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HomeMy WebLinkAbout040-1206-50-000 co o -0 o c ° ° C7 `~1 v ' v m n n, N o . N T N HI (CD O 0 d Z d N N cn D. W N CD CD 0) N Cc) O T O= Q CD = m cn O C CD co p O r O d pp N N n. p C N ~ N C .l~ (D CD N G O. N ~j T N :3 m (1) 1 c m C: o n_ p 0 c C CD D l~ O O W CD n 7 f- - (D to 0 r- CD CA Cl) OD 00 CD to PI) 0 n 'O Z O O O o = ~y °10 can ° cn 0 N Icr O O CD o' D ro m m N (D 7 a - I =r a) I :3 9 A) 4~ :5 CD p 7 Z N DWO O CD ° n CD CD N CD v ; CD CD w a a 3 5 @ -1 ti p R p Z CD ~A Z O o' 'I cn -i 0o v m N rn w CL , ~ Z 0 F Z C~ y < Z CD ~ w ! D Cl a ~ no c 3 Z CL o (D (n S 14 A b a t N O I N O O A (D D A fH p p * yV C) (D p (D v 0 Q) cli 00 _ n ~ N W a ON W ~ N N Oo ~ b0 v1 N H ro v V O O 0. ! ~4 O ~a nz~ 3 M U .4 -W v~ Parcel 040-1206-50-000 12/20/2006 10:13 AM PAGE 1 OF 1 Alt. Parcel 16.28.19.969 040 - TOWN OF TROY 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 O - MOUNTAIN, JOHN D & HELEN B TR JOHN D & HELEN B TR MOUNTAIN 372 SOUTHERN PACIFIC RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ' 372 SOUTHERN PACIF RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.440 Plat: 1993-GLOVER STATION SEC 16 T28N R1 9W 2.44A GLOVER STATION Block/Condo Bldg: LOT 15 LOT15 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 01/05/2006 815780 QC 08/18/2003 736013 2367/382 EZ-U 05/22/1998 581449 1333/505 WD 07/23/1997 829/80 more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 159343 405,800 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.440 90,000 280,200 370,200 NO Totals for 2006: General Property 2.440 90,000 280,200 370,200 Woodland 0.000 0 0 Totals for 2005: General Property 2.440 90,000 280,200 370,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 128 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT Ot- TOWNSHIP SEC ADDRESS y,r PIERCE COUNTY, Wr$CONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 RING WITHIN 100 FEET OF YSTEM .r+4 . 4 1 T 1 r u 0,11r, I di a e Jo th Arrow BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: r Number of rings on cover : - Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity o - distribution lines gallon:. size of pump head; gallon per minute horsepower , brandname of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits eet diameter feet liquid dept seepage pit inlet pipe-elevation _ bottom of seepage pit lation feet. SEEPAGE BED SIZE: number of lines 7 width _lengthr tile depth SEEPAGE TRENCH: ith length PERCOLATION RATE REA REQUIRED ' '.AREA AS BUILT '`r DATED PLUMBER ON 0 LICENSE NUMBER- ' A, POW Vw_ *.001400W 'DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. Bt)X 7969" MADISO SON, , WI 53707 BUREAU OF PLUMBING • ' ,CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number III assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound [NAME ERMIT HOLDER. AD HESS OF PERMIT HOLDER. INSPECTION DATE Ile BENCH MLARK (Per manem reference pomU/DN`E S,C~RIB IF DIFFERENT FROM PLAN: REF. PT. ELEV.: JCST REF. PT. ELEV. A W Name of Plumber. MP/MPRSW No.. Cou nt v. Sanitary Permit Number_ / SEPTIC TA HO DI G TANK: Z MANUFACTU LIQUID CAPACITY. TANK INLET ELEV.. TANK OU LET ELEV. WARNING LABEL ILOCKI O P O OFU PROV YES ❑NO Y O prc BEDDING. VENT CIA VENTrTL HIGARH WATER 6 NUMBER OF ROAD: PROPERTY WELL. 1BUILNING: IVENTT FRESH ALM --F FEET FROM _ LINE AIR Er. YES ❑NO ~O ❑Y NO NEAREST •s Z OSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUM EL /PUMP/;TON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND, NTH LSOPER ION NUMBER OF PROPFRTV JWELL BUILDING (DIFFERENCE BETWEEN FEET FROM LINE IVENTTOFRESLi AIR INLET PUMP ON AND OFF) iz YE ❑'NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at e dept Of lowin Ncrrv _ 1WETEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, constru ion shal ease Lin it F RCE the soil is dry enough to continue.) AIN CONVENTIONAL SYSTEM: AIDTH LENGTH NO.OF DISTR. PIPE PACING COVER INSIDE DIA 11-111111D BEd/TRENCH .2 TRENCHES MnTERiAL: DEPTH DIMENSIONS 7 PIT GRAVEL DEPTH FILL DEPTH J'E ISTR PIPF DISTR. PIPE DISTR. PIPE MATERIAL NO. DISTH UMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BE LOW PIP/~S / AB() VE COVER L FV INLET ELEV. END PIPES. LINE AIR INLET FEET FROM : NEAREST: MOUND SYSTEM: Mound site plowed perpendicular to slope Che the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: u syste YES to make certain that it ON REVERSE SIDE. SHOW ELEVA- mee riteria for medium sand. TIONS MEASURED. ❑ ` SOIL COVER. TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DFPTH OVER TRENCI{. BFD DEP: OVER HE IT BED D TH OF TOPSOIL. SODDED SEEDED. MULCHED CENTER ED~ ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH Q TRENCHES j 6 -1 DIMENSIONS 36 ^AANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAIp NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING FI.LV.. ELEV. DIA. ELEV. IP ES CIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS:` PERMANENT MARKERS. OBSERVATION WELLS: NUMBER OF PROPE PITY WELL. BUILDING. FEET FROM LINE' ❑YES ❑NO ❑YES ❑NO NEAREST- / L Sketch System on Retain in county file for audit. Reverse Side. sl,ow~uRE ITITLE ' , DILHR SBD6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS IND,USTRY,. FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATI.QNS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: ~~'A.ucfS M c 4104V 7-7 610,11?R49,v ll/4 400 &//+2o' Property Location: City, Village or Township: County: 5 4pe t/a /l#)t/4S / ~e J 2S N/R 19 E (or )(@ 7_1160 /V 57' 4~01 x Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (~1_60"Cn 5;,r4;7/0l•.I (If assigned) A1,+ TYPE OF BUILDING Number of ❑ Public* ❑ Variance*. ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. 3 C TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY /OVV X HOLDING TANK CAPACITY VI+ LIFT PUMP TANK/SIPHON CHAMBER A MANUFACTURER: -C-I 0 ,Q- -0 EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPO. ED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit /0 9~~ X rt ❑ Alternative (specify) El Seepage Trench Water Supply: wner's Name as Listed on Soil Test Report (If other than present owner): X1 Private [:1 Joint [:1 Public T 41 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: 7atur~,~ MP/MPRSW No.: Phone Number: Z & ( 7150 1?6 ~ o Plumber's Address: Name of Designer: X 22 NI DN 1P0~ 5'T : Vh;,0 A,) S ya/ Z COUNTY/DEPARTMENT USE ONLY ure of Iss i is Fee: Date: APPROVED Sanitary Permit Number: ~~Q ❑ DISAPPROVED eason for Disapproval: i._ Alternate course(s) of Action Available: Change of ownership, building use or plumber reqs Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber nILHR-SBD-6398 (R.07/81) w O LL &j ~i 10 o O L T- 0 co J ] X z w0 = 9 :D fL z 2 0 w co Z W O O w .0 aS O p m x Z co > E 2 ° f~ a 2 Z a O co a E LL Q '5 2 > ° Q c a ° a CL uj z °E~ z D z U CO 3 0 a cw7 O w Q 7 c = a O O L U (n U Y LL 2 p co = z w o W W O Q Lu J W Z m U T vLLi ? N N Q e °w a m cc co m N d a Q om. co co 2 -Z O N ,Q Cl. 2_ 'l Z Q Y N N C w, 0 O pW co 0 Q ° H N cr w > > J Q 0 a w a> w W rr L cc LbYI ~ IT 7 w z a o o -M -1 z a z a o w ~ W N w cc ~ ° LL. m co y a Q ' a ~ W U Z Q' 1- ~ i W S 'a Q Z iLl z0 O Q Q i = i CL a w O O ° Y co I w 9 w LU Q w 9 N Z L7 N N a * LLQ O O co I CL Z CC N V Q a ~ I Ll' C: CL T , Ul N E °w 0 o co 5 3: C- i CL T. a > n Q W ~ W Q m c7 0_ LU Z LU v L O W i N Z w Z C: co CC N ? (n 2. Y n ` _ s Cn a 0 co U T U co Q > Z _0 LL. z~' O u ` w ° Q cc O CC Q 7 * m y U u~1 ~ " H co ~ J w J d W N 6i 2 3 'n w fY7 a Q CL. z ca .j: w> Z CC 7 w Z 9 0 = m O J E-~aZ Q W Z Ow 0 D a o cn ~Q H a wQ a o z ~ a FEZ r, co LU (n o- DEPARTMENT OF REPORT ON SOIL BORINGS AND r-l F'~Y" )Nw ION IDUSTRY , F111F~969 LABOR AND PERCOLATION TESTS (115) NOgI§HUMAN RELATIONS 707 Job No LNG . (19 LOCATI ON: SECTION: TOWNSHIP/MUNICIPALITY: LOTNO.:BLK.NO.: IVISIWFWE: "j SE N4~4 16 /T28 N/R 19 K (or) W Tro 15 - - r Station COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: V St. Croix Francis McFadden 44 Cimarron Village, Lake Elmo NN USE DATES OBSERVATIONS MADE TESTS: NO. BEDRMS.: COMMERCIAL DESCRIPTION: IRF DESCRIPTIONS: PERCOLATION RIResidence 3 l [R] New ❑Replace Il 06/02/82 None RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ®S ❑U ®S ❑U _]S au ❑ S EU Conventional 181x55' Bed If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. I If any portion of the lot is in the under s.H63.09(5)(b), indicate: 10 -C -,Floodplain, indicate Floodplain elevation: N/A CLASS 2 PROFILE DESCRIPTIONS pg. 82, BXC2 & BXC2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 1 72 94.0 None 72 12, Dark Bn sl; 12, Bn sl; 48, Bn ls. B-2 114 97.5 None 7 114 12, Bl sl; 102, Bn ls. B- 3 88 95.3 None 7 88 12, B1 sl; 19, Bn sl; 57, Bn ls. B-4 122 98.2 None ? 122 12, BI sil; 14, Bn sl; 93, Bn ls; 3, light Bn s. B-5 98 96.0 None 7 98 12, Bl sl; 18, Bn sl; 63, Bn ls; 5, Bn s. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- P- P- NONE REQUIRED P H .09(5)(b) P- P- -P- PLAN VIEW: 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 slop. SCALE 1"=40' SYSTEM ELEVATION 91.5 LEGEND Approximate _ ....d. 4) 2" PIPE FOUND 96.02 Top of Pipe- Location of ! l" PIPE FOUND __.Ouse Basement 0 1" PIPE SET ;96.0 Fin.Gr. 0 BORING SITE loan Elev. , 93.5 `96.47, Top of Pipe _B-2 96.0 Fin.' Gr. B-10 0 n 96.6 Ex Gr. ~o 0 40~ 96.0 Fin. Gr. IN ti 93.8 Ex. 'Gr. OSS, rV ti 55, 74.7' v~ 94.0 Fin. Gr. X0- 6, o0 3% A B-5 o- s 91.0 _Fin. Gr. B-3 c 94.7 Ex. G 0 94.0 r ; vti e° 00 94.0 Fin. r. Fin. Gr. Bench Mark To of X10 Ex Grp 111 Iron Pipe 91.89 94.8 EX Gr ~o S o I, the undersigned, hereby certify that the soil tests reported on this form were made by me i accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): Walter J. Gregory TESTS WERE COMPLETED ON: Ogden Engineering Company 06/04/82 ~ORESS: 123 East Elm Street CERTIFICATION NUMBER: PHONE NUMBER optional): Ri-%T(-r -Falls, WI S4022 CST0588 1(715) 425-7631 CST G TU S d ' Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. 95 (N. 03/81) ~ ~ Af s~ ~.t g, i C ~ ` y _ _ _ ~ i - .~~l~P j ,';y'- r l~ i k ~ ' j/'`w, r t i Er. rr ~ s 1 \ ' 7 - JA, 610 ~ C v~, j $o/ rG'-S T. 9C. y 7 r 1 ~y 9 % IV D ~ll J t' `iCCys~ Fresh Air Inlets And Observation Pipe i Approved Vent Cap Minimum 12" Above Final Grade j i~ 4" Cast iron ~~-6 Above Pi c - Vent Pipe o Final Grade ' i r Morsh Hay Or Synthetic Covering ' r Min. 211 Aggrec'-'e Ova.- Pipe C Distribution iy 70 Pipe a O O O G t ~ n Benea`h Pt e o~• Coup lin c? I+:r n ii~lni p = z O ~ Cl) r N ~ C/) m o0 m \O z o0 0 0 CY) m O J r O O m x < U) Cn m m O IU) m \ wimp 0 00 ~ 0 p r D (7 O z = D r cn O m o n C) ~p ■ z m Cl) O O m Cn o c x z n O f l o Cn Z C/, o wimp -n O- U) n c Z 1JJ mom' a =rjlo 0 6 d Z m ° d - - _ m - _ 0. CD o m m -1 2 m S m s m s m s m.~ ~ o .m •m 7m m m m m m m m ad am cn~ 0 0 m 2 N 0 a a H 7 p~ ~ m C 3 m m o H o D 1 m o m ss r m o a ID CD < O m-o 3o m~ mm 0o H 3o m m m o m o a m s all= rn 1 m m 3 3_ cD nCD ~a w 0 ~ A m c~ c_ ~ m D m 0. _ m r > - -o< 0 00 O m m m m c o m a c D c o m n ° s -Av -~-7 E~m 4- 3 3 c o o < m y JV 1.3 °m J~ L o.ON m ~3 0 m ~(D _3 f1~ z m m > > a~ fn C cr H CL ID Z- N m m Q a m ~ Q m ~ _ C m a m o c D m d ~a 0 m a m~ -i o ~ -0 ° mmo 3y C o0 CD - 'i m 3 m m F~ ® 3 - 3 m n m C/) S N m a j c o m m m C) o n 3 0 '0 ~m 0 D 0 1 H 'o y m 0CL H CD 3 c m m m 3~. =r° m I :A r I. r r \ iu X, tj 17 r6lo 3 13 IL, I-) r 64 Fresh Air Inlets And Observation Pipe [ ~ Approved Vent Cap Minimum 12" Above is 2 Final Grade Above Pipe 4 Cast Iron Vent Pipe i o Final Grade 1 •.J r,v _ e 1. t n i~. Syr1Ti-o--`tic Covering c,reca#e Over Pipe e0 Pike -'_v 0 G © J p 9 ~ h . r'. Ci e n of Beneath Pipe Couplin cj, -11-er,min 3aFiom Of Sysia-m l ~ 4 .t i 1 ~ _ I- - ST. CROIX COUNTY WISCONSIN ZONING OFFICE 6ixnnneu■ ""'"d ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - - Hudson, WI 54016-7710 (715) 386-4680 v%D SZ-ULIz/ March 15, 1995 Landmark Bank P.O. Box 808 Hudson, WI 54016 Attn: Karen RE: Water Results for Harold & Catherine Martinez Address: 372 Southern Pacific Road, Hudson, Wisconsin Dear Karen: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions regarding these results, please do not hesitate in contacting our office. incere y, ~j J es K. Thompson ssistant Zoning Administrator db Enclosure COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 .CROIX CTY GOV.CIR REFUR7 DA E; 3/13/95 101 CARMICHAEL ROAD DATE RECEIVED** 3/09/95 i at Nwi 54016 i..t17;TIONi 372 Southern Pacific Rd., Hudson COLLECTORS Jim Thomps:,-• DATE' COLLECTED* 3-08-9`' TIME COLLECTED# 2200pm UJRCE OF St -,c &'JE ANALYZE'., ° .A. ANALUU.' S1' Gam" L1;7ORM,MFCCS TY INTERPRETATION.' Racterio U.,ve 10 ij d Leh 14D, :i OF.INOFPENpEN . t le p P J 4 PROFESSIONAL LABORATORY SERVICES SINCE 1912 Y „ ~ 4 S' ~ f ' ~P 'rrrN f + . 1.~, a "r' rE~ ~Y S ST. CROIX COUNTY 1 WISCONSIN ZONING OFFICE ~ 4YNIIpllen■ ST. CROIX COUNTY GOVERNMENT CENTER _ _ 1101 Carmichael Road - - Hudson, WI 54016-7710 " (715) 386-4680 March 9, 1995 Landmark Bank P.O. Box 808 Hudson, Wisconsin 54016 ATTN: Karen RE: Septic Inspection for Harold and Catherine Martinez Address: 372 Southern Pacific Rd. Hudson, Wisconsin Dear Karen: An inspection of the septic system for the Martinez residence at the above location was conducted March 8, 1995. 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. A water sample was also taken at that time. When we receive the results we will forward them on to you. Should you have any questions in the meantime, please do not hesitate in contacting this office. Since ely, James K. Thompson Assistant Zoning Administrator %aROIX COUNTY WISCONSIN ^NING OFFICE a w u u "b ST. CRO!X 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. ❑ Water (VOC's) $185.00 J°•Sept ic 50.00 \ Water (N3it~-a4Ce & Bacteria) 45-.700 , ❑ Nitrate & Bacteria ~h retest $15.00 . MQl ►1 Z Requested by: La idyyu-, A ba Owner: C4qherr,1(, Address: Address: P-C• 08 }{-'c(6o)l I i Z I P 6Z/U1 m Z I P~Q / Telephone N4: ( t,) 4) ~25 - / q 1 Telephone N4: (2L,f) Property address (Fire N2 & Street) : -)'7,,;f Jsw`~ x PciC(A'C- Location: Sec. , TN, R W,Town of -Tot L-0r is, EnloeerS*5--+'cn iQ+n ~ b'd-c. Realty firm: Lock Box Combo: Closing Date: h&jcc t,) TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: kA _6u Is the dwelling currently occupied? V Yes 0 No If vacant, date last occupied: Age of septic system: a+ Septic tank last pumped bY Date: !>f r Previous Owner's Name (s) : `i~)+c{ Have any of the following been ogserved? ❑Y ❑N Slow drainage from house. ❑Y ON Sewage Back-up into dwelling. ❑Y DN Sewage discharge to ground surface or road ditch. ❑Y ON Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. DATE : ) , OWNERS SIGNATURE:, 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN 5u,~ porzc l~ 1D~Glt t 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.2 []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 ❑Warninglabel []Pump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: []House []Well []Prop. line []Other ❑Ponding: ❑Disch e: General comments : ,cures ,ra-c, l~sy~ INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title DOMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 4:l:A;w 4', 715-962-3121 800 - 962 - 5227 d i ST, CROIX COUNTY ,4F r,GRT TlA f E+. -:5 Obi COURTHOUSE AUDS4N~ try '3 401 t~g/2..,~ ( LOCATION: 372 Soutt+e,,..,. ;OLLECTOR2 M. .Jenks i n COLLECTEDI 5-04_. COLLECTED1 9:00a 1E. OF' SAMPLE; ANALYZETI:5- ANALYZED: 4: .ORMI lTERFRETATION~ Batt ve OF.(NDEVENpEH ' l 2~ ,9m approved Late No. O P V D PROFESSIONAL LABORATORY SERVICES SINCE 1952 a u, m a rt o co -AA - - w g y m I t3j 1 I ~ F~-3 c ~I 0 a 05/06/92 11:56 $715 962-j 0.3 0 COMM. TEST LAB 444 S.C. CO CRTHOUSE 0 002 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O..Box 526 Coifax, Wisconsin 54730 715 . 962 - 3121 800.962 - 5227 RAT IfO : 21982/01 FABE ST. CR4IX IONiN6 5T. mix CCLII`iTf ..rE"rGRT rA-,E: 5/46/92 03t1RTFICIUSE DATE MCEIVED: 5/44/9^c Ifimm. Wi 54016 ATTN4f THCi4AS C. WELMN 4aro ld A & C ather i Me hat t i Mea LfirCATTO it in Southern Pac if i€ Rd. r HddsOr COLLECTOR: H. Jerk i Ma DATE COLLECTED-1 5-04-42 s IME COU..ECTEDt 9!04am SgURC>_ OF &WLEI Kitchen faucet DATE ANALYZEDY5-04-9' TIME AiVAI..YZED442.00Pm ML.ICrOi M*+ 0 /100ml INTERPRETAT1001 0acter i a Log iua L LY SAFE I YITn''ATE-Nz 2 PPm Above 1^v Ppw exceeds the recommended Public Dr i itk i ng WAter Staindard Colifora+ $acteria/1QQ m~ ~!i'crate-Ni tr69er. LAS TECMICIAW Pam CaMe ~µDfPCNy i W! Approved Lab No. 1Q Fans "LESS Tr3A; Detectable'' Level Approved W PROFESSIONAL LABORATORY SERVICES SINCE 1952 _ i S ST. CROIX COUNTY ZONING OFFICE fJ St. Croix County Courthouse Cis 911 4th Street Hudson, WI 54016 1 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic V and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form ia essential SQ that tlig property can ba located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. / WATER TESTING---------------------------- FEE: $ 35.00'.1/ (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at.time of inspection) PROPERTY OWNER'S NAME: I~~)~ PROP. ADDRESS: 12 <<<"CITY 1I<<,_~ ,c;~~.I Legal Description 1/4 of the 1/4 of Section , T N-R Town of T~~ I Lot Number Subdivision: FIRE NUMBER 372 LOCK BOX NUMBER Color of house&WWO C , 1:Z Realty sign by house? tj,.,,,._If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,i.e,COPY OF PLAT BOOR, 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: Telephone Number REPORT TO BE SENT TO: CLOSING DATE:, 'Vo Signature n I ~ k ~ s~ c ..F ST. CROIX COUNTY WISCONSIN ~k :a 1t ZONING OFFICE R~ 4 9l y,~y ST. CROIX COUNTY COURTHOUSE z 911 FOURTH STREET • HUDSON, WI 54016 _ (715) 386-4680 May 4, 1992 Harold & Catherine Martinez 372 Southern Pacific Road Hudson, WI 54016 Dear Mr. & Mrs. Martinez: An inspection of the septic system on the property of Harold & Catherine Martinez located at 372 Southern Pacific Road, Hudson, WI was conducted on May 4, 1992. 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. i eerely,r; Mt W en}kns' Assistant Zoning Administrator js