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'COMrdERCIAL TESTING LABORATORY, INC.
14 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121 ~4j
800 - 962 - 5227 C3:w
FAX - 715 - 962 - 4030 C
ilia ix L'UU ! f Y REpu t i i)Ai rE: 1/22/93
OURTHOl{SE DATE RE CEI V D+'
Tlscl.`4 WTI 1,101
r+ E'
qZ; ~
Cty Rd V,
Jenk i ns
LicVlcU: 1°14-93
.:OLLECTED: 3; 34pm
L. OF SAMPLE+* K' Ichel~ faucet
.'PRETATION' $acte.
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rT p ipproved Lab No. 15
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PROFESSIONAL LABORATORY SERVICES SINCE 1952
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ST. CROIX COUNTY ZONING OFFICE
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 i-q essential a-Q that _tb_Q poperty 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 FEati $185.00
(For VOC' S ) a. k ; _ jr , . r ,
SEPTIC SYSTEM INSPECTIO ----------------FE . $25.00
(Determines if system is properly functioning at.time of
inspection)
PROPERTY OWNER'S NAME : kp1 k t•ft-iTk_
1`~S i ~ E`FEC~S~=
PROP. ADDRESS: PLO t.._C i.li-,T'( R0
CITY
Legal Description 1/4 of the 1/4 of Section 2'S__, T~U N-R20
Town of Lot Number Subdivision:
/ n
FIRE NUMBER ( 3 ? C, LOCK BOX NUMBER
Color of house_C-c_-n Realty sign by house? 1J0 If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF TILE 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.
TINTER 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.
l
Firm or individua requesting selrvices : ~~ttAL ' ~ l~lcF tS
Telephone Number 1) 6 - _ `wl A ' LK
REPORT TO BE SENT TO: iCLOSING DATE:
Signature -
k ST. CROIX COUNTY
WISCONSIN
r r~ ;s ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
f 911 FOURTH STREET • HUDSON, WI 54016
- (715) 386-4680
January 27, 1993
Mark Christoffersen
1320 Co. Rd. V
Hudson, WI 54016
Dear Mr. Christoffersen:
An inspection of the septic system on the property of Mark & Beatta
Christoffersen, located at 1320 Co. Rd. V, Hudson, WI was conducted
on Jan. 19 and 27th, 1993. At the same time a water sample was
obtained for testing. The results of that testing have already
been sent to you.
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.
Should you have any questions, please contact his office.
S cerely,
qx' A' q'
Mary J. Jenkins
Assistant Zoning Administrator
cj
NOTE: The vent cover is missing and should be replaced.
Parcel 030-2041-40-000 05/17/2007 05:06 PM
PAGE 1 OF 1
Alt. Parcel 25.30.20.492F 030 - TOWN OF SAINT JOSEPH
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
RUDOLPH B & CAROLYN I TITERA O - TITERA, RUDOLPH B & CAROLYN 1
1320 CTY RD V
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 1320 CTY RD V
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 4.190 Plat: N/A-NOT AVAILABLE
SEC 25 T30N R20W SE SE COM NE COR SE SE, Block/Condo Bldg:
TH W 400 FT, SLY TO A PT 437 FT S & 380
FT W OF NE COR, SELY TO PT 560 FT S & Tract(s): (Sec-Twn-Rng 40 '1/4 160 1/4)
257 FT W OF SD NE COR TH E 257 FT TO A 25-30N-20W
PT ON E LN 560 FT S OF NE COR, TH N TO
POB EXC. LOT 4 CSM VOL 6/1705
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 991/417 WD
07/23/1997 846/66
07/23/1997 756/34
07/23/1997 446/390
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.190 114,000 179,000 293,000 NO
Totals for 2007:
General Property 4.190 114,000 179,000 293,000
Woodland 0.000 0 0
Totals for 2006:
General Property 4.190 114,000 179,000 293,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 214
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisoansia Department of Health and Sooial Ssrvic-^
~07 3/70 Division of Health -
SEPTIC TANK PERU'LIT APPLICATION
TYPE or USE BLACK INK
A. OWNER OF PROPERTY j
Name Address (Street, City, Zip Code)
B. LOCATION OF PROPiMTY W 5.RE SYST7-M'•'.LL BE CCNSTRUCTED ALTEREL OR EXTENDED COUNTY-~e/--~-=~
Chack Ona: Al
, J CITY VILLAGE LEGAL DESCRIPTION 1-19 V ~
TOWNSHIP
'-AA KA- C. IS LOCAL PERPiiT U1R D FOR THIS WORK? _ YES NG PERMIT NLr15E.t
VV ;
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION i/ REPLACK'ENT ADDITICN
MATERIALS: Prefab Concrete Poured in Place Steel Other
KLTM E-q OF TA`I~s TO BE '.NSTALLED: l ~A
1
- t
i
E. TYPE OF OCCUPANCY ~
Ch:!ck OTe: One or Two Faztily Residence a Commercial Industrial Other _
Spauii'y) -M. giber of persons to be Acco~.moda,"ed i Number of Bedrooms _
F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer ✓ YES NO
Dishs~.she- YES Y! NO Automatic Potsto Peeler Yr'S!y NO
Other (Specify)
G. MASER PLiit'aER FialNC NSTALLAT?0111
Name: Address: 7~ Li33n
. . F
Si,r aturo of Ap; '._.'_tt: r M° RSd
Address:
H. (T be C plated by IQSUirg Agent)/~
Date of Application l~7 Fee Paid / `7/
Permit Issued (datel Permit Ntimbel
Agent (Name) Fortes[
Town, Village, City, County, etc.
(Specify)
Note: The application cannot - -ons:der d for filing until all of the above questions are answered and the
fee paid. Agents will for+kard application, the fee of 41.00 for each sentie tanic and the third copy
of the permit (canary' to the Division of Health. Checks and money orders should be made payable to
the Division of Health, 1
i
Do not write in space below - FOR DEPARTMENT USE ONLY
15
1. DA'L'E RECEIVED ACCEPTED BY ~ + RETURNED _
(Initials) (Date) See ~orres. )
FEE RECEIVED ✓ VALID. No. PERMIT NO. S j
(Yes or No~-
REVISWED BY APPROVED DATE j
(Initials) Yes or Noj
COMPLETE OTHER SIDE
f
,2 3
i a SEPTIC TANK PERMIT NO. ~0 X4,
R X P 0 R T O N S O I L P E R C 0 L A T 1 0 N T Y S T
A N D S 0 I L B O R I N G S
TO
DIVISICH OF HEALTH - PLUIBING S=TI6w
P.O.Box 40, Madison, Wis., 53701
Pursuant to H 62.20, Wis. Administrative Code
P t R C 0 L A T I 0 N T E S T
Test I Depth Character of So3? uc-rs Water Test T1m3 D:-o,) in Water Lcvel L^=3_I.-~3 i:El- tes
Number Inches Thickness is Incbas .rocs Hole in Hols Interval Second to liar'. to Last To Fabl
1st Wetted Ovcrni in Minutoc Last Period Last Psr:ouIPeriod Cr.-- Inch
Example
P - 0 b611 Top Sell 10" C !,-y 26" 25 Yes or No 30 1 2 1 2 112 I c,
RECORD DATA FROM ML4L'iL" I OF 3 TEST HO 'S
Compute aize of absorption a.-aa in accord with H 62.20 Wis. Administrative Code.
S O I L B O R I N G S- :[ini=m 3611 Bela:: Prooos3d AbsUrptica Systs-l
Boring Total Dap h Dep`.h to Grcun3 Water udd~;: to Baaroc.
Number Inches tbservad r~ti^ ted Ob®arved Esti,..a.tad I Character of Soil with Thio'c- ass in IiXhas
Example
B - 0 72 72" Black. Top Soil 1211; -Clay i811: Sand 1811;- Gravel 24"
l
3 iC
:PE OF OCCUPANCY:
RESIDENCE, Number of Bed,-ocas OiHr.R: (Speaify) Number of Par-sons
D WASTE GRINDERS Yes . N_ D19tzar3.sh5r : Yv3 NO i+u:u: atia C1o,.:Jy ravha Ya3 No
FFLUeEN DISPOSAL SYS1^t.,'1: NEW EXTENSION ADDITION R*PLA.''-'l1.E-N
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Leng+.h Width Depth Tile Size.- No. Lines
Seepage Pit$ Inside Diameter Liquid Depth
I, 'uhe undersigned, hereby certify that the percolation tests reported on this form were made by me or under nay super-
vision ir. accord with the proo3-ares and method specified in Chapter H 52.20 (13), Wisconsin Adxiniltr°tivz CO s, s._d
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
NAME TITLE p
Type or Print -
REGISTRATION NO. or MASTER PLUMBER LICENSE NO. !
ADDRESS
DATE SIGNATURE o
t
3 y J, t o
3
-71
J~jt Gh-tYaA S
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