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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:: w 16io@
ST. CROIX ZONING REPORT NO.: 06575/01 PAGE 1
ST. CROIX COUNTY REPORT BATE: 6/25/90
COURTHOUSE DATE RECEIVED: 6/21/90
HUDSON, WI 54016
ATTN: THOMAS C. NELSON v I
r 1/J _ lD 7S' - `/U- 6?1D
a~.1'`" c
OWNER: rs. Lucite Butter
r
LOCATION: 760-10 . Ro
COLLECTOR.' M. Jenkins
SOURCE OF SAMPLE: Kithcen faucet
COLIFORM: 0 /100 mt
INTERPRETATION: Bacteriologically SAFE
NITRATE-N: 8 ppm
Under 10 ppm is safe for human consumption.
Conform Bacteria/100 ml.
Nitrate-Nitrogen, mg/L
LAB TECHNICIAN: Pam Gane
WI Approved Lab No. 19
~,NOEFENO~
J` 90 I
( VO D j
Z56 s~° Means "LESS THAN" Detec+abte Level Approved by:
PROFESSIONAL LABORATORY SERVICES SINCE 1952
~ ~ NJ;a' ~ IeJifi.
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COMMERCIAL TESTING,, LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 -962-3121
C111fir 't'j
800 - 962 - 5227 16i
$T. =IX ZONINu REPORT NO.: 06575/01 pp f
ST. CROIX COUNTY REPORT DATE: bl2S/90
CDJZTHOUSE DATE RECkMIG 6/21/90
mmm, wr S4016
ATTN: THOMAS C. NELSON
Mfrs. Lucite Butter
LOCATION: 760-107th St., Roberts
COLLECTOR: M. JeW ns
SOURCE OF SAMPLE; Kithcen faucet
COLIFOR M: 0 /100 Alt
INTERPRETATION: BactOrfoLogicaLLy SAFE
NITRATE-N: 8 ppm
Catifcra Bacteria/100 at Under 10 ppm is safe for huaan tonsuaption.
Nitrate-Nitrogen, "/L
LAB TEU ICIAN: Pan Gave
WI Approved Lab No. is
~.MDEPFNGF
3 N~
V
t Maans "LESS THAN' Detectable Level Approved by:
m PROFESSIONAL LABORATORY SERVICES SINCE 1952
F~ ST.
i11~ -!-Z
CROIX COUNTY ZONING OFFICE
~l St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
~T St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
tenletion of this form ig essentia~ 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)FEE: $175.00
WATER TESTING
(For VOC'S) FEE: $25.00
SEPTIC SYSTEM INSPECTION--
(Determines if system is properly functioning at time of
inspection)
Property owner's name
Property owner's address P e~ o Legal Description 1/4 of the 1/4 of-Section !~,j , T N-R
Town of Lot Number Subdivision Name
It MMER
Color of house _'r Realty sign by house?~_If so, list firm:
PLBABS INCLUDE, IF AT ALL POSSIBLE, A NAP,i.e,COPY OF PLAT BOOK,
r
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: -f✓''
Telephone Number r='-
REPORT TO BE SENT TO:
~ ` Closing date
signature
i
WARREN T•29N- 1
RA 8 W 29
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Dependable Hybrids
PLEASE From Dependable People
PATRONIZE THE
'A ADVERTISERS ' Richard H. Kamm
They Will Welcome
The Opportunity Roberts Wisconsin
To Serve You.
CALL: 749-3332
ST. CROIX COUNTY
Aviz WISCONSIN
'F`f '49V ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
- (715) 386-4680
June 21, 1990
David Burnley
Edina Realty
700 2nd St.
Hudson, WI 54016
Dear Mr. Burnley:
An inspection of the septic system of the Lucile Butler
property located at 760 107th St., Roberts, WI was conducted on
June 21, 1990. At the same time I also obtained a water sample
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 inspections. 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 is totally dependent upon proper
maintenance of the system.
Should you have any questions regarding this subject, please feel
free to contact this office.
Sincerely,
r
Mary J. Jenkins
Assistant Zoning Administrator
cj
i
• AS BUILT SANITARY SYSTEM REPORT
R t-.. TO`,TNSHIP
SEC.T, l N R W.
ADDRESS P7 P j L- SST. CROIX COUNTY, WISCONSIN.
DIVISION ~ 1 ,te1,~ , LOT__/_LOT SIZE .
PLAN VIEW
'Distances & dimensions to meet requirements of H62.20
SHOW EVE RYTE,1NG WITHIN 100 F,'ET OF SYS-FIki _
! I I_~-s i i ( - i
i
3e I
Ali
lit-
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TIC TAIL-K(S) tv;FGR. C01;CRETE ,-/STEEL I nd cca e rt'a` h A~trcaw~
_1 r u ~ _ t~ STEyL Scate '
NOS -i-' rings on cover 3 De rh
p - c!"f DRY NELL ~ P
CHES NO. of
_ aidth~ length jr area
no. of lines width iengthi:~ 6, area
epth to top of pipe
i:,EGATE
4_'
.~11: RATE AREA RF_QUI .P.D / 5- AREA AS BUILT
-claimer: The inspection of this system by St. Croix County does not imply complete
.roliance with State Administrative Codes. :here 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
ermine cause of failure.
1SrS AND OILS SHonD NOT BE DISPOSED THROUGH THIS SYSTEM.
41
_'INSPECTO
DATED Y PLU';tBER ON JOB _y
LICENSE NUtH3ER
g
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-REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.i.tan y Penm.i•t
State Septic
NAME rownzh.ip S~. CAO.ix County
Location Section
SEPTIC TANK
I
S.i,ze~_gattonb. Numbers o6 CompaAtmen.tz j
ViAtance FAOm: We.e.~_~ ~ it. 12% on gneateA sX.ope it
Bu.i.2d.ing,z it. We.ttandz 6t.
H.ighwateA it.
DISPOSAL SYSTEM
D.ie.tanee FAOm: Wet 12% on gAea,teA zZope it.
Bu.iZd.ing 3 a it. we,ttand6 Ft.
• H.ighwateA =6.t.
FIELD DIMENSIONS:
Width o6' tten ch /G it. Depth o6 Ao ck b e.2ow t.i.2e,/,2-i n .
Length o6 each tine it. Depth o6 Aock oveA .t.i.2e z- .in.
NumbeA o6 tines ~ Depth o6 -t.iZe below gAade_12~_.in.
Totat teng,th o6 tines '7:2_6.t. Stope o6 .tAeneh _ in pet 100 it.
Distance between tines 6t. Depth to bedtock
Totat abzoAbt.ion area 6t2 Depth to gAOUndwateA 6t.
Requited aAea 6t2 Type o6 Covet: ape oA StAaw
PIT DIMENSIONS:
NumbeA o6 pity GAavet around pits ye.a no
Outside d.iamet Depth below .inlet it.
Totat absorb io anelz 6t2
A
Area Aeq a LA-td--- it
~n
I NS P E,C T E N T I T L E r
APPROVED DATE c~ 197_Z.
197_
REJECTED DATE
a ..ti:_ .....:moo... n '
.:...:...„...",,,tea,,..,. ........ua+.,,::
EH 115 (11-74)
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,Section T_N, R _ E (or) W, Township or Municipality
Lot No. , Block No. County
Subdivision Name
Owner's Name:
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrocros Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSE=RVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B-
B-
B-
PLAN VIEW (Locate percolationtests;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 reference point. Indicate slope.
tN
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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) Signature
Certification No.
Name of installer if known
Copy C - Local Authority
PL B 6 7 State and County State Permit #
Per #
Permit Application County
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:!'/4 /4, Section T N, R E (or) W, Lot# City
Subdivision Name, nearest road, lake ,y or landmark Blk# Village
e 5-w(" Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. f Bedrooms -_3 No. of Persons ti
D. SEPTIC TANK CAPACITY lee e' Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete i Poured-in-Place Steel Fiberglass Other (specify)
New Installation G~ Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT 91SPOSAL SYSTEM: Percolation Rate 4.1' - tJotal Absorb Ar, ' sq. ft.
New -Replacement Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed:- - Length_ Z 9' Width 'yam Depth 12" Tile depth (top) _2 ~ No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- -2 - 3 ~ Distance from critical slope
WATER SUPPLY: Private RI'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 Certified Soil Tester, ' / /
NAME /V~ s -,J
y , { L 1 C.S.T. # :--at :2 7 3 and other information
obtained from 7 6 (owner/builder).
X Plumber's Signatu MP/MPRSW# e-, 4~ t- s / Phone #J(5 - 7`1-V °j'S`/
Plumber's Address - c
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.
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Do Not Write in Space elow - FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application / Fees Paid: State 1l,-!~ 4 > County Date 1 / 17
Permit Issued/R ate) 7 q Issuing Agent Name -tip r
Inspection Yes No 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