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COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
; CROIX ZONING t<EPORT NO. 04653/01 PAGE 1
CROIX COUNTY REPORT DATE: 5/03/91
.JURTHOUSE DATA: RECEIVED: 5/02/91
~'~SOi~, WI 54016
cis I
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Sandra Gi lber t
.;)CATION; 1973 - 1 F. S N~ 4, s,,,., ✓ £ ~u~..
. )LLECTOR: M. Jenk
;TERPRETATION: BacterioL .z; v.:;i
10 PPM
'wove 10 PPm exceeds the recommended Public
Drinking Wafter Standard.
OF.NDEPENpEH
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PROFESSIONAL LABORATORY SERVICES SINCE 1952
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Jl 'l &4t/lil-ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4G80
°f 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: $ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00;„
(Determines if system is properly functioning at time of
inspection) J
Property owner's name '/~Cl-1k,14t,0. ~.~~.rk.4~k
Property owner's address 3 00
CAP`-n4
Legal Descriptjop 1/4 of the 1/4 of Section TAN-R i
Town of Lot Number Subdivision Name
FIRE NUMBER LOCK BOX NUMBER(
Color of house".,L<>ri,=C~ d~yoRealty sign y house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A M ,i.e,COPY OF PLAT BOOK,v
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 2
Signature r
b V
~ERIN PRAIRIE T.30N.-R.17W. 45
.
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/9J/ iPoc~Efor /9al, o/s jnc SEE PAGE 3/ c5'f Cro;x bu nfy w.-a N
1500 1600 1700 1800 1900 2000 2100
DEER'S FOOD LOCKER, INC.
CREATING AND PRODUCING
39 Years in Business
1952-1991 BETTER PRODUCTS IN
- CONCRETE
CUSTOM PROCESSING READY MIX CONCRETE
CURING, SMOKING, SAUSAGE MAKING SAND - GRAVEL
RETAIL MEAT & CHEESE - SAUSAGE - ON FARM SLAUGHTER
LOCKER RENTALS
THE WSIDELICH'S * (715) 269-5118 New Richmond Amery River Falls St. Paul Plant
DEER PARK, WISCONSIN 246-4238 268-6948 425-1119 386-3922
ST. CROIX COUNTY
WISCONSIN
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'~z-` ZONING OFFICE
t x ST. CROIX COUNTY COURTHOUSE
3 - Y
~fL 911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
May 2, 1991
Judy Steiner
Edina Realty
700 2nd St.
Hudson, WI 54016
Dear Ms. Steiner:
An inspection of the septic system on the property
of Sandra Gilbert, located at 1973 So. 170th St., New Richmond,
WI was conducted on May 1, 1991. 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 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.
Sincerely
P
Zk M ar J ins
Assistant Zoning Administrator
cj
AS BUILT SANITARY SYSTEM REPORT
~ SEC.
OWNER TOWNSHIP-i.i.rr iE_ )<3c~ N-Rl%W
ADDRRSS ST. CROIX COUNTY, WISCONSIN.
SUBDIVT.SION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
Q _EVERYTHING WITHIN 100 FEET OF SYSTEM
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Sc-.r.~~-~ ~,r L
BENCHMARK: (Permanent reference Point) Des`ci`i~be:/vy~`~~'`
Elevation of vertical reference point: 4pw' Slope at site:
SEPTIC TANK: Manufacturer: 1,' Z!r'`' Liquid Capacity:
Number of .rings on cover : Tangmanhole cover elevation:
Tank Inlet Elevation: g~-7L- Tank Outlet Elevation: -
PUMP CHAMBER
Manufacturer: Number of gallons Int5~c~,
Number of gal. pump set for a cycle gallons ; tota capacity 0-
di stribution lines gallon: size o~ pump _head;
gallon per minute horsepower brand name of pump
i rid. model number. l
Type of warning device k
HOLDING TANK- Manufacturer- Number of gallons
l:leva n of manhole cover
1'y e of warning device -
SEEPA;E P: SIZE: Number of pits eet i.ameter
-T- t
fee iquid depth seepage pit in et pipe-elevation
6ttom seepage pit El evasion feet.
SEEPAGE iED 517,E: number of lines w-ic th letigth tile depth
Sl E13AGE TRENCH: widtl(-- lengthJ3r '
411 .liCOIsA17:CON RATE , AREA REQUTRED~~~~sy ARLA AS BUILT-
INSPECTOR _
DA'l't?D 'PLUMBER UN JOB-
LICENSE 1. r ~'G~
NUMBER_ 11/,_Y 17
L
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM (:~A
Sanitary Permit~6,&
State Septic 1449P8--A
NAME TOWNSHIP St. Croix Count
~WM4-e-s -
LOCATION- Y6 Section/ Lot # Subdivision
SEPTIC 'LANK
Size (AIL)- gallons Number of compartments
r
Distance from: Well 1 _ Building 7 12% slope
Highwater
I'UMPING CHAMBER
Size c c gallons Pump Manufacturer cCr i-) _ Model Number
HOLDING TANK
Size gallons umberl of C partments
Pumper_ Alarm System
Distance from: Well Budding 12% slope
Highwater_
ABSORPTION SITE
Bed Trench
Distance from: Well Building 1.2% slope
Highwater
ABSORPTION SITE DIMENSIONS
Width of trench ft Required area ft.
Length of each line ft Depth of rock below til..e in
Number of lines Depth of rock over the in
Total length of lines ft Depth of tile below grade in.
Distance between lines ft Slope of trench in. Per 100 ft.
Total absortption area ft Type of Cover:
PIT DIMENSIONS
Number of pits Gravel around pits --_yes no
Outside diameter ft Depth below inlet ft
'T'otal absorption area ft
Area required ft
INSPEC'rED BYJ _ TI`T'LE
C./
APPROVED DATE ~ ~~198
REJECTED DATE. 198
REASON FOR REJECTION
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (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. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address:
1~ . z.
Property Location: City, Village or owns ip'! County:
W t/a'/aS iT _ NiR Z!Z E (or) W i - IA .
r bdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
Lot NumbeT~__
,/8 lkt r„ - (If assigned)
6 ~
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required. -41
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY Z06
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER L-
MANUFACTURER: -
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New K Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) Seepage Trench
2 0c)
Water Supply: Owner's Name as Listed on Soil Test Report (if other than present owner):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name Plumber: Signature. MP/ PRSW NO.: Phone Number:
Plumber's Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Sig t e of Issuing Age Fee: Date: Sanitary Permi Number:
} APPROVED Q
C 6 d / DISAPPROVED
e on 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 (N.03/81)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
`-INDUSTRY, DIVISION
LAF30R ANP PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
LOCATION: t, SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
" ~ %,V/4 N/Rj7.1 (or) W _ i-, , C-
000NTY: OWNER'S BUYER'S NA MAILING ADDRESS:
f~
USE DATES OBSERVATIONS ADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: R DESCRIPTIONS: IFtHUULA ON TESTS:
Residence ❑New ,Replace d .
RATING: S= Site suitable for system U= Site unsuitable for system 7 4 G~
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: JSYSTEM-IN-FlLLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
S OU OS OU OS ❑U OS OU OS DU
If Percolation Tests are NOT re uired DESIGN RATE: SYSTEM EL
q If any portion of the lot is in the
under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 2" 35' ri t 2
13- ),57 Ile
9 T
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P-
16
P- Z '3 L- r 0 17
P- , / C7 1 r, r a
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.
SYSTEM ELEVATION 1 r7'
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8
_ o`er
2
• 5'
44
z
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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 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)cc) TESTS WERE COMPLETED ON:
I
-
Or
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional):
1 6011
CST SIG URE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
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