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COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
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CRO'IX COUNTY REPORT DATE. 3/28/91
si (THOUSE DATE RECEIVED*# 3/27/91
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David F. Cloutier C/
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LLECTOR: M. ,Jerk i P,
"RCE OF SAMPLES Out-ii i
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'Al tECHNICIAN4 Pam
OF.\NDE7EN Eryu.`
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PROFESSIONAL LABORATORY SERVICES SINCE 1952
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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) _
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Property owner's name J-h,"i / ) L C L I
Property owner's address
Legal Description 1/4 of the 1/4 of Section , T N-R
Town of Lot Number Subdivision Name _
FIRE NUMBER LOCK BOX NUMBER
F~ Color of house Realty sign by house?,vc,a If so, list firm:
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PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,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.
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Firm or individual requesting services : ,st NT . -,at -B U d iTudao
Telephone Number 307 2-td Strect
REPORT TO BE SENT TO: Hudson, W1 54016
Closing da~t -
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Signature
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
artya ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
Y - - 715 386-4680
Mar. 27, 1991
Peg Starke
1st National Bank of Hudson
307 2nd St.
Hudson, WI 54016
Dear Ms. Starke:
An inspection of the septic system on the property
of David Cloutier, located at 590 Oak Dr. Hudson, WI was
conducted on March 26, 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 for present use, however non code complying
materials were found. Schedule 40 PVC pipe was seen coming from
the house at what appeared to be the laundry room. This leads to
the suspicion that gray water from the washing machine may be
discharged at this point rather than into the septic system.
The pipe must be disconnected and the washing machine discharge
routed into the septic system.
A second inspection will be required to determine compliance.
Should you have any questions, please feel free to contact me at
this office.
~tJ rely,
M~ Je nkins
Assistant Zoning Administrator
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Parcel 040-1195-20-000 07/18/2006 10:09 AM
PAGE 1 OF 1
Alt. Parcel 4.28.19.883 040 - 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 - CLOUTIER, DAVID F & JEANNE R TRST
DAVID F & JEANNE R TRST CLOUTIER
590 OAK DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 590 OAK DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.830 Plat: 2080-HIGH RIDGE COURT
SEC 4 T28N R1 9W 3.83A HIGH RIDGE COURT Block/Condo Bldg: LOT 12
LOT 12
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
04-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/28/2000 630764 1546/326 QC
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.800 60,500 241,500 302,000 NO
Totals for 2006:
General Property 3.800 60,500 241,500 302,000
Woodland 0.000 0 0
Totals for 2005:
General Property 3.800 60,500 241,500 302,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 133
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• AS BUILT SANITARY SYSTEM REPORT
3
' ;E;R0 TOUNSHIP 7i_ SEC. ~ TN, R~W
A DRESSK,1, ST. CROIX CO NTY, WISCONSIN.
:DIVISION LOTS/ LOT SIZE -
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
S11-OW EVERYTHING WITHIN 100 FEET OF SYSTEM
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I ndticate L) Annaw
TIC TANK(S) CONCRETE X' STEEL S
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NO. &A rings on cover Q Depth 01/ DRY WELL
~.NCHES NO. of - width length area
no. Of lines width. length area
depth to top of pipe
31EGATE % y
FATE 'jsl ( AREA REQUIRED
AREA AS BUILT
,ciaimer: The inspection of this system by St. Croix County does not imply complete
_l)liance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
em operation. However, if failure is noted the County will make every effort to
ormine cause of failure.
ASrS AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
'INSPECTOR"'
DATED PLU;iBER ON JOB. -tot
LICENSE NUMBER
REPORT OF ITTSPECTION--INDIVIDUAL SE"JADE DISPOSAL SYSTEM
Sanitary Permit
State Septic
l
1E TOWNSHIP 00
o, 6t. Croi;; County
SRDTIC TA71I
Size gallons. "umber of Compartments
Distance From: Ylell ft. 12% or greater slope ft.
Building' ft. Wetlands ft
11ighwater ft.
DISPOSAL SYSTE11 Tile Field or. Seepage Pit(s)
Distance Front: TTell ~ ft. 12% or greater slope ft
Building ft. Wetlands f1
FIELD `Flighwater ft.
Total length of lines ft. !Number of lines - Length of
each line eft, Distance between lines ft, Width of the
trench ft. Total absorption area - sq. ft. Depth
of rock below the in. Depth of rock over tile in. Cover
over.rock, Depth of the below grade in. Slope of
trench ___in ner 100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS
Number of pits Outside diameter ~ft. Depth below inlet
ft. Gravel around pit _L_yes no. Total absorption area
sq. ft.
.Square feet of seepage trench bottom area required
Oquars feet of seepage nit area required
Inspected by:,. Title
Approved Date 197 w
Rejected Date 197
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EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: '/4.!-~/4, SectionTZ)SN, R JQ E (or) Township or Municipality
Lot No. , Block No. ' , c
ubdivision Name CountyT
Owner's Name: PE~ Imo(
Mailing Address: i_,Zn
TYPE OF OCCUPANCY: Residence x-- No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT n
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS AL'N",:F I~Lf~~. i :~=1>
SOIL.MAPSHEEL____ SOIL TYPE ~t'ICCf:"i/.
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL y HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
I BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P_ / ~ - -
i C en. lit
P-9
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IP 3 q~j
SOIL BORING TESTS
r TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
j NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
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B _ rr s DWI"
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PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.)
~diGate on the plan the location and square feet of sulta le ~areas. In cate number of square feet of absorption area
needed for building type and occupancy. Qlyla ? - bo Indicate scale
cr distances. Give horizontal and vertical referencey4nts. Indicate slope.
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1, 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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) Certification No.
Address tE l ".5 L ,
Name of installer if known _ r
CST Signature
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PLB67 State and County State Permit # }C
Permit Application County Per i #
for Private Domestic Sewage Systems Count
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
(n r, 4 M t4 udsen
B. LOCATION: N C 1/. F- Section TaR N, R E (or) W Lot# _I City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYP OF OCCU ANCY: Comte *Industrial *Other (specify) *Variance
Single family x Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES _J NO Food Waste Grinder YES )<I NO # of Bathrooms)
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation XAddition- Replacement- Prefab Concrete- x
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1► e ► Total Absorb Area (y Tsq. it.
New Addition Replacement *Fill System &o s ed
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length 3_Width _ r Depth Tile Depth :3 No. of Lines _5
Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope
I, 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 C.S.T. # and other information
obtained from DckUP S" le),f-i,~fe' K (owner/builder).
Plumber's Signatur&~- MP/MPRSW# 12 C~ Phone ON6
Plumber's Address , . z~
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
331.5
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Do Not Write in Space- Below FOR DEPARTMENT USE ONLY
Date
1001 Z
Date of Application 7 Fees Paid: State,//) CZ4-'
Permit Issued/Rejected (date) - - -Issuing Agent Name
Inspection Yes No Valid# Date Recd
county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
'qte (pink copy) 4. plumber (canary copy) Revised Date 6/1 /76