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OilM OOL L dS NOSanH L L9Z OS 02i 2 AM0189C uo!;d!josea #;sla adA.L AJ2wud :(so)ssaippy A:podoJd IeloadS = dS Ioo4oS = OS :s;olj;sla M179 IM NosanH L9b X08 Od 3NO1SH3Hlb'3d d N33-1100'8 0 aQ01 d NAA1100'8 0 4401 'ANOiMd3H1d33 - O aaumo-o0 juaiin0 = O 'jaumo juaiin0 = O :(s)jaunno :ssaippy xel 0 00 ads jL I!wJad #;!waad # uo!jeo!lddy easy sales # deW a;ea Ieolao;s!H a;ea uo!;eaaa NISNOOSIM '.llNnoo XIOijO '1S X ;uanna AO0 Ji JO NMOl - 0t0 0£8'6 V9Z'90 laoaed 'IIy L :1O L 39Vd Wd9tT0 900Z/WZL 000-08-VZOV00 laaaed ,r? AS BUILT SANITARY SYSTEM REPORT -1+GK ` '-N N /Q , TOWNSHIP SEC. . T 2 N, R~W .0. ADDRESS ST. CROIX COUNT , WISCONSIN. BDIVISION LOT LOT SIZE S / PLAN VIEW Distances & dimensions to meet requirements of H62.20 -~m SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM wo A L ►e Ile ."S "PA6 F., P -TIC TANK(S) MFGR. CONCRETE STEEL N0, of rings on cover Depth DRY WELL =NCHES NO. of width length area D no. of lines width , 1 length area ~L depth to top of pipe f JREGATE ZK RATE ! AREA REQUIRED AREA AS BUILT C 'sciaimer: The inspection of this system by St. Croix County does not imply complete ..npliance 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 'stem operation. However, if failure is noted the County will make every effort to termine cause of failure. -c.ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST M. 'INSPECTOR DATED - PLUMBER ON JOB LICENSE NUMBER - i • 1 NV ~ ~O COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 C 4'j `'715-962-3121 800- 962- 5227 gio FAX-715-962-4030 Cr y~ a « i,ttlliA \.U~;i`t 4 `r htr'OF~ i aJh f c: ti/ lb! i:. COWTHOUSE DAF FTCrT AFT!: ._nN IT. ILL ;COLLECTED: 11«4v: CE OF SAMPLE "TV INTERPRETATION*# Batteriolu NITRATE-W 6 ppm -r Above 10 ppm exceeu~ me 9 Dr i ni; i ng Water Standard. Conform BaCte'e'1a:14Ci ail -n Nitrate-Nitroge,',. ii,), RESULTS: Esc v~ Y FAX'C ON:-. PHONED CIN: CALLER: OE.\NOECENOFNr. ?V ~9B _ w t:.. < ~ O 4 n "'-EIS ruC;r(PROFESSIONAL LABORATORY SERVICES SINCE 1952 7-?2 ST. CROIX COUNTY ZONING OFFICE • ,Li. St. Croix County Courthouse 911 4th Street Hudson, WI 54016 q~ 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. C ~ Completion of this form j, essential 9Q that thg 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.. t~ WATER TESTING----------------------------FEE: $ 35.00 L (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.tiMN 5f ` inspection) PROPERTY OWNER' S NAME: x'14-7 PROP. ADDRESS: Lt, erL 00cr CITY Legal Description 1/4 of the 1/4 of Sect' N-R Town of Lot Number Subdiv' on: T~ -e FIRE NUMBER ~ LOCK BOX NUMBER WD q~ - ?~ZColor of house Realty- sign by house. If so, list firm: ~f y U PLEASE INCLUDE, IF LE, A KAP,i.e,COPY OF PLAT HOOK, WITH LOCATION Spl- L>L1 F THE LISTING SHEET. Testing of rL- X~ -es a sample that is fresh. If the home is v, for some time, the water line must be purges,. for several hours before the test can be cor. WINTER TESTING: water lines are turned off, or sill cocks are turned _.,aking 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. 1 Firm or individual requesting services: cc4 K ` C (-1 ~1 S 0/Z 1(,e Telephone Number $ _ fl-` REPORT TO BE SENT TO: K p C/GLQ V c L-~ TU~~ CLOSING DAT Signature 1 i ST. CROIX COUNTY r~ v WISCONSIN ZONING OFFICE ^ , 3 ik gg' Yy ST. CROIX COUNTY COURTHOUSE 1 s ti= . 'F , 911 FOURTH STREET • HUDSON, WI 54016 715 386-4680 November 11, 1992 Patricia Storkey 372 Tower Rd. Hudson, WI 54016 Dear Ms. Storkey: An inspection of the septic system on the property of Patricia Storkey, located at 372 Tower Rd. , Hudson, WI was conducted on Nov. 11, 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 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, _.y 7 I Mary J. Jenkins Assistant Zoning Administrator cj Z y REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM State r, NAME i"own.ahip l ~St. CAoix County Locat,ioa / Section SEPTIC TANK Size 00 gattons. NumbeA o6 CompaAtments Distance FAOm: WeZZ 6t. 12% oA gneateA s.Zope it i Bu.i.ed.ing~it. Wettands r----- H.ighwatvL DISPOSAL SYSTEM Distance F, OLm : Wett jo _ 6t. 12-06 oA gAeateA stope it. Bu.itd.ing wet-Zands Ft. H.ighwate.tc it. FIELD DIMENSIONS: Width o6 tAench l °~-6t. Depth o6 Ao ch. b e.-Zow t iZe /X-in. Length of each it. Depth o4 Aock ovet tiZe aZ. .in. Numbe.tz o, A.ine.s_ _ Depth o6 t.iZe below gAade .in. ~ n jJ' Tot-at Ze,zg;~1~ o Z. nes^L p_.0 ..6t. S.Z~'p - o6 tAench ^Z-- in pvL 100 $0 Distance between Depth to bedu(ik it. . Tota Z abs oAbt~:on a)-ea 10~ ;x._2 Der;th tio gg Lou ndwate%z N ~ 6, -V Requ.i}Le_d area t2 Type of Coven Papers StAaw PIT DIMENSIONS: Numb e.rL o j pits GAavet around pits_ yes no Out,6 de d.icc~n .~`eA 't, Depth be.Zov., inlet it. ✓ 2 Total absoAbtion k it 2 INSPECTED B5'_ 7-ITLE APPROVED DATE 197,70. REJECTED ..DATE 197 E H 11,5. Rev. 9/78 ` REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION-' 4, %4, Section T ~N,RE (or) W, Township or Municipality T~~C y Lot No. ,Block No. ~ County Subdivision.. Name Owner's/Buyers Name: Mailing Address: A T 3 TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT V ^ ALTERNATE SYSTEM ~y OTHER DATES OBSERVATIONS MADE: SOI RINGS Ll 7~ PERCOLATION TESTS a ^~y 7 y SOIL MAP SHEET ~C S 73 NAME OF SOIL MAP UNIT X~-Z- /s'~~PKiy"~P~T PERCOLATION TESTS Al dAI1 , TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- / 54 7" L; 210"51 2CS ~L /f ~Q• f j'j ~s Z P- Z s3 15 s 3o ^ C5 li //X- iz: 1PL - 3 " 3 P- TZ 2 P- nl s P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- > fo 17" 0,3/ , 3 0. efj 94 s /6 )fEo, -5. B- z ~O vaflE -L )T "651 .10" 0 n 3 /j•' *--Ps . t ~ 'cs . ~ fs B- AX0, VE > ,.z 13 0. S / Ji B- B- B- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. Oi-D. IVY,- Aar 6_= ©.N TI?r AWL o of1,? y =/00 Mr E Q ~ O 132 A01 < P. P14,v tip'T 70 5r-4le . c vX 4 Tt"e F- N 1 ; OF t ` 0 3 ; ~ - i c ¢ ~ E ~ a s t ~e 14VIA1AR ARivC14/,f'y _ : . E IVED 1, the and q endAb*ebg cQ9ft the a soil tests reported on this form were made by me in accord with the procedures and methods specified i WiscgidministrJatI a Code, and that the data recorded and location of test holes are correct to the best of my knowledge belief.OFFICE `z. ichT SS 02 y~z Name (print) Certification No. Address tl _ EjLy 7i~U~-Salt/ GU/-S syCif Cr. Name of installer if known ~=h Copy A - Local Authority CST Signature id? Z~~/ State and County State Permit PLB 6 7 W Permit Application County Perini # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: Si,(,! '/4 '/4, Section, T N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village f ~ i ~-C f 6f 9 ('-)/'i Township '-7-iQC-' C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance_ Single family Duplex No. of Bedrooms No. of Persons- D. SEPTIC TANK CAPACITY C1C/C_) Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks _ Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)' New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)-- E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate otal Absorb Area sq. ft. New Replacement Alternate (Specify) 7 6 6 i "`r I G t'j Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: LengthZ , Width Depth Tile depth (top) No. of Lines Z- Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: 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 Cer ied /Soil Tester, n NAME _ Q A ('9T L,' ( e H T C.S.T. # C/1~2and other information obtained from =T C 4, L ow /builder). Plumber's Signature MP/MPRSW# /(P /`z Phone -n 1 C% Plumber's Address ~2 7- L -Al e PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. . F E . $ f U r, PR>;SC wT' s , a E 5Z l~ LLIJ I, . , , E E ) , ~e A F Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY _ Date of Application ` Fees Paid: State County Date Permit Issued/ tad (date) Issuing Agent Name Inspection Yes_ XNo State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78