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COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227 Cj::
FAX - 715 - 962 - 4030
CROIX CTY OOV.CTR REPORT TIATE: 2/02/9
II CARM6ICHAEL ROAD
C+SON, WI
1
'-I-LECTORS M # Jens:
7TE COLLECTED. 1
SSE COLLECTEDI 102 o.
'E OF SAMPLE t-: i .1
.ANALYZED:2-0
I ANALYZED:2 0(;7 pp'"
j
\OF.%NOEPENOFN
lB -
2 O ail l pprow-!d Lab No. .
w 7
O P
D
O
PROFESSIONAL LABORATORY SERVICES SINCE 1952
02/02/94 15:55 $715 962 4030 COMM. TEST LAB 444 COUNTY CLERK 0001
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715.962-3121
800 - 962 - 5227 p
FAX - 715 - 962 - 4030
ST. CROIX COLKff ZONIW OFFICE REPORT NO- 56560/01 PAGE 1
PT.CROIX CTY WV-CTR 13RT DATE: 2/02/94
1101 CARMICHAEL RW DA FFMIVO, 2/01/94 ,
HUDSON, WI 54016
ATTN: THOMAS G NELMN
i
ski Wyman Julius
LOCATION' 1061-65th Ave., Roberts
COLLECTOR: M+ Jenkiw-.
DATE COLLECTED. 1-3i-94
TIME COLLECTED: 14230am
SQIRM OF SAMFi r: Kiichen faucet
HATE ANALYZED 4 2-01-94
TIME AAAL,ZED:2:00pm
COLIFORM,i4FCC: 0 /100 mi
INTERKETATION: BacteriologicalLy SAFE
NITRATE-*: 7 Fpm
Above 10 ppm exce-eds the recommended Public
Drinking Dater Standard.
COLiform Bacteria/100 mL
Nitrate-Nitrogen, mg/L
RESULT:: _
FAX'R ON; zip as
PHONED OM:
CALLED:
LAB TECHNICINJ*- Pam vane
0.04Y-A,~N.,
d Lab No+ V
UI Approve
( beans "LESS THAN" Betectable leveL Approved by:
n~ ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street ,
Hudson, WI 54016
Telephone - (715)386-4680
Khe St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, 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 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
(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) J
PROPERTY OWNER'S NAME : LA) K rN
PROP. ADDRESS: ,0 CITY C f / S ~f l
Legal Description i-' 1/4 of the ljtl;~ 1/4 of Section TN-R
Town of 1„) A, 'r r' ^ Lot Number Subdivision:
FIRE NUMBER LOCK BOX NUMBER
Color of house ~ -Realty sign by house?//oIf so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained. J
Firm or individual requesting services: Telephone Number WO C y q - 3 tl y' U v `71 <7 `(2 3 L
REPORT TO BE SENT TO:'- FZ w' ' c_ , C = ( ^ N /V l f ~
c E
a 2 -A 6 r, t c C,~ el
CLOSING DATE:
Signature h, 4
n
•4
WARREN T29N-R.18W 29
• E. SEE PAGE 43 E p
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a 1991 ~o~,a a1Ma~ me SEE PAGE ~/7 a r' y
900 1000 1100 200 1300 1400 500
t
r
Dependable Hybrids From
BE A 4-H Dependable People
Richard H. Kamm
.10 .0 1382 - 100th Avenue
TM Roberts, Wisconsin
0 CIBA-GEIGY
Seed Division Call: 749-3332
i
y
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street i
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning office offers the service of septic
and water inspections to Lending Institutions, 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 County Zoning office, and mail,
along with form to the above address. Testing will be done as
, 7soon as pV.".'7. 1.'1.J1C after 1CC and J_vrlli are C~.e .YGU.
WATER TESTING----------------------------FEE: $---3-5.00
(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 : c. u, rR
PROP. ADDRESS: A) C t CITY gc s.
Legal Description 1/4 of the /L+ 1/4 of Section L , TAN - R
Town of ' V e Lot Number Subdivision:
FIRE NUMBER / LOCK BOX NUMBER
Color of house - -L Realty sign by house?=If so, list firm:
i
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: L
LAI
Telephone Number_
REPORT TO BE SENT TO: IZL ,
r
CLOSING DATE: ~e!
Signature
\ Y
T. CROIX COUNT
WISCONSIN
~ uqunpiinn_ _`L ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
' Hudson, WI 54016-7710
(715) 386-4680
January 19, 1994
Wyman Julius
1061 65th Ave.
Roberts, WI 53023
Dear Mr. Julius:
I received your water test application. In order for our office to
do the water test you must use the new application form. Please
fill out the new application for enclosed. Since there is an
increase in the water inspection fees, we will need an additional
of $10.00. Make the check out to St. Croix Zoning Office.
If you have any questions, please feel free to contact our office.
Sincerely,
v'Jackie Stohlberg
Secretary
ST. CROIX COUNTY ZONING OF
St. Croix County Courthouse
911 4th Street ,
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, 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 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
(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 : K / / S
PROP. ADDRESS: '•1 Li { CITY
Legal Description s 1/4- of the lLt A 1/4 of Section L , T_~?cy N-R le
Town of tj 1i r v- r Lot Number Subdivision: yW f3
FIRE NUMBER / LOCK BOX NUMBER
Color of house e Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,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: ~~wt l v1 /i
Telephone Number _Z .1 - j y r Y 7 Q`
REPORT TO BE SENT TO: C
CLOSING DATE
Signature 7 -4
6e
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
--J
1101 Carmichael Road
'
Hudson, WI 54016-7710
(715) 386-4680
January 19, 1994
Wyman Julius
1061 65th Ave.
Roberts, WI 53023
Dear Mr. Julius:
I received your water test application. In order for our office to
do the water test you must use the new application form. Please
fill out the new application for enclosed. Since there is an
increase in the water inspection fees, we will need an additional
of $10.00. Make the check out to St. Croix Zoning Office.
If you have any questions, please feel free to contact our office.
Sincerely,
Jackie Stohlberg
Secretary
AS BUILT SANiTARY_ SYSTEM RI',VOKT
OWNL'k TOWNSHIP SEC .3 r,I - K/~W
Al~UItI SS ST. CROIX COUNTY' WISCONSIN.
SUBIJIVIS ON LOT - LOT SIZE ~2o
PLAN VIEW
and d Gmt_,w" l_ow; tU III~'l 1 ~'q'l-l~~ 1 teUli.'I1l b (_l~ lib-j
- ~iIUW_ L:V:Lltyd'ifINC; W:'1'I:LN 10() l.'i:l:'I' l)i' SY:;'I'I:f1 SCcxl~ 3D
~'S A7 aq/ / C.b l
Es~
.
I - Irdi atl~ 11()i-ri n r~,w
BENCH iAF?K: (Permanent reference Point) Describe:
l levation of vertical reference point: ___~QD~f1 _-Slope at site. o
SEPTIC TANK : Mar..ufac;turer : - - Liquid Capacity :
Number of rin.s on cover z-
+~-____---Tank AnTP
manhole cover elevation:
Tank I Iet `elevation: 4D21,1c1 'l'ank Outlet Elevation.
- - a~=may
PUMP CIiAMBER
Matiutac furor : , Nuinbc r o t gal lolls _
Number of eal. pump set fur it CYC Le__ gallons ; L 0 L c ity
distribution lines L;a11.01: size O pump-- head,
g.,allon per winute horsepower brand name of pump
and model number _
't'ype of warning; device
HOLDING TANK: Manufacturer Number of ~,alions
l':levaLiori of manhole covor
I'ypu of warning device _ r
SL'EPAGL: PIT SIZE:_ __---NUwbur of it's ect -aamk'~ ur
Luut liquid depLh~ - - seepa8u hit inlut pipe-elevation
hoi t ow of seupag'u pit CUL .
:;I:►:I'All, BED SILK: riumbur of Iii-us _width ad' --luti~;tli tilC d
I'.I:I'!\l E TRENCH: wilt:h _ ler;t;cli _
I1.KI:OL.A'TION M'rL__/_ AIZLA RLQU~RhI?_~1 ' AREA AS BUILT
INSPL:C'1'Olt 1
H..UMBER ON JOB_~ ~ -
LICLrNSE NUMBE.K
14 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI'5~707
❑~CONVENTIONAL ❑ALTERNATIVE State Elan DNumber.
111 aes,L)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
PERMIT HOLDER: INSPEC IO DATE
NAME OF PERMIT HOLDER ADDFI, 5
BENCH MARK (P,-anent efe-ce pond DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. C5T REF. PT. ELEV
1,
l c )
N.i 1 Plumber MP 'MP RSW N County Sanitary Permit Number.
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVE
Q P OV ED. PR-O,V(IPJE,D;
L/ (J 27 re" C L 1 YES ❑NO r7r,41 S~'_ NO
BE DDING VENT IA/ VENT MATE. HIGH WAT f rUET MBEROF ROAD PRONE RTV WEL BUILDI GVEFjN/tT~TO FSH
M AI~~ T
J A,/
! ALARM EFRO u E
❑ES ❑NO EAREST----~►~_ r G~
❑YES NO
DOSING CH MBER:
PUMP~IPHON MANUF A<:TIIHEH~ WARNING LABEL LOCKING COVER ER
MANUFACTURER BEDDING IL IQUID (;APACITV PUMP MODEI PROVIDED PROVIDED.
~I
_ ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERA oNAL 7ZFF UMBER OF PHUPEHrv WELL ewI DINT; a~R TNTO FRESH
(DIFFERENCE BETWEEN ETFROM
PUMP ON AND OFF) ❑YES I1❑NO AR'EST-)-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ulAt.ll , E H MAT1 HIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease yntil FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
r - WIDTH LFNG TH NO. OF DISTR PIPE SPA( -INVf~(JVEH r INSI UE I71A API TS LIQUID
BED/TRENCH lil ~~EPni )ISTR P~ rHENCHES ~a-hfalAlPIT _____IDEPTH
DIMENSIONS ✓ - sr _
Pf UISIH PIPE DISTR PIPE MATERIAL NO DI NUMBER OF PROPERTY WELL BUILDI VENTTOF SH
uv covErl r v //I 1 I ELE V EN PIPE FEET FROM LINE A1R~NLEr
( V~ S SI_ I / NEAREST L G
MOUND SYSTEM: /
Mound site plowed perpendicular Pe 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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑NO
SOIL COVER iEY.I UHF PERMANENT MARKERS OLSER VA TION WELLS
❑YES ❑NO ❑YES ❑NO
SEEDED MULCHED
LJ E P T H()VCH TRF~'NI B ED DE PIH OVI H IHIN(,H HI D DEPTH OF 'Ups'), L SODDF1) ❑
CF NIEH EDGES
❑YES ❑NO ❑YES NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
',NIDTH I ENG141 NO. OF LAT E RAL SPAC ING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE I'-IV' H
BED/TRENCH TRENCHES
DIMENSIONS _
,~.1NIFOLp PUMP MANIFOt 17 DISTR-PIPE MANIFOLD MATERIAL NO DISTR DISTR PIPE UISTRIBUIION PIPL MATE HIAL&V1AHKIN(~
-I. ELEV. UTA ELEV. PIPES DIA /
ELEVATION AND EV Y
DISTRIBUTION -AL
INFORMATION MOLE SIZE HOI E SPACING, DRILLED COHHECI I V 11COVER MATERIAL VFHTI( LIFT COR ONDS TO APPROVED
PLANS f
❑YES ❑NO YES NO
_ ❑
OBSERVATI. NUMBER OF PROPERTY WELL e'UILDI G.
COMMENTS: PERMANENT MARKERS. ON WELLS LINE
FEET FROM
❑YES ❑NO ❑YES ❑NO _ NEAREST- _
l -T d
7 7
Sketch System on ,Reta rl in county file for audit. _
Reverse Side.
I( NATURE TITLE
77~>7 7~~~
DILHR SBD 6710 (R. 0'1/82) /
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN,RELAYIONS (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: g Address:
UOY MR&BE RTC Wise- *S 4/a2- 3
Property Location: City, Village or Township: County:
Sit' '/4 A(,r'/4S 3Z iT.Z N/R /Q E (or w lull 'ST, C~l'd1
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(If assigned)
,rte
TYPE OF BUILDING
Number of
E] Public* F-1 Variance* E] Other (specify)* G~~-`dJ:~?=7K_6V0 Bedrooms:
'1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM ' o S,
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑?`New ❑ Replacement ❑ Experimental EeS epage Bed ❑ Seepage Pit
6~.5 t1 ' ❑ Alternative (specify) ❑ Seepage Trench
Water eSS pply: Owner's Name as Listed on Soil Test Report (If other than present owner):
U Private ❑ Joint ❑ Public SA/)1"t
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
090
Name of Plumber: Signature: MP/f*Fft3W No.: Phone Number:
Plumber's Address: Name of Designer:
/o ANT r11~E rs ,E. 1C, (0,CZ) E
COUNTY/ DEPARTMENT USE ONLY
Sanitary Permit Number:
Si nature of Issuing Agent: - Fee: Dater J ri R ❑ VED
APPRO
~~L.~ I n1I ~'1_ a~ 6 ~~r~ ❑ DISAPPROVED
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a 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
DILHR-SBD-6398 (R.07/81)
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
INDUSTRY, DIVISION
N
LABOR AND BOX HUMAN 13ELA?IONS PERCOLATION TESTS (115) MADISON WI 539069
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: O
WNSHIP/MUNICIPALITY: LOT NOBLK. NO.: SUBDIVISION NAME:
'14V
r , -
S-Z /T N/R j E (AT
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
3
sT e~, i)(_ 40 44! Men 'I Z-1 Z its_
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence .y New ❑ Replace a p
RATING: S= Site suitable for system U= Site unsuitable for system
TIO❑NAL: a[:]s ~ IN-GROU~ PRESSURE: SYSTEM-IALI Fl ❑ LDING TA :RECOMMENDED SYSTEM: (optional)
rNUU UU SS S ~tl] yc rl
[under Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
s.H63.09(5)(b), indicate: !(f Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS _
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLD TEXTUR , AN DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- J 77 7 A e * Si' ! .t y' S4 r
B- 7
r.
B- ly 9C/ ?,f
B- s' 9"l- ".g Mug y r W/ 4P r "x I/ a, .5
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH
P- -
P- 1.
d
P- &I.Z r 6L J, r
,
P- A/ ,iL s
P - f
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. ti- I _ZO
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SYSTEM 10N N1 / i-, ii ?ol't'j z' -e
.Q ~rn _ l ~ys~ld, sue/ Pf ~ < --4vt jkl~J-
t ~e
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I, the undersigned, 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 the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
T rte'
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ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
L 3 G z 7 J__- TV _~?6X_
/C0 if P 4/ kv I ' S-41a-1- S I -
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02!82) OVEN'
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