers o6 Compantmentz Distance Fnom: W ett it. 12% on gneaxen tope i t Bu.i.id.ing it. Wez.Eand4 b . Highwaten - it. DISPOSAL SYSTEM D.i4.tance Fnom: Wett it. 12% on greaten ztope S.t. Bu.i.Cd.ing it. Wettandb Ft. • H ighwaten it. FIELD DIMENSIONS: Width o6.. thench it. Depth o6 rock below t.i.Ce .in. Length o6 each tine it. Depth o j )Lock oven t.i.Ee in. Numbers o6 tines Depth of z.ite betow grade in. Totat .length o6 tines it. Stope ob txench in pen 100 it. Distance between t ineb jt. Depth to b edxo ck it. Tota.b abzoxbt.ion axea jt2 Depth to gxoundwatex it. Requited area it2 Type of Coven: Papers on Stxaw PIT DIMENSIONS: Numbers o6 p.it4 Gnavet axound pit-5 yea no Outside d.iametex it. Depth betocv inlet it. 2 Totat abzoxbt.ion area it A Axea %equited it2 rm INSPECTED By' .v Lj~ TITLE APPROVED _ . , DATE 197 - C _ ~ REJECTED , DATE 197 r EH 115 Rev. 9/78 • REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION::12/ '/4 ~''/4, Section T' l N,R "I E (or& Township or Municipality Lot No. , Block No.f~~/~~~~ County' ^Su 'ivisl- ion ame Owner's/Buyers Name: :W , Mailing Address: ~ T/~ eO {1'' 0011f TYPE OF OCCUPANCY: Residence No. of Bedrooms- COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS hl4le-A J, ;S IM" PERCOLATION TESTS SOIL MAP SHEET .57e,-5' 3_7 NAME OF SOIL MAP UNIT (1020- PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- 40 40F5 T 9£/P,1 P'/"x !e) P- 7zeC~ /0 P- 116-2-2-0 ,^Aj T 7 ,~,e /0 P- off- Cs T ~XTE,~l C/~ 7`c~ rJ 6.0 OR oAr - P_ / 0 SOIL BORING TESTS till 'q A-A ~ -6jc` c rE ,OM s AJ.O. TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES m B- I 7o " ND ()E- Z_? /0 "B,✓• /s r "L t v /S 41 L`~.,.s' w 4*~ YIP" Z 15W 13- jP C,< 113- & PLAN VIEW (Lo ate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy fd Q Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. IPI,4N5 N07- To 91 am o 41 r e 13cRE 5_` W , -15' tN Ile( 1c; r\ VN ` E/E ~✓~l,~,v' ~ F 131"1 f 95 G !110 _50156 IAI 72Fs7` 'kif. E/eV oro. ~ 19// 110le ` z- 100 i, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. t Na+ne (print) ,PoAE,e h/ Certification No. Address C,--- 110VJ 5- ,~,~~©~i1'`ClfiT/~'t'z~- Name of installer if known Copy A - Local Authority CST Signature State and County State Permit # PLB .67 a( Permit Application County Per i # `i - for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 21 B. LOCATION: SEi~ /4 /1>L '/a, Section Tj?~? N, R f E (or) W Lot# r City Subdivision Name, nearest road, lake or landmark Blk# Village '5 ,T Q~.~T 1.~~4c~, ~.Pe~ LlfiTownship /%t~ ~SCi C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family x Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY /J0 Total gallons No. of tanks -1- HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rat %0 " %Q Total Absorb Area L-O sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: X_Length Gp ' idth- /~Z Depth -Tile depth (top) No. of Lines 'z- Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land N17Ve Distance from critical slope zf ~T WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME ~QT Z~/'b~t'OC / C.S.T. # J ! Z and other information obtained from Lit )A.7,CR A0IV (owner/builder). 7 Plumber's Signature MP/MPRSW# Phone #/~~I- Plumber's Address 7ZZ AL"V LE I/V10A-J (.t IS PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. ~R//G~4~/d®E _ /~rj,E1( ®f A 0/0 N4 M 13 - 3 ~c~ST 2 Of! _ F E - E d1= y~Oe- c10 O R 8,6,60 =/0a 7ipA) o 130 TTa Ae ~k'rttqe ' fC~ Ae4 n~ Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application ~~-/~7e Fees Paid: State Count - C Date Permit Issued/ (date) 3 Issuing Agent Nam6 _ - Inspection Yes No State Valid# Date Recd 1. county (w to copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 .r, ST. CROIX COUNTY WISCONSIN ZONING OFFICE .row\\ bpNUp11M11 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road " ' Hudson, WI 54016-7710 (715) 386-4680 May 5, 1994 25 /1 Richard Levey 62~ M 871 Strawberry Drive Hudson, WI 54016 jZvrY Dear Mr. Levey: In response to your correspondence received by this office on May 2, 1994, regarding the sampling site of the water, it is common for our staff to sample from an outside faucet, especially when no one is at home when we visit the property. The sample was tested for bacteria, nitrates, and volatile organic compounds(VOC). We utilize two laboratories for the testing. You have received the results from Commercial Testing Laboratory for bacteria and nitrates, and I am enclosing the VOC results from SERCO Laboratory. Regarding the septic system inspection, as explained in my correspondence to you dated April 19, 1994, it is a visual, surface inspection, and does not include any excavation. The septic tank cover was not removed. Therefore, I am not aware of the level of liquid in the tank, and recommend that the system be pumped every two to three years as normal maintenance. Should you have any further questions, please contact me. Sincerely, ~f V&/ 2Mary Jenkins Assistant Zoning Administrator c: File ~I SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 44386 PAGE 1 of 3 05/02/94 St. Croix County Zoning DATE COLLECTED: 04/19/94 1101 Carmichael DATE RECEIVED: 04/21/94 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: Levey SERCO SAMPLE NO: 55834 SAMPLE DESCRIPTION: Levey ANALYSIS : <1-0---- ~5 Benzene, ug/L . i Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 c Bromoform, ug/L <0.5 61 G 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) <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) < means "not detected at this level". 1 mg = 1000 ug. MEMBER SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 44386 PAGE 2 of 3 05/02/94 SERCO SAMPLE NO: 55834 SAMPLE DESCRIPTION: Levey ANALYSIS: 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) 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-1,2-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-1,3-Dichloropropene, ug/L <0.9 Ethylbenzene, uq/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 <1.0 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 < means "not detected at this level". 1 mg = 1000 ug. MEMBER SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636.7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 44386 05/02/94 PAGE 3 of 3 SERCO SAMPLE NO: 55834 SAMPLE DESCRIPTION: Levey ANALYSIS: 1,1,2-Trichloroethane u Trichloroethene, ug/L' g/I' <0.1 Trichlorofluoromethane <0.4 1,2,3-Trichloropropane, ug~L (Freon 11) <0.2 1,2,4-Trimethylbenzene, ug/L <0.2 <1.0 1,3,5-Trimethylbenzene, ug/L (Mesitylene) <1.0 vinyl chloride, ug/L Total Xylene, ug/L <1.0 <1.0 This samples analytical results are below the U.S. EPAfs SDWA Maximum contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL list. Temperature of cooler: 18.2 C. The All resperformedults in ort p ertain only to the items tested. or a Samples that may be of an environmentallyshazardousonatturetmayobegies. 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. Anderson Project Manager < means "not detected at this level". 1 mg = 1000 ug. MEMBER R~ v Mary Jenkins St. Croix County Wisconsin Zoning Office''` St. Croix County Government Center S 1101 Carmichael Road INGOFFK - Hudson, WI 54016 Dear Ms. Jenkins: In regard to our recent water testing and septic system inspection, I have some questions. First, I had requested that the water be tested from the kitchen faucet; instead it was taken from the yard hydrant. Is this some sort of regulation? Second, could you inform me what form the $50.00 septic system inspection took? Does that include checking the fluid level at the vent pipe and lifting the tank cover to visually inspect the level in the septic tank? Finally, the water test cost $230.00 and it was my understanding that this would include testing for Volatile Organic Compounds, i.e., petroleum distillates. The water report makes no mention of any VOC testing. Could you please clear these questions up for me? Thank you, Richard Levey 871 Strawberry Drive Hudson, WI 54016 ST. CROIX COUNTY WISCONSIN - ZONING OFFICE 'naeunuMn~ .I.■` _ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 April 28, 1994 Mr. and Mrs. Richard Levey 871 Strawberry Drive Hudson, Wisconsin 54016 RE: Water Inspection Results for Richard and Amy Levey Address: 871 Strawberry Drive, Hudson, Wisconsin Dear Mr. and Mrs. Levey: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions with regard to said report, please let me know. Sincerely, Mary Jenkins Assistant Zoning Administrator mz Enclosure CGIVIMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 c T. CROIX COUNT. .i.~, NCROIX CTY GOV4CTR REPORT TATE: 4/22/94 .101 CARMICHAEL R13AD DATE RECEIVED: 4/20/94 ;TION: 871 Strawberry Dr., Hudsor. .._ECTOR: M. Jenkin_ AfL COLLECTEW 4-19-9. IME COLLECTED; 11:15 -'CE OF . ANALY ; ANALY E_st: : o-'4 ' ORM, MF'CC t 0 /100 ml :RI.'PRETATIOW Satteriotogicatly SAFE 1 pp* ;eve 10 ppm exceeds the recommended Public g4 _Ab tEGtii~ICTANi r''as~R OF.,IDEPEN, J O O Zg 'd 4 - , - 1 1. ^..G PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN `L ZONING OFFICE t r r r r if now ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road = Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. O/elmater (VOC's) $185.00 t Septic $50.00 t~ Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria D / retest $15.00 Owner: Requested by: Address: S7 Address: . 1- -%--11 111 ZIP 5-y e t ZIP Telephone N4: (-7 ~ ) 3n -T 3I- Telephone N4: ( ) Property.ajdYkW (Fire N2 & Street) Locat],eS~tf Sec. T. N, R W, To n of Real*"-Airm:'' - Lock Box Combo: Closing Date: - TO iE'&MPLETED BY PROPERTY OWNER *PROVIDE A SKETCH' `OF=HabUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tall 'loca~ion: l{ ~ Is the dwelling currently occupied? U _Yes ❑ No If vacant, date last occupied: Age of septic system: 1fkc, Septic tank last pumped by: Date: Previous Owner's Name(s): v1 Have any o the following been observed? ❑Y / Slow drainage from house. Ely 9 Sewage Back-up into dwelling. ❑Y PIK/ Sewage discharge to ground surface or road ditch. ❑Y Pf~ Foul odors. Other comments relative to system operation: I certify that the above informatio s omplete and true to the best of my knowledge. OWNERS SIGNATIZE: DATE: y ~3 fX 1/94 r~ OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION I (a2 Al~ 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: OBelow grd ❑At-Grd []Mound Approx. size 'X []Gravity []Dose OPressurized Ft.Z []Bed []Trench ODry Well []Holding Tank OOutfall pipe OBSERVED DEFICIENCIES []Other OUnknown Septic tank Setbacks: []House []Well ❑Prop. line []Other Dose tank Setbacks: OHouse OWell ❑Prop. line []Other []Locking cover []Warning label OPump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: OHouse OWell [)Prop. line OOther ❑Ponding: []Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY WISCONSIN _ ZONING OFFICE ANIIIIpNIIU■ Noma, ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - - - - Hudson, WI 54016-7710 (715) 386-4680 April 19, 1994 Richard and Amy Levey 871 Strawberry Drive Hudson, Wisconsin 54016 RE: Septic Inspection for Residence located at 871 Strawberry Drive, Wisconsin Dear Mr. and Mrs. Levey: An inspection of the septic system of your property located at 871 Strawberry Drive, Hudson, Wisconsin, was conducted today, April 19, 1994. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Also, water samples were taken. Once we receive the results, we will forward the same on to you. Should you have any questions, please do not hesitate in contacting this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator mz ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r r r r a■ ,l„~ ST. CROIX COUNTY GOVERNMENT CENTER , 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION /.WATER TEST REQUEST FORM L lease specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. mater (VOC's) $185.00 'fs Septic $50.00 l Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria retest $15.00 Owner: Requested by: Address: Address: • .aL1 IP 7 ~Ioi ZIP Telephone N4: 3n yi-7 Telephone N4: ( ) Property address (Fire N2 & Street) : I S ~-e,« z" Location: Sec. , TN, R W, To n of Realty firm: Lock Box Combo: Closing Date: TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: k ~ +Su---far Is the dwelling currently occupied? L Yes ❑ No If vacant, date last occupied:_ Age of septic system: (fcl Septic tank last pumped by: ? Date: ~Y`f0 Previous Owner's Name(s):~L Have any o the following been observed? ❑Yp; Slow drainage from house. 11Y 6 / Sewage Back-up into dwelling. ❑Y LAN Sewage discharge to ground surface or road ditch. ❑Y 91~ Foul odors. Other comments relative to system operation: I certify that the above informatio s o_mplete and true to the best of my knowledge. OWNERS SIGNATOE. DATE 1/94 y OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN 0 I I,I i T - ~ke '01 a wC~e~~'" c3 O TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? []Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: []Below grd ❑At-Grd []Mound Approx. size 'X []Gravity []Dose []Pressurized Ft.' []Bed []Trench []Dry Well []Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES []Other []Unknown Septic tank Setbacks: ❑House []Well []Prop. line []Other - Dose tank Setbacks: ❑House []Well ❑Prop. line []Other []Locking cover []Warning label []Pump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: ❑House []Well ❑Prop. line []Other ❑Ponding: []Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title f OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN ✓ ,I ~~T1~ \ Avg`" I y (~~G - ~ 03 II 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: DBelow grd ❑At-Grd []Mound Approx. size 'X []Gravity []Dose []Pressurized Ft.z []Bed []Trench []Dry Well OHolding Tank DOutfall pipe OBSERVED DEFICIENCIES DOther []Unknown Septic tank Setbacks: ❑House Dwell OProp. line DOther Dose tank Setbacks: OHouse OWell ❑Prop. line []Other []Locking cover DWarning label OPump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: OHouse OWell ❑Prop. line []Other OPonding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N I i I I i I Inspector Title